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58 Cards in this Set
- Front
- Back
The immobilized child
what should nursing care focus on |
healing, regaining function and promoting normal development
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The immobilized child
Etiology |
includes fractures, congenital diseases, neurological and musculoskeletal disease
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The immobilized child
Effects of immobilization on the musculoskeletal system |
Reduced strength and coordination
bone demineralization leading to Osteoporsis -loss of joint mobility and contracture formation |
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The immobilized child
Nursing Diagnoses Effects of immobilization on the musculoskeletal system |
#1 Neurovascular dysfunction, risk for
mobility impaired self-care deficit body image disturbed |
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The immobilized child
Assess the effects o immobility on neurosensory system |
Damage is IATROGENIC
poor postioning/pressure on nerves pain, burning, reduced sensation and movement Peroneal Nerve damage-foot drop radial nerve damage- wrist drop AVOID UNNATURAL POSITIONS |
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The immobilized child
Assess the effects o immobility on neurosensory /nursing diagnoses |
RF peripheral neurovascular dysfunction
pain acute |
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The immobilized child
sIGNS OF EFFECTS OF IMMOBILITY ON THE CARDIO- VASCULAR SYSTEM |
orthostatic hypotension
thrombus formation-+homans increased cardiac workload venous stasis and dependant edema |
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The immobilized child
sIGNS OF EFFECTS OF IMMOBILITY ON THE CARDIO- VASCULAR SYSTEM nursing DX |
tissue perfusion alteration cerebral R/T orthostatic hypotension and/or emboli
cardiac output decreased R/T increased work load (BV) |
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The immobilized child
sIGNS OF EFFECTS OF IMMOBILITY ON THE RESP System |
reduced rate and depth
limited chest expansion by position, casts, braces reduced movement of secretions atelectasis leading to hypostatic pneumonia |
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The immobilized child
sIGNS OF EFFECTS OF IMMOBILITY ON THE RESP System Nursing DX |
Ineffective airway clearance
ineffective breathing pattern impaired gas exchange |
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The immobilized child
sIGNS OF EFFECTS OF IMMOBILITY ON THE GI system |
overweight r/t inactivity
underweight r/t poor appitite neg nitrogen balance muscle wasting constipation |
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The immobilized child
sIGNS OF EFFECTS OF IMMOBILITY ON THE GI system NURSING DX |
constipation
nutrition-risk for imbalance |
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The immobilized child
sIGNS OF EFFECTS OF IMMOBILITY ON THE GU system and nursing DX |
Urinary stasis and UTI/stones
RF infection risk for fluid volume imbalance (electrolytes too) |
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The immobilized child
sIGNS OF EFFECTS OF IMMOBILITY ON METABOLISM |
ANEMIA- poor appetite and blood and protein loss
HYPERCALCEMIA-after 4-8wks of bedrest. ecourage fluids, ck. lytes and notrmal to low CA intake |
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signs and symptoms of hypercalcemia
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n/v polydipsia and MUSCLE ATONY
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The immobilized child
sIGNS OF EFFECTS OF IMMOBILITY ON THE iNTEGUMENTARY SYSTEM/ RN DX |
ulcers or necrosis
-ck pressure points -no sheering action skin integrity impaired/RF |
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PSYCHOLOGICAL EFFECTS OF BedREST
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increased tension as movement used to reduce
if under 3yo may have lang. difficulties TODDLERS-may not develop autonomy SCHOOL AGE-concered over achievement ADOLESCENCE-reduced independence/privacy/self image |
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PSYCHOLOGICAL EFFECTS OF BedREST
PRESCHOOLER |
GUILT
unable to move and relieve tension. magical thinking may make them feel it is their fault they got hurt |
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Reactions to watch for in the immobilized/hospitalized
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regression
depression guilt, protest, anger |
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Nursing interventions for the immobilized
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dependent- tilt table, high protein, high cal diet, hydration, hyperalimentation(TPN/tube feeding)
INTERDEPENDENT-position changes and activity as allowed,hydrate INDEPENDENT-small meals and bites if flat or abd restircted, private toileting |
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Nursing Care for the immobilized
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encourage visitors
encourage allowable activity street clothes ASAP self-care w/i limits promote play&games&school work roomates per lenght of stay know fit of canes, crutches Know if WB or not |
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Three types of Club foot
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positiona, transitional, mild or posturic
Teratogenic (assocaited with syndrome) Idiopathic (best case scenerio) |
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Nursing care club foot
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assess
actions-denise brown splint cast care, prepare and support for surgery teaching OUTCOME BASED ON DEGREE OF DEFORMITY |
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Dysplasia of hip
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Incidence girls 4x>than boy
1:100 have instability 1-2:1000 have dislocation patho: misalignment of the femoral head and the acetabalum results in dysplasia |
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Types of dislocation
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acetabular dysplasia-later angle of the acetabulum which may lead to dislocation
SUBLUXATION-the hip is dislocated DISLOCATION- liginmentum teres is stretched and hip is displaced upward |
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Assessment of hip dysplasia
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AFFECTED LEG IS SHORTER
asymmetric skin folds-extra or deep folds on affect side Thigh abduction is reduced on Affected side ALLIS sign-when supine and knees bent A. knee is lower ORTALANI'S MANEUVER-hip click w/ abduction that means the hip was dislocated |
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The five signs of dysplasia of the hip
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1. unequal gluteal folds
2. limited abduction 3.unequal leg length 4. judy did not put on slide 5.allis sign |
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other tests for hip dysplasia
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Barlows test-dislocatable hip
Galleanzzi's sign- limb shorter on a. side Older infant- bilateral waddle or unilateral limp delayed walking and prominent trochanter OlDER child- TRENDELENBURG SIGN-stand on the affected leg and the unaffected hip is down |
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nursing care for dysplasia
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key role is assess and reporting poss. dislocations
treatment is begun immediately GOAL IS TO MAINTAIN ABDUCTION maintain cast&avoid complication nutrition promote physical,emotional and social development educate |
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Treatments for dysplasis
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OUTCOME IS GOOD IF RX BEFORE TODDLEHOOD
0-6mo-pavlik harness, pillow splint, spica cast 6-18mo- skin traction to stretch muscles and joint capsule then reduction/spica Older- more difficult esp with underlying causes |
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MAINTAIN AND MONITOR SPLINT USE
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-wear per order #hours per day
-apply correctly cotton clothes help w/absorb -assess skin daily and prn RECHECK RED SKIN IN 30MIN -Spica cast-head up to feed encourage play and walk parent education |
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OSTEOGENESIS IMPERFECTA
PATHO |
Inherited disorder of connective tissue and bone defects. Bone fragility &resultant fracturs
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OSTEOGENESIS IMPERFECTA
Care |
provide GENTLE care and moving to prevent fx
Don't confuse with abuse reinforce activity level cast care, brace use, post op care |
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LEGG-CALVE PERTHES DISEASE
patho |
avascular necrosis of the head of the femur which is most frequently seen in children from 4-8 yrs of age
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LEGG-CALVE PERTHES DISEASE
Assessment |
intermittent limp w/ or w/o pain
intermittent or constant hip soreness,ache, stiffness which improves with rest ROM may be limited in hip intenral roatation and hip abduction PAIN > W/ w/ WB ACTIVITY pain may radiate to internal thigh and knee |
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LEGG-CALVE PERTHES DISEASE
ROM exam for diagnosis |
place prone with knees flexed-if foot goes out than hip is rotated internally
place supine with knee flexed xray-best info in fragmentation stage |
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LEGG-CALVE PERTHES DISEASE
treatment |
may contiue for 2 years
skin traction for abduction/internal rotation NWB initially standing//kneeling prohibited bracing abduct hip at 45deg surgery |
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SLIPPED CAPITAL FEMORAL EPIPHYSIS
PATHO |
spontaneous displacement of the proximal femoral epephysis in a posterior or inferior direction
cause may be increased growth hormone or decreased sex hormone occur in adolescents who are over wt, or tall and thin |
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SLIPPED CAPITAL FEMORAL EPIPHYSIS
assessment |
onset-abrupt w. injury or gradual (peak onset 12-13yr)
limited hip abduction and internal rotation pain which may be referred to the knee, anterior medial thigh and groin limp on affected side and finally inability to walk and leg shortening |
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SLIPPED CAPITAL FEMORAL EPIPHYSIS
nursing care/tx |
delayed tx may lead to OA
bed rest and traction pre-op post op- NWB a. side until painless ROM and MD order care of immobilized child |
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SCOLIOSIS
define |
An S shaped lateral curature of the spine with rotation of the rib cage. causes cosmetic and physiologic change in the spine, chest,pelvis
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What is idiopathic scoliosis
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It is an autosomal dominant with variable penetrance or multifactoral
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SCOLIOSIS
assessment/diagnosis |
prominent scapula
uneven shoulders/hips&hem length flattening of the flank progressive curvature of the spine that may end after puberty rib hump when bending at waist |
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SCOLIOSIS
management |
less than 20deg-observe
20-40deg brace >40deg surgery |
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SCOLIOSIS
when can you log roll after surgery |
harrington system-post op
luque-log roll, walk in few days cortrel(combo)- no post immobilization |
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SCOLIOSIS
complications of surgery |
spinal cord injury
nerve damage from surg/hardware hypotension from blood loss infection |
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SCOLIOSIS
POST-OP CARE |
activity strictly per order
log roll maintain body alignment and avoid twisting luque procedure-flat 12h before logrolling quadriceps setting exercises assess neuro signs/CSM |
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TRACTION
purpose |
reduce a dislocated joint
relieve a muscle spasm reduce fractures and realign bones immobilize and align fx until healed prevent further soft tissue damage rest a joint prevent/improve deformityor contractures |
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Classification of Traction
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manual-used in emergencies or temporarily of reappication of skin traction
Mechanical-skin or skeletal |
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types of skin traction
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bucks extension-leg extended&can turn if alignment is maintained/no fx
cervial traction-reduce muscle spasm russels traction- leg tx plus sling under knee(keeps knee flextion constant) |
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skeletal traction
90/90 suspension |
90degress/90 degree-less complication and easier care. keep pt in same position.
balanced suspension-designed to life person and everything stays in place. can move up and down the bed |
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external fixators
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ilizarov- immobilzers fx, corrects angulation defects, lengthen limbs (1cm/mo to max15cm) artifical growth plate created. PWB, pin care, cast or cruthces
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mechanics of traction
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angle determines the line of pull
do nothing to alter the line of pull maintain bed position keep child in center of bed keep in good alignment weights must hang free and be correct amt&documented ropes must rest in pulleys correctly knots must not interfere with pull |
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continuous vs intermittent traction
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cont- never interrupt traction to reduce fx
Intermittent-used for muscle spasms |
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nursing care for pt in traction
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risk for injury
check line of pull position of bandage,splint,frames ropes for freying-pullies freely moveable, knots tight and not in pully WEIGHTS IN SAFE LOCATION&HANGING FREELY,CORRECT WT chart wt of traction bed position to counter traction |
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special rn care for SKIN traction
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assess and treat pain
replace non-adhesive straps and ace if allowed maintain traction when replacing ace assess bandages; too loose/ too tight/skin integrit |
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special care for skeletal traction
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check pin sites for infection and bleeding
make sure all devices/screws are tight not for even pull on pin correct body alignment dressings for tightness skin at pressure points contractures neuros/csm |
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hazards of traction
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neurovascular complications
5 P's :pallor, pulselessness, pain, paresthesia, paralysis misalignment infection at pin site injury nonunion |