Term
|
Definition
•Ends of long bones (epiphyses) remain cartilaginous - growth occurs here
•Skeletal maturation: About 20 years of age
•Calcium is needed for new bone growth |
|
|
Term
|
Definition
•Most common congenital foot disorder
•Forefoot turns inward (“intoeing”)
•Probable cause: Genetic; intrauterine positioning
•Treatment: Exercise, casting, braces, orthopedic shoes |
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Term
| Metatarsus Adductus Nursing care |
|
Definition
•Parental teaching
–Condition is correctable
–How to exercise foot
–Cast care if child requires casting |
|
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Term
|
Definition
•Congenital anomaly: Foot is twisted - involves muscles, bones, and tendons
•Occurs in boys more than girls - bilateral in half of cases
•Cause unknown - many theories
•Treatment
–Cannot be corrected by exercise
–Serial casting if done early
–Surgical correction (3 to 12 months of age) |
|
|
Term
|
Definition
•Provide emotional support
•Cast and brace care
•Postsurgical care
•Home care teaching |
|
|
Term
| Genu Varum and Genu Valgum |
|
Definition
•Genu varum: “Bowlegs,” Blount’s disease, rickets
•Genu valgum: “Knock-knees”
•Normal unless persists beyond 4 to 5 years of age
•Treatment: Braces, surgery |
|
|
Term
| Genu Varum and Genu Valgum: Nursing Care |
|
Definition
•Parental reassurance if child is less than 4 years of age
•Parental teaching - brace wear |
|
|
Term
| Developmental Dysplasia of the Hip (DDH) |
|
Definition
•Femoral head and acetabulum improperly aligned
•May include hip instability, dislocation, subluxation, or dysplasia
•Occurs in girls more than boys - unilateral in 80% of cases
•Cause: Unknown - genetic factors likely |
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|
Term
|
Definition
•Pavlik harness (younger than 3 months of age)
•Skin traction (older than 3 months of age)
•Spica cast, surgery (older than 18 months of age) |
|
|
Term
|
Definition
•Assessment of hip during well-child visits
•Nursing care depends on the treatment
–Maintain traction
–Provide cast care
–Prevent complications from immobility |
|
|
Term
| Legg-Calve-Perthes Disease |
|
Definition
•Avascular necrosis of the femoral head - blood supply to femoral epiphysis is interrupted
•Occurs in boys more than girls
•Average age of onset: 7 years
•Cause unknown - may be genetic or coagulation system disorder
•Occurs in four distinct stages of 1 to 4 years
•Treatment: Traction, casting, bracing - goal is to keep hip abducted |
|
|
Term
| Legg-Calve-Perthes Disease: Nursing Care |
|
Definition
•Assessment: Hip discomfort plus limp - pain
•Promote normal growth and development
•Brace care |
|
|
Term
| Slipped Capital Femoral Epiphysis (SCFE) |
|
Definition
•Femoral head displaced from femoral neck
•Occurs during adolescent growth spurt
•Occurs in boys more than girls
•Cause: Unknown - likely related to obesity, endocrine disorders
•Symptoms: Acute or chronic - limp, pain, loss of hip motion |
|
|
Term
| SCFE: Treatment and Nursing Care |
|
Definition
•Treatment: Surgical most common
•Address obesity if present
•Provide emotional support
•Home care teaching |
|
|
Term
|
Definition
•Lateral S- or C- shaped curvature of the spine
•More than 10 degrees is abnormal
•Types
–Idiopathic (most common)
–Congenital
–Acquired
•Most common in girls around adolescent growth spurt |
|
|
Term
|
Definition
•Idiopathic - cause unknown
•Congenital
–Related to spinal structure
–Examples: Spina bifida, cerebral palsy, muscular dystrophy
•Acquired: Injury to spinal cord |
|
|
Term
|
Definition
•Observation, serial x-rays
•Mild (10 to 20 degree curve): Exercise
•Moderate (20 to 40 degree curve): Brace (worn 23 hours a day)
•Severe (greater than 40 degree curve): Surgery (spinal fusion) |
|
|
Term
|
Definition
•Screening (usually during fifth and seventh grades)
•Promote acceptance of care plan
•Post-op care
•Home care teaching |
|
|
Term
|
Definition
•Head tilt caused by rotation of the spine
•Treatment
–Stretching exercises
–Surgical correction |
|
|
Term
|
Definition
•Kyphosis: Convex curvature of spine (“hunchback”): Treatment - exercise, bracing, surgery
•Lordosis: Concave curvature of spine (“swayback”): Treatment - exercise, postural awareness |
|
|
Term
|
Definition
•Infection of the bone, usually a long bone in lower extremity
•Acute or chronic
•Occurs at any age - boys more than girls (due to trauma)
•Cause: Microorganism, usually bacterial
•Symptoms: Pain, swelling, decreased mobility, fever
•Treatment: Antimicrobials (oral or IV) for 3 to 6 weeks |
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|
Term
| Osteomyelitis: Nursing Care |
|
Definition
•Immunization status (tetanus)
•Obtain cultures and blood work
•Administer fluids and medications
•Protect from spread of infection
•Encourage well-balanced diet
•Home care teaching - considerations for home IV therapy |
|
|
Term
|
Definition
•Rare infection that affects spine and other joints
•Antimicrobial therapy |
|
|
Term
|
Definition
•Joint infection
•Most common sites: Knee, hip, ankle, elbow
•Joint drained via aspiration, then IV antibiotics for 3 to 4 weeks |
|
|
Term
| Achondroplasia (Dwarfism) |
|
Definition
•Genetic condition
•Head, torso are normal size - arms and legs are short
•Treatment: None (gene therapy in the future) - limp lengthening may be palliative
•Nursing care
–Genetic counseling for parents
–Positive self-image
–Modifications to adjust for size |
|
|
Term
|
Definition
•Genetic condition that affects the connective tissue
•Common problems
–Cardiac: Mitral valve prolapse, aortic regurgitation, and abnormal aortic root dimensions
–Skeletal: Pectus excavatum, long arms and digits, scoliosis, elongated head, high arched palate
–Ocular: Lens subluxation
–Respiratory: Pneumothorax |
|
|
Term
| Marfan Syndrome: Treatment |
|
Definition
•None specific
•Surgery to prevent aortic dissection (most common cause of death) |
|
|
Term
| Marfan Syndrome: Nursing Care |
|
Definition
•Identification of disease
•Monitoring
•Surgical care
•Genetic counseling
•Medication management |
|
|
Term
|
Definition
•“Brittle bone disease”
•Genetic condition affecting collagen production
•Manifestations
–Frequent fractures
–Blue sclerae
–Thin, soft skin
–Short stature |
|
|
Term
| OsteogenesisImperfecta: Treatment |
|
Definition
•Fracture prevention, treatment
•Prevention of deformity
•Maximize mobility
•Support for family, child |
|
|
Term
|
Definition
•Group of inherited diseases - Duchenne most common
•Muscle fibers degenerate
•Onset varies (birth to late in life)
•Progression varies (few years to many years)
•All are terminal |
|
|
Term
| Muscular Dystrophy: Treatment |
|
Definition
•None specific
•Gene therapy in the future?
•Preserve muscle function: Steroids, deflazacort
•Prevent complications (infection, spinal deformities) |
|
|
Term
| Muscular Dystrophy: Nursing Care |
|
Definition
•Promote independence and mobility
•Psychosocial support and acceptance
•Referral to resources for support |
|
|
Term
| Care of the Child in a Cast |
|
Definition
•Elevation
•Drainage, bleeding
•Neurovascular checks - pulses, capillary refill, warmth, edema
•Itching |
|
|
Term
| Care of the Child in a Brace |
|
Definition
•Brace should be comfortable
•Skin care
•Wear clothes beneath brace |
|
|
Term
| Care of the Child in Traction |
|
Definition
•Types of traction
–Skin
–Dunlop
–Bryant
–90-90
–Skeletal
–Halo
–Russell |
|
|
Term
| Post-Surgical Care: External Fixator |
|
Definition
•Neurovascular checks
•Pin care
•Drainage |
|
|
Term
|
Definition
•Occur at any age
•Result from trauma to bones or diseases that weaken bones
•Types
•Signs and symptoms
•Treatment: Closed versus open reduction |
|
|
Term
|
Definition
•Maintain proper alignment
•Monitor neurovascular status
•Pain control
•Promote mobility
•Discharge teaching |
|
|
Term
|
Definition
•Most common type of injury in youths 13 to 19 years
•Football, wrestling, soccer, gymnastics |
|
|
Term
| Risk Factors for Injury in Childhood |
|
Definition
•Vulnerability of growth plates
•Increased joint mobility leads to joint injuries
•Softer bones lead to fractures
•Lack of experience, training
•Not wearing protective gear
•Impatience with healing process |
|
|
Term
|
Definition
•Proper training and instruction
•Protective gear
•Supervision
•Warm up before activity |
|
|
Term
| Neuro Developmental Considerations |
|
Definition
•Nervous system complete but immature at birth
•Infant born with all nerves he or she will have
•Myelination of nerves incomplete until age 4
•Development proceeds in cephalocaudal direction |
|
|
Term
| Level of Consciousness (LOC) |
|
Definition
•Most important indicator of neurologic dysfunction
•Describing LOC
–Conscious versus unconscious
–Alertness: Ability to react to stimuli
–Cognitive power: Processing of data |
|
|
Term
|
Definition
•Trauma and/or injury
•Hypoxia
•Infection
•Poisoning
•Seizures
•Endocrine or metabolic disturbances
•Electrolyte or acid-base imbalance
•Congenital structural defect |
|
|
Term
| Assessment of LOC: Monitoring |
|
Definition
•Responsiveness to environment or stimuli
•Pupil size and reactivity
•Movement of extremities
•Ability to maintain an airway
•Changes in vital signs
•Changes in breathing patterns
•Status of the cranial nerves |
|
|
Term
| Deterioration of LOC: A Sequential Pattern |
|
Definition
•Awake and alert - responds appropriately
•Slight disorientation to time, place, or person
•Restless, fussy, or irritable
•Drowsy but responds to loud commands, painful stimuli
•Nonpurposeful response
•Posturing
•No response |
|
|
Term
| Long-Term Management of Seizures |
|
Definition
•Most are treated with monotherapy medication - successful in 60% to 70% of children
•Ketogenic diet
•Family teaching
–Management of seizure at home, school
–Blood levels may be needed to monitor anticonvulsant dosing |
|
|
Term
|
Definition
•Inflammation of the meninges
•Newborns and infants at greatest risk
•Higher morbidity and mortality than viral meningitis
•Common bacterial causes
–Haemophilusinfluenzae type B
–Neisseria meningitides
–Streptococcus pneumoniae
–Group B Streptococcus |
|
|
Term
| Bacterial Meningitis: Signs and Symptoms (Infants) |
|
Definition
•Fever
•Changes in feeding pattern
•Vomiting, diarrhea
•Anterior fontanelle bulging or flat
•Alert, restless, lethargic, or irritable
•Difficult to console |
|
|
Term
| Bacterial Meningitis: Signs and Symptoms (Children) |
|
Definition
•Fever
•Confusion, delirium, irritable, lethargic
•Vomiting
•Muscle or joint pain |
|
|
Term
| Bacterial Meningitis: Signs and Symptoms (Children) (cont’d) |
|
Definition
•Hemorrhagic rash (meningococcal meningitis)
•Meningeal irritation
–Headache
–Photophobia
–Nuchal rigidity |
|
|
Term
|
Definition
The child with bacterial meningitis assumes an opisthotonic position, with the neck andthe head hyperextended, to relieve discomfort. |
|
|
Term
|
Definition
| raise the child’s leg with the knee flexed. Then extend the child’sleg at the knee. If any resistance is noted or pain is felt, the result is a positive Kernig sign.This is a common finding in meningitis |
|
|
Term
|
Definition
flex the child’s head while in a supine position. If this action makesthe knees or hips flex involuntarily, a positive Brudzinski sign is present. This is a commonfinding in meningitis. |
|
|
Term
| Progression of Symptoms of meningitis |
|
Definition
•Seizures
•Apnea
•Cerebral edema
•Subdural effusion
•Hydrocephalus
•Disseminated intravascular coagulation (DIC)
•Shock
•Increased intracranial pressure |
|
|
Term
| Bacterial Meningitis: Treatment |
|
Definition
•Labs and cultures (blood, urine, cerebrospinal fluid)
•Intravenous antibiotics
•Steroids, anticonvulsants, antipyretics
•IV fluids, fluid resuscitation
•May be left with severe neurologic deficits |
|
|
Term
| Viral (Aseptic) Meningitis |
|
Definition
•Inflammatory response of meninges
•Most common cause: Enterovirus
•Child not as ill-appearing as child with bacterial meningitis |
|
|
Term
| Viral Meningitis: Signs and Symptoms |
|
Definition
•Irritable or lethargic - general malaise
•Fever
•Headache
•Photophobia
•Upper respiratory symptoms
•Positive Kernig and Brudzinski signs - indicate meningeal irritation
•Seizures are rare |
|
|
Term
| Viral Meningitis: Treatment |
|
Definition
•Labs and cultures (blood, urine, cerebrospinal fluid)
•Intravenous antibiotics until cultures are negative - treat as bacterial meningitis until proven otherwise
•Treatment of symptoms is supportive
•Symptoms usually resolve in 3 to 10 days
•Neurologic deficits are uncommon |
|
|
Term
|
Definition
•Inflammation of the brain
•Meninges may be inflamed as well
•Viruses most common cause (herpes simplex type I) |
|
|
Term
| Encephalitis: Signs and Symptoms |
|
Definition
•Depend on causative organism
•Classic presentation
–Acute onset of febrile illness
–Neurologic signs (disoriented, confused)
–Severe headache, nausea, vomiting
–Meningeal signs
–Seizures |
|
|
Term
|
Definition
•Diagnosis by history, lab findings
•Acyclovir (for herpes infections)
•Supportive care
•Many children left with severe neuralgic deficits |
|
|
Term
|
Definition
•Acute encephalopathy
•Associated with use of aspirin and a mild viral illness
•With decreased aspirin use, condition is now rare
•Condition develops over five stages |
|
|
Term
|
Definition
•Diagnosis by history, lab findings
•Treatment is supportive
•Often require treatment for increased intracranial pressure
•Mortality is high |
|
|
Term
|
Definition
•Acute inflammatory demyelinating polyneuropathy
•Motor function deteriorates, causing paralysis
•Ascending pattern (legs to head)
•Cause: Autoimmune response to infectious organism |
|
|
Term
| Guillain-Barré Syndrome: Signs and Symptoms |
|
Definition
•History of infectious illness about 10 days prior to onset of symptoms
•Infants: Severe hypotonia, respiratory distress, poor feeding
•Children
–Progressive symmetric weakness
–Legs to upper extremities, head
–Difficulty swallowing
–Respiratory failure |
|
|
Term
| Guillain-Barré Syndrome: Treatment |
|
Definition
•Supportive care for respiratory failure
•Intravenous immunoglobulin (IVIG)
•Plasmapheresis
•Condition is rarely fatal |
|
|
Term
| Myelodysplasia: Pre-op Nursing Care |
|
Definition
•Cover sac with sterile dressing (warm saline)
•Monitor for CSF leakage
•Place infant in prone position with knees slightly flexed
•Assess bowel, bladder function
•Monitor for signs of infection
•Feed with head turned to one side
•Avoid latex products |
|
|
Term
| Myelodysplasia: Post-op Nursing Care |
|
Definition
•Monitor for wound healing
•Monitor for signs of infection
•Monitor for signs of hydrocephalus, increased ICP
•Place in prone or side-lying position
•Measure head circumference daily
•Assess intake and output
•Avoid latex products |
|
|
Term
| Hydrocephalus: Nursing Care |
|
Definition
•Measure head circumference daily
•Observe for signs of increased ICP
•Neurologic assessment
•Signs of shunt malfunction
•Positioning: usually supine - head of bed is raised gradually |
|
|
Term
| Cerebral Palsy (CP): Background Information |
|
Definition
•Cerebral palsy caused by insult to central nervous system
–Congenital
–Hypoxic
–Ischemic
–Infectious
•Very premature infants at high risk
•Birth asphyxia accounts for only 9% of cases |
|
|
Term
| Nurses in the Community: Care of the Child with CP |
|
Definition
•Continuous support
•Coordination of care - referrals
•Working with schools to individualize education plan
•Adaptive devices
•Transition to adult living |
|
|
Term
| Assessment Findings: Mild Brain Injury |
|
Definition
•No loss (or very brief loss) of consciousness
•Mild headache that will not go away with medications
•Memory problems
•Fatigue and irritability
•Change in appetite
•Changes in school performance
•Sensitivity to lights and sounds |
|
|
Term
| Assessment Findings: Moderate Brain Injury |
|
Definition
•Glasgow Coma Scale: 9 to 12
•Loss of consciousness
•Headache
•Nausea and vomiting
•Amnesia for 1 to 24 hours |
|
|
Term
| Assessment Findings: Severe Brain Injury |
|
Definition
•Glasgow Coma Scale: Less than 8
•Amnesia for more than 24 hours
•Signs of increased ICP
•Prolonged period of unconsciousness |
|
|
Term
| Nursing Management: Mild Brain Injury |
|
Definition
•Monitor level of consciousness
•Signs of increased ICP
•Home teaching
•Restrictions on activities
•May take 6 weeks for full healing - may affect school performance |
|
|
Term
| Nursing Management: Severe Brain Injury |
|
Definition
•Airway, breathing, and circulation: Hyperventilation - prolonged use causes cerebral ischemia
•Assess neurologic status frequently
•Elevate head of bed 30 degrees if no neck injury present
•Keep head midline to promote venous drainage |
|
|
Term
| Nursing Management: Severe Brain Injury (cont’d) |
|
Definition
•Minimal stimulation
•Monitor vital signs, intake and output, and intracranial pressure
•Skin care, range of motion |
|
|
Term
| Medications Common with Severe Brain Injury |
|
Definition
•Diuretics (furosemide, mannitol)
•Opthalmic lubricants to protect cornea
•Stool softeners
•Sedatives, paralytics if needed |
|
|
Term
|
Definition
|
|
Term
| Anticonvulsansts used to tx seizures |
|
Definition
|
|
Term
|
Definition
|
|
