Week 6 Chapter 44 Flashcards

1
Q

Time of rapid growth is

A

Adolescence

Increased risk of injury with this age group as well.

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2
Q

Neuromuscular system includes

A

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.

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3
Q

If child does not develop milestones in a timely manner then neuro or muscular disorder may be the culprit

A

True

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4
Q

Growth plate injuries can result in

A

Diminished growth

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5
Q

Child’s bones have thick, strong periosteum with an _____________ ___________ supply to allow for quicker healing.

A

adequate blood

Children’s bones also produce callus more quickly than adults.

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6
Q

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

A

Differences in Child vs Adult

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7
Q

Eliciting History of Present Neurologic Disorder

A

Changes in gait
Activity level compared to peers
Recent Trauma
Poor Feeding
Lethargy
Fever
Weakness
Alteration in muscle tone
History of Developmental Milestones

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8
Q

Physical Examination of the Nervous System and Musculoskeletal Systems

A

Inspect and Observation
- Motor Function
- Reflexes
- Sensory Function

Palpation
- Muscle strength and tone

Auscultation
- Lungs for adventitious sounds

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9
Q

CBC
CK
Radiographs
Fluoroscopy/ Arthrography
Myelography EMG Muscle Biopsy
Nerve Conduction Testing
CT MRI Ultrasound
Genetic Testing

A

Laboratory and Diagnostic Testing

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10
Q

Indicated to evaluate with a fracture for potential bleeding

Leaks from muscle into the plasma as muscle deteriorates

A

CBC

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11
Q

Xray of the spinal cord and its roots

A

Myelography

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12
Q

Recording electrode is placed in the skeletal muscle and electrical activity is recorded

A

EMG

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13
Q

Measures the speed of nerve conduction

A

Nerve Conduction Testing

Patch like nodes placed and various nerve spots

Mini Shocks and EMG done at the same time

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14
Q

Common Meds Used for Skeletal Muscle Disorders

A

Benzodiazepines
Baclofen
Corticosteroids
Botulin Toxin
Acetaminophen
Narcotics
NSAIDs
Bisphosphonate

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15
Q

Common Medical Disorders for Skeletal Disorders

A

Casting
Splinting Fixation
Cold Therapy
Crutches
Traction
Therapies
Orthotics and Braces

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16
Q

Central Acting Muscle Skeletal Relaxant

A

Baclofen

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17
Q

Anti- Inflammatory and immunosuppressive action

A

Corticosteroids

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18
Q

Neurotoxin that blocks neuromuscular conduction

A

Botox

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19
Q

Increase bone mineral density and decrease incidence of fractures in moderate to sever osteogenesis imperfecta.

A

Bisphosphonate

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20
Q

______________ 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

A

Casts

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21
Q

Cast Care watch for CSM?

A

True
C olor
S ensation
M ovement

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22
Q

CAST stands for

A

C clean and dry
A above the heart
S Scratch and itch
T Take it easy

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23
Q

Common method of immobilization used to reduce or immobilize a fracture to align and injured extremity to be restored to its normal length.

A

Traction

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24
Q

Nursing Interventions in Children with impaired mobility

A

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

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25
Spina Bifida Occulta Meningocele Myelomeningocele
Neural Tube Defects
26
Structural Disorders of the skeleton
Pectus Excavatum and Carinatum Limb Deficiencies Metatarsus Adductus Congenital Club Foot Polydactyl and Syndactyl
27
Developmental Dysplasia of the Hip Torticollis Tibia Vara Genetic Disorders
Congenital and Developmental Neuromuscular and Muscoskeletal Disorders
28
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
29
Complications of rare with Spina Bifida
True
30
Tissue attachments that limit the movement of the spinal cord in the spinal column
Tethered Cord
31
Fluid filled Cyst in spinal cord
Syringomyelia
32
Splitting at the spinal into 2 hemicords
Diastematomyelia
33
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
34
Nursing management of Meningocele
Prevent rupture of the sac Prevent Infection Provide adequate nutrition and hydration Treatment is surgical correction of the lesion
35
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
36
Spinal cord ends at the point of defect and absent motor and sensory function beyond that point
Myelomeningocele
37
Long Term complications of Myelomeningocele
Paralysis Orthopedic Deformities Bladder and Bowel Incontinence Hydrocephalus, Chiari defect seen in 80% Treatment is multiple surgeries
38
Sensitivity to latex or natural rubber is common among children with
Myelomeningocele Nurses must create a latex free environment
39
Anterior chest wall deformities Male Predominance
Pectus Excavatum and Carinatum
40
Protuberance of the chest wall Less common 5-15 % of cases
Pectus Carinatum
41
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
42
Therapeutic Management of Pectus Excavatum and Carinatum
Observation PT Surgery
43
Presence of extra digit is known as
Polydactyl
44
Webbing of fingers and toes
Syndactyl
45
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
46
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
47
Goal of Talipes Equinovarus
Therapeutic management is is achievement of a functional foot
48
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
48
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)
49
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
50
Risk Factors of Dysplasia
Family History, female gender Large infant size, breech birth Native American or Eastern European Descent
51
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
52
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
53
Spica Cast care is same as ?
Normal cast care
54
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
55
"Bow-leggedness"
Tibia Vara ( Blount Disease)
56
3 types of Tibia Vara
Infantile - Most common Juvenile Adolescent
57
Developmental Disorder occurs most frequently in what with Tibia Vara?
Early Walkers African American Females Obesity
58
Growth plate of upper tibia stops bone production, asymmetric growth at knee occurs and bowing progresses
Tibia Vara Bracing and Surgical intervention for treatments
59
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
60
Tooth enamel wearing easily, brittle and discolored teeth
Dentinogenesis
61
S/S of Osteogenesis Imperfecta
Frequent fractures Screaming with routine care Blue, purple, gray sclerae Problems with primary teeth Bruising, joint hypermobility
62
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
63
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
64
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
65
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
66
May limit lifespan due to compromised ability to adequately support ventilation
Muscular Dystrophy
67
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
68
Muscular Dystrophy affected in early childhood and most fatal
Duchenne
69
2 -16 years and type of Muscular dystrophy
Less severe than Duchenne
70
At birth muscular dystrophy
Congenital
71
Childhood to early teens Muscular Dystrophy
Congenital
72
Muscular Dystrophy of childhood to earl teens
Emery Dreifuss
73
Late teens to middle age Muscular Dystrophy
Limb Girdle
74
Late childhood to early adulthood
Facioscapulohumeral
75
Myotonic muscular dystrophy occurs in
Teens
76
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
77
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
78
Nursing considerations of Duchenne's
Fatigue Mobility Frequent Infections Psychological Effects Maintain Function
79
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
80
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
81
S/S of Cerebral Palsy
Motor impairments including abnormal motor patterns including spasticity, muscle weakness, and ataxia, abnormal brain function is not progressive
82
Complications of Cerebral Palsy
Mental Impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus Therapeutic Management - PT, OT, orthotics
83
Most causes occur before delivery and many times no specific cause can be identified
Cerebral Palsy
84
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
85
Acquired Neuromuscular and Musculoskeletal Disorders
Rickets Scoliosis Injuries -Spinal Cord - Fractures - Trauma
86
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
87
Softening or weakening of the bones Caused by nutritional deficiencies - Not enough calcium or vitamin D - Limited exposure of sunlight
Rickets
88
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
89
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
90
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
91
Therapeutic Management of SCFE
Prevent further slippage Minimize deformity Surgical intervention and pin and screw
92
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
93
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
94
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
95
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
96
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
97
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
98
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
99
Phrenic Nerve is
C3-C5 C5-T1 Tetraplegia
100
T1 and down
Paraplegia Head and Sympathetic Outflow T1-L4 Temperature and blood vessel control of lower limbs
101
Lower Limbs involve
Bladder control and external genetalia
102
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
103
Spinal cord injuries can affect?
Elimination Neurogenic is term used describe bladder function and no longer voluntarily and be due to neuromuscular disorder
104
Teaching topics to prevent Spinal Cord injury
Vehicular Safety Seat Belts and safety seats Sports Prevention of falls Violence prevention Water Safety
105
Pain unrelieved with morphine and extreme pain with medication
Compartment Syndrome
106
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
107
Prevention Complications of Immobility
Qh2 turning Assessing skin ROM CDI Intake of fluids Cough and deep breathing
108
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
109
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