Nursing 2Nd Semester: Peds Exam 4: Musculoskeletal

Front 1

True or False: Muscle tissue is almost completely developed at birth. Growth occurs because of an increase in size rather than number of the muscle fibers.

Back 1

True

Front 2

Skeletal growth is stimulated by ______ growth hormone.

Back 2

pituitary

Front 3

Growth of long bones occurs at the _____, which are located at the ends of the bones and separated from the main portion of the bone by cartilage during the period of growth. Injury to this area can cause ____ disturbances.

Back 3

epiphyses
growth

Front 4

Growing bones produce callus and heal quickly, making internal fixation for fractures necessary/unnecessary for most children.

Back 4

unnecessary

Front 5

Fractures in children younger than 1 year old are unusual because a large amount of force is necessary, ____ or underlying pathophysiology is often the cause of fractures in children.

Back 5

abuse

Front 6

The skull is not rigid during infancy, and the sutures of the cranium do not fuse completely until approximately ___ to ___ months of age. Increased ___ can separate the sutures, causing the infant's head to enlarge.

Back 6

16 to 18 months
ICP

Front 7

______ changes are a good indication of the level of development of the musculoskeletal and neurologic systems.

Back 7

Postural

Postural changes during infancy and childhood result from the development of neurologic control, bone and muscle growth, and the laying down of adipose tissue.

Front 8

Because soft tissues are resilient in children, dislocations are more common/less common than in adults.

Back 8

less common

Front 9

_________ a bone or joint helps achieve and maintain a more functional position or rests an affected area during bone healing.

Back 9

immobilizing

Front 10

A ____ provides support and maintains anatomic position for bone healing or correction of a ____. They can also be used to ensure adherence to treatment protocols.

Back 10

cast
deformity

Front 11

Most casts are made of synthetic materials, such as _______. They dry quickly and are lighter weight than materials formerly used for casting, such as plaster of Paris, and are water _______.

Back 11

fiberglass
resistant

Front 12

If a synthetic cast becomes wet, inadequate ___ under the cast will prevent thorough drying of the skin, and damp skin is more susceptible to ____ ________.

Back 12

airflow
skin breakdown

Front 13

The standard cast usually involves cast padding over a ____ stockinette. Waterproof casts are now also available, and when used for stable fractures, provide acceptable immobilization without associated risk.

Back 13

cotton

Front 14

True or False: Most casts are applied on an inpatient basis.

Back 14

false, outpatient

Front 15

The type of fracture or injury and the amount of weight _____ the extremity can tolerate dictate the ____ of the cast. Short or long leg or arm casts are generally used for fractures of the upper and lower limbs. Fractures of the hip and knee may require a body or ___ cast.

Back 15

bearing
size
spica

Front 16

The equipment needed to apply a cast includes tubular ____ (a stockinette), cotton under-cast ____ material (i.e. Webrin), casting material: ____ or _____, and w____.

Back 16

gauze
padding
rolls or strips
water

Front 17

A chemical reaction between the casting material and the water causes a feeling of _____ as the cast is applied.

Back 17

warmth

Front 18

Effective immobilization can also be achieved with ____, which is a pull or force exerted on one part of the body. In treatment, this can be applied to the spine, pelvis, or long bones of the upper and lower extremities. The _____ formed by the placement of the pulley on the bed frame and the ____ of the involved joint determine the ____ of the pull or force.

Back 18

traction
angle
angle
direction

Front 19

Once the direction of the pull or force has been determined, the traction is directed along the ____ axis of the bone. Traction can be applied to the ___ or ____.

Back 19

long
skin, bone

Front 20

An opposing pull or force, ________, must be provided at the same time for the traction to be effective. It results in a two-way pull that maintains alignment of the affected extremity. The child's _____ is usually sufficient to provide the countertraction.

Back 20

countertraction
weight

Front 21

The part of the bed that holds the traction apparatus is tilted or elevated, thereby assisting with countertraction. For example, if the leg were being placed in traction, the foot of the bed would be _____. Otherwise,the child would slide in the direction of the traction, disrupting the alignment of the extremity and reducing the effectiveness of treatment.

Back 21

elevated

Front 22

What are the disadvantages of traction?

Back 22

need for hospitalization
prolonged immobility
Early casting and percutaneous pinning are beginning to replace the use of traction for some musculoskeletal conditions.

Front 23

Traction can be described as either continuous or intermittent. Continuous traction exerts a constant pull and is used for fractures and dislocations. Intermittent traction provides a periodic pull or force and is used for contractures, low back pain, or muscle spasm. What should the nurse assume if the physician does not state whether the traction is continuous or intermittent?

Back 23

The nurse should always assume that traction is continuous unless the physician states otherwise. The removal of traction that was intended to be continuous could prove harmful to the child and result in poor healing.

Front 24

In regards to traction, the nursing care plan should always reflect the _____ and amount of time intermittent traction may be _____.

Back 24

frequency
removed

Front 25

When removing the traction apparatus, the nurse must use the ____ to maintain ___ traction and ____ on the body part.

Back 25

hands
manual
pull

Front 26

In caring for casts, it is important to assess for circulatory /neuro impairment. What should be included in this assessment?

Back 26

5 P's
pain
pallor
pulseless
parasthesia (tingling)
paralysis (numbness)
--Can they move their fingers? Sense touch?

Front 27

In checking for circulatory /neuro impairment, check for skin color such as ____ or ______. Check the skin for m_____. Assess for temperature changes, such as _____ temperature. Check for decreased peripheral pulses _____ to fracture or cast site. Check c_____ r_____ t___. If there is ____, is it relieved by elevating above the heart? How often should these assessments be done?

Back 27

In checking for circulatory /neuro impairment, check for skin color such as pallor or cyanosis. Check the skin for mottling. Assess for temperature changes, such as cool temperature. Check for decreased peripheral pulses distal to fracture/cast site. Check CRT. If there is edema, is it relieved by elevating above the heart? These assessments should be done every 2 hours or as needed.

Front 28

Plaster casts can take ___ to ____ hours to dry. When casts are drying, turn affected limb q__h and use the ____ of the ____ when handling so you don't put dents in the cast with your fingertips.

Back 28

12-48
q2h
palm
hand

Front 29

_____ the casted limb to decrease swelling. Remove ___ items, especially with young children, so that they are not used to itch the skin under the cast and possibly get stuck.

Back 29

elevate
small

Front 30

Edges of the cast are ____ so that there are not sharp edges. Outline ____ with a marker (use date & time) to monitor changes in this. Assess for infection, what is a strong indication? Clean plaster cast with _____ and water and a synthetic cast with ____ ___ and water. Teach parents how to care for the cast.

Back 30

Edges of the cast are petaled so that there are not sharp edges. Outline drainage with a marker (use date & time) to monitor changes in this. Assess for infection, what is a strong indication? Foul Odor Clean plaster cast with vinegar and water and a synthetic cast with mild soap and water. Teach parents how to care for the cast.

Front 31

What are the 2 types of traction?

Back 31

skin & skeletal

Front 32

_____ traction exerts force directly on the body surface. it is applied when there is minimal ______ and just a little bit of muscle ____. This traction works by indirectly positioning the bone by pulling on the ___ and ___.

Back 32

skin
displacement
spasm
skin and muscle

Front 33

True or False: Skin traction is invasive and requires anesthesia.

Back 33

False.
noninvasive, well tolerated, does not require anesthesia

(p. 1384)

Front 34

Skin traction is most effective with children who weigh less than ___ lbs. or are younger than __ to __ years old.

Back 34

30 lbs
2-3 years old

(p. 1384)

Front 35

What are some contraindications to skin traction?

Back 35

skin infection
open wound
extensive tissue damages

(p. 1384)

Front 36

Skin traction works by directly/indirectly positioning the bone by pulling the skin and muscle.

Back 36

indirectly

Front 37

______ traction is used when there is a significant amount of pulling needed to properly align the bone and immobilize the fracture or dislocation site.

Back 37

skeletal

Front 38

In skeletal traction, a _____ device or ___ is inserted directly into or through the bone and then attached to a prescribed weight.

Back 38

mechanical
pin

Front 39

Fractured ______ bone is the most common injury that requires skeletal traction.

Back 39

femur

Front 40

Some basic principles of traction include: make sure the correct amount of _____ is used. Weights should hang _____ly. Try not to knock or hit the weights because this could cause ____ and muscle ____. Make sure the correct _____ of the joints are adhered to. Check the ___ site frequently and clean it as ordered. Generally, they are cleaned with ____ strength _______ and ____ ______. Prevent complications by doing regular ________ assessments.

Back 40

Some basic principles of traction include: make sure the correct amount of weight is used. Weights should hang freely. Try not to knock or hit the weights because this could cause pain and muscle spasm. Make sure the correct angles of the joints are adhered to. Check the pin site frequently and clean it as ordered. Generally, they are cleaned with half strength peroxide and normal saline. Prevent complications by doing regular neurovascular assessments.

Front 41

What is CMS?

Back 41

circulatory, motor, sensation
(assessments important for monitoring fractures, as well as the 5 Ps)

Front 42

Which gives more mobility, the Buck's extension or the Russell traction?

Back 42

Russel

Front 43

The __/__ femoral traction is more common than the balanced suspension type of skeletal type.

Back 43

90/90

most common type for fractures of femur

Front 44

Halo traction is used for _____ involvement.

Back 44

cervical

Front 45

______ is the restriction of motion and can be partial or total (all of body.) It is the result of _____ or _____.

Back 45

immobilization

treatment (keeping in alignment & at rest)
or
disease/disability

Front 46

Pediatric patients need activity for growth and development. A lack of activity and play can delay them in meeting age appropriate ______ _______.

Back 46

developmental milestones

Front 47

What are some issues that can occur in the body because of immoblization

Back 47

constipation (GI)
skin breakdown
PNA
DVT
Depression (long term)
Muscle Wasting (atrophy)

Front 48

Long bone fractures put the patient at risk for what 2 things?

Back 48

pulmonary embolism
fat embolism

Front 49

Nursing interventions for immobility include: ____ frequently, promote adequate ______ to prevent constipation and preserve ______ function, provide age appropriate _______ activities, move as able such as in a wagon or wheelchair to get them out of the room and moving somewhat, encourage verbalization and ____ therapy which are positive coping measures. Teach families about the purpose of traction, cast care, and home care etc.

Back 49

turn
hydration
kidney
diversional
play

Front 50

Limb defects can include birth anomalies such as syndactaly, polydactly, genu valgum, and genu varum. Describe each one.

Back 50

syndactaly- webbing fingers
polydactaly- extra digit
genu valgum- knock kneed
genu varum- bow legged

Front 51

talipes equinovarus is also known as ___ _____ and is a ______ of the ____ tissue of the ___. Describe the 3 manifestations.

Back 51

club foot
contracture of the soft tissue of the foot

plantar flexed foot
inverted heel
adducted forefoot

Front 52

What is the initial treatment of club foot?

Back 52

manipulation and serial casting until an over correction has been achieved

Front 53

In the treating of club foot, manipulation and serial casting until an over correction has been achieved is the initial treatment. This gradually _____ the contractures on the medial side of the foot. How often is this done and how successful is it?

Back 53

stretches
It is done weekly for the first 6-12 weeks of life.
Successful 50% of the time with just casting, if not successful, surgery is needed. (more severe cases)

Front 54

How often is the cast for club foot changed? Follow up should be done until..

Back 54

at least weekly
... skeletal growth is complete

Front 55

Surgery for club foot involves ____ the short tendons and _____ the long tendons.

Back 55

lengthening, shortening

Front 56

Developmental dysplasia of the hip may be due to maternal _____ influence, from ___ breech, or from _____ gestation.

Back 56

hormone
frank
multiple

Front 57

Developmental dysplasia of the hip is rare, occurring in 1% of births. Is it more common in males or females? It can involve one or both hips, usually if it's one hip it's the right/left hip. It is important to detect early during newborn screening.

Back 57

females
left

Front 58

The name of the maneuver done at newborn screening to check for Developmental dysplasia of the hip is called...

Back 58

Ortolani's maneuver

Front 59

What are some signs of Developmental dysplasia of the hip ? (for both infant and then older child)What do we do to prevent permanent disability?

Back 59

asymmetric gluteal folds
ortolani's click (hip click)
limited ABduction of hip
shorter leg
limp (older child)
not wanting to bear weight on affected leg (older child)

infant- splinting or harnessing
toddler- fix surgically (open reduction procedure), then spica cast

Front 60

What are the types of Developmental dysplasia of the hip in the varying degrees?

Back 60

dysplasia- slightly dislocated
subluxation- almost all dislocated
dislocation

Front 61

The key to treating Developmental dysplasia of the hip is catching it early, usually there is a good/poor prognosis.

Back 61

good

Front 62

look at care plans for therapeutic management of Developmental dysplasia of the hip on page ...

Back 62

1391-1393 Pavlik Harness (there's 2 types)
1393-1396 spica cast

Front 63

_____ ____ _____ Disease is an interupption of vascular supply to the femoral head of the epiphysis. It is a form of ______ of the ___ only found in children

Back 63

Legg-Calve-Perthes Disease (LCPD)
osteonecrosis of the hip

Front 64

Legg-Calve-Perthes Disease (LCPD) is characterized by interruption of the femoral head that leads to ______ _ ______.

Back 64

avascular necrosis.

Front 65

Legg-Calve-Perthes Disease (LCPD) is more common in males or females? It can happen between ages 3-12 but usually ages 4-8 years. It is most common among the ____ race.

Back 65

males
white

Front 66

Children with Legg-Calve-Perthes Disease (LCPD) exhibit pain that radiates to the ___, thigh, or ____ which is related to the ___ compression.

Back 66

groin, knee
nerve

Front 67

S/S of Legg-Calve-Perthes Disease (LCPD) include pain in ____, knee, ___, or _____, decreased weight ______, decreased _____, they may ______- especially in the evening, and demonstrate _____ hip _____ upon examination.

Back 67

S/S of Legg-Calve-Perthes Disease (LCPD) include pain in thigh, knee, groin, hip, decreased weight bearing, decreased activity, they may limp- especially in the evening, and demonstrate external hip rotation upon examination.

Front 68

What usually causes Legg-Calve-Perthes Disease (LCPD)?

Back 68

usually from overuse
sports cause some kind of compromise to vessels

Front 69

For the therapeutic management for Legg-Calve-Perthes Disease (LCPD) What are the goals of treatment?

Back 69

Goals
-try to reduce hip irritability
-restore and maintain hip mobility
-prevent femoral head from protruding from socket
-maintain spherical femoral head shape

Front 70

What is the therapeutic management for Legg-Calve-Perthes Disease (LCPD) ?

Back 70

try to minimize weight bearing during healing phase
usually self limiting
(wait & see approach)

Tx usually includes just a few modifications such as exercises, bedrest, and later may need bracing, traction, or surgery (rare)

Front 71

______ is a condition of the hip joint that affects children where the head (ball) of femur slips out of pelvic socket.

Back 71

Slipped Capital Femoral Epiphysis (SCFE)

Front 72

When we're talking about capital, we mean..

Back 72

upper, meaning the head of the femur

Front 73

Slipped Capital Femoral Epiphysis (SCFE) is when the capital femoral growth plate is affected, it slips out of the hip socket. This is is most commonly seen hip disorder in _____. Does it usually affect one hip or both? The cause is unknown but may be related to increased ____ and ____.

Back 73

adolescents
one
height, weight

Front 74

Clinical manifestations of Slipped Capital Femoral Epiphysis (SCFE) include a ____, ____ disturbance, pain in ____, _____, and _____, and the pain is worse with _____.

Back 74

limp
gait
groin, hip, knee
activity

Front 75

Slipped Capital Femoral Epiphysis (SCFE) is diagnosed with an x-ray after complaints of symptoms such as pain and limping. The x-ray will show femur not engaged in the socket. What is the therapeutic management of Slipped Capital Femoral Epiphysis (SCFE)?

Back 75

internal fixation- pin or screw across growth plate to keep in place
may do bucks extension pre op (uncommon)
teach about using crutches

Front 76

A _____ is a break in the continuity of the bone. They are treated with a splint, traction, or a cast. _____ formation needs to occur progressively before bone can heal completely.

Back 76

fracture
callous

Front 77

What are some common causes of fractures in children?

Back 77

climbing-- falls
falls
MVAs
sports
cancer
child abuse

Front 78

Fractures are classified according to type of ____ injury. Identify the 6 types of fractures.

Back 78

tissue
Simple or closed- no open wound
Compound or open- bone breaks through skin resulting in open wound
Comminuted- fracture is splintered, shattered, crushed
Transverse- straight across
oblique- slanted
spiral- slanting & circular, occurs with twisting motion

Front 79

Are comminuted fractures common or rare in children? What can cause a spiral fracture?

Back 79

rare.

Spiral fracture requires a twisting motion to make the bone break in this manner- could be something like a ski accident but one should suspect child abuse because of the amount of force required and type of injury this presents

Front 80

What should we look for in assessing potential fractures?

Back 80

any deformity or shortness
edema
bruising
tenderness on palpation
abnormal mobility
reluctance to move
Look for 5 PS

Front 81

true or false:A child may deny pain in fear of getting a shot (injection) and may also lie about what really happened to cause the injury in fear of getting in trouble or being punished for what they were doing when the injury occurred.

Back 81

true

Front 82

What are the 5 types of childhood fractures? Which is most common in young children?

Back 82

bend
buckle
greenstick (most common in young children)
complete
periosteal hinge

Front 83

Describe a bend fracture

Back 83

bone bends almost to breaking point and will not straighten without tx, due to impact

Front 84

describe a buckle fracture

Back 84

impact injury where there is compression of the porous bone- bone tries to telescope on itself and shows as a bump

Front 85

describe a greenstick fracture

Back 85

incomplete fracture, not all the way through the bone, fracture line is transverse

Front 86

describe a complete fracture

Back 86

fracture through the whole bone, divides the bone into proximal and distal fragments

Front 87

describe a periosteal hinge fracture

Back 87

complete fracture but periosteum still attached

Front 88

True or False: Usually, once the broken bone is properly alligned and immobilized, the pain goes away.

Back 88

true

Front 89

Emergency treatment for a major break includes what 5 things?

Back 89

assessment 5 Ps
immobilization (use env. sticks, shirt etc. if hiking)
reassessent
elevation (above heart to minimize edema)
cold (ice packs)
transport

Front 90

Knowing the _______ of injury along with the child's age gives you some predictability of patterns of injury beyond the _____.

Back 90

mechanism
obvious

Front 91

In a car accident, sometimes a phenomenon called ____ ___ occurs where there is a injury to the femur, internal organs (abdominal/thoracic injury), and then finally a head injury.

Back 91

Waddell's Triad

Front 92

The term fat embolism indicates that the often asymptomatic presence of fat globules have formed in lungs or peripheral ______ after major trauma. It can occur with _____ injuries and fractures of the _____ and ____ bones. The emboli travels to the ___ and causes ______ distress, h_____, and respiratory/metabolic alkalosis/acidosis.

Back 92

The term fat embolism indicates that the often asymptomatic presence of fat globules have formed in lungs or peripheral circulation after major trauma. A fat embolism can occur with crush injuries and fractures of the pelvis and long bones. The emboli travels to the lungs and causes respiratory distress, hypoxemia, and respiratory acidosis.

Front 93

Fat embolism syndrome is when the long bone fracture causes a fat embolism which then leads to systemic dysfunction, involving the ___, ____ and _____. Also known as a fat embolism ___. What are the manifestations?

Back 93

skin, brain lung

triad

s/s: respiratory compromise,
cerebral dysfunction- altered LOC, skin changes or petechiael rash

Front 94

How is fat embolism prevented?

Back 94

lovenox
TCDB
incentive spirometer

Front 95

Lovenox is often given to anyone on _____ if not contraindicated.

Back 95

bedrest

Front 96

Compartment syndrome involves ____ from ____ing injury such as a forklift and _____ impairment from swelling and decreased circulation to ___ and ____.

Back 96

Compartment Syndrome involves compression from crushing injury such as a forklift and circulatory impairment from swelling and decreased circulation to muscles and nerves.

Front 97

Types of soft tissue injuries include what 4?

Back 97

contusion
sprain
strain
dislocation

Front 98

Describe a contusion

Back 98

damage to subcutaneous tissue or muscle usually relate to crushing injury (ex- closing hand in door)
s/s: pain, ecchymosis, swelling, muscle spasm

Front 99

Describe a sprain

Back 99

Sudden trauma to joint, usually twisting motion which results in a torn or stretched ligament. May see inflammation, complaints of pain, edema, loss of normal function, don't want to bear weight.

Front 100

Describe a strain

Back 100

similar to sprain but may have occurred OVER TIME, can either be a stretching or tearing of the muscle or tendon

Front 101

Which is more severe a strain or sprain?

Back 101

a sprain

Front 102

Describe a dislocation, what is it usually caused by? s/s? tx?

Back 102

bones of a joint are separated or the end of a bone is dislocated from the socket
usually caused by some force or stress
results in pain, deformity, inability to move joint
Tx- conscious sedation (versed usually) joint forced/pushed or pulled back into correct position

Front 103

What is the tx for a soft tissue injury? When is it best done and for how long?

Back 103

ICES- ice, compression, elevation, support
or
RICE- rest, ice compression, elevation
best if done in 1st 6-12 h
Do ice for 20 min q 2 h (not directly on skin can cause damage), wrap with an ace bandage etc. then put ice on top

Front 104

Osgood-Schlatter Disease is an irritation of the patellar tendon at the tibial tuberosity. It involves bilateral ___ pain worse with ____ and ____. There is _____ and point _____ over ___ tubercle. It is related to ______ ___ from sports related activity. The tight patellar tendon becomes tender to the touch.

Back 104

It involves bilateral knee pain worse with running and jumping. There is swelling and point tenderness over tibial tubercle. It is related to repetitive stress from sports related activity. The tight patellar tendon becomes tender to the touch.

Front 105

Therapeutic management for Osgood-Schlatter Disease includes a modification or avoidance of ____, use ___ supports, ICE or N_____, and ____ therapy for ______ stretching and strengthening to help improve and stretch out the tendons. It is usually ____ limiting.

Back 105

Therapeutic management for Osgood-Schlatter Disease includes a modification or avoidance of activities use knee supports, ICE or NSAIDS, and physical therapy for quadriceps stretching and strengthening to help improve and stretch out the tendons. Usually self limiting.

Front 106

_______ ______ is an inherited disorder characterized by a biochemical defect in the formation of connective tissue. It results in very ___ bones and you'll see ______ development of bones, sometimes teeth, and _____.

Back 106

Osteogenesis Imperfecta
fragile
incomplete
ligaments

Front 107

Osteogenesis imperfecta is classified into 2 types. There are those in which the bones break very easily, which is more severe, bones can actually break in ___. There are also milder forms that can start later in life and usually improve after ___.

Back 107

utero
puberty

Front 108

In osteogenesis imperfecta, the bones break extremely easily. Supportive treatment is important. Goal is to provide ____ _____ especially if they have severe condition. In severe condition, bones can break from just turning them over or changing a ____. Can be treated with splints or ____.

Back 108

gentle handling
diaper
bracing

Front 109

Parents of children with _____ ____ may be accused of child abuse until it is found that they have the condition due to the multiple broken bones.

Back 109

osteogenesis imperfecta

Front 110

Osteomyelitis is an ____ of the bone and can occur in any part of the body, most common sites include the ____ and ___ in children and the ____ in infants.

Back 110

infection
tibia, femur
skull

Front 111

A predisposing factor to osteomyelitis is often poor ___ or ____, but this is not always the case.

Back 111

hygiene, nutrition

Front 112

What happens with osteomyelitis, is an infection spreads beneath the ____ and causes _____ of the blood vessels and increased ____. It can also be caused by a penetrating wound which enters through the ______ route (from the outside of the body). Osteomyelitis can also occur in the endogenis route where it occurs secondarily through the ____ ____ from an infection from elsewhere in the body such as an upper ____ infection, t_____, or i____, etc.

Back 112

periosteum
thrombosis
necrosis
exogenous
blood stream
respiratory
tonsilitis
impetigo

Front 113

True or False: Osteomyelitis can occur at any age but most often in children age 5-14 and is more common in females.

Back 113

false, more common in males, everything else is true

Front 114

What are the manifestations of osteomyelitis? Sometimes young children will describe osteomyelitis as "___" beneath the cast. There may also be systemic manifestations such as...
Holding limb in semi- flexed position may be due to ___ ______ associated with osteomyelitis.

Back 114

abrupt pain, warmth above bone, tenderness.

"fire"
Systemic manifestations include fever, dehydration, unwillingness to move limb or bear weight, may be irritable, poor appetitie.
Holding limb in semi- flexed position may be due to muscle spasms associated with osteomyelitis.

Front 115

The most important information for diagnosing osteomyelitis includes what 2 tests?

Back 115

WBC count- increased, marked leukocytosis
ESR- Increased, means there's inflammation in the body

Front 116

A possible complication of osteomyelitis is a ____ fracture.

Back 116

pathological

Front 117

When does Osteomyelitis initially present itself on an x-ray? Bone scan might be positive early for ____. What is an definitive diagnosis?

Back 117

does not initially present on x-ray during 1st 10-12 days until some bone dysfunction is experienced
inflammation
direct needle aspiration, which provides a culture of the site, but usually a blood culture etc. is done first.

Front 118

Therapeutic management for osteomyelitis includes several ___ of antibiotics via a ____ line, but first make sure ___ cultures are done. B____ and i_______ of the extremity will help healing. Surgery is done if an ____ is present to drain or remove necrotic bone tissue. The area will also be irrigated with antibiotic solution.

Back 118

weeks
PICC
blood
bedrest
immobility
abscess

Front 119

In treating osteomyelitis, if there is an open wound, the patient must be put on ___ ____. If it is on the lower extremity, no weight ____ should be done. Maintain _____ of unaffected extremity. Provide pain relief measures with analgesics and pillow support.

Back 119

contact precautions
bearing
ROM

Front 120

Juvenile Arthritis is chronic ______ or ______ disease which leads to _____.

Back 120

Juvenile Arthritis is chronic inflammatory or autoimmune disease which leads to disability.

Front 121

Juvenile Arthritis begins before the child is ___ years old. There are 2 peak periods that you see this, ages 1-3 and 8-10. Is it more common in males or females? It is the most common ____ disease in children and can lead to disability.

Back 121

16
females
rheumatic

Front 122

The cause of Juvenile Arthritis is unknown, but 3 things can trigger the autoimmune response, what are they? It can also be genetic, the presence of genetic factors called human ______ antigens can play a role in the development of Juvenile Arthritis .

Back 122

infection
trauma
emotional stress
leukocyte

Front 123

The pathophysiology of Juvenile Arthritis involves chronic _______ around the ____ that starts to cause _____ and _____ of articular _____. Children can get _____ around the joint surfaces and inflammation. It is very ____ for children.

Back 123

The pathophysiology of Juvenile Arthritis involves chronic inflammation around the joints that starts to cause erosion and destruction of articular cartilage. Children can get adhesions around the joint surfaces and inflammation. It is very painful for children.

Front 124

Usually, with Juvenile Arthritis, intermittent joint pain can last more than ___ weeks. Painful, stiff, and swollen joints are ___ to the touch at the area of the joint. When is the stiffness worst? What are some s/s?

Back 124

6
warm
morning
limited ROM
lethargy
anorexia
weight loss
growth problems
Spikes of fever to 102*F then goes back down to normal
salmon colored macular rash on trunk or extremities

Front 125

An x-ray of Juvenile Arthritis will show....

Back 125

widening in joint spaces (due to inflammation)

Front 126

The basic goal of treatment is to Juvenile Arthritis is to decrease the _____ and ______. Supportive treatment is aimed at controlling this inflammatory process, minimizing _____, and decreasing impact on ____ and ______. Also important is to maintain joint _____ and strength. Because it is a chronic disease, Juvenile Arthritis can negatively affect self ____. A physical therapist and an occupational therapist can help to meet goals.

Back 126

pain and inflammation
deformity
growth & development
function
self esteem

Front 127

Medications for Juvenile Arthritis include _____, if these meds aren't helpful, ____ drugs can be prescribed. _______ also are used but they try to limit when there is potential for complications such as _____ or profound _____. ______ is NOT used to treat Juvenile Arthritis

Back 127

Medications for Juvenile Arthritis include NSAIDS, if these meds aren't helpful, cytotoxic drugs can be prescribed. Corticosteroids also are used but they try to limit when there is potential for complications such as pericarditis or profound anemia. Aspirin is NOT used to treat Juvenile Arthritis

Front 128

To help ease pain and increase joint mobility Juvenile Arthritis, what can be used? (nonpharmacological)

Back 128

warm baths/ hot tubs
heating pads
(provide warmth to area to increase ability to have adequate ROM)
also crutches, walkers, and other assistive devices

Front 129

____ is a group of cytotoxic drugs used to treat Juvenile Arthritis. It is a disease modifying anti-rheumatic drug. It includes methotrexate (most commonly), sulfasalazine, and entanercept.
NSAIDS commonly used include ____ and ___. The corticosteroid of choice is _____. SAARD is a slower acting anti-_____ drug which includes hydroxycholoquine, gold salts, and D-penicillamine. Immunosupporessive agents and other cytotoxic drugs are also used, such as chlorambucil (used commonly).

Back 129

DMARD
ibuprofen, naproxyn
anti-rheumatic

Front 130

Nursing considerations for Juvenile Arthritis include relieving pain, avoid full ___ ____, promote _____ and prevent _____. Always, teach and support the child and family.

Back 130

weight bearing
mobility
contractures

Front 131

What are some commonly used nursing diagnosis related to Juvenile Rheumatoid Arthritis?

Back 131

pain r/t inflammatory process

impaired physical mobility r/t inflammation of joints and associated muscle weakness

altered growth and development r/t activity intolerance

Front 132

____ is a common, specific test which screens for SLE and other collagen diseases such as Juvenile Arthritis

Back 132

ANA

Front 133

In assessing a patient with Juvenile Arthritis, be sure to assess pain level, assess mobility, stiffness, temperature, is there a ___? See if there is a ___ on their skin, and assess ______ status, current medications. Assess what assistive devices they may be using and encourage ____ fitting clothing.

Back 133

spike
rash
hydration
loose

Front 134

Muscular Dystrophy (MD) is a curable/incurable progressively ______ disease of the voluntary/involuntary muscles. It is a acquired/inherited that affects the ___ cells of specific ___ groups. It varies in the pattern of inheritance and age of onset.

Back 134

incurable
degenerative
voluntary
inherited
muscle
muscle

Front 135

What is the most common form of Muscular Dystrophy ? Is this disorder autosomal dominant, recessive, or x-linked?

Back 135

Duchenne Muscular Dystrophy
x-linked
(males are affected, females are carriers)

Front 136

The pathophysiology of Muscular Dystrophy is that the muscle ____ degenerate and are replaced by ___ and ____ tissue. The result is progressive _______ and _____ of muscle groups.

Back 136

The pathophysiology of Muscular Dystrophy is that the muscle fibers degenerate and are replaced by fat and connective tissue. The result is progressive weakness and wasting of muscle groups.

Front 137

The onset of Muscular Dystrophy is usually between 2 to 6 years of age. What are the manifestations of Muscular Dystrophy?

Back 137

reports of frequent falls & clumsiness
waddling, wide-based gate
wasting & weakness of muscles w/o loss of sensation
Gower's sign

Front 138

What is Gower's Sign, a characteristic sign of Muscular Dystrophy?

Back 138

hands on knees to push themselves up off the floor because of hip girdle instability & weakness. (look at p. 16 of powerpoint for image)

Front 139

Muscular Dystrophy is diagnosed in many approaches. A family history is relevant and ____ counseling is recommended. Genetic testing can also be done to identify ____. Creatinine phoshokinase (CPK) SGOT/AST, & adolase are extremely low/high in the first 2-3 y of life. __________ shows a decrease in amplitude and duration of motor unit potential. A muscle ____ reveals degenerative muscle fibers.

Back 139

genetic
carriers
high
Electromyography
biopsy

Front 140

The goal of the therapeutic management for Muscular Dystrophy is to maintain ____ or _____ and ______ and prevent _____. What are some options? It is also important to assess the airway to control and prevent _______ _____.

Back 140

ambulation or mobility & independence
obesity (too much weight can cause more stress on joints & muscles)
surgery
bracing
assistive devices - crutches, walkers, wheelchairs
physical therapy
respiratory infections

Front 141

Nursing considerations for the management of Muscular Dystrophy are similar to that of Juvenile Arthritis. Asst family to cope with chronic disease and help avoid complications caused by ______.

Back 141

immobility

Front 142

Curvatures of the spine include what 3 types? (describe the 2 that we learned about in 1st semester)

Back 142

Kyphosis- hump back, an exaggerated, abnormal posterior curve of thoracic spine. Can be 2ndary to disease. Tx- postural exercises or splinting

Lordosis- exaggerated concave curvature of lumbar spine (swayback, Oh Lordy!), can be from disease, injury or associated with postural kyphosis. Can cause lower back pain, physical therapy exercises help improve mobility

scoliosis

Front 143

Scoliosis is the most common spinal deformity and involves a _____ curvature. Is it more common in males or females? When are kids assessed for this disorder?

Back 143

lateral
females
10-12 y old
6th - 7th grade (during growth spurt)

Front 144

When assessing for scoliosis, what are the 3 landmarks we look at the most? What position should we have them assume? There may also be a discrepancy in the length of legs or in the hips.

Back 144

scapula
shoulders
iliac crest
have them bend over

Front 145

In scoliosis, the ______ start to rotate which causes the ____ and ___ to also rotate. ______ function can become compromised leading to _______ hypertension and _________ alkalosis/acidosis.

Back 145

vertebrae
hips and spine
Respiratory
pulmonary HTN
respiratory acidosis

Front 146

Therapeutic management for scoliosis includes exercises with the help of a physical therapist, _____, and/or _____ ____ (Harrington rods)

Back 146

bracing
spinal fusion

Front 147

Braces are a common treatment for scoliosis. Common types include the _______ brace and more often the _______ brace.

Back 147

Milwaukee and Boston

Front 148

If the degree of lateral curvature is ___ to ___ and the degree of kyphosis is ___ to _____ (which is seen on an x-ray), then a brace is usually indicated.

Back 148

20-40
55- 70

Front 149

Surgery for scoliosis using the harrington rods involves ______ rods ____ to the spine to keep it ____. This is usually avoided because it is very _____. If done, what needs to be used and monitored?

Back 149

straight
fused
straight
painful

muscle relaxants used to prevent muscle spasms
foley catheter
NG tube

Monitor I & O
bedrest- monitor skin integrity

Front 150

For the care plan about scoliosis refer to page...

Back 150

1415-1417

Front 151

See characteristics of the abusive family on page...

Back 151

1522

Front 152

_________ factors can be linked with child physical abuse and neglect, such as during hard financial times. The _____ is usually the perpetrator in 87% of cases. The abused child is usually younger than ___ years old. The child may have ____ abnormalities and may demonstrate a difficult ______ such as ____ behavior. The victim often somehow reminds the abuser of someone else, who likely abused him or her in the past.

Back 152

Socioeconomic
parent
5
physical
temperament
defiant

Front 153

The _____ abuse occurs the more profound the damage is to the child.

Back 153

earlier

Front 154

Neglect includes failure to provide a child with ____, ____, _____, and ___ ____.

It is also defined as leaving a child in a situation where the child is at risk of ___.

Back 154

food, clothing, shelter, medical care

harm

Front 155

Neglect is a pattern of failing to provide for a child's ____ ____, to the extent that the child's _____ and/or ______ wellbeing are damaged or endangered. What are the 3 basic types of neglect?

Back 155

basic needs
physical and/or psychological

physical
educational
emotional

Front 156

Physical neglect involves a failure to provide adequate ___, ____, or ____. Physical neglect can also involve reckless ____ for the child's safety. Name some examples of this.

Back 156

food, clothing, hygiene
disregard
-inattention to hazards in the home
-drunk driving w/ kids in car
-leaving baby unattended

Front 157

Physical neglect also includes refusal to provide or delaying the providing of necessary ____ ____ for a child who may be ill or injured. Another example is when children are abandoned and the parent or guardian does not provide for their care or when they are expelled from the home without care arrangements being made.

Back 157

health care

Front 158

What are some examples of educational neglect?

Back 158

failure to enroll a child in school
permitting or causing a child to be truant too many days
refusal to follow up on obtaining services for a child's special educational needs

Front 159

______ neglect is the hardest to define.

Back 159

emotional

Front 160

Emotional neglect can be many things. Some examples include:
-exposure of the child to ____ abuse
-permitting a child to drink ___ or use _____ ____
-failure to intervene when the child demonstrates _______ behavior
-refusal of or delay in providing necessary ________ care

Back 160

spousal
alcohol, recreational drugs
antisocial
psychological

Front 161

What are some characteristics of an abuser?

Back 161

have been abused themselves
have stressful life situation
socially isolated
inappropriate coping
poor impulse control
substance abuser

Front 162

Manifestations of physical abuse include _________ bruises or injuries and _______ history of injury, such as when the story does not add up with the injury.

Back 162

unexplained
inconsistent

Front 163

What are some manifestations of neglect? (3)

Back 163

FTT
poor hygeine, inadequate clothing
hunger

Front 164

Look up shaken baby and Munchausen Syndrome by Proxy in the ...

Back 164

textbook
page # unk...

Front 165

Shaken baby will have issues with _____ distress and you may see ______ hemorrhaging.

Back 165

respiratory
retinal

Front 166

What is Munchausen Syndrome by Proxy ?

Back 166

when the parent or caregiver causes intentional harm to the child and gets some sort of sick satisfaction from the behavior

Front 167

Coining is a cultural method used to alleviate an upper respiratory problem or other problems and involves rubbing a coin on the child's body. It may be confused with child abuse because it will cause bruises, or welt like marks. What culture is this seen in?

Back 167

Southeast Asian, such as Vietnamese

Front 168

For info about failure to thrive, see pages

Back 168

1552-1553

Front 169

What are some signs of failure to thrive? What should be assessed if this is suspected?

Back 169

weight below 5th percentile
delay of developmental milestones
decreased muscle mass
(muscle wasting)

Assess nutritional status, intake
Get nutrition consult
Assess parent/infant interactions- look at bonding & attachment, does parent respond to child's cues?

Front 170

See careplan for abused child page ... It involves a multidisciplinary approach in that there are several ways to determine whether there is actual abuse. Reporting laws is dictated in Penal Code section 11166. The reporting procedure may vary between facilities and CPS is usually involved.

Back 170

1525-1528