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maternal child health RN > Musculoskeletal, Genitourinary, hematological final > Flashcards

Musculoskeletal, Genitourinary, hematological final Flashcards

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1
Q

How many bones are there and how are they connected to body?

A

200 bones connected by the joints and tendons protects internal organs in the body

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2
Q

Supplies the body with RBC and WBC in bone marrow

A

Muskoskeletal system

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3
Q

Prenatal health for the muscoskeletal system - bone development

A

High calcium - used in main embryonic period for bone development and helps as child grows

Vitamin D

, minerals

Vitamin c

Iron

Protein

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4
Q

parathyroid hormone in muscoskeletal system which helps with overall absorption and remodeling of the body

A

Calcitonin

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5
Q

Examples of protein

A 
Meat 
Fish
Beans/ peas 
Tofu 
Milk 
Yogurt 
Cheese
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6
Q

Iron food examples

A 
Liver 
Chuck 
Cereal 
Kidney beans 
lentils
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7
Q

Calcium foods

A 
Milk
Yogurt
Cheese
Ice cream
Spinach
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8
Q

Vitamin d examples

A

UV light
Salmon
Tuna

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9
Q

Vitamin c examples

A 
Orange juice 
Green pepper 
Strawberries 
Broccoli 
Kiwi 
Orange
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10
Q

When are most muscoskeletal disorders first noticed?

A

during Routine physical exams

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11
Q

When is scoliosis assesses for

A

Elementary school

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12
Q

How to diagnose muscoskeletal issues in kids

A

History

Diagnostic tests

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13
Q

S/s of muscoskeletal issues in children

A 
Malaise 
Fever 
Ptosis 
Poor sucking 
Muscle weakness 
Pain in hip 
Stiffness and swelling external rotation 
Waddling gait 
Flat feet pigeon toed 
Limp 
Knock kneed or bowed legs 
Repeated fractures 
Spinal curvature 
Irritability
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14
Q

Open growth plates vs closed in children

A

Open means child will continue to grow

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15
Q

When do growth plates close in females

A

13-15 years of age

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16
Q

When rowdy plates close in males

A

15-17 years old

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17
Q

Growth plate is stronger or weaker than solid bone?

A

Weaker

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18
Q

Injury to growth plate interferes with what?

What can occur ?

A

Growth- deformities

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19
Q

Injury’s in growth plates may cause what deformities

A

Long bone shorter than the other or crooked

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20
Q

During birth children can have fractures to what

A

Collar bone (clavicle )

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21
Q

Crawling and walking starts when? May be inflicted injury or fracture if occur before when?

A

14-15 months

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22
Q

Where should bruises be on children associated with self injury? Falls

A

Knees , ankles, elbows

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23
Q

Stress injuries are common in who

Due to what?

A

Adolescents

Gymnastics/ sports

Low vitamin D levels - relates to bone structure

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24
Q

Type of fracture where surgery is required and patient is at greatest risk for infection

A

Open fracture

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25
Q

Fracture - no breaks in skin, provider can align the fracture together and manually manipulate it

A

Closed fracture

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26
Q

Children commonly have what type of fractures

S/s

A

Green stick - bone bent with fracture but not crossing through the bone.

(One side (half) of the bone is broken and the other is just bent) these fractures cause minimal pain, swelling, or deformity, the usual hallmarks of a fracture.

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27
Q

What to asses in a bone break?

A

Neurovasvular assessment

Sensation - touch pressure
Skin temp- cold or warm (cold no perfusion)
Color -normal bilateral
Cap refill - be concerned if greater than 3 seconds
Pulse- equal bilaterally - May use Doppler in BLE
Movement -

CWEM

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28
Q

Cast education

A

Elevate extremity for the first 24 hr with pillows to decrease edema (a little edema is normal)

Avoid intending cast

Check for swelling and discoloration

Observe for sensation and movement

Warmth - of no sensation or unable to move contact health care provider

Activity restrictions depend of the break

Limb should not be in a dependent position

Do not put anything inside cast- if anything stuck inside- cut it and reapply

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29
Q

Because children experience falls during their growth years, fractures of long bones are common childhood injuries. Fractures in children tend to be different than in adults because:

A

●Bone in childhood is fairly porous, allowing bones to bend rather than break.
●The periosteum is thick, so the bone may not break all the way through.
●Epiphyseal lines may cushion a blow so that the bone does not break.
●Healing is rapid as a result of overall increased bone growth.

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30
Q

Bone Bends causing a microscope fracture line that does not cross the bone, most common in the ulna and fibula

A

Plastic deformation (bend)

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31
Q

Fracture on the tension side of the bone near softened metaphyseal bone causing a buckling and raised area on the harder diaphyseal (opposite side)

A

Buckle (torus)

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32
Q

When the bone is divided either way, laterally or transverse, slanted, or straight, spiral or circular, bone remains possibly attached by a periosteal hinge

A

Complete fracture

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33
Q

• Elevate the extremity with the cast on pillows for at least the first 24 hours
●• Avoid indenting the cast.
●• Assess the extremity for swelling and discoloration.
●• Observe the extremity for sensation and movement.
●• Notify a health-care professional immediately if abnormalities are noted.
●• Follow activity restrictions.
●• Do not allow the affected limb to hang down for any length of time.
●• Prevent the child from putting anything inside the cast.
●• Keep a clear path for ambulation.
●• Ensure the child uses crutches appropriately.

A

Casting education

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34
Q

What is the purpose of traction?

A

Pulling force to reduce a fracture, maintain alignment, and provide muscle rest prior to surgery

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35
Q

What is the care for a patient in traction?

A

TRACTION

Temperature (infection?)
Ropes hanging freely 
Alignment- after repo 
Circulation check (5 p’s)
Type of location of fracture
Increase fluid intake/nutrition 
Overhead trapeze-position 
No weights on bed or floor- hang freely
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36
Q

Type of traction?
●Buck, Russel, Bryant
●Tape/Straps applied to skin with cuffs or boots
●Weights are applied by rope to the boots or cuffs to edge of bed over a bar

A

Skin traction

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37
Q

Type?
●Pin or rod inserted through bone
●Nurses do not touch weights

Be very careful about repo and alignment of patient/ bone

Pin site care

A

●Skeletal Traction

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38
Q

Type?

Neck injury
Pins put into scalp to hold halo in place
●Maintain body alignment
●Pin site care

A

Halo Traction

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39
Q

A nurse is caring for child who is in skeletal traction. Which of the following actions should the nurse take?

A

C.Assess the child’s position frequently

D.Assess pin sites every 4 hours

E.Ensure the weights are handing freely

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40
Q

What tractions are Important to complete pin site care

A

Halo and skeletal traction

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41
Q

A complication of fracture where.. Compression of the nerves, muscles occur as well as the blood vessels in a confined space which leads to Neuromuscular ischemia (nerve damage)

increased pressure within one of the body’s anatomical compartments (leg or arm) results in insufficient blood supply to tissue within that space. Resulting in Pain, numbness, pallor, decreased ability to move the affected limb

A

Compartment syndrome

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42
Q

What is the s/s of compartment syndrome

Five Ps

A 
Pain- that is unrelieved 
Pallor - cold and cyanotic skin 
Pulselessness - distal to the fracture 
Paresthesia - or numbness 
Paralysis -unable to move digits
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43
Q

Complication that Commonly occurs after fracture of the long bones if they do not heal in their own (which they usually do)

What long bones?

A

Fat embolism

such as femur, tibia, pelvis

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44
Q

Complication of fracture where if you have a break in the Skin you have an increased chance of infection

Can be unidentified because some people don’t have s/s of infection

Very common in children and older adults that are immunocompromised.

A

Osteomyelitis

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45
Q

Symptoms of osteomyelitis

A

Fever

Swelling, redness, warmth over area/infection

Pain to site

Overall fatigue

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46
Q

A complex Muscoskeletal deformity of the ankle and foot

A

Talipes deformities- clubfoot

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47
Q

●Assessment and diagnostic testing to detect this disorder?

A

●Assessment: straighten all newborn feet to the midline as part of the initial assessment to detect this disorder.

●Prenatal ultrasounds also provide data for identification

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48
Q

Treatment of Club Foot

Nursing care-

A

●Castings starting shortly after birth
●Weekly manipulation of the foot into aligned position, cast is modeled around the heel while the four foot Is abducted and the knee is flexed to a 90 degree angle

●Denis Browne splint – has to leave it on for 23 hours a day, should take it off for an hour at a time at least once a day.
●DB may be recasted 7 times with in three years to fix the club foot -shoes are attached to a metal bar to maintain position

Nursing care- encourage breastfeed (good nutrition)
Be sure proper position with splint - cross cradle hold - mom holds babies head next to one arm and their feet to the other arm

Hold in football position where head is next to breasts and feet are touched behind mom or to the side of mom

Teach mom about skin breakdown, sensation, movement

Frequent assessments when it comes off at least an hour every day

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49
Q

Risk factors of club foot

A

Diagnosed during infancy

Can be genetic

Identical twins may have greater chance

Position of fetus in uterus

Planter flexed, inverted heel, objected four foot, rigid and cannot be manipulated to a neutral position

50
Q

Non painful complex lateral deformity/curvature of the spine that also causes rib asymmetry due to spinal rotation -

most common spinal deformity in children

(May see one leg shorter then the other)

Shape of spine?

A

Scoliosis

S or C shaped - lateral deviation on each vertebrae

51
Q

When is scoliosis commonly identified

When does it start to become a problem ? When they need surgery??

What happens after surgery of this?

A

Elementary school

During large growth spurts - around puberty (8-15 yo) pressure pushes against thoracic cavity- this is when surgery is needed

They won’t grow any more- need to determine if benefits outweigh the risks

52
Q

Which test identifies scoliosis ?

A

Adams test

53
Q

What is used to measure extent of spinal curve?

What reading indicates a scoliotic curve

A

Scoliometer -

A reading greater than 7 equals a 20 degree scoliotic curve detected by an X-ray

54
Q

What to determine with an adams test

A

Is the head level Centered over the trunk

Are the shoulders the same height

Are the hips at the same level

When bent forward with arms drop in toward feet, is rib cage level on both sides?

55
Q

Tx of scoliosis

●Curve less than 20 degrees?

●Curves between 20-40

●Curves greater than 40 degrees

●Severe cases greater than 80 degrees

A

Look at child through out growth and make sure are growing

Well being vs growth determines surgery or not

●Curve less than 20 degrees requires no immediate interventions, just close monitoring.
●Curves between 20-40 degrees require a back brace and possibly surgery.
●Provide emotional support, especially regarding low self-esteem and concerns about body image

●Curves greater than 40 degrees may require surgery with spinal fusion

●Severe cases greater than 80 degrees may require halo traction
●Promote positive aspects of this intervention to parents and children

56
Q

When body excretes too much protein in the urine and damage to the small blood vessels in the kidneys that filter waste

A

Nephrotic syndrome

57
Q

Nephrotic s/s

A

Swelling in feet and ankles

Neuropathy (bergers disease)- primary cause of glomerulonephritis

Oliguria

HTN

Hematuria (dark urine)

Fatigue

Loss of appetite

Inflammation of the glomeruli - unable to filter blood properly (clots) due to loss of blood protein -which can result in malnutrition, HTN (build up in blood), damage to the glomeruli, and damage to kidney/ kidney failure

Hypoalbuminemia

Hyperlipemia

Proteinuria

Hyperlipidemia

58
Q

How to tx nephrotic syndrome

A

Figure out why you have the inflammation and tx underlying problem

Medications

Dietary changes

59
Q

Nephrotic syndrome can do what to the body

A

can increase Infection and blood clots

60
Q

Caused from streptococcus strep infection

Can result if strep is not treated about a week after

A

Acute glomerulonephitis

61
Q

S/s of acute glomerulonephritis

A 
Dark urine 
Decreased urine output 
Sore throat
Fatigue 
Lethargy 
Increased breathing 
Headache 
HTN
Rash over butt and legs 
Wt loss 
Joint pain 
Pallor skin 
Fever
62
Q

How to dx acute glomerulonephritis

A

Throat and urine culture

63
Q

Tx of acute glomerulonephritis

A

Restrict fluids to allow for kidneys to rest
Decrease protein

Decrease salt

Manage BP

Dialysis?

64
Q

How to know if acute glomerulonephritis is resolving ?

A

When urine output increases

65
Q

Most common cause of acute renal failure

Thrombocytopenia (low platelets)

Hemolytic anemia

Almost always follows some sort of infectious agent such as e-coli —-> shingra like toxin (verotoxin) In GI

Breakdown of RBC that clots your kidneys

A

Hemolytic uremic syndrome (HUS)

66
Q

S/s of Hemolytic uremic syndrome (HUS)

A 
Loss of appetite 
Abd pain 
Fever 
Seizures 
Lethargy 
Bloody diarrhea
67
Q

Hemolytic uremic syndrome (HUS) parental education

A

Avoid undercooked foods

Make sure kids don’t drink pool water

Watch when swimming in lakes

68
Q

Hemolytic uremic syndrome (HUS) nursing care

A

Fluid volume assessment is very important

Mainly supportive care

Give IV fluids

plasmapheresis/Supplements via IV or tube feeding

Blood transfusion

Dialysis

NO antibiotics because it will slow down GI mobility (need to speed up to get rid of toxin) and they retain the toxins

69
Q

Dialysis tx that uses the lining of the abdomen

Cleans the blood with a cleaning solution called what? (absorbs waist and fluid from the blood using the peritoneum as a filter

A

Peritoneal dialysis

Desolate

70
Q

Peritoneal dialysis complications - bacteria that gets into cathedar incision

Can lead to great infection

A

Peritonitis

71
Q

How to prevent Peritonitis

A

Good hand hygiene

Use clean cathedars

72
Q

An anatomical Birth defect/condition in which the urethra opening of the penis is on the underside rather than the tip.

is a congenital condition where the opening of the penis is on the underside of the organ. This condition is more common in infants with a family history of hypospadias.

A

Hypospadias

73
Q

Very rare - urethra opening is at top Of penis

Children who have this are not circumcised (which helps to fix these defects)

A

Epispadias

74
Q

When are penis defects fixed?

A

After 6 months of age - circumsicion tissue can be used to fix the defects

Does not effect baby until potty training

75
Q

Inflammation or infection of vulva and vaginal tissues

Can cause discomfort , pain, itching , irritation, burning with urination

A

●Vulvovaginitis

76
Q

What to report as parent with vulvovaginitis , odor, redness of vulva

A

Discharge in diaper or underwear

77
Q

Parent teaching in vulvovaginitis

What to do?

Causes?

Tx?

A

●Client Education: proper bathroom hygiene. wipe from front to back Wearing loose-fitting cotton underwear can keep the infection from occurring again.

Causes : Typically in young girls- neutral PH in girls, no pubic hair yet- pubic hair protects it, may be caused from irritation soaps and bubble baths

●Vulvovaginitis in children can be treated with daily bathing, steroids, and low-dose, topical antibiotics.

78
Q

●Blood is composed of what 2 parts –

A

fluid (plasma) and the cellular portion

79
Q

Solutes in blood plasma include what?

Cellular portion is what formed elements ?

A

●Solutes in plasma include albumin, electrolytes, proteins, clotting factors, fibrinogen, globulins, and circulating antibodies

●Cellular portion is formed elements
●RBCs
●WBCs
●platelets

80
Q

Blood issues can be due to what

A

Injury
Hematologic complications genetics
Infection
Congenital problem

81
Q

Very common blood issue in children

A

Iron deficiency anemia

82
Q

What does iron deficiency anemia affect in kids

A

Growth and development

83
Q

S/s of anemia

A 
Fatigue 
Headache 
Dizziness 
Weak 
Difficult concentrating 
Irritability

Motor development
Tachycardia

Sob 
Decreased activity 
Pallor
Lisp 
Murmur 
Congestive heart failure 
Low BP
Palpitations 
Pale 
Yellow skin 
Cold 
Yellow eyes 
Redness in severe anemia 
Patomegly 
Enlarged spleen 
Changed color in BM

Fainting
Chest pain (no oxygen / dehydration)
Angina
Heart attack

84
Q

When we don’t have enough iron we don’t make enough what?

A

Hemoglobin/ oxygen in cells (labs)

85
Q

Who is at highest risk for iron deficiency?

A

Premies (decreased iron supply)

86
Q

Causes of iron deficiency anemia

A

Decreased iron supply

Increased iron demands

Blood loss

Acute and chronic parasite infection , GI tract

Inability to form hemoglobin
Impaired absorption

Malabsorption

87
Q

Teaching/ care/ education to prevent iron deficiency anemia

A

Prevention

Feed iron rich foods (beans, meat, cereals, eggs, green leafy veggies , nuts, whole grains

Feed infant breast milk or commercial infant formula for first 12 months of life (stopping to early may cause)

Don’t give formula that is non iron fortified

Iron fortified cereal from 6-12 months

Cows milk after 12 months of life, but limit to 18-24 oz per day - more than 2 cups daily may cause

Offer solid foods before giving a bottle - don’t prolong bottle feeding

88
Q

Normal new born hemoglobin

Teenager normal?

A

11-7-18.6

10.7-15.7

89
Q

Understand a patient with iron deficiency anemia may be fatigued and that clustering care is important

A

True

90
Q

One of the most common types of anemia genetic condition where red blood cells are creasant shaped and can get stuck in the vascular system

A

Sickle cell anemia

91
Q

How is sickle cell transferred

A

??

34 min - first video slide 28

Genetic hematological condition transported via an autosomal recessive pattern of inheritance

92
Q

Sickle cell s/s

A

●Large amount of hemoglobin S and
decrease in O2 levels, abnormal hemoglobins clump together within the cell and change the shape from donut-like to a sickled shape resulting in tissue ischemia and fragility of the sickled cell
●If there are occlusions because RBCs cannot circulate – ischemia, infarcts and possible tissue death
●Infants under 6 months of age are often asymptomatic

Weakness
Pallor
Fatigue
Tissue hypoxia - due to RBC breakdown

93
Q

●Abnormal vascular coagulation process Secondary to underlying disease

Can result from any bacterial infection that leads to sepsis or any traumatic injury
●excessive stimulation of normal coagulation that results in microthrombi.

  • result more coagulation factors and platelets are consumed and produced.
  • destruction of platelets and coagulation factors resulting in hemorrhaging and thrombosis.
A

DIC disseminated intravascular coagulation

94
Q

DIC disseminated intravascular coagulation

s/s ?

Tests?

Care?

A

●s/s – May initially have petechiae or purpura, hypotension,
excessive bleeding from orifices such as mouth, IV site, nose or from other locations because of minor procedures, hematomas, can result in end organ failure

No definitive tests- based on presenting factors

●Collaborative care – assess and provide supportive care. Monitor for hemorrhage, bleeding, petechia, cutaneous oozing, dyspnea, lethargy, pallor, increased Hr, decreased bp, headache, dizziness, muscle weakness and restlessness. Also monitor for internal bleeding. Administer blood and factor products

95
Q

●Absolute neutrophil count is less than 1,000mcl in infants less than 1 year and 1,500 for those over a year

A

Neutropenia

96
Q

Neutropenia

S/s?

Dx?

Care?

Pt. Education?

A

●s/s – fever, lymphadenopathy, organomegaly, pallor, bruising, petechiae

●Diagnosis – meticulous history, cbc with differential and a peripheral smear.
Bone marrow aspirate or biopsy

97
Q

Why does sickle cell not support hemoglobbin and oxygenation to the cells or vascular system

The cells have a hard time circulating

A

The creasent shape

98
Q

Average lifespan on sickle cells -short

A

8-21 days

99
Q

How to diagnose sickle cell anemia

A

Assessment of genetics

Noting joint pain and chronic fatigue

100
Q

Newborn screening that all children have at 24 hour of age

A

Sickle cell anemia is one that is tracked - when parents will find out

101
Q

Why do sickle cell patient have pain in joints?

A

The cells jam up in joints and cause pain

102
Q

Sickle cell anemia tx

A

Hydration
Pain management
Warm compress to joints

103
Q

Inherited blood disorder

No cure

Absents or deficiency of factor 8&9 and plasma protein for normal blood clotting - coagulation can not be completed for bleeding is prolonged - NOT faster- just longer

Sex linked - recessive- mother is a carrier of deficiency - sons are affected

A

Hemophilia

104
Q

S/s of hemophilia

A 
Persistent /prolonged bleeding 
Unusual easily bruising 
Oozing after circumcision 
Intercrainial hermmorage In neonates 
Soft tissue bleeding
Stiffness or warm swelling in joints with movement
Decreased ROM or painful joints 
Visual disturbances

Most children are afraid of the symptoms until they beginning crawling or walking

May have extreme bleeding after loosing teeth in older children

105
Q

Life expectancy of hemophilia

A

Depends on amount of bleeding and ability to control bleeding

106
Q

Teachings with hemophilia

A

No cure

Avoid injury or meds that promote bleeding

Eat good nutrition

Good dental hygiene

IV administration of Deficient clotting factor

Predominantly in males

107
Q

Equally common in males and females
most common inherited bleeding disorder

Nosebleeds (Epistaxis), heavy vaginal bleeding (menorrhagia)during menstraution , GI bleeding

Bleeding of oral cavity

Easy bruising from normal care

Acts are a carrier protein for factor 8 in plasma

type 1 defIciency of WF is most common type

VWF helps with platelet aggregation and adhesion to damaged endothelium

A

Von willebrand disease

108
Q

Pt with hemophilia and Von willebrand disease need to wear what

A

Medical alert bracelets

109
Q

Tx for Von willebrand disease

A

Desmopressin

Cryoprecipitate

110
Q

Type 2 Von willebrand disease

Type 3?

Tx?

A

Abnormal and dysfunctional vwf

VWF is absent

Actor eight concentrate or cryoprecipitate

111
Q

●Collaborative care
●Pt Education

Of neutropenia

A

Protect patient from others/illness

No fresh fruits or veggies- cooked to reduce bacteria

No plants in room

112
Q

What info we need prior to give blood in patients

A

Informed consent is always needed *

Who patient is / ID *

Check labels on blood bag and blood bank transfusion record

Baseline vitals

Allergies *

Prepare Normal saline IV solution

Previous blood transfusion reactions? *

*check cross match

113
Q

After getting blood from blood bank start with In how long for how long maximum?

A

After getting blood from blood bank start with in 30 minutes

And run no longer than 4 hours

114
Q

How to give Blood on tubing ?

A

All blood should be on its own tubing - don’t add any medications to blood products

Set administration with filter

Change tubing after 4 hours

18G or 20G needle

115
Q

When do severe reactions to blood transfusions most likely occur

A

Within the first 15 min and first 50cc’s

116
Q

How to check blood transfusion crossmatch

A

Record with two nurses

Check blood type: ABO- group 
determine RH-type 
Check Clients name 
Check ID blood band 
Check Hospitals #
check Expiration date
117
Q

If someone has an allergic reaction to blood transfusion what to do?

A

Immediately stop it and run normal saline through

118
Q

How to known if one is having an allergic reaction to blood transfusion?

Stay with patient and frequent monitor and vitals

When do reactions normal occur?

A

2% increase in temp/fever/chills
Tachycardia
Increased resp
Hypotension

Chest pain 
Low back pain 
Anxiety 
Apprehension 
Hives 
Puritis 
Itchy 
Flushing 
Swelling to face 
Shaking 
Vomiting 
Dry cough 
Difficulty breathing 
Rales 
headache

With in first 10-15 min or first 50 ccs

119
Q

Do not warm blood unless?

A

Risk of hypothermic response then only by specific blood warming equipment

120
Q

How long to infuse each unit of blood ?

A

Infuse each unit over 2-4 hours but no longer than 4 hours

maternal child health RN (15 decks)

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