Pediatric Musculoskeletal, Neuromuscular, and Integumentary Disorders

Flashcards covering pediatric musculoskeletal defects, neuromuscular dysfunctions, and integumentary conditions from lecture notes.

Clubfoot (Deformity Components, Risk Factors, Treatment, & Nursing Tips)

A congenital deformity where the front foot is turned inward due to shortened tendons.

• Deformity Components: Midfoot plantarflexion (downward), hindfoot varus (inward), and forefoot adduction/cavus (inward and upward) with lower leg atrophy.

• Risk Factors: Breech positioning and maternal smoking.

• Treatment: Early serial casting within $1$ to $2\,\text{weeks}$ of life (Ponseti method) for $2$ to $3\,\text{months}$, followed by bracing at naptime/bedtime for several years; surgery if casting fails.

• Nursing Tips: Perform routine neurovascular checks (capillary refill, color, warmth).

Ponseti Method

A primary treatment protocol for clubfoot involving serial casting initiated within the first $1$ to $2\,\text{weeks}$ of life, followed by splinting or bracing.

Developmental Dysplasia of the Hip (DDH) (Risk Factors, S/S, Diagnosis, & Treatment)

Abnormal development of the acetabulum socket.

• Risk Factors: Breech positioning.

• Signs & Symptoms: Limited hip abduction, asymmetrical gluteal/thigh folds, telescoping (shortened appearance) of the thigh, and a limp in older children.

• Diagnosis: Barlow and Ortolani physical examination maneuvers.

• Treatment: Age $< 6\,\text{months}$: Pavlik harness or Bryant traction; Age $> 6\,\text{months}$: Surgical reduction and spica cast; Age $> 18\,\text{months}$: Surgery, casting, and bracing.

Barlow and Ortolani Tests (Procedure & Diagnostic Findings)

Diagnostic physical examination maneuvers for DDH performed supine with hips flexed.

• Barlow: Posterior pressure is applied to assess if the femoral head dislocates from the acetabulum.

• Ortolani: Abduction pressure relocates the hip back into place, producing an audible or palpable pop/click.

Pavlik Harness (Treatment & Nursing Tips)

An abduction orthotic device used to treat DDH in infants under $6\,\text{months}$ of age.

• Treatment & Nursing Tips: Worn $23\,\text{hours/day}$ (with a $1\,\text{hour}$ break for skin care); keeps legs abducted; straps are adjusted ONLY by a physician; wear a soft undershirt under the harness at all times; gentle skin massage, sponge baths only (no lotions/powders), and regular neurovascular checks.

Bryant Traction (Indication & Nursing Tips)

Continuous skin traction used for infants under $6\,\text{months}$ with DDH to stretch soft tissues around the hip prior to surgery or casting.

• Nursing Tips: Ropes must remain straight and weights hang freely; perform regular assessments for alignment, circulation, skin integrity, perfusion, infection, and pain; provide sponge baths while maintaining traction and avoiding soiling.

Spica Cast (Indication & Nursing Tips)

An immobilization cast used for DDH in children over $6\,\text{months}$ of age to hold the hip in alignment while it develops.

• Nursing Tips: Double-diapering (one diaper inside cast edges, one outside), reposition child every $2\,\text{hours}$, handle cast with palms of hands while wet, and monitor for compartment syndrome or signs of poor perfusion (e.g., cold/cyanotic toes).

Legg-Calvé-Perthes Disease (Stages, S/S, & Treatment)

Self-limited avascular necrosis of the femoral head caused by temporary blood supply interruption to the femoral epiphysis.

• Stages: Ischemia -Bone death - Fragmentation - Healing/Remodeling.

• Signs & Symptoms: Painless limp, hip pain or stiffness, and thigh muscle atrophy.

• Treatment: Abduction casting/bracing, activity restriction, and limited weight-bearing (late diagnosis can lead to osteoarthritis).

Slipped Capital Femoral Epiphysis (SCFE) (S/S & Treatment)

A pediatric medical emergency where the femoral head slips off the femoral neck at the growth plate (epiphysis) during a growth spurt.

• Signs & Symptoms: Limp, hip or knee pain, out-toeing gait, limited rotation, loss of hip motion, and severe inability to bear weight.

• Treatment: Strict non-weight-bearing status to stabilize the femoral head, followed by urgent surgical fixation with pins or screws.

Scoliosis (S/S, Diagnosis, & Treatment)

An S- or C-shaped lateral curvature of the spine.

• Signs & Symptoms: Spinal asymmetry, uneven shoulders/hips, prominent scapula, and a one-sided rib hump on forward bending.

• Diagnosis: Radiographs evaluated via Cobb technique and Risser scale.

• Treatment: Mild ($10^\bullet$ to $20^\bullet$): Exercise and muscle toning; Moderate ($20^\bullet$ to $40^\bullet$): Boston brace for $23\,\text{hours/day}$; Severe ($40^\bullet$ to $50^\bullet$): Surgical spinal fusion with rods, screws, hooks, and bone graft.

Boston Brace

An orthotic rigid brace worn $23\,\text{hours/day}$ for the management of moderate scoliosis with a spinal curvature between $20^\bullet$ and $40^\bullet$.

Kyphosis (Treatment & Nursing Tips)

An exaggerated posterior curvature of the spine ('hunchback').

• Treatment & Nursing Tips: Support, exercises, and brace wear.

Lordosis (Treatment & Nursing Tips)

An exaggerated inward curvature of the spine ('swayback').

• Treatment & Nursing Tips: Support and exercises; child usually outgrows it.

Torticollis (Treatment & Nursing Tips)

Tilting of the head caused by cervical spine rotation due to sternocleidomastoid muscle injury or neck abnormalities.

• Treatment & Nursing Tips: Physical therapy (stretching neck rotation and lateral flexion multiple times daily) is primary; encourage repositioning (facing non-preferred side for feeding, play, sleep) and tummy time; helmet therapy for plagiocephaly; surgery if PT fails after $6$ to $12\,\text{months}$.

Osteogenesis Imperfecta (S/S, Treatment, & Nursing Tips)

A genetic disorder ('brittle bone disease') caused by defective collagen production resulting in fragile bones.

• Signs & Symptoms: Frequent fractures, blue sclera, thin/soft skin, short stature, enlarged anterior fontanelle, weak muscles, and conductive hearing loss by adolescence.

• Treatment & Nursing Tips: No cure; handle with care at all times; administer Pamidronate with calcium and Vitamin D; avoid alcohol; use braces/splints (child abuse may be initially suspected due to multiple fractures).

Pamidronate

A bisphosphonate medication administered in osteogenesis imperfecta to inhibit bone breakdown, strengthen fragile bones, and increase bone density.

Osteomyelitis (Risk Factors, S/S, Diagnosis, & Treatment)

Infection of long bones and surrounding soft tissue.

• Risk Factors: Upper respiratory infection (URI), bone trauma, sickle cell disease, or compromised immune system.

• Signs & Symptoms: Rapid onset of severe localized pain, swelling, erythema, fever, nausea, decreased mobility, and limping.

• Diagnosis: Leukocytosis, elevated ESR and CRP, positive blood/wound cultures.

• Treatment: High-dose IV broad-spectrum antibiotics (e.g., vancomycin, clindamycin) adjusted based on culture sensitivity; monitor inflammatory lab values.

Juvenile Idiopathic Arthritis (JIA) (Types/Features, S/S, Diagnosis, & Treatment)

A chronic autoimmune inflammatory disease attacking joint synovium.

• Types/Features: Systemic (fever, rash, organ involvement), Psoriatic (nail changes), Uveitis (eye inflammation).

• Signs & Symptoms: Joint swelling, pain, and morning/activity stiffness lasting at least $6\,\text{weeks}$ across $4+$ joints.

• Diagnosis: Anti-CCP, ESR, CBC, ANA, and radiographs.

• Treatment & Nursing Tips: Exercise, splints, heat application; NO pillows under affected joints; NSAIDs, Corticosteroids (e.g., Prednisone for acute flare-ups — monitor blood glucose), and DMARDs (e.g., Methotrexate).

Methotrexate (Nursing Tips)

A disease-modifying antirheumatic drug (DMARD) used for long-term therapeutic control of juvenile idiopathic arthritis.

• Nursing Tips: Live vaccines are strictly contraindicated during therapy.

Compartment Syndrome (S/S, Treatment, & Nursing Tips)

A neurovascular emergency caused by increased tissue pressure within a muscle compartment.

• Signs & Symptoms (6 Ps): Pain (out of proportion), Pressure (taut skin), Paresthesia, Pallor, Paralysis, and Pulselessness.

• Treatment & Nursing Tips: Immediate emergency intervention; elevate the limb to heart level and apply cold compresses.

Cerebral Palsy (S/S, Treatment, & Nursing Tips)

A non-progressive motor dysfunction resulting from brain injury or hypoxic insult.

• Signs & Symptoms: Hypertonia or hypotonia, poor coordination, delayed motor milestones, diplegia, hemiplegia, quadriplegia, and potential seizures.

• Treatment & Nursing Tips: Modify home/school environment, use ankle-foot orthotics (AFOs) to prevent contractures, and maximize child independence.

Duchenne Muscular Dystrophy (S/S, Diagnosis, Treatment, & Prognosis)

The most common terminal genetic muscular dystrophy causing progressive muscle degeneration.

• Signs & Symptoms: Generalized muscle weakness, Gower sign, lordosis, waddling gait, pseudohypertrophy (fat replacing muscle in lower limbs).

• Diagnosis: Muscle biopsy and serum enzyme assays.

• Treatment & Prognosis: Corticosteroids to preserve muscle function; loss of ambulation by age $12$; death usually occurs in late adolescence due to respiratory or cardiac failure.

Gower Sign

A characteristic physical maneuver in muscular dystrophy where a child uses their hands to walk up their legs to rise to a standing position.

Spinal Muscular Atrophy (SMA) (S/S, Treatment, & Nursing Tips)

A genetic neuromuscular disease causing degeneration of motor neurons.

• Signs & Symptoms: Severe hypotonia, poor suck/swallow (high aspiration/choking risk), frog-leg posture, absent deep tendon reflexes, bell-shaped chest, and progressive scoliosis/contractures.

• Treatment & Nursing Tips: Respiratory support, nutritional management, and contracture prevention.

Osteosarcoma (Site & S/S)

A primary malignant bone tumor situated mainly in the metaphysis of long bones (especially lower extremities).

• Signs & Symptoms: Localized bone pain that worsens with physical activity, swelling, and a palpable lump over the tumor site.

Ewing Sarcoma (Origin & S/S)

A malignant bone tumor originating in the bone marrow of long and flat bones.

• Signs & Symptoms: Severe bone pain that increases at night, accompanied by systemic symptoms such as fever and headaches.

Rhabdomyosarcoma (S/S by Site)

A soft tissue malignancy predominantly occurring in the head/neck, genitourinary tract, or abdomen.

• Signs & Symptoms: Painless tumor mass.

  • Head/Neck: Unilateral proptosis (bulging eye), facial swelling, ear pain.

  • GU Tract: Dysuria, hematuria, vaginal bleeding, bowel obstruction.

  • Abdomen: Abdominal mass and vomiting.

Impetigo (S/S & Treatment)

A highly contagious superficial bacterial skin infection secondary to minor trauma.

• Signs & Symptoms: Erythematous macules evolving into characteristic honey-crusted lesions; child typically lacks systemic fever and appears well.

• Treatment: Topical antibiotics.

Cellulitis (S/S & Nursing Tips)

A deep bacterial skin infection affecting facial tissues or extremities.

• Signs & Symptoms: Rapidly spreading localized erythema with poorly defined borders, warmth, swelling, potential vesicles, and systemic illness/fever.

• Nursing Tips: Mark and date the erythematous borders with a pen to monitor spreading.

Scabies (S/S, Treatment, & Nursing Tips)

A parasitic mite infestation where female mites burrow into skin over $45\,\text{minutes}$.

• Signs & Symptoms: Intensely pruritic linear burrow lesions.

• Treatment & Nursing Tips: Take a warm bath prior to applying scabicide lotion, leave lotion on skin for $8$ to $12\,\text{hours}$, repeat treatment $1\,\text{week}$ later, and treat all household contacts simultaneously, even if not showing any s/s!

Lyme Disease (S/S & Treatment)

A tick-borne infection caused by Borrelia burgdorferi.

• Signs & Symptoms: Characteristic expanding bullseye rash (erythema migrans) accompanied by flu-like symptoms.

• Treatment: Oral Doxycycline.

Rocky Mountain Spotted Fever (S/S & Treatment)

A severe, life-threatening tick-borne rickettsial infection.

• Signs & Symptoms: High fever, severe headache, myalgia, nausea/vomiting, abdominal pain, and a maculopapular rash that starts on the palms and soles and becomes petechial, indicating vascular damage.

• Treatment: Administer oral doxycycline immediately when clinically suspected.