Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - ML8

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors?

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death.

A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment?

Quietly observe the child at play while interviewing the parent.

The pediatric nurse practitioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this?

The boy rises from the floor by walking his hands up his legs.

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?

diazepam

The nurse is educating a group of caregivers about fractures seen in children. One of the caregivers states, "I have heard that if a bone breaks it can cause permanent damage and stop the growth of the bone." This statement is accurate if the break occurs in the:

epiphyseal plate.

A nurse is conducting a physical examination of an infant with suspected metatarsus adductus. Type II metatarsus adductus is indicated when the forefoot is:

flexible passively past neutral, but only to midline actively.

An infant with a femur fracture is placed in Bryant traction. What would the nurse include in the infant's plan of care?

keeping the buttocks slightly elevated.

When a child is suspected of having muscular dystrophy, a nurse should expect which muscles to be affected first?

muscles of the hip

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.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent?

"Applying ice to the area will reduce the pain and swelling."

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?

Cartilage

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

Color Sensation Pulse Capillary refill

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority?

Deficient knowledge related to diagnosis and condition

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?

Gowers sign

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 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 nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?

Type II

A group of students is reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?

adolescence

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

back with hips up off the bed.

The nurse is caring for a child with muscular dystrophy. Which prescription will the nurse question?

clozapine

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

creatine kinase

The child diagnosed with muscular dystrophy often exhibits a forward curvature of the lumbar spine. What is this spinal condition called?

lordosis

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 serum calcium levels

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test?

muscle biopsy

A nurse is conducting a physical examination of a 5-year-old boy with spinal muscular atrophy (SMA) type 2. What assessment findings would the nurse expect to find?

pectus excavatum ("funnel chest")

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?

presence of Moro reflex

The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to:

prevent edema.

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

significant level of alpha-fetoprotein present in amniotic fluid

A nurse is caring for an 11-year-old with an Ilizarov fixator and is providing teaching regarding pin care. The nurse should provide which instruction?

"Cleansing by showering should be sufficient."

A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby. The nurse should stress which teaching point?

"It is important that the harness be worn continuously."

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."

The nurse is reinforcing teaching with the caregivers of a child who has been placed in an external fixation device for the treatment of an orthopedic condition. Which statement made by the caregivers indicates an understanding of the external fixation device?

"It will be hard, but we know our child will be in this device for a long time."

The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention?

"Let's ask your parents to bring your friends for a visit."

A nurse is assisting the parents of an infant who requires a Pavlik harness. The parents are apprehensive about how to care for their infant and concerned about holding and playing with the infant. How can the nurse best assist the parents?

"Let's put you in touch with other families who have experienced this."

The caregiver of a 2-year-old who has a polyurethane resin cast on her arm calls the clinic to report that her child is crying and says that the cast has sand in it. The caregiver states that she has had casts herself and knows how badly they can itch. She says she always used a hanger to scratch but is worried that it will be too sharp for the child. Which statement would be appropriate for the nurse to make to this caregiver?

"Nothing should be put into the cast. You can blow cool air into it with a hair dryer."

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

"Pale, cool, or blue skin coloration is to be expected."

A young child with Duchenne muscular dystrophy is placed on both prednisone and calcium. Parents view these two medications as rather "common" and question their importance for the child. What explanation by the nurse will be most helpful to the parents?

"Prednisone helps to keep muscle fibers strong and delays progression of the disease. Calcium protects against osteoporosis caused by both prednisone and lack of weight bearing."

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?

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

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?

"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."

A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond?

"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group."

The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information?

"Would you please describe the weakness you are seeing in your son?"

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?

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

The nurse is assessing an infant at a well-check visit. The infant's parent expresses worry about the infant's feet because they are so flat and wide. What is the most appropriate response by the nurse?

"Your baby's feet are normal. The longitudinal arch will develop after your baby walks for several months."

The nurse is caring for a child diagnosed with a sprain of the lower extremity. Which health care prescription(s) would the nurse clarify with the provider before implementing? Select all that apply.

Apply a heating pad four times daily for 20 minutes per application Offer aspirin (ASA) three times daily orally to the child for pain and inflammation

A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. What is most important for the nurse to do when she has finished applying the cast?

Assess the fingers for warmth, pain, and function

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?

Assess the popliteal region carefully for skin breakdown.

Why will it be necessary for the nurse to be supportive of parents' attempts to feed their infant with recently repaired myelomeningocele?

Assuming the usual feeding position will be difficult.

A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg?

Check the infant's toes for coldness or blueness.

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

The nurse cares for an infant with myelomeningocele before surgical intervention. What action will the nurse take?

Cover the sac with a saline-moistened dressing.

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.

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:

Duchenne.

The nurse is caring for an extremely active 13-year-old adolescent who has recently been prescribed a back brace to treat scoliosis. Which intervention will be most critical to the success of treatment?

Emphasize and encourage compliance related to the use of a back brace.

The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions?

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.

The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client?

Ensure traction weights are hanging freely, not touching the bed or floor.

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.

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

A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective?

Inspect the child's skin for rashes, redness, irritation, or pressure injuries.

A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation?

Muscular wasting results in generalized immobility and difficulty feeding and breathing.

The nurse meets a child with a slipped capital femoral epiphysis. In what type of child does this usually occur?

Obese adolescent boys

A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury?

Place the newborn in a prone or lateral position.

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

The nurse should monitor for decreased circulation every 4 hours.

Which nursing concern will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?

altered skin integrity risk

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant?

baclofen

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal?

development of gross motor movement

A type of traction sometimes used in the treatment of the child with scoliosis is called:

halo traction.

Through which mechanism is Duchenne muscular dystrophy acquired?

heredity

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant?

inspection of the cystic sac on the child's back for leakage

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

latex

A nursing instructor is preparing a class presentation about tibia vara. What would the instructor include as a risk factor?

obesity

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

skeletal traction.

The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as:

spastic.

The parents of a preschool-age child learn their child is diagnosed with Duchenne muscular dystrophy (DMD), based on the nurse noting a Gower sign during a well-child visit. How should the nurse explain Gower sign to these parents?

the way the child stands up

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

to continue with age-appropriate activities

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

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?

wheelchair belt

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?

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

The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education?

"Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future."

A pediatric client's parent calls the nurse and states, "My child fell off the bike. My child was wearing a helmet, but did scrape the knee and it is bleeding a lot. What should I do?" Which response by the nurse is best?

"You should apply pressure to the site and then bring your child in to be evaluated."

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental bowlegs (genu varum)?

A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray

The nurse is conducting a neuromuscular assessment on a toddler. What assessment technique(s) is important for the nurse to include in this assessment? Select all that apply.

Compare muscle strength and tone bilaterally. Observe for involuntary muscle contractions. Perform passive range-of-motion on all extremities.

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele?

The spinal meninges protrude through the bony defect and form a cystic sac.

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

standing

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

The nurse is discussing treatment for a child diagnosed with scoliosis. Which statement indicates the parents understand the nurse's education?

"Because our child is being treated by using braces, the braces will have to be worn almost all the time."

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?

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

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."

A nurse is preparing a class on neural tube disorders to present to a community group. What information regarding prevention is most important for the nurse to include in the teaching?

dietary considerations

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 is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should the nurse use to best describe this condition?

degeneration of muscle fibers

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.