MCN 374 Exam Questions and Answers | Latest Update 2023/2024 (Graded A+)

Orthopedic disorders can be - correct answers Congenital Acquired/trauma Infectious Club Foot - correct answers 1-2 per 1000 live births *Males more affected* Involves both the bony structures and soft tissues Club Food: Causes - correct answers Intrauterine positioning Neuromuscular or vascular problem Genetics Club Foot: Interventions - correct answers Manipulation and serial casting immediately The more rigid the higher likelihood surgery will be necessary Surgery is performed between 3-12m Developmental Dysplasia of the Hip (DDH) - correct answers Encompasses a variety of hip abnormalities: Acetabular dysplasia - abnormal development leading to instability Subluxation - incomplete dislocation Dislocations - femoral head has no contact with the acetabulum DDH: Predisposing Factors - correct answers 5 F's: Female Family hx in 20% of cases Frank breech birth First born Left hip involvement (3x more often than the right) DDH: Clinical Manifestations: Infant - correct answers Shortened limb on affected side Restricted abduction of hip on affected side Unequal gluteal folds when infant is prone Positive Ortolani test MCN 374 Exam III Questions and Answers (Latest Update 2023) Verified Solutions (Rated A+) Positive Barlow test Many resolve by 2m of age DDH: Clinical Manifestations: Older Infant and Child - correct answers Affected leg shorter than the other Positive Trandelenburg sign (while bearing weight on the affected side the pelvis tilts downward) Limp May walk on toes on one side Marked lordosis and waddling gait if bilateral dislocations DDH: Treatment: 0-6m - correct answers Pavlik harness to maintain *abduction and flexion* Typically worn all day - only removed for bath time Every 1-2wks the child is brought in for evaluation and the harness is readjusted DDH: Treatment: 6-18m - correct answers Closed reduction under general anesthesia MCN 374 Exam III Questions and Answers (Latest Update 2023) Verified Solutions (Rated A+) Hip spica cast for 2-3m Hip Spica cast can be difficult at this age because of diapering - cover around cast and perineal area is waterproof Cast care: Frequent assessments Frequent ROM exercises with unaffected extremities Pay attention to skin integrity around diaper area or around edges of cast Teach parents to turn frequently to prevent pressure ulcers Special car seats are available to use when baby in a hip spica cast DDH: Treatment: 18m - correct answers Open surgical reduction - pelvic and/or femoral osteotomy Very difficult after 4yrs of age Slipped Capital Femoral Epiphysis (SCFE) - correct answers Occurs during maximal pubertal growth spurt Males - age 13-15 Females - age 11-13 MCN 374 Exam III Questions and Answers (Latest Update 2023) Verified Solutions (Rated A+) Most common adolescent hip disorder Incidence 1 to 4 per 100,000 Blacks affected more than whites Unilateral involvement in 90% of cases Child is often overweight Occurs before the epiphyseal plate closes SCFE: S/S - correct answers Hip, knee, or groin pain Limp Decreased ROM Hip held in abduction and external rotation Very limited internal rotation Could happen over time or be acute that is associated with trauma AEB not being able to walk at all Stable SCFE = still able to walk Unstable SCFE = typically unable to walk SCFE: Treatment - correct answers *Orthopedic emergency* MCN 374 Exam III Questions and Answers (Latest Update 2023) Verified Solutions (Rated A+) Immediate hospitalization Surgery to realign dn stabilize Open reduction and internal fixation with pins and screws Osteotomy High probability of later occurrence on opposite side Post-Op Care after Orthopedic Surgery - correct answers Maintain circulation Elevate affected extremity above heart Ice packs to relieve swelling Monitor C, S, M to distal area Provide pain relief Cast care Adjustment to immobility