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exam 4 Flashcards

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1
Q

management of soft tissue injury

A

RICE

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2
Q

most common broken bone in childhood

A

distal forearm

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3
Q

fracture in infants

A

huge red flag for abuse
their bones are harder to fracture

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4
Q

types of fractures

A

simple/closed
open/compound
comminuted
complicated

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5
Q

growth plate injuries

A

growth plates are the weakest of long bones.
injury here may affect future bone growth

treatment may include open reduction and internal fixation

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6
Q

bone healing times

A

the younger you are the quicker it will heal

neonates: 2-3 weeks
early childhood: 4 weeks
later childhood: 6-8 weeks
adolescents: 8-12 weeks

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7
Q

goals of fracture management

A

reduction and immobilization
restoring function
preventing deformity

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8
Q

diagnosing fracture

A

xray
history

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9
Q

assessing compartment syndrome: the 6 Ps

A

pain
pallor
pulselessness
paresthesia
paralysis
pressure

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10
Q

spica cast

A

Used for pelvic to keep legs in position

bar is to keep legs at a certain position/in place

dont use bar to move pt!

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11
Q

why is traction used in children

A

relieve fatigue of muscles
position bone ends
immobilize
prevent deformity
reduce muscle spasms

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12
Q

distraction of fracture

A

process of separating opposing bone to encourage regeneration of new bone in created space

external fixation devices are commonly used

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13
Q

developmental dysplasia of the hip (DDH)

A

misplaced hip.
Congenital
more common in girls

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14
Q

s/s of DDH

A

infants:
restricted adduction of hip
unequal gluteal folds
positive ortolani test result
positive barlow test
hip joint laxity

toddlers: walking/standing may appear off

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15
Q

management of DDH

A

from birth to 6 months: plavik harness for hip adduction and flexion. prevent harness from scratching baby-use clothes

ages 6-24 months- typically not recognized until standing/walking. need closed reduction and spica cast

as child gets older (past age 4), correction gets difficult. Need operative reduction, tenotomy, osteotomy

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16
Q

club foot

A

deformity of the foot and ankle
multiple different types: talipes varus most common

correct deformity
ponseti method (serial casting)- every couple weeks cast is changed and made straighter each time

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17
Q

osteogenesis imperfecta

A

brittle bones that fracture easy due to faulty bone mineralization or abnormal bone architecture.

med- IV pamidronate Q3 months to promote increased bone density/prevent fractures

handle these pts/babies gentle!!
they should avoid contact sports

prevent osteoporosis, malalignment, weakness, contractures

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18
Q

legg-calve-perthes disease

A

Aseptic necrosis of femoral head due to disturbed circulation to femoral head.

typically only occurs in one hip but could be bilateral

most common in white boys age 4-8

dx by MRI and XRAY

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19
Q

legg-calve-perthes disease manifestations

A

pain and limp is most evident
may also have limited ROM, soreness, stiffness

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20
Q

legg-calve-perthes disease management

A

goal is to keep head of femur in acetabulum.
femoral head collapses due to blood supply loss, it does not stay where it needs to be.

containment can be done with various appliances and devices
no weight bearing initially, rest
NSAIDs
surgery may be needed

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21
Q

slipped capital femoral epiphysis (coxa vara)

A

femoral head slips off spontaneously in a posterior-inferior direction

develops shortly before puberty
bilateral half of the time

treated by surgery

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22
Q

scholiosis

A

inward curvature of spine

most common spinal deformity

could be congenital or develop in childhood
typically idiopathic cause
generally noticeable after growth spurt

dx by XRAY and assymetry

treated by brace is not severe or surgery - rods and fusion, if severe

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23
Q

osteomyelitis

A

infection of bone

most commonly caused by staph

s/s begin abruptly, resemble arthritis and leukemia

bone scans for dx. bone cultures done for abx

ABX and good nutrition (protein) needed!
Pain management is important

may get sent with picc line for long term abx

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24
Q

cerebral palsy

A

non-progressive brain disorder affecting movement/motor skills.
causes growth and development issues as well as intellectual disabilities.

most common motor disability with childhood.

could occur prenatally or postnatal

multiple types

severity ranges person to person

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25
causes of prenatal cerebral palsy
hypoxia radiation infection
26
causes of postnasal cerebral palsy
CNS infection head trauma hypoxia
27
spastic CP
Most common type We see contractures. Really jerky and stiff movements due to hypotonia muscles. Muscles are flexed Foot drop may. Sometimes will walk on tip toes if can walk, scissor legs, newborn refluxes stay throughout life
28
s/s of CP
pain sleep disorders difficulty taking PO if spasticity communication difficulties intellectual disabilities hearing/vision problems seizures GERD constipation/incontinence contractures scoliosis
29
diagnosis of CP
MRI and CT to role out brain damage dx via clinical manifestations milestones not met is common, but dont assume this is case when they arnt met
30
treatment of CP
give muscle relaxers and botox most common med: Baclofen speech therapy, OT, PT laxatives for constipation maximize coordinate movement, decrease pain, prevent complications surgeries- G tube, nissen fund, spinal fusions, etc.... educate on importance of immunizations, support family
31
neural tube defects- spina bifida
meningocele- involves only meninges myelomenigocele- involves meninges and spinal cord sac could be intact or ruptured dx by manifestations. could also be dx in utero with prenatal care surgery will be done in 12-18 hours for best prognosis. ruptured sac is prioritized due to high infection risk
32
nursing care at birth for spina bifida
apply sterile dressing soaked in NS assess/prevent infection prevent pressure on back. keep them on stomach or side
33
what are spina bifida babies commonly allergic too
latex
34
spinal muscular atrophy (SMA)
Degenerative disorder causing weakness and atrophy of skeletal muscles #1 genetic disorder that is lethal in children under 2 years of age 3 types. The worst is wernig hoffman disease NO CURE. care is supportive: mobility, nutrition, respiratory, developmental dx by genetic analysis
35
wernig-hoffman disease (SMA)
begins in utero or by 6 months of age Baby cannot lift head, has trouble sucking/swallowing, loss of DTR, fasciculations of tongue, weak resp muscles death occurs due to resp compromose
36
Duchenne muscular dystrophy (DMD)
Due to absence of the protein dystophin, which causes muscle deterioration over time typically dx btwn ages 3 and 7 no cure corticosteroid meds given for clinical trial these patients can live until they are 30, but will eventually develop cardio and resp issues
37
DMD s/s
Pelvic weakness, waddle, clumsy, lordosis, calf muscles look tight but its just fatty buildup gowers maneuver- use hands pushing on thighs to get up because they are so weak
38
goals for treatment for DMD
maintain function, prevent contractures resp care cardiac assessment family support
39
blood flow thru heart
vena cava- right atrium- tricuspid valve- right vent- pulmonary valve- pulmonary artery- lungs- pulmonary vein- left atrium- mitral valve- left ventricle- aortic valve- aorta
40
right side of heart
goes to pulmonary only needs to pump to lungs so easy going
41
left side of heart
goes to body work horse of the heart
42
L to R shunt heart
Blood from left side going to lungs, but o2 also going to body so sats are fine pulmonary over load occurs acryanotic
42
types of congenital heart diseases
Patent ductus arteriosus atrial septal defect ventricular septal defect tetrolgy of fallot transposition of the great arteries (TGA) hypoplastic left heart syndrome (HLHS)
43
Patent ductus arteriosus (PDA)
L to R shunt pulmonary overload sats are normal, lungs are congested if not treated can lead to CHF systolic murmur may be heard
44
how to treat PDA
indomethacin (prostaglandin inhibitor) can be successful in premies and some newborns coil occlusion in cath lab surgery may be needed if cant repair in cath lab- a clip on ductus would be needed which would be done through left thoracotomy
45
Atrial Septal Defect (ASD)
left to right shunt their is a whole in the septum which divides the atrium of heart usually asymptomatic. referred to by murmur exercise intolerance may be seen unrepaired adults could have atrial dysrhythmias, emboli, etc
46
ASD treatment
depends on size could be closed in cath lab surgical repair- pericardial patch. this is much more invasive and is open chest surgery. Surgical repair typically happens between age 2-5 unless symptomatic
47
Ventricular Septal Defect (VSD)
Whole in septum between ventricles. Left to right shunting. can result in CHF, enlarged LV size varies. it may close spontaneously if small THIS IS FREQUENTLY ASSOCIATED WITH OTHER CARDIAC DEFECTS
48
what septal defect is worse
ventricular because left ventricle is very powerful
49
VSD treatment
complete surgical repair is procedure of choice. This is almost always the case could be closed in the cath lab, but this is not common
50
s/s of pulmonary congestion
tachypnea may be sweaty due to breathing so fast cough, wheezing, grunting resp distress poor feeding/growing decreased exercise tolerance pulmonary edema
51
R to L shunt
decreased blood flow to the lungs, body not getting good o2
52
Tetrology of Fallot
4 aspects: VSD right ventricular outflow tract obstruction (blocking blood from getting out of RV to get to lungs) overriding aorta (misplaced) RV hypertrophy (pumping hard due to obsruction)
53
when do tet spells occur
crying, feeding they exhibit blue skin
54
what to do in a tet spell
***knee to chest position- prevents blood from circulating to lower body, changes pressure in heart calm child 100% o2 morphine IV fluids
55
repair of TET
complete repair: patch VSD resect stenosis enlarge RV palliative shunt
56
transportation of great arteries
aorta comes off right ventricle pulmonary artery comes off left ventricle death will occur without repair
57
what to do with TGA- repair
we want PDA to stay open- use prostaglandins. if it closes prior to finding out about this, we need to get a whole in the heart surgery will then be needed to place the arteries in the right place
58
obstructive congenital heart diseases
coarctoin of the aotra pulmonary stenosis aortic stenosis
59
Coarc of the aorta
a kink/blockage of the aorta that interrupts bloodflow to the body. typically on the aorta arch
60
coarc of aorta s/s
BP will be drastic changes from upper body to lower body because blood flow isn't good to lower extremities due to coaction, but very high in upper extremities due to high pressure CHF may occur when PDA closes
61
treatment of coarc of the aorta
surgical repair- cut out coarction and sew aorta back together balloon angioplasty may be done manage HTN evaluate upper and lower BP after surgery to evaluate if worked
62
Kawasaki disease
vasculitis of small/medium sized blood vessels (coronary highest risk) usually seen in children ages 5 and under- unknown causes, noncongenital
63
s/s of Kawasaki disease
high persistant fever for 5 days swelling of conjuctiva inflamed mouth rash swollen red hands and feet cervical lymphaenopathy
64
Kawasaki treatment
IVIG to reduce incidence of cardiac abnormalities aspirin IVF mouth care
65
hypopituitarism
deficient secretion of pituitary hormones: GROWTH HORMONES, TSH, corticotropin, gonadotropin inhibits somatic growth and development of secondary sex characteristics
66
GH deficiency clinical manifestations
normal growth for the first year, then slowed growth curve after first year appear overweight due to short size
67
stim testing
kid will fast, we will give clonidine or glucagon to excrete GH, drawl blood frequently (15-30 mins) to see how much hormone is excreted, if it is not as much as we anticipated, than we know they have a deficiency
68
diagnosing GH deficiency under age 3
do a skeletal survey (take a Xray of most of body) to decide what bones look like from a developmental standpoint
69
diagnosing GH deficiency over age 3
we would take a x-ray of their left hand. They are looking at the growth plates. They will compare to bones of other ages.
70
what are we looking for in a hand xray for GH
advancing bone age (older than chronological age)=less time to help them or younger bone age than chronological age = more time we can help them or normal bone age for chronological age
71
Growth Hormone replacement
we cant help if growth plates are closed GH replacement is done at home and is synthetic. There is not a lot of side effects. Daily injections, done sub cut. It is very successful. It is best to do these GH at night because that is when kids grow. Changes typically take a few months. Feet grow first. An appetite increase also occurs therapy is ended when growth rates are less than a inch/year. this is around age 14 for girls and 16 for boys, but could be different depending on bone age
72
pituitary hyperfunction
excess GH before closure of growth plates patients may get VERY tall. weight is typically normal treatment depends on cause. it is most commonly due to tumor
73
acromegaly
excess GH after growth plate closure bones cant grow anymore since plates are closed so it typically causes facial overgrowth this doesnt occur until late adolecents after growth plates are closed psychosocial support will be needed
74
precocious puberty
sexual development before age of 9 in boys and 8 of girls if its younger than 7 in white girls and 6 in african american girls we need to fix the underlying cause
75
types of precocious puberty
central (CPP)- most common, caused by gonodotropin peripheral- caused by any other hormone than gonodotropin
76
management of precocious puberty
leuprolide (lupron) med that slows pubertal growth, but does not reverse it. If girls have started their periods than we dont give this
77
diabetes mellitus 1
Born with a predisposition of this than a autoimmune process kicks in causing the pancreas to make no insulin not revirsable teach carb counting
78
type II DM
more common in adults but can happen in kids caused by insulin resistance, revirsable

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