objective 10.3 Flashcards
Muscular & Skeletal systems work in harmony
These systems provide support for the body & allow for
body movement
Nervous system plays an important role as it transmits
messages in order for it to be purposeful & rhythmic
fundamental principles
Begin to walk & have a wide unstable gait
Arms do not swing with walking motion
toddler
Child’s walk is more stable with narrowing of wide base
18 months
Child can hop on one foot
Arm swings occur with walking
4 years
Childs gait resembles adult’s walk with equal stride lengths and
associated arm swing
6 years
how do we assess the childs gait?
Gait is characteristic manner of walking, The LPN
should observe the child as they engage in their
routine activities in order to assess gait
Gait disturbances could be caused by
neuromuscular or musculoskeletal disturbances
how do we assess newborn/infant?
Primarily through observation of:
Symmetry of movement
Strength & contour of body & extremities
Infants usually walk by 12 months; observe curvature of
spine & Active ROM
How would the PN test the strength of an extremity of a
child?
what are the signs of problems?
Pain
Tenderness
Discoloration
Edema
Pulses
Deformity
what are the musculoskeletal conditions?
Soft Tissue & Sports Injuries
Fractures
Infections & Osteomyelitis
Clubfoot
Developmental Dysplasia of the hip
Legge-Calve Perthes Disease
Rheumatoid Arthritis
Scoliosis
- Contusion, Sprain, Strain
Soft tissue injuries should be treated immediately
to limit damage from edema & bleeding
soft-tissue injuries
what is the nsg care of soft-tissue injuries?
Cold pack & elastic wrap will reduce edema &
bleeding, & relieve pain; should be applied at 20
min intervals to prevent ischemia
a break in a bone and is mainly caused
by accident
Characterized by:
Pain, tenderness on movement, and swelling
Discoloration, limited movement, and numbness may also
occur
Can be due to Pathology, Trauma or Abuse
fractures
bone broken, skin not
closed fracture
broken bone & skin
open/compound fracture
incomplete fracture, one side broken-other bent
greenstick fracture
broken bone with several bone fragments at the fracture site
comminuted fracture
caused by twisting motion
spiral fracture
The area of growing tissue in the long bones of children &
Adolescents
Each long bone has at least 2 growth plates (One at each end)
Growth Plate determines the future length & shape of the bone
When growth is complete (sometimes during adolescence), the
growth plates close and are replaced by solid bone
epiphyseal plate
what are pathological fratures caused by?
Malignancy ex. Osteosarcoma
Treatment that weakens bones
what are the goals in treating fractures?
- Reduce stress on healing bone (bedrest, nonweight
bearing movement) - Align bone so as it heals it can resume its natural anatomy
- Reduce risks of complications (thrombosis, contracture,
infection)
what are the invasive treatments of fractures?
surgery with or without pins, rods, or screws
what are the non invasive treatment of fractures?
cast, traction
Can be made from a variety of materials
Child is at increased risk for
Impaired skin integrity
Compartment syndrome
casts
Progressive loss of tissue perfusion
because of an increase in pressure
caused by edema or swelling that presses
on the vessels and tissues
If not carefully monitored, significant
complications can occur
compartment syndrome
what are the 6 Ps?
Pain & tenderness
Pulselessness
Paraesthesia
Pallor or cyanosis
Paralysis
Pressure & swelling
is used when cast cannot maintain alignment of the two bone
fragments
aligns injured bones, immobilization maintained until bones
fuse
Skin and skeletal traction both involve pulling force to realign bones
traction
what are the types of traction determined by?
Age of child, condition of soft tissue, type & degree of displacement
Traction commonly used in fractures of larger bones. Ex. Humerus,
Femur, Vertebra
Nonivasive traction used in femur, hip & knees. Pulls
Hip and leg into extension. Counter traction supplied
by child’s body. Ex. Buck’s, Russel and Bryant’s
skin traction
Client goes into surgery and has pins, wires inserted
into bone. Traction applied to the pin
Daily cleansing of the pin is ESSENTIAL
Ex. Steinmann pin or cervical traction for skull
fractures
skeletal traction
Used for the young child who has a
fractured femur who are:
Less than 2 years old or
Lighter than 20-30 lbs.
Child’s Weight act as countertraction
Note that the buttocks are slightly off the
bed to facilitate counter traction
Active infants may require a jacket restraint
to maintain body alignment
bryant’s traction
A type of skin traction used in fractures of the
femur and in hip and knee contractures
It pulls the hip and leg into extension
Counter traction is supplied by the child’s body
Essential that the child not slip down in bed
Used to reduce pain & muscle spasm associated
with slipped capital femoral epiphysis
bucks skin traction
Similar to Buck’s
extension traction
A sling is positioned under
the knee, which suspends the
distal thigh above the bed
Pulls in two directions
russell traction
Used for cervical fractures and spinal disorders
Head & Neck are immobilized while healing takes
place
Halo traction will almost always be used post neck
injury if surgery is not performed immediately after
injury
If surgery is ruled out then the halo traction will be
used for up to two months on bed rest and then a
further month to three months attached to specially
made vest so the head is kept perfectly still.
halo traction
what is the checklist for traction>
Weights are hanging freely
Weights are out of reach of the child
Ropes are on the pulleys
Bed linens are not on traction ropes
Counter traction is in place
Apparatus does not touch foot of bed
what is the checklist for the pt in traction>
Body in alignment
HOB no higher than 20 degrees
Heels of feet elevated from bed
ROM of unaffected parts checked at regular intervals
Antiembolism stockings or foot pumps in place as ordered
Neurovascular checks performed regularly and recorded
Skin integrity monitored regularly and recorded
Pain relieved by medication is recorded
Measures to prevent constipation are provided
Use of trapeze for change of position is encouraged
characterized by a foot that’s been twisted inward or outward
common, congenital deformity, affecting 1 / 1000
mild forms are often related to intrauterine positioning, and is often
corrected with stretching and exercise
cannot be reversed with exercise
Types:
TALIPES (‘heel’ & ‘foot’) EQUINOVARUS (‘extension and bent inward’)
Accounts for 95% of cases seen. The feet are turned inward & child
walks on toes & outer borders of feet usually affects both feet.
club foot
what is the treatment and nursing care of club foot?
must be PROMPT, may involve
splinting & casting, passive
stretching
surgery /post op care (if initial
measures have not been successful)
CAST CARE
assess neurovascular status
emotional support
Common orthopedic deformity (80% girls); 1 /1000 births
Diagnosed in the first or second month
Head of femur partially/completely displaced from shallow
hip socket
developmental hip dysplasia
what are the S&S of developmental hip dysplasia?
Limited abduction of leg on affected side
Asymmetry of Gluteal folds
Shortening of femur; uneven knee
height
Barlow’s or Ortolani’s test
Ortolani’s sign
what is the treatment of hip dysplasia?
Goal - return femoral head to acetabulum ASAP
Maintain hips constant abduction & flexion 4-8 weeks
Triple thick Diaper
Pavlick harness 1-6 mos age
Body spica cast/traction if detected when walking (usually
for a period of 5-9 months)
Surgery required > 18 months
Blood supply to epiphysis or end of the bone is
disrupted
May lead to osteonecrosis or femoral head
deformity
Symptoms include painless limp, limited ROM, thigh
& knee pain
Occurs in boys between 4-8 yrs
Treatment
Keep femoral head in hip socket (ambulation –
abduction cast or brace)
legg-calve perthes disease
Most common arthritic condition of
childhood
Systemic autoimmune inflammatory
disease involving joints, connective
tissues, and viscera
Periods of remissions and
exacerbations
Cause Unknown- autoimmune
No specific tests or cures for JRA
juvenile idiopathic arthritis
what is the treatment of juvenile idiopathic arthritis?
Requires multidisciplinary approach
Reduce joint pain and swelling
Promote mobility and preserve joint function
Promote growth and development
Promote independent functioning
Help the child and family to adjust to living with a chronic
disease
NSAID’s, Steroids, heat packs, splints, pool exercises, sleep,
alleviate stress, suppor
Infection of bone
Median age of 6 years more common in boys than girls
After local injury #, burn, contamination during surgery
DX: Inc. WBC, x-ray, &/or bone scan
S&S:
Pain
Limping
Dec. vol move’s
Reduced ROM
Local inflammation: Inc. WBC & ESR (a measure of inflammation)
osteomyelitis
include:
Lordosis, kyphosis, scoliosis
Causes: congenital,
neuromuscular, weakness,
poor posture, idiopathic
abnormal spine curvatures
Abnormal side to side curvature - S-shape
More common in girls
If untreated it can lead to back pain, disability, heart & lung problems
Usually accompanied by rotation of the spine
Hips and shoulders may appear to be uneven
scoliosis
what are the 3 types of scoliosis?
functional
structural
idiopathic curve
caused by poor posture
functional
caused by changes in the shape of vertebrae or thorax
structural
at least 10 degrees, cause unknown
idiopathic-curve
what is the treatment of scoliosis?
Aimed at correcting curvature and preventing severe scoliosis
Targets the cause
Curves up to 20 degrees do not require treatment
Curves 20 to 40 degrees require the use of a Milwaukee
brace
Curves of 45 degrees and patients in whom conservative
therapy was not successful require hospitalization
Spinal fusion is performed
Halo traction may be used if neck weakness
exerts pressure on chin, pelvis
and convex (arched) side of the
spine.
Worn 16-23 hours per day over
a cotton t-shirt
milwaukee brace
