Exam 2: Pedi/OB: musculoskeletal

What are the 6 P's (pain, pulselessness, pallor, paresthesia, paralysis, pressure/poikilothermic) used for?

Used for neurovascular assessment to check circulation and nerve function and detect compartment syndrome.

What does a neurovascular assessment check for?

Circulation and nerve function in a limb, and helps detect compartment syndrome.

What is Developmental Dysplasia of the Hip (DDH)?

A condition where the head of the femur and acetabulum are improperly aligned.

What are risk factors for DDH?

Gender, family history, intrauterine position (breech), oligohydramnios, joint laxity, cultural and genetic factors.

What device is used to treat DDH and how is it worn?

A Pavlik harness worn 24 hours a day.

What is the purpose of a Pavlik harness?

Keeps the hips flexed and abducted to promote proper alignment.

What should be checked regularly when using a Pavlik harness?

Skin integrity under the straps.

What is the Ortolani sign in DDH?

When the hips are flexed and gently abducted, a "clunk" or click is felt or heard as the femoral head slips back into the socket.

What is the Barlow sign in DDH?

When the hips are flexed and gently adducted with pressure, the femoral head can be dislocated from the socket; positive if a "clunk" is felt.

Why are children's bones more likely to bend or crack?

Because their bones are more porous and less dense.

How fast do children's bones heal compared to adults?

They heal faster.

Why are injuries to the epiphyseal plate concerning?

They can lead to growth abnormalities.

How common are fractures in infants?

Rare.

What medication can prolong fracture healing?

NSAIDs.

What are the manifestations of a fracture?

Pain or tenderness, guarding, diminished function or mobility, ecchymosis (bruising), and crepitus (grating at the fracture site).

What is a spiral fracture?

A fracture where the bone is twisted apart, creating a spiral-shaped line around the shaft; often caused by a twisting force.

What should a nurse suspect if a child has a spiral fracture?

Possible abuse.

What are other types of fractures in children?

Greenstick and transverse fractures.

What is the emergency care for fractures?

Determine the cause, immobilize the limb, cover open wounds, apply a splint, elevate the limb, and apply cold to reduce swelling.

What should be done to prevent compartment syndrome after a fracture?

Elevate the limb, monitor for pain, and loosen dressings or casts if needed.

What is fracture reduction?

Restoring the bone to proper alignment.

What is closed reduction?

Manual alignment without surgery.

What is open reduction?

Surgical correction of the bone alignment.

What is traction?

The use of splints, bandages, or tape to apply pulling force on a limb to align bones.

What is skeletal traction?

Involves placing a pin, wire, or screw into the bone to apply continuous pulling force.

What is compartment syndrome?

Compression of nerves, blood vessels, and muscles within a closed space that can cause tissue death and may require immediate fasciotomy.

What is scoliosis?

An S-shaped lateral curve of the spine measuring 10 degrees or more.

When is scoliosis usually diagnosed?

During the preadolescent growth spurt at middle school screenings.

At what ages should scoliosis screening occur?

Girls: 10-12 years; Boys: 13-14 years.

What is the Adams test?

A screening test where the child bends forward to check for curvature of the spine.

Is scoliosis usually painful?

No, it is usually painless.

What are the signs and symptoms of scoliosis?

Poorly fitted clothes, unequal shoulder or pelvic height, and a protruding scapula.

Does bracing cure scoliosis?

No, bracing does not cure scoliosis but slows the curvature.

What confirms a scoliosis diagnosis?

Standing radiographs.

What is the definitive treatment for severe scoliosis?

Straightening and realignment of the vertebrae by external or internal fixation.