Week 6 Chapter 44 Flashcards
Time of rapid growth is
Adolescence
Increased risk of injury with this age group as well.
Neuromuscular system includes
The nervous system and muscular system
Musculoskeletal provides body with form, support, stability, protection, and ability to move. Made up with cartilages`, bones, and tendons.
If child does not develop milestones in a timely manner then neuro or muscular disorder may be the culprit
True
Growth plate injuries can result in
Diminished growth
Child’s bones have thick, strong periosteum with an _____________ ___________ supply to allow for quicker healing.
adequate blood
Children’s bones also produce callus more quickly than adults.
Motor development begins at birth and proceeds in predictable sequence
Full range of motion is present at birth
Child’s spinal cord more mobile than adult
Myelinization not complete until 2 years of age
Skeleton not completely ossified until late adolescence
Growth of bones occurs primarily at specialized growth plates at the end of long bones
Bones in children are more vascular
Differences in Child vs Adult
Eliciting History of Present Neurologic Disorder
Changes in gait
Activity level compared to peers
Recent Trauma
Poor Feeding
Lethargy
Fever
Weakness
Alteration in muscle tone
History of Developmental Milestones
Physical Examination of the Nervous System and Musculoskeletal Systems
Inspect and Observation
- Motor Function
- Reflexes
- Sensory Function
Palpation
- Muscle strength and tone
Auscultation
- Lungs for adventitious sounds
CBC
CK
Radiographs
Fluoroscopy/ Arthrography
Myelography EMG Muscle Biopsy
Nerve Conduction Testing
CT MRI Ultrasound
Genetic Testing
Laboratory and Diagnostic Testing
Indicated to evaluate with a fracture for potential bleeding
Leaks from muscle into the plasma as muscle deteriorates
CBC
Xray of the spinal cord and its roots
Myelography
Recording electrode is placed in the skeletal muscle and electrical activity is recorded
EMG
Measures the speed of nerve conduction
Nerve Conduction Testing
Patch like nodes placed and various nerve spots
Mini Shocks and EMG done at the same time
Common Meds Used for Skeletal Muscle Disorders
Benzodiazepines
Baclofen
Corticosteroids
Botulin Toxin
Acetaminophen
Narcotics
NSAIDs
Bisphosphonate
Common Medical Disorders for Skeletal Disorders
Casting
Splinting Fixation
Cold Therapy
Crutches
Traction
Therapies
Orthotics and Braces
Central Acting Muscle Skeletal Relaxant
Baclofen
Anti- Inflammatory and immunosuppressive action
Corticosteroids
Neurotoxin that blocks neuromuscular conduction
Botox
Increase bone mineral density and decrease incidence of fractures in moderate to sever osteogenesis imperfecta.
Bisphosphonate
______________ are used to immobilize a bone that has been injured or a diseased joint
Serves to hold the bone in reduction
Prevents deformity as fracture heals
Keeps bone aligned and helps to reduce pain
Casts
Cast Care watch for CSM?
True
C olor
S ensation
M ovement
CAST stands for
C clean and dry
A above the heart
S Scratch and itch
T Take it easy
Common method of immobilization used to reduce or immobilize a fracture to align and injured extremity to be restored to its normal length.
Traction
Nursing Interventions in Children with impaired mobility
Frequent Pain Assessments
Skin Integrity maintained
Supporting adequate ROM
CSM
Frequent Neurovascular Checks
- Ice and Elevation
Teach about cast and crutch care
Consult physical and occupational therapies to improve the mobility and independent functioning
Spina Bifida Occulta
Meningocele
Myelomeningocele
Neural Tube Defects
Structural Disorders of the skeleton
Pectus Excavatum and Carinatum
Limb Deficiencies
Metatarsus Adductus
Congenital Club Foot
Polydactyl and Syndactyl
Developmental Dysplasia of the Hip
Torticollis
Tibia Vara
Genetic Disorders
Congenital and Developmental Neuromuscular and Muscoskeletal Disorders
Defect of the vertebral bodies without protrusion of the spinal cord and meninges
Benign and asymptomatic
- Dimpling
Abnormal Patches of hair
- Discoloration of skin at defect site
Spina Bifida Occulta
Complications of rare with Spina Bifida
True
Tissue attachments that limit the movement of the spinal cord in the spinal column
Tethered Cord
Fluid filled Cyst in spinal cord
Syringomyelia
Splitting at the spinal into 2 hemicords
Diastematomyelia
Less serious form of spina bifida cystica
Meningocele
Occurs when the meninges herniate through a defect in the vertebrae
Spinal cord is normal and no associated neurologic defects
Nursing management of Meningocele
Prevent rupture of the sac
Prevent Infection
Provide adequate nutrition and hydration
Treatment is surgical correction of the lesion
Most severe form of neural tube defect
Type of spina bifida cystica, clinically known as spina bifida
May be diagnosed in utero or visually obvious at birth
Myelomeningocele
At risk for
Meningitis
Hypoxia
Hemorrhage
Spinal cord ends at the point of defect and absent motor and sensory function beyond that point
Myelomeningocele
Long Term complications of Myelomeningocele
Paralysis
Orthopedic Deformities
Bladder and Bowel Incontinence
Hydrocephalus, Chiari defect seen in 80%
Treatment is multiple surgeries
Sensitivity to latex or natural rubber is common among children with
Myelomeningocele
Nurses must create a latex free environment
Anterior chest wall deformities
Male Predominance
Pectus Excavatum and Carinatum
Protuberance of the chest wall
Less common 5-15 % of cases
Pectus Carinatum
Funnel Shaped Chest
More common and greater than 90%
Progresses with growth
May cause cardiac and pulmonary compression
Symptoms include SOB, withdraw from physical activities, poor body image
Pectus Excavatum
Therapeutic Management of Pectus Excavatum and Carinatum
Observation
PT
Surgery
Presence of extra digit is known as
Polydactyl
Webbing of fingers and toes
Syndactyl
Medical deviation of the forefoot
Most common foot deformities of childhood
Occurs because of utero positioning
Metatarsus Adductus
- Mild Cases requires stretching exercises
- Severe cases require serial casting before the age of 8 months
Surgical intervention is rarely needed
Congenital Anomaly that occurs 1 of 1000th live births
Bone deformity in which shape of one or both both feet are twisted out of shape position
Foot resembles the head of a golf club
Talipes Equinovarus
Goal of Talipes Equinovarus
Therapeutic management is is achievement of a functional foot
Nursing interventions for Clubfoot
Check toes several times a day
Do NOT elevate feet with a pillow
Do NOT place on stomach during sleep
Treatment stars soon after birth and involves serial casting
Long Leg cast and weekly recasting 5-8 weeks
Denis Browne Brace
S/S of Clubfoot
Foot or feet point down and inwards
Soles of feet face each other
Important to check toes several times per day ( CSM)
Ball and socket joint of the hip does not form properly - full dislocation of hip joint- head of femur pops out of socket- affected leg shorter as femur head gets displaced
Hip Dysplasia
Risk Factors of Dysplasia
Family History, female gender
Large infant size, breech birth
Native American or Eastern European Descent
S/S of Hip Dysplasia
Extra gluteal folds
Shortened leg
Instability
Clicking Sensation
Use Barlow and Ortolani Tests
Therapeutic management
- Pavlik Harness, closed reduction- spica cast
No adjusting the harness straps, leave on 100%, check skin 2-3 x per day
Massage under the straps every day while looking for redness and dress child under the straps; diapers under the straps
Avoid Powders and lotions
Pavlik Harness
Spica Cast care is same as ?
Normal cast care
Painless muscle condition
Results from tightness of the sternocleidomastoid muscle to tilt on one side
- In utero positioning
- Difficult birth
Therapeutic Management -
Passive Stretching
PT
Tubular for Torticollis
Torticollis
Wryneck or head tilt shows
“Bow-leggedness”
Tibia Vara ( Blount Disease)
3 types of Tibia Vara
Infantile - Most common
Juvenile
Adolescent
Developmental Disorder occurs most frequently in what with Tibia Vara?
Early Walkers
African American Females
Obesity
Growth plate of upper tibia stops bone production, asymmetric growth at knee occurs and bowing progresses
Tibia Vara
Bracing and Surgical intervention for treatments
Most common type of osteoporosis
Known as brittle bone disease
Genetic bone disorder that results in low bone mass, increased fragility of the bones, connective tissue problems
Fractures easily
Osteogenesis Imperfecta
Tooth enamel wearing easily, brittle and discolored teeth
Dentinogenesis
S/S of Osteogenesis Imperfecta
Frequent fractures
Screaming with routine care
Blue, purple, gray sclerae
Problems with primary teeth
Bruising, joint hypermobility
Therapeutic Management of OI
Decrease fractures, maintain mobility, early PT/OT
Bisphosphonate administration
Splints or Braces
Severe cases requires surgical insertion of rods into long bones
Ranges from mild to severe
Complications include: short stature, hearing loss, acute and chronic pain, scoliosis, and respiratory problems
Use caution when lifting, changing diapers, etc
Taking blood pressure or IV due to possible fractures occurring
OI
Genetic motor neuron disease that affects the spinal nerves ability to communicate with muscles
SMA
Muscle lose function and over time atrophy
Cognition is unaffected
Respiratory muscle weakness may occur in all types of SMA
General term for a group of inherited types of neuromuscular disorders that affect voluntary muscles
Symptoms not always evident at birth; may manifest later in childhood
Muscular Dystrophy
May limit lifespan due to compromised ability to adequately support ventilation
Muscular Dystrophy
Rare similar type of neuromuscular disease that affects the motor neurons in the spinal cord, rather than the muscle fibers itself
Symptoms are like those of Muscular Dystrophy
Spinal Muscular Atrophy
Muscular Dystrophy affected in early childhood and most fatal
Duchenne
2 -16 years and type of Muscular dystrophy
Less severe than Duchenne
At birth muscular dystrophy
Congenital
Childhood to early teens Muscular Dystrophy
Congenital
Muscular Dystrophy of childhood to earl teens
Emery Dreifuss
Late teens to middle age Muscular Dystrophy
Limb Girdle
Late childhood to early adulthood
Facioscapulohumeral
Myotonic muscular dystrophy occurs in
Teens
Progressive weakness and muscle weakness
Onset is 3-5 years and in males primarily
History of motor development delay
Clumsiness
Frequent Falls
Difficulty climbing stairs, running, riding bikes
Duchenne’s Muscular Dystrophy
Shows Gower’s Signs
Waddling gait
Ambulation by age 12 is impossible
Breathing muscles become more affected and life threatening infections are most common
Leads to death at age 15- 18 years
Duchenne’s
Common Complications
Nursing considerations of Duchenne’s
Fatigue
Mobility
Frequent Infections
Psychological Effects
Maintain Function
Nursing management Goals for a Child with Muscular Dystrophy
Promote mobility
- Administer meds
- Perform passive stretching and strength exercises
- Gentle exercise
Managing elimination
- Diet: Fluids and Fiber
Maintenance Cardiopulmonary Function
- Teach deep breathing exercises
- Perform CPT
Preventing complications and maximizing quality of life
- remove throw rugs
- Develop a diversional schedule
- Providing emotional support
Term used to describe a range of nonspecific symptoms
Most common motor disorder in childhood, lifelong impairment
Incidence is higher in premature and low birth weights
Cerebral Palsy
S/S of Cerebral Palsy
Motor impairments including abnormal motor patterns including spasticity, muscle weakness, and ataxia, abnormal brain function is not progressive
Complications of Cerebral Palsy
Mental Impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus
Therapeutic Management
- PT, OT, orthotics
Most causes occur before delivery and many times no specific cause can be identified
Cerebral Palsy
Causes of CP include
birth trauma from pressure of birth, especially prolonged or abrupt labor, abnormal or difficult presentation, abnormal or difficult presentation, cephalopelvic disproportion, or mechanical forces, such as forceps or vacuum used during delivery
Acquired Neuromuscular and Musculoskeletal Disorders
Rickets
Scoliosis
Injuries
-Spinal Cord
- Fractures
- Trauma
Delayed closure of fontanelles
Frontal bossing
Dental Hypoplasia
Pectus Carinatum
Swelling in wrist and ankle joints
Wide Sutures
Craniotabes
Rachitic Rosary
Harrison’s Sulcus
Bowing of legs
Clinical Features of Rickets
Softening or weakening of the bones
Caused by nutritional deficiencies
- Not enough calcium or vitamin D
- Limited exposure of sunlight
Rickets
Therapeutic Management of Rickets
Aimed at correcting the calcium imbalances
- Calcium and Phosphorus Supplements
- Need to be given at alternate times to promote absorption
Vitamin D Supplements
Fish, Dairy, and liver are good dietary sources
Growth plate is damaged and the femoral head moves with respect to rest of the femur
Left hip is more affected
Causes is unknown
SCFE
Slipped Capital Femoral Epiphysis
S/S of SCFE
Pain an din ability to bear weight and limp
Risk Factors:
Obesity
African American and Polynesian Race
Rapid Growth Spurt
Classified Based on Severity
Therapeutic Management of SCFE
Prevent further slippage
Minimize deformity
Surgical intervention and pin and screw
Decreased blood flow to femoral head
Bones dies due to lack of O2 and nutrients
Head of femur breaks apart and loses round shape
Legg Calve Perthes Disease
S/S: Limited ROM, Hip pain and stiffness, limp when walking
Diagnostics include Xray’s and MRI
Tx: Resolve on own
Rest and Pain control
Brace Surgery
For Legg Calve Perthes Disease x-rays shows
Deformity
MRI can show shape of bone and new blood vessels
Brace may be used to keep legs abducted and femoral head inline to promote healing
Surgery may be needed to provide a more permanent placement if femoral head is displaced
Common cause of hip pain and limping in children
Associated with recent or active infection, trauma, allergic hypersensitivity
Transient Synovitis of the Hip
Self Limiting and resolves in a week
Use NSAIDs, Analgesics, Bed rest
Lateral curvature of the spine greater than 10 degrees
May be congenital and associated with other disorders
Noticed first during rapid growth females ages 10-12
Scoliosis
Therapeutic Management of Scoliosis
Social Interaction
Braces - wear cotton shirt under brace
Worn 23 hours per day
Difficult for teens due to body changes
Surgical Repair for severe cases
Mild to severe- stiff spine
Severe- Chest deformity
S/S of Spinal Cord Injury
Inability to move or feel extremities
Numbness
Tingling
Weakness
Loss of voluntary movement below the level of lesion
Inability to breathe if injury is high cervical vertebrae
Injuries above C-4
Paralysis of the respiratory muscles and all four extremities
Tetraplegia
Higher the injury greater loss of function
Temperature regulation problems decrease level of injury
Phrenic Nerve is
C3-C5
C5-T1
Tetraplegia
T1 and down
Paraplegia
Head and Sympathetic Outflow T1-L4
Temperature and blood vessel control of lower limbs
Lower Limbs involve
Bladder control and external genetalia
Interventions for Neurogenic Bladder
Clean intermittent catheterization to promote bladder emptying
Medications such as oxybutynin chloride (Ditropan)
Prompt recognition and treatment of infections
Surgical interventions such as continent urinary reservoir or vesicostomy to facilitate urinary elimination
Spinal cord injuries can affect?
Elimination
Neurogenic is term used describe bladder function and no longer voluntarily and be due to neuromuscular disorder
Teaching topics to prevent Spinal Cord injury
Vehicular Safety
Seat Belts and safety seats
Sports
Prevention of falls
Violence prevention
Water Safety
Pain unrelieved with morphine and extreme pain with medication
Compartment Syndrome
Twisting or turning of body part
Tendons and ligaments stretch much and may tear
Sprains
Common ankle and knee
RICE
Activity restrictions
Splints
Crutches
PT
Prevention Complications of Immobility
Qh2 turning
Assessing skin
ROM
CDI
Intake of fluids
Cough and deep breathing
Focus of nursing care of child with neuromuscular disorder
Maximize physical mobility
Promote nutrition
Promote effective elimination
Promote skin integrity
Self Care
Promote development
Prevent injury
Provide support and education
Promote Child and Family Teaching
Assess child and family willingness to learn
Provide family time to adjust
Repeat information
Teach in short sessions
Gear teaching to level of understanding of child
Provide rewards
Use multiple modes of learning
