The Child with Musculoskeletal or Articular Dysfunction Flashcards
1
Q
PEDIATRIC VS. ADULT FRACTURES
A
- Bones of children very porous and less dense than adults
- Injury to epiphyseal plate can impact future growth
- Bones can bend, buckle, and break
- Rapid growth allows for rapid healing
2
Q
Pediatric Injury Risks:
A
- Vulnerability of growth plates
— *Fracture to growth plate= limb will have trouble growing - Increased joint mobility leads to joint injuries
- Softer bones lead to fractures
- Lack of experience, training
- Not wearing protective gear
- Impatience with healing process
3
Q
Complete fracture: nursing implications
A
suspect child abuse bc kids cant really completely break bones
4
Q
Types of Fractures
A
5
Q
Fractures: Nursing Care
A
- Maintain proper alignment and immobilize extremity until cast is placed
- Cast put on only after swelling goes down
- Monitor neurovascular status 7 P’s
— Pain, pallor, pulse, pulse ox, paralysis, parathesia, poikilothermia - Assess for Compartment Syndrome
- Pain control
- Promote mobility
- Discharge teaching
- Elevation
- Drainage, bleeding
- Itching
- Skin breakdown- check edges
- Keep dry
6
Q
Developmental Dysplasia of the Hip
A
- Femoral head and acetabulum improperly aligned
- May include hip instability, dislocation, subluxation, or dysplasia
- Occurs in girls more than boys – unilateral in 80% of cases (left hip affected three times as often as the right hip)
- Cause: Unknown – genetic factors likely
7
Q
Developmental Dysplasia of the Hip
Diagnostic
A
- Ortolani and Barlow Test
- Shortening of limb on affected side
- Asymetric gluteal and thigh folds
- Decreased hip abduction on affected side
Barlow: hip starts in a reduced position; and is then dislocated
Ortolani: hip starts in a dislocated position; and is then reduced
8
Q
Developmental Dysplasia of the Hip
Treatment
A
- Newborn-6mo=Pavlik Harness
- 6-24months= spica cast
- Older children- surgery, traction.
9
Q
Scoliosis
A
Lateral S- or C-shaped curvature of the spine
- * More than 10 degrees is abnormal
10
Q
Scoliosis types
A
- Idiopathic (most common) unknown cause
- Congenital
- Acquired
- Most common in girls around adolescent growth spurt
11
Q
Scoliosis treatment
A
- Observation, serial x-rays
- Mild (10 to 20 degree curve): Exercise
- Moderate (20 to 40 degree curve): Brace (worn 23 hours a day)
- Severe (greater than 40 degree curve): Surgery (spinal fusion)
- Brace should be comfortable
- Skin care
- Wear clothes beneath brace
- Check brace daily for rough edges
12
Q
Juvenile Idiopathic Arthritis
A
- Group of chronic autoimmune diseases that causes inflammation in the joint synovium and surrounding tissue
- Cause unknown
- Starts before 16 years of age with a peak age between 1-3 years old
- Girls 2x more affected than boys
- Correlated with Rubella, Epstein-barr virus and Parvovirus B19 but etiology unclear
13
Q
Juvenile Idiopathic Arthritis
S/S:
A
- Swelling and loss of motion develop in affected joints
- Joints are warm and mildly tender to touch
- Even with large effusion there may be no reports of pain
- *Morning stiffness
- Subtle limp
- Growth disturbances either under or overgrowth
- Uveitis: eye inflamation
14
Q
Juvenile Idiopathic Arthritis
Diagnostic Evaluation
A
- Diagnosis of exclusion
- Based on Clinical criteria: onset before 16 years, arthritis in one or more joints for 6 weeks or longer with no other cause
- Lab tests may include: *ESR/CRP, Leukocytosis, *Antinuclear antibodies, x-rays,
- Slit lamp eye examination: diagnosis uveitis
15
Q
Juvenile Idiopathic Arthritis
Therapeutic Management
A
- There is no cure for JIA
- *Goal of therapy include
- **Control Pain
- Preserve Joint Range of Motion and Function
- Minimize effects of inflammation such as joint deformity
- Promote normal growth and development
— Treatment Plan includes: medications( NSAIDS, Disease modifying antirheumatic drugs, steroids, PT/OT, Ophthalmologic examinations, splints, comfort measures, dietary management, school modification and psychosocial support.
