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PEDs Exam 3 > Muscular Alterations > Flashcards

Muscular Alterations Flashcards

1
Q

What is muscular dystrophy?

A

inherited disease of the muscles, causing muscle atrophy and weakness

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2
Q

What is the most serious and most common of the dystrophies ____________, an X linked recessive disease affecting primarily males.

A

Duchenne muscular dystrophy

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3
Q

Duchenne muscular dystrophy appears in what age group?

A

early childhood ( 3 to five years)

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4
Q

Duchenne muscular dystrophy rapidly progresses, causing respiratory or cardiac complications and death, usually by ____ years of age.

A

25

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5
Q

What are some signs and symptoms of muscular dystrophy?

A
  • waddling gait, lordosis
  • increasing clumsiness, muscular weakness
  • Gowers sign: difficulty rising to standing position; Has to “walk” up legs using hands
  • pseudohypertrophy of muscles (especially noted in calves) due to fat deposits
  • muscular degeneration, especially the thighs, and fatty infiltrates (detected by muscle biopsy); cardiac muscle also involved
  • delayed cognitive development
  • elevated CPK and SGOT/AST
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6
Q

what are some late signs and symptoms of muscular dystrophy?

A
  • scoliosis
  • respiratory difficulty
  • cardiac difficulties
  • eventually wheelchair dependency, confinement to bed
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7
Q

what are some nursing interventions that need to be provided to patients who have muscular dystrophy?

A
  • provide supportive care
  • provide exercises (active and passive)
  • prevent exposure to respiratory infection
  • encourage a balanced diet to avoid obesity
  • support families grieving process
  • support participation in the muscular dystrophy Association
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8
Q

who are some people in the health care team that the nurse coordinate with if the patient has muscular dystrophy?

A
  • physical therapy
  • occupational therapy
  • nutritionist
  • neurologist
  • orthopedist
  • geneticists
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9
Q

What is a traumatic injury to a bone called?

A

fracture

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10
Q

what are the three classifications of a fracture?

A
  • complete
  • incomplete
  • comminuted
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11
Q

what is a complete fracture?

A

bone fragments are completely separate

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12
Q

what is an incomplete fracture?

A

bone fragments remain attached (green sticks, bins, buckles)

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13
Q

what are comminuted fractures?

A
  • bone fragments from the fractured shaft break free and go in the surrounding tissue
  • this type of fracture is rare in children
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14
Q

Fractures that occur in the __________ plate may affect growth of the limb.

A

epiphyseal (growth plate)

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15
Q

Fractures in ______ children are common because of falls during play and are involved in motor vehicle accidents.

A

older (school age and adolescence)

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16
Q

Spiral fractures (caused by twisting) and fractures in _______ may be related to child abuse.

A

Infants

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17
Q

what are the general conditions, signs and symptoms, that will be seen with fractures?

A
  • visible bone fragments
  • pain
  • swelling
  • contusions
  • child guarding or protecting the extremity
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18
Q

what are the five P’s that may indicate the presence of ischemia with a fracture?

A
  • pain
  • pallor
  • pulselessness
  • paresthesia
  • paralysis
  • poikilothermia
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19
Q

what are some nursing interventions that need to be done for a fracture?

A
  • obtain based on data and frequently perform narrow vascular assessments
  • report abnormal assessment promptly
  • maintain traction if prescribed
  • maintain child in proper body alignment
  • monitor for problems of immobility
  • provide age-appropriate play and toys
  • prepare child for cast application; use age-appropriate terms when explaining procedure
  • provide routine cast care following application; petal cast edges
  • teach home cast care to family
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20
Q

What are some signs and symptoms that need to be assessed when checking vascular changes?

A
  • check pulses distal to injury to assess circulation
  • color: check injured extremity for pink, brisk, capillary refill
  • movement and sensation: check injured extremity for nerve impairment; compare for symmetry with uninjured extremity
  • temperature: check extremity for warmth
  • swelling: check for an increase in swelling, elevate extremity to prevent swelling
  • pain: monitor for severe pain that is not relieved by analgesics
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21
Q

why should abnormal assessments of a fracture be reported immediately?

A

compartment syndrome may occur; It results in permanent damage the nerves and vasculature of the injured extremity due to compression

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22
Q

What should be noted if traction is prescribed?

A
  • bed position
  • type of traction
  • weight
  • pulleys
  • pins
  • pin sites
  • adhesive strips
  • ACE wraps
  • splints
  • casts
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23
Q

What are two types of skin traction that are used for a fracture?

A
  • buck extension traction

- Russell traction

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24
Q

What is buck extension traction?

A

lower extremity, legs extended, no hip flexion

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25
Q

what is Russell traction?

A

2 lines pull on the lower extremity, one perpendicular, one longitudinal

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26
Q

What is skeletal traction and an example?

A
  • pin or wire applies pull directly to the distal bone fragment
  • Halo traction
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27
Q

What are some examples of home cast care to teach a family?

A
  • teach neurovascular assessment of casted extremity
  • teach child not to get cast wet
  • teach child not to place anything under cast
  • teach child to keep small objects, toys, and food out of cast
  • teach family to modify diapering and toileting to prevent cast soilage (double diapering)
  • teach that in the presence of a hip spica, family may use a Bradford frame under a small child to help with toileting; they must not use abduction bar to turn child
  • Teach to seek follow up care with health care provider
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28
Q

what is developmental dysplasia of the hip?

A

abnormal development of the femoral head in the acetabulum

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29
Q

what are the treatment options for developmental dysplasia of the hip?

A
  • conservative treatment consists of splinting

- surgical intervention is necessary if splinting is not successful

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30
Q

what are some signs and symptoms of developmental dysplasia of the hip in an infant?

A
  • positive Ortolani sign (“clicking” with abduction)
  • unequal folds of skin on buttocks and thigh
  • limited abduction of affected hip
  • unequal leg lengths
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31
Q

what are some signs and symptoms of developmental dysphasia other the hip in older children?

A
  • limp on affected side
  • Trendelenburg sign (when the child stands, bearing weight on the affected hip, the pelvis tilts downward on the normal sod instead of upward with the normal stability – this is a positive Trendelenburg sign)
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32
Q

What are some nursing interventions to provide for a patient who has developmental dysplasia of the hip?

A
  • perform newborn assessment at birth
  • apply abduction device or splint (Pavlick harness); therapy involves positioning leg in flexed abducted position
  • teach parents home care
  • provide nursing care for a child requiring surgical correction
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33
Q

what are some home teaching points that need to be given to parents who have a child with developmental dysplasia of the hip?

A
  • teach application and removal of device (worn 24 hours a day)
  • teach skin care and bathing (physician may allow parents to remove device for bathing)
  • teach diapering
  • teach that follow-up care involves frequent adjustments because of growth
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34
Q

What are some post-operative cares that needs to be provided for a patient who has had surgical correction for developmental dysplasia of the hip?

A
  • assess vital signs
  • check cast for drainage and bleeding
  • perform narrow vascular assessment of extremities
  • perform respiratory hygiene
  • administer narcotic analgesic around the Clock
  • teach family cast care when child goes home
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35
Q

What are some questions we need to ask ourselves when dealing with musculoskeletal conditions in Pediatrics?

A
  • is this normal for them/baseline
  • is this a new illness
  • is this a new injury
  • is this caused by congenital defect
  • physical and social aspects that are affected (sports, prom, dance)
  • is this a hypotonic patient (flaccidness of movement)
  • do we need special beds, pillows, barriers
36
Q

What are the physiological effects of an immobilized patient?

A
  • decreased muscle mass and strength
  • decrease metabolism
  • bone demineralization (osteopenia)
37
Q

What happens if decreased muscle mass and strength occurs in an immobilized patient?

A
  • significant loss of muscle strength, endurance, and muscle mass
  • loss of joint mobility
  • inactive muscles lose strength at the rate of 3% a day
  • leads to tissue breakdown and muscle atrophy
38
Q

Range of motion must be re-established within 3 - 7 days or patient will develop _________.

A

contractures

39
Q

Why is it important to promote early movement/ambulation?

A
  • increase mobility
  • decrease risk of pneumonia
  • decrease risk of breakdown, pressure injuries
  • decrease risk of thrombus
40
Q

what are three things that happen if there is no muscle contraction?

A

-venous stasis=edema=skin breakdown

41
Q

What happens if decrease metabolism becomes a problem in an immobilized patient?

A
  • lessened demand for oxygen-carbon dioxide exchange causes the respirations to become slower and more shallow
  • lying supine for prolonged periods leads to altered respirations
  • reduced energy requirements leads to anorexia
42
Q

what happens if bone demineralization (osteopenia) occurs in an immobilized patient?

A
  • weakened bones
  • hypercalcemia: increased calcium levels in blood
  • kidney stones
43
Q

Prolonged redness of greater than ____ minutes appears when there is a developing pressure area.

A

30

44
Q

Decreased mobility leads to what problem in the gastrointestinal system, and how can we prevent/treat this?

A
  • Constipation
  • Get moving if possible
  • adequate fluids
  • stool softener
  • monitor for BM
45
Q

Decreased mobility leads to what problems in the genitourinary system, and how can we prevent this from occurring?

A
  • decreased urinary output from stasis or retention
  • strict I&O monitoring
  • monitor for UTI
46
Q

What is the first thing we must rule out if an infant comes in with multiple fractures or fractures in multiple stages of healing?

A

osteogenesis imperfecta

47
Q

what are some nursing management interventions that need to be done for fractures?

A
  • monitor work of breathing
  • LOC
  • pulses
  • monitoring circulation
  • color skin
  • cool/warm to touch
  • sensation
  • history of circumstances surrounding the fracture
  • examination of fracture site for bruising, skin lacerations comment swelling
  • obtain baseline data
  • every 1 to 4 hours neurovascular assessments (depending on pre/post-op state)
48
Q

What are the six parts of the neurovascular assessment?

A
  • pulses (check pulses distal to the injury)
  • color (check injury extremity for capillary refill, brisk, and pink color)
  • movement and sensation (check for nerve impairment)
  • temperature (check extremity for warmth)
  • swelling (check for an increase in swelling, elevate extremity to reduce or prevent swelling)
  • pain (monitor for severe pain that is not relieved by analgesics)
49
Q

what is compartment syndrome?

A
  • happens very quickly
  • non-subsiding severe pain with use of medication or elevation
  • decreased sensation in affected limb
  • paleness of skin
  • weakness
  • swallowed, shiny skin
50
Q

how does a pulmonary embolus present?

A
  • quick onset
  • SOB
  • decreased O2 saturation
  • diaphoresis
  • increased respiratory rate/work of breathing
  • chest pain
  • dyspnea
51
Q

what are some nursing interventions that need to be done for a pulmonary embolus?

A
  • immediately elevate head
  • administer 02
  • notify health care provider immediately
52
Q

what are the four most common fracture types in PEDs?

A
  • greenstick
  • plastic deformation
  • buckle
  • complete
53
Q

what is a major concern for a preschool age child when it comes to an injury and cast?

A
  • fixation on the cast related to it being on for six to 8 weeks
  • intervene with child life to lessen the stress and fear in these children
54
Q

what are some major interventions and teachings that need to be done if a child has a spica cast?

A
  • don’t use the bar as a way to lift the patient (it puts pressure on the hips and injured site)
  • new injuries can occur at the bar site
  • make sure children don’t put toys or food inside the cast (risk of skin breakdown)
  • double diaper
55
Q

what is some cast care education that needs to be taught to the families?

A
  • neurovascular assessment of casted extremity
  • elevate extremity
  • teach child not to get cast wet
  • teach child not to place anything under cast
  • keep small objects, toys, and food out of cast
  • modified diapering and toileting to prevent cast soilage
  • teach to seek follow up care with health care provider
56
Q

What are the two types of skin traction that are used in Pediatrics?

A
  • Bucks

- Russell

57
Q

when do we use skin traction?

A
  • when we can’t get the patient into the OR right away
  • it is used to release muscle spasm and reduce pain
  • non-invasive
58
Q

what is the type of skeletal traction use most often in peds?

A

Halo

59
Q

what kind of care is important if the patient has skeletal traction?

A
  • never release the weights/traction without notice from health care provider or MD
  • pin care typically twice a day with normal sailing and a Q-tip
  • look for infection while providing care
60
Q

What are two types of long bone stability?

A
  • internal fixation

- external fixation

61
Q

what are some nursing considerations for the child in a cast or in traction?

A
  • neurovascular assessment everyone to two hours after application of device
  • assessment of strengthen post distal to the site
  • assessment of capillary refill
  • assessment of five P’s
  • reposition every two hours; encourage mobility within the confines of traction or cast
  • prevent skin breakdown
  • maintain hydration
  • encourage or provide a range of motion exercises as appropriate for caster traction
  • provide opportunities for therapeutic play
  • encourage and provide opportunities for school age children and adolescents to keep up with schoolwork and friends
62
Q

What are three types of congenital musculoskeletal conditions?

A
  • clubfoot
  • developmental dysplasia of the hip
  • osteogenesis imperfecta
63
Q

what is clubfoot?

A

congenital malformation of the lower extremity that affects the lower leg, ankle, and foot

64
Q

what are the clinical manifestations of clubfoot?

A
  • 1 or a combination of four deformities:
  • planter flexion (foot in a downward position)
  • dorsi flexion (foot in an upward position)
  • vaRus deviation (put turns in)
  • valgus deviation (but turns out)
65
Q

What are some therapeutic managements used for clubfoot?

A
  • serial manipulation and casting soon after birth
  • if sufficient correction is not achieved within three to six months, surgery is performed
  • long term follow-up care
66
Q

what is a type of serial manipulation used for clubfoot?

A

Denis Browne splint (looks like a skateboard, snowboard)

67
Q

What are some postoperative nursing considerations for clubfoot?

A
  • neurovascular checks at least every two hours
  • observe for any swelling around cast edges
  • elevate ankle and foot on pillows; apply ice
  • monitor drainage in cast
  • pain management (analgesics as ordered , distraction)
  • education for home management (discharge teaching)
68
Q

what is developmental dysplasia of the hip?

A

refers to a variety of conditions in which the femoral head and acetabulum are improperly aligned

69
Q

What are some nursing assessments that will be seen in infants who have developmental dysplasia of the hip?

A
  • positive Ortolani sign
  • Barlow test
  • unequal folds of skin on buttocks and thigh
  • limited abduction of affected hip
  • unequal leg lengths
70
Q

What is the Ortolani sign in infants who have developmental dysplasia of the hip?

A

filling the femoral head slip into the acetabulum; “clicking” or a “clunk” with abduction

71
Q

What is the Barlow test in infants who have developmental dysplasia of the hip?

A

being able to dislocate the femoral head then it slips back in place

72
Q

What are some nursing assessments that will be seen in children who have developmental dysplasia of the hip?

A
  • limp on affected side
  • Trendelenburg sign
  • Galeazzi sign
73
Q

What is the Trendelenburg sign in a child who has developmental dysplasia of the hip?

A

when the child stands, bearing weight on the affected hip, the pelvis tilts downward on the normal side instead of upward with normal stability

74
Q

What is the Galeazzi sign in a child who has developmental dysplasia of the hip?

A

performed by flexing an infant’s knees when they are lying down so that the feet touch the surface and the ankles touch the buttocks

75
Q

What is a therapeutic management used in the neonatal period for developmental dysplasia of the hip?

A
  • Splinting the hips with the Pavlik harness to maintain flexion, abduction, an external rotation
  • keep at 100-110*
  • worn for a minimum of six weeks
76
Q

what is some home care education that needs to be taught if using the Pavlik harness?

A
  • teach application and removal of device= worn 24 hours a day
  • teach skin care in bathing (physician may allow parents to remove device for bathing)
  • always wear undershirt or onesie
  • check frequently for red areas under the straps
  • diapering always under straps
  • teach the follow-up care involves frequent adjustments because of growth and development (to increase mobility and decrease pain)
  • pick the child up at the helps when changing their diaper
77
Q

what is osteogenesis imperfecta?

A
  • brittle bone disease
  • type one is the most common
  • autosomal dominant or recessive inherited disorder (based on gene variations)
78
Q

What are some signs and symptoms of osteogenesis imperfecta?

A
  • some degree of bone fragility
  • word blue sclera
  • discolored teeth
  • conductive hearing loss by age 20 to 30 years
  • skin may appear translucent
  • easily bruised
  • short stature
  • multiple fractures tend to cause limb and spinal deformities
79
Q

what are some teachings that needs to be done for osteogenesis imperfecta?

A
  • GENTLE turning and handling
  • daily skin care
  • proper nutrition to support growth and development, with emphasis on foods high in calcium
  • do not grab ankles when changing the diaper
80
Q

what is an important nursing intervention that needs to be done for a patient who has osteogenesis imperfecta?

A
  • manual BP cuffs, if blood pressures are needed at all
  • play sign at bedside if no blood pressure should be performed
  • higher baseline temps in more sensitive to warm temperatures
81
Q

___________ is the most common acquired orthopedic condition.

A

scoliosis (idiopathic, can be congenital or acquired)

82
Q

what is a major concern for a patient who has scoliosis and is to wear a TLSO brace?

A
  • self-esteem issues

- body image

83
Q

what is some preoperative teaching for a patient who has scoliosis?

A
  • turn, cough, deep breathe every two hours; use of spirometry
  • pain medications
  • range of motion exercises, activity
  • teach to logroll prior to surgery
84
Q

what are some postoperative nursing care that needs to be provided to a patient who has scoliosis?

A
  • frequent vital signs and neurologic/neurovascular checks
  • range of motion exercises
  • logrolling every two hours
  • turn, cough, deep breathe
  • monitor for bowel sounds
  • strict I&O
  • Pain management
  • antibiotics as ordered
  • sequential compression device
  • gradual resumption of activity as ordered
  • encourage child’s participation in care
85
Q

What is osteomyelitis and what is the most common cause in all ages?

A
  • bacterial infection of the bone that involves the cortex of marrow cavity
  • most common causative Organism in all ages: Staphylococcus aureus
86
Q

what are some clinical manifestations of osteomyelitis in older children?

A
  • severe pain
  • fever
  • irritability
  • warmth
  • tenderness localized over site of infection
  • child may hold extremity in semi flexion and resist movement
  • favoring of affected extremity
  • erythema
  • limited range of motion
  • lethargy
  • increase white blood cell count
  • increase sedimentation rate
87
Q

what are some therapeutic managements used for osteomyelitis?

A
  • high dose parenteral antibiotic therapy
  • complete bed rest
  • possible immobilization of extremity with a splint or bivalved cast
  • surgical intervention if Abscess is present or antibiotic failure occurs

PEDs Exam 3 (3 decks)

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