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ortho Flashcards

1
Q

Microcephaly - primary - how many weeks

A

Intrauterine exposure to toxins (weeks 4 to 20)

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2
Q

Microcephaly - secondary

A

Third-trimester exposure
Perinatal exposure
Exposure in early infancy

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3
Q

Microcephaly - Effects

(micro is twitchy)

A

Mild hyperkinesis (twitchy), mild motor impairment
Decerebration (apart from brain stem), complete unresponsiveness
Autistic behavior

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4
Q

CRANIOSTENOSIS - Therapeutic Management

(think crane)

A

Surgical excision of bone (strip craniectomy)
Along or parallel to suture
Releases fused suture
Directs new growth

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5
Q

PLAGIOCEPHALY

(plagerism is flat)

A

Skull progressively flattened
Not associated with brain malformation
Treatment
Helmets, bands, time

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6
Q

DEVELOPMENTAL DYSPLASIA 
of the HIP (DDH)

A

Formerly called “congenital hip dysplasia” and “congenital dislocation of the hip”
Incidence 1-10/1000 live births
More common in females (60%)
More common in Caucasians than any other group

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7
Q

Etiology of DDH - classifications

(DDH is ASD)

A

Acetabular (shallow)
Subluxation (partial)
Dislocation

(look at photo in slides)

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8
Q

Clinical Manifestations of DDH - what test?

(dds ortega)

A

Positive Ortolani test (when laying baby on back and open hips)
Audible click when abducting and externally rotating hip

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9
Q

Therapeutic Management of DDH - deepen what?

A

Directed toward enlarging and deepening acetabulum
Place head of femur within acetabulum

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10
Q

Congenital Clubfoot

(soft club)

A

Bone deformity and malposition of foot
Soft tissue contracture
Foot twisted out of alignment
May be misshaped

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11
Q
A
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12
Q

CLUB FOOT - rigid or flexible?

A

Deformity apparent at birth
Classification
Rigid or flexible

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13
Q

Physiologic Effects of Immobility - Muscular system

A

Decreased muscle strength and endurance
Atrophy
Loss of joint mobility
Skeletal system
Bone demineralization
Negative calcium balance

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14
Q

Physiologic Effects of Immobility - Metabolism - what about nitrogen?

A

Decreased metabolic rate
Negative nitrogen balance

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15
Q

Physiologic Effects of Immobility - Cardiovascular system - what about vasopressor?

A

Decreased efficiency of orthostatic neurovascular reflexes
Diminished vasopressor mechanism
Altered distribution of blood volume
Venous stasis
Dependent edema

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16
Q

Physiologic Effects of Immobility - Respiratory system

A

Decreased need for oxygen
Diminished vital capacity
Poor abdominal tone and distention
Mechanical or biochemical secretion retention
Loss of respiratory muscle strength

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17
Q

Physiologic Effects of Immobility - gI - difficulty feeding in what position?

A

Distention caused by poor abdominal muscle tone
Difficulty feeding in prone position
Gravitation effect on feces
Anorexia

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18
Q

Physiologic Effects of Immobility - Urinary system

A

Alteration of gravitational force
Difficulty voiding in supine position
Urinary retention
Impaired ureteral peristalsis

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19
Q

Physiologic Effects of Immobility - Loss of innervation

A

If nerve tissue is damaged by pressure
If circulation to nerve tissue is interrupted
Effects of improper positioning
Sensory and perceptual deprivation

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20
Q

EPIPHYSEAL INJURIES- what is special about it?

A

Epiphysis
Growth end of long bones
Growing cartilage
Growth plate located in the epiphysis
Weakest point of long bones
Frequent site of damage during trauma
May affect future bone growth
Treatment may include open reduction and internal fixation to prevent growth disturbances

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21
Q

FRACTURES - from what for school age kids?

A

Common injury in children
Clavicle most frequently broken bone in child, especially younger than age 10
School age—bike, sports injuries
Methods of treatment different in pediatrics than in older adult population

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22
Q

Types of Fractures - compound

(compounded to the outside)

A

Compound or open
fractured bone protrudes through the skin

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23
Q

Immediate Interventions - fracture

A

Immobilize
Assess circulation
Apply cool/cold compress
Elevate limb ( keep in alignment)
Sterile/clean dressing over open wound

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24
Q

External Fixation

A

Ilizarov external fixator
The induction of new bone between bone surfaces that are pulled apart in a gradual, controlled manner
Permits limb lengthening by manual distraction
Stimulates new bone formation

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25
Bone Healing - how long for the 4 different groups? (heal in 2 - 12 weeks)
Typically rapid healing in children Neonatal period—2 to 3 weeks Early childhood—4 weeks Later childhood—6 to 8 weeks Adolescence—8 to 12 weeks
26
THE CHILD in TRACTION
Traction—extended pulling force may be used to Provide rest for an extremity Help prevent or improve contracture deformity Correct a deformity Treat a dislocation Allow position and alignment Provide immobilization Reduce muscle spasms (rare in children)
27
Traction- Essential Components
Traction—forward force produced by attaching weight to distal bone fragment Adjust by adding or subtracting weights Countertraction—backward force provided by body weight Increase by elevating foot of bed Frictional force—provided by patient’s contact with the bed
28
Types of Traction
Manual traction applied to the body part by the hand placed distally to the fracture site Skin traction pulling mechanisms are attached to the skin with adhesive material or elastic bandage Skeletal traction applied directly to skeletal structure by pin, wire, or tongs Inserted into or through the diameter of the bone distal to the fracture
29
Cervical Traction
Crutchfield or Barton tongs Inserted through burr holes in skull with weights attached to the hyperextended head As neck muscles fatigue, vertebral bodies gradually separate so the spinal cord is no longer pinched between vertebrae Halo traction can be applied in some cases
30
Therapeutic Management of Soft Tissue Injuries - what type of elastic bandage?
RICE Rest the injured part Ice immediately (max 30 minutes at a time) Compression with wet elastic bandage Elevation of the extremity ICES- Ice, Compression, Elevation, Support Immobilization and support (casts or splints as appropriate to injury)
31
MUSCULOSKELETAL COMPLICATIONS
Circulatory impairment Nerve compression syndromes Compartment syndromes Volkmann contracture (a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm) Epiphyseal damage Nonunion/malunion Infection Kidney stones Pulmonary emboli
32
COMPARTMENT SYNDROME
Pressure within the muscles builds to dangerous levels (from swelling or bleeding) Decreases blood flow Prevents nourishment and oxygen from reaching nerve and muscle cells Causes cell damage and death Acute or chronic More painful than would be expected Not relieved by pain meds
33
Clinical Manifestations of Osteomyelitis - where is the pain?
Localized Pain - pain will be in a specific spot Swelling at site Warm at site Redness at site Pain upon weight bearing
34
Osteomyelitis Diagnosis - is it slow or fast onset?
Signs and symptoms begin abruptly; resemble symptoms of arthritis and leukemia
35
Therapeutic Management of Osteomyelitis - and how long?
May have subacute presentation with walled-off abscess rather than a spreading infection Prompt, vigorous IV antibiotics for extended period (3 to 4 weeks or up to several months) Monitor hematologic, renal, hepatic responses to treatment
36
SCOLIOSIS
The most common spinal deformity
37
SCOLIOSIS - Clinical Manifestations - when does pain occur? (2 times) (scoly active)
Insidious onset May have history of limp Soreness or stiffness Limited ROM Vague history of trauma Pain and limp most evident on arising and at end of activity Diagnosed by x-ray
38
SCOLIOSIS - Therapeutic Management - how many hours a day to wear the brace?
Team approach to treatment Bracing Must be worn 23 hrs/day Exercise Surgical intervention for severe curvature (various systems of instrumentation and fusion)
39
SCOLIOSIS - Nursing Interventions
Maintain spinal alignment per protocol Provide care when wearing brace Examine skin surfaces where contact with brace Implement corrective action for skin breakdown Help select appropriate apparel to wear over brace to minimize altered appearance Encourage wearing low-heeled shoes for balance Reinforce instructions regarding plan of care Use of appliance Activities Prepare for surgery when appropriate
40
JUVENILE IDIOPATHIC ARTHRITIS (JIA) - what type of disease is it?
Formerly called JRA (juvenile rheumatoid arthritis) Chronic autoimmune inflammatory disease
41
JUVENILE IDIOPATHIC ARTHRITIS - what about RA factor?
90% children have negative rheumatoid factor
42
Symptoms of JIA
Pain Stiffness Swelling Loss of motion in affected joints
43
Diagnostic Evaluation of JIA - what is elevated? (JIA has ESP)
No specific diagnostic tests Elevated ESR and CRP Rheumatoid factor and Antinuclear antibodies may be + Leukocytosis during exacerbations
44
American College of Rheumatology Diagnostic Criteria - JIA (4 things) (JIA is 16 and 6)
Age of onset younger than 16 years One or more affected joints Duration of arthritis more than 6 weeks Exclusion of other forms of arthritis
45
Therapeutic Management of JIA
No specific cure Goals of therapy Preserve function Prevent deformities Relieve symptoms Iridocyclitis/uveitis Inflammation of iris and ciliary body Unique to JRA Requires treatment by ophthalmologist
46
Pharmacology for JIA (Sarry for JIA)
NSAIDs (Nonsteroidal anti-inflammatory drug) SAARDs (Slow-acting anti-rheumatic drug) Used when first-line therapy (NSAIDs), fails to control disease Corticosteroids Cytotoxic agents - methotrexate Immunomodulators
47
Management of JIA
Therapy individualized to child PT, OT Nutrition Exercise Splinting devices Pain management Prognosis
48
injuries at 12 (knee at 12)
overuse injuries, knee
49
injuries at 17
MVA,
50
what age for a craniectomy
Before 6 mo old Best cosmetic and neurodevelopmental results
51
nursing interventions - JIA - warm or cold compresses?
Emphasize medication protocol Promote functional alignment Encourage warm baths or warm moist compresses Offer nutritious diet Promote adequate rest and sleep Provide emotional support
52
DDH - another test (Dentist Barlow)
Barlow maneuver (guiding the hips into mild adduction and applying a slight forward pressure with the thumb)
53
DDH - limbs?
Shortening of limb (femur) on affected side
54
DDH - what about the thighs?
Asymmetric gluteal, popliteal, and thigh folds Broadening of the perineum
55
DDH - limited what? (DDH gets abducted)
Limited abduction of hip on affected side Waddling gait and lordosis
56
DDH - in older infant and children (older children are pistols)
Affected leg shorter than the other Telescoping or piston mobility of joint
57
DDH - in older infant and children - trendeleburg?
Positive trendelenburg sign- when hip swings down when walking (weak gluteal muscles) Greater trochanter is prominent and appears above a line from anterior superior iliac spine to tuberosity of ischium Marked lordosis if bilateral dislocations Waddling gait if bilateral dislocations
58
DDH - management - pressure?
Apply constant pressure Legs slightly flexed and abducted Splinting Spica cast Pavlik harness Surgical intervention ORIF with casting Age variations Newborn to 6 months 6 to 18 months Older child
59
club foot - Talipes equinovarus (TEV) (horse pointing down)
Talipes equinovarus (TEV) Toes pointed downward and inward
60
club foot - more common in who? (men club)
More common in males Bilateral clubfeet in 50% of cases Familial tendency
61
club foot - mild (mild position)
Mild (positional)
62
club foot - Syndromic (the syndrome is elsewhere)
Syndromic (associated with other congenital abnormalities) Congenital Wide range of prognosis Usually requires surgical intervention
63
immobility and metabolism - what about calcium? (calcium builds up)
Hypercalcemia
64
immobility and metabolism - what about hormones? what type of hormones?
Decreased production of stress hormones
65
compartment syndrome - what is a sign?
when pain is so bad it won't go away
66
Osteomyelitis - will prob need
a pic line. will be immobile on that leg.
67
scoliosis - what age?
7th (girl) or 8th grade (boy)
68
fracture - Complicated (complicated bone fragments)
Complicated bone fragments have damaged other organs or tissues
69
fracture - Comminuted (comminuted not commuting)
Comminuted small fragments of bone are broken from the fractured shaft and lie in surrounding tissue
70
fracture -Greenstick (incomplete greenstick)
Greenstick compressed side of bone bends, but tension side of bone breaks, causing incomplete fracture
71
osteomylitis - what blood marker is elevated?
Marked leukocytosis Bone cultures obtained from biopsy or aspirate Early x-rays may appear normal Bone scans for diagnosis
72
scoleosis - Complex spinal deformity in three planes (lst complex scoleosis)
Lateral curvature Spinal rotation causing rib asymmetry Thoracic hypokyphosis May be congenital or develop during childhood
73
Lordosis
Accentuation of the cervical or lumbar curvature beyond physiologic limits (swayback)
74
Kyphosis
Abnormally increased convex angulation in the curvature of the thoracic spine (round shoulders or hunched shoulders)
75
JIA - peak ages
Affects joints and other tissue Peak ages: 1-3 years and 8-10 years
76
JIA - which gender? (Ja female)
Female predominance 2:1 Often undiagnosed Actually a heterogeneous group of diseases
77
JIA - Pauciarticular onset (particular at 4)
involves ≤4 joints
78
JIA - Polyarticular onset (Poly is 5)
involves ≥5 joints
79
JIA - systemic symptoms - serious
Systemic onset (high fever, rash, hepatosplenomegaly, pericarditis, pleuritis, lymphadenopathy)
80
JIA - are they active?
Symptoms may “burn out” and become inactive \
81
JIA - inflammation of what?
Chronic inflammation of synovium with joint effusion Destruction of cartilage Scar tissue Limits range of motion
82
JIA - does it affect growth?
Alters growth
83
JIA - when is the pain most common? (Ja can't exercise)
Most common in morning and after inactivity
84
JIA - is there erythema?
Warm to touch, usually without erythema Tender to touch in some cases
85
JIA - does stress make it worse?
Symptoms increase with stressors

XIO (400 decks)

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