Pediatric HIV, Immunology, Scoliosis, Clubfoot, Sports Injuries, and Orthopedic Topics (Flashcards)

A comprehensive set of vocabulary-style flashcards covering HIV in infants, antiretroviral therapy and vaccines considerations, scoliosis assessment and management, clubfoot treatment, sports injuries, fracture management, and osteomyelitis.

HIV

Human immunodeficiency virus; a retrovirus that infects CD4+ T cells and impairs the immune system.

Vertical transmission

Mother-to-child transmission of HIV during pregnancy, delivery, or breastfeeding; risk reduced with antiretroviral therapy.

Horizontal transmission

HIV spread through sexual contact, contaminated blood or fluids, or IV drug use.

Zidovudine (ZDV/AZT)

NRTI used during pregnancy, labor, and up to 6 weeks after birth to reduce perinatal HIV transmission.

HIV DNA or RNA PCR

PCR test detecting HIV DNA; used for diagnosis in infants <18 months.

ELISA or western blot is unreliable in

infants under 18 months due to maternal antibodies.

Pneumocystis jirovecii pneumonia (PJP/PCP) prophylaxis

Preventive treatment started around 4–6 weeks of age in HIV-exposed infants

PJP/PCP prophylaxis is given at and until

at 4-6 weeks and until 1 yr of age or until HIV negative

LIP (lymphoid interstitial pneumonia)

A potential AIDS-defining lung infection in children with HIV.

MAC infection (Mycobacterium avium–intracellulare complex)

Opportunistic mycobacterial infection in advanced HIV; can occur with AIDS.

AIDS indicators in children

Serious bacterial infections, LIP, herpes simplex disease, MAC, and other opportunistic infections.

HIV RNA (viral load)

Measure of HIV RNA in blood to assess viral replication and treatment response.

Infant HIV testing (<18 months)

HIV DNA or RNA PCR is used because maternal antibodies can yield false-positive ELISA/Western blot results.

ANTIRETROVIRAL therapy (ART)

two NRTI and either one NNRTI or INSTI or PI

NRTI (nucleoside reverse transcriptase inhibitors)

Class of HIV drugs; examples include zidovudine (ZDV) and didanosine (DDI).

NNRTI (non-nucleoside reverse transcriptase inhibitors)

HIV drugs like efavirenz and nevirapine; act differently from NRTIs.

Efavirenz is a… and avoided in…

NNRTI; generally avoided in pregnancy due to teratogenic risk.

Tanner stage 1&2 HIV dosing

pediatric dosing

Tanner stage 3&4 HIV dosing

adult dosing

MMR and Varicella vaccines with HIV/CD4 status

Vaccination may be delayed if CD4% is <15%; BUT immunoglobulin may be given after exposure instead.

CD4% count is

Percentage of lymphocytes that are CD4+ and is used to assess immune status in HIV-infected individuals, and response to therapy

failure of treatment results in

development of drug resistance and treatment failure

Barriers to medication adherence

Denial, embarrassment w/ diagnosis, financial, adjusting to medication route

ART(antiretroviral therapy) initiation in infants begins

as soon as HIV infection is confirmed in infants.

Deferment of ART in asymptomatic older children occurs when

immune status is strong and viral load is low, but require close monitoring

Testing for HIV negative infants, but were exposed to HIV requires

repeat at 1-2 months of age then 4-6 months

Adams forward bend test

Screening maneuver to detect scoliosis by observing spine symmetry during forward bending. also assess flexibility by turning side to side

Scoliometer

screening tool that will tell you whether you need further eval. Readings greater than 7–10% indicate further evaluation.

Cobb angle

magnitude of curve and is done by taking top and bottom degree

Risser scale

Assessment of skeletal maturity; higher score means less remaining growth potential.

Sanders bone age

Radiographic assessment of hand/wist to look at epiphyseal growth plates to see how much growth they have left

AIS (Adolescent idiopathic scoliosis)

Most common scoliosis in adolescents; multifactorial etiology with possible genetic predisposition.

Double curves (scoliosis)

Two adjacent spinal curves; progression is a risk greater than single curves.

RSC brace is

the only brace that helps correct the curve but needs to be combined with the schroth method

Always wear tight fitting shirts under brace to prevent

skin breakdown

SpineCor brace

don’t use this brace, it does not help prevent curve progression

TLSO brace and Boston brace

prevent curve progression, does not correct it

Schroth method

Specialized scoliosis exercises to de-rotate and elongate the spine and reduce curvature. used in combo with RSC brace

Cobb angle threshold for surgery

greater than 45 degrees

complications of surgery

bleeding, pain, infection, nerve damage

Determining factors of curve progression

gender, curve magnitude at time of diagnosis, growth potential

Tanner stage growth spurt for males

3-5

Tanner stage growth spurt for females

2-3

What can causes curve progression even more

double curves, gender (females progress more than males), peak height velocity

S/sx of scoliosis

one shoulder, hip, rib cage, is higher than the other. uneven waist, uncentered head

Pain only the spine and urine incontinence is not a normal symptom of

scoliosis

Females are screened twice at the age of

10-12 yrs

Males are screened once at the age of

13-14 yrs

How to correct scoliosis during surgery

bone grafts are placed to fuse the vertebrae along the spine and it is stabilized with a rod

How long does it take for vertebrae to fuse

3 months and 1 yr until it is complete

Congenital (idiopathic or true clubfoot)

most common

Positional clubfoot

occurs in utero

Syndrome clubfoot

congenital abnormalities, more severe

S/sx of clubfoot

small foot, short achilles tendon, underdeveloped calf muscle, empty heel bed, normal leg lengths but appears short bc of the achilles tendon

Diagnosis of clubfoot

inspection, MRI (rare), radiographs to confirm degree of severity

Tx for clubfoot

serial casting, successive casting

Serial casting aka Ponseti method

move and stretch the feet, cast & repeat. Initially every few days for the first 1-2 weeks then every 1-2 weeks until max correction.

Last step. of ponseti method

cut achilles tendon

Once clubfoot is corrected, then child must

wear Dennis brown splint or corrective shoes

Dennis-Browne splint is worn

for 3 months 24 hrs a day then after it is nightly until 4 yrs of age

Tenotomy

Surgical cutting of a tendon (commonly Achilles) to release tightness in clubfoot correction.

Talipes equinovarus (clubfoot) is

diagnosed in utero

Rocker bottom foot

due to overcorrection from casting

Clavicle fracture (peds)

Common fracture in children; rare in infants; typically from falls.

Stress fracture

Overuse fracture commonly seen in adolescents; chronic pain at a single bone site.

Fat embolism syndrome (trauma)

Fat droplets in blood after trauma or fracture, causing dyspnea, tachycardia, tachypnea, and petechiae.

Fracture signs

Deformity, pain, tenderness, swelling, edema, reduced range of motion, crepitus.

Closed reduction

Nonoperative realignment of a fracture.

Open reduction

Surgical realignment of a fracture.

Clavicle fracture is the most

common fracture in children

Salter-Harris determines

if there is any future bone growth involvement and indicates fracture of epiphyseal plate

Osteomyelitis is a

Bone infection

Hematogenous osteomyelitis

Bone infection spread through blood; common in children.

Exogenous osteomyelitis

Bone infection from outside source (surgery, wound).

Laboratory markers for osteomyelitis

Elevated ESR/CRP and leukocytosis; blood and bone cultures aid diagnosis.

Imaging for osteomyelitis

CT/MRI; blood and bone cultures guide therapy.

Osteomyelitis treatment duration

IV antibiotics for 1 week then oral antibiotics for 6–8 weeks

education for casting

don’t put powder or anything inside if itching just put cool air, elevate, and keep an eye for skin breakdown

Community acquired MRSA treatment

IV antibiotics for 6–8 weeks

Compartment syndrome

Increased pressure within a fascial compartment causing severe pain; requires cast removal or fasciotomy. caused by IV infiltration, immobilizing device

s/sx of Fat embolism

dyspnea, restless and fever and petechiae, tachycardia, tachypnea, and hypoxia

signs of compartment syndrome

severe pain unrelieved by pain med, pallor, no sensation, no pulse.

S/sx of osteomyelitis for infants is

very vague/non-specific

S/sx of osteomyelitis for older children

decreased ROM, fever, lethargic, and pain/warm/tenderness over site of infection

Osteomyelitis management nursing considerations

Monitor vitals, ensure antibiotic adherence, watch for isolation needs and rehabilitation.