Peds Exam 1 Ortho PDF

What are common barriers to medication adherence? - Non-compliance development of drug resistance and tx failure - Barriers: o Palatability  Unpleasant taste, texture, or odor can lead to non-compliance o Adjusting medication routine to existing rout...

What are common barriers to medication adherence? - Non-compliance development of drug resistance and tx failure - Barriers: o Palatability  Unpleasant taste, texture, or odor can lead to non-compliance o Adjusting medication routine to existing routines  Adjustments can create confusion, inconvenience, or interfere with the patient’s lifestyle  Poor communication about the importance of adherence, complex medication schedules, and disruptions to daily routines can all contribute to non-compliance o Denial o Embarrassment o Financial Nursing Care Plane - Deficit knowledge - Risk for infection imbalanced nutrition - Impaired gas exchange - Ineffective airway clearance - Risk for impaired skin integrity - Delayed growth and development - Acute and chronic pain - Anxiety - Ineffective Therapeutic Regimen  Pediatric Orthopedics Study Guide Scoliosis is defined as a lateral curve in the spine greater than 10 degrees. What is the most common form of scoliosis? - Adolescent Idiopathic Scoliosis Type Common Age of Onset Important Facts Adolescent Idiopathic 10-16 years  Most common form  Possible genetic link  More common females  Surgery needed at  40  Only 10% have curve progression requiring medical attention Double curves progress more than single curves. Larger (20-40) curves progress more than smaller(20-30) curves. Which gender is likely to have a further curve progression? - Females Why are curves more likely to progress during Tanner stages? - Due to growth spurt in short time frame During which Tanner stages does a growth spurt occur? - Females- 2-3 - Males- 3-5  Hx: - Primarily diagnosis of exclusion possible underlying cause and curve Head not centered progression over body - Family hx - Present of pain and neurologic changes including bowel and bladder One shoulder higher dysfunction Atypical for AIS Unequal gaps between the arms and the trunk One shoulder-blade higher and possibly more prominent Spine obviously Determines of progression: One hip more curved - Gender prominent o Development of and sexual characteristics and recent growth patterns - Future growth potential o Tanner Age o Risser Scale o Bone Age o Menstrual onset estimate tanner stage and determine how much growth is left determines treatment o - Curve magnitude at time of diagnosis o Cobb Angle  determines the magnitude of - S/sx curve and assess superior and inferior o MSK discomfort vertebrae if scoliotic curve o Waist appears uneven o One leg appears shorter than the other but is nots not actually just appears Females screen twice 10 and 12 Males screened once 13 or 14 In the Adam’s Bend Forward test, it is important to assess for asymmetry in the contour of the child’s back, using a tool called a Scoliometer (screening tool only notes need for further evaluation) - bend forward at waist until spine is parallel with the floor while holding palms together with arms extended - Flexibility should be evaluated stabilize the spine and ask the child to twist to both sides - 90% of curves are to the right - If curve is to the left thoracic concern - Scoliometer  7 degrees refer to orthopedic What does a Risser scale evaluate? - Evaluates skeletal maturity  evaluation of growth potential Type of scoliosis Indicated Angle of Goal/Objectives Length of Tx Additional Facts treatment Curvature Bracing: - > 30  - Prevent curve - Worn 18- Types of braces include: - Compliance - Increases from progression 23 hr/day biggest 10-25 in short - Or until curve until issues period of time progression growth has poor results can’t be stopped controlled - Part/ nighttime for curves < 35 - Milwaukee - TLSO - Boston - Charleston - Providence - Spine-Core not effective - RSC tx lateral and rotation o Use in partnership with exercises Schroth Methods Surgery: Cobbs Angle >45 - Arrest N/A Complications include: - Fusing vertebrae progression - Bleeding along the curve - Achieve max - Post-op pain - Supporting fused permanent - Infection bones with correction - Nerve damage instrumentation - Improve - Pseudoarthrosis attached to spine appearance - Disk degeneration and low back - Bone grafts fuse - Keep short- pain the vertebrae and long-term - Complication that involves lungs together complications and circulation - Causedetermines to a minimum - Flat back syndrome with procedure type Harrington rod What is the most frequently occurring form of clubfoot? How does it present? - Involves bone deformities and malposition with soft tissue contractions - Early evaluation and treatment for optimal correction o Evaluation:  Antenatally  Visal inspection at birth  Radiographs confirm degrees and severity  MRI o Tx:  Serial casting start immediately  Allows for gradual stretching proof skin and tight structures on medial side of foot - TEV (Talipes Equinovarous) is the most common95% - Talipes Calcaneovarus 2nd most common  Complex deformity of both ankle and foot - Other symptoms: o Small foot o Shortened Achilles tendon o Underdeveloped calf muscle o Empty heel bed o Transverse plantar crease o Normal leg lengths Which gender is more likely to develop clubfoot? - Males are more likely almost twice as often o Bilateral50% of cases - A positive family hx increases risk Name some potential causes of clubfoot:  Intrauterine positioning responds to simple stretching and casting  Neuromuscular or muscle abnormality  Genetic Predisposition  Arrested fetal development of skeletal and soft tissue  Congenital abnormalities (idiopathic or true clubfoot) occur in otherwise healthy infants Most common form  Amniotic banding rare congenital disorder caused by fibrous strands from the amniotic sac entangling parts of a developing fetus  Oligohydramnios  Breeched Syndromic (tetralogic) is a more severe form of clubfoot and is often associated with other congenital abnormalities. With serial casting, how often are casts changed? How long does the process take? - Every few days for 1-2 weeks and then q1-2weeks until max corrections achieved o Max correction takes 8-12 weeks after starting serial casting o Then performs  casted for 1-2 weeks after this procedure - Avoid overcorrection can cause rocker bottom foot= overstretched Achilles tendon - Once corrected via serial casting child wears Denis Browne Splint-corrective shoes o First 3 months for 23hr/day o After 3 months they wear them while napping or overnight until they are 4 years old - If not corrected with serial casting-> surgical intervention is required between 3-12 months Key notes: - Outcomes are not always predictable results vary with: o Severity o Age of child at initial intervention o Compliance w/ tx o Development of bones, muscles and nerves - Surgical intervention doesn’t restore the ankle to the entirely normal state o Affect foot anf leg remains smaller and thinner than nonaffected - Nursing Diagnosis o Impaired physical mobility o Risk for impaired parenting o Risk for delayed motor development o Risk for altered parent/ infant relationship  Type of Injury Location Definition Sprain Ligament Severe trauma to a joint causing a ligament to be partially or completely torn ACL, POOPING NOISE Strain Tendon Injury to the muscle neat the musculotendinous junction resulting from a forceful contraction of the muscle Dislocation Joint - A dislocation displacement of bones that form a joint resulting from trauma that cause complete displacement of adjoining bones= all contact is lost - A subluxation is a partial or incomplete dislocation still some contact between the adjoining bones is retained HIP HAS TO BE RESOLVED WITHIN 1 HR Separation Salter Harris Fracture Epiphysis Straight across growth plate no bone Plate involvement end part of a long bone Metaphysis above growth plate Epiphysis Rounded end Contusion Muscles - Damage to soft tissue, subcutaneous structure and Soft tissue muscle  - Treatment: o RICE= Rest, Ice, Compress, Elevate o Immobilization o Nursing Intervention - Nursing: o Initial Assessment:  Cause  Examine  Neurovascular evaluation o Assess and manage fat embolism  After crush injury of long bones  Dyspnea, restless, fever over 103, petechia rash, tachycardia, tachypnea, hypoxia o Cast Care - Fracture Complications o Infection o Neurovascular injury  Damage to both nerves and blood vessels at or near the site of a fracture o Vascular injury  Damage to the blood vessels (arteries or veins) in or around the site of a fracture o Malunion or Delayed Union  Malunion occurs when a fractured bone heals in the wrong position or with an improper alignment  Delayed UnionFracture takes longer than expected to heal, but the healing process is still progressing o Leg length discrepancy The five stages of bone healing include: Rapid in children thick periosteum 1. Hematoma w/in first 24hrs a. Localized collection of blood outside of blood vessels, usually in a tissue or organ, caused by trauma, injury, or damage to the blood vessel 2. Cellular proliferation proliferation of bone cells 3. Callus formation provisional callus that envelops the fracture 4. Ossification new bone forms 5. Consolidation and Remodeling regular bone replaces callus What is the most commonly fractures bone in children? - Causes by increased mobility and/or immature motor and cognitive skills - Traumatic musculoskeletal injuries most common - Clavicle most common broken bone Why might fractures be less common in infants and more common in toddlers? - InfantsFractures are less common due to their softer, more flexible bones and limited mobility - Toddlers fractures are more common because of their increased mobility, explorative behavior, and developing bone structure, which puts them at a higher risk for falls and accidents Stress Fracture - An area of chronic pain that is localized don a bone with focal tenderness could likely be a stress fracture. - Overuse injury - Becoming more common in adolescents w. limit calorie and calcium intake that remain lean for sports o Recommended daily allowance (RDA) of calcium for adolescence is 1500 mg/daily. - Symptoms: o Chronic pain changes with intensity o Focal tenderness in a singular site on the bone o Immobility or decreased ROM o Deformity of extremity o Edema, Crepitus, Ecchymosis or Muscle spasms - Diagnostic o X-ray What is the difference between an open and closed reduction? - Closed reduction is a non-surgical procedure used to manually realign a fractured bone without making any incisions in the skin o Use for:  Fracture is simple, non-displaced, or minimally displaced o Muscle relaxant w/ casting and reduction - Open reduction is a surgical procedure used to realign a fractured bone by making an incision to access the bone directly o Used for:  Complex fractures, displaced fractures Compartment Syndrome - Results from swelling cause by trauma and immobilizing device. - Symptoms: o Pallor o Paresthesia o Weak/absent pulses distal to trauma o Severe pain not relived with analgesics o Pain w/ extension of fingers or toes Osteomyelitis is most common between which ages? - Infection of the bone that occurs in the metaphyseal region of long bones above the growth plate; wide area of femur/bone - Most frequent between 5-14 yrs What are the differences between exogenous and hematogenous osteomyelitis? - Exogenous- direct inoculation from outside bone - Hematogenous- spread of organism from pre-exiting infection o Acute develops symptoms