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61 Cards in this Set
- Front
- Back
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Bones of children
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- more purous, less dense
- injury to epiphyseal plate can hurt growth - bone can bend, buckle and break - rapid growth and rapid healing |
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Muscles in children
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- completely formed
- increase in length and circumference not number |
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Ligaments and tendons
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- stronger than bones until puberty
- grow in length and fibrous tissue as mechanical pressure is placed on them |
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Metatarsus Adductus
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pigeon toes "intoeing"
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Nursing care for Metatarsus Adductus
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- correctable
- exercises - cast care if required |
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Club foot tx
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can not be corrected with exercise
-serial casting or surgical correction (3-12 months) |
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Club foot
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- boys more than girls
- foot is twisted (muscle, bones, and tendons) |
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Club foot nursing care
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- emotional support
- cast and brace care - post surgical care - home care teaching |
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Geny varum
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Bowlegs, Blount's disease, rickets
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Genu valgum
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knock knees
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genu valgum and genu verum
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normal unless persists beyond 4-5 yrs old
tx: braces, surgery |
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nursing care for genu valgum and genu verum
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- parental reassurance if child is less than 4 yrs old
- parental teaching- brace wear |
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Developmental Dysplasia of the hip (DDH)
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dislocation, subluxation, instability, and dysplasia of the hip joint
- femoral head has abnormal alighnment with acetabelum (may have no contact) - more common in girls than boys - unknown cause - look for asymmetry of hip or gluteal folds |
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DDH tx
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- Pavlik harness (younger than 3 months of age)
- skin traction (older than 3 months of age) - spica, cast, surgery (older than 18 months) |
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Pavlik harness
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holds legs in frog position, forces femur into hip
- clothes should be worn underneath |
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DDH Nursing care
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- assessment of hips
- care depends on tx --maintain traction --cast care --prevent complications from immobility |
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Legg-Calve- Perthes Disease
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- Avascular necrosis of the femoral head (inturrupted blood supply to epiphysis)
- boys more than girls - average onset is 7 yrs old - unknown cause - four distinct stages (1-4) |
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Legg Calve-Perthes Disease tx
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traction, casting, bracing
--> goal is to keep hip abducted |
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Nursing care of Legg-Calve-Perthes Disease
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- assessment for hip discomfort, painless limp--> mild hip pain will result and go to knee or thigh
- Promote normal growth and development - antiinflammatory meds -Brace care (ie: toronto where legs are out in V shape) |
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Brace care
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Brace may be wiped with a damp cloth if it becomes dirty
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Slipped Capital Femoral Epiphysis (SCFE)
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- femoral head displaced from femoral neck at the level of the epiphyseal plate
- during adolescent growth spurt (growing to fast to keep up with body) - boys more than girls, higher in AA, 9-16yo - sudden in onset and inability to bear weight |
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Slipped Capital Femoral Epiphysis (SCFE) cause
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unknown, but likely related to obesity or endocrine disorders
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SCFE Treatment and Nursing care
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- surgical
- address obesity if present - Provide emotional support - Home care teaching - Osteoarthritis may be long term complication - refer to orthopedic surgeon - bed rest and activity restriction - immmobility = isolation, so encourage phone calls, visit, games, etc. |
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Scoliosis
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- more than 10 degrees is abnormal
- Idiopathic (most common), congenital, acquired - girls around adolescent most common |
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Mild scoliosis tx
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10-20 degrees
strengthening and stretching |
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moderate scoliosis tx
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20-40 degrees
bracing- worn 23 hrs a day |
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Severe scoliosis tx
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greater than 40 degrees surgery- spinal fusion
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Congenital scoliosis causes
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- related to spinal structure
(spina bifida, cerebral palsy, muscular dystrophy) |
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Acquired scoliosis causes
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Injury to spinal cord
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Nursing care of scoliosis
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- Screening (5th and 7th grades)
- promote acceptance of care plan - post op care - home care teaching |
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Torticollis
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- Head til caused by rotation of the spine
- painless muscular condition |
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scoliosis back brace care
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- inspect skin for evidence of rubbing or impaired skin integrity
- teach families skin care - and how to check for daily fit and breakage - encourage teeth to shower during the 1 hr brace is off - Wear cotton t-shirt under brace - make sure skin is clean an dry - back strengthening exercises |
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Troticollis tx
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- stretching exercises
- surgical correction - botox injections have been used recently |
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Kyphosis
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convex curvature of spine (hunchback)
tx: exercies, bracing, surgery |
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Lordosis
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Concave curvatyre of spine (swayback)
tx: exercise, postural awareness |
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Osteomyelitis
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- Infection of the bone, usually long bone in lower extremity
- acute or chronic - any age, boys more, but only due to trauma |
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Symptoms of osteomyelitis
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pain, swelling, decreased mobility, fever
Child be refuse to walk or show decreased range of motion in affected extremity palpate for local warmth and tenderness |
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Nursing care of osteomyelitis
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- immunization status (tetanus)
- obtain cultures and blood work - Administer fluids and medications (antibiotics an possible antipyretics) - Protect from spread of infection (maintain bed rest to prevent further trauma) - Encourage well-balanced diet - Home care teaching (home IV therapy possible) |
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Skeletal TB
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Rare infection that affects spine and other joints
tx is antimicrobial therapy |
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Septic arthritis
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- joint infection
- most common is knee, hip, ankle, elbow tx: joint drained via aspiration, then IV antibiotics for 3-4 weeks |
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Achondroplasia
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Dwarfism
- genetic - head and torso normal size, arms and legs are short |
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Treatment and nursing care for Achondroplasia
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(Dwarfism)
- no treatment (gene therapy in future), limb lengthening may be palliative nursing: - genetic counseling for parents - positive self image - modifications to adjust for size |
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Marfan Syndrome
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- genetic condition of connective tissue
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Common problems of Marfan syndrome
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- cardiac mitral valve prolapse, aortic regurg, abdominal root dimensions --> aorta dissection
Skeltal pectus excavatum (caved in sternum), long arms and digits, scoliosis, elongated head, high arched palate Arm spans is longer than they are tall Ocular- lens subluxation (if not treated they can go blind) |
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tx for Marfan syndrome
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none specific
- surgery to prevent aortic dissection (*Most common cause of death) **NO SPORTS! |
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Nursing care of Marfan syndrome
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- Identification of the disease
- Monitoring - Surgical care - Genetic counseling - Medication management |
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Osteogenesis imperfecta
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- "brittle bone disease"
- Genetic condition affecting collagen production |
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Manifestations of osteogenesis imperfecta
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- frequent fractures
- blue sclarae - thin, soft skin - short stature |
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tx for osteogenesis imperfecta
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- fracture prevention, treatment
- prevention of deformity - maximize mobility - support for family and child |
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Muscular dystrophy
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- group of inherited disease (Duchenne most common and only affects boys)
- muscle fibers degenerate - onset varies (birth to late in life) - progression varies (few to many years) - ALL are terminal |
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Tx of muscular dystrophy
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- none specific
- gene therapy in future? - preserve muscle function- steroids, deflazacort (corticosteroids and calcium supplements too) - preserve cardiopulmonary function - Prevent complications (infection, spinal deformities) |
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Nursing care of muscular dystrophy
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- promote independence and mobility as much as possible
- Psychosocial support and acceptance - referral to resources for support (muscular dystrophy associationg- mda.org) |
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Cast Care
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- elevation
- drainage, bleeding - neurovascular checks- pulses, capillary refill, warmth, edema - Itching |
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Care of child in a brace
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- brace should be comfrotable
- skin care - wear clothes beneath brace |
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Type of tractions
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Skin
Dunlop Bryant 90-90 Skeletal Halo Russell |
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Post surgical care with External Fixator
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- Neurovascular checks
- Pin care (if have an external fixator, but EBP has shown NO pin care, most do not use it, but there are some that still do pin care) - Drainage |
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Fractures
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- occur at any age
- results from trauma to bones or diseases that weaken bones |
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Nursing Care of Fractures
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- maintain proper alignment
- Monitor neurovascular status - Pain control (muscular spasms are more painful than fracture, valium is given for this--monitor respiratory status) - promote mobility - discharge teaching |
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Sports Injuries
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- most common type of injur in youth 13-19 yo
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Risk factors for injury in childhood
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- vulnerability of growth plates
- increased joint mobility leads to joint injuries - softer bones lead to fractures - lack of experience and training - not wearing protective gear - impatience with healing process |
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Prevention on injury
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- proper training and instruction
- protective gear - supervision - warm up before activity |
