exam 3: (ch 50) the child with a musculoskeletal alteration

children with a soft tissue injury (*not dislocation)

RICE - rest, ice, compression, elevation ICES - ice, compression, elevation, support

muscular dystrophies

agroup of 30 genetic diseases - duchenne muscular dystrophy is the most common - progressive muscle atrophy and weakness - ages 3-7 years - walking ability is lost by ages 9-12 - shortened life span - nursing interventions focus on coordinating a variety of healthcare services - mobility, toileting, diet, respiratory support, and emotional support

juvenile idiopathic arthritis (JIA)

autoimmune inflammatory disease with no known cause - swelling in the joint for > 6 weeks -- joint stiffness, pain, decreased ROM, or increased warmth - onset commonly between ages 2-4 - more common in girls therapeutic management - drug therapy → NSAIDs; methotrexate - physical and occupational therapy

Kristin, age 10, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. when discussing this injury with her parents, what should the nurse consider? - healing is usually delayed in this type of fracture - bone growth can be affected by this type of fracture - this is an unusual fracture site in young children - this type of fracture is inconsistent with a fall

bone growth can be affected by this type of fracture

ligaments

bone to bone

muscle function

help stabilize joints and maintain contact between articular surfaces

traction

immobilization with a pull or force exerted on the body - an opposing pull or force must be provided - skin → non invasive, well tolerated - skeletal → metal device inserted in bone, allows for greater pull

compartment syndrome

involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles

dislocation

joint is disrupted so that articulating surfaces are no longer in contact

sprains

ligaments are stretched or torn

tendons

muscle to bone

the 5 Ps of ischemia

pain, pallor, pulselessness, paresthesia, paralysis

strains

pulls, tears, or ruptures to muscles or tendons

treatment of fractures

reduction methods - repositioning of the bone fragments into normal alignment - closed or open reduction retention - once aligned, the fracture site must be protected - application of splint, cast, traction, or external fixator

contusions

soft tissue or muscles are damages

splints

stablizes, protects, and rests affected area

function of skeletal system

support the body, protect vital organs, provide movement, provides a storage space for blood cell production and minerals

fractures

trauma - increased mobility puts young children at risk inadequate motor and cognitive skills - accidental trauma -- falls, sports, motor vehicle crashes - nonaccidental trauma - child abuse - pathologic conditions -- osteogenesis imperfecta

ortolani test

- baby supine, hips flexed and knees bent - place middle fingers over the great trocanter and thumbs on the inner side of thigh - carry knees to mid-abduction - push one leg lateral (out) and pull anterior/ up - is a relocation maneuver

osteomyelitis

- bacterial infection of the bone - high morbidity and mortality - considered chronic if infection persists > 1 month

clubfoot

- congenital dysplasia of all the tissue below the knee - treated with physiotherapy and/or serial casting for 6-8 weeks - at times, surgical intervention is required

joints

- connective tissue and cartilage - connect two or more bones together

cartilage

- dense connective tissue - withstands considerable tension

Barlow test

- flex infants hips and knees to 90 degrees, place thumb along medial thigh, apply pressure in a posterior direction while adducting the femur - this maneuver will force the head out of the socket

pediatric differences

- infant bones are only 65% ossified by 8 months old - periosteum is stronger in children - growing bones heal quickly compared with adults abuse or underlying pathophysiology - often the cause for fractures in infants - takes a lot of force to break an infant's bone - soft tissues are resilient in children, sprains/dislocations less common than in adults - cranial sutures not fused until about 18 months old*

nursing interventions for compartment syndrome

- keep extremity at heart level - loosen and remove restrictive clothing - notify physician! bivalve cast, decrease weight on traction *in a severe case a fasciotomy will be performed, cutting open the fascia to relieve pressure*

osteomyelitis nursing care

- long term IV antibiotics - assessment and documentation of the child's status - pain control - promote optimal development

scoliosis screening

- more common in females; genetic tendency - recommended for girls at 10 and 12, and boys at 13 or 14 - if curvature is noted or asymmetry in shoulders, scapula, or hips → orthopedic referral

fractures general signs

- pain - immobility or decreased ROM - deformity - swelling - crepitus, ecchymosis, erythema, muscle spasm, and inability to bear weight

the child in a cast or traction important notes

- pain or a burning sensation may indicate tissue ischemia - prompt intervention is crucial and requires referral to the physician

casts

- promotes bone healing and aids in correction of deformity - ensures adherence

musculoskeletal developmental disorders include

- scoliosis - kyphosis - hip dysplasia - clubfoot - muscular dystrophies - juvenile idiopathic arthritis

developmental dysplasia of the hip

- the leg on the side of the dislocated hip may appear shorter - the leg on the side of the dislocated hip may turn outward - the folds in the skin of the thigh or buttocks may appear uneven - the space between the legs may look wider than normal - **assess hips using barlow and ortolani tests

external fixation devices

- used to manage open fractures with soft tissue damage - provide support for complicated or comminuted fractures

neuromuscular assessment

CSM (circulation, sensation, motion) - 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 compartment syndrome