lOMoARcPSD|122 102 17
Summary Wong’s nursing care of infants and children - study guide for the final
exam
, lOMoARcPSD|122 102 17
Final Exam Study Guide
New Stuff:
Musculoskeletal (13 questions)
• JRA (juvenile rheumatoid arthritis)
o Peak ages—1 to 3 years and 8 to 10 years
o 90% children have negative rheumatoid factor
o Symptoms may “burn out” and become inactive
o Chronic inflammation of synovium with joint effusion, destruction of cartilage, and ankyloses of
joints as disease progresses
o Systemic onset (high fever, rash, hepatosplenomegaly, pericarditis, pleuritic, lymphadenopathy)
o Clinical manifestations:
▪ Stiffness
▪ Swelling
▪ Loss of mobility in affected joints
▪ Warm to touch, usually without erythema
▪ Tender to touch in some cases
▪ Symptoms increase with stressors
▪ Growth retardation
▪ Iridocyclitis/uveitis
• Inflammation of iris and ciliary body
• Unique to JRA
• Requires treatment by ophthalmologist
o Dx:
▪ No definitive diagnostic tests
▪ Elevated ESR rate in some cases
▪ Antinuclear antibodies common but not specific for JRA
▪ Leukocytosis during exacerbations
o American College of Rheumatology Diagnostic Criteria:
▪ Age of onset younger than 16 years
▪ One or more affected joints
▪ Duration of arthritis more than 6 weeks
▪ Exclusion of other forms of arthritis
o TMT:
▪ NSAIDs
▪ SAARDs
▪ Corticosteroids
▪ Cytotoxic agents
▪ Immunomodulatory
▪ Disease-modifying anti-rheumatic drugs (DMARDs)
o MGMT:
▪ Control pain
▪ Preserve ROM and fx
▪ Minimize effects of inflammation: joint deformity
▪ Promote nml growth and dev.
• Torticollis
o “wry neck”; limited neck motion with neck flexed to affected side
o Congenital (d/t abnl position in utero) or acquired
• Fracture: Type, Healing
o Features of children’s fractures not observed in adults
, lOMoARcPSD|122 102 17
▪ presence of growth plates
▪ thicker and stronger periosteum
▪ bone porosity
▪ more rapid healing
▪ less joint stiffness.
o Complete vs. incomplete
o Simple vs. compound
o Compound or open—fractured bone protrudes through the skin
o Complicated—bone fragments have damaged other organs or tissues
o Transverse
o Oblique
o Spiral
o Comminuted—small fragments of bone are broken from the fractured shaft and lie in surrounding
tissue
o Greenstick—compressed side of bone bends, but tension side of bone breaks, causing incomplete
fracture
o Stress fracture
▪ Occur as result of repeated muscle contraction
▪ Often seen in repetitive weight-bearing sports (running, gymnastics, basketball)
▪ Tibial fracture most common
o Clinical Manifestations:
▪ Generalized swelling
▪ Pain or tenderness
▪ Diminished functional use
▪ May have bruising, severe muscular rigidity, crepitus
o Typically rapid healing in children
▪ Neonatal period—2 to 3 weeks
▪ Early childhood—4 weeks
▪ Later childhood—6 to 8 weeks
▪ Adolescence—8 to 12 weeks
o TMT:
▪ Fracture reduction: determined by child’s age, degree of displacement, amount of
overriding, amount of edema, condition of the skin and soft tissues, sensation, and
circulation distal to the fracture
▪ Immobilization: for simple, nondisplaced fractures; with synthetic cast x 4-6 weeks
▪ Surgical intervention: for open, displaced, and compound fractures
▪ Surgical pinning & open/closed reduction: for complex fractures
▪ Traction: to fatigue involved muscles and reduce muscle spasm, position bone ends in
desired realignment, and immobilize the fracture site until realignment has been achieved to
permit casting or splinting
• Skin vs. skeletal
o MGMT:
▪ GOAL: Promote healing, prevent injury or complications
▪ Pulses, CRT, skin color, and temperature
▪ Palpation of cast for hot spots
▪ Alleviate pressure on nerves, treat pain
▪ Compartment syndrome
▪ Promote nutrition and hydration
▪ Pain mgmt: ibuprofen for minor fracture pain
• Osteogenesis Imperfecta
o Excess fragility and bone defects
Summary Wong’s nursing care of infants and children - study guide for the final
exam
, lOMoARcPSD|122 102 17
Final Exam Study Guide
New Stuff:
Musculoskeletal (13 questions)
• JRA (juvenile rheumatoid arthritis)
o Peak ages—1 to 3 years and 8 to 10 years
o 90% children have negative rheumatoid factor
o Symptoms may “burn out” and become inactive
o Chronic inflammation of synovium with joint effusion, destruction of cartilage, and ankyloses of
joints as disease progresses
o Systemic onset (high fever, rash, hepatosplenomegaly, pericarditis, pleuritic, lymphadenopathy)
o Clinical manifestations:
▪ Stiffness
▪ Swelling
▪ Loss of mobility in affected joints
▪ Warm to touch, usually without erythema
▪ Tender to touch in some cases
▪ Symptoms increase with stressors
▪ Growth retardation
▪ Iridocyclitis/uveitis
• Inflammation of iris and ciliary body
• Unique to JRA
• Requires treatment by ophthalmologist
o Dx:
▪ No definitive diagnostic tests
▪ Elevated ESR rate in some cases
▪ Antinuclear antibodies common but not specific for JRA
▪ Leukocytosis during exacerbations
o American College of Rheumatology Diagnostic Criteria:
▪ Age of onset younger than 16 years
▪ One or more affected joints
▪ Duration of arthritis more than 6 weeks
▪ Exclusion of other forms of arthritis
o TMT:
▪ NSAIDs
▪ SAARDs
▪ Corticosteroids
▪ Cytotoxic agents
▪ Immunomodulatory
▪ Disease-modifying anti-rheumatic drugs (DMARDs)
o MGMT:
▪ Control pain
▪ Preserve ROM and fx
▪ Minimize effects of inflammation: joint deformity
▪ Promote nml growth and dev.
• Torticollis
o “wry neck”; limited neck motion with neck flexed to affected side
o Congenital (d/t abnl position in utero) or acquired
• Fracture: Type, Healing
o Features of children’s fractures not observed in adults
, lOMoARcPSD|122 102 17
▪ presence of growth plates
▪ thicker and stronger periosteum
▪ bone porosity
▪ more rapid healing
▪ less joint stiffness.
o Complete vs. incomplete
o Simple vs. compound
o Compound or open—fractured bone protrudes through the skin
o Complicated—bone fragments have damaged other organs or tissues
o Transverse
o Oblique
o Spiral
o Comminuted—small fragments of bone are broken from the fractured shaft and lie in surrounding
tissue
o Greenstick—compressed side of bone bends, but tension side of bone breaks, causing incomplete
fracture
o Stress fracture
▪ Occur as result of repeated muscle contraction
▪ Often seen in repetitive weight-bearing sports (running, gymnastics, basketball)
▪ Tibial fracture most common
o Clinical Manifestations:
▪ Generalized swelling
▪ Pain or tenderness
▪ Diminished functional use
▪ May have bruising, severe muscular rigidity, crepitus
o Typically rapid healing in children
▪ Neonatal period—2 to 3 weeks
▪ Early childhood—4 weeks
▪ Later childhood—6 to 8 weeks
▪ Adolescence—8 to 12 weeks
o TMT:
▪ Fracture reduction: determined by child’s age, degree of displacement, amount of
overriding, amount of edema, condition of the skin and soft tissues, sensation, and
circulation distal to the fracture
▪ Immobilization: for simple, nondisplaced fractures; with synthetic cast x 4-6 weeks
▪ Surgical intervention: for open, displaced, and compound fractures
▪ Surgical pinning & open/closed reduction: for complex fractures
▪ Traction: to fatigue involved muscles and reduce muscle spasm, position bone ends in
desired realignment, and immobilize the fracture site until realignment has been achieved to
permit casting or splinting
• Skin vs. skeletal
o MGMT:
▪ GOAL: Promote healing, prevent injury or complications
▪ Pulses, CRT, skin color, and temperature
▪ Palpation of cast for hot spots
▪ Alleviate pressure on nerves, treat pain
▪ Compartment syndrome
▪ Promote nutrition and hydration
▪ Pain mgmt: ibuprofen for minor fracture pain
• Osteogenesis Imperfecta
o Excess fragility and bone defects
