WEEL 8 PEDS Flashcards
ATI neuromuscular and musculoskeletal system
what are the 5 injuries to know?
contusions
dislocations
sprains
strains
overuse
where could contusions occur that would be a potential sign of abuse?
the neck and cheek
children under 2 should not have frequent contusions unless they have a disorder
risk factors for contusions
decreased coordination (falls, bumping, etc)
blood disorder (anticoagulants)
collision
falls
jumping
participation in sports
clinical presentation of contusion
bluish or purplish color, or fade to greenish yellow
more severe manifestations: severe bone or soft tissue contusion include decreased movement, pain at the injury site, swelling, and ecchymosis
Why would a provider order lab work for a pediatric client who has several contusions?
to rule out blood disorders
what is a med that might be ordered for contusions?
ibuprofen
what could a painful bruise indicate?
injury to soft tissue or possibly the bone
how to ask younger ped patients to verbalize discomfort?
assist younger pediatric clients with verbalizing discomfort by giving them a doll to use to point to areas that hurt.
how long does it generally take for a bruise to heal
2 weeks
define dislocations
injury where two bones come apart at the joint, which may cause a tear in the ligament
what is the most common dislocated joint in peds?
shoulder joint
biggest risk factor for dislocations is
forceful movements
also:
intense activity
extreme sports
playing sports
Ehlers-Danlos syndrome
clinical presentation of peds patient with dislocation?
swelling and bruising around injury
pain
numbness
deformities
trouble moving joint
unaffected limb will be longer than dislocated limb
genetic condition that are high risk for dislocations
Ehlers-Danlos syndrome
treatments for dislocations
ice
immobilizing joint until provider sees it
splint/cast
maybe surgery
why is treatment time sensitive with dislocations?
healing will not begin until the bones are put back together
how will different age children communicate dislocations?
infants: cry
toddlers: point to area/hold affected joint
preschool: may be able to express but may need help
school-age: can even assits in finding out what they cause may be
what are some diagnostic tools for a dislocation?
X-ray or MRI
define sprains
damaging a ligament with excessive movements, such as stretching or twisting, resulting in injury
what are common locations for sprains in children
ankles and wrists
why are sprains NOT commonly seen in younger children?
their weaker growth plates
what ligaments are most commonly affected?
those of the ankle
posterior talofibular, anterior talofibular, and calcaneofibular ligaments.
risk factors for sprains
youth sports
lack of coordination
growth (plates are active)
most commonly in ankle with highly active kids
clinical presentation of sprains
discoloration/ecchymosis at site
decrease mobility in affected extremity
pain
swelling
holding limb or injured extremity
what age are sprains most commonly seen in
age 10-18
treatments and therapies for sprains
PRICE
ice application
mobilizing devices
elastic bandage
OTC analgesics
even though sprains are a minor injury, why are they taken seriously with peds patients?
the child is still growing
how to prevent sprains
good stretching!
define strain
injury to tendon or MUSCLE caused by stretching, leading to damage of the tissue and, at times, partial or complete tear to muscle
are strains commonly seen in younger children
no, due to weaker growth plates
risk factors for strains in peds
youth sports (football)
certain stages of growth
jumping sports
clinical presentation of strains
pain
redness
bruising
swelling
decreased movement in affected area
hold injury
how to prevent strains
have at least one rest day a week from activity
wearing protective gear
stretching before
warming up
when do overuse injuries occur
not resting in between a lot of physical activity
two types of overuse injuries
Sever’s disease
Osgood-Schlatter disease
Severe’s disease
when the pediatric client’s growth plate in the heel bone becomes inflamed
Osgood-Schlatter disease
the growth plate located at the top of the tibia (shin bone) becomes inflamed
risk factors for overuse injuries
poor body mechanics when training
excessive training
lack of rest
playing same sports over period of time, not taking a break in between seasons
clinical presentation of overuse injuries
discomfort
inflammation
also stress fracture/injured growth plate can indicate overuse
treatments for overuse
NSAIDs
heel pad for heal injury
crutches
rest
PT
when would certain mobilization tools be given?
cane: problem with balance
crutches: cannot bear weight on one extremity
walker: difficulty bearing weight on the other both legs
plastic deformation
bent bone, not fracture
children because of their bones
requires surgery
two fractures in children
torus: buckle (catch yourself from a fall)
greenstick: not fully broken bone (splintering of the bone)
complicated/complex fracture (comminuted)
bone shatters into pieces and damages surrounding tissues or blood vessels
how to confirm fracture
X-ray
MRI
CT scan
what is a disease that would increase risk for child to get fractures
juvenile osteoporosis
risk factors for fractures include
weaker bones
decrease calcium/vitamin D
obesity
sports
clinical presentation of fractures
pain
swelling
discoloration
ecchymosis (bruising)
limbing
limited use of extremity
deformity to the extremity
Buckle fractures are typically sustained when a child
runs
falls
or put hands out to catch themselves
labs and Dx for fractures
X-ray, MRI
CBC to rule out bone infection
vit D/calcium/phosphorus levels checked
comps of fractures: compartment syndrome
increase fascia leads to decrease perfusion to injury site
manifestations:
pain that continues to worsen, an inability to move the affected body part, and a tingling sensation
immediate surg intervention!
comps of fractures: physeal involvement
damage to growth plates (injuries to physis)
comps of fractures: nonunion and malunion
nonunion: bone doesn’t heal due to LACK of circulation
malunion: bone doesn’t heal and leads bone to be shorter or shaped weird
comps of fractures: infection
open fractures can lead to infections (treat with antibiotics)
comps of fractures: pulmonary emboli
FAT embolus going into lungs!!
fracture=fat bone marrow into blood stream and go into lungs
respiratory depression and needs immediate treatment
infection section: what infection does it cover?
osteomyelitis
define osteomyelitis
bone infection that can occur when bacteria or fungi attack any bone in the body.
patho of osteomyelitis: what is the most common bacteria that causes it?
Staphylococcus aureus
screening for osteomyelitis
no screening, if a client is exhibiting manifestations then you can do a BIOPSY to diagnose condition
patho of osteomyelitis
- has to be damaged or have an area exposed to foreign antibodies
- bacteria and microbes settle in the metaphysis of the bone
- can cause necrosis if blood supply stops or slows down
what is osteomyelitis caused by
an infection in the blood
fractures (open)
inadequate circulation to extremities
surgery can create an exposure to foreign bodies
what are risk factors for osteomyelitis (two main ones; plus a few extra causes)
compromised immune system and sickle cell disease
infections
break to the bone
skin trauma
clinical presentation of osteomyelitis
similar to cold or the flu
fever
lethargy
nausea
limping of affected extremity
discomfort
redness on the skin
swelling above the site of infection
labs for osteomyelitis
CBC (WBC count: high indicates an infection)
X-ray
bone scan
biopsy
MRI
procedure of a bone scan
help determine reason for bone pain
injecting radioactive tracers and use a camera to scan the bones to create an image
treatment for osteomyelitis
IV antibiotics
what is the choice antibiotic for osteomyelitis
vancomycin
why would osteomyelitis result in amputation
if it causes extensive damage to the bone and surrounding tissue
when does osteomyelitis usually occur in infants?
premature infants because they do not have a very strong immune system
increase risk for infection
education to prevent skin infections for parents and ped clients
hand washing
any opening of skin should be washed with soap and water
wounds should be covered with clean gauze
contact PCP if wound takes longer than 1 week to heal
why to educate parents about with play for peds patients with osteomyelitis?
give child NSAIDs because they can lower pain and they are play and socialize
how to help prevent osteomyelitis
good bone health:
movement and physical activity to help strengthen bones
educate patients to do PT after treatment
hand hygiene
stay up to date on vaccines
define torticollis
condition that causes the neck to be in an unexpected position or to look “twisted”
what causes torticollis
shortened sternocleidomastoid
A large pair of muscles in the neck.
an indication of torticollis
ped client is consistently turning head to one side
congenital muscular torticollis
infants
damage to muscles when born
risk factors for torticollis
trauma during pregnancy and birth
rheumatoid disorder
stroke
stress to muscles
common manifestation of torticollis
twisting of the neck
other:
fever
problems with balance
vision
headaches
vomiting
treatment for torticollis
PT and neck brace kind of thing (tubular orthosis)
with consistent Tx, it can be resolved in 6 months
how to treat infant who has torticollis
tummy time: encourage baby to turn head away from affected side
spinal curvature: 3 main things
Scoliosis: spine has an S shape
Lordosis: spine tups back and back is swayed
Kyphosis: spine tips forward (hunchback)
screening for scoliosis
Adam’s test
risk factors for spinal curvature
anomalies in the vertebrae
trauma to the spine
degenerative disc disease
severe slouching
compensation in the spine
Development Dysplasia of the Hip (DDH)
anomaly in the acetabulum
risk factors for DDH
female
infant born breeched
restricted from swaddling or restricted movement in womb
family Hx of bone disorders (osteoarthritis)
clinical presentation of DDH
infant with limited ROM in the hip (differing lengths of legs as well)
treatment for DDH
orthotic device (Pavlik harness) worn all day
surgical treatment (if hip becomes dislocated
Legg-Calve-Perthes Disease
occurs when the head of the femur (thigh bone) begins to die because of decreased blood flow
what can cause Legg-Calve-Perthes disease
blood clots or blood vessel damage/blockage
clinical presentation of Legg-Calve-Perthes disease
decrease ROM in hip
painful rotation of the thigh
differing leg lengths
pain when walking
atrophy of the thigh
Congenital Talipes Equinovarus (Clubfoot)
present from birth
infants foot is twisted to the side due to SHORTENED tendons
risk factors for clubfoot
being male
family Hx
cerberal palsy
birth defects
smoking during preg
born breeched
clinical presentation of clubfoot
foot turned (inward)
treatment for clubfoot
series of casts
what are three skeletal alterations to know for peds?
osteogenesis imperfecta
juvenile idiopathic arthritis
systematic lupus erythematosus
define osteogenesis imperfecta
a condition present at birth and is also called brittle bone disease. Pediatric clients with this disease will have very fragile bones that may have an unexpected shape and can easily fracture
what is the ONLY risk factors for osteogenesis imperfecta?
family history carrying the gene (that causes collagen production is distrupted)
what medication to give for osteogenesis?
Ibandronate (bisphosphonates)
what is osteogenesis imperfecta increase risk for
fractures because of weak bones
Juvenile Idiopathic Arthritis
autoimmune disorder during childhood which the BODY attacks the synovial fluid (inflammation)
clinical presentation of JIA
fever
eye discomfort
inflammation
rash
difficulty ambulating
joint stiffness
medications prescribed for JIA
corticosteroids and DMARDs
two meds to know for JIA
prednisone
methotrexate
Systemic Lupus Erythematous
SLE (aka lupus) autoimmune disease that attacks healthy tissue and organs
leads to inflammation and compromises the integrity of the body tissues anywhere in the body
what can trigger SLE
increase in hormones (most commonly seen in adolescent females)
risk factors for SLE
cigarette smoke
low vitamin D
stress
clinical presentation of lupus
BUTTERFLY RASH on face
pain in joints
fever
hair loss
weight loss
mouth sores
swelling of the hands or feet
goal of treatment for SLE
prevent organs from being attacked and decrease the severity of flareups
medications for SLE
hydroxychloroquine
define cerebral palsy
non-progressive motor dysfunction (brain damage)
risk factors for CP
premature
LBW
prenatal deprivation of oxygen!!!! (brain damage)
intrauterine infection
birth tramua
genetic
clinical presentation of CP (important)
unexpected muscle tone
muscle spasticity
hyperreflexia
clonus
dyskinesia
ataxia
hypo/hyper tonia
management for CP
improve ADLs and functional task, strength, conditioning
meds to help with seizures for CP
Diazepam
define hypotonia
condition of poor muscle ton
risk factors for developing hypotonia include
inherited
prenatal hypoxia
Down syndrome
Prader Willi syndrome
clinical presentation of hypotonia
low Apgar score (0-1) in activity category
flaccid limbs
tx for hypotonia
occupational, speech, and physical therapy may be beneficial to reduce the risk of additional deformities, maximize muscle function, and promote mobility.
define spinal muscular atrophy
recessive genetic disease, causes WEAK muscles
risk factors for SMA
only way is if BOTH parents are carriers
tx for SMA
Gi doctor
pulmonologist
dietitian
PT
neurologist
define muscular dystrophy
group of generalized progression of muscle weakness and degeneration
risk factor for muscle dystrophy
mom is carrier
clinical presentation of muscle dystrophy
development delays
appears clumsy
weak
falls
med for MD
Delandistrogene moxeparvovec
