MSK and Articular Dysfunction Flashcards
One of the most difficult aspects of illness for a child
immobility
Muscular effects of immobilization
decreased muscle strength & endurance
atrophy & loss of joint mobility
can happen very quickly
What nurse can do to promote muscle strengths and mobility
passive ROM exercises if child is unable to do this themselves
Skeletal effects of immobilization
bone demineralization
negative calcium balance
What does bone demineralization increase the risk of?
fractures
Metabolism effects of immobilization
decreased metabolic rate; hypercalcemia
decreased production of stress hormones
Cardiovascular effects of immobilization
altered distribution of blood volume; venous stasis
dependent edema; diminished vasopressor mechanism
What are adolescents at an increased risk of related to cardiovascular?
DVT
especially if on birth control
Respiratory effects of immobilization
atelectassis* use incentive spirometry
decreased need for oxygen; diminished vital capacity
poor abdominal tone & distention
loss of respiratory muscle strength
GI effects of immobilization
constipation and anorexia*
distention
caused by poor abdominal tone
Integumentary effects of immobilization
decreased circulation and pressure leading to decreased healing capacity
skin breakdown - not as bad as adults
Urinary system effects of immobilization
alteration of gravitational force
difficulty voiding in supine position
urinary retention
Psychological effects of immobilization (many)
diminished environmental stimuli
altered perception of self and environment
increased feelings of frustration, helplessness, anxiety
depression, anger, aggressive behavior
developmental regression
What to tell parents related to psychological effects
developmentally normal responses
Effects of immobilization on family
logistics
family support, home care
coping skills
What are most traumatic soft-tissue injuries caused by in children?
sports and play!
strain
tendon
sprain
ligament
dislocation
at a joint
contusion
muscle and soft tissue
separation
at the epiphysis
What to do for sprains and strains
RICE
RICE acronym
rest
ice
compression
elevation
Consideration when using ice
30 mins max at a time
Skippy joint injury
slipped capital femoral epiphysis
hip joint gets loose and slips out
very painful
T or F: Children break bones easier than adults
TRUE
but they health faster
T or F: Fractures are rare in infants
TRUE
MVA, birth injury
Epiphyseal injuries
cartilage growth plate
weakest point of long bones
frequent site of damage during trauma
may affect future bone growth
Treatment for epiphyseal injuries
ORIF
Post-ORIF complications
vascular necrosis
infection
Main types of fractures (4)
1) simple or closed
2) compound or open
3) complicated
4) comminuted
simple or closed fracture
does not produce a break in the skin
most can be casted
compound or open fracture
fractured bone protrudes through the skin
complicated fracture
bone fragments have damaged other organs or tissues
comminuted
small fragments of bone are broken from fractured shaft and lie in surrounding tissue
Type of fracture that can be indicative of non-accidental injury
spiral
involves twisting of the bone
Tests that are done when non-accidental injury suspected (2)
1) skeletal survey
2) blood work - look for something that could predispose child to injury
CSM acronym
colour
sensation
movement
5 P’s of fracture assessment
Pain
Pallor
Paresthesia
Pulselessness
Paralysis
6th P that the physician would assess for
pressure
What are we assessing for with the 5 Ps?
compartment syndrome
Treatment for compartment syndrome
remove cast
Cast care consideration
don’t stick anything in the cast
don’t get wet (unless fibreglass)
look for signs of compartment syndrome e.g. swollen fingers
bath and lotion after cast removed
prepare kids for cast removal –> scary
Osteosarcoma
most common type of primary malignant bone tumour in children
Symptoms of osteosarcoma
localized pain
limping
palpable mass
Most common location of osteosarcoma
femur
Treatment of osteosarcoma
chemo
rotationplasty
Traction
moving away from this
using ropes, pulleys, and weights, gently pulls on a fractured or dislocated body part to realign bones and reduce pain
Developmental Dysplasia of the Hip (DDH)
hip abnormalities
-shallow acetabulum
-subluxation (incomplete dislocation)
-dislocations
When to assess for developmental dysplasia of the hip
after birth
Clinical manifestation of DDH
shortened limb on AFFECTED side
restricted abduction of hip on affected side
unequal gluteal folds when infant prone
Tests that physicians do for DDH (2)
1) Ortolani
2) Barlow
Ortolani test
hip started off dislocated
abducting
will hear “clunk” as dislocated femur enters the acetabulum
Barlow test
hip started off reduced
adducting
positive if hips pops out
Treatment for DDH when child UNDER 6 months
Pavlik Harness
stays on for 4 to 8 weeks
hip in constant flexion and abduction
Treatment for DDH when child 6 to 8 months
Spica cast
Petaling of cast meaning
putting tape around sharp edges
Osteogenesis Imperfecta (OI)
aka brittle bone disorder
connective tissue disorder
defective periosteal bone formation and reduced cortical thickness of bones
hyperextensibility of ligaments
Treatment and management for Osteogenesis Imperfecta
primarily supportive
drugs are not that great
handle with care
education for parents, daycare, school
diet rich in calcium
physio, swimming
surgery - rods
What to NEVER do with children with Osteogenesis Imperfecta
lift under the armpits
pulls arms or legs
Scoliosis
complex spinal deformity
3 planes that scoliosis occurs on
1) lateral curvature
2) spinal rotation causing rib asymmetry
3) thoracic hypokyphosis
Signs/symptoms of scoliosis
pain
ill-fitting clothes
visible deformities
Diagnosis of scoliosis
x-ray!
Treatment for scoliosis when grade of curve is < 50%
brace
Treatment for scoliosis when grade of curve is > 50%
surgery
Osteomyelitis
inflammation and infection of bony tissue
exogenous or hematogenous sources
Most common cause of osteomyelitis
S. aureus
Types of osteomyelitis (4)
1) acute hematogenous
2) exogenous
3) subacute
4) chronic
Signs and symptoms of osteomyelitis
begin ABRUPTLY
resemble symptoms of arthritis and leukemia
marked leukocytosis
Diagnosis of osteomyelitis
MRI*
bone cultures obtained from biopsy or aspirate
early x-rays may appear normal
Treatment of osteomyelitis
prompt, vigorous IV antibiotics
3 to 4 weeks or up to several months
monitor hematologic, renal, hepatic responses to treatment
prevent complications like fractures
BIG nursing consideration for osteomyelitis
complete bed red and immobility
DON’T move the patient
Other considerations for osteomyelitis
pain management
PICC line
calories and protein
long-term hospitalization
psychosocial
Juvenile Idiopathic Arthritis (JIA) symptoms (many)
stiffness
swelling
loss of mobility
warmth (without redness)
tender sometimes
symptoms increase with stressors
growth retardation
Is children, which joints are typically affected with arthritis?
LARGE joints
Diagnosis of JIA
blood work
-WBC
-ESR, CRP
genetic test
Management of JIA
no specific cure
meds: steroids, NSAIDs
methotrexate - in more severe cases, cytotoxic
pain management
physical activity
nutrition
