Ch 44: Peds Musculoskeletal Flashcards Preview

NCLEX > Ch 44: Peds Musculoskeletal > Flashcards

Flashcards in Ch 44: Peds Musculoskeletal Deck (38):
1

Developmental Dysplasia of the Hip

head of the femur is seated improperly in the acetabulum of the pelvis

2

Acetabular Dysplasia (preluxation) (DDoH)

mildest form
neither subluxation nor dislocation
delay in acetabular development occurs
femoral head remains in acetabulum

3

Subluxation (DDoH)

incomplete dislocation of the hip
femoral head remains in acetabulum
stretched capsule and ligamentum teres causes head of the femur to be partially displaced

4

dislocation (DDoH)

femoral head loses contact with acetabulum and is displaced posteriorly and superiorly over fibrocartilaginous rim
ligamentum teres is elongated and taut

5

Galeazzi's sign, Allis' sign

shortening of the limb on the affected side (DDoH)

6

Ortolani's test (DDoH)

meaneuver is a test to assess for hip instability. examiner abducts the thigh and applies gentle pressureforward over the greater trochanter. a "clunking" sensation indicated a dislocated femoral head moving into the acetabulum.

7

Barlow's test (DDoH)

examiner adducts the hips and applies gentle pressure down and back with the thumbs. in hip dysplasia, the examiner can feel the femoral head move out of the acetabulum.

8

Trendelenburg's sign (DDoH)

child stands on one foot and then the other foot, holding onto a support and bearing weight on the affected hip; the pelvis tilts downward on the normal side instead of upward, as it would with normal stability.

9

Pavlik harness

DDoH: birth to 6 mo
worn continuously until ~3-6mo

10

hip spica cast

DDoH: 6-18 mo
following reduction under general anesthesia
worn for 2-4 mo until hip is stable
then flexion abduction brace for ~3mo

11

CF: talipes varus

inversion or bending inward

12

CF: talipes valgus

eversion or bending outward

13

CF: talipes equinus

plantar flexion in which the toes are lower than the heel

14

CF: talipes calcaneus

dorsiflexion in which the toes are higher than the heel

15

clubfoot treatment

manipulation an dcasting are performed weekly for about 8-12 wks
splint is then applied if casting and manipulation are succesful
surgical intervention may be necessary if normal alignment is not achieved by ~6-12 wks of age

16

Adam's test

(scoliosis)
asymmetry of the ribs and flanks is noted when the child bends forward at the waist and hangs the arms down toward the feet

17

scoliosis post op

monitor for superior mesenteric artery syndrome:
caused by mechanical changes in the position of the child's abdominal contents during surgery

18

superior mesenteric artery syndrome symptoms

emesis and abdominal distention similar to what occurs with intestinal obstruction or paralytic ileus

19

Marfan Syndrome

disorder of connective tissue that affects the skeletal system, CV system, eyes, and skin

20

Marfan Syndrome caused by -

defects in the fibrillin -1 gene, which serves as a building block for elastic tissue in the body.
disorder may be inherited.
no cure.

21

Marfan Syndrome symptoms

tall and thin body structure: slender fingers, long arms and legs, curvature of spine
visual problems
cardiac problems

22

Juvenile Idiopathic Arthritis meds

NSAIDS
Methotrexate
Corticosteroids
Tumor Necrosis Factor Receptor Inhibitors
Slower Acting Antirheumatic Drugs

23

(JIA meds) NSAIDS

first meds used
GI irritation and easy bruising

24

(JIA meds) Methotrexate

used is NSAIDS ineffective
CBC and LFTs monitored closely

25

(JIA meds) Corticosteroids

potent immunosuppressives used for life threatenign complication, incapacitating arthritis, and uveitis. Lowest possible dose admin-ed. Prolonged use = Cushing's syn, osteoporosis, up infection risk, glucose intolerance, hypokalemia, cataracts, growth suppression.

26

(JIA meds) Tumor Necrosis Factor Receptor Inhibitors

Etanercept (Enbrel)
Infliximab (Remicade)
adverse effects: allergic rxn at inj site, up risk for infection, demyelinating disease, pancytopenia

27

(JIA meds) Slower Acting Antirheumatic Drugs

usually prescribed in combo w/ NSAIDS
Sulfasalazine *Azulfidine)
hydroxychloroquine (Plaquenil)
gold sodium thiomalate (Myochrysine)
penicillamine

28

Priority Nursing Actions of Extremity Fracture

1. Assess extent of injury and immobilize
2. compound fracture - cover wound w/ sterile dressing
3. elevate the injured extremity
4. apply cold to injured area
5. monitor neurovascular status
6. transport to nearest ED

29

five "P's" of fracture assessment

pain and point of tenderness
pulses distal to fracture site
pallor
paresthesia (sensation distal to the fracture)
paralysis (mvmt distal to site)

30

Russell skin traction

stabilizes a femur fracture pre op
double pull (knee and foot) using a knee sling
similar to Buck's traction

31

Balanced suspension

skin or skeletal traction
approximates fracture of femur, tibia, or fibula

32

90 degree 90 degree traction

lower leg supported by boot cast or calf sling
skeletal Steinmann pin or Kirschner wire is placed in distal fragment of femur
allows 90 degree flexion at hip and knee

33

simple fracture

fracture of the bone across its entire shaft w/ some possible displacement but w/o breaking the skin

34

greenstick fracture

incomplete fracture that occurs through only a part of the cross section of the bone; one side of the bone is fractured and the other side is bent.

35

comminuted fracture

complete fracture across the shaft of the bone w/ splintering of the bone fragments.

36

compound fracture

aka open / complex fracture
the skin or mucous membrane has been broken and the wound extends to the depth of the fractured bone.

37

JIA

a complication of JIA is iridocyclitis (uveatis)
JIA most often occurs before the age of 16
JIA is twice as likely to occur in girls than in boys
clinical manifestations of JIA include morning stiffness and painful, stiff, swollen joints

38

spiral fracture

a fracture that has a twisted or circular break.
affects the length rather than the width.
seen frequently in child abuse.