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Once cast is removed the skin will be dry and flaky. Wash the area with warm water and soap. Discourage the child from scratching. Extremity will be stiff and look smaller because the muscles have not been used. May need to be supported with a sling. Normal movement will correct the stiffness
What specific nutrition teaching would be important for a child with a fracture?
Prevent complications of immobility - hydrate
Calories / based on weight/height
Healing/ calcium, protein, vitamins/minerals (calcium, vit D, phosophurus), fiber
a. see with hip or pelvis fractures mostly. DVT prevention is early return to ambulation when possible, post op physiotherapy and elevate extremity
Fat Embolism - particles of fat are carried through circulation and lodge in lung capillaries causing pulmonary edema or respirator distress with hypoxemia and respiratory acidosis.
TX fat embolism by increasing IV fluids and using respiratory support and adequate oxygenation
Pain unrelieved by analgesics
Numbness, pins and needles, electricity like pain
Excessive pressure inside enclosed space due to bleeding (internal) or constriction (external)
Circulation is affected/tissue is impaired
Treated by faciotomy. Nurse will loosen constrictive dressing bandage/tape
Cast cutters@ bedside
Place affected extremity @ level of heart No higher. Since this decreased arterial flow narrowing arterial - venous pressure gradient (allowing more blood to seep into tissue)
NPO since they are going to surgery
Give oxygen and pain meds
Call DR for emergency fasciotomy
What is the most serious complication associated with skeletal traction?
Osteomyelitis - an infection involving the bone.
What is the pathology related to a congenital hip dislocation?
Head of femur is improperly seated in the acetabulum (cup of the pelvis) of the pelvis
Unknown cause. Assessment is done with normal newborn exam. May be increased in frank breech births. Often affects bilateral hips
3. What is Ortolani sign – how performed? How does the nurse interpret the results of this procedure?
Barlow test - Femoral head moves out of acetabulum or becomes dislocated with adduction.
Ortolani Test - Femoral head reduces or relocateds after the barlow’s maneuver or abduction has been performed
3. How does the Pavlik harness corrects this anomaly by maintaining the hip in which 3 positions?
Ensures hip flexion and abduction. Does not allow hip extension or adduction. Maintains correct position of the femoral head in the acetabulum
3. What is a possible complication of interrupted blood supply to the head of the femur if the infant’s hip is malpositioned in a Pavlik harness? How does this potential complication relate to important parental teaching about adjusting straps on the device?
Affected leg will be shorter, limp, marked lordosis/waddle, delay in walking
It is important to teach parents about managing the device to protect skin (T-shirt or diaper shirt underneath). They may remove for bathing once daily
Can cause necrosis of femoral head so parents must not shorten or lengthen straps or tighten or loosen buckles
Teach parents to remove and apply harness appropriatley - only remove for bathing and skin checks.
Teach skin assessment
Encourage cuddling infant to promote cognitive development and infant/caregiver bonding
Parents must not adjust buckles
3. List 5 actual or potential problems encountered when caring for a child in a spica cast.
Spica cast covers lower half of body except perineal area
5 actual potential problems with spica cast
A. Resp. (assess breathing patterns and lung sounds frequently)
B. Skin and neuro assessments q 2hr to detect skin breakdown or problems with circulation
C. Padding on popliteal area to prevent breakdown (use moleskin or petal/flute edges of cast)
D. Position change q 2hr and encourage nutrition
E. Monitor for constipation
Elimination/protection of cast
C. Neurovascular assessment
D. Skin care
E. Hygiene (triple diapering)
3. What is the priority goal in the care of the infant with a clubfoot (talipes equinovarus)?
Stretch tightened ligaments and tendons gently over time
Return the foot to optimum anatomic position
Genu Varum: Bow legs
Normal in children under 18
Straighten as children begin to lose weight and walk around 12-18 months
No tx unless extreme. May need to rule out rickets
Genu valgum: Knock Knees
By age 3, children can become knocked knees
Typically outgrown by puberty
May be due to injury or rickets
3. Compare the medical measures utilized in aligning the clubfoot – discuss specific nursing interventions/teaching related types of serial manipulation and treatment.
a. corrective casting (Ponseti method)- cast applied to hold foot in desired position. Changed every 1-2 weeks until max correction is achieved.
Nursing care: cast care, skin care and education of parents
c. Dennis-Brown splint- Used after casts are removed to maintain the correction. Worn most of the day, removed for bathing
d. Surgical correction-
What is included in a neurovascular assessment following cast application for clubfoot?
What is parent’s role in treatment and how can the nurse assist the parents in this role?
Provide emotion support for family throughout discovery (loss if perfect child)
Teach need for ongoing assessment and tx over several weeks/months
Parents trained and become active in physical therapy tx and child stretching program
Nurse need to help the parents understand time commitment involved
Assess parents ability to monitor the child adequately for complications and confirm they understand the s/s of the complications
3. Briefly describe juvenile arthritis.
Inflammatory disease of unknown cause. Has two peak times, 2-5 years and 9-12 years
Manifestations of Juvenile RA
Joint Pain; swelling, stiffness, tenderness, thickening, fever
Treatment for Juvenile RA
Goal - maintain joint function and muscle strength
Routine; physical therapy; weight control; moist heat; warm baths (esp in AM); exercise
26. What common characteristics and are causative factors that have been identified among patients with LCP Disease?
Hyperactivity; trauma; hereditary influence; environmental factors; aseptic necrosis of femoral head; self-limiting ususally gets better on its on
The most serious complication of LCP Disease includes
Disorder of adolescent hip (over age 10)
Associated with obesity and use of growth hormone
Ball of hip slips backward due to growth plate
Assess adolexcent with c/o of knee/ thigh pain and or limp
TX: hospitalization, bed rest and non weight bearing 4-6wks. May transfer to wheelchair. Internal fixation-pin or screw inserted across growth plate to prevent slippage of femoral head
Teach isometric exercise, crutch walking, weight control
Inflammation of bone, cartilage and or tendon at the tibial tuberosity (where tendon attaches to patella to the top of the shinbone)
Insidious nature, knee pain followed by swelling
Usually happens during growth spurts 8-16yrs of age
Self resolves in 12-24 months; NSAIDs; knee immobilizer, no activity restriction.
Conservative tx, avoid activities/rest, Rest Ice Elevate
Delayed walking (first sign) Progressive, symmetric muscle wasting, frequent falls, easily tired when walking, running or climbing stairs, hypertrophied calves muscle, waddling wide based gait. Gowers maneuver - trouble getting off floor, getting up slowly bracing themselves on floor as they get up
Muscle biopsy - reveals fatty fibroius tissue that gradually replaces muscles
Elevated serum enzyme CK (creatine kinase)
Complications: obesity, constipation, aspiration, pneumonia, heart failure. Child quits walking at 9-12 years old. Expected to live from late adolescence to early adulthood
Splingting/bracing; physical therapy; ambulation; exercise; low calorie, high protein, high fiber high fluid diet
Cant cure, we want to preserve function and maintain ambulation and independence for as long as possible
Coordinate services; maintain activity and self care functions, skin care, maintain bladder and bowel functioning, protect from resp. Infections, teach dietary modifications to decrease obesity
26. What members of the health care team work together to provide care? MD
Physical therapist, dr, nurse, speech and occupational therapist, home health
Death occurs 9-10 years after diagnosis.
What are three common manifestations of Osteogenesis Imperfecta?
Blue sclear; thin soft skin
B. Bruise easily; deafness
C. Cognitive; normal intelligence and above normal intelligence
Bacterial infection of the bone that involves the cortex or marrow cavity. Infection destroys the bone. Serious problem/difficult to diagnose/treat
High morbidity/mortality rates
Foolish - Fever
People - Pain
Often - Odor
Say - Swelling
Wrong - Warmth
Things - Tenderness
X-ray; ultrasound; bone scans; MRI; CT; and labs: ESR, CRP, WBC, Blood cultures, C and S
Adequate nutrition: high in calories
Possible surgery to drain abscess, debride necrotic tissue, sequestrectomy (wound care)
Iv antibiotics 3-6 weeks based on C and S results
High dose parenteral therapy via PICC
May requie peak/trough serum levels
Frequent blood counts to measure bone marrow activity
Lateral curvature of spine
Prominent scapula- uneven height
Screen kids around 6th grade (12yr old)
What psychosocial implications may be related to this treatment of scoliosis? Consider life and developmental tasks for the adolescent.
26. Decorate it, stickers etc. Keep tshirt on under it so it doesn’t rub skin
26. What is the pre-operative teaching for spinal fusion?
Demonstrate incentive spirometer and TC&DB
Discuss all potential equipment (chest tubes, IV, O2 masks and nasal canula, Foley Catheter)
Teach use of pumps for PCA or epidural block. Demonstrate log rolling and assist out of bed
26. What is priority nursing care for a client following a spinal fusion? Include discharge teaching. What kinds of activities are appropriate?
Maintain airway; neurovascular assessment of lower extremities; teach passive and active ROM exercise; encourage independence in ADL’s, provide with resources/information on scoliosis support groups, log rolling every 2 hrs, nasogastric intubation, bilateral neurovascular checks of lower extremities, use of incentive spirometer every 2hrs and assess skin on bony prominences
May hear pop or snapping sound. Trauma to the joint involving stretchede, partially or completely torn ligaments
where it is just stretched, pulls, tears or ruptures, happens after muscle is stretched to much
occur when soft tissue, muscle or subq tissues are damages
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