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Pediatrics Test III > Mobility > Flashcards

Mobility Flashcards

1
Q

cast petaling

A
  • using tape to cover sharp or rough edges that may come in contact w/ the skin
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2
Q

scratching w/ a cast on

A
  • make sure patient is not scratching underneath the cast
    • may need to give diphenhydramine
    • if scratch skin open, can lead to infection
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3
Q

skeletal traction

A
  • pull directly applied to skeletal structure by a pin, wire, tongs
    • used when significant traction is needed
    • placement of skin/wire puts stress on bone (not surrounding tissue) so can use more weight than skin traction
  • weights need to be correct and not on floor
  • if moving patient, hold weightso so don’t sway and give pain meds
  • biggest concern: infection b/c pin going through bone
    • assess site, monitor V/S–esp temp
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4
Q

skin traction

A
  • pull applied to the skin surfaces and indirectly to the skeletal surfaces
  • pulling mechanism applied to the skin w/ adhesive material or elastic bandage
  • not to be used if there is altered skin integrity
  • limited weight allowed b/c can pull/tear skin
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5
Q

orthotics

A
  • don’t put directly against skin
    • especially if lack of sensation b/c can cause breakdown
    • wear long athletic socks underneath
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6
Q

ilizarov external fixator

A
  • used for limb lengthening
  • assess for infection where pin goes through skin
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7
Q

neurovascular assessment of immobilized child

A
  • 5 P’s:
    • P: pain
    • P: pallor
    • P: pulselessness
    • P: paresthesia
    • P: paralysis
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8
Q

what pathology occurs with decreased muscle activity?

A
  • dec muscle activity–>disuse atrophy–>dec venous return and catabolism–>dependent edema and negative nitrogen balance
  • dec metabolism–>dec need for O2–>dec ventilation
  • bone demineralization–>osteoporosis and hypercalcemia–>renal calculi
    • make sure they have lots of fluids!
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9
Q

analgesia with immobilization

A
  • can use tylenol or ibuprofen (if over 6 mos)
    • but may also need an opioid–assess RR, depth of respirations, should be on continuous pulse oximeter, inc fluids and monitor for constipation
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10
Q

preventing muscle atrophy and impaired mobility

A
  • prevent contractures in the unaffected extremities
  • collaborate with PT/OT
  • prepare for disuse atrophy
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11
Q

fractures: etiology

A
  • have to differentiate b/w intentional and non-intentional injury
  • trauma: certain developmental characteristics make them more susceptible to injury
    • infants: dependent on us to keep them safe
      • make sure strapped in infant seat
      • car seat has not been involved in an accident
    • toddlers:
      • learning to walk
      • curious, getting into things
    • school age/adolescents:
      • drugs, sex, alcohol
      • thrill seeking
      • feel invincible
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12
Q

S/S, diagnostics, and mgmt of fractures

A
  • clinical manifestations: swelling, pain, diminished use
  • x-rays: may need pain meds to keep them in specific position w/o pain
  • mgmt: splint/cast, pain meds
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13
Q

goals of fracture mgmt

A
  • reduction: regain alignment and length
    • may have open or closed reduction
  • immobilization:
    • retain alignment and length
    • restore function
    • prevent further injury
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14
Q

criteria for determining use of reduction method for fractures

A
  • age of child
  • degree of displacement
  • amount of overriding
  • degree of edema
  • condition of skin and soft tissue
  • sensation and circulation distal to the fracture
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15
Q

rapidity of bone healing

A

inversely related ot the child’s age, so the younger the child, the more quickly their bone will heal

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16
Q

cast care

A
  • most casts are made of synthetic material
    • advantages:
      • dries w/in minutes
      • lightweight
      • may get wet w/ permission of MD–clean with soap and water and blow dry on cool!
  • when handling, don’t use fingertips, b/c can cause indentations–>pressure
  • “hot spots” indicate inflammation or infection
  • chief concern during first few hours is compartment syndrome–>elevate extremity, check temp/color of skin, pulses, cap refill
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17
Q

pathophys of development dysplasia of the hip (DDH)

A
  • cause is unknown, but 4 P’s related
    • gender (Female)
    • birth order (First born)
    • Family hx
    • intrauterine position (Feet first–breech)
    • delivery type and postnatal positioning known to inc risk
18
Q

clinical manifestations of DDH

A
  • infants:
    • unequal skin folds on thighs and buttocks
    • limitation of abduction on affected side
    • unequal knee height or leg length
  • older children
    • limp and trendelenberg’s gait (pelvis tips forward on normal side rather than upward)
19
Q

Barlow and Ortolani maneuvers

A
  • for DDH
    • for Barlow: if hip is dislocated, so if the hip can be popped out of the socket–>test is positive
    • for Ortolani: positive sign is distinctive “clunk” which can be heard and felt as the femoral head relocates anteriorly into acetabulum
20
Q

diagnosis of DDH

A
  • <3 mos old: U/S–>high incidence of false positives
  • >3 mos old: x ray–>ossification of the femoral head occurs b/w 3-6 mos
21
Q

tx of DDH

A
  • Pavlik harness:
    • dynamic splinting used to keep femoral head where it should be
    • make sure the infant doesn’t wear harness w/o undershirt and diaper b/w skin and straps
    • used for 3-6 mos
    • need to check straps every 1-2 weeks due to infant’s rapid growth
22
Q

etiology and patho of osteomyelitis

A
  • acquired from exogenous or hematogeneous sources
    • most commonly caused by staph aureus
  • infective emboli travel from focus of infection to the small end arteries in the bone
    • infection leads to local bone destruction and abscess formation
    • abscess and necrotic debris exerts pressure on the bone and infection spreads to periosteum
23
Q

clinical manifestations and lab findings of osteomyelitis

A
  • manifestations: don’t start occurring for 7-10 days
    • fever
    • failure ot use affected extremity
    • erythema, heat, and swelling
    • tenderness in affected area
    • dec ROM in joints of affected extremity
  • labs:
    • CBC w/ diff: elevated WBC
    • inc ESR
    • cultures
24
Q

nursing mgmt of osteomyelitis

A
  • aggressive abx tx for 4-6 weeks
    • usually given a PICC line and parents taught how to assess and flush PICC and then infuse abx
    • must finish full course of abx
    • usually cephalosporins, gentamycin
  • if MRSA, may have to use vancomycin
25
Q

scoliosis etiology

A
  • often unknown cause
  • complex spinal deformity in 3 planes:
    • lateral curvature
    • spinal rotation causing rib asymmetry
    • thoracic hypokyphosis
      • issue is degree of curvature and how much pulmonary function is being affected
26
Q

clinical manifestations, diagnostics, and mgmt of scoliosis

A
  • idiopathic curvature not typically evident until 10 yo
    • usually no pain
  • eval:
    • check with x ray in standing position
    • Cobb technique for curvature magnitude
    • have child bend over and touch toes
    • assess gait
  • mgmt:
    • bracing and exercise (in and out of brace)
      • should not be worn directly against skin
      • encourage exercise
      • wear for 16-23 hrs a day
    • if >40 deg, need surgery
27
Q

surgical repair of scoliosis

A
  • realignment and straightening w/ internal fixator
  • post op:
    • neuro checks, circulation checks
    • assess for infection at the incision site
    • pulmonary system
    • assess skin, U/O, bowel sounds
    • logroll for first 24 hrs, then ambulate 2-3x per day
    • remove foley asap
    • need good pain mgmt
    • monitor H&H b/c potential for significant blood loss
    • typically d/c in 48-72 hrs
28
Q

cerebral palsy etiology

A
  • any perinatal or neonatal brain lesion or brain maldevelopment
  • prenatal/postnatal infection
  • prenatal/postnatal hypoxia/asphyxia
  • often no identifiable immediate cause
  • inc incidence with prematurity
    • preterm birth of ELBW and VLBW is most important determinant
    • anoxia–most common cause of brain damage whenever it occurs
29
Q

spastic CP

A
  • most common type
  • presents as hypotonia most often
30
Q

motor signs of CP

A
  • poor head control after age 3-4 mos
  • stiff or rigid limbs
  • arching back/pushing away
  • floppy tone
  • unable to sit w/o support at age 8 mos
  • clenched fists after 3 mos
31
Q

behavioral signs of CP

A
  • excessive irritability
  • no smiling by age 3 mos
  • feeding difficulties
    • persistent tongue thrust
    • frequent gagging or choking w/ feeds–aspiration common
32
Q

pharmacology to dec spasticity in CP

A
  • botulinum toxin (botox)
  • baclofen
    • oral
    • implanted pump for intrathecal administration
  • dantrolene sodium
  • diazepam
33
Q

assoc disabilities with CP

A
  • intellectual impairment
  • ADHD
  • SZs
  • drooling
  • difficulty feeding–can lead to aspiration
  • impaired gas exchange
  • orthopedic complications
  • visual (nystagmus) and hearing loss
  • constipation
  • dental problems–caries, malocclusion, gingivitis
34
Q

nursing mgmt of CP

A
  • holistic approach
  • interdisciplinary
    • PT/OT, speech therapy
  • when feeding, make sure they are not lying flat
    • may need jaw support to help swallow
    • may thicken foods/fluids to prevent aspiration
35
Q

hypotonia

A
  • “floppy infant syndrome”
    • muscles feel atrophied, marked head lag, poor suck
  • characteristics of SMA type 1 and 2:
    • progressive weakness and wasting of skeletal muscles
    • degeneration occurs in spinal cord and brainstem–>atrophy of skeletal muscles
    • age of onset variable, earlier onset=poorer prognosis
      • eventually progresses to affected respiratory muscles
36
Q

infantile SMA (spinal muscular atrophy) type 1

A
  • Werdnig Hoffmann dz
  • autosomal recessive trait
  • most common form of floppy infant syndrome
  • often die at an early age, b/c affects respiratory Ms
37
Q

infantile SMA type 2

A
  • manifests b/w 2-12 mos
  • first weakness of arms and legs, then generalized weakness
  • prominent pectus excavatum
  • movements absent during relaxation and sleep
  • life span: 7 mos to 7 yrs
38
Q

muscular dystrophy

A
  • X linked inheritance pattern
  • mutation of gene that encodes dystrophic–>protein product in skeletal muscle, so it builds up
  • muscle weakness begins to demonstrate around 3 yo
  • its an ascending disorder
    • starts in extremities and works way up
39
Q

DMD clinical manifestations

A
  • pelvic weakness:
    • waddling gait, lordosis, falls frequently
    • Glower’s sign: push themselves up with hands instead of legs
  • muscle atrophy–>calf muscle hypertrophies and fatty infiltrates develop
  • occasional mental deficiency
  • inc respiratory distress–>eventually affects diaphragm
40
Q

nursing mgmt of DMD

A
  • genetic counseling: prenatal testing
  • encourage exercise: delays wheelchair confinement
  • interdisciplinary consultation
41
Q

talipes equinovarus

A
  • AKA clubfoot
  • strong familial tendency
  • mgmt: 3 stages:
    • correct deformity
    • maintenance of correction
    • f/u to avoid recurrence
  • will have serial casting
    • will need analgesics and edu about cast care
    • if severe, may need surgery
    • after correction, may need splint to prevent reoccurrence
42
Q

osteogenesis imperfecta (OI)

A
  • brittle bone dz: on a continuum
  • manifestations:
    • bone fragility, deformity, fx
    • blue sclerae
    • hearing loss
    • dentinogenesis imperfecta
  • inheritance: most are autosomal dominant, but most severe form is sometimes autosomal recessive
  • mgmt: mainly supportive

Pediatrics Test III (6 decks)

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