Musculoskeletal and Infectious Disease Flashcards
1
Q
How many bones at birth
A
300
2
Q
Birth/childhood bone qualities
A
- Large cartilage component
- More flexible
- Dense periosteum
- Open epiphyseal plate
- Spine c-shaped
3
Q
How many bones in adulthood
A
206
4
Q
Adulthood bone qualities
A
- Bones are ossified
- Bones more dense and rigid
- Spine s- shaped
5
Q
Factors in Bone and muscle development
A
- Genetics
- Gender
- Mechanical force
- Nutrition
- Environment/context
- Sleep
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
7
Q
Diagnostic and Lab test
A
- X-ray
- bone scan
- CT
- electromyelogram
- MRI
- ultrasound
- bone marrow biopsy
- muscle biopsy
- serum enzymes
8
Q
Physical complications of musculoskeletal conditions
A
- pain
- cardiovascular
- respiratory
- GI/GU
- skin
- nutrition/metabolic
- safety
9
Q
psychosocial complications of musculoskeletal conditions
A
- Depression
- anxiety
- fear
- altered development
- altered body image
- family disruption/dysfunction
10
Q
Talipes equinovarus (congenital club foot) etiology
A
unknown, abnormal intrauterine positioning, family hx
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
12
Q
Talipes equinovarus nursing care
A
- long range planning for casting and appointments
- promotion of normal developmental needs
- cast care
- monitoring neuro function
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
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)
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
16
Q
Genu varum
A
bow-leg
17
Q
Fenu valgum
A
Knock-knee
18
Q
Legg-Calve-perthes etiology
A
Coagulation Disorder
Genetic and family history
Mild trauma to site
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)
20
Q
Legg-Calve-perthes treatment
A
- Bracing or traction
- Surgery to release muscles, treat acetabulum or femur, and restore range of motion
21
Q
Legg-Calve-perthes complications of untreated disease
A
- Osteoarthritis
- Hip dysfunction
- Shorten height
- Leg length discrepancy
22
Q
Slipped Capital Femoral Epiphysis etiology
A
Obesity Recent growth spurt Hypothyroidism Hypogonadism Can be acute or gradual
23
Q
Slipped Capital Femoral Epiphysis clinical manifestations
A
Pain in affected hip or referred to knee
Change in hip range of motion
24
Q
Slipped Capital Femoral Epiphysis treatment
A
- Surgical fixation of hip and bone graft followed by
- Spica cast or russell traction
25
Slipped Capital Femoral Epiphysis nursing care
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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
Scoliosis etiology
- congenital
- idiopathic
- acquired
27
Scoliosis manifestations
```
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
Scoliosis treatment- 10-20 degrees
Physical Therapy to improve posture and muscle strength and tone
29
Scoliosis treatment- 20-40 degrees
Bracing with Boston brace in order to maintain current level of curve. Does not reduce the degree of curve.
30
Scoliosis treatment- over 40 degrees
spinal fusion with segmental instrumentation
31
Muscular Dystrophy – Duchenne's etiology
Genetic- autosomal recessive (x-linked)
32
Muscular Dystrophy – Duchenne's clinical manifestations
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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
Muscular Dystrophy – Duchenne's treatment
Supportive/palliative care:
- Developmental support/maximize function
- Infection prevention
- Skin care
- Respiratory support
- Nutrition support
- PT & OT
- Parent support
- Genetic counseling referral
34
fractures common causes
- non-accidental trauma
- falls
- collisions
35
fractures- common sites
- Radius
- Clavicle
- Femur
36
fractures-nursing care
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Monitor for compartment syndrome
Pain management
Infection control and asepsis
Monitor neurovascular status
Cast care
Activity restriction for 8 weeks
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37
Osteomyelitis- etiology
- 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
Osteomyelitis- clinical manifestations
```
Pain
Edema
Decreased mobility
Fever
Redness surrounding the affected area
```
39
Osteomyelitis- treatment
-IV antibiotics (PICC line) 3-6 wks
40
Immunizations
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
Immunizations-nurse role
```
Reduce transmission of infections
Educate parents
Screen for eligibility
Promote and provide immunizations
Reduce pain and anxiety with administration
Monitor for side effects
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42
Immunizations- safe administration
- 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
Immunization- procedural pain/anxiety management
```
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”
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44
Chickenpox-complications
- Cellulitis
- Pneumonia
- Sepsis
- Meningitis
- Reyes’s syndrome
- Can be fatal
45
Chickenpox vaccine
- 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
Diphtheria-bacterial infection-clinical manifestations
Cough, stridor, noisy breathing
Bluish white/gray covering oropharynx, tonsils, soft, hard palate
Severe sore throat
Enlarged cervical lymph nodes
47
Diphtheria-bacterial infection- complications
- Endotoxins can cause Myocarditis and peripheral neuropathy (diplopia, paralysis of the palate)
- Guillian-Barre syndrome
- Severe respiratory distress
- Long period of communicability
48
Diphtheria-bacterial infection- vaccine
- 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
Haemophilus Influenza – Type B Bacterial Infection- clinical manifestations
Clinical manifestations specific for target site (meninges, lungs, heart, joints).
50
Haemophilus Influenza – Type B Bacterial Infection- complications
Severe sequelae including meningitis, epiglottis, sinusitis, pneumonia, cellulitis and death, especially in young infants
51
Haemophilus Influenza – Type B Bacterial Infection- vaccine
Inactivated Hib vaccine
| 4 total doses
52
Influenza A/B – Viral Infection- clinical manifestations
Chills, cough, runny nose, sore throat, malaise, aches, HA, nausea, anorexia. Children may have vomiting, diarrhea and abdominal pain, croup, bronchiolitis, and conjunctivitis
53
Influenza A/B – Viral Infection- complications
Otitis media, exacerbation of lung disorders (asthma, CF), pneumonia, myostitis, myocarditis, encephalitis, Reye’s syndrome, Guillian-Barre syndrome
54
Influenza A/B – vaccine
- 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
Rubeola (hard measles)- clinical manifestations
- 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
Rubeola- vaccine
-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
Parotitis (Mumps) – Viral Infection- clinical manifestations
Bilateral or unilateral parotid gland swelling, peaking by the third day
Meningeal irritation: stiff neck, headache, and photophobia
58
Parotitis (Mumps) – Viral Infection- complications
Orchitis, inflammation of the epididymis, scrotal swelling, pancreatitis, glomerulonephritis, myocarditis, hearing impairment, cerebellar ataxia
59
Parotitis (Mumps) – Viral Infection- vaccine
Subcutaneous, live attenuated, given with Measles and Rubella (MMR) 2 doses
60
Pertussis (Whooping Cough) Bacterial Infection- clinical manifestations
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
Pertussis (Whooping Cough) Bacterial Infection- complications
: Pneumonia, atelectasis, otitis media, encephalopathy, seizures, death with highest mortality under 1 year
62
Pertussis (Whooping Cough) Bacterial Infection- vaccine
- 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
Poliomyelitis – Viral Infection- prodromal
fever, HA,, back ache, vomiting, and sore throat
64
Poliomyelitis – clinical manifestations
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
Poliomyelitis – complications
Permanent motor paralysis, respiratory arrest, myocardial failure, aseptic meningitis, post-polio syndrome
66
Poliomyelitis- vaccine
- Subcutaneous or intramuscular, inactivated IPV
- 4 doses
- Contraindicated in children hypersensitive to neomycin, streptomycin, or polymyxin B.
- Contraindicated in pregnancy
67
Rotavirus – Viral Infection- clinical manifestations
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
Rotavirus- complications
dehydration and electrolyte disturbances, death in rare circumstances.
69
Rotavirus- vaccine
- Oral, live attenuated virus
| - 3 doses
70
Rubella (German Measles) Viral Infection- prodromal
- 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
Rubella (German Measles)- clinical manifestations
Mild disease with pink, nonconfluent, maculopapular rash on face progressing to neck, trunk, and legs.
72
Rubella (German Measles)- complications
Dangerous to pregnant women who can be exposed and result in congenital rubella syndrome in unborn child
73
Rubella (German Measles)- Vaccine
- Live attenuated, subcutaneous
| - 2 doses
74
Tetanus – Bacterial Infection- clinical manifestations
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
Tetanus – complications
laryngospasm, respiratory distress, death
76
Tetanus – vaccine
5 doses, and then a tetanus booster every 10 years, additional booster with contaminated wounds
77
Erythema Infectiosum – Fifth Disease Viral Infection- clinical manifestations
- 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
Erythema Infectiosum – Fifth Disease Viral Infection- immunization schedule-
No Immunization for this condition
79
Lyme Disease Bacterial Infection (Tick-borne)- prodromal
malaise, fatigue, HA, stiff neck, mild fever, and muscle and joint aches. Rash starts from a red macule with a central clearing.
80
Lyme Disease Bacterial Infection (Tick-borne)- clinical manifestations
1-4 months later – multiple erythema migrans, cranial nerve palsy, HA, meningitis, fatigue. Followed by arthritis months later.
81
Lyme Disease Bacterial Infection (Tick-borne)- complications
Neurologic deficits – Bell’s palsy, encephalopathy, optic neuropathy, peripheral nerve disorders
82
Lyme Disease Bacterial Infection (Tick-borne)- immunization schedule
none
