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Mat-Child Nursing > objective 10.3 > Flashcards

objective 10.3 Flashcards

1
Q

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

A

fundamental principles

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2
Q

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

A

toddler

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3
Q

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

A

18 months

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4
Q

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

A

4 years

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5
Q

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

A

6 years

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6
Q

how do we assess the childs gait?

A

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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7
Q

how do we assess newborn/infant?

A

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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8
Q

what are the signs of problems?

A

Pain
Tenderness
Discoloration
Edema
Pulses
Deformity

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9
Q

what are the musculoskeletal conditions?

A

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

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10
Q
  • Contusion, Sprain, Strain
    Soft tissue injuries should be treated immediately
    to limit damage from edema & bleeding
A

soft-tissue injuries

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11
Q

what is the nsg care of soft-tissue injuries?

A

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

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12
Q

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

A

fractures

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13
Q

bone broken, skin not

A

closed fracture

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14
Q

broken bone & skin

A

open/compound fracture

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15
Q

incomplete fracture, one side broken-other bent

A

greenstick fracture

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16
Q

broken bone with several bone fragments at the fracture site

A

comminuted fracture

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17
Q

caused by twisting motion

A

spiral fracture

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18
Q

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

A

epiphyseal plate

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19
Q

what are pathological fratures caused by?

A

Malignancy ex. Osteosarcoma
Treatment that weakens bones

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20
Q

what are the goals in treating fractures?

A
  1. Reduce stress on healing bone (bedrest, nonweight
    bearing movement)
  2. Align bone so as it heals it can resume its natural anatomy
  3. Reduce risks of complications (thrombosis, contracture,
    infection)
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21
Q

what are the invasive treatments of fractures?

A

surgery with or without pins, rods, or screws

22
Q

what are the non invasive treatment of fractures?

A

cast, traction

23
Q

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

A

casts

24
Q

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

A

compartment syndrome

25
Q

what are the 6 Ps?

A

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

26
Q

 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

A

traction

27
Q

what are the types of traction determined by?

A

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

28
Q

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

A

skin traction

29
Q

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

A

skeletal traction

30
Q

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

A

bryant’s traction

31
Q

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

A

bucks skin traction

32
Q

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

A

russell traction

33
Q

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.

A

halo traction

34
Q

what is the checklist for traction>

A

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

35
Q

what is the checklist for the pt in traction>

A

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

36
Q

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.

A

club foot

37
Q

what is the treatment and nursing care of club foot?

A

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

38
Q

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

A

developmental hip dysplasia

39
Q

what are the S&S of developmental hip dysplasia?

A

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

40
Q

what is the treatment of hip dysplasia?

A

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

41
Q

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)

A

legg-calve perthes disease

42
Q

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

A

juvenile idiopathic arthritis

43
Q

what is the treatment of juvenile idiopathic arthritis?

A

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

44
Q

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)

A

osteomyelitis

45
Q

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

A

abnormal spine curvatures

46
Q

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

A

scoliosis

47
Q

what are the 3 types of scoliosis?

A

functional
structural
idiopathic curve

48
Q

caused by poor posture

A

functional

49
Q

caused by changes in the shape of vertebrae or thorax

A

structural

50
Q

at least 10 degrees, cause unknown

A

idiopathic-curve

51
Q

what is the treatment of scoliosis?

A

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

52
Q

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

A

milwaukee brace

Mat-Child Nursing (23 decks)

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