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Nursing > Musculoskeletal and Infectious Disease > Flashcards

Musculoskeletal and Infectious Disease Flashcards

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1
Q

How many bones at birth

A

300

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2
Q

Birth/childhood bone qualities

A
  • Large cartilage component
  • More flexible
  • Dense periosteum
  • Open epiphyseal plate
  • Spine c-shaped
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3
Q

How many bones in adulthood

A

206

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4
Q

Adulthood bone qualities

A
  • Bones are ossified
  • Bones more dense and rigid
  • Spine s- shaped
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5
Q

Factors in Bone and muscle development

A
  • Genetics
  • Gender
  • Mechanical force
  • Nutrition
  • Environment/context
  • Sleep
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6
Q

Assessment of musculoskeletal system

A
  • history
  • size and symmetry of body
  • joint range of motion
  • gait
  • muscle strength
  • muscle tone
  • developmental milestones
  • nutrition
  • pain
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7
Q

Diagnostic and Lab test

A
  • X-ray
  • bone scan
  • CT
  • electromyelogram
  • MRI
  • ultrasound
  • bone marrow biopsy
  • muscle biopsy
  • serum enzymes
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8
Q

Physical complications of musculoskeletal conditions

A
  • pain
  • cardiovascular
  • respiratory
  • GI/GU
  • skin
  • nutrition/metabolic
  • safety
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9
Q

psychosocial complications of musculoskeletal conditions

A
  • Depression
  • anxiety
  • fear
  • altered development
  • altered body image
  • family disruption/dysfunction
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10
Q

Talipes equinovarus (congenital club foot) etiology

A

unknown, abnormal intrauterine positioning, family hx

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11
Q

Talipes equinovarus treatment

A
  • non-operative serial casting ASAP after birth
  • casting every 1-2 weeks
  • surgery may be required, followed by a long cast and bracing
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12
Q

Talipes equinovarus nursing care

A
  • long range planning for casting and appointments
  • promotion of normal developmental needs
  • cast care
  • monitoring neuro function
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13
Q

Developmental dysplasia of the hip etiology

A
  • Physiologic factors (maternal hormones that lead to laxity of the joints, intrauterine positioning)
  • Mechanical factors (delivery methods, postnatal positioning)
  • Genetic factors
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14
Q

Developmental dysplasia of the hip treatment

A

Pavlik harness (newborn-6 mo)
Traction (6 mo-18 mo)
Closed surgical reduction with casting (spica cast)

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15
Q

Developmental dysplasia of the hip nursing care

A
  • Monitoring for skin breakdown or neurovascular compromise
  • Teaching for parents and caregivers
  • Promotion of normal developmental activities
  • Safety and home modifications
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16
Q

Genu varum

A

bow-leg

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17
Q

Fenu valgum

A

Knock-knee

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18
Q

Legg-Calve-perthes etiology

A

Coagulation Disorder
Genetic and family history
Mild trauma to site

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19
Q

Legg-Calve-perthes progression

A

Prenecrosis –insult to blood supply
Necrosis/asymptomatic – 3-6 months (stage I)
Revascularization – 1-4 years (stage II)
Bone Healing - reossification (stage III)
Remodeling – improved joint function (stage IV)

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20
Q

Legg-Calve-perthes treatment

A
  • Bracing or traction

- Surgery to release muscles, treat acetabulum or femur, and restore range of motion

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21
Q

Legg-Calve-perthes complications of untreated disease

A
  • Osteoarthritis
  • Hip dysfunction
  • Shorten height
  • Leg length discrepancy
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22
Q

Slipped Capital Femoral Epiphysis etiology

A 
Obesity
Recent growth spurt
Hypothyroidism 
Hypogonadism 
Can be acute or gradual
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23
Q

Slipped Capital Femoral Epiphysis clinical manifestations

A

Pain in affected hip or referred to knee

Change in hip range of motion

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24
Q

Slipped Capital Femoral Epiphysis treatment

A
  • Surgical fixation of hip and bone graft followed by

- Spica cast or russell traction

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25
Q

Slipped Capital Femoral Epiphysis nursing care

A 
Pain management
Monitor for complications of immobility
Traction or cast care
Body image
Weight control (proper nutrition and fluid intake)
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26
Q

Scoliosis etiology

A
  • congenital
  • idiopathic
  • acquired
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27
Q

Scoliosis manifestations

A 
Truncal asymmetry
Uneven shoulders
Uneven hips
On-sided rib hump
Prominent scapula 
Hip and back pain
Extreme fatigue
Dyspnea with exertion
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28
Q

Scoliosis treatment- 10-20 degrees

A

Physical Therapy to improve posture and muscle strength and tone

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29
Q

Scoliosis treatment- 20-40 degrees

A

Bracing with Boston brace in order to maintain current level of curve. Does not reduce the degree of curve.

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30
Q

Scoliosis treatment- over 40 degrees

A

spinal fusion with segmental instrumentation

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31
Q

Muscular Dystrophy – Duchenne’s etiology

A

Genetic- autosomal recessive (x-linked)

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32
Q

Muscular Dystrophy – Duchenne’s clinical manifestations

A 
Lower extremities weakness
Gower Sign
Toe-walking
Tripping
Enlarged calves
Progresses to complete immobility, respiratory difficulty and failure, cardiomyopathy, fractures, chronic disability
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33
Q

Muscular Dystrophy – Duchenne’s treatment

A

Supportive/palliative care:

  • Developmental support/maximize function
  • Infection prevention
  • Skin care
  • Respiratory support
  • Nutrition support
  • PT & OT
  • Parent support
  • Genetic counseling referral
34
Q

fractures common causes

A
  • non-accidental trauma
  • falls
  • collisions
35
Q

fractures- common sites

A
  • Radius
  • Clavicle
  • Femur
36
Q

fractures-nursing care

A 
Monitor for compartment syndrome
Pain management
Infection control and asepsis
Monitor neurovascular status
Cast care
Activity restriction for 8 weeks
37
Q

Osteomyelitis- etiology

A
  • Infection most often in the long bone of lower extremity
  • May spread to surrounding soft tissue
  • Common organisms:
    - Staphylococcus aureus
    - Escherichia coli
    - Group B streptococci
    - Haemophilus influenza
    - Kingella kingae
    - MRSA
38
Q

Osteomyelitis- clinical manifestations

A 
Pain
Edema
Decreased mobility
Fever
Redness surrounding the affected area
39
Q

Osteomyelitis- treatment

A

-IV antibiotics (PICC line) 3-6 wks

40
Q

Immunizations

A

Immunization is the process of inducing immunity to a specific disease either through passive immunity (administration of antibody) or active immunity (administration of vaccine or toxiod to stimulate the immune system).

41
Q

Immunizations-nurse role

A 
Reduce transmission of infections
Educate parents
Screen for eligibility
Promote and provide immunizations
Reduce pain and anxiety with administration
Monitor for side effects
42
Q

Immunizations- safe administration

A
  • Store according to manufacturer recommendations
  • Needle size (22 – 25 gauge needle)
    - 5/8 inch for newborns
    - 1 inch for 2-12 months
    - Toddler 1 ¼ inch needle
  • 5 Rights of Medication Administration
  • Procedural pain management
43
Q

Immunization- procedural pain/anxiety management

A 
Anesthetic/Lidocaine cream, 1 hour before injection
Vapocoolant spray
Non-pharmacologic devices
Distraction
Oral sucrose, young infants
Therapeutic holding technique
Age appropriate explanation and choice
“One-voice”
44
Q

Chickenpox-complications

A
  • Cellulitis
  • Pneumonia
  • Sepsis
  • Meningitis
  • Reyes’s syndrome
  • Can be fatal
45
Q

Chickenpox vaccine

A
  • Subcutaneous, Live Attenuated Virus between 12-15 months and 4-6 years (two doses)
  • Not to be given to child who is immunosuppressed or allergic to neomycin or gelatin.
  • Girls of childbearing age should avoid pregnancy for 3 months after immunization
46
Q

Diphtheria-bacterial infection-clinical manifestations

A

Cough, stridor, noisy breathing
Bluish white/gray covering oropharynx, tonsils, soft, hard palate
Severe sore throat
Enlarged cervical lymph nodes

47
Q

Diphtheria-bacterial infection- complications

A
  • Endotoxins can cause Myocarditis and peripheral neuropathy (diplopia, paralysis of the palate)
  • Guillian-Barre syndrome
  • Severe respiratory distress
  • Long period of communicability
48
Q

Diphtheria-bacterial infection- vaccine

A
  • Inactivated
  • Given in combination with Tetanus and Pertussis (DTaP), 6 doses
  • If child has a progressive neurologic disorder defer vaccine until the child is stable.
49
Q

Haemophilus Influenza – Type B Bacterial Infection- clinical manifestations

A

Clinical manifestations specific for target site (meninges, lungs, heart, joints).

50
Q

Haemophilus Influenza – Type B Bacterial Infection- complications

A

Severe sequelae including meningitis, epiglottis, sinusitis, pneumonia, cellulitis and death, especially in young infants

51
Q

Haemophilus Influenza – Type B Bacterial Infection- vaccine

A

Inactivated Hib vaccine

4 total doses

52
Q

Influenza A/B – Viral Infection- clinical manifestations

A

Chills, cough, runny nose, sore throat, malaise, aches, HA, nausea, anorexia. Children may have vomiting, diarrhea and abdominal pain, croup, bronchiolitis, and conjunctivitis

53
Q

Influenza A/B – Viral Infection- complications

A

Otitis media, exacerbation of lung disorders (asthma, CF), pneumonia, myostitis, myocarditis, encephalitis, Reye’s syndrome, Guillian-Barre syndrome

54
Q

Influenza A/B – vaccine

A
  • Inactivated (TIV) for all ages or Intranasal
  • Live attenuated (LAIV) for ages 5 years and older.
  • Yearly after 6 months.
  • If receiving the vaccine for the first time, if younger than 9 years, should get two doses 4-6 weeks apart.
  • 80% effective
55
Q

Rubeola (hard measles)- clinical manifestations

A
  • Rash starts 2-4 days after prodromal period
  • Rash begins on face and spreads to trunk and extremities
  • Symptoms last 4-7 days
  • Generalized malaise, fatigue, lymphadenopathy, anorexia, cough
  • Lesions can erupt on mucous membranes in mouth
56
Q

Rubeola- vaccine

A

-Subcutaneous
-Live attenuated vaccine
-Given with Measles and Mumps (MMR)
-2 doses
-If child has egg allergy observe for 90 minutes after injection
College students who have not had the second dose of MMR are encouraged to receive
-Avoid pregnancy for 4 weeks post immunization.

57
Q

Parotitis (Mumps) – Viral Infection- clinical manifestations

A

Bilateral or unilateral parotid gland swelling, peaking by the third day
Meningeal irritation: stiff neck, headache, and photophobia

58
Q

Parotitis (Mumps) – Viral Infection- complications

A

Orchitis, inflammation of the epididymis, scrotal swelling, pancreatitis, glomerulonephritis, myocarditis, hearing impairment, cerebellar ataxia

59
Q

Parotitis (Mumps) – Viral Infection- vaccine

A

Subcutaneous, live attenuated, given with Measles and Rubella (MMR) 2 doses

60
Q

Pertussis (Whooping Cough) Bacterial Infection- clinical manifestations

A

Prodromal (Stage 1) – Nasal congestion, runny nose, low grade fever, mild nonproductive cough for (about 2 weeks)

Paroxysmal (Stage II) – Severe cough at night with spasms in an attempt to expel thick mucous plugs, whooping sound after a forceful and difficult inspiratory phase of breathing; periods of hypoxia and apnea (6 weeks)

Convalescent (Stage III) - Paroxysms gradually subside

61
Q

Pertussis (Whooping Cough) Bacterial Infection- complications

A

: Pneumonia, atelectasis, otitis media, encephalopathy, seizures, death with highest mortality under 1 year

62
Q

Pertussis (Whooping Cough) Bacterial Infection- vaccine

A
  • DTaP and Tdap with Diphtheria and tetanus
  • 5 doses
  • Adolescents and adults encouraged to get the Tdap when getting tetanus toxiod booster

-An increase in magnitude of local reaction by 4th and 5th dose. Can cause high fever; so administer with caution in children who have had previous fever > 40.5 C (105 F), continuous or inconsolable crying, convulsions.

63
Q

Poliomyelitis – Viral Infection- prodromal

A

fever, HA,, back ache, vomiting, and sore throat

64
Q

Poliomyelitis – clinical manifestations

A

Affects the central nervous system; vomiting, sore throat, stiff neck, progressive weakness; meningeal irritation, respiratory tract muscle weakness if cranial nerves involved, paralysis due to damaged motor neurons

65
Q

Poliomyelitis – complications

A

Permanent motor paralysis, respiratory arrest, myocardial failure, aseptic meningitis, post-polio syndrome

66
Q

Poliomyelitis- vaccine

A
  • Subcutaneous or intramuscular, inactivated IPV
  • 4 doses
  • Contraindicated in children hypersensitive to neomycin, streptomycin, or polymyxin B.
  • Contraindicated in pregnancy
67
Q

Rotavirus – Viral Infection- clinical manifestations

A

watery diarrhea 1-2 days following fever and vomiting. Can have up to 10-20 diarrheal stools a day. Symptoms can last 3-8 days

68
Q

Rotavirus- complications

A

dehydration and electrolyte disturbances, death in rare circumstances.

69
Q

Rotavirus- vaccine

A
  • Oral, live attenuated virus

- 3 doses

70
Q

Rubella (German Measles) Viral Infection- prodromal

A
  • 1-5 days before rash low-grade fever, HA, malaise, sore throat, anorexia
  • Pinpoint lesions on soft palate
  • Generalized lymphadenopathy, 7 days before rash appears
71
Q

Rubella (German Measles)- clinical manifestations

A

Mild disease with pink, nonconfluent, maculopapular rash on face progressing to neck, trunk, and legs.

72
Q

Rubella (German Measles)- complications

A

Dangerous to pregnant women who can be exposed and result in congenital rubella syndrome in unborn child

73
Q

Rubella (German Measles)- Vaccine

A
  • Live attenuated, subcutaneous

- 2 doses

74
Q

Tetanus – Bacterial Infection- clinical manifestations

A

stiffness of neck and jaw, painful facial spasms, HA, difficulty chewing and swallowing, prolonged and painful muscle spasms, opisthotonus, respiratory muscle spasms causing suffocation, increased oral secretions

75
Q

Tetanus – complications

A

laryngospasm, respiratory distress, death

76
Q

Tetanus – vaccine

A

5 doses, and then a tetanus booster every 10 years, additional booster with contaminated wounds

77
Q

Erythema Infectiosum – Fifth Disease Viral Infection- clinical manifestations

A
  • Fiery-red rash on cheeks, later a lacy, erythmatous, maculopapular rash on trunk and limbs. May be pruritic.
  • Circumoral pallor
  • Rash may reappear ,lasting up to 3 weeks
78
Q

Erythema Infectiosum – Fifth Disease Viral Infection- immunization schedule-

A

No Immunization for this condition

79
Q

Lyme Disease Bacterial Infection (Tick-borne)- prodromal

A

malaise, fatigue, HA, stiff neck, mild fever, and muscle and joint aches. Rash starts from a red macule with a central clearing.

80
Q

Lyme Disease Bacterial Infection (Tick-borne)- clinical manifestations

A

1-4 months later – multiple erythema migrans, cranial nerve palsy, HA, meningitis, fatigue. Followed by arthritis months later.

81
Q

Lyme Disease Bacterial Infection (Tick-borne)- complications

A

Neurologic deficits – Bell’s palsy, encephalopathy, optic neuropathy, peripheral nerve disorders

82
Q

Lyme Disease Bacterial Infection (Tick-borne)- immunization schedule

A

none

Nursing (22 decks)

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