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Nsg 213

What musculoskeletal injury? Soft tissue damage, broken small vessels and inflammation- manifestations: pain, edema, ecchymosis, disability contusion
Management of a contusion? immediate and appropriate evaluation, cold application, relief of pooled blood, especially if under nail
What musculoskeletal injury? force on the ligament causes opposing ends of bones to be dislocated-manifestations: pain, deformity, limited or restricted movement of limb, possible compromise in circulation in ball and socket joints, mostly hip joint dislocation
Management of a dislocation reduction of dislocation- pulling or manipulation of extremity to bring joint end back into its socket or position
What does a sprain involve? joint and ligaments
What is a strain? tear at muscle-tendon junction
How are strains and sprains managed? Assess 5 Ps, RICE: Rest- allow for healing, movement before tissue is healed could cause more tearing and damage. Ice: immediately 20 minutes at a time. Compression: dry wrap. Elevation: venous return
What time frame is critical for tx of soft tissue injuries? w/in 12 hours
Weakest part of bone structure in children- very prone to injury epiphyseal plate(cartilage growth plate) During adolescence, plates replaced with bone
What is the risk of recovery for a child with a fracture at the epiphyseal plate? altered bone growth
What is the risk of recovery for a young child with a bend fracture? bend fx straighten slowly and risk of incomplete straightening
Type of fracture where there is a break on one side and a bend on the other greenstick- usually in young children- trauma causes incomplete fx
Manifestations of an elbow fx tenderness, inability to rotate, deformity, acute pain- occurs when fall hard on outstretched hands, ulna and radius can be broken
Management of fractures 5 Ps, move injured area as little as possible, splint with soft items, then firm items, elevate, cold compresses
What are the 5 Ps? pain, pulses, pallor, parasthesia, paralysis
Why is pedaling done on a cast? to make edges smooth- taping down edges of cast
Components of traction? forward force- force on distal end of bone counter traction- body weight- backward force friction- body contact with bed surface
Purpose of traction? fatigue involved muscle and reduce muscle spasms so bone ends can align. immobilize the fx site until realignment has been acheived
What is different about the periostium of children? It is thicker and has more blood supply than the adult, osteoblasts form rapidly and produce callus around the broken ends of the bone
What component of the bone healing phase serves as the "joint fixator" holding the ends together? Callus
What is bone remolding? As the callus ages and real bone is laid down at fx site, and as activity and weight bearing is increased, the shape of the bone will regain its prior angulations and dimensions- callus resolves and bone ends heal over time- 6 mos to 1 year
What musculoskeletal injury? Trauma causes ligament to be torn or stretched when the joint is twisted or wrenched- damage to blood vessels, muscles, tendon and nerves. Usually sudden onset Sprain
Manifestions of a sprain laxity, loss of strength, joint feels loose or a snap, pop, or tearing- swelling, inability to move
What musculoskeletal injury? microscopic tear at muscle tendon junction- usually occurs over time strain
Manifestions of a strain painful to touch, swollen, immediate swelling,
Which is more severe, strain or sprain? strain
Which overuse syndrome? rotator cuff injury swimmers shoulder- rest until symptoms clear
Which overuse syndrome? occurs when arm is extended under high speed frequently little league shoulder- pain and loss of ROM, rest until healed
Which overuse syndrome? occurs with repetitive throwing, puttling twist on ball little league elbow- also called tennis elbow
Which overuse syndrome? overuse of quadriceps with trauma to the tibial tuberosity- stress on the patellar tendon that attaches the quadriceps at the front of the thigh to the tibial tuberosity Osgood Schlatter disease- vulnerabilty at growth spurt, age 9-16 y/o- limit stress until epiphyseal plate is fused
Which overuse syndrome can cause the shoulder to drop, sometimes confused with scoliosis? back pack- backpacks worn incorrectly or too heavy
Interventions for a child with musculoskeletal trauma Neurovascular checks, pain assessments, skin care, system assessment r/t immobilization
What can cause a pulled elbow in a child? longitudinal pull to arm, swinging around by arms
At what age is a child at risk for a dislocated hip from a fall? Under 5 years old
What type of child will have more pain from muscle spasms? a child with well developed musulature along long bones
Do infants have a lot of muscle spasms? No, they have little tone, fewer spasms
What kind of problems should be addressed in a child with extensive casting? How can we manage these things? limited mobility, loss of time for developmental milestones, problems with hygiene- use diversional activities, promote cognitive skills and other skills that are not affected
Which congenital defect? extra digits polydactyly
Which congenital defect? fusion of digits syndactyly
How are poly/syndactyly treated? surgical correction
What types of things could be the cause of underdeveloped limbs? heredity, prenatal environmental factors, hx of thalidomide drug used for morning sickness
How is underdevelopment of limb structures treated? prosthetic devices as early as possible- replaced as child grows
Which congenital defect? anulation of bone or within a bone distal to a joint(knee) is towards the midline. Bowlegged Genu Varum
How is genu varum(bowlegged)treated? Will correct on its own with activity after 2-3 years. Could be pathological- rickets. If doesn't resolve, orthopedic consult.
Which congenital defect? angulation of a bone distal to a joint (knee) or in a part of a bone is away from the midline (knock-knees) Genu valgum- presents between 2-7 years- spontaneously self corrects- if doesn't, orthopedic consult
What is metatarus adductus(varus)? In-toeing most likely caused by abnormal position in uterus- teach parents PROM- if doesn't work, casting can be done to correct
Most common form of clubfoot also associated with other conditions such as neuromuscular paralysis, spina bifida, hip dysplasia? talipes equinus
What are the three forms of clubfoot? Positional(extrinsic) clubfoot Syndromic Congenital(intrinsic) clubfoot
Which type of clubfoot? caused by intrauterine crowding, can be corrected with stretching exercises, ROM and casting Positional(extrinsic) clubfoot
Which type of clubfoot? associated with other congenital anomalies, more difficult to treat, surgical intervention, reoccurance of condition Syndromic
Which type of clubfoot? idiopathic, wide range of rigidity, deformity, bony abnormality requires surgical intervention- no neuromuscular issues Congenital (intrinsic) clubfoot
Management of clubfoot gradually corrected by stretching the structures via serial casting(Ponseti method- final tenotomy at last casting, followed by foot abduction brace for 2-3 mos) or if that doesn't work, surgery(insert pins to stabalize joints, serial casting 2-3 mos
What could wearing the shoe on the wrong foot for several months be a tx for? clubfoot
Etiology of DDH(Developmental dysplasia of the hip) abnormal formation of the hip joint in which the femoral head is not stable in the acetabulum, may occur during fetal development, at delivery, or after birth
Risk factors for DDH familial tendancy, cramping or crowding of fetus in uterus, female, first born babies, breech delivery
What is the mildest form of DDH? Acetabular dysplasia (preluxation)- femoral head remains in the acetabulum
Which test to assess for DDH? fingers over heads of femurs, infant on back with hips abducted, bring hips to adducted and flexed position, then extend legs Barlow's test
Which test to assess for DDH? fingers over heads of femurs, infant on back with hips adducted and flexed, knees flexed, lifting the femurs and abducting- palpable click Ortolan's Maneuver
Which assessment for DDH? standing on the affected leg/hip, that hip/pelvis tilts upward as the opposite hip/pelvis tilts downward- head of femur is slipping up and out of the acetabulum Trendelenburg sign
Which test to assess for DDH? flex infant's knees in the supine position so that ankles touch buttocks, if knees not level, test is positive Galeazzi sign
Management of DDH Multiple diapers- abduction, Pavlik harness up to 6 mos- hip flexion and abduction- needs f/u every 1-2 weeks due to rapid growth, For older child, surgical intervention- tenotomy/osteotomy, bryant's traction, cast applied afterward
Cultural differences that increase and decrease the incidence of DDH Mothers who wrap their child on swaddling boards with hips extended have highest incedence- Mothers who carry their infant in pouches or on their hips (widely abducted hips) have lowest incidence of DDH
A genetic disorder of bone predisposition to osteoporosis- frequent fractures and bone deformity, other anomolies such as blue sclera, hearing loss,easy bruising, and hypo plastic discolored teeth Osteogenesis Imperfecta
Collaborative management for osteogenesis imperfecta supportive- braces and splints, gentle handling, activity limitations, vocational guidance, genetic counseling
Degenerative disease of the hip joint, loss of bone mass leads to some degree of collapse of the hip joint, deformity of the ball of the femur and the surface of the hip socket develops- typically in young children Legg-Calve-Perthes Disease- cause unknown, avascular necrosis of femoral head
Manifestations of Legg-Calve-Perthes Disease limp on affected side, hip soreness, ache or stiffness(continuous or intermittent) Limp more pronounced with activity, limited ROM, knee pain is referred pain
Treatment for Legg-Calve Perthes Disease rest, activity restrictions, medications, bedrest, traction, casting/bracing, surgery if necessary, PT, crutches
Two most critical factors that determine the child's outcome with Legg-Calve-Perthes disease child's age at diagnosis and how much of the femoral head is affected
What is the displacement of the femoral head epiphysis? generalized metabolic disorder of puberty Slipped femoral capital epiphysis
Manifestations of a slipped femoral capital epiphysis limp, groin, thigh, knee pain- referred pain, can also have avascular necrosis of the femoral head, limited ROM, unable to bear weight, external rotation of foot
What is the cause of slipped femoral capital epiphysis? possible imbalance of growth hormone with testosterone- tends to occur in overlarge children, particularly boys
How is Slipped femoral capital epiphysis diagnosed? LATERAL x-ray- anteroposterior x-ray will not show
Management of slipped femoral capital epiphysis bedrest, non weight bearing, surgery- pins to stabalize the femoral head until growth plate is closed, pin removed after closure
What is kyphosis? abnormal covex curvature of thoracic spine, shoulders slouch
What is lordosis? pronounced concave curvature of lumbar spine, if severe, painful
How is kyphosis and lordosis treated? promote correct posture, regular exercise, braces, spinal fusion in severe cases
What is scoliosis? three dimensional curvature of spine, lateral curvature, spinal rotation with rib asymmetry, thoracic hypokyphosis more commonly during growth spurt
What is the cause of scoliosis? One side of the vertebral joint grows faster than the other side, one side of spine has more bone than other side
What are the 4 manifestations of scoliosis? truncal asymmetry, uneven shoulders and hips, one sided hump, prominent scapula
Tx for child with 10- 30 degrees of scoliosis observed for progression, seen every 6 mos for follow up
If scoliosis progresses to 30-50 degrees, what is done? A TLSO(thoraco-lumbar spinal orthotic) is worn more than 20 hours a day - if successful, the curve will be reduced by half or better- successfully stops progression in 80% of children
What is done if scoliosis is more than 50 degrees? spinal fusion surgery followed by bone graft
How long after spinal surgery does it take for the child to possible return to unrestricted activity? 12 mos if all is well
What is muscular dystrophy? Duchenne- most common form x linked inherited muscle disease of childhood, progressive weakenss, muscle fiber degeneration and muscle wasting, absence of dystrophin, glue that holds muscles together
Manifestations of muscular dystrophy child follows growth and development until about 3 years old, then begins to lose gross motor control, weakness, fatigue, overdeveloped calves, lordosis, contracted achilles tendon, frequent falls, waddling gait, lax shoulder muscles, purple feet, cx,
As muscular dystrophy progresses, what symptoms will be seen? dysphagia, difficulty with speech, profound weakness and wasting, mental deficiency, contractures, loss of ability to ambulate 9-11 y/o
At what stage of muscular dystrophy will these symptoms be seen? profound muscular atrophy, bad contractures, respiratory failure (around age 10), cardiac failure, death and dying issues latent stage
How is muscualr dystrophy diagnosed? muscle biopsies, CK, EMG, NCV (Nerve conduction velocity), Single condition amplification/internal primer sequencing- allows total evaluation of dystrophin gene to find mutations
How is muscular dystrophy treated? prednisone, deflazacort, albuterol, creatine(builds up muscle's energy supply), calcium blockers, gentamycin
Infection of bone, occurs from direct trauma or seeded by pathogens in the blood osteomyelitis
Manifestiations of osteomyelitis pain, warmth, tenderness, decreased ROM
Treatement for osteomyelitis abx per culture assay, IV meds followed by oral, dead bone debridement, positioning limb in alignment, gentle handling, support and rest, non weight bearing if long bones affected, gradual return to activities after infection gone
Infection of the joints(synovial tissues-joint cavity) that occurs from local tissue infection (cellulitis) or seeded from pathogens in the blood Septic arthritis
Manifestations of septic arthritis inflammation, pain, swelling, tenderness of joint
How is septic arthritis treated? joint aspiration followed by IV abx, surgical intervention for trauma repair, removal of foreign objects, rest of joint
What is the term used to describe arthritis/inflammation of the synovium with onset before 16 years of age? It is an autoimmune inflammatory disease causing inflammation of joints and other tissues. Jevenile Idiopathic Arthritis
Manifestations of juvenile rheumatoid arthritis may begin with swollen knuckle, spiking fever, or unexplainable rash, can be subtle or obvious. May have limping, sore wrist, finger, or knee. swollen and enlarged joints. stiffness in neck or hips. rashes come and go, in 1 area and then another.
What type of fever is characteristic of systemic juvenile rheumatoid arthritis? High fevers that tend to spike in the evenings and suddenly disappear
Name some tests that will be used to diagnose juvenile rheumatoid arthritis. CBC, cultures(r/o infection), bone marrow aspiration (r/o leukemia), ESR, leucocytosis, ANA(common, not specific- also may predict likelyhood of getting eye disease with IJA), RF, x-rays, bone scan, samples of synovium, test for viral disease
If a child has inflammation of the joints, what other part of their body should be examined? Eyes, inflammation of joints may be associated with inflammation of the eyes
Meds used to treat Juvenile Arthritis NSAIDS, methotrexate, methotrexate plus folate to ward off side effects, corticosteroids, Autologous stem cell transplantation, etanercept or the monoclonal antibodies infliximab and adalimumab- blocks the TNF
What treatment besides meds is used for Juvenile Arthritis? OT and PT, ROM, sports restrictions, balanced diet with calcium
A fast-growing, highly malignant tumor which accounts for over half of the soft tissue sarcomas in children rhabdomyosarcoma- most common in children 1-5 y/o
What are the four major sites where rhabdomyosarcoma is found? 1. head and neck, around eyes 2. genitourinary tract 3. extremities 4. trunk, chest and lungs
manifestations of rhabdomyosarcoma noticeable lump on child's body, depends on where the tumor is located as to what symptoms will be seen
How is rhabdomyosarcoma diagnosed? tests for blood, muscle, and marrow- diagnosis depends on recognition of differentiation toward skeletal muscle cells
treatment options for rhabdomyosarcoma chemo, radiation, sometimes surgery. Removal of tumor is very difficult, if in extremities, amputation.
most common type of bone cancer in children osteosarcoma- arises in ends of bones, most frequently large bones of humerus and femur and tibia.
manifestations of osteosarcoma pain and swelling, pain severe enough to make child limp
How is osteosarcoma confirmed? biopsy, CT, MRI- commonly metastasizes to other parts of body, such as lungs, so CT scans of chest, x-rays ,bone scans are done
How is osteosarcoma managed? surgery is primary tx, followed by chemo- prostesis important part of therapy
common name for primitive neuroectodermal tumor- rare disease where cancer cells are found in the bone or soft tissue Ewing sarcoma- most commonly in pelvis, femur, humerus, and ribs- most frequently in male teenagers
Where does the cancer arise from in ewings sarcoma? bone marrow spaces of bone
two goals for management of ewings sarcoma and tx 1. cure cancer 2. save as much function of affected area as possible- tx with chemo and radiation- surgery scheduled 2-4 mos after chemo begins
What is an autograft? bone graft from a patient's own tissue after removing cancerous tissue
What is an allograft? bone graft from donor's tissue after removing cancerous tissue
What is a rotationplasty? used for young or athletic pts with ewings sarcoma- tumor is removed by cutting above and below the knee. lower portion of leg is rotated and reattached so that ankle becomes knee. get prosthetic ankle and foot
how are prosthetic implants used? used when portion of bone is removed and replaced with implant
Created by: 1656878667