Chapter 24: The Child with a Musculoskeletal Condition

The nurse demonstrates which similarities among all traction devices? (Select all that apply.) a. Pull the limb into extension. b. Decrease muscle spasm. c. Reduce pain. d. Align two bone fragments. e. Immobilize the limb.

ANS: A, B, D, E Tractions are designed to immobilize and pull limbs into extension. Traction can also align broken bones and decrease muscle spasm. Although some traction devices may relieve pain, many may actually cause pain.

The nurse explains that Bryant's traction is reserved for children who weigh less than _____ pounds.

ANS: 30 Bryant's traction is a skin traction used in the treatment of orthopedic disorders of young children who weigh less than 30 pounds. Greater weight would cause excessive counterbalance and injury to soft tissues.

A 6-year-old sustained a fractured femur and was put in Russell traction 2 days ago. She screams in pain when she raises herself onto the bedpan. Which nursing diagnosis takes highest priority for this child? a. Pain resulting from tissue trauma b. High risk for impaired skin integrity resulting from immobility c. Altered growth and development related to separation from family d. Altered urinary elimination related to immobility and traction

ANS: A Although all of these nursing diagnoses are relevant to the child in traction, pain resulting from muscle spasm and tissue trauma is the highest priority.

On entering the room of a child in Buck traction, the nurse makes all of the following observations. Which observation requires a nursing intervention? a. Child's heels are placed firmly against the foot of the bed. b. Head of bed is elevated 20 degrees. c. Weights are hanging freely. d. Ropes are on pulleys.

ANS: A Buck traction is dependent on the child as a counterweight. The heels should be elevated above the level of the foot of the bed.

The nurse is checking for capillary refill on a child in Bryant's traction. How long does it take for the toe to regain color if adequate perfusion is assessed? a. 3 seconds b. 4 seconds c. 5 seconds d. 6 seconds

ANS: A Capillary refill in 3 seconds or less is determined to be indicative of adequate perfusion.

What nursing action will significantly decrease the risk of serious complications for a child in Bryant's traction? a. Neurovascular checks are done frequently. b. Bandages are wrapped tightly. c. The child is restrained from rolling over. d. The child's buttocks are resting on the bed.

ANS: A The nurse caring for a child in traction must be alert for Volkmann's ischemia, which occurs when circulation is obstructed.

Which intervention would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis? a. Wearing splints at night to prevent extension contractures b. Applying moist heat packs upon awakening c. Taking a warm tub bath the evening before d. Sleeping with two pillows under the head

ANS: B Application of moist heat, with a compress or by tub bath upon awakening in the morning, will help to lessen stiffness.

A child hospitalized for treatment of osteomyelitis complains that he is tired of being sick and wants to know when the antibiotic protocol will end. How long will the nurse indicate that antibiotic therapy will probably last? a. 2 weeks b. 6 weeks c. 2 months d. 3 months

ANS: B Because osteomyelitis is an infection in the bone, antibiotics are given intravenously for 4 to 6 weeks.

What intervention will the nurse caring for a child in Buck skin traction implement? a. Position in high Fowler's position. b. Assist the child to be pulled up in bed. c. Keep child's heel on the bed surface. d. Maintain child's feet against the foot of the bed.

ANS: B Buck traction is a type of skin traction that relies on the child's weight as counterbalance. The child must be kept with head elevated no more than 20 degrees and pulled up in bed, and the feet should not touch the bed surface or the foot of the bed.

The parent of a child with osteomyelitis asks why his child is in so much pain. What will the nurse respond causes the pain experienced with osteomyelitis? a. "Pressure of inelastic bone" b. "Purulent drainage in the bone marrow" c. "The cast applied on the extremity" d. "Circulatory congestion of the skin"

ANS: B Osteomyelitis is an infection of the bone. Inflammation produces an exudate that collects under the marrow and cortex of the bone. The vessels are compressed and thrombosis occurs, producing ischemia and pain.

What will the nurse include when caring for a child in Buck's extension? a. Positioning the child with hips flexed 90 degrees at all times b. Keeping the weights in contact with the floor c. Checking for skin irritation from traction equipment d. Releasing the weights on a schedule

ANS: C The skin exposed to frequent friction may break down.

The nurse assessing a child with juvenile rheumatoid arthritis notes the child's right knee and ankle are swollen, warm, and tender. The child has a temperature of 38.8° C (102° F) and abdominal pain. What type of juvenile rheumatoid arthritis do these findings suggest? a. Psoriatic b. Enthesitis c. Systemic d. Acute febrile

ANS: C The systemic form of juvenile rheumatoid arthritis is associated with an elevated temperature, erythrocyte sedimentation rate (ESR), and C-reactive protein; abdominal pain; and a macular rash.

The nurse performing a neurovascular check on a limb in traction would report and document which finding(s) as indicative of altered circulation? (Select all that apply.) a. Pulse is equal to uncasted limb. b. Patient is aware of touch and warm and cold application. c. Limb is cool to the touch. d. Capillary refill is 5 seconds. e. Distal limb can flex and extend.

ANS: C, D The limb should be warm, and capillary refill should be less than 3 seconds.

What finding would the nurse assessing the neurovascular status of a child in Russell traction report immediately? a. Skin that's warm to the touch b. Capillary refill less than 3 seconds c. Ability to wiggle toes d. Bluish coloration of skin

ANS: D Cyanosis or pallor noted in an extremity is an indication of circulatory impairment.

Which assessment performed by a nursing student performing a neurovascular check alerts the instructor that further education is necessary? a. Pulses b. Capillary refill c. Movement d. Pupils

ANS: D Neurovascular checks include assessment of pain, pulse, sensation, color, capillary refill, and movement. Pupils are assessed with a neurological check.

How does Russell traction provide adequate skin traction? a. Subluxates the tibia b. Does not interfere with range of motion c. Prevents the knee from flexing d. Supplies continuous pull in two directions

ANS: D Russell traction is skin traction, similar to Buck, with a sling positioned under the knee, which prevents subluxation of the tibia. Although the traction interferes with full ROM, the patient can change position without disrupting the continuous pull in two directions.