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NURS254 Peds > MSK > Flashcards

MSK Flashcards

1
Q

what type of fracture should be reported as it is a sign of child abuse

A

spiral fracture: twisting motion

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2
Q

bones of children vs. adults

A

Children
- bones contain more cartilage & water: more flexible
- porous and less dense
- heals faster

  • more likely for greenstick fx due to flexibility

Adult
- more rigid, stronger
- takes longer to heal

  • complete or stress fx due to rigidity
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3
Q

what is greenstick fracture

A

incomplete fracture

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4
Q

what is a stress fracture

A
  • small fx or cracks in the bone due to muscle contractions during weight bearing activities
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5
Q

causes and risks for fractures

A
  • bed rest prolonged
  • osteoporosis
  • steroids “sone”
  • trauma
  • obesity
  • poor nutrition
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6
Q

s/s of fractures

A
  • pain, swelling
  • crepitus
  • muscle spasms
  • deformity
  • ecchymosis
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7
Q

what are signs of internal bleeding due to a fracture

A
  • hypotension
  • tachycardia
  • hematuria
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8
Q

what is the main sign for basilar skull fracture

A
  • clear liquid drainage from nose: CSF
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9
Q

what to watch out for for spine fracture that’s T-6 or higher

A
  • neurogenic shock: hypotension, bradycardia, pink and dry skin
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10
Q

what to watch for mandibular fracture

A
  • bleeding and drooling in the mouth: suction to keep airway intact
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11
Q

nursing care after fracture, before cast

A
  • splint at the joint above and below the injured area
  • if pelvic fx, monitor for hypovolemic shock, check for hematouria
  • elevate extremity and apply ice packs
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12
Q

what to look for in hip fracture

A
  • shortening of leg on affected side: due to muscle spasms
  • groin and hip pain with weight bearing
  • ecchymosis on thigh and hip
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13
Q

what to do for tractions

A
  • free hanging weights
  • ropes tight
  • reposition pt by holding weights
  • keep limb in neutral position
  • assess for skin breakdown
  • neuro checks: pulse, motor, sensation, cap refill
  • always supine
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14
Q

what is skin traction, skeletal traction, halo traction, and manual traction

A
  • skin traction: tape and straps applied to skin w/ boots
  • skeletal traction: pin or rod into bone
  • halo traction: screws into outer skull
  • manual traction: distal to injured area with casting or closed reduction
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15
Q

what is Buck’s traction used for

A
  • femur fx
  • hip fx
  • “knee immobilization”
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16
Q

what is Bryant traction used for

A
  • hip dysplasia <3years
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17
Q

key words for hip & femur surgery

A
  • total hip replacement
  • open reduction internal fixation (ORIF)
  • external fixation
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18
Q

3 priority of assessments for fractures

A
  • bleeding
    HgB less than 7 = HEAVEN
    monitor pulses distal to injury
    hypotension & tachycardia
  • infection
    elevated WBC >10,000
    drainage
    pin care with sterile solution at least 3x day
  • position education
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19
Q

what position education to give for hip fracture

A
  • position education
    abducted legs for total hip arthroplasty: place a pillow between legs to keep legs away from each other
    no crossing legs
    no sitting in chair (no sitting at 90 degrees angle)
    no leaning forward
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20
Q

complication for fractures

A
  • fat embolism syndrome
    common in: femur, pelvic/hip, crushing fractures
  • compartment syndrome from cast

don’t use SCDs

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21
Q

s/s of fat embolism syndrome

A
  • mental status changes
    confusion, restlessness
    altered mental status
  • dyspnea & chest pain
  • low pulse ox
  • petechiae over neck and chest
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22
Q

what are the cast care complications

A
  • hot spots: infection
  • compartment syndrome: no perfusion -> loss of limb
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23
Q

s/s of compartment syndrome

A
  • pain: muscle ischemia
    unrelieved with morphine or other meds
    extreme pain with passive movement
  • paresthesia
    tingling, burning, numbness
    problem moving or extending fingers/toes

6Ps

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24
Q

interventions for compartment syndrome

A
  • notify PCP immediately
    loosen cast
    fasciotomy: cut through tissue to relieve pressure
  • don’t elevate extremity
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25
Q

how many fingers should fit between cast and skin

A

1 finger

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26
Q

nursing assessments for compartment syndrome

A
  • assess fingers and toes “neuro checks”
    PMSC
    P: pulses, pain
    M: movement/grips
    S: sensation
    C: cap refill & color: not over 3secs/temperature not hot or cool
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27
Q

what are the 6 P’s for perfusion/oxygenation

A
  1. pain
  2. paresthesia
  3. pulses
  4. pallor
  5. paralysis: can’t move limb
  6. polar: cold (Poikilothermia)

pain & paresthesia priority

typically for lower limbs since it’s further from the heart

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28
Q

s/s of hot spots in a cast

A

infection under cast
- hot areas
- hot feeling
- foul odors

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29
Q

nursing intervention for hot spots

A
  • assess the circulation
  • change position
30
Q

cast care

A

CAST
- C: clean & dry NEVER WET
- A: above the heart (1st 48hrs to decrease swelling & ice)
- S: scratch an itch (hair dryer on a cool setting) don’t put anything in it
- T: take it easy (no bearing weight initially, no finger indentations or pressure, no hard surfaces), turn q2hr to dry the cast faster

31
Q

safe crutch use

A
  • weight on hands & arms
  • both crutches forward WITH injured leg
    move unaffected leg forward
  • stairs
    up with GOOD, down with BAD
32
Q

safe cane use

A
  • move cane 1st, weaker leg 2nd
  • stairs: up with GOOD, down with BAD
    up with strong, cane moves, weak leg last
    descend with cane, weaker leg down, strong leg last
33
Q

what is club foot

A
  • foot twisted inward and down, sole of feet facing each other
  • affected foot may be smaller than unaffected one
  • foot is rigid and can’t be moved easily
  • walking deformity
34
Q

when does treatment occur for club foot

A
  • right after birth
35
Q

treatment for clubbed foot

A
  • casts
    new cast every week for 5-8 weeks
  • heel cord tenotomy: fix achilles tendon -> long-leg cast again
  • denis browne cast after original cast is done (snowboard for babies) worn at bedtime for 3-5 yrs
36
Q

parent education for clubbed foot with casts

A
  1. new long-leg cast placed every week for 5-8weeks
  2. check toes several times a day = pink & warm
  3. keep the cast dry
  4. don’t elevate feet during sleep, don’t sleep on stomach = increased risk for SIDS
37
Q

what is hip dysplasia (DDH)

A

ball and socket joint doesn’t form normally -> hip instability -> may fully displace -> making affected leg shorter

38
Q

when does hip dysplasia get diagnosed

A

from birth to first few years of life

39
Q

causes of hip dysplasia

A
  • breech birth & large infant size
  • family hx
40
Q

hip dysplasia is easier to correct when they are a baby, what are the s/s to look for at birth?

A

0-12 weeks old:
- extra gluteal folds
inguinal/thigh folds
- one leg shorter than another
- instability and clicking sensating when abducting thighs
Ortolani (abduction of hip) and Barlow (adduction of hip) test

after 12 weeks old:
- limited hip abduction
- shorter leg on affected side -> difficult to stand up straight

walking years:
- limp
- walking on toes
- pelvis tilt leans towards unaffected leg “trendelenburg sign”

41
Q

parent teaching for hip dysplasia

A
  • keep legs abducted (away)
  • car seats/strollers with wide bases
42
Q

treatment for hip displasia

A

Pavlik harness
before 6 months of age
- only doctor adjust straps once a week
- keep on all the time, only take off for baths
- skin checks 2-3 times daily
- massage under straps every day
- dress with clothes under straps
- diapers under straps (only 1)
- avoid powders and lotions: excess moisture

once hip stabilized -> worn during sleep

if still doesn’t work, then surgical closed reduction with hip spica cast

43
Q

what is achondroplasia

A
  • without cartilage growth: autosomal mutation in a gene no endochondral bone formation
    increased risk with older paternal age
  • dwarfism
44
Q

s/s of achondroplasia

A
  • normal head and trunk size, recurrent ear infections due to narrow passages of the ear
  • abnormally large prominent forehead
    - hydrocephalus
  • flattened nasal bridge
  • crowded misaligned teeth
  • underdeveloped area of the face between forehead and jaw
  • kyphosis or lordosis
  • shorter arms & fingers and legs
  • bowed legs
  • flat, short, broad feet
  • poor muscle tone, loose joints
  • sleep apnea
  • fertility, life span, and mental function unaffected
45
Q

diagnosis for achondroplasia

A
  • ultrasound during pregnancy
  • DNA or genetic test: amniotic fluid in womb
  • x-rays after birth, blood test for defective gene
46
Q

s/s of hydrocephalus in a child with dwarfism

A
  • headache
  • vomiting
  • behavioral changes
  • vision issues
  • balance & coordination issues
  • delayed development or cognitive decline
47
Q

what is scoliosis

A
  • s shaped spine
  • “lateral curvature” and spinal rotation -> rib asymmetry
48
Q

s/s of scoliosis

A
  • varied pain
  • asymmetry in scapula, ribs, flanks, shoulders, hips
49
Q

when is scoliosis most prominent

A

periods of rapid growth:
- adolescent females ages 10-12
- adolescent males ages 13-14

50
Q

diagnosis of scoliosis

A
  • cobb angle: degree of curvature
  • Risser scale: skeletal maturity (bone growth on iliac crest)
    bend over at the waist with arms hanging down to observe symmetry
  • xray, MRI, CT
  • lung capacity: pulmonary function studies, CXR
51
Q

causes and risk factors of scoliosis

A
  • unsure, maybe something to do with intervertebral discs
  • genetics
  • associated with neuromuscular disorders: muscular dystrophy, Marfan syndrome, cerebral palsy
52
Q

treatment for scoliosis

A
  • physical exercise to limit progression & maintain ROM
  • fixing braces: Boston Brace
    wear cotton shirt under brace at all times
    wear at all times besides hygiene
  • spinal fusion with rod placement if curvature >45 degrees
53
Q

post op care for spinal fusion with rod placement (scoliosis)

A
  • NG tube, chest tube, urinary catheter, breathing exercises, PCA pump
  • frequent neuro checks
  • turn by log rolling
  • ambulation by 2nd or 3rd day as tolerated
  • monitor for paralytic ileus, infections
54
Q

complications of scoliosis

A
  • breathing difficulties with severe curvatures
    pneumothorax, atelectasis
  • lowered self-esteem
  • superior mesenteric artery syndrome: compression of the duodenum by aorta and superior mesenteric artery -> obstruction
    monitor for N/V, epigastric pain
55
Q

pathophysiology of muscular dystrophy

A

MD: muscle damage & weakness
- replacement of muscle fibers with connective tissue
- DNA sequencing issue with the protein dystrophin (for muscle stabilization)
- progressive disease: overtime more muscle cells die starting from legs

56
Q

muscular dystrophy mostly affects what population

A
  • boys 2-5 years old
57
Q

compare Duchenne vs. Becker Muscular dystrophy
- onset, progression, life expectancy, cardiac

A

Duchenne
- mutations -> complete lack of functional dystrophin
- onset: early childhood
- progression: rapid, wheel chair bound by teens
- life expectancy: reduced

Becker
- partial functional dystrophin
- later onset
- progression: slower, can ambulate into adulthood
- life expectancy: adulthood with care

both
- cardiomyopathy, arrhythmias
- milder in Becker

58
Q

diagnostics for muscular dystrophy

A
  • elevated creatine kinase (CK)
  • genetic testing
  • muscle biopsy: absent dystrophin
59
Q

s/s of muscular dystrophy

A
  • walks on tiptoes (achilles tendon tightened)
  • disproportionately large calves
  • frequently trips & falls
  • places hands on thighs to stand (Gower sign)
60
Q

interventions for muscular dystrophy

A
  • no cure
  • steroids: prednisone
  • physical therapy
  • NO BACLOFEN
  • wheelchair bound in adolescence
  • pass away due to respiratory failure in 20-30’s
61
Q

nurse teaching for parents with a child with muscular dystrophy

A
  • remove throw rugs
  • diet: fluids and fiber
  • gentle exercise: swimming, yoga, walking, NOT weight lifting
  • iron & vit D UNRELATED
62
Q

pathophysiology of osteomyelitis

A
  • bacterial infection of the bone
  • hematogenous spread: bacteria enters via bloodstream and localize in the metaphysis of long bones
63
Q

what are the most common etiologies for osteomyelitis

A
  • staph aureus
  • streptococcus pyogenes
  • kingella kingae
64
Q

risk factors for osteomyelitis

A
  • recent trauma or bone injury
  • immunosuppression
  • indwelling devices
  • chronic conditions: DM, sickle cell anemia
  • prior bacterial infection: pneumonia
  • poor hygiene or malnutrition
65
Q

s/s of osteomyelitis

A
  • localized pain
  • swelling, redness, warmth
  • reluctance to use limb or weight bearing avoidance
  • systemic symptoms: fever, fatigue, malaise
  • infants: poor feeding, pseudoparalysis, irritability
66
Q

lab/diagnostics for osteomyelitis

A
  • increased WBC
  • increased CRP, ESR
  • blood cultures
  • bone biopsy or aspiration
  • xray: after 1-2wks of infection
  • MRI: early detection
  • ultrasound: adjacent abscess or effusion
  • bone scan if MRI not possible
67
Q

treatment for osteomyelitis

A
  • broad spectrum abx: vanco, cefazolin, clindamycin
  • adjust based on culture results
  • sx if: abscess, necrotic bone, poor response to abx
    debridement of bone, removal of dead bone
  • pain meds
  • immobilize affected limb
  • physical therapy maybe after restored mobility
68
Q

pathophysiology of osteosarcoma

A
  • mesenchymal cells that produce immature bone matrix
  • typically in metaphysis of long bones
  • gene mutation
  • tumor destroys normal bone and invades surrounding tissues
69
Q

s/s of osteosarcoma

A
  • localized severe pain, often worse at night or with activity
  • muscle atrophy and weakness
  • palpable mass or swelling
  • restricted mobility
  • increased fracture risk
  • systemic in advanced stages: fever, weight loss, fatigue
70
Q

imaging diagnostics for osteosarcoma

A
  • xray: sunburst appearance, Codman’s triangle (elevation of periosteum)
  • MRI: soft tissue involvement
  • bone scan or PET scan: metastasis
  • bone biopsy
71
Q

lab diagnostic for osteosarcoma

A
  • increased alkaline phosphatase (enzyme produced by osteoblasts during bone turnover)
  • increased lactate dehydrogenase (anaerobic metabolism & cellular damage)
    osteosarcoma outgrows blood supply, creating hypoxic tumor regions
72
Q

treatment for osteosarcoma

A
  • sx: tumor resection & reconstruction with prosthesis or bone grafts
  • amputation: extensive tumor invasion, neurovascular compromise, infection
  • chemotherapy

NURS254 Peds (6 decks)

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