chap 22

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 Explanation: 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 working with a 6-year-old child recently diagnosed with Legg-Calvé-Perthes disease. The child's parents tells the nurse they understand exercise is important for their child but are not sure which activities are appropriate. Which activity will the nurse recommend for this client?

Swimming Explanation: Legg-Calvé-Perthes disease occurs when blood supply to the femoral head of the hip joint is temporarily interrupted and the bone begins to die. The child with Legg-Calvé-Perthes disease will experience limited range of motion in the hip. Thus, swimming and tricycle or bicycle riding are excellent exercises because they provide smooth joint action and will help to reduce joint destruction. In contrast, activities that place excessive strain on joints, such as running, jumping, prolonged walking, and kicking, should be avoided. Reference:

After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching?

"We'll apply a warm moist compress to the wrist for 20 minutes at a time." Explanation: Care for a sprain includes rest, ice, compression, and elevation. Cold therapy, not heat, is used for 20 to 30 minutes at a time, then removed for 1 hour and repeated for the first 24 to 48 hours. Compression via an elastic bandage, elevating above heart level, and limiting activity are appropriate measures.

A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note?

The posterior spine when bending forward Explanation: Diagnosis of scoliosis is best made with inspection and observation. When inspecting the back with the child in a standing position, the nurse should note asymmetries such as shoulder elevation, the prominence of one scapula, an uneven curve at the waistline, or a rib hump on one side. A lateral curvature of the spine is best revealed when the child bends forward. The child should bend forward with the arms hanging freely. The curve and asymmetry of the back can be observed. The height of the iliac crest, not the angle, is measured on both sides and the difference is noted. Bending to the side would not provide an accurate assessment of the spine because the curvature cannot be seen from the side. The lower chest angle would not be an accurate assessment as it would be more associated with the ribs as opposed to the spine. Reference:

A 7-year-old child diagnosed with Duchenne muscular dystrophy (DMD) uses a wheelchair for mobility. The child's parent tells the nurse "I want my child to participate in activities with peers but I am so concerned about my child's health." Which comment(s) is appropriate for the nurse to make? Select all that apply.

Wheelchair team sports might be something your child would enjoy." "Encourage your child to remain active but to also take time to rest." Explanation: The most appropriate comments would be to suggest wheelchair team sports and to encourage the child to remain active but take time to rest. Because the child has lower extremity involvement and uses a wheelchair, riding a stationary bicycle would not be possible. Engaging in daily active and passive range-of-motion exercises are important but this response does not address the parent's desire for the child to engage in activities with peers. Telling the parent that the child will not be able to engage in activities with peers is inappropriate and not true.

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction?

When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." Explanation: Scoliosis refers to the lateral curvature of the spine. There are differing types of the condition. Mild-to-moderate curvatures can be managed by a brace. The brace is worn daily for all activities other than bathing. Clients should remove the brace for only 1 hour each day. Exceeding this time with the brace off will impair the therapeutic effects of the bracing treatment. During the time the brace is off, hygiene activities such as bathing should be done. It is important to check the brace for any damage daily to prevent injury. For comfort, a lightweight t-shirt may be worn under the brace.

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 wear the brace now to stabilize your spinal alignment, decreasing your symptoms." Explanation: 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 who fractured the arm in an accident. A cast has been applied to the child's right arm. Which action(s) should the nurse implement? Select all that apply.

Document any signs of pain. Check capillary refill time in the both arms. Monitor the color of the nail beds in the right hand. Explanation: The most important function for the nurse in caring for a child in a cast is frequent neurovascular checks. The nurse should monitor for increased pain and edema, a pale or blue color to the extremities, skin coolness, numbness or tingling, poor capillary refill, and decreased pulse strength. Increased pain, especially unrelieved with pain medications, can indicate serious complications such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary as the cast is not sterile.

The nurse is assessing a young boy who has been brought to the health care provider for mobility and balance issues by his parents. Which findings are positively associated with the presence of Duchenne muscular dystrophy? Select all that apply.

Serum creatine kinase levels are elevated. A muscle biopsy shows an absence of dystrophin. The child is unable to rise easily into a standing position when placed on the floor. Explanation: Significant muscle wasting is associated with this diagnosis. Creatine kinase levels increase with muscle wasting. A muscle biopsy will show an absence of dystrophin. Gowers sign will be positive. An electromyogram will indicate the problem is with the muscles, not the nerves. Genetic testing will reveal the presence of the gene associated with Duchenne muscular dystrophy.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

unhooking a weight while providing pin care Explanation: Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze.