Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?

latex

peanuts

cat dander

alcohol gel

latex

A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as:

facioscapulohumeral.

Duchenne.

limb-girdle.

myotonia.

Duchenne.

Studies have shown that Duchenne is the most severe form of muscular dystrophy. Myotonia isn't a form of the disease; it's a symptom.

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response?

"It has been linked to maternal alcohol consumption during pregnancy."

"It's a common complication of amniocentesis."

"The cause is unknown and there are many environmental factors that may contribute to it."

"Older age at conception is one of the major causes of the defect."

"The cause is unknown and there are many environmental factors that may contribute to it."

There is no one known cause of spina bifida, but scientists believe that it's linked to hereditary and environmental factors. Neural tube defects, including spina bifida, have been strongly linked to low dietary intake of folic acid. Maternal age doesn't have an impact on spina bifida. An amniocentesis is performed to help diagnose spina bifida in utero but doesn't cause the disorder. Maternal alcohol intake during pregnancy has been linked to intellectual disability, craniofacial defects, and cardiac abnormalities, but not spina bifida.

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first?

standing

breathing

swallowing

sitting

standing

Muscular dystrophy usually affects postural muscles of the hip and shoulder first. Swallowing and breathing are usually affected last. Sitting may be affected, but a client would have difficulty standing before having difficulty sitting.

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.

The boy experiences mild pain when wiggling his toes.

The boy's toes are light blue and very swollen.

New drainage is seeping out from under the cast.

The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours.

The outside of the boy's cast got wet and had to be dried using a hair dryer.

The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours.

New drainage is seeping out from under the cast.

The boy's toes are light blue and very swollen.

The parents should call the physician when the following things occur: The child has a temperature greater than 101.5° F (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment?

meeting motor milestones such as sitting, walking, and standing but at a later age than the average child

when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand

a short heel cord caused by walking on the toes

the presence of a waddling gait and difficulty climbing stairs

when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand

A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.

The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningocele. They ask the nurse what exactly that means. Which would be the nurse's best reply?

"The contents of the sac you see only has fluid in it and should cause the child no problem."

"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved."

"The sac is a very small cyst and should resolve within the first year of life."

"Your child's defect involves only the nerves to the bladder and bowel and can be easily repaired."

"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved."

A myelomeningocele is the more severe form of spina bifida cystica, in which the spinal cord and nerve roots herniate into the sac through an opening in the spine, compromising the meninges and usually resulting in neurological impairment. A meningocele includes the meninges and spinal fluid only. A myelomeningocele usually contains the bowel and bladder innervation but involves many more nerves also. A myelomeningocele is not just a cyst that resolves within a year.

A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client?

Teach the client not to rest with the crutch pad pressing on the axilla.

Assess the tips of the crutches to be certain the rubber tip is intact.

Be certain the child is walking with the crutches about 6 inches to the side of the foot.

Caution parents to clear articles such as throw rugs out of paths at home.

Teach the client not to rest with the crutch pad pressing on the axilla.

Pressure of a crutch against the axilla could lead to compression and damage of the brachial nerve plexus crossing the axilla, resulting in permanent nerve palsy. Teach children not to rest with the crutch pad pressing on the axilla but always to support their weight at the hand grip. Always assess the tips of crutches to be certain the rubber tip is intact and not worn through as the tip prevents the crutch from slipping. Be certain the child is walking with the crutches placed about 6 inches to the side of the foot. This distance furnishes a wide, balanced base for support. Caution parents to clear articles such as throw rugs, small footstools or toys out of paths at home, to avoid tripping the child.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers?

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

The nurse should be a contact person when the child is hospitalized.

The nurse should support the caregivers in restricting activity during the treatment.

The nurse should provide information when the child or caregiver requests it.

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns?

"There are simple noninvasive treatment options."

"Don't worry; this is a relatively common diagnosis."

"Your daughter will likely wear a Pavlik harness."

"This is not your fault and we will help you with her care and treatment."

"This is not your fault and we will help you with her care and treatment."

Because the mother is crying and experiencing the initial shock of the diagnosis, the nurse's primary concern is to support the mother and assure her that she is not to blame for the DDH. While education is important, the nurse should let the mother adjust to the diagnosis and assure her that the baby and her family will be supported now and throughout the treatment period.

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way?

Cover the sac with a saline-moistened dressing.

Keep the mass uncovered and dry.

Prevent cold stress using an Isolette and blankets.

Change position from side to side hourly.

Cover the sac with a saline-moistened dressing.

Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. Blankets may cause trauma to the sac. An Isolette can be used for warmth, but much attention will have to be directed toward keeping the sac moist. Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided.

An infant was born with a severely deformed hand. He is now 6 months old. The nurse informs the parents that the orthopedic surgeon has recommended amputation of the hand and fitting of a prosthesis. The mother objects and tells the nurse that they would like to wait and see how the hand develops. Which of the following should the nurse say in response?

"If we perform the amputation and you change your mind later, the hand can always be surgically reattached."

"An alternative to amputation and prosthesis is administration of a new drug that can help regenerate the hand."

"With a deformity such as this, the hand is highly unlikely to improve."

"I agree. You should wait until your son is older and let him decide whether he would like to have it done."

"With a deformity such as this, the hand is highly unlikely to improve."

Depending on the condition, in many children, there is a potential for better function if the malformed portion of an extremity is amputated before a prosthesis is fitted. This creates a difficult decision for parents because it is one they cannot undo later. They need assurance that hands with malformed fingers, for example, will not later grow to become normal and a well-fitted prosthesis will allow their child a more usual childhood (and adult life) than if the original disorder was left unchanged. It is not the nurse's place to insert her opinion about the matter.

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered?

pamidronate

opioid analgesics

diazepam

alendronate

diazepam

Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Opioid analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesis imperfecta.

Through which mechanism is Duchenne muscular dystrophy acquired?

heredity

environmental toxins

virus

autoimmune factors

heredity

Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors.

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding?

kyphosis

sway back

idiopathic scoliosis

lordosis

idiopathic scoliosis

Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis.

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?

Internal fixation device

Stockinette

External fixation device

Spica cast

Spica cast

The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client?

Impaired physical mobility related to a cast on the leg

Deficient diversional activities related to a need for imposed activity restriction for 6 weeks

Pain related to chronic inflammation of the lower leg

Situational low self-esteem related to the use of a walker

Impaired physical mobility related to a cast on the leg

Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should clean the pin sites at least once every 8 hours.

The nurse should provide age-appropriate activities for the child.

The nurse should monitor for decreased circulation every 4 hours.

The nurse should record accurate intake and output.

The nurse should monitor for decreased circulation every 4 hours.

Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction.

The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond?

"This could be an indicator of spina bifida; we need to evaluate this further."

"Dimpling, skin discoloration, and abnormal patches of hair are often indicators of spina bifida occulta."

"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."

"This is often an indicator of spina bifida occulta as opposed to spina bifida cystica."

"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."

Dimpling and skin discoloration in the child's lumbosacral area can be an indication of spina bifida occulta. It would be best to respond that the dimpling and discoloration is possibly a normal variation with no problems and indicate that the doctor will want to take a closer look; this response will not alarm the parent, but it also does not ignore the findings. Spina bifida is a term that is often used to generalize all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. It is probably best to avoid the use of the term initially until a diagnosis is confirmed. Nursing care would then focus on educating the family.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals?

"It is important to correct spinal curvature before it gets too bad, causing you problems."

"It is important to prevent torticollis."

"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."

"It is important to prevent herniation of a spinal disk, which is painful."

"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."

It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record?

low alkaline phosphate levels

low serum calcium levels

high serum phosphate levels

x-ray confirmation of adequate bone shape

low serum calcium levels

With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:

significant bending without actual breaking.

incomplete fracture.

bone that breaks into two pieces.

bone buckling due to compression.

significant bending without actual breaking.

A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces.

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

Complete

Incomplete

Spiral

Greenstick

Complete

If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?

appearance of smaller than normal calf muscles

lordosis

indications of hydrocephalus

Gowers sign

Gowers sign

A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.

When teaching a group of parents about the skeletal development in children, what information will the nurse provide?

Children's bones have a thin periosteum and limited blood supply.

The growth plate is the area of growing tissue near the ends of flat bones.

A young child's bones commonly bend instead of break when an injury occurs.

The infant's skeleton has undergone complete ossification by birth.

A young child's bones commonly bend instead of break when an injury occurs.

The infant and a young child's bones are more flexible and more porous with a lower mineral count than adults. The structural differences of a young child's bone allow for greater shock absorption thus, bones will often bend rather than break when an injury occurs. Growth plates are growing tissue found near the ends of long bones. The infant's skeleton is not fully ossified at birth. Children's bones have a thick periosteum and an abundant blood supply.

A toddler is diagnosed with osteomyelitis. When developing the child's plan of care, which intervention would the nurse include?

instructions for using crutches

maintenance of bed rest with a full body cast

implementation of fluid restriction

administration of intravenous antibiotic therapy

administration of intravenous antibiotic therapy

For osteomyelitis, the priority is to eradicate the infection by administering intravenous antibiotic therapy, initiated in the hospital and then continued at home for as long as 2 weeks; an intermittent infusion device or peripherally inserted central catheter (PICC) may be used. After this, the child will be prescribed an oral antibiotic for 3 to 4 more weeks. Immobilization would be important; however, there is no indication of the need for crutches. Although bed rest is warranted, a full body cast is unlikely. The child is not at risk for fluid overload so fluid restriction would be inappropriate.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?

sodium

bilirubin

serum potassium

creatine kinase

creatine kinase

Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse?

"Braces have been replaced with surgical intervention. Your child will only wear a brace for a few weeks after the surgery."

"The newer braces only have to be worn while the child is asleep and don't have to be worn at school."

"Unfortunately, bracing is the only option for treating this disorder. I'm sure your child will get used to it after a few weeks."

"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."

"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."

Bracing is the primary treatment for scoliosis. The braces used today are designed by computer-aided techniques and fit under the arms rather than extending to the neck. Braces must be worn 23 hours a day. Surgical intervention is only performed in severe cases.

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply.

semi-Fowler

supine

right side lying

left side lying

prone

right side lying

left side lying

prone

Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.

A child is to undergo testing for suspected muscular dystrophy and is scheduled for the following tests. Which test would the nurse identify as most important to be completed first?

muscle biopsy

nerve conduction velocity

creatine kinase

electromyogram

creatine kinase

The sample for creatine kinase must be obtained before the electromyogram or muscle biopsy because those tests may lead to a release of creatine kinase and provide false results. Nerve conduction velocity tests could be done at any time.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents?

"Ice will help reduce the inflammation."

"You and your coaches need to understand that you cannot play soccer for at least six weeks."

"You will need to see a physical therapist for stretching and strengthening exercises."

"NSAIDs can help with pain control and inflammation."

"You and your coaches need to understand that you cannot play soccer for at least six weeks."

A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse?

"A small amount of lotion or baby oil can be poured in the cast to moisturize the area."

"Itching is common. It's nothing to worry about."

"You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there."

"Blowing cool air with a fan or hair dryer may relieve the feeling."

"Blowing cool air with a fan or hair dryer may relieve the feeling."

Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

A nurse assesses a client who is reporting calf pain and a very sore leg. The client has a temperature of 101°F (38.3°C). X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and the erythrocyte sedimentation rate is elevated. What condition do these symptoms suggest?

muscular dystrophy

osteomyelitis

Legg-Calvé-Perthes disease

compartment syndrome

osteomyelitis

Osteomyelitis is a bone infection usually caused by Staphylococcus aureus, which causes leg pain and fever. Lab work reflects an elevated leukocyte count and an increased erythrocyte sedimentation rate. X-rays look normal until 5 to 10 days after onset of symptoms.

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:

epiphysiolysis of the proximal humerus.

Sever disease (calcaneal apophysitis).

epiphysiolysis of the distal radius.

Osgood-Schlatter disease.

epiphysiolysis of the proximal humerus.

Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease (calcaneal apophysitis) causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?

"In most cases treatment is not necessary, only observation."

"This is the most common facial nerve palsy."

"Was this from pressure resulting from forceps?"

"Have you seen any signs of improvement?"

"In most cases treatment is not necessary, only observation."

The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide?

to stand absolutely still when not wearing the brace

to continue with age-appropriate activities

that secondary sex changes will stop until the brace is removed

to wear the brace a maximum of 20 hours each day

to continue with age-appropriate activities

The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. Bracing is one way to do that. The brace should be worn for 23 hours per day. Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. It is extremely important that the adolescent has compliance with the brace usage. The nurse can help by teaching the adolescent ways to help peers understand the need for the brace. Sex changes continue with or without bracing.

Which diagnostic measure is most accurate in detecting neural tube defects?

significant level of alpha-fetoprotein present in amniotic fluid

amniocentesis for lecithin-sphingomyelin (L/S) ratio

presence of high maternal levels of albumin after 12th week of gestation

flat plate of the lower abdomen after the 23rd week of gestation

significant level of alpha-fetoprotein present in amniotic fluid

Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect.

Which of these strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy?

manual wheelchair

long leg braces

motorized wheelchair

walker

long leg braces

Long leg braces are functional assistive devices that provide increased independence and increased use of upper and lower body strength. Wheelchairs, both motorized and manual, provide less independence and less use of upper and lower body strength. Walkers are functional assistive devices that provide less independence than braces.

The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications?

Provide pin care as needed.

Clean and massage his entire leg daily.

Assess the popliteal region carefully for skin breakdown.

Adjust the weights as needed.

Assess the popliteal region carefully for skin breakdown.

The nurse would assess the popliteal region carefully for skin breakdown from the sling. The nurse would adjust the weights only per physician orders. Cleaning and massaging the skin is unrelated to care of the child with Russell traction. Russell traction is a form of skin traction, so there is no pin care.

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele?

delayed growth and development

constipation

impaired physical mobility

risk for infection

risk for infection

All of these diagnoses are important for a child with a myelomeningocele. However, during the first 12 hours of life, the most life-threatening event would be an infection. The other diagnoses will be addressed as the child develops.

The school nurse cares for children with overuse injuries and refers them for treatment. Which statements accurately describe conservative interventions to prevent or care for these types of injuries? Select all that apply.

Perform appropriate stretching during a 20-to 30-minute warmup.

Apply ice to the injured area to reduce inflammation.

Have the coach monitor the treatment program for sports injuries.

Immobilize the muscles that are involved.

Encourage 1 to 2 days off per week of competitive athletics.

Avoid using NSAIDs for pain control.

Encourage 1 to 2 days off per week of competitive athletics.

Apply ice to the injured area to reduce inflammation.

Perform appropriate stretching during a 20-to 30-minute warmup.

Conservative treatment methods for the child with an overuse injury include encouraging 1 to 2 days off per week of competitive athletics, performing appropriate stretching during a 20-to 30-minute warmup, and applying ice to the injured area to reduce the inflammation and irritation. NSAIDs (ibuprofen) are used for inflammation and pain control. The physical therapist institutes a stretching and strengthening program for the appropriate muscle groups. Parents and coaches may not understand that the level of activity that causes overuse symptoms varies from child to child. Notes or telephone conversations from the physician or nurse to the child's coach can clarify any misconceptions about what is expected during the recovery and recuperative periods.

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child?

Handling the cast with open palms when moving the arm.

Encouraging the child to move the arm slowly up and down to help the cast dry.

Using only a draw sheet to move the casted arm.

Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm.

Handling the cast with open palms when moving the arm.

A wet plaster cast should be handled only with open palms because fingertips can cause indentations and result in pressure points. There is no reason the arm should be restrained or the arm moved to aid in the drying process.

The nurse is conducting a physical examination of a child with a brachial plexus injury. Which finding would lead the nurse to be highly suspicious of Erb palsy?

The involved extremity is adducted, prone, and internally rotated.

Asymmetry of the face occurs when the child is crying.

The child is unable to close one of his eyes.

The mouth is drawn to the noninvolved side.

The involved extremity is adducted, prone, and internally rotated.

Erb palsy is an upper brachial plexus injury and the involved extremity usually presents as adducted, prone, and internally rotated. Inability to close one eye, facial asymmetry, or drawing of the mouth to the noninvolved side are associated with facial nerve palsy as a result of cranial nerve injuries.

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching?

"He must have an adequate amount of fluid."

"I need to figure out his usual pattern for passing stool."

"My son's activity is too limited to stimulate his bowels."

"I can palpate his abdomen to assess for constipation."

"My son's activity is too limited to stimulate his bowels."

The nurse needs to point out to the mother that even minimal activity increases peristalsis. Together they can come up with appropriate activities within the child's limits or restrictions to promote peristalsis. It is important to determine the usual pattern for passing stool so that the mother and nurse can determine the best program. Palpating the abdomen can reveal distention, suggesting constipation. Adequate fluid is necessary to stimulate peristalsis.

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:

back with hips flat on the bed.

back with hips up off the bed.

stomach with both legs extended.

back with the injured hip flexed and the uninjured one extended.

back with hips up off the bed.

Bryant traction is used to reduce fractures or with developmental dysplasia of the hip (DDH) in children younger than 2 years of age. In this type of traction, both legs are extended vertically with the child's weight serving as the counterbalance. For there to be traction, the infant's hips must be off the bed. The position of having the child on the back with the hips flat is describing Buck traction. The position where the hip is flexed on the injured side and the uninjured extended is 90-90 traction. There is no traction when the child would be on the stomach.

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair?

antitip device

wheelchair belt

headrest support

extended breaks

wheelchair belt

This client has poor trunk control; a belt will prevent him from falling out of the wheelchair. Antitip devices, head rest supports, and extended breaks are all important options but aren't the most important options in this situation.

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates?

spina bifida with myelomeningocele

spina bifida with meningocele

spina bifida occulta

a normal spinal closure

spina bifida occulta

Spina bifida occulta is a bony defect that occurs without soft-tissue involvement. A dimple in the skin or a tuft of hair over the site may arouse suspicion of its presence, or it may be overlooked entirely.

An 8-year-old client with a fractured forearm is to have a fiberglass cast applied. Which information will the nurse include when teaching the child and family about the cast?

The child initially may experience a very warm feeling inside the cast.

The cast will take a day or two to dry completely.

The cast will need to be "petaled" to prevent skin irritation.

The child will need to keep the arm down at the side for 48 hours.

The child initially may experience a very warm feeling inside the cast.

A fiberglass cast usually takes only a few minutes to dry and will cause a very warm feeling inside the cast. Therefore, the nurse needs to warn the child that this will occur. Fiberglass casts usually have a soft fabric edge, so they usually do not cause skin rubbing at the edges and do not require petaling, unlike plaster casts, which will require petaling. The child should be instructed to elevate the arm above the level of the heart for the first 48 hours.

A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used?

Inspection

Observation

Auscultation

Palpation

Auscultation

The physical examination specific to fractures includes inspection, observation, and palpation. The nurse may assume that auscultation is not used; however, auscultation of the child's lungs may reveal adventitious sounds that are often present when respiratory muscle function is impaired.