MSK

Question 1

When does the anterior and posterior fontanels close

Answer 1

anterior: 18 months
posterior: 3 months

Question 2

pediatric differences

Answer 2

• growth plates (end of long bones )
• ligaments and tendons are stronger than bones unitl puberty (ligaments connects bones, tendons connects muscles to bones )

Question 3

Club foot (patho, s/sx, dx, tx, and nursing )

Answer 3

• PATHO: Foot is twisted ( there are 4 different types )
  
  1. Talipes Equinus ( toes lower than heels )
  2. Varus ( feet turns inwards )
  3. Valgus ( feet bends out )
  4. Calcaneus ( toes higher than heels
• TREATMENT:
  
  1. serial casting, starts ASAP, 8-12 weeks –> splint –> brace
  2. Surgery if casting doesnt work

-NURSING: monitor neurovascular status (cap refill, skin: blue or pale ), clean sock no wrinkles, lotion, and powders

Question 4

Developmental Dysplasia of the Hip, DDH( patho, s/sx, dx, tx, and nursing )

Answer 4

-PATHO: weak joint, the ball of the femur slips from hip socket

-S/SX:
1. INFANT: limited abduction ( away from the body ), asymmetrical gluteal folds and knee folds, positive ortolani and barlow sign ( when you hear the click = (+)= DDH)
2. CHILD: affected leg is shorter, asymmetrical folds, limp with lordosis ( belly will push out )

-TREATMENT:
1. Pavlik Harness= a splint that allows movement used <6 months
2. Surgical reduction is done >6 months
3. Hip spica cast ( voiding concerns )

• NURSING:
  Skin care (neurovascular, circulation, color )

Question 5

Legg- Calve Perthe Disease

Answer 5

Patho: blood supply disrupted to the femoral head = necrosis (disease process takes years )

-S/SX: Seen in school age boys (4-8 years old ) or limping w/o PMHX or injury ( limping, pain, limited ROM)

-TX: physical therapy (1-4 y.o.) , brace, crutches, traction, or surgery

• Nursing: watch for skin breakdown

Question 6

Osteomyelitis

Answer 6

Patho: bone infection spread through wound or other infection (URI)

S/SX: bone pain, edema, decreased mobility,fever

DX: x-ray, CBC (increased WBC )

TX: Antibiotics - IV then PO for 3-6 weeks

Question 7

Slipped capital Femoral Epiphysis

Answer 7

Patho: femoral head displaced from the femoral neck caused by trauma obesity, recent growth spurt, and radiation

S/Sx: limp, leg pain, loss of motion

TX: surgical repair

Nursing: ROM, strength, tissue profusions

Question 8

Scoliosis

Answer 8

Patho: lateral S or C curve ( more noticable after growth spurt

Dx: screenings

Tx: 1.Mild- exercise
2. Moderate - brace ( wear 23 hours a day )
3. Severe - surgery

Nursing: patient may have body image concerns
Post op care: log roll only, IS, pain control, I/O
Superior mesenteric artery syndrome- N/V/D

Question 9

Osteogenesis Imperfecta (patho, s/sx, dx, tx, and nursing )

Answer 9

Patho: brittle bone disease (autosomal dominant Hh- will cause the disease )

S/Sx: multiple fx, hyperflexible joints, short stature

TX: supportive care and rehab

Nursing: handle with care

Question 10

Duchenne muscular dystrophy ( patho, s/sx, dx, tx, and nursing )

Answer 10

Patho
- Necrosis of the muscle fibers leads to ascending muscle weakness ( starts at feet then goes upwards )
-Progressive = terminal
- x-linked= only males are affected

S/Sx: growers maneuver ( how they go from sitting to standing), enlarged leg muscles

Nursing: Non ambulatory -> resp. failure

Question 11

Type 1 spinal muscular atrophy ( Werding- Hoffman disease )

Answer 11

Patho: progressive destruction of motor neurons (genetic)

S/Sx: appear <6 months old = hypotonic, lack of reflexes, swallowing and breathing difficulties

TX: there is no tx

Nursing: manage sx and prevent complications

Question 12

Fracture

Answer 12

Patho: break in bone

Types:
1. closed (Skin intact)
2. open (break in skin)
3. comminuted (pieces)
4. spiral
5. greenstick (crack)

S/sx: pain, abnormal positioning, edema, immobile, brusing, guarding, crepitus

Nursing: 5 P’s (neurovascular check)
1. pain
2. pallor
3. pulselessness
4. paresthesia
5. paralysis

Question 13

Growth plate injuries

Answer 13

Patho: weakest point of bone (may affect future bone growth)

Tx: ORIF to prevent growth disturbances (open reduction internal fixation )

Question 14

Cast care

Answer 14

• pad bony prominences
• neurovascular checks 5 P’s ( pain, pallor, paresthesia, paralysis, pulselessness)
• keep dry
• skin care (no lotions or powders )
• no toys or scratchers down the cast it could break the skin and cause infection

Question 15

Compartment Syndrome

Answer 15

• pressure increased in closed area
• sudden increase in pain
• 5 P’s
• absent pulse= emergency
• notify the physician
• bivalve cast or facia

Question 16

Traction

Answer 16

• used to reduce deformity, spasm, contracture, or fx
• skin vs skeletal (infection risk- b/c pins in bone)
• frequent neurovascular (5 P’s ) and skin checks
• immobilization risk
• provide distraction/play