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PHST4001 Exam > Paeds > Flashcards

Paeds Flashcards

1
Q

What are the 3 limitations of self-report of pain in Paeds?

A

:
o Developmental level
o Verbal limitations
o Emotional distress etc

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2
Q

What are the 3 approaches to pain assessment in children? Explain them and give one example of each

A
  1. Physiological: Monitoring parameters e.g. heart rate (HR), respiratory rate (RR), blood pressure (BP), and oxygen saturation (O2 sats).
  2. Behavioral: Observing vocal expressions (e.g., crying), facial expressions, rigid body posture, clenched hands/toes, body movements (e.g., withdrawal from pain stimulus, limpness or flaccidity in preterm or ill infants), altered sleep patterns, and inconsolability)
    Examples of outcome measures: Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS)
  3. Self- report: 2-year-olds: presence and location of pain, Age 3/4: pain intensity
    Examples: Faces Pain Scale (FPS), Wong-Baker Faces Pain Scale, verbal numerical rating scale, Visual analogue scales (VAS), Coloured Analogue Scale (CAS), Pieces of Hurt Tool, The Oucher-Photographic and Numerical Rating Scale
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3
Q

Give examples of Nonpharmacologic pain management

A

NOT substitute for analgesia, rather complementary
Distraction
Guided imagery
Hypnosis (trained practitioner)
Infants and younger children: Comfort measures e.g.
 Cuddling
 Auditory and tactile stimulation
 Suckling

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4
Q

Outline the physiotherapy management of paediatric pain:

A
  • Thorough Pain assessment
    o nature, intensity, location, and duration
    o age-appropriate, considering the child’s ability to communicate their discomfort.
  • Monitor correct pharmacological management
  • Advocate for child
  • Communication with parents/caregiver
  • Distraction techniques, play therapy, or relaxation exercises to help the child cope with pain.
  • Other Physio analgesic modalities
    o Ice and Heat Therapy: acute pain
    o Transcutaneous Electrical Nerve Stimulation (TENS): chronic pain management
    o Soft Tissue Techniques
    o Stretches
    o Cardiovascular Exercise: endorphins
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5
Q

What are the 2 indications for respiratory physiotherapy in infants?

A
  • Lobar collapsed due to plugging (not inflammation - RSV)
  • Increase or retention of secretions that baby can’t clear on their own
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6
Q

At how many weeks is a baby considered to be born premature?

A

<37 weeks

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7
Q

What are the indications for physiotherapy in the premature infant?

A

Retention of secretions and lobar collapse due to plugging
Meconium aspiration
Aspiration of feed or vomit
Chronic lung disease
Postoperatively (positioning)

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8
Q

What are the 2 kinds of chronic lung disease?

A

Chronic lung disease (CLD I): Infants who are still oxygen dependent at one month

Bronchopulmonary dysplasia (CLD II): cystic changes on x-ray.

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9
Q

What are the contraindications to respiratory physiotherapy in infants?

A
  • Unstable infant
  • Pulmonary haemorrhage
  • Respiratory distress syndrome
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10
Q

What are the signs of respiratory distress in infants and young children?

A

Tachypnoea
Nasal/alar flaring
Grunting
Recessions or retractions
Head bobbing
Abnormal positioning
Expiratory wheeze/prolonged expiration
Stridor

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11
Q

The musculoskeletal system of children is different to that of adults. These differences account for differences in fracture presentation, healing and management. What are these differences?

A

Growth plate
o Children have an active growth plate
o Facilitates remodelling
o Injured growth plate leads to deformity

Bone
o Higher collagen to bone ratio
o More porous
o Bone fails in tension and compression
o Bone transitions

Periosteum
o Metabolically active
o Thickness and strength

Cartilage
o Increased ratio of cartilage to bone improves resilience but makes interpretation of xrays more difficult.

Ligaments
o Relatively stronger than bone.
o Avulsion injuries common in children

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12
Q

What are the preventable and non-preventable complications of fractures?

A

Non-preventable complications
o Avascular necrosis
o Physeal injuries

Preventable complications
o Compartment syndrome
o Malunion
o Physeal bar formation
o Deformity from small physeal bars
o Fixation complications
o Cast complications

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13
Q

What are the issues with early specialisation in sports?

A
  • Can lead to increased stress on specific body areas and overuse injuries.
  • Year-round participation in same sport
  • Infrequent rest periods
  • Lack of diversity of movement and loading
  • Focusing on a single sport at a young age may hinder overall physical development.
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14
Q

Why are females at a higher risk of developing ACL and lateral ankle ligament injuries?

A

 Anatomical variances such as increased Q-angle and dropped navicular bone.
 Hormonal influences, potentially affecting ligament laxity and stability.
 Neuromuscular control differences between genders.
 Biomechanical variances, including differences in landing mechanics and muscle strength.

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15
Q

What is the female athlete triad?

A

Combination of three interrelated health issues often observed in active females:
o Disordered eating /low energy availability.
o Menstrual disturbances/amenorrhea.
o Bone loss/Osteoporosis

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16
Q

What are the 7 risk factors for pediatric sports injuries?

A
  1. Training Errors:
    * Sudden increase in training volume, speed, or intensity.
  2. Musculo-Tendinous Imbalances:
    * Result from Repetitive Demands on Physiological and Biomechanical Systems
    o E.g. baseball pitcher, swimmer, long distance runners
    * Risk can be reduced by concentrating on a well-designed training programme which corrects the imbalances and focuses on technique above performance measures initially
  3. Anatomical Malalignment:
    * Structural deviations affecting joint alignment and movement patterns.
    * Altered joint mechanics increase stress on surrounding structures.
    * May lead to abnormal movement patterns and contribute to injuries.
  4. Improper Footwear:
    * Contributes to increased muscle action and potential injuries.
  5. Faulty Playing Surfaces:
    * Playing surfaces can cause increased muscle action by increasing the ground reaction forces, uneven surfaces, cambered road or increase muscle work as with long grass
  6. Associated Pathology:
    * Conditions like Perthes disease or juvenile rheumatoid arthritis can affect movement mechanics and increase injury risk.
    * Growing bones and cartilage are susceptible to overuse and trauma.
    * Pathology or previous injuries may impact injury susceptibility and severity
  7. Growth Factors:
    * Growing bones, cartilage, and soft tissues vulnerable to trauma.
    * Rapid bone growth can lead to increased risk of fractures and other injuries.
  8. In SA context: nutritional status –current and during development
17
Q

Why does performance in sport decrease in a growth spurt?

A
  • Effect of growth spurt
    o Loss of Body awareness
    o Loss of Proprioception
    o Loss of Motor control
    o Loss of Muscle strength
    o Loss of Muscle flexibility
    o Loss of Co-ordination
    o “Gangly”
18
Q

What are the 3 most common lesions in prematurity?

A
  1. periventricular leukomalacia (PVL)
  2. Intraventricular haemorrhage (IVH)
  3. Periventricular haemorrhagic infarction (PHI)
18
Q

Outline the preterm picture

A
  • The preterm infant has hypotonia, poor physiological flexion and therefore little activity
  • Movement is jerky and limbs are abudcted and extended
  • There is poor postural stability
  • Most sensory input is noxious
  • No self-soothing strategies
  • Primary reactions are absent or weak
  • Primary responses therefore not reliable for survival
  • No established sleep wake cycles
  • Infant is physiologically unstable
  • The preterm infant has no established midline and therefore no reference point from which to move
  • Therefore, acts as if he has no middle
  • Therefore, the preterm child with CP has severe hypotonic trunk
  • Distal spasticity
  • Patterns of movement are more extended and asymmetrical
  • Therefore, different combinations of abnormal patterns are seen
18
Q

What are the general outcomes of prematurity?

A
  • Increased risk of disability and CP
  • Lower scores on tests of language, cognition and visuo-spatial recognition (precursors of later learning difficulties)
  • NB for physio: motor developmental problems
19
Q

What are the signs and symptoms of meningitis

A
  • Develops over 1 – 4 days
  • Triad
    o Rigidity
    o Sudden high fever
    o Altered mental status
  • Increased irritability
  • Neck stiffness and pain
  • Neck retraction and back extension
  • High Fever (cold hands and feet)
  • Lethargic
  • Increased sensitivity to light
  • Seizures
19
Q

What are the 4 most common complaints affecting the quality of life of children with HIV

A

Pain (joint, limb, headaches)
Fatigue
Sleep disturbances (ARV side effect)
Mobility/physical challenges

20
Q

What are the physiotherapy principles in burn management

A
  • Maintain a clear dry chest
  • Monitor burn wounds
  • Maintaining mobility of joints
  • Maintaining or increasing strength in LL’s and UL’s
  • Maintain good circulation and pressure care
  • Keep patient at highest functional level possible
  • Educate the patient and family on injury, contraindications and precautions
  • Administer a bed exercise program
  • Respect Pain!!!
  • Infection Control
  • Mobilisation
21
Q

What are the principles of integrated palliative care?

A

Respect for the dignity of patients and families
o Respect and listen to patient and family goals, preferences and choices.
o School age children can articulate treatment preferences.
o Children older than 14 can be involved in decision making.
o Address differences in opinion between family and health care providers.

Access to comprehensive and compassionate palliative care
o Address physical symptoms, comfort, functional capacity, pain etc
o Acknowledge psychological distress
o Respite care?

Use of interdisciplinary resources
o No one clinician can provide all the care and support needed
o Don’t forget psychologists, social workers, pastoral care, friends and family, the child’s peers.

Acknowledging and supporting caregivers
o Parents
o Siblings
o Extended family

Commitment of quality improvement of palliative care through research and education
o Continue to monitor and evaluate services

PHST4001 Exam (3 decks)

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