week 12: caring for child and their family w MSK and articular dysfunction Flashcards
MSK sys effects of immobilization
Decreased muscle strength and endurance, atrophy and loss of joint mobility - does not take long to lose muscle mass when immobilized, important to mobilize as early and as much as possible.
skeletal sys effects of immobilization
Bone demineralization, negative calcium balance - weakness and increased risk of fracture
metabolism effects of immobilization
Decreased metabolic rate, hypercalcemia due to calcium leaving bones, decreased production of stress hormones.
CVS effects of immobilization
Altered distribution of blood volume, venous stasis, dependent edema in extremities due to diminished vasopressor mechanism, obesity, clotting/DVT risk especially for adolescent girls on birth control.
resp sys effects of immobilization
Decreased need for oxygen, diminished vital capacity, poor abdominal tone & distension, loss of respiratory muscle strength - not losing lungs could lead to pneumonia.
GI sys effects of immobilization
Distension caused by poor abdominal muscle tone, weakened smooth muscle tone causing constipation, anorexia.
integ sys effects of immobilization
Decreased circulation and pressure leading to decreased healing capacity, increased risk for pressure injuries
urinary sys effects of immobilization
Alteration of gravitational force, difficulty with voiding in supine position, urinary retention.
overall psychological effects of immobilization for children
Diminished environmental stimuli, altered perception of self and environment.
Increased feelings of frustration, helplessness, anxiety, depression, anger and aggressive behaviour
Developmental regression, children do not do well when they are not moving around and being mobile
Need to consider what we can implement into the careplanto buffer these negative effects.
describe soft tissue injuries
what are these and how do we treat them
what is the most common
Soft-tissue injury:
-Injuries to muscles, ligaments and tendons most often due to sports injuries and mishaps during play.
-Dislocation is common especially for a toddler.
-Treat these injuries through rest, ice (on and off for 30 mins), compression and elevation / RICE.
describe fractures
what is the most commonly broken bone in childhood
Common injury in children, however rare in infants with the exception of motor vehicle collisions. Need to be diligent about investigating whether the fracture is non-accidental.
Clavicle is the most frequently broken bone in childhood, especially in those less than 10 years old.
For infants the most likely cause is shoulder dystocia. For school age children, most likely causes include bike, sports injuries.
Methods of treatments are different in pediatrics, as bones heal faster but break more easily, consideration needs to be made on where the break occurred.
describe healing periods for fractures for
1. neonate
2. early childhood
3. later childhood
4. adolescent
Neonate: 2-3 weeks
Early childhood: 4 weeks
Later childhood: 6-8 weeks
Adolescent: 8-12 weeks
what are the 5 types of fractures (dont describe just state them)
- simple/closed
- compound/open
- complicated
- comminuted
- spiral fracture
describe simple/closed fractures
Does not produce a break in the skin.
describe compound/open fractures
Fractured bone protrudes through the skin.
complicated fractures
Bone fragments have damaged other organs or tissues, hard to heal
comminuted fratures
Small fragments of bone are broken from fractured shafts and lie in surrounding tissue, much harder to heal.
spiral fracture
Caused by twisting motions.
how do we assess fractures (5 P’s)
- neurovascular assessment
5 P’s
Pallor
Pain
Pulse
Paralysis
Paresthisia (numbness/tingling)
Colour, movement and sensation (CSM) are another important analysis.
what is a concerning complications of fractures
Concerning findings of the complications of compartment syndrome (when swelling gets so bad that it cuts off blood supply to a joint of the affected area). Elevation will help decrease the risk of compartment syndrome. The limb will want to swell but it can’t as much as it wants, due to being in a cast.
Monitor w 5 P’s
If there is suspected compartment syndrome, cut the cast to have some room to continue to swell, code 99 and medical emergency.
describe
Epiphyseal injuries
Weakest point of long bones is the cartilage growth plate (epiphyseal plate), and therefore this is a frequent site of damage during trauma.
May simply dislocate during growing and slowly move out of the socket.
Damage here can affect future bone growth, and therefore requires close monitoring for any problems later on.
treatment for epiphyseal injuries
Treatments may include open reduction and internal fixation to prevent growth distrubances. Many x-rays must be performed to make sure the bone is healing appropriately. Must look for post-op complications such as infection, malunion and shifting.
what is osteosarcoma
Most common type of primary malignant bone tumor in children. Very serious condition and the prognosis is poor.
clinical presentation of osteosarcoma
Localized pain, limping, palpable mass
Half of cases are in the femur
osteosarcoma management
Medical-chemo
Surgical-rotationplasty which is a salvage limb procedure that removes the femur, and turns the lower part of the limb around using the ankle joint in the replacement of the knee joint. This leaves the individual with a full functioning upper leg which they can then apply a prosthetic too
nursing care of osteosarcoma
Emotional support
Body image changes
3 developmental dysplasia of the hip
- shallow acetabulum
- subluxation
- dislocation
shallow acetabulum
this is the mildest form where the femoral head is in the acetabulum
subluxation
incomplete dislocation
dislocations
complete dislocation
clinical manifestations of DDH
Shortened limb and restricted abduction of hip on the affected side
Unequal gluteal folds when the infant is prone
Positive ortolani test (test will dislocate the hip - used for newborns)
Positive barlow test (test will reduce the hip - used for newborns)
pavlik harness
Used for newborn up to six months, used to keep the acetabulum in place with constant pressure from the harness. Adjusted to fit the needs of the newborn.
Spica cast
This is what is used for treatment if diagnosis is later on. Is used to keep the hip in position, and has openings for the infant to use and change their diaper. The ends of the cast can be very hard and scratchy, therefore need to take waterproof tape and wrap around the end of the cast to keep it soft and clean.
osteogenesis imperfecta (OI)
A group of heterogeneous inherited disorders of connective tissue, characterized by excessive fragility and bone defects.
Defective connective tissue or an inability to make connective tissue with a deficiency in type 1 collagen.
Defective periosteal bone formation and reduced cortical thickness of bones, and hyperextensibility of ligaments.
May be diagnosed prenatally or post birth when older
therapeutic management of OI
Therapeutic management
Primarily supportive care to build up muscles and bone strength
Drugs of limited benefit
May need to test for and try rule out OI if multiple fractures occur
Nursing considerations OI
Caution with handling to prevent fractures by using gentle movements
Family education
Occupational planning and genetic counseling
Sociliosis
Most common spinal deformity, may be congenital or develop during childhood. Generally becomes notciceable after a pre adolescent growth spurt.
three planes of scoliosis
Lateral curvature
Spinal rotation causing rib asymmetry
Thoracic hypokyphosis
causes of Scoliosis
Multiple potential causes and most are idiopathic
Scoliosis Diagnostic evaluation
School screening is controversial, and may have complaints of ill-fitting clothes.
Only screened in children that have complaints of pain, or if it is noticeable like different heights of each leg.
Standing radiographs to determine the degree of curvature.
Asymmetry of shoulder height, scapular or flank or hip height.
Often have primary curve and compensatory curve to align head with guletal cleft.
Scoliosis therapeutic management
Team approach to treatment, needs to be seen by an orthopedic surgeon
Bracing
Exercise
Surgical intervention for severe curvature (instrumentation and fusion), if more than 40 degrees. Rods are used that are the length of the spine, but there is always a risk of paralysis. Surgery is a long proccess and there are many possible post-op complications and care that is needed.
Osteomyelitis
Inflammation and infection of bony tissue that may be caused by exogenous (outside of the body) or hematagenous (comes from inside the body) sources.
Staphylococcus aureus is the most common causative organism
Types of osteomyelitis (4)
Acute hematogenous
Exogenous
Subacute
Chronis
Osteomyelitis Therapeutic management
MRI for diagnosis
May have subacute presentation with walled-off abscess than than spreading infection
Prompt vigorous intravenous antibiotics for an extended period of 3-4 weeks or several months.
Monitor hematologic, renal, hepatic responses to treatment
Prevent complications such as sepsis, meningitis, weakened bone, fracture and monitor antibiotic side effects.
Osteomyelitis Symptoms
Pain, swelling, redness
Decreased movement of area
Marked leukocytosis
Bone cultures obtained from biopsy or aspirate
Fever
May being abruptly and resemble symptoms of arthiritis and leukemia (pain in a joint)
X-ray film may appear normal at first
Osteomyelitis Nursing management
Complete bed rest and immobility of limb until treatment starts to work
Pain management.
Long-term intravenous access for antibiotics.
Portal of entry may not be obvious so a good head to toe is needed
Nuritional considerations
Long-term hospitalization/therapy and consider the psychological effects of this.
Juvenile idiopathic arthritis
Juvenile rheumatoid arthritis of childhood is not very common. Possible causes include wear and tear, genetics, may be viral or bacterial infection that triggered this. Peak onset is 1-3 years of age and it often goes undiagnosed.
Juvenile idiopathic arthritis s/s
Stiffness
Swelling
Loss of mobility in affected joints
Arms to touch, usually without erythema
Tender to touch
Symptoms increased with stressors
Slowing of growth
Juvenile idiopathic arthritis Therapeutic management
No specific cure
Goals of therapy include preserving function, prevent deformities, and relieve symptoms.
