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60 Cards in this Set
- Front
- Back
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Developmental dysplasia of the hip
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Abnormal development of one or all of the hip components
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DDH dislocation
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-Femoral head loses contact with the acetabulum
-Femoral head is displaced posterior and superior |
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Factors that increase DDH risk
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-Oligohydraminos
-First born -Female (r/t hormones) -Breech -White > black -Multiple births -Big baby -Family history -Cultures that tightly swaddle their babies (hips are adducted) |
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Clinical manifestations of DDH in the first 2 months of life
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-Ortolani's sign: can reduce the femoral head via abduction
-Barlow's maneuver: can dislocate the femoral head via adduction |
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Clinical manifestations of DDH after 2 months of life
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-Best indicator is incomplete abduction
-Shortening of the limb on the affected side -Asymmetric gluteal and thigh folds -Does not pull to standing by 11 to 12 mths |
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Clinical manifestations of DDH in childhood
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-Positive Tredelenburg sign (hip on the affected side drops when standing on one foot)
-Waddling gait |
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Treatment of DDH in infancy
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-Pavlik harness - worn 2 to 5 months and adjusted q 1 to 2 wks
-Possible Spica cast -Do not double or triple diaper |
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Treatment of DDH as a toddler
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-Bryant's traction
-Closed reduction -Spica cast for 2 to 4 mths -Possible open reduction |
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Treatment of DDH in the older child
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Surgery is more difficult
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Nursing priority of DDH: skin care
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-Undershirt, knee socks, and diapering under the harness
-Check for reddened areas -Massage -Avoid lotions and powders |
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Nursing priority of DDH: cast care
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-Pulse, color, cap refill, temp, sensation, motor
-Prevent soiling -Turn frequently |
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Nursing priority of DDH: education
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-Feeding: football hold to breastfeed, high chair
-Cast and/or harness care -Caution about food and small objects -Need for holding and touching -Adapted car seat/stroller -Development: they will make up for lost time within a year |
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Clubfoot (talipes equinovarus)
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-Equinus: ankle is plantar flexed
-Forefoot is adducted -Varus (suppination): midfoot, hindfoot |
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Clubfoot risk factors
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-Males 2:1 to females
-Family history -Increased risk of DDH -Bilateral 50% |
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Clubfoot correction: casting
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-Usually done ASAP after birth
-Short leg cast -Serial casting: every few days for 1 to 2 wks, then every 1 to 2 wks -Nursing considerations: cast care, development, education |
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Correction of clubfoot: surgery
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-Done if casting fails
-Internal/external fixation |
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Immediate care after cast application
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-No hot air drying
-Assess skin -Check if it is too loose or too tight -Minimal swelling is normal (elevate) |
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Traction
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-Purpose is to fatigue the involuntary muscle and decrease spasm
-Types: manual, skin, skeletal |
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Internal fixation
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-Screw and plate
-S & S of infection, neurovascular |
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Complications in orthopedic care
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-Compartment syndrome
-Nerve compression (numbness/tingling) -Circulation impairment -Epiphyseal damage -Non-union -Mal-union -Infection -Kidney stones (calcium is released from broken bones) -Pulmonary emboli |
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Compartment syndrome
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-Redness, warmth
-Elevate limb |
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Nursing responsibilities in orthopedic care
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-Maintain traction/alignment
-Check skin and pin sites frequently -Prevent skin breakdown -Assess for complications -Comfort |
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Hydrocephalus
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The flow of CSF is obstructed
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Communicating hydrocephalus
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CSF flows through the ventricular system but there is impaired absorption of CSF outside the ventricles such as in the arachnoid villi
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Noncommunicating hydrocephalus
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-Obstruction to the flow of CSF through the ventricular system
-Congenital disorders, brain tumors, bleeding |
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Tumor of the choroid plexus
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Increased production of CSF
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Clinical manifestations of hydrocephalus in the infant
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-Head enlargement
-Behavioral changes -Bulging, tense, nonpulsatile fontanels -Dilated scalp veins -Frontal enlargement (bossing): the forehead sticks out -Setting sun sign: the sclera can be seen above the iris -Pupil changes: anasarcoria (1 pupil is bigger than the other) |
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Clinical manifestations of hydrocephalus in the older child
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-Behavioral changes
-Headache upon awakening -Projectile emesis without nausea -Strabismus (lazy eye) -Ataxia (muscle incoordination) |
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Surgical repair of hydrocephalus
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-Shunt drainage of CSF
-From ventricles to an extracranial compartment (ventriculoperitoneal, ventriculoatrial) -Third ventriculostomy procedure (Stealth) |
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Ventriculoperitoneal (VP) shunt
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-From the 3rd ventricle to the abdomen
-Has reservoir to give antibiotics, chemo, and draw CSF -Extra tubing for growth |
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Ventriculoatrial (VA) shunt
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-From the 3rd ventricle to the R atrium
-Older children -Children with an abdominal pathology |
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Nursing priority for hydrocephalus: postop care
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-Position: usually flat on back, NEVER on the side of the shunt
-Monitor for complications: headache, fever, vomiting, behavioral changes -Assessments |
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Nursing priority for hydrocephalus: long term care
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-Developmental deficits or delays: ADD/ADHD (happen in those who have a lot of infections)
-Education -Optimize G & D |
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Spina Bifida Occulta
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-Opening in the vertebral column with nothing coming out
-Dimple -Lypomas -Dark tuft of hair -Tethered cord (cord twisting): loss of feeling, troubled gait |
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Spina Bifida Cystica
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-Meningocele: meninges and spinal fluid is coming out
-Myelomeningocele: meninges, spinal fluid, and neural elements coming out -Sac on back |
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Etiology of myelomeningocele
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-Folic acid deficiency: recommended dose is .4 mg with no family history, 4.0 mg with family history
-Family history -Heat (hot tubs, etc.) -Teratogens (valproic acid) |
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Defects associated with myelomeningocele
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-Hydrocephalus
-Chiari malformation -Paralysis -Clubfoot -DDH |
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Immediate postnatal care of the myelomeningocele
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-Assessment of the sac
-Protection of the sac -Moist dressing -Prone position -Skin care -Basic infant care: keeping warm, feeding (may breastfeed), tactile stimulation |
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Surgical repair of the myelomeningocele
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-Done within 24 to 48 hrs
-Procedures vary and involve closure of the skin over the sac without disturbing the neural elements |
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Postop nursing care of the myelomeningocele
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-Skin care
-Prone positioning -Wound care -Pain control -Assess I&Os, VS -Neurological assessments: hydrocephalus (head circ.), S & S of infection/meningitis |
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Motor impairments of the myelomeningocele
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-Location of defect
-Assoc. musculoskeletal deformities -Goals of management: prevent contractures (ROM), correct assoc. defects, prevent skin breakdown (frequent turning), optimize ambulation/mobility |
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Sensory impairments of the myelomeningocele
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-Risk for injury
-Skin care |
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Genitourinary impairments of the myelomeningocele
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-Neurogenic bladder: incontinence, problems with residual urine, increased bladder tone
-Complications: renal failure, skin breakdown, body image -Goals: prevent infection, skin breakdown, and promote normal G & D |
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Nursing care of the myelomeningocele: genitourinary impairment
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-Clean intermittent cath (may need to be done q 4 hrs...parents can be taught)
-Temporary urinary diversion -Augmentation cystoplasty (stomach/intestine): put a wedge of the colon/stomach into the bladder -Continent urinary diversion: appendix or colon makes a pathway from the bladder to the abdominal wall -Medications: antispasmotics, alpha-sympathetic agonist -Education |
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Nursing care of the myelomeningocele: bowel impairment
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-Training
-Prevention of problems (constipation, impaction): keep hydrated -Diet: fiber, weight issues -Medications: laxatives, stool softeners -Avoid rectal temps -Latex allergy precautions r/t increased exposure |
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Myelomeningocele ongoing issues
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-Nutrition
-Body image -Grieving -Child/family coping |
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Cleft lip/palate
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-Lip defect occurs more often in males
-Palate defect occurs more often in females -With the palate defect there is an increased risk for ear infections, speech problems, and orthodontic work |
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Feeding modifications with cleft lip/palate
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-Nipple variation
-Cleft palate feeder: will swallow a lot of air so must be burped at least every 15 cc -Syringe -Breast feeding is difficult without pumping -Upright positioning -Flow of milk -A lot of burping is necessary |
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Surgical correction of a cleft lip
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-Done within the 1st week of life
-Z-plasty |
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Surgical correction of a cleft palate
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-Usually done when the child begins talking
-Closure may require a pharyngeal flap or palate bone grafting |
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Postop nursing care of the cleft lip/palate
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-Elbow or jacket restraint so they don't grab their sutures
-Position with head up on their backs -Oral restriction -Nutritional support -Airway clearance with mild suctioning -Pain control -Wound care: cleanse the area with an antibiotic ointment -D/C teaching about choking, food, and skin care: no forks, spoons, or cups |
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Long term care of the cleft lip/palate
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-Speech therapy
-Body image -Hearing assessments -Dental correction |
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Tracheoesophageal fistula (TEF)
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-Failure of the esophagus to develop as a continuous passage
-Failure of the esophagus and trachea to seperate into distinct structures |
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TEF presentation
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-Frothy saliva, drooling
-Coughing, choking, cyanosis -Unable to feed -Cyanotic/apneic -Abdominal distention |
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Goals of TEF care
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-Maintain a patent airway (NPO until surgery)
-Prevent pneumonia -Gastric decompression -Supportive therapy -Repair of the defect |
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Preop nursing priorities of TEF
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-Airway clearance: assessments, NPO, position with head up to facilitate drainage, suction with a Reploge
-Hydration/nutrition -Antibiotics -Parent support |
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TEF surgical repair
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-Ligation of the fistula
-Anastomosis of the upper and lower esophageal segments -Esophagostomy with gastrostomy -Colonic interposition with esophagostomy (part of the colon is used to hook esophagus to the stomach) |
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Postop complications of TEF repair
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-Strictures
-Leaks -Esophagus dysmotility -GER -Respiratory compromise |
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Postop nursing priorities of TEF repair
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-Surgical site
-Gastrostomy tube -Chest tube -Nurtition: initally NPO with IVF, then GT, then oral feeding with sterile water, then small amounts of formula -Non-nutritive sucking |
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Late complications of TEF
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-Tracheomalacia (floppy airway)
-Recurrence of TEF -Esophageal stricture -GER -Dysphagia -Recurrent pneumonia -Airway hyperreactivity and asthma |
