Keiser University
Course Number: NUR2310C
Course Title: Pediatric Nursing
Credit Hours:4.0
Exam: Midterm
Date:2026
Orthopedic injuries in children
• Bone properties and age-dependent activities predispose age groups to different fracture sites/patterns
• Fractures increase linearly from birth (?); peak btwn 12-15 yrs
• Epidemiologic factors
o Demographics: age, sex, socio-economic status, season, obesity
o Behavior: risk taking
o Bone health: density, nutrition, medication use, genetics, performance enhancing drugs, smoking
• Incidence of fracture: peaks in early adolescence
o Rapid skeletal growth
o Kids have increasing motor skills are testing them out (sports, etc.)
o Increased demand of newly formed bone
o Increased secretion of growth regulatory hormones
• Location
o >80% in upper limbs
o 37% at home; 20% at school
o Children who have experienced one increased r/f more
▪ Insufficient calcium intake is found
• Recreational fractures
o Heelys (lol); nonmotorized scooters; ATVs; trampolines; climbing structures; mountain biking; alpine
sports; in-line skating
• Unique characteristics of pediatric bone
o Lower bone density increased porosity
▪ Allows for greater energy absorption BEFORE breaking
▪ Thick periosteum leads to less displacement of fracture fragments
▪ Increased susceptibility to compression fractures
o Epiphyseal plate is weakest area; exists in growing bones… (?)
o Increased vascularity more rapid healing and callous formation
o Very good remodeling capacity even if non-anatomic alignment
, o Growth plate
▪ Located at epiphyseal plate or physis
▪ Growing tissues near ends of long bones in children & adolescents
▪ Each long bone has two growth plates: one @ each end
▪ Determines future length & shape of mature bone
▪ **WEAKEST AREA of growing skeleton
▪ earlier maturation in females
▪ Suspected injury: Dx is xray and exam
• sometimes not visible on an xray
• Unable to walk/move/bear weight may still be put in cast in case the injury is in the
growth plate and you can’t see it
• Tx
o Age is most important factor due to potential for remodeling
o Wt: effect on bone stabilization
o Type/location of fracture: casting vs. operative repair
• Abusive fractures
o Second only to falls as cause of fractures requiring hospitalization
o Some bones are more commonly fractured due to abuse than other mechanisms
o Rib – common in abuse; very uncommon otherwise
▪ Bc ribs are very pliable as compared to an adult
• even rare in CPR situations
▪ Particularly posterior rib factures squeezing a child
o Metaphyseal
▪ Swung/shaken no external signs of injury; looked for during abuse eval
o Complex skull
o Spinous process
o Multiple in various stages of healing
• Assessment of fractures
o Neurovascular check
▪ Circulation; color/temperature/cap refill/pulse/edema&swelling
o Sensation paresthesia; unrelenting pain
o Mobility
• Immobilization of fractures
, o Casting/splinting
▪ Fracture reduction if needed
▪ Immobilize joint above and below
• Rest, ice, compression, elevation
▪ Fiberglass
• Most common
• Lighter than plaster
• Harden within minutes
• Porous preferred for long term casting (no autographs lol)
▪ Plaster
• Moldable, permeable, setting time @ least 24 hours
▪ Bivalving – cutting into the cast and rewrapping with ace bandage; to allow for swelling &
prevent compartment syndrome
▪ Spica cast
• Often w/ femur fracture
• All the way down one leg; partially down the other further immobilization
o Pain control
o Cast care
▪ Neurovascular checks
▪ Skin check for breakdown: “petaling” edges w/ waterproof tape
▪ Check integrity cracks
▪ Sniff infxn
▪ Keep dirt, particles out
• Compartment syndrome – medical emergency
o Increased tissue pressure in limited space
o Five Ps!
▪ Pain, pallor, pulselessness, paresthesia, paralysis
o Delay in Tx can result in infxn, contractures, limb loss!
• Traction
o Skin traction: wrap the skin & hang with weights ???
o Skeletal traction: pins surgically placed
o Halo traction (skeletal): stabilizing the head
o External fixation: bone is stabilized but not attached to wts or freely hanging traction…
o Want to assess pin sites
o Nursing care
▪ Assessment
▪ Neurovascular checks Q4
▪ Maintain body alignment: ropes, pulleys, wts
• Keep wts hanging freely
▪ Assess skin
▪ Pin site care; observe for s/s infxn
Module 4: Respiratory Conditions in Children
• ARDS is most common respiratory thing that puts kids in hospital
Difference in airway btwn adults and children
, • Children’s everything is smaller except for head
o tongue can be obstructive
• Shorter, narrower trachea; thyroid & cricoid is immature
o Airway is floppy…; easily collapses
• Lots of lymph tissue tonsillitis; edema
• Airways of infants and children
o Bifurcation of trachea at T3 lvl (higher than adults); right mainstem bronchus is steeper
▪ aspiration
o Retractions
▪ Ribs are more horizontal than vertical
o Physiological differences
▪ Diaphragmatic breathers until about age 7
▪ Infants are obligatory nose breathers
▪ Airway constantly growing (increased # of alveoli)
▪ Increased BMR
▪ Increased O2 consumption: 6-8L/min (rather than 4-6L/min)
▪ Airway resistance increased
o R/f occlusion:
▪ Nasopharynx, nares
o R/f aspiration/obstruction:
▪ Small oral cavity & large tongue
▪ Long, floppy epigloṄs vulnerable to swelling
▪ Larynx & glottis are higher in neck
▪ Thyroid, cricoid, tracheal cartilages can easily collapse when neck is flexed
▪ Fewer functional muscles less able to compensate for edema, spasm, trauma
▪ Large amounts of soft tissue and loosely anchored mucous membranes
Croup Syndromes (3 months – 3 yrs)
• **Upper respiratory issue
• Etiology
Course Number: NUR2310C
Course Title: Pediatric Nursing
Credit Hours:4.0
Exam: Midterm
Date:2026
Orthopedic injuries in children
• Bone properties and age-dependent activities predispose age groups to different fracture sites/patterns
• Fractures increase linearly from birth (?); peak btwn 12-15 yrs
• Epidemiologic factors
o Demographics: age, sex, socio-economic status, season, obesity
o Behavior: risk taking
o Bone health: density, nutrition, medication use, genetics, performance enhancing drugs, smoking
• Incidence of fracture: peaks in early adolescence
o Rapid skeletal growth
o Kids have increasing motor skills are testing them out (sports, etc.)
o Increased demand of newly formed bone
o Increased secretion of growth regulatory hormones
• Location
o >80% in upper limbs
o 37% at home; 20% at school
o Children who have experienced one increased r/f more
▪ Insufficient calcium intake is found
• Recreational fractures
o Heelys (lol); nonmotorized scooters; ATVs; trampolines; climbing structures; mountain biking; alpine
sports; in-line skating
• Unique characteristics of pediatric bone
o Lower bone density increased porosity
▪ Allows for greater energy absorption BEFORE breaking
▪ Thick periosteum leads to less displacement of fracture fragments
▪ Increased susceptibility to compression fractures
o Epiphyseal plate is weakest area; exists in growing bones… (?)
o Increased vascularity more rapid healing and callous formation
o Very good remodeling capacity even if non-anatomic alignment
, o Growth plate
▪ Located at epiphyseal plate or physis
▪ Growing tissues near ends of long bones in children & adolescents
▪ Each long bone has two growth plates: one @ each end
▪ Determines future length & shape of mature bone
▪ **WEAKEST AREA of growing skeleton
▪ earlier maturation in females
▪ Suspected injury: Dx is xray and exam
• sometimes not visible on an xray
• Unable to walk/move/bear weight may still be put in cast in case the injury is in the
growth plate and you can’t see it
• Tx
o Age is most important factor due to potential for remodeling
o Wt: effect on bone stabilization
o Type/location of fracture: casting vs. operative repair
• Abusive fractures
o Second only to falls as cause of fractures requiring hospitalization
o Some bones are more commonly fractured due to abuse than other mechanisms
o Rib – common in abuse; very uncommon otherwise
▪ Bc ribs are very pliable as compared to an adult
• even rare in CPR situations
▪ Particularly posterior rib factures squeezing a child
o Metaphyseal
▪ Swung/shaken no external signs of injury; looked for during abuse eval
o Complex skull
o Spinous process
o Multiple in various stages of healing
• Assessment of fractures
o Neurovascular check
▪ Circulation; color/temperature/cap refill/pulse/edema&swelling
o Sensation paresthesia; unrelenting pain
o Mobility
• Immobilization of fractures
, o Casting/splinting
▪ Fracture reduction if needed
▪ Immobilize joint above and below
• Rest, ice, compression, elevation
▪ Fiberglass
• Most common
• Lighter than plaster
• Harden within minutes
• Porous preferred for long term casting (no autographs lol)
▪ Plaster
• Moldable, permeable, setting time @ least 24 hours
▪ Bivalving – cutting into the cast and rewrapping with ace bandage; to allow for swelling &
prevent compartment syndrome
▪ Spica cast
• Often w/ femur fracture
• All the way down one leg; partially down the other further immobilization
o Pain control
o Cast care
▪ Neurovascular checks
▪ Skin check for breakdown: “petaling” edges w/ waterproof tape
▪ Check integrity cracks
▪ Sniff infxn
▪ Keep dirt, particles out
• Compartment syndrome – medical emergency
o Increased tissue pressure in limited space
o Five Ps!
▪ Pain, pallor, pulselessness, paresthesia, paralysis
o Delay in Tx can result in infxn, contractures, limb loss!
• Traction
o Skin traction: wrap the skin & hang with weights ???
o Skeletal traction: pins surgically placed
o Halo traction (skeletal): stabilizing the head
o External fixation: bone is stabilized but not attached to wts or freely hanging traction…
o Want to assess pin sites
o Nursing care
▪ Assessment
▪ Neurovascular checks Q4
▪ Maintain body alignment: ropes, pulleys, wts
• Keep wts hanging freely
▪ Assess skin
▪ Pin site care; observe for s/s infxn
Module 4: Respiratory Conditions in Children
• ARDS is most common respiratory thing that puts kids in hospital
Difference in airway btwn adults and children
, • Children’s everything is smaller except for head
o tongue can be obstructive
• Shorter, narrower trachea; thyroid & cricoid is immature
o Airway is floppy…; easily collapses
• Lots of lymph tissue tonsillitis; edema
• Airways of infants and children
o Bifurcation of trachea at T3 lvl (higher than adults); right mainstem bronchus is steeper
▪ aspiration
o Retractions
▪ Ribs are more horizontal than vertical
o Physiological differences
▪ Diaphragmatic breathers until about age 7
▪ Infants are obligatory nose breathers
▪ Airway constantly growing (increased # of alveoli)
▪ Increased BMR
▪ Increased O2 consumption: 6-8L/min (rather than 4-6L/min)
▪ Airway resistance increased
o R/f occlusion:
▪ Nasopharynx, nares
o R/f aspiration/obstruction:
▪ Small oral cavity & large tongue
▪ Long, floppy epigloṄs vulnerable to swelling
▪ Larynx & glottis are higher in neck
▪ Thyroid, cricoid, tracheal cartilages can easily collapse when neck is flexed
▪ Fewer functional muscles less able to compensate for edema, spasm, trauma
▪ Large amounts of soft tissue and loosely anchored mucous membranes
Croup Syndromes (3 months – 3 yrs)
• **Upper respiratory issue
• Etiology
