musculoskeletal Flashcards
pediatric bone structure and growth
growth begins in center of bone, growth plates active until 20s, more porous and elastic, thicker periosteal sleeve, ligaments and tendons stronger than bone
how many bones in infants and adults
300 at birth, 206 as adults from fusing
alignment of bone in peds
flat feet until 6yrs, pidgeon toed until 8yrs, knock knees until 7yrs
nursing interventions for all conditions
pain relief (faces or nips scale), body alignment and function (proper positioning, assistive devices), promote physical ability (range of motion, early ambulation), promote growth and development (activities, continue school)
pectus excavatum definition
congenital deformity, sternum grows inward, severity increases during puberty, can compromise heart.
pectus excavatum tx
surgery to reshape (metal rod through chest to lift chest), relieve pressure on heart and lungs.
post op care of pectus excavatum
physical therapy, pain management, breathing exercises, straight posture for 1mo, no lifting objects, no contact sports 6mo, metal bars removed 2yrs later. monitor rr and cardiac systems as fluid can build in chest.
polydactyly
extra digits on hands or feet, can be random or inherited. xray to dx
syndactyly
missing digits that fused together often involves nerves and muscles. xray to dx
tx for poly and syndactyly
surgery to remove or separate digits, requires casts, occupational therapy, physical therapy.
osteogenesis imperfecta
brittle bone disease. multiple fractures in various stages of healing. problem with collagen which causes bones to be weak.
tx of OI
growth hormones, bisphosphonates for growth, PT for muscle strengthening
sx of OI
triangle shape face, broad forehead, whites of eyes look blue, hearing loss, brittle teeth, barrel shape chest, kyphosis, deformed bones
care of OI
no bp cuffs, no cure, treat broken bones, pain rx, healthy diet, exercise to strengthen muscles, no smoke or etoh, physical therapy, careful dressing child, education on careful bathing and dressing.
blount disease
bowed legs, tibial growth plate causes inward turning of lower leg below knee that worsens with time. suspected by 3yrs. will see length discrepency and pain.
blount disease tx
bracing under 4yrs, surgery, casts or frames postop. r/f compartment syndrome or dvt. give psychosocial support
congenital clubfoot
foot turns inward and achilles tendon becomes shorter. seen on ua, <boys, can be bilateral or unilateral.
congenital clubfoot tx
serial casting with long leg casts changed weekly for 4-6wks (ponsety method), percutaneous lengthening of achilles after casting complete, bracing for 2-4yrs after, surgery if needed.
developmental dysplasia of hip
dx during newborn exam, will hear click or feel instability in hip. will see flat pelvis so ball wont sit in joint
sx of developmental dysplasia of hip
limited hip abduction, differing leg lengths, uneven thigh skin folds, palpable and audible click (ortolani and barlow test), limping gait
tx of developmental dysplasia of hip
pavlik harness (90degree flexion) before 6mo, monitor skin with cast or brace, encourage growth and development, 6-24mo need open reduction surgery and spica casting for tissue repair.
rickets
softening and malformation of bones due to vit D deficiency. R/F are breastfed babies, low sun exposure, dark skinned, refugees, liver and kidney diseases
rickets sx
large forehead, rachitic rosary when ribs overgrow, protruberant abd, bowed and wide legs from soft bones, kyphoscoliotic deformity of spine, wide elbow.
care of rickets
increase vit D via food, supplementation, and sun exposure.
