Orthopedics

Question 1

DDH

Answer 1

developmental hip dysplasia

• abnormality in development of proximal femur, acetabulum or both
• > females and caucasians
• cause is unknown

Question 2

DDH risk factors

Answer 2

• family hx
• 1st pregnancy
• oligohydramnios
• breech presentation
• maternal hormones
• twins
• large size

Question 3

DDH Dx

Answer 3

• physical exam
• ultrasound during PE (2 wks of age)
• x-rays (>4 months)
• ortalomi test in newborns

Question 4

DDH s/s

Answer 4

• Asymmetry of gluteal or thigh folds
• leg length discrepancy
• hip abduction limitation
• leg with more folds is the affected leg
• • Ortolani Sign (click with abduction)
• pain
• abnormal gait - older child
• • trendelenberg sign - older child

Question 5

Trendelenberg Sign

Answer 5

when child stands on affected leg the unaffected hip tilts down

Question 6

DDH Management

0-6mos

Answer 6

Pavlik Harness

• wear 24/hrs day
• adjust straps with growth
• assess for skin irritation

Question 7

DDH Management

>6 mos

Answer 7

closed or open reduction w/ hip spica cast application

Question 8

DDH post op spic cast care

Answer 8

• neurovascular assessments of extremities
• assess cast for drainage and bleeding
• assess resp. system (cast constriction)
• pain management
• skin assessment
• petal cast

Question 9

Clubfoot Talipes

Answer 9

congenital deformity of the foot and is twisted out of shape or position

Question 10

Clubfoot Equinius

Answer 10

bent downward

Question 11

Clubfoot Varus

Answer 11

bent inward, with angulation towards the midline

Question 12

Clubfoot Dx

Answer 12

Prenatal ultrasound
physical exam
x-ray

Question 13

Clubfoot Etiology/ risks

Answer 13

• familial hx
• crowding in uterus
• maternal smoking during preg
• Amniocentesis
• > in boys
• > in twins

Question 14

Clubfoot management

Answer 14

• manipulation and serial casting
• corrective shoes/splints
• surgery

Question 15

Clubfoot Outcome

Answer 15

-foot may always be slightly smaller and stiffer

Question 16

Scoliosis

Answer 16

• lateral curve of the spine

- idiopathic scoliosis occurs most commonly in girls 10-15 yrs

Question 17

Other causes of scoliosis

Answer 17

• neuromuscular dissease
• trauma
• tumors
• vertebrae infections/ diorders

Question 18

Scoliosis Dx

Answer 18

School screening: middle school
Radiograph to measure curve
MRI
CT

Question 19

Scoliosis s/s

Answer 19

hips at angle
pants/skirt length uneven
shoulder heights unequal
uneven waist angles
respiratory dysfunction (severe curvatures)

Question 20

Scoliosis Management

Answer 20

-Bracing 25-35 degrees
Milwaukee brace
wear 23/hrs day
wear t-shirt under brace to < skin irritation
assess skin under brace frequently
-spinal fusion if >40 degrees

Question 21

Nursing spinal fusion care

Answer 21

• prepare pt for foley, NG tube, chest tubes (rare)
• review pain management (PCA)
• log-roll and avoid twisting trunk
• neuro/ vascular assessments
• assess OR site for blood and CSF
• body jacket used when ambulating

Question 22

JRA

Answer 22

Juvinile Rheumatoid Arthritis

Question 23

JIA

Answer 23

Juvenile Idiopathic Arthritis

Question 24

JRA/ JIA

Answer 24

• group of chronic autoimmune inflammatory diseases affecting joints and other tissues
• chronic inflammation of the synovium of the joints that results in wearing down and damage to articular cartilage
• sxs begin before 16 yrs and last >6 wks
• Peak ages: 2-5 yrs & 9-12 yrs
• > in girls

Question 25

JRS s/s

Answer 25

• joint swelling, stiffness, redness
• joint pain
• joints warm to touch
• mobility limitations
• fever, rash, malaise
• mild-severe in presentation

Question 26

JRA types

Answer 26

Pauciariticular
polyarticular
systemic

Question 27

Pauciarticular JRA

Answer 27

4 or fewer joints

greater risk for iris inflammation (iveitis)

Question 28

Polyarticular JRA

Answer 28

5 or more joints

Poorest prognosis w/ this and + rheumatoid factor

Question 29

Systemic JRA

Answer 29

any number of joints involved with high fever, rash, pericarditis, hepatosplenomegaly, lymphadenopathy

Question 30

JRA Dx

Answer 30

• ESR may be elevated
• Rheumatoid factor > in 10%
• ANA antinuclear antibodies w/ particular only
• Radiographic: may show increased synovial fluid in joint
• R/O other disorders

Question 31

JRA Management

Answer 31

• NSAIDS (ibu, naproxen)
• Cytotoxic drugs when NSAIDS not effective alone
• Corticosteroids
• Antirheumatic drugs

Question 32

JRA RN care

Answer 32

• moist heat to joints before exercise
• rest acutely inflamed joints
• splint joints for sleep to decrease pain and prevent flexion deformities

Question 33

Muscular Dystrophy

Answer 33

• A group of inherited disorders w/ preogressive degeneration of symmetric skeletal muscle groups
• Duchenne muscular dystrophy (DMD) is most common
• Affects > boys
• Inherited from mom to son

Question 34

DMD s/s

Answer 34

early onset (3-5 yrs)
by 9-11 yrs loss of independent ambulation
progressive muscle weakness
calf muscle hypertrophy
waddling gait
lordosis
winged scapulae
gowers sign (difficulty rising to standing position)
30% have mental delay and learning disabilities
later in diseasse: scoliosis, resp difficulty, cardiac diff

Question 35

DMD Management

Answer 35

• Maintain muscle function as long as possible
• ROM keep joints flexible
• Splints and braces to prevent contractions
• encourage child to be independent
• respiratory support: intermittent positive pressure ventilation
• support group for DMD