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Pediatrics
Musculoskeletal/Articular Disorders
| Question | Answer |
|---|---|
| T/F Bones are not very porous and flexible in children? | False Bones are more porous and flexible in children than in adults |
| T/F Bone growth activity high: 2-4 wks in infants; 8-10 weeks in adolescents; and 10-16 weeks in adults? | True |
| Unique characteristics of bone growth in children is that ___ is thicker & more active; remodeling potential is ___; and the ___ plate is present? | Periosteum thicker & more active; remodeling potential is great; and epiphyseal plate present |
| T/F The epiphyseal plates ossify by the mid twenties and growth arrests, thus the growth plate appears thinniner/harder to distinguish on x-rays? | True The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cartilage plate in the metaphyses of children and adolescents. In most adults, the epiphyseal plates ossify by the mid twenties and growth arrests |
| Whereas endochondral ossification is responsible for the initial ____ development from cartilage in utero and infants, the epiphyseal plate is responsible for ____ growth of bones? | Whereas endochondral ossification is responsible for the initial bone development from cartilage in utero and infants, the epiphyseal plate is responsible for longitudinal growth of bones |
| Risk factors for injuries are playground; recreational injuries; motorized vehicle injuries; and other-lawn moter, trampoline, fireworks, sledding, & farm injuries. what is the most common injury? What is the most common sport injury? | Most injuries are from motor vehicle accidents; most common sport injuries in children & adults is basketball |
| What are the risk factors or etiology of sport injuries? | More time & energy spent than any other age group in sports; every sport has the potential for injury; often phsyical mismatch; don't relize limitations; and increased number of children involved in sports |
| Sports contributes to growth & development, education process and better health. What are some bennifets that sports give children? | provides exercise; provides interaction with peers; socially acceptable means enjoy stimulation & conflict; and helps process of self-apprasial, development of self-respect and concern of others |
| What do you want to do if you are present when a sport injury happens and are the only medical professional present? | Ice, don't take shoe off, immobilize joint and call 911. often we are not equiped with the best things for immobilization and can cause more damage if no ambulance is called. |
| When do you want to eat carbs and drink gaterade? | over 1 hr of exercise |
| Acute overload sport injuries are what types of injuries? | Dislocations, sprains, and muscle pulls |
| Chronic overload sport injuries are what types of injuries? | Stress fracture, Tendonitis, bursitis, and fasciculitis |
| What is fasciculitis? | Muscle or nerve fiber inflammation. |
| What is bursitis? Hint: Bursae are fluid-filled sacs that cushion areas of friction between tendon & bone or skin. Like air-filled bubble wrap, these sacs reduce friction Btwn moving parts of the body, such as in the shoulder, elbow, hip, knee, and heel. | When this fluid becomes infected by bacteria or irritated because of too much movement, the painful condition known as bursitis results. |
| Role of Health professional in regaurds to sport injuries: prevention, treatment & rehab; Encourage ___ activities; Parents- ___; exploitation; Nutrition & ___; and ___ misuse? | 1. prevention, treatment and rehabilitation 2. encourage variety of activites 3. parents-pressure 4. Exploitation 5. Nutrition & Hydration 6. Drug Misuse |
| You are attending your daughters softball game. A child trips over home plate. you hear a bone snap. The coach ask "is there a nuse or a doctor here?" What needs to be done 1st. | I am a nurse; Immobolizer 1st, dont take shoe off call 911. ambulances have the equipment to keep it immobolized if broken dont want to risk further injury to child. |
| High activity level; limited coordination; Injury; disease; and child abuse are all risk factors for ____? | fractures |
| What are common locations in children for fractures? | Forearm (distal radius or ulna); Epiphyses; Elbow (very hard to set); Leg and clavicle |
| Fractures are cluse to ___? | possible abuse. Fractures are red flags, be suspicious of fracture type or location and other injuries. 25% less than 3 yrs of age fractures are due to child abuse |
| What are the 3 types of fractures common in children? | Bends, Buckle, and greenstick ((partial fracture) or Complete (oblique)) |
| What are the 5 Ps of vascular injury to access for? | Pain, Pallor, Pulselessness, Paresthesia, peralisis |
| _____ is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect. | Paresthesia (pron. /ˌpɛɹɪsˈθiʒə/; paraesthesia in British English, pron. /ˌpæɹɪsˈθiʒə/) is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect. |
| What are the clinical manifestations of fractures? | Swelling, bruising or redness; pain/tenderness; diminished functional use of affected part; muscular rigidity; crepitus; and vascular injury |
| ___ impairment, nerve ___ syndromes; ___ damage; nonunion, malunion; infection; and ____ emboli are all complications of fractures | ciculatory impairment (can be due to edema & casts); nerve compression syndromes (swelling, its rare); Epiphyseal damage; nonunion, malunion; infection; pulmonary emboli(rare unless adolescent age) |
| Diagnositic studies (x-rays); laboratory studies; closed/open reduction; plaster immobliziation; traction; and external/internal fixation are all therapeutic management of ____? When are laboratory studies done? | Fractures; laboratory studies are not done unless major trauma Hgb & Hct decreased increased bilirubin |
| How do you care for a Ilizarov External Fixator? | leg discrepency-break short leg and you have to turn the screw; partial wt bearing; pin care teach parent to clean with 1/2 strength peroxide & press down on skin to make sure its not attached. |
| plaster cast are used on ___ & ___? | used on legs & body casts. Write 48 hrs generally. |
| Light weight cast are used on ___ and sometimes applied to plaster cast because why? | light weight cast are used on arms and sometimes applied to plaster casts for the color. Must use permanet markers to write on it. |
| T/F it isnt importnat to not have ruff edges on cast? | false it is important to not have ruff edges on casts |
| What is a Spica cast and what is it made of? | Full body cast and it is made of plaster and the last layer can be synthetic for color |
| Fractuers=cast nursing interventions: observe __ status closely; trun q 2hrs; support __ cast with pillow & palm hand; Elevate ___; ___ rough cast edges; No objects under cast; and ___ to extremity distal to cast? | Observe NV status closely; Trun every 2 hrs; support wet cast with pillow & palm hand; elevate extremity (higher than heart to decrease edema); petal rough cast edges; no objects under casts; and ROM to extremity distal to the cast (the one w/o the cast) |
| Nerovascular, NV and the 5 P's are immortant nursing interventions for___? | fractures |
| fractrues/cast nursing interventions: restrict ___ activity; report __ odor, observe drainage; clean ___ areas; prepare for cast removal; provide ___ diversion & ____ play? | restrict strenuous activity; report foul odor, observe drainage; clean soild areas (soft scrubor or AJ & cool hair dryer); prepare for cast removal (noisy, no pain cast stuff animal & remove it then childs); provide positive diversion & theraputic play |
| Dont use ___ to clean the cast? | DO NOT USE comet |
| Cast petaling is used on any areast that have ruff areas, usually due to ___? | cast petaling is used on any areas that have ruff areas, usaully due to cufting cast like total body cast around the groin |
| Cast Petaling steps 1-2: cut severl strips of petaling tape to a length of ~__ inches; tuck one end of tape under the edge of the cast, & apply the tape to the _____. | Cast Petaling: cut severl strips of petaling tape to a length of ~4 inches; tuck one end of tape under the edge of the cast, & apply the tape to the cotton lining |
| Cast Petaling steps 3-4: Continue to overlap the strips until complete ___ is formed; cover all edges of cast, paying special attention to the ____ opening. to dry it use hair dryer on ___ setting. | Cast Petaling steps 3-4: Continue to overlap the strips until complete edge is formed; cover all edges of cast, paying special attention to the diaper area opening. to dry it use hair dryer on cold setting. |
| You are assisting to remove a cast on a 5 yr old male. When the cast removal machine is turned on, the child begins screaming & pulling his arm away. How would you respond? | Stay calm, reasure them, comfort them, dont have parents restrain them. possibly cast stuffed animal and remove it to demonstrate it will not hurt them |
| Spica cast takes ___ hrs to dry; instruct ___ of pt; protect cast from __ or ___; and petal cast. | Takes 24-48 hrs to dry; instruct movement of pt (q2hrs); protect cast from urine or stool; petal cast |
| Circulatory/respiratory; muscle atrophy; joint contracture; metabolic; integument; GI/Gu; psychological and family maladaption are all effects of ___ with fractures? | Immobilization with fractures |
| How can you help a immoblizied fracture pt prevent circulatory/respiratory problems? | Can't use a incentive sparomoter (IS) in kids but they can blow bubbles & use spin wheels |
| T/F kidney stones are rare with immobliziezed fractured pts? | true |
| What do you need to do to prevent integument problems with a fractured immobolized pt? | check edges of cast, you should be able to get your finger in it |
| fracture immobolized pts need nutritional food, pain meds, and ___? How often do you need to check dippers with spica cast pts? | nutritional food, pain meds, and stool softners due to constipation problems. check dipper & use bed pan in females every 1 hr |
| Why are children often placed in traction instead of the extremity pinned? | Immobolize, children bc they are still growing. using a pin will disrupt their growth potentially. Make sure you know who is going to watch child & home school this child. Can't be left alone |
| T/F traction fracture children can be left alone? | NO NEVER |
| What are the 4 different traction types? | 1. Intermittent (deformity & muscle spasms) 2. continuous (use for reductions) 3. Skin (spplied directly to skin) 4. Skeletal (wire or pin inserted distal to fracture w/ wts on end) |
| When is skin traction used? | Brians traction/skin traction is only used on fractured femurs or hip surgery. under 2 yrs of age less than 30lbs hand between buttox & bed |
| What would you assess 1st when entering a room with a child in traction? 2nd? | 1st circulation: no pulse, discolored foot call the dr then give pain meds 2nd check alignment: needs to be straight. are weights hanging freely |
| How do you do a bed change with a pt on traction? | change bed head to toe |
| Traction Nurisng Interventions: close observation of ____ status; maintain traction ____; encourage diet increase ___ & ___; maintain ___ integrity; ROM ___ parts; Pin care; provide diversional ___ & therapeutic ___? | Traction Nursing Interventions: close observation NV status; maintain traction apparatus; encourage diet increase roughage & fluids; maintain skin integrity; ROM unaffected parts; Pin care; provide diversional activites & therapeutic play |
| What does DDH stand for? | Developmental Dysplasia of the Hip |
| The incidence of DDH: unstable hip __ per 1000 live births and completely dislocated hip ___ per 1000 live births? | Incidence: unstable hip 10 per 1000 live births and completely dislocated hip 1 per 1000 live births |
| What are the 3 different degrees a DDH can be? | Preluxation (Dysplasia); Subluxation; and Luxation (Dislocation) |
| What does Preluxation (dysplasia) mean? | hip is capable of dislocating |
| What does subluxation mean? | Hip has an incomplete dislocation. |
| What does luxation (dislocation) mean? | Total dislocation of the hip joint |
| The etiology of Developmental Dysplasia of the Hip (DDH) is unknown and ___% have no risk factors? | The etiology is unknown and 60% have no risk factors |
| What are the POTENTIAL risk factors for DDH? | caucasian, girls (8:1), positive family Hx, matrenal hormone secretion, & interauterine posture |
| What two test will be positive if a baby has DDH? | Postivie Ortolani & Barlow Test |
| Ortolani performed by gently abducting the infant's leg using the examiner's thumb while placing anterior pressure on the greater trochanter using the examiner's index & forefinger. How do you know if it is positive? | A + sign is a distinctive 'clunk' which can be heard & felt as the femoral head relocates anteriorly into the acetabulum. |
| Barlow maneuver is performed by adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly. It is performed with the Ortolani test. How do you know if it is positive? | If the hip is dislocatable - that is, if the hip can be popped out of socket with this maneuver`- the test is considered positive. The Ortolani maneuver is then used, to confirm that the positive finding (i.e., that the hip actually dislocated). |
| DDH x-ray is not helpful until ___ months? | 4 months |
| What are the clinical manifestations of DDH? | Positive Ortolani & Barlow Tests; Unequal skin folds; limitation of abduction on affected side; unequal knee height; Positive Trendelenberg sign |
| T/F Trendelenburg's sign is found in people with weak abductor muscles of the hip. | True |
| What does a positive Trendelenburg's sign look like? | positive if, when standing on one leg, the pelvis drops on the side opposite to the stance leg. The body is not able to maintain the center of gravity on the side of the stance leg. Pelvis tilts downward on affected side |
| Ortolani Manuever: 1. Abduct each knee until the lateral ____ of the knees touch the examining table 2. click or clunk is heard on ___ 3. most reliable from birth to __ or __ months 4. confirms _____ | 1. Abduct each knee until the lateral aspecs of the knees touch the examining table 2. click or clunk is heard on abduction 3. most reliable from birth to 2 or 3 months 4. confirms dislocated hip |
| Barlow Manuever: 1. Flex & slightly abduct both hips while lifting the ___ & applying pressure to the trochanter 2. Causes an ____ hip to dislocate 3. confirms joint instability until ___ weeks | Barlow Manuever: 1. Flex & slightly abduct both hips while lifting the femur & applying pressure to the trochanter 2. Causes an unstable hip to dislocate 3. confirms joint instability until 6 weeks |
| DDH is positive if: Limited hip abduction, as seen in flexion at ___ to ___ weeks? | Limited hip abduction, as seen in felxion at 6-10 weeks |
| DDH Barlow and Ortolani Test is possitive if Apparent shortneing of femur, as indicated by level of ___ in flexion (baby on back, knees bent with feet on buttox parrell to each other. one ___ will be lower if poisitive) | Knees, Knee |
| DDH positive there is ___ of the gluteal and thigh folds? | Asymmetry of the gluteal and thigh folds |
| What is the therapeutic management of DDH in a newborn to 6 months of age? Hint: 1. ___ for newborn 2. ___ splint 3. ___ harness | 1. cast for newborn 2. abduction splint 3. pavlik harness(Surgery and Spica cast are requried 3-6months if not caught early) |
| What is the Theraputic management of DDH for a 6-18 month old? Hint: 1. gradual reduction by __ followed by ___ then ____ 2. closed reduction followed by ___ then ___ 3. if not successful an ____ is required | 1. gradual reduction by traction followed by cast then brace 2. closed reduction followed by cast then brace 3. if not successful an open reduction is required |
| What is the theraputic management of a child older than 18 months? | open reduction then cast followed by rehabilitation. |
| DDH nursing interventions: 1. Assessment for ____ 2. Teach __ or __ care 3. Provide ___ support 4. Teach parents how to apply and maintain ___ device | DDH nursing interventions: 1. Assessment for deformity 2. Teach cast or traction care 3. provide psychological support 4. teach parents how to apply and maintain reduction device |
| Maintaining a reduction device: 1. may or may not be removed for ___ 2. Wear undershirt & knee socks-place diaper under ____ 3. assess skin beneath harness __x/day 4. Don't use __ or ___ 5. Proper positioning 6. prevent ___ 7. provide ___ relief | 1. May or may not be removed for bathing 2. wear undershirt & knee socks-place diaper under straps 3. asses skin beneath harness 2-3x/day 4. Dont use powder or lotion 5. proper positioning 6. prevent soiling 7. Provide boredom relief |
| T/F 40% of Clubfoot (Talipes) is seen falsely on ultrasounds? | True |
| Clubfoot (Talipes) etiology/risk factors: incidence ___ per 1000 live births; more common in ___ (2:1 ratio); and positive family history up to ___ cases | Clubfoot (Talipes) etiology/risk factors: incidence 1 to 2 per 1000 live births; more common in males (2:1 ratio); and positive family history up to 1/3 cases |
| What are the 3 types of clubfoot (talipes)? Give exmaples of each | Positional-in utero turned funny just crunched, syndromic-spina bifida, and congenital-most common form |
| If pt has a positional talipes what do you teach the parents if the foot can be brought back to normal? | If the foot can be brought back to normal teach parent to exercise the foot back to normal every diaper change |
| ___ is a deformity of limb characterized by smaller calf muscles and tightening or lax muscles of the foot? | Clubfoot Talipes-it is also manifested by adductus of the forefoot; increased longitudinal arch; heel turned in/out; plantar flexion; and dorsiflexion |
| What is Talipes Varus? | clubfoot: Heel turned in |
| What is Talipes carvus? | clubfoot: increased longitudinal arch |
| What is Talipes valgus? | clubfoot: heal turned out |
| What is Talipes equinus? | clubfoot: Plantar flexion (toes & foot curve down toward heel) |
| What is Talipes calcaneus? | clubfoot: dorsiflexion |
| what is the most common type of talipes? | 95% of cases are Talipes equinovarus (ie plantar flexion with heal turned in) |
| What is the therapeutic management goal of clubfoot? | Goal is pain-free foot with good mobility, without calluses, and without the need to wear modified shoes and inserts |
| In therapeutic management of clubfoot what do you do for a functional abnormality? | passive stretching exercises |
| In therapeutic management of clubfoot what do you do for a structural abnormality? | 1. serial casting 2. Ponseti method 3. Surgical intervention (if not discovered until older; generally walking when we catch this or addopted from other contries) |
| What is the purpose of serial casting? | change cast every few days to manipulate foot to get good alignment. done for 1-3 weeks |
| Clubfoot nursing interventions: assessment; teach parents ___ care; reinforce orthopedic surgeon's ___ &___; ___ support; support normal ___ & ____? | assessment; teach parents cast care (parents must be compliant for care come back every few days for addjustments); reinforce orthopedic surgeon's explainations & instructions; emotional support; support normal growth & developement |
| Legg-Calve-Perthes Disease etiology/risk factors: ___ necrosis of femoral head; 2-12 yrs ___% bilateral; mostly ___ and caucasion; Cause unknown-trauma, inflammation and coagulation defect | Aseptic necrosis of femoral head; 2-12 years 20% bilateral; mostly male (10x more common in males) and caucasian; cause-unknown, trauma, inflammation, or coagulation defect |
| What is Legg-Calve-Perthes Disease? | blood flow blocked to femoral head |
| What are the clinical manifestations of Legg-Calve-Perthes Disease? | Onset insidious; ache or stiffness; referred pain; joint dysfunction; limited ROM; limping in morning and end of day |
| What do you use to diagnosis Legg-Calve-Perthes Disease? | radiographic examination |
| Therapeutic Mangement of Legg-Calve-Perthes Disease: ___- non-wt bearing; ___ containment; and ___ reconstruction & containment | Rest (non-wt bearing); Nonsurgical containment (rest & anti imflammatory meds; bed rest 6 wks w/ bucks traction)-use non wt bearing devices and wt-bearing appliances; surgical reconstruction & containment (take it from other extremitiy) |
| Nursing interventions Legg-Calve-Perthes Disease: assessment; education of ___ device-emphasize importance of ___; post-op & cast care; ___ support; promotion of normal __ &___? | Assessment; Education of corrective device-emphasize importance of compliance; post-op & cast care; psychological support; promotion of normal growth and development. Pt with Legg-Calve-Perthes Disease is least likely to want to do gymnastics |
| What is slipped femoral capital epiphysis (SFCE)? | Disorder of proximal femoral physis that results in malalignment of femoral head realative to femoral neck |
| What are the etiology for slipped femoral capital epiphysis (SFCE)? | Hormonal & machanical factors; endocrine disorders, growth hormone, therapy, radiation therapy, & chemotherapeutic agents |
| T/F the ball of the femoral head dislocates from the pelvis in slipped femoral capital epiphysis (SFCE) | True |
| slipped femoral capital epiphysis (SFCE) risk factors: ___ in 1,000 children; More common in __ & ___; ___ yrs in males; and ___ % bilateral? | 1 in 1,000 children; more common polynesians & african-americans; 10-16 years- males (boys more common); 23-60% bilateral |
| SFCE Manifestations Variable history: __ or __ pain or __ pain; some limp, out-toeing or ___ abnormality; less often, easily ____; may or may not relate symptoms to ___ | Variable history: thigh or knee pain or no pain; some limp, out-toeing or gait abnormality; less often, easily fatigued; may or may not relate symptoms to injury |
| What is the classic sign of slipped femoral capital epiphysis (SFCE)? | Limping |
| SFCE Manifestaions Physical Examination: __ limp; out-toeing; decreased internal rotation of ___; and ___ flexation limited & produces ___? | SFCE clinical manifestions Physical examination: antalgic limp; out-toeing; decreased interanl rotation of hips; hip flexion limited & produces pain (they have a shortened stance on outside when standing) |
| What dignostic equipement is used to Dx SFCE? | Radiography; MRI & bone scans |
| T/F It is not important that SFCE is Dx early? | False Early diagnosis is crucial |
| T/F Prior to surgery SFCE pts are weight bearing and have internal fixation? | False they are non-weight bearing and have internal fixation |
| T/F Post surgery- non wt bearing & crutch use until painless ROM is achived? | True |
| SFCE nursing interventions: Assessment; maintain ___ status; ___ control; pre-op ___; Post-op __ care & ___ walking; Promoting normal growth & developement | Assessment; maintain non-weight bearing status; pain control; pre-op teaching; post-op wound care & crutch walking; promoting normal growth & development |
| T/F SFCE post-op pts will not partcipate in sports for at least 3 months in general? | True |
| ___ is a spinal deformity usually involving lateral curve, spinal rotation causing rib asymmetry and thoracic hypokphosis? | Scoliosis |
| Causes of scoliosis may be unknown or related to other disorders such as? | Genetic, muscular imbalance, neurofibromatosis, surgery, spinal irritation,nutrition, metabolic |
| T/F Scoliosis is not congenital but can be acquired? | False may be congenital or acquired. |
| __% of scoliosis cases occur in aldolescents? | 3% |
| T/F Scoliosis occurs mostly before age 10? | False Scoliosis occurs rarely before age 10 |
| T/F Scoliosis is most noticeable begining preadolescent growth spurt; has rare discomfort and many outward signs? | Scoliosis is most noticeable begining preadolescent growth spurt; has rare discomfort and FEW outward signs |
| What observation postion is used as a diagnositc evaluation of scoliosis? What is a scoliometer used for? | Adam's Postion (This is the screening u do in ambulatory for scoliosis. Pt stands with hands at side and then bends downward) A Scoliometer is used to determine the extent of the hump in the pts back. |
| T/F Radiographi examination and MRIs can be used to dx scoliosis? | True |
| It a pt has postural scoliosis what do you want them to do? | Exercises for postural scoliosis |
| What is mild scoliosis and what do you monitor? | Mild scoliosis is up to 15 degrees curvature and monitor progression of curve |
| What is Moderate scoliosis and what is the therapeutic managment of it? | Moderate 15-40 degrees and bracing is the theraputic management |
| Bracing is required in scooliosis if there is ___ yr of growth remaning and the brace must be worn for ___ hrs each day? | 1 yr of growth remaining and it is required to be worn 23hrs each day. 1 hr off for bathing |
| T/F Bracing cures scoliosis? | False Bracing doesn't cure scoliosis it slows progression of it |
| T/F there are 3 types of braces for scoliosis? | True (Boston & Wilmington braces; Thoracolumbosacral orthotic; and Charleston nightime bending brace) |
| T/F When bracing is used in scoliosis it is okay to participate in contact sports? | False no contact sports; no gymnastics or horseback riding activities |
| T/F In scoliosis compliance with bracing is a problem? | True |
| When will a scoliosis pt have surgery and why? | 50% degree they will have surgery because of diminished pulmonary function, cosmetic, pain (older kids); and children with neurologic difficulty have difficulty sitting & walking because of imbalance |
| Scoliosis children with neurologic difficulty have difficulty __ &___ because of imbalance | children with neurologic difficulty have difficulty sitting & walking because of imbalance |
| Scoliosis surgery is to ___ & ___ the spine with internal fixation & instrumentation combined with spinal fusion? | Realign & straighten |
| T/F There are 3 types of surgerys for scoliosis? | True 1. harrington Rod 2. Luque segmental instrumentation 3. Cotrel-Dubousset approach |
| T/F Harrington rod the rod goes all the way up the spine. they are immobolized a few days or hardshell brace. | True they slide out of bed to stand up |
| When using wire & rods in scoliosis surgical repair the wire & rods are arround the vertabre. They Don't need a body cast and they can walk ___ days after getting it? | 1-2 days after getting it |
| Scoliosis nursing interventions: Assessment of ___; Bracing-teach care of brace, emphasize ___, & encourage normal growth & developemnt; Preoperative Care-assist with preop workup and preop teaching | assessment of curve; bracing teach care of brace, emphasize compliance, & encourage normal G & D; preop care |
| Scoliosis surgical repair there will be lots of ___; ICU 1st 24-48hrs; blood loss in surgery typed and crossed; ___ problems after and ___ complications | Lots of pain; ICU 1st 24-48hrs; blood loss in surgery typed & crossed; Pulmonary problems after and hardware complications |
| What are the postoperative care nursing interventions of scoliosis? | monitor in ICU for 24-48hrs; ABC's; Carefullly assessment of NV status; Place on special mattress or mattress pad; and log roll every 2hrs |
| PCA pumps are important in regulating pain postoperatively of a scoliosis pt. What do you want to teach the pt? | cant overmedicate self; dont have parent push PCA ; children are sometimes affraid to push pca |
| Do you want to use SCDS postoperatively for surgical repair of Scoliosis? | NO there is a problem with clot formation and use of SCDs. Log roll them instead without bending them. Paralytic is common because of several hours not moving |
| Nurising interventions of Scoliosis postoperatively: frequent administraion of pain meds via ___; Assess ___ motility; assess skin integrity, incision; instruct ___; instruct brace or cast care; and promote normal growth & developement | frequent administration pain meds via PCA; assess bowel motility; assess skin integrity, incision; instruct ambulation; instruct brace or cast care; promote normal growth & development |
| Osteogenesis Imperfecta (OI)is an ___ hereditary disorder of the connective tissue? | autosomal dominant hereditary disorder of the connective tissue |
| Osteogenesis Imperfecta (OI) is a rare ___ inhereitance? | Rare autosomal recessive inheritance |
| T/F Osteogenesis Imperfecta (OI) is heterogeneous? | True |
| Most common type of Osteogenesis Imperfecta (OI)is a defect in ___ gene: error results in faulty ___ mineralization, abnormal ___ architecture, & increased susceptibilty to ___? | Most types defect in precollagen gene-error results in faulty bone mineralization, abnormal bone architecture, & increased susceptiblity to fracture |
| T/F there are 4 types of Osteogenesis Imperfecta (OI)with wide variablity bone fragility and clinical manifestations depends on the type? | True |
| Most common type is Type 1 (2/3 of cases) what are the manifestations of type 1 Osteogenesis Imperfecta (OI)? | mild bone fragility, blue sclerae, normal teeth, joint laxity, hearling loss is common in 20's to 30's |
| T/F Osteogenesis Imperfecta (OI) may be confused with child abuse | True |
| Osteogenesis Imperfecta (OI) if born vag lots of fractures and usually die in ___ with types 3 and 4? | 20s |
| Osteogenesis Imperfecta (OI)therapeutic management: primarily supportive; medications to increase ___; experimental bone marrow transplant; lightweight __ &__; PT; and may need surgery to correct deformities later | primarily supportive; medications to increase bone density; experimenta; bone marrow transplant; lightweight braces & splints; PT; may need surgery correct deformities later |
| What would we as nurse not want to do with Osteogenesis Imperfecta (OI)? | No BP (if u must use manual); Baby (dont hold feet up to change diaper instead slide it under buttox; cup in arm don't pull on limbs); dont use a turnicate to start IV; dont restrain them |
| What do you want to teach a Osteogenesis Imperfecta (OI) parent? | 1st aid for fractures |
| What are some supportive interventions of Osteogenesis Imperfecta (OI)? | Extensive teaching with parents: care of child, assessment of fracture, 1st aid of fracture and discpline |
| T/F Osteogenesis Imperfecta (OI) carefully support chld when turned and be sure to always take BP? | False carefully support child when turned, positioned or moved and NO BP |
| T/F Refer family to OI foundation if their child has Osteogenesis Imperfecta (OI)? | True |
| T/F In Osteogenesis Imperfecta (OI) guide suitable activities that promote optimum development as well as protect chld from harm | True |
| Juvenile Idiopathic Arthritis (JIA)__ in 1,000 children; 2:1 ___; Peak __ to __ years & __ to ___ years? | 1 in 1,000 children; 2:1 female; peak 1 to 3 years & 8 to 10 years. 30% will get RA as an adult and 70% are inactive as children |
| What is Juvenile Idiopathic Arthritis (JIA)? | Chronic inflammation with joint effusion and eventual erosion |
| What are some theories of causes of Juvenile Idiopathic Arthritis (JIA)? | some theories-caused when infectious agents creates autoimmune inflammatory process |
| T/F Juvenile Idiopathic Arthritis (JIA) pts are on long term corticoid steroid therapy? | True |
| What are the clinical manifestations of Juvenile Idiopathic Arthritis (JIA)? | Stiffness, Swelling, warm to touch; loss motion; may be tender & painful to touch; Growth disturbances |
| What are the 3 major classifications of Juvenile Idiopathic Arthritis (JIA)? | 1. systemic onset 2. pauciarticular 3. polyarticular |
| How is Juvenile Idiopathic Arthritis (JIA) Diagnosed? | Diagnosed by exclusion-age of onset, number of joints involved, & exclusion of other cuases |
| In Juvenile Idiopathic Arthritis (JIA) RF positive in only ___% of children | 10% |
| T/F In Juvenile Idiopathic Arthritis (JIA) elevated sedimentation rate is always present | False elevated sedimentation rate may or may not be present |
| T/F Leukocytosis frequently present during exacerbations in Juvenile Idiopathic Arthritis (JIA)? | True |
| T/F Antinuclear antibodies is common in Juvenile Idiopathic Arthritis (JIA)? | True |
| T/F there is a cure for Juvenile Idiopathic Arthritis (JIA)? | False there is no cure |
| What are the major goals of therapeutic managment of Juvenile Idiopathic Arthritis (JIA)? | control pain (never can take all pain away); preserve joint ROM; Minimize the effects of inflammation; Promote growth & developement. Be sure to use a multidisciplinary approach |
| T/F Juvenile Idiopathic Arthritis (JIA) have frequent eye exams | True due to eye edema |
| T/F Juvenile Idiopathic Arthritis (JIA) theraputic management can involve surgery? | True |
| What types of pharmalogical drugs are used theraputically in Juvenile Idiopathic Arthritis (JIA)? | NSAIDS (up to 3 weeks); slow acting antirheumatic drugs; corticosteroids; etanercept; other cytotoxic agents (increased risk of infection) |
| T/F asprin can be given to kids with Juvenile Idiopathic Arthritis (JIA)? | False no asprin for kids |
| What are the GI side effects of the theraputic pharmalogical agents used in Juvenile Idiopathic Arthritis (JIA)? | fragile skin, use sun screen |
| ___% of pts with Juvenile Idiopathic Arthritis (JIA) need other meds besides NSAIDS | 65% |
| Juvenile Idiopathic Arthritis (JIA)nursing interventions: Assessment; relieve pain; diet & exercise (make suer enough calories); sleep & ___: encourage ___; promote normal growth & development activites; ___ support; activity ___; play ___ | assessment; relieve pain; diet & exercise; sleep & rest; encourage compliance; promote normal growth & developement; emotional support (parents overwhelemd-guilt, anxiety); activity as tolerated; play encouraged and school is important to go to |
| What does DMD stand for? | Duchenne (Pseudohypertrophic) Muscular Dystrophy |
| Duchenne (Pseudohypertrophic) Muscular Dystrophy cause basic defect MD unknown...metabolic disturbance is unrelated to the ____? | nervous system |
| ___ is the most common and most severe form of muscular dystrophy? | Duchenne (Pseudohypertrophic) Muscular Dystrophy (DMD) |
| Duchenne (Pseudohypertrophic) Muscular Dystrophy (DMD) 1 in ___ males; ___ recessive pattern- 1/3 due new gene mutations and there is an absence of ___ in muscle | 1 in 3600 males; x-lined recessive pattern- 1/3 due new gene mutations; and there is an absence of dystrophin in muscle |
| What is dystrophin? | protein product in cell. w/o it cells explode and die in the muscle |
| T/F pts with Duchenne (Pseudohypertrophic) Muscular Dystrophy are initially normal | true |
| Onset of Duchenne (Pseudohypertrophic) Muscular Dystrophy is ___ yrs and there is a history of ____? | DMD onset 3-5 yrs; history delay motor developement |
| What is the common 1st symptom of Duchenne (Pseudohypertrophic) Muscular Dystrophy? | 1st symptom often difficulty running, riding bicycle or climbing stairs |
| What are the later manifestations of DMD after the 1st symptom? | later manifestations: abnormal gait, lordosis, freq falling and characteristic manner rising from squatting on floor |
| Waht is the Gower's sign? | In DMD pts they walk themselves up off the floor from crawling position to standing position |
| Clinical manifestations of DMD: Calf muscles ___; loss independent ambulation by ___ yrs; mild ____ is common; slowly progressive ____ weakness; Death from __ or ___ failure | calf muscle hypertrophy (looks large-muscle is replaced by fat due to necrosis); loss independent ambulation by 9-11 yrs; mild mental retardation common; slowly progressive general weakness; death from respiratory/cardiac failure (20s); emotional problems |
| T/F In DMD the more you exercise the muslces the worse it gets? | true |
| What are the DMD complications? | Contractures; scoliosis; disuse atrophy; infections; obesity (need less calories) and cardiac |
| Genetic studies (Dx w/ muscle biopsy); serum enzumes; biopsy and EMG (muscle response to elecricity decreased response) are all diagnostic evlauations of ___? | DMD |
| What will the sereum enzymes show in a DMD pt? | increased CPK & AST enzymes--affected by muscle wasting. elevated seen. 1-2 yrs before symptoms usually |
| T/F There is no effective treatment of DMD? | True |
| What is the goal of therapeutic management of DMD? | Goal-maintain ambulation as long as possible prevent the fractures |
| DMD therapeutic management: long term decisions like ___; research and genetic & professional counseling? | long term decisions like trachs |
| DMD nursing interventions: requires multidisciplinary team; balance between limiting ___ and allowing ___; Assist develop individualized program to promote self-care, cope with progression & limitaitns, &___ disablities; encourage avoidance ___ infections | requires multidisciplianry teams; balance between limiting activity & allowing activity; assist develop indiviualized program to promote self-care, cope with progression & limitations, & reduce disabilities; encourage avoidance respiratory infections |
| The priamry care of nurses & doctors of DMD pts is to ___? | coordinate their care |
| DMD nursing interventions: ___ caloric, ___ vit C diet; growth & developement issues; ___ support for pt & family; refer to MD association; palliative care for ___? | Low caloric, high vitamin C diet; Growth & development issues; emotional support for pt & family; refer MD association; palliative care for future decisions |
| Torticollis, metatarsus adductus, metatarsus varus, pes plantus, genu varum, genu valgum, genu recuravtion and osgood-schlater disease are other ___ abnormalities? | MS |
| What is torticollis? | Torticollis, or wry neck, is a condition in which the head is tilted toward one side, and the chin is elevated and turned toward the opposite side. |
| What is Metatarsus Adductus? | feet turn outward at least 20 degrees |
| What is Metatarsus Varus? | Feet turn inward at least 20 degrees |
| What is Pes plantus? | flat feet |
| what is Genu varum? | bow leg |
| What is Genu valgum? | Knowck knees |
| What is Genu recurvation? | hyperextension of knee joint |
| What is Osgood-Schlater Disease? | preadolcent period of rapid growth pain or swelling just below the knee. Use ice and rest prior to exercise |
| YOU observe a child with DMD arising from a sit position on the floor. The child moves his hands up his legs to stand. The nurse documents that the child demonstrates what sign? A. Galeazzi's sign B. Goodell's sign C. Goodenough's sign D. Gower's sign | Gower's sign |
| What is the priority assessment of a child admitted following placement on skeletal traction? A. The pull of traction on the pin B. The Ace bandage C. The pin sites for signs of infection D. The dressings for drainage | #1- traction #2- dsgs drainage #3 signs infection pin site |
| A 2-year-old arrives at a refugee camp. The child limps when walking. What exam technique would the nurse utilize to assess this child for DDH? A. Ortolani's maneuver B. Barlow maneuver C. Adam's position D. Trendelenburg's sign | Trendelenburg's sign - Found in weight bearing toddler- pelvis tilts downward on the unaffected side instead of upward as it would normally. |
| On examination of a newborn's feet, the nurse noticed that the child had bilateral foot deformities characterized by forefoot adduction. This finding is most characteristic of? A. talipes equinovarus B. metatarsus varus C. pes planus D. torticollis | B. metatarsus varus. |
| The mother of a 6-year-old asks the nurse if she will have to home school her child that was recently diagnosed with JIA? The nurse responds ? | "Your child should be encouraged to attend school, but will need extra time to work out early-morning stiffness." |
| T/F In JIA Socialization is important and activity is important to maintain function. This could be accomplished through home schooling but illness should not be the reason to home school. Child may need extra time in the am. | True |
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cgwayland
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