Peds Exam 3 Flashcards
Production of what causes growth plates to fuse?
Androgens
What is the mildest form of Developmental Dysplasia of Hip (DDH)?
Dysplasia; femoral head remains in acetabulum (socket)
What are some assessment findings of DDH?
When baby on a flat surface:
Asymmetry of gluteal folds in prone position
Unequal number of skin folds on posterior thigh
Affected limb shorter, older kids walk with limp
Positive Ortolani and Barlow signs
What’s an Ortolani maneuver?
“clunk” when femoral head relocates back into the socket (with abduction)
What’s a Barlow maneuver?
“clunk” when femoral head slips out of the socket (dislocated with adduction)
What type of DDH is it when the femoral head does not have contact with the acetabulum and is displaced posteriorly?
Dislocation
What type of DDH is most common?
Subluxation; incomplete dislocation of the hip with intact femoral head
What are the priorities of care for DDH?
Neurovascular assessment (sensation, skin temp, color, cap refill, pulses, movement)
Skin care
Parent teaching
Why is neurovascular assessment and skin care important in DDH patients?
Because the management of this requires harness/cast/traction depending on their age and severity
What’s a Pavlik Harness?
Chest harness that abducts legs. Worn full-time for up to 12 weeks
DDH management for newborn - 6 months
What are some important parent teaching about Pavlik Harness?
Do not adjust straps
Harness must be used continuously until instructed by provider
Change diaper while in harness
Place baby on back for sleep
Check skin folds for redness, irritation or breakdown. Keep skin dry and clean
Baby may be bathed while harness is off but it requires provider permission
What are the big education points for Pavlik Harness?
Keep baby in it full time and not take it off unless instructed by provider
Keep skin clean and dry to prevent breakdown
When do parents need to contact provider regarding their baby in Pavlik Harness?
Baby’s feet are swollen or bluish
Harness appears too small
Skin raw or a rash develops
Baby unable to actively kick their legs
What is cerebral palsy?
Nonprogressive impairment of motor function, especially muscle control, coordination and posture
What abnormalities can cerebral palsy cause?
Abnormal perception and sensation, visual, hearing and speech impairments
Seizures and cognitive disabilities
What are some physical cues of cerebral palsy?
Failure to meet developmental milestones
Persistent primitive reflexes
Gagging or choking with feeding, poor suck reflex
Poor head control
Rigid posture & extremities
Arching back
Strabismus
What are the nursing priorities when caring for cerebral palsy patients?
Oxygenation/ventilation - positioning, suctioning, IS, aspiration precaution
Pain management - muscle spasms
Adequate nutrition
Skin care - reposition, monitor under splints/braces
Communication - picture boards, touch screen computers
Psychosocial - promote independence
Developmental - monitor developmental milestones, interact based on developmental age, not chronologic
Why are oxygenation and ventilation important in patients with CP?
It’s a motor/muscle-related disorder; they have difficulty breathing deeply.
They are prone to gagging and chocking due to poor suck reflex, which puts them at aspiration risk
What are some medications that are used to treat muscle spasms r/t CP?
Baclofen - centrally acting skeletal muscle relaxant
Botox - reduces spasticity in specific muscle groups
Carbidopa - dopaminergic that promotes relaxation of muscles
What are some complications of CP?
Seizures
Delayed growth and development
Hydrocephalus
Aspiration
Injury r/t limited mobility
What is muscular dystrophy?
Group of inherited disorders of progressive muscle weakness and wasting
What’s the most common form of muscular dystrophy?
Duchenne MD; onset 3-5 yrs of age with life expectancy into early adulthood
Absence of what causes progressive weakness of voluntary muscle in muscular dystrophy?
Dystrophin.
Fat tissue replace lower limb muscles
What are the labs/diagnostics used in muscular dystrophy?
Serum CK - levels high early before muscle wasting occurs
Electromyography (EMG) - reveals nerve/muscle dysfunction
Muscle BX - definitive dx showing absence of dystrophin
DNA testing - positive for dystrophin gene mutation