Peds Musculoskeletal or Articular Dysfunction

Pt comes in with hx of multiple fracture occurrences. In order to suspect abuse, what must you first rule out?

osteogenisis imperfecta

When is pain and limp most evident for legg-calve-perthes disease?

pain and limp most evident on arising and at end of activity

Assessment of fractures: 6 P

pallor pulselessness paresthesia pain/point of tenderness paralysis pressure

What is mecromeila?

partial absence of extremity

What is important to remember about pins used for skeletal traction?

Pin sites can be a source of infection. Monitor for signs of infection. Cleanse and dress pin sites as prescribed.

What is trendelenburg sign?

pelvis tilts downward on normal side instead of upward when standing on leg of affected hip used to test developmental dysplasia of hip (DDH) in older children

Management of Legg-Calve- Perhtes

*rest, no weight bearing* NSAID for inflammation and pain surgery in some cases home traction in some cases *keep head of femur in acetabulum*

What is important to remember about hip dislocation?

potential loss of blood supply to head of femur would lead to necrosis and loss of leg, so monitor

What is the Ortolani test?

"clicking" with abduction; is the sound heard when the health care provider maneuvers the femoral head and it slips back into the acetabulum

What is the Barlow test?

"feel" the dislocation as the femur leaves the acetabulum when the health care provider adducts and extends the hips while stabilizing the pelvis

cervical traction

(halo brace or vest)

Which measure is important in managing hypercalcemia in a child who is immobilized? Promoting adequate hydration Changing position frequently Encouraging a diet high in calcium Providing a diet high in protein and calories

*Read* Hydration is extremely important to help remove the excess calcium from the body. This can help prevent hypercalcemia. Changing position frequently will help manage skin integrity but will not affect calcium levels. The calcium will not be incorporated into bone because of the lack of weight bearing. The child is at risk of developing hypercalcemia. The child's metabolism is slower because of the immobilization. A diet with sufficient calories and nutrients for healing is important.

Care management of osteomyelitis

*prompt, vigorous IV antibiotics for extended period (3-4 weeks or up to several months)* complete bed rest and immobility of limb pain management *long IV access* nutritional considerations for healing psychosocial considerations of long term hospitilization

clinical manifestations of developmental dysplasia of hip (DDH) in infants

*shortened limb on affected side* Positive ortolani test Positive barlow test hip joint laxity restricted abduction of hip on affected side unequal gluteal folds when infant is prone

Traction nursing management

*the nurse should never remove/release traction until ordered by healthcare provider prevent skin breakdown neurovascular checks to affected extremities: 6 p's CDB (minus the t) Monitor for SSx of infection age appropriate activities pain management

Clinical manifestation of slipped capital femoral epiphysis

*very often obese* limp on affected side possible inability to bear weight because of severe pain pain in groin, thigh, or knee affected leg is externally rotated loss of hip flexion

Sprain vs strain

- Sprain: tear to a ligament at the joint Strain: tear to muscle

When the scoliosis curve reaches higher than ____ degrees, the dr prescribes a back brace.

45

Care management for fractures

6 p's assess for abrasion check for compartment syndrome *keep affected extremity elevated above level of heart *At home teach signs of complications and to keep it elevated/dry

Spica cast management

6-24 months check for abrasions around cast *bar should never be used to move child (don't move kid by bar)*

What does bracing do for scoliosis?

A brace does not correct the spine's curve in a child with scoliosis; it only stops or slows the progression

The nurse is caring for a client with a slipped capital femoral epiphysis. Which clinical manifestations does the nurse observe in the client? Select all that apply. Dehydration Loss of abduction Limp on affected side Elevated temperature Shortening of lower extremity

A slipped capital femoral epiphysis is a spontaneous displacement of the proximal femoral epiphysis in a posterior and inferior direction. This condition is most common in males and obese children. Due to the dislocation of the joint, the client will lose abduction, will limp on the affected side, and will show shortening of the lower extremity. Unlike acute osteomyelitis, a slipped capital femoral epiphysis is not associated with loss of fluids and hyperthermia, so a child with this condition should not have dehydration and fever.

The primary health care provider has prescribed intravenous (IV) antibiotic therapy for a client with acute osteomyelitis. After assessment, the nurse notes that the client is not responding to the therapy. Which treatment strategy would the nurse expect to be prescribed for the client? Surgery Chemotherapy Phototherapy Oral antibiotic therapy

Acute osteomyelitis is infection in the bone caused by a blood-borne bacterium. If a client is unresponsive to IV antibiotic therapy, the primary health care provider would recommend surgery. Chemotherapy is used in cancer treatment, but is not indicated in the treatment of osteomyelitis since it may cause bone deformation. Phototherapy may not be effective in treating infection because it does not have any antibacterial activity. Oral antibiotic therapy is less effective than IV therapy, so oral antibiotics would not be a suitable treatment when IV antibiotics fail.

Which postoperative nursing interventions are useful to avoid secondary complications in a young patient who has undergone spinal surgery? Select all that apply. Assessing for signs indicating neurologic impairment Administering intravenous opioids on a regular basis Educating the patient on use and function of chest tube Assessing for the signs of superior mesenteric artery syndrome Teaching the patient to manage a patient-controlled analgesia (PCA) pump

After a spinal surgery, the patient has a considerable amount of pain for a few days. Pain relief requires frequent administration of intravenous pain medicines, preferably opioids. Postoperative assessment of any neurologic impairment should be performed because delayed paralysis might occur after spinal surgery. Educating the patient on the management of a patient-controlled analgesia (PCA) pump is done to promote self-care to encourage the patient's participation in treatment and recovery. Superior mesenteric artery syndrome is likely to be seen after spinal surgery in which there is compression of the duodenum by aorta and superior mesenteric artery. Clinical symptoms are nausea, vomiting, and epigastric pain which aggravate in the supine position and are relieved in the prone position. Teaching the patient about the use and function of a chest tube is also part of patient education for self-care.

A 5-year-old child fractured the left elbow while playing with friends. The health care provider has prescribed regular cast changes and bed rest. What should the nurse educate the parents about cast care? Apply lotion to the skin after cast removal. Scrub away residual material on the skin. Immerse the cast briefly in a tub bath. Cover the damp cast edges with adhesive.

After the cast is removed, the skin surface will be caked with desquamated skin and sebaceous secretions. Application of mineral oil or lotion may remove the particles and provide comfort. The parents and child should be instructed not to pull or forcibly remove this material with vigorous scrubbing because it may cause excoriation and bleeding. The skin under the cast may become macerated from inadequate drying after water immersion. Adhesive will not adhere to a damp cast even if the cast is composed of fiberglass; it takes about a half-hour for it to dry.

A nurse is caring for a young infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? Select all that apply. Lordosis Negative Babinski sign Asymmetric thigh and gluteal folds Positive Ortolani and Barlow tests Shortening of limb on affected side

Asymmetric thigh and gluteal folds are a clinical manifestation of DDH and seen from birth to 2 months old. Positive Ortolani and Barlow tests are clinical manifestations of DDH. The Ortolani test is the abducting of the thighs to test for hip subluxation or dislocation.The Barlow test is the adducting to feel if the femoral head slips out of the socket posterolaterally. Shortening of limb on affected side is another clinical manifestation of DDH. Lordosis is the inward curve of the lumbar spine just above the buttocks and is not a clinical manifestation of DDH. A negative Babinski sign is not a clinical manifestation of DDH. It is a neurologic reflex.

Which assessment findings support the nurse's conclusion that a 2-week-old neonate has hip dysplasia? Select all that apply. Positive Barlow test Positive Ortolani test Positive Galeazzi sign Piston mobility of hip joint Positive Trendelenburg sign

Barlow, Ortolani, and Galeazzi tests are the most reliable for confirming the presence of hip dysplasia in a 2-week-old child. If the hip gets dislocated due to adduction, it indicates a positive Barlow test. If the hip is reduced by abduction, then it indicates a positive Ortolani test. If the affected limb appears to be shorter than that of the other limb, then it indicates a positive Galeazzi test. A positive Trendelenburg sign and piston mobility of joint are assessment findings which indicate hip dysplasia in older infants and children.

Which instructions should the nurse provide the patient and the family about the management of systemic lupus erythematosus (SLE)? Select all that apply. "Avoid exposure to sunlight." "Consume a diet with low protein." "Perform moderate-intensity exercises daily." "Take prescribed antimalarial drugs on a regular basis." "Always carry medical identification indicating the disease and steroid dependence."

Exposure to sunlight may lead to exacerbation of symptoms of SLE. Thus, the nurse should ask the patient to avoid exposure to sunlight. Antimalarial drugs are helpful in reducing rashes and arthritis, and thus should be taken in prescribed doses regularly. Steroids are the chief drugs for treatment of SLE since they are useful for reducing inflammation, and patients should be advised to always carry identification with this information included. Patients with SLE should consume a balanced diet. A diet deficient in proteins would prevent building up of tissues and worsen the prognosis. Moderate-intensity exercise would not be possible for the patient. The nurse should encourage the patient to perform mild exercise regularly.

What drug do you give for osteogensis imperfecta? What is nursing care for osteogenisis imperfecta?

IV biphosphonate therapy helps increase bone density rehabilitative approach for prevention of further complications

A 2-month-old infant has been diagnosed with developmental dysplasia of the hip. The health care provider has prescribed immediate treatment for the baby using a Pavlik harness. What is the rationale behind this urgency? Mobility will be delayed if correction is postponed. Traction is effective if it is used before toddlerhood. Infants are easier to manage in spica casts than are toddlers. It is easier to get the hip into a more abducted position.

In infants, with time, motion, and gravity, the hip works into a more abducted, reduced position with the help of a Pavlik harness. The harness is worn continuously until the hip is proved stable on clinical and ultrasound examination. Congenital hip dysplasia does not limit ambulation for the young child, although the gait will be affected. Traction is not used to correct developmental dysplasia of the hip. Although casted infants are easier to manage than toddlers, this is not the key reason for early treatment.

Which finding would the nurse observe during the fourth radiographic stage of Legg-Calvé-Perthes disease? The reformation of a spherical femoral head A mottled appearance of the affected bone The filling in and formation of new bone The flattening of the upper surface of the femoral head

Legg-Calvé-Perthes disease is a self-limiting disorder affecting children, which is associated with aseptic necrosis of the femoral head. By reviewing radiographs, the nurse can observe the bones and determine the stage of the disease. During the fourth radiographic stage of the disorder, the nurse would observe gradual reformation of the femur head and a spherical shape. The second stage of the disorder is associated with the resorption and revascularization of capital bone, which gives it a mottled appearance. The third phase is associated with the formation of new bone. During the first stage of the disorder, aseptic necrosis of the capital femoral epiphysis with degenerative changes takes place and flattens the upper surface of the femoral head.

Bone healing in children

Neonatal: 2-3 weeks Early childhood: 4 weeks Later childhood: 6-8 weeks Adolescence: 8-12 weeks

The callus that develops at the fracture site is important because it provides what? Functional use of injured part Sufficient support for weight bearing Means for adequate blood supply Means for holding bone fragments together

New bone cells are formed in large numbers and are stimulated to maximum activity. They are found at the site of the injury. In time, calcium salts are absorbed to form the callus. Functional use cannot occur until the fracture site is stable. The callus does not provide support for weight bearing or an adequate blood supply.

A 4-month-old infant has been diagnosed with developmental dysplasia of the hip (DDH). What appropriate intervention will follow the diagnosis? The baby will be set up to be fitted with a Pavlik harness. The baby will be tightly swaddled in warm blankets. The baby will be strapped to a cradleboard. The baby will be scheduled time to sit in an infant seat.

Of the numerous devices available, the Pavlik harness is the most widely used; and with time, motion, and gravity, the hip works into a more abducted, reduced position. The Pavlik harness promotes hip abduction and flexion. Swaddling limits hip abduction and puts stress on the hip joint. Strapping the infant to a cradleboard limits hip abduction and puts stress on the hip joint. Although placing the infant in an infant seat allows movement in the flexed position, it does not promote abduction.

How is juvenile arthritis diagnosed?

Onset before 16. Have had the following for minimum of 6 weeks: - continuous arthritic pain in single or multiple joints - repetitive fevers up to 103 - systematic indications appearing as pinkish/reddish rash on legs, arms, and trunk

Which statement is true concerning osteogenesis imperfecta? It is easily treated. It is an inherited disorder. Later-onset disease usually runs a more difficult course. Braces and exercises are of no therapeutic value.

Osteogenesis imperfecta is an inherited disorder. Osteogenesis imperfecta is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. The type of disease determines the course it will take. Lightweight braces and splints can help support limbs and fractures.

What is an appropriate nursing intervention when caring for the child with chronic osteomyelitis? Provide active range-of-motion exercises for the affected extremity. Administer antibiotics with meals. Encourage frequent ambulation. Move and turn the child carefully and gently to minimize pain.

Osteomyelitis is extremely painful. Movement is carried out only as needed and then carefully and gently. Active range of motion is contraindicated until pain has subsided. Pain medication, not antibiotics, should be administered as needed. Ambulation is contraindicated until pain has subsided.

Positional, syndromic, and congenital clubfoot

Positional: may correct spontaneous or necessitate passive exercise or serial casting. No bony abnormality Syndromic: usually necessitates surgical correction associated with other congenital anomalies *correlation between clubfoot and hip dysplasia* Congenital: bony abnormality; always necessitates surgical intervention

Therapeutic management of soft tissue injuries

RICE and ICES rest the injured part Ice immediately (maximum 30 minutes at a time) Wet elastic bandage for compression Elevation of extremity Immobilization and support (casts or splints as appropriate to injury) Rest Ice Compression Elevation Ice Compression Elevation Support

A patient with juvenile idiopathic arthritis has been prescribed steroid medications. During the follow-up assessment, the nurse finds that the patient may have developed side effects from the drugs. Which findings are consistent with the nurse's conclusion? Select all that apply. The patient has weight gain. The patient has low bone density. The patient has a low white blood cell count. The patient has antinuclear antibodies in the blood. The patient has an elevated erythrocyte sedimentation rate.

Side effects of corticosteroids include weight gain, osteoporosis, and increased risk of infection. Low bone density is indicative of osteoporosis. Low white blood cell count indicates increased risk of infections. The presence of antinuclear antibodies in blood and elevated erythrocyte sedimentation rate are signs associated with juvenile idiopathic arthritis.

Types of fractures: Simple/closed Open/compound Complicated Comminuted

Simple/closed: does not produce a break in the skin Open: fractured bone protrudes through the skin Complicated: bone fragments have damaged other organs or tissues Comminuted: small fragments of bone are broken from fractured shaft and lie in surrounding tissue

Clinical manifestations of sprains and strains

Sprains: rapid onset of pain, swelling, disability Strain: swollen, painful to touch

The nurse is consulting with a client with systemic lupus erythematosus. Which is the best instruction to prevent an exacerbation of the disease? Go outside only after the sun has set at night. Get 1 hour of early-morning sunlight per day. Wear loose clothing to increase comfort. Use sunscreen and wear sun-resistant clothes.

Sunlight can exacerbate the symptoms of systemic lupus erythematosus, so the nurse should instruct the client to use sunscreen and wear sun-resistant clothes to reduce the effects of sunlight. Instructing the client to go out only at night may not be practical and will impair the client's social interactions. Continuous exposure to sunlight may aggravate the client's inflammatory response, so the nurse would not instruct the client to get 1 hour of sun each morning. Loose clothing may be most comfortable for the client, but does not prevent the exacerbation of systemic lupus erythematosus.

The nurse is caring for a client with systemic lupus erythematosus. Which clinical manifestations might the nurse find in the client? Select all that apply. Epistaxis Atelectasis Abdominal crisis Joint deformity Thrombophlebitis

Systemic lupus erythematosus is a chronic autoimmune disease. Due to the immunogenic reactions, the client with systemic lupus erythematosus may develop atelectasis, abdominal crisis, and thrombophlebitis. Epistaxis is a sign of rhabdomyosarcoma. The client with rhabdomyosarcoma may have a bleeding nose due to the compression of blood vessels with the tumor. The client with juvenile idiopathic arthritis has joint deformities due to osteoporosis.

The nurse is caring for an infant who has been diagnosed with talipes calcaneus. The affected foot has a plaster cast on it. What is an appropriate way to handle the infant when the cast is wet? Touch the cast using only the fingertips. Turn the infant without touching the cast. Handle the cast with the palms of the hands. Move the infant's body while sliding the cast.

The cast should be handled with the palms of the hands. The palm of the hand provides a wide base of support for infant's body and the casted extremity. Touching the cast with the fingertips will cause indentations that may create pressure areas; this may compromise the skin and neurovascular functioning. It is impossible to turn the child without touching the cast. Therefore, it is acceptable to touch the cast, but with the palms of the hands. The cast must be touched because the lower extremity and the cast must be supported.

A home care nurse is caring for a 4-month-old infant with developmental dysplasia of the hip (DDH). The baby is in a Pavlik harness. The baby's mother tells the nurse, "I don't think my baby will be able to sleep while wearing the harness." What is an appropriate response by the nurse? "The harness can be removed during a short 30-minute nap." "You can reapply the harness after the baby falls asleep." "It is important for the harness to be worn continuously." "You can have the baby not take one of the daily naps."

The harness is worn continuously until the hip is proved stable on clinical and ultrasound examination, usually in 6 to 12 weeks. Some practitioners permit its removal for bathing. Removal or re-application of the harness will probably awaken the infant. Babies should not be prevented from taking naps, as such naps are essential for good health.

A young child is brought into the emergency room with a partial dislocation of the radial head in the right arm. The health care provider manipulates the arm back into position. Following the treatment provided by the health care provider, what is the nurse's priority action? Administer a narcotic for pain. Administer a mild pain reliever. Prepare to immobilize the arm. Prepare the child for a radiographic evaluation.

The nurse's priority action following a successful treatment of a dislocation is to administer a mild pain reliever. Upon successful manipulation, the use of the arm returns within minutes. Narcotics or anesthesia are usually not needed. It is not necessary to immobilize the arm. A radiographic evaluation is only needed if the injury is not a subluxation or if the treatment attempt is unsuccessful.

An infant is born with one lower limb deficiency. When is the optimum time for the infant to be fitted with a prosthetic device? As soon as possible after birth When the infant begins sitting up and can maintain balance At about age 12 to 15 months, when most children are walking At about 4 years, when the healthy limb is not growing so rapidly

The optimum time for the infant to be fitted with a prosthetic device is when the infant begins sitting up and can maintain balance. The device should be provided when the infant is showing readiness to stand; the prosthetic device will be integrated into the infant's capabilities. The device will not be useful until the infant is developmentally ready to use the leg.

The nurse manager on the orthopedic unit is preparing an in-service about types of traction at the next staff meeting. What information should the nurse manager include in the presentation? Select all that apply. Skeletal traction is most likely used when closed reduction is performed. Skin traction can be applied using a pulling mechanism attached with adhesive material. Soft, foam-backed traction straps are used to distribute manual traction pull. Pins are commonly used with skeletal traction. Manual traction involves using wires or tongs inserted through the diameter of the bone distal to the fracture.

Types of traction include: (1) Manual traction—Applied to the body part by the hands placed distal to the fracture site. Manual traction may be provided during application of a cast but more commonly when a closed reduction is performed. (2) Skin traction—Applied directly to the skin surface and indirectly to the skeletal structures. The pulling mechanism is attached to the skin with adhesive material or an elastic bandage. Both types are applied over soft, foam-backed traction straps to distribute the traction pull. (3) Skeletal traction—Applied directly to the skeletal structure by a pin, wire, or tongs inserted into or through the diameter of the bone distal to the fracture.

Therapeutic management of the patient with systemic lupus erythematosus includes what? Cold salts to suppress the inflammatory process A high-protein, low-salt diet An exercise regimen to build up muscle strength and endurance Corticosteroids to control inflammation

Using corticosteroids to control inflammation is the primary mode of therapy. Cold salts will not affect the inflammatory process. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation.

A nursing student is helping to care for a client with lower extremity venous stasis. The student places three pillows under the client's legs and instructs the client to rest in only one position. The student measures the circumference of the client's extremities periodically and administers anticoagulants as prescribed. Which intervention of the student indicates the need for additional teaching? Advising the client to rest in only one position Placing three pillows under the client's legs Preparing client for administration of anticoagulants Measuring the circumference of the extremities

Venous stasis in the leg can result in pulmonary embolism and thrombi formation. To reduce the risk of the venous stasis, the nurse should instruct the client to change positions frequently rather than staying in one position. The nurse is correct in elevating the extremities to promote the circulation and reduce the risk of emboli formation. Venous stasis is caused by blood coagulation; therefore, anticoagulants reduce the risk of developing blood clots. The nurse should measure the circumference of the extremities periodically, as an increase in circumference of the extremities indicates thromboembolism.

What lab value may help identify osteomyelitis?

WBC, leukocytes Osteomyelitis causes leukocytosis

A newborn baby has been diagnosed with talipes equines. How often should the parents be taught to do a cast change? Change the cast weekly. Change the cast monthly. Change the cast when its edges fray. Change the cast if it becomes soiled.

Weekly gentle manipulation and serial long-leg casts allow for gradual repositioning of the foot. Casts are changed weekly to accommodate the rapid growth in early infancy. Once a month is not frequent enough in early infancy; the cast may become too tight because of the infant's rapid growth. The cast is not on the foot long enough for fraying to occur. Soiling usually is not a problem because casts for clubfoot do not extend to the perineal area.

What do you do if a client has traction but wants to change positions in bed?

When moving the client in bed, with either skin or skeletal traction, it is necessary for someone to hold and move the weights of the traction as the client changes position to avoid additional tension on the traction and fracture sites.

The nurse is caring for a child with a hip spica cast. Which nursing interventions will be beneficial to the child? Select all that apply. Change the child's position every 2 hours. Dry the cast with heated fans or dryers. Remove rings and any other accessories. Check for any cuts or abrasions on skin. Cover the cast with a polythene sheet.

While caring for a child with a spica cast, the nurse should change the position of the child every 2 hours. This practice helps the cast to dry evenly and prevents complications such as pressure ulcers and bedsores that occur due to immobility. To prevent constriction of blood vessels and swelling of the limbs, the nurse should remove rings and other accessories from the client's body before applying the cast. To prevent infections and discomfort, the nurse should check the client's skin for the presence of cuts or abrasions before applying the cast. The nurse should not use heated fans or dryers to dry the cast as it leads to irregular drying of the cast and may cause burns because of the conduction of heat from the cast to underlying tissues. The nurse should not cover the cast with a polythene sheet as polythene retains moisture and does not allow the cast to dry inside out.

What is amelia?

absence of entire extremity (whole limb is obstructed)

Why is traction used in children?

allow physiologic stability align bone fragments enable closer evaluation of the injured site

What is Legg-Calve-Perthes disease and how is it caused?

aseptic necrosis of femoral head *idiopathic cause in children 2-12 years of age*

What is septic arthritis and how do you treat it?

bacterial infection in the joint. Leukocytosis, pain, swelling leads to resistance of movement

Pavlik harness management

birth-6 months wear for 6-12 weeks check around straps for abrasion or irritation *diaper goes under straps not over* *parents should never adjust* don't remove unless they have permission to bath without it

Bryant traction

both lower extremities flexed 90 degree at hips (rarely used because extreme elevation of lower extremity

What is juvenile idiopathic arthritis?

chronic inflammatory disorder of the joint synovium is considered on of the most common rheumatoid conditions occurring in children under the age of 17.

What is systemic lupus erythematosus?

chronic, multisystem, autoimmune (body thinks good tissue is bad tissue and attacks) more common in girls/women 10-19 years of age

talipes varus, talipes valgus, talipes equinus, talipes calcaneus are all forms of what?

clubfoot

Three stages of clubfoot management What method could also be use

correction of deformity maintenance of the correction until normal muscle balance is regained follow-up to avert possible recurrence Ponseti: serial casting

When are corticosteroids used for juvenile arthrititis?

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

management of lupus

corticosteroids, nsaids, immunosuppressive drugs *minimize exposure to sun and UV*

What is phocomelia?

deficiency of long bones with relatively good developmen of hands and feet attached at or near shoulder or hip ("seal limbs")

gardner-wells tongs

device for immobilization of cervical spine injuries in which two sharp metal pins are screwed into the superficial layer of the skull. they are then connected to hang in weights or other traction devices for stabilization of the spine. they may also be used for definitive treatment of spine injuries.

Dislocation is more common in children with? Why?

down syndrome bc they have more lax joints

clinical manifestations of scoliosis

elevated shoulder or hip head and hips not aligned 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)

What is the frequent site of damage during trauma? What is the treatment?

epiphyseal plate Tx may include open reduction and internel fixation to prevent growth disturbances

What is the name of the growth plate?

epiphyseal plate it's the weakest point of long bones

What is osteogensis imperfecta?

faulty bone mineralization characterized by excessive fragility and defects of bones hyperextensibilty of ligaments

clinical manifestations of lupus

fever, fatigue, weight loss, *butterfly rash*, joint pain, proteinuria and renal failure

A small child refuses to walk or crawl. What do you suspect?

fracture

Clinical manifestations of a fracture

generalized swelling pain/tenderness deformity diminished function bruising muscular rigidity crepitus (abnormal popping or crackling sound in joints) *suspect fracture in a child who refuses to bear weight*

There is a correlation between clubfoot and....?

hip dysplasia

When does pain worsen for juvenile arthritis patients?

in mornings/after periods of rest

Why would lordosis be associated with obesity?

in obese children lordosis is caused by alteration in center of gravity by abdominal fat

What is compartment syndrome and what is the treatment?

increase pressure of muscles *medical emergency bc pressure compromises circulation of tissue* fasciotomy is treatment

Treatment goal of Legg-Calve-Perthes disease (1)

keep head of femur in acetabulum -casts, splints are used to keep it where we want it to be

Therapeutic management of DDH Birth to 6 months 6-24 months Older child

key is early intervention: Newborn assessment birth to 6 months: Pavlik harness for abduction of hip typically 6-12 weeks 6-24 months: dislocation unrecognized until child begins to stand and walk; closed reduction and spica cast typically 12 weeks Older child: operative reduction, tetonomy, osteotomy; *correction is very difficult after age 4 years*

Common sites of sprains

knees and ankles

Post op care for scoliosis surgery

log roll q2h for 5 days ICU pain management progressively ambulate

buck extension traction

lower extremity, legs extended, no hip flexion

Minor crush injury vs major crush injury Immediate treatment?

minor: fingers in doors severe: injury involves bones treatment: ice

oblique fracture

occurs at an angle across the bone slanting, but straight between a horizontal and perpendicular direction

clinical manifestations of legg-calve-perthes disease

occurs slowly over time *insidious onset* -possible hx of limp, soreness, or stiffness, limited range of motion, vague hx of trauma

Transverse fracture

occurs straight across the bone

define oligoarthritic and polyarthritic

oligo involves <4 joints poly involves >5 joints

Nursing considerations of immobilization

promote venous return: antiembolism stocking/intermittent compression devices promote optimal level of functioning closely monitor respiration status (atelectasis is possible) If they can physically and developmentally perform an ADL, encourage them to do so

therapeutic management of limb deformity (and phocomelia in general)

prosthetics as early as possible -early prosthetics encourage maximum exploration and development in infancy Phocomelic digits: may be surgically modified, preserved, and reattached for use with prosthetics

What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle? Increases the pain threshold Increases metabolism in the tissues Produces a deep tissue vasodilation Reduces edema formation

reduces edema formation

What is another name for skeletal limb deficiency?

reduction malformation

Severe, untreated scoliosis can cause?

respiratory difficulty

School-age fracture would most likely occur from what activities? Adolescents?

school age: bike-related, sports injuries, falls, trampolines adolescents: MVAs, bikes, skateboards, sports

What is the most common spinal deformity?

scoliosis most common in adolescents in females

spiral fracture

slanting and circular, twisting around the bone and shaft *need to rule out abuse (especially in infants) bone gets jerked up and twisted

Pt comes in with groin, thigh, or knee pain. What do you suspect?

slipped capital femoral epiphysis also Legg-calve-perthes disease

What fractures are commonly seen in abusive homes? (2)

spiral and fractures of infants

What is slipped capital femoral epiphysis? When is it mostly seen?

spontaneous displacement of the proximal femoral epiphysis in a posterior-inferior direction seen in adolescents (mostly male) age 9-16

clinical manifestations of developmental dysplasia of hip (DDH) in older childeren

trendelenburg sign affected leg shorter limp on affected side lordosis waddling gait

russell traction

two lines of pull on lower extremity, on perpendicular, one longitudinal

dunlop traction

two lines of pull on the arm

Balance suspension traction

used w/ or w/o skin or skeletal traction; suspends the leg in a flexed position to relax the hip and hamstring muscles