Musculoskeletal / Neuro

Question 1

What clinical tests of movement are used to assess for DDH? (2)

Answer 1

• Barlow maneuver
• Ortolani maneuver

Question 2

How is DDH treated at 3 - 6 months old?

Answer 2

Pavlik harness

Question 3

Describe the education associated with a pavlik harness (7)

Answer 3

• Wear 24 hours per day
• Place diaper under straps
• Use cotton onesies / socks
• Dry thoroughly under straps
• Massage skin under straps daily
• DO NOT apply lotions / powders
• DO NOT swaddle

Question 4

What are the manifestations of clubfoot? (3)

Answer 4

• Rigid foot pointed downward / inward
• Shortened achilles tendon
• Atrophic calf muscle

Question 5

When is clubfoot diagnosed?

Answer 5

At birth

Question 6

When is treatment of clubfoot started?

Answer 6

As soon as possible after birth

Question 7

How is clubfoot treated?

Answer 7

Ponseti method of serial casting

Question 8

Describe the ponseti method of serial casting

Answer 8

Process of manual manipulation of the foot, cast removal, re-manipulation, and re-casting until foot is properly aligned

Question 9

What is scoliosis?

Answer 9

Lateral curvature of the spine with vertebral body rotation

Question 10

Describe the incidence of scoliosis in males vs females (2)

Answer 10

• Higher incidence in males
• Greater curve progression in females

Question 11

When is scoliosis usually diagnosed?

Answer 11

During growth spurt in early adolescence

Question 12

Describe the muscular changes occurring on the concave side of the spine in scoliosis

Answer 12

Muscles become thick and contracted

Question 13

Describe the muscular changes occurring on the convex side of the spine in scoliosis

Answer 13

Muscles become thin and atrophied

Question 14

What are the manifestations of scoliosis? (3)

Answer 14

• Curved spinal column
• Unequal shoulder / hip level
• Prominence of one scapula

Question 15

In a child with scoliosis, when does the rotation of the spine / scapula become more prominent?

Answer 15

When the child bends over

Question 16

What type of scoliosis curve is most common?

Answer 16

Thoracic curve

Question 17

What types of bracing are used for scoliosis? (3)

Answer 17

• Boston brace
• TLSO brace
• Milwaukee brace

Question 18

Describe the nursing considerations associated with the Milwaukee brace (2)

Answer 18

• Most invasive
• Unable to conceal with clothing - impact on self-image

Question 19

How long should scoliosis braces be worn each day?

Answer 19

16 - 23 hours

Question 20

What is the treatment for a scoliosis curve > 40 degrees?

Answer 20

Surgery - Harrington rods

Question 21

Describe the post-op nursing interventions associated with scoliosis (2)

Answer 21

• Log roll to maintain spinal alignment
• DO NOT elevate HOB

Question 22

Describe the pathophysiology of muscular dystrophy

Answer 22

Absence of dystrophin causes degeneration / wasting of skeletal (voluntary) muscles

Question 23

What laboratory finding is associated with diagnosis of muscular dystrophy?

Answer 23

Elevated CK enzymes

Question 24

What are the manifestations of muscular dystrophy? (3)

Answer 24

• Gower sign
• Pseudohypertrophy
• Muscle atrophy (later stages)

Question 25

Describe Gower sign

Answer 25

Walking the hands up to the feet in order to stand

Question 26

When does Gower sign typically occur?

Answer 26

5 - 6 years old

Question 27

Describe the prognosis of muscular dystrophy

Answer 27

Death in late teens / early 20s - due to cardiac / respiratory failure

Question 28

What is the goal of muscular dystrophy management?

Answer 28

Maintain function for as long as possible (no cure)

Question 29

Describe the management of muscular dystrophy (4)

Answer 29

- Range-of-motion exercises - Breathing exercises - Bracing - ADL practice

Question 30

Describe education associated with casting (5)

Answer 30

- DO NOT place objects into the cast (for scratching) - DO NOT use lotions / powders - Reposition Q 2 hours - Elevate for first 24 hours - Spica cast - increase fiber / fluid intake (due to immobility)

Question 31

What alternative method can be used to relieve itching under a cast?

Answer 31

Hairdryer blown into the cast on cool setting

Question 32

For what cast findings should the provider be notified? (4)

Answer 32

- Numbness / cyanosis in fingers or toes - Persistent redness - Temperature > 100 - Foul smell

Question 33

What are neural tube defects?

Answer 33

Incomplete closure of vertebrae / neural tube

Question 34

Which type of neural tube defect is most severe?

Answer 34

Myelomeningocele

Question 35

Describe myelomeningocele

Answer 35

Meninges AND spinal cord protrude through an opening in the spine - creates sac of CSF and vertebrae

Question 36

What complications are associated with neural tube defects? (3)

Answer 36

- Urinary stasis - Kyphosis / scoliosis - Lower extremity paralysis

Question 37

What method is used for diagnosis of neural tube defects?

Answer 37

Trans-illumination of meningeal sac

Question 38

Describe the pre-op nursing interventions associated with neural tube defects (2)

Answer 38

- Prone position - Cover sac with sterile dressing

Question 39

In the case of neural tube defects, it is important to monitor for ______

Answer 39

Hydrocephalus - due to impaired CSF flow

Question 40

Which type of meningitis has a higher mortality rate?

Answer 40

Bacterial

Question 41

Petechiae associated with meningitis could indicate ______

Answer 41

Septic shock (bacterial meningitis)

Question 42

What additional manifestations of meningitis may be present in infants? (2)

Answer 42

- Bulging fontanel - High-pitched cry

Question 43

What clinical tests of pain / resistance are used to assess for meningitis? (2)

Answer 43

- Kernig's sign - Brudzinski's sign

Question 44

What CSF analysis findings are associated with bacterial meningitis? (3)

Answer 44

- Low glucose - Elevated WBCs - Elevated protein

Question 45

What type of isolation is needed for bacterial meningitis?

Answer 45

Droplet isolation for 24 - 48 hours after initiation of antibiotic therapy

Question 46

What medication is used for head injury pain management?

Answer 46

Acetaminophen (NOT ibuprofen)

Question 47

Why is ibuprofen not used for head injury?

Answer 47

NSAID - risk of bleeding