Musculoskeletal System Flashcards
Disorder where a disruption of blood flow to the femoral head leads to necrosis
Legg-Calve Perthes
S/S of legg-calve perthes
Painless limp, hip/pain stiffness that increases with activity, reduced ROM of hip, can cause affected leg to become shorter
Legg-calve perthes treatment
- non-surgical: activity restriction and limited weight-bearing, NSAIDs, PT
- surgical: osteotomy — femur is cut, repositioned, and secured in hip socket using plates and screws
Genetic disorder that causes deformity of the foot
Clubfoot
S/S of clubfoot
Affected foot turned inward sharply, calf muscle on affected leg may be smaller
Gold standard treatment for clubfoot
Serial casting followed by bracing (children will need between 5-10 casts, and then once the foot is in the proper position they will need to wear a brace)
Clubfoot family teaching
Compliance with bracing to prevent recurrence**, wear brace 24 hr/day for 3 months (after that, children will still need to wear brace at night and during naps for several years)
Asymmetry of the cranium of skull caused by prolonged pressure on one side of the skill that causes it to flatten over time
Positional plagiocephaly
Signs of positional plagiocephaly
Misshapen skull, bald spot, facial asymmetry
Main risk factor for positional plagiocephaly
Putting babies to sleep on back at night (make sure to reposition baby’s head during sleep)
Positional plagiocephaly treatment
Helmet therapy for 23 hours/day lasting for about 3 months
Positional plagiocephaly family education
Provide tummy time for baby (at least 3x/day for 10-15 min), avoid having baby spend prolonged time in car seat or swing
S/S of scoliosis
Asymmetry of child’s shoulder, scapular shape, or hip height, change in posture causing clothes to not lay or fit correctly
Screening for scoliosis
Adam’s forward bend test — shows asymmetry of ribs/flanks. Scoliometer measures degree of truncal rotation. Definitive diagnosis through x-ray
Scoliosis treatment
- Non-surgical: Bracing (worn at all times except during showering or swimming); educate family that thin t-shirt or tank top should be worn beneath the brace to protect skin
- Surgical: spinal fusion — nurse should perform neurologic assessments following surgery, turn patient by LOG-ROLLING to maintain alignment of spine, administer opioid analgesics on a schedule
Dislocation or instability of the hip joint
Developmental dysplasia of the hip (DDH)
DDH risk factors
Females, breech position birth, family hx
S/S of DDH
Affected leg appears shorter, asymmetric skin folds on the thighs or buttocks, limited ROM of the hip joint, asymmetric gait once the child is walking
Screening for DDH
Barlow and Ortalani maneuver: provider will apply gentle pressure to infants thighs, move the femoral head in the acetabulum and listen for clicks, clunks, and pops — positive Barlow or ortalani sign indicate DDH. Ultrasound or x-ray confirms diagnosis
DDH treatment
Pavlik harness — infants under 6 months
Surgery and hip spica cast — infants and children over 6 months
Pavlik harness for DDH
- keeps baby’s legs apart and legs turned outward
- family education: harness should be worn 23 hrs/day and at least 6 weeks, assess skin several times a day, gently massage skin under straps, avoid lotions and powders, baby should wear undershirt and socks under harness, baby’s diaper should be placed under the straps, DO NOT adjust harness yourself (appointments with provider every 1-2 weeks for eval and adjustment of straps)
Genetic disorder that causes issues with the synthesis of collagen, which is essential for making bones hard
Osteogenesis imperfecta
S/S of osteogenesis imperfecta
extremely brittle bones resulting in bone deformities and fractures, blue sclera, hearing loss, short stature
Osteogenesis imperfecta treatment
Supportive: bisphosphonates (Alendronate), bracing and splinting, surgical stabilization, PT, OT, assistive devices (wheelchairs, walkers)
Disorder that causes bone loss due to vitamin D deficiency which impairs bone mineralization (bc calcium requires vitamin D for absorption)
Rickets
Rickets risk factors
Insufficient sunlight exposure, insufficient dietary intake of vitamin D, disorders that impair production or absorption of vitamin D (celiac disease, CF)
S/S of rickets
Bone deformities such as bow legs and knock knees, bone pain, fractures
Labs associated with rickets
Increased alkaline phosphatase, decreased vitamin D
Rickets treatment
Vitamin D supplementation, increased exposure to sunlight, increased intake of vitamin D rich foods (fish, eggs)
Chronic autoimmune disorder where the child’s immune system attacks the joints causing inflammation and pain
Juvenile idiopathic arthritis
S/S of juvenile idiopathic arthritis
Joint swelling, warmth, stiffness (especially in morning), decreased ROM in the joint
Note: there are several types of JIA. Some may cause rash, lymphadenopathy, enlarged liver and spleen, serositis (includes membranes that line heart and lungs)
Labs associated with JIA
Elevated ESR and CRP, (+) ANA test
Treatment of JIA
NSAIDs, corticosteroids, DMARDs (methotrexate), PT, OT, splinting of painful joints
JIA family teaching
Encourage use of moist heat (warm shower) to relieve join stiffness, firm mattress recommended
Neurovascular assessment are particularly important when caring for a patient with a fracture. What assessments are included in a neurovascular assessment?
Pain, sensation, skin temp, skin color, cap refill, pulses, movement
Family education for hip spica cast
Monitor for constipation (d/t decreased mobility and pain meds), increase intake of fiber and fluid
