Peds Musculoskeletal Dysfunction

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  1. What are the three essential elements of traction?
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  2. What is the difference between skin and skeletal traction and what are some examples of each?
    • Skin: involves tapes, boots, etc, but no machinery.
    • – Buck’s Extension
    • – Russell Traction
    • – Cervical Traction 

    • Skeletal: this is the heavy machinery type with pins and rods and screws etc. 
    • – Halo
    • – Balanced suspension
    • – Femoral traction 
  3. What's important to assess after a fxr?
    • The 5 P's:
    • Pain and Point of tenderness
    • Pulse-distal to the fracture site
    • Pallor
    • Paresthesia-sensation distal to the fracture site
    • Paralysis-movement distal to the fracture site 
  4. What are some nursing considerations for chilren in traction?
    • • Skin care issues
    • • Pain management/comfort 
    • (See Guidelines on p. 1762)
  5. What are some psychological effects of immobilization?
    • Diminished environmental stimuli
    • Altered perception of self and environment
    • ncreased feelings of frustration, helplessness, anxiety
    • Depression, anger, aggressive behavior
    • Developmental regression. The older the child, the more severe the psychological impact. 
  6. What are some typical MSk congenital dysfunctions?
    • • Clubfoot
    • • Developmental Dysplasia of the Hip
    • • Legg-Calve’-Perthes Disease
    • • Slipped Capital Femoral Epiphysis 
  7. What can you do to correct clubfoot?
    • shortly after birth cast will be admin'd and changed 1-2 weeks to remodel foot/calf. 
    • after cast, will move to brace.
  8. What are the three degrees of DDH
    • • Unstable hip: Mildest form-hip ligaments are lax, allowing displacement
    •  • Sublaxated hip: Head of femur is under lip of acetabulum, but not well seated
    • • Dislocated hip:Femoral head loses contact with acetabulum 
  9. SnSs of DDH in an infant?
    • – Shortened limb on affected side
    • – Restricted abduction of the hip on affected side
    • – Unequal gluteal folds when infant prone
    • – Positive ortolani test
    • • Click heard when hips pulled up to flex. 
    • --Positive barlow test
    • • Click heard when hips abducted
  10. SnSs of DDH in an older child?
    • • Affected leg shorter than the other
    • • Trendelenburg Sign
    • – Hips should remain level when weight is shifted from one leg to the other
    • • Greater trochanter is prominent
    • • Waddling gait if bilateral dislocations 
  11. Tx of child with DDH?
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  12. What is Legg-Calve'-Perthes Disease?
    • • Osteochondritis deformans juvenilis or coxa plana
    • Self-limited, idiopathic, occurs in juveniles ages 2 to 12, more common in males ages 4 to 9
    • Avascular necrosis of the femoral head (avascular because head of femur does not articulate with acetabulum.)
    • 10%-15% have bilateral hip involvement
    • After resolving may have normal femoral head or may have alteration
  13. SnSs of Legg-Calve'-Perthes Disease?
    • – Insidious (slow) onset, may have history of limp, soreness or stiffness, limited ROM, vague history or trauma
    • –  Pain and limp most evident on arising and at end of activity
    • –  Diagnosed by x-ray
  14. What is Tx for child with Legg-Calve'-Perthes Disease?
    • – Goal: keep of femur in acetabulum
    • – Containment with various devices
    • – Rest, no weight bearing initially
    • – Surgery, in some cases
    • – Home traction, in some cases
  15. What is Slipped Capital Femoral Epiphysis?
    • Affects the upper (capital) femoral growth plate/slips backwards in the acetabulum
    • Hip disorder related to times of growth, especially during adolescence
    • Cause is unknown, but 
    • Connection to stress on the epiphyseal plate just prior to closure, ie usually occures in obesce clients during puberty b/c structure cannot support the child's weight plus growth. 
    • Majority of patients exceed 95th percentile for weight and 90th percentile for height
  16. SnSs of child with Slipped Capital Femoral Epiphysis?
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  17. Tx of Slipped Capitol Femoral Epiphysis?
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  18. What do you need to know about fxrs that damage the epiphyseal growth plates?
    • • Weakest point of long bones is the cartilage growth plate (epiphyseal plate)
    • • Frequent site of damage during trauma
    • • May affect future bone growth
    • • Treatment may include open reduction and internal fixation to prevent growth disturbance 
  19. What are the four types of fxr?
    • Compound or open: Fractured bone protrudes through the skin
    • Complicated: bone fragments have damaged other organs or tissues
    • Comminuted: small fragments of bone are broken from fractured shaft and lie in surrounding tissues
    • Greenstick: compressed side of bone bends, but tension side of bone breaks causing incomplete fracture
  20. What are some possible complications with a bone fxr?
    Fat embolism: remember the yellow marrow (usually femur fxr)? Fat from yellow marrow leeches into vasculature and embolizes in heart, lung, ect. 

    Compartment syndrome: Area is crushed/constricted. Cuts off vasculature/nerve function. Will turn necrotic. Can occur with casting.
  21. What is Osteogenesis Imperfecta (OI)?
    • • A group of autosomal recessive inherited disorders of connective tissue
    • • Involves a gene deficiency that leads to deficiency in collagen
    • • Characterized by excessive fragility and bone defects
    • • Multiple classifications ranging from stillborn/early death to mild bone fragility
  22. What are the three types of soft tissue injuries?
    • Sprains
    • Strains
    • Contusions
  23. Be able to talk about sprains
    • • Trauma to a joint from ligament partially or completely torn or stretched due to force
    • • May have associated damage to blood vessels muscles, tendons and nerves
    • • Presence of joint laxity as indicator of severity
    • Rapid onset of swelling with disability 
  24. Be able to talk about strains
    • A microscopic tear to musculotendinous unit
    • • Similar to sprain
    • • Swollen, painful to touch
    • • Generally incurred over time 
  25. Be able to talk about contusions
    • Damage to soft tissue, subQ tissue, and muscle
    • • Escape of blood into tissues-ecchymosis-black and blue discoloration
    • • Swelling, pain, disability
    • • ie Crush injuries 
  26. What is Tx for Soft Tissue Injuries?
    • RICE & ICES
    • R = rest
    • I = ice (max 30 min at a time)
    • C = compression
    • E = elevation

    • I = ice (max 30 min)
    • C = compression
    • E = elevation
    • S= support
  27. What is treatment of Osgood-Schlatter's Knees?
    • • Disease is usually self-limiting
    • • Treatment is conservative
    • • Avoidance of activities that cause knee pain
    • • Wrapping with elastic bandages
    • • PT
    • • Ice, heat, and NSAIDs
    • • Knee brace 
  28. What is Osteomyelitis?
    • Inflammation and infection of bone by bacteria
    • May be caused by exogenous or hematogenous sources
    • Exogenous
    • – Infectious agent invades following penetrating wound, surgery (orthopedic pinning most common in children), etc.
    • Hematogenous
    • – Preexisting infection spreads to bone from skin, URI, abscessed tooth, phyelonephritis, etc.
  29. What is Tx for Osteomyelitis?
    • • Any organism can cause, but most common is staph aureus
    • • Signs and symptoms begin abruptly, resemble those of arthritis and leukemia
    • – Erythema, limited ROM, fever, lethargy, pain
    • • Treatment:
    • – IV antibiotics for extended time 
  30. What is Juvenile Arthritis?
    • Autoimmune inflammatory disease
    • No known cause
    • Peak ages: 1-3 years and 8 to 10 years
    • Often undiagnosed
    • 90% have negative Rheumatic Factor
    • Symptoms may burn out and become inactive
    • Chronic inflammation of synovium with joint effusion, destruction of cartilage 
  31. SnSs of JA?
    • Stiffness, swelling, loss of mobility in affected joints (worse in the am)
    • Warm to touch, usually without erythema
    • Symptoms increase with stressors
    • Growth retardation
    • Treatment: NSAIDs, corticosteroids 
  32. Why might a child have a kyphosis?
    Can result from TB, arthritis, osteodystrophy or compression fracture
  33. What is Lordosis?
    • • Accentulation of the cervical or lumbar curvature beyond physiologic limits
    •  • May be idiopathic or secondary due to complication of trauma
    •  • May occur with flexion contractures of hip, CHD
    • • In obese children, abdominal fat alters center of gravity, causing lordosis
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Peds Musculoskeletal Dysfunction

The Child with Musculoskeletal Dysfunction
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