Unit 8 - pt 2

Genu varum

bow-legged or knees turned outward

Osteomyelitis

infection of the bone

Contusion

tearing of subcutaneous tissue that results in hemorrhage, edema, and pain

Sprain

ligament that is torn or stretched away from the bone

Genu valgum

knock-kneed or knees turned inward

Osteosarcoma

bone tumor

Toricollis

limited neck motion due to shortening of the sternocleidomastoid muscle.

Assessment of the musculoskeletal system in children who can walk includes:

Observation
Palpation
Range of motion
Gait assessment

It is normal for toddlers to have what kind of gait?

Wide or unstable

How would the nurse test the strength of a child's extremities?

The strength of the extremities can be tested
by having the child push away the examiner 's
hand with his or her foot or hand.

True or False? A newborn's feet may turn inward or outward?

true

True or False? Children who do not walk independently by 12 months of age should be evaluated for a musculoskeletal proplem.

false

True or False? Young children may appear "bow-legged" until 5 years of age.

true

True or False? A neurologic assessment is part of a comprehensive musculoskeletal assessment.

true

List three types of traction used for children.

Bryant's traction
Buck's extension
Russell's traction

Identify three or more differences in the skeletal system of a child as compared to an adult.

Epiphyses are present.
Periosteum is thicker and produces callus more
rapidly.
Bone is stronger because of the lower mineral
content and greater porosity.
Bone overgrowth is common in healing fractures in children younger than 10 years.
Injury to the epiphysis can affect bone growth.

The major signs of a muscle sprain are?

swelling, disability, pain

Describe the treatment of a soft tissue injury.

A cold pack and elastic wrap will reduce
edema, bleeding, relieve pain, and should be
applied at alternating 30-minute intervals. Elevating the extremity above heart level reduces
edema.

Simple fracture

bone is broken but the skin over the area is not broken.

Compound fracture

open fracture in which the wound in the skin leads to the broken bone.

Greenstick fracture

incomplete fracture

Spiral fracture

caused by forceful twisting motion

Bryant's traction is used for treating fractures of the femur in children younger than __________years of age or less than _________ to ____________ pounds.

2, 20, 30

You are performing a neurovascular assessment on an infant or child being treated with traction, casting, or ace bandages. Describe the six findings on the neurovascular assessment that should be reported immediately to the nurse in charge.

Pain (severe)
Pulse (absence in extremity with traction)
Sensation (numbness)
Color (pallor or cyanosis)
Capillary refill (>3 seconds)
Movement (cannot move fingers or toes in area affected)

What is Volkmann's ishemia?

A specific and serious complication of any
type of traction. It occurs when circulation is
obstructed. Arterial occlusion can cause anoxia of the muscles and reflex vasospasm, which could
result in contracture and paralysis.

Explain spit Russell traction.

Traction is in two directions: vertical pull for
the knee and horizontal pull for the lower leg.
A sling is positioned under the knee. Vertical
traction to maintain distal thigh and knee sus-
pension uses weights at head of bed. Horizon-
tal skin traction applied to the lower extremity
exerts pull toward weights at the foot of bed.

How is nursing care for a child in skeletal traction different from that for a child in skin traction?

Daily evaluation and care of pin insertion site;
observe for signs/symptoms of infection; arrange for school tutoring as needed.

Traction-related weights are hanging?

freely

Traction-related weights are out of reach of

child

Traction-related ropes are on the

pulleys

Traction-related knots are not resting against

pulleys

Traction-related bed linens are not on

traction ropes

Apparatus does not touch the _____________ of the _________________.

foot, bed

A priority nursing responsibility in the care of a child with a cast or in traction is.

performing neurovascular assessments or
checks

Pain at the trauma site that is not relieved by analgesics may be a sign of.

compartment syndrome

A child is receiving intravenous antibiotics for treatment of osteomyelitis. What is a nursing responsibility related to this treatment?

Monitor the child for toxic responses to the
long-term antibiotic therapy. Ensure long-term
compliance.

The most common type of muscular dystrophy is?

Duchenne's

List three signs that suggest a child has muscular dystrophy?

Hypertrophy of calf muscles
Clumsiness
Progressive weakness involving frequent falling
Contractures of the ankles and hips
The Gower's maneuver when rising from the
floor

List two or more clinical manifestations of slipped femoral capital epiphysis.

Thigh pain
Limp or inability to bear weight on the involved leg

What information should the nurse expect the physician to give parents about the prognosis of Legg-Calve-Perthes disease in their child?

Healing occurs spontaneously over a 2- to
4-year period. However, marked distortion of
the head of the femur may lead to an imperfect
joint or degenerative arthritis of the hip in later
life.

A diagnosis of osteosarcoma is confirmed through a (n).

biopsy

What are the goals of care for juvenile idiopathic arthritis?

Reduce pain and swelling.
Promote mobility.
Preserve joint function.
Promote independent functioning.
Help child and family to adjust to living
with a chronic disease.

The two types of scoliosis and the cause for each are:

Functional, caused by poor posture
Structural (fixed), caused by changes
in the shape of the vertebrae or thorax

The Milwaukee brace must be worn__________hours a day.

23

Screening for scoliosis should be done before___________.

middle school

What does a screening examination for scoliosis involve?

No slip or undershirt should be worn. The
spine is examined from the front, side, and
back while the student stands erect. The back
is observed as the student bends forward. The
nurse looks for general body alignment and
asymmetry.

A child with scoliosis who needs a spinal fusion has special needs related to immobilization. Identify two nursing interventions to prevent gastrointestinal complications from immobility in the postoperative period.

Increase fluid intake.
Allow child to select foods with the aid of
the dietitian or nurse.

A parent asks you for guidelines to help prevent injuries in a child who is in competitive sports. List four guidelines.

Warm-up and cool-down periods
Year-round conditioning
Careful selection of activity according to
maturity
Safe, well-fitting equipment

What are shin splints?

Pain and discomfort in the lower leg caused
by repeated running on a hard surface such as
concrete.

Describe what the nurse should do if child abuse is suspected.

Report all suspected child abuse to child protective services.

What guideline for documentation should the nurse follow when caring for a child who has been abused?

Documentation should be factual and objective.

One of the most common causes of death in a child with muscular dystrophy is:

cardiac failure

Which type of traction would the nurse expect to be used for a 20-month-old-child who has a fractured femur?

Bryant's

The nurse is aware that a fracture involving the epiphyseal plate in a long bone can result in:

impaired done growth

When a child is referred to a physician after scoliosis screening, the plan is to defer treatment and watch the child. The nurse determines that the child's curvature must be less than:

20 degrees

Which is an expected assessment finding in a child with suspected scoliosis?

Asymmetry of the shoulders

Which disease is usually inherited as a sex-linked disorder?

Duchenne's muscular dystrophy

The nurse is reinforcing the physican's explanation of treatment for Legg-Calve-Perthes disease. What information would the nurse review with parents?

ambulation-abduction casts or braces

The nurse completed a neurovascular check on a child in Russell's traction for a fractured femur. Which finding should be reported to the charge nurse?

toes feel tingly

The treatment of osteomyelitis includes the use of:

antibiotics

The development of uveitis is an autoimmune complication of:

juvenile rheumatoid arthritis

An appropriate nursing action when caring for a child in Bryant's traction is to:

position the child's legs at right angles to the body

Which is a priority nursing diagnosis for an adolescent treated for osteosarcoma?

Disturbed body image

A toddler has been walking independently for one month. Observation of a toddler's gait reveals the child's feet are wide apart and the gait is unsteady. How would the nurse interpret this finding?

This is a normal gait for a child in the toddler age group.

The mother of an infant born with congenital torticollis tells the nurse she is concerned that her child will always have limited neck motion. What is the best nursing response to the mother's concern?

The condition will most likely resolve by 2-6 months.

A 3 year-old is being removed from the home of an abusive parent. The child is crying and a co-worker wonders if this could be a sign that the child was not abused. The nurse understands that the child:

will mourn the loss of family, even if there was abuse.

Which statement by a mother might indicate future problems related to the care of a newborn infant?

The baby cries all the time. She doesn't seem to like me. I didn't think it would be like this. Sometimes I think she is just trying to irritate me.

What would be the priority nursing intervention when a nurse is caring for a child wearing an Ace bandage for a sprained ankle?

perform a neurovascular assessment

A type of fracture in a young child that may be indicative of child abuse is:

spiral fracture of the femur

A teenager who had a cast applied after a tibia fracture complains that his pain medication is not working and his pain is still a 9 or 10. The nurse notices some edema of the toes and a capillary refill of 6 seconds. The priority action of the nurse would be:

call the health care provider immediately

A neurovascular check for tissue perfusion includes which of the following observations.

pulse, color and capillary refill, movement and sensation

An abnormal s-shaped curvature of the spine seen in school -age children is:

scoliosis

A yellow bruise is approximately:

7 to 10 days old

What are the principles of managing soft tissue injuries include?

RICE rest/ice/compression/elevation

Arthroscopy

physician is able to look inside the joint to determine the extent of the injury

Bryant's traction

used for treating fractures of the femur in children less than 2 years of a. age or lighter than 20 to 30 lb. Weight's and pulleys extend the limb, the legs are suspended vertically. The weight of the child supplies the countertraction.

Russell traction

a sling is positioned under the knee, which suspends the distal thigh above the bed.

Compartment syndrome

is a progessive loss of tissue perfusion caused by an increase in pressure resulting from edema or swelling that presses on the vessels and tissues. Circulation is compromised, and the neurovascular check is abmormal.

Ewing's sarcoma

It is a malignant growth that occurs in the marrow of the long bones. It occurs mainly in older-school-age children and early adolescents.

Juvenile idiopathic arthritis (juvenille rheumatoid arthritis)

most common arthritis condition of childhood. it is a systemic autoimmune disease that involves the joints, connective tissues, and viscera, and it differs from adult rheumatoid arthritis.