Musculoskeletal, Genitourinary, hematological final Flashcards
How many bones are there and how are they connected to body?
200 bones connected by the joints and tendons protects internal organs in the body
Supplies the body with RBC and WBC in bone marrow
Muskoskeletal system
Prenatal health for the muscoskeletal system - bone development
High calcium - used in main embryonic period for bone development and helps as child grows
Vitamin D
, minerals
Vitamin c
Iron
Protein
parathyroid hormone in muscoskeletal system which helps with overall absorption and remodeling of the body
Calcitonin
Examples of protein
Meat Fish Beans/ peas Tofu Milk Yogurt Cheese
Iron food examples
Liver Chuck Cereal Kidney beans lentils
Calcium foods
Milk Yogurt Cheese Ice cream Spinach
Vitamin d examples
UV light
Salmon
Tuna
Vitamin c examples
Orange juice Green pepper Strawberries Broccoli Kiwi Orange
When are most muscoskeletal disorders first noticed?
during Routine physical exams
When is scoliosis assesses for
Elementary school
How to diagnose muscoskeletal issues in kids
History
Diagnostic tests
S/s of muscoskeletal issues in children
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
Open growth plates vs closed in children
Open means child will continue to grow
When do growth plates close in females
13-15 years of age
When rowdy plates close in males
15-17 years old
Growth plate is stronger or weaker than solid bone?
Weaker
Injury to growth plate interferes with what?
What can occur ?
Growth- deformities
Injury’s in growth plates may cause what deformities
Long bone shorter than the other or crooked
During birth children can have fractures to what
Collar bone (clavicle )
Crawling and walking starts when? May be inflicted injury or fracture if occur before when?
14-15 months
Where should bruises be on children associated with self injury? Falls
Knees , ankles, elbows
Stress injuries are common in who
Due to what?
Adolescents
Gymnastics/ sports
Low vitamin D levels - relates to bone structure
Type of fracture where surgery is required and patient is at greatest risk for infection
Open fracture
Fracture - no breaks in skin, provider can align the fracture together and manually manipulate it
Closed fracture
Children commonly have what type of fractures
S/s
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.
What to asses in a bone break?
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
Cast education
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
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:
●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.
Bone Bends causing a microscope fracture line that does not cross the bone, most common in the ulna and fibula
Plastic deformation (bend)
Fracture on the tension side of the bone near softened metaphyseal bone causing a buckling and raised area on the harder diaphyseal (opposite side)
Buckle (torus)
When the bone is divided either way, laterally or transverse, slanted, or straight, spiral or circular, bone remains possibly attached by a periosteal hinge
Complete fracture
• 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.
Casting education
What is the purpose of traction?
Pulling force to reduce a fracture, maintain alignment, and provide muscle rest prior to surgery
What is the care for a patient in traction?
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
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
Skin traction
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
●Skeletal Traction
Type?
Neck injury
Pins put into scalp to hold halo in place
●Maintain body alignment
●Pin site care
Halo Traction
A nurse is caring for child who is in skeletal traction. Which of the following actions should the nurse take?
C.Assess the child’s position frequently
D.Assess pin sites every 4 hours
E.Ensure the weights are handing freely
What tractions are Important to complete pin site care
Halo and skeletal traction
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
Compartment syndrome
What is the s/s of compartment syndrome
Five Ps
Pain- that is unrelieved Pallor - cold and cyanotic skin Pulselessness - distal to the fracture Paresthesia - or numbness Paralysis -unable to move digits
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?
Fat embolism
such as femur, tibia, pelvis
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.
Osteomyelitis
Symptoms of osteomyelitis
Fever
Swelling, redness, warmth over area/infection
Pain to site
Overall fatigue
A complex Muscoskeletal deformity of the ankle and foot
Talipes deformities- clubfoot
●Assessment and diagnostic testing to detect this disorder?
●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
Treatment of Club Foot
Nursing care-
●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
Risk factors of club foot
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
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?
Scoliosis
S or C shaped - lateral deviation on each vertebrae
When is scoliosis commonly identified
When does it start to become a problem ? When they need surgery??
What happens after surgery of this?
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
Which test identifies scoliosis ?
Adams test
What is used to measure extent of spinal curve?
What reading indicates a scoliotic curve
Scoliometer -
A reading greater than 7 equals a 20 degree scoliotic curve detected by an X-ray
What to determine with an adams test
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?
Tx of scoliosis
●Curve less than 20 degrees?
●Curves between 20-40
●Curves greater than 40 degrees
●Severe cases greater than 80 degrees
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
When body excretes too much protein in the urine and damage to the small blood vessels in the kidneys that filter waste
Nephrotic syndrome
Nephrotic s/s
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
How to tx nephrotic syndrome
Figure out why you have the inflammation and tx underlying problem
Medications
Dietary changes
Nephrotic syndrome can do what to the body
can increase Infection and blood clots
Caused from streptococcus strep infection
Can result if strep is not treated about a week after
Acute glomerulonephitis
S/s of acute glomerulonephritis
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
How to dx acute glomerulonephritis
Throat and urine culture
Tx of acute glomerulonephritis
Restrict fluids to allow for kidneys to rest
Decrease protein
Decrease salt
Manage BP
Dialysis?
How to know if acute glomerulonephritis is resolving ?
When urine output increases
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
Hemolytic uremic syndrome (HUS)
S/s of Hemolytic uremic syndrome (HUS)
Loss of appetite Abd pain Fever Seizures Lethargy Bloody diarrhea
Hemolytic uremic syndrome (HUS) parental education
Avoid undercooked foods
Make sure kids don’t drink pool water
Watch when swimming in lakes
Hemolytic uremic syndrome (HUS) nursing care
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
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
Peritoneal dialysis
Desolate
Peritoneal dialysis complications - bacteria that gets into cathedar incision
Can lead to great infection
Peritonitis
How to prevent Peritonitis
Good hand hygiene
Use clean cathedars
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.
Hypospadias
Very rare - urethra opening is at top Of penis
Children who have this are not circumcised (which helps to fix these defects)
Epispadias
When are penis defects fixed?
After 6 months of age - circumsicion tissue can be used to fix the defects
Does not effect baby until potty training
Inflammation or infection of vulva and vaginal tissues
Can cause discomfort , pain, itching , irritation, burning with urination
●Vulvovaginitis
What to report as parent with vulvovaginitis , odor, redness of vulva
Discharge in diaper or underwear
Parent teaching in vulvovaginitis
What to do?
Causes?
Tx?
●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.
●Blood is composed of what 2 parts –
fluid (plasma) and the cellular portion
Solutes in blood plasma include what?
Cellular portion is what formed elements ?
●Solutes in plasma include albumin, electrolytes, proteins, clotting factors, fibrinogen, globulins, and circulating antibodies
●Cellular portion is formed elements
●RBCs
●WBCs
●platelets
Blood issues can be due to what
Injury
Hematologic complications genetics
Infection
Congenital problem
Very common blood issue in children
Iron deficiency anemia
What does iron deficiency anemia affect in kids
Growth and development
S/s of anemia
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
When we don’t have enough iron we don’t make enough what?
Hemoglobin/ oxygen in cells (labs)
Who is at highest risk for iron deficiency?
Premies (decreased iron supply)
Causes of iron deficiency anemia
Decreased iron supply
Increased iron demands
Blood loss
Acute and chronic parasite infection , GI tract
Inability to form hemoglobin
Impaired absorption
Malabsorption
Teaching/ care/ education to prevent iron deficiency anemia
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
Normal new born hemoglobin
Teenager normal?
11-7-18.6
10.7-15.7
Understand a patient with iron deficiency anemia may be fatigued and that clustering care is important
True
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
Sickle cell anemia
How is sickle cell transferred
??
34 min - first video slide 28
Genetic hematological condition transported via an autosomal recessive pattern of inheritance
Sickle cell s/s
●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
●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.
DIC disseminated intravascular coagulation
DIC disseminated intravascular coagulation
s/s ?
Tests?
Care?
●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
●Absolute neutrophil count is less than 1,000mcl in infants less than 1 year and 1,500 for those over a year
Neutropenia
Neutropenia
S/s?
Dx?
Care?
Pt. Education?
●s/s – fever, lymphadenopathy, organomegaly, pallor, bruising, petechiae
●Diagnosis – meticulous history, cbc with differential and a peripheral smear.
Bone marrow aspirate or biopsy
Why does sickle cell not support hemoglobbin and oxygenation to the cells or vascular system
The cells have a hard time circulating
The creasent shape
Average lifespan on sickle cells -short
8-21 days
How to diagnose sickle cell anemia
Assessment of genetics
Noting joint pain and chronic fatigue
Newborn screening that all children have at 24 hour of age
Sickle cell anemia is one that is tracked - when parents will find out
Why do sickle cell patient have pain in joints?
The cells jam up in joints and cause pain
Sickle cell anemia tx
Hydration
Pain management
Warm compress to joints
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
Hemophilia
S/s of hemophilia
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
Life expectancy of hemophilia
Depends on amount of bleeding and ability to control bleeding
Teachings with hemophilia
No cure
Avoid injury or meds that promote bleeding
Eat good nutrition
Good dental hygiene
IV administration of Deficient clotting factor
Predominantly in males
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
Von willebrand disease
Pt with hemophilia and Von willebrand disease need to wear what
Medical alert bracelets
Tx for Von willebrand disease
Desmopressin
Cryoprecipitate
Type 2 Von willebrand disease
Type 3?
Tx?
Abnormal and dysfunctional vwf
VWF is absent
Actor eight concentrate or cryoprecipitate
●Collaborative care
●Pt Education
Of neutropenia
Protect patient from others/illness
No fresh fruits or veggies- cooked to reduce bacteria
No plants in room
What info we need prior to give blood in patients
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
After getting blood from blood bank start with In how long for how long maximum?
After getting blood from blood bank start with in 30 minutes
And run no longer than 4 hours
How to give Blood on tubing ?
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
When do severe reactions to blood transfusions most likely occur
Within the first 15 min and first 50cc’s
How to check blood transfusion crossmatch
Record with two nurses
Check blood type: ABO- group determine RH-type Check Clients name Check ID blood band Check Hospitals # check Expiration date
If someone has an allergic reaction to blood transfusion what to do?
Immediately stop it and run normal saline through
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?
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
Do not warm blood unless?
Risk of hypothermic response then only by specific blood warming equipment
How long to infuse each unit of blood ?
Infuse each unit over 2-4 hours but no longer than 4 hours
