-
What is the weakest area in the long bone?
- Epiphyseal plate
- (common area to fracture)
-
What should be suspected if fractures are observed in various healing stages?
Child abuse
-
What are the 5 P's to assess for in fractures?
- Pain
- Pallor
- Pulselessness
- Paresthesia
- Paralysis
-
When are nurses allowed to take off traction?
NEVER
-
What are two ways to diagnose congenital clubfoot?
- Intrauterine ultrasound
- X-Ray
-
How do you treat club foot in:
Mild
Tetralogic
Congenital
M - passive ROM or serial casting
T - surgical correction with high incidence of recurrence
C - surgical correction due to bony abnormality
-
What disease is known as the necrosis of the femoral head?
Legg-Calve-Perthes Disease
-
Legg-Calve-Perthes Disease:
S/S
Prognosis
- Limp
- Pain/stiffness in joint
The earlier it is found, the better the outcome
-
What are the proper ways to treat Legg-Calve-Perthes Disease?
Initial - rest, non-weight bearing to decrease inflammation
Later - active movement to encourage proper alignment and increased circulation
-
What kind of secondary exposure causes osteomyelitis to occur?
- Surgery
- Trauma
- Tonsillitis
- Impetigo
- (staph. aureus is most common)
-
Osteomyelitis:
S/S
Dx
- Pain, Warmth, Tenderness
- Decreased ROM
- Fever
- Lethargy
-
How long are IV antibiotics given for osteomyelitis?
4-6 weeks
-
If the osteomyelitis is chronic, how is it treated?
Surgical debridement
Direct infiltration of antibiotics
-
What kind of nursing interventions are indicative for osteomyelitis?
- Pain managment
- Give high calorie fluids for decreased appetite
- Contact isolation if open wound
- Diversional activities
-
Juvenile Rheumatoid Arthritis:
What is it?
Cure?
Autoimmune disease causing inflammation of the joints and organs
No cure, just remission
-
Juvenile Rheumatoid Arthritis:
Pauciarticular onset
Polyarticular onset
Systemic onset
Less than 4 joints
More than 5 joints
Fever, rash, enlarged spleen, pericarditis
-
Juvenile Rheumatoid Arthritis:
S/S
- Stiffness
- Swelling
- Warm without redness
- Tender to touch
- Loss of mobility
- Slow growth
-
How is Juvenile Rheumatoid Arthritis diagnosed appropriately?
- Onset is less than 16 years of age
- One or more affected joints
- Arthritis lasts for 6 weeks or more
- Excludes other arthritis
-
How is pain and inflammation controlled in Juvenile Rheumatoid Arthritis?
First line
Second line
Third line
#1 - NSAIDS
#2 - Methotrexate & NSAIDS
#3 - Tumor Necrosing Factor inhibitors, Gold salts, Sulfasalazine
-
Juvenile Rheumatoid Arthritis:
Physical vs Occupational Therapy
P - Strengthen muscles, improve joint function, prevent deformities
O - General mobility, ADL's
-
Juvenile Rheumatoid Arthritis:
What are ways to preserve function and prevent deformity?
- Swimming
- Splint joints at night
- Stretch
- Maintain body weight
- Use heat
-
Cerebral Palsy:
What is it?
Causes:
Non-progressive, neuromuscular disorder that results from developmental defects or insult in the brain
- Anoxia
- Infection
- Trauma
- Unknown
-
Cerebral Palsy:
Types
Spastic - most common, hyperactive stretch reflex, contractures
Dyskinetic - abnormal involuntary movements, poor speech
Ataxic - poor balance and coordination
Mixed - combination of spastic and dyskinetic
-
Cerebral Palsy:
Early S/S
- Failure to meet milestones
- Poor muscle tone
- Use one side of the body
-
How do you medically manage these conditions of Cerebral Palsy:
Deformities
Muscle spasticity
Seizures
D - braces/splints, surgery to lengthen tendons
M - botox, baclofen pump relaxes spinal cord
S - anticonvulsants
-
Muscular Dystrophy:
What is it?
Genetic?
Gradual degeneration of muscle fibers
X-linked inheritance
-
Muscular Dystrophy:
Onset age?
Age of loss of independent mobility?
Age of death? From what?
3-5 years
11-12 years
20's from respiratory or cardiac failure
-
Muscular Dystrophy:
S/S
Dx
- Gower sign
- Lordosis
- Large thigh muscles
- Waddling gait
Confirmed by EMG, muscle biopsy and serum enzyme measurement
-
What is the primary goal for Muscular Dystrophy?
Maintain function in unaffected muscles as long as possible
-
Myelomenigocele:
What is it?
Main cause
Type of neural tube defect where it fails to close during embryonic development
Multifactorial
-
Myelomenigocele:
S/S
- Spinal fluid on the outside with nerves
- Neurogenic bladder
- CNS infection
- Hydrocephalus
- Decreased motor activity below the sac/injury
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