pediatric musculoskeletal (not PP)

Where does bone length occur?

-Epiphyseal plates at the ends of bones, when the epiphyses close, growth stops.

Most common fractures in children?

-clavicular and greenstick (bones are soft and flexible; compressed side bends and tension side fractures)

What is the purpose of traction?

-decrease muscle spasms and realign and position bone ends Types: skin (pulls indirectly on the skeleton) Skeleton pulls directly on the skeleton via pins/tongs -keep child aligned properly can be challenging Check: weights hanging freely? Skin irritation? Infection at pin sites? NV response? Bryant's traction: skin traction for lower extremity 2yo or less. Legs kept straight, both legs extend 90 degrees toward ceiling from the trunk.

1. When examining school-age and adolescent children, the nurse routinely screens for scoliosis. Which statement accurately summarizes how to perform this screening? a. Have the child stand firmly on both feet and bend forward at the hips. b. Listen for a clicking sound as the child abducts the hips. c. Have the child run the heel of one foot down the shin of the other leg while standing. d. Have the child shrug the shoulders as the nurse applies pressure to the shoulders.

Answer: A

3. A child is admitted to the pediatric unit with a fracture of the hip. The physician orders Bryant's traction. The type of traction is: a. Skin traction applied to both legs, with the legs suspended 90 degrees above the bed. b. Skeletal traction applied to one leg c. Skin traction applied to an arm, suspending it above the bed d. Skeletal traction applied bilaterally to the lower extremities at 45 degree

Answer: A

2. Congenital hip dislocation is diagnosed in an infant. On assessment, the nurse expects to note: a. Symmetrical thigh gluteal folds b. Ortolani sign c. Increased hip abduction d. Femoral lengthening

Answer: B

6. What assessments would you make of a 3yo with a diagnosis of Duchenne's muscular dystorphy? a. Lethargy, pallor, and a low hemoglobin b. Uses his hands to push himself off the floor from a sitting position c. Mild intellectual disability or cognitive delay d. Seizure activity

Answer: b

4. A child with a fractured left femur receives a cast. A short time later, the nurse notices that the toes on the child's left foot are edematous. Which nursing action would be most important? a. Applying ice to the foot b. Massaging the toes c. Elevating the foot of the bed d. Placing the child on the right side

Answer: c

5. Which type of fracture in a young child would have the greatest impact on the child's future growth? a. A greenstick fracture b. Fracture of the fibula c. Fracture of the tibia d. Fracture of the epiphyseal plate

Answer: d

What is Juvenile Rheumatoid Arthritis?

Autoimmune disease of the connective tissue; chronic inflammation of the synovia and possible joint destruction. Episodes of excerbations and remissions. Asymmetrical involvement of fewer than 5 joints; especially hands and feet and wht bearing joints. S/S: pain, stiffness, Labs elevated ESR, + antinuclear antibody, presence of rheumatoid factor. *Children with JRA may not show these findings. Exacerbations can be due to stress, climate, and genetics.

What is osteogenesis imperfecta

Autosomal dominant disorder of the connective tissue; involving bones, ligaments, and (blue tinged) sclera, with different degrees of presentation. Absence of normal adult collagen, results in brittle bones and can easily fracture. Confused with child abuse at first. Blueish grey teeth, deafness issues?

What is the rate in which children's bones heal?

Bone healing occurs much faster in the child. Younger the child, the faster *Bone healing takes approximately 1wk for every year of life up to age 10

What is Duchenne muscular dystrophy?

Childhood muscular deterioration with progression; genetic and sex-linked recessive and occurs only in males. Absence of protein in the muscles. S/S: delayed motor development and progressive, waddling gait, falling, Gower's sign and use hands to push self up from floor. Contractures, muscle hypertrophy.

Describe the different types of club foot.

Congenital, foot and ankle twisted and cannot be passively manipulated in correct position. Valgus -feet turn out; Varus- inversion of ankles/ feet facing each other; Equinus- plantar flexion Calcaneus-walking on heel's Tx: serial foot casts to gradually stretch and realign the angle of the foot; passive ROM

What is Gower's sign?

Gowers' sign is a medical sign that indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use their hands and arms to "walk" up their own body from a squatting position due to lack of hip and thigh muscle strength.

What is legg-calve-perthes disease

Ischemic aseptic necrosis of the head of the femur; degenerative changes result from lack of circulation to the femoral capital epiphysis. S/S: Child limping, have hip pain; pain referred to knee? Limited hip motion? .

What is scoliosis?

Lateral curvature of the spine Kyphosis: protrusion/convex angulation of the spine or "humpback" Lordosis: accentuation of the lumber curvature; swayback; normal in toddlers -tends to be structural and progressive in most cases;

What is slipped capital femoral epiphysis?

Proximal femoral epiphysis is displaced, growth hormones weaken plate in the hip joint. Displacement occurs when adolescent is actively growing or is overweight. S/S: limp, pain in groin or knee, foot turns outward during gait.

Describe a spica cast.

Spica cast: body cast mid-chest to the legs; legs abducted with a bar between them, never lift or turn the child with the crossbar. Keep cast level but on a slant, with the head of the bed raised. This will allow for urine and stool to drain downward away from the cast. Reposition child frequently to avoid pressure on the skin and bony prominences.

What is the treatment for JRA?

Tx. Low dose corticosteroids, NSAIDS. Warmth, splints, may require additional time to perform ADL's.

What is the treatment for legg-calve-perthes disease?

Tx: 2-3yrs for revascularization; younger better prognosis. Must avoid wht bearing until reossification occurs. Bed rest with abduction brace follows

How is congenital hip dysplagia treated?

Tx: goal to enlarge and deepen the socket by pressure; legs need to be abducted with Pavlik harness for 3mos; keeps hips and knees flexed and the hips abducted. May use Bryants traction, older child spica cast

What is the treatment for slipped capital epiphysis?

Tx: spica cast, skeletal traction. Surgical stabilization and immobilization of the hip with a pin?

Describe types of congenital hip dysplasia.

abnormal development head of femur and acetabulum. Femur comes out of the hip socket. Laxity of ligaments with varying degrees affected of dislocation from partial subluxation to complete. Can affect one or both hips.

What are characteristics of braces?

appliances to assist in mobility and posture, shell or hinged; check skin, accurate fit? Chest braces (TSLO/Milwaukee) worn 23hrs day for what??? Scoliosis.

How do you assess for congenital hip dysplasia?

assess for restricted abduction of hips; Ortolani's click felt with fingers at the hip area; asymmetrical skinfolds in gluteus; affected side with increased folds.

What is the medical name for club foot?

talipes

What is the treatment for scoliosis?

tx torso shells; spinal fusion >50% curve -child bends forward with knees straight and arms hanging down toward feet, spinal curve fails to straighten. Asymmetry with hips, ribs, shoulders, and shoulder blades. Dx with xray. Curve worsens with increased growth.