Musculoskeletal Flashcards
What is Legg-Calve
Perthes
p. 834-835
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
What is Slipped Capital Femoral Epiphysis (SCFE)
p. 835-837
The ball of the femur (capital epiphysis) slips off the growth plate
Medical emergency because further slippage can cause deformity or necrosis
What is Developmental Dysplasia of the Hip (DDH)
p. 831-833
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
What is Osteomalacia (Rickets)?
Osteomalacia is softening of the bones due to a lack of vitamin D or inability to regulate calcium and phosphorous
What is Scoliosis
p. 837-841?
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.
S/S Legg-Calve Perthes
Limping and/or groin pain, knee pain, c/o often occur after activity
S/s slipped capital femoral epiphysis
Limping, thigh or knee pain
S/s developmental dysplasia of the hip
Hip clunk, Limited movement, different leg lengths, waddle
S/s osteomalacia (rickets)
Bone fractures, muscle weakness, numbness, spasms
S/s Scoliosis
p. 837-841
Asymmetrical hips and shoulders, when bending at the waist = curvature and rib hump
Tx Legg-Calve Perthes
Before 6:
Restrict movement, casting
After 8 (general): surgery
Tx Slipped Capital Femoral Epiphysis
General
Surgery
Tx Developmental Dysplasia of the Hip
General
Pavlik harness (< 6 months)
Surgery (with or without traction first)
Tx osteomalacia (rickets)
Vit D, calcium, phosphorous
Tx scoliosis
General
Observation, bracing, surgery
What are the nursing implications of Legg-Calve Perthes?
Couch potatoes, pain management (NSAIDs)
What are the nursing implications of slipped capital femoral epiphysis
Medical emergency; bedrest, stay off the affected side, wheelchair, no crutches
What are the nursing implications of developmental hip dysplasia?
Pavlik harness 23-24 hours/day
Casting (spica cast)
What are the nursing implications of osteomalacia (rickets)?
Factors that reduce formation of Vit D
↓ exposure to sunlight, dark skin, smog, winter months, ↓ milk intake
What are the nursing implications of scoliosis?
General (postop)
Pain control, log roll (no bending or twisting), neurovascular checks (perfusion, sensation, AND movement)
What is Osteogenesis Imperfecta?
A genetic defect that impairs the body’s ability to make strong bones resulting in easily fractured bones
What is Osteomyelitis?
Bone infection and soft tissue around the bone
What is Juvenile Idiopathic Arthritis?
Autoimmune chronic disease resulting in joint pain and swelling
S/s osteogenesis imperfecta
Weak bones, bone deformities, brittle teeth, blue sclera
s/s osteomyelitis
Fever, chills, local swelling, redness, warmth, pain
s/s juvenile idiopathic arthritis
Swollen, red, painful joints, joint stiffness with limited movement, intermittent rash with fever, limp
Tx osteogenesis imperfecta
Bisphosphonate
Bracing
Surgery to place rods in long bones for stability
Tx osteomyelitis
IV antibiotics for 4-6 weeks
Tx juvenile idiopathic arthritis
NSAIDs, steroids, DMARDs
Nursing implications osteogenesis imperfecta
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)
Nursing implications osteomyelitis
Erythrocyte sedimentation rate (ESR) and
C-reactive protein are indicators of long-term infection/inflammation
Nursing implications juvenile idiopathic arthritis
Need to stay active with non-weight bearing activities, growth affected
warm baths/showers to loosen up muscles/joints helps with function and mobility
What are the implications of fractures in children related to the growth plate?
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
What are the red flags related to fractures and child abuse?
Fractures in children < 6 months, spiral fractures of infants, multiple fractures of various ages, rib, sternal, vertebral fractures, depressed skull fractures
What are nursing implications regarding cast care?
p. 854
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
What three components make up a neurovascular assessment?
pefusion, movement & sensation
