week 12: caring for child and their family w MSK and articular dysfunction

Question 1

MSK sys effects of immobilization

Answer 1

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.

Question 2

skeletal sys effects of immobilization

Answer 2

Bone demineralization, negative calcium balance - weakness and increased risk of fracture

Question 3

metabolism effects of immobilization

Answer 3

Decreased metabolic rate, hypercalcemia due to calcium leaving bones, decreased production of stress hormones.

Question 4

CVS effects of immobilization

Answer 4

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.

Question 5

resp sys effects of immobilization

Answer 5

Decreased need for oxygen, diminished vital capacity, poor abdominal tone & distension, loss of respiratory muscle strength - not losing lungs could lead to pneumonia.

Question 6

GI sys effects of immobilization

Answer 6

Distension caused by poor abdominal muscle tone, weakened smooth muscle tone causing constipation, anorexia.

Question 7

integ sys effects of immobilization

Answer 7

Decreased circulation and pressure leading to decreased healing capacity, increased risk for pressure injuries

Question 8

urinary sys effects of immobilization

Answer 8

Alteration of gravitational force, difficulty with voiding in supine position, urinary retention.

Question 9

overall psychological effects of immobilization for children

Answer 9

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.

Question 10

describe soft tissue injuries
what are these and how do we treat them
what is the most common

Answer 10

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.

Question 11

describe fractures
what is the most commonly broken bone in childhood

Answer 11

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.

Question 12

describe healing periods for fractures for
1. neonate
2. early childhood
3. later childhood
4. adolescent

Answer 12

Neonate: 2-3 weeks
Early childhood: 4 weeks
Later childhood: 6-8 weeks
Adolescent: 8-12 weeks

Question 13

what are the 5 types of fractures (dont describe just state them)

Answer 13

• simple/closed
• compound/open
• complicated
• comminuted
• spiral fracture

Question 14

describe simple/closed fractures

Answer 14

Does not produce a break in the skin.

Question 15

describe compound/open fractures

Answer 15

Fractured bone protrudes through the skin.

Question 16

complicated fractures

Answer 16

Bone fragments have damaged other organs or tissues, hard to heal

Question 17

comminuted fratures

Answer 17

Small fragments of bone are broken from fractured shafts and lie in surrounding tissue, much harder to heal.

Question 18

spiral fracture

Answer 18

Caused by twisting motions.

Question 19

how do we assess fractures (5 P’s)

Answer 19

• neurovascular assessment
  5 P’s

Pallor
Pain
Pulse
Paralysis
Paresthisia (numbness/tingling)

Colour, movement and sensation (CSM) are another important analysis.

Question 20

what is a concerning complications of fractures

Answer 20

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.

Question 21

describe
Epiphyseal injuries

Answer 21

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.

Question 22

treatment for epiphyseal injuries

Answer 22

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.

Question 23

what is osteosarcoma

Answer 23

Most common type of primary malignant bone tumor in children. Very serious condition and the prognosis is poor.

Question 24

clinical presentation of osteosarcoma

Answer 24

Localized pain, limping, palpable mass
Half of cases are in the femur

Question 25

osteosarcoma management

Answer 25

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

Question 26

nursing care of osteosarcoma

Answer 26

Emotional support
Body image changes

Question 27

3 developmental dysplasia of the hip

Answer 27

• shallow acetabulum
• subluxation
• dislocation

Question 28

shallow acetabulum

Answer 28

this is the mildest form where the femoral head is in the acetabulum

Question 29

subluxation

Answer 29

incomplete dislocation

Question 30

dislocations

Answer 30

complete dislocation

Question 31

clinical manifestations of DDH

Answer 31

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)

Question 32

pavlik harness

Answer 32

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.

Question 33

Spica cast

Answer 33

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.

Question 34

osteogenesis imperfecta (OI)

Answer 34

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

Question 35

therapeutic management of OI

Answer 35

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

Question 36

Nursing considerations OI

Answer 36

Caution with handling to prevent fractures by using gentle movements
Family education
Occupational planning and genetic counseling

Question 37

Sociliosis

Answer 37

Most common spinal deformity, may be congenital or develop during childhood. Generally becomes notciceable after a pre adolescent growth spurt.

Question 38

three planes of scoliosis

Answer 38

Lateral curvature
Spinal rotation causing rib asymmetry
Thoracic hypokyphosis

Question 39

causes of Scoliosis

Answer 39

Multiple potential causes and most are idiopathic

Question 40

Scoliosis Diagnostic evaluation

Answer 40

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.

Question 41

Scoliosis therapeutic management

Answer 41

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.

Question 42

Osteomyelitis

Answer 42

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

Question 43

Types of osteomyelitis (4)

Answer 43

Acute hematogenous
Exogenous
Subacute
Chronis

Question 44

Osteomyelitis Therapeutic management

Answer 44

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.

Question 45

Osteomyelitis Symptoms

Answer 45

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

Question 46

Osteomyelitis Nursing management

Answer 46

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.

Question 47

Juvenile idiopathic arthritis

Answer 47

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.

Question 48

Juvenile idiopathic arthritis s/s

Answer 48

Stiffness
Swelling
Loss of mobility in affected joints
Arms to touch, usually without erythema
Tender to touch
Symptoms increased with stressors
Slowing of growth

Question 49

Juvenile idiopathic arthritis Therapeutic management

Answer 49

No specific cure
Goals of therapy include preserving function, prevent deformities, and relieve symptoms.