Chapter 44

Question 1

What is mobility?

Answer 1

Mobility is the mechanism that facilitates or impairs a persons ability to move

Question 2

What can mobility disorders result from?

Answer 2

-neurological insult
-trauma or hypoxia to the brain or spinal cord
-genetic dysfunction
-structural abnormality

Question 3

Why are sprains and strains less common in young children?

Answer 3

Young children have resilient soft tissue

Question 4

Which age group has increased risk of sprains, fractures, and torn ligaments =?

Answer 4

Older school children and adolescents due to sports participation

Question 5

How can immobility affect children with mobility issues?

Answer 5

It can interfere with development of motor skills, leading to motor dysfunction

Question 6

How do chronic mobility disorders affect children?

Answer 6

They impact the child’s entire life and can result in handicaps

Question 7

When is myelination complete in children?

Answer 7

Around 2 years of age

Question 8

Why do newborns lac purposeful movements?

Answer 8

Because myelination is not complete

Question 9

What developmental skills are acquired as myelination progresses?

Answer 9

Fine motor skills, gross motor skills, and coordination

Question 11

How does motor development progress in children?

Answer 11

It begins at birth and follows a predictable sequence

Question 12

Which motor control develops first: head/neck or trunk/extremeties?

Answer 12

Head and neck control develops before trunk and extremeties

Question 13

Is full range of motion present at birth?

Answer 13

Yes

Question 14

How does the pediatric spinal cord different from adults?

Answer 14

It is more mobile than the adult spinal cord

Question 15

Why are children at higher risk for cervical spine injury?

Answer 15

Increased spinal cord mobility, especially in the cervical spine

Question 16

When the infection, trauma, malnutrition, or teratogens affect spinal and brain development?

Answer 16

During 3-4 weeks of gestation

Question 17

Which musculoskeletal structures are present at birth?

Answer 17

Tendons, ligaments, and cartilage (term or re term)

Question 18

What type of movement are newborns capable of?

Answer 18

Spontaneous movement, but not purposeful movement

Question 19

What muscle tone is expected in healthy infants and children?

Answer 19

Normal muscle tone

Question 20

What is hypertonia?

Answer 20

Increased muscle tone

Question 21

What is hypotonia?

Answer 21

Low muscle tone

Question 22

How are deep tendon reflexes in newborns?

Answer 22

Initially brisk

Question 23

How do deep tendon reflexes change over time?

Answer 23

They progress to average over the first few months

Question 24

What is an abnormal deep tendon reflex finding in infants?

Answer 24

Sluggish deep tendon reflexes

Question 25

How does muscle development change as infants mature?

Answer 25

Muscle strengthen develop as the infant matures

Question 26

What happens to muscles during adolescence?

Answer 26

Rapid muscle growth occurs

Question 27

Why does adolescence increase injury risk?

Answer 27

Rapid muscle growth contributes to clumsiness and increased injury risk.

Question 28

When is the skeleton completely ossified?

Answer 28

The skeleton is not completely ossified until adolescence

Question 29

Where does bone growth primarily occur?

Answer 29

Specialized growth plates at the end of the long bones

Question 30

How do children’s bones differ from adults in vascularity and healing?

Answer 30

Children’s bones are more vascular and tend to heal fast faster than adults

Question 31

Why do children’s bones heal more quickly?

Answer 31

Due to a rich nutrient supply to the periosteum

Question 32

How does age affect bone healing in children?

Answer 32

The younger, the child, the more quickly, the bone heals

Question 33

How does fracture location affect healing speed in children?

Answer 33

The closer the fracture is to the growth plate the more quickly it heals

Question 34

How does callus formation differ in children compared to adult adults?

Answer 34

Children’s bones produce careless more rapidly and in larger quantities

Question 35

How do children’s bones differ in porosity and mineral content?

Answer 35

They are more porous and have lower mineral content than adults

Question 36

What effect does lower mineral content have on children’s bones?

Answer 36

Allow allows for greater shock absorption bones may bend rather than break

Question 37

What structures make up the growth plate?

Answer 37

The end of a long bone epiphysis plus the physis

Question 38

Where does bone growth primarily occur in children?

Answer 38

In the epiphyseal region

Question 39

How long does epiphyseal growth continue?

Answer 39

Until skeletal maturity during adolescence

Question 40

Why is this region vulnerable?

Answer 40

It is structurally weak

Question 41

What can injury to the epiphyseal region cause?

Answer 41

Early incomplete or partial closure of the growth plate

Question 42

What are potential outcomes of growth plate injury?

Answer 42

Deformity Shortening of the bone

Question 43

What is the normal appearance of an infant lower extremities?

Answer 43

They often have a bowed appearance

Question 44

What causes the bowed appearance of infant legs?

Answer 44

In utero positioning

Question 45

What is the normal developmental variation called internal tibial torsion?

Answer 45

A normal variation caused by in neutral positioning

Question 46

When does internal tibial torsion usually resolve?

Answer 46

Independently within the second or third year of life

Question 47

What occurs as internal tibial torsion resolves?

Answer 47

Physiologic genu valgum occurs

Question 48

What is genu valgum?

Answer 48

Knock knees

Question 49

When is genu valgum usually demonstrated

Answer 49

Buy 2 to 3 years old

Question 50

When does Geno valgum usually resolve?

Answer 50

By age 7 or eight in most children

Question 51

What are characteristics of knock knees?

Answer 51

Knees touching Ankle significantly separated Lower legs angled outward

Question 52

What activities should be observed to assess cranial nerves, cerebellar, and motor function?

Answer 52

Play, crawling and walking

Question 53

What should be noted when inspecting posture?

Answer 53

Trunk alignment, and muscle symmetry

Question 54

What should be examined when assessing extremities?

Answer 54

Symmetry Deformities Limb length Digits(absence, duplication, webbing)

Question 55

What gate abnormalities should be observed in walking children?

Answer 55

Refusal Limp In toeing Out toeing Foot slap

Question 56

What should be assessed when examining joints?

Answer 56

Swelling, bruising, and color of fingers and toes

Question 57

What should be observed regarding movement?

Answer 57

Spontaneous range of motion and movement symmetry(extremities, and facial muscles)

Question 58

How is scoliosis screened in children?

Answer 58

By assessing spinal alignment and symmetry of thigh folds

Question 59

What skin and spine findings should be inspected?

Answer 59

Redness, warmth, bruises, puncture sites, dimples, and hair tufts

Question 60

How is neck tone evaluated in infants?

Answer 60

Pulling the infant from supine to a sitting position

Question 61

What head control should an infant demonstrate by 4 to 5 months?

Answer 61

Ability to maintain the head in a neutral position

Question 62

What weight-bearing ability should a four month old infant demonstrate?

Answer 62

Momentarily support their weight when placed vertically with feet on a flat surface

Question 63

What is the purpose of casting?

Answer 63

To hold the bone in reduction and prevent deformity as fracture heels

Question 64

What nursing assessments are required for casting?

Answer 64

Neurovascular compromise Skin impairment at cast edges Protect, cast from moisture

Question 65

What is splinting used for?

Answer 65

Temporarily stiff support, temporary fracture, reduction, immobilization, and support of strains

Question 66

What assessments are needed with splinting?

Answer 66

Neurovascular compromise, skin impairment at cast edges, protect from moisture 

Question 67

What is the purpose of cold therapy?

Answer 67

Causes vasoconstriction to decrease pain and swelling

Question 68

What is traction used for?

Answer 68

Reduce and or immobilize a fracture A line and injured extremity Restore, normal length Reduce pain by decreasing muscle spasm

Question 69

What nursing care is required for traction?

Answer 69

Neural vascular checks, assessed for infection, impaired skin, integrity, and provide appropriate pin care

Question 70

What is fixation?

Answer 70

Surgical fracture reduction, using internal or external pins or fixation device devices

Question 71

What should be assessed with fixation devices?

Answer 71

Drainage or pin slippage

Question 72

What complications are associated with casting and traction?

Answer 72

Neurovascular compromise Skin integrity impairment Soft tissue injury Compartment syndrome Pin site infection(skeletal traction) Osteomyelitis (skeletal traction)

Question 74

When should routine pin care be performed?

Answer 74

Weekly after the first 48 to 72 hours

Question 75

When should pin care be performed earlier than scheduled?

Answer 75

If there is heavy drainage, wet dressing, or suspected infection

Question 76

What is the most effective solution for pain care site?

Answer 76

Chlorhexidine 2 mg/mL in alcohol

Question 77

What solution is used if a child is sensitive to chlorhexidine

Answer 77

Normal saline

Question 78

What type of material should be used for cleaning pins sites?

Answer 78

Non-shedding material

Question 79

How should pins sites be covered?

Answer 79

With non-shedding dressing

Question 80

What education should families receive before discharge?

Answer 80

Pin site care and signs and symptoms of infection

Question 81

How should pain care interventions be planned?

Answer 81

Individualized to prevent infection

Question 82

What is the focus of physical therapy?

Answer 82

Attainment or improvement of gross motor skills

Question 83

What is the focus of occupational therapy?

Answer 83

Refinement of fine motor skills, feeding, and activities of daily living

Question 84

When is speech therapy indicated?

Answer 84

For speech impairment or feeding difficulty related to oral muscular issues

Question 85

What are orthotics and braces?

Answer 85

Adaptive positioning devices, specially fitted for each child

Question 86

Who fits orthotics and braces?

Answer 86

Physical therapist, occupational therapist or orthotist

Question 87

What are orthotics and braces used for?

Answer 87

Maintain proper alignment, improve mobility, and prevent contractures