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97 Cards in this Set
- Front
- Back
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What is immobilization?
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1. Fixation of a body part so that it cannot move during surgery or after setting of a fracture
2. Prolonged inactivity of an individual, as with bed rest of neurologic injury such as coma, paraplesia or quadraplesia |
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What is bedrest?
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A therapeutic intervention to assist with healing and restorative process
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Which group has the most difficulty coping with immobility?
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Children whose diagnosis impose permanent or lengthy physical limitations
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What does immobilization affect?
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Affects all aspects of growth and development (physical, social, emotional)
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What are the musculoskeletal effects of immobilization?
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1. Loss of muscle strength/mass and endurance at 3% per day
2. Track creatinine 3. Wristdrop/footdrop 4. Bone demineralization leading to osteoporosis 5. Establish physical therapy within 3-7 days to prevent contractures 6. Track calcium 7. Loss of joint mobility/contractures |
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What are the cardiovascular effects of immobilization?
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1. ↓venous return = ↑workload
2. DVT 3. Orthostatic hypotension |
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What are the respiratory effects of immobilization?
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1. Shallow respirations
2. Supine = pneumonia (PNA) 3. Atelectasis |
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What are the renal effects of immobilization?
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1. Urinary stasis/retention = UTI
2. Stone formation |
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What are the gastrointestinal effects of immobilization?
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1. Negative nitrogen balance
2. ↓appetite 3. Aspiration 4. Defecation problems |
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What are the metabolic effects of immobilization?
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1. Altered BMR = fatigue
2. Delayed healing |
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What are the skin/integumentary effects of immobilization?
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Pressure ulcer from tissue compression/hypoxia and shear/friction
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What are the psychological effects of immobilization?
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1. Diminished stimulation from isolation = feel forgotten, bored
2. Activity needed for normal growth & development 3. Outlet for anxiety = lead to bad dreams 4. Loss of touch 5. Inhibits language and speech development 6. Thwarts development of autonomy and independence = regression and behaviorial changes |
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What are the family effects of immobilization?
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1. Financial burden = cost of illness and/or loss of work to be with child
2. Challenges in accepting child’s diagnosis 3. Difficulty coping 4. Feel guilty 5. Siblings may feel left out 6. Caretaker role strain |
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What nursing care is provided to the immobilized child?
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1. Provide opportunities for stimulation
2. Advocate for PT/OT orders 3. Involve Social worker 4. Frequent position changes 5. Monitor labs (calcium, creatinine) 6. Monitor I/O – urine odor/color, BM 7. Monitor diet, nutritionist consultation |
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What are the opportunities to stimulate an immobilized child?
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1. Use of wagon, stretcher to take to playroom, “walk” in hall
2. Bring developmentally appropriate toys into room 3. Encourage family, friend visits 4. HW, tutor for school aged child 5. Involve Child-Life specialist |
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How can nurses advocate PT/OT orders for the immobilized child?
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Get out of bed as often as able
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How should the skin be assessed for integrity and/or impairment?
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Assess skin daily using Braden scale
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How should diet be monitored for the immobilized child?
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1. Allow healthy food choices from home
2. Encourage protein, nutrient rich foods |
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What is the significance of the mobilization devices?
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1. Variety of options to allow child to become mobile
2. Fit very important – check for irritation, skin breakdown frequently 3. Need position changes 4. Consult with PT as needed to determine proper fit and device |
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What are the pediatric variations of the skeletal system?
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1. ↑Physical mobility & ↓coordination = ↑suspectibility to fractures
2. Each development group has a common bone/joint that is fractured/injured 3. Bones more pliable in kids – fracture easier than adults 4. Bones more porous (bend) 5. Bones still ossifying 6. Growth plate (epiphyseal plate) cushions, but if damaged growth can be disrupted |
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What is the most common bone/joint that is susceptible to fractures/injuries in infants?
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Clavicle
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What is the most common bone/joint that is susceptible to fractures/injuries in adolescents?
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Knee
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What is the weakest area of long bones?
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Growth plate (epiphyseal plate)
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How should trauma be assessed?
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1. Investigate unreasonable crying, restlessness
2. Note evidence of “old” fractures 3. Match story of injury to actual injury |
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What is an index of suspicion?
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An indication of how seriously a particular disease is being used as a diagnosis
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What is of high concern in infants?
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Fractures or signs of fractures
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What is a spiral fracture indicative of?
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Usually abuse
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What are the phases of bone healing?
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1. Inflammatory
2. Restorative 3. Remodeling |
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What is the inflammatory phase of bone healing?
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Formation of hematoma (giant blood clot)
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What is the restorative phase of bone healing?
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1. Hematoma resorbed
2. Osteoblasts proliferate 3. Callus formation 4. Union of fractured bone |
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What is the remodeling phase of bone healing?
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Bone restored, influenced by stress placed on the bone
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What is rapid healing?
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1. Inversely r/t age
2. Thick periosteum, rich blood supply |
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What is unusual with bone healing?
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Stiffness at the union site
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What is required for proper bone healing?
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Adequate nutrition
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What is a hip spica cast?
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1. Essentially a whole body cast
2. Often applied for months 3. Need to ensure adequate developmental stimulation |
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What is the necessary care for a child in a hip spica cast?
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1. Allow good air circulation around cast first 24-48 hrs (turn patient every 2 hours)
2. Check CSMT frequently 3. Keep groin area free of stool and urine 4. Tuck small diaper into opening and cover with larger diaper and change frequently 5. Petal edges with waterproof material 6. Check for regular BM 7. Proper positioning for feeding and car seat 8. Head elevation while supporting back and hips 9. Social worker may assist with finding special car seat |
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What is the nursing care of a child with a fracture?
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1. Assess 5 – “Ps”
2. Check for Compartment Syndrome 3. Check for Pulmonary Emboli 4. Check for Nonunion Fracture |
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What are the 5 P's for assessing a fracture?
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1. Pain
2. Pallor 3. Pulse 4. Paralysis (movement) 5. Paresthesia (sensation) |
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What is compartment syndrome?
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1. ↑pressure (swelling and edema) in a close space (muscles enclosed in fascia)
2. Early recognition key to preventing LT complications |
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What is the treatment for compartment syndrome?
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Fasciotomy
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What causes pulmonary embolism in a child with a fracture?
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Clots break off from the formed hematoma and travel to lungs
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What is nonunion fracture?
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Fragments too far apart to bridge gap
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What complications are associated with nonunion fracture?
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1. Infection
2. Poor nutrition 3. Steroids |
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What is a great outlet for children?
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Sports
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What is a main cause of sports injuries?
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Parents are too involved and push the child beyond abilities
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What is important to prevent sport injuries?
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1. Match child sizes, abilities
2. Doing warm-ups |
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Where is sports injuries seen?
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Significant injuries occur in recreational sports as well as team
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What are the common sports injuries?
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1. Soft tissue injuries
2. Overuse |
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What are the treatments for soft tissue injuries and overuse?
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1. RICE = rest, ice, compression, elevation
2. NSAIDs 3. Nutrition (Water, Calories, Iron) |
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What do female athletes commonly experience?
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1. Amenorrhea
2. Osteoporosis 3. Increased eating |
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What are the life-threatening conditions related to sports injuries?
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1. Cardiac = congenital anomalies, commotio cordis
2. Temperature related = hypothermia or heat stroke |
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What is developmental dysplasia hip?
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Dysplasia (delay in acetabulum dev); subluxation (femur head can be displaced); dislocation
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What are the manifestations of developmental dysplasia hip?
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1. Displace femoral head
2. Uneven gluteal folds 3. Asymmetric abduction 4. Uneven knees 5. Limited ROM 6. Leg length discrepancy |
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What is the treatment for developmental dysplasia hip?
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Treatment dependent upon severity of DDH and age of discovery – harness to casting to open reduction
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What is congenital clubfoot?
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1. Involves bone deformity and soft tissue contracture
2. Rigid, can't be placed into neutral position |
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What causes congenital clubfoot?
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Genetic predisposition, some neuromuscular disorders (ie spina bifida)
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What is the treatment of congenital clubfoot?
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Fixed, serial castings at birth– surgery if not resolved at 6 mos
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What is Legg-Calve-Perthes disease?
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Disturbance in circulation to femur head
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What is the onset of Legg-Calve-Perthes disease?
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1. Occurs over 18mos – years but is self-limiting
2. Insidious onset |
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What are the manifestations of Legg-Calve-Perthes disease?
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1. Limp
2. Pain 3. ↓ROM in hip |
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What are the treatments of Legg-Calve-Perthes disease?
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1. Keep femur head inside acetabulum
2. Rest, non-weight-bearing (NWB), surgical correction 3. Early diagnosis ↓arthritis, so younger child will have better prognosis |
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What is slipped femoral capital epiphysis (SFCE)?
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Spontaneous displacement of proximal femoral epiphysis
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What is the onset of slipped femoral capital epiphysis (SFCE)?
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Occurs just before or during pubertal growth spurt, often overweight
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What are the manifestations of slipped femoral capital epiphysis (SFCE)?
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1. Limp
2. Hip pain |
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What are the treatments of slipped femoral capital epiphysis (SFCE)?
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1. Non-weight-bearing (NWB)
2. Surgical pin placement |
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What is scoliosis?
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Lateral curvature of spine (>10 degrees), vertebrae rotate & pull ribs, thoracic hypokyphosis
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What are some causes of scoliosis?
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1. Congenital
2. Neuromuscular |
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What is the onset of scoliosis?
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Early adolescence at beginning of growth spurt
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What are the manifestations of scoliosis?
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1. Observed curvature
2. XR (to determine degree of curvature) |
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What are the treatments of scoliosis?
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1. Braces (slows curvature formation, best for <40 degree curve)
2. Surgical fusion using bone grafts with internal rod fixation (Harrington or Dwyer) – surgical approach may be anterior or posterior, although posterior most common |
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What is the nursing care for a child with scoliosis in braces?
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1. Correct application
2. Assess skin breakdown 3. Provide psych support |
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What is the nursing care for a child with scoliosis post surgery?
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1. Anterior approach – CT
2. Promote mobility – logroll q 2h, no supine, physical therapy 3. Neurologic damage – assess LE q4h 4. Wound – large drsg, drain(s), WBC 5. Pulmonary – TCDB, I/S, O2 sats 6. Pain – HUGE Owie – PCA 3-4d 7. Abdomen – Check BS, advance diet slowly, BM 8. Blood loss – Check H/H, color and amount |
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What is osteomyelitis?
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Bacterial invasion (usually Staph) via exogenous or endogenous (blood) routes causing abscess, necrosis and sequestration
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What are the manifestations of osteomyelitis?
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1. Fever
2. Pain 3. Lethargy 4. Sepsis |
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How is osteomyelitis diagnosed?
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1. MRI/CT
2. Bone scan 3. ESR 4. CBC |
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What are the treatments for osteomyelitis?
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1. Long-term, high dose antibiotics
2. Bed rest, CMST 3. Pain control |
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What is juvenile idiopathic arthritis?
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Chronic inflammatory disease of the synovium that affects the joints and other tissues
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What are the characteristics of juvenile idiopathic arthritis?
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1. Variable and unpredictable course
2. May “outgrow” but ↑arthritis as adult 3. No Cure |
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What are the manifestations of juvenile idiopathic arthritis?
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1. Stiffness
2. Swelling 3. ↓motion in affected joints 4. Warm to touch 5. Flareups triggered by infection 6. Injury 7. Fever 8. Rash 9. Pericarditis 10. Uveitis |
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What are the diagnostic tests for juvenile idiopathic arthritis?
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1. No definitive test
2. Neg RF 3. ↑ESR 4. ANA 5. ↑WBC |
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What are the treatments for juvenile idiopathic arthritis?
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1. Control inflammation (NSAID, MTX), steriods if above not effective, Etanercept, other cytotoxic agents
2. Exercise, physical therapy 3. Good diet 4. Sleep and rest |
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What is systemic lupus erythematosus (SLE)?
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Chronic multisystem autoimmune disease of the blood vessels and connective tissue
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What causes systemic lupus erythematosus (SLE)?
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1. Variable course from mild to life-threatening
2. Cause unknown – genetic with unidentified trigger |
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What are the manifestations of systemic lupus erythematosus (SLE)?
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1. Fever
2. Fatigue 3. Weight loss 4. Arthralgia 5. Butterfly rash 6. Renal involvement from circulating immune complexes – prognosis guarded 7. Neuropsychiatric – serious complication |
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How is systemic lupus erythematosus (SLE) diagnosed?
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4 of 11 criteria present
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What are the criteria for diagnosing systemic lupus erythematosus (SLE)?
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1. Malar rash
2. Discoid rash 3. Photosensitivity 4. Oronasal ulcers 5. Arthritis 6. Serositis 7. Renal disorder 8. Neurologic disorder 9. Hematologic disorder 10. Immunologic disorder 11. Antinuclear antibodies |
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What are the treatments for systemic lupus erythematosus (SLE)?
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1. Regular monitoring of urine and behavioral status for renal and psych involvement
2. Steroids, NSAIDs, Cytotoxic agents if needed 3. Proper diet 4. Avoid sun 5. Exercise 6. Rest 7. Handwashing 8. Family support |
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Immobilization causes which of the following effects on the cardiovascular system?
A. Venous stasis B. Increased vasopressor mechanism C. Normal distribution of blood volume D. Increased efficiency of orthostatic neurovascular reflexes |
A. Venous stasis
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A young child has recently been fitted with knee, ankle, and foot orthosis (brace). Care of the skin should include which of the following?
A. Apply lotion or cream to soften skin. B. Contact practitioner or orthotist if skin redness does not disappear. C. Place padding between skin and brace if child experiences burning sensation under brace. D. If small blister develops, apply rubbing alcohol and place padding between skin and brace. |
B. Contact practitioner or orthotist if skin redness does not disappear
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A child, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, the nurse should consider which of the following?
A. This type of fracture is inconsistent with a fall. B. Bone growth can be affected by this type of fracture. C. This is an unusual fracture site in young children. D. Healing is usually delayed in this type of fracture. |
B. Bone growth can be affected by this type of fracture
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Which of the following would cause a nurse to suspect that an infection has developed under a cast?
A. Cold toes B. Increased respirations C. Complaint of paresthesia D. "Hot spots" felt on cast surface |
D. "Hot spots" felt on cast surface
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Which of the following statements is correct regarding sports injuries during adolescence?
A. Rapidly growing bones, muscles, joints, and tendons offer some protection from unusual strain. B. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. C. More injuries occur during organized athletic competition than during recreational sports participation. D. Adolescents may not possess insight and judgment to recognize when an activity is beyond their capabilities. |
D. Adolescents may not possess insight and judgment to recognize when an activity is beyond their capabilities
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A 4-year-old is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include which of the following?
A. Encourage normal activity for as long as possible. B. Explain the cause of the disease to the child and family. C. Prepare child and family for long-term, permanent disabilities. D. Teach family the care and management of the corrective appliance. |
D. Teach family the care and management of the corrective appliance
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The nurse is preparing an adolescent girl for Dwyer instrumentation to treat scoliosis. Which of the following should the nurse include?
A. Urinary catheter may be required. B. Ambulation will not be allowed for up to 3 months. C. Surgery eliminates the need for casting and bracing. D. Discomfort can be controlled with nonpharmacologic methods. |
A. Urinary catheter may be required
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An important nursing consideration when caring for a child with juvenile rheumatoid arthritis would be which of the following?
A. Apply ice packs to relieve stiffness and pain. B. Administer acetaminophen to reduce inflammation. C. Teach child and family correct administration of medications. D. Encourage range-of-motion exercises during periods of inflammation. |
C. Teach child and family correct administration of medications
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Which of the following clinical manifestations of developmental dysplasia of the hip would be seen in the newborn?
A. Lordosis B. Ortolani sign C. Trendelenburg sign D. Telescoping of the affected limb |
B. Ortolani sign
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A newborn with congenital clubfoot is being treated with successive casts. The parents ask why so many casts are required. The nurse should explain that:
A. Casts are needed for the traction. B. Each cast is good for only 6 weeks. C. Surgical intervention will not be necessary. D. They allow for gradual stretching of tight structures. |
D. They allow for gradual stretching of tight structures
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