musculoskeletal Flashcards
development
mature at 17M and 2 years post menarche F
epiphysis plate = growth plate and growth
porous - flex and bend = incomplete breaks
thicker periosteum = heal quicker
casts purpose
immobilize affected part, usually fiberglass (palms only, no fingertips - pressure points), no fan or hairdryer to accelerate drying
casts pain
meds (range), no ibuprofen bc interferes with recovery
ice - itch, swell, pain
elevate
skin breakdown, 5 Ps (few fingers)
casts mobility
exercise non affected side, isometric on affected side
prevent foot drop, keep moving and active
casts healing
diet and fluids
casts - neurovascular
5 Ps (pain, paralysis, paresthesia, pulse, pallor)
elevate, tightness (few fingers)
casts - complications
keep heel off mattress, feel hot spots and tingling, wound drainage, skin break down (petal edges with moleskin)
casts - removal
scary - distract, headphones
explain and demonstrate on self, put vibrate on them to feel, cant cut skin
maybe restrain
traction
maintain correct balance, care of weights, skin inspections, pin care, neurovascular assess
DDH cm
hip out of socket
infant: asymmetry (gluteal folds, thigh fold, longer limb, more fat folds), limited abduction (clunk or clink, more ROM on 1 side, galleazzi sign (shorter femur), ortolani test (clink clunk)
older: trendelenberg, wadding gait, limp
DDH tm and nc
identify and treat early
hip in flexed abducted position to deepen socket
DDH tm 0-6 mo
pavlik harness - no thick diapers, check skin breakdown, always on except bath, creative holding, clothes under, no lotion or powder, massage under
DDH tm 6 -18 mo
pre op skin traction (3 week) - buck or russel, closed or open reduction under general anesthesia, hip spica cast 2-4 months until hip is stable
DDH tm older
surgical reduction
congenital clubfoot (talipes equinovarus) tm
serial casting q1-1.5 weeks (8-12 weeks), surgery for pins and tendons and casting 2-3 months
splint/brace after either
congenital clubfoot (talipes equinovarus) nc
injury r/t cast, fam help (defect)
osteogenesis imperfecta cm
brittle bone disease (precollegen issue)
often confused with abuse
bone fragility and deformity, poor growth, bruising and recurrent epistaxis, blue sclerae, hearing loss, thin skin, diaphoresis and teeth discolor, mild hyperpyrexia, normal intelligence
decrease fractures in adolescence
osteogenesis imperfecta tm
support: prevent break, muscle weak, osteoporosis, malalignment
brace, swim, traction, moderate activities, rods with bone, activity non contact, pt, splint, pamidronate med - bone healing and decreased bone reabsorption
osteogenesis imperfecta nc
handle carefully, teach limitations to increase g+d, family support
legg calve parthes cm
insidious, pain always, limp and trend
decreased ROM, history of trauma
legg calve parthes tm
diagnose with radiography
hips abducted and off feet (maybe) - for months
or sx
legg calve parthes nc
teach (care at home), diversional activites (industry), return to school, long treatment (adherence)
scoliosis cm
structural v funcitonal
lateral curve, asymmetric hip and shoulder, unequal scapula prominences and ribs, asymmetry of abd skinfolds
scoliosis tm - mild
<20
observe, eval q 3-12 months
scoliosis tm mod
20-40
brace until no more bone growth (skin breakdown, body image, wear 23 hours a day)
scoliosis tm - severe
> 40 spinal fusion
spinal fusion nc
preop: hospital for weeks for traction, lots of labs, and x rays, skin assess (bacne), educate - PCA, log roll, IS (breathing is hard bc pain)
post op: vs (htn), wound, circulation, 5Ps; IS q2hr, logroll q2 (flat), PCA, PT asap, indep, fam involve
juvenille idiopathic arthritis nc
paui - eye doctor q 6 months (uveitis)
juvenile idiopathic cm
fever, rash, pericarditis, morning stiff, joint swell, warm joint, pain, malaise, anorexia, decreased ROM, eye issues
juvenile idiopathic tm
decrease inflam, and ROM
heat and exercise, prevent deformity (PT/Ot, ROM), relieve s (pain), swim, play
osteomyelitis cm
vaccine
(bone infection)
appear ill, bone pain, wont walk/move, fever, irritable, malaise, decreased appetite
osteomyelitis tm
IV abx 3-4 weeks, then oral, heat
bed rest
sx drainage of abscess
osteomyelitis nc
supportive, pain, PICC line care, cast care, nutrition (increase protein and calories), diversional activities
