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Pediatrics/ Maternity > Pediatics- Musculoskeletal > Flashcards

Pediatics- Musculoskeletal Flashcards

1
Q

What is a fracture?

A

When the resistance between a bone in an applied, stress yields to stress, resulting in disruption to the integrity of the bone

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2
Q

Is bone healing and remodeling faster in children or adults

A

Children due to a thicker periosteum and good blood supply

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3
Q

What is an expected finding in a fracture?

A

Pain
Crepitus
Deformity
Edema
Ekhymosis
Worms and redness

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4
Q

What is plastic deformation?

A

Bend
The bone is bent no more than 45° without breakage

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5
Q

What is buckle fracture (torus)?

A

Compression of the bone resulting in a bulge or raised area at the fracture site

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6
Q

What is a greenstick fracture?

A

Incomplete fracture of the bone

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7
Q

What is a transverse fracture?

A

Break is straight across the bone

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8
Q

What is an oblique fracture?

A

Break is diagonal across the bone

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9
Q

What is a spiral fracture?

A

Break spirals around the bone

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10
Q

What is a physeal fractur

A

Growth plate fracture
Injury to the end of the long bone on the growth plate

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11
Q

What is a stress fracture?

A

Small fracture cracks in the bone due to repeated muscle contraction

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12
Q

What is a complete fracture?

A

Bone fragments are separated

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13
Q

What is an incomplete fracture?

A

Bone fragments are still attached

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14
Q

What is a closed or simple fracture

A

The fracture occurs with an open wound in a bone protruding

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15
Q

What is a complicated fracture?

A

The fracture results in injury to other organs and tissues

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16
Q

What is a comminuted fracture?

A

The fracture includes small fragments of bone that lie in surrounding tissue

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17
Q

What is a radiograph used for in fractures?

A

Confirm diagnosis and determine the positioning of the bone

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18
Q

What is nursing care for someone who has a fracture?

A

Emergency care at time of injury
History of how injury occurred
Maintain ABC’s
Check neurovascular status
Remove jewelry
Stabilize injured area
Elevate the affected limit apply ice packs

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19
Q

For injuries to the distal arm, pelvis, and lower extremity what position to the client be in

A

Supine

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20
Q

For injuries to the shoulder or upper arm what position to the client be in

A

Sitting position

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21
Q

Where do you provide splinting?

A

At the joint above, and below the injured area

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22
Q

If a pelvic fracture is suspected, what should you monitor for?

A

Urine for blood, and for development of hypovolemic shock

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23
Q

What are nursing interventions for a fracture?

A

Assess pain
Check Nuro status
Maintain proper alignment
Promote range of motion of fingers toes in unaffected extremities
Increase calcium intake

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24
Q

Neurovascular assessment for musculoskeletal

A

Sensation
Skin temp
Skin color
Capillary refill
Pulses
Movement

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25
Q

What is sensation in a neurovascular assessment?

A

Assessed for numbness or tingling sensation of the extremity loss of sensation can indicate nerve damage

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26
Q

What is skin temperature in a neurovascular assessment?

A

Assess the extremity for temperature if should be warm not cool to touch

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27
Q

What is skin color in a neurovascular assessment?

A

Assess the color of the affected extremity, check distal to the injury and look for changes in pigmentation

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28
Q

What is capillary refill in a neurovascular assessment?

A

Press, the nail beds of the affected extremity until bleaching occurs. Blood return should be within three seconds.

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29
Q

What is pulses in a neurovascular assessment?

A

Call Syd should be powerful and strong. Pasa should also be equal to the pulses of the unaffected extremity.

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30
Q

What is movement in a neurovascular assessment?

A

The client should be able to move the joints distal to the injury, fingers or toes

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31
Q

What immunization do you need for an open fracture?

A

Tetanus

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32
Q

What is a plaster of Paris cast?

A

Heavy, not water resistant and can take 10 to 72 hours to dry

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33
Q

What is a synthetic fiberglass cast?

A

White water, resistant, and dry quickly 5 to 20 minutes

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34
Q

What should be petted to prevent skin breakdown in casting

A

Bony prominence

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35
Q

Nursing actions for casting

A

Show procedure on a doll
Apply ice for the first 24 hours
Turn in position client every two hours
Keep affected extremity, supported with a sling or a pillow
SS warm or hot spots on Cast which can indicate infection

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36
Q

Where should the cast be elevated to to prevent swelling?

A

Heart level for first 24 to 48 hours

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37
Q

For plaster cast, how do you avoid denting?

A

Use palms of hands and expose the cast of air to promote drying

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38
Q

What does increased warmth or hotspots on a cat surface indicate

A

Infection

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39
Q

If a hotspot occurs in the cast change in sensation or increased pain, what should you do?

A

Notify the provider immediately

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40
Q

What is traction care?

A

Involves the use of a pulling force to reduce a fracture, maintain alignment and provide muscle rest

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41
Q

What is skin traction?

A

Uses a pulling force that is applied by weights
Using tape in straps, applied to the skin along with boots or cuffs weights are attached by rope to extremity

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42
Q

What does skeletal traction?

A

Continuous pulling force that is applied directly to the skeletal structure or bone

It is used when more pulling force is needed then skin traction can withstand

A pin or rod is inserted through or into the bone force is applied through the use of weights attached by ropes

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43
Q

Interaction care what should never be removed by the nurse

A

Weights

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44
Q

What is halo traction?

A

Cervical traction
Halo type bar that encircles the head screws are inserted into the outer skull

The halo is attached either the bed, traction or rides that are secured to a vest worn by the client

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45
Q

What is a nursing action for traction care

A

Maintaining body alignment
Notifying provider, if experiencing pain from muscle spasms that is unrelieved with meds
Nuro status

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46
Q

What should you assess pin sites for?

A

Pain, redness, swelling, drainage, or odor

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47
Q

For a client with a Heelo device what do you need to do

A

Ensure that the wrench to release, the rods is readily available when event that CPR is necessary

Move the client without applying pressure to the rods to prevent loosening pins

Inspect the pins regularly

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48
Q

What is the most common fracture that require surgery?

A

Supracondylar fracture in fractures of the humerus and femur

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49
Q

What should you do if you suspect violence in a situation

A

Notify social services

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50
Q

What is compartment syndrome?

A

Compression of nerves, blood vessels and muscle inside a confined place, resulting in neuromuscular ischemia

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51
Q

What happens if compartment syndrome is left untreated

A

Deformity of the extremity paralysis an infection can result

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52
Q

What is Volkmann contracture?

A

A permanent contracture of the forearm and hand caused by tight dressing or cast

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53
Q

What is a fat embolism

A

Complication of a fracture fat, breaks away from the bone marrow of the injured one, and enters the bloodstream

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54
Q

What is a pulmonary embolism?

A

Complication of a fracture client develops and forms at the injury site and travels to the lungs

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55
Q

What are the five p in finding embolism

A

Pain
Paresthesia
Pulselessness
Paralysis
Pale

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56
Q

What does pain mean
In embolism

A

Paying that is unrelieved with elevation or analgesics increase with passive movement

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57
Q

What does paresthesia mean in embolism

A

Numbness, which is an early finding of compartment syndrome

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58
Q

What is pulsenessness of embolism

A

Distal to the fracture late finding of compartment syndrome

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59
Q

What does paralysis of embolism

A

Inability to move digits means nerve damage

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60
Q

What is pale of embolism

A

Call skin in cyanosis to nail beds

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61
Q

What should the nurse do if the patient has compartment syndrome

A

Assess extremity every hour for first 24 hours
Space between skin in the cash should allow for once finger to be placed
Effected extremity at heart level
Loosen the dressing

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62
Q

What is osteomyelitis?

A

Infection within the bone secondary to a bacterial infection from an outside source

Found in an open fracture or from a blood-borne bacterial source

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63
Q

What happens if you have osteomyelitis

A

Irritability
Fever
Tachyc Ardis
Edema
Pain that is constant, but increases with movement
Not wanting to use affected extremity
Site of infection, tender

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64
Q

What would you teach a patient with osteomyelitis?

A

Monitor hearing due to ototoxicity of some antibiotics
Limit movement of affected limb, and avoid bearing any wait until cleared

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65
Q

A nurse is caring for a child who is in a plaster spica cast, which of the following action, should the nurse take?
Use a heat lamp to facilitate drying
Avoid turning the child until the cast is dry
Assisted client with crutch walking after the cast is dry
Apply moleskin to the edges of the cast

A

Apply moleskin to the edges of the cast

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66
Q

A nurse is teaching a group of caregivers about fractures, which of the following information should the nurse include in the teaching
Children need a longer time to heal from a fracture than an adult
Epithelial plate injuries can result in altered bone growth
A greenstick fracture is a complete break of the bone
Bonez are unable to bend so they break

A

Epithelial plate injuries can result in ultra bone growth

67
Q

A nurse is caring for a child to sustain a fracture which of the following action should the nurse take(select)
Place a heat pack on the site of injury
Elevate the affected limb
Assess neurovascular status frequently
Encourage ROM of affected limb
Stabilize the injury

A

Elevate the affected limb
Sus neurovascular status frequently
Stabilize the injury

68
Q

A nurse is caring for a child who has a fracture which of the following are manifestations of the fracture(select)
Crepitus
Edema
Pain
Fever
Ekhymosis

A

Crepitus
Edema
Pain
Ekhymosis

69
Q

A nurse is caring for a child who is in skeletal traction, which of the following action should the nurse take(select)
Remove the weights to reposition the client
Assess the child’s position frequently
Assess pin sites every four hours
Ensure the weights are hanging freely
Ensure the ropes knot is in contact with the pulley

A

Assess the child position frequently
Access pin sites every four hours
Ensure the weights are hanging freely

70
Q

What is clubfoot?

A

A complex deformity of the ankle and foot can affect one or both feet

71
Q

What is positional club foot

A

Occurs from interuterine crowding

72
Q

What is syndromic club foot?

A

Occurs in association with other syndromes

73
Q

What is congenital clubfoot?

A

Idiopathic

74
Q

What is Talipes varus?

A

Inversion foot bending in ward

75
Q

What is talipes Valgus

A

Eversion of foot bending outward

76
Q

What is talipes calcaneus

A

Dorsiflexion toes are higher than the heels

77
Q

What is talipes equinus

A

Horsefoot plantar flexion toes are lower than the hills

78
Q

What is talipes equinovarus

A

Toes are facing inward and lower than the heal

79
Q

What should the nurse envcourage the parents to do with a patient with clubfoot?

A

Encourage the parents to hold and cuddle the child

80
Q

Therapeutic procedures for a patient with clubfoot

A

Casting
Series of casting, starting shortly after birth, and continuing until Maxximum correction is accomplished

81
Q

Buy three weeks what procedures usually performed in club foot

A

Heel cord tenotomy long leg cast for three weeks

82
Q

After six weeks, what occurs in clubfoot

A

Dennis BrownE bar that connects specialized shoes to maintain correction and prevent reoccurrence

83
Q

What should be done weekly for a patient with clubfoot?

A

Manipulation of the foot to stretch the muscles

84
Q

What are affects of casting

A

Skin breakdown, neurovascular operations

85
Q

What is left-calve-perthes disease

A

Aseptic necrosis of the femoral head can be unilateral or bilateral

86
Q

Expected findings in leg calves, Perthes disease

A

Intermittent, painless, limp
Hip stiffness
Limited ROM
Shortening of the affected leg
Muscle wasting

87
Q

What should the nurse do with a patient who has leg calves, Perthes disease?

A

Maintain rest and limited weight-bearing
Abduction, brace, or Cast
PT
Traction

88
Q

What is a surgical intervention for someone who is Leg calve Perthes disease?

A

Osteotomy of the hip or femur

89
Q

What is developmental dysplasia of the hip DDH?

A

A variety of disorders resulting in abnormal development of the hip structure that can affect infants or children

90
Q

What is acetabular dysplasia?

A

Delay in acetabular development

Acetabular roof is shallow, an oblique

91
Q

What is subluxation

A

Incomplete dislocation of the hip

92
Q

What is dislocation in DDH?

A

Femoral head does not have contact with the acetabulum

93
Q

Risk factor for DDH

A

First born
Female
Breech
Oligohydraminos

94
Q

Expected findings in a infant patient with DDH

A

Asymmetry in an equal number of skin folds on the posterior thigh
Limited hip abduction
Shortening of the femur
Widen perineum

95
Q

What is a positive ortolani test

A

Performed by provider
Hip is reduced by abduction

96
Q

What is a postive Barlow’s test?

A

Performed by provider
Hip is dislocated by adduction

97
Q

Expected findings in a child with DDH

A

One leg shorter than the other
Walking on toes
Walking with a limp

98
Q

When should an ultrasound be performed in DDH

A

Two weeks of age to determine cartilaginous head of the femur

99
Q

What kind of nursing care should you do with a newborn to six months who has DDH

A

Pavlik harness (chest harness, that abducts legs)
Maintain harness placement for 12 weeks
Check straps every one to two weeks
Do not adjust straps
Check skin under straps

100
Q

What kind of nursing care should you do when adduction contracture is present?

A

Bryant traction
(skin traction hips flex at 90° angle with buttocks raised off of bed)

Hip Spica cast (maintains external rotation of the hip)

101
Q

What should you teach a patient when adduction contracture is present

A

Understand proper positioning
Position case on pillow
Keep the cats elevated until dry
Change position, frequent
Use waterproof barrier around the general opening of the spica cast to prevent soil 

102
Q

What kind of nursing care should you do with a patient who six months to two years with DDH?

A

Surgical closed reduction with placement of hip spica cast

103
Q

What kind of nursing care should you do with older children with DDH?

A

Surgical reduction with pre-surgical traction

104
Q

What kind of diet should you maintain with DDH

A

High-fiber diet and promote adequate hydration

105
Q

What is osteogenesis imperfecta?

A

Inherited connective tissue condition, that results in bone fractures and deformity along with restricted growth

106
Q

What is expected finding an osteogenesis imperfecta

A

Multiple bone fractures
Blue sclera
Early hearing loss
Small discolor teeth

107
Q

What medication should you use for osteogenesis imperfecta

A

Pamidronate ( increases bone density)

108
Q

What should you teach a patient with osteogenesis imperfecta?

A

Caution, with live virus
Antibiotics will be needed prior to dental work
Low impact exercise
May need bone marrow transplant

109
Q

What is scoliosis?

A

Complex deformity of the spine that also affects the ribs

Characterized by lateral curvature of the spine and spinal rotation that causes rib asymmetry

110
Q

Diagnostic procedure with a patient who has scoliosis

A

Screen during preadolescence
Have child bent over at waist with arms hanging down and observe for asymmetry of ribs and flank

111
Q

How often should you be wearing a brace for scoliosis?

A

Every 23 hours per day only removal for personal hygiene

112
Q

Surgical intervention for scoliosis

A

Spinal fusion with Rod placement

113
Q

 What can you preoperatively teacher patient about scoliosis?

A

The use of autoLogous self donate blood donations

114
Q

Postoperative nursing actions for scoliosis

A

Log roll to prevent damage of spinal fusion
Assessed for skin pressure areas
Monitor bowel sounds
Encourage mobility ambulation by second and third day
Use of PCA

115
Q

What should the nurse encourage after a scoliosis surgery?

A

Independence and importance of physical therapy

116
Q

A nurse is caring for a toddler who is hip dysplasia and has been placed in a hip spica cast the child’s guardian asks the nurse why pavlik harness is not being used which of the following responses should the nurse make
The pelvic harness is used for children with scoliosis, not hip dysplasia
The pelvic harness is used for school age children
The pelvic harness cannot be used for your child, because their condition is too severe
The pelvic harnesses use for infants, less than six months of age

A

The pavlik harness is used for infants, less than six months of age

117
Q

A nurse is completing preoperative, teaching with an adolescent client who is scheduled to receive spinal instrumentation for scoliosis, which of the following information should the nurse include in the teaching
You will go home the same day of your surgery
You will have minimal pain
You will need to receive blood
You will not be able to eat until the day after surgery

A

You will need to receive blood

118
Q

A nurse is caring for a child who is suspected of having leg calves, Perthes disease the nurse should prepare the child for which of the following diagnostic procedures
Bone biopsy
Genetic testing
CT scan
Radiographs

A

Radiographs

119
Q

A nurse is assessing a child who has leg calves, Perthes disease, which of the following finding should the nurse expect(select)
Longer affected leg
Hips stiffness
Back pain
Limited ROM
Limp with walking

A

Hips stiffness
Back pain
Limited ROM
Limp with walking

120
Q

A nurse is caring for an infant and notices an audible click in there left hip which of the following diagnostic test. Should the nurse expect the provider to perform(select)
Barlow test
Babinski sign
Manipulation of foot and ankle
Ortolani test
Ponseti method

A

Barlow test
Ortolani test

121
Q

What is cerebral palsy?

A

Nonprogressive impairment of motor function, especially that of muscle control, coordination and posture

122
Q

Expected findings and cerebral palsy

A

Concerns with developments
Gagging, or choking and feeding
Tongue thrust
Poor head control
Asymmetric crawl
Arching back
Toe walking

123
Q

What is spastic CP (pyramidal)

A

Hypertonicity( muscle tightness, or spasticity) poor control of motion, balance, and posture

124
Q

What is dyskinetic CP non-spastic extra pyramidical
Athetoid

A

Findings include involuntary, jerking movements that appear slow, weathering and warm like

125
Q

What is dyskinetic CP non-spastic extra pyramidical
Dystonic

A

Slow twisting trunk or extremities with abnormal posturing for muscle contractions, drooling and speech impairment

126
Q

What is ataxic CP nonspastic extra pyramidical

A

Evidence of white bass, Kate, and difficulty with coordination
Poor ability to do repetitive movements
Lack of coordination

127
Q

What should a patient with cerebral palsy position be after feeding?

A

Upright for possibility of aspiration

128
Q

Some nursing care for cerebral palsy

A

Monitor, developmental milestones
Need for hearing and speech eval’s
Promote independence

129
Q

What is baclofen?

A

Essentially acting, skeletal muscle relaxant that decreases muscle spasms and severe specificity

130
Q

Client education for cerebral palsy

A

Provide time for rest periods
Adhere to feeding schedule
Proper dental care
Respite care

131
Q

What is spina bifida?

A

Neural tube defect present at birth in characterized by failure of the osseous spine to close with CNS effects

132
Q

What is spina bifida occulta

A

Affects the lumbosacral area and it’s not visible externally surface of the vertebral phone is missing no spinal cord involvement

133
Q

What is spina bifida cystica?

A

Protrusion of the sack is visible

134
Q

What is Menginocele

A

The sac contains spinal fluid in meninges, increased risk for infection

135
Q

What is myelomeningocele

A

Most common
Dissect contain spinal fluid meninges and nerves
Causes decrease motor and sensory function

136
Q

Risk factors for spina bifida

A

Substance taken during pregnancy
Maternal malnutrition
Insufficient Folick acid
Exposure to radiation

137
Q

Findings in occulta

A

Tumbling in the lumbosacral area
Portwine, Angionoma
Dark hair, Tufts

138
Q

Findings in cystica

A

Flaccid muscles
Lack of bowel control
Prolapse rectum
Protruding sack

139
Q

Maternal blood test taken to see if you have spina bifida

A

Blood alpha-fetoprotein during second trimester

140
Q

What is done as soon as possible to prevent complications of injury an infection

A

Closure of myelomenigocele sac

141
Q

Preoperative care for spina bifida

A

Surgery within the first 24 hours after birth
Protect sack
Apply sterile, moist nonadherent dressing changing every two hours
Do not remove dressing if it becomes dryadd more solution
Report leakage of fluid
Measure head circumference

142
Q

What should a patient be placed in who has spina bifida

A

Prone position with hips, flex, legs, abducted

143
Q

What should you avoid with a patient who is spina bifida?

A

Rectal temps, cuddling, or putting pressure on aac

144
Q

What does spina bifida increased risk of?

A

Latex allergy

145
Q

Manifestations of increased intracranial pressure of spina bifida in infants

A

High-pitched crying
Bulging fontanelles
Increase head circumference

146
Q

Manifestations of increased intracranial pressure in children with spina bifida

A

Headache
Double vision
Decrees school
Decreased level of consciousness

147
Q

What is juvenile idiopathic arthritis

A

Chronic autoimmune inflammatory disease, affecting joints, and other tissues rarely life-threatening

148
Q

Findings in juvenile idiopathic
Arthritis

A

Joint swelling worse in the morning
Mobility limitation
Limp in the morning
Delay in growth

149
Q

Nursing care for a patient with juvenile idiopathic arthritis

A

He or warm moist packs to child effective joints
Appropriate exercise, swimming
Encourage warm baths
Relaxation techniques

150
Q

What is muscular dystrophy

A

Inherited disorder with progressive degeneration of symmetric, skeletal muscle groups, causing progressive muscle weakness in wasting

151
Q

What is dochenne muscular dystrophy

A

Most common inherited as X linked recessive trait
Life expectancy reaches into early adulthood
Fat tissue replaces muscle in lower limbs

152
Q

What is facioscapulohumeral muscular dystrophy

A

Autosomal dominant inherited disorder onset during early adolescence progression is slow
Characterized by facial weakness and inversion of shoulders

153
Q

What is limp girdle muscular? Dystrophy

A

Autosomal, dominant and recessive disorder. It appears later in childhood with slow progression.

154
Q

What is Gowers sign?

A

Difficulty getting out of bed rising from seated position or climbing stairs
Child walks, hands up, legs for support will going to standing position

155
Q

Expected findings for muscular dystrophy

A

Grower sign
Delayed motor skills
Muscle weakness
Progressive muscle atrophy

156
Q

What is nursing care with muscle dystrophy?

A

Genetic counseling
Respiratory function
Understanding long term affects
Child independent as long as possible
Stretching exercises
Proper body alignment

157
Q

What kind of diet should a patient be on with muscle dystrophy?

A

Low calorie high protein

158
Q

What should you encourage the parents of the patients who have muscle dystrophy?

A

Consider assistance with care as disease progressives

159
Q

A nurse is caring for a child who has cerebral palsy which of the following medication should the nurse expect to administer to treat painful muscle spasms(select)
Baclofen
Diazepam
Oxybutynin
Methotrexate
Prednisone

A

Baclofen diazepam

160
Q

A nurse is developing a plan of care for a toddler who is cerebral palsy which of the following action should the nurse include
Structure interventions, according to the toddlers chronological age
Evaluate the toddlers need for an evaluation of hearing ability
Monitor the toddlers pain level routinely using a numeric rating scale
Provide total care for daily hygiene activities

A

Evaluate the toddlers need for an evaluation of hearing ability

161
Q

The nurse is caring for school age child who has juvenile idiopathic arthritis which of the following home care instruction should the nurse include in the teaching(select)
Provide extra time for completion of ADLs
Use cold compression for joint pain
Take ibuprofen on an empty stomach
Remain home during periods of exacerbation
Perform range of motion exercises

A

Provide extra time for completion of ADLs
Perform range of motion exercises

162
Q

A nurse is caring for a child who is muscular dystrophy for which of the following findings should the nurse assess(select)
Purposeless, involuntary abnormal movements
Spinal defect and saclike protrusion
Muscular weakness in lower extremities
Unsteady, wide, base or waddling gate
Upward slant of eyes

A

Muscular weakness and lower extremities
Unsteady, wide base or waddling gait

163
Q

A nurse is caring for an infant who has myelmeningocele which of the following action should the nurse include in the preoperative plan of care
Assist the caregiver was cuddling the infant
Assess the infants, temperature rectally
Place the infant in supine position
Apply a sterile Moiz dressing on the sack

A

Apply a sterile, moist dressing on the sack

Pediatrics/ Maternity (15 decks)

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