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lecture 10 [musculoskeletal + neuromuscular] Flashcards

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1
Q

what are the acquired skeletal defects?

(6)

A
  • Legg-Calve-Perthes
  • slipped capital femoral epiphysis(SCFE)
  • kyphosis
  • lordosis
  • scoliosis
  • spinal neuromuscular atrophy
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2
Q

what is Legg-Calve-Perthes disease?

A

asceptic necrosis of the femoral head that can either be unilateral or bilateral

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3
Q

what are the symptoms of LCP?

(6)

A
  • painless limping
  • hip stiffness
  • limited ROM
  • hip, thigh, & knee pain
  • shortened affected leg
  • muscle wasting
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4
Q

what are the treatment goals for LCP?

(4)

A
  • eliminate hip irritability
  • maintain ROM
  • prevent bone collapse
  • ensure well-rounded femoral head
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5
Q

what are the primary therapeutic measures for LCP?

A
  • abduction brace/ cast
  • traction
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6
Q

what is slipped capital femoral epiphysis (SCFE)?

A

spontaneous displacement of the proximal femoral epiphysis that develops shortly before onset of puberty or accelerated growth

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7
Q

SCFE is more commonly seen in boys & obese children

A

true

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8
Q

which conditions are associated with SCFE?

A
  • GH therapy
  • endocrine disorders
  • renal osteodystrophy
  • radiotherapy
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9
Q

what are the primary treatments for SCFE?

A
  • non-weight bearing activity
  • surgery
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10
Q

SCFE must be diagnosed early

A

true

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11
Q

what is kyphosis?

A

convex curvature of the thoracic spine

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12
Q

kyphosis is usually a secondary condition to other diseases like:

A
  • TB
  • chronic arthritis
  • compression fractures
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13
Q

how is kyphosis treated?

A
  • shoulder/ abdomen exercises
  • bracing
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14
Q

what is lordosis?

A

cervical or lumbar curvature of the spine

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15
Q

lordosis is often associated with which other conditions?

A
  • hip contractures
  • scoliosis
  • obesity
  • hip dysplasia
  • SCFE
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16
Q

what is scoliosis?

A

lateral curvature of the spine, possible spinal rotation & thoracic hypokyphosis

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17
Q

what is the “gold standard” treatment for scoliosis?

A

bracing

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18
Q

what are the different types of braces for scoliosis?

(3)

A
  • Boston
  • Milwaukee
  • Charleston
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19
Q

what are the congenital muscular disorders?

A
  • spinal muscular atrophies
  • Duchenne’s muscular dystrophy
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20
Q

Duchenne’s muscular dystrophy is the most severe form of muscular dystrophy

A

true

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21
Q

why are males more affected with Duchenne’s?

A

it is primarily an x-linked genetic disorder

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22
Q

what are the diagnostic procedures for Duchenne’s?

A
  • muscle biopsy
  • blood polymerase chain reaction to detect dystrophin gene mutation
  • blood creatine phosphokinase (elevated)
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23
Q

there is no treatment for Duchenne’s; and families only need to be prepared for impending cardiac & respiratory difficulties along w/ mental retardation

A

true

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24
Q

what are the manifestations of Duchenne’s?

(5)

A
  • Gowers sign
  • waddling
  • difficulty rising to positions
  • progressive muscle atrophy
  • loss of ability to walk by 12yrs
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25
what are the *congenital* ***skeletal defects***? | (5)
* hip dysplasia * club foot * genu varum * genu valgum * osteogenesis imperfecta
26
what are the expected diagnostic signs of ***hip dysplasia***? | (6)
* Ortolani sign *(hip is reduced w/ abduction)* * Galeazzi/ Allis sign *(uneven knee levels)* * Barlow sign *(hip dislocates by adduction)* * Trendelenberg sign w/ lordosis *(tilted hips with standing on one foot)* * U/S or x-ray
27
when is an *ultrasound* appropriate for ***hip dysplasia***?
2 weeks old
28
when is an *x-ray* appropriate to diagnose ***hip dysplasia***?
older than 4mos
29
what are the treatments for ***hip dysplasia***?
* Pavlik harness * Bryant traction * Hip spica cast * surgical reduction
30
at what age is the ***Pavlik harness*** appropriate?
newborn to 6 months
31
what is a ***Pavlik harness***?
a chest harness that abducts legs
32
what is the treatment for ***hip dysplasia*** WITH *adduction contracture*?
* Bryant traction * Hip spica cast
33
when is *surgical reduction* appropriate for a child with ***hip dysplasia***?
when they are 6 months to 2 years old
34
what is ***club foot***?
a complex deformity of the ankle & foot that is sometimes associated with *cerebral palsy* & *spina bifida*
35
what are the categories of ***club foot***?
* positional * syndromic * congenital
36
what causes *positional* ***clubfoot***?
intrauterine crowding
37
what is *syndromic* ***clubfoot***?
a category of the disorder that occurs with other *syndromes*
38
what are the therapeutic procedures for ***club foot***?
casting
39
how are the series of *casts* implemented for ***clubfoot***?
applied every 2-3 days for up to 3 weeks, then 1-2 week intervals
40
genu varum
41
genu valgum
42
what is ***osteogenesis imperfecta***?
an inherited connective tissue disorder that results in bone fractures along w/ restricted growth | "brittle bone disease"
43
what are the clinical manifestations of ***osteogenesis imperfecta***?
* multiple bone fractures * blue sclera * early hearing loss * hypoplastic discolored teeth
44
what is the treatment for ***osteogenesis imperfecta***?
pamidronate IV with biphosphate
45
what is the expected MOA of ***pamidronate***?
increases bone density
46
what are the types of ***fracture*** in children?
* bend * buckle * greenstick * complete
47
***bend fratcures*** only occur in the *ulna* & *fibula* when there is a fracture in the radius & tibia
true
48
the most common site for a fracture in a child is the ***growth plates***, where is it?
located on the ends of the hard bone *(epiphysis)*
49
what are the types of ***fracture lines***?
* transverse * oblique * spiral *(circular)*
50
what are the signs of ***compartment syndrome*** that occurs with *casts*? | 5 P's
* paresthesia * pallor * paralysis * pain * pulselessness
51
what are the nursing priorities for a child with a *cast*?
regular *skin checks* & *neurovascular checks*
52
what are the components of ***neurovascular assessments***?
* sensation * skin temperature * skin color * cap refill * pulses * movement
53
what are ***tractions*** used for? | (4)
* provide muscle rest * immobilization * alignment * prevent contractures
54
what are the types of ***tractions***? | (3)
* skin * manual * skeletal
55
how do ***skin tractions*** correct musculoskeletal dislocations?
applies pulling force using tape & straps on the skin *(w/ weights)*
56
what are the types of ***skin tractions***?
* Bryant * Buck * Russell
57
what is a ***skeletal traction***?
a continuous pulling force through the use of weights that uses pins or rods inserted through a bone
58
what are the types of ***skeletal traction***?
* cervical/ halo * 90-90 * external fixators
59
what is a ***manual traction***?
application of casts along with having a *closed reduction*
60
what are the ***infectious*** *musculoskeletal problems*? | (4)
* osteomyelitis * septic arthritis * lupus * juvenile arthritis
61
what is ***osteomyelitis***?
an infection within the bone secondary to a bacterial infection *(open fracture or bloodborne)*
62
what are the treatments & measures for ***osteomyelitis***? | (3)
* IV/ oral ABX * immobilize w/ cast * monitor for adverse rxns *(such as superinfection & hepatic, renal, and hematologic complications)*
63
what is ***septic arthritis***?
bacterial infection of the joint
64
what is the most common bacterial agent for ***septic arthritis***?
S. aureus
65
what are the manifestations of ***septic arthritis***? | (3)
* severe joint pain * swelling * warmth at site
66
what is ***juvenile arthritis***?
a chronic inflammation of synovium & eventual erosion of articular cartilage
67
what are the medications for ***juvenile arthritis***? | (4)
* NSAIDs * Methotrexate * Etanercept *(tumor-necrosis factor alpha receptor)* * Prednisone
68
nurses must apply *heat packs* to the affected joints for pain & stiffness reduction
true
69
what is ***lupus***?
a chronic multisystem autoimmune disease of connective tissue & blood vessels
70
what are the *congenital* ***neuromuscular problems***? | (4)
* cerebral palsy * neural tube defects * hypotonia
71
what are the types of ***neural tube defects***?
* anencephaly * spina bifida
72
what is ***cerebral palsy***?
a nonprogressive impairment of motor function that causes *spasticity* or *dyskinesia* (involuntary movements)
73
what is the most prominent etiology of ***cerebral palsy***?
kernicterus | elevated bilirubin in newborns
74
what are some risk factors for ***cerebral palsy***?
* LBW * maternal chorionaminionitis * anoxia in-utero
75
what are the s/s of ***cerebral palsy***? | (8)
* persistent *Moro reflex* or *tonic neck reflex* * failure to smile by 3 months * persistent tongue thrust by 6 months * spasticity * scissoring of legs * nystagmus * hearing loss * feeding difficulties
76
what kinds of care management do patients with ***cerebral palsy*** need? | (5)
* physical therapy * speech therapy * occupation therapy * rhizotomy *(surgery)* * medication
77
children with ***cerebral palsy*** are more likely to aspirate while feeding
true
78
what are the medications that are usually given to patients with ***cerebral palsy***? | (7)
* ***Baclofen*** * Diazepam * Botulinin toxin A * Dilantin * Valium * Botox * ADHD meds
79
what are the measures that parents can take to prevent aspiration in children with ***cerebral palsy***?
* jaw support * upright position
80
what is the etiology of ***anencephaly***?
the neurall tube in-utero fails to close, leading to an underdeveloped brain in which the infant does not have a forebrain nor a cerebrum
81
what is ***spina bifida***?
an NTD characterized by failure of the osseus spine to close
82
what are the categories of ***spina bifida***? | (2)
* occulta * cystica
83
what are the characteristics of *spina bifida* ***occulta***? | (4)
* affects the lumbosacral area * not visible externally * missing vertebral bone surface*(dimpling)* * no spinal cord involvement
84
what are the characteristics of *spina bifida* ***cystica***?
visible defect w/ sac-like protrusion
85
what are the subtypes of *spina bifida* ***occulta***?
* meningocele * myelomeningocele
86
what are the characteristics of *spina bifida cystica* w/ a ***meningocele***?
* sac contains spinal fluid & meninges * no neurologic deficits
87
what are the characteristics of *spina bifida cystica* w/ a ***myelomeningocele***?
* sac contains spinal fluid, meninges, and *nerves* * caused by failure to close of neural tube * decreased motor & sensory function
88
what are the expected findings of *spina bifida* ***occulta***? | (4)
* dimpling in the lumbosacral area * port wine angioma * dark hair tufts * subcutaneous lipoma
89
what are the expected findings of *spina bifida* ***cystica***? | (5)
* flaccid muscles * lack of bowel control * rectal prolapse * spinal curvature abnormalities *(kyphosis/ scoliosis)* * protruding sac
90
most patients with ***spina bifida*** have a *latex allergy*
true
91
what are the s/s of ***hydrocephalus***?
* sunset eyes * increased head circumference * Cri du chat * poor feeding *(w/ increased ICP)*
92
what is the *primary* cause for ***hydrocephalus***?
Arnold Chiari syndrome
93
what is another term for ***hypotonia***?
floppy infant syndrome
94
what is the most common diagnostic test for ***hypotonia***?
EMG | measures muscle response to a nerve's stimulation of the muscle
95
what are the causes of ***spinal cord injuries***? | (4)
* MVA * long-acting PCN in the artery * hyperextension of the neck * spinal compression
96
***cervical*** *spines 1-8* innervate which part of the body?
* diaphragm * neck * upper arms * upper trunk
97
***thoracic*** *spines 1-12* innervate which part of the body?
* anterior trunk * posterior trunk * intercostal muscles
98
***lumbar*** *spine 1* through ***lumbar*** *spine* 5 innervate which part of the body? | (5)
* lower trunk * bladder * rectum * sexual organs * legs
99
what is *stage 1* of ***spinal cord injuries***? | (5)
* flaccid paralysis * loss of sensation * spinal shock syndrome * edema * autonomic dysreflexia
100
what happens duing *stage 2* of a ***spinal cord injury***?
* autonomic dysreflexia * spinal reflex activity returns
101
what are the diagnostic tests for ***spinal cord injuries***?
* check sensation along dermatomes * CT * MRI
102
what is the nursing management for ***spinal cord injuries***? | (6)
* cervical traction * reduce spinal swelling with steroids * immobilize the spine * assess neuro status q1h * rehab
103
what are the ***infectious neuromuscular dysfunctions***?
* Guillain Barre syndrome * Tetanus * Botulism
104
***Guillain Barre syndrome*** usually arises from viral infections & vaccinations as an immune response
true
105
what is the hallmark sign for ***Guillian Barre syndrome***?
*ascending* paralysis
106
which neurotoxin causes ***tetanus***? | "lock jaw"
clostridium tetani
107
how long is the incubation period for *C. tetani*?
3 days - 3 weeks
108
what are the s/s of ***tetanus***?
* risus sardonicus * opisthotonus * muscular rigidity of neck muscles * trismus *(lock jaw)*
109
what is the treatment for children w/ ***tetanus*** who are unimmunized?
* tetanus immune globulin * tetanus toxoid * ABX
110
what is ***botulism***?
serious food poisoning caused by the bacteria *clostridium botulinum* from improperly sterilized food
111
what are the s/s of ***botulism***? | (5)
* blurred vision * dizziness * vomiting * dysphagia * descending paralysis
112
honey is the most common cause for ***botulism***
true

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