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33 Cards in this Set
- Front
- Back
Congenital Defects
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Developmental Dysplasia of the Hip (DDH)
Congenital Clubfoot Metatarsus Adductus |
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Developmental Dysplasia of the Hip (DDH)
DDH |
an abnormal development of the hip
DDH health history Health history breech birth girls>boys >Caucasian family history cultural factors |
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Assessment for DDH
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Galeazzi’s sign
asymmetry of gluteal and thigh folds with shortening of thigh Barlow hip adduction Ortoloni sign abduction (clunk) when spreading Alli’s sign shortening of the femur Trendelenburg sign with lordosis Ultrasound before 4 months X ray after 4-6 months |
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DDH Treatment - early diagnosis
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Early diagnosis allows the femoral had and acetabulum to develop normally
Early treatment Birth to 6 months Pavlik Harness Parent education (p. 1476) -Initially worn continuously; then short periods off for 3-5 months Bath, feeding, playing only in the harness -Weekly checks for strap adjustment -Skin care -lotions, powders -clothing, diapering |
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DDH Treatment - late diagnosis
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Late diagnosis (older infant and child)
Loss of range of motion affected leg is shorter than the other early osteoarthritis waddling gait Age 6-18 months Disorder not recognized until child walks -limb shortening -contractures adductions and flexion traction closed reduction under anesthesia or open reduction hip spica casting for 2-4 months ALL OLDER CHILDREN WILL REQUIRE SURGERY |
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Metatarsus Adductus
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assessment (“pigeon toe”)
Medial deviation of forefoot Health history intrauterine positioning Physical exam Passive ROM normal Types I and II. Passive ROM limited Type III |
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Treatment metatarsus adductus
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Reassurance, Stretching
Types I and II Type III Serial casting Surgery |
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Congenital Clubfoot
Talipes equinovarus |
Health history
1 to 2/1000 Boys >girls 50% bilateral associated with DDH, spina bifida postural |
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Congenital Clubfoot
Physical examination |
Plantar flexion of foot
-Forefoot adduction and supination -Ankle equinus |
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Congenital Clubfoot
Treatment |
Serial casting with
cast changes 1-2 weeks Denis Browne splint Surgery if normal alignment of foot not achieved by 3 months |
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The Child in A Cast
Cast Issues |
Swelling can continue after cast is put on
Elevate to decrease risk, permanent damage within 6-8 hrs Nursing Assessment Swelling and….. Pain Persistent pain an hour after medication Pallor Discoloration of exposed extremities (pallor or cyanosis) Pulselessness Decreased pulses or temperature of extremities Paresthesia Abnormal sensation Paralysis Decreased movement of distal extremities |
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Developmental regression from a cast
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autonomy young children
initiative preschooler industry school age independence adolescent |
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Acquired Orthopedic Defects
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Idiopathic scoliosis
Legg-Calve-Perthes Slipped Capital Femoral Epiphysis Septic Arthritis Juvenile idiopathic Arthritis |
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Types of Scoliosis
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Congenital, associated with other syndromes, idiopathic (65%)
Idiopathic scoliosis lateral curvature of the spine >10% -infantile < age 3 -juvenile age 4-10 prior to adolescence -adolescent age 11-17 most high incidence due to rapid growth |
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Major concerns of scoliosis
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Major concerns respiratory then cardiovascular compromise related to shape of the thoracic cage
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Assessment Scoliosis Inspection
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Use of scoliometer
Adams Bend over test scoliosis screening early adolescence prevent progression decrease impact on respiratory and cardiac system |
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Scoliosis Treatment
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< 10°-normal
10°- 20° observation, exercise 20°- 50° bracing > 45° surgery fused in segments > 60º risk of cardiopulmonary involvement |
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Scoliosis Surgery Nursing Care
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Pre-operative Period
routine surgical pre-op teaching turning, deep breathing, coughing preoperative autologous donation of blood Auscultation heart and lungs secondary to compromise |
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Legg Calve Perthes
Assessment |
Inspection
Painless limp, Trendelenburg gait or pain in hip, thigh or knee >with activity Internal rotation of hip Abduction limited Imaging X-rays MRI |
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Legg Calve Perthes Medical Treatment
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Wide abduction traction
Relieve spasms, stretches contractures, restore hip motion Partial ambulation cane crutches Casting 4-6 weeks or Bracing To keep the femoral head in the acetabulum If range of motion cannot be maintained Developing, preventable deformity that can be controlled Surgery To keep the femur in the acetabulum, screws, 6-8 weeks |
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Slipped Femoral Capital Epiphysis
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Epiphysis of the femur slips off the head of the femur in a posterior direction
Health History Boys > girls 9-16-years old Obesity African American>Caucasian Acute hip pain sudden onset with inability to bear weight Chronic hip pain slower onset pain and limp History of referred pain or groin, medial thigh or knee |
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Assessment Slipped Capital Femoral Epiphysis
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Inspection
Limp, Trendelenburg gait Decreased range of motion in hip Loss of abduction and internal rotation ~ 50% have bilateral involvement Imaging Xray Frogs Leg view Bone scan CT scan |
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Slipped Capital Femoral Epiphysis treatment
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Prevent further slippage until the growth plate closes
Treatment options Bedrest, traction, crutches but no wheelchairs While waiting for surgery Surgery to fix the femoral head to the growth plate 24-48 hours after diagnosis Crutches post op for weeks to months Ortho care for 18-24 months, limits on sports |
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Septic Arthritis
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Septic arthritis is an infection in a joint
-trauma or wound infection -distal infection -adjacent osteomyelitis near the joint Health History Septic Arthritis Age 3-7, under 10 years Warmth, tenderness, erythema, pain of joint Accompanying upper respiratory infection Recent history of trauma or venipuncture Hip most common joint affected |
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labs for septic arthritis
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Normal or elevated WBC count
Signs of inflammation ESR and C Reactive protein Culture Positive blood culture |
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Treatment Septic Arthritis
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Goal
Prevent avascular necrosis of joint head Maintain function, motion and strength Medical emergency joint aspiration; IV antibiotics in hospital |
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Juvenile Idiopathic Arthritis
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Chronic autoimmune inflammatory disease of the joints
Unknown cause Erosion of the synovium and destruction of articular cartilage – causes adhesions and stiffening (ankylosis) of the joint 70% inactive after childhood 30% have progressive arthritis into adulthood |
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JIA Types
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Pauciarticular onset
Most common type 4 or fewer joints, usually knee More at risk for vision problems Polyarticular onset 5 joints, small joints Systemic onset Enlarged spleen, liver, lymphadenopathy, pericarditis. pulmonary involvement ; pleuritis |
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JIA
Health History |
Unknown cause with girls > boys
1-3 years 8-10 years Always starts before age 16 Swelling, warmth, pain and joint stiffness irritability or fussiness, or play refusal Fever x 2 weeks |
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JIA
Medications |
NSAIDs
Approved for children Naproxen, ibuprofen, tolmectin Very effective side effect GI upset - take with food Methotrexate Used in combination with NSAIDs for failures Must closely monitor liver function, CBC Birth defects – birth control for teens |
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JIA
Medications Corticosteroids |
Corticosteroids are reserved for
Incapacitating arthritis Orally at lowest dose for shortest time Intraarticular injections Uveitis Use corticosteroids as eye drops |
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JIA
Medications Tumor Necrosis Factor Inhibitor |
Used when Methotrexate fails
Etanercept (Enbrel) interfere with immune system live virus vaccines, not with active infection twice weekly subcut injection |
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JIA
Nursing Considerations Promotion of general health |
Routines, include school attendance
avoid social isolation start school day later in morning double books Maintenance of rules and discipline allow as much self-care as possible Splints for sleeping Balanced diet Exercise, swimming Medical treatment for minor illnesses |