Musculoskeletal Flashcards
1
Q
Why do peds bones fracture more easily than adults?
A
Pediatric bones have more cartilage in them than adults, so they break more easily (less strong)
2
Q
What part of a bone grows?
A
Epiphyseal plate (at the end of the bone)
3
Q
What are the 3 segments of a long bone?
A
- Epiphysis (x2)
- Metaphysis (x2)
- Diaphysis (middle)
4
Q
What 2 things facilitate bone growth?
A
- Ca+2
- Activity
5
Q
How does stress affect bone growth?
A
Bones require stress (pressure from activity, etc.) to grow and reshape
6
Q
What is genu varum?
A
Abnormal position of bow legs and feet bending INWARD (towards midline)
7
Q
What is genu valgum?
A
Abnormal position of knock knees and limb bending OUTWARD (away from midline)
8
Q
What is a possible cause of genu varum?
A
Rickets (vitamin D deficiency)
9
Q
What is a cause of genu valgum?
A
Unknown
10
Q
When do musculoskeletal defects become evident?
A
~4yo (typically developing until then)
11
Q
How is genu Varum tx?
A
- Wearing of a brace
- Vit D supplementation
12
Q
How is genu Valum tx?
A
Bracing –> casting –> splinting (from least invasive to most)
13
Q
What is clubfoot?
A
Foot and lower leg is twisted and inverted inward from birth
14
Q
How does clubfoot occur?
A
Genetic traits, develops in utero
15
Q
Which gender is more at risk for club foot?
A
Males
16
Q
What is the prognosis r/t clubfoot?
A
Since develops in utero (bones grow that way), deficit can be modified but will most likely remain to some extent
17
Q
What are interventions for clubfoot?
A
- surgery
- serial casting
18
Q
How often is a new cast placed with serial casting?
A
Q1-2weeks
19
Q
How long does serial casting occur?
A
~3-6mo (12mo maximum = window of opportunity after surgery)
20
Q
What education is needed for home care of a cast?
A
- Prevent loss of circulation (stretching)
- Prevent infection (don’t stick anything in the cast)
- Check circulation (cap refill)
21
Q
How do you describe lateral movement of a limb towards the body?
A
Adduction
22
Q
How do you describe lateral movement of a limb away from the body?
A
Abduction
23
Q
What is hip dysplasia?
A
Limited abduction of the hip
24
Q
How is hip dysplasia detected?
A
- Telescoping (of hip with DDH)
- Allis sign
- Limp
25
What is DDH?
Developmental hip dysplasia
26
What is the Allis sign?
If knees are bent and held towards chest, one leg appears shorter than the other (indicates DDH)
27
What is the most common tx for a child <3mo w/ DDH?
Pavlik harness
28
What is a safety concern of a Pavlik harness?
Skin breakdown (wear shirt under the harness)
29
What intervention would be used after a Pavlik harness?
Spica cast
30
What is a spica cast?
Cast from the hips down (keeps hips abducted)
31
What type of hip fracture is most common in adolescent boys?
Slipped femoral capital epiphysis
32
What is slipped femoral capital epiphysis
Displacement of the epiphysis plate of the femur (fracture of the growth plate)
33
How should a slipped femoral capital epiphysis plate be assessed for in an adolescent boy?
Observation rather than questioning (boys less likely to complain)
34
How is a slipped femoral capital epiphysis fracture dx?
Bone scan via CT or MRI
35
How is a slipped femoral capital epiphysis fracture tx?
- Surgery + pin placement
- Traction
- Spica cast
36
What is Legg-Calve-Perthes?
Avascular necrosis of the femoral head (no circulation to femoral head = bone death)
37
What age is it most common to experience Legg-Calve-Perthes?
3-4yo
38
What population is most at risk for Legg-Calve-Perthes?
2-12yo (most common @3-4yo) white males
39
How is Legg-Clave-Perthes assessed?
Observation of limp and hip pain rather than asking questions
40
What is the course of tx for Legg-Calve-Perthes?
- Surgery or brace (surgery = remove dead bone)
- Need to keep leg abducted and internally rotated
- Need to prevent pressure on joint (limit activity)
- Can be years from diagnosis to end oftx
41
What nursing management is important in the care of Legg-Calve Perthes disease?
- Education about extensive timeline from dx to end of tx
- Pain management
- Activity/distraction during tx
42
What is inversion?
Tilt of the sole of the foot towards the midline?
43
What is eversion?
Tilt of the sole of the foot away form the midline?
44
What 3 types of traction are there?
- Skin
- Skeletal
- External fixator
45
What are the risks of internal traction?
- Infection (traction is attached to internal pins)
46
What is the largest concern with traction?
Circulation (extremity should not be high in the air for more than a few minutes at a time)
47
What does a nurse require to remove traction?
An order (can lift and care without an order, but cannot remove)
48
What are 3 distortions of the spine?
- Scoliosis
- Lordosis
- Kyphosis
49
What is scoliosis?
Lateral curve (C/S) of the spine
50
What is Lordosis?
Lumbar curvature
51
What is Kyphosis?
Hunched over
52
What ages should be screened for spinal distortions?
9-14yo (before and later in puberty)
53
What determines the level of care required for a spinal distortion?
Angle of distortion
54
What is mild scoliosis and how is it tx?
```
Mild = 10-20 degrees of curvature
Tx = exercise (PT) and evaluation
```
55
What is moderate scoliosis and how is it tx?
```
Moderate = 20-40 degrees of curvature
Tx = Boston or Milwaukee body jacket
```
56
How much time each day does a person need to wear their Boston or Milwaukee body jacket?
23 hours
57
What is the difference between a boston and milwaukee back brace?
Milwaukee has cervical neck brace/ring
58
What is severe scoliosis and how is it tx?
```
Severe = >40 degrees of curvature
Tx = surgical fusion and/or instrumentation, possible halo traction
```
59
What is a crucial nursing assessment after surgery for severe scoliosis?
Neuro checks r/t spinal involvement
60
What are the 5ps?
```
1 = pulselessness
2 = parathesia (tingling of extremities)
3 = pain
4 = paralysis
5 = pallor
```
61
What do the 5ps assess?
Neurovascular injury r/t fracture
62
What is a nursemaids elbow?
Elbow dislocation (radius is dislodged)
63
How is a nursemaids elbow detected?
Observation - elbow/arm is held in a funny position to avoid pain w/ movement
64
What is involved in the care of a child with a cast?
- Dry care
- Do not put objects in cast
- Check for circulation (cap refill, numbness)
- Check for infection (smell, redness, temp)
- Pain control
- Nutrition (protein, Ca+2, vitamins, fiber (prevent constipation of spica))
65
What are rare but serious complications of fractures?
- PE (immobility --> clots)
| - Compartment syndrome
66
What is compartment syndrome?
Bleeding within a particular muscle (hematoma), muscle needs to be punctured since occludes distal extremity
67
What system is used to grade fractures of the physeal plate?
Salter-Harris FX Classification system
68
What is osteogenesis imperfecta?
OI = genetic condition w/ defect in collagen production
| - Frequent factors
69
What needs to be assessed for in frequent fracture cases before thinking abuse?
Osteogenesis imperfecta
70
How is osteogenesis imperfecta tx?
- Prevention and s/s management
- PT
- Casting of fractures
- Surgical stabilization
- Vit D and Ca+2
71
How is osteogenesis imperfecta dx?
- Bone density scan (CT/MRI)
72
What are 4 common neuromuscular disorders?
- Spina bifida
- Myelomeningocele
- Muscular dystrophy
- Cerebral Palsy
73
What are priority nursing concerns with neuromuscular disorders?
- Infection prevention
- Elimination support (neurogenic bowel and bladder)
- Nutrition
- Skin breakdown (sedentary lifestyle)
- Latex allergy (d/t increased exposure)
- Family support
74
Why are boys dx with muscular dystrophy more than girls?
X-linked genetic condition
75
What is the mechanism of muscular dystrophy?
Muscle fiber degeneration and muscle wasting
76
What is Gower's sign?
Child gets up from lying down by pushing up different parts of body rather than just standing up
77
What type of muscular dystrophy is most common?
Duchenne's
78
How do you tx muscular dystrophy?
Supportive w/ symptom management (some research)
79
What type of cast is often used after kyphosis surgery?
Riser cast (of abdomen and thoracic cavity covering all the way around upper body to spine)
80
What hx needs to be thoroughly assessed in pre-participatin physical exams?
Cardiac hx (family hx, fainting spells, HTN, BP, VS, murmurs, etc.)
81
What is assessed in a comprehensive pre-participation PE?
- Cardio hx
- Orthopeidc screening
- Hx of damaged or missing organs
- Review of eating disorders, substance abuse, domestic violence, patient concerns
82
What social issues are discussed at a pre-participation PE?
- Eating disorders
- Substance abuse
- Domestic violence
- Patient concerns
83
What is assessed after a sport related injury?
Neuro
84
How do you tx a sport related injury?
- RICE
- Gradual ROM
- Strength exercises
85
What education is required to prevent sport related injuries?
- Warm up info
| - Gear needed for protection
