Pedi MS Flashcards
Ribs and sternum grow abnormally/inward. Depression/concavity in chest. Boys 3x more likely than girls. Severity increases with growth spurts.
Assess for cardiopulmonary difficulties from pressure on heart and lungs; alteration in body imagine, low self esteem
Pectum Excavatum (“sunken chest”)
Treatment only if symptomatic: surgery- bar placed to reshape sternum (remove after 2y).
Post-op: pain management, deep breathing, mobility/PT
Splinting with C and DB; straight posture and no lifting for 1 mo; no contact sports for 6 mos
Treatment and Interventions for Pectus Excavatum (“sunken chest”)
Extra digits on hands and or feet
Polydactyly
Digits fail to separate; fused/webbed appearance. Can involve nerves and muscles.
Syndactyly
X rays to determine nature and extent.
Treatment: surgical correction- remove extra/ separate fused digits. Can be complex. Splinting/casting for immobilization. OT/PT
Treatment and Nursing for Polydactyly and Syndactyly
Genetic disorder. Too little or poor quality of Type 1 collagen (connective tissue that bones are formed around). Eight types varying in symptoms and severity; type one is the mildest and most common. “brittle bone disease”
Osteogenesis Imperfecta (OI)
Bone fractures very early, frequently during birth. Muscle weakness, bone deformities, short stature, triangular face, bluish sclera, hearing loss.
Treatment: Manage symptoms/fractures; PT to strengthen muscles; mobility aids. No contact sports; non weight bearing or low impact activities.
Nursing: Avoid automatic BP cuffs; careful handling/repositioning (lifting under trunk with diaper changes)
Growth hormone shown to increase collagen
S/s, treatment, and nursing for Osteogenesis Imperfecta (OI)
Disorder of tibial growth plate; worsens with time. Normal in toddlers, alignment should be straight by 3. Bowed legs (tibia vara). Associated with obesity, vitamin D deficiency, genetics. May have leg length discrepancy and knee pain
Blount Disease
Treatment: Bracing; surgery to reshape tibia. Cast vs external fixator (ex-fix)
Nursing: Assess skin color, temp, pulses, edema, cap refill, movement (risk for compartment syndrome with cast), pin care with ex fix. Assess for DVT (leg pain, redness, swelling, warmth)
Treatment and Nursing Interventions for Blount Disease
Talipes Equinovarus. 1 in 1000, boys more likely than girls. Heel in and down; bottom of foot faces upward. Smaller foot and calf muscle, shorter Achilles tendon.
Clubfoot
Treatment: Non surgical: Ponseti method- serial casting. Then brace- up to 4-5 years! Surgical correction: tendon release, bone realignment; tendon transfer.
Nursing: emphasize COMPLIANCE!! Cast care; brace care (Recurrrence 90% in 1st year, 80% in 2nd)
Clubfoot Treatment and Nursing Interventions
Femoral head not adequately covered or dislocated. Usually discovered in newborn exam (older children will limp). Limited abduction, leg length discrepancy.
Hip Dysplasia
Assess skin folds of thigh; knee height. Ortolani sign (abduction - dysplasia) Barlow’s test (adduction - unstable). Both should be negative by 3 mo.
Early treatment: less than 6 mo: non surgical leading to bracing. 90% success; Palvik harness.
6-24 mos: Surgical leading to closed reduction (no incision)
Over 2y: Surgical leading to open reduction/osteotomy, spica cast- double diaper.
Nursing: Harness and cast care. Skin (redness? irritation? breakdown?). Toileting, movement, transportationdws
S/s, Treatment, and Nursing Interventions of Hip Dysplasia
Ball at the head of the femur slips off at the growth plate. Most common hip disorder in adolescents, boys more than girls. Develops during growth spurts. If one hip affected, 25% change of other hip.
Slipped Capital Femoral Epiphysis (SCFE)
Limping, pain, turning of leg; limited ROM. X Ray
EMERGENCY- STOP WEIGHT BEARING; prepare for surgery. Can limit blood supply to femoral head.
Treatment: Surgery- secure femur head back into place. Crutches x6 weeks. Toe-touch weight bearing. PT.
Nursing: Teaching re: non weight bearing; crutch use, post op care.
S/s, Treament, and Nursing Interventions for Slipped Capital Femoral Epiphysis (SCFE)
Idiopathic; self limiting; 1 in 12,000; boys more frequently than girls.
Occurs in children usually aged 6-10y (3-12y)
Bone supply to head of femur is disrupted.
Bone cells die (Avascular necrosis (AVN) and femoral head becomes deformed. Sometimes can affect both hips
Legg Calve Perthes Disease (Perthes)
Course of disease- approximately 12-26 months.
4 stages: Necrosis/bone death, Fracture/fragmentation/resorption, revascularization/reossifcation, healing.
Prognosis depends on patient age (younger = better)
Treatment: Conserviative vs Surgical (femoral ossification)
Limited- NO weight bearing. PT, anti-inflammatories. CONTAINMENT; restore maximum hip movement.
Details and Treatment on Legg Calve Perthes Disease
Goals: Relieve pain, protect/prevent further bone deterioration. Give bone best chance of re-growing into round shape. Prevent osteoarthritis.
Nursing: Pain control. Ambulation, skin integrity, compliance (age, understanding, inconvenience). Coping with immobility; distraction, suitable activities. Family and social dynamics. Opportunities for TEACHING and SUPPORT
Goals and Nursing Interventions for Legg Calve Perthes Disease
Bacterial infection leading to infection/inflammation of the bone. Through bloodstream or infected surrounding tissue (trauma, surgery, foreign body). S aureus most common.
Osteomyelitis
S/s: Pain, redness, swelling, warmth, fever, chills, malaise/fatigue. Difficulty weight bearing or lifting; limited mobility.
Labs: CBD: increased WBC, CRP and ESR elevated; blood cultures.
Treatment: Antibiotics for 4-8 weeks. IV first then oral.
Nursing: antibiotics, comfort measures; teaching re: antibiotics at home; line care; infection prevention
S/s, Treament, and Nursing Interventions for Osteomyelitis
Lateral curvature of the spine. Over 10% causing vertebrae rotation and S shaped appearance. Classified by location of curvature (thoracic or lumbar). Congenital, neuromuscular, idiopathic - 80% of cases.
AIS= most common, manifests during puberty
Truncal asymmetry, uneven shoulders, hips, waist curvature; head not midline.
Scoliosis
School nurses: screening in grades 5 and 7; Adam’s foward bending test.
Treatment: Bracing (30-45°) vs surgery ( over 50°)
Nursing: Compliance with bracing; post op priorities: Neurovascular status, positioning, pain
Ambulation post op day 1. Blood loss? LE movement/feeling? Consistent pain control, anti spasm. Activity restriction- no bending and twisting for 3 months
Treatment and Nursing Interventions for Scoliosis
Stretched or torn muscle or tendon
Strain
Injury to a ligament
Ankles, knees, shoulders (jumping, lateral/”cutting” movement)
Sprain
Pain, swelling, bruising, decreased ROM, difficulty weight bearing/lifting
Treatment: RICE: Rest, Ice, Compression, Elevate; NSAIDS.
Mobility aids, PT to facilitate recovery
S/s and Treatment of Strains and Sprains
Broken bone. Most common reason in pedi: falls and trauna. Upper extremities more common. Open growth plates leading to higher risk for healing/deformity complications
Fractures
Pain, swelling, cant move extremity; visible deformity? S/s vary depending on location and severity.
Treatment: Put back in place- closd or open (surgical) reduction, cast. Pain meds, sedation necessary? Immobilize above and below injury; elevate.
Assess neurovascular status (color, temp, pulses, cap refill, movement/feeling)
COMPARTMENT SYNDROME= RED FLAG: pain out of proportion; unrelieved.
Twisting fractures in non-ambulating children= abuse?
S/s, Treatment and Nursing Interventions for Fractures
Repetititve stress injury; microtrauma to bone, muscle, or tendon. Many sports related: Sever disease (inflamed growth plate in heel bone), Osgood-Schlatter (inflamed growth plate at top of tibia/front of knee), Patellar tendonitis (“jumper’s knee”- pain in lower portion of knee cap), throwing injuries in elbow, stress fractures (mostly in bones of lower legs and feet)
RICE, NSAIDS, stretching, immobilization; casting/bracing for stress fractures; PT
Nursing: Teach compliance is imperative to prevent further injury, prevention
Overuse Syndrome
For broken neck or compressed or severely curved spine.
Nursing: Pin care; WRENCH AT BEDSIDE
Halo/Halo traction
Multiple fractures, high energy trauma, MVA, skiing, bicycling, external fixator (lengthening?), amputation
Types of Trauma
inflamed growth plate in heel bone
Sever disease
inflamed growth plate at top of tibia/front of knee
Osgood-Schlatter disease
“jumper’s knee”- pain in lower portion of knee cap
Patellar tendonitis
