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peds unit 3 > Musculoskeletal Disorders > Flashcards

Musculoskeletal Disorders Flashcards

1
Q

The periosteum is more ____ than in adults, which aids in their healing time.

A

vascular

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2
Q

Describe “Nursemaid Elbow”

A
  • An elbow that has been pulled resulting in a partially slipped radius and torn ligament
  • Can occur accidentally by holding the hand of a walking child that is over is overextending to reach their parents
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3
Q

What are the s/s of nursemaid elbow?

How may you assess it?

A
  • May not use their arm, because its sore (not necessarily painful, but something “doesn’t feel right”
  • Can test it by asking them to hand you something with the suspected arm, if they don’t do so, it needs to be assessed further
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4
Q

What is the tx for nursemaid elbow and what is its affect on the patient?

A
  • Reduction - they reset it
  • They’ll usually immediately start reusing
  • The are more @risk for this if it has happened before
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5
Q

What are the key points for contusions?

A
  • Bruises
  • occur when soft tissue, muscle, or subcutaneous tissues are damaged.
  • Frequently accompanies a sprain.
  • Large contusions will need medical attn
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6
Q

What are dislocations?

A

occurs when a ligament/joint is disrupted in such a way that articulating surfaces are no longer in contact.

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7
Q

What is subluxation?

A
  • A term that is used when a joint doesn’t work the way it’s supposed to, whether it’s simply not moving how it should or it’s misaligned.
  • Subluxation leads to numbness, tingling, pain, and burning in that area of the body.
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8
Q

What are sprains?

A
  • Result of trauma to a joint in which ligaments are stretched or are partially or completely torn
  • Not common in young children because of their poorly developed epiphyseal plates
  • Frequently result of athletic injury in adolescents
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9
Q

What are strains?

A
  • An excessive stretch of muscle.
  • Also known as pulls, tears, or ruptures
  • Frequently result of athletic injury in adolescents
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10
Q

What does RICE stand for?

A
  • Rest
  • Ice
  • Compression
  • Elevation
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11
Q

_____ help to alleviate pain and reduce inflammation for a basic soft tissue injury.

A

NSAIDs

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12
Q

What are the key points for Scoliosis?

A
  • Commonly identified during growth spurt of puberty
  • Cause unknown
  • Screening
    • Girls: 10-12 years (more common)
    • Boys 13-15 years
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13
Q

What is the tx for scoliosis?

A
  • Bracing
  • Surgery
  • Exercise and chiropractic treatment
  • All pending the details of each case
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14
Q

What are psychosocial concerns of wearing a brace to treat scoliosis?

A
  • Teens can be self conscious
  • Makes them look “heavy”
  • Draws unwanted attn/scorn
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15
Q

What are the key points to spinal fusion?

A
  • For curves >40%, braces are for < 40%
  • Anterior or posterior approach, or both
  • Most common: posterior spinal fusion w/ instrumentation and bone grafting
  • align first, then insert metal rods to keep everything in place
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16
Q

What are our post op concerns for spinal fusion?

A
  • Long recovery
  • Post op worried about resp status since we’ve adjusted spine
  • May need chest tube
  • Mobility will be limited, can’t bend, will need to do logroll in bed
  • Will get PCA so they can control the pain meds
  • When they’re done and healed, they’ll be completely ok
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17
Q

What is Superior Mesinteric Artery Syndrome?

A
  • Digestive condition
  • Duodenum gets compressed between the two arteries in the area
  • Food won’t be able to pass properly
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18
Q

What are the nursing interventions for musculoskeletal consequences of immobility?

A
  • Range of motion exercises
  • Body alignment
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19
Q

What are the nursing interventions for respiratory consequences of immobility?

A
  • Incentive spirometer
  • blowing bubbles for kiddos
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20
Q

What are the nursing interventions for GI consequences of immobility?

A

Frequent small meals

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21
Q

What are the nursing interventions for integumentary consequences of immobility?

A
  • turn q2-4hrs
  • assess
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22
Q

What are the nursing interventions for GU consequences of immobility?

A
  • I/Os
  • Stimulate bladder
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23
Q

What are the nursing interventions for metabalism consequences of immobility?

A
  • mobilize
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24
Q

What are the nursing interventions for Cardiovascular consequences of immobility?

A
  • Continually assess
  • enusure perfusion
  • make sure the blood is moving
  • ALPs
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25
Q

What are the nursing interventions for the family regarding consequences of immobility?

A

dischrarge planning

26
Q

What is Legg-Calve-Perthes Disease?

A
  • Avascular necrosis to femoral head which generally self resolves by reabsorbing decayed bone and new bone is formed to original shape
27
Q

What are the physical s/s of Legg-Calve-Perthes Disease?

A
  • Limp,
  • hip pain,
  • soreness,
  • pain sometimes referred to groin
28
Q

What is our nursing care management for spinal cord injuries?

A
  • Acute Phase
    • Airway, Neuro checks, Neurogenic shock, UOP, temp
  • Stabilizing the mobility of neck
  • Neck brace care
  • Pain management
  • Spasticity management
  • Rehab phase
    • DVT and PE prevention.
    • Autonomic dysreflexia
29
Q

What is autonommic dysreflexia?

A
  • Involuntary nervous system reaction to stimuli
  • Can result in high BP, faster HR, blood vessel constriction, etc
  • Can be life threatening (stroke, cardiac arrest, pulmonary edema, etc)
  • When we have any pt with a spinal cord injury, we are looking for s/s of this
  • A stimulus of a wrinkled sheet could cause this over-reaction to happen - need tight fitted sheets
30
Q

What is a simple or closed fracture?

A
  • A break in the bone
  • Skin is in place
31
Q

What is an oblique fracture?

A
  • Diagonal break across bone
32
Q

What is an open or compound fracture?

A
  • A break where the bone pentrates the skin
33
Q

What is a transverse fracture?

A
  • A break that occurs at a right angle to the long access of the bone
34
Q

What is a spiral fracture?

A

A breaak that is sircular and twists arond the bone shaft

35
Q

What is a greenstick fracture

A

Bone breaks on one side but bends on other

36
Q

When we have broken bones involved with a child, how do we assess for possible abuse?

A
  • is cause of fracture consistent with the child’s developmental abilities;?
  • are there any bruising patterns, hx of multiple breaks?
  • what are the parent-child interactions like?
  • Make sure the story matches the injury.
37
Q

What are the stages of bone healing?

A
  • Inflammatory
  • Callus
  • Bone
  • Remodeling
38
Q

What do we need to remember from the “Salter” classification of epiphyseal injuries?

A
  • A break above or below the epiphyseal plate is fine
  • A break through the epiphyseal plate needs to be monitored as it may hinder growth
  • A crush injury to the plate can erase it and severely effect growth
39
Q

What are the goals of treatment for fractures?

A
  • Reduction of fracture to realign bones
  • Immobilization decreases pain, prevents rotation, maintains position
  • Maintain alignment until callus well established
40
Q

What is open vs closed reduction?

A
  • Closed reduction = fixed from the outside
  • Open reduction = surgical procedure
41
Q

Key points for Compartment syndrome?

A
  • Medical Emergency!!
  • Fascia fails to expand to accommodate bleeding, swelling, or pressure
  • Necrosis of soft tissues
  • Irreversible damage can occur in 4-5 hours
  • Tx: relieve pressure
42
Q

What are the six “P’s” that indicate possible compartment syndrome?

A
  1. Pain
  2. Pallor
  3. Pressure
  4. Paralysis
  5. Paresthesia
  6. Pulselessness
43
Q

What are our nursing care issues regarding traction?

A
  • Know purpose/function of traction
  • Maintain traction
  • Not to be d/c’d without physician order
  • Do not lift up on weights or hold them for extended amounts of time
  • No knots in rope length, knots securing rope to weights/devices need to be secure
  • Ropes should move freely through pulleys
  • Maintain alignment
  • Prevent skin breakdown
44
Q

What are we monitoring for comlications re: traction?

A
  • circulatory impairment
  • Compartment syndrome
  • infection
  • FX of Immobility
45
Q

What is osteomyelitis?

A
  • Bone infection
  • Usually in pelvis, femur, tibia or foot
46
Q

S/s of osteomyelitis?

A
  • Fever
  • Pain
  • Reluctance to use extremity
47
Q

How is the dx of osteomyelitis confirmed?

A
  • X-rays/bone scan
  • CRP, ESR
  • Blood culture
48
Q

Med care of osteomyelitis?

A
  • abx
  • surgery
  • symptom management
  • No active range of motion
49
Q

What is Developmental Dysplasia of the Hip (DDH)?

A
  • General term for hip abnormalities
  • Can be a shallow acetabulum, subluxation, or dislocation
  • May occur at any time of childhood
  • Unknown cause but most likely diagnosed at newborn visits
50
Q

What is the medical tx for DDH?

A
  • Splint (spica cast)
  • Surgical reduction of the hip (though not common)
51
Q

What is Talipes Equinovarus?

A
  • Clubbed foot
  • Deformity of ankle and foot
    • pointed downward and inward
  • Cause unknown
52
Q

Med tx for clubbed foot?

A
  • Serial casting
    • (Ponseti method)
  • Surgical correction
  • Frequent follow-up
53
Q

What is Osteogensis Imperfecta (OI)?

A
  • A condition of extremly brittle bones. So much so that even the bones in the ear can break from use
54
Q

Med tx for osteogenesis imperfecta?

A
  • Not much
  • Drugs of limited benefit
  • Caution with handling to prevent fractures
  • Family education
  • Maintain normal growth & development
  • Occupational planning and genetic counseling
55
Q

What is Duchenne Muscular Dystrophy?

A
  • Most severe and most common MD in childhood
  • Atrophy profound in later stages
  • This effects muscle cells!
  • Around 2 the s/s start
56
Q

How is Duchenne Muscular Dystrophy dx’d?

A
  • Waddling gait, falls, lordosis/scoliosis
  • Muscle biopsy
    • fatty fibrous tissues have invaded muscle cells (indicates positive)
  • Blood enzymes
57
Q

What is the life expectancy of those with Duchenne Muscular Dystrophy?

A

Most don’t live past 20

58
Q

What is Gower’s Sign?

A
  • The way MD kids have to get up like an old man
59
Q

Key points for Progressive Infantile Spinal Muscular Atrophy (SMA)?

A
  • Autosomal recessive trait
  • Most common paralytic form of floppy infant syndrome (congenital hypotonia)
  • Degeneration in spinal cord and brainstem, resulting in atrophy of skeletal muscles, progressive weakness
  • Age of onset variable; earlier onset has poorest prognosis
60
Q

How is Spinal Muscular Atrophy dx’d?

A
  • electromyography,
  • muscle biopsy
61
Q

Life expectancy of those with Spinal Muscular Atrophy?

A

Most don’t live past 4yrs

62
Q

Nursing Care for SMA?

A
  • Coordination of care
  • Nutrition
  • Activities to promote mobility
  • Treatment is symptomatic
  • Prevent infection or treat infection
    • Respiratory is biggest concern
  • Family education and support

peds unit 3 (9 decks)

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