Ped Ms Ch 34 Part 1 Canvas.pptx

N124IN Spring 2013

Anatomy and Physiology  Children’s bones contain large amount of

cartilage  More flexible and porous 

Bones bend rather than break

 Periosteum is thicker, more vascular, stronger,

tougher  Bones absorb more energy prior to breaking  Periosteum is more metabolically active  Quicker healing and remodeling

Anatomy and Physiology, cont.  Epiphyseal growth plate  Thin cartilage layer  Controls bone growth  Epiphyseal side of growth plate: new cartilage is

laid down  Metaphyseal side of growth plate: cartilage converted to bone  Fracture in this area could result in growth complications

 Growth hormone: increases bone length

Anatomy and Physiology, cont.  2nd month of life  Bone formation begins  Birth  Ossification is almost complete  2-3 months of age  Posterior fontanel fusing  16-18 months of age  Anterior fontanel fusing  Maturation and bone modeling continues to occur until 21 years

Sports and Recreation Injuries  Boys are 6x more likely to be hospitalized

than girls for sports injuries  Blunt trauma to chest wall is 2nd leading cause of death in athletes 7-16 years old

Sports and Recreation Injuries, cont.  Overuse injury: mictrotraumatic damage to a

bone, muscle, or tendon which has been used repeatedly without enough time to heal or repair itself  1-pain after physical exertion  2-pain during physical exertion; no performance

restriction  3-pain during performance; pain restricts performance  4-chronic pain, even at rest

 Compartment Syndrome

Sports and Recreation Injuries, cont.  Sports injury prevention  Understanding risk factors

 Proper coaching/supervision  Protective equipment  Safe playing conditions

 Adequate conditioning  Sufficient warm-ups, cool-downs

Sports and Recreation Injuries, cont.  Anabolic steroids  Signs/Symptoms         

Temper tantrums Personality changes Decreasing body fat Increasing acne Stunted growth Decreased sperm production Irreversible breast enlargement in males LDL increase HDL decrease

Soft-Tissue Injuries  Incidence and Etiology  Sprains: forceful sports activities 

Football, wrestling

 Strains: excessive physical activity or effort 

High action sports, lifting

 Muscle contusions: contact and collision

type sports 

Football

Soft-Tissue Injuries, cont.  Pathophysiology  Sprain  Due to twisting or turning injury to joint  Ligament stretches or tears  Strain  Excessive stretching or tearing of muscle or tendon

 Contusion  Damage to soft tissues, subcutaneous structures, small vessels and muscles  Skin integrity not disrupted

Soft-Tissue Injuries, cont.  Clinical Manifestations  Sprain 





Mild sprain: local tenderness, minimal swelling, no joint instability Moderate sprain: partial tearing of ligament, partial joint instability, immediate pain, swelling, ecchymosis Severe sprain: less pain than moderate, diffuse swelling, severe ecchymosis, complete tearing of ligament, joint instability, loss of function

Soft-Tissue Injuries, cont.  Clinical Manifestations, cont.  Strain  Mild muscle strain: microscopic tear in muscle, local tenderness, minimal swelling/ecchymosis  Moderate strain: more muscle fibers are torn, “pop” felt, small defect palpated  Severe strain: popping/snapping sound, rupture of muscle, severe pain, marked ecchymosis, loss of function

Soft-Tissue Injuries, cont.  Clinical Manifestations, cont.  Contusion    

Soft tissues and small blood vessels tear Inflammatory response Ecchymosis Pain to move injured body part

Soft-Tissue Injuries, cont.  Diagnosis  Clinical manifestations

 Radiographic studies

Soft-Tissue Injuries, cont.  Treatment  RICE (rest, ice, compression, elevation)  Pain control  Bandages, splints  Casting, bracing  Surgery

 Strengthening/stretching exercises  Physical Therapy

Soft-Tissue Injuries, cont.  Nursing Management  Monitoring neurovascular status

 Pain management  Elevate affected limb  Activity restriction

 Help patient return to previous

functioning levels

Soft-Tissue Injuries, cont.  Family Teaching  Rest

 Elevation  Ice  Crutch-walking principles

 Activity restrictions

Dislocations  Incidence and Etiology  Occurs when force of stress on ligament is

great enough to displace a bone from its normal articulation within a joint  Fingers and elbows most common in children  Pathophysiology  Ligament and joint capsule damage

Dislocations, cont.  Clinical Manifestations  Pain  Immobility  Joint contour change  Extremity length change

 Diagnosis  Physical Assessment  Radiographs

Dislocations, cont.  Treatment  Closed manual reduction  Splint, sling, cast

 Nursing Management and Family Teaching  Pain management  Neurovascular status assessments  Educate family on caring for equipment

and how to prevent reinjury

Fractures  Incidence and Etiology  Upper extremity fractures      

Finger/hand Clavicle Proximal humerus Elbow Supracondylar fractures of humerus Distal radius fracture

Fractures, cont.  Incidence and Etiology, cont.  Lower extremity fractures      

Pelvic and tibial eminence avulsion fractures Femoral shaft Metatarsal/phalanx Tibia fractures Ankle Femoral neck

Fractures, cont.  Pathophysiology  Simple (closed) vs. compound (open)

 Classified based on type of break     

Transverse Oblique Spiral Greenstick Buckle (torus)

Fractures, cont.  Pathophysiology, cont.  Epiphyseal growth plate injuries   

Epiphyseal growth plate vulnerable to injury Salter fracture Can result in growth disruption, arrest, uneven growth

Fractures, cont.  Pathophysiology, cont.  Physiologic process after fracture occurs

Inflammatory  Reparative  Bony callus formation or ossification  Bone remodeling 

Fractures, cont.  Clinical Manifestations  Pain/tenderness  Edema  Decreased range of motion  Extremity deformity  Bruising  Muscle spasms  Crepitus

Fractures, cont.  Diagnosis  Signs/Symptoms

 History  Physical examination  Radiographs

 Ultrasound  CT  MRI

Fractures, cont.  Treatment  Closed reduction

 Open reduction  Slings/braces/splints  Casts

 External Fixation  Internal Fixation

Fractures, cont.  Treatment, cont.  Traction 

Skin traction  Buck extension  Short-term continuous immobilization, treat contractures and muscle spasms before surgery  Bryant traction  Developmental hip dysplasia, femur fractures  Russell traction  Reduce and immobilize hip fractures, tibial plateau fractures, femur fractures  Cervical skin traction  Mild cervical trauma without spinal cord injury, cervical strains and sprains, whiplash, spastic neck contractions, degenerative spine and disc disorders, arthritis, subluxations

Fractures, cont.  Treatment, cont.  Traction, cont. 

Skeletal Traction  Skeletal (Crutchfield or Garner-Wells) tong  Stabilize fractures or displaced vertebrae in cervical or high thoracic spinal areas  Balanced suspension  Femur, hip, tibia fractures  90/90 Femoral traction  Complicated femur fractures  Dunlap or sidearm traction  Fractured elbow or dislocations of elbow, humerus, shoulder

Fractures, cont.  Complications  Malunion

 Compartment syndrome  Growth disturbances

Fractures, cont.  Nursing Management  Immobilization  Neurovascular status assessments  Assess and manage pain  Be aware of psychological responses  Continue schoolwork  Promote mobility when able to do so  Encourage visits from family and friends

Fractures, cont.  Family Teaching  Initially: hospital routine, casts, traction devices,

mobility restrictions  Before discharge: cast care, mobility restrictions  Identify any modifications for home or school environment  Referral to social services and physical therapy  Safety equipment

Osteomyelitis  Incidence and Etiology  Routes 



Hematogenous: infection starts elsewhere in body and spreads to bone via bloodstream Exogenous: bone is infected from external factor  Penetrating wounds, open fractures, contamination in surgery, trauma

Osteomyelitis, cont.  Pathophysiology  Organisms travel to arteries in bone

metaphysis  

Inflammation, hyperemia, edema Pus increases pressure  Elevation/bump of periosteum

Osteomyelitis, cont.  Clinical Manifestations  Infant: irritability; diarrhea; poor feeding  Toddlers: pseudoparalysis; pain with passive movement; limping  Older children: Pain that is constant, localized, and increases with movement/palpation; restricted movement; swelling; heat; red skin; fever; night sweats; weight loss; anorexia; systemic fever

Osteomyelitis, cont.  Diagnosis  History and physical  Radiographs  Lab tests (CBC w/ differential, ESR, C-

reactive protein, blood cultures)  Ultrasound  Bone scanning  CT  MRI

Osteomyelitis, cont.  Diagnosis, cont.  Osteomyelitis diagnosis requires at least 2 of

the following:   



Aspiration of pus from site Positive bone or blood culture Classic signs (localized pain, swelling, increased skin temperature, limited joint mobility) Positive imaging study (radiography, bone scan, CT, MRI)

Osteomyelitis, cont.  Treatment  Antibiotics

 Splint limb  Surgery

Osteomyelitis, cont.  Nursing Management  Pain control

 Splint/traction care  Proper alignment; move limb cautiously  Neurovascular/skin assessments

 Administer antibiotics

 Family Teaching  Antibiotics

Septic Arthritis

 Incidence and Etiology  Haemophilus influenzae type b  Staphylococcus aureus

 Pathophysiology  Inflammation in synovial membrane 

Pus forms, causing the synovial fluid to thicken  Articular cartilage destroyed  Scar tissue replaces cartilage 

Joint mobility affected

Septic Arthritis, cont.  Clinical Manifestations  Nonweight bearing on affected side

 Painful, limited range-of-motion  Warmth or redness over area  Fever

 Toxic (sickly) appearance  Joint swelling  Increased WBC count

Septic Arthritis, cont.  Diagnosis  Lab tests: CBC w/ differential, ESR, CRP  Joint fluid aspiration/culture  Radiography, ultrasound, bone scan

 Treatment  Needle aspiration/open surgical drainage  Antibiotics  Immobilize joint  Pain relief

Septic Arthritis, cont.  Nursing Management  Maintain comfort  Administer antibiotics  Avoid complications related to impaired

mobility  Family Teaching  Antibiotic therapy  Enforcing bedrest