Part1
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Help!
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| If you don't use it... | you lose it!
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| Why do tendons and ligaments take longer to heal than bone? | less blood flow
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| Issues with immobilization | -Disuse atrophy
-Bone demineralization, osteoporosis, and hypercalcemia
-Possible contractures (rare in kids)
-Venous stasis and thrombus formation
-Dependent edema
-Decreased metabolic rate, anorexia, constipation
-Skin breakdown
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| Compartment Syndrome | extremity loses blood supply, starts to become nacrotic. Can lose limb.
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| Immobilization nursing care | -Encourage fluids
-Provide diversional activity
-ROM for unaffected limbs(make it fun)
-Small frequent meals
-Increased fiber
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| Muscle relaxent for children | Valium
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| Factures are common in kids due to... | -Increased mobility
-limited coordination
-more easily injured
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| How fast are do fractures heal | Neonates, 2-3wks
Young kids, 4 wks
Older kids, 6-8 wks
Teens, 8-12 wks
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| Fracture Dx | Xray
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| Fractures in children | Periosteum of kids' bones have more active osteogenic potential
Kids' pliable bones are more porous
Healing is rapid
stiffness unusual
Kids' usually only complain when something is wrong
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| Goals for fractures | -Regain alignment and length of the bony fragments (reduction)
-Retain alignment and length (immobilization)
-Restore function to the injured parts
-Prevent further injury
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| Diet when have a fracture | Increase protein and Calcium
Vitamin C
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| Fracture Nursing Care | Control pain, hemorrhage, and edema. Relief of muscle spasm. Realignment of fracture fragments. Promote of bone healing. Immobilization of fracture until adequate healing has begun. Prevention of secondary complications. Limitation of disuse syndrome. PT
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| Fiberglass cast | Most common. Light weight, dry quickly (mins). More expensive but can get a bit wet. Edges rough don't mold as well.
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| Plaster of paris cast | Occasionally used. Heavier, take longer to dry (hrs) compared to fiberglass. Mold readily to body part. Can't get wet smoother edges. chemical reaction generates heat.
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| Nursing care with casts | elevate above heart to reduce edema. Check for pallor, pulselessness, pain. If edges rough, petal. Can "window" cast, small cut out in cast ex. to watch an abrasion
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| Traction | Bone fragments that can't be reduced with simple traction and stabilization with a cast ma require this.
May help overcome muscle spasm, keep in alignment and immobilize until healing begins (callus form)
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| New CLIENTS | New for neuro sensory
Circulation
Lungs
Integumentary
Elimination
Nutrition
Traction
Socal and Psychological
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| Developmental Dysplasia of the Hip (DDH-Congenital Hip) | Imperfect or abnormal hip development.
Usually shallow acetabulum with subluxation or disloaction of femoral head.
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| Acetabular dysplasia or Preluxation | mildest, not subluxed or dislocated, shallow acetabular roof/delay in full development
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| Subluxation | most common. partial disclocation, head of femur still in contact but ligament stretched, inhibits ossification, causes flattening of socket.
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| Dislocation | femoral head loses contact with acetabulum, displaced posteriorly and superiorly (back and up) over rim, ligament elongated and taunt.
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| Congenital Hip At risk | More common in femailes (possibly r/t estrogen)
L>R
Higher risk-infants tightly swaddled, larger babies.
Lower risk-babies carried on hip
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| Congenital Hip-S/S | May notice asymetrical gluteal thigh folds, apparent uneven length of femur.
Ortolani's sign-click on abduction
Barlow's sign-hip dislocates and reinserts
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| Ortolani's sign | click on abduction (not done by nursing)
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| Barlow's sign | hip dislocates and reinserts
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| Congenital Hip Dx | Xray or Ultrasound to confirm (mainly ultrasound)
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| Congenital Hip Tx | If dx at 0-6 months, keep hip abducted (double diapers, pillow splint, Pavlik harness or brace) usually works.
If dx at 6-8months, usually need gradual reduction by traction and f/u cast or open reduction surgery
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| Bryant's Traction | Rare. Used for young chid who has a fractured femur.
Note that the buttocks are slightly off the bed to facilitate countertraction.
Active infants may require a jacket restraint to maintain body alignment.
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| Russell Skin Traction | A sling is positioned under the knee, which suspends the distal thigh above the bed
-Pulls in 2directions
-Prevents posterior subluxation of the tibia on the femur
-2 sets of wts, one @the head& one @the foot of the bed
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| Checklist for traction apparatus: | -wts hanging freely
-wts are out of reach of child
-Ropes are on the pulleys
-knots are not resting against pulleys
-bed linens are not on traction ropes
-countertraction is in place
-apparatus does not touch foot of bed
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| Why use forces of traction | to align bone ends
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| Bilateral congenital talipes equinovarus | CLUB Foot
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| Club foot caused by | usually being breach in utero, not enough room for movement
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| Club foot | Congenital skeletal deformmity of the foot.
Foot is twisted out of normal position.
Cannot be manipulated into a normal position.
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| Club foot Tx | Serial castings done until defect corrected.
Surgery if castings unable to correct.
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| Legg-Calve-Perthes Disease (Coxa Plana) | One of a group of disorders called the osteochondroses in which the blood supply to the epiphysis (end of the bone) is disrupted.
Tissue death resulting from inadequate blood supply is termed avascular necrosis.
Affects development of the head of femur.
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| Legg-Calve-Perthes Disease (Coxa Plana)-Seen more commonly in... | Boys 5-12 years of age
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| Legg-Calve-Perthes Disease (Coxa Plana)-Tx | Healing occurs spontaneously over 2 to 4 years.
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| Legg-Calve-Perthes Disease (Coxa Plana)-S/S | Self limiting, idiopathic avascular necrosis of the femoral head.
pain in hip, inner thigh, knee.
develops limp.
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| Legg-Calve-Perthes Disease (Coxa Plana)-Dx | Xray confirms.
Rest and non weight bearing for up to 2-4 years.
May do surgery.
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| Scoliosis | Complex spinal deformity usually with:
-Lateral curvature of spine
-Spinal rotation causing rib asymmetry
-Thoracic hypokyphosis
Most common in girls
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| Scoliosis-Functional | Caused by poor posture
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| Scoliosis-Structural | Caused by changes in the shape of the vertebra or thorax
-Usally accompanied by rotation of the spine
-Hips and shoulders may appear to be uneven
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| Scoliosis-Causes | Abnormal formation (congenital deformity) of vertebrae.
Trauma-fracture or from radiation
Muscle weakness-like CP, MD or polio
Unequal leg lenths
Or Idiopathic
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| Scoliosis-Dx | Screening-assess w/o shirt, bend slowly
Xray to confirm
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| Scoliosis-Tx | Observe if mild (exercises may help)
Braces 23hr/day through growth if <40degrees
Surgery if >40 degree curve
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| Scoliosis-Post Op | Neuro assessment important!
Keep pretty flat, log roll initially
Up with brace with in day or so
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| Scoliosis-Braces | Milwaukee brace.
SpineCor brace.
SpineCor brace improved outcomes over Milwaukee bracing
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| Osteomyelitis | Common organisms
-Staphylococcus aureus in children >5 years of age (75-80% of cases)
-Haemophilus influenzae most common cause in young children
May be preceded by a local injury to the bone.
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| Osteomyelitis-S/S | Present as irritable, restless, with increased temp.
May be localized tenderness, increased warmth or swelling over involved bone, gaurd extremity d/t pain with movement.
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| Osteomyelitis-Dx | Xray, blood culture, ESR (Erythrocyte sedimentation rate or sed rate), and WBC
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| Osteomyelitis-Tx | IV antibiotics long term (6wks-3months), then PO abx.
Immobilize, no weight bearing
Surgical drainage if fear of pus erupting and spreading infection
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| Osteomyelitis-Nursing Care | Monitor for side effects of drugs.
Encourage adequate nutrition.
Diversional activity.
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| Bone Tumors S/S, DX | usually cause pain.
Dx-CT or MRI
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| Ewing's Sarcoma | Malignant growth that occurs in the marrow of the long bones.
Mainly occurs in older school-age kids and early adolescents.
When metastasis is present, prognosis is poor.
-Primary sites for metastasis are lungs and long bones.
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| Ewing's Sarcoma, Tx | Radiation therapy and chemo therapy. (usually save limb
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| Osteosarcoma (Osteogenic Sarcoma) | Primary malignant tumor of the long bones
-onset 10-15 yr old
-Kids who've had radiation for other cancers or w/retinoblastoma have a >incidence.
Metastasis occurs quickly b/c of the high vascularity of bone tissue
-Lungs r primary site of metastasi
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| Osteosarcoma-Manifestations | Experience pain and swelling at the site.
May be lessened by flexing the extremity.
Pathologic fractures can occur.
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| Osteosarcoma-Dx | Confirmed by biopsy.
Radiological studes help to comfirm.
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| Osteosarcoma-Tx | Radical resection or amputation surgery.
Phantom limb pain can occur b/c of nerve tracts continue to "report" pain.
Then chemo.
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| Juvenile Rheumatoid Arthritis (JRA) | Most common arthritic condition of childhood.
Systemic inflammatory disease involving joints, connective tissues, and viscera.
Duration of symptoms is important, particularly if they have lasted longer than 6 wks.
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| Juvenile Rheumatoid Arthritis (JRA) happens in what gender and age group? | In children <16yo.
Often "burns out" after 2-3 years.
Or may last 8-10 years or so.
More often in girls with onset b/w 1-3 and 8-10 most common.
No specific tests or cures for JRA!
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| Juvenile Rheumatoid Arthritis (JRA)-methods of inset | Systemic (or acute febrile)
Polyarticular-Involving many joints
Pauciarticular-Involving a few joints
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| Juvenile Rheumatoid Arthritis (JRA)-Systemic | -Occurs most often in kids 1-3yrs of age and 8-10 yrs of age.
-Intermittent spiking fever (>103) persisting over 10 days
-Nonpruritic macular rash
-Abdominal pain
-Elevated ESR and C-reactive protein
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| Juvenile Rheumatoid Arthritis (JRA)-Polyarticular | -Involves 5 or more joints
-Often of hangs and feet
-Become swollen, warm, and tender
-Occurs throughout childhood and adolescence
-Predominantly seen in girls
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| Juvenile Rheumatoid Arthritis (JRA)-Pauciarticular | -Limited to 4 or fewer joints
-Generally in larger ones such as hips, knees, ankles, and elbows
-Occurs in children <3 yo (mostly girls)
-May be at risk for iridocyclitis-an inflammation of the iris and ciliary ody of the eye
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| Juvenile Rheumatoid Arthritis (JRA)-Pauciarticular:S/S | redness, pain, photophobia, decreased visual acuity, and nonreactive pupils.
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| Juvenile Rheumatoid Arthritis (JRA)-TX: | Goals of therapy are:
-Reduce joint pain and swelling
-Promote mobility and preserve joint function
-Promote growth and development
-Promote independent functioning
-Help child and family to adjust to living with a chronic disease
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| Juvenile Rheumatoid Arthritis (JRA)-Long term disease characterized by | periods of remissions and exacerbations
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| Childrens reaction to pain: young infant | whole body response, cry
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| Childrens reaction to pain: older infant | more localized, cry, pull away
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| Childrens reaction to pain: young child | more resistance more vocal
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| Childrens reaction to pain: School age child | may regress, try delay, may be rigid
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| Childrens reaction to pain: Adolescent | less vocal and motor, more verbal and increased muscle tension and body control
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| Treating Pain in Children: Medications | as ordered. Use pain scales and observe to determine use
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| Treating Pain in Children: Non Pharmacologic Interventions | -Distraction
-Relaxation
-Massage, touch
-Heat or cold
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| Cognitive Impairment | Any type of mental difficulty or deficency-Mental Retardation.
-Intelligence quotient(IQ) <70-75
-Functional impairment in at least 2 of 10 adaptive skill domains including communication, self care, home living, social skills, health and safety.....
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| Cognitive Impairment: Causes? | -Infection & Intoxication
-Trauma/physical agent
-Metabolism/nutrition
-Gross postnatal brain disease or
-Unknown prenatal influence
-Chromosome abnormalities
-Gestational disorders
-Psychiatiric disorders w/onset during kids develop period
-Envio
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| Cognitive Impairment: Primary prevention strategies | -Rubella Immunization
-Genetic counseling
-Folic acid b4 & during pregnancy
-Educate alcohol during pregnancy & lead
-Adequate prenatal care ad childhood nutrition
-Reduction of head injuries
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| Cognitive Impairment: Secondary prevention strategies | Identify early and institute tx to avert cerebral damage.
-Prenatal diagnosis or carrier detection
-Newborn screening for treatable inborn errors of metabolism.
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| Cognitive Impairment: Tertiary Prevention Strategies | Tx to minimize long-term consequences.
-Early rehab and tx of coexisting problems
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| Early behavioral signs suggestive of cognitive impairment: | -Non responsiveness to contact
-Poor eye contact during feeding
-Diminished spontaneous activity
-Decreased alertness to voice or movement
-Irritability
-Slow feeding
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| Cognitive impairment: Nursing interventions | -Educate child and family
-Promote childs optimum development
-Promote independent self help skills
-Help families adjust to future care
-Care for the child during hospitalization.
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| Downs Syndrome | Most common chromosome abnormality.
Etiology unknow but trisomy 21 (rarely translocation of chromosome 21).
Majority from younger moms but more likely with older moms and even dads.
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| Downs Syndrome: Intelligence | low normal to severely retarded
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| Downs Syndrome: Social development | may lag 2-3 yr behind mental age
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| Downs Syndrome: Congenital anomalies | 40-45% have CHD
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| Downs Syndrome: Sensory Problems | eye and ear problems
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| Downs Syndrome: Other physical disorders | altered immune fx
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| Downs Syndrome: Growth | reduced, ht more than wt
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| Downs Syndrome: Sexual Development | may be delayed or incomplete
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| Downs Syndrome: Nursing Care | -Support family at time of dx
-Assist family in preventing physical problems
-Promote childs development progress
-Determine potential and help to reach
-Assist in prenatal dx and genetic counseling
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