Neuro/Muscular Problems Ch. 54 & 55

  1. What is the weakest area in the long bone?
    • Epiphyseal plate
    • (common area to fracture)
  2. What should be suspected if fractures are observed in various healing stages?
    Child abuse
  3. What are the 5 P's to assess for in fractures?
    • Pain
    • Pallor
    • Pulselessness
    • Paresthesia
    • Paralysis
  4. When are nurses allowed to take off traction?
  5. What are two ways to diagnose congenital clubfoot?
    • Intrauterine ultrasound
    • X-Ray
  6. How do you treat club foot in:

    M - passive ROM or serial casting

    T - surgical correction with high incidence of recurrence

    C - surgical correction due to bony abnormality
  7. What disease is known as the necrosis of the femoral head?
    Legg-Calve-Perthes Disease
  8. Legg-Calve-Perthes Disease:

    • Limp
    • Pain/stiffness in joint

    The earlier it is found, the better the outcome
  9. 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
  10. What kind of secondary exposure causes osteomyelitis to occur?
    • Surgery
    • Trauma
    • Tonsillitis
    • Impetigo
    • (staph. aureus is most common)
  11. Osteomyelitis:

    • Pain, Warmth, Tenderness
    • Decreased ROM
    • Fever
    • Lethargy

    • Ultrasound
    • MRI
  12. How long are IV antibiotics given for osteomyelitis?
    4-6 weeks
  13. If the osteomyelitis is chronic, how is it treated?
    Surgical debridement

    Direct infiltration of antibiotics
  14. 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
  15. Juvenile Rheumatoid Arthritis:

    What is it?
    Autoimmune disease causing inflammation of the joints and organs

    No cure, just remission
  16. Juvenile Rheumatoid Arthritis:

    Pauciarticular onset
    Polyarticular onset
    Systemic onset
    Less than 4 joints

    More than 5 joints

    Fever, rash, enlarged spleen, pericarditis
  17. Juvenile Rheumatoid Arthritis:

    • Stiffness
    • Swelling
    • Warm without redness
    • Tender to touch
    • Loss of mobility
    • Slow growth
  18. 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
  19. 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
  20. Juvenile Rheumatoid Arthritis:

    Physical vs Occupational Therapy
    P - Strengthen muscles, improve joint function, prevent deformities

    O - General mobility, ADL's
  21. Juvenile Rheumatoid Arthritis:

    What are ways to preserve function and prevent deformity?
    • Swimming
    • Splint joints at night
    • Stretch
    • Maintain body weight
    • Use heat
  22. Cerebral Palsy:

    What is it?
    Non-progressive, neuromuscular disorder that results from developmental defects or insult in the brain

    • Anoxia
    • Infection
    • Trauma
    • Unknown
  23. Cerebral Palsy:

    Spastic - most common, hyperactive stretch reflex, contractures

    Dyskinetic - abnormal involuntary movements, poor speech

    Ataxic - poor balance and coordination

    Mixed - combination of spastic and dyskinetic
  24. Cerebral Palsy:

    Early S/S
    • Failure to meet milestones
    • Poor muscle tone
    • Use one side of the body
  25. How do you medically manage these conditions of Cerebral Palsy:

    Muscle spasticity
    D - braces/splints, surgery to lengthen tendons

    M - botox, baclofen pump relaxes spinal cord

    S - anticonvulsants
  26. Muscular Dystrophy:

    What is it?

    Gradual degeneration of muscle fibers

    X-linked inheritance
  27. 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
  28. Muscular Dystrophy:

    • Gower sign
    • Lordosis
    • Large thigh muscles
    • Waddling gait

    Confirmed by EMG, muscle biopsy and serum enzyme measurement
  29. What is the primary goal for Muscular Dystrophy?
    Maintain function in unaffected muscles as long as possible
  30. Myelomenigocele:

    What is it?
    Main cause
    Type of neural tube defect where it fails to close during embryonic development

  31. Myelomenigocele:

    • Spinal fluid on the outside with nerves
    • Neurogenic bladder
    • CNS infection
    • Hydrocephalus
    • Decreased motor activity below the sac/injury
Card Set
Neuro/Muscular Problems Ch. 54 & 55