Exam 3: 50-65 multiple choice questions. Questions will primarily be application-type
requiring use of information in decision making, making nursing diagnosis or identifying
problems, identifying goals, choice of intervention and action, evaluation of intervention,
establishing priority. Numbers of questions for each topic are approximate. Material
comes from the class discussion, PowerPoint slides, and main topics in your readings and
videos. This is a guide and may not be all inclusive.
Musculoskeletal alterations (5-10 questions): assessment, treatment, medications, laboratory findings,
and nursing care
Fractures
● Common injury in children
● Methods of treatment are different in pediatric population than in the older adult population
● Rare in infants (motor vehicle crashes and falls from heights)
● Most common fracture is of the distal forearm (radius, ulna, or both)
● Clavicle is also a common fracture in childhood (<10 years old)
● In school age children, playground, bicycle and sports injuries
● Clinical manifestations
○ Generalized swelling
○ Pain or tenderness
○ Deformity
○ Diminished use of limb or digit
○ Possibly: bruising, muscular rigidity, crepitus
→ Most common fractures in children
● Plastic deformation
○ Bone is bent but not broken; most common the ulna and fibula and often associated with
fractures of the radius and tibia
● Buckle
○ Produced by compression of porous bone; appears as a raised or protruding projecting at
the fracture site; more common in young children
● Greenstick
○ Occurs when bone is angulated beyond the limits of bending; incomplete fracture on the
opposite side of the bend
● Complete
○ Divides bones into fragments that often remain attach by a periosteal hinge, which can
hinder reduction
,
→ Injury to growth plates
● Type I: separation or slip of growth plate without fracture of the bone
● Type 2: separation of growth plate and breaking off of a section of a metaphysis
● Type 3: fracture of epiphysis that extends through joint surface
● Type 4: Fracture of growth plate, metaphysis, and epiphysis
● Type 5: due from crushing injury of epiphysis
● Diagnosed with x-ray
● Treatment is usually casting, but can include surgery
● Bone healing is typically rapid in children
○ In neonatal period, 2 to 3 weeks
○ In early childhood, 4 weeks
, ○ In later childhood, 6 to 8 weeks
○ In adolescence, 8 to 12 weeks
→ evaluation of compartment syndrome
● Pain
● Pulselessness
● Pallor
● Paresthesia
● Paralysis
● Pressure
Casting
● Immobilizes to promote healing
● Completeness of fracture, type of bone involved, and the amount of weight bearing influence how
much of the extremity must be included in the cast
● Two types of casting material
○ Plaster
○ Synthetic
● Cast removal
→ Nursing care
● Pain management
● Evaluate for compartment syndrome
● Educate
○ Nothing put into the cast
○ Circulation checks
○ Keeping cast dry
○ Medication administration
○ Follow up visits
Traction
● Traction: extended pulling force may be used
○ To provide rest for an extremity
○ To position for bone healing
○ To immobilize a fracture until healing is sufficient to permit casting or splinting
○ To help prevent or improve contracture deformity
○ To provide immobilization
○ To reduce muscle spasms (rare in children)
● Traction: forward force produced by attaching weight to a distal bone fragment
○ Adjust by adding or subtracting weights
● Countertraction: backward force provided by body weight
, ○ Increase by elevating the foot of the bed
● Frictional force
○ Provided by patients contact with the bed
→ Types of traction
● Manual traction is applied to a body part by the hand placed distally to the fractures site
● Skin traction involves pulling mechanisms that are attached to the skin with adhesive material or
an elastic bandage
● Skeletal traction is applied to directly to the skeletal structure by a pin, wire, or tongs inserted into
or through the diameter of the bone distal to the fracture
→ Nursing care
● Assessing the patient in traction
● Skin care issues
● Pain management and comfort
Congenital hip dysplasia
Formerly called congenital hip dysplasia or congenital dislocation of the hip
● Girls > boys
● Family history increases risk
● DDH is categorized in two major groups
○ Idiopathic
■ Infant neurologically intact
○ Teratologic (occur in utero and less common)
● Neuromuscular defect
→ 3 types of DDH
● Acetabular dysplasia (preluxation)
○ Mildest form: osseous hypoplasia of acetabular roof
○ Femoral head remains in the acetabulum
● Subluxation (incomplete dislocation of the hip)
● Dislocation (femoral head loses contact with the acetabulum and is displaced posteriorly and
superiorly; ligaments are elongated and taut)
→ Therapeutic management
● Importance of early intervention
● Newborn to age 6 months; Pavlik harness for abduction of the hip
● Age 6 to 24 months: dislocation is unrecognized until the child begins to stand and walk; use
traction and cast immobilization (spica)
● Older child: operative reduction, tenotomy, osteotomy; difficulty after 4 years
requiring use of information in decision making, making nursing diagnosis or identifying
problems, identifying goals, choice of intervention and action, evaluation of intervention,
establishing priority. Numbers of questions for each topic are approximate. Material
comes from the class discussion, PowerPoint slides, and main topics in your readings and
videos. This is a guide and may not be all inclusive.
Musculoskeletal alterations (5-10 questions): assessment, treatment, medications, laboratory findings,
and nursing care
Fractures
● Common injury in children
● Methods of treatment are different in pediatric population than in the older adult population
● Rare in infants (motor vehicle crashes and falls from heights)
● Most common fracture is of the distal forearm (radius, ulna, or both)
● Clavicle is also a common fracture in childhood (<10 years old)
● In school age children, playground, bicycle and sports injuries
● Clinical manifestations
○ Generalized swelling
○ Pain or tenderness
○ Deformity
○ Diminished use of limb or digit
○ Possibly: bruising, muscular rigidity, crepitus
→ Most common fractures in children
● Plastic deformation
○ Bone is bent but not broken; most common the ulna and fibula and often associated with
fractures of the radius and tibia
● Buckle
○ Produced by compression of porous bone; appears as a raised or protruding projecting at
the fracture site; more common in young children
● Greenstick
○ Occurs when bone is angulated beyond the limits of bending; incomplete fracture on the
opposite side of the bend
● Complete
○ Divides bones into fragments that often remain attach by a periosteal hinge, which can
hinder reduction
,
→ Injury to growth plates
● Type I: separation or slip of growth plate without fracture of the bone
● Type 2: separation of growth plate and breaking off of a section of a metaphysis
● Type 3: fracture of epiphysis that extends through joint surface
● Type 4: Fracture of growth plate, metaphysis, and epiphysis
● Type 5: due from crushing injury of epiphysis
● Diagnosed with x-ray
● Treatment is usually casting, but can include surgery
● Bone healing is typically rapid in children
○ In neonatal period, 2 to 3 weeks
○ In early childhood, 4 weeks
, ○ In later childhood, 6 to 8 weeks
○ In adolescence, 8 to 12 weeks
→ evaluation of compartment syndrome
● Pain
● Pulselessness
● Pallor
● Paresthesia
● Paralysis
● Pressure
Casting
● Immobilizes to promote healing
● Completeness of fracture, type of bone involved, and the amount of weight bearing influence how
much of the extremity must be included in the cast
● Two types of casting material
○ Plaster
○ Synthetic
● Cast removal
→ Nursing care
● Pain management
● Evaluate for compartment syndrome
● Educate
○ Nothing put into the cast
○ Circulation checks
○ Keeping cast dry
○ Medication administration
○ Follow up visits
Traction
● Traction: extended pulling force may be used
○ To provide rest for an extremity
○ To position for bone healing
○ To immobilize a fracture until healing is sufficient to permit casting or splinting
○ To help prevent or improve contracture deformity
○ To provide immobilization
○ To reduce muscle spasms (rare in children)
● Traction: forward force produced by attaching weight to a distal bone fragment
○ Adjust by adding or subtracting weights
● Countertraction: backward force provided by body weight
, ○ Increase by elevating the foot of the bed
● Frictional force
○ Provided by patients contact with the bed
→ Types of traction
● Manual traction is applied to a body part by the hand placed distally to the fractures site
● Skin traction involves pulling mechanisms that are attached to the skin with adhesive material or
an elastic bandage
● Skeletal traction is applied to directly to the skeletal structure by a pin, wire, or tongs inserted into
or through the diameter of the bone distal to the fracture
→ Nursing care
● Assessing the patient in traction
● Skin care issues
● Pain management and comfort
Congenital hip dysplasia
Formerly called congenital hip dysplasia or congenital dislocation of the hip
● Girls > boys
● Family history increases risk
● DDH is categorized in two major groups
○ Idiopathic
■ Infant neurologically intact
○ Teratologic (occur in utero and less common)
● Neuromuscular defect
→ 3 types of DDH
● Acetabular dysplasia (preluxation)
○ Mildest form: osseous hypoplasia of acetabular roof
○ Femoral head remains in the acetabulum
● Subluxation (incomplete dislocation of the hip)
● Dislocation (femoral head loses contact with the acetabulum and is displaced posteriorly and
superiorly; ligaments are elongated and taut)
→ Therapeutic management
● Importance of early intervention
● Newborn to age 6 months; Pavlik harness for abduction of the hip
● Age 6 to 24 months: dislocation is unrecognized until the child begins to stand and walk; use
traction and cast immobilization (spica)
● Older child: operative reduction, tenotomy, osteotomy; difficulty after 4 years
