Term
|
Definition
| Continue to grow in size and function until approximately 2 years of age (although all nephrons are present at birth) |
|
|
Term
|
Definition
Is not as effective, newborn urine production: approx. 1-2ml/kg/hour
Child urine production is approx: 1ml/kg/hour
This is due to the renal system still being immature
The risk for dehydration is heightened, renal metabolis/excretion of drugs is affected by decreased creatinine clearance/ GFR |
|
|
Term
|
Definition
Ph: 5-9
Secific gravity: 1001-1035
Protein <20 mg/Dl (trace)
Color: Clear |
|
|
Term
|
Definition
Difficulties with urinary control can occur during the night and or day.
Primary enuresis the child has never experienced a period of dryness
Secondary enuresis: A 6-12 month period of dryness has preceded the onset of wetting (UTI, Stress, DM/polyuria) |
|
|
Term
|
Definition
Physical: decreased bladder capacity, UT abnormalities, neurologic alterations, obstructive sleep apnea, constipation, UTI, pinworms, DM
Emotional: increased stress due to family disruption, pressure during toilet training, inadequate attn to voiding cues, sexual abuse. |
|
|
Term
| Therapuetic Management of Enuresis |
|
Definition
| Limiting fluids after dinner, frequent voiding imagery training, reward systems behavioral conditioning, Medications (imiprimine, DDAVP vasopression) |
|
|
Term
|
Definition
Characterized by the presence of bacteria in the urine along with systemic signs of infection, could cause long term complications that include scarring, decreased renal function, high blood pressure and very rarely, end stage renal failure.
Most common cause is e.coli |
|
|
Term
|
Definition
| Urinary tract obstruction, voiding dysfunction, anatomic differences of females vs. males, Individual susceptiblity to infection, Reflux (urine flows back into the kidneys), toddler age, sexually active girls. |
|
|
Term
|
Definition
| Involves the renal parenchyma, pelvis, and ureters. Typically causes fever, chills, flank pain. |
|
|
Term
|
Definition
| Involve lower urinary tract, Usually no systemic manifestations |
|
|
Term
| Etiology and pathophysiology of UTI |
|
Definition
Physiologic and mechanical defense mechanisms normally maintain sterility, alteration of defense mechanisms increases risk of UTI, organisms introduced via ascending route from urethra.
Urologic instrumentation allows bacteria present in opening of urethra to enter urethra or bladder, UTI is a common hospital aquired infection because of this. |
|
|
Term
| Infant clinical manifestations of UTI |
|
Definition
| fever or hypothermia in neonate, irritability, dysuria, change in urine odor or color, poor weight gain, feeding difficulties. |
|
|
Term
| Children clinical manifestations of UTI |
|
Definition
| Abdominal or suprapubic pain, voiding frequency and urgency, dysuria, new or increased incidence of enuresis, fever |
|
|
Term
|
Definition
Uncomplicated cystits (bladder infection) short term course of antibiotics,
Complicated UTIS- Long term treatment
ABX options: TMP-SMX depends on regional sensitivities |
|
|
Term
|
Definition
Inflammation caused by bacteria, fungi, protozoa, or viruses that infect the kidneys, usually infection is via ascending urethral route
Preexiting factors- vesicouretreral reflu (flow of bladder urine into the ureters)
Dysfunction of lower urinary tract function |
|
|
Term
| Clincial Manifestations of Pyelonephritis |
|
Definition
Vary from mild to classic and very severe, presenting symptoms (more systemic): n/v, anorexia, chills, nocturia, frequency, urgency, suprapubic or low back pain, dysuria, fever, hematuria, foul smelling urine
Costovertebral tenderness, symptoms often suabside in a few days without therapy
Bacturia and pyuria still persist |
|
|
Term
| Treatment of Acute Pyelonephritis |
|
Definition
| Hospitalization and IV ABX |
|
|
Term
|
Definition
Undescended or hidden testes, occurs when one or both testes fail to descend through the inguinal canal into the scrotal sac. Incidence higher in premature and LBW infants since levels of testosterone dictate the descent of the testes (8 -9 months)
Most infants will have spontaneous descent in the first year of life. |
|
|
Term
|
Definition
| Urethral endpoint is on the ventral suface of the penis |
|
|
Term
|
Definition
| Urethral endpoint isn on the dorsal surface of the penis. |
|
|
Term
| Spadias Therapeutic Management |
|
Definition
| Surgical intervention, Ideally between 6-12 months, Do not circumcise prior to surgery (commonly use the foreskin to repair) |
|
|
Term
|
Definition
Also called Nephroblastoma (in adrenal gland)
Malignant renal and intraabdominal tumor of childhood, occurs three times more in African American children, peak age of diagnosis is 3 years, more frequent in males (growing since gestation) |
|
|
Term
|
Definition
| Arises from malignant undifferentiated primordial cells, more prevalent in the left kidney |
|
|
Term
| Wilms tumor clinical manifestations |
|
Definition
Abdominal swelling or mass (firm, nontend and confined to one side) DO NOT PALPATE ABDOMEN UNLESS ABSOLUTELY NECESSARY
Hematuria (blood in urine due to pressure on the kidneys)
Fatigue/ maliase (anemia)
HTN (due to pressure on kidney)
Weight loss, fever (inflammation), manifestations resulting from compression of tumor mass |
|
|
Term
| Wilms tumor therpeutic management |
|
Definition
Treatment with surgery, chemotherapy and or radiation
Prognosis: Survival rates are among the highest for childhood cancers
Localized 90% cure |
|
|
Term
| Acute Poststreptococcal Glomerulonephritis |
|
Definition
A greoup of kidney disorders characterized by inflammatory injury in the glomerulus.
Occurs as an immune reaction to a group of A-beta hemolytic streptococcal infection of the throat or skin
Most frequent in ages 5-12
Clinical symptoms usually develop 1-2 weeks after intial strep infection |
|
|
Term
| Glomerulonephritis Symptoms |
|
Definition
Hemautruia (gross or microscopic)
Proteninuria
Oluguria
Generalized edema due to ineffective filtration- begins with periorbital, progresses to lower extremities and then to ascites
HTN
Mild Anemia (not producing adequate levels of EPO) |
|
|
Term
| Acute post streptococcal Glomerulonephritis Prognosis |
|
Definition
95% rapid improvement to complete recovery
5-15% chronic glomerulonephritis
1% irreversible damage |
|
|
Term
| Clincial Management of Glomerulonephritis |
|
Definition
10 day course of ABX may be required, manage edema (daily weights, I/O, daily abdomincal girth)
Nutrition (low sodium, low to moderate protein)
Steroid use to control inflammatory response (risk for infection is heightened)
Bed rest is not necessary |
|
|
Term
|
Definition
Most common presentation of glomerular injury in children
Characteristic:
Massive preoteinuria, hypoalbuminemia, edema progressing to sever, usually has normal or low BP because the fluid moves to the 3 space. |
|
|
Term
| Physologic changes in Neprhotic syndrom |
|
Definition
| Glomerular membrane, normally impermeable to proteins becomes permeable to proteins, especially albumin, albumin lost in urine, serum ablumin decreased, fluid shifts from plasma to intertitial spaces (hypovolemia and ascites) |
|
|
Term
| Nephrotic syndrome management |
|
Definition
| Diet: low to moderate protein, sodium restrictions, Steroids (prednisone is the drug of choice, 2mg/kg divided into BID doses), diuretics Pullout 3 space instead of vascular |
|
|
Term
|
Definition
Sudden severe loss of kidney function, kidney can no longer filter waste products, regulate fluid
Etiology:
Most common cause in children is HUS (hemolytic Uremic Disease/Syndrome)
Prerenal: dehydration, hypotension, septic shock, renal artery obstruction
Intrarenal:nephrotoxins (aminoglycosides, contrast media)
Postrenal: structural abnormalities, turmors, kidney stones |
|
|
Term
| HUS Hemolytic Uremic Disease/Syndrome HUS |
|
Definition
Most common cause of acquired acute renal failure in children
Occurs primarily in infants and small children between 6 months to 5 years
Thought to be associated with bacterial toxins, chemicals andviruses
Coxsackie virus, echovirus, and adneovirus, also some cases due to E-Coli |
|
|
Term
|
Definition
| Primary site of injury appears to be the endothelial lining of the small glomerular arterioles. Beomce swollen and occluded, with deposits of fibrin and platelet clots, RBCs are damaged as they attempt to move through the partially occluded vessels (lead to thrombocytopenia due to platelet aggregation within the damaged vessels, nothing gets to the kidney) |
|
|
Term
| Clincial Manifestations of HUS |
|
Definition
The triad of anemia, thrombocytopenia and renal failure is significant for diagnosis)
Vomiting, irritability, lethargy, marked pallor, oliguria, or anuria, CNS involvement (seizures, stupor), hemorrhagic manifestations (bruising, petechia, juandice, bloody diarrhea) |
|
|
Term
| Therapeutic management of HUS |
|
Definition
| Early diagnosis and aggressive, Treat ARF and hemolytic anemia (dialysis, blood transfusions (FFP clotting factors and packed RBC) |
|
|
Term
|
Definition
| Recovery rate is about 95% with prompt treatment, but residual renal impairment ranges from 10-50%, long term complications (chronic renal failure, HTN, CNS disorders) |
|
|
Term
| ARF clinical manifestations |
|
Definition
| F/E and Acid base imbalances, increased BUN and creatinine, oliguria, Anuria, Edema, HTN, nausea, vomiting, lethargy, pallor |
|
|
Term
| ARF therapeutic management |
|
Definition
| Treatment of the underlying cause, supportive care, (volume restoration, electrolyte and acid base management, dialysis) |
|
|
Term
|
Definition
Irreversible loss of kidney function that occurs over months to years
Progressive to ESRD
Initial symptom (polyuria with very dilute urine- everything goes through becuase the nephrons wont work)
The nprogresses to oliguria and anuria
Culminate in uremia (urine in the blood) |
|
|
Term
| Potential Causes of Chronic Renal Failure |
|
Definition
| Congential anomalies are most common, reflux associated with recurrent UTIs, chronic pyelonephritis, chronic glomerulonephritis, HUS |
|
|
Term
| Chronic Renal Failure Clinical Manifestations |
|
Definition
Early (F/E and acid base imbalance, anemia, poor, growth, hypertnsion, fatigue, anorexia, n/v, neurologic s/s/ indicative of waste build up BUN)
Progression (mutli system, uremic syndrom ensues) |
|
|
Term
| Chronic Renal Failure Management |
|
Definition
Manage diet, hypertention, recurrent infections, seizures, electrolyte distrubances, fluid retention
Dialysis:
Peritoneal is the preferred method for children, abdomial cavity acts as a semi permeable membran for filtration, warmed solution enters the peritoneal cavity by gravity, remains for a period of time before removal, can be managed at home in some cases |
|
|
Term
|
Definition
Requires creation of vascular access and special dialysis equipment, best suite for children who can be brought to the facility 3/week for 4-6hours
Achieves rapid correction of F/E balance |
|
|
Term
|
Definition
| Most common diseases in the world, children are often cared for in pediatric centers in the same location as oncology patients, hematology is the science of blood, its nature, function and diseases. |
|
|
Term
| Pediatric Hemotologic system |
|
Definition
Erythrocytes lifespan is shorter in neonates thatn in infants and children due to increased destruction during rapid growth, by age 2 months, erythropoeisis increases, leading to an increase in hemoglobin, erythrocytes are produced initially in the marrow of all bones. As age increases, hematopoieses occurs primarily in the amrrow of the ribs, sternum, bertebra, pelvis, skull, clavicles, and scapulae
Hgb/Hct levels vary by age |
|
|
Term
|
Definition
Oxygen-carrying capacity, RBC production increases when kidneys produce a hormone called erythropoietin
Polycythemia- Increase in number of RBCs, response to hypoxia (heart disease, high altitude) |
|
|
Term
| Types and Functions of WBCs |
|
Definition
Granulocytes
Nuetrophils (bacteria)
Eosinophils (allergic response and parasites)
Basophils (contain histamine, secrete heparin)
Agranulocytes
Monocytes/macrophages (phagocytize)
Lymphocytes (found in BM, spleen, theymus)
T Cells (cell mediated immunity)
B cells (humoral immunity) |
|
|
Term
|
Definition
RBC 4.5-5.5
Hgb 11.5-15.5
Hct 35-45%
RBC Indexes (MCV, MCH, MCHC)
Reticulocytes 0.5-1.5% (immature RBCs)
WBC 4.5-13.5
ANC (>1000)
Plt 150-400 |
|
|
Term
|
Definition
condition in which the number of RBCs or the hemoglobing concentration is reduced below normal values.
Consequences:
Decrease in oxygen carrying capacity of blood and consequently a reduction in the amount of oxygen avialable to the cells. Hypoxic, pale, tachycardic to make up for decreased O2 |
|
|
Term
|
Definition
Children are able to function well despite low levels of Hgb, (cyanosis is not typically evident, growth retardation found in chronic anemia) In general not noticed on assessment. Lab findings determine decreased level Hgb <11g/dL
S/S:
Lethargy, pale mm and conjuctiva, easy fatigability, irritability, extremem pallow, tachycardia
Treatment:
Revers the process causing anemia, replace deficiency, severe: O2, bed rest, replace blood factors and products |
|
|
Term
| Classification of Anemias |
|
Definition
Decreased RBC Production- nutritional deficiency or bone marrow failure
Increased RBC Loss- Acute blood loss (Trauma)
Increased RBC Destruction-intracorpuscular or extracorpuscular
(HUS, wrong trype of blood give, sickle cell) |
|
|
Term
| Anemia Caused by Nutritional Deficiences |
|
Definition
| Iron Deficiency Anemia:Most common hematological disorder, caused by inadequate supply of dietary iron, impaired absorption, blood loss, excessive demands for Fe required for growth (give with citrus), preventable, impact of Fe fortified formula and cereal, adolescents especially at risk due to rapid gwoth and poor eating habits. |
|
|
Term
| Pathophysiology of Anemia |
|
Definition
| Any number of factors that decrease the supply of Fe (dietary), impair its absorption (decreased Vit. C), Increase the bodys need for Fe, affect synthesis of Hgb |
|
|
Term
| Management (Inadequate Fe in the diet) |
|
Definition
Fortified formula and cereals, Oral Fie supplements (ferrous iron 3-6mg/kg)
Vit C aids in absorption
Severe: IV/Parenteral Fe, Packed RBC transfusions |
|
|
Term
| Anemia Caused By Increased Destruction of RBC SICKLE CELL ANEMIA |
|
Definition
Hereditary hemoglobinopathy (autosomal recessive disorder 1in 4, mendelian prediction
Ethnicity:
Occurs primarily in African American Population
1 in 12 have trait
1 in 400 black americans have SCD |
|
|
Term
| Sickle Cell Pathophysiology |
|
Definition
Normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin, HGG in the RBCs take on an elongated sickle shape, sickled cells are rigid and obstruct capillary blood flow (lead to microvascular occlusions, ischemia, infarcts, and tissue death)
Hypoxia occurs and further worsens sickling |
|
|
Term
| Infarctions of Sickle Cell |
|
Definition
| Occur in tissues (large and small), Cause chronic damage to liver, spleen, heart, kidneys, eyes and bones, pulmonary infarction leadeing to acute chest syndrome, Cerebral infarction leads to stroke, sickled cells are more likely to be destroyed leading to jaundice |
|
|
Term
|
Definition
| No cure (BM transplants), supportive care, frequenct bacterial infections due to immunocompromise (spleen unable to filter bacteria), leading cause of death in young children with disease, Strokes in 5-10% of children with disease (neurodevelopmental delay, MR) |
|
|
Term
|
Definition
Precipitating Factors
Any event that increases bodys need for O2 or alters transport of O2, (trauma, infection, feber, physical and emotional stress, increased viscosity of blood due to dehydration, hypoxia (high altitude, poorly pressurized flights, hypoventilation, vasocintriction due to hypothermia) |
|
|
Term
| Cerebral Vascular Accident (CVA) |
|
Definition
Emergency, occurs in 7% of children with SCD
Signs (convulsions/slurred speech, ataxia, weakness, paralysis)
Treatment
(Symptoms, exchange transfusion, chronic trnafusion program, neuropsych follow up? |
|
|
Term
|
Definition
Infarction of spleen at microvascular level, occurs primarily in children <4yrs, Life threatening-death can occur within hours(high mortality), Blood pools in the spleen
S/S
Rapidly enlarging abdomen with left sided pain, profound anemia, hypovolemia, and shock |
|
|
Term
| S/S of Splenic Sequestration |
|
Definition
| Irritability, unusal sleepiness, looks pale, weakness, fast heart beat, big spleen, pain on the left side of the abdomen |
|
|
Term
|
Definition
Temporary cessation of bone marrow function, decreased production and increased destruction of RBCs, Triggered by viral infection or depletion of Folic acid
S/S
Profound anemia/pallor
Treatment
PRBC transfusions, treat infection, monitor closely |
|
|
Term
|
Definition
Persistent, painful,unwanted erection (stuttering, multple shore episodes, sever prolonged lasting 24hours)
High incidence of sexula dysfunction
Treatment:
Hydration/ opiods, exchange transfusion, avoid temperature extremes |
|
|
Term
|
Definition
Agressive treamtnet of infection, hydrations, protection from cold exposure, frequenct transfusion (concern of Fe overload, hemosiderosis- chelation therapy)
Supportive Care- pain relief, oxygen |
|
|
Term
| Vaso Occlusive Crisis (VOC) |
|
Definition
Most common very painful, stasis of blood with clumping of cells in microcirculation->ischemia-> infarction
Sites:
Bones, lungs, liver/spleen, brain, penis
S/S
Fever, pain tissue swelling |
|
|
Term
|
Definition
Can occur anywhere in the body, hands feet (dactylitis)usually if less than 2 years old
Long bones, joints abdomen, usually if greater than 2 years old
Soft tissue swelling, association with infection
Treatment:
Hydration, pain management (opoids, NSAIDs) |
|
|
Term
|
Definition
EMERGENCY
Leading caude of dealth in SCD patients older than 10 years
Causes: Infection, infarction, or pulmonary fat embolus
Symptoms:
Fever, chest or back pain, Decreased O2 sats, cough, dyspnea |
|
|
Term
| Acute Chest Syndrome Management |
|
Definition
Symptoms Management: (Antiobiotics/ steroids, pain/fever control/ O2, Maintenance fluids/ rehydration)
Close monitoring: CSR, pulmonary toilet |
|
|
Term
|
Definition
Inherited blood disorders of hemoglobin synthesis (autosomal recessive), classified by Hgb chanin affected (alpha or beta) and by severity of effect, anemia results from defective synthesis
S/S: chronic hypoxia (HA, irritability, precordial and bone pain, exercise intolerance, anorexia, epistaxis)
Treatment:
RBC transfusion to maintain Hct (side effect: hemosiderosis Fe overload) treat with Fe-chelating drugs to bind excess |
|
|
Term
| Anemia caused by impaired or Decreased production of RBCs (Aplastic Anemia) |
|
Definition
| Pancytopenia, absent abnormal stem cell production with marked decrease in RBC, WBC, and platelets, profound depression of all 3 cell lines. |
|
|
Term
|
Definition
Etiology: primary or secondary
Acquired (50% idiopathic, activated suppressor lymphocytes, drugs/ toxins/ chemicals, radiation)
Congenital
Fanconi's anemia- diagnosed by chromosome analysis |
|
|
Term
| Presentation of aplastic anemia |
|
Definition
Decreased RBCs
(pallor and weakness)
Decreased platelets
(petuchiae, bruising)
Decreased WBCs
(infections, mouth sores)
NO Hepatosplenomegaly |
|
|
Term
| Aplastic Anemia Treatment |
|
Definition
Remove exposure to hazardous drugs/ toxins
HCT (hematopeoietic cell transplant)
Non HCT treatment (antithymocyt globulin (ATG), Methylprednisone, Cyclosporin, Cytokines (G-CSF/GM-CSF, Epogen/IL-3) |
|
|
Term
| Aplastic Anemia Prognosis |
|
Definition
| High risk of late malignancies, AML |
|
|
Term
|
Definition
Group of hereditary bleeding disorders that result from deficinecies of specific clotting factors, x-linked congenital bleeding disorder (protein deficiency affects normal clotting, occurs among all races)
Transmitted by mom mainly effects males |
|
|
Term
|
Definition
A: "Classic hemophilia) deficiency of factor VII (clotting cascade)
80% of hemophilia cases
B: Caused by deficinecy of factor IX, also known as "Christmas disease", 15% of hemophilia cases |
|
|
Term
| Clincial Manifestations of Hemophilia |
|
Definition
| Same for both types of hemophilia, excessive/ prolonged bleeding, (life threatening bleeds, tongue throuat, CNS) Signs of bleeding (tingling, pain, swelling) |
|
|
Term
|
Definition
| Bleeding into joint spaces of knee, ankle, elbow (leads to impaired mobility) Causes dyarthrosis (pain in joints) |
|
|
Term
|
Definition
Prevent bleeding, (close supervision, dental, shaving, pressure for 15 minutes and ice to vasoconstrict any ooze)
DDAVP (Vasopressin)- increases factor VII
Replace missing clotting factors, transfusions of other blood products to prevent hemorrhage. |
|
|
Term
|
Definition
| Excellent with appropriate management by multidisciplinary center, gene therapy is hope for the future, need hepatitis C screening, HIV no longer an issue |
|
|
Term
|
Definition
Hereditary bleeding disorder (auto dom), involves deficiency of vWf (carrier for factor VII), necessary for platelet adhesion
S/S:
Easy bruising, espistaxis, gingival bleeding, excessive bleeding with lacerations or surgery
Treatment: Infsuion of vWB protein concentrate
DDAVP infusion before bleeding event
Avoid aspirin and NSAIDS (increases bleeding time and decreased plt) |
|
|
Term
| Immune thrombocytopenia Purpura (ITP) |
|
Definition
| Acquired hemorrhagic disorder resulting in excess destruction of circulating platelets (platelet count less than 100K, shortened platelet life span, anti platelet activity, increase megakarycocytes in bone marrow), hisotry of viral infection within 2-4 weeks, present with eccymosis/petechia, epistaxis |
|
|
Term
|
Definition
| More common in children, average age 2-6yrs but may occur at any age, follows minor viral infection, average duration 2-6 weeks, 90% have normal platelet count by 4 months |
|
|
Term
|
Definition
| More common in adults, 3:1 females, Insidous onset and lupus antigen association, duration is months to years, fluctuating chronic disease. |
|
|
Term
|
Definition
| Petechia/purpura, decreased circulating platelets, all other blood incies normal, no hepatomegaly, healthy looking child |
|
|
Term
|
Definition
| No therapy/ observation (safety precautions, quiet play), steroids, IVIG |
|
|
Term
|
Definition
| 80-90% resolve in 4 months, 95% resolve by 6 months, chronic if lasts more than 6 months, recurrence in children is rare, not associated with any further disease or malignancy |
|
|
Term
| Nursing Care of Children recieving blood transfusion |
|
Definition
Hemolytic reactions, febrile reactions, allergic reactions, circulatory overload (given over 4 hours), air emobli, hypothermia (due to cold blood), electrolyte distrubances.
Check date of blood, lysse cells relase K+, citrate binds Ca+ and the pts claciul will bind and the heart will be effected. |
|
|
Term
| Immunologic defiency disorders |
|
Definition
| SCIDS- severe combined immunodefiecinecy syndrom (absence of both humoral and cell mediated immunity, genetic, chronic infections very early in life) TX: Prevent infection, and stem cell transplant |
|
|
Term
|
Definition
| X-linked recessive disorder, poor prognosis, clotting issues, also affects b and t lymphocytes, triat of abnomralitis, (thrombocytopenia, excema, and immunodeficiency) |
|
|
Term
| Immunologic Deficiency Disorders |
|
Definition
HIV-AIDS
Affects t-lymphocytes
S/S:
Lymphadenopathy, petaosplenomegaly, oral candiasis, chronic or recurrent diarrhea, FTT, DD
Severtiy based on Pediatric HIV classificaation and age specific CD4 and T lymphocyte counts |
|
|
Term
| Musculoskeletal Pediatric Differences |
|
Definition
| Muscle tissue is amost completely developed at birth, the infants bones are only 65% ossified at 8 months and are neither as firm nor as brittle as those of the older child, new bony tissue is produced during periods of growth, growing bones heal quickly, sutures of the cranium do not fuse until approx 16-18 months of age, fractures in children <1 yr are unusual because a large amont of force is necessary... consider abuse or underlying pathophysiology |
|
|
Term
|
Definition
| extended pulling force may be used to provide rest for an extremity, to help prevent or improve contracture deformity, to correct deformity, to treat dislocation, to allow position and alignment, to provide immobilization, to reduce muscle spasms |
|
|
Term
| Traction: Essential componenets |
|
Definition
| Traction: forward forced produced by attaching weight to distal bone fragment (adjust by adding or subtracting weight), Counteraction: backward force provided by body weight (increas by elevating food of bed), Frictional forc: provided by patient's contact with the bed |
|
|
Term
|
Definition
| Buck's extension, Russell Traction, Cervical Traction |
|
|
Term
|
Definition
| Halo, balanced suspension, femoral traction |
|
|
Term
|
Definition
| Continous or intermittent boot or circular wrap is applied to the skin, used to treat some fractures, hip disorders, contractures and muscle spasms |
|
|
Term
|
Definition
| Continuous traction, used to stabilize fractures femurs until callus forms |
|
|
Term
|
Definition
| May be continuous or intermittent, maintains the head in extension by a halter |
|
|
Term
| Important to assess the five P's |
|
Definition
| Pain and point of tenderness, pulse- distal to the facture site, pallor, paresthesia- sensation distal to the fracture site, paralysis- movement distal to the fracture site |
|
|
Term
|
Definition
| Immobilization was once thought to be restoratvie for patients with illness and injury, we know now that immobilization has serious consequencyse (physical,social psychological) |
|
|
Term
| Physiologic effects of immobilization |
|
Definition
| Muscular, skeletal, cardiovascular, respiratory, GI (slows down), renal metabolism, integumentary |
|
|
Term
| Psychological effects of Immobilization |
|
Definition
| Diminished environmental stimuli, altered perception of self and enviornment, increased feelings of frustration, helplessness, anxiety, depression, anger, aggressive behavior, development of regression |
|
|
Term
|
Definition
| Extended periods of immobilizations (logistical management of sick child, need for family support and home care assistance, financial and mised work related issues), coping skills |
|
|
Term
|
Definition
| Club foot, developmental dysplasia of the hip, legg-calve-pethes disease, slipped capital femoral epiphysis |
|
|
Term
|
Definition
| Congenital malformation of the lower extremity, affects the lower leg, ankle, and foot, genetic predisposition and mulifactorial etiology, plant-flexed foot with an inverted heel and adducted forefoot |
|
|
Term
| Developmental Dysplasia of the Hip |
|
Definition
| Head of femur is improperly seated in the acetabulum of the pelvis, varies in sweverity, can be present at birth or develop after birth, multifactorial in origin, genetic factors and prenatal positioning may play a role |
|
|
Term
| Three degrees of developmental dysplasia of the Hip |
|
Definition
Unstable hip- mildest form-hip ligaments are lax, allowing displacement
Sublaxated hip- Head of femur is under lip of acetabulum, but not well seated
Dislocated Hip- femoral head loses contact with acetabulum |
|
|
Term
| Clinical Manifestations of DDH |
|
Definition
Infant
Shortened limb on affected side, restricted abduction of the hip on affected side, unequal gluteal folds when infant prone |
|
|
Term
|
Definition
| Click heard when hips pulled up to flex |
|
|
Term
|
Definition
| Child heard when hips abducted |
|
|
Term
| DDH in Older Infant and Child |
|
Definition
Affected leg shorter than the other
Trendelenburg sign- hips should remain level when weight is shifted from one leg to the other
Greater trochanter is prominenet, waddling gait if bilateral dislocations |
|
|
Term
| Therapeutic management of DDH |
|
Definition
Importance of early intervention, newborn to 6 months: pavlik harness for abduction of hip
Ages 6-18 months: Disolocation unrecognized until child begins to stand and walk; use traction and case immobilization (spica)
Older child: operative reduction; tenotomy, osteomy; very difficult after age 4 |
|
|
Term
| Legg-Calve'-Perthes Disease |
|
Definition
| Osteochondritis deforman juvenilis or coxa plana, self limited, idiopathic, occurs in juveniles ages 2-12, more common in males ages 4-9, avsacular necrosis of the femoral head, 10-15% have bilater hip involvement |
|
|
Term
| Legg-Calve'-Perthes Disease Pathophysiology |
|
Definition
Cause is unknown but involves disturbed circulation to the femoral head with ischemic aseptic necrosis
After resolving may have normal femoral head or may have alteration |
|
|
Term
| Clinical manifestations of Legg-Calve-Perthes Disease |
|
Definition
Insidiuous onset, may have history of limp, soreness or stiffness, limited ROM, vauge history or trauma
Pain and limp most evident on arising and at end of activity, diagnosed by xray |
|
|
Term
| Treatment of Legg-Calve-Perthes Disease |
|
Definition
| Keep femur in acetabulum, caontainement with various devices, rest, no weight bearing initially, surgery in some cases, home tractction in some cases, keep abducted. |
|
|
Term
| Slipped Capital femoral epiphysis |
|
Definition
Affects the upper femoral growth plate/ slips backward into the acetabulum
Hip disorder related to times of growth, especially during adolescence, cause is unknown, connection to stress on the epiphyseal plate just prior to clusre, majority of patients exceed 95th percentile for weigh and 90th percentile for heigh |
|
|
Term
| Slipped Capital femoral epiphysis Clinical Manifestation |
|
Definition
| Limp, gait disturbance, and pain, pain is usally in the groin, thigh, or knee, Intermittent and worsens with activity, confirmed by xray with patient in frog leg position |
|
|
Term
| Slipped Capital femoral epiphysis Therapeutic Management |
|
Definition
| Internal fixation (pin or screw inserted actross the growth plate to secure the femoral head and prevent further slippage |
|
|
