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Arthrogram
- needle inserted into joint space
- local anesthetic
- Joint fluid can be aspirated
- radipaque dye injected; radiographs can help in Dx
- Nursing Imp: prepare pt/fam
- local anethesia used; general anesthesia for very young
- vital signs before, during, after
- support child when anethetic inserted
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Bone Scan
- phosphate or phosphonate radionuclide given IV, concentrates in the bone
- scintillation camer scans body
- assess for occult Fx, infxn, bone tumors
- Nursing Imp: prepare pt/fam
- Contrast Medium: Hx of hypersens. to iodine, seafood, contrast dye
- Start IV for injection of contrast
- Sedate young children; monitor
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Computed Tomography (CT)
- Narrow beam of radiation examines body sections from different angles
- Two dimensional cross-section of structures
- Detects muscle/bone tumors or abn.
- Contrast can be used
- Nrsg Imp: may be NPO, or need bowel evac.
- Teach about procedure: size of equipment, noises, length of time
- Contrast: Hx of hypersens.
- Sedation for young; monitor
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Dual Energy X-Ray Absorptiometry (DEXA)
- *Body Part is Placed btwn 2 photon energy beams
- *Bone Mineral Density and Bone Mineral Concentration detected; compared to norms
- Nrsg Imp: explain proc. to child
- Need to hold still
- Have child practice holding breath while keeping still
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Electromyelogram
- *Needle electrodes inserted into skel. musc.
- *Muscle activity measure during rest, voluntary activity, and electrical stim.
- *Dx of musc. dystrophy
- *Differentiate muscle diseases and lower motor nueron neuropathies
- NRSG: record the child's meds
- *Inform: may be sligh pain w/needles
- *Relaxation Techiques or Distraction
- *Analgesics as needed
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Evoked Potential
- *Child is awake; monitored by electrodes
- *Measures brain and muscle activity
- *Baseline of electrical activity recorded; used later for surgery to monitor innervation to muscle groups and avoid injury to spinal cord
- NRSG: prepare child
- *Size of equipment, Sounds, Time it will take
- *Relax w/quiet music
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Magnetic Resonane Imaging (MRI)
- *large magnet and radio waves delievered to body part
- *Energy field produced transferred as visual image to computer
- *Soft Tissue injury can be Dx
- NRSG: Prepare the child
- *Size of equipment, Sounds, Time, Tunnel
- *No metallic objects/implants, not attached to metal equip.
- *Sedation for young children
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Radiograph (x-ray)
- *Irradiation to obtain images; captured on film
- *Dx bone Fx, assess healing
- *Hand: detect bone age, Dx of delayed or slow growth
- NRSG: explain procedure
- *Need to hold still
- *Practice holding breath, being still
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Ultrasound
- *Tranducer (ultrasound probe) held over skin, produces ultrasound beam
- *Reflected sound waves transformed into graphs/pictures
- *Dx hip displasia in infants
- *Bone Mineral Density in adults
- NRSG: prepare child
- *NPO if ordered
- *Child has not received any tests that interfore (i.e. GI series)
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Alkaline Phosphatase (ALP)
- Enzyme fxn of liver and bone
- Children have levels 1-2 + than adult
- More Elevation: indicate bone destruction, bone cancer, healing Fx, hyperparathyroidism, VitD deficit, or Ca deficit
- Decreased: inadequate bone formation (hyperthyroidism, celiac disease, cystic fibrosis)
- NRSG: prepare child
- Test in Tx room, not Hosp/Clinic room
- Label/Transport specimens
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C-Reactive Protein (CRP)
- Not normally present in blood
- Presence indicates inflammation or infection
- NRSG: prepare child
- Test in Tx room, not Hosp/Clinic room
- Label/Transport specimens
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Erythrocyte Sedimentation Rate (ESR or sed rate)
- *Measures speed with which RBCs settle in a test tube
- *Elevated in inflammation, infxn, tissue injury, or rhuematologic disorders
- *Degree of elevation determines severity of infxn
- *Decrease: indicate improvement, or seen in sickle cell anemia
- NRSG: prepare child
- Test in Tx room, not Hosp/Clinic room
- Label/Transport specimens
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Rheumatoid Factor (RF)
tests for an immunoglobulin present in blood serum of many indiv. w/ JRA
- NRSG: prepare child
- Test in Tx room, not Hosp/Clinic room
- Label/Transport specimens
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Assessment of Muscles
- Symmetrical muscle mass
- Fine/Gross motor movements ok developmentally
- Abn signs? (asymm. movement, tenderness, masses, wekness, hypotonia, hypertonia)
- School-age: get up from lying/sitting position in usual manner
- Usual daily physical activity
- Loss of ability to perform developmental milestones
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Assmnt of Joints
- Movements smooth and symmetrical
- Signs of tenderness, decr. ROM, inflamm, crepitus/grating, masses
- Newborns/Infants: hips have symmetrical, full ROM
- Recent events of trauma
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Assmnt of Bones
- Masess
- Arms/Legs same length
- Recent decr. or change in mobility
- Bones in alignment (ABN? bowlegs, knock-knees)
- Spine properly aligned
- What sports played? Protective gear worn?
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Assmnt of Tendons/Ligaments
- All joints move thru full ROM
- Any pain upont joint motion/palpation
- Grinding or crepitus as joint moves
- Recent sports of other injury?
- What sports?
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Fontanels: Expain the development.
- Fontanels: cranial bones, fibrous membrane btwn
- Posterior: close at 2-3 mo.
- Anterior: close aprox. 18 mo.
- Most of skull growth by 2 yr.
- Full size by 16 yr.
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Secondary Ossificiation
- as long bones grow, cartilage cells at epiphyses replaced by oseoblasts
- helps push end of bone away
- deposition of calcium
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At what age does skeletal maturation occur?
Age 20 years
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How are children's long bones different?
- porous and less dense
- bend, buckle, and break easier
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Function Differences of Spine
- Before Birth: thoracic & sacral convex
- Hold Head Up: cervical concave
- Learn to Stand: lumbar concave
- Failur to Curve this way: abn. curvature, kyphosis, lordosis
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Explain the Development of the Muscular System.
- Almost completely formed at birth
- Increase in 1st yr of life
- Afterward, no increase in number, but rather in length and circumference
- Girls: max diam. 10 yrs
- Boys: max. diam. 14 yrs
- Strength increases until 25-20 yr
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