[Exam 4] Chapter 44 - Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder Flashcards
(174 cards)
1
Q
Anatomy Changes, Skeletal Development: How does fetal spine display?
A
Kyphosis, an outward curvature
2
Q
Anatomy Changes, Skeletal Development: When does cervical lordosis develop?
A
Its the inward curvature, and develops as infant starts to hold their head up.
3
Q
Common Medical Txs, Traction: What is this?
A
Use to reduce or immobilzie a fracture, align an injured extremity, and to allow the extremity to be restored to its normal length.
4
Q
Common Medical Txs, Traction: Reduces pain how?
A
Decreases incidence of muscle spasm.
5
Q
Common Medical Txs, Traction: How does running traction work?
A
Weight pulls directly on the extremity in only one plane.
6
Q
Common Medical Txs, External Fixation: Why is this used?
A
For complciated fractures, especially open fractures with soft tissue damage. Wires inserted into bone then attached to an external frame.
7
Q
Common Medical Txs, External Fixation: Advantages of this?
A
Increased comfort for injured child and improved function of muscles and joints when complicated fractures occur
8
Q
Common Medical Txs, Caring for Child with Cast: Diffences in edges with fiberglass casts and plaster casts?
A
Fiberglass: Have a soft fabric edge, so they usually do not cause skin rubbing
Plaster Casts - REquire special treatment of cast edge to prevent skin rubbing , done with petaling (cut rounded-edge strips of moleskin)
9
Q
Common Medical Txs, Caring for Child with Cast: If cast lined with gore-tex, do not do what to it?
A
Petal it
10
Q
Common Medical Txs, Caring for Child with Cast: What to do during first 48 hours after application?
A
Elevate extremity above the heart, and apply cold therapy for 20-30 minutes, then off 1-2 hours then repeat
11
Q
Common Medical Txs, Caring for Child with Cast: How to help with itching?
A
Blow cool air from a hair drying in the lowest setting or tap lightly on the cast
12
Q
Common Medical Txs, Caring for Child with Cast: What to do if cast gets wet?
A
Dry it with a blow dryer on the cold setting.
13
Q
Common Medical Txs, Caring for Child with Cast: How to prepare child for cast removal?
A
Tell them cast cutter will make loud noise
Skin will not be injured
Child will feel warmth or vibration
14
Q
Common Medical Txs, Caring for Child with Cast: What to do if skin is brown and flaky?
A
It is normal. Occurs as dead skin and secretions accumulate under the cast
15
Q
Common Medical Txs, Caring for Child with Cast: Care for skin after cast taken off?
A
Soak with warm , soapy water.
16
Q
Common Medical Txs, Traction: What is Bryant traction?
A
Both legs are extended vertically, with childs weight serving as coutnertraction. Used for femur fraction in those younger than 2
17
Q
Common Medical Txs, Traction: What is russel traction?
A
Skin traction for femur fracture, hip injuries. Uses knee sling.
18
Q
Common Medical Txs, Traction: What is cervical skint raction?
A
Skin traction applied with a skin strap (head halter). Used for neck sprains or nerve trauma
19
Q
Common Medical Txs, Traction: What is side arm 90-90
A
Skin traction for humerus fractures and injuries in or around shoulder girdle
20
Q
Common Medical Txs, Traction: What is dunlop side arm 00-90?
A
Skeletal traction through olecranon screw or pin in humerus. Lower arm held in suspension
21
Q
Common Medical Txs, Traction, Providing Pin Care: How often is pin care performed?
A
Weekly after the first 48-72 hours.
22
Q
Common Medical Txs, Traction, Providing Pin Care: What solution is used for pin care?
A
Chlorhexidine 2 mg/mL in alcoohol.
23
Q
Neural Tube Defects: What should women take to prevent this?>
A
0.4 mg of folic acid daily.
24
Q
Neural Tube Defects, Spina Bifida Occulta: What is spina bifida?
A
Term used to refer to all neural tube disorders that affect the spin cord.
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Neural Tube Defects, Spina Bifida Occulta: What is this?
Defect of the vertebral bodies without protrusion of the spinal cord or meninges. Not visible externally.
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Neural Tube Defects, Spina Bifida Occulta: Complications of this?
Rare , may include tethered cord, syringomyelia or diastematomyelia
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Neural Tube Defects, Spina Bifida Occulta: Medical interventions?
They do not need immediate itnerventions
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Neural Tube Defects, Spina Bifida Occulta - Nursing Assessment: How is this noticed?
Usually goes undetected. They may be noticeable dimpling, abnormal patches of hair, or discoloration of skin at defect site
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Neural Tube Defects, Spina Bifida Occulta - Nursing Mx: What treatment do children eventually need?
Surgery, due to degenerative changes or involvement of the spine and nerve roots resulting in complications like thethered cord, syringomyelia or diastematomyelia
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Neural Tube Defects, Meningocele: What is this?
Less serious form of spina bifida cystica, when meninges herniate through a defect in the vertebrae. Spinal cord normal
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Neural Tube Defects, Meningocele:Treatment for this?
Surgical correction of the lesion
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Neural Tube Defects, Meningocele - Nursing Assess: How will this appear on assessment?
Visible external sac protruding from spinal area. Seen in lumbar area. Covered with skin.
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Neural Tube Defects, Meningocele - Nursing Mx: What should immediately be reported?
Any evidence of leaking CSF.
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Neural Tube Defects, Myelomeningocele: What is this?
Type of spina bifida cystica. Spinal cord ends at point of the defect, resulting in absent motor/sensory function beyond that point.
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Neural Tube Defects, Myelomeningocele: Long term complications of this?
Paralysis, orthopedic deformities, and bladder/bowel incontinence.
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Neural Tube Defects, Myelomeningocele: Why does hydrocephalus result here?
Due to improper development and the downward displacement of the brain into the cervical spine, CSF flow is blocked.
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Neural Tube Defects, Myelomeningocele: The lower the deformity on the spine, the lower the risk of developing what?
hydrocephalus
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Neural Tube Defects, Myelomeningocele: Treatment for this?
Multiple surgical procedures.
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Neural Tube Defects, Myelomeningocele - Therapeutic Mx: What will be performed as soon as possible?
Surgical closure, especially if CSF leak is present or if there is danger of sac rupturing.
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Neural Tube Defects, Myelomeningocele - Health Hx: RF include what?
Lack of prenatal care
Lack of preconception or folic acid supplementation
Previous child born with neural tube defects
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Neural Tube Defects, Myelomeningocele - Health Hx: Questiosn asked at child should include what?
Current mobility status
GU function
Bowel function and regimen
Signs of urinary infections
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Neural Tube Defects, Myelomeningocele - Physical Exam: Initial assessment after delivery will reveal what?
Visible external sac protruding from spinal area.
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Neural Tube Defects, Myelomeningocele - Physical Exam: What signs may be found in newborn?
Flaccid paralysis, absence of deep tendon reflexes, lack of response to touch and pain stimuli.
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Neural Tube Defects, Myelomeningocele - Physical Exam: What labs will be performed?
MRI, CT, Ultrasound,
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Prevent Infection: What is used to keep sac moist?
Use a sterile saline-soaked nonadhesive gauze or antibiotic-soaked gauze to keep sac moist.
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Prevent Infection: How should infant be positioned?
Prone position or supported on the side to avoid pressure on the sacc.
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Prevent Infection: How to prevent feces from coming into contact?
Place prone, or place a towel under them. It can also be wrapped with plastic as well.
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Prevent Infection: How should they be positioned after surgery?
Prone or side-lying, to allow incision to heal
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Neurogenic Bladder: What does this refer to?
Failure of the bladder to eitehr store urine or empty itself of urine. They have loss of control over voiding.
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Neurogenic Bladder: What does a spastic type of neurogenic bladder yield
hyperreflexive and yields frequent release of urine, but with incomplete emptying.
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Neurogenic Bladder: What happens to a hypotonic neurogenic bladder?
Is flaccid and weak and becomes stretched out. Can hold very large amounts of urine, resulting in continuous dribbling of urine from urethra.
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Neurogenic Bladder: Goal of this type of management?
Promote urinary continence and prevent renal complications
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Neurogenic Bladder: Interventions for this?
clean intermittent catheterization to promote bladder emptying, medications like oxybutyin chloride to improve bladder capctiy, and prompt recognition and treatment of infections
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Neurogenic Bladder: Teaching parents techiniques of clean intermittent catheterization helps why
helps preserve renal function, prevent infection, and helps the family gain some control over child's physical condition
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Promoting Bowel Elimination: How does this occur?
Bowel training with the use of timed enemas or suppositories along with diet modifcations.
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Preventing Latex Allergic RX: Why are they at increased risk for this
Due to multiple exposures to latex productions during surgical procedures and bladder catheterizations.
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Neural Tube Defects, Myelomeningocele - Nursing Mx, Maintaining Skin Integrity: What does prone position create risk of?
Puts constant pressure on knees and elbows, and it may be difficult to keep the infant clean of urine and feces.
58
Congenital Clubfoot: What does this consist of?
Talipes Varus (inversion of heel)
Talipes Equinus (plantarflexion of the foot, heel raised)
Cavus (plantarflexion of forefood on hindfoot)
Forefoot adduction with supination (forefoot is inverted)
59
Congenital Clubfoot: What does this foot resemble?
Head of a golf club
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Congenital Clubfoot: Classified into what four categories?
postural, neurogenic, syndromic, and idiopathic.
61
Congenital Clubfoot: How does this usually resolve?
Short series of manipulative casting.
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Congenital Clubfoot, Therapeutic Mx: Goal is what?
Achievement of functional foot.
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Congenital Clubfoot, Therapeutic Mx: When does treatment start
As soon as after birth as possible.
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Congenital Clubfoot, Therapeutic Mx: How is treatment performed?
Weekl manipulation wtih serial cast changes. Then changes every 2 weeks. Others require corrective shoes. Or others need surgery + corrective shoes
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Congenital Clubfoot, Therapeutic Mx: Complications of this?
residual deformity, rocker-bottom foot, awkward gait
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Congenital Clubfoot, Nursing Assess: What should you inspect about foot?
For position at rest, and perform active ROM, noting inability to move foot.
67
Developmental Dysplasia of the Hip (DDH): What is this?
Abnormalities of the developing hip that include dislocation, subluxation and dysplasia of the hip joint.
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Developmental Dysplasia of the Hip (DDH): How is femoral head here?
Has an abnormal relationship to acetabulum. Frank dislocation can occur when theres no contact between the two.
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Developmental Dysplasia of the Hip (DDH): What is subluxation?
Partial dislocation, meaning acetabulum is not fully seated within hip joint.
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Developmental Dysplasia of the Hip (DDH): What is dysplasia?
Acetabulum that is shallow or sloping instead of cup shaped.
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Developmental Dysplasia of the Hip (DDH) - Patho: Why does this occur in newborn?
Because of the laxity of the newborns hip to dislocate and relocate.
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Developmental Dysplasia of the Hip (DDH) - Patho: What happens if subluxation and periodic or continued dislocation occur?
Structural changes of the hips anatomy occur. Leads to limited abduction and contracture of muscles.
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Developmental Dysplasia of the Hip (DDH) - Patho: What can contribute to development of this?
Mechanical factors like breech positioning or oligohydramnios.
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Developmental Dysplasia of the Hip (DDH) - Patho: Complications of this?
Avascular necrosis of femoral head, loss of ROM, recurrently usntable hip, femoral nerve palsy
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Developmental Dysplasia of the Hip (DDH) - Therapeutic Mx: Goal here is what?
Maintain the hip joint in reduction so that femoral head and acetabulum develop properly.
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Developmental Dysplasia of the Hip (DDH) - Therapeutic Mx: How will those younger than 6 months be treated?
Pavlik harness, which reduces and stabilizes the hip by preventing hip extension and adduction and maintianing the hip in felxion and abduction
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Developmental Dysplasia of the Hip (DDH) - Therapeutic Mx: Children from 4 months to 2 years require what
closed reduction. This includes skin or skeletal traction used first to stretch soft tissue.
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Developmental Dysplasia of the Hip (DDH) - Therapeutic Mx: How is brace warn after surgery?
Full time. and then it is worn at night and during naps until development is normal.
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Developmental Dysplasia of the Hip (DDH) - Therapeutic Mx: Tx for those older than 2 yers?
Open surgical reduction followed by period of casting.
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Developmental Dysplasia of the Hip (DDH) - Health Hx: Risk factors include?
Family Hx
Female Gender
Native American
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Developmental Dysplasia of the Hip (DDH) - Physical Exam: What will observation reveal?
Asymmetry of thight or gluteal folds. Also may show trendelenburg gait, due to weakness of hip abductors as childs trunk is shifted over.
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Developmental Dysplasia of the Hip (DDH) - Physical Exam: What sound should be paid attention for?
A "clunk" heard when legs abducted. Sound indicates femoral head hitting the acetabulum.
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Muscular Dystrophy: What is this?
Inherited conditions that result in progressive muscle weakness and wasting. Are primarily voluntary muscles.
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Duchenne Muscular Dystrophy: What is this?
Mostcommon neuromuscular. Universally fatal. Consists of generalized weakness, muscle wasting, with limbs and trunk first
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Duchenne Muscular Dystrophy, Patho: What gene mutation occurs here?
Absence of dystrophin. X-Linked recessive, meaning boys are affected.
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Duchenne Muscular Dystrophy, Patho: Absence of dystrophin gene leads to what?
generalized weakness of voluntary msucle and weakness progresses over time
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Duchenne Muscular Dystrophy, Patho: What muscles affected first
hips, thighs, pelvis, and shuouldes. Eventually cardiac and respiratory muscles affected.
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Duchenne Muscular Dystrophy, Patho: How will they walk and appear?
Will learn late to walk
Toddlers , enlarged calves
Preschool, fall often and clumsy
Later - difficulty climbing stairis and running.
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Duchenne Muscular Dystrophy, Patho: How willl they walk by teen years?
They will lose the ability to ambulate, and will require assitance or support.
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Duchenne Muscular Dystrophy, Therapeutic Mx:What slows progression of this?
Use of corticosteroids. Prednisone helps protect muscle fibers from damage to the sacrolema.
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Duchenne Muscular Dystrophy, Therapeutic Mx:Side effects of corticosteroids (prednisone)?
weight gain, osteoporosis, and mood changes.
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Duchenne Muscular Dystrophy, Therapeutic Mx:What kind of aids are necessary?
Braces or orthoses and mobilitility / positioning aides.
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Duchenne Muscular Dystrophy, Therapeutic Mx:What will result as muscles deteriorate?
Joints may become fixated resulting in contractures.
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Duchenne Muscular Dystrophy, Therapeutic Mx:What spinal changes will occur?
Lordosis, more frequently scoliosis or kyphosis as time progresses.
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Duchenne Muscular Dystrophy, Therapeutic Mx:What surgery is often needed in adolescence?
surgical spinal fiation with rod implantation
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Duchenne Muscular Dystrophy, Therapeutic Mx: Complciations?
pulmonary, UTI, depression, learning disorders.
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Duchenne Muscular Dystrophy, Health Hx: Primary hallmark finding of this is what?
Gowers sign, ,child cannot rise from floor in standard fashion because of increasing weakness.
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Duchenne Muscular Dystrophy, Labs: Common labs?
EEG shows that problem lies in muscles, not the nerves. Serum creatine kinase levels elevated
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Duchenne Muscular Dystrophy, Nursing Mx - Promote Mobility: What is administered medicine wise?
Corticosteroids and calcium supplements.
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Duchenne Muscular Dystrophy, Nursing Mx - Promote Mobility: What is used to prevent muscle atrophy?
Standing walker. May also use passive stretching or strengthening exercises.
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Duchenne Muscular Dystrophy, Nursing Mx - Promote Mobility: What is sused to prevent contractures?
Using orthotic supports such as hand braces or ankle-foot orthoses.
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Duchenne Muscular Dystrophy, Nursing Mx - Maintaining Cardiopulmonary Function: Position child how
Upright position. while also performing deep-breathing exercises to srengthen or maintain respiratory muscles.
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Duchenne Muscular Dystrophy, Nursing Mx - Maximizing Quality of Life: What helps prevent further weakness?
Working with family and child to develop a schedule for diversional activites that provide appropriate developmental stiulation but avoid overexertion.
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Cerebral Palsy: What is this?
Used to describe a range of nonspecific clinical symptoms characterized by abnormal motor pattern and postures caused by nonprogresive abnormal brain function
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Cerebral Palsy: How will this appear in children?
Can appear as mild limp, or can be severe motor and neurologic impairments
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Cerebral Palsy: Primary signs include motor impairments like
spasticity, muscle weakness, and ataxia, which is the lack of coordination of muscle movements during volunary movements such as walking or picking up objects
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Cerebral Palsy: Complications of this?
Mental impairments, seizures, growth problems, impaired vision or hydrocephalus
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Cerebral Palsy - Patho: What is this caused by?
Abnormal development or damage to motor area of brain resulting in lesion.
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Cerebral Palsy - Patho: What is spastic version?
Hypertonicity and permanent contractures.
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Cerebral Palsy - Patho: What is athetoid or dyskinetic version
abnormal involuntary movements
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Cerebral Palsy - Patho: what is ataxic version
affects balance and depth perception
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Cerebral Palsy - Patho: what is mixed version?
combination of the above
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Cerebral Palsy - Therapeutic Mx: Who does this involve?
Primary physician, neurologists, orthopedic surgeon, nurses PT, OT, ST, dietitians,
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Cerebral Palsy - Therapeutic Mx: Treatment is mostly what
preventative, symptomatic, and supportive
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Cerebral Palsy - Therapeutic Mx: Medical management focused on what?
promoting mobility through use of therapeutic modalities and medications.
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Cerebral Palsy - Therapeutic Mx - PT, OT, ST: PTs do what?
Help with development of gross motor movements such as walking and positioning. Also prevent conractions and assit with walkers.
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Cerebral Palsy - Therapeutic Mx - PT, OT, ST: What are AFOs?
Most common orthotic used by children. Prevent deformity from conditions such as contractures. Improve mobility.
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Cerebral Palsy - Therapeutic Mx - PT, OT, ST: Whe are spinal orthotics used?
To comat scoliosis that develops due to spasticity. Dela surgical management until they reach surgical maturity.
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Cerebral Palsy - Therapeutic Mx - Pharmacologic Mx: Oral meds include?
baclofen, dantrolene sodium and diazepam. May also begiven anticholinergics.
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Cerebral Palsy - Therapeutic Mx - Pharmacologic Mx: Drooling is a problem why
can lead to dehydration, dental enamel erosion, and maceration of the skin.
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Cerebral Palsy - Therapeutic Mx - Pharmacologic Mx: Paraenterally administered meds include?
Botulin toxins and baclofen are used to manage spasticity.
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Cerebral Palsy - Therapeutic Mx - Surgical Mx: Why may surgery be done?
To correct contractures that are severe enough to cause movement limitations.
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Cerebral Palsy - Therapeutic Mx - Surgical Mx: Common procedues include?
tendon lengthening, correction of hip and adductor muscle spasticity, and fusion of unstable joints.
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Cerebral Palsy - Therapeutic Mx - Healh Hx: Common signs of this include?
intrauterine infection, prematurity with intracranial hemorrhage, multiple births, and history of head trauma.
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Cerebral Palsy - Therapeutic Mx - Physical Exam: What position may they display when lying supine?
Scissor crossing of the legs with plantar flexion.
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Cerebral Palsy - Therapeutic Mx - Physical Exam: How will head appear in prone position>
May raise their head higher than nroaml due to arching of the back
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Cerebral Palsy - Therapeutic Mx - Physical Exam: What will happen to primitive reflexes?
Will persist beyond point at which they disappear in healthy infant
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Cerebral Palsy - Therapeutic Mx - Physical Exam: Labs fo rthis?
EEG
Cranial X Rays
MRI
Screening for metabolic defects
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Cerebral Palsy - Nursing Mx, Promoting Mobility: Treatment modalites to promote mobility include?
Physiotherapy, pharmacologic management, and surgery.
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Legg-Calve-Perthes Disease: What is this?
Involves avascular necrosis of the femoral head. Interruption of blood supply to femoral head results in bone death, and spherical shape is lost. Swelling of soft tissue occurs.
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Legg-Calve-Perthes Disease: What happens as new blood vessels develops?
Bone resorption and deposition akes place. Takes 18-24 months wheree bone is soft and more likely to fracture. Over time, femoral head reforms
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Legg-Calve-Perthes Disease - Therpeutic Mx: Goal of this?
To maintain normal femoral head shape and restore approrpiate motion
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Legg-Calve-Perthes Disease - Therpeutic Mx: Treatment?
Anti-inflamatory medication to decrease muscle spasms around the hip joint and to relieve pain.
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Legg-Calve-Perthes Disease - Therpeutic Mx: What is recommende to contain femoral head?
Activity limiation, with maybe bracing,casting, or traction.
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Legg-Calve-Perthes Disease - Therpeutic Mx: Complciations of this?
Joint deformity, early degenerative joint disease, persistent pain, and loss of hip motion
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Legg-Calve-Perthes Disease - Nursing Assess: Explore for history of what
short stature, delayed bone maturation, related trauma, or family hx.
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Legg-Calve-Perthes Disease - Nursing Mx: What should be admiinistered?
anti-inflammatory medications, noting their pain.
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Legg-Calve-Perthes Disease - Nursing Mx: If activites are restructed, what should be done
exercise the unaffected body parts.
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Scoliosis: what is this?
Lateral curvature of the spine that exceeds 10 degrees.
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Scoliosis: What are idiopathic scoliosis?
Majority of cases, during adolescence.
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Idiopathic Scoliosis: what may contribute to this?
genetic factors, growth abnormalites, bone, mucle, or CNS disorders.
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Idiopathic Scoliosis - Patho: How does this occur?
In growing adolescent, involves vertebrae rotate around vertical axis, resulting in lateral curvature. Growth suppressed on concave side.
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Idiopathic Scoliosis - Therapeutic Mx: Treatment is aimed at doing what?
Preventing progression of curve and decreasiing impact on pulmonary and cardiac function.
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Idiopathic Scoliosis - Therapeutic Mx: For curves of 25-40 degrees, what is recommended?
bracing may be dufficient to decrease progression of the curve
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Idiopathic Scoliosis - Therapeutic Mx: When is surgical correction required?
For curves greater than 45 degrees. Achieved with rod placement and bone grafting.
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Idiopathic Scoliosis - Therapeutic Mx: What does traditional rod placement involve?
Single rod fused to the vertebrae, resulting in cruve correction.
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Idiopathic Scoliosis - Physical Exam: How will they appear?
Will have shoulder elevation, prominence of one scapula, uneven curve at waistline.
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Idiopathic Scoliosis - Encouraging Compliance with Bracing: How long must they wear this daily?
23 hours a day to prevent curve progression.
149
Fracture: Most commonly occur wher
in the forearm and wrist.
150
Fracture: Which ones result from birth trauma?
midclavicular, humerus, or femur fractures.
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Fracture - Patho: What is the most vulnerable portion of childs bone?
Growth plate
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Fracture - Patho: What classification system is used to describe fractures involve growt plate?
Salter-Harris classification. The thicker , more elastic periostenum in children yields to the force encourtered with trauma.
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Fracture - Patho: What types may result in angular deformity?
/Plastic deformity and Salter-Harris type IV fractures.
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Fracture - Patho: Additional complications of this?
Infection, avascular necrosis, bone shortening, vasculr/nerve injuries and fat embolism.
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Fracture - Patho and Salter Harris Classification: What is Type I?
Fracture through physis, widening it
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Fracture - Patho and Salter Harris Classification: What is Type II
Fracture partially through physis, extending into metaphysis
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Fracture - Patho and Salter Harris Classification: What is type III
Partially thorugh epiphysis , extenidng into the epiphysis
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Fracture - Patho and Salter Harris Classification: What is type IV
fracture is through metaphysis, physis and epiphysis
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Fracture - Patho and Salter Harris Classification: What is type V
crushing injury to physis
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Fracture - Patho : What is a buckle fracture?
Compression injury. Bone buckles instead of breaking
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Fracture - Patho : What is a greenstick fracture?
Incomplete frature of the bone
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Fracture - Therapeutic Mx: Displaced fractures require what
manual traction to align bones, followed by casting.
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Fracture - Therapeutic Mx: Severe or complicated fractures may require what
open reduction and internal fixation
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Fracture - Therapeutic Mx: How are compelx fractures treated?
with external fixation
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Fracture - Health Hx: Common signs reported include
recent innjury, trauma or fall, complain of pain, difficulty bearing weight, limp.
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Fracture - Health Hx: Risk factors for this?
Rickets, Participation in sports,
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Fracture - Health Hx: Inspect the skin for what
bruising, erythema or swelling.
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Fracture - Nursing Mx: What should be done immediately after surgery?
Immobilize the limb above or below injury. Use cold therapy to reduce swelling in first 48 hours after injury. Elevate above the heart.
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Fracture - Nursing Mx: Check the five P's, wich include what
Pallor, pain, pulselessness, paresthesis, and paralysis.
170
A boy with Duchenne muscular dystrophy is admitted to the pediatric unit. He has an ineffective cough. Lung auscultation reveals diminished breath sounds. What is the priority nursing intervention?
Apply supplemental oxygen.
Notify the respiratory therapist.
Monitor pulse oximetry.
Position for adequate airway clearance.
Position for adequate airway clearance.
171
A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history?
Age that the child learned to walk
Parents’ expectations of the child’s development
Functional status related to eating and mobility
Birth history to identify cause of cerebral palsy
Functional status related to eating and mobility
172
The nurse is caring for a 2-year-old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required?
“Routine catheterization will decrease the risk of infection from urine staying in the bladder.”
“I know it will be important for me to catheterize my child for the rest of her life.”
“I will make sure that I always use latex-free catheters.”
“I will wash the catheter with warm soapy water after each use.”
“I know it will be important for me to catheterize my child for the rest of her life.”
173
The nurse is caring for a child with cerebral palsy who requires a wheelchair to attain mobility. Which intervention would help the child achieve a sense of normality?
Encourage follow-through with physical therapy exercises.
Restrict the child to a special needs classroom.
Encourage after-school activities within the limits of the child’s abilities.
Ensure the school is aware of the child’s capabilities.
Encourage after-school activities within the limits of the child’s abilities.
174
The nurse is caring for orthopedic children who are in the postoperative period following spinal fusion. What is the most appropriate activity to delegate to unlicensed assistive personnel?
Ambulate the children twice daily to promote mobility.
Encourage commode use to promote bowel function.
Provide diversionary activities, as the children must stay flat on their backs.
Assist with log-rolling the children every 2 hours.
Assist with log-rolling the children every 2 hours.
