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Peds Exam 5 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Psychological Effects of Immobilization

A

Diminished environmental stimuli
Altered perception of self and environment
Increased feelings of frustration, helplessness, and anxiety
Depression, anger, and aggressive behavior
Developmental regression – from immobilization

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2
Q

sprain**

A

twisting of joint resulting in damage to ligaments and or blood vessels: edema, pain, heat, redness, bruising

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3
Q

strain**

A

tearing or pulling of muscle that can lead to tendon damage: swelling, bruising

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4
Q

Dislocation**

A

bones of a joint no longer in alignment: swelling, ROM affected, deformity

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5
Q

contusions**

A

serious bruising of muscle; inflammation

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6
Q

Soft Tissue Injury Treatment

A

RICE

  • Rest: limit activity.
  • Ice: apply cold packs for 20 to 30 minutes, remove for 1 hour, and repeat (for the first 24 to 48 hours). - Put something between skin and ice, do not put ice directly on skin
  • Compression: apply an Ace wrap or other elastic bandage or brace; check skin for alterations when rewrapping. - Do not stretch and tighten ace
  • Elevation: elevate the injured extremity above the level of the heart to decrease swellin - Best pain reliever is to elevate
  • NSAIDS
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7
Q

5 Ps for assessment of compartment syndrome**

A

Pain
Pulses
Pallor
Paresthesia- tingling, burning
paralysis

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8
Q

Fractures

A
  • A fracture is a break!
  • Common injury in children
  • Methods of treatment are different in pediatric population than in the older adult population
  • Rare in infants, except with motor vehicle crashes, nonaccidental injuries(abuse)
  • Clavicle is the most frequently broken bone in childhood, especially in those younger than 10 years old - Because of center of gravity
  • In school-age children, bicycle and sports injurie - Most common sports injuries from trampolines
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9
Q

Compound or open fracture**

A

Fractured bone protrudes through the skin

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10
Q

Complicated fracture**

A

Bone fragments have damaged other organs or tissues

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11
Q

Greenstick/incomplete fracture**

A

Compressed side of the bone bends but the tension side of the bone breaks, causing an incomplete fracture- like a green switch

(side opposite of pressure breaks)

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12
Q

Buckle or bending fracture**

A

compression causing buckle of the bone

(compression injury - bone buckles rather than breaks)

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13
Q

Spiral fracture**

A

think abuse, also could be from football

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14
Q

Epiphyseal Fracture**

A

fracture of growth plate- can effect growth- requires surgery

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15
Q

plastic of bowing deformity

A

significant bending without breaking

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16
Q

Complete fracture

A

bone breaks into 2 pieces

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17
Q

CM of fracture

A
  • Generalized swelling
  • Pain or tenderness
  • Deformity – may or may not be deformed (Complete, buckle, greenstick)
  • Diminished functional use
  • May have bruising, severe muscular rigidity, and crepitus
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18
Q

Diagnostic evaulation of fracture

A

Obtain information from the person who observed the injury- mechanism of injury, does it match the injury?
X-ray is the most useful diagnostic tool - Obtain and compare xrays of both extremities

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19
Q

therapeutic management of fracture

A

immobilization for comfort and function, pain meds, surgery

If pt comes in not moving extremity and is comfortable, DO NOT move it
Can use magazine if need to for splinting

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20
Q

nursing management of fractures

A

_assess CSMs – Circulation, Sensation, and Movement**_

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21
Q

Closed reductions of fractures

A

meds, finger traps, splint/cast application

Can fix without surgery
Put on splent for 4-5 days before cast because of swelling

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22
Q

open reductions of fractures

A

surgery in OR

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23
Q

child in a cast

A
  • Cast application techniques
  • Nursing considerations- CSMs - Teach parents how to assess for CSMs
  • Cast care at home- keep elevated above level of heart when sitting up
    • Do not sleep in sling, sleep with extremity elevated on pillows
  • Cast removal
  • Skin care
24
Q

Traction: Extended pulling force may be used

A

To provide rest for an extremity
To position for bone healing
To immobilize a fracture until healing is sufficient to permit casting or splinting
To help prevent or improve contracture deformity
To provide immobilization
To reduce muscle spasms (rare in children)

25
Q

Most common type of traction**

A

Bucks – for femur fractures**

26
Q

Nursing care for child in traction

A
  • Assessing the patient in traction - Assess CSMs
  • Skin care issues
  • Pain management and comfort
27
Q

Talipes varus is**

A

inversion, or bending inward of the heel

28
Q

Talipes valgus is**

A

eversion, or bending outward

29
Q

Talipes equinus is**

A

plantarflexion with the toes lower than the heel

30
Q

Talipes calcaneus is **

A

dorsiflexion with the toes higher than the heel

31
Q

Therapeutic management of club foot

A
  • serial casting
32
Q

Nursing considerations of clubfoot

A

teach parents to monitor in a cast, CSMs

33
Q

Developmental dysplasia of the hip (DDH) is categorized in two major groups

A

Idiopathic

· Infant neurologically intact

Teratologic

· Neuromuscular defect

34
Q

Newborn to age 6 months DDH

A

Pavlik harness for abduction of the hip

35
Q

Age 6 to 24 months DDH

A

Dislocation is unrecognized until the child begins to stand and walk;

use traction and cast immobilization (spica)

36
Q

Older child DDH

A

Operative reduction, tenotomy, osteotomy;

difficult after 4 years

37
Q

CM of DDH in infant

A
  • Shortened limb on the affected side
  • Restricted abduction of hip on the affected side
  • Unequal gluteal folds when the infant is prone
  • Positive Ortolani test
  • Positive Barlow test
38
Q

Important to assess what with infant with DDH***

A

gluteal folds when the infant is prone are unequal

39
Q

Ortolani test-

A

placed on back, knees and hips bent feels for instability

40
Q

Barlow test-

A

placed on back- hips bent legs abducted , hip click or slippage of hip is felt

41
Q

Pavlik Harness Nursing care should focus on

A

Maintaining reduction
Teaching the parents
Providing skin care
or Spica cast
Teach parents skin care and how to keep baby in abduction

42
Q

Defects of the Spinal Column

A
43
Q

Kyphosis (just know definition)

A

Abnormally increased convex angulation in the curvature of the thoracic spine
Most common form is postural
Can occur secondary to

Tuberculosis
Arthritis
Osteodystrophy
Compression fracture of the thoracic spine

44
Q

Lordosis (just know definition)

A

Accentuation of the cervical or lumbar curvature beyond physiologic limits
May be an idiopathic or secondary complication of trauma
May occur with flexion contractures of the hip, congenital dislocated hip
In obese children, abdominal fat alters the center of gravity, causing lordosis

45
Q

Scoliosis

A
  • Most common spinal deformity
  • Complex spinal deformity in three planes
    • Lateral curvature
    • Spinal rotation causing rib asymmetry
    • Thoracic hypokyphosis
  • May be congenital or develop during childhood
46
Q

Osteomyelitis

A

Inflammation and infection of bony tissue
Bacteria enters bone via vasculature or directly from break in skin

47
Q

Osteomyelitis s/s

A

redness, warmth, swelling and pain over area of infection, limping, complain of pain in nearest joint
Bone cultures are obtained from biopsy or aspirate
Early x-rays may appear normal
Bone scans for diagnosis
A lot like cellulitus

48
Q

Therapeutic Management of Osteomyelitis

A
  • May have subacute presentation with a walled-off abscess rather than spreading infection
  • Prompt, vigorous intravenous (IV) antibiotics for an extended period (6 weeks) PICC - Be careful with Vanc
  • Monitor hematologic, renal, hepatic responses to treatment
49
Q

Bone Tumors

A

Osteosarcoma and Ewing sarcoma account for 85% of all primary malignant bone tumors in children
Occur more commonly in boys, with the highest incidence during the accelerated growth rate period of adolescence
Usually present to ER with a fracture because bone is weakened

50
Q

Diagnosis of Bone Tumors

A

Rule out trauma or infection first
Definitive diagnosis is based on radiologic studies (computed tomography [CT] scans, bone scans) and bone biopsy
Magnetic resonance imaging (MRI) to evaluate neurovascular and soft tissue extension
Laboratory studies show elevated alkaline phosphatase with some bone tumors

51
Q

Osteosarcoma

A

long bones stretching

Most frequent malignant bone tumor type in children
Peak incidence at age 10 to 25 years
Most primary tumor sites are in the metaphyses of the long bones, especially the legs
More than 50% occur in the distal femur
Other sites are the humerus, tibia, pelvis, and jaw

52
Q

Therapeutic Management of Osteosarcoma

A

Traditional approach is radical surgical resection or amputation of the affected area
Limb-salvage procedures involve resection of bone with prosthetic replacement of the affected area
Chemotherapy accompanying surgical treatment

53
Q

Nursing Care Management of Osteosarcoma

A
  • Preoperative preparation is crucial!!
  • Support during adjustment to the concept of amputation or surgical resection – might or might not wake up with leg
  • Most are athletes and life will be completely different for them
  • Body image concerns in adolescents
  • Pain management
  • Phantom limb pain
54
Q

Ewing Sarcoma

A
  • Second most common malignant bone tumor in children and adolescents; rare in those older than 30 years of age
  • Arises in marrow, especially in
    • Femur, tibia, ulna, humerus
    • Vertebrae, pelvis, scapula, ribs, skull
55
Q

Treatment of Ewing Sarcoma

A

Irradiation is the most common first approach
Chemotherapy as an adjunct to irradiation
Surgical resection in some cases; usually possible to preserve the affected limb
Prognosis is best if no metastasis has occurred at the time of diagnosis; distal lesions have the best potential for cure

56
Q

Nursing Care Management of Ewing Sarcoma

A

Assisting the family in dealing with a diagnosis of cancer
Managing complications of irradiation and chemotherapy
Nutritional concerns throughout the treatment regimen

Peds Exam 5 (5 decks)

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