MUSCULOSKELETAL Flashcards
What difference in childrens bones makes them stronger than adults?
Periosteum
Ligament characterisitcs
links bones
provide stability
lack elasticity & blood supply
tendon characteristics
muscles to bones
little blood supply –> long healing time
Main Cast complication?
Compartment syndrome
what is compartment syndrome?
Pressure in fascial compartment causing inflammation –> decreases blood flow leading to ischemia & necrosis
5 P’s of compartment syndrome?
Pain unrelieved by narcotics
Pallor
Pulselessness
Paraesthesia (numbness/tingling)
Poikilothermia: Cold
what should you assess in neurovas assessment for compartment synd?
Pain
Sensation
Temperature (cool = poor circulation)
cap refill
color
pulse (distal)
for a spica hip cast what are key interventions?
Turn every 2 hours
protect proximal edges of leg cast from soiling (bivalving cast)
what is a bivalve procedure?
Cut down one or both sides to relieve pressure
what position helps a child in Spica cast feed independently?
Prone on floor
what is a complication of being in spica cast?
cast synd: Duodenum is compressed
- causes V, abdominal distention & bowel obstruction
prevention of cast syndrome?
- Frequent repositioning
- Fluids&increased fiber in childs diet
- “belly hole” to allow expansion
in skin traction, how must the patient be positioned?
Parallel to weight/traction
what are appropriate interventions for a child in a long leg cast after an open reduction?
- Handle cast carefully when wet to prevent dents
- Elevate leg & apply ice for short periods
- Ensure proximal edge of cast stays clean
What is the appropriate timing for ice?
first 48 hours for 15 min
after a scoliosis spinal fusion, how must the patient be turned?
by logrolling
besides logrolling what are other appropriate interventions for a spinal fusion?
- Incentive spirometer Qhr
- Monitor chest tube for leak/drainage
- Assess neuro status & V/S Qhr
Osgood-Schlatter disease is characterized by what?
Pain below knee cap
Worse by activity & better with rest
what is the priority nursing diagnosis for a patient with a brace treating scoliosis?
no redness/breakdown under brace
what lab values would be low with Rickets?
Calcium (under 8.5) & phosphorus (under 3)
do children’s bones heal quicker than adults? & why?
Yes
& bc bones are still growing
how would you describe a spiral fracture?
diagonal line that coils around the bone
In legg-calve-perthes diesease, what would a priority be for someone on bed rest?
Ensuring full ROM in all joints
(to prevent immobility complications)
what type of trait is Duchenne’s? & what does that mean about the disease?
Sex linked recessive
Its highly likely to only effect males
what s/sx would occur in Rickets?
- Bone pain (Arms, legs, pelvis or spine)
- Short stature
- Bone deformities
- Dental problems
what conditions can Bryant’s traction (skin tract) be used for & what are the limitation/position put in?
- Developmental dysplasia (hip) or femur fractures
- Must weight less than 26.4 lbs
- Laying supine with thighs flexed & hips slighly off bed
what is skin traction?
Pulling force applied to material directly attached to limb
Only used for short perids
important parent teaching for bryant’s traction?
Diapering needs to be modified
- Small diaper placed in perineal area w/ all edges of cast outside of diaper
when should you do neuromuscular assessments for affected limbs (skin traction)?
- Q4hr
- check for numbness in finger/toes = poss compartment synd
what should you assess Q2-4 hr for skin traction?
- circulation
- sensation
- pain
- pallor/cyanosis
- pulse (distal)
how often should skin traction be removed/reapplied?
Q4 hr
Remove body oils with rubbing alcohol
when is skeletal traction used?
- Rarely, for when traction weight >5lb+
- Long periods of time until bone is ready for open reduction.
can the weights be removed in skeletal traction?
No
- pin is placed distally to the fracture
Pin care uses what?
Cleaning would with normal saline gauze
(abx if ordered)
for skeletal traction how often are neurovascular status checks preformed?
Q1-2 hr for first 48 hour –> Q4hr
how often should pin sites be assessed & specifically for what?
- Q8hr
- Osteomyelitis
what is recommended pain management with skeletal traction?
- Epidural w/ bupivacaine (Marcaine) + narcotic morphine sulfate
- Hydromorphone
what is plagiocephalyl?
- Cranial sutures overriding & can impede brain growth
normal ages for fontanelles to close?
3 months = posterior
12/18 months = posterior
s/sx of PLAGIOCEPHALY
- full/bulging fontanelle
- bony ridges along sutures
- bulging brows/uneven cheekbones/eye sockets
- prominent blood vessels in scalp
treatment for PLAGIOCEPHALY
- corrective helmet
- molded helmet if not improved w/in 4 months
how long do you wear a corrective helmet?
23hr/day for 3-6 months
what position should be encouraged when a child is wearing a helmet?
Tummy time (varying head position is important)
what is CRANIOSYNOSTOSIS? & what can is cause?
- premature fusion of 1 or more cranial sutures
- incomplete brain development –> seizures, mental delay, visual/breathing problems
what are s/sx of CRANIOSYNOSTOSIS?
- Sleepiness (or less alert than usual)
- Increased irritability
- High pitched cry
- Changes in head circumference
treatment options for CRANIOSYNOSTOSIS?
- head shape normal = molded helmet
- surgery is primary treatment (craniotomy)
what is torticollis?
“twisted neck” lateral flexion of cervical spine
- fibrosis of sternocleidomastoid muscle
what can be hindered with torticollis?
- Developmental milestone bc of unable to turn head (can’t see/hear/touch)
classic s/sx of toricollis?
- Twisted neck
- Spasmodic torticollis
nursing care for torticollis?
- PT w/ botox to inhibit muscle spasms
- tummy time to strengthen muscles
what is clubfoot?
-Hindfoot & forefoot rotated inwards w/ arched midfoot (when pointed down)
what can cause clubfoot?
- maternal obesity/smoking
- amniocentesis before 20 weeks
- position of fetus in utero
what are the 4 types of clubfoot?
- Postural: Resolves with stretching & casting
- Idiopathic: True congenital w/ varied severity
- Neurogenic: Usually r/t spina bifida
- Syndromic: Associated with rigid feet & other anomalies
S/Sx fo clubfoot?
- Plantar flexed foot
- Inverted heel
- Adducted forefoot
- CAN’T be manipulated into a neutral position
when/how is clubfoot diagnosed?
- @ birth w/ physical exam
- 20 week ultrasound
what is the treatment for clubfoot?
- Serial casting
- Brown cast
- Tenotomy
edu about serial casting?
Q 1-2 weeks recasting moving into a more neutral position
what is Brown’s split? education about it?
- Splint molded around heel while forefoot is abducted & knee flexed @ 90.
- Changed weekly & worn 23 hours/day till 3 y
what is a tenotomy?
Cutting & repositioning tendon (achilles for length)
what is metatarsus adductus (varus)?
Front part of foot (toes area) point inward (medial)
“pigeon toes”
s/sx of metatarsus adductus?
- High arch
- Separated big toe
- Bean shaped foot (forefoot turned inward)
best treatment for metatarsus adductus?
- wearing shoes on opposite foot
what is legg calve perthes?
Hip disorder where femur head temp loses blood supply
who is most commonly affected by LCP?
3-12yr
- Caucasians & Asians
s/sx of legg-clave-perthes (LCP)?
- Hip/knee soreness or stiff
- Limping (especially after activity or late in day)
- Quad muscle atrophy
how would you diagnose LCP?
radiograph then MRI shows osteonecrosis
what is the goal when caring for LCP?
keep femoral head in acetabulum
best way to achieve treatment goal of LCP?
bedrest to reduce inflammation & restore joint ROM
discharge info for LCP?
Avoid weight bearing activities
what is polydactyly & syndactyly?
P: One/both hands 6+ finger/toes
S: 2+ phalanges of fingers/toes are fused together
which is more complicated syndactyly or polydactyly?
Syn
- Separate nerves, tendons/ligaments and blood vessels.
surgical care for syndactyly?
osteotomy & place a distractor
- pin placed in bones and 1/4 turn of allen wrench 2x week
s/sx of sprain?
- Pain
- Swelling
- Bruising
- INSTABILITY
- LOSS of joint mvmt
s/sx of strain?
- limited motion
- muscle spasms
- swelling
What does RICE stand for?
R: Rest
I: ice - first 48 hr, 15 min intervals
C: compression, ACE wrap
E: Elevation
how do you wrap a strain/sprain?
wrap area distally & work up to proximal area beyond injury
consequences if there’s break on epiphyseal plate?
limb length differences, limb deformity and joint incongruity
where does osteomylitis most often occur?
long bones in lower extremities
what is the most common cause of osteomylitis?
Staphylococcus aureas
s/sx of osteomylitis
pain in affected bone
- fever
- guarding of limb
- localized tenderness, redness/ warmth
care for osteomylitis?
- Broad spectrum antibiotics (after blood culture)
eval 2 days after inital dose
surgical care for osteomylitis?
K wire: Steel rod placed thru long bone w/ antibiotics implanted into bone cement
what labs would you monitor for osteomylitis?
ESR (tell if infection is resolving)
what is juvenile arthritis?
Autoimmune inflammatory response
when is the peak onset and gender for juvenile arthritis
1-3 y & 8-12y
- females 2x likely as males
juvenile arthritis causes what in children?
Leading cause of blindness & disability in children
s/sx of juvenile arthritis?
- Swollen, tender joint
- limited ROM
- Afternoon fever up to 105
- Morning stiffness
labs to monitor for juvenile arthritis?
WBC, ESR
meds for juvenile arthritis?
- NSAIDS: Ibuprofen, Naproxen
- Methotrexate
- Prednisone (steroid)
what type of exercises are best for juvenile arthritis?
isometric exercises (planks, wall sits)
what is scoliosis?
nonpainful lateral curve of spine (>/=110)
what does S & C curve scoliosis look like?
S: Curve in 2 opposite directions
C: Curve laterally in one direction
3 types of scoliosis
- Nonstructural: Spine corrects itself
- Structural: Curve can’t correct self
- Congenital: Abnormal fetal development
s/sx of scoliosis?
- unequal shoulder heights (measure from floor to acromioclavicular joint)
- Scapula/rib prominences
- Cafe au lait spots
what is Cobb’s angle?
Measurement of curvature of spine in degrees
degrees of cobbs angle for scoliosis?
10-15: Mild, assess @ regular check up
15-40: Moderate, use back brace (23hr/day) & possible surgical correction
spinal surgery pain management
PCA pain pumps or epidural
then 3 days post op –> PO
how many days post op can the patient start ambulating
5
how should a patient be positioned in bed with spinal fusion?
- HOB no more than 30 degrees
(may make eating difficult)
discharge education for spinal fusion?
No twisting/bending or lifting heavy objects & no contact sports for 2 years
first line of treatment for hip dysplasia?
pavlic harness
(don’t ever readjust)
(hip aduction - no leg extension)
(no baby poweder)
when treating SCFE, when can full weight bearing be resumed?
1 week post op
what is NOT true regarding SCFE?
- affected limb may be longer than unaffected
- ROM exercises should be done Q8hr
what groups have the higher incidence of SCFE?
- Male obese children
S/SX of SCFE?
- Pain in groin reffered to thigh,knee
- Pain with internal rotation of hip
- Limited abduction
- Shorter effected leg
what advice does the nurse give if a child is overly fussy after tylenol & toes seem cool?
- go to ED
if a patient has a scoliosis curve of 35, what is the most likely next step?
- Bracing
priority action after surgery/casting?
- neurovascular check Qhr
for a child in a spica cast, what is a modification made for the child?
- Using a wagon instead of a stroller
s/sx of hip dysplasia?
limited abduction of affected hip.
unequal gluteal folds
unequal leg lengths when bent (galeazzi)
postive tendelenburg (older)
which position(s) is more likely to cause a baby to have hip dysplasia?
Breech
Intrauterine
what movement does the Pavlik harness allow & what does it not?
Allow: Hip flexion/ aBduction
No: Hip extension/aDduction
if a child presents with unequal gluteal folds, what would be a priority question to ask the parents?
has your child been limping? (LCP)
if a child is given a neuromuscular block, what intervention would be a priority?
Providing ventilator care to prevent pneumonia
what diagnostic testing would be ran for a child with a family hx of muscular dystrophy?
Muscle biopsy
Creatinine Kinase
Electromyelogram
