objective 10.3 Flashcards by Kaitlyn Dominie

Muscular & Skeletal systems work in harmony
These systems provide support for the body & allow for
body movement
Nervous system plays an important role as it transmits
messages in order for it to be purposeful & rhythmic

fundamental principles

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Begin to walk & have a wide unstable gait
Arms do not swing with walking motion

toddler

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Child’s walk is more stable with narrowing of wide base

18 months

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Child can hop on one foot
Arm swings occur with walking

4 years

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Childs gait resembles adult’s walk with equal stride lengths and
associated arm swing

6 years

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how do we assess the childs gait?

Gait is characteristic manner of walking, The LPN
should observe the child as they engage in their
routine activities in order to assess gait
 Gait disturbances could be caused by
neuromuscular or musculoskeletal disturbances

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how do we assess newborn/infant?

Primarily through observation of:
Symmetry of movement
Strength & contour of body & extremities
Infants usually walk by 12 months; observe curvature of
spine & Active ROM
How would the PN test the strength of an extremity of a
child?

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what are the signs of problems?

Pain
Tenderness
Discoloration
Edema
Pulses
Deformity

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what are the musculoskeletal conditions?

Soft Tissue & Sports Injuries
Fractures
Infections & Osteomyelitis
Clubfoot
Developmental Dysplasia of the hip
Legge-Calve Perthes Disease
Rheumatoid Arthritis
Scoliosis

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Contusion, Sprain, Strain
Soft tissue injuries should be treated immediately
to limit damage from edema & bleeding

soft-tissue injuries

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what is the nsg care of soft-tissue injuries?

Cold pack & elastic wrap will reduce edema &
bleeding, & relieve pain; should be applied at 20
min intervals to prevent ischemia

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a break in a bone and is mainly caused
by accident
Characterized by:
Pain, tenderness on movement, and swelling
Discoloration, limited movement, and numbness may also
occur
Can be due to Pathology, Trauma or Abuse

fractures

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bone broken, skin not

closed fracture

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broken bone & skin

open/compound fracture

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incomplete fracture, one side broken-other bent

greenstick fracture

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broken bone with several bone fragments at the fracture site

comminuted fracture

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caused by twisting motion

spiral fracture

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The area of growing tissue in the long bones of children &
Adolescents
Each long bone has at least 2 growth plates (One at each end)
Growth Plate determines the future length & shape of the bone
When growth is complete (sometimes during adolescence), the
growth plates close and are replaced by solid bone

epiphyseal plate

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what are pathological fratures caused by?

Malignancy ex. Osteosarcoma
Treatment that weakens bones

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what are the goals in treating fractures?

Reduce stress on healing bone (bedrest, nonweight
bearing movement)
Align bone so as it heals it can resume its natural anatomy
Reduce risks of complications (thrombosis, contracture,
infection)

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what are the invasive treatments of fractures?

surgery with or without pins, rods, or screws

what are the non invasive treatment of fractures?

cast, traction

Can be made from a variety of materials
Child is at increased risk for
Impaired skin integrity
Compartment syndrome

casts

Progressive loss of tissue perfusion
because of an increase in pressure
caused by edema or swelling that presses
on the vessels and tissues
If not carefully monitored, significant
complications can occur

compartment syndrome

what are the 6 Ps?

Pain & tenderness Pulselessness Paraesthesia Pallor or cyanosis Paralysis Pressure & swelling

 is used when cast cannot maintain alignment of the two bone fragments aligns injured bones, immobilization maintained until bones fuse Skin and skeletal traction both involve pulling force to realign bones

traction

what are the types of traction determined by?

Age of child, condition of soft tissue, type & degree of displacement Traction commonly used in fractures of larger bones. Ex. Humerus, Femur, Vertebra

Nonivasive traction used in femur, hip & knees. Pulls Hip and leg into extension. Counter traction supplied by child’s body. Ex. Buck’s, Russel and Bryant’s

skin traction

Client goes into surgery and has pins, wires inserted into bone. Traction applied to the pin Daily cleansing of the pin is ESSENTIAL Ex. Steinmann pin or cervical traction for skull fractures

skeletal traction

Used for the young child who has a fractured femur who are: Less than 2 years old or Lighter than 20-30 lbs. Child’s Weight act as countertraction Note that the buttocks are slightly off the bed to facilitate counter traction Active infants may require a jacket restraint to maintain body alignment

bryant's traction

A type of skin traction used in fractures of the femur and in hip and knee contractures It pulls the hip and leg into extension Counter traction is supplied by the child’s body Essential that the child not slip down in bed Used to reduce pain & muscle spasm associated with slipped capital femoral epiphysis

bucks skin traction

Similar to Buck’s extension traction A sling is positioned under the knee, which suspends the distal thigh above the bed Pulls in two directions

russell traction

Used for cervical fractures and spinal disorders Head & Neck are immobilized while healing takes place Halo traction will almost always be used post neck injury if surgery is not performed immediately after injury If surgery is ruled out then the halo traction will be used for up to two months on bed rest and then a further month to three months attached to specially made vest so the head is kept perfectly still.

halo traction

what is the checklist for traction>

Weights are hanging freely Weights are out of reach of the child Ropes are on the pulleys Bed linens are not on traction ropes Counter traction is in place Apparatus does not touch foot of bed

what is the checklist for the pt in traction>

Body in alignment HOB no higher than 20 degrees Heels of feet elevated from bed ROM of unaffected parts checked at regular intervals Antiembolism stockings or foot pumps in place as ordered Neurovascular checks performed regularly and recorded Skin integrity monitored regularly and recorded Pain relieved by medication is recorded Measures to prevent constipation are provided Use of trapeze for change of position is encouraged

characterized by a foot that’s been twisted inward or outward common, congenital deformity, affecting 1 / 1000 mild forms are often related to intrauterine positioning, and is often corrected with stretching and exercise  cannot be reversed with exercise  Types: TALIPES (‘heel’ & ‘foot’) EQUINOVARUS (‘extension and bent inward’) Accounts for 95% of cases seen. The feet are turned inward & child walks on toes & outer borders of feet usually affects both feet.

club foot

what is the treatment and nursing care of club foot?

must be PROMPT, may involve splinting & casting, passive stretching surgery /post op care (if initial measures have not been successful) CAST CARE assess neurovascular status emotional support

Common orthopedic deformity (80% girls); 1 /1000 births Diagnosed in the first or second month Head of femur partially/completely displaced from shallow hip socket

developmental hip dysplasia

what are the S&S of developmental hip dysplasia?

Limited abduction of leg on affected side Asymmetry of Gluteal folds Shortening of femur; uneven knee height Barlow’s or Ortolani's test Ortolani's sign

what is the treatment of hip dysplasia?

Goal - return femoral head to acetabulum ASAP Maintain hips constant abduction & flexion 4-8 weeks Triple thick Diaper Pavlick harness 1-6 mos age Body spica cast/traction if detected when walking (usually for a period of 5-9 months) Surgery required > 18 months

Blood supply to epiphysis or end of the bone is disrupted May lead to osteonecrosis or femoral head deformity Symptoms include painless limp, limited ROM, thigh & knee pain Occurs in boys between 4-8 yrs Treatment  Keep femoral head in hip socket (ambulation – abduction cast or brace)

legg-calve perthes disease

Most common arthritic condition of childhood Systemic autoimmune inflammatory disease involving joints, connective tissues, and viscera Periods of remissions and exacerbations Cause Unknown- autoimmune No specific tests or cures for JRA

juvenile idiopathic arthritis

what is the treatment of juvenile idiopathic arthritis?

Requires multidisciplinary approach Reduce joint pain and swelling Promote mobility and preserve joint function Promote growth and development Promote independent functioning Help the child and family to adjust to living with a chronic disease NSAID’s, Steroids, heat packs, splints, pool exercises, sleep, alleviate stress, suppor

Infection of bone Median age of 6 years more common in boys than girls After local injury #, burn, contamination during surgery DX: Inc. WBC, x-ray, &/or bone scan S&S: Pain Limping Dec. vol move's Reduced ROM Local inflammation: Inc. WBC & ESR (a measure of inflammation)

osteomyelitis

include: Lordosis, kyphosis, scoliosis Causes: congenital, neuromuscular, weakness, poor posture, idiopathic

abnormal spine curvatures

Abnormal side to side curvature - S-shape More common in girls If untreated it can lead to back pain, disability, heart & lung problems Usually accompanied by rotation of the spine Hips and shoulders may appear to be uneven

scoliosis

what are the 3 types of scoliosis?

functional structural idiopathic curve

caused by poor posture

functional

caused by changes in the shape of vertebrae or thorax

structural

at least 10 degrees, cause unknown

idiopathic-curve

what is the treatment of scoliosis?

Aimed at correcting curvature and preventing severe scoliosis Targets the cause Curves up to 20 degrees do not require treatment Curves 20 to 40 degrees require the use of a Milwaukee brace Curves of 45 degrees and patients in whom conservative therapy was not successful require hospitalization Spinal fusion is performed Halo traction may be used if neck weakness

exerts pressure on chin, pelvis and convex (arched) side of the spine. Worn 16-23 hours per day over a cotton t-shirt

milwaukee brace