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Flashcards in Peds Final Review - Skeletal Disorders Deck (29)
1

FRACTURES

Traumatic injury to bone

A. Fractures can be classified according to type

1. Complete fractures: bone fragments are completely separate

2. Incomplete fractures: bone fragments remain attached (eg. greenstick, bends, buckles)

3. 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.

2

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.

3

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

4

FRACTURES

Nursing Diagnosis

A. Ineffective tissue perfusion (peripheral) related to

B. Acute pain R/T

5

FRACTURES

Nursing Interventions:

A. Obtain baseline data, and frequently perform neurovascular assessments

1. Check pulses distal to the injury to assess circulation

2. Color: Check injured extremity for pink, brisk, capillary refill

3. Movement and sensation: check injured extremity for nerve impairment; compare for symmetry with uninjured extremity (child may guard injury).

4. Temperature: check extremity for warmth

5. Swelling: Check for an increase in swelling. Elevate extremity to prevent swelling.

6. Pain: Monitor for severe pain that is not relieved by analgesics.

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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.

1. 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)

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FRACTURES

Nursing Interventions:

2. 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

8

FRACTURES

Nursing Interventions:

Teach home cast care to family:

1. Teach neurovascular assessment of casted extremity

2. Teach child not to get cast wet

3. Teach child not to place anything under cast

4. Teach child to keep small objects, toys, and food out of cast.

5. Teach family to modify diapering and toileting to prevent cast soilage

6. 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

7. Teach to seek follow-up care with health care provider.

9

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.

10

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

11

CONGENITAL DYSPLASIA OF THE HIP (Developmental Dysplasia of Hip)

Nursing Assessment:

Infant

1. Positive Ortolani sign (“clicking” with abduction)

2. Unequal folds of skin on buttocks and thigh

3. Limited abduction of affected hip

4. Unequal leg lengths

12

CONGENITAL DYSPLASIA OF THE HIP (Developmental Dysplasia of Hip)


Nursing Assessment:

Older child

1. Limp on affected side

2. 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)

13

CONGENITAL DYSPLASIA OF THE HIP (Developmental Dysplasia of Hip)

Nursing Diagnoses:

Impaired physical mobility R/T

Deficient knowledge (home care) R/T

14

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.

1. Teach application and removal of device (worn 24 hours a day)

2. Teach akin care and bathing (physician may allow parents to remove device for bathing).

3. Teach diapering.

4. 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

15

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

16

SCOLIOSIS

Nursing Assessment:

A. Occurs most commonly in adolescent females ( 10 to 15 years old)

1. Elevated shoulder or hip

2. Head and hips not aligned

3. While child is bending forward, a rib hump is apparent. (Ask child to bend forward from the hips with arms hanging free, and examine child for a curve of the spine, rib hump, and hip asymmetry.)

17

SCOLIOSIS

Nursing Diagnoses:

A. Impaired physical mobility R/T

B. Disturbed body image R/T

18

SCOLIOSIS

Nursing Interventions:

A. Screen all adolescent children, especially females, during growth spurt

B. Prepare child and family for conservative treatment such as the use of a brace

1. Teach application of Milwaukee brace
a. Instruct to wear
23 hours a day
b. Instruct to wear a
t-shirt under brace
to decrease skin
irritation
c. Instruct to check
skin for areas of
irritation or
breakdown

2. Suggest clothing modifications to camouflage brace

'3. Reinforce prescribed exercise regimen for back and abdominal muscles

'4. Plan with adolescent ways of improving self-concept

5. Teach family that severe, untreated scoliosis can cause respiratory difficulty

19

SCOLIOSIS

NCLEX Hint: A brace does not correct the spine’s curve in a child with scoliosis; it only stops or slows the progression.

20

SCOLIOSIS

Nursing Interventions:

Prepare child and family for surgical correction if required.

1. Teach child and family log-rolling technique

2. Teach how to practice respiratory hygiene

3. Orient child to ICU

4. Discuss postoperative tubes: Foley, nasogastric tube, and chest tube if anterior fusion is performed

5. Describe postoperative pain management; patient-controlled analgesic (PCA) may be used.

6. Obtain a baseline neurologic assessment.

Provide postoperative care

1. Perform frequent neurologic assessments

2. Log-roll for 5 days

3. Administer IV fluids and analgesics as prescribed

4. Perform oral hygiene if client NPO

5. Monitor nasogastric tube and bowel sounds

6. Assist with ambulation

7. Client may wear a body jacket until bone fusion is stable

8. Determine the need for home-bound teacher

9. Encourage child’s participation in care to promote self-esteem

21

JUVENILE RHEUMATOID ARTHRITIS

Chronic inflammatory disorder of the joint synovium

A. Single or multiple joints may be involved

B. It may also have a systemic presentation

C. It occurs between ages 2 and 5 and between ages 9 and 12

22

JUVENILE RHEUMATOID ARTHRITIS

Nursing Assessment:

A. Joint swelling stiffness (usually large joints)

B. Painful joints

C. Generalized symptoms: fever, malaise, and rash

D. Periods of exacerbations and remissions

E. Varying severity: mild and self-limited or severe and disabling

F. Lab data: latex fixation test (usually negative) and elevated ESR

23

JUVENILE RHEUMATOID ARTHRITIS

Poorest prognosis:
1. Positive rheumatoid factor

2. Polyarticular systemic onset

24

JUVENILE RHEUMATOID ARTHRITIS

Nursing Diagnoses:

A. Impaired physical mobility R/T

B. Chronic pain R/T

25

JUVENILE RHEUMATOID ARTHRITIS

Nursing Interventions:

A. Plan home program of prescribed exercise, splinting, and activity

B. Assist in identifying adaptations in routine (e.g., Velcro fasteners, frequent rest periods)

C. Support the maintaining of school schedule and activities appropriate for age

D. Teach about medication regimen; combination drugs are used

1. Nonsteroidal anti-inflammatory drugs
a. Aspirin
b. Tolmetin sodium
c. Ibuprofen
d. Naproxen

2. Antirheumatic drugs

3. Corticosteroids (prednisone)

4. Cytotoxic drugs (cyclophosphamide, methotrexate)

26

JUVENILE RHEUMATOID ARTHRITIS

More fucking interventions: As if there isn't enough shit to remember.......

E. Teach child and family about side effects and toxic effects of prescribed drugs

F. Inform family that the optimum anti-inflammatory effects of drugs may take a month to achieve

G. Encourage periodic eye exams for early detection of iridocyclitis so as to prevent vision loss

H. Encourage family to allow child’s independence

27

JUVENILE RHEUMATOID ARTHRITIS

NCLEX Hint:

Corticosteroids are used in the short term in low doses during exacerbations.

Long-term use is avoided because of side effects and their adverse effects on growth.

28

THE FUCKING

MOTHER FUCKING END

29

THE FUCKING

MOTHER FUCKING END

Don't pass go....don't collect $200

Yes...You have to leave the stick up your ass until the ride is over...

It will be rotated periodically without lube.