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
Which lab is used for definitive diagnosis of muscular dystrophy?
Muscle biopsy
What are some voluntary muscles affected by muscular dystrophy?
Hips, thighs, pelvis, and shoulders initially
Where does muscle weakness begin in muscular dystrophy?
In lower extremities
What’s the Gower’s sign for muscular dystrophy?
Observing child getting up from the floor. They will use all limbs to get up
What is the primary goal of muscular dystrophy?
Promote mobility, maintain cardiopulmonary function, prevent complications, and maximize QOL
What are the nursing priorities for muscular dystrophy?
Optimize physical function (ROM, strength/muscle training)
Oxygenation/Ventilation (breathing exercises, cough devices)
Adequate nutrition (lowe calorie, high protein & fiber)
Skin care (repositioning)
Psychosocial (respite/palliative, end-of-life)
Why is oxygenation and ventilation important in pt with muscular dystrophy?
Muscle atrophy is progressive; that includes muscles to breathe adequately and those smooth muscles to keep beating
What’s the nutritional need for pt with muscular dystrophy?
Low calorie, high protein and fiber
Because their mobility is limited
What are the complications of muscular dystrophy?
Respiratory compromise
Obesity
Contractures
Scoliosis
Infections
What are the physical findings for scoliosis?
Asymmetry in shoulder height
Prominence of one scapula
Uneven curve of waistline
Rib hump on one side
What is included in scoliosis post-op care?
Frequent neurovascular assessment of extremities
VS
Log rolling only to prevent damage to hardware
Pre-medicate before ambulation or moving
PCA pump
Wound care and assessment for any drainage around operation site and drainage tubes
When do girls need to be screened for scoliosis?
Age 10-12
When do boys need to be screened for scoliosis?
Age 13-14
What indicates surgical intervention for scoliosis?
For severe lateral curves (> 45 degrees), bracing not helping, cardiac or respiratory compromise
How long should scoliosis brace need to be worn?
18 hrs/day
What type of device will the scoliosis post-op patient have?
Hemovac
Why should we type and crossmatch scoliosis surgery patient?
Severe blood loss is anticipated with surgery
What is spina bifida?
Midline defect with failure of osseous body to close
What is spina bifida cystica?
Visible defect with saclike protrusion of meninges, spinal fluid, and nerves with varying degrees of neuromuscular, limb and sensory deficits
What is meningocele?
Meninges and spinal fluid herniate through defect in vertebrae
Usually minor or no neurological deficits
What is the less serious form of spinal bifida cystica?
Meningocele
What’s the most severe form of spina bifida?
Myelomeningocele
Lack of what causes spina bifida?
Prenatal care and folic acid
What’s the difference between meningocele and myelomeningocele?
Meningocele usually has minor or no neuro deficits, while myelomeningocele has varying degrees of neuromuscular, limb, and sensory deficits
What’s the priority of care for meningocele?
Sac care; Prevent rupture of sac, prone positioning before and after surgical repair
Monitor head circumference and monitor signs of increased ICP
Can surgery be delayed for meningocele patients?
Yes; as long as pt has normal neuro function and sac intact
What should the nurse do if there is a leakage from the sac in meningocele patient?
Immediately report to provider to prevent infection
Can surgery be delayed in pt with myelomeningocele?
No. surgical closure is needed as soon as possible after birth to prevent infection and trauma to the sac
While waiting on myelomeningocele surgery, the nurse should do what to prevent rupture of sac?
Frequent NS moistened dressings
Keep sac moist and prevent rupture
What is one big thing to monitor for when caring for post-op myelomeningocele patient?
Latex allergy
What position is recommended for both pre and post-op myelomeningocele pt?
Prone or supported on side
Why do we have to avoid swaddling and blankets on babies with myelomeningocele?
To monitor sac continuously for drying out
Instead of swaddling the myelomeningocele baby, what can you do to keep them warm and continue to monitor sac from drying out?
Keep in warmer or in isolette
In what position can we put baby into to prevent sac from being soiled by urine or stool?
Prone
May have to place plastic wrap below lesion to prevent contamination
After myelomeningocele surgery, can mom hold infant in normal position for breastfeeding/bottle feeding?
Yes. It is encouraged to keep parent-baby bond
What are the priorities of care for fractures?
Promote & monitor tissue perfusion (NV assessment on regular schedule)
Pain management
Infection prevention & monitoring
Promote mobility
Pt/family support & education (proper crutch use, signs to report. etc)
What are the components of Neurovascular assessment?
Sensation
Skin temp
Skin color
Spontaneous movement
Capillary refill
Pulses
What are the 2 complications of fracture?
Compartment syndrome
Osteomyelitis
What are the 5 P’s of compartment syndrome?
Pain (unrelieved with elevation of analgesics & increases with passive movement)
Paresthesia (early sign)
Pulselessness (distal to fx)
Paralysis
Pallor (cold skin, cyanotic nail beds, delayed cap refill)
What are the late signs of compartment syndrome?
Pallor, paralysis and pulselessness
What is the 2nd most common injury in child physical abuse?
Fractures
What disorder is caused by growth hormone deficiency?
Hypopituitarism
What is the pathophysiology behind hypopituitarism?
Pituitary not making enough GH -> impairs body’s ability to metabolize protein, fat, carbs -> hypoglycemia -> retarded bone age -> delayed maturation
What are the physical cues of hypopituitarism (GH deficiency)?
Large/prominent forehead
Underdeveloped jaw
High-pitched voice
Delayed sexual maturation
Delayed dentition/skeletal maturation
Decreased muscle mass
