NUR2010 - Exam 2 (Neuro, GU,
musculoskeletal, abuse) Study
Guide
Musculoskeletal system of children vs adults - Answer - child's spine is more mobile =
higher risk for cervical spine injury
- infant's muscles make up less up their body mass vs. adults
- infants and young children have more flexible & porous bones vs older children/adults
= can absorb more force
- bone healing is faster, the younger the child, the faster it is
What is clubfoot/Talipes Equinovarus? - Answer Congenital foot deformity - foot looks
like head of a golf club, more common in males
4 categories:
-postural (resolves w/a short series of casting)
- neurogenic (occurs w/spina bifida)
- syndromic (occurs w/other syndromes like dwarfism & harder to treat)
- idiopathic (occurs in healthy infants)
Nursing assessment of clubfoot - Answer - Occurs with family history of foot deformities
and breech babies, twins, oligohydramnios, tobacco exposure
- inspect foot at rest, perform ROM, X-rays to view bone abnormalities
Therapeutic & Nursing management of clubfoot - Answer - Perform neurovascular
assessments, cast care, education about orthotics/braces/corrective shoes
- Elevated casted leg with pillows padding pressure points
- Consult w/child life specialist to come up with distraction methods
- One option: weekly manipulation with serial casting - change the cast every 2 weeks
- Surgical option: Surgical release of soft tissues, then immobilization w/a cast and ankle
foot orthoses (AFOs) or corrective shoes for several years
,Complications of clubfoot - Answer - Abnormal gait and balance
- Trouble or pain w/walking
- Residual deformity
- Stress to lateral side of foot
- Even after correction, that foot may be 1-1 1/2 sizes smaller
Hip Dysplasia - Answer - Abnormal development of the pelvic joint causing the head of
the femur and the acetabulum not to be aligned properly
- More common in females due to maternal hormones
- Leads to limited abduction & contracture of muscles
Checks at birth for hip dysplasia - Answer Ortolani & Barlow - listen for the click
O for out, B for back
Types of hip dysplasia - Answer - Dislocation: no connection at all
- Subluxation: the acetabulum is not fully seated in the hip joint
- Dysplasia: acetabulum is shallow or sloping instead of cup shaped
Risk factors for hip dysplasia include: - Answer - Female
- Breech
- Oligohydramnios
- Genetics
- Multiple gestation
- Large birth weight
Treatment for hip dysplasia - Answer - <6 months can use Pavlik harness which prevents
hip extension or adduction by keeping hip flexed and abducted
- >6 months up to 2 years may require closed reduction
- can use skin or skeletal traction
- Spica cast for 12 weeks to maintain the reduction, then an abduction brace
- After 2 years if there is no response to previous methods, open surgical reduction &
casting
Nursing management for Pavlik harness - Answer - Babies should be in these about 23
hours a day (or as much as possible) - give them a bath, wash the harness during that
, break
- leave 2 fingers space between chest and strap when adjusting
- Follow up visit every 2-3 weeks for new scans and readjusting of harness as baby
grows
- Neurovascular checks (for all harnesses, casts, braces): assess pulses, cap refill,
sensation, pain)
Nursing management of spica cast - Answer - Regular cast care: no objects under cast,
do not break cast, do not get cast wet, do not pull out any padding, do not scratch
inside, use a cool blow dryer or fan for itching
- Biggest concern is skin integrity - diaper is tucked INSIDE need frequent diaper
changes so there is no leakage into inside of cast
Trendelenburg sign - Answer Sign of hip dysplasia in older children -
- When the child stands on the good leg, the pelvis looks level. - When the child stands
on the affected leg the pelvis drops toward the good side (one butt cheek will looker
lower than the other)
galeazzi sign - Answer - lay the patient flat with knees up and one knee/leg will look
shorter than other
Bryant's traction - Answer Helps to treat hip dysplasia/dislocation under 2yrs.
Butt sightly elevated and hips flexed.
Keep weights hanging freely like all traction
CIRCULATION is priority to lower extremities, keep heels and ankles free from pressure
Assess elastic bandages every shift & change/rewrap as ordered
Duchenne's muscular dystrophy - Answer - Most common neuromuscular disorder of
childhood - shortened life expectancy
- Progressive muscle weakness & wasting
- Absence of dystrophin (protein critical for maintenance of muscles cells
- Xlinked recessive - mostly boys are affected and they receive the gene from their
mothers
Signs of muscular dystrophy - Answer - Late to walk
- Difficulty climbing stairs, running, cannot get up from floor
- Walk on the toes or balls of the feet & with a waddling gait
musculoskeletal, abuse) Study
Guide
Musculoskeletal system of children vs adults - Answer - child's spine is more mobile =
higher risk for cervical spine injury
- infant's muscles make up less up their body mass vs. adults
- infants and young children have more flexible & porous bones vs older children/adults
= can absorb more force
- bone healing is faster, the younger the child, the faster it is
What is clubfoot/Talipes Equinovarus? - Answer Congenital foot deformity - foot looks
like head of a golf club, more common in males
4 categories:
-postural (resolves w/a short series of casting)
- neurogenic (occurs w/spina bifida)
- syndromic (occurs w/other syndromes like dwarfism & harder to treat)
- idiopathic (occurs in healthy infants)
Nursing assessment of clubfoot - Answer - Occurs with family history of foot deformities
and breech babies, twins, oligohydramnios, tobacco exposure
- inspect foot at rest, perform ROM, X-rays to view bone abnormalities
Therapeutic & Nursing management of clubfoot - Answer - Perform neurovascular
assessments, cast care, education about orthotics/braces/corrective shoes
- Elevated casted leg with pillows padding pressure points
- Consult w/child life specialist to come up with distraction methods
- One option: weekly manipulation with serial casting - change the cast every 2 weeks
- Surgical option: Surgical release of soft tissues, then immobilization w/a cast and ankle
foot orthoses (AFOs) or corrective shoes for several years
,Complications of clubfoot - Answer - Abnormal gait and balance
- Trouble or pain w/walking
- Residual deformity
- Stress to lateral side of foot
- Even after correction, that foot may be 1-1 1/2 sizes smaller
Hip Dysplasia - Answer - Abnormal development of the pelvic joint causing the head of
the femur and the acetabulum not to be aligned properly
- More common in females due to maternal hormones
- Leads to limited abduction & contracture of muscles
Checks at birth for hip dysplasia - Answer Ortolani & Barlow - listen for the click
O for out, B for back
Types of hip dysplasia - Answer - Dislocation: no connection at all
- Subluxation: the acetabulum is not fully seated in the hip joint
- Dysplasia: acetabulum is shallow or sloping instead of cup shaped
Risk factors for hip dysplasia include: - Answer - Female
- Breech
- Oligohydramnios
- Genetics
- Multiple gestation
- Large birth weight
Treatment for hip dysplasia - Answer - <6 months can use Pavlik harness which prevents
hip extension or adduction by keeping hip flexed and abducted
- >6 months up to 2 years may require closed reduction
- can use skin or skeletal traction
- Spica cast for 12 weeks to maintain the reduction, then an abduction brace
- After 2 years if there is no response to previous methods, open surgical reduction &
casting
Nursing management for Pavlik harness - Answer - Babies should be in these about 23
hours a day (or as much as possible) - give them a bath, wash the harness during that
, break
- leave 2 fingers space between chest and strap when adjusting
- Follow up visit every 2-3 weeks for new scans and readjusting of harness as baby
grows
- Neurovascular checks (for all harnesses, casts, braces): assess pulses, cap refill,
sensation, pain)
Nursing management of spica cast - Answer - Regular cast care: no objects under cast,
do not break cast, do not get cast wet, do not pull out any padding, do not scratch
inside, use a cool blow dryer or fan for itching
- Biggest concern is skin integrity - diaper is tucked INSIDE need frequent diaper
changes so there is no leakage into inside of cast
Trendelenburg sign - Answer Sign of hip dysplasia in older children -
- When the child stands on the good leg, the pelvis looks level. - When the child stands
on the affected leg the pelvis drops toward the good side (one butt cheek will looker
lower than the other)
galeazzi sign - Answer - lay the patient flat with knees up and one knee/leg will look
shorter than other
Bryant's traction - Answer Helps to treat hip dysplasia/dislocation under 2yrs.
Butt sightly elevated and hips flexed.
Keep weights hanging freely like all traction
CIRCULATION is priority to lower extremities, keep heels and ankles free from pressure
Assess elastic bandages every shift & change/rewrap as ordered
Duchenne's muscular dystrophy - Answer - Most common neuromuscular disorder of
childhood - shortened life expectancy
- Progressive muscle weakness & wasting
- Absence of dystrophin (protein critical for maintenance of muscles cells
- Xlinked recessive - mostly boys are affected and they receive the gene from their
mothers
Signs of muscular dystrophy - Answer - Late to walk
- Difficulty climbing stairs, running, cannot get up from floor
- Walk on the toes or balls of the feet & with a waddling gait
