Exam 2- Nursing care of the child with a musculoskeletal alteration

How should the genitourinary system be monitored in an immobile child?

monitor intake and output

closed reduction

nonsurgical (manual) realignment of broken bone ends and splinting of bone (usually place bone back into place followed by casting, typically under conscious sedation)

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. Administer an analgesic. 2. Release the skin traction. 3. Apply ice to the extremity. 4. Notify the health care provider (HCP).

notify the health care provider

A 4 year old child with a long leg cast complains of "fire" in his case. Which action by nurse should be done first? a. elevate the extremity b. give pain meds c. notify the provider

notify the provider (this is an emergency, we are concerned for compartment syndrome)

How is scoliosis treated when the curve is less than 25 degrees?

observation, might resolve on it's own

SIGNS OF compartment syndrome (5 Ps)

pallor, pain, pulselessness, paresthesia, paralysis

Example of a sesamoid bone

patella

Interventions in the care of a child with a brace for scoliosis

perform prescribed exercises wear soft fabric clothing under brace avoid the use of powder/lotion because it will cake under brace

Muscle weakness and atrophy are some consequences of immobility. What can the nurse do to prevent this?

range of motion exercises high protein, high calcium diet to facilitate bone growth

repositioning of the bone fragments into normal alignment, most likely casting affected extremity

reduction methods

How can the nurse prevent skin breakdown in an immobile child?

reposition every 2 hours, keep them dry, keep child clean, elevate extremities, avoid lotions

What are respiratory consequences of immobility?

respiratory depression from opioids pulmonary embolism risk for pneumonia

once aligned, the fracture site must be protected by application of splint, cast, traction, or external fixator

retention

Scoliosis Diagnosis

school screening, physical exam, x-rays

Scoliosis Patients are told to wear a form-fitting T-shirt underneath the brace to reduce

skin breakdown and irritation

When would a traction device be used?

spinal fracture to pull vertebrae together

twisted or circular break that affects the length rather than the width

spiral

What type of fracture is frequently seen in child abuse?

spiral fracture

Device used to stabilize or protect affect area, increases range of motion, not as restrictive as a cast

splint

How is circulation assessed?

strength of pulse distal to the site capillary refill time should be less than 2 seconds

open reduction

surgical insertion of internal or external fixation devices such as rods, wires, or pins that help maintain alignment while healing occurs

Compartment syndrome occurs when

swelling causes pressure to rise within these closed fascial compartments, compromising vascular perfusion to the muscles and nerves

Example of amphiarthrotic or slightly movable joints include

symphysis pubis

Examples of flat bones include

temporal bone clavicle rib

What are manifestations of fractures?

tenderness at site, swelling, pain, bruising, crepitus, redness, muscle spasm, inability to bear weight, immobility or decreased ROM, deformity, ecchymosis, erythema, muscle spasm

appendicular system

the part of the skeleton made up of the bones of the arms, legs, scapula, clavicle, pectoral girdle, and pelvis

Musculoskeletal alterations are more common in children because

they are more prone to injury (begin walking) adolescence- risky behaviors

Flexibility of pediatric bones is due to...

thicker periosteum and increased amounts of immature bone

A child with a cast is complaining of burning pain. What is this indicative of?

tissue ischemia

the pulling or force exerted on a skeletal structure (as in a fracture)

traction

A 4 year old sustains a fall at home. After an XR, the child is determined to have a fractured arm and plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicated need for furtherer instruction?

"I can use lotions or powders on the skin around the cast edges or inside the cast"

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction?

"I should apply lotion under the brace to prevent skin breakdown"

Example of irregular bone include

vertebra

When are adolescent girls typically tested for scoliosis?

10 years and 12 years (usually seen in post-menarche)

When are adolescent boys typically tested for scoliosis?

13 years or 14 years (only once!!)

Example of diarthrotic or freely movable joint includes

knee, ankle

test used to evaluate adolescents for scoliosis

Adams Forward Bend Test

most common type of scoliosis

Adolescent Idiopathic Scoliosis

Musculoskeletal Alterations affect

Affect muscles, bones, joints and tendons

Scoliosis

lateral deviation, or curvature, of the spine that is greater than 10 degrees Progressive curvature is more prevalent in females than males

CSM

Assess at least every 2 hours during first 48 hours Strength of the pulse distal to the site Capillary refill time Signs of circulatory impairment Paresthesia, numbing

Skeletal system

Bones—axial skeleton and appendicular system

Neurovascular Assessment should include

CSM (circulation, sensation, and motion)

A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention?

Check the health care provider's prescriptions for the amount of weight to be applied

Why are Musculoskeletal Alterations common in children?

Children are still growing and prone to injury Increased mobility puts young children at risk

Cartilage

Dense connective tissue

Articular system

Joints connect two or more bones together Enable movement

Muscular System

Muscles and ligaments

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? 1. Administer an antiemetic. 2. Increase the intravenous fluids. 3. Place the child in a Sims's position. 4. Notify the health care provider (HCP).

Notify the health care provider- superior mesenteric artery syndrome is a complication of surgical treatment resulting in emesis and abdominal distention to which occurs with intestinal obstruction or paralytic ileus

How can the nurse prevent developmental regression in an immobile patient?

maintain routines, help with decision making, therapeutic play

What are complications of spinal fusion?

massive blood loss, neurological, lack of solid bone fusion, implants could fail, infection

Compartment syndrome is a

True surgical emergency that requires prompt diagnosis and intervention to prevent paralysis and tissue necrosis

epiphyseal fracture

a break at the location of the growth plate, which can cause growth disturbances

fracture

a break or disruption in a bone's continuity

lordosis

abnormal anterior curvature of the lumbar spine (sway-back condition)

Nurses play a crucial role in identifying

abnormal growth and development patterns

Fractures in children can be due to...

accidental trauma (falls, sports, MVC) non accidental trauma (child abuse) pathologic conditions (osteogenesis imperfecta)

How can the nurse assess motion?

ask the patient to move the limbs distal to the area (patient may not be able to move limbs if they had an epidural)

Comminuted fracture

bone is splintered into pieces (RARE in kids)

How is scoliosis treated when the curve is greater than or equal to 25 degrees?

brace treatment if curve worsens, spinal fusion (risky surgery)

greenstick fracture

break occurs through the periosteum on one side of the bone while only bowing or buckling on the other side (common in forearm)

transverse fracture

break or fracture line occurs at right angles to the long axis of the bone

The nurse understands that external fixators...

can cause infections therefore pin care must be done and patient may be on prophylactic antibiotic

Why should the nurse always assume a traction is continuous?

can disrupt fracture alignment

Example of short bone include

carpal bones in wrist

used for true fracture, helps in healing and correcting a deformity, concerned about skin integrity, muscle atrophy

casts

A nurse is caring for a child with a traction device. Before removing the device the nurse must...

check the orderer frequency and amount of time the traction should be removed always assume the traction is continuous before removing device

osteogenesis imperfecta

conditions that result in abnormally fragile bones (e.g., osteogenesis imperfecta, tumors, cysts).

What are gastrointestinal consequences of immobility?

constipation (may be due to opioids)

The nurse is preparing to care for a 5 year old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which is the most appropriate activity for this child?

crayons and coloring book

What can the nurse encourage a patient to do to decrease the risk of pneumonia due to immobility?

deep breathing and coughing incentive spirometer

oblique fracture

diagonal or slanting break that occurs between the horizontal and perpendicular planes on the bone

Traction is used to achieve

effective immobilization

How often should a neuromuscular assessment be completed on a patient with a musculoskeletal alteration?

every 2 hours during first 48 hours

Kyphosis (hunchback)

exaggerated thoracic curvature

A device that goes directly into bone to treat a complex fracture or to lengthen bones

external fixator

Example of a long bone includes

femur

How can constipation be relieved in an immobile child?

high fiber diet, high water diet, stool softeners, laxatives, position upright during BM

Visible curvature of the spine greater than 10 degrees, rib hump, asymmetrical ribcage, uneven shoulder and pelvic heights, uneven leg length, back pain

idiopathic scoliosis

When is surgery typically needed for scoliosis?

ineffective brace treatment spinal fusion 40-50 degree curve

What are complications of an open reduction?

infection (introducing foreign objects), delayed healing

Preventing muscle atrophy while in a cast

isometric exercises

The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list?

while cast is drying, palms of hands are used to lift cast keep small toys and sharp objects away from cast elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling contact the PCP if the child complains of numbness/tingling in the extremity