Peds Final Review - Skeletal Disorders Flashcards
FRACTURES
Traumatic injury to bone
A. Fractures can be classified according to type
- Complete fractures: bone fragments are completely separate
- Incomplete fractures: bone fragments remain attached (eg. greenstick, bends, buckles)
- Comminuted fractures: bone fragments from the fractured shaft break free and lie in the surrounding tissue. This type of fracture is rare in children.
B. Fractures that occur in the epiphyseal plate (growth plate) may affect growth of the limb.
FRACTURES
NCLEX Hint: Fractures in older children are common because they fall during play and are involved in motor vehicle accidents.
Spiral fractures (caused by twisting) and fractures in infants may be related to child abuse.
Fractures involving the epiphyseal plate (growth plate) can have serious consequences in terms of the growth of the affected limb.
FRACTURES
Nursing Assessment:
General condition
1. Visible bone fragments 2. Pain 3. Swelling 4. Contusions 5. Child guarding or protecting the extremity
The five P’s (may indicate the presence of ischemia):
1. Pain 2. Pallor 3. Pulselessness 4. Paresthesia 5. Paralysis
FRACTURES
Nursing Diagnosis
A. Ineffective tissue perfusion (peripheral) related to
B. Acute pain R/T
FRACTURES
Nursing Interventions:
A. Obtain baseline data, and frequently perform neurovascular assessments
- Check pulses distal to the injury to assess circulation
- Color: Check injured extremity for pink, brisk, capillary refill
- Movement and sensation: check injured extremity for nerve impairment; compare for symmetry with uninjured extremity (child may guard injury).
- Temperature: check extremity for warmth
- Swelling: Check for an increase in swelling. Elevate extremity to prevent swelling.
- Pain: Monitor for severe pain that is not relieved by analgesics.
FRACTURES
Nursing Interventions:
B. Report abnormal assessment promptly! Compartment syndrome may occur; it results in permanent damage to the nerves and vasculature of the injured extremity due to compression.
C. Maintain traction if prescribed. Note bed position, type of traction, weights, pulleys, pins, pin sites adhesive strips, ace wraps, splints, and casts.
- Skin traction: force is applied to skin
a. Buck extension traction: lower extremity, legs extended, no hip flexion
b. Dunlop traction: two lines of pull on the arm
c. Russell traction: two lines of pull on the lower extremity, one perpendicular, one longitudinal
d. Bryant traction: both lower extremities flexed 90 degrees at hips (rarely used because extreme elevation of lower extremities causes decreased peripheral circulation)
FRACTURES
Nursing Interventions:
- Skeletal traction: pin or wire applies pull directly to the distal bone fragment.
a. 90-Degree traction: 90-degree flexion of hip and knee; lower extremity is in a boot cast; can also be used on upper extremities
b. Dunlop traction: may be used as skeletal traction
D. Maintain child in proper body alignment
E. Monitor for problems of immobility
F. Provide age-appropriate play and toys
G. Prepare child for cast application; use age-appropriate terms when explaining procedures
H. Provide routine cast care following application; petal cast edges
FRACTURES
Nursing Interventions:
Teach home cast care to family:
- Teach neurovascular assessment of casted extremity
- Teach child not to get cast wet
- Teach child not to place anything under cast
- Teach child to keep small objects, toys, and food out of cast.
- Teach family to modify diapering and toileting to prevent cast soilage
- Teach that in the presence of a hip spica, family may use a Bradford frame under a small child to help with toileting; they must not use abduction bar to turn child
- Teach to seek follow-up care with health care provider.
FRACTURES
NCLEX Hint: Skin traction for fracture reduction should not be removed unless health care provider prescribes its removal.
NCLEX Hint: Skeletal disorders affect the infant’s or child’s physical mobility, and typical NCLEX-RN questions focus on appropriate toys and activities for the child who is confined to bed rest and is immobilized.
CONGENITAL DYSPLASIA OF THE HIP (Developmental Dysplasia of Hip)
Abnormal development of the femoral head in the acetabulum
A. Conservative treatment consists of splinting.
B. Surgical intervention is necessary if splinting is not successful
CONGENITAL DYSPLASIA OF THE HIP (Developmental Dysplasia of Hip)
Nursing Assessment:
Infant
- Positive Ortolani sign (“clicking” with abduction)
- Unequal folds of skin on buttocks and thigh
- Limited abduction of affected hip
- Unequal leg lengths
CONGENITAL DYSPLASIA OF THE HIP (Developmental Dysplasia of Hip)
Nursing Assessment:
Older child
- Limp on affected side
- Trendelenburg sign (when the child stands, bearing weight on the affected hip, the pelvis tilts downward on the normal side instead of upward with normal stability – this is a positive Trendelenburg sign)
CONGENITAL DYSPLASIA OF THE HIP (Developmental Dysplasia of Hip)
Nursing Diagnoses:
Impaired physical mobility R/T
Deficient knowledge (home care) R/T
CONGENITAL DYSPLASIA OF THE HIP (Developmental Dysplasia of Hip
Nursing Interventions:
A. Perform newborn assessment at birth
B. Apply abduction device or splint (Pavlik harness). Therapy involves positioning legs in flexed abducted position.
C. Teach parents home care.
- Teach application and removal of device (worn 24 hours a day)
- Teach akin care and bathing (physician may allow parents to remove device for bathing).
- Teach diapering.
- Teach that follow-up care involves frequent adjustments because of growth
D. Provide nursing care for child requiring surgical correction
1. Perform preoperative
teaching of child and
family, including cast
application
2. Perform postoperative
care
a. Assess vital signs
b. Check cast for drainage and bleeding
c. Perform neurovascular assessment of extremities
d. Promote respiratory hygiene
e. Administer narcotic analgesic around the clock
f. Teach family cast care when child gets home
SCOLIOSIS
Lateral curvature of the spine
A. If severe, it can cause respiratory compromise
B. Surgical correction by spinal fusion or instrumentation may be required if conservative treatment is ineffective
