Peds Exam 3a - MS Flashcards
developmental considerations of bones
-bones are porous
-thicker periosteum allows bones to heal quicker
-if a break involves the epiphyseal plate, length of bone can be affected
when a cast is wet, how do we handle it
-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
when relieving pain or itching when limb is in a cast
-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
mobility for pt in cast
-exercise on non affected side
-isometric exercises to affected side
-keep child moving
5 P’s to ensure cast is not too tight
-pain
-parestesia
-paralysis
-pulse
-pallor
removal of cast in children
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
what does traction do
application of a pulling force to the body to provide reduction, alignment & rest at the site
nursing considerations for a pt in traction
-right amount of wts
-right angle
-assess skin & pins
-assessment of neuro-vascular status
developmental dysplasia of the hip
the head of femur is not securely in hip socket as it should
DDH clinical manifestations
-unequal leg length
-unequal fat folds
-difference in abduction of the hips
-clicks on rotation
-older child: + transdelenburg
treatment of DDH
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
DDH nursing considerations
-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
therapeutic mgt of congenital clubfoot
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
nursing considerations for clubbed feet
-injury r/t casts
-5 P’s
-apple ice & elevate to decrease swelling
-affect on family
osteogenesis imperfecta
a group of inherited disorders of connective tissue (brittle bone disease), a callogen issue
bones will break from normal activity
osteogenesis imperfecta clinical manifestations
-bone fragile & deformed
-poor growth
-bruising
-blue sclerae
-hearing loss
-thin skin
-excessive diaphoresis
-teeth discoloration
-mild hyperpyrexia
-normal intelligence
when do we see a decrease in fractures in a osteogenesis imperfecta kid
when they go through puberty
osteogenesis imperfecta therapeutic mgt
-prevent contractures & deformities
-prevent muscle weakness & osteoporosis
-prevent mal alignment
osteogenesis imperfecta treatment
-lightweight braces & splints
-simple exercise & pt
-surgery to correct breaks
-pamidronate disodium (IV) to aid in bone healing and slows bone reorption
osteogenesis imperfecta nursing considerations
-often confused with child abuse
-careful handling
-teaching r/t limitations & activities for optimal G&D
-support family
legg-calve-perthes disease
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
functional scoliosis
appears to be scoliosis but it is because of something else like unequal legs
structural scoliosis
when there is actual twisting of the curvature of the spine
therapeutic mgt of scoliosis
-mild (<20): observe
-moderation (20-40): bracing, wear 23 hrs a day
-severe: (>40): surgical spine fusion
nursing considerations with scoliosis brace
-skin breakdown
-low compliance
-increased suicide risk
-adolescences want to fit in and this makes them stand out
pre opt scoliosis
-skin assess
-cannot send with bad ache
-example post opt (traction, log roll, PCA pump)
-xrays
-IV
-lab work
post opt scoliosis
-monitor vitals
-circulation
-IS q2
-keep flat, roll q2
-pain relief
-pt asap
juvenile idiopathic arthritis
chronic inflammatory joint disease (most common rheumatic disease in children)
poly is when more than 5 joints are affected
what screening do kids w/ juvenile idiopathic arthritis need
eye exams every 6 months bc of pauciarticular JRA -> can lead to blindness
juvenile idiopathic arthritis therapeutic mgt
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
osteomyelitis
infection of the bone
osteomyelitis nursing considerations & treatment
-these kids do not feel good, they are irritable
-bed rest
-IV antibitoics (PICC)
-support pain
-high kcal & protein
