Flashcards in Musculoskeletal Disorders Deck (53):
What is the most severe and common type of muscular dystrophy?
Duchenne muscular dystrophy
What is absent in the muscle of children with Duchenne Muscular Dystrophy?
What is Dystrophin?
A protein product in skeletal muscle that helps the muscles contract and stay toned.
What is pseudohypertrophy?
Muscular englargement caused by fatty infiltration.
What occurs as DMD progresses?
When do symptoms of DMD generally occur age wise?
What is the progression of DMD?
Weakness to abnormal gait to paralysis
What generally happens by 12 years old to patients with DMD?
They can be wheelchair or bed bound because they have contractures and deformities of small and large joints.
What are some clinical manifestations of DMD?
Waddling, Lordosis, faling, gower sign, pseudohypertrophy, atrophy in later stages, cognitive impairment, contractures, obesity
What is the prognosis of DMD?
Death from respiratory tract infection or cardiac failure- very difficult diagnosis
How is DMD diagnosed?
by blood polymerase chain reaction for dystrophin gene mutation, EMG, and CPK levels, and muscle biopsys
How can DMD be diagnosed prenatally?
If another child has had this problem it can be Dx-ed at 12 weeks
What is an EMG test?
electromyography- painful test that tests for muscle activity in each muscle.
Why are CPK levels high in DMD patients in the first two years of life?
because as the muscle is damages, it elevates CPK
What is the treatment of DMD?
Corticosteroids, PT, Respiratory therapy, bracing, surgery
What are some nursing care techniques with DMD patients?
Supportive care to PT and family, Assess systems, promote self care, educate, provide resources.
What is Osteogenesis Imperfecta (OI)?
Brittle bone disease- an autosomal dominate disease with 6 types.
What are the 6 types of OI?
Mild, lethal, severe, mild to moderate, similar to IV, DX by bone biopsy
What are clinical manifestations of OI?
Increase fractures, fractures at birth, deformities, small stature, blue sclerae, decrease hearing
What is the treatment for OI?
Supportive; light weight braces, rehab therapy, surgery to correct fractures, biophosphate therapy to promote bone density
What is the nursing care for OI?
Be careful and treat fragily, educate parents.
What is Legg-Calve Perthes Disease?
Aseptic necrosis of the femoral head because it is depleted of vascularization.
When does legg-calve perthes disease affect children age wise?
What are the 4 stages of legg-calves perthes disease?
Necrosis, revascularization, re-ossification, regenerative
What are clinical manifestations of legg-calves perthes disease?
hip pain, soreness, stiffness, limp, symptoms worsen in morning and night, decrease ROM
What can you see on an X-ray or MRI of a patient with legg-calves perthes disease?
What is the goal of treatment for legg-calves perthes disease?
to restore ROM, decrease pain, prevent epiphyseal collapse, decrease necrosis
How is legg-calves perthes disease treated?
abductor casts (hips apart), brace, traction, surgery to put head back in socket if neccessary
What is the prognosis of Legg-Calves Perthes disease?
Depends if there is an early diagnosis and interventions
What is compartmental syndrome?
When the tissue around a cast swells because the cast is too tight- look for cold, white extremities
What is Slipped Capital Femoral Epiphysis (SCFE)?
Spontaneous displacement of the proximal femoral epiphysis- head of femur slips out
What is SCFE associated with?
accelerated bone growth and obesity.
What is the etiology of SCFE?
Endocrine disorders, renal osteodystrophy, and radiotherapy.
What are clinical manifestations of SCFE?
Limping on the affected side, pain, decreased ROM, shortening of LE
How is SCFE diagnosed?
Clinical symptoms and confirmed with X-ray
How is SCFE treated?
Non-weight bearing (crutches/wheelchair), bedrest with traction, surgery.
What are some complications of SCFE?
Avascular necrosis- breakdown of bones, and Chondrolysis- joint is lost
What is scoliosis?
Complex spinal deformities with a lateral curvature, spinal rotation that leads to rib asymmetry, and thoracic hypokyphosis.
What are the age classifications for scoliosis?
Congenital, infantile, juvenile, adolescent.
What are some clinical manifestations of scoliosis?
Adams test, scoliometer, Risser scale, tanner maturity rating
What is the Adams test for scoliosis?
Bending over and lookingat the shoulders and hips.
What is a scoliometer?
Looking at trunkal rotation.
What is an X-ray with Cobb Technique?
An X ray looking at the degree of curvature.
What is the Risser Scale with scoliosis?
Looking at how fast the child is growing
What is the tanner maturity scale with scoliosis?
Looking at the progression of the curvature.
What are some nursing assessments for scoliosis?
Assess asymmetry between shoulders and hip alignment, Adams test, accurate height measurements
What degree of scoliosis is not threatening?
less than 10
Which degree of scoliosis indicates mild scoliosis?
20 degrees or less
Which degree of scoliosis indicates a progressive scoliosis that needs intervention?
greater than 30
Which degree of scoliosis indicates a need for surgical intervention?
What is the goal of surgical intervention in scoliosis?
To realign and straighten the spine through internal fixation and instrumentation, also to stabilize through spinal fusion.
What is pre-op care for scoliosis patients?
Teach, labs, Xrays, marking, degrees