NURS 271 Exam 2

DDH special considerations:

*Positive Ortolani *Positive Barlow Older child: telescoping/trendelenburg sign Pavlik for infant Bryant traction/surg/spica (6+months) Surg/casting/bracing (18+ months)

Pediatric differences in GI system:

-Relaxed cardiac sphincter (reflux/spit up) -Increased peristalsis -Immature liver during first year of life

HD/DDH manifestations in the older child

1. Affected leg is shorter than the unaffected leg 2. Telescoping or piston mobility of the joint 3. Trendelenburg sign 4. Marked lordosis if bilateral dislocations 5. Waddling gait if bilateral dislocations 6. Greater trochanter is prominent and appears above the line from the anterosuperior iliac spine to the tuberosity of the ischium

Legg-Calve Perthes Disease possible predisposing factors

1. Disruption in blood supply to the femur a. trauma b. coagulation disorders c. genetics d. breech position at birth

Muscular Dystrophy S/Sx

1. Early: weakness, hypotonia 2. Falls, delay in response/walking development, waddle 3. Life Threatening: Respiratory involvement *Immobility can cause osteoporosis

DDH conditions...

1. Hip instability 2. Dislocation (femoral head) 3. Subluxation (incomplete dislocation of the hip) 4. Acetabular dysplasia

Clubfoot can be related to...

1. Intra-uterine positioning 2. Neuromuscular or vascular problem 3. Genetic component

Legg-Calve Perthes Disease noteworthy items:

1. Self-limiting, idiopathic, occurs in juveniles 3-12yo (most common: 4-8yo males) 2. 10-15% of cases involve both hips 3. Most have delayed skeletal maturation 4. Insidious onset (may have hx of limp, soreness/stiffness, limited ROM, hx of trauma) *Pain and limp are most evident on arising and at end of day

HD/DDH manifestations in infants

1. Shortened limb on the affected side 2. Restricted abduction of hip on the affected side 3. Unequal gluteal folds when the infant is prone 4. Positive Ortolani test 5. Positive Barlow test

Control of stool is achieved by:

18mo- 4 years

Coordinated oral pharyngeal movements necessary to swallow solids develops after what age?

2 months (touch cheek or lips of infant to stimulate)

Suck/Swallow reflex develops at what age?

34 weeks

bryant's traction

6+month DDH

Clubfoot

A CONGENITAL abnormality where the foot is twisted out of its normal position (3 areas of deformity).

Muscular Dystrophy

A group of inherited diseases characterized by muscle fiber degeneration and muscle wasting. Terminal with varying rates of progression.

Hip Dysplasia/Developmental dysplasia of the hip (DDH)

A variety of disorders in which the femoral head and the acetabulum are improperly aligned. (Girls 4x more likely)

Four-year-old David is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. Which action should the nurse take first? A) Reposition the child and notify the physician B) Give the child medication to relieve the pain C) Notify the practitioner of the changes noted D) Chart the observations and check the extremity again in 15 minutes

A) Reposition the child and notify the physician

Which assessment finding should the nurse address first when caring for child with a cast on their leg? A) The child's toes are cool and non-blanchable B) The child reports severe itching beneath the cast C) The child's skin is blistered near a rough cast edge D) The patient is irritable and reports pain

A) The child's toes are cool and non-blanchable

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor related to the child's immobilization status? A) Venous stasis leading to thrombi or emboli formation B) Bone calcium increases, releasing excess calcium into the body (hypercalcemia) C) Increased joint mobility leading to contractures D) Metabolic rate increases

A) Venous stasis leading to thrombi or emboli formation

Stomach capacity of infant: A Stomach capacity of adolescence: B

A: 10-20 mL B: 3 L

Legg-Calve Perthes Disease

Avascular necrosis of the femoral head

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement? A) This type of fracture is inconsistent with a fall B) Growth can be affected by this type of fracture C) Healing is usually delayed in this type of fracture D) This is an unusual fracture site in young children

B) Growth can be affected by this type of fracture

Genu Varum

Bowlegs

Genu Vlagum/Varum TX

Braces Surgery ROM PT

Scoliosis/kyphosis/lordosis special considerations:

Bracing Exercise Surgery if other interventions are unsuccessful *Congenital OR postural*

Newborns requiring casting should be encouraged to..

Breast feed

The nurse is providing parent education on how to manage their infant's new leg brace at home. Which statement made by the parent indicates a need for further teaching? A) I will avoid lotion and powder use beneath the brace B) I will check the brace daily for rough edges C) I will apply the brace for only 4 hours initially D) I will check the color and temperature of the leg every 1-2 hours

C) I will apply the brace for only 4 hours initially

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? A) Encouraging normal activity for as long as possible B) Explaining the cause of the disease to the child and family C) Teaching the family the care and management of the corrective appliance D) Preparing the child and family for long-term, permanent disabilities

C) Teaching the family the care and management of the corrective appliance

Which is a type of skin traction with the legs in an extended position? A) Russel B) Dunlop C) Bryant D) Buck Extension

D) Buck Extension

A neonate is born with bilateral mild talipes equinovarus (clubfoot). When the parents ask the nurse how this will be corrected, the nurse should give which explanation? A) Traction is tried first B) Children outgrow this condition when they learn to walk C) Surgical intervention is needed D) Frequent, serial casting is tried first

D) Frequent, serial casting is tried first

The nurse is caring for an infant with developmental dysplasia of the hip. Which manifestations should the nurse expect to observe? A) Lordosis B) Telescoping of affected limb C) Trendelenberg sign D) Positive Ortolani test

D) Positive Ortolani test

The nurse is updating the care plan for a child diagnosed with Duchenne Muscular Dystrophy. Which of the following health promotion topics is NOT appropriate for the nurse to include for this client? A) Growth and development B) Physical activity C) Disease prevention D) Surgical preparation

D) Surgical preparation

Spica cast

DDH post op

Infants/pediatrics have a high % of water so when they vomit/diarrhea it puts them at great risk for...

Dehydration!

Slipped Capital Femoral Epiphysis specail considerations:

EMERGENCY SURGERY (no wt baring post op) *pre-teen/teen most at risk

Genu Valgum

Knock Knees

Legg-Calve Perthes special considerations:

Pain/limp most evident after activity/on arising. Males 3-12 most at risk. Takes 2+ years to tx.

Muscular Dystrophy special considerations:

Positive Gowers Maneuver Need calcium + Vit D (osteoporosis)

Club foot special considerations:

Serial casting!

Pavlik Harness

used for hip dysplasia in infants Remove only to take baths