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WH and Pedi > Pedi MS > Flashcards

Pedi MS Flashcards

1
Q

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

A

Pectum Excavatum (“sunken chest”)

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2
Q

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

A

Treatment and Interventions for Pectus Excavatum (“sunken chest”)

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3
Q

Extra digits on hands and or feet

A

Polydactyly

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4
Q

Digits fail to separate; fused/webbed appearance. Can involve nerves and muscles.

A

Syndactyly

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5
Q

X rays to determine nature and extent.
Treatment: surgical correction- remove extra/ separate fused digits. Can be complex. Splinting/casting for immobilization. OT/PT

A

Treatment and Nursing for Polydactyly and Syndactyly

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6
Q

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”

A

Osteogenesis Imperfecta (OI)

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7
Q

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

A

S/s, treatment, and nursing for Osteogenesis Imperfecta (OI)

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8
Q

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

A

Blount Disease

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9
Q

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)

A

Treatment and Nursing Interventions for Blount Disease

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10
Q

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.

A

Clubfoot

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11
Q

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)

A

Clubfoot Treatment and Nursing Interventions

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12
Q

Femoral head not adequately covered or dislocated. Usually discovered in newborn exam (older children will limp). Limited abduction, leg length discrepancy.

A

Hip Dysplasia

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13
Q

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

A

S/s, Treatment, and Nursing Interventions of Hip Dysplasia

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14
Q

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.

A

Slipped Capital Femoral Epiphysis (SCFE)

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15
Q

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.

A

S/s, Treament, and Nursing Interventions for Slipped Capital Femoral Epiphysis (SCFE)

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16
Q

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

A

Legg Calve Perthes Disease (Perthes)

17
Q

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.

A

Details and Treatment on Legg Calve Perthes Disease

18
Q

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

A

Goals and Nursing Interventions for Legg Calve Perthes Disease

19
Q

Bacterial infection leading to infection/inflammation of the bone. Through bloodstream or infected surrounding tissue (trauma, surgery, foreign body). S aureus most common.

A

Osteomyelitis

20
Q

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

A

S/s, Treament, and Nursing Interventions for Osteomyelitis

21
Q

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.

A

Scoliosis

22
Q

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

A

Treatment and Nursing Interventions for Scoliosis

23
Q

Stretched or torn muscle or tendon

A

Strain

24
Q

Injury to a ligament

Ankles, knees, shoulders (jumping, lateral/”cutting” movement)

A

Sprain

25
Q

Pain, swelling, bruising, decreased ROM, difficulty weight bearing/lifting
Treatment: RICE: Rest, Ice, Compression, Elevate; NSAIDS.
Mobility aids, PT to facilitate recovery

A

S/s and Treatment of Strains and Sprains

26
Q

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

A

Fractures

27
Q

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?

A

S/s, Treatment and Nursing Interventions for Fractures

28
Q

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

A

Overuse Syndrome

29
Q

For broken neck or compressed or severely curved spine.

Nursing: Pin care; WRENCH AT BEDSIDE

A

Halo/Halo traction

30
Q

Multiple fractures, high energy trauma, MVA, skiing, bicycling, external fixator (lengthening?), amputation

A

Types of Trauma

31
Q

inflamed growth plate in heel bone

A

Sever disease

32
Q

inflamed growth plate at top of tibia/front of knee

A

Osgood-Schlatter disease

33
Q

“jumper’s knee”- pain in lower portion of knee cap

A

Patellar tendonitis

WH and Pedi (20 decks)

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