Pedi Musculoskeletal Disorders Flashcards
Fractures
Healing
Bone healing and remodeling is faster in children than adults due to thicker periosteum and good blood supply
Fractures
Risk Factors
Obesity
poor nutrition
developmental characteristics
Fractures
Evidence
radiographic evidence of previous fractures in various stages of healing or in infants may = physical abuse or osteogenesis imperfecta
Fractures
Stress
tiny cracks in bone
Fractures
Spiral
break spirals around bone
Fractures
Greenstick
incomplete fracture of bone
Fractures
Plastic deformation (bend)
bone is bent no more than 45 degrees
Fractures
Buckle (torus)
compression of bone = bulge or raised area at fracture site
Fractures
Transverse
break is straight across bone
Fractures
Oblique
break is diagonal across bone
Fractures
Growth Plate
injury to end of long bone on growth plate
Fractures
Complete
Bone fragments are separated
Fractures
Incomplete
Bone fragments are still attached
Fractures
Closed or simple
fracture occurs without a break in the skin
Fractures
Open of compound
fracture occurs with an open wound and bone protruding
Fractures
Complicated fracture
fracture results in injury to other organs and tissues
Fractures
Manifestations
Pain Crepitus deformity edema ecchymosis warmth or redness
Fractures
Diagnostics
X-ray
MRI
Fractures
Nursing Care
ABCs
VS, pain, neurological status
Neurovascular status of injured extremity
supine position
stabilize injured area, elevate and apply ice
keep client warm
Pain Scales
toddler - FLACC Scale
pre-school - Faces
5 years and older - Numeric pain scale
Fractures
Plaster of Paris
heavy, not water resistant, 10-72 hrs to dry
Fractures
Synthetic fiberglass
light, water resistant, 5-20 min to dry
Fractures
Prior to casting
observe skin for integrity
clean and dry
pad to bony prominences
show procedure on doll/toy
Fractures
Casting
Nursing care
assess and monitor neurovascular status
elevate above heart for first 24-48 hr to prevent swelling
ice for first 24 hr
turn and position q2h
support/elevate when sitting
assess for increased warmth or hot spots could indicate infection
monitor for drainage: outline area with a marker and date and time the area
use moleskin over any rough areas that might rub against skin
assist with proper crutch fitting and reinforce proper use
Fractures
Casting
Family Education
When cast is applied it will feel warm but won’t burn
if pain is sever and not alleviated within 1 hr of pain med admin call MD
teach neurovascular checks and when to call MD
explain cast removal and cast cutter
Traction
selection of traction determined by type of fracture, age of client, associated injuries
Traction
Skin traction
uses pulling force that is applied by weights
Buck, Russell, Bryant
Russell - assess child’s position, hip flexion must be maintained
do not remove boots
weights hang freely
Traction
Skeletal traction
continuous pulling force applied to specific bone
pin or rod inserted through bone
force applied through use of weights attached by rope
allows child to change position without interfering with pull of traction (90/90 traction- femur/tibia)
assess pin sites for infection and provide care per facility protocol
Traction
Halo
cervical traction
halo bar encircles head
screws inserted into outer table of skull
attached to either bed traction or rods secured to a vest
assure that wrench is available to release rods attached to vest to do CPR
Compartment syndrome
compression of nerves, blood vessels, muscle inside confined space
Compartment syndrome
Manifestations
increased pain unrelieved with elevation or analgesics
intense pain when passively moved
paresthesia or numbness
pulselessness distal to fracture
inability to move digits
warm digits with skin that is tight and shiny
pallor
Compartment syndrome
Prevention
loosen constrictive dressing or cut bandage or tape
elevate extremity apply ice
prepare for fasciotomy
Clubfoot
deformity of ankle or foot
can affect one or both feet
isolated defect or in association with other disorders such as cerebral palsy and spinal bifida
Talipes varus
inversion - bending inward
Talipes valgus
eversion - bending outward
Talipes calcaneous
dorsiflexion - toes are higher than heels
Talipes equinus
plantar flexion - toes are lower than heels
Talipes equinovarus
toes are facing inward and lower than heel
Talipes equinus
Sign of
sign of
Clubfoot
Diagnostic
Prenatal ultrasound
Clubfoot
Nursing Care
hold and cuddle
developmental needs
neurovascular and skin integrity
perform and teach cast care
Clubfoot
Therapeutic procedures
Castings
Series of casting starting shortly after birth and continuing until maximum correction
Clubfoot
Surgical interventions
osteotomy - removing part of bone
fusion - fusing two or more bones together
tendon lengthening or shortening
Developmental Dysplasia of the Hip DDH
Manifestations
Infant: asymmetry of gluteal and thigh folds; limited hip abduction; shortening of femur; positive Ortolani test - reduced by abduction; positive Barlow test - dislocated by adduction
Child: one leg shorter; positive Trendelenburg sign - bear weight affected side pelvis tilts down toward unaffected sign; walking on toes on one foot; walk with limp
DDH
Treatment
Newborn - 6 mos
Pavlik harness for 12 weeks - check straps every 1-2 weeks; shirt worn under harness
Bryant traction - skin traction; for adduction contracture; hips flexed 90degrees with buttock raised
Hip spica cast - needs to be changed to accommodate growth; cast on pillows
DDH
Treatment
6 mos - 2 years
surgical closed reduction with placement of hip spica cast
DDH
Complications
post-op complications - atelectasis, ileus, infection
effects of immobilization - decreased muscle strength, bone demineralization, altered bowel motility
effects of casting - skin breakdown, neurovascular alterations
Osteogenesis Imperfecta (OI)
disorder of bones resulting in fractures and deformity
Osteogenesis Imperfecta (OI)
Manifestations
multiple bone fractures blue sclera early hearing loss bowed legs and arms kyphosis scoliosis
Osteogenesis Imperfecta (OI)
Medication
pamidronate - increase bone density
IV
adverse effects: hypokalemia, hypomagnesemia, hypocalcemia, hypophosphatemia, general malaise
Scoliosis
deformity of spine and affects ribs
curve greater than 10 degrees
child bend over observe for asymmetry of ribs and flank
Scoliosis
Treatments
Bracing
Surgical interventions (greater than 45 degrees curvature) - spinal fusion with rods; autologous (self-donated) blood donations
post-op: monitor pain, admin analgesia using PCA pump
frequent turning to prevent damage to the spinal fusion
