Care for Child w/MSK Condition & Maltreatment

Question 1

Several different methods to immobilize an extermity

Answer 1

Splinting Devices
Boots
Casts
Skin traction
Skeletal traction
Distraction devices

Splinting devices and boots can be done in outpatient setting or ER; easily removed

Question 2

6 P’s of Neurovascular Assessment

Answer 2

Pain unrelieved by narcotics
Pallor
Paralysis
Paresthesia
Pulselessness
Poikilothermia

Question 3

Main principles of traction is to

Answer 3

reduce dislocations and immobilize fractures

Question 4

Skin traction

Answer 4

Force is applied over a large area of skin (DDH, femur fractures)

Question 5

Skeletal traction

Answer 5

Force is applied directly to the bone (pin or wire, often for multiple injuries sustained)

Question 6

What head shape abnormality?

Most often positional (Back to Sleep)
Cranial sutures are overriding
Facial abnormalities
Treated with corrective helmet

Answer 6

Plagiocephaly

Question 7

What head shape abnormality?

Premature fusion of one or more of the cranial sutures
Most need craniotomy

Answer 7

Craniosynostosis

Question 8

Common foot deformity diagnosed in newborns

May be associated with spina bifida or other anomalies, can be idiopathic

Answer 8

CONGENITAL TALIPES EQUINOVARUS (CLUBFOOT)

Question 9

S/sx of clubfoot

Answer 9

Foot is:
Plantar-flexed
Inverted heel
Adducted forefoot
Rigid and cannot be manipulated into a neutral position

Question 10

Risk factors for clubfoot

Answer 10

maternal obesity, maternal smoking, amniocentesis before 20 weeks, CVS

Question 11

Treatment for clubfoot

Answer 11

-Serial casting
Provide cast care education, ADL’s- bathing, diapering

-Severe cases of clubfoot may require surgery
Post-op care & monitoring

Question 12

Abnormal development of the hip (subluxation or dislocation of acetabulum)

Can result in abnormal gait, decreased strength, and hip & knee joint disease if untreated

Answer 12

DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)

Question 13

S/sx of DDH

Answer 13

+ Ortolani or Barlow sign (first 3 months of age)
+ Galeazzi sign
Unequal gluteal folds
In older children, + Galeazzi, unequal leg length

Question 14

Treatment for DDH

Answer 14

-Abduction brace (Pavlik harness 23 hours a day)
-If Pavlik fails, closed reduction and hip spica casting
-If after 18 months, open reduction and hip reconstruction

Question 15

interrupted blood supply to the femoral head  avascular necrosis of femoral head

Can be genetic or environmental

Answer 15

LEGG-CALVE-PERTHES DISEASE

Question 16

S/sx of Legg-Calve-Perthes disease

Answer 16

-Hip or knee soreness or stiffness
-Pain that increases with activity and decreases with rest
-Painful limp
-Quadriceps muscle atrophy
-Joint dysfunction
-Limited ROM

Question 17

Capital femoral epiphysis (top of femur) slips through epiphysis (growth plate) in a posterior direction

Cause unknown, genetic/obesity
8-15 years old

Treated with surgery (pinning)

Answer 17

SLIPPED Femoral Capital Epiphysis (SCFE)

Question 18

S/sx of Slipped Femoral Capital Epiphysis

Answer 18

Pain in groin or referred pain to thigh or knee
Pain during internal rotation of hip
Hip does not fully rotate externally
Abduction is Limited
Affected leg may be shorter in moderate or severe slip

Question 19

Sprains and strains are

Answer 19

soft tissue injuries

Question 20

Connect muscle to bone

Answer 20

tendons

Question 21

Connect bone to bone

Answer 21

ligaments

Question 22

Sprain stretches or incomplete tears of a __________.

Causing Pain, Swelling, Bruising, Instability, & Loss of ability to move and use joint

Answer 22

ligament

Question 23

__________ or muscles are stretched in a strain.

Causing Pain, Swelling, Limited motion, Muscle spasms, Muscle weakness, & Cramping

Answer 23

tendons

Question 24

Patellar ligament irritation at the prominence of the tibial tubercle
Overuse in active school age children or adolescents

S/sx: pain below kneecap, pain when squatting or extending knee against resistance

Answer 24

Osgood-Schlatter Disease

Question 25

What is it: Bone undergoes more stress than it can absorb Cause: Most common are falls, MVA’s & bicycle accidents S/S: Pain, swelling around area, immovable limb Diagnosed w/ imaging

Answer 25

Fractures

Question 26

How are fractures treated?

Answer 26

Closed reduction Open reduction (surgery)- pins, screws, plates, rods Elevate & cold packs

Question 27

What it is: Non-painful lateral curvature of the spine. Types: C-curve: laterally in one direction S-Curve: two opposite directions Diagnosed initially with Adam's position or the bend over test. Then, radiography at Cobb's angle.

Answer 27

Scoliosis

Question 28

S/sx of scoliosis

Answer 28

Unequal shoulder heights Scapular prominences and heights Rib prominences Chest asymmetry Unequal leg length

Question 29

Treatment for scoliosis

Answer 29

Back Brace -Brace worn 23 hours a day -Skin care and monitoring -PT Halo Traction -Will sometimes use before surgery Spinal Surgery: Spinal Fusion, may delay to prevent issues with spinal growth, necessary if pulmonary function is compromised

Question 30

Bacterial Infection of the bone and tissues around the bone and bone marrow. Infection spreads to ends of bones and can destroy epiphyseal plate. Causes: Open fracture or blunt trauma Penetration of skin Septic joint Infected wound Bacterial infection in body

Answer 30

Osteomyelitis

Question 31

S/sx of Osteomyelitis

Answer 31

Pain Fever Irritability Soft tissue swelling, redness, warmth, pain

Question 32

How is osteomyelitis treated?

Answer 32

w/ antibiotics

Question 33

Connective tissue disorder which can cause fractures with minimal or no trauma (decrease in synthesis of collagen)

Answer 33

Osteogenesis Imperfecta AKA brittle bones disease

Question 34

Blue sclera, deformed teeth, brittle bones

Answer 34

osteogenesis imperfecta

Question 35

Group of muscle disorders that cause the gradual wasting and degeneration of symmetrical groups of skeletal muscle

Answer 35

MUSCULAR DYSTROPHIES

Question 36

What are the three types of MD?

Answer 36

3 Types: Duchenne’s (most common) Congenital myotonic dystrophy Facioscapulohumeral MD

Question 37

Symptoms appear after child can walk (3-7 years of age) Waddling, wide-based gait Calf muscles become weak and hypertrophied Leg, Pelvis, arm, shoulder, and cardiac muscles weak and hypertrophied Gower’s maneuver to rise from floor

Answer 37

Duchenne's MD

Question 38

Risk factors for abuse

Answer 38

-Children < 1 -Children with disabilities/chronic illness -Single parents -Low socioeconomic level -Caregivers with: Mental Illness, Substance use, Strict ideas of discipline, hx of generational abuse, &Marital discord

Question 39

-Intentional injuries -Injuries are inconsistent with story: Bruises, Burns, Fractures, &Changes in behavior

Answer 39

Physical abuse

Question 40

-Any behavior, attitude, or failure to provide emotional or physical care -Impairs a child’s socio-emotional development, mental health, and sense of self-worth

Answer 40

Emotional abuse

Question 41

-Any sexually related act involving adult and a child -Violation of bodily privacy -Exposing to adult sexuality -Exploiting through child pornography or prostitution -Electronic sexual luring -UTIs, changes in behavior, regression, running away, abnormal knowledge of sex

Answer 41

Sexual abuse

Question 42

-Most common yet most difficult to prove -Seen in families with mental illness and/or substance abuse

Answer 42

Neglect

Question 43

Retinal hemorrhage can lead to

Answer 43

blindness

Question 44

-Caregiver fabricates signs and symptoms of illness in child -Child may undergo needless and painful procedures and treatments -10% of cases may be fatal to the child -Difficult to prove

Answer 44

Munchausen Syndrome by Proxy (MSBP)

Question 45

Munchausen Syndrome by Proxy (MSBP) Perpetrators will

Answer 45

-Gain support of the health care team through skilled deceit, leading professionals to believe they are a devoted, loving caregiver. -Doctor shops & hospital jumps so that tracking the child’s true medical history is virtually impossible -Typically, the mother -Often work in health care -Reporting of signs and symptoms occurring only in the presence of the parent -Reports that illness is unresponsive to treatments -Marital discord is often present -May have other children with complicated medical histories

Question 46

Common Presentations and Methods of Deception of Munchausen Syndrome by Proxy

Answer 46

Apnea- suffocation, drugs, poisoning Seizures- drugs, poisoning, asphyxiation Vomiting- poisoning w/drugs that initiate vomiting Diarrhea- poisoning w/drugs such as laxatives, mineral oil, or salt