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ADN005 Pediatrics > Week 6 Chapter 44 > Flashcards

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
Q

Spina Bifida Occulta
Meningocele
Myelomeningocele

A

Neural Tube Defects

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26
Q

Structural Disorders of the skeleton

A

Pectus Excavatum and Carinatum
Limb Deficiencies
Metatarsus Adductus
Congenital Club Foot
Polydactyl and Syndactyl

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27
Q

Developmental Dysplasia of the Hip
Torticollis
Tibia Vara
Genetic Disorders

A

Congenital and Developmental Neuromuscular and Muscoskeletal Disorders

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28
Q

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

A

Spina Bifida Occulta

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29
Q

Complications of rare with Spina Bifida

A

True

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30
Q

Tissue attachments that limit the movement of the spinal cord in the spinal column

A

Tethered Cord

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31
Q

Fluid filled Cyst in spinal cord

A

Syringomyelia

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32
Q

Splitting at the spinal into 2 hemicords

A

Diastematomyelia

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33
Q

Less serious form of spina bifida cystica

A

Meningocele

Occurs when the meninges herniate through a defect in the vertebrae

Spinal cord is normal and no associated neurologic defects

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34
Q

Nursing management of Meningocele

A

Prevent rupture of the sac
Prevent Infection
Provide adequate nutrition and hydration

Treatment is surgical correction of the lesion

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35
Q

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

A

Myelomeningocele

At risk for
Meningitis
Hypoxia
Hemorrhage

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36
Q

Spinal cord ends at the point of defect and absent motor and sensory function beyond that point

A

Myelomeningocele

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37
Q

Long Term complications of Myelomeningocele

A

Paralysis
Orthopedic Deformities
Bladder and Bowel Incontinence

Hydrocephalus, Chiari defect seen in 80%

Treatment is multiple surgeries

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38
Q

Sensitivity to latex or natural rubber is common among children with

A

Myelomeningocele

Nurses must create a latex free environment

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39
Q

Anterior chest wall deformities
Male Predominance

A

Pectus Excavatum and Carinatum

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40
Q

Protuberance of the chest wall
Less common 5-15 % of cases

A

Pectus Carinatum

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41
Q

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

A

Pectus Excavatum

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42
Q

Therapeutic Management of Pectus Excavatum and Carinatum

A

Observation
PT
Surgery

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43
Q

Presence of extra digit is known as

A

Polydactyl

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44
Q

Webbing of fingers and toes

A

Syndactyl

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45
Q

Medical deviation of the forefoot
Most common foot deformities of childhood
Occurs because of utero positioning

A

Metatarsus Adductus

  • Mild Cases requires stretching exercises
  • Severe cases require serial casting before the age of 8 months

Surgical intervention is rarely needed

46
Q

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

A

Talipes Equinovarus

47
Q

Goal of Talipes Equinovarus

A

Therapeutic management is is achievement of a functional foot

48
Q

Nursing interventions for Clubfoot

A

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
Q

S/S of Clubfoot

A

Foot or feet point down and inwards
Soles of feet face each other

Important to check toes several times per day ( CSM)

49
Q

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

A

Hip Dysplasia

50
Q

Risk Factors of Dysplasia

A

Family History, female gender
Large infant size, breech birth
Native American or Eastern European Descent

51
Q

S/S of Hip Dysplasia

A

Extra gluteal folds
Shortened leg
Instability
Clicking Sensation

Use Barlow and Ortolani Tests

Therapeutic management
- Pavlik Harness, closed reduction- spica cast

52
Q

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

A

Pavlik Harness

53
Q

Spica Cast care is same as ?

A

Normal cast care

54
Q

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

A

Torticollis

Wryneck or head tilt shows

55
Q

“Bow-leggedness”

A

Tibia Vara ( Blount Disease)

56
Q

3 types of Tibia Vara

A

Infantile - Most common
Juvenile
Adolescent

57
Q

Developmental Disorder occurs most frequently in what with Tibia Vara?

A

Early Walkers
African American Females
Obesity

58
Q

Growth plate of upper tibia stops bone production, asymmetric growth at knee occurs and bowing progresses

A

Tibia Vara

Bracing and Surgical intervention for treatments

59
Q

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

A

Osteogenesis Imperfecta

60
Q

Tooth enamel wearing easily, brittle and discolored teeth

A

Dentinogenesis

61
Q

S/S of Osteogenesis Imperfecta

A

Frequent fractures
Screaming with routine care
Blue, purple, gray sclerae
Problems with primary teeth
Bruising, joint hypermobility

62
Q

Therapeutic Management of OI

A

Decrease fractures, maintain mobility, early PT/OT

Bisphosphonate administration
Splints or Braces
Severe cases requires surgical insertion of rods into long bones

63
Q

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

A

OI

64
Q

Genetic motor neuron disease that affects the spinal nerves ability to communicate with muscles

A

SMA

Muscle lose function and over time atrophy

Cognition is unaffected

Respiratory muscle weakness may occur in all types of SMA

65
Q

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

A

Muscular Dystrophy

66
Q

May limit lifespan due to compromised ability to adequately support ventilation

A

Muscular Dystrophy

67
Q

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

A

Spinal Muscular Atrophy

68
Q

Muscular Dystrophy affected in early childhood and most fatal

A

Duchenne

69
Q

2 -16 years and type of Muscular dystrophy

A

Less severe than Duchenne

70
Q

At birth muscular dystrophy

A

Congenital

71
Q

Childhood to early teens Muscular Dystrophy

A

Congenital

72
Q

Muscular Dystrophy of childhood to earl teens

A

Emery Dreifuss

73
Q

Late teens to middle age Muscular Dystrophy

A

Limb Girdle

74
Q

Late childhood to early adulthood

A

Facioscapulohumeral

75
Q

Myotonic muscular dystrophy occurs in

A

Teens

76
Q

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

A

Duchenne’s Muscular Dystrophy

Shows Gower’s Signs

77
Q

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

A

Duchenne’s

Common Complications

78
Q

Nursing considerations of Duchenne’s

A

Fatigue
Mobility
Frequent Infections
Psychological Effects
Maintain Function

79
Q

Nursing management Goals for a Child with Muscular Dystrophy

A

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
Q

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

A

Cerebral Palsy

81
Q

S/S of Cerebral Palsy

A

Motor impairments including abnormal motor patterns including spasticity, muscle weakness, and ataxia, abnormal brain function is not progressive

82
Q

Complications of Cerebral Palsy

A

Mental Impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus

Therapeutic Management
- PT, OT, orthotics

83
Q

Most causes occur before delivery and many times no specific cause can be identified

A

Cerebral Palsy

84
Q

Causes of CP include

A

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
Q

Acquired Neuromuscular and Musculoskeletal Disorders

A

Rickets
Scoliosis
Injuries
-Spinal Cord
- Fractures
- Trauma

86
Q

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

A

Clinical Features of Rickets

87
Q

Softening or weakening of the bones

Caused by nutritional deficiencies
- Not enough calcium or vitamin D
- Limited exposure of sunlight

A

Rickets

88
Q

Therapeutic Management of Rickets

A

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
Q

Growth plate is damaged and the femoral head moves with respect to rest of the femur

Left hip is more affected

Causes is unknown

A

SCFE

Slipped Capital Femoral Epiphysis

90
Q

S/S of SCFE

A

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
Q

Therapeutic Management of SCFE

A

Prevent further slippage
Minimize deformity
Surgical intervention and pin and screw

92
Q

Decreased blood flow to femoral head
Bones dies due to lack of O2 and nutrients
Head of femur breaks apart and loses round shape

A

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
Q

For Legg Calve Perthes Disease x-rays shows

A

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
Q

Common cause of hip pain and limping in children

Associated with recent or active infection, trauma, allergic hypersensitivity

A

Transient Synovitis of the Hip

Self Limiting and resolves in a week

Use NSAIDs, Analgesics, Bed rest

95
Q

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

A

Scoliosis

96
Q

Therapeutic Management of Scoliosis

A

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
Q

S/S of Spinal Cord Injury

A

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
Q

Injuries above C-4

A

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
Q

Phrenic Nerve is

A

C3-C5
C5-T1
Tetraplegia

100
Q

T1 and down

A

Paraplegia
Head and Sympathetic Outflow T1-L4

Temperature and blood vessel control of lower limbs

101
Q

Lower Limbs involve

A

Bladder control and external genetalia

102
Q

Interventions for Neurogenic Bladder

A

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
Q

Spinal cord injuries can affect?

A

Elimination

Neurogenic is term used describe bladder function and no longer voluntarily and be due to neuromuscular disorder

104
Q

Teaching topics to prevent Spinal Cord injury

A

Vehicular Safety
Seat Belts and safety seats
Sports
Prevention of falls
Violence prevention
Water Safety

105
Q

Pain unrelieved with morphine and extreme pain with medication

A

Compartment Syndrome

106
Q

Twisting or turning of body part

Tendons and ligaments stretch much and may tear

A

Sprains

Common ankle and knee

RICE
Activity restrictions
Splints
Crutches
PT

107
Q

Prevention Complications of Immobility

A

Qh2 turning
Assessing skin
ROM
CDI
Intake of fluids
Cough and deep breathing

108
Q

Focus of nursing care of child with neuromuscular disorder

A

Maximize physical mobility
Promote nutrition
Promote effective elimination
Promote skin integrity
Self Care
Promote development
Prevent injury
Provide support and education

109
Q

Promote Child and Family Teaching

A

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

ADN005 Pediatrics (21 decks)

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