Pediatric MusculoSkeletal: Diagnostic/Lab Tests, Assmnt

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Pediatric MusculoSkeletal: Diagnostic/Lab Tests, Assmnt
2011-01-08 12:52:13
nursing msk

Dx/Lab Test, Assmnt
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  1. Arthrogram
    • needle inserted into joint space
    • local anesthetic
    • Joint fluid can be aspirated
    • radipaque dye injected; radiographs can help in Dx

    • Nursing Imp: prepare pt/fam
    • local anethesia used; general anesthesia for very young
    • vital signs before, during, after
    • support child when anethetic inserted
  2. Bone Scan
    • phosphate or phosphonate radionuclide given IV, concentrates in the bone
    • scintillation camer scans body
    • assess for occult Fx, infxn, bone tumors

    • Nursing Imp: prepare pt/fam
    • Contrast Medium: Hx of hypersens. to iodine, seafood, contrast dye
    • Start IV for injection of contrast
    • Sedate young children; monitor
  3. Computed Tomography (CT)
    • Narrow beam of radiation examines body sections from different angles
    • Two dimensional cross-section of structures
    • Detects muscle/bone tumors or abn.
    • Contrast can be used

    • Nrsg Imp: may be NPO, or need bowel evac.
    • Teach about procedure: size of equipment, noises, length of time
    • Contrast: Hx of hypersens.
    • Sedation for young; monitor
  4. Dual Energy X-Ray Absorptiometry (DEXA)
    • *Body Part is Placed btwn 2 photon energy beams
    • *Bone Mineral Density and Bone Mineral Concentration detected; compared to norms

    • Nrsg Imp: explain proc. to child
    • Need to hold still
    • Have child practice holding breath while keeping still
  5. Electromyelogram
    • *Needle electrodes inserted into skel. musc.
    • *Muscle activity measure during rest, voluntary activity, and electrical stim.
    • *Dx of musc. dystrophy
    • *Differentiate muscle diseases and lower motor nueron neuropathies

    • NRSG: record the child's meds
    • *Inform: may be sligh pain w/needles
    • *Relaxation Techiques or Distraction
    • *Analgesics as needed
  6. Evoked Potential
    • *Child is awake; monitored by electrodes
    • *Measures brain and muscle activity
    • *Baseline of electrical activity recorded; used later for surgery to monitor innervation to muscle groups and avoid injury to spinal cord

    • NRSG: prepare child
    • *Size of equipment, Sounds, Time it will take
    • *Relax w/quiet music
  7. Magnetic Resonane Imaging (MRI)
    • *large magnet and radio waves delievered to body part
    • *Energy field produced transferred as visual image to computer
    • *Soft Tissue injury can be Dx

    • NRSG: Prepare the child
    • *Size of equipment, Sounds, Time, Tunnel
    • *No metallic objects/implants, not attached to metal equip.
    • *Sedation for young children
  8. Radiograph (x-ray)
    • *Irradiation to obtain images; captured on film
    • *Dx bone Fx, assess healing
    • *Hand: detect bone age, Dx of delayed or slow growth

    • NRSG: explain procedure
    • *Need to hold still
    • *Practice holding breath, being still
  9. Ultrasound
    • *Tranducer (ultrasound probe) held over skin, produces ultrasound beam
    • *Reflected sound waves transformed into graphs/pictures
    • *Dx hip displasia in infants
    • *Bone Mineral Density in adults

    • NRSG: prepare child
    • *NPO if ordered
    • *Child has not received any tests that interfore (i.e. GI series)
  10. Alkaline Phosphatase (ALP)
    • Enzyme fxn of liver and bone
    • Children have levels 1-2 + than adult
    • More Elevation: indicate bone destruction, bone cancer, healing Fx, hyperparathyroidism, VitD deficit, or Ca deficit
    • Decreased: inadequate bone formation (hyperthyroidism, celiac disease, cystic fibrosis)

    • NRSG: prepare child
    • Test in Tx room, not Hosp/Clinic room
    • Label/Transport specimens
  11. C-Reactive Protein (CRP)
    • Not normally present in blood
    • Presence indicates inflammation or infection

    • NRSG: prepare child
    • Test in Tx room, not Hosp/Clinic room
    • Label/Transport specimens
  12. Erythrocyte Sedimentation Rate (ESR or sed rate)
    • *Measures speed with which RBCs settle in a test tube
    • *Elevated in inflammation, infxn, tissue injury, or rhuematologic disorders
    • *Degree of elevation determines severity of infxn
    • *Decrease: indicate improvement, or seen in sickle cell anemia

    • NRSG: prepare child
    • Test in Tx room, not Hosp/Clinic room
    • Label/Transport specimens
  13. Rheumatoid Factor (RF)
    tests for an immunoglobulin present in blood serum of many indiv. w/ JRA

    • NRSG: prepare child
    • Test in Tx room, not Hosp/Clinic room
    • Label/Transport specimens
  14. Assessment of Muscles
    • Symmetrical muscle mass
    • Fine/Gross motor movements ok developmentally
    • Abn signs? (asymm. movement, tenderness, masses, wekness, hypotonia, hypertonia)
    • School-age: get up from lying/sitting position in usual manner
    • Usual daily physical activity
    • Loss of ability to perform developmental milestones
  15. Assmnt of Joints
    • Movements smooth and symmetrical
    • Signs of tenderness, decr. ROM, inflamm, crepitus/grating, masses
    • Newborns/Infants: hips have symmetrical, full ROM
    • Recent events of trauma
  16. Assmnt of Bones
    • Masess
    • Arms/Legs same length
    • Recent decr. or change in mobility
    • Bones in alignment (ABN? bowlegs, knock-knees)
    • Spine properly aligned
    • What sports played? Protective gear worn?
  17. Assmnt of Tendons/Ligaments
    • All joints move thru full ROM
    • Any pain upont joint motion/palpation
    • Grinding or crepitus as joint moves
    • Recent sports of other injury?
    • What sports?
  18. Fontanels: Expain the development.
    • Fontanels: cranial bones, fibrous membrane btwn
    • Posterior: close at 2-3 mo.
    • Anterior: close aprox. 18 mo.
    • Most of skull growth by 2 yr.
    • Full size by 16 yr.
  19. Secondary Ossificiation
    • as long bones grow, cartilage cells at epiphyses replaced by oseoblasts
    • helps push end of bone away
    • deposition of calcium
  20. At what age does skeletal maturation occur?
    Age 20 years
  21. How are children's long bones different?
    • porous and less dense
    • bend, buckle, and break easier
  22. Function Differences of Spine
    • Before Birth: thoracic & sacral convex
    • Hold Head Up: cervical concave
    • Learn to Stand: lumbar concave
    • Failur to Curve this way: abn. curvature, kyphosis, lordosis
  23. Explain the Development of the Muscular System.
    • Almost completely formed at birth
    • Increase in 1st yr of life
    • Afterward, no increase in number, but rather in length and circumference
    • Girls: max diam. 10 yrs
    • Boys: max. diam. 14 yrs
    • Strength increases until 25-20 yr