Mobility Flashcards
Fracture are often a result of
Accidental trauma at home or at school (falls, climbing, running into immovable objects
•Motor vehicle-related injuries
•Recreational activities (skateboards, bicycles, ATVs, snowboards, motorcycles, and sports)
Fracture during infancy
- Typically caused by MVAs or falls from heights.
- Injuries causing fracture are uncommon.
•Bony injuries warrants further investigation to rule out nonaccidental trauma.
-Skeletal Surveys (radiologic evidence of fractures at various stages of healing).
Fractures suspicious for abuse include
- Any fracture in a non-ambulatory infant
- Mid-shaft humeral or femoral fractures in children less than 18 months old
- Rib fractures in children less than 3 years of age
- Unusual fractures such as:
- Scapula
- Sternum
BONE HEALING AND REMODELING
Fractures heal much faster in children. The younger the child, the more quickly the bone heals
- Children’s bones have a thick, strong periosteum with an abundant blood supply which contributes to a more rapid formation of callous strong enough to heal the fracture more rapidly than adults
- With pediatric fractures less callus formation is required to achieve a clinically stable or healed fracture than with adults.
Stages of bone healing
1) hematoma formation
2) granulation tissue formation (inflammation)
3) callus formation
4) consolidation
5) bone remodeling
Nursing care for fractures
- Assess NV status of the distal extremity
- Move injured part as little as possible.
- Inspect skin for bruising, erythema, or swelling.
- Observe the extremity for deformity.
- Cover open wounds with a sterile or clean dressing.
- Immobilize limb (above and below fx site)
- Do not attempt to push protruding bone under the skin.
- Apply manual traction if circulatory compromise is present.
- Elevate the injured limb if possible.
- Apply cold (no longer than 20 minute intervals).
What is SCOLIOSIS
- Spinal deformity, usually involving a lateral curvature than exceeds 10 degrees, and spinal rotation causing rib asymmetry.
- Classified according to age of onset: congenital, infantile, juvenile, or adolescent.
- Most are idiopathic (no known cause).
- May occur alone or in association with neuromuscular disease
ADOLESCENT IDIOPATHIC SCOLIOSIS (AIS)
- Develops during the growth spurt of early adolescence, and may become progressively worse with growth.
- Predominant in females, and may be familial.
- AIS screening usually starts at age 10 years during well-child visits.
- Screenings are also commonly done by school nurses
Scoliosis screening
Early screening/detection and management results in improved outcomes
- Shoulder height
- Hip height
- Scapular predominance
- Distance between elbows and waist (flank area)
- Asymmetry of ribs and flanks (during Adam’s forward bend test)
SCOLIOSIS DIAGNOSIS
Degree of Cobb Angle
Classification:
< 10° Normal
10° to 25°Mild
25° to 45° Moderate
> 45° Severe
Risser grade
Used to determine when child is done growing(at stage5)
SCOLIOSIS SURGERY (SPINAL FUSION)
Pre‐Op Patient/Family Education
•Bathe daily with CHG cloths starting 3 days prior to surgery.
•Miralax 17gm daily,
one day prior to surgery. (If
patient is constipated, start
2 days prior to surgery.)
POSTERIOR SPINAL FUSION POSTOPERATIVE CARE
Patient log-rolled every 2 hours
- Ambulation started as soon as possible (2nd post-op day) with physical therapy assistance
- Indwelling foley catheter is typically removed prior to ambulation.
- Priority assessments: wound, VS, NV, neurologic, pain
- Pain management (PCA MSO4 initially and then oral narcotics once tolerating fluids
- Dressing changes daily
- In some cases, brace or cast may be needed.
CEREBRAL PALSY (CP)
Characterized by abnormal muscle tone and coordination
- Caused by damage to the motor areas of the brain, resulting in a neurological lesion.
- The lesion disrupts the brain’s ability to control movement and posture.
- The lesion does not get worse (non-progressive); however, the symptoms can change.
Spastic CP
Stiff muscles
Damage to cerebral cortex
Athetoid/ dyskinetic CP
Uncontrollable movement
Damage to basal ganglia
Ataxic CP
Poor balance and coordination
Damage to cerebellum
Mixed CP
Combo of two or more
Congenital CP
related to brain damage before or during birth. Specific cause is often not known
•Risk factors: low birthweight, premature birth, multiple births, assistive reproductive technology, infections during pregnancy, jaundice and kernicterus, medical conditions of the mother such as thyroid disease or seizures, and birth complications.
Acquired CP
caused by brain damage that occurs more than 28 days after birth.
Usually caused by infection (meningitis or encephalitis), injury (motor vehicle injuries or child abuse), or cerebrovascular accidents.
Associated Problems with CP
- Cognitive and learning difficulties
- Speech and language disorders
- Behavioral and mental health disorders
- Sensory impairments
- Impaired vision/hearing
- Seizures
- Growth and nutrition problems
- Drooling and feeding problems
- Dental problems
- Hydrocephalus
Complications of CP
- Pressure ulcers
- UTIs
- Constipation
- Bowel and bladder incontinence
- GERD
- Sleep disorders
- Failure to thrive
- Joint contractures
- Scoliosis
- Pulmonary problems
MANAGEMENT OF COMPLICATIONS
•Pulmonary problems are the leading cause of hospitalization and death for children with CP
- Multifactorial
- Aspiration
- Ineffective airway clearance
* Airway obstruction - Chronic lung disease
PREVENTION OF COMPLICATIONS with CP
- Immunizations
- Regular dental care
- Screen for aspiration (Feeding evaluation and/or video swallow study)
- Screen for sleep-disordered breathing
- Mucous clearance
- Management of constipation
CP therapeutic interventions
PT OT Speech Special education Surgical interventions Medication therapy Care coordination
COMMON PHARMACOLOGIC AGENTS for CP
- Stool softeners (Colace)
- Osmotic laxatives (MiraLax - polyethylene glycol PEG)
- Baclofen – may be administered orally, g-tube, or via intrathecal pump
- Diazepam
- Dantrolene sodium
