Musculoskeletal System

Question 1

Disorder where a disruption of blood flow to the femoral head leads to necrosis

Answer 1

Legg-Calve Perthes

Question 2

S/S of legg-calve perthes

Answer 2

Painless limp, hip/pain stiffness that increases with activity, reduced ROM of hip, can cause affected leg to become shorter

Question 3

Legg-calve perthes treatment

Answer 3

• 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

Question 4

Genetic disorder that causes deformity of the foot

Answer 4

Clubfoot

Question 5

S/S of clubfoot

Answer 5

Affected foot turned inward sharply, calf muscle on affected leg may be smaller

Question 6

Gold standard treatment for clubfoot

Answer 6

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)

Question 7

Clubfoot family teaching

Answer 7

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)

Question 8

Asymmetry of the cranium of skull caused by prolonged pressure on one side of the skill that causes it to flatten over time

Answer 8

Positional plagiocephaly

Question 9

Signs of positional plagiocephaly

Answer 9

Misshapen skull, bald spot, facial asymmetry

Question 10

Main risk factor for positional plagiocephaly

Answer 10

Putting babies to sleep on back at night (make sure to reposition baby’s head during sleep)

Question 11

Positional plagiocephaly treatment

Answer 11

Helmet therapy for 23 hours/day lasting for about 3 months

Question 12

Positional plagiocephaly family education

Answer 12

Provide tummy time for baby (at least 3x/day for 10-15 min), avoid having baby spend prolonged time in car seat or swing

Question 13

S/S of scoliosis

Answer 13

Asymmetry of child’s shoulder, scapular shape, or hip height, change in posture causing clothes to not lay or fit correctly

Question 14

Screening for scoliosis

Answer 14

Adam’s forward bend test — shows asymmetry of ribs/flanks. Scoliometer measures degree of truncal rotation. Definitive diagnosis through x-ray

Question 15

Scoliosis treatment

Answer 15

• 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

Question 16

Dislocation or instability of the hip joint

Answer 16

Developmental dysplasia of the hip (DDH)

Question 17

DDH risk factors

Answer 17

Females, breech position birth, family hx

Question 18

S/S of DDH

Answer 18

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

Question 19

Screening for DDH

Answer 19

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

Question 20

DDH treatment

Answer 20

Pavlik harness — infants under 6 months
Surgery and hip spica cast — infants and children over 6 months

Question 21

Pavlik harness for DDH

Answer 21

• 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)

Question 22

Genetic disorder that causes issues with the synthesis of collagen, which is essential for making bones hard

Answer 22

Osteogenesis imperfecta

Question 23

S/S of osteogenesis imperfecta

Answer 23

extremely brittle bones resulting in bone deformities and fractures, blue sclera, hearing loss, short stature

Question 24

Osteogenesis imperfecta treatment

Answer 24

Supportive: bisphosphonates (Alendronate), bracing and splinting, surgical stabilization, PT, OT, assistive devices (wheelchairs, walkers)

Question 25

Disorder that causes bone loss due to vitamin D deficiency which impairs bone mineralization (bc calcium requires vitamin D for absorption)

Answer 25

Rickets

Question 26

Rickets risk factors

Answer 26

Insufficient sunlight exposure, insufficient dietary intake of vitamin D, disorders that impair production or absorption of vitamin D (celiac disease, CF)

Question 27

S/S of rickets

Answer 27

Bone deformities such as bow legs and knock knees, bone pain, fractures

Question 28

Labs associated with rickets

Answer 28

Increased alkaline phosphatase, decreased vitamin D

Question 29

Rickets treatment

Answer 29

Vitamin D supplementation, increased exposure to sunlight, increased intake of vitamin D rich foods (fish, eggs)

Question 30

Chronic autoimmune disorder where the child’s immune system attacks the joints causing inflammation and pain

Answer 30

Juvenile idiopathic arthritis

Question 31

S/S of juvenile idiopathic arthritis

Answer 31

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)

Question 32

Labs associated with JIA

Answer 32

Elevated ESR and CRP, (+) ANA test

Question 33

Treatment of JIA

Answer 33

NSAIDs, corticosteroids, DMARDs (methotrexate), PT, OT, splinting of painful joints

Question 34

JIA family teaching

Answer 34

Encourage use of moist heat (warm shower) to relieve join stiffness, firm mattress recommended

Question 35

Neurovascular assessment are particularly important when caring for a patient with a fracture. What assessments are included in a neurovascular assessment?

Answer 35

Pain, sensation, skin temp, skin color, cap refill, pulses, movement

Question 36

Family education for hip spica cast

Answer 36

Monitor for constipation (d/t decreased mobility and pain meds), increase intake of fiber and fluid