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Peds exam 1 > Musculoskeletal > Flashcards

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)

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2
Q

What part of a bone grows?

A

Epiphyseal plate (at the end of the bone)

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3
Q

What are the 3 segments of a long bone?

A
  • Epiphysis (x2)
  • Metaphysis (x2)
  • Diaphysis (middle)
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4
Q

What 2 things facilitate bone growth?

A
  • Ca+2

- Activity

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5
Q

How does stress affect bone growth?

A

Bones require stress (pressure from activity, etc.) to grow and reshape

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6
Q

What is genu varum?

A

Abnormal position of bow legs and feet bending INWARD (towards midline)

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7
Q

What is genu valgum?

A

Abnormal position of knock knees and limb bending OUTWARD (away from midline)

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8
Q

What is a possible cause of genu varum?

A

Rickets (vitamin D deficiency)

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9
Q

What is a cause of genu valgum?

A

Unknown

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10
Q

When do musculoskeletal defects become evident?

A

~4yo (typically developing until then)

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11
Q

How is genu Varum tx?

A
  • Wearing of a brace

- Vit D supplementation

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12
Q

How is genu Valum tx?

A

Bracing –> casting –> splinting (from least invasive to most)

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13
Q

What is clubfoot?

A

Foot and lower leg is twisted and inverted inward from birth

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14
Q

How does clubfoot occur?

A

Genetic traits, develops in utero

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15
Q

Which gender is more at risk for club foot?

A

Males

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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

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17
Q

What are interventions for clubfoot?

A
  • surgery

- serial casting

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18
Q

How often is a new cast placed with serial casting?

A

Q1-2weeks

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19
Q

How long does serial casting occur?

A

~3-6mo (12mo maximum = window of opportunity after surgery)

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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)
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21
Q

How do you describe lateral movement of a limb towards the body?

A

Adduction

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22
Q

How do you describe lateral movement of a limb away from the body?

A

Abduction

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23
Q

What is hip dysplasia?

A

Limited abduction of the hip

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24
Q

How is hip dysplasia detected?

A
  • Telescoping (of hip with DDH)
  • Allis sign
  • Limp
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25
Q

What is DDH?

A

Developmental hip dysplasia

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26
Q

What is the Allis sign?

A

If knees are bent and held towards chest, one leg appears shorter than the other (indicates DDH)

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27
Q

What is the most common tx for a child <3mo w/ DDH?

A

Pavlik harness

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28
Q

What is a safety concern of a Pavlik harness?

A

Skin breakdown (wear shirt under the harness)

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29
Q

What intervention would be used after a Pavlik harness?

A

Spica cast

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30
Q

What is a spica cast?

A

Cast from the hips down (keeps hips abducted)

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31
Q

What type of hip fracture is most common in adolescent boys?

A

Slipped femoral capital epiphysis

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32
Q

What is slipped femoral capital epiphysis

A

Displacement of the epiphysis plate of the femur (fracture of the growth plate)

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33
Q

How should a slipped femoral capital epiphysis plate be assessed for in an adolescent boy?

A

Observation rather than questioning (boys less likely to complain)

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34
Q

How is a slipped femoral capital epiphysis fracture dx?

A

Bone scan via CT or MRI

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35
Q

How is a slipped femoral capital epiphysis fracture tx?

A
  • Surgery + pin placement
  • Traction
  • Spica cast
36
Q

What is Legg-Calve-Perthes?

A

Avascular necrosis of the femoral head (no circulation to femoral head = bone death)

37
Q

What age is it most common to experience Legg-Calve-Perthes?

A

3-4yo

38
Q

What population is most at risk for Legg-Calve-Perthes?

A

2-12yo (most common @3-4yo) white males

39
Q

How is Legg-Clave-Perthes assessed?

A

Observation of limp and hip pain rather than asking questions

40
Q

What is the course of tx for Legg-Calve-Perthes?

A
  • 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
Q

What nursing management is important in the care of Legg-Calve Perthes disease?

A
  • Education about extensive timeline from dx to end of tx
  • Pain management
  • Activity/distraction during tx
42
Q

What is inversion?

A

Tilt of the sole of the foot towards the midline?

43
Q

What is eversion?

A

Tilt of the sole of the foot away form the midline?

44
Q

What 3 types of traction are there?

A
  • Skin
  • Skeletal
  • External fixator
45
Q

What are the risks of internal traction?

A
  • Infection (traction is attached to internal pins)
46
Q

What is the largest concern with traction?

A

Circulation (extremity should not be high in the air for more than a few minutes at a time)

47
Q

What does a nurse require to remove traction?

A

An order (can lift and care without an order, but cannot remove)

48
Q

What are 3 distortions of the spine?

A
  • Scoliosis
  • Lordosis
  • Kyphosis
49
Q

What is scoliosis?

A

Lateral curve (C/S) of the spine

50
Q

What is Lordosis?

A

Lumbar curvature

51
Q

What is Kyphosis?

A

Hunched over

52
Q

What ages should be screened for spinal distortions?

A

9-14yo (before and later in puberty)

53
Q

What determines the level of care required for a spinal distortion?

A

Angle of distortion

54
Q

What is mild scoliosis and how is it tx?

A 
Mild = 10-20 degrees of curvature
Tx = exercise (PT) and evaluation
55
Q

What is moderate scoliosis and how is it tx?

A 
Moderate = 20-40 degrees of curvature
Tx = Boston or Milwaukee body jacket
56
Q

How much time each day does a person need to wear their Boston or Milwaukee body jacket?

A

23 hours

57
Q

What is the difference between a boston and milwaukee back brace?

A

Milwaukee has cervical neck brace/ring

58
Q

What is severe scoliosis and how is it tx?

A 
Severe = >40 degrees of curvature
Tx = surgical fusion and/or instrumentation, possible halo traction
59
Q

What is a crucial nursing assessment after surgery for severe scoliosis?

A

Neuro checks r/t spinal involvement

60
Q

What are the 5ps?

A 
1 = pulselessness
2 = parathesia (tingling of extremities)
3 = pain
4 = paralysis
5 = pallor
61
Q

What do the 5ps assess?

A

Neurovascular injury r/t fracture

62
Q

What is a nursemaids elbow?

A

Elbow dislocation (radius is dislodged)

63
Q

How is a nursemaids elbow detected?

A

Observation - elbow/arm is held in a funny position to avoid pain w/ movement

64
Q

What is involved in the care of a child with a cast?

A
  • 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
Q

What are rare but serious complications of fractures?

A
  • PE (immobility –> clots)

- Compartment syndrome

66
Q

What is compartment syndrome?

A

Bleeding within a particular muscle (hematoma), muscle needs to be punctured since occludes distal extremity

67
Q

What system is used to grade fractures of the physeal plate?

A

Salter-Harris FX Classification system

68
Q

What is osteogenesis imperfecta?

A

OI = genetic condition w/ defect in collagen production

- Frequent factors

69
Q

What needs to be assessed for in frequent fracture cases before thinking abuse?

A

Osteogenesis imperfecta

70
Q

How is osteogenesis imperfecta tx?

A
  • Prevention and s/s management
  • PT
  • Casting of fractures
  • Surgical stabilization
  • Vit D and Ca+2
71
Q

How is osteogenesis imperfecta dx?

A
  • Bone density scan (CT/MRI)
72
Q

What are 4 common neuromuscular disorders?

A
  • Spina bifida
  • Myelomeningocele
  • Muscular dystrophy
  • Cerebral Palsy
73
Q

What are priority nursing concerns with neuromuscular disorders?

A
  • Infection prevention
  • Elimination support (neurogenic bowel and bladder)
  • Nutrition
  • Skin breakdown (sedentary lifestyle)
  • Latex allergy (d/t increased exposure)
  • Family support
74
Q

Why are boys dx with muscular dystrophy more than girls?

A

X-linked genetic condition

75
Q

What is the mechanism of muscular dystrophy?

A

Muscle fiber degeneration and muscle wasting

76
Q

What is Gower’s sign?

A

Child gets up from lying down by pushing up different parts of body rather than just standing up

77
Q

What type of muscular dystrophy is most common?

A

Duchenne’s

78
Q

How do you tx muscular dystrophy?

A

Supportive w/ symptom management (some research)

79
Q

What type of cast is often used after kyphosis surgery?

A

Riser cast (of abdomen and thoracic cavity covering all the way around upper body to spine)

80
Q

What hx needs to be thoroughly assessed in pre-participatin physical exams?

A

Cardiac hx (family hx, fainting spells, HTN, BP, VS, murmurs, etc.)

81
Q

What is assessed in a comprehensive pre-participation PE?

A
  • Cardio hx
  • Orthopeidc screening
  • Hx of damaged or missing organs
  • Review of eating disorders, substance abuse, domestic violence, patient concerns
82
Q

What social issues are discussed at a pre-participation PE?

A
  • Eating disorders
  • Substance abuse
  • Domestic violence
  • Patient concerns
83
Q

What is assessed after a sport related injury?

A

Neuro

84
Q

How do you tx a sport related injury?

A
  • RICE
  • Gradual ROM
  • Strength exercises
85
Q

What education is required to prevent sport related injuries?

A
  • Warm up info

- Gear needed for protection

Peds exam 1 (3 decks)

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