1
Q
cast petaling
A
- using tape to cover sharp or rough edges that may come in contact w/ the skin
2
Q
scratching w/ a cast on
A
- make sure patient is not scratching underneath the cast
- may need to give diphenhydramine
- if scratch skin open, can lead to infection
3
Q
skeletal traction
A
- pull directly applied to skeletal structure by a pin, wire, tongs
- used when significant traction is needed
- placement of skin/wire puts stress on bone (not surrounding tissue) so can use more weight than skin traction
- weights need to be correct and not on floor
- if moving patient, hold weightso so don’t sway and give pain meds
- biggest concern: infection b/c pin going through bone
- assess site, monitor V/S–esp temp
4
Q
skin traction
A
- pull applied to the skin surfaces and indirectly to the skeletal surfaces
- pulling mechanism applied to the skin w/ adhesive material or elastic bandage
- not to be used if there is altered skin integrity
- limited weight allowed b/c can pull/tear skin
5
Q
orthotics
A
- don’t put directly against skin
- especially if lack of sensation b/c can cause breakdown
- wear long athletic socks underneath
6
Q
ilizarov external fixator
A
- used for limb lengthening
- assess for infection where pin goes through skin
7
Q
neurovascular assessment of immobilized child
A
- 5 P’s:
- P: pain
- P: pallor
- P: pulselessness
- P: paresthesia
- P: paralysis
8
Q
what pathology occurs with decreased muscle activity?
A
- dec muscle activity–>disuse atrophy–>dec venous return and catabolism–>dependent edema and negative nitrogen balance
- dec metabolism–>dec need for O2–>dec ventilation
- bone demineralization–>osteoporosis and hypercalcemia–>renal calculi
- make sure they have lots of fluids!
9
Q
analgesia with immobilization
A
- can use tylenol or ibuprofen (if over 6 mos)
- but may also need an opioid–assess RR, depth of respirations, should be on continuous pulse oximeter, inc fluids and monitor for constipation
10
Q
preventing muscle atrophy and impaired mobility
A
- prevent contractures in the unaffected extremities
- collaborate with PT/OT
- prepare for disuse atrophy
11
Q
fractures: etiology
A
- have to differentiate b/w intentional and non-intentional injury
- trauma: certain developmental characteristics make them more susceptible to injury
- infants: dependent on us to keep them safe
- make sure strapped in infant seat
- car seat has not been involved in an accident
- toddlers:
- learning to walk
- curious, getting into things
- school age/adolescents:
- drugs, sex, alcohol
- thrill seeking
- feel invincible
- infants: dependent on us to keep them safe
12
Q
S/S, diagnostics, and mgmt of fractures
A
- clinical manifestations: swelling, pain, diminished use
- x-rays: may need pain meds to keep them in specific position w/o pain
- mgmt: splint/cast, pain meds
13
Q
goals of fracture mgmt
A
- reduction: regain alignment and length
- may have open or closed reduction
- immobilization:
- retain alignment and length
- restore function
- prevent further injury
14
Q
criteria for determining use of reduction method for fractures
A
- age of child
- degree of displacement
- amount of overriding
- degree of edema
- condition of skin and soft tissue
- sensation and circulation distal to the fracture
15
Q
rapidity of bone healing
A
inversely related ot the child’s age, so the younger the child, the more quickly their bone will heal
16
Q
cast care
A
- most casts are made of synthetic material
- advantages:
- dries w/in minutes
- lightweight
- may get wet w/ permission of MD–clean with soap and water and blow dry on cool!
- advantages:
- when handling, don’t use fingertips, b/c can cause indentations–>pressure
- “hot spots” indicate inflammation or infection
- chief concern during first few hours is compartment syndrome–>elevate extremity, check temp/color of skin, pulses, cap refill
17
Q
pathophys of development dysplasia of the hip (DDH)
A
- cause is unknown, but 4 P’s related
- gender (Female)
- birth order (First born)
- Family hx
- intrauterine position (Feet first–breech)
- delivery type and postnatal positioning known to inc risk
18
Q
clinical manifestations of DDH
A
- infants:
- unequal skin folds on thighs and buttocks
- limitation of abduction on affected side
- unequal knee height or leg length
- older children
- limp and trendelenberg’s gait (pelvis tips forward on normal side rather than upward)
19
Q
Barlow and Ortolani maneuvers
A
- for DDH
- for Barlow: if hip is dislocated, so if the hip can be popped out of the socket–>test is positive
- for Ortolani: positive sign is distinctive “clunk” which can be heard and felt as the femoral head relocates anteriorly into acetabulum
20
Q
diagnosis of DDH
A
- <3 mos old: U/S–>high incidence of false positives
- >3 mos old: x ray–>ossification of the femoral head occurs b/w 3-6 mos
21
Q
tx of DDH
A
- Pavlik harness:
- dynamic splinting used to keep femoral head where it should be
- make sure the infant doesn’t wear harness w/o undershirt and diaper b/w skin and straps
- used for 3-6 mos
- need to check straps every 1-2 weeks due to infant’s rapid growth
22
Q
etiology and patho of osteomyelitis
A
- acquired from exogenous or hematogeneous sources
- most commonly caused by staph aureus
- infective emboli travel from focus of infection to the small end arteries in the bone
- infection leads to local bone destruction and abscess formation
- abscess and necrotic debris exerts pressure on the bone and infection spreads to periosteum
23
Q
clinical manifestations and lab findings of osteomyelitis
A
- manifestations: don’t start occurring for 7-10 days
- fever
- failure ot use affected extremity
- erythema, heat, and swelling
- tenderness in affected area
- dec ROM in joints of affected extremity
- labs:
- CBC w/ diff: elevated WBC
- inc ESR
- cultures
24
Q
nursing mgmt of osteomyelitis
A
- aggressive abx tx for 4-6 weeks
- usually given a PICC line and parents taught how to assess and flush PICC and then infuse abx
- must finish full course of abx
- usually cephalosporins, gentamycin
- if MRSA, may have to use vancomycin
25
scoliosis etiology
* often unknown cause
* complex spinal deformity in 3 planes:
* lateral curvature
* spinal rotation causing rib asymmetry
* thoracic hypokyphosis
* issue is degree of curvature and how much pulmonary function is being affected
26
clinical manifestations, diagnostics, and mgmt of scoliosis
* idiopathic curvature not typically evident until 10 yo
* usually no pain
* eval:
* check with x ray in standing position
* Cobb technique for curvature magnitude
* have child bend over and touch toes
* assess gait
* mgmt:
* bracing and exercise (in and out of brace)
* should not be worn directly against skin
* encourage exercise
* wear for 16-23 hrs a day
* if \>40 deg, need surgery
27
surgical repair of scoliosis
* realignment and straightening w/ internal fixator
* post op:
* neuro checks, circulation checks
* assess for infection at the incision site
* pulmonary system
* assess skin, U/O, bowel sounds
* logroll for first 24 hrs, then ambulate 2-3x per day
* remove foley asap
* need good pain mgmt
* monitor H&H b/c potential for significant blood loss
* typically d/c in 48-72 hrs
28
cerebral palsy etiology
* any perinatal or neonatal brain lesion or brain maldevelopment
* prenatal/postnatal infection
* prenatal/postnatal hypoxia/asphyxia
* often no identifiable immediate cause
* inc incidence with prematurity
* preterm birth of ELBW and VLBW is most important determinant
* anoxia--most common cause of brain damage whenever it occurs
29
spastic CP
* most common type
* presents as hypotonia most often
30
motor signs of CP
* poor head control after age 3-4 mos
* stiff or rigid limbs
* arching back/pushing away
* floppy tone
* unable to sit w/o support at age 8 mos
* clenched fists after 3 mos
31
behavioral signs of CP
* excessive irritability
* no smiling by age 3 mos
* feeding difficulties
* persistent tongue thrust
* frequent gagging or choking w/ feeds--aspiration common
32
pharmacology to dec spasticity in CP
* botulinum toxin (botox)
* baclofen
* oral
* implanted pump for intrathecal administration
* dantrolene sodium
* diazepam
33
assoc disabilities with CP
* intellectual impairment
* ADHD
* SZs
* drooling
* difficulty feeding--can lead to aspiration
* impaired gas exchange
* orthopedic complications
* visual (nystagmus) and hearing loss
* constipation
* dental problems--caries, malocclusion, gingivitis
34
nursing mgmt of CP
* holistic approach
* interdisciplinary
* PT/OT, speech therapy
* when feeding, make sure they are not lying flat
* may need jaw support to help swallow
* may thicken foods/fluids to prevent aspiration
35
hypotonia
* "floppy infant syndrome"
* muscles feel atrophied, marked head lag, poor suck
* characteristics of SMA type 1 and 2:
* progressive weakness and wasting of skeletal muscles
* degeneration occurs in spinal cord and brainstem--\>atrophy of skeletal muscles
* age of onset variable, earlier onset=poorer prognosis
* eventually progresses to affected respiratory muscles
36
infantile SMA (spinal muscular atrophy) type 1
* Werdnig Hoffmann dz
* autosomal recessive trait
* most common form of floppy infant syndrome
* often die at an early age, b/c affects respiratory Ms
37
infantile SMA type 2
* manifests b/w 2-12 mos
* first weakness of arms and legs, then generalized weakness
* prominent pectus excavatum
* movements absent during relaxation and sleep
* life span: 7 mos to 7 yrs
38
muscular dystrophy
* X linked inheritance pattern
* mutation of gene that encodes dystrophic--\>protein product in skeletal muscle, so it builds up
* muscle weakness begins to demonstrate around 3 yo
* its an ascending disorder
* starts in extremities and works way up
39
DMD clinical manifestations
* pelvic weakness:
* waddling gait, lordosis, falls frequently
* Glower's sign: push themselves up with hands instead of legs
* muscle atrophy--\>calf muscle hypertrophies and fatty infiltrates develop
* occasional mental deficiency
* inc respiratory distress--\>eventually affects diaphragm
40
nursing mgmt of DMD
* genetic counseling: prenatal testing
* encourage exercise: delays wheelchair confinement
* interdisciplinary consultation
41
talipes equinovarus
* AKA clubfoot
* strong familial tendency
* mgmt: 3 stages:
* correct deformity
* maintenance of correction
* f/u to avoid recurrence
* will have serial casting
* will need analgesics and edu about cast care
* if severe, may need surgery
* after correction, may need splint to prevent reoccurrence
42
osteogenesis imperfecta (OI)
* brittle bone dz: on a continuum
* manifestations:
* bone fragility, deformity, fx
* blue sclerae
* hearing loss
* dentinogenesis imperfecta
* inheritance: most are autosomal dominant, but most severe form is sometimes autosomal recessive
* mgmt: mainly supportive
Pediatrics Test III
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