Musculoskeletal

Question 1

What is Legg-Calve
Perthes
p. 834-835

Answer 1

The blood supply to the femoral head is disrupted causing avascular necrosis. The femoral head can become flattened and is slowly replaced with new bone

Question 2

What is Slipped Capital Femoral Epiphysis (SCFE)
p. 835-837

Answer 2

The ball of the femur (capital epiphysis) slips off the growth plate
Medical emergency because further slippage can cause deformity or necrosis

Question 3

What is Developmental Dysplasia of the Hip (DDH)
p. 831-833

Answer 3

Abnormal relationship between the ball and socket of the hip joint in which there is inadequate coverage of the ball by the socket or there is a dislocation of the ball from the socket

Question 4

What is Osteomalacia (Rickets)?

Answer 4

Osteomalacia is softening of the bones due to a lack of vitamin D or inability to regulate calcium and phosphorous

Question 5

What is Scoliosis
p. 837-841?

Answer 5

Scoliosis is a sideways curvature and rotation of the spine that makes the spine look more like an “S” and one shoulder appears higher than the other.

Question 6

S/S Legg-Calve Perthes

Answer 6

Limping and/or groin pain, knee pain, c/o often occur after activity

Question 7

S/s slipped capital femoral epiphysis

Answer 7

Limping, thigh or knee pain

Question 8

S/s developmental dysplasia of the hip

Answer 8

Hip clunk, Limited movement, different leg lengths, waddle

Question 9

S/s osteomalacia (rickets)

Answer 9

Bone fractures, muscle weakness, numbness, spasms

Question 10

S/s Scoliosis
p. 837-841

Answer 10

Asymmetrical hips and shoulders, when bending at the waist = curvature and rib hump

Question 11

Tx Legg-Calve Perthes

Answer 11

Before 6:
Restrict movement, casting
After 8 (general): surgery

Question 12

Tx Slipped Capital Femoral Epiphysis

Answer 12

General
Surgery

Question 13

Tx Developmental Dysplasia of the Hip

Answer 13

General
Pavlik harness (< 6 months)
Surgery (with or without traction first)

Question 14

Tx osteomalacia (rickets)

Answer 14

Vit D, calcium, phosphorous

Question 15

Tx scoliosis

Answer 15

General
Observation, bracing, surgery

Question 16

What are the nursing implications of Legg-Calve Perthes?

Answer 16

Couch potatoes, pain management (NSAIDs)

Question 17

What are the nursing implications of slipped capital femoral epiphysis

Answer 17

Medical emergency; bedrest, stay off the affected side, wheelchair, no crutches

Question 18

What are the nursing implications of developmental hip dysplasia?

Answer 18

Pavlik harness 23-24 hours/day
Casting (spica cast)

Question 19

What are the nursing implications of osteomalacia (rickets)?

Answer 19

Factors that reduce formation of Vit D
↓ exposure to sunlight, dark skin, smog, winter months, ↓ milk intake

Question 20

What are the nursing implications of scoliosis?

Answer 20

General (postop)
Pain control, log roll (no bending or twisting), neurovascular checks (perfusion, sensation, AND movement)

Question 21

What is Osteogenesis Imperfecta?

Answer 21

A genetic defect that impairs the body’s ability to make strong bones resulting in easily fractured bones

Question 22

What is Osteomyelitis?

Answer 22

Bone infection and soft tissue around the bone

Question 23

What is Juvenile Idiopathic Arthritis?

Answer 23

Autoimmune chronic disease resulting in joint pain and swelling

Question 24

S/s osteogenesis imperfecta

Answer 24

Weak bones, bone deformities, brittle teeth, blue sclera

Question 25

s/s osteomyelitis

Answer 25

Fever, chills, local swelling, redness, warmth, pain

Question 26

s/s juvenile idiopathic arthritis

Answer 26

Swollen, red, painful joints, joint stiffness with limited movement, intermittent rash with fever, limp

Question 27

Tx osteogenesis imperfecta

Answer 27

Bisphosphonate
Bracing
Surgery to place rods in long bones for stability

Question 28

Tx osteomyelitis

Answer 28

IV antibiotics for 4-6 weeks

Question 29

Tx juvenile idiopathic arthritis

Answer 29

NSAIDs, steroids, DMARDs

Question 30

Nursing implications osteogenesis imperfecta

Answer 30

Don’t lift under armpits, no B/P, no weight bearing/contact activities; be aware of child abuse implications with multiple broken bones (good assessment)

Question 31

Nursing implications osteomyelitis

Answer 31

Erythrocyte sedimentation rate (ESR) and
C-reactive protein are indicators of long-term infection/inflammation

Question 32

Nursing implications juvenile idiopathic arthritis

Answer 32

Need to stay active with non-weight bearing activities, growth affected
warm baths/showers to loosen up muscles/joints helps with function and mobility

Question 33

What are the implications of fractures in children related to the growth plate?

Answer 33

Growth plates are more susceptible to fracture, but heal faster, if not healed properly can result in growth abnormalities and/or deformities of the bone

Question 34

What are the red flags related to fractures and child abuse?

Answer 34

Fractures in children < 6 months, spiral fractures of infants, multiple fractures of various ages, rib, sternal, vertebral fractures, depressed skull fractures

Question 35

What are nursing implications regarding cast care?

p. 854

Answer 35

Assess 5 P’s (pain, pallor, pulselessness, paresthesia, paralysis), elevate, ice, not compression, odor, allow to dry, nothing stuck into cast, if itchy use dryer on cool setting, cover rough edges with moleskin, position changes.
Compartment syndrome: pain greater than expected or with passive movement

Question 36

What three components make up a neurovascular assessment?

Answer 36

pefusion, movement & sensation