Chapter 26. Orthopedics
1. A mother brings into the emergency department a frail-looking infant with blue sclera and
arm and leg deformities. The mom said she was changing her diaper and heard a snap. She put
her shirt on and she heard another snap. She says that the baby has been crying, but eating a
little. Mom reports a clavicle fracture in the delivery room, but the doctors told her it was
nothing and would heal fine. The nurse notes a small lump on her right clavicle. It is not
painful to the touch. The infants left forearm and right femur appear swollen and deformed.
Based on your clinical knowledge of birth defects, your best answer to the mother would be:
1. We will call the doctor to do a skeletal survey.
2. We will call the Child Protective Services team to rule out abuse.
3. We will call Genetics to see if any genetic birth defects run in your family.
4. All of the above.
ANS: 4
Feedback
1.Often, children with osteogenesis imperfect (OI) are misdiagnosed;
therefore, all children should undergo steps to rule out abuse, then
proceed with genetic counseling, testing to verify a genetic
disorder. The blue sclera and fractures without severe trauma are
signs of OI.
2.Often, children with osteogenesis imperfect (OI) are misdiagnosed;
therefore, all children should undergo steps to rule out abuse.
3.Often, children with osteogenesis imperfect (OI) are misdiagnosed;
therefore, all children should undergo steps to rule out abuse, then
proceed with genetic counseling, testing to verify a genetic
disorder.
4.All of the responses are correct. Often, children with osteogenesis
imperfect (OI) are misdiagnosed; therefore, all children should
undergo
steps to rule out abuse, then proceed with genetic counseling, testing
to verify a genetic disorder. The blue sclera and fractures without
severe
trauma are signs of OI.
2. A 13-year-old boy, who has played baseball for three years, comes in complaining of left
elbow pain and swelling. He is a pitcher. He plays baseball all year. X-rays reveal medial
epicondyle irritation. There is no avulsion fracture. Based on these findings, you explain to
the child that he can:
,1. Swim. Its a safer sport.
2. Resume baseball gradually with pain-free motion.
, 3. Change positions in baseball for the season.
4. Protect, rest, ice, compress, and elevate the injury as well as stop baseball for three weeks.
ANS: 4
Feedback
1.The repetitive motion of swimming can cause the same irritation.
2.Sports injuries are common in adolescents, especially overuse
injuries. Open growth plates are locations for overuse injuries. Little
Leaguers elbow is characterized by pain, swelling, and repetitive
motions.
3.The child may not have an interest in other positions. A modification to
his pitching may need to be made.
4.Sports injuries are common in adolescents, especially overuse injuries.
Open growth plates are locations for overuse injuries. Little
Leaguers elbow is characterized by pain, swelling, and repetitive
motions.
3. A 16-year-old soccer player comes into the ER with left knee effusion and extreme pain. The
child claims that while kicking the ball away from an opponent, she felt a pop and fell to the
ground. She had to be assisted off the field. She is in the playoffs and wants to play again. X-
rays are normal, but as the nurse, you know which of the following about sports injuries?
1. X-rays can help classify fractures, but cannot classify tissue, tendons, and ligaments.
2. She probably has an ACL tear based on the symptoms of swelling, pain, inability to
bear weight, and hearing a pop before she went down.
3. She will need an MRI.
4. She will need crutches and a knee immobilizer as well as to rest, ice, compress, and elevate
the injury.
ANS: 4
Feedback
1.The X-ray can see some damage to the ligaments and swollen areas.
2.The pop does not classify the injury.
3.A CT scan would help identify the injured area.
4.Care of acute sports-related injuries include PRICE: protect from further
injury, rest, ice, compression, and elevation to relieve pain.
1. A mother brings into the emergency department a frail-looking infant with blue sclera and
arm and leg deformities. The mom said she was changing her diaper and heard a snap. She put
her shirt on and she heard another snap. She says that the baby has been crying, but eating a
little. Mom reports a clavicle fracture in the delivery room, but the doctors told her it was
nothing and would heal fine. The nurse notes a small lump on her right clavicle. It is not
painful to the touch. The infants left forearm and right femur appear swollen and deformed.
Based on your clinical knowledge of birth defects, your best answer to the mother would be:
1. We will call the doctor to do a skeletal survey.
2. We will call the Child Protective Services team to rule out abuse.
3. We will call Genetics to see if any genetic birth defects run in your family.
4. All of the above.
ANS: 4
Feedback
1.Often, children with osteogenesis imperfect (OI) are misdiagnosed;
therefore, all children should undergo steps to rule out abuse, then
proceed with genetic counseling, testing to verify a genetic
disorder. The blue sclera and fractures without severe trauma are
signs of OI.
2.Often, children with osteogenesis imperfect (OI) are misdiagnosed;
therefore, all children should undergo steps to rule out abuse.
3.Often, children with osteogenesis imperfect (OI) are misdiagnosed;
therefore, all children should undergo steps to rule out abuse, then
proceed with genetic counseling, testing to verify a genetic
disorder.
4.All of the responses are correct. Often, children with osteogenesis
imperfect (OI) are misdiagnosed; therefore, all children should
undergo
steps to rule out abuse, then proceed with genetic counseling, testing
to verify a genetic disorder. The blue sclera and fractures without
severe
trauma are signs of OI.
2. A 13-year-old boy, who has played baseball for three years, comes in complaining of left
elbow pain and swelling. He is a pitcher. He plays baseball all year. X-rays reveal medial
epicondyle irritation. There is no avulsion fracture. Based on these findings, you explain to
the child that he can:
,1. Swim. Its a safer sport.
2. Resume baseball gradually with pain-free motion.
, 3. Change positions in baseball for the season.
4. Protect, rest, ice, compress, and elevate the injury as well as stop baseball for three weeks.
ANS: 4
Feedback
1.The repetitive motion of swimming can cause the same irritation.
2.Sports injuries are common in adolescents, especially overuse
injuries. Open growth plates are locations for overuse injuries. Little
Leaguers elbow is characterized by pain, swelling, and repetitive
motions.
3.The child may not have an interest in other positions. A modification to
his pitching may need to be made.
4.Sports injuries are common in adolescents, especially overuse injuries.
Open growth plates are locations for overuse injuries. Little
Leaguers elbow is characterized by pain, swelling, and repetitive
motions.
3. A 16-year-old soccer player comes into the ER with left knee effusion and extreme pain. The
child claims that while kicking the ball away from an opponent, she felt a pop and fell to the
ground. She had to be assisted off the field. She is in the playoffs and wants to play again. X-
rays are normal, but as the nurse, you know which of the following about sports injuries?
1. X-rays can help classify fractures, but cannot classify tissue, tendons, and ligaments.
2. She probably has an ACL tear based on the symptoms of swelling, pain, inability to
bear weight, and hearing a pop before she went down.
3. She will need an MRI.
4. She will need crutches and a knee immobilizer as well as to rest, ice, compress, and elevate
the injury.
ANS: 4
Feedback
1.The X-ray can see some damage to the ligaments and swollen areas.
2.The pop does not classify the injury.
3.A CT scan would help identify the injured area.
4.Care of acute sports-related injuries include PRICE: protect from further
injury, rest, ice, compression, and elevation to relieve pain.
