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neuromuscular musculoskeletal disorder Flashcards

Exam 3 (102 cards)

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1
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

When does motor development begin? How does it develop?

A

Motor development begins at birth and proceeds in predictable sequence.

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2
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

How is range of motion at birth?

A

Full range of motion is present at birth.

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3
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

How is a child’s spinal cord compared to an adult?

A

The child’s spinal cord is more mobile than the adult.

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4
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

When is myelinization complete?

A

Myelinization is not complete until 2 years of age.

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5
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems

What is ossification? When does this occur? When is it complete?

A

Ossification is when the cartilage turns to bone.

This occurs throughout childhood and is complete by adolescence.

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6
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

Where does growth of bones occur?

A

Growth of bones occurs primarily at specialized growth plates at the end of the long bones.

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7
Q

Anatomic Differences in Children versus Adults Related to NM and MS Systems:

How are children’s bones compared to adults?

A

Children’s bones are more vascular and tend to heal faster than adults.

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8
Q

Eliciting History of Present Neurologic Disorder

A

Changes in gait, any “clumsiness”

Activity level compared to peers

Recent trauma

Poor feeding

Lethargy

Fever

Weakness

Alteration in muscle tone - Hypo and hypertonia are abnormal signs

History of developmental milestones

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9
Q

Physical assessment:

Inspection and observation?

A

Motor function.
Reflexes.
Sensory function.

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10
Q

Physical assessment:

Palpation

A

Muscle strength and tone.

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11
Q

Physical assessment

Auscultation

A

Lungs for adventitious sounds.

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12
Q

Laboratory and Diagnostic Tests for NM and MS Disorders

A

CBC, creatine kinase

Radiographs

Fluoroscopy, arthrography

Myelography, electromyography (EMG),

muscle biopsy

Nerve conduction testing

CT, MRI, ultrasound

Genetic testing

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13
Q

Types of Neuromuscular or Musculoskeletal Disorders:

A

Congenital

Acquired

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14
Q

Types of Neuromuscular or Musculoskeletal Disorders:

Congenital: What is it? When does it develop?

A

Structural abnormality.

Genetic abnormality (may develop later in life).

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15
Q

Types of Neuromuscular or Musculoskeletal Disorders

Acquired: How?

A

Trauma, any hypoxia to the brain or spinal cord.

Autoimmune, bacterial or viral infections.

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16
Q

Types of Neuromuscular or Musculoskeletal Disorders:

What can Congenital and Acquired result in?

A

Each can result in neuromuscular or musculoskeletal dysfunction.

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17
Q

Positional alterations:

How are infants hips normally?

What is it called?

A

Infants hips are usually flexed, abducted, and externally rotated, with the knees flexed and lower limbs internally rotated. This is a normal developmental variation termed internal tibial torsion.

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18
Q

Positional alterations:

What is the term for bowlegged?

A

Genu varum: bowlegged

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19
Q

Positional alterations:

What happens to ITT and varum as a child gets older? What can develop instead? When does that resolve?

A

As ITT and varum resolve as child gets older, Genu valgum, or knock knees can happen by age 2-3. Should resolve by 7-8 years old.

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20
Q

Congenital/Developmental Neuromuscular and Musculoskeletal Disorders

A

Neural tube defects

Structural disorders of the skeleton

Developmental dysplasia of the hip

Torticollis

Tibia vara

Genetic disorders

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21
Q

Congenital/Developmental Neuromuscular and Musculoskeletal Disorders:

Neural tube defects including

A

Spina bifida occulta

Meningocele

Myelomeningocele

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22
Q

Congenital/Developmental Neuromuscular and Musculoskeletal Disorders

Structural disorders of the skeleton

A

Pectus excavatum and carinatum,

limb deficiencies,

polydactyly/syndactyly,

metatarsus adductus)

Congenital club foot

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23
Q

Congenital/Developmental Neuromuscular and Musculoskeletal Disorders

Genetic disorders

A

Osteogenesis imperfecta

Various types of muscular dystrophy

Spinal muscular atrophy

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24
Q

Osteogenesis Imperfecta: What is it?

A

Brittle bone disease

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25
Osteogenesis Imperfecta: What are signs and symptoms?
Lax joints Small, weak muscles
26
Osteogenesis Imperfecta: Diagnosis?
Clinical symptoms and level of disability Radiographic studies
27
Osteogenesis Imperfecta: Nursing care- What should you teach parents?
Teach parents to watch for signs of fractures (irritability, fever, and refusal to eat)
28
Osteogenesis Imperfecta: Nursing care continued:
Olpadronate (bone-resorption inhibitor) therapy Bisphosphonates Postoperative care
29
Osteogenesis Imperfecta: Education/discharge instructions
Play and physical therapy ROM Ambulatory devices Genetic counseling Protect child while allowing as normal a life as possible
30
Osteogenesis Imperfecta: What is the hallmark sign?
Blue eyes- blue sclera
31
Muscular Dystrophy: What is it?
General term for a group of inherited types of neuromuscular disorders that affect voluntary muscles.
32
Muscular Dystrophy: How do symptoms appear?
Symptoms not always evident at birth; may manifest later in childhood.
33
Muscular Dystrophy: How is lifespan?
May limit life span due to compromised ability to adequately support ventilation.
34
Nursing Management Goals for a Child With Muscular Dystrophy:
Promoting mobility Managing elimination Maintaining cardiopulmonary function Preventing complications and maximizing quality of life
35
Nursing Management Goals for a Child With Muscular Dystrophy: Promoting mobility- What should be done?
Administering medications Performing passive stretching and strengthening exercises
36
Nursing Management Goals for a Child With Muscular Dystrophy Maintaining cardiopulmonary function: How?
Teaching deep breathing exercises Performing chest physical therapy
37
Nursing Management Goals for a Child With Muscular Dystrophy Preventing complications and maximizing quality of life: How?
Developing a diversional schedule Providing emotional support
38
Duchenne's Muscular Dystrophy: What is it?
Progressive weakness and wasting of muscles
39
Duchenne's Muscular Dystrophy: When is onset? Who is it in mainly?
Onset 3-5 years old Primarily males
40
Duchenne's Muscular Dystrophy: What is a major sign of this disorder?
Gower's sign
41
Slide 12
42
Acquired Neuromuscular and Musculoskeletal Disorders: What are examples?
Rickets, Slipped capital femoral epiphysis (SCFE), Legg–Calvé–Perthes disease, transient synovitis of the hip Scoliosis Injuries
43
Acquired Neuromuscular and Musculoskeletal Disorders: What are examples of injuries?
Spinal cord injury Birth trauma Fractures, strains/sprains, overuse syndromes, and dislocated radial head. Trauma or unintentional injury is the leading cause of childhood morbidity and mortality
44
Acquired neuromuscular disorders include:
Cerebral palsy. Spinal cord injury. Infections such as botulism toxicity. Stroke or intraventricular hemorrhage. Viral or bacterial infections of CNS. Post-viral syndromes such as Guillian–Barré. Neurologic compromise due to compartment syndrome. Autoimmune disorders.
45
Cerebral palsy: What is it?
A term used to describe a range of nonspecific symptoms.
46
What is the most common motor disorder in childhood? How is it lifelong?
Cerebral palsy Most common motor disorder in childhood; lifelong impairment.
47
Cerebral palsy: Who is it a higher incidence in?
Incidence is higher in premature and low birth-weight infants.
48
Cerebral palsy: Signs and symptoms?
Motor impairments including abnormal motor patterns including spasticity, muscle weakness, and ataxia; abnormal brain function is not progressive.
49
Cerebral palsy: What are complications?
Mental impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus.
50
Slide 16
51
Scoliosis: What is it?
Lateral curvature of the spine >10 degrees. Non-painful lateral curvature of the spine
52
Scoliosis: What are signs and symptoms?
Unequal shoulder heights Scapular prominences and heights
53
Scoliosis: Diagnosis?
Radiography
54
Scoliosis: Why does it occur?
May be congenital, associated with other disorders, or acquired.
55
Scoliosis: Management?
Braces (multiple types based on severity). Surgical repair for severe cases.
56
Other Types of Spinal Curvature
Kyphosis Lordosis
57
Other Types of Spinal Curvature: Kyphosis?
Nonpainful spinal curvature (hunchback)
58
Other Types of Spinal Curvature: Lordosis?
Spinal curvature (swayback)
59
Other Types of Spinal Curvature: Nursing Care
Similar to that for the child with scoliosis
60
Legg-Calvé-Perthes Disease: How does it start?
Legg-Calvé-Perthes disease starts with an interrupted blood supply to the femoral head
61
Legg-Calvé-Perthes Disease: Signs and symptoms?
Hip or knee soreness or stiffness Pain that increases with activity and decreases with rest Painful limp
62
Legg-Calvé-Perthes Disease: Diagnosis?
Radiograph establishes initial diagnosis
63
Legg-Calvé-Perthes Disease: Nursing care
Obtain history, pain description by child; assess ROM Non–weight bearing using brace Assess skin for breakdown Bedrest Manage pain After surgery, hip-spica cast is required
64
Legg-Calvé-Perthes Disease: Nursing care- What is required after surgery?
After surgery, hip-spica cast is required
65
Legg-Calvé-Perthes Disease: Education/discharge instructions
Avoid weight-bearing activities; mobility restrictions maintained ROM Emotional support and diversional activities
66
Slipped Femoral Capital Epiphysis: What is it?
Capital femoral epiphysis (top of femur) slips through epiphysis (growth plate) in a posterior direction
67
Slipped Femoral Capital Epiphysis: What are signs and symptoms?
Pain in groin or referred pain to thigh or knee Pain during internal rotation of hip
68
Slipped Femoral Capital Epiphysis: What is a diagnosis
Radiographic studies
69
Slipped Femoral Capital Epiphysis: Nursing care
No weight bearing permitted Prevent further slippage Bed rest with child in traction Russell’s traction used before surgery Surgery (pinning)
70
Slipped Femoral Capital Epiphysis: Nursing care for surgery (pinning)
Pain management Monitor neurovascular status Crutch walking
71
Fractures
Bone undergoes more stress than it can absorb
72
Fractures: Signs and symptoms
Location and description of fracture Described in terms of amount of injury
73
Fractures: Diagnosis
Radiograph CT scans, MRI, fluoroscopy, myelography
74
Fractures: Nursing care
Obtain history Prevent complications Closed reduction Open reduction (surgery)
75
Fractures: Nursing care for closed reduction
Frequent checks to assess for pain, numbness, or tingling Frequent neurovascular assessments
76
Fractures: Nursing care for Open reduction (surgery)
Assess wound Prevent infection Manage pain Increase fluid and fiber intake Provide emotional support
77
Soft Tissue Injuries (Sprains and Strains): What are signs and symptoms?
Sprain (Pain, swelling) Strain (Pain, limited motion)
78
Soft Tissue Injuries (Sprains and Strains): What are signs and symptoms with Sprain?
Pain Swelling
79
Soft Tissue Injuries (Sprains and Strains): What are signs and symptoms with Strain?
Pain Limited motion
80
Soft Tissue Injuries (Sprains and Strains): What are Diagnosis?
History and physical examination
81
Soft Tissue Injuries (Sprains and Strains): Nursing Care:
RICE = rest, ice, compression and elevation Immobilization of the joint
82
Soft Tissue Injuries (Sprains and Strains): Education/discharge instructions
Teach the proper technique for wrapping the affected joint Physical activity restrictions
83
Sports Injuries: How do they occur?
Occur as a result of competitive and solitary sports
84
Sports Injuries: Signs and symptoms?
Ruptured or torn anterior cruciate ligament causes: Instability and pain in knee In elbow injury: Pain and tenderness Loss of full extension of elbow
85
Sports Injuries: Signs and symptoms of Ruptured or torn anterior cruciate ligament causes what?
Instability and pain in knee
86
Sports Injuries: Signs and symptoms of in elbow injury?
Pain and tenderness Loss of full extension of elbow
87
Sports Injuries: Diagnosis?
X-ray exam followed by MRI
88
Sports Injuries: Nursing care
Rest, immobilization, ice Topical anesthetic Cast Leg immobilizer Anti-inflammatory agent
89
Sports Injuries: Education/discharge instructions
Teach family how to perform neurovascular assessment Care of suture line Instruct how to care for immobilizer Elevate extremity
90
Casts: What are they used for?
Casts are used to immobilize a bone that has been injured or a diseased joint.
91
Casts: What should be done?
Preapplication teaching Neurovascular assessment Facilitate drying of cast Elevate affected extremity Promote good fluid intake and high-fiber diet Prevent itching Teach about cast removal
92
Casts: What are cast complications?
Compartment syndrome Cast syndrome
93
Casts: Cast complications: Compartment syndrome?
(accumulation of fluid in the fascia)
94
Casts: Cast complications: Cast syndrome?
(portion of duodenum compressed between superior and mesenteric artery and aorta)
95
Cast Complications: Compartment Syndrome- What are two assessments done for this?
Neurovascular assessment Assess for “5 Ps”
96
Cast Complications: Compartment Syndrome- What are the 5 P's to assess for?
Pain unrelieved by narcotics Pallor Paralysis Paresthesia Pulselessness
97
Cast Complications: Compartment Syndrome- What can help alleviate risk of compartment syndrome?
Application of ice and elevation of affected extremity can help to alleviate risk of compartment syndrome
98
Traction: What is it?
Another method of immobilization
99
Traction: What can it be used for?
Can be used to reduce and/or immobilize, align an injured extremity, allow the extremity to be restored to its normal length.
100
Traction: What else can it reduce? How?
May also reduce pain by decreasing muscle spasm
101
Spinal cord injury signs/symptoms
Inability to move or feel extremities Numbness Tingling Weakness Loss of voluntary movement below the level of the lesion Inability to breathe, if injury is at a high cervical vertebra
102
Teaching Topics to Prevent Spinal Cord Injury
Vehicular safety. Seat belt and age-appropriate safety seat use. Bicycle, sports, and recreation safety. Prevention of falls. Violence prevention, including gun safety. Water safety, including the risk of diving.

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