TLO 2.8 Musculoskeletal Child Flashcards

Question

Osteomyelitis manifestations

Answer 1

``` Fever, irritability, lethargy, feeding difficulties Pain, warmth, ,erythema Tenderness over site of infection Favoring affected extremity Limited ROM Painful joint with movement Odor possible ```

Answer 2

MRI, CT, Bone scan, US Labs: Elevated ESR and CRP, WBC, blood culture

Answer 3

Pain management Monitor and document neurovascular status Admin IV antibiotics Provide wound care Maintain nutritional status, high calories, protein, frequent small meals

Answer 4

Lateral deviation/curvature of spine >10 degree Curvature causes rotation of vertebral bodies of spine Worsening curvature leads to: Rib cage deformities= compromised respirator function Distortion of intrathoracic and abdominal organs that does not affect organ function generally

Answer 5

``` Visible curvature of spine Rib hump when child bends forward Asymmetric rib cage Uneven shoulder or pelvic heights Scapular prominence Hip and leg length discrepancy ```

Answer 6

Curves <25 degree require long term monitoring | Curves >25 degree require brace treatment

Answer 7

Doesn't correct curve but prevents progression Wear fitted t-shirt under brace to protect skin Remove for bathing, swimming, exercise only Re check size as child grows Analgesics for discomfort

Answer 8

Recommended for curvatures reaching 40-50 degrees Goal is to reduce size of curvature and obtain solid fusion using metal rod and bone grafts (ribs, iliac crest, vertebral body) May not completely correct spine but stabilized spine that centers head, shoulders and truck over the pelvis

Answer 9

Significant blood loss common r/t vascular nature of vertebrae and spinal column Injury to spinal cord Infection

Answer 10

Routine teaching (resp, circulation, pain) Remain flat/log rolling technique Express feelings/anxiety PCA, foley, chest tube (if anterior approach)

Answer 11

Neurovascular checks q 2hr for 48 hr then q 4hr Pain management Teach log roll, turn q 2hr Ambulate post op day 2-3 and d/c day 4-5 Respiratory status, inspirex, cough and deep breathing Encourage self care activities as appropriate Bed flat unplug bed controls Bowel function Wound healing/sit

Answer 12

Developmental dysplasia of the hip (DDP) described variety of disorders that present different ages and forms -if present at birth called congenital -develops after birth called developmental Etiology: unknown Instability of hip joint occur as result of laxity of ligaments holding head of femur in acetabulum

Answer 13

``` First bone child Female Breech position Low levels amniotic fluid in utero African and Chinese decent low incidences Native American high incidences ```

Answer 14

Older infants: asymmetry of gluteal folds limited ROM in affected hop abduction present when supine with knees and hips flexed femur on affected side appears shorter s/s range from lax ligaments to contractures and stiffness in affected hip

Answer 15

``` Older child: Any abnormalities in gait need evaluation Child may: Limp Toe walking or waddling gait ```

Answer 16

Pavlick harness: provides hip flexion, abduction, external rotation Bryant's traction: releases muscles and tendons to manipulate hip joint Closed or open hip reduction surgery Spica cast post op immobilization

Answer 17

Don't straighten legs or swaddle together No car seats that restrict hip position Check skin under harness daily Check neurovascular status on feet Cast care, management elimination, keep dry Adapt clothing for weather Never leave child unattended, kids still move, safety issue Change positions q 2 hr How to apply Pavlick Harness and only remove as provider order Protect skin, use onesie

Answer 18

Cause is unknown but accepted as growth disorder Involves femoral head progresses through 5 stages over 1-2 year period -epiphysis shows ischemia -reduction in size and increased femoral head density -bone weakens and dies causing femoral head collapse -avascular bone reabsorbed and begin to form new bone -femoral head reform result in final healing **disease is self limiting (runs its course generally)

Answer 19

Pain in hip worsens with movement Shortening of affected side, indicates collapsing of femoral head Muscle wasting of thigh and buttocks Unilateral hip involvement Permanent deformity if healing process is incomplete (femoral head protrudes outside acetabulum)

Answer 20

X-ray Bone scan or MRI can revel necrosis and irregularity of femoral head **more common in boys than girls ages 4-9 year

Answer 21

Initial treatment: anti-inflammatory meds ROM exercises and bedrest After 7-10 days if still unable to abduct hip: traction or abduction braces surgery to place femur securely into acetabulum

Answer 22

Plantar flexed foot with inverted heel and adducted forefoot unilateral or bilateral defect cannot be manipulated into neutral position readily apparent at birth

Answer 23

Ultrasounds prenatally ``` Therapeutic: stared ASAP serial stretching, manipulation and casting surgery recurrence is common f/u until skeletal maturity ```

Answer 24

``` Same as child with cast Clear parental instructions -bathing -time feeding with manipulations to allow distraction -encourage normal development ```

Answer 25

Progressive degenerative diseases that affect muscle cells or specific muscle groups causing weakness and atrophy. * *most identified early childhood * *includes >30 types but Duchenne MD is most common. affects limb and trunk muscles first

Answer 26

Muscle fibers leak creatinine kinase and take on excess Ca+ causing more damage Muscles degenerate and replace with fat and connective tissue Muscle death causes weakness and wasting

Answer 27

Progressive, symmetric muscle wasting and weakness without loss of sensation Symptoms become acute age 3-7 (hypertrophied muscles) Waddling wide based gait, can't climb stairs Gowers sign, use hands to walk up legs to stand erect Walking ability lost age 9-12 years Shortened life span r/t affect on GI, brain, cardio Cardiopulmonary complications common cause of death

Answer 28

EMG and muscle biopsy Genetic screening Physical findings Serum creatinine kinase (CK) elevated early stages of disease then decrease as muscle decreases

Answer 29

Goal to maintain ambulation and independence as long as possible No effective treatment Manage symptoms Prevent contractures: ROM, bracing, PT, weight control