Pedi Musculoskeletal Disorders

Question 1

Fractures

Healing

Answer 1

Bone healing and remodeling is faster in children than adults due to thicker periosteum and good blood supply

Question 2

Fractures

Risk Factors

Answer 2

Obesity
poor nutrition
developmental characteristics

Question 3

Fractures

Evidence

Answer 3

radiographic evidence of previous fractures in various stages of healing or in infants may = physical abuse or osteogenesis imperfecta

Question 4

Fractures

Stress

Answer 4

tiny cracks in bone

Question 5

Fractures

Spiral

Answer 5

break spirals around bone

Question 6

Fractures

Greenstick

Answer 6

incomplete fracture of bone

Question 7

Fractures

Plastic deformation (bend)

Answer 7

bone is bent no more than 45 degrees

Question 8

Fractures

Buckle (torus)

Answer 8

compression of bone = bulge or raised area at fracture site

Question 9

Fractures

Transverse

Answer 9

break is straight across bone

Question 10

Fractures

Oblique

Answer 10

break is diagonal across bone

Question 11

Fractures

Growth Plate

Answer 11

injury to end of long bone on growth plate

Question 12

Fractures

Complete

Answer 12

Bone fragments are separated

Question 13

Fractures

Incomplete

Answer 13

Bone fragments are still attached

Question 14

Fractures

Closed or simple

Answer 14

fracture occurs without a break in the skin

Question 15

Fractures

Open of compound

Answer 15

fracture occurs with an open wound and bone protruding

Question 16

Fractures

Complicated fracture

Answer 16

fracture results in injury to other organs and tissues

Question 17

Fractures

Manifestations

Answer 17

Pain
Crepitus
deformity
edema
ecchymosis
warmth or redness

Question 18

Fractures

Diagnostics

Answer 18

X-ray

MRI

Question 19

Fractures

Nursing Care

Answer 19

ABCs
VS, pain, neurological status
Neurovascular status of injured extremity
supine position
stabilize injured area, elevate and apply ice
keep client warm

Question 20

Pain Scales

Answer 20

toddler - FLACC Scale
pre-school - Faces
5 years and older - Numeric pain scale

Question 21

Fractures

Plaster of Paris

Answer 21

heavy, not water resistant, 10-72 hrs to dry

Question 22

Fractures

Synthetic fiberglass

Answer 22

light, water resistant, 5-20 min to dry

Question 23

Fractures

Prior to casting

Answer 23

observe skin for integrity
clean and dry
pad to bony prominences
show procedure on doll/toy

Question 24

Fractures

Casting

Nursing care

Answer 24

assess and monitor neurovascular status
elevate above heart for first 24-48 hr to prevent swelling
ice for first 24 hr
turn and position q2h
support/elevate when sitting
assess for increased warmth or hot spots could indicate infection
monitor for drainage: outline area with a marker and date and time the area
use moleskin over any rough areas that might rub against skin
assist with proper crutch fitting and reinforce proper use

Question 25

Fractures Casting Family Education

Answer 25

When cast is applied it will feel warm but won't burn if pain is sever and not alleviated within 1 hr of pain med admin call MD teach neurovascular checks and when to call MD explain cast removal and cast cutter

Question 26

Traction

Answer 26

selection of traction determined by type of fracture, age of client, associated injuries

Question 27

Traction Skin traction

Answer 27

uses pulling force that is applied by weights Buck, Russell, Bryant Russell - assess child's position, hip flexion must be maintained do not remove boots weights hang freely

Question 28

Traction Skeletal traction

Answer 28

continuous pulling force applied to specific bone pin or rod inserted through bone force applied through use of weights attached by rope allows child to change position without interfering with pull of traction (90/90 traction- femur/tibia) assess pin sites for infection and provide care per facility protocol

Question 29

Traction Halo

Answer 29

cervical traction halo bar encircles head screws inserted into outer table of skull attached to either bed traction or rods secured to a vest assure that wrench is available to release rods attached to vest to do CPR

Question 30

Compartment syndrome

Answer 30

compression of nerves, blood vessels, muscle inside confined space

Question 31

Compartment syndrome Manifestations

Answer 31

increased pain unrelieved with elevation or analgesics intense pain when passively moved paresthesia or numbness pulselessness distal to fracture inability to move digits warm digits with skin that is tight and shiny pallor

Question 32

Compartment syndrome Prevention

Answer 32

loosen constrictive dressing or cut bandage or tape elevate extremity apply ice prepare for fasciotomy

Question 33

Clubfoot

Answer 33

deformity of ankle or foot can affect one or both feet isolated defect or in association with other disorders such as cerebral palsy and spinal bifida

Question 34

Talipes varus

Answer 34

inversion - bending inward

Question 35

Talipes valgus

Answer 35

eversion - bending outward

Question 36

Talipes calcaneous

Answer 36

dorsiflexion - toes are higher than heels

Question 37

Talipes equinus

Answer 37

plantar flexion - toes are lower than heels

Question 38

Talipes equinovarus

Answer 38

toes are facing inward and lower than heel

Question 39

Talipes equinus Sign of

Answer 39

sign of

Question 40

Clubfoot Diagnostic

Answer 40

Prenatal ultrasound

Question 41

Clubfoot Nursing Care

Answer 41

hold and cuddle developmental needs neurovascular and skin integrity perform and teach cast care

Question 42

Clubfoot Therapeutic procedures

Answer 42

Castings | Series of casting starting shortly after birth and continuing until maximum correction

Question 43

Clubfoot Surgical interventions

Answer 43

osteotomy - removing part of bone fusion - fusing two or more bones together tendon lengthening or shortening

Question 44

Developmental Dysplasia of the Hip DDH Manifestations

Answer 44

Infant: asymmetry of gluteal and thigh folds; limited hip abduction; shortening of femur; positive Ortolani test - reduced by abduction; positive Barlow test - dislocated by adduction Child: one leg shorter; positive Trendelenburg sign - bear weight affected side pelvis tilts down toward unaffected sign; walking on toes on one foot; walk with limp

Question 45

DDH Treatment Newborn - 6 mos

Answer 45

Pavlik harness for 12 weeks - check straps every 1-2 weeks; shirt worn under harness Bryant traction - skin traction; for adduction contracture; hips flexed 90degrees with buttock raised Hip spica cast - needs to be changed to accommodate growth; cast on pillows

Question 46

DDH Treatment 6 mos - 2 years

Answer 46

surgical closed reduction with placement of hip spica cast

Question 47

DDH Complications

Answer 47

post-op complications - atelectasis, ileus, infection effects of immobilization - decreased muscle strength, bone demineralization, altered bowel motility effects of casting - skin breakdown, neurovascular alterations

Question 48

Osteogenesis Imperfecta (OI)

Answer 48

disorder of bones resulting in fractures and deformity

Question 49

Osteogenesis Imperfecta (OI) Manifestations

Answer 49

``` multiple bone fractures blue sclera early hearing loss bowed legs and arms kyphosis scoliosis ```

Question 50

Osteogenesis Imperfecta (OI) Medication

Answer 50

pamidronate - increase bone density IV adverse effects: hypokalemia, hypomagnesemia, hypocalcemia, hypophosphatemia, general malaise

Question 51

Scoliosis

Answer 51

deformity of spine and affects ribs curve greater than 10 degrees child bend over observe for asymmetry of ribs and flank

Question 52

Scoliosis Treatments

Answer 52

Bracing Surgical interventions (greater than 45 degrees curvature) - spinal fusion with rods; autologous (self-donated) blood donations post-op: monitor pain, admin analgesia using PCA pump frequent turning to prevent damage to the spinal fusion