neuromuscular musculoskeletal disorder Flashcards
Exam 3
Anatomic Differences in Children versus Adults Related to NM and MS Systems:
When does motor development begin? How does it develop?
Motor development begins at birth and proceeds in predictable sequence.
Anatomic Differences in Children versus Adults Related to NM and MS Systems:
How is range of motion at birth?
Full range of motion is present at birth.
Anatomic Differences in Children versus Adults Related to NM and MS Systems:
How is a child’s spinal cord compared to an adult?
The child’s spinal cord is more mobile than the adult.
Anatomic Differences in Children versus Adults Related to NM and MS Systems:
When is myelinization complete?
Myelinization is not complete until 2 years of age.
Anatomic Differences in Children versus Adults Related to NM and MS Systems
What is ossification? When does this occur? When is it complete?
Ossification is when the cartilage turns to bone.
This occurs throughout childhood and is complete by adolescence.
Anatomic Differences in Children versus Adults Related to NM and MS Systems:
Where does growth of bones occur?
Growth of bones occurs primarily at specialized growth plates at the end of the long bones.
Anatomic Differences in Children versus Adults Related to NM and MS Systems:
How are children’s bones compared to adults?
Children’s bones are more vascular and tend to heal faster than adults.
Eliciting History of Present Neurologic Disorder
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
Physical assessment:
Inspection and observation?
Motor function.
Reflexes.
Sensory function.
Physical assessment:
Palpation
Muscle strength and tone.
Physical assessment
Auscultation
Lungs for adventitious sounds.
Laboratory and Diagnostic Tests for NM and MS Disorders
CBC, creatine kinase
Radiographs
Fluoroscopy, arthrography
Myelography, electromyography (EMG),
muscle biopsy
Nerve conduction testing
CT, MRI, ultrasound
Genetic testing
Types of Neuromuscular or Musculoskeletal Disorders:
Congenital
Acquired
Types of Neuromuscular or Musculoskeletal Disorders:
Congenital: What is it? When does it develop?
Structural abnormality.
Genetic abnormality (may develop later in life).
Types of Neuromuscular or Musculoskeletal Disorders
Acquired: How?
Trauma, any hypoxia to the brain or spinal cord.
Autoimmune, bacterial or viral infections.
Types of Neuromuscular or Musculoskeletal Disorders:
What can Congenital and Acquired result in?
Each can result in neuromuscular or musculoskeletal dysfunction.
Positional alterations:
How are infants hips normally?
What is it called?
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.
Positional alterations:
What is the term for bowlegged?
Genu varum: bowlegged
Positional alterations:
What happens to ITT and varum as a child gets older? What can develop instead? When does that resolve?
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.
Congenital/Developmental Neuromuscular and Musculoskeletal Disorders
Neural tube defects
Structural disorders of the skeleton
Developmental dysplasia of the hip
Torticollis
Tibia vara
Genetic disorders
Congenital/Developmental Neuromuscular and Musculoskeletal Disorders:
Neural tube defects including
Spina bifida occulta
Meningocele
Myelomeningocele
Congenital/Developmental Neuromuscular and Musculoskeletal Disorders
Structural disorders of the skeleton
Pectus excavatum and carinatum,
limb deficiencies,
polydactyly/syndactyly,
metatarsus adductus)
Congenital club foot
Congenital/Developmental Neuromuscular and Musculoskeletal Disorders
Genetic disorders
Osteogenesis imperfecta
Various types of muscular dystrophy
Spinal muscular atrophy
Osteogenesis Imperfecta: What is it?
Brittle bone disease
Osteogenesis Imperfecta: What are signs and symptoms?
Lax joints
Small, weak muscles
Osteogenesis Imperfecta: Diagnosis?
Clinical symptoms and level of disability
Radiographic studies
Osteogenesis Imperfecta: Nursing care- What should you teach parents?
Teach parents to watch for signs of fractures (irritability, fever, and refusal to eat)
Osteogenesis Imperfecta: Nursing care continued:
Olpadronate (bone-resorption inhibitor) therapy
Bisphosphonates
Postoperative care
Osteogenesis Imperfecta:
Education/discharge instructions
Play and physical therapy
ROM
Ambulatory devices
Genetic counseling
Protect child while allowing as normal a life as possible
Osteogenesis Imperfecta: What is the hallmark sign?
Blue eyes- blue sclera
Muscular Dystrophy: What is it?
General term for a group of inherited types of neuromuscular disorders that affect voluntary muscles.
Muscular Dystrophy: How do symptoms appear?
Symptoms not always evident at birth; may manifest later in childhood.
Muscular Dystrophy: How is lifespan?
May limit life span due to compromised ability to adequately support ventilation.
Nursing Management Goals for a Child With Muscular Dystrophy:
Promoting mobility
Managing elimination
Maintaining cardiopulmonary function
Preventing complications and maximizing quality of life
Nursing Management Goals for a Child With Muscular Dystrophy:
Promoting mobility- What should be done?
Administering medications
Performing passive stretching and strengthening exercises
Nursing Management Goals for a Child With Muscular Dystrophy
Maintaining cardiopulmonary function: How?
Teaching deep breathing exercises
Performing chest physical therapy
Nursing Management Goals for a Child With Muscular Dystrophy
Preventing complications and maximizing quality of life: How?
Developing a diversional schedule
Providing emotional support
Duchenne’s Muscular Dystrophy: What is it?
Progressive weakness and wasting of muscles
Duchenne’s Muscular Dystrophy: When is onset?
Who is it in mainly?
Onset 3-5 years old
Primarily males
Duchenne’s Muscular Dystrophy: What is a major sign of this disorder?
Gower’s sign
Slide 12
Acquired Neuromuscular and Musculoskeletal Disorders: What are examples?
Rickets,
Slipped capital femoral epiphysis (SCFE),
Legg–Calvé–Perthes disease,
transient synovitis of the hip
Scoliosis
Injuries
Acquired Neuromuscular and Musculoskeletal Disorders: What are examples of injuries?
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
Acquired neuromuscular disorders include:
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.
Cerebral palsy: What is it?
A term used to describe a range of nonspecific symptoms.
What is the most common motor disorder in childhood? How is it lifelong?
Cerebral palsy
Most common motor disorder in childhood; lifelong impairment.
Cerebral palsy: Who is it a higher incidence in?
Incidence is higher in premature and low birth-weight infants.
Cerebral palsy: Signs and symptoms?
Motor impairments including abnormal motor patterns including spasticity, muscle weakness, and ataxia;
abnormal brain function is not progressive.
Cerebral palsy: What are complications?
Mental impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus.
Slide 16
Scoliosis: What is it?
Lateral curvature of the spine >10 degrees.
Non-painful lateral curvature of the spine
Scoliosis: What are signs and symptoms?
Unequal shoulder heights
Scapular prominences and heights
Scoliosis: Diagnosis?
Radiography
Scoliosis: Why does it occur?
May be congenital, associated with other disorders, or acquired.
Scoliosis: Management?
Braces (multiple types based on severity).
Surgical repair for severe cases.
Other Types of Spinal Curvature
Kyphosis
Lordosis
Other Types of Spinal Curvature: Kyphosis?
Nonpainful spinal curvature (hunchback)
Other Types of Spinal Curvature: Lordosis?
Spinal curvature (swayback)
Other Types of Spinal Curvature: Nursing Care
Similar to that for the child with scoliosis
Legg-Calvé-Perthes Disease: How does it start?
Legg-Calvé-Perthes disease starts with an interrupted blood supply to the femoral head
Legg-Calvé-Perthes Disease: Signs and symptoms?
Hip or knee soreness or stiffness
Pain that increases with activity and decreases with rest
Painful limp
Legg-Calvé-Perthes Disease: Diagnosis?
Radiograph establishes initial diagnosis
Legg-Calvé-Perthes Disease: Nursing care
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
Legg-Calvé-Perthes Disease: Nursing care- What is required after surgery?
After surgery, hip-spica cast is required
Legg-Calvé-Perthes Disease: Education/discharge instructions
Avoid weight-bearing activities; mobility restrictions maintained
ROM
Emotional support and diversional activities
Slipped Femoral Capital Epiphysis: What is it?
Capital femoral epiphysis (top of femur) slips through epiphysis (growth plate) in a posterior direction
Slipped Femoral Capital Epiphysis: What are signs and symptoms?
Pain in groin or referred pain to thigh or knee
Pain during internal rotation of hip
Slipped Femoral Capital Epiphysis: What is a diagnosis
Radiographic studies
Slipped Femoral Capital Epiphysis: Nursing care
No weight bearing permitted
Prevent further slippage
Bed rest with child in traction
Russell’s traction used before surgery
Surgery (pinning)
Slipped Femoral Capital Epiphysis: Nursing care for surgery (pinning)
Pain management
Monitor neurovascular status
Crutch walking
Fractures
Bone undergoes more stress than it can absorb
Fractures: Signs and symptoms
Location and description of fracture
Described in terms of amount of injury
Fractures: Diagnosis
Radiograph
CT scans, MRI, fluoroscopy, myelography
Fractures: Nursing care
Obtain history
Prevent complications
Closed reduction
Open reduction (surgery)
Fractures: Nursing care for closed reduction
Frequent checks to assess for pain, numbness, or tingling
Frequent neurovascular assessments
Fractures: Nursing care for Open reduction (surgery)
Assess wound
Prevent infection
Manage pain
Increase fluid and fiber intake
Provide emotional support
Soft Tissue Injuries (Sprains and Strains): What are signs and symptoms?
Sprain (Pain, swelling)
Strain (Pain, limited motion)
Soft Tissue Injuries (Sprains and Strains): What are signs and symptoms with Sprain?
Pain
Swelling
Soft Tissue Injuries (Sprains and Strains): What are signs and symptoms with Strain?
Pain
Limited motion
Soft Tissue Injuries (Sprains and Strains): What are Diagnosis?
History and physical examination
Soft Tissue Injuries (Sprains and Strains):
Nursing Care:
RICE = rest, ice, compression and elevation
Immobilization of the joint
Soft Tissue Injuries (Sprains and Strains):
Education/discharge instructions
Teach the proper technique for wrapping the affected joint
Physical activity restrictions
Sports Injuries: How do they occur?
Occur as a result of competitive and solitary sports
Sports Injuries: Signs and symptoms?
Ruptured or torn anterior cruciate ligament causes: Instability and pain in knee
In elbow injury: Pain and tenderness
Loss of full extension of elbow
Sports Injuries: Signs and symptoms of Ruptured or torn anterior cruciate ligament causes what?
Instability and pain in knee
Sports Injuries: Signs and symptoms of in elbow injury?
Pain and tenderness
Loss of full extension of elbow
Sports Injuries: Diagnosis?
X-ray exam followed by MRI
Sports Injuries: Nursing care
Rest, immobilization, ice
Topical anesthetic
Cast
Leg immobilizer
Anti-inflammatory agent
Sports Injuries: Education/discharge instructions
Teach family how to perform
neurovascular assessment
Care of suture line
Instruct how to care for immobilizer
Elevate extremity
Casts: What are they used for?
Casts are used to immobilize a bone that has been injured or a diseased joint.
Casts: What should be done?
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
Casts: What are cast complications?
Compartment syndrome
Cast syndrome
Casts:
Cast complications: Compartment syndrome?
(accumulation of fluid in the fascia)
Casts:
Cast complications: Cast syndrome?
(portion of duodenum compressed between superior and mesenteric artery and aorta)
Cast Complications: Compartment Syndrome- What are two assessments done for this?
Neurovascular assessment
Assess for “5 Ps”
Cast Complications: Compartment Syndrome- What are the 5 P’s to assess for?
Pain unrelieved by narcotics
Pallor
Paralysis
Paresthesia
Pulselessness
Cast Complications: Compartment Syndrome- What can help alleviate risk of compartment syndrome?
Application of ice and elevation of affected extremity can help to alleviate risk of compartment syndrome
Traction: What is it?
Another method of immobilization
Traction: What can it be used for?
Can be used to reduce and/or immobilize, align an injured extremity, allow the extremity to be restored to its normal length.
Traction: What else can it reduce? How?
May also reduce pain by decreasing muscle spasm
Spinal cord injury signs/symptoms
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
Teaching Topics to Prevent Spinal Cord Injury
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.
