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effects of immobilization on skeletal system (3)
bone demineralization, negative calcium balance, contractures of joing
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decreased metabolic rate, negative nitrogen balance, hypercalcemia, decreased stress hormones
effects of immobilization on metabolism
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S/S of hypercalcemia
N/V, polydipsia, polyuria, lethargy
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Effects of immobility on cardiovascular system (5)
Decreased efficiency of orthostatic neruovascular reflexes; diminished vasopressor mechanism; altered distrubtion of BV; venous stasis; dependent edema
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5 effects of immobility on respiratory system
decreased need for O2; diminished vital capacity; poor abdominal tone/distention; mechanical restriction; loss of respiratory muscle strength
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4 effects of immobility on GI system
Distention; anorexia; difficulty feeding; gravitation effects on feces
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Effects of immobility on integumentary system (2)
decreased circulaiton and pressure; prone to pressure sores
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effects of immobility on urinary system (4)
alteration of gravitational force; impaired ureteral peristalsis; difficulty voiding in supine position; urinary retention
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most frequently broken bone in child
Clavicle
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the weakest point of long bones is the what?
cartilage growth plate; epiphyseal plate
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Triad of injuries assoiciated with motor vehicle injuries
Femur fracture, truncal injury, contralateral head injury
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when fractured bone protruded through the skin
compound/open fracture
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bone fragments have damaged other organs/tissues
complicated fracture
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small fragments of bone are broken from the fractured shaft and lie around surrounding tissue
comminuted fracture
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compressed side of bone bends, but tension side of bone breaks, causing incomplete fracture
Greenstick fracture
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The 5 ps for assessment of fractures
Pain and point of tenderness; pulse distal to site; pallor; parestheisa, sensation distal to fracture; paralysis
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What is the typical bone healing for the following?
Neonatal period, early childhood, late childhood, adolescence
2 -3 weeks, 4 weeks, 6 to 8 weeks, 8 to 12 weeks
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forward force produced by attaching weight to distal bone fragment
traction
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backward force provided by body weight
contertraction
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provided by patient's contact with bed
frictional force
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applied to body part by the hand placed distally to fracture
manual traction
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pulling mechanisms are attached to the skin with adhesive material/elastic bandage
skin traction
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applied directly to skeletal structure by pin, wire, or tons inserted into or through the diameter of the bone distal to the fracture
skeletal traction
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inserted through burr holes in skull with weights attached to hyperextended neck
cervical traction
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process of separating opposing bone to encourage regeneration of new bone in created space; can be used when limbs are unequal in length and new bone is needed to elongate shorter limb
distraction
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Permits limb lengthening by manual distraction; allows earlier mobilization and hospital discharge
ilizarox external fixator
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causes include tight dressing for casts, hemorrhage, trauma, burns, surgery
compartment syndrome
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ischemic muscular atrophy
volkmann contracture
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when fat droplets from the marrow are transferred to general circulation and transported to lungs/brain
fat embolism
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occurs when force of stress on ligament is sufficient to displace normal position of opposing bone ends or bone ends to its socket
dislocation
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trauma to a joint from ligament partially or completely torn/stretched by force
sprain
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microscopic tear to musculotendinous unit; swollen, painful to touch
strain
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S/S include sharp, persistent, progressive pain or deep dull ache over bone
stress fracture
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caused by sodium depletion; usually leg cramps; treat with rest/replace fluids
heat cramps
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collapse due to excessive fluid loss; may be disoriented
heat exhaustion
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failure of normal thermoregulation mechanisms; rapid onset of headache, weakness, temp greater thatn 104
heat stroke
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female athlete triad
amenorrhea, osteoporosis, eating disorders
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positive olrtolani test; shortening of limb on affected side; assymmetric thigh/gluteal folds; broadening of perineum
S/S of developmental dysplasia of hip
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DDH in older infant and child (4)
trendelenburg sign; lordosis; waddling gate; greater trochangter is prominent
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types of congenital clubfoot:
inversion; eversion; plantar flexio with toes loer than heel; dorsiflexion with toes higher than heel
talipes varus, talipes valgus, talipes equinus, talipes calcaneus
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most common congenital foot deformity; often results from abnormal position in uterus; "pigeon-toed gait"
metatarsus adductus
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"wry neck"; congenital/acquired ilmited neck motion with neck flexed to affected side; initally firm nontender mass that turns into fibrous tissue
Torticollis
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Self-limited, idopathic, 3 to 12 years of age, avascualr necrosis for femoral head
Legg-Calve-Perthes Disease
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hip soreness, stiffness or ache, pain in hip, groin, or knee; usually associated with joint dysfunction and limited ROM
S/S of Legg Calve Perthes Disease
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most common spinal deformity; may be congenital or develop during childhood
Scoliosis
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log roll to prevent spinal motion; molded plastic jacket to provide external stabilization (scoliosis)
Harrington rods
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use of wires and rods to straighten spine for scoliosis
L-rods
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wheen a preexisting infectino spreads to bone
hematogenous osteomyelitis
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characterized by excessive fragility and bone defects, blue sclera, hearing loss, and discolored teeth
Osteogenesis Imperfects (OI)
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peaks at ages 1 to 3 and ages 8 to 10
Juvenile Rheumatoid Arthritis (JRA)
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Stiffness, swelling, loss of mobility in affected joins, warm to touch, tender to touch, symptoms increase with stressors, growth retardation are S/S of what
JRA
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inflammation of iris/ciliary body; unique to JRA
Iridocyclitis/uveitis
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first line of treatment for JRA; immediate analgesia but delayed antiinflammatory effect
NSAIDs
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slower acting antireheumatic drugs; side effects include liver disease, bone marrow suppression, GI disturbances, teratogenisis
SAARDs
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characterized by early onset and impaired movement/posture with abnormal muscle tone/lack of coordination
Cerebral Palsy (CP)
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type of CP that includes hpertonicity, lack of fine/gross motor skills
Spastic
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type of CP that includes abnormal involuntary movements
Athetoid/dyskinetic
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type of CP that includes wide-based gaiin, uncoordinated movement of upper body
ataxic
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type of CP that includes combination of spasticity and athetosis
Mixed/dystonic
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poor head control after 3 months of age; stiff/rigid limbs; arching back, pushing away; floppy tone; unable to sit w/o support @ 8 months; clenched fists after 3 months
Possible s/s of CP
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excessive irritability, no smiling @ 3 months, feeding difficulties
possible behavioral signs of CP
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skeletal muscle relaxants for CP; decreases spasticity
Dantrium, Robaxin
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most severe/common muscular dystrophy in childhood; X linked; males
Duchenne Muscular Dystrophy (DMD)
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waddling gait, frequent falls, gower sign, lordosis, enlarge muscles, profound muscular atrophy, mental deficiency
S/S of DMD
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