Musculoskeletal/Neuromuscular

• Fractures:

  • Manifestations
  • G_ S_
  • P_ or T_
  • D_ from S_ and B_ D_
  • D_ F_ of limb
  • B_, R_, C_
  • S_ and M_ deficits?
  • generalized swelling, pain, tenderness, deformity, swelling, bone displacement, diminished function, bruising, rigidity, crepitus, sensory, motor
• Fractures:

  • Management
  • R_ A_ with R_
  • R_ A_ with I_
  • A_ the _ P's
  • C_ O_ W_
  • I_
  • Check A_ and B_ site
  • Reassess N_ status
  • E_, A_ C_?
  • regain alignment, reduction, retain alignment, immobilization, assess, 6, cover open wound, immobilize, above, below, neurovascular, elevate, apply cold
• Fractures:

  • 6Ps
  • P_, P_, P_
  • P_, P_, P_
  • Assess C_ S_
  • C_ of N_, B_ V_ and F_?
  • pain, pulseless, pallor, paresthesia, paralysis, pressure, compartment syndrome, compression, nerves, blood vessels, fasciotomy
• Compartment Syndrome:

  • Pain
  • S_ and U_ by A_ and E_
  • Pulselessness
  • I_ to P_ D_ to F_ or C_
  • Pallor
  • P_
  • P_ P_
  • C_ R_ greater than _ seconds
  • Paresthesia
  • I_ to M_ E_
  • Pressure
  • T_ and W_
  • T_ and S_?
  • severe, unrelieved, analgesics, elevation, inability, palpate distal, fracture, compartment, pale, poor perfusion, cap refill, 3, inability, move extremity, tense, warm, tight, shiny
• Compartment Syndrome:

  • L_ E_ if not F_ P_
  • I_ to O_ F_
  • Check N_ S_
  • Changes in C_ and C_ R_
  • W_ P_ and N_/T_?
  • lose extremity, fixed properly, incision, open foot, neurovascular status, color, cap refill, weak pulses, numbness, tingling
• Hip Spica:

  • C_ and B_ in M_
  • R_ U_ to allow D_
  • May experience H_ during D_
  • Turn child E_ _ hrs to help D_
  • R_ or C_ A_ D_
  • No H_ F_ or D_ due to drying on O_ and cause B_ on I_?

  cast, bar, middle, remain uncovered, drying, heat, drying, every 2, drying, regular, cold air dryer, heated fans, outside, burns, inside
• Wet Plaster:

  • Should be S_ by P_ C_ P_ and handled with P_ to prevent indents
  • any H_ S_ or F_ S_ can lead to I_ and needs to be R_
  • Watch signs for C_ S_
  • B_ and A_ vascular assessment
  • E_ may need to B_ cast
  • P_ cast if I_
  • supported, plastic cover pillow, palms, hot spots, foul smell, infection, reported, compartment syndrome, before, after, edema, bivalve, petal, irritation
• Wet Plaster

  • Prevent complications of immobility which are
  • R_ of A_ and P_
  • C_ and D_ B_
  • R_
  • Watching for S_ B_ and C_
  • T_ and P_
  • D_ A_?
  • respiratory, atelectasis, pneumonia, coughing, deep breathing, ROM, skin breakdown, constipation, turning, positioning, divergent activity
• Wet Plaster:

  • Teaching to Caregiver
  • Don't get cast W_, P_ I_ I_, E_
  • A_ the H_ environment
  • C_ and prevent S_ B_
  • F_
  • Teach about Cast C_
  • R_ E_ and A_ will return F_ and A_
  • S_ in T_ and B_ O_ or L_ to remove skin cells
  • No R_?
  • wet, place items inside, elevate, adapt, home, clean, skin breakdown, feeding, cutter, resume exercise, activity, function, appearance, soak, tub, baby oil, lotion, rubbing
• Traction:

  • Reduce S_ and F_ M_
  • Check B_ P_ and W_
  • Don't R_ or R_ S_
  • Check after M_
  • Make sure straps are not T_ T_ or L_
  • Check P_ for B_, I_, or I_
  • Check B_ and A_ and with E_ I_ with Neurovascular Checks
  • R_ E_ on U_ F_?
  • spasms, fatigue muscles, bed position, weights, remove, reduce straps, moving, too tight, loose, pins, bleeding, infection, inflammation, before, after, every intervention, ROM exercises, unaffected foot
• Osteogenesis Imperfecta:

  • B_ B_ E_
  • Features
  • S_ S_
  • B_ S_
  • H_ L_
  • D_ T_?
  • bones break easily, short stature, blue sclera, hearing loss, discolored teeth
• Osteogenesis Imperfecta:

  • Management
  • L_ B_ and S_
  • S_ is priority
  • S_
  • S_ when P_, T_, M_ or H_
  • Never hold by A_ when D_
  • L_ B_
  • E_ on L_ and A_
  • lightweight braces, splints, safety, surgery, support, positioning, turning, moving, holding, ankles, diapering, lift butt, education, limitation, activities
• Developmental Hip Dysplasia (DDH):

  • I_ and T_ as E_ A_ P_
  • I_ is N_ I_
  • T_ is N_
  • Diagnosis
  • O_ test is A_ of the thigh
  • B_ test is A_ of the thigh?
  • identify, treat, early as possible, idiopathic, neurologic intact, teratologic, neuromuscular, ortoiani, abduction, Barlow, Adduction
• Developmental Hip Dysplasia (DDH):

  • Manifestations
  • Infants
  • S_ of L_ (G_ sign)
  • R_ A_
  • U_ G_ F_
  • Positive O_ and B_ sign
  • Older Children
  • S_
  • T_ or P_ mobility of the joint
  • T_ S_
  • G_ T_ P_
  • M_ L_
  • W_ G_?
  • shortening, limb, galeazzi, restricted abduction, unequal gluteal folds, ortolani, barlow, shortening, telescoping, piston, Trendelenburg sign, greater trochanter prominence, marked lordosis, waddling gait
• Developmental Hip Dysplasia (DDH):

  • Newborn to Age 6 months:
  • P_ H_
  • _ to _ hrs per day until S_ usually _ to _ wks
  • D_ M_ stable reduction of the femoral head
  • H_ S_ once sufficient S_ is acquired at approximately _ months?
  • Pavlik harness, 22, 34, stable, 6, 12, difficulty maintaining, hip spica, stable, 3
• Developmental Hip Dysplasia (DDH):

  • 6 to 24 months
  • D_ often not recognized until begins to S_ or W_
  • Gentle S_ of hip to F_ A_ then S_ for _ wks?
  • dislocation, stand, walk, stretch, full abduction, spica, 12
• Developmental Hip Dysplasia (DDH):

  • Older Children
  • M_ D_
  • Need R_ to R_ M_ after cast removal
  • Management
  • P_ H_
  • U_
  • G_ S_ M_ to stimulate C_
  • Avoid L_ and P_
  • Place D_ U_ S_
  • Removal depends on H_, some may allow removal for B_
  • C_
  • I_ in A_
  • M_ things?
  • most difficult, ROM, restore movement, pelvic harness, undershirt, gentle skin massage, circulation, lotion, powders, diaper under straps, hcp, bathing, casts, involve, activities, mobility
• Club Foot:

  • A_ B_
  • P_ by U_
  • Management
  • S_ C_ shortly after B_ with W_ gentle M_ and S_
  • Casted for _ to _ wks
  • After T_ a long L_ C_ is applied for _ wks that can R_
  • P_ S_ with a B_ in A_
  • S_ maybe
  • G_ V_ C_?
  • after birth, prenatal, ultrasound, serial casting, birth, weekly, manipulation, stretching, 6, 10, tenotomy, leg cast, 3, reoccur, ponseti sandals, bar, abduction, surgery, good vascular checks
• Scoliosis:

  • U_ S_
  • C_ don't F_
  • X_ and M_ A_
  • Management
  • B_ for less than _ degrees
  • N_ C_ but S_ P_
  • C_ I_
  • S_ A_ and A_
  • S_ when greater than _ to _ degrees to reduce R_ I_?
  • unequal shoulders, clothes, fit, x-ray, measure angle, brace, 45, not cure, slow progression, compliance issues, school age, adolescent, surgery, 45, 50, respiratory issues
• Scoliosis:

  • B_ D_ I_
  • Post-op
  • P_ is controlled by P_ not P_
  • A_
  • Not to someone who D_ U_
  • Can decrease R_ F_
  • L_ R_ on _ post-op day
  • R_ on _ to _ post-op day
  • D_ _ to _ days?
  • body disturbance issues, PCA, pt, parent, adolescent, doesn't understand, respiratory function, log roll, first, from, 2, 3, discharged 5, 7
• Legg Calve Perthes Disease:

  • N_ of F_ H_
  • Manifestations
  • L_
  • H_ S_/A_/S_
  • P_ in H_, T_ and K_
  • Diagnosis
  • X_?
  • necrosis, femoral head, limping, hip soreness, ache, stiffness, pain, hip, thigh, knee, xray
• Legg Calve Perthes Disease:

  • Management
  • A_ B_ or C_
  • N_
  • R_ and L_ B_
  • S_ R_ B_ for B_ L_ with bar in middle
  • Treatment can last _ yrs
  • N_ A_
  • S_ C_
  • I_ D_ A_?
  • abduction brace, casts, nsaids, rest, limited bearing, Scottish rite brace, both legs, 2, neurovascular assessment, skin care, inactive diversional activities
• Slipped Capital Femoral Epiphysis:

  • Spontaneous displacement of the P_ F_ E_ in a P_ and I_ direction
  • G_ S_ that is B_ or D_
  • Symptoms
  • O_
  • L_ on A_ side
  • I_ to B_ W_ because of S_ P_
  • P_ in G_, K_ or T_
  • A_ L_ E_ R_
  • L_ of H_ F_
  • A_ and I_ R_ as S_ I_
  • A_ L_ may appear S_?
  • proximal femoral epiphysis, posterior, inferior, growth spurt, before, during, obese, limping, affected, inability, bear weight, severe pain, pain, groin, knee, thigh, affected leg externally rotated, loss, hip flexion, abduction, internal rotation, severity increases, affected leg, shortened
• Slipped Capital Femoral Epiphysis:

  • Management
  • N_ W_ B_ to prevent further S_
  • P_ through F_ N_
  • C_ for W_ to M_
  • R_ from S_ and A_ until F_ occurs?
  • non weight bearing, slippage, pinning, femoral neck, crutches, weeks, months, restriction, sports, activities, fusion
• Cerebral Palsy:

  • M_ A_, A_ I_, A_ and R_ F_
  • P_ and P_ N_
  • Diagnosis
  • N_ E_
  • M_
  • M_ and G_ T_?
  • motor abnormalities, associated impairments, anatomic, radiologic finding, pre, postnatal, neuro exam, MRI, metabolic, genetic testing
• Cerebral Palsy:

  • Manifestations
  • D_ G_ M_ development
  • A_ M_ performance
  • A_ in M_ T_
  • A_ P_
  • R_ A_
  • A_ D_?
  • delayed gross motor, abnormal, motor, alterations, muscle tone, abnormal posture, reflex abnormalities, associated disabilities
• Cerebral Palsy:

  • Early Signs
  • Failure to meet milestones
  • R_ at _ months
  • R_ H_ and G_ H_ C_ by _ months
  • S_ U_ at _ to _ months
  • P_ R_ like M_ and A_ N_
  • C_ F_ after _ months
  • F_ to S_ by _ months
  • Using O_ S_ of body or only A_ to C_
  • T_ T_ after _ months?
  • rolling, 6, raising head, good head control, 3, sitting up, 6, 8, persistent reflexes, moro, atonic neck, clenched fists, 3, failure, smile, 3, one side, arms, crawl, tongue thrust, 6
• Cerebral Palsy:

  • Management
  • F_ B_
  • A_ E_
  • S_ only for those who don't respond to C_ T_
  • Meds for S_
  • B_ to R_ S_ in M_
  • B_ P_ and watch for H_
  • A_ to M_ S_
  • Worried about A_, F_ and S_ risk
  • Prevention of N_ in I_ with H_ within _ hrs?
  • foot braces, adaptive equipment, surgery, conservative therapy, spasm, botox, reduce spasticity, muscles, baclofen pump, hypotonicity, airway, mobilize secretions, aspiration, fall, safety, neuroprotection, infants, hypothermia, 6
• Cerebral Palsy:

  • Nursing Management
  • F_ R_
  • U_ P_ with F_
  • S_ P_
  • D_ C_ since A_ can cause T_ D_
  • S_ F_?
  • frequent rest, upright position, feeds, safety precautions, dental care, anticonvulsants, teeth damage, support family
• Duchenne Muscular Dystrophy:

  • X R_ T_
  • Characteristics
  • E_ O_ between _ to _
  • P_ M_ W_
  • W_ and C_
  • M_ E_
  • L_ of I_ A_ by _ to _ yrs
  • S_ P_ W_ during A_
  • R_ P_ until D_ from R_ and C_ F_?
  • recessive trait, early onset, 3, 5, progressive muscle weakness, wasting, contractures, muscle enlargement, loss, independent ambulation, 9, 12, slowly progressive weakness, adolescence, relentless progression, death, respiratory, cardiac function
• Duchenne Muscular Dystrophy:

  • P_ M_ W_
  • D_ W_ and C_ S_
  • W_ G_
  • L_
  • G_ sign
  • S_ by K_ then P_ T_ upright with W_ H_ up the L_
  • E_ M_ that are F_
  • R_ and S_ is big concern
  • P_ P_?

  progressive muscle weakness, difficulty walking, climbing stairs, waddling gait, lordosis, gower, standing, kneeling, push torso, walking hands, legs, enlarged muscles, firm, respiratory, safety, posture problems
• Duchenne Muscular Dystrophy:

  • Diagnosis
  • P_ for gene mutation
  • P_ as early as _wks
  • M_ B_
  • C_ levels high first _yrs before onset of W_?
  • PCR, prenatal, 12, muscle biopsy, creatine, 2, weakness
• Duchenne Muscular Dystrophy:

  • Management
  • N_ C_
  • S_
  • Remain A_ as P_
  • S_
  • B_ E_
  • A_ as L_ as C_?
  • no cure, steroids, active, possible, stretching, breathing exercises, adl's, long, can