Pediatics- Musculoskeletal Flashcards
(163 cards)
1
Q
What is a fracture?
A
When the resistance between a bone in an applied, stress yields to stress, resulting in disruption to the integrity of the bone
2
Q
Is bone healing and remodeling faster in children or adults
A
Children due to a thicker periosteum and good blood supply
3
Q
What is an expected finding in a fracture?
A
Pain
Crepitus
Deformity
Edema
Ekhymosis
Worms and redness
4
Q
What is plastic deformation?
A
Bend
The bone is bent no more than 45° without breakage
5
Q
What is buckle fracture (torus)?
A
Compression of the bone resulting in a bulge or raised area at the fracture site
6
Q
What is a greenstick fracture?
A
Incomplete fracture of the bone
7
Q
What is a transverse fracture?
A
Break is straight across the bone
8
Q
What is an oblique fracture?
A
Break is diagonal across the bone
9
Q
What is a spiral fracture?
A
Break spirals around the bone
10
Q
What is a physeal fractur
A
Growth plate fracture
Injury to the end of the long bone on the growth plate
11
Q
What is a stress fracture?
A
Small fracture cracks in the bone due to repeated muscle contraction
12
Q
What is a complete fracture?
A
Bone fragments are separated
13
Q
What is an incomplete fracture?
A
Bone fragments are still attached
14
Q
What is a closed or simple fracture
A
The fracture occurs with an open wound in a bone protruding
15
Q
What is a complicated fracture?
A
The fracture results in injury to other organs and tissues
16
Q
What is a comminuted fracture?
A
The fracture includes small fragments of bone that lie in surrounding tissue
17
Q
What is a radiograph used for in fractures?
A
Confirm diagnosis and determine the positioning of the bone
18
Q
What is nursing care for someone who has a fracture?
A
Emergency care at time of injury
History of how injury occurred
Maintain ABC’s
Check neurovascular status
Remove jewelry
Stabilize injured area
Elevate the affected limit apply ice packs
19
Q
For injuries to the distal arm, pelvis, and lower extremity what position to the client be in
A
Supine
20
Q
For injuries to the shoulder or upper arm what position to the client be in
A
Sitting position
21
Q
Where do you provide splinting?
A
At the joint above, and below the injured area
22
Q
If a pelvic fracture is suspected, what should you monitor for?
A
Urine for blood, and for development of hypovolemic shock
23
Q
What are nursing interventions for a fracture?
A
Assess pain
Check Nuro status
Maintain proper alignment
Promote range of motion of fingers toes in unaffected extremities
Increase calcium intake
24
Q
Neurovascular assessment for musculoskeletal
A
Sensation
Skin temp
Skin color
Capillary refill
Pulses
Movement
25
What is sensation in a neurovascular assessment?
Assessed for numbness or tingling sensation of the extremity loss of sensation can indicate nerve damage
26
What is skin temperature in a neurovascular assessment?
Assess the extremity for temperature if should be warm not cool to touch
27
What is skin color in a neurovascular assessment?
Assess the color of the affected extremity, check distal to the injury and look for changes in pigmentation
28
What is capillary refill in a neurovascular assessment?
Press, the nail beds of the affected extremity until bleaching occurs. Blood return should be within three seconds.
29
What is pulses in a neurovascular assessment?
Call Syd should be powerful and strong. Pasa should also be equal to the pulses of the unaffected extremity.
30
What is movement in a neurovascular assessment?
The client should be able to move the joints distal to the injury, fingers or toes
31
What immunization do you need for an open fracture?
Tetanus
32
What is a plaster of Paris cast?
Heavy, not water resistant and can take 10 to 72 hours to dry
33
What is a synthetic fiberglass cast?
White water, resistant, and dry quickly 5 to 20 minutes
34
What should be petted to prevent skin breakdown in casting
Bony prominence
35
Nursing actions for casting
Show procedure on a doll
Apply ice for the first 24 hours
Turn in position client every two hours
Keep affected extremity, supported with a sling or a pillow
SS warm or hot spots on Cast which can indicate infection
36
Where should the cast be elevated to to prevent swelling?
Heart level for first 24 to 48 hours
37
For plaster cast, how do you avoid denting?
Use palms of hands and expose the cast of air to promote drying
38
What does increased warmth or hotspots on a cat surface indicate
Infection
39
If a hotspot occurs in the cast change in sensation or increased pain, what should you do?
Notify the provider immediately
40
What is traction care?
Involves the use of a pulling force to reduce a fracture, maintain alignment and provide muscle rest
41
What is skin traction?
Uses a pulling force that is applied by weights
Using tape in straps, applied to the skin along with boots or cuffs weights are attached by rope to extremity
42
What does skeletal traction?
Continuous pulling force that is applied directly to the skeletal structure or bone
It is used when more pulling force is needed then skin traction can withstand
A pin or rod is inserted through or into the bone force is applied through the use of weights attached by ropes
43
Interaction care what should never be removed by the nurse
Weights
44
What is halo traction?
Cervical traction
Halo type bar that encircles the head screws are inserted into the outer skull
The halo is attached either the bed, traction or rides that are secured to a vest worn by the client
45
What is a nursing action for traction care
Maintaining body alignment
Notifying provider, if experiencing pain from muscle spasms that is unrelieved with meds
Nuro status
46
What should you assess pin sites for?
Pain, redness, swelling, drainage, or odor
47
For a client with a Heelo device what do you need to do
Ensure that the wrench to release, the rods is readily available when event that CPR is necessary
Move the client without applying pressure to the rods to prevent loosening pins
Inspect the pins regularly
48
What is the most common fracture that require surgery?
Supracondylar fracture in fractures of the humerus and femur
49
What should you do if you suspect violence in a situation
Notify social services
50
What is compartment syndrome?
Compression of nerves, blood vessels and muscle inside a confined place, resulting in neuromuscular ischemia
51
What happens if compartment syndrome is left untreated
Deformity of the extremity paralysis an infection can result
52
What is Volkmann contracture?
A permanent contracture of the forearm and hand caused by tight dressing or cast
53
What is a fat embolism
Complication of a fracture fat, breaks away from the bone marrow of the injured one, and enters the bloodstream
54
What is a pulmonary embolism?
Complication of a fracture client develops and forms at the injury site and travels to the lungs
55
What are the five p in finding embolism
Pain
Paresthesia
Pulselessness
Paralysis
Pale
56
What does pain mean
In embolism
Paying that is unrelieved with elevation or analgesics increase with passive movement
57
What does paresthesia mean in embolism
Numbness, which is an early finding of compartment syndrome
58
What is pulsenessness of embolism
Distal to the fracture late finding of compartment syndrome
59
What does paralysis of embolism
Inability to move digits means nerve damage
60
What is pale of embolism
Call skin in cyanosis to nail beds
61
What should the nurse do if the patient has compartment syndrome
Assess extremity every hour for first 24 hours
Space between skin in the cash should allow for once finger to be placed
Effected extremity at heart level
Loosen the dressing
62
What is osteomyelitis?
Infection within the bone secondary to a bacterial infection from an outside source
Found in an open fracture or from a blood-borne bacterial source
63
What happens if you have osteomyelitis
Irritability
Fever
Tachyc Ardis
Edema
Pain that is constant, but increases with movement
Not wanting to use affected extremity
Site of infection, tender
64
What would you teach a patient with osteomyelitis?
Monitor hearing due to ototoxicity of some antibiotics
Limit movement of affected limb, and avoid bearing any wait until cleared
65
A nurse is caring for a child who is in a plaster spica cast, which of the following action, should the nurse take?
Use a heat lamp to facilitate drying
Avoid turning the child until the cast is dry
Assisted client with crutch walking after the cast is dry
Apply moleskin to the edges of the cast
Apply moleskin to the edges of the cast
66
A nurse is teaching a group of caregivers about fractures, which of the following information should the nurse include in the teaching
Children need a longer time to heal from a fracture than an adult
Epithelial plate injuries can result in altered bone growth
A greenstick fracture is a complete break of the bone
Bonez are unable to bend so they break
Epithelial plate injuries can result in ultra bone growth
67
A nurse is caring for a child to sustain a fracture which of the following action should the nurse take(select)
Place a heat pack on the site of injury
Elevate the affected limb
Assess neurovascular status frequently
Encourage ROM of affected limb
Stabilize the injury
Elevate the affected limb
Sus neurovascular status frequently
Stabilize the injury
68
A nurse is caring for a child who has a fracture which of the following are manifestations of the fracture(select)
Crepitus
Edema
Pain
Fever
Ekhymosis
Crepitus
Edema
Pain
Ekhymosis
69
A nurse is caring for a child who is in skeletal traction, which of the following action should the nurse take(select)
Remove the weights to reposition the client
Assess the child’s position frequently
Assess pin sites every four hours
Ensure the weights are hanging freely
Ensure the ropes knot is in contact with the pulley
Assess the child position frequently
Access pin sites every four hours
Ensure the weights are hanging freely
70
What is clubfoot?
A complex deformity of the ankle and foot can affect one or both feet
71
What is positional club foot
Occurs from interuterine crowding
72
What is syndromic club foot?
Occurs in association with other syndromes
73
What is congenital clubfoot?
Idiopathic
74
What is Talipes varus?
Inversion foot bending in ward
75
What is talipes Valgus
Eversion of foot bending outward
76
What is talipes calcaneus
Dorsiflexion toes are higher than the heels
77
What is talipes equinus
Horsefoot plantar flexion toes are lower than the hills
78
What is talipes equinovarus
Toes are facing inward and lower than the heal
79
What should the nurse envcourage the parents to do with a patient with clubfoot?
Encourage the parents to hold and cuddle the child
80
Therapeutic procedures for a patient with clubfoot
Casting
Series of casting, starting shortly after birth, and continuing until Maxximum correction is accomplished
81
Buy three weeks what procedures usually performed in club foot
Heel cord tenotomy long leg cast for three weeks
82
After six weeks, what occurs in clubfoot
Dennis BrownE bar that connects specialized shoes to maintain correction and prevent reoccurrence
83
What should be done weekly for a patient with clubfoot?
Manipulation of the foot to stretch the muscles
84
What are affects of casting
Skin breakdown, neurovascular operations
85
What is left-calve-perthes disease
Aseptic necrosis of the femoral head can be unilateral or bilateral
86
Expected findings in leg calves, Perthes disease
Intermittent, painless, limp
Hip stiffness
Limited ROM
Shortening of the affected leg
Muscle wasting
87
What should the nurse do with a patient who has leg calves, Perthes disease?
Maintain rest and limited weight-bearing
Abduction, brace, or Cast
PT
Traction
88
What is a surgical intervention for someone who is Leg calve Perthes disease?
Osteotomy of the hip or femur
89
What is developmental dysplasia of the hip DDH?
A variety of disorders resulting in abnormal development of the hip structure that can affect infants or children
90
What is acetabular dysplasia?
Delay in acetabular development
Acetabular roof is shallow, an oblique
91
What is subluxation
Incomplete dislocation of the hip
92
What is dislocation in DDH?
Femoral head does not have contact with the acetabulum
93
Risk factor for DDH
First born
Female
Breech
Oligohydraminos
94
Expected findings in a infant patient with DDH
Asymmetry in an equal number of skin folds on the posterior thigh
Limited hip abduction
Shortening of the femur
Widen perineum
95
What is a positive ortolani test
Performed by provider
Hip is reduced by abduction
96
What is a postive Barlow’s test?
Performed by provider
Hip is dislocated by adduction
97
Expected findings in a child with DDH
One leg shorter than the other
Walking on toes
Walking with a limp
98
When should an ultrasound be performed in DDH
Two weeks of age to determine cartilaginous head of the femur
99
What kind of nursing care should you do with a newborn to six months who has DDH
Pavlik harness (chest harness, that abducts legs)
Maintain harness placement for 12 weeks
Check straps every one to two weeks
Do not adjust straps
Check skin under straps
100
What kind of nursing care should you do when adduction contracture is present?
Bryant traction
(skin traction hips flex at 90° angle with buttocks raised off of bed)
Hip Spica cast (maintains external rotation of the hip)
101
What should you teach a patient when adduction contracture is present
Understand proper positioning
Position case on pillow
Keep the cats elevated until dry
Change position, frequent
Use waterproof barrier around the general opening of the spica cast to prevent soil 
102
What kind of nursing care should you do with a patient who six months to two years with DDH?
Surgical closed reduction with placement of hip spica cast
103
What kind of nursing care should you do with older children with DDH?
Surgical reduction with pre-surgical traction
104
What kind of diet should you maintain with DDH
High-fiber diet and promote adequate hydration
105
What is osteogenesis imperfecta?
Inherited connective tissue condition, that results in bone fractures and deformity along with restricted growth
106
What is expected finding an osteogenesis imperfecta
Multiple bone fractures
Blue sclera
Early hearing loss
Small discolor teeth
107
What medication should you use for osteogenesis imperfecta
Pamidronate ( increases bone density)
108
What should you teach a patient with osteogenesis imperfecta?
Caution, with live virus
Antibiotics will be needed prior to dental work
Low impact exercise
May need bone marrow transplant
109
What is scoliosis?
Complex deformity of the spine that also affects the ribs
Characterized by lateral curvature of the spine and spinal rotation that causes rib asymmetry
110
Diagnostic procedure with a patient who has scoliosis
Screen during preadolescence
Have child bent over at waist with arms hanging down and observe for asymmetry of ribs and flank
111
How often should you be wearing a brace for scoliosis?
Every 23 hours per day only removal for personal hygiene
112
Surgical intervention for scoliosis
Spinal fusion with Rod placement
113
 What can you preoperatively teacher patient about scoliosis?
The use of autoLogous self donate blood donations
114
Postoperative nursing actions for scoliosis
Log roll to prevent damage of spinal fusion
Assessed for skin pressure areas
Monitor bowel sounds
Encourage mobility ambulation by second and third day
Use of PCA
115
What should the nurse encourage after a scoliosis surgery?
Independence and importance of physical therapy
116
A nurse is caring for a toddler who is hip dysplasia and has been placed in a hip spica cast the child’s guardian asks the nurse why pavlik harness is not being used which of the following responses should the nurse make
The pelvic harness is used for children with scoliosis, not hip dysplasia
The pelvic harness is used for school age children
The pelvic harness cannot be used for your child, because their condition is too severe
The pelvic harnesses use for infants, less than six months of age
The pavlik harness is used for infants, less than six months of age
117
A nurse is completing preoperative, teaching with an adolescent client who is scheduled to receive spinal instrumentation for scoliosis, which of the following information should the nurse include in the teaching
You will go home the same day of your surgery
You will have minimal pain
You will need to receive blood
You will not be able to eat until the day after surgery
You will need to receive blood
118
A nurse is caring for a child who is suspected of having leg calves, Perthes disease the nurse should prepare the child for which of the following diagnostic procedures
Bone biopsy
Genetic testing
CT scan
Radiographs
Radiographs
119
A nurse is assessing a child who has leg calves, Perthes disease, which of the following finding should the nurse expect(select)
Longer affected leg
Hips stiffness
Back pain
Limited ROM
Limp with walking
Hips stiffness
Back pain
Limited ROM
Limp with walking
120
A nurse is caring for an infant and notices an audible click in there left hip which of the following diagnostic test. Should the nurse expect the provider to perform(select)
Barlow test
Babinski sign
Manipulation of foot and ankle
Ortolani test
Ponseti method
Barlow test
Ortolani test
121
What is cerebral palsy?
Nonprogressive impairment of motor function, especially that of muscle control, coordination and posture
122
Expected findings and cerebral palsy
Concerns with developments
Gagging, or choking and feeding
Tongue thrust
Poor head control
Asymmetric crawl
Arching back
Toe walking
123
What is spastic CP (pyramidal)
Hypertonicity( muscle tightness, or spasticity) poor control of motion, balance, and posture
124
What is dyskinetic CP non-spastic extra pyramidical
Athetoid
Findings include involuntary, jerking movements that appear slow, weathering and warm like
125
What is dyskinetic CP non-spastic extra pyramidical
Dystonic
Slow twisting trunk or extremities with abnormal posturing for muscle contractions, drooling and speech impairment
126
What is ataxic CP nonspastic extra pyramidical
Evidence of white bass, Kate, and difficulty with coordination
Poor ability to do repetitive movements
Lack of coordination
127
What should a patient with cerebral palsy position be after feeding?
Upright for possibility of aspiration
128
Some nursing care for cerebral palsy
Monitor, developmental milestones
Need for hearing and speech eval’s
Promote independence
129
What is baclofen?
Essentially acting, skeletal muscle relaxant that decreases muscle spasms and severe specificity
130
Client education for cerebral palsy
Provide time for rest periods
Adhere to feeding schedule
Proper dental care
Respite care
131
What is spina bifida?
Neural tube defect present at birth in characterized by failure of the osseous spine to close with CNS effects
132
What is spina bifida occulta
Affects the lumbosacral area and it’s not visible externally surface of the vertebral phone is missing no spinal cord involvement
133
What is spina bifida cystica?
Protrusion of the sack is visible
134
What is Menginocele
The sac contains spinal fluid in meninges, increased risk for infection
135
What is myelomeningocele
Most common
Dissect contain spinal fluid meninges and nerves
Causes decrease motor and sensory function
136
Risk factors for spina bifida
Substance taken during pregnancy
Maternal malnutrition
Insufficient Folick acid
Exposure to radiation
137
Findings in occulta
Tumbling in the lumbosacral area
Portwine, Angionoma
Dark hair, Tufts
138
Findings in cystica
Flaccid muscles
Lack of bowel control
Prolapse rectum
Protruding sack
139
Maternal blood test taken to see if you have spina bifida
Blood alpha-fetoprotein during second trimester
140
What is done as soon as possible to prevent complications of injury an infection
Closure of myelomenigocele sac
141
Preoperative care for spina bifida
Surgery within the first 24 hours after birth
Protect sack
Apply sterile, moist nonadherent dressing changing every two hours
Do not remove dressing if it becomes dryadd more solution
Report leakage of fluid
Measure head circumference
142
What should a patient be placed in who has spina bifida
Prone position with hips, flex, legs, abducted
143
What should you avoid with a patient who is spina bifida?
Rectal temps, cuddling, or putting pressure on aac
144
What does spina bifida increased risk of?
Latex allergy
145
Manifestations of increased intracranial pressure of spina bifida in infants
High-pitched crying
Bulging fontanelles
Increase head circumference
146
Manifestations of increased intracranial pressure in children with spina bifida
Headache
Double vision
Decrees school
Decreased level of consciousness
147
What is juvenile idiopathic arthritis
Chronic autoimmune inflammatory disease, affecting joints, and other tissues rarely life-threatening
148
Findings in juvenile idiopathic
Arthritis
Joint swelling worse in the morning
Mobility limitation
Limp in the morning
Delay in growth
149
Nursing care for a patient with juvenile idiopathic arthritis
He or warm moist packs to child effective joints
Appropriate exercise, swimming
Encourage warm baths
Relaxation techniques
150
What is muscular dystrophy
Inherited disorder with progressive degeneration of symmetric, skeletal muscle groups, causing progressive muscle weakness in wasting
151
What is dochenne muscular dystrophy
Most common inherited as X linked recessive trait
Life expectancy reaches into early adulthood
Fat tissue replaces muscle in lower limbs
152
What is facioscapulohumeral muscular dystrophy
Autosomal dominant inherited disorder onset during early adolescence progression is slow
Characterized by facial weakness and inversion of shoulders
153
What is limp girdle muscular? Dystrophy
Autosomal, dominant and recessive disorder. It appears later in childhood with slow progression.
154
What is Gowers sign?
Difficulty getting out of bed rising from seated position or climbing stairs
Child walks, hands up, legs for support will going to standing position
155
Expected findings for muscular dystrophy
Grower sign
Delayed motor skills
Muscle weakness
Progressive muscle atrophy
156
What is nursing care with muscle dystrophy?
Genetic counseling
Respiratory function
Understanding long term affects
Child independent as long as possible
Stretching exercises
Proper body alignment
157
What kind of diet should a patient be on with muscle dystrophy?
Low calorie high protein
158
What should you encourage the parents of the patients who have muscle dystrophy?
Consider assistance with care as disease progressives
159
A nurse is caring for a child who has cerebral palsy which of the following medication should the nurse expect to administer to treat painful muscle spasms(select)
Baclofen
Diazepam
Oxybutynin
Methotrexate
Prednisone
Baclofen diazepam
160
A nurse is developing a plan of care for a toddler who is cerebral palsy which of the following action should the nurse include
Structure interventions, according to the toddlers chronological age
Evaluate the toddlers need for an evaluation of hearing ability
Monitor the toddlers pain level routinely using a numeric rating scale
Provide total care for daily hygiene activities
Evaluate the toddlers need for an evaluation of hearing ability
161
The nurse is caring for school age child who has juvenile idiopathic arthritis which of the following home care instruction should the nurse include in the teaching(select)
Provide extra time for completion of ADLs
Use cold compression for joint pain
Take ibuprofen on an empty stomach
Remain home during periods of exacerbation
Perform range of motion exercises
Provide extra time for completion of ADLs
Perform range of motion exercises
162
A nurse is caring for a child who is muscular dystrophy for which of the following findings should the nurse assess(select)
Purposeless, involuntary abnormal movements
Spinal defect and saclike protrusion
Muscular weakness in lower extremities
Unsteady, wide, base or waddling gate
Upward slant of eyes
Muscular weakness and lower extremities
Unsteady, wide base or waddling gait
163
A nurse is caring for an infant who has myelmeningocele which of the following action should the nurse include in the preoperative plan of care
Assist the caregiver was cuddling the infant
Assess the infants, temperature rectally
Place the infant in supine position
Apply a sterile Moiz dressing on the sack
Apply a sterile, moist dressing on the sack
