N-Trivia

Fractures of Extremity
Roles of a Pediatric Nurse
Phenylketonuria (PKU)
Hypothyroidism

Fractures of Extremity

Posted: 11 Oct 2010 02:01 AM PDT

$fracturetypesimage Fractures of Extremity$ Etiology and Pathophysiology

Breaks in the continuity of bone, usually accompanied by localized tissue response and muscle spasm.
Cause usually trauma, but pathologic fractures may occur as a result of osteoporosis, multiple myeloma, or bone tumors, which weaken bone structure.
Types

- Complete fracture – bone completely separated into two parts, may be transverse or spiral.
- Incomplete fracture – only part of the bone broken.
- Comminuted fracture – bone broken into several fragments.
- Greenstick fracture – splintering on one side of the bone, with bending of the other side; occurs only in p;iable bones, usually in children.
- Simple (closed) fracture – bone broken but no break in the skin.
- Compound (open) fracture – break in the skin at the time of fracture with or without protrusion of the bone.

Stages of bone healing include:

- Formation of a hematoma
- Followed by cellular proliferation
- And callus formation by the osteoblasts
- Ossification
- Remodeling of the callus

Signs and Symptoms

Subjective

Pain aggravated by motion
Tenderness

Objective

Loss of motion
Edema
Crepitus
Ecchymosis

Diagnostic Procedure

X-ray examination reveals break in continuity of bone
Deformity caused by change in bone alignment; often results in shortening of the extremity.

Assessment

Ability of the client to move extremity.
Altered appearance of involved body part.
Neurovascular assessment, soft tissue injury or edema may compromise circulatory or neurologic functioning.
Factors precipitating injury.
Nutritional status.

Nursing Diagnosis

Disturbed body image
Constipation
Fear
Risk for injury
Pain
Impaired physical mobility
Altered role performance
Self-care deficits
Risk for skin integrity

Nursing Interventions

Evaluate the client's general physical condition
Splint extremity in position found before moving the client; consider all suspected fractures until X-ray films are available.
Cover open wound with sterile dressing if available.
Observe for signs of emboli, severe chest pain, dyspnea, pallor, and diaphoresis.
Observe for signs of circulatory impairment such as change in skin temperature or color, numbness and tingling, unrelieved pain, decrease in pedal pulse, prolonged blanching of toes after compression or inability to move toes.
Protect the cast from damage until dry by elevating it on a pillow.
Promote drying of the cast by leaving it uncovered; a light may be used with care to promote drying.
Maintain bed rest until the cast is dry and ambulation is permitted.
Observe for swelling and notify the physician if necessary.
Check that weights are hanging freely and that the affected limb is not resting against anything that will impede the pull of the traction.
Maintain in proper alignment.
Observe for foot drop on clients with Russel traction or Buck's extension, since this may indicative of nerve damage.
Observe for signs of thrombophlebitis.
Encourage high protein, high vitamin diet to promote healing.
Encourage fluids to help prevent constipation, renal calculi, and urinary tract infection.
Teach isometric exercises to prevent muscle strength and tone for crutch walking.
Teach appropriate crutch-walking technique; non-weight bearing; weight bearing progressing to use of cane.

Complications

Early

Shock
Fat embolism syndrome
Compartment syndrome
Deep vein thrombosis
Thromboembolism
Pulmonary embolus

Delayed

Delayed union and nonunion
Avascular Necrosis
Reaction to Internal Fixation devices
Complex Regional Pain Syndrome
Heterotrophic Ossification

More information about fracture

Roles of a Pediatric Nurse

Posted: 10 Oct 2010 06:26 PM PDT

Pediatric nurses nowadays serves a variety of roles, from teaching in various setting to rendering hands-on care in hospitals or clinic. Taking care of children involves self-awareness that one must be patient enough about kids as well as consider the fundamentals of child psychology especially the developmental stages. Since children could not sometimes utter what they really felt whenever they are sick, careful assessment and an experienced “clinical eye” must be employed.

It may sound too complex, but beyond the grimaces and cries of children comes their angelic faces smiling at you when you will be able to talk their language. Their parents and caregivers are the next people who must be well taken cared of in terms of proper health teaching since they will be the primary caregivers once children will return to thier community.

Here are some of the important roles of a pediatric nurse:

A. Family Advocate – Nurses are expected to be sensible enough in voicing out the needs of their patients and folks in behalf of them when it is impossible for them to readily address their needs.

B. Health Promoter – Nurses prefer measures to prevent diseases rather than waiting for it to be complicated. They are the ones responsible enough to guide the parents to promote proper nutrition, updated immunizations, and early detection of health problems. It is their primary responsibility to ensure the normal growth and development of children so that they can perform daily activities to its optimum level.

C. Health teacher – Health teaching is very basic for nurses since they are the ones responsible for monitoring the patients as well as carry out the physician’s discharge orders. It is then a must to anticipate parents to ask for ways to improve their children’s health such as parenting and disease process so as to prevent future hospital admission as much as possible.

D. Counselor – Nurses must be active listeners in order to establish a therapeutic relationship between parents and the child, making health care plans easier.

E. Researcher- Change is constant in the health care setting, so it is a must to practice evidenced-based practice. This means that pediatric nurses should have the ability to improve themselves in order to give updated care.

F. Coordinator / Collaborator – Pediatric nurses are sometimes or most of the member of the health team, so he or she might be in a position wherein he or she is the avenue of important information that other health team members need in delivering competent care. So it is a must that pediatric nurses need to be a good information giver and communicator among health team members to promote a harmonious working environment.

There are many roles that a pediatric nurse could perform as health care settings evolved from one stage to another. The challenge lies behind the application of evidenced-based practice to provide competent care to children. Last but not the least, having a heart for children matters a lot when the work load at the area seems to be heavy – children could make you smile no matter how harsh the world could be.

*Photo credits from Google images

Phenylketonuria (PKU)

Posted: 10 Oct 2010 05:54 PM PDT

Phenylketonuria (PKU) is an inborn error of metabolism that results from the absence of a liver enzyme, phenylalanine hydroxylase. It is an inherited autosomal recessive trait that causes negative impact on development and mental retardation.

Phenylalanine hydroxylase enzyme is responsible for the conversion of phenylalanine (an essential amino acid) to tyrosine. The nonessential amino acid, tyrosine, is a significant element for some neurotransmitters such as dopamine, norepinephrine, epinephrine and serotonin. It is also essential in the production of melanin and function of the hormone regulating organs such as thyroid, pituitary, and adrenal glands.

Consequences of absent liver enzyme in children with PKU would result to deficient tyrosine leading to the following conditions:

Absence of serotonin, dopamine and epinephrine

Result: Faulty nerve (Nervous System) transmission

Neurotransmitters communicate impulses to the nerve cells. Lack of tyrosine would lead to deterioration of this function. Mood regulation is also connected to the presence of these chemicals (dopamine, serotonin, and epinephrine); therefore, alteration of one's disposition and temperament will be expected.

Deficient Melanin levels

Result: Unusual skin color

Melanin is responsible for skin pigmentation. Deficient levels of melanin lead to a very fair complexion, a light blond hair and blue eyes.

Hyposecretion of thyroid hormones

Result: Permanent brain damage (Mental Retardation) and developmental delay

Thyroid glands are located at the throat that comprises the two lateral masses on each side of the trachea. Before the two active thyroid hormones are produced, a process known as iodide trapping (iodide ion is concentrated within the thyroid) occurs. Then iodide is dissolved inside the follicular cells of the thyroid to become iodine and later released as a colloid. Colloids contain thyroglobulins which are made up of the amino acid tyrosine. Iodide when combined with tyrosine produces Monoiodotyrosine (MIT) and Diiodotyrosine (DIT). Conversion of MIT and DIT would form the two active thyroid hormone, triiodothyronine (T3) and Thyroxine (T4). These hormones are stored in the follicular cells until needed. T3 and T4 are primarily responsible for cellular metabolism affects nearly all cells in the body. They play a vital role for normal development to occur.

In PKU, no Monoiodotyrosine (MIT) and Diiodotyrosine (DIT) is formed due to absence of tyrosine. Production of T3 and T4 would be inevitable causing decrease basal metabolism, cessation of cognitive and physical development. Most children with PKU are cognitively challenged having an IQ of less than 20.

Increase Phenylalanine levels

Result: Mousy urine odor

Phenylalanine levels increase due to the absence of the liver enzyme. The end product of phenylalanine metabolism is phenylpyruvic acid (a keto acid). The by-product spills into the urine that gives it a strong "mousy" or "musty" odor that often spreads through the entire body of the infant or child. This is the reason why the disorder is called phenylketonuria (meaning there is phenylpruvic or keto acid in the urine)

Hypothyroidism

Posted: 10 Oct 2010 05:43 PM PDT

Hypothyroidism is an endocrine disorder caused by a reduction or absent of thyroid hormones. Dysfunction in the thyroid gland itself causes primary hypothyroidism. Central hypothyroidism is due to malfunction of the pituitary gland, hypothalamus or both. Exclusive pituitary gland failure results to a pituitary or secondary hypothyroidism. If low levels of thyroid-stimulating hormones (TSH) result from a defective hypothalamus the condition is referred as hypothalamic or tertiary hypothalamus. Hypothyroidism present at birth (congenital) is called cretinism.

The most common cause of a hypothyroid state is the presence of an autoimmune disease. The major hormone released by the thyroid gland is called thyroxine (T4). Normally, the thyroid gland releases 5-12 mcg/dl or 65-154 nmol/L of thyroxine (T4) in a daily basis. The half-life of T4 is roughly 7-10 days. Triiodothyronine (T3), the second thyroid hormone, is released in smaller amounts.

In the early stage of the disorder, the hypothalamus triggers a massive release of thyrotropic-releasing hormone (TRH) as a compensatory mechanism for thyroid hormone deficiency. TRH is the one responsible for stimulation of the anterior pituitary gland to release thyroid-stimulating hormone (TSH), also called thyrotropin. The TSH then binds with the follicular cells in the thyroid gland to activate the release of the stored thyroid hormones (T3 and T4) to tissues. Hypofunctioning of the thyroid glands leaves the TSH unused and the APG continually releasing it due to hypothalamic stimulation. As a result hypertrophy of the thyroid gland (goiter) occurs.

Thyroid hormones are the body' major metabolic. They are primarily responsible for cellular metabolism affecting all cells in the body. Reduction of its level poses extensive and systemic effects categorized into:

1. Indirect Effects (Early Stage of the disease)

These include delay or cessation of cognitive and physical development due to derangement of cellular and basal metabolism. Declining metabolic rate will result to sluggish and weaker muscular movements. Lesser generation of body heat (lowering of body temperature) is also noted that leads to cold intolerance of affected individuals.

2. Direct effects (Late and Advance Stages)

The accumulation of mucopolysaccharides in the subcutaneous and interstitial tissues (myxedema) results to signs and symptoms directly related to the organ affected.

Gastrointestinal tract: a slowing motility is noted resulting to constipation and gastric stasis.
Myocardium: reduced contractility, decrease pulse rate, low cardiac output, cardiac enlargement, pericardial effusion, cardiovascular collapse and shock (if left untreated)
Respiratory tract: hypoventilation, carbon dioxide retention, depressed respiratory drive

In myxedema, edematous engorgement is noted around the lips, fingers and periorbital areas. In severe and untreated cases, the affected individual may lapse to a coma, which can be deadly.