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65 Cards in this Set
- Front
- Back
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5 P's of Ischemia
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Pain
Pallor Pulselessness Paresthesia Paralysis |
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Congenital Problems with Mobility
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Dev. Hip Dysplasia
Club Foot Osteogenesis Imperfecta Muscular Dystrophy |
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Developmental Hip Dysplasia
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A congenital disorder of the hip caused by abnormal development of one or all of the components of the hip joint
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Developmental Hip Dysplasia: Physical Findings
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Newborn:
-Ortolani -Barlow's Maneuvers -Decreased Adduction -Asymmetrical Thigh Folds Toddler: -Painless Limp -Waddling Gait (if bilateral) -Increased Lumbar Lordosis -Affected Leg Shorter |
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Developmental Hip Dysplasia: Diagnosis
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No X-ray (bones not calcified)
Ultrasound C-T Scan |
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Developmental Hip Dysplasia: Treatment
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Best success if treated before 2mo.
0-6mo: -Pavlik Harness (skincare) 80-90% Sucessful 6-18mo: -Traction -Surgery (spica) 18mo-6yrs: -Open Reduction Osteotomy |
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Developmental Hip Dysplasia: Nursing Care
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Immobility
Skin Care Circulation Checks Nutrition Cast Care Special Carseats |
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Congenital Club Foot: Talipes Equinovarus
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Complex deformity of the ankle and foot.
-Possible familial tendency -2x greater in males -50% bilateral -Genetic Factors |
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Congenital Club Foot: Classification
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Positional
Syndromatic |
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Osteogenisis Imperfecta
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Inherited condition (usually autosomal dominant) which is characterized by fractures and deformities. Most common osteoporosis syndrome in childhood.
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Osteogenisis Imperfecta: 4 Types
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Type 1 (most common):
-Variable fractures, little deformity, blue sclera, hearing loss possible in 20-30's, fewer fractures after puberty. Type 2: -Lethal In Utero or infancy Type 3: -Fractures common, long bone deformity, barrel chest, spinl curve, hearing loss common, frequent blue sclera Type 4: -Fractures common, stature reduced, bone deformity common but not severe, sclera normal or grayish, variable hearing loss |
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Osteogenisis Imperfecta: Therapeutic Management
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Supportive:
-Medication of little value -Braces -Water Exercise -PT -Rod Placement |
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Osteogenisis Imperfecta: Goal
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Prevent fractures and deformities, muscle weakness, osteoporosis, malalignment
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Osteogenisis Imperfecta: Nursing Considerations
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Careful Handling
Support w/ positioning Suitable activity Protect from harm Referral: Osteogenisis Imperfecta Foundation |
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Acquired Problems with Mobility
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Legg-Calves-Perthes Disease
Scoliosis Osteomyelitis Septic Arthritis Bone & Soft Tissue Tumors JRA Systemic Lupus |
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Legg-Calves-Perthes Disease
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Aseptic necrosis of femoral head. Most common in boys 4-8yrs. 10-1 more common in whites.
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Legg-Calves-Perthes Disease: Clinical Manifestation
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Insidious Onset
Intermitant limp, hip soreness, ache, stiffness Referred pain in hip, thigh, knee Impaired ROM Sx on arising or at end of day |
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Legg-Calves-Perthes Disease: Diagnosis
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Radiological Exam
Early Dx and efficient Tx decides ultimate outcome |
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Legg-Calves-Perthes Disease: Treatment
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Conservative:
-Non-wt bearing & rest -Braces or cast -Non-wt bearing devices -2-4yrs Surgical Recon: -Additional Risks -Return to activity in 3-4 months |
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Legg-Calves-Perthes Disease: Nursing Considerations
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Education about appliances
Explain non-wt bearing Age appropriate diversions Peer interaction |
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Spinal Curvatures: Kyphosis
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Increased convexity of thoracic spine.
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Spinal Curvatures: Lordosis
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Accentuation of lumbar curve. Normal in toddlers. Can be seen in pubertal growth spurt in adolescents or in disease states (contractures of the hip, obesity, DHD, SFCE)
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Spinal Curvatures: Scoliosis
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Most common spinal deformity that involves a complex lateral curve of spine. Curvature >20 degrees or before age 10 should be referred.
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Spinal Curvatures: Scoliosis Therapeutic Management
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Bracing
-Worn 16-33hrs/day Surgical Correction Spinal fusion |
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Spinal Curvatures: Nursing Considerations
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Maintain Spinal Alignment
-LT cooperation w/ therapy Examine brace site freq. Maintain skin integrity (skin care, shirt worn between skin and brace) Plain of care: developmental -Brace time -Loose clothing -Activity restriction -Maintain body image |
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Osteomyelitis
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Acute infectious process of the bone.
Infections: Under 10- S. Aureus Neonates- GBS Sickle Cell- Salmonella Teenagers- N. gonorrhoeae |
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Osteomyelitis: Types
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Acute Hematogenous:
-Blood-borne bacterium causing infection in bone Exogenous: -Direct inoculation of the bone from a puncture wound, open fracture, surgical contamination or adjacent tissue infection Subacute (easy to treat): -Longer course, less virulent microbes, walled off abcess Chronic (diffucult to treat): -dead bone, bone loss, drainage and sinus tracts |
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Osteomyelitis: Clinical Manifestations
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-Ill appearance
-Pain, fever, irritability -Localized swelling and warmth -Commonly involves long bones |
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Osteomyelitis: Diagnosis
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Labs
-leukocytosis (^neutrophils & polymorphs) -^Sed rate (rx to inflammation) -Blood Cultures |
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Osteomyelitis: Treatment
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IV antibiotics
-4wks vis PICC line Drain Surgically -Direct instilation of antibiotic Splint/cast Non-wt bearing on affected limb |
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Osteomyelitis: Nursing Considerations
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Promote Comfort
Pain Man. ATC Monitor IV antibiotics Wound Man. Cast care Nutrition Decreased wt. bearing Diversionary activity |
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Septic Arthritis
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Bacterial infection in the joint. Knees, hips (very common), ankles, elbows.
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Septic Arthritis: Clinical Manifestations
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Severe joint pain
Swelling Overlying tissue warmth |
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Septic Arthritis: Diagnosis
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Aspirate joint & culture
Labs Xray |
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Septic Arthritis: Treatment
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Iv antibiotics
Open surgical drainage |
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Malignant Bone Tumors: Types
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Osteogenic Sarcoma
Ewing Scarcoma |
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Osteogenic Sarcoma
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Most common bone cancer in children. Arises from bone forming mesenchyme which gives rise to malignant osteoid tissue. Primarily affects Metaphasis (wide part of shaft) of long bones.
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Osteogenic Sarcoma: Treatment
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Surgery
Chemotherapy |
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Ewing Sarcoma
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Primitive neuroectodermal tumor of the bone. Arises from the marrow spaces of bone. Originates in the shaft and long bones and trunk bones.
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Ewing Sarcoma: Treatment
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Irradiation
Chemotherapy |
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Clinical Manifestations of Bone Tumors
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Severe/Dull pain in affected side
Weight loss Freq. infections Limp Curtails physical activity Unable to hold heavy objects |
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Nursing Considerations for Bone Tumors
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Emotional/Psychocological support
Pain control Concern over amputation Effects of Chemo/Irradiation (skin) Sun sensitivity Loose fitting clothing PT Treatment Plan Honesty Use of prosthetics Allow for grieving |
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Juvenile Rheumatoid Arthritis
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Idopathic chronic inflammatory disease affecting the joints and other tissues. Peaks twice 1-3 then 8-10
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Juvenile Rheumatoid Arthritis: Clinical Manisfestations
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Stiffness, swelling and loss of ROM in affected joints
Swollen and warm but no redness Joints maybe tender Limited ROM Morning stiffness LS- Growth retardation |
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Juvenile Rheumatoid Arthritis: Types
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Systemic Onset
Pauciarticular -Involving <5 joints Polyarticular -Involving >=4 joints |
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Juvenile Rheumatoid Arthritis: Diagnosis
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One of exclusion
Criteria: -Onset <16yrs -Arthritis in one or more joints lasting 6+ wks -Exclusion of other etiologies |
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Juvenile Rheumatoid Arthritis: Treatment
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No cure
Prevent joint dysfunction (PT/OT) Prevent deformity Yearly slit lamp eye exam NSAID's -Cox-2 Corticosteroids Etanercept Cytotoxic Agents (last resort) Physical man.: -Water exercise -Splinting Joint Replacement |
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Juvenile Rheumatoid Arthritis: Nursing Considerations
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Relieve Pain
Promote Health Facilitate Compliance Encourage Heat & Exercise Refer: -Arthritis Foundation -AJAF This disease affects every aspect of child's life. |
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Systemic Lupus Erythematosus
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Chronic, multi system, autoimmune disease of the blood vessels and connective tissue. Involves remissions and exacerbations.
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Systemic Lupus Erythematosus: Clinical Manifestations
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Maybe insidious
Fever, fatigue, weight loss, arthralgia/arthritis, Butterfly rash on face Other macropapular rashes Photo sensitivity Raynaud's phenomenon Renal complications Neurological,hematological, immunological disorders |
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Systemic Lupus Erythematosus: Diagnosis
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Must have 4 of 11 criteria
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Systemic Lupus Erythematosus: Treatment
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None
Reverse immune process prevent exacerbations and complications Corticosteroids Immunotherapy |
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Systemic Lupus Erythematosus: Nursing Considerations
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Diet, exercise, rest
Fatigue and stress can cause relapse Moderate low salt diet Avoid sun exposure Skin care Weight gain Support family Refer: -Lupus Foundation of America Help adolescent adjust to drug therapy Check urine for protein Avoid precipitating factors Sexual Factors |
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Muscular Dystrophies
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Largest group of muscle diseases in childhood. Gradual, progressive degeneration of muscle fibers. Progressive weakness & wasting of symmetric groups of muscles.
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Muscular Dystrophy: Pseudohypertrophic (Duchenne's)
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Most common form. X-linked (females are carriers).
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Duchenne's Muscular Dystrophy: Clinical Manifestations
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Early onset (3-5yrs)
Waddling gait, lordosis Progressive muscle wasting Muscle pseudo-hypertrophy-calves manifestation Weakness Contractures Calf muscle hypertrophy 1st sign: -Trouble riding a bike or climbing stairs Motor delays Growers Sign |
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Duchenne's Muscular Dystrophy: Growers Sign
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Child assumes kneeling position ten gradually puses his torso upright w/ knees straight to a standing position.
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Duchenne's Muscular Dystrophy: Prognosis
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Cause of Death is typically from respiratory tract infection or cardiac failure
Many complications |
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Duchenne's Muscular Dystrophy: Diagnosis
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Serum Enzyme Measurements (CPK)
Muscle Biopsy EMG |
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Duchenne's Muscular Dystrophy: Treatment
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No effective treatment
Encourage activity as long as possible Support family |
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Duchenne's Muscular Dystrophy: Nursing Considerations
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Use comprehensive health team
Encourage self help skills Assist family in coping w/ fatal disease Skilled nursing care is needed Guilt of mother r/t gene transmission Genetic Counseling Assist families in acquiring adaptive devices Consider family need fr respite care Social isolation of children |
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Adaptive Devices
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AFO's: ankle-foot orthosis
KAFO's: knee-ankle-foot orthosis TSLO's: thoracolumbar sacral orthosis (keeps spine straight) |
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Adaptive Devices: Teaching
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Skin care
Protective clothing Esthetics-fitting of braces, casts, splints, prosthetics Fitting of artificial limbs, adaptive devices Wheelchairs Scooters Other adaptive equip. |
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Soft Tissue Injury
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Sprain:
-Ligamentous injury (swelling) Strain: -Tendon injury |
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Soft Tissue Injury: Management in 1st 24hrs
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Rest
Ice Compression Elevation |
