nurs 303 nursing care of children & families musculoskeletal disorders & trauma

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  • NURS 303 Nursing Care of Children & Families Musculoskeletal Disorders & Trauma
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  • Nursing Diagnoses Pain related to inflammation Impaired ability Self-esteem disturbance related to need to wear brace or cast Diversional activity deficit related to restricted activity.
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  • Genu Varum Bowlegs Malleoli of ankles touch, medial surface of knees are over 1 inch apart. Seen most commonly in 1-year-olds. Corrects itself by normal growth. Blounts Disease is failure of growth of epiphyseal line of tibia. Serious Disorder. Corrected by bracing or osteotomy.
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  • Genu Valgum Knock Knees Medial surfaces of knees touch, ankles are separated by more than 1 inch. Corrected by normal growth.
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  • Talipes Deformities Club foot Plantar flexion Dorsiflexion (heel lower than foot) Valgus: foot turns out Varus (foot turns in) equinovarus (down and in) calcaneovalgus (heel down and out)
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  • Talipes Deformities Some newborns have intrauterine deviation True condition cannot be brought back into line. Therapy: cast to above knee Change frequently as child grows so rapidly. Teach parent to do neuro check of foot.
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  • Hip Dysplasia Shallow acetabulum of hip allows femur to ride up in socket. Assessment: Extra skin folds on affected side. Hip does not abduct. Click heard on abduction (Ortolanis sign)
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  • Hip Dysplasia Therapy: Keep hips in abducted (frog leg) position. Frejka splint Pavlik harness Long term correction. Good results
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  • Legg-Calv-Perthes Disease Avascular necrosis of the proximal femoral epiphysis. More frequent in males than female Peak age of incidence: 4-8 yrs.. Assessment: Pain in the hip joint limitation of motion due to spasm X-ray reveals problems.
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  • Legg-Calv-Perthes Disease Therapy: In the past, child couldnt put weight on leg for 18 months. Today, they wear a brace which abducts the hip and brings femur head unto good alignment OR Surgery to center the femur head. May need a spica cast for 3-4 months.
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  • Legg-Calv-Perthes Disease Evaluation: Without correction, degenerative changes occur that might necessitate hip replacement in later years.
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  • Osgood Schlatter Disease Enlargement of tibial tuberosity from stress Occurs in preadolescence Athletic children Assessment: Pain and swelling below knee Aggravated by running /squatting
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  • Osgood Schlatter Disease Therapy: Limit exercise Brace to immobilize knee for 6 weeks. Evaluation: Good outcome
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  • Slipped Capital Femoral Epiphysis Slipping of femur head at neck epiphyseal line Destroys circulation to femur Occurs in preadolescence Most frequent in African-Americans Obese or rapidly growing
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  • Slipped Capital Femoral Epiphysis Assessment: Hold leg externally rotated May have knee pain from strain on knee Therapy: Surgery to stabilize femur head Evaluation: 30% develop same problem in second hip.
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  • Osteomyelitis Infection of bone Staphylococcus aureus in older children Hemophilus infuenzae in young children Children with sickle cell are particularly susceptible.
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  • Osteomyelitis Assessment: High fever, pain Skin over area feels warm and redeened. Positive blood culture Therapy: Intravenous antibiotics Rest to infected bone
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  • Osteomyelitis Evaluation: Will continue on oral antibiotics for extended time. Chronic infectious process with sinuses draining to surface can be result. Growth plates can be destroyed.
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  • Scoliosis Lateral curvature of the spine Most frequent in girls Have a primary and secondary curvature. Begins in preadolescence Family tendency
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  • Scoliosis Assessment: Mandatory screening in schools More obvious in thin than obese children X-ray reveals deformity. Therapy: Curve between 20 and 40 degrees, bracing may be use. Over 40%, surgery with spinal rods
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  • Scoliosis Postoperative Care: Keep back straight. Log roll. Hemovac drains to remove blood. NG tube for paralytic ileus Assess for lower extremity circulation & movement. Provide pain relief (PCA?)
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  • Juvenile Rheumatoid Arthritis (JRA) Inflammation of connective tissue Incidence peaks at 1-3 years or 8-12 yrs. Probably an autoimmune proves More common in girls than boys Joints are inflamed and very painful on movement.
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  • Juvenile Rheumatoid Arthritis (JRA) Therapy: Program of physical exercise Rest inflamed joints during acute inflammation. Heat application Splinting to maintain alignment Anti-inflammatory drugs (May receive aspirin or Motrin) Nonsteroidal anti-inflammatory drugs NSAIDS or DMARDS (naproxen) Steroid such as prednisone
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  • Juvenile Rheumatoid Arthritis Evaluation: Most today do not have permanent deformities. Maintain long term drug therapy. May have iris involvement.; need frequent eye examinations.
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  • Muscular Dystrophy Occurs in several types. Most common is inherited as sex linked recessive and occurs only in boys. Pseudohypertrophic (Duchennes Disease) Assessment; Progressive skeletal muscle weakness Positive Gowers sign. Slip through hands.
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  • Muscular Dystrophy Therapy: Keep ambulatory as long as possible. Try and avoid over weight.
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  • Trauma Infant: falls, aspiration, drowning Preschool: Falls, drowning, MVA, poisoning, burns Schoolage: MVA, bicycle, drowning, burns, firearms. Adolescence: MVA, drowning, falls, firearms. Be aware that trauma may the result of abuse
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  • Head Injuries Subdural hematoma: Bleeding into space between dura and arachnoid membrane from a lacerated vein. Most frequent in infants. Assessment: Symptoms: ICP; seizures, vomiting, enlargement of head, anemia Angiography Therapy: Subdural puncture through anterior fontanelle. Surgery to repair lacerated vein.
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  • Head Injuries Epidural hematoma Bleeding into space between dura and the skull from a lacerated artery. Result of severe head trauma bleeding is extreme. Assessment: Vomiting, LOC, headache, seizures, hemiparesis, unequal pupil dilatation, decorticate posturing Sonogram Therapy: OR to repair damaged vessel.
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  • Concussion Head injury from a hard, jarring shock. Assessment: At least transitory LOC at time of injury. No memory for accident. To test alertness: Ask to name a familiar object, name a color or name Children dont do this well (bored with exercise). Parents assess Q2h while at home.
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  • Coma Unconsciousness from which children cannot be roused Stupor: Grogginess from they can be aroused. Based on Glasgow coma scale.
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  • Glasgow Coma Scale Areas Assessed: Eye opening(1-4) Motor Response (1-6) Verbal Response (1-5) Total is 15. 3-8 = severe trauma; 9-12 = moderate; 13-14 = slight.
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  • Glasgow Come Scale Scoring Eye Opening 4. Child opens eyes spontaneously when you approach. 3. Child opens eyes in response to speech (spoken or shouted) 2. Child opens eyes only n response to painful stimuli such as pressure on a nail bed 1. Child does not open eyes in response to painful stimuli (tested by eye pressure)
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  • Glasgow Come Scale Scoring Motor Response 6. Child obeys simple commands such as hand me a toy (infant smiles or attunes) 5. Child moves an extremity to locate a painful stimuli applied to head or trunk. 4. Child withdraws from source of pain. 3. Child flexes arms at the elbows in response to painful stimuli (decorticate rigidity) 2. Child extends arms in response to painful stimuli (cerebrate rigidity) 1. Child has no motor response to pain.
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  • Glasgow Come Scale Scoring Verbal Response 5. Child is oriented to time, place and person (over 4 yrs, knows name, date + where he is; infant recognizes parents. 4. Child can converse, although not oriented X3. 3. Child speaks but words make no sense; infants vocabulary is less than usual. 2. Child makes incomprehensible sounds or groans. 1. Child does not respond verbally at all.
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  • Abdominal Trauma Spleen and Liver trauma greater in children than adults. Assessment: ABD tenderness X-ray shows fluid level in abdomen. Paracentesis reveals blood. Liver enzymes are elevated. Anemia
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  • Dental Trauma Dislodged teeth should be washed in water and replaced or dropped in salt water or milk and taken to E.R. Tooth is replaced and wired into place. Antibiotics & tetanus prophylaxis may be administered. Teeth may discolor.
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  • Near Drowning Episode of suffocation from submersion in liquid. First reaction is spasm of larynx. Simple asphyxia. Can be revived easily. Second reaction is airway relaxation; water enters. Blocks exchange space; carries contaminants. Young children have a diving reflex in cold water.
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  • Near Drowning Therapy depends on type of water: Salt Water is hypertonic; fluid shifts i


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