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neuromuscular musculoskeletal disorder Flashcards

Exam 3

1
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

When does motor development begin? How does it develop?

A

Motor development begins at birth and proceeds in predictable sequence.

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2
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

How is range of motion at birth?

A

Full range of motion is present at birth.

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3
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

How is a child’s spinal cord compared to an adult?

A

The child’s spinal cord is more mobile than the adult.

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4
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

When is myelinization complete?

A

Myelinization is not complete until 2 years of age.

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5
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems

What is ossification? When does this occur? When is it complete?

A

Ossification is when the cartilage turns to bone.

This occurs throughout childhood and is complete by adolescence.

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6
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

Where does growth of bones occur?

A

Growth of bones occurs primarily at specialized growth plates at the end of the long bones.

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7
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

How are children’s bones compared to adults?

A

Children’s bones are more vascular and tend to heal faster than adults.

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8
Q

Eliciting History of Present Neurologic Disorder

A

Changes in gait, any “clumsiness”

Activity level compared to peers

Recent trauma

Poor feeding

Lethargy

Fever

Weakness

Alteration in muscle tone - Hypo and hypertonia are abnormal signs

History of developmental milestones

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9
Q

Physical assessment:

Inspection and observation?

A

Motor function.
Reflexes.
Sensory function.

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10
Q

Physical assessment:

Palpation

A

Muscle strength and tone.

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11
Q

Physical assessment

Auscultation

A

Lungs for adventitious sounds.

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12
Q

Laboratory and Diagnostic Tests for NM and MS Disorders

A

CBC, creatine kinase

Radiographs

Fluoroscopy, arthrography

Myelography, electromyography (EMG),

muscle biopsy

Nerve conduction testing

CT, MRI, ultrasound

Genetic testing

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13
Q

Types of Neuromuscular or Musculoskeletal Disorders:

A

Congenital

Acquired

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14
Q

Types of Neuromuscular or Musculoskeletal Disorders:

Congenital: What is it? When does it develop?

A

Structural abnormality.

Genetic abnormality (may develop later in life).

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15
Q

Types of Neuromuscular or Musculoskeletal Disorders

Acquired: How?

A

Trauma, any hypoxia to the brain or spinal cord.

Autoimmune, bacterial or viral infections.

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16
Q

Types of Neuromuscular or Musculoskeletal Disorders:

What can Congenital and Acquired result in?

A

Each can result in neuromuscular or musculoskeletal dysfunction.

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17
Q

Positional alterations:

How are infants hips normally?

What is it called?

A

Infants hips are usually flexed, abducted, and externally rotated, with the knees flexed and lower limbs internally rotated. This is a normal developmental variation termed internal tibial torsion.

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18
Q

Positional alterations:

What is the term for bowlegged?

A

Genu varum: bowlegged

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19
Q

Positional alterations:

What happens to ITT and varum as a child gets older? What can develop instead? When does that resolve?

A

As ITT and varum resolve as child gets older, Genu valgum, or knock knees can happen by age 2-3. Should resolve by 7-8 years old.

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20
Q

Congenital/Developmental Neuromuscular and Musculoskeletal Disorders

A

Neural tube defects

Structural disorders of the skeleton

Developmental dysplasia of the hip

Torticollis

Tibia vara

Genetic disorders

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21
Q

Congenital/Developmental Neuromuscular and Musculoskeletal Disorders:

Neural tube defects including

A

Spina bifida occulta

Meningocele

Myelomeningocele

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22
Q

Congenital/Developmental Neuromuscular and Musculoskeletal Disorders

Structural disorders of the skeleton

A

Pectus excavatum and carinatum,

limb deficiencies,

polydactyly/syndactyly,

metatarsus adductus)

Congenital club foot

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23
Q

Congenital/Developmental Neuromuscular and Musculoskeletal Disorders

Genetic disorders

A

Osteogenesis imperfecta

Various types of muscular dystrophy

Spinal muscular atrophy

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24
Q

Osteogenesis Imperfecta: What is it?

A

Brittle bone disease

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25
Q

Osteogenesis Imperfecta: What are signs and symptoms?

A

Lax joints

Small, weak muscles

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26
Q

Osteogenesis Imperfecta: Diagnosis?

A

Clinical symptoms and level of disability

Radiographic studies

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27
Q

Osteogenesis Imperfecta: Nursing care- What should you teach parents?

A

Teach parents to watch for signs of fractures (irritability, fever, and refusal to eat)

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28
Q

Osteogenesis Imperfecta: Nursing care continued:

A

Olpadronate (bone-resorption inhibitor) therapy

Bisphosphonates

Postoperative care

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29
Q

Osteogenesis Imperfecta:

Education/discharge instructions

A

Play and physical therapy

ROM

Ambulatory devices

Genetic counseling

Protect child while allowing as normal a life as possible

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30
Q

Osteogenesis Imperfecta: What is the hallmark sign?

A

Blue eyes- blue sclera

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31
Q

Muscular Dystrophy: What is it?

A

General term for a group of inherited types of neuromuscular disorders that affect voluntary muscles.

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32
Q

Muscular Dystrophy: How do symptoms appear?

A

Symptoms not always evident at birth; may manifest later in childhood.

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33
Q

Muscular Dystrophy: How is lifespan?

A

May limit life span due to compromised ability to adequately support ventilation.

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34
Q

Nursing Management Goals for a Child With Muscular Dystrophy:

A

Promoting mobility

Managing elimination

Maintaining cardiopulmonary function

Preventing complications and maximizing quality of life

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35
Q

Nursing Management Goals for a Child With Muscular Dystrophy:

Promoting mobility- What should be done?

A

Administering medications
Performing passive stretching and strengthening exercises

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36
Q

Nursing Management Goals for a Child With Muscular Dystrophy

Maintaining cardiopulmonary function: How?

A

Teaching deep breathing exercises

Performing chest physical therapy

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37
Q

Nursing Management Goals for a Child With Muscular Dystrophy

Preventing complications and maximizing quality of life: How?

A

Developing a diversional schedule

Providing emotional support

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38
Q

Duchenne’s Muscular Dystrophy: What is it?

A

Progressive weakness and wasting of muscles

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39
Q

Duchenne’s Muscular Dystrophy: When is onset?

Who is it in mainly?

A

Onset 3-5 years old

Primarily males

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40
Q

Duchenne’s Muscular Dystrophy: What is a major sign of this disorder?

A

Gower’s sign

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41
Q

Slide 12

A
42
Q

Acquired Neuromuscular and Musculoskeletal Disorders: What are examples?

A

Rickets,

Slipped capital femoral epiphysis (SCFE),

Legg–Calvé–Perthes disease,

transient synovitis of the hip

Scoliosis

Injuries

43
Q

Acquired Neuromuscular and Musculoskeletal Disorders: What are examples of injuries?

A

Spinal cord injury

Birth trauma

Fractures, strains/sprains, overuse syndromes, and dislocated radial head.

Trauma or unintentional injury is the leading cause of childhood morbidity and mortality

44
Q

Acquired neuromuscular disorders include:

A

Cerebral palsy.

Spinal cord injury.

Infections such as botulism toxicity.

Stroke or intraventricular hemorrhage.

Viral or bacterial infections of CNS.

Post-viral syndromes such as Guillian–Barré.

Neurologic compromise due to compartment syndrome.

Autoimmune disorders.

45
Q

Cerebral palsy: What is it?

A

A term used to describe a range of nonspecific symptoms.

46
Q

What is the most common motor disorder in childhood? How is it lifelong?

A

Cerebral palsy

Most common motor disorder in childhood; lifelong impairment.

47
Q

Cerebral palsy: Who is it a higher incidence in?

A

Incidence is higher in premature and low birth-weight infants.

48
Q

Cerebral palsy: Signs and symptoms?

A

Motor impairments including abnormal motor patterns including spasticity, muscle weakness, and ataxia;

abnormal brain function is not progressive.

49
Q

Cerebral palsy: What are complications?

A

Mental impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus.

50
Q

Slide 16

A
51
Q

Scoliosis: What is it?

A

Lateral curvature of the spine >10 degrees.

Non-painful lateral curvature of the spine

52
Q

Scoliosis: What are signs and symptoms?

A

Unequal shoulder heights

Scapular prominences and heights

53
Q

Scoliosis: Diagnosis?

A

Radiography

54
Q

Scoliosis: Why does it occur?

A

May be congenital, associated with other disorders, or acquired.

55
Q

Scoliosis: Management?

A

Braces (multiple types based on severity).

Surgical repair for severe cases.

56
Q

Other Types of Spinal Curvature

A

Kyphosis

Lordosis

57
Q

Other Types of Spinal Curvature: Kyphosis?

A

Nonpainful spinal curvature (hunchback)

58
Q

Other Types of Spinal Curvature: Lordosis?

A

Spinal curvature (swayback)

59
Q

Other Types of Spinal Curvature: Nursing Care

A

Similar to that for the child with scoliosis

60
Q

Legg-Calvé-Perthes Disease: How does it start?

A

Legg-Calvé-Perthes disease starts with an interrupted blood supply to the femoral head

61
Q

Legg-Calvé-Perthes Disease: Signs and symptoms?

A

Hip or knee soreness or stiffness

Pain that increases with activity and decreases with rest

Painful limp

62
Q

Legg-Calvé-Perthes Disease: Diagnosis?

A

Radiograph establishes initial diagnosis

63
Q

Legg-Calvé-Perthes Disease: Nursing care

A

Obtain history, pain description by child; assess ROM

Non–weight bearing using brace

Assess skin for breakdown

Bedrest

Manage pain

After surgery, hip-spica cast is required

64
Q

Legg-Calvé-Perthes Disease: Nursing care- What is required after surgery?

A

After surgery, hip-spica cast is required

65
Q

Legg-Calvé-Perthes Disease: Education/discharge instructions

A

Avoid weight-bearing activities; mobility restrictions maintained

ROM

Emotional support and diversional activities

66
Q

Slipped Femoral Capital Epiphysis: What is it?

A

Capital femoral epiphysis (top of femur) slips through epiphysis (growth plate) in a posterior direction

67
Q

Slipped Femoral Capital Epiphysis: What are signs and symptoms?

A

Pain in groin or referred pain to thigh or knee

Pain during internal rotation of hip

68
Q

Slipped Femoral Capital Epiphysis: What is a diagnosis

A

Radiographic studies

69
Q

Slipped Femoral Capital Epiphysis: Nursing care

A

No weight bearing permitted

Prevent further slippage

Bed rest with child in traction

Russell’s traction used before surgery

Surgery (pinning)

70
Q

Slipped Femoral Capital Epiphysis: Nursing care for surgery (pinning)

A

Pain management

Monitor neurovascular status

Crutch walking

71
Q

Fractures

A

Bone undergoes more stress than it can absorb

72
Q

Fractures: Signs and symptoms

A

Location and description of fracture

Described in terms of amount of injury

73
Q

Fractures: Diagnosis

A

Radiograph

CT scans, MRI, fluoroscopy, myelography

74
Q

Fractures: Nursing care

A

Obtain history
Prevent complications
Closed reduction
Open reduction (surgery)

75
Q

Fractures: Nursing care for closed reduction

A

Frequent checks to assess for pain, numbness, or tingling

Frequent neurovascular assessments

76
Q

Fractures: Nursing care for Open reduction (surgery)

A

Assess wound

Prevent infection

Manage pain

Increase fluid and fiber intake

Provide emotional support

77
Q

Soft Tissue Injuries (Sprains and Strains): What are signs and symptoms?

A

Sprain (Pain, swelling)
Strain (Pain, limited motion)

78
Q

Soft Tissue Injuries (Sprains and Strains): What are signs and symptoms with Sprain?

A

Pain
Swelling

79
Q

Soft Tissue Injuries (Sprains and Strains): What are signs and symptoms with Strain?

A

Pain

Limited motion

80
Q

Soft Tissue Injuries (Sprains and Strains): What are Diagnosis?

A

History and physical examination

81
Q

Soft Tissue Injuries (Sprains and Strains):

Nursing Care:

A

RICE = rest, ice, compression and elevation

Immobilization of the joint

82
Q

Soft Tissue Injuries (Sprains and Strains):

Education/discharge instructions

A

Teach the proper technique for wrapping the affected joint

Physical activity restrictions

83
Q

Sports Injuries: How do they occur?

A

Occur as a result of competitive and solitary sports

84
Q

Sports Injuries: Signs and symptoms?

A

Ruptured or torn anterior cruciate ligament causes: Instability and pain in knee

In elbow injury: Pain and tenderness
Loss of full extension of elbow

85
Q

Sports Injuries: Signs and symptoms of Ruptured or torn anterior cruciate ligament causes what?

A

Instability and pain in knee

86
Q

Sports Injuries: Signs and symptoms of in elbow injury?

A

Pain and tenderness

Loss of full extension of elbow

87
Q

Sports Injuries: Diagnosis?

A

X-ray exam followed by MRI

88
Q

Sports Injuries: Nursing care

A

Rest, immobilization, ice

Topical anesthetic

Cast

Leg immobilizer

Anti-inflammatory agent

89
Q

Sports Injuries: Education/discharge instructions

A

Teach family how to perform
neurovascular assessment

Care of suture line

Instruct how to care for immobilizer

Elevate extremity

90
Q

Casts: What are they used for?

A

Casts are used to immobilize a bone that has been injured or a diseased joint.

91
Q

Casts: What should be done?

A

Preapplication teaching

Neurovascular assessment

Facilitate drying of cast

Elevate affected extremity

Promote good fluid intake and high-fiber diet

Prevent itching

Teach about cast removal

92
Q

Casts: What are cast complications?

A

Compartment syndrome

Cast syndrome

93
Q

Casts:

Cast complications: Compartment syndrome?

A

(accumulation of fluid in the fascia)

94
Q

Casts:

Cast complications: Cast syndrome?

A

(portion of duodenum compressed between superior and mesenteric artery and aorta)

95
Q

Cast Complications: Compartment Syndrome- What are two assessments done for this?

A

Neurovascular assessment

Assess for “5 Ps”

96
Q

Cast Complications: Compartment Syndrome- What are the 5 P’s to assess for?

A

Pain unrelieved by narcotics

Pallor

Paralysis

Paresthesia

Pulselessness

97
Q

Cast Complications: Compartment Syndrome- What can help alleviate risk of compartment syndrome?

A

Application of ice and elevation of affected extremity can help to alleviate risk of compartment syndrome

98
Q

Traction: What is it?

A

Another method of immobilization

99
Q

Traction: What can it be used for?

A

Can be used to reduce and/or immobilize, align an injured extremity, allow the extremity to be restored to its normal length.

100
Q

Traction: What else can it reduce? How?

A

May also reduce pain by decreasing muscle spasm

101
Q

Spinal cord injury signs/symptoms

A

Inability to move or feel extremities

Numbness

Tingling

Weakness

Loss of voluntary movement below the level of the lesion

Inability to breathe, if injury is at a high cervical vertebra

102
Q

Teaching Topics to Prevent Spinal Cord Injury

A

Vehicular safety.

Seat belt and age-appropriate safety seat use.

Bicycle, sports, and recreation safety.

Prevention of falls.

Violence prevention, including gun safety.

Water safety, including the risk of diving.

Peds (15 decks)

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