PEDI Exam 3 Review by chapter[1].docx

PEDI Exam 3 Review by chapter[1].docx - 1 Musculoskeletal...

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Musculoskeletal: Chapter 31 Pediatric Differences Ossification nearly complete at birth Posterior fontanel closes 2-3 months of age Anterior fontanel closes approx. 18-24 months of age Most skull growth by 2 years of age Long bones of children porous and less dense than adults Muscles increase in length and circumference, not in number Until puberty, ligaments & tendons are stronger than bone Cartilage replaced by bone & skeletal maturation by approximately 20 years of age MOST IMPORTANT: Children bounce because of their cartilage. They have a lot of it and it acts as a sponge. Less likely to break something. It diminishes as they get older. Periosteum. Lining that goes around the bone. It is a coating. Highly vascular, thicker, more fibrous and stronger in children. Reason why the children get the green-stick fractures. Usually breaks in adults. Immobilized Child Once thought to be restorative for patients with illness and injury We now know that immobilization has serious consequences Especially on growth & development of the child Inactivity leads to decrease in functional capacity of the entire body Can delay age appropriate milestones Decreased muscle mass & strength Decreased metabolism If children eat their normal diet, they gain weight because of the immobility. Decreased bone mineralization Immobilization *** Muscular system Decreased muscle strength and endurance Disuse atrophy—Muscle disuse leads to tissue breakdown and loss of muscle mass Loss of joint mobility During immobilization a joint contracture begins when the arrangement of collagen, the main structural protein of connective tissues, is altered, resulting in a denser tissue that does not glide as easily. Eventually muscles, tendons, and ligaments can shorten and reduce joint movement, ultimately producing contractures that restrict function (1107). Skeletal system Bone demineralization Daily stresses on bone by motion & weight bearing maintain balance between bone formation (osteoblastic activity) and bone resorption (osteoclastic activity). During immobilization INCREASED calcium leaves the bone causing osteopenia (demineralization) Reason why weight-bearing exercises are important for the bone. Negative calcium balance ( osteopenia-demineralization of the bones when increased calcium leaves the bones ) Immobilization psychologically Movement is critical: immobility deprives child of natural outlet for feelings Physical growth and development depend on movement Instrument of communication, expression and learning Respond to anxiety with increased activity (tantrums, running around) Traumatic Injury Soft Tissue Injury *** Muscles Ligaments Tendons Sports injuries Mishaps during play 1
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Contusions Damage to soft tissue, subcutaneous tissue and muscle Escape of blood into tissue-ecchymosis-black and blue Swelling, pain disability (large contusions) Crush injuries Occur when children slam their fingers or hit their fingers. (p. 1111)
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  • Fall '16
  • Orthopedic surgery, Bone fracture, nursing care management, therapeutic management

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