Muskuloskeletal Flashcards
Review the care of a child in a cast
what are the 5 P’s
Purpose: immobilization to promote healing and proper alignment
Neurovascular assessment
Education on cast:
-Do not put anything into the cast,
pain, pulse, pallor, parasthesia, paralysis (5 ps)
Acute Compartment Syndrome
Symptoms?
A serious and life-threatening complication that requires immediate action and may cause permanent damage to extremity.
Swelling or bleeding within a compartment of the musculoskeletal system.
Fascia does not stretch, therefore, increased pressure on the capillaries, nerves, and muscles in the compartment.
Blood flow to muscle and nerve cells is disrupted and results in ischemia.
Acute Compartment Syndrome
Symptoms? Biggest sign?
Management?
Extreme pain not controlled by medication!!!!!! BIGGEST SIGN
Swelling of extremity
Decrease or loss of pulses
Cool to touch
Extremity pale or cyanotic
Numbness or tingling
Management: Surgery (Fasciotomy) to reduce the pressure and restore circulation.
Discuss the child in traction including purpose and nursing management
Purpose: Maintains straight alignment of fractured bone.
Decreases pain and spasms
Do not remove, adjust, or add weights unless there is a provider order.
Allow weights to hang freely
Monitor skin for redness and signs of breakdown
Neurovascular assessment (5 P’s)
How to suspect abuse?
When do most inflicted fractures occur?
What fractures in infants?
Most inflicted fractures occur in infancy or early childhood.
Stated history not consistent with injury pattern or mechanism
Injury inconsistent with developmental stage
Discrepancy in caregiver’s story and/or conflicting caregiver stories
Presence of multiple fractures
Spiral fractures or rib fractures in infants
-Skeletal Survey done to detect other fractures
-Nurses are mandatory reporters!
What is Scoliosis?
Most cases are what?
When does it become noticeable?
What test to determine degree of curvature?
Treatment of severe and nonsevere scoliosis?
Abnormal lateral curvature of the spine.
Most cases idiopathic
Generally becomes noticeable after PRE ADOLESCENT GROWTH SPURT
Standing radiographs to determine degree of curvature
Severe Scoliosis:
Surgery with insertion of rods
Not severe- brace
Developmental Dysplasia of Hip (DDH)
Abnormal development of the hip joint during fetal growth or early infancy.
Genetic predisposition, intrauterine positioning, or hormonal factors,
The socket of the hip (acetabulum) is too shallow and the femoral head is not held tightly in place, so the hip joint is loose.
Hip instability can lead to dislocation of the hip joint, abnormal gait, and arthritis if not treated early.
Developmental dysplasia of the hip
Diagnostic Evaluation of DDH?
Infants and older children?
Infants:
-Ortolani and Barlow tests
-Galeazzi (Allis) sign
-Uneven thigh folds
-All newborns are evaluated for DDH using above procedures
Older children with limp, leg discrepancy
-Radiographic exam
Ultrasound < 4 months;
XRAY > 4 months)
Signs and symptoms of Developmental Dysplasia of Hip (DDH)
Ortoloni-Abducting?
B. Barlow-Adducting?
What is abnormal?
Galeazzi (Allis) Sign?
Harness and Cast?
A. Ortoloni-Abducting
B. Barlow-Adducting (push in on hip and then out)
**Abnormal: Hear a ‘click’ or ‘clunk’
with procedure
Galeazzi (Allis) Sign: Uneven Thigh Folds
Uneven Knee Height
Management:
Pavlik harness (0-6 mo)
Spica cast: (6-24 mo)
Legg-Calvé-Perthes Disease
Occurs in who?
ball-shaped head of the thighbone (femoral head) temporarily loses its blood supply
-Poor blood supply-> weakened bone-> gradually breaks apart and can potentially lose its round shape
Occurs in children 3 to 12 years of age (peak incidence 5-8)
Symptoms-Gradual onset, limping, hip pain
Legg-Calvé-Perthes
Diagnosis?
Treatment?
Diagnostic evaluation- MRI
Treatment- Rest (no weight) and NSAIDS
-Outcome- Body eventually restores blood supply to the ball and the ball heals (surgery rarely)
-Potential long-term complication of arthritis
Slipped Capital Femoral Epiphysis (SCFE)
Involves what growth plate?
Occurs at what age?
What factors cause it to occur?
Spontaneous displacement of the femoral head (epiphysis) from femoral neck.
Involves the femoral growth plate.
Occurs between 10-16 yrs old
Usually idiopathic, multifactorial
OBESITY
Puberty hormone changes,
Bone changes.
Slipped Capital Femoral Epiphysis (SCFE)
Symptoms?
Treatment?
Hip pain
Limping
Difficulty bearing weight on the affected leg
Treatment:
Surgery
Screw fixation is standard of care
Osteogenesis imperfecta (OI)
“Brittle Bone Disease”
What is it?
Symptoms? four
Genetic condition that causes fragile bones
affects connective tissue (>20 types OI)
Clinical features:
-Blue sclera
-Fracture early on in childhood
-Short stature
-Ligamentous laxity
Therapeutic Management of OI
Drugs- bisphosphonate therapy
-Pamidronate (Aredia)
-Promote bone density and prevent fractures
Nursing care management
-Caution with handling to prevent fractures
-PT/OT recommendations
Cerebral palsy (CP)
Etiology?
Symptoms are what?
PERMANENT MOVEMENT, BALANCE, AND POSTURE DISORDER that appear in infancy or early childhood.
Etiology: Abnormal development or damage to the brain that occurs before, during, or after delivery that affects both the neurological and musculoskeletal systems.
Symptoms are PERMANENT and NONPROGRESSIVE and vary from mild to severe defects.
Risk Factors for Cerebral Palsy
Premature
Low birth weight
CNS malformation
Asphyxia during birth (lack of oxygen)
Intracranial hemorrhage after birth
Cerebral Palsy (CP) symptoms
Delay in achieving developmental milestones
Difficulty swallowing or uncontrolled drooling
Poor sucking
Clenched fists beyond 3 months of age
Stiff or rigid limbs
Arching of back
Types of Cerebral Palsy
Spastic?
Dyskinetic?
Ataxic?
Mixed?
Which one is most common?
Spastic: stiffness and tightness in muscles
(most common type).
Dyskinetic: involuntary, uncontrolled,
repetitive movements.
Ataxic: incoordination with decreased muscle tone
Mixed: Symptoms of Spastic, Dyskinetic, and Ataxic
Therapeutic Management of cerebral palsy
Medications?
two
- Botox - reduce spasticity to improve mobility and pain control
- Baclofen ( Reduce Spasms-Implanted pump for intrathecal administration -(into spinal canal)
neural tube defects
Attributed largely to?
Elavated what in pregnant women indicates neural tube defect?
congenital anomalies that occur due to the incomplete closure of the neural tube, which forms the brain and spinal cord.
Attributed largely to insufficient Maternal Folic Acid
-Recommendation mother takes 400mcg PO QD prenatally
Elevated Alpha-fetoprotein (AFP) in pregnant women indicates neural tube defect.
Neural Tube Defects types
Spina Bifida Occulta?
Meningocele?
Myelomeningocele?
Spina Bifida Occulta:
-Dimple or hair noted at the base of the spine.
-No protrusion of meninges.
-Ultrasound to determine if there is any underlying problem.
-Treatment usually not needed.
Meningocele:
-protrusion of meninges, CSF, no nerves within a sac of skin.
Myelomeningocele:
-protrusion of meninges, CSF, and nerves within sac of skin.
Therapeutic Management of neural tube defects
Surgical closure?
Nursing management?
Precausions?
Early surgical closure of the myelomeningocele sac within 24-48 hours
Nursing management
-Side lying or prone position to protect defect
-Prevent infection (cover w/ moist sterile dressing)
-LATEX precautions- all spina bifida patients
-Antibiotics
Guillain-Barré Syndrome (GBS)
Ascending Paralysis!!
Rare autoimmune disorder where the body’s immune system attacks PNS
Etiology unknown
Usually preceded by viral illness that induces an abnormal autoimmune response targeting peripheral nerves.
Therapeutic Management of GBS
Treatment is supportive
Respiratory support
Steroids, IV immunoglobulin, and plasmapheresis (plasma exchange).
Low-molecular-weight heparin, gabapentin, (neuropathic pain), analgesics
Risk of recurrence low
Duchenne Muscular Dystrophy
What kind of disorder?
Characterized by what?
generally affects who and around what age?
Genetic disorder characterized by PROGRESSIVE muscle degeneration and weakness.
It primarily affects boys (x-linked), typically becoming evident around ages 3 to 5.
Clinical signs and symptoms of Duchenne Muscular Dystrophy (DMD)
Affects what limbs?
Wheelchair bound by what age?
Average life expectancy?
Progressive muscle weakness*, wasting, and contractures
Affects proximal before distal limb muscles, & lower extremities before upper extremities
Waddling gait, frequent falls, Gower’s sign
Pts. usually wheelchair bound by ~12 years of age
Average expectancy 28 years
What is Gower’s sign?
Child uses their hands to “walk” up their Thighs .gradually straightening their legs until fully upright.
