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Nursing 263 > unit 5 > Flashcards

unit 5 Flashcards

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0
Q

Bones Heal

A

Faster in younger children
Quicker the closer to the growth plate
Better in children because bone remodeling is increased

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1
Q

Fractures in children

A

often result from accidental trauma at home or school
motor vehicle related injuries
recreational activities
non-accidental trauma (child abuse)

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2
Q

Types of fractures

A

Plastic deformation(bowing)-significant bending w/o breaking
Buckle, or torus-compression injury; the bone buckles not break
Greenstick- Incomplete fracture of the bone
Complete fractures-bone breaks in two pieces
Transverse Fractures-complete break in bone runs perpendicular to the bone
Oblique fractures-break in bone that runs diagonally to the bone shaft
Spiral fractures-rare in children-caused by a twisting force
Simple closed fractures-break in bone that does not penetrate skin
Compound open fractures-broken bone penetrates the skin

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3
Q

Abuse fracture information

A

Rib fractures rarely if ever result of minor accidental trauma in infants and children
Discrepancy between the age of fractures and the clinical history of injury is often the first indication of inflicted injury, and the presence of multiple fractures of different ages is evident in repetitive inflicted injury
Consideration must be given to possible pure existing medical conditions that may predispose weak bones to injury.

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4
Q

assessment of fracture

A
  • Determine mechanism if injury
  • move injured part as little as possible
  • Inspect the skin for bruising, erythema, or swelling
  • observe the extremity for deformity
  • Assess neurovascular status of the distal extremity (temp., movement, sensation, numbness, capillary refill time, and quality of pulses)
  • –remember pupils are not part of neurovascular check but instead they are part of neurological check—
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5
Q

Nursing management of fractures

A
  • Immobilize the limb above and below the site of injury
  • Cover open wounds with a sterile or clean dressing
  • Use cold therapy to reduce swelling in the first 48 hours
  • Elevate the injured extremity above the level of the heart
  • Perform frequent neurovascular checks
  • Assess pain level and administer pain medications as needed
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6
Q

Cast care first 48 hours

A
  • Elevate the extremity above the level of the heart
  • Apply cold therapy for 20 to 30 minutes, then off 1 hour, and repeat
  • Assess for swelling, and have the child wiggle the fingers or toes hourly
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7
Q

Cast care for itching

A
  • Never insert anything in the cast
  • Blow cool air in from a hair dryer set on the lowest setting or tap lightly on the cast
  • Do not use lotions or powders
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8
Q

Protecting casts from wetness

A
  • Apply a plastic bag around cast and tape securely for bathing or showering.
  • Continue to avoid placing the cast directly in water
  • Cover cast when your child eats or drinks
  • If cast becomes soiled it can be wiped clean with a slightly damp clean cloth
  • If the cast gets wet, dry it with a blow dryer on the cold setting
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9
Q

General cast care

A

-If the child has a large cast, change position every 2 hours during the day and while sleeping change position as often as possible

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10
Q

Cast skin protection

A

-Check skin for irritation
.by pressing the skin back around edges of the cast
.using a flashlight to look for reddened or irritated areas
.by feeling for blisters or sores

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11
Q

Call the physician if

A
  • The castes extremity is cool to the touch, pale, blue, or very swollen
  • The child cannot move the fingers or toes
  • Persistent numbness or tingling occurs
  • Drainage or a foul smell comes from under casts
  • severe itching occurs inside the cast
  • The child runs a fever greater than 101.5 for longer than 24 hours
  • Skin edges are red and swollen or exhibit breaking down
  • Child complains of rubbing or burning under cast
  • The cast gets wet or is cracked, split, or softened
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12
Q

Cast care

A
  • Keep cast uncovered while it is drying
  • Turn child at least every 2 hours to help cast dry evenly
  • Handle wet plaster casts by palms of the hands to prevent indentation
  • Petal the edge of the plaster cast
  • Teach the child or parent how to prevent the cast from getting wet or soiled.
  • Keep extremety elevated
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13
Q

indications of compartment syndrome

A
  • Increased pain
  • Increased edema
  • Pale or blue color
  • Skin coolness
  • Numbness or tingling
  • Prolonged capillary refill time
  • Decreased pulse strength or absence of pulse
  • –Notify the physician or nurse practitioner of changes In neurovascular status, or odor, or drainGe from the cast immediately
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14
Q

Traction is used

A
  • To reduce pain by decreasing muscle spasms
  • To position the distal and proximal bone ends in desired realignment to promote satisfactory bone healing.
  • To immobilize the fracture site until realignment has been achieved and sufficient healing has taken place to permit casting or splinting.
  • To help prevent or improve contracture deformity
  • To provide immobilization of specific areas of the body
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15
Q

Traction uses

A
  • Fractures of the humerous side arm 90-90 skin traction
  • Dunlop side arm 00-90 skeletal traction
  • Bryant traction used for femur/hip dislocation for children less than 2-3 years
  • Buck traction is skin traction for the hip and knee contractures delivers traction force in a straight line
  • Russell traction is skin traction for femur fracture, hip and knee injuries or contractures
  • 90-90 traction for femur fracture reduction when skin traction is inadequate
  • Balanced suspension is used for femur or tibial fracture, suspends leg relaxes hip and hamstring muscles
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16
Q

Nursing mngt. of traction involves

A
  • Understanding the therapy
  • Maintaining traction
  • Maintaining alignment
  • Monitor skin traction
  • With skeletal traction maintain pin care, watch for infection, temperature( both most important)
  • Prevent skin breakdown
  • Prevent complications
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17
Q

Pin care

A
  • Perform pin care daily or weekly after the first 48 to 72 hours
  • The most effective solution for pin site care may be chlorhedidine 2mg/ml
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18
Q

External fixation

A
  • May be used for complicated fractures

- Pins or wires are inserted into bone and then attached to an external frame

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19
Q

llizarov external fixator

A
  • Used to lengthen or widen bones
  • To correct angular or rotational defects
  • To immobilize a complex fracture
  • Uses small wires under tension on a circular ring, connecting them to rods, hinges, plates
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20
Q

What is osteomyelitis

A

A bone infection usually caused by staphlococcus are us with MRSA on the rise

21
Q

Osteomyelitis

A
  • Is acquired by bacteria from the bloodstream which invades growing bone.
  • The bacteria causes an inflammatory response, formation of pus and edema, and vascular congestion.
  • Infection progresses throughout the bone which results in death of the bone tissues
22
Q

Symptoms of osteomyelitis in children include

A
  • Fever
  • Moderate to severe pain
  • Pain which increases with movement
  • Refusal to bear weight or straighten the joint
  • Limted range of motion
  • Warmth and swelling of the affected area
23
Q

Labs for osteomyelitis In children include

A
  • CBC with differential to check for elevated WBC and elevated neutrophils
  • Erythocyte sedimentation rate(Esr) and C-reactive protein levels (crp)
  • W/joint involvement, fluid aspiration will be done and sent off to lab
  • X-ray, ultrasound, and/or ct scan
  • Blood culture
24
Q

Therapeutic Mngt of Osteomyelitis in children

A
  • After culture specimens are obtained, empiric therapy is started with IV antibiotics lasting. antibiotics will be taken 4 to 6 weeks and usually requires central line placement
  • Surgical debridment may be necessary
  • Hemovac may be needed following surgery.
  • Bed rest while in pain
  • Immobilization of the affected extremity
  • Manage fever and pain
  • With open wounds, precautions are put in effect depending on the institution.
25
Q

Developmental Dysplasia of the hip(DDH)

A
  • Is abnormal development of the h joint which includes dislocation, subluxation, and Dysplasia of the hip joint.
  • newborns and infants may have the femoral head loosely in the socket, or the hip may be completely dislocated at birth
  • Cause is unknown, there is often a genetic or familial tendency.
26
Q

Developmental Dysplasia of the hip

A
  • affects left more than right
  • Can be affected by Intrauterine positioning
  • Can be caused by mechanical factors such as: Breech position, first born babies, multiple fetus’, oligohydrmmnios, and large infant size
  • can come from genetic issues such as: family history, gender includes 60% girls, and increased incidence among Native American ans Eastern Europe descent. Low in African and Chinese heritage.
27
Q

Signs of DDH in the infant includes

A

Shortening of femur on affected side like unequal knee height
-Limited hip abduction on affected side
-asymmetry of the high and gluteal folds
-Positive ortoloni or Barlow maneuvers during infancy
With Barlow the joint goes up and out, with ortoloni the joint goes back in

28
Q

Signs of DDH in older children

A
  • Trendelenburg sign (pelvis/hip drops when leg is raised)
  • Greater trochanter prominent
  • Marked lordosis(bilateral dislocations)
  • Waddling gait(bilateral dislocations)
29
Q

Diagnosing DDH

A

-Hip ultrasound for newborns and young infants because many bones of hip joint are soft cartilage and not visible on x-Ray until 5-6 months old.

30
Q

Therapeutic mngt of DDH

A
  • Newborn to age 4-6 months- duration of treatment depends on development of the acetabulum but is usually accomplished within the first year.
  • Pavlik harness
  • Skin traction and abduction brace
  • Hip spica cast and abduction brace
  • For 4 to 24 months of age use traction followed by closed reduction of the hip under general anesthesia; then hip spica cast, followed by flex ion-abduction brace
  • Children older than 2 years of age get open surgical reduction followed by a period of casting ( very difficult to correct after 4 years and impossible or in advisable in children older than 6 years of age.
31
Q

what is congenital clubfoot(congenital talipes equinovarus)

A

A congenital anomaly of the foot which includes the following:

  • —-talipes varus which is inversion of the heel
  • —-talipes equinus which is plantarflexion
  • —-Cavus which is plantarflexion of the forefoot on the hind foot
  • —-forefoot adduction with supination
  • A normally developing foot becomes clubfoot during the second trimester of pregnancy
  • The cause is unknown, however, clubfoot clusters in families and effects family members across generations
  • Boys are more commonly affected than boys
32
Q

clubfoot classification include

A
  • Postural
  • Syndromic
  • Neurogenic
  • Idiopathic:”true clubfoot”
33
Q

Postural clubfoot

A
  • no bony abnormality
  • believed to occur primarily from intrauterine crowding
  • Many resolve spontaneously or require passive exercise or serial casting
34
Q

Syndromic clubfoot

A
  • more severe form of clubfoot that is often resistant to treatment
  • usually requires surgical correction and have a high incidence of recurrence
  • associated with other congenital abnormalities
35
Q

Neurogenic clubfoot

A

-occurs in infants with myelomeningocele

36
Q

Idiopathic or true clubfoot

A
  • May occur in otherwise normal child

- almost always requires surgical repair or Ponseti method because there is bony abnormality

37
Q

Congenital Clubfoot (Congenital talipes equinovarus)

A

-A congenital anomaly of the foot which includes the following:
——-Talipes varus (inversion of the heel)
——-Talipes equinus (plantarflexion)
——-Cavus (plantarflexion of the forefoot on the hindfoot)
——-Forefoot adduction with supination
o A normally developing foot becomes clubfoot during the second trimester of pregnancy.
o Clubfoot clusters in families and affects family members across generations.

38
Q

Club foot treatment

A

The Ponseti Method involves the following steps:

  • ——-Manipulation of foot and serial casting weekly in doctor’s office for 6 to 8 weeks
  • ——-Small surgical procedure under local anesthesia in doctor’s office to lengthen heel cord
  • ——-Special orthopedic device with a bar separating feet (Dennis Brown Brace) is worn for 2 months, and then only at night time for 2 years.
39
Q

Surgical Repair (Reconstructive foot procedure) for club foot

A
  • The type and extent of surgery depends on the severity. The surgery involves lengthening some tendons and releasing tight ligaments to place the bones and joints in normal positions.
  • Sometimes pins are temporarily placed in the foot and a cast in applied after surgery to maintain its position while it heals.
40
Q

Congenital Clubfoot Treatment

A
  • Correction of deformity
  • Maintenance of the correction until muscle balance is regained
  • Follow-up observation to avert possible recurrence of deformity
41
Q

What is scoliosis

A

-A lateral curvature of the spine that exceeds 10 degrees

42
Q

Idiopathic scoliosis

A
  • is classified according to onset.
  • is Predominant in females and may be familial
  • AIS screening usually starts age 10 years
  • Screening usually occurs in the schools and during routine physical exams
  • Unknown cause
  • Infantile: occurs in the first 3 years of life
  • Juvenile: diagnosed between age of 4 and 10, or prior to adolescence
  • Adolescent: age 11 to 17
43
Q

Scoliosis Screening

A
  • Early screening/detection results in improved outcomes
  • Compare Shoulder height
  • Compare hip height
  • Compare Scapular predominance
  • Compare Distance between elbows and waist (flank area)
  • Bending over test is the most important
  • need to be looking for asymmetry of ribs and flanks (Fig. 23.22, pp. 864)
44
Q

Scoliosis diagnosis involves

A
  • Definitive diagnosis is made by x-rays of the child in the standing position
  • Cobb technique (standard measure of angle curvature), which establishes the degree of curvature.
45
Q

Scoliosis Therapeutic Management

A
  • The treatment of scoliosis is based on Cobb angle, the clinical deformity (rib and/or lumbar prominence, trunk shift), and the risk for further progression.
  • with an 11° to 25° curve: observe and close follow up; exercise may help
  • with an 25° to 45° curve: bracing/exercise to prevent further curvature with growth
  • Braces worn daily until skeletal maturity occurs (Fig. 23.20, pp. 863)
  • Braces worn 22-23 hours per day:

-45° for thoracic curvatures and > 40° for thoracolumbar or lumbar curvatures: spinal fusion considered to reduce the deformity of the spine and relieve pressure on lungs and heart

46
Q

Spinal fusion Postoperative Care

A
  • Patient log-rolled every 2 hours Ambulation started as soon as possible (2nd postop. day)
  • Physical therapy assists initially
  • Priority Assessments (Wound, neurovascular, vital signs, neurologic, pain)
  • Pain management. PCA MSO4 is used to control pain postoperatively.
  • Dressing changes.
  • Chest tube (for anterior repair)
  • In some cases, brace or cast may be needed postoperatively.
47
Q

Possible Postoperative Problems after spinal fusion:

​

A

-Acute blood loss (watch for hypotension and decreased Hgb)
-Urinary retention may r/t loss of blood supply and decreased renal perfusion; and narcotic medications.
-An indwelling urinary catheter is discontinued when the patient is ambulating well.
-Constipation related to pain medication
-Pain.
-PCA MSO4 is used to control pain postoperatively and converted to oral narcotic therapy once they are tolerating fluids
-Wound infection. Prophylactic antibiotics are discontinued after the drains and catheter are removed, typically on the third postoperative day.
-Neurological injury or spinal cord injury.
​

48
Q

Neuromuscular scoliosis

A

-Associated with neurological or muscular disease such as cerebral palsy, myelomeningocele, spinal cord rumors,spinal muscular atrophy, muscular dystrophies

49
Q

Congenital scoliosis

A

results from anomalous vertebral development

Nursing 263 (8 decks)

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