Module 15 - rest & exercise
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| Highest priority w/ cast care? | Maintaining Skin integrity
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| Nursing interventions to minimize swelling and promote circulation w/ casts? | ice, elevate, CMS checks, keep dry
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| Major complication of any constricting cast or splint? | Compartment syndrome
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| How do you handle a wet cast? | With open palms, not fingers; to prevent pressure spots
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| Purpose of traction? | Stretch muscles and alignment
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| Kinds of skin traction? | Bryant's - legs straight and 90degrees toward ceiling AND Pugh's - child's wt is counterbalance
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| What to remember w/ skin traction? | never release traction w/o MD order
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| Why is skin traction used for hemophiliacs? | Hemoarthrosis
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| Most serious complication w/ skeletal traction? | Osteomyelitis
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| 5 P's of vascular impairment? | Pain, Pallor, Pulselessness, Paresthesia, Paralysis
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| After traction applied, how often are neurovascular assessments done? | q 1-2hrs during first 48hrs, then q 4hr CMS w/ v/s
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| S/S of Neurovascular impairment? | cold, blue, pale, loss of motion, numbness, tingling, sluggish cap refill
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| How do you assess pain level? | Pain scale, vital signs, open ended questions
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| Cerebral Palsy | Neuromuscular disorder resulting from damage to brain from anoxia
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| S/S of CP | Hypertonicity (spasticity), mental retardation (in 18-50%), speech/hearing disturbance, dental anomalies, sz
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| Interventions for CP? | Nutrition, safety, meds
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| Med for CP? | Dilantin, Baclofen
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| Things to know about Dilantin? | s/e = gingival hyperplasia, oral care w/ soft toothbrush
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| Baclofen - why is it given and how? | Given to reduce spasticity and given intrathecally
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| Priority goal for CP? | maintain optimal level of wellness
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| Developmental Dysplasia of the Hip | Abnormal development of head of femur and acetabulum
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| How do you assess for DDH? | +Ortolani's, shorter limb, asymmetrical gluteal skin folds
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| Intervention for DDH? | Plavik Harness for 3mos; hip-spica cast or surgery for older child
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| Highest priority teaching for DDH? | Prevent complications --> proper placement of harness
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| Highest priority of care for DDH? | Prevent skin breakdown
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| How to assess for scoliosis? | Child bends forward w/ knees straight and arms hanging down --> spine fails to straighten; hips, ribs, shoulders asymmetrical
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| Interventions for scoliosis? | Milwaukee brace worn 23hrs/day
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| Post-op care for scoliosis? | Flat, supine position, log roll q 2hrs, NG tube to reduce gas, NPO, incentive spirometer, PCA, strict I&O
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| Priority Nursing Dx for Scoliosis? | Disturbed body image, Pain, Risk for noncompliance
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| Osteogenesis imperfecta (aka OI or "brittle bones") | Autosomal dominant d/o of the connective tissue involving bones, ligaments and sclera
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| Assessment findings for OI | Hx of frequent fractures, blue-tinged sclera, thin skin, blue-gray teeth
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| Abnormal labs for OI? | Precollagen type I
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| Interventions for OI? | Gentle handling, soft environment, parent teaching
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| Juvenile rheumatoid arthritis | Autoimmune disease of connective tissue w/ chronic inflammation of the synovia and possible joint destruction
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| Assessment findings of JA? | elevated ESR, +antinuclear antibody (ANA), +rheumatoid factor
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| What can influence JA exacerbations? | stress, climate, genetics
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| what meds are given for JA? | low-dose corticosteroids, NSAIDS (naproxen, ibuprofen)
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| Important thing to remember when administering JA meds? | admin w/ food
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| What do you do if child feels pain in joints? | If stiff, may need heat; if swollen, may need ice
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| Muscular dystrophy | Genetic, sex-linked recessive trait, mostly in males d/t absence of protein in muscles
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| Assessment findings w/ MD? | Pelvic girdle weakness, waddling gait, falls, difficulty climbing stairs, +Gowers sign
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| Diet for MD? | high fiber, High fluid, high protein, low Cal diet
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| Priority Nursing Dx for MD? | Risk for injury, Impaired physical mobility, risk for constipation, disturbed self esteem
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