Muscular Alterations Flashcards
1
Q
What is muscular dystrophy?
A
inherited disease of the muscles, causing muscle atrophy and weakness
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
3
Q
Duchenne muscular dystrophy appears in what age group?
A
early childhood ( 3 to five years)
4
Q
Duchenne muscular dystrophy rapidly progresses, causing respiratory or cardiac complications and death, usually by ____ years of age.
A
25
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
6
Q
what are some late signs and symptoms of muscular dystrophy?
A
- scoliosis
- respiratory difficulty
- cardiac difficulties
- eventually wheelchair dependency, confinement to bed
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
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
9
Q
What is a traumatic injury to a bone called?
A
fracture
10
Q
what are the three classifications of a fracture?
A
- complete
- incomplete
- comminuted
11
Q
what is a complete fracture?
A
bone fragments are completely separate
12
Q
what is an incomplete fracture?
A
bone fragments remain attached (green sticks, bins, buckles)
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
14
Q
Fractures that occur in the __________ plate may affect growth of the limb.
A
epiphyseal (growth plate)
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)
16
Q
Spiral fractures (caused by twisting) and fractures in _______ may be related to child abuse.
A
Infants
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
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
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
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
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
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
23
Q
What are two types of skin traction that are used for a fracture?
A
- buck extension traction
- Russell traction
24
Q
What is buck extension traction?
A
lower extremity, legs extended, no hip flexion
25
what is Russell traction?
2 lines pull on the lower extremity, one perpendicular, one longitudinal
26
What is skeletal traction and an example?
- pin or wire applies pull directly to the distal bone fragment
- Halo traction
27
What are some examples of home cast care to teach a family?
- 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
28
what is developmental dysplasia of the hip?
abnormal development of the femoral head in the acetabulum
29
what are the treatment options for developmental dysplasia of the hip?
- conservative treatment consists of splinting
| - surgical intervention is necessary if splinting is not successful
30
what are some signs and symptoms of developmental dysplasia of the hip in an infant?
- positive Ortolani sign (“clicking” with abduction)
- unequal folds of skin on buttocks and thigh
- limited abduction of affected hip
- unequal leg lengths
31
what are some signs and symptoms of developmental dysphasia other the hip in older children?
- 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)
32
What are some nursing interventions to provide for a patient who has developmental dysplasia of the hip?
- 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
33
what are some home teaching points that need to be given to parents who have a child with developmental dysplasia of the hip?
- 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
34
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?
- 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
35
What are some questions we need to ask ourselves when dealing with musculoskeletal conditions in Pediatrics?
- 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
What are the physiological effects of an immobilized patient?
- decreased muscle mass and strength
- decrease metabolism
- bone demineralization (osteopenia)
37
What happens if decreased muscle mass and strength occurs in an immobilized patient?
- 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
Range of motion must be re-established within 3 - 7 days or patient will develop _________.
contractures
39
Why is it important to promote early movement/ambulation?
- increase mobility
- decrease risk of pneumonia
- decrease risk of breakdown, pressure injuries
- decrease risk of thrombus
40
what are three things that happen if there is no muscle contraction?
-venous stasis=edema=skin breakdown
41
What happens if decrease metabolism becomes a problem in an immobilized patient?
- 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
what happens if bone demineralization (osteopenia) occurs in an immobilized patient?
- weakened bones
- hypercalcemia: increased calcium levels in blood
- kidney stones
43
Prolonged redness of greater than ____ minutes appears when there is a developing pressure area.
30
44
Decreased mobility leads to what problem in the gastrointestinal system, and how can we prevent/treat this?
- Constipation
- Get moving if possible
- adequate fluids
- stool softener
- monitor for BM
45
Decreased mobility leads to what problems in the genitourinary system, and how can we prevent this from occurring?
- decreased urinary output from stasis or retention
- strict I&O monitoring
- monitor for UTI
46
What is the first thing we must rule out if an infant comes in with multiple fractures or fractures in multiple stages of healing?
osteogenesis imperfecta
47
what are some nursing management interventions that need to be done for fractures?
- 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
What are the six parts of the neurovascular assessment?
- 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
what is compartment syndrome?
- 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
how does a pulmonary embolus present?
- quick onset
- SOB
- decreased O2 saturation
- diaphoresis
- increased respiratory rate/work of breathing
- chest pain
- dyspnea
51
what are some nursing interventions that need to be done for a pulmonary embolus?
- immediately elevate head
- administer 02
- notify health care provider immediately
52
what are the four most common fracture types in PEDs?
- greenstick
- plastic deformation
- buckle
- complete
53
what is a major concern for a preschool age child when it comes to an injury and cast?
- 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
what are some major interventions and teachings that need to be done if a child has a spica cast?
- 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
what is some cast care education that needs to be taught to the families?
- 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
What are the two types of skin traction that are used in Pediatrics?
- Bucks
| - Russell
57
when do we use skin traction?
- 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
what is the type of skeletal traction use most often in peds?
Halo
59
what kind of care is important if the patient has skeletal traction?
- 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
What are two types of long bone stability?
- internal fixation
| - external fixation
61
what are some nursing considerations for the child in a cast or in traction?
- 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
What are three types of congenital musculoskeletal conditions?
- clubfoot
- developmental dysplasia of the hip
- osteogenesis imperfecta
63
what is clubfoot?
congenital malformation of the lower extremity that affects the lower leg, ankle, and foot
64
what are the clinical manifestations of clubfoot?
- 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
What are some therapeutic managements used for clubfoot?
- 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
what is a type of serial manipulation used for clubfoot?
Denis Browne splint (looks like a skateboard, snowboard)
67
What are some postoperative nursing considerations for clubfoot?
- 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
what is developmental dysplasia of the hip?
refers to a variety of conditions in which the femoral head and acetabulum are improperly aligned
69
What are some nursing assessments that will be seen in infants who have developmental dysplasia of the hip?
- positive Ortolani sign
- Barlow test
- unequal folds of skin on buttocks and thigh
- limited abduction of affected hip
- unequal leg lengths
70
What is the Ortolani sign in infants who have developmental dysplasia of the hip?
filling the femoral head slip into the acetabulum; “clicking” or a “clunk” with abduction
71
What is the Barlow test in infants who have developmental dysplasia of the hip?
being able to dislocate the femoral head then it slips back in place
72
What are some nursing assessments that will be seen in children who have developmental dysplasia of the hip?
- limp on affected side
- Trendelenburg sign
- Galeazzi sign
73
What is the Trendelenburg sign in a child who has developmental dysplasia of the hip?
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
What is the Galeazzi sign in a child who has developmental dysplasia of the hip?
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
What is a therapeutic management used in the neonatal period for developmental dysplasia of the hip?
- 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
what is some home care education that needs to be taught if using the Pavlik harness?
- 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
what is osteogenesis imperfecta?
- brittle bone disease
- type one is the most common
- autosomal dominant or recessive inherited disorder (based on gene variations)
78
What are some signs and symptoms of osteogenesis imperfecta?
- 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
what are some teachings that needs to be done for osteogenesis imperfecta?
- 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
what is an important nursing intervention that needs to be done for a patient who has osteogenesis imperfecta?
- 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
___________ is the most common acquired orthopedic condition.
scoliosis (idiopathic, can be congenital or acquired)
82
what is a major concern for a patient who has scoliosis and is to wear a TLSO brace?
- self-esteem issues
| - body image
83
what is some preoperative teaching for a patient who has scoliosis?
- turn, cough, deep breathe every two hours; use of spirometry
- pain medications
- range of motion exercises, activity
- teach to logroll prior to surgery
84
what are some postoperative nursing care that needs to be provided to a patient who has scoliosis?
- 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
What is osteomyelitis and what is the most common cause in all ages?
- bacterial infection of the bone that involves the cortex of marrow cavity
- most common causative Organism in all ages: Staphylococcus aureus
86
what are some clinical manifestations of osteomyelitis in older children?
- 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
what are some therapeutic managements used for osteomyelitis?
- 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
