Peds Exam 3a - MS

Question 1

developmental considerations of bones

Answer 1

-bones are porous
-thicker periosteum allows bones to heal quicker
-if a break involves the epiphyseal plate, length of bone can be affected

Question 2

when a cast is wet, how do we handle it

Answer 2

-with the palms of our hands bc finger dents can make pressure points
-turn every 2 hrs till dry no fans, fiberglass dries within minutes

Question 3

when relieving pain or itching when limb is in a cast

Answer 3

-never stick anything in the cast beyond a coupe fingers
-ice can help w/ itching & decrease swelling
-give NSAIDs avoid ibuprofen
-always watch for skin breakdown
-elevate

Question 4

mobility for pt in cast

Answer 4

-exercise on non affected side
-isometric exercises to affected side
-keep child moving

Question 5

5 P’s to ensure cast is not too tight

Answer 5

-pain
-parestesia
-paralysis
-pulse
-pallor

Question 6

removal of cast in children

Answer 6

since a cast cutter is used, many freak out that they will cut them & bc it is loud and vibrates so cover their ears, give a distraction, demo on self, restrain if necessary

Question 7

what does traction do

Answer 7

application of a pulling force to the body to provide reduction, alignment & rest at the site

Question 8

nursing considerations for a pt in traction

Answer 8

-right amount of wts
-right angle
-assess skin & pins
-assessment of neuro-vascular status

Question 9

developmental dysplasia of the hip

Answer 9

the head of femur is not securely in hip socket as it should

Question 10

DDH clinical manifestations

Answer 10

-unequal leg length
-unequal fat folds
-difference in abduction of the hips
-clicks on rotation
-older child: + transdelenburg

Question 11

treatment of DDH

Answer 11

ultrasounds to confirm dx
put in a pavlik harness at all times for months to press the femur into the socket expect when changing a diaper or bathing
or
surgical correction and hip spinal cast

Question 12

DDH nursing considerations

Answer 12

-always put a shirt under the harness
-check skin for redness 2-3x/d
-gently massage skin under straps daily to increase circulation
-teach how to hold child w/ harness on
avoid lotions & powders

Question 13

therapeutic mgt of congenital clubfoot

Answer 13

serial casting
-new cast every 1-1.5 wks for 8-12 wks then surgery followed by more casting then splint or brace for maintenance

Question 14

nursing considerations for clubbed feet

Answer 14

-injury r/t casts
-5 P’s
-apple ice & elevate to decrease swelling
-affect on family

Question 15

osteogenesis imperfecta

Answer 15

a group of inherited disorders of connective tissue (brittle bone disease), a callogen issue
bones will break from normal activity

Question 16

osteogenesis imperfecta clinical manifestations

Answer 16

-bone fragile & deformed
-poor growth
-bruising
-blue sclerae
-hearing loss
-thin skin
-excessive diaphoresis
-teeth discoloration
-mild hyperpyrexia
-normal intelligence

Question 17

when do we see a decrease in fractures in a osteogenesis imperfecta kid

Answer 17

when they go through puberty

Question 18

osteogenesis imperfecta therapeutic mgt

Answer 18

-prevent contractures & deformities
-prevent muscle weakness & osteoporosis
-prevent mal alignment

Question 19

osteogenesis imperfecta treatment

Answer 19

-lightweight braces & splints
-simple exercise & pt
-surgery to correct breaks
-pamidronate disodium (IV) to aid in bone healing and slows bone reorption

Question 20

osteogenesis imperfecta nursing considerations

Answer 20

-often confused with child abuse
-careful handling
-teaching r/t limitations & activities for optimal G&D
-support family

Question 21

legg-calve-perthes disease

Answer 21

idiopathic, self limiting aseptic nercrosis of the femoral head
-slow onset, can cause arthritis in the future
-all day complaining of pain (most in the morning & at night)
keep legs spread in casts to prevent the head from coming out of the socket then surgery

Question 22

functional scoliosis

Answer 22

appears to be scoliosis but it is because of something else like unequal legs

Question 23

structural scoliosis

Answer 23

when there is actual twisting of the curvature of the spine

Question 24

therapeutic mgt of scoliosis

Answer 24

-mild (<20): observe
-moderation (20-40): bracing, wear 23 hrs a day
-severe: (>40): surgical spine fusion

Question 25

nursing considerations with scoliosis brace

Answer 25

-skin breakdown
-low compliance
-increased suicide risk
-adolescences want to fit in and this makes them stand out

Question 26

pre opt scoliosis

Answer 26

-skin assess
-cannot send with bad ache
-example post opt (traction, log roll, PCA pump)
-xrays
-IV
-lab work

Question 27

post opt scoliosis

Answer 27

-monitor vitals
-circulation
-IS q2
-keep flat, roll q2
-pain relief
-pt asap

Question 28

juvenile idiopathic arthritis

Answer 28

chronic inflammatory joint disease (most common rheumatic disease in children)
poly is when more than 5 joints are affected

Question 29

what screening do kids w/ juvenile idiopathic arthritis need

Answer 29

eye exams every 6 months bc of pauciarticular JRA -> can lead to blindness

Question 30

juvenile idiopathic arthritis therapeutic mgt

Answer 30

get inflammation under control so we want them to be wiggling and moving, get them in the pool, prevent deformity & NSAID (RTC & increase dose w/ age), short term cort steroids

Question 31

osteomyelitis

Answer 31

infection of the bone

Question 32

osteomyelitis nursing considerations & treatment

Answer 32

-these kids do not feel good, they are irritable
-bed rest
-IV antibitoics (PICC)
-support pain
-high kcal & protein