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Peds Exam 4 > Musculoskeletal/Neuromuscular > Flashcards

Musculoskeletal/Neuromuscular Flashcards

1
Q

What is developmental hip dysplasia?

A

A abnormality of the hip joint associated with hip dislocation

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2
Q

Causes of hip dysplasia?

A

Idiopathic - no known cause
Teratologic - genetic abnormality
Breech position

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3
Q

What birthing position can cause hip dysplasia?

A

Breech position due to the legs being first.

- 17-23% of cases

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4
Q

Swaddling technique to prevent hip dysplasia?

A

Hips in slight flexion and abducted

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5
Q

Types of Hip dysplasia

A

Acetabular
Subluxation
Dislocation

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6
Q

Acetabular Dysplasia

A

Mildest form of hip dysplasia. The ball is in the socket, but doesn’t fit right. Not an actual dislocation

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7
Q

Subluxation Dysplasia

A

Most common form of hip dysplasia.

An incomplete dislocation due to stretched capsule and round ligament

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8
Q

Dislocation Dysplasia

A

The femoral ball in not in contact with the acetabulum so completely disclocted

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9
Q

What is the optimal age for diagnosis of hip dysplasia

A

Newborn age

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10
Q

Four signs of hip dysplasia

A

Limited hip movement
Shorter leg
Ortoloni test positive
Asymmetrical gluteal/thick folds

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11
Q

Diagnostic tests done for hip dysplasia in older kids?

A

Ultrasound for young infants (not newborn)

Xray for infant or child

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12
Q

When assessing for hip dysplasia, what is important?

A

Someone who is well trained needs to be doing the assessments and diagnostic as to not make the hip function worse

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13
Q

How is treatment picked for hip dysplasia?

A

Based off severity but also age of the client

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14
Q

0-6 months old Hip dysplasia treatment

A

Pavlik Harness to prevent adduction from 3-5 months

Hip Spica for 3-6 months

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15
Q

6-18 months old Hip dysplasia treatment

A

Closed or open reduction + casting

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16
Q

18 months + older children Hip dysplasia treatment

A

Surgical correction followed by casting

- the older the kid, the more need for surgery

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17
Q

Who is allowed to adjust the Pavlik harness straps?

teachings?

A

Professionals only. Parents should be educated on how they work, but professional need to size the straps correctly.

How to change diapers

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18
Q

What should be monitored with skin when using Pavlik harness? Can anything go underneath the straps?

A

Skin integrity due to the straps rubbing and putting pressure

Clothing can go underneath straps but parents should be educated that this may make the child have unwanted attention

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19
Q

Assessment done after putting on a spica cast ?

Teachings?

A

Make sure the child can breath properly

Teach tricks to change diapers

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20
Q

Why do we need to explain to parents that follow up for hip dysplasia treatment is SO important?

A

Follow up is important for sizing purposes of the devices. Infants grow extremely fast so serial appts may be needed

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21
Q

Things to check for child with hip spica cast on?

A

Distal pulses
Sensation
Movement

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22
Q

How can we alter the spica cast to protect the skin?

A

Petal the edges

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23
Q

Overall education for parents when dealing with spica cast?

A

Cast and skin integrity/hygiene are important.
Frequent follow up appts are likely.
Want to make sure child doesn’t put any sharp objects down the cast

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24
Q

What is congenital Clubbed foot?

A

Talipes Equinovarus or when there is malpositioning of foot that involves the bones

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25
Q

How is clubbed foot diagnossed?

A

Visual assessment on someone who is already born

Could be seen on ultrasound though if baby is in utero

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26
Q

Treatment for mild clubbed foot

A

Exercise manipulation

  • if alignment is not achieved by 3 months, will need surgery.
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27
Q

Treatment for more severe clubbed foot

A

1) Serial casting in the 8-12 weeks old range
2) Followed up with heel-cord tenotomy
3) And lastly leg cast for 3 weeks

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28
Q

What are Denis Brown splints?

A

Splints with shoes attacked that some people with clubbed foot may need after surgery or exercise manipulation to keep the legs aligned

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29
Q

What is Legg Calve Perthes disease?

What age?

A

Idiopathic necrosis of the femoral head of children aged 2-12 (avg is 6)

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30
Q

How many stages are there of Legg Calve Perthes?

A

Four

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31
Q

Stage 1 of Legg Calve Perthes

A

Flattening of the upper surface of femoral head 6-12 months

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32
Q

Stage 2 of Legg Calve Perthes

A

Revascularization of femoral head that has

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33
Q

Stage 3 of Legg Calve Perthes

A

New bone starts to repair itself

  • could go on for years
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34
Q

Stage 4 of Legg Calce Perthes

A

The new femoral head is reformed

  • could go on for years
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35
Q

Signs of Legg Calve Perthes

A

Limping in the morning or at night
Pain from hip to the knee
Stiffness
Limited ROM

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36
Q

Diagnostic testing for Legg Calve Perthes?

A

MRI

Xray

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37
Q

Treatment goal of Legg Calve Perthes

A

Keep head of the femur in the acetabulum
Keep head rounded
Decrease irritability
Restore ROM

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38
Q

What type of of activity can kids with Legg Calve Perthes do?

A

They need to be resting and doing non-weight bearing activity. So things like ROM exercises are good.

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39
Q

What is a conservative treatment of Legg Calve Perthes like?

A

Abduction casts/brace

- could take 2-4 years to see results

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40
Q

What is an aggressive treatment of Legg Calve Perthes like?

A

Surgical approach and can get back to normal stuff maybe 3 months later
- this one is more likely due to the lesser amount of time needed for results

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41
Q

Developmental concerns for Legg Calve Perthes?

A

You want the child to be able to fit in and remain active.

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42
Q

Things the nurse will have to take care of after surgical construction with Legg Calve Perthes? Assessments done too?

A

Care of the cast, wound, and drains (and teach how to do this with patients)

Neuromuscular assessment
Pain management

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43
Q

What is the disorder of Slipped Femoral Capital Epiphysis called?

A

When the proximal epiphyses spontaneously becomes displaced and so there is a widened growth plate and irregular metaphysis

44
Q

When does the slipped femoral capital epiphysis usually occur?

A

Usually occurs during puberty or growth spurt

- boys 13, girls 12

45
Q

What can slipped femoral capital epiphysis be associated with?

A

Endocrine issues

Radiation issues from therapy that the child may have had to have done

46
Q

What type of kids usually have the slipped femoral capital epiphysis?

Can this happen to both hips?

A

Boys
Obese kids

Yes it can. 60% actually

47
Q

Signs and symptoms of slipped femoral capital epiphysis

A

Gradual disability of the hip to where you can’t internally rotate or move it out and you’ll limp
There will also be pain that may come and go

48
Q

How will they diagnose slipped femoral capital epiphysis?

A

Xray

49
Q

Activity level for kid with slipped femoral capital epiphysis?
How might they take pressure off and stretch the joint before surgery?

A

Non-weight bearing

Traction done pre-operatively

50
Q

What is surgery like for a slipped femoral epiphysis?

What will post-op conditions of activity be like?

A

Pin/screw placement and osteotomy for shape correction

Non-weight bearing activities and will have to use crutches until painless ROM can be achieved

51
Q

What is idiopathic scoliosis

A

Lateral curve in the spine

52
Q

When/who does scoliosis occur in

A

Those going through puberty

And those with neuromuscular disorders

53
Q

When does scoliosis screening start

A

Around 10-12 in girls
13-14 boys
puberty

54
Q

How might clothes fit in scolioisis

A

uneven fit especially of the bottoms

55
Q

What will a scoliosis back look like

A

Uneven scapula , shoulder higher, and hip height is off

56
Q

What will scoliosis back look like when a child bends over?

A

The torso is asymmetrical along with the flank and ribs

57
Q

What does scoliosis do to other body systems?

A

The pulmonary and cardiovascular systems will be compromised

58
Q

How id scoliosis diagnosed?

A

Xray
Risser scale - bone maturity
Cobb technique - degree of curve

59
Q

Risser scale

A

Bone maturity test used for those who have scoliosis

60
Q

Cobb technique

When is treatment done for scoliosis of these levels?

A

For scoliosis but determine curve degree

  • if less than 10% , it is just a variation
  • if between 10-25% it is mild

Treatment is only done if these ^^^ numbers can progress (with bracing and exercise or surgery)_

61
Q

Torso brace for scoliosis

A

Slows progression of scoliosis but will still need exercise

62
Q

Scoliosis surgery purpose?

And what is it like?

A

Can be anterior or posterior but done in order to straighten the torso
can be long and painful due to the stretching of the ligaments and tendons

63
Q

Due to bleeding, what should the nurse do before scoliosis surgery?

What can nurse educate on before surgery?

A

Anticipate needing type and cross transfusion of blood bc bleeding with spinal surgery tends to be a lot

Developmental/skin issues of bracing. Kid may have a hard time growing up due to the brace and social life.

Skin cleaning and integrity is important

64
Q

What assessments need be done after scoliosis surgery

A

Neurological and neurovascular due to proximity of spinal cord
And for fluid volume issues rt blood loss

65
Q

How is a nurse supposed to turn a patient with spinal surgery of scoliosis?
Tube management?

A

Log rolling technique and they made need help doing this

Pt on tubes bc they may not be able to breath very well.. but just depends. Manage them

66
Q

What is Muscular Dystrophy

Which is most prevalent?

A

Gradual and progressive degeneration of muscle fibers that results in a progressive weakness

Duchene’s Muscular Dystrophy

67
Q

How is Duchene’s passed on?

A

It is x linked recessive meaning mom’s are the only ones to carry it on but the boys are affected most of the time

(does this mean the girl will never be affected but just a carrier?)

68
Q

How does duchene’s progress?

A

The progressive weakness isn’t noticeable at first. First two years things are going as they should. Onset is 3-5 years of age with trouble walking and mild mental delays
- 20 iq points lower

69
Q

The likely posture with duchennes?

What happens to the muscle?

A

1) Sway back or Lordosis in order to help compensate for weak core
2) Quads hypertrophy with fat - not muscle. Calf muscles will be made up of fat too and you see tip toe walking

70
Q

Child with duchene’s has to walk up their legs with hands to stand up. What sign is this?

A

Gowers sign

71
Q

What age will those with duchene’s lose their ambulation ability?
Can they die?

A

1) 9-11 years old
- so they will need a wheelchair or another assistive device

Yes they can die due to cardiac and pulmonary muscles not working in teen years
- use incentive spirometer to help track their breathing though

72
Q

Diagnosis for Duchenes

A

1) Clinical manifestations are key

2) Blood Polymerase chain reaction for dystrophin gene mutation

73
Q

How can ambulation be prolonged with duchennes?

A

Corticosteroids in order to prolong function as long as possible.

74
Q

How to prevent contractures in Duchenes ?

A

Since contractions are common, we try to prevent this as much as possible do muscle stretching/ROM exercises.

75
Q

Main focus of nursing care for Duchenes?

A

1) Focus on keeping functioning as long as possible by helping with ADL’s
2) Second is avoid contractures

76
Q

Should we use tracheostomy care for patients with Duchennes?

A

Controversial. It can increase risks to pulmonary functioning and patency issues and make swallowing hard. Also have to consider with nursing care:

  • secretions
  • stoma care
  • humidification
77
Q

First symptoms parents notice that are usually noted with Duchenes?

A

Hard time learning how to run or ride a bike due to the weakness

78
Q

What is it important to do for patients with Duchenes as far as emotional support?

A

1) The child may have a hard time developing as they age around other peers
2) Anticipatory grieving for patient is important bc the life expectancy is shorter
3) Help family cope and help them put together end of life care

79
Q

What is Cerebral Palsy?

A

Disorder of posture and movement from static brain injury

- perinatally or postnatally

80
Q

Possible causes of Cerebral Palsy prenatally?

A

Birth asphyxia
Prenatal brain abnormalities
Maternal and perinatal infections

81
Q

Possible causes of Cerebral Palsy postnatally?

A 
Infections ... meningitis
Intracerebral hemorrhage
MVAs
Child abuse
Falls
82
Q

Main types of Cerebral Palsy?

A

Spastic (Pyramidal)
Dyskinetic (Non-spastic Extrapyramidal) but this has 2 types as well
Apastic

83
Q

Describe Spastic Cerebral Palsy

A

Scissoring and in toeing with hypertonicity with poor control of posture and movement
Very prone to contractures as well

84
Q

How many subtypes of Dyskinetic Cerebral palsy are there?

A

Athletoid - choria extremities , trunk, neck, facial muscle, tongue OR just an abnormal movement that can’t be controlled

Dystonic - slow, twisting trunk and extremities w abnormal posture that may involve the oral muscles and cause drooling and dysarthria (causes uncontrolled noises)

These 3 really affect the muscle fibers

85
Q

Athletoid DYSKINETIC cerebral palsy

A

Athetoid - choria extremities , trunk, neck, facial muscle, tongue OR just an abnormal movement that can’t be controlled

86
Q

Dystonic DYSKINETIC cerebral palsy

A

Dystonic - slow, twisting trunk and extremities w abnormal posture that may involve the oral muscles and cause drooling and dysarthria (causes uncontrolled noises)

87
Q

Describe Aspastic cerebral palsy

A

Aspastic - wide gait with lack of balance or equilibrium. slurred speech. Hypotonicity of muscles
Disintegration of movements of upper extremities when reaches object

88
Q

Neuro exam results for cerebral palsy that often occur?

A

Persistent Moro reflex and asymmetrical tonic neck (fencing)

89
Q

What is development like in children with cerebral pasly?

A

May not be hitting the motor milestones
May have trouble speaking
- speech consult

May also be having seizures (40% do)
- make sure to do seizure prevention

90
Q

Which cerebral palsy needs hearing screening?

A

Athetoid

91
Q

Treatment goal for cerebral palsy?

A

Early recognition and promotion of optimal functioning

92
Q

How do we address education of those with cerebral palsy?

A

Mainstream education and fostering communication with teachers

93
Q

Why are immunizations important for people with cerebral palsy?

A

To protect against respiratory tract infections

94
Q

How will cerebral palsy patients get feedings if they can’t feed normally?

A

Through regular gastrostomy feedings in order to make sure they gain/keep weight but also maybe for medications

95
Q

Meds for muscle relaxation?

A

Dantrolene
- but be aware of hepatoxicity

Botox injected into muscle group to relax them
- must be scheduled periodically

Baclofen

  • do test dose first with intrathecal pump
  • then do the catheter
96
Q

Baclofen side effects

Antidote?

A

Baclofen

  • do test dose first with intrathecal pump
  • then do the catheter

Side effects:
hypotonia, somnolence, seizure

Antidote is Physostigmine

97
Q

Procedure for cerebral palsy to release contractures?

A

Tenotomy

98
Q

What is tendon lengthening ?

A

For cerebral palsy but you go in and release bones and tendons from one another

99
Q

Post op concerns with tendon lengthening and contraction release for cerebral palsy?

A

Blood loss and fluids
Neurovascular checks
Pain management
Cast/skin care

100
Q

Osteogenesis Imperfecta is what?

A

Osteoporosis syndrome where a genetic error causes faulty bone mineralization which leads to more fractures

101
Q

How many types Of Osteogenesis imperfecta are there?

How is passed on?

A

4 types ; type 1 is most common and least fatal

Autosomal dominant

102
Q

Type 1 of Osteogenesis Imperfecta

A

The most normal one with fracture incidence that tend to go away after puberty. Eyes may be blue and hearing impairment could be present.

103
Q

Type 1 of Osteogenesis goals?

A

Prevent contractures, deformities, muscle weakness, malalignment, and osteoporosis

104
Q

Nursing care is mean to prevent what in Osteogenesis?

A

Fractures from occurring and so we have to educate parents on this.

  • position child carefully
  • monitor their physical activity
105
Q

What do we have to educate parents of Osteogenesis patients about?

A

Genetic counseling may be wanted for future

Often gets mistaken as child abuse

Developmental issues may arise

106
Q

Med for Osteogenesis that can increase bone density and decrease pain by inhibiting bone reabsorption to reduce amount of fractures

Other med that can be used?

A

Biphosphantes Pamidronate IV

PO Alendronate

Peds Exam 4 (5 decks)

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