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Peds Exam 3 Study Guide, Study Guides, Projects, Research of Pediatrics

Virginia State University (VSU)Pediatrics

Peds Exam 3 Study GuidePeds Exam 3 Study Guide

Typology: Study Guides, Projects, Research

2024/2025

Available from 04/09/2025

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Peds Exam 3 Study Guide
1. **Musculoskeletal Alterations: Fractures**
- Common injury in children
- Methods of treatment are different in pediatric populations than the older adult population
- Younger the child, the faster the bone heals due to growth from the child
- RARE in (?): may get a fracture from MVA or falls from different heights: - Infants
2. **Musculoskeletal Alterations: Fractures**
- Most common fracture is of the (?) -> radius, ulna, or both
- (?) is the most common fracture in childhood (<10 years old) -> occurs from falls
- In school-aged children, falls can occur from PLAYGROUNDS, BICYCLES, and SPORT INJURIES: - Distal
forearm
-Clavicle
3. **Musculoskeletal Alterations: Clinical Manifestations of Fractures**
- Generalized (?)
- Pain or tenderness
- (?)
- Diminished use of limb or digit
- Possible (?), muscular rigidity, CREPITUS: - Swelling
-Deformity
-Bruising
4. **Musculoskeletal Alterations: Common Fractures in Children
- (?): a bone is bent but NOT broken, most common in the ULNA and FIBULA and often associated with
fractures of the radius and tibia: - Plastic deformation
5. **Musculoskeletal Alterations: Common Fractures in Children
- (?): produced by COMPRESSION of porous bone; appears as a raised or PROTRUDING projection at the
fracture site
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Peds Exam 3 Study Guide

1. Musculoskeletal Alterations: Fractures

  • Common injury in children
  • Methods of treatment are different in pediatric populations than the older adult population
  • Younger the child, the faster the bone heals due to growth from the child
  • RARE in (?): may get a fracture from MVA or falls from different heights: - Infants

2. Musculoskeletal Alterations: Fractures

  • Most common fracture is of the (?) -> radius, ulna, or both
  • (?) is the most common fracture in childhood (<10 years old) -> occurs from falls
  • In school-aged children, falls can occur from PLAYGROUNDS, BICYCLES, and SPORT INJURIES: - Distal forearm
  • Clavicle

3. Musculoskeletal Alterations: Clinical Manifestations of Fractures

  • Generalized (?)
  • Pain or tenderness
  • (?)
  • Diminished use of limb or digit
  • Possible (?), muscular rigidity, CREPITUS: - Swelling
  • Deformity
  • Bruising

4. **Musculoskeletal Alterations: Common Fractures in Children

  • (?): a bone is bent but NOT broken, most common in the ULNA and FIBULA and often associated with fractures of the radius and tibia: - Plastic deformation

5. **Musculoskeletal Alterations: Common Fractures in Children

  • (?): produced by COMPRESSION of porous bone; appears as a raised or PROTRUDING projection at the fracture site

More common in young children: - Buckle

6. **Musculoskeletal Alterations: Common Fractures in Children

  • (?): occurs when the bone is ANGULATED beyond the limits of bending Incomplete fracture on the opposite side of the bend: - Greenstick

7. **Musculoskeletal Alterations: Common Fractures in Children

  • (?): divide bones into fragments that often remained attached by periosteal hinge Hinders reduction: - Complete

8. Musculoskeletal Alterations: Fractures

  • Growth plates can also cause fractures
  • Diagnosed with (?)
  • Treatment is usually casting, but can involve surgery -> use pins and screws- : - X-ray

9. Musculoskeletal Alterations: Fractures

Bone healing is typically RAPID in children

  • Neonatal: (?)-(?) weeks: - 2-3 weeks

10. Musculoskeletal Alterations: Fractures

Bone healing is typically RAPID in children

  • Early childhood: (?) weeks: - 4 weeks

11. Musculoskeletal Alterations: Fractures

Bone healing is typically RAPID in children

  • Later childhood: (?)-(?) weeks: - 6-8 weeks

12. Musculoskeletal Alterations: Fractures

Bone healing is typically RAPID in children

  • Adolescence: (?)-(?) weeks: - 8-12 weeks

13. Musculoskeletal Alterations: Fractures: Compartment Syndrome

  • Serious complication of nerves, blood vessels, and muscles inside a closed space
  • Can result in tissue death, needs to be treated IMMEDIATELY
  • Can be molded close to the body: - Plaster

17. Musculoskeletal Alterations: Casting: Plaster vs. Synthetic

  • Takes a long time to dry
  • Heavy
  • NOT waterproof: - Plaster

18. Musculoskeletal Alterations: Casting: Plaster vs. Synthetic

  • Lightweight
  • Dries fast
  • Promotes weight bearing: - Synthetic

19. Musculoskeletal Alterations: Casting: Plaster vs. Synthetic

- WATER RESISTANT

  • Comes in different colors
  • CANNOT be closely molded to the body
  • Difficult to write on cast: - Synthetic

20. Musculoskeletal Alterations: Cast Removal

  • A (?) to open cast
  • Blade does not cut skin, only cuts cast
  • Important to show child that it does not hurt before removing cast: - "Saw"

21. Musculoskeletal Alterations: Types of Casts

  • Long leg/short leg cast
  • Bilateral LLC
  • (?) cast
  • Single cast
  • Long arm/short arm cast: - Full spica

22. Musculoskeletal Alterations: Casting: Nursing Care

  • Pain management
  • Evaluate for (?): - Compartment syndrome

23. Musculoskeletal Alterations: Casting: Educate

  • Nothing should be put into the cast
  • Circulation check -> (?), (?), (?)
  • Keep cast dry
  • Medication administration
  • Follow-up visits: - Color, temperature, capillary refill

24. Musculoskeletal Alterations: Traction

Extended pulling force may be used

  • To provide rest for an extremity
  • To position for bone healing
  • To immobilize a fracture until healing is sufficient to permit casting or (?): - Splinting

25. Musculoskeletal Alterations: Traction

Extended pulling force may be used

  • To help prevent or improve contracture deformity
  • To provide immobilization
  • To reduce (?) -> rare in children: - Muscle spasms

26. Musculoskeletal Alterations: Traction

  • (?): FORWARD force produced by attaching weight to a distal bone fragment; adjust by ADDING or SUBTRACTING weights
  • (?): BACKWARD force provided by body weight; increase by ELEVATING FOOT OF THE BED
  • (?): provided by patient's contact with bed: - Traction
  • Countertraction
  • Frictional force
  • (?) traction is applied to a body part by the hand placed distally to the fracture site: - Manual traction

28. Musculoskeletal Alterations: Types of Traction

  • (?) traction involves pulling mechanisms that are attached to the skin with adhesive material or an elastic bandage: - Skin traction

29. Musculoskeletal Alterations: Types of Traction

  • (?) traction is applied directly to the skeletal structure by a pin, wire, or tongs, inserted into or through the diameter of the bone distal to the fracture: - Skeletal traction

30. Musculoskeletal Alterations: Tractions: Nursing Care

  • Assessing the patient in traction
  • Skin care -> risk of (?)
  • Pain management and comfort: - Breakdown

31. Musculoskeletal Alterations: Congenital Hip Dysplasia

  • Occurs more in girls than boys
  • (?) increases risk: - Family history

32. Musculoskeletal Alterations: Congenital Hip Dysplasia

DDH is categorized into TWO major groups

  • (?): infant neurologically intact
  • (?): occurs in utero and it is less common; neuromuscular defect: - Idiopathic
  • Teratologic

33. Musculoskeletal Alterations: 3 Types of Congenital Hip Dysplasia

  • (?): mildest form; osseous hypoplasia of the acetabular roof; femoral head remains in the acetabulum
  • (?): incomplete dislocation of the hip
  • (?): femoral head loses contact with the acetabulum and is displaced pos- terior and superiorly; ligaments are elongated and taut: - Acetabular dysplasia (preluxation)
  • Subluxation
  • Dislocation

34. Musculoskeletal Alterations: Congenital Hip Dysplasia: Therapeutic Man- agement

  • Importance of early intervention
  • Newborn to age (?) months: Pavlik harness for abduction of the hip
  • Age (?) to (?) months: dislocation is unrecognized until the child begins to stand and walk; use traction and cast immobilization (spica)
  • Older child: operative reduction, tenotomy, osteotomy; difficult after 4 years: - 6 months
  • 6 months to 24 months

35. Musculoskeletal Alterations: Congenital Hip Dysplasia: Infant vs Older Children

  • Shortened limb on the affected side
  • Restricted ABDUCTION of hip on the affected side
  • Unequal GLUTEAL FOLDS when prone: - Infant

36. Musculoskeletal Alterations: Congenital Hip Dysplasia: Infant vs Older Children

  • Positive Ortolani test
  • Positive Barlow test: - Infant

37. Musculoskeletal Alterations: Congenital Hip Dysplasia: Infant vs Older Children

  • Affected leg is shorter than unaffected leg
  • Telescoping or piston mobility of the joint
  • Trendelenburg sign: - Older children

38. Musculoskeletal Alterations: Congenital Hip Dysplasia: Infant vs Older Children

  • Greater trochanter is prominent and appeared above the line from the antero- superior iliac spine to the tuberosity of the ischium
  • Marked lordosis if bilateral discolorations
  • Waddling gait if bilateral discolorations: - Older children

39. Musculoskeletal Alterations: Congenital Hip Dysplasia: Nursing Care

  • (?) -> maintains reduction, teach the parents how to use this, provide skin care
  • Cast care with older children: - Pavlik harness

40. Musculoskeletal Alterations: Scoliosis

  • Gluteal cleft

45. Musculoskeletal Alterations: Scoliosis: Therapeutic Management

  • Team approach to treatment
  • Bracing
  • Exercise What are the TWO surgical interventions for SEVERE curvature?: - Harring- ton rids
  • L-rods

46. Musculoskeletal Alterations: Scoliosis: Nursing Care: True or False

  • Concerns of body image, social isolation, prolonged treatment
  • Preoperative care
  • Postoperative care
  • Family issues:

47. Musculoskeletal Alterations: Osteomyelitis

  • Inflammation and infection of bony tissue
  • Most frequently seen in children less than or 10 years with a median age of 5-6 years old
  • Most affects the foot, (?), (?), and (?): - Femur
  • Tibia
  • Pelvis

48. Musculoskeletal Alterations: Osteomyelitis

  • (?): most common causative organism
  • Acute (?) osteomyelitis: bloodborne bacterium causes an infection in a bone
  • (?) osteomyelitis: acquired from a direct inoculation of the bone from a puncture wound, open fracture, surgical contamination, or adjacent tissue infection: - Staphylococcus aureus
  • Acute hematogenous osteomyelitis
  • Exogeneous osteomyelitis

49. Musculoskeletal Alterations: Osteomyelitis: Signs and Symptoms

  • Begins ABRUPTLY
  • Nutritional considerations
  • Long-term (?) and therapy
  • Psychosocial needs: - Antibiotic
  • Hospitalization

53. Musculoskeletal Alterations: Septic Arthritis

  • Bacterial infection in the joint
  • Usually results from extension of soft tissue infection (cellulitis) or (?)
  • Most COMMON causative agent: (?): - Osteomyelitis
  • Staphylococcus aureus

54. Musculoskeletal Alterations: Septic Arthritis

  • May involve any joint but common in the HIP, KNEE, ANKLE, ELBOW
  • Usually involves only ONE JOINT
  • Joint is warm, tender, (?), and (?): - Painful
  • Swollen

55. Musculoskeletal Alterations: S/S of Septic Arthritis

  • Fever
  • Malaise
  • Headache
  • Nausea
  • (?)
  • Increased (?) or (?): - Leukocytosis
  • Increased ESR or CRP

56. Musculoskeletal Alterations: Diagnosis of Septic Arthritis

  • Blood culture
  • (?)

- MRI

  • CT scan: - Joint fluid aspirate

57. Musculoskeletal Alterations: Treatment Goals for Septic Arthritis

  • Prevent destruction of the (?)
  • Decompress the joint to maintain circulation to the epiphysis
  • Eradicate infection
  • Prevent secondary bone infection or hematogenous spread
  • IV (?) therapy based on gram stain results and clinical presentation: - Joint cartilage
  • Antibiotic

58. Neurological Alteration: Neurologic Exam

  • (?): clues for GENETIC disorders with neurologic manifestations
  • (?): birth history: gestation, Apgar score, type of delivery, developmental milestones, trauma, acute/chronic illnesses, ingestion or inhalation of neuro- toxic substances, animal or insect encounters, LOC, posture, motor function, sensory function, cranial nerves, reflex testing, VS: - Family History
  • Health History

59. Neurological Alteration: Level of Consciousness (LOC)

  • Consciousness: implies awareness and ability to respond to sensory stimuli and have subjective experiences What are two components of consciousness?: - Alertness
  • Cognitive power

60. Neurological Alteration: 2 Components of Level of Consciousness (LOC)

  • (?): an AROUSAL-WAKING state, ability to respond to stimuli
  • (?): ability to process stimuli and produce verbal or motor response: - Alert- ness
  • Cognitive power

61. Neurological Alteration: Level of Consciousness (LOC)

  • (?): depressed cerebral function, inability to respond to sensory stimuli and have subjective experiences
  • (?): permanently lose function of cerebral cortex, eyes follow objects only by

reflex or when attracted to the direction of loud sounds, all limbs are spastic but withdrawal from painful stimuli, reflexive grasp and groping of hands, facial grimace, may be able to swallow some foods, may groan or cry but no utter words: - Persistent vegetative state

67. Neurological Alteration: Glascow Coma Scale (GCS)

  • Scale used to standardize the description and interpretation of the degree of depressed consciousness
  • Assessing (?), (?) response, and (?) response: - Eye opening
  • Verbal response
  • Motor response

68. Neurological Alteration: Glascow Coma Scale (GCS)

  • Highest score of 15: (?)
  • Lower than 8: (?)
  • The lowest score of 3: (?) A decrease in the GCS score indicates deterioration of the child's condi- tion: - Unaltered LOC
  • Coma
  • Deep coma

69. Neurological Alteration: Vital Signs Based on LOC

  • Body Temp: often elevated; can be (?) or (?)
  • Pulse: variable; may be RAPID, SLOW, BOUNDING, or FEEBLE: - Hypothermia
  • Hyperthermia

70. Neurological Alteration: Vital Signs Based on LOC

  • Blood Pressure: variable (normal, high, low)
  • Respirations: often slow, deep, irregular; may be slow and shallow or deep and rapid
  • Breathing Patterns: periodic or irregular breathing is an ominous sign of (?): - Brainstem dysfunction

71. Neurological Alteration: Eye Exam: LOC

Pupils assess size, reactivity, and symmetry

  • (?) pupils: poisoning and brainstem dysfunction

76. Neurological Alteration: Motor Function of LOC

  • (?) posturing (brain is not dead): occurs due to severe dysfunction of the cerebral cortex
  • (?) posturing (brain is not dead): dysfunction at level of mid brain or brain stem: - Decorticate
  • Decelebrate

77. Neurological Alteration: Nursing Care of Unconscious Child

  • Careful observation and evaluation of change in status
  • Priority is maintaining (?)
  • Careful and frequent neurological exams
  • Pain evaluation: - Airway

78. Neurological Alteration: Nursing Care of Unconscious Child

  • Proper and changing (?)
  • Monitor for (?)
  • ROM
  • Support family: - Positioning
  • Increased Intracranial Pressure

79. Neurological Alteration: Increased Intracranial Pressure (ICP)

  • Solid, bony cranium is enclosed tightly around the brain
  • The cranium's total volume contains around the brain (80%), (?) (10%), and (?) (10%) Children with open fontanels compensate by skull expansion and widened sutures: - Cerebrospinal fluid
  • Blood

80. Neurological Alteration: Increased Intracranial Pressure (ICP)

  • An increase in ICP can be caused by tremors, (?), and (?) of cerebral tissues
  • An acute rise in ICP can cause secondary brain injury: - Bleeding and edema

81. Neurological Alteration: S/S of Increased Intracranial Pressure (ICP)

Infants

  • (?)
  • Irritability and restlessness
  • (?)
  • Increased sleeping: - Widened sutures
  • Drowsiness

82. Neurological Alteration: S/S of Increased Intracranial Pressure (ICP)

Infants

  • High-pitch cry
  • Poor feeding
  • (?) -> only can see half of eyeball: - Setting-sun sign

83. Neurological Alteration: S/S of Increased Intracranial Pressure (ICP)

Child

  • Headache, nausea
  • Forceful (?)
  • (?), blurred vision: - Vomiting
  • Diplopia

84. Neurological Alteration: S/S of Increased Intracranial Pressure (ICP)

Child

  • (?)
  • (?), drowsiness
  • Decline in school performance
  • Lethargy: - Seizures
  • Indifference

85. Neurological Alterations: ICP Monitoring