Musculoskeletal disorders - exam 3 Flashcards
1
Q
Is it normal for children to have flat-footed feet?
A
yes, normal until age 2
2
Q
is it normal for a child to be bow-legged?
A
yes, normal until age 3
3
Q
3 examples of soft tissue injuries
A
sprain, strains, contusions
4
Q
What is a sprain?
A
- twisting of a joint
- damage to the LIGAMENTS (stretched or torn by force of a twisted joint)
5
Q
What is a strain?
A
- tearing or pulling of muscle
- may also effect TENDONS
6
Q
What is a contusion?
A
bruises to the muscle (i.e. from being punched)
7
Q
Signs and Sx of soft tissue injury AND fractures (5 P’s)
A
- Pain
- pulses
- pallor
- paresthesia (tingling, burning)
- paralysis (ability to move)
8
Q
Signs and Sx of a SPRAIN
A
- **EDEMA
- pain
- heat
- redness
- ecchymosis
9
Q
Signs and Sx of a STRAIN
A
- inflammation
- ecchymosis (bruising)
10
Q
Signs and Sx of a CONTUSION
A
- inflammation
- discoloration
11
Q
Nursing interventions of soft tissue injury
A
- assessment: need X-ray to r/o fracture
- Treat: RICE (whether it’s fractured or not)
- -rest: slings, crutches, bedrest
- -Ice: 3-5 times per day; 20 min application (should be iced immediately!)
- -compression: ace-bandage/splint
- -elevation: above heart
- NSAIDS as ordered
- PT: prescribed exercises (only if absolutely necessary)
12
Q
What is a fracture
A
ANY type of break in the bone
13
Q
Signs and Sx of a fracture
A
- inflammation
- bruising
- pallor
- limited ROM
- non-weight bearing
- point tenderness is more indicative of a fracture
14
Q
How to diagnose fractures
A
-Assessment (x-ray and ultrasound)
15
Q
Nursing interventions for fractures
A
- casting
- -help keep calm/distract
- -rest w/ elevation of cast recommended
- -move joints above and below casted joints
- comfort measures: sedation, ice to relieve itching
- traction: pulling (physically moving bone back)
- external fixation devices
- teaching
- -don’t stick anything in cast
- -check for cap refill, feeling, sensation, movements
- -rapidity of healing is inversely related to child’s age
- -check for tightnes/weakness/contractures in uninvolved joints and mscles
16
Q
Club foot definition:
A
malalignment of feet which resists being moved into proper alignment (feet are turned inward)
17
Q
Pathophysiology of a club foot
A
- fetal positioning (e.g. seen more in twins/triplets)
- intrauterine restriction
- boys>girls
18
Q
Treatment of club foot
A
- serial casting (1st treatment choice)
- -needs constant reapplication d/t rapid growth
- surgery (not always required)
- physical therapy
19
Q
Dysplasia of the hip definition
A
subluxation or complete dislocation of hip d/t fetal positioning
20
Q
Signs and Sx of dysplasia of the hip and how to test for it
A
-asymmetry of thigh folds/gluteal folds
-asymmetry of femur length
Tests: ortolani and barlow tests (if positive, need x-ray/US to confirm)
21
Q
What is ortolani’s test?
A
- Tests for dysplasia of the hip
- pull knees OUT, reduction is done by ABDUCTION of the hip and pushing the thigh anteriorly)
- positive = click/clack in hip = DDH+
22
Q
What is Barlow’s test?
A
- Tests for dysplasia of the hip
- push knees back, flex hip and knees to 90 degrees, bring thigh towards midline (ADDUCTING the hip), mild pressure is then placed on the knee while directing the force posteriorly
23
Q
Treatment of dysplasia of the hip
A
- Pavlik harness
- less than 6 months old
- keeps legs abducted
- keeps trochanter in acetabulum - spica casting: if harness fails or >6 month (big open cast w hole to put diaper in)
24
Q
What is legg-calve-perthes?
A
- necrosis of femur and at times, acetabulum (hip joint)
- blood supply returns but damage to bone is permanent
25
Pathophysiology of Legg-calve-perthes?
-blood doesn't go to the head of the femur ( and sometimes acetabulum)
26
Signs and Sx of Legg-calve-perthes?
- pain
| - **limp (worsens with activity)
27
Assessment/diagnosis of Legg-calve-perthes?
- x-ray/bone scan/MRI
| - EARLY DX IS KEY TO CATCH BEFORE NECROSIS OCCURS
28
Tx of Legg-calve-perthes?
- NSAIDS
- surgery (requires 3-4 month recovery)
- non-weight bearing (so it has time to grow and get blood supply back
29
What is slipped capital femoral epiphysis (sks SCFE or slipped hip)
-Head of the femur separated from the rest of the femur at the growth plate
30
Pathophysiology of slipped capital femoral epiphysis
- overweight
| - teenagers at growth spurts
31
Signs and Sx of slipped capital femoral epiphysis
```
– Hip tenderness
– Painful ROM
– Limp
– Decreased hip flexion
– Pain increases with toes turned inward
– Position of comfort with external rotation of the affected leg (they’ll often prefer to stand w feet turned outward)
```
32
Assessment and Tx of slipped capital femoral epiphysis (slipped hip)
- history (obese pre-teen, or teen with growth spurts)
- x-ray definitive (think of ice cream falling off cone)
- Treatment:
1. surgery (IMMEDIATELY)
2. immobilization of joint (in meantime and before and after surgery)
33
Scoliosis
lateral curvature and rotation of spine (nurses are integral in SCREENING)
34
is scoliosis more common in girls or boys?
girls
35
When is scoliosis usually most noticeable?
during pubertal growth (seldom apparent before 10 years old)
36
Signs and Sx of scoliosis
– Uneven posture
– One scapula/clavicle higher than the other
– Hip/rib asymmetry
– **Severe=cardiac and respiratory compromise (bc one lung is not able to aerate properly)
– **Back pain
37
Nursing interventions for scoliosis (assessment and treatment)
Assessment:
• Screening: Bend over at the hips and touch toes
• Monitor physical appearance during exam
Treatment:
• Based on age and curvature
• Bracing: NOT curative, help prevent worsening
(Wear brace 23 hrs/day)
• Surgery (rod is put in)
38
Duchenne muscular dystrophy
progressive loss of function d/t muscular loss
39
pathophysiology of duchenne muscular dystrophy
- hereditary
| - boys>girls (carried on X chromosome)
40
Signs and Sx of duchenne muscular dystrophy
– Initially growth/development appear normal
– Around 3 yo: loss of function previously attained, loss of milestones
– Initially small functions, then becomes gross motor
– *GOWER'S sign develops (needing to stand up slowly, like an old person) (Usu by age 7)
– Wheelchair by teenage years
41
Nursing interventions for duchenne muscular dystrophy (assessment and Tx)
```
Assessment:
• Monitoring using screening tools
• DNA tests
Treatment:
• **No cure
• Preserve ambulation, vital organ function, and independence for as long as possible
```
42
Osteomyelitis
- bacterial infection of the bones, usu bigger bones
| - cellulitis turns into osteomyelitis). Introduced via skin break or via the vascular system
43
Signs and Sx of osteomyelitis
```
– Fever
– Crying a lot
– Redness
– Warmth
– Swelling
– Pain (with moving of the joint, whereas cellulitis is just painful in the skin tissue)
– Limping
```
44
Nursing interventiong for osteomyelitis
- weight bearing not allowed until healing is well underway to avoid pathologic fractures
- prep for surgery PRN
- prep for x-rays/MRI/CT scars/bone scans
45
Complications of muscular dystrophy include
contractures, disuse atrophy, infections, obesity, respiratory complications (respiratory muscles atrophy--this is a later sign), and cardiopulmonary problems
