Orthopedics Flashcards
1
Q
DDH
A
developmental hip dysplasia
- abnormality in development of proximal femur, acetabulum or both
- > females and caucasians
- cause is unknown
2
Q
DDH risk factors
A
- family hx
- 1st pregnancy
- oligohydramnios
- breech presentation
- maternal hormones
- twins
- large size
3
Q
DDH Dx
A
- physical exam
- ultrasound during PE (2 wks of age)
- x-rays (>4 months)
- ortalomi test in newborns
4
Q
DDH s/s
A
- 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
5
Q
Trendelenberg Sign
A
when child stands on affected leg the unaffected hip tilts down
6
Q
DDH Management
0-6mos
A
Pavlik Harness
- wear 24/hrs day
- adjust straps with growth
- assess for skin irritation
7
Q
DDH Management
>6 mos
A
closed or open reduction w/ hip spica cast application
8
Q
DDH post op spic cast care
A
- neurovascular assessments of extremities
- assess cast for drainage and bleeding
- assess resp. system (cast constriction)
- pain management
- skin assessment
- petal cast
9
Q
Clubfoot Talipes
A
congenital deformity of the foot and is twisted out of shape or position
10
Q
Clubfoot Equinius
A
bent downward
11
Q
Clubfoot Varus
A
bent inward, with angulation towards the midline
12
Q
Clubfoot Dx
A
Prenatal ultrasound
physical exam
x-ray
13
Q
Clubfoot Etiology/ risks
A
- familial hx
- crowding in uterus
- maternal smoking during preg
- Amniocentesis
- > in boys
- > in twins
14
Q
Clubfoot management
A
- manipulation and serial casting
- corrective shoes/splints
- surgery
15
Q
Clubfoot Outcome
A
-foot may always be slightly smaller and stiffer
16
Q
Scoliosis
A
- lateral curve of the spine
- idiopathic scoliosis occurs most commonly in girls 10-15 yrs
17
Q
Other causes of scoliosis
A
- neuromuscular dissease
- trauma
- tumors
- vertebrae infections/ diorders
18
Q
Scoliosis Dx
A
School screening: middle school
Radiograph to measure curve
MRI
CT
19
Q
Scoliosis s/s
A
hips at angle pants/skirt length uneven shoulder heights unequal uneven waist angles respiratory dysfunction (severe curvatures)
20
Q
Scoliosis Management
A
-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
21
Q
Nursing spinal fusion care
A
- 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
22
Q
JRA
A
Juvinile Rheumatoid Arthritis
23
Q
JIA
A
Juvenile Idiopathic Arthritis
24
Q
JRA/ JIA
A
- 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
25
JRS s/s
- joint swelling, stiffness, redness
- joint pain
- joints warm to touch
- mobility limitations
- fever, rash, malaise
- mild-severe in presentation
26
JRA types
Pauciariticular
polyarticular
systemic
27
Pauciarticular JRA
4 or fewer joints
| greater risk for iris inflammation (iveitis)
28
Polyarticular JRA
5 or more joints
| Poorest prognosis w/ this and + rheumatoid factor
29
Systemic JRA
any number of joints involved with high fever, rash, pericarditis, hepatosplenomegaly, lymphadenopathy
30
JRA Dx
- 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
31
JRA Management
- NSAIDS (ibu, naproxen)
- Cytotoxic drugs when NSAIDS not effective alone
- Corticosteroids
- Antirheumatic drugs
32
JRA RN care
- moist heat to joints before exercise
- rest acutely inflamed joints
- splint joints for sleep to decrease pain and prevent flexion deformities
33
Muscular Dystrophy
- 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
34
DMD s/s
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
35
DMD Management
- 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
