PEDS Musculoskeletal congenital disorders
The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction?
1."I will encourage my child to perform prescribed exercises." 2."I will have my child wear soft fabric clothing under the brace." 3."I should apply lotion under the brace to prevent skin breakdown." 4."I should avoid the use of powder because it will cake under the brace." Answer: 3 A brace may be prescribed to treat scoliosis. Braces are not curative, but may slow the progression of the curvature to allow skeletal growth and maturity. The use of lotions or powders under a brace should be avoided because they can become sticky and cake under the brace, causing irritation. Options 1, 2, and 4 are appropriate interventions in the care of a child with a brace.
The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? Select all that apply.
1.Use the fingertips to lift the cast while it is drying. 2.Keep small toys and sharp objects away from the cast. 3.Use a padded ruler or another padded object to scratch the skin under the cast if it itches. 4.Place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold. 5.Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling. 6.Contact the health care provider (HCP) if the child complains of numbness or tingling in the extremity Answer: 2, 5, 6 While the cast is drying, the palms of the hands are used to lift the cast. If the fingertips are used, indentations in the cast could occur and cause constant pressure on the underlying skin. Small toys and sharp objects are kept away from the cast, and no objects (including padded objects) are placed inside the cast because of the risk of altered skin integrity. The extremity is elevated to prevent swelling, and the HCP is notified immediately if any signs of neurovascular impairment develop. A heating pad is not applied to the cast or fingers. Cold fingers could indicate neurovascular impairment, and the HCP should be notified.
A child with cerebral palsy is in a management program to achieve maximum potential for locomotion, self-care, and socialization in school. The nurse works with the child to meet these goals by performing which action?
1. Placing the child on a wheeled scooter board 2.Removing ankle-foot orthoses and braces once the child arrives at school 3. Keeping the child in a special education classroom with other children with similar disabilities 4. Placing the child in the supine position with a 30-degree elevation of the head of the bed to facilitate feeding Answer: 1 The correct option provides the child with maximum potential in locomotion, self-care, and socialization. While lying on the abdomen, the child can move around independently anywhere the child wants to go and can interact with others as desired. Orthoses need to be used all the time to aid locomotion. Children with cerebral palsy (CP) need to be mainstreamed as much as cognitive ability permits to provide for maximum socialization and normalization. Not all children with CP are intellectually challenged. Just as children without CP sit up and use assistive devices when eating, so should children with CP.
The pediatric nurse educator provides a teaching session to the nursing staff regarding juvenile idiopathic arthritis (JIA). Which action by a nursing staff member in the care of a child with JIA indicates a need for further education?
1.Assesses for joint stiffness in the child 2.Encourages performance of isometric exercises 3.Administers nonsteroidal antiinflammatory medication 4.Emphasizes the importance of rising quickly in the mornings Answer: 4 The nursing plan of care for juvenile idiopathic arthritis (JIA) focuses on the status of affected joints. Isometric exercises and passive range of motion exercises will prevent contractures and deformities. Nonsteroidal antiinflammatory medications are used to treat joint stiffness and pain. The child may need more time than average to begin morning activities.
A nurse is assessing a preschool age child for developmental dysplasia of the hip. Which of the following assessments should the nurse include?
1. Barlow test 2. trendelenburg sign 3. manipulation of foot and ankle 4. ortolani test Answer: 2
A nurse is caring for a child who has a fracture. Which of the following are manifestations of a fracture? SATA
1. Creptius 2. Edema 3. Pain 4. Fever 5. Ecchymosis Answer: 1, 2, 3, 5
The nurse has reinforced teaching for a school-age child who was given a brace to wear for the treatment of scoliosis. The nurse determines that the child needs further teaching if the child makes which statement?
1."This brace will correct my curve." 2."I will wear my brace under my clothes." 3."I may not need surgery if I wear my brace." 4."I will do back exercises at least five times a week." Answer: 1 Bracing can halt the progression of most curvatures, but it is not curative for scoliosis. The statements in the remaining options represent correct understanding on the part of the child.
A 9-year-old child fractures the left tibia along an epiphyseal line while using a skateboard. What is the nurse's priority concern during future growth?
1.Infection 2.Paralysis 3.Pressure ulcer 4.Uneven leg growth Answer: 4 The epiphyseal line is the area that is responsible for longitudinal bone growth. A fracture affecting this area places the child at risk for uneven future growth if proper healing does not occur. The epiphyses are located at the proximal and distal ends of a bone and are the insertion sites for muscles. The diaphysis is the shaft or main longitudinal portion of a long bone. The metaphysis is an area of flaring of bone, located between the epiphysis and the diaphysis. Paralysis, pressure ulcer, and infection are not priority concerns for future growth. Paralysis and neurovascular status are priority concerns during the immediate period postinjury, but not during future growth.
A nurse is providing discharge teaching for the parent of a newborn who is prescribed a pavlik harness for development dysplasia of the hip. which of the following responses indicates an understanding of the teaching?
A. I should apply powder to the folds of the skin on my babys knees and thighs B. I should adjust the straps on the harness once a week as my baby grows C. I should lightly massage my baby underneath the straps once a day D. I should place my babys diaper over the straps of the harness. Answer: C
A 4-year-old child sustains a fall at home. After an x-ray examination, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicates a need for further instruction?
1."The cast may feel warm as the cast dries." 2."I can use lotion or powder around the cast edges to relieve itching." 3."A small amount of white shoe polish can touch up a soiled white cast." 4."If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast." Answer: 2 Teaching about cast care is essential to prevent complications from the cast. The parents need to be instructed not to use lotion or powders on the skin around the cast edges or inside the cast. Lotions or powders can become sticky or caked and cause skin irritation. Options 1, 3, and 4 are appropriate statements.
The nurse is caring for a child who fractured the ulna bone and had a cast applied 24 hours ago. The child tells the nurse that the arm feels like it is falling asleep. Which nursing action is appropriate?
1.Encourage the child to keep the arm elevated. 2.Report the findings to the health care provider. 3.Document the findings and reassess the arm in 4 hours. 4.Tell the child that this is normal while the cast is drying. Answer: 2 A child's complaint of pins and needles or of the extremity falling asleep needs to be reported to the health care provider. These complaints indicate the possibility of circulatory impairment and paresthesia. Paresthesia is a serious concern because paralysis can result if the problem is not corrected. The five Ps of vascular impairment are pain, pallor, pulselessness, paresthesia, and paralysis. Prompt intervention is critical if neurovascular impairment is to be prevented.
A child has just returned from surgery and has a hip spica cast. What is the nurse's priority action for this client?
1.Elevate the head of the bed. 2.Assess the circulatory status. 3.Abduct the hips using pillows. 4.Turn the child onto the right side. Answer: 2 During the first few hours after a cast is applied, the chief concern is swelling, which may cause the cast to act as a tourniquet and obstruct circulation. Therefore, circulatory assessment is a high priority. Elevating the head of the bed of a child in a hip spica cast would cause discomfort. Using pillows to abduct the hips is not necessary because a hip spica cast immobilizes the hip and knee. Turning the child from one side to the other at least every 2 hours is important because it allows the body cast to dry evenly and prevents complications related to immobility; however, it is not a higher priority than checking circulation
A child is brought to the emergency department, and diagnostic x-rays of the child reveal that a fracture is present. The mother states that the child was rollerblading and attempted to break a fall with an outstretched arm. A plaster of Paris cast is applied to the arm. Which instructions should the nurse provide the mother? Select all that apply.
1.The cast will mold to the body part. 2.The cast should be dry in about 6 hours. 3.Keep the cast elevated on pillows for the first day. 4.Make sure that the child can frequently wiggle the fingers. 5.The cast is water-resistant, so the child is able to take a bath or a shower. 6.The cast needs to be kept dry because it will begin to disintegrate when wet. Answer: 1, 3, 4, 6 Plaster of Paris is a heavier material than that used in a synthetic cast. It molds easily to the extremity and is less expensive than a synthetic cast. It takes about 24 hours to dry, but drying time could be longer, depending on the size of the cast. Plaster of Paris is not water resistant and will begin to disintegrate when wet. The cast should be elevated on a pillow for the first day to decrease swelling as the cast begins to mold to the arm. As the cast molds, it is imperative that the child can wiggle the fingers because the extremity continues to swell. If the child can wiggle the fingers, adequate motion is present. Color and sensation of the fingers should also be assessed. All of these are important components of a teaching plan for a parent.
The nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which statement by one of the parents indicates an understanding of the use of the harness?
1."I can remove the harness to bathe my infant." 2."I need to remove the harness to feed my infant." 3."I need to remove the harness to change the diaper." 4."My infant needs to remain in the harness at all times." Answer: 1 The harness should be worn 23 hours a day and can be removed only to check the skin and for bathing. The hips and buttocks should be supported carefully when the infant is out of the harness. The harness does not need to be removed for diaper changes or feedings.
The nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse should monitor for which sign of a serious complication associated with this type of traction?
1.Lack of appetite 2.Elevated temperature 3.Decrease in the urinary output 4.Increase in the blood pressure Answer: 2 The most serious complication associated with skeletal traction is osteomyelitis, an infection involving the bone. Organisms gain access to the bone systemically or through the opening created by the metal pins or wires used with the traction. Osteomyelitis may occur with any open fracture. Clinical manifestations include complaints of localized pain, swelling, warmth, tenderness, an unusual odor from the fracture site, and an elevated temperature. The remaining options are not specifically associated with osteomyelitis.
A child sustains a fall at home and is brought to the hospital emergency department by the child's mother. After a radiographic examination, the child is determined to have a fractured arm, and a plaster cast is applied. The nurse provides instructions to the mother regarding neurocirculatory assessment and function. Which statement by the mother indicates a need for further instruction?
1."I'll need to check her skin twice a day at the cast edges." 2."If her hand gets real cool and pale, I can apply the heating pad to it." 3."For the first couple of days, I should try to keep her hand higher than her heart most of the time using pillows." 4."If she seems way too fussy and her arm is painful even after I've given her the pain medication, it might be a problem, and I should call you for help to decide on what is happening." Answer: 2 The mother needs to understand that compartment syndrome is a complication of fracture and casting and can result in permanent limb damage as a result of pressure-related tissue necrosis. The extremity is elevated to prevent swelling, and the health care provider is notified immediately if any signs of neurovascular impairment develop. Cold fingers could indicate neurovascular impairment and should be reported. A heating pad is not applied to the cast or fingers. Skin edges are checked to monitor for irritation and skin breakdown.
A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take?
1.Administer an analgesic. 2.Release the skin traction. 3.Apply ice to the extremity. 4.Notify the health care provider (HCP). Answer: 4 An absent pulse to an extremity of the affected limb after a bone fracture could mean that the child is developing or experiencing compartment syndrome. This is an emergency situation, and the HCP should be notified immediately. Administering analgesics would not improve circulation. The skin traction should not be released without an HCP's prescription. Applying ice to an extremity with absent perfusion is incorrect. Ice may be prescribed when perfusion is adequate to decrease swelling.
A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action?
1.Administer an antiemetic. 2.Increase the intravenous fluids. 3.Place the child in a Sims' position. 4.Notify the health care provider (HCP). Answer: 4 Scoliosis is a three-dimensional spinal deformity that usually involves lateral curvature, spinal rotation resulting in rib asymmetry, and hypokyphosis of the thorax. A complication after surgical treatment of scoliosis is superior mesenteric artery syndrome. This disorder is caused by mechanical changes in the position of the child's abdominal contents, resulting from lengthening of the child's body. The disorder results in a syndrome of emesis and abdominal distention similar to that which occurs with intestinal obstruction or paralytic ileus. Postoperative vomiting in children with body casts or children who have undergone spinal fusion warrants attention because of the possibility of superior mesenteric artery syndrome. Options 1, 2, and 3 are incorrect.
The nurse is assisting a health care provider (HCP) examining a 3-week-old infant with developmental dysplasia of the hip. What test or sign should the nurse expect the HCP to assess?
1.Babinski's sign 2.The Moro reflex 3. Ortolani's maneuver 4.The palmar-plantar grasp Answer: 3 In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Ortolani's maneuver is a test to assess for hip instability and can be done only before 4 weeks of age. The examiner abducts the thigh and applies gentle pressure forward over the greater trochanter. A "clicking" sensation indicates a dislocated femoral head moving into the acetabulum. Babinski's sign is abnormal in anyone older than 2 years of age and indicates central nervous system abnormality. The Moro reflex is normally present at birth but is absent by 6 months; if still present at 6 months, there is an indication of neurological abnormality. The palmar-plantar grasp is present at birth and lessens within 8 months.
A child who sustained a fractured ankle has a short leg cast applied, and the nurse provides home care instructions to the mother. The mother returns to the emergency department 16 hours later because the child is complaining of severe pain. The nurse notes that the child's toes are cool, pale, and puffy and that the child is agitated and crying loudly. The mother states, "I gave her the pain medication you sent with us just like you told us, and I have kept her foot up on two pillows since we left, except when she gets up to go to the bathroom. I don't understand why she hurts so much. Do something!" What is the most likely clinical situation that occurred?
1.Compartment syndrome 2.Inadequate pain medication 3.Skin breakdown around the cast edges 4.Noncompliance with home care instructions Answer: 1 Compartment syndrome occurs as a result of pressure buildup within a tissue compartment bound by anatomical structures such as fascia. With a fracture, this pressure increase may occur as a result of the intense inflammatory response or severe bleeding caused by the bone injury, even when diligent nursing care has been provided. Pain disproportionate to the injury despite analgesic administration is the classic sign of compartment syndrome. The nurse should constantly assess for this complication and should instruct the caregiver about the manifestations associated with this complication.
A neighborhood nurse is attending a soccer game at a local middle school. One of the students falls off the bleachers and sustains an injury to the left arm. The nurse quickly attends to the child and suspects that the child's arm may be broken. Which nursing action would be the priority before transferring the child to the hospital emergency department?
1.Immobilize the arm. 2.Ask for the name of the child's pediatrician or family health care provider so that he or she can be contacted. 3.Have someone call the radiology department of the local hospital to let staff know that the child will be arriving. 4.Tell the child that the arm probably is fractured but not to worry because permanent damage to the arm will not occur. Answer: 1 When a fracture is suspected, it is imperative that the area be splinted and immobilized before the injured person is transferred or moved. The nurse should remain with the child and provide realistic reassurance. Although it may be necessary to contact the child's pediatrician, this is not the priority. It is not necessary to notify the radiology department because this would be the responsibility of the emergency department staff when the child arrives if it is determined that the child needs a radiograph. The child should not be told that permanent damage will not occur.
A child must wear a brace for correction of scoliosis. The nurse creates a plan of care knowing the child is at risk for which problem?
1.Inability to ambulate 2.Breaks in skin integrity 3.Decreased oxygenation 4.Delayed growth and development Answer: 2 Braces for treatment of scoliosis usually are worn 16 to 23 hours a day. The skin should be kept clean and dry and inspected for signs of redness or breakdown. Therefore, breaks in skin integrity are the client problem that should be included in this child's plan of care. The brace assists with posture, so mobility is not an issue. The brace does not compromise the respiratory status, so oxygenation is not decreased. The child will not have a risk for delayed growth and development because normal developmental milestones can be met while wearing a brace.
A nurse is caring for a child who sustained a fracture. Which of the following actions should the nurse take? Select all that apply
1. Place a heat pack on the site of injury 2. Elevate the affected limb 3. Assess neurovascular status frequently 4. encourage ROM of the affected limb 5. Stabilize the injury Answer: 2, 3, 5
A nurse is caring for a toddler who is diagnosed with DDH and has been placed in a hip sica cast. The child's mother asks the nurse why a pavlik harness is not being used. Which of the following responses should the nurse make?
1. The Pavlik harness is used for children with scoliosis, not hip dysplasia 2. The Pavlik harness is used for school age children 3. The Pavlik harness cannot be used for your child because her condition is too severe 4. The Pavlik harness is used for infants less than 6 months of age Answer: 4 The pavlik harness is a soft brace designed for infants, a toddler is to large to fit into the brace.
The nurse is caring for a 3 year old patient who has returned to the pediatric ICU after insertion of a ventriculoperitoneal shunt to correct hydrocephalus. Which assessment finding is most important to communicate to the surgeon?
1. The child is crying and says, "It hurts!" 2. The right pupil is 1mm larger than the left pupil 3. The cardiac monitor shows a heart rate of 130 beats/min. 4. The head dressing has a 2 cm area of bloody drainage. Answer: 2 Pupil dilation may indicate increased intracranial pressure and should be reported immediately to the surgeon. The other data is not unusual in a 3 year old patient after surgery.
A child has a fractured femur. Which finding would the nurse instruct the UAP to report immediately?
1. The patient reports pain 2. The patient appears confused 3. The patients blood pressure is 100/90 4. The patient voided using the bedpan Answer: 2 Fat embolism syndrome is a serious complication that often results from fractures of long bones. Its earliest manifestations is altered mental status caused by a low arterial oxygen level.
A child with a fractured fibula is receiving skeletal traction and has skeletal pins in place. What would the nurse instruct the UAP to report immediately?
1. The patient wants to change position in bed 2. There is a small amount of clear fluid at the pin sites 3. The traction weights are resting on the floor 4. The patient reports pain and muscle spams Answer: 3 When the weights are resting on the floor, they are not exerting pulling force to provide reduction and alignment or to prevent muscle spasms.
A nurse is caring for a child who is in a plaster spica cast. Which of the following actions should the nurse take?
1. Use a heat lamp to dry cast 2. Avoid turning the child until the cast is dry 3. Assist the child with crutch walking after the cast is dry 4. Apply moleskin to the edges of the cast Answer: 4 The nurse should apply moleskin to the edges of the cast to prevent the cast from rubbing on the childs skin
A nurse is completing preoperative teaching with an adolescent client who is scheduled to receive spinal instrumentation for scoliosis. which of the following information should the nurse include in the teaching?
1. You will go home the same day of surgery 2. you will have minimal pain 3. you will need to receive blood 4. you will not be able to eat until the day after surgery Answer: 3 client who have spinal instrumentation for scoliosis have a lengthy surgery with blood loss and require blood replacement
A nurse is teaching a group of parent about fractures. Which of the following information should the nurse include in the teaching?
1. children need a longer time to heal from a fracture than an adult 2. Epiphyseal plate injuries can result in altered bone growth 3. A greenstick fracture is a complete break in the bone 4. Bones are unable to bend, so they break Answer: 2 Detection and early treatment is crucial for an epiphyseal plate injury to prevent altered bone growth.
A nurse is caring for a child who is in skeletal traction. Which of the following actions should the nurse take?
1. remove the weights to turn the patient 2. assess the child's position frequently 3. assess pin sites Q4h 4. ensure the weights are hanging freely 5. ensure the rope's knot is in contact with the pulley Answer: 2, 3, 4
Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder?
1."Treatment needs to be started as soon as possible." 2."I realize my infant will require follow-up care until fully grown." 3."I need to bring my infant back to the clinic in 1 month for a new cast." 4."I need to come to the clinic every week with my infant for the casting. Answer: 3 Clubfoot is a complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus; the defect may be unilateral or bilateral. Treatment for clubfoot is started as soon as possible after birth. Serial manipulation and casting are performed at least weekly. If sufficient correction is not achieved in 3 to 6 months, surgery usually is indicated. Because clubfoot can recur, all children with clubfoot require long-term interval follow-up until they reach skeletal maturity to ensure an optimal outcome.
The nurse is assisting a health care provider (HCP) during the examination of an infant with developmental hip dysplasia. The HCP performs the Ortolani maneuver. The nurse determines that the infant exhibits a positive response to this maneuver if which finding is noted?
1.A shrill cry from the infant 2.Asymmetry of the affected hip 3.Reduced range of motion in the right and left hip 4.A palpable click during abduction of the affected hip Answer: 4 In the Ortolani maneuver, the examiner abducts both hips. A positive finding is a palpable click on the affected side during abduction. Crying is expected. Asymmetry and reduced range of motion of the affected hip are not positive signs of this maneuver.
The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range-of-motion exercises at this time. The nurse should make which response?
1."Avoid all exercise during painful periods." 2."Range-of-motion exercises must be performed every day." 3."Have the child perform simple isometric exercises during this time." 4."Administer additional pain medication before performing range-of-motion exercises." Answer: 3 Juvenile idiopathic arthritis is an autoimmune inflammatory disease affecting the joints and other tissues, such as articular cartilage. During painful episodes of juvenile idiopathic arthritis, hot or cold packs and splinting and positioning the affected joint in a neutral position help reduce the pain. Although resting the extremity is appropriate, beginning simple isometric or tensing exercises as soon as the child is able is important. These exercises do not involve joint movement.
The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates a need for further teaching?
1."I cannot place powder under the brace." 2."I need to place a soft shirt on my child under the brace." 3."I need to be sure to apply lotion on the skin under the brace." 4."I need to encourage my child to perform prescribed exercises." Answer: 3 The use of lotions or powders should be avoided with a brace because they can become sticky or cake under the brace, causing irritation. The actions in the remaining options are appropriate interventions for the use of a brace on a child.
An alert child, who is crying loudly, is brought to the hospital emergency department for a simple fracture to the lower right arm that occurred after a fall off a bicycle. What is the nurse's priority assessment?
1.Mobility 2.Skin integrity 3.Neurovascular 4.Level of consciousness Answer: 3 A simple fracture is a fracture of the bone across its entire shaft with some possible displacement but without breaking the skin. The priority assessment is the neurovascular status in the affected arm. The affected arm should be immobilized. Skin integrity is a higher priority in a compound fracture since there is an open wound. The level of consciousness is already established, as the child is alert and crying.
A child with developmental dysplasia of the hip is placed in a Pavlik harness. The nurse should demonstrate to the parents how to place the child in this harness by placing the child's legs in which position?
1.Prone 2.Abduction 3.Adduction 4.Extension Answer: 2 The Pavlik harness consists of chest and shoulder straps and foot stirrups. The device, which is used to correct hip dislocations in infants with developmental dysplasia of the hip, consists of a set of straps that hold the hips in flexion and abduction. Therefore, the remaining options are incorrect positions.
Russell's traction is prescribed for a child with a lower leg fracture. The mother of the child asks the nurse about the purpose of the traction. The nurse explains to the mother that which is the primary action of this type of traction?
1.Relieves the child's pain 2.Reduces or realigns a fracture site 3.Provides a form of restraint for the child 4.Keeps the child from moving around in bed Answer: 2 Russell's traction uses skin traction to realign a fracture in the lower extremity and to immobilize the hip and knee in a flexed position. It is important to keep the hip flexion at the prescribed angle to prevent fracture malalignment. The traction may also relieve pain by reducing muscle spasms, but this is not the primary reason for this traction. The child can still move in bed with some restriction as a result of the traction. Traction is never used to restrain a child.
The nurse is reviewing the health care record of an infant suspected of having unilateral hip dysplasia. Which assessment finding should the nurse expect to note documented in the infant's record regarding this condition?
1.Full range of motion in the affected hip 2.An apparent short femur on the unaffected side 3.Asymmetrical adduction of the affected hip when placed supine, with the knees and hips flexed 4.Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table Answer: 4 Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table is noted in hip dysplasia. Asymmetrical abduction of the affected hip when an infant is placed supine with the knees and hips flexed would also be an assessment finding in hip dysplasia in infants beyond the newborn period. An apparent short femur on the affected side is noted, as well as limited range of motion.
The nurse is implementing a teaching plan for a 4-month-old child who has been diagnosed with developmental dysplasia of the hip. The child will be placed in the Pavlik harness. Which statement by the family indicates that they understand the care of their child while placed in the Pavlik harness?
1."I know that the harness must be worn continuously." 2."I will bring my child back to the orthopedic office in a month or two so the straps can be checked." 3."I realize that I will also need to put two diapers on my child so that the harness will stay dry and does not get soiled." 4."I will watch for any redness or skin irritation where the straps are applied and call the health care provider for red areas." Answer: 4 If stabilization of the hip is required, a cast is initially applied. This is kept in place for 3 to 6 months until the hip is stabilized. After this is completed, and if further treatment is required, a Pavlik harness is the treatment of choice next. A Pavlik harness is a removable abduction brace. The brace must be checked every 1 to 2 weeks for adjustment of the straps. The use of double diapering is not recommended for developmental dysplasia of the hip (DDH) because of the possibility of hip extension. Because there are straps applied to the child's skin, it is important to check the skin of the child frequently.
The nurse is reinforcing instructions to the mother of a child who has a plaster cast applied to the left arm. Which statement by the mother indicates a need for further teaching?
1."I will have to use a heat lamp to help the cast dry." 2."I need to cover the cast with plastic during baths or showers." 3."I should call the health care provider if the cast feels warm or hot or has an unusual smell or odor." 4."I will keep small toys and sharp objects away from the cast and be sure that my child does not put anything inside the cast." Answer: 1 The mother needs to be instructed not to use a heat lamp to help the cast dry because of the risk associated with a burn injury from the heat lamp. The statements in the remaining options indicate understanding of instructions.
A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention?
1.Ensure that all ropes are outside the pulleys. 2.Ensure that the weights are resting lightly on the floor. 3.Restrict diversional and play activities until the child is out of traction. 4.Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied. Answer: 4 When a child is in traction, the nurse would check the HCP's prescription to verify the prescribed amount of traction weight. The nurse would maintain the correct amount of weight as prescribed, ensure that the weights hang freely, check the ropes for fraying and ensure that they are on the pulleys appropriately, monitor the neurovascular status of the involved extremity, and monitor for signs and symptoms of immobilization. The nurse would provide therapeutic and diversional play activities for the child.
The clinic nurse is assessing a child suspected of having juvenile rheumatoid arthritis (JRA). Which assessment findings should the nurse expect to note in a child who has been diagnosed with JRA? Select all that apply.
1.Hematuria 2.Morning stiffness 3.Painful, stiff, and swollen joints 4.Limited range of motion of the joints 5.Stiffness that develops later in the day 6.History of late-afternoon temperature Answer: 2, 3, 4, 6 Clinical manifestations associated with JRA include intermittent joint pain that lasts longer than 6 weeks and painful, stiff, and swollen joints that are warm to the touch, with limited range of motion. The child will complain of morning stiffness and may protect the affected joint or refuse to walk. Systemic symptoms include malaise, fatigue, lethargy, anorexia, weight loss, and growth problems. A history of a late-afternoon fever with temperature spiking up to 105°F (40.6°C) will also be part of the clinical manifestations. Hematuria is not specifically associated with JRA.
An adolescent is seen in the emergency department for a suspected sprain of the ankle. X-rays have been obtained, and a fracture has been ruled out. Which instruction should the nurse provide to the adolescent regarding home care for treatment of the sprain?
1.Elevate the extremity, and maintain strict bed rest for a period of 7 days. 2.Immobilize the extremity, and maintain the extremity in a dependent position. 3.Apply heat to the injured area every 4 hours for the first 48 hours, and then begin to apply ice. 4.Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 to 48 hours. Answer: 4 The injured area should be wrapped immediately to support the joint and control the swelling. Ice is applied to reduce the swelling and should be applied for not longer than 30 minutes every 4 to 6 hours for the first 24 to 48 hours. The joint should be immobilized and elevated, but strict bed rest for a period of 7 days is not required. A dependent position will cause swelling in the affected area.
