Caring for the Child with Neuromuscular and Musculoskeletal Dysfunction

What is used as prevention for neural tube defects?

folate prior to conception, foods high in folic acid, supplement with 400mg before and during pregnancy

What type of neural tube defect is where the boney spine fails to close but is not visible?

spina bifida occulta

What type of neural tube defect is where there is a sac like cyst filled with meninges and CSF but has no neurological involvement?

meningocele

What typeof neural tube defect is where there is a cyst filled with meninges, CSF and spinal cord with nerve and has neurological involvement?

myelomeningocele

What are the physiologic manifestations of neural tube defects?

lesion on spine, motor and sensory deficits, issues with bowel and bladder, hydrocephalus, paralysis of lower limbs, clubfeet, develops after repair, too much csf after repair

What are the treatment options for neural tube defects?

in utero surgical intervention, immediate colsure of defect, shunting for hydrocephalus

What is important for pre-op nursing care for neural tube defect surgery?

maintain integrity of sac, prone positioning, monitor urine output, baseline assessment for hydrocephalus

What is important for post-op nursing care for neural tube defect?

prevent infection, maintain integrity of surgical incisions, neurogenic bladder, assess musculoskeletal system, assess for s/s of hydrocephalus, nutrional intake, skin integrity

What is a non-progressive central motor function and can range in severity and expression can change across time as brain matures?

cerebral palsy

What are motor and mobility products used for kids who have CP?

braces, orthotics, walker, wheelchair, assistives feeding tools, positioning aids

What are the pharmacologic used for kids with CP?

baclofen pump, muscle relaxantsm anti-seizure meds, anticholinergic, anti-inflammatory

Kids with CP who cant walk or who have trouble getting enough nutrients in their diet due to feeding problems are more likely to have what problems?

low bone density

What ADL adaptations do those with CP need?

adaptive seating, toileting/catheter, pull ups/depends, feeding, bathing/skin integrity

What is bladder malfunction caused by injury or disorder of brain, spinal cord, or nerves?

neurogenic bladder

What are causes of neurogenic bladder?

congenital defects, SCI, tumors, strokes

What can a neurogenic bladder cause?

incontinence, frequency, urgency, retention, repeated UTI, kidney damage

What are treatments for neurogenic bladder?

catheterization, bladder training, medications

What is a birth defect where cranial sutures are prematurely closed?

craniosynostosis

What can craniosynostosis cause?

restricted brain growth

What is treatments for craniosynostosis?

endoscopic surgery, open surgery, helmet therapy

What is flat head syndrome which is characterized by the flattening of one side or the back of the head?

plagiocephaly

What is a progressive muscle degenerative disease that results in muscle weakness, hypertrophied muscles, and waddling gait?

Duchenne Muscular dystrophy

What are the symptoms of Duchenne Muscular dystrophy in teens?

increasing respiratory impairment

What are the symptoms of Duchenne Muscular dystrophy in teens to twenties?

decreasing cardiac dysfunction

What is a sideways curvature of the spine that is most often diagnosed in adolescents?

scoliosis

What are the manifestations of scoliosis?

uneven shoulders, one shoulder blade is more prominent than the other, uneven waist, one hip higher than the other, one side of the rib cage jutting forward, and prominence on one side of the back when bending forward

What are the causes of scoliosis?

DMD, CP, birth defects affecting the spine, previous chest wall surgery, injuries or infections of the spine, spinal cord irregularities

What monitoring is needed with scoliosis?

Dr check mild curves every few months or x-rays

What non-surgical treatment is used for scoliosis?

PT or bracing

What are the surgical treatments for scoliosis?

spinal fusion, rods, vertebral body tethering

What scoliosis surgery permanently connects two or more vertebrae to correct a spinal curve?

spinal fusion

What scoliosis surgery is where a strong cord called a tether is attaches to the spine to correct the curve?

vertebral body tethering

What is a genetic or heritable disease in which bones fracture easily and is also known as brittle bone disease?

osteogenesis imperfecta

How many forms of OI are there?

19

What are s/s of mild OI?

fractures form minor trauma, blue-grey tint of sclera, hearing loss

What are s/s of severe OI?

bones fractures easily, blue grey tint to sclera, scoliosis, short stature, hearing loss, contractures, respiratory problems, dental abnormalities

What are treatments for OI?

fracture care, PT, bracing, surgery, medication, oxygen administration

What disease is when the top of an infants foot is usually twisted downward and inward, increasing the arch and turning the heel inward and the affected leg may be slightly shorter, and the calf muscles in the affected leg are underdeveloped?

talipes equinavarus

What are the risk factors for club feet?

boys, family hx, spina bifida, birth defect, mother smoking during pregnancy, not enough amniotic fluid during pregnancy

What is the treatment for club foot?

stretching and serial casting of the foot which is worn all the time for 3 months

What is abnormality of the shape of the head of the femur or the shape of the acetabulum, or an abnormality with the area surrounding the femur and hip socket?

developmental dysplasia of the hip (DDH)

What are the risk factors for DDH?

female, first born child, babies born breech, family hx

What are the early s/s DDH?

hip is felt going in and out of socket, unequal leg lengths, unequal thigh skin folds

What are the late s/s of DDH?

gait abnormalities, hard to move the leg away from the body, hip pain

What is the non-surgical treatment for DDH?

pavlik harness and rigid abduction orthosis

What is a possible complication of pavlik harness?

avascular necrosis

What DDH treatment is used after Pavlik is unsuccessful for 3 weeks?

Rigid abduction orthosis

What is the surgical treatment for DDH?

hip reduction and spica casts for 12 weeks

What education is needed DDH?

heavy casts, developmental concerns, special car seat, hygiene concerns

What is a disorder where the ball of the femur slips off the neck?

slipped capital femoral epiphysis (SCFE)

What are risk factors for SCFE?

obesity, steroids, radiation treatment, chemo, family hx, endocrine or metabolic disorders

What type of SCFE is when you are able to put weight on the affected hip with or without crutches and is most common?

stable SCFE

What type of SCFE is when you cannot put ant weight on the hip even with crutches and is more prone to complications?

unstable SCFE

What are the s/s of unstable SCFE?

outward turning of the affected leg, discrepancy in leg lengt h

What is the treatment for SCFE?

Surgery

What can unstable SCFE lead to?

avascular necrosis

What pt education is needed for SCFE?

crutches for 4-6 weeks, staples vs dissolvable stiches, may occur on opposite leg as well, PT, x-rays every 3-6 months

What type of soft tissue injury is characterized by damage to the soft tissue, subcutaneous structures and muscle?

contusions

What type of soft tissue injury happens when the force of stress on a ligament is so great that is displaces the normal position of the opposing bone ends or the bone end to its socket?

dislocation

What type of soft tissue injury happens when there is trauma to a joint that is so severe that a ligament is partially or completely torn or stretched?

sprain

What type of soft tissue injury is characterized by a microscopic tear in the musclotendinous unit and has features in common with sprains?

strain

What are s/s of fractures?

swelling, pain, tenderness, deformity, diminished use, bruising, muscular rigidity, crepitus

What type of fracture is characterized by a incomplete break where one side of a bone compresses and bulges outward?

torus “buckle” fracture

What type of fracture is characterized by an incomplete break where a bone bends and cracks on one side?

greenstick fracture

What type of fracture is characterized by a complete break that goes diagonally or at an angle across a long bone?

oblique fracture

What type of fracture is characterized by a straight across or perpendicular to the length of the bone?

transverse fracture

What type of fracture is unique to children and occurs since the growth plate area is not as strong at the surrounding bone?

physeal/growth plate fractures

What are the goals of fracture management ?

regain alignment and length of boney fragments, restore fx to injured parts, prevent further injury and deformity

What is needed for pediatric cast care?

keep clean and dry, nothing down cast, no pulling the padding, no lotions or powder on the skin under the cast, keep dirt and sand away, wrap in plastic bag if raining

What is an infection process in the bone that may occur in may age but primarily seen in 10 years of age or younger?

osteomyelitis

What bones is osteomyelitis primarily seen in?

foot, femur, tibia, and pelvis

What organism is the primary causative agent of osteomyelitis?

staphylococcus aureus

What management is needed for osetomyelitis?

organism identification, culture of drainage and skin, bone biopsy, lab result, radiology imaging