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49 Cards in this Set
- Front
- Back
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What do you assess for neurovascular status?
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coldness, pallor, blueness of extremity, swelling, loss of motion, numbness and tingling, temperature.
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Paresthesia is of serious concern because it can cause..
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paralysis
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Who is at risk for clubfoot?
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Children with neuromusclar disorders such as myelomeningocele. Those who have siblings with clubfoot.
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What is the ponseti method for clubfoot?
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foot manipulation and serial long leg casting for several weeks.
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What is the most common type of clubfoot?
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Talipes equinovarus where foot is point downward an inward
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How often do you want to change the cast for a infant/toddler?
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every two weeks because they grow rapidly
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How would you reduce pain and swelling for post op clubfoot?
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elevate feet and apply ice
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What are some interventions for a child with clubfoot or DDH?
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Encourage parents to hold/cuddle the child.
Perform neurovascular and skin integrity checks |
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head of femur is improperly seated in acetabulum (hip socket) of pelvis. Varies in severity from mild to severe dislocation. Can be congenital or child can develop it after birth
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DDH Developmental Dysplasia of Hip
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What can cause DDH?
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Genetic factors, prenatal and postnatal positioning. Family hx, laxity of ligaments, status as first born child, uterine crowding, breech deliveries.
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What are the NB manifestations of DDH?
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Femoral head that can be displaced with manipulation
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What are the infant manifestations of DDH?
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asymmetric gluteal skin fold, limited abduction, shorter-appearing femur on affected side.
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What are the toddler manifestations of DDH?
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gait variation with lurching towards affected side.
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What test would you use to assess subluxation or laxity?
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Ortolani adn Barlow tests.
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Parents must be taught the proper use of the harness because improper positioning of the infants hip can cause interruption of the blood supply to the head of the femur resulting in...
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avascular necrosis (tissue damage caused by inadequate blood supply)
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What is the preferred tx for profoundly affect children and older children?
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osteotomy (surgical cutting of the bone) and repositioning of femur.
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avascular necrosis of femoral head. Painful limp exacerbated by running or walking. Usually unilateral.
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Legg-Calve-Perthes Disease
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Pt with Perthes disease may complain of pain in the..
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thigh or knee, increasing with activities, decreasing with rest.
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Physical examination of a child with perthes disease may find
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muscle wasting of the thigh and buttock (reflection of disuse)
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What psychosocial feelings may the child with Perthes disease exhibit?
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frustration and anger; unable to keep up with peers. Maybe rebellious and uncooperative.
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What goal for tx in Perthes disease?
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prevent deformity and incongruity of hip and delay onset of arthritis and degenerative joint disease that can occur later in life.
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Osteomyelitis is caused commonly by what bacteria?
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staphylococcus aureus
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In younger children, osteomyelitis may be caused by
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HIB, Salmonella
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Children with _______ require complete bed rest to prevent infx from spreading and promote healing
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osteomyelitis
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What can you do to prevent contractures in patients with osteomyelitis?
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ROM exercises
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Lab results of osteomyelitis have __ erythrocyte sedimentation rate, ___ C-reactive protein, ___ WBC
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increase, increase, increase
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What is a complication to the child's appetite when on bed rest for osteomyelitis?
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immobility can decrease appetite. Diet should be high in calories and protein. Frequent small meals and food from home are helpful.
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Episodic exacerbations and remissions of joint swelling with limited ROM accompanied by pain, tenderness and inflammation, usually of multiple joints.
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Juvenile arthritis
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Symptoms of JA must be present for how many weeks to be diagnosed?
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6 weeks
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What is the leading cause of blindness and disability in children?
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JA
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What is the gel phenomenon in juvenile arthritis?
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joints seem to gel in place, making joint pain (stiffness) worse in the morning after prolonged period of rest.
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What drugs are used to manage JA?
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NSAIDs (ibuprofen, naproxen sodium, tolectin, aspirin). If NSAIDs do not improve condition, adjunctive methrotrexate is considered.
Corticosteroids are used for brief exacerbation. |
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What are some physical and occupational therapy for JA?
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Swimming
Heat helps reduce joint stiffness and spasms because the fibrous tissue in joints and tendons yeild better to stretching (hot baths, whirlpools, hydrocollator packs, paraffin baths) |
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For JA, nurse needs to advise parents to give NSAIDS with
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food or milk to prevent GI irritation
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When and why do you not give aspirin to a child with JA?
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do not give aspirin after a viral infx because it can cause Reyes syndrome
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Hospital nurse should communicate with the school nurse to schedule what for the child with JA?
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rest periods during school day.
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What is the most common form of muscular dystrophy?
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Duchenne muscular dystrophy
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What characterizes muscular dystrophy?
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progressive muscle weakness and atrophy
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What is the genetic pattern of muscular dystophy?
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x linked recessive; 30-50% have no family hx. Females are carriers and passes on to male children.
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What usually causes death in a patient with muscular dystophy?
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pneumonia
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Muscular dystophy appears commonly at ages...
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3-5years
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Muscle fibers degenerate and turn into fat. Progressive, symmetric muscle wasting, weakness w/o loss of sensation first appear after walking is achieved.
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muscular dystrophy
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Child puts hands on knees and moves hands up legs until standing erect.
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Gowers' Maneuver
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How do serum creatine kinase levels measure in a child with muscular dystophy?
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elevated in early stages but decreases as muscle bulk decreases.
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What are some nursing interventions for muscular dystophy?
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swimming
reposition q2h prevent urine stasis by increasing liquids stool softeners |
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What is the degree of curvature of the spine that requires surgery?
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>40 degrees
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What are the manifestations of scoliosis?
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curve of spine
rib hump when bending forward asymmetric rib cage uneven shoulder or pelvis prominence of scapula or hip |
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What is the cobb angle?
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measures the angle between two lines drawn from top and bottom vertebrae in curve.
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When do you want to use spinal fusion for severe scoliosis?
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you want to delay it as long as possible because fusion does not allow skeletal growth.
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