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

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is: Russell traction. skeletal traction. Buck extension traction. skin traction.

skeletal traction. RATIONALE: Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck extension traction, and Russell traction.

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 extended breaks headrest support

wheelchair belt RATIONALE: 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.

The nurse is caring for a child admitted with possible Legg-Calvé-Perthes disease. Which assessment question should the nurse ask the child's caregivers to help support this diagnosis? "Does your child report pain in the groin that results in a limp?" "Are your child's knees every swollen and red?" "Have you ever been told your child has any malformed vertebrae?" "Does your child have difficulty standing or walking?"

"Does your child report pain in the groin that results in a limp?" RATIONALE: Symptoms first noticed in Legg-Calvé-Perthes disease are pain in the hip or groin and a limp accompanied by muscle spasms and limitation of motion.

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching? "The casted arm must be kept still." "We must avoid causing depressions in the cast." "Pale, cool, or blue skin coloration is to be expected." "We need be aware of odor or drainage from the cast."

"Pale, cool, or blue skin coloration is to be expected." RATIONALE: It is very important to teach parents to identify the signs of neurovascular compromise (pale, cool, or blue skin) and tell them to notify the physician immediately. The other statements are correct.

The nurse is teaching a group of peers regarding different types of fractures seen in children. Which statement best describes a complete fracture? A fracture in which the bone buckles rather than breaks An incomplete fracture of the bone A fracture in which the bone breaks into two pieces A fracture in which the bone bends without breaking

A fracture in which the bone breaks into two pieces RATIONALE: A fracture in which the bone breaks into two pieces is called a complete fracture. A fracture in which the bone bends without breaking is called a plastic or bowing deformity. A fracture in which the bone buckles rather than breaks is called a buckle fracture. An incomplete fracture of the bone is called a greenstick fracture.

The mother of a child who has sustained a fractured leg is worried how long her child will be unable to walk without crutches. The nurse would explain to the mother that the child should be walking independently soon due to what reason? A child weighs less than an adult so the child can walk earlier. Children's bones heal faster than adults. Children are less compliant and tend to quit using the crutches. Children do not feel as much pain as adults.

Children's bones heal faster than adults. RATIONALE: Fractures in children heal faster, are generally less complicated, and occur for different reasons than fractures in adults. Thus, children rehabilitate faster than most adults. Children feel pain just like adults. Weight does not lessen the time required for crutches. Compliance is not an issue.

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. limb-girdle. Duchenne. myotonia.

Duchenne. RATIONALE: 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 young boy fell off of his bike and injured his arm. X-rays indicate that he has a greenstick fracture. His parents ask the nurse the meaning of this term. What is the nurse's best response? The fracture occurred from the bone bending and then breaking apart. The two parts of the fractured bone are only partially separated in his forearm. Your son's arm has sustained a twisting fracture. The fractured bone is totally separated from the other part of the bone in his forearm.

The two parts of the fractured bone are only partially separated in his forearm. RATIONALE: A greenstick fractures is a type of incomplete fracture that occurs when the bone bends and partially cracks due to decreased ossification. The bone fragments remain partially connected.

A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected? Trendelenburg gait loss of strength in ankle dorsiflexion lordosis kyphosis

Trendelenburg gait RATIONALE: The nurse would expect to note a Trendelenburg gait due to pain. Lordosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Kyphosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Loss of strength in ankle dorsiflexion is associated with some neuromuscular disorders but not this condition.

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? upper motor neuron lesions a demyelinating disease lesions of the brain cortex degeneration of muscle fibers

degeneration of muscle fibers RATIONALE: Degeneration of muscle fibers with progressive weakness and wasting best describes muscular dystrophy. Demyelination of myelin sheaths is a description of multiple sclerosis. Lesions within the brain cortex and the upper motor neurons suggest a neurologic, not a muscular, disease.

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: incomplete fracture. bone that breaks into two pieces. significant bending without actual breaking. bone buckling due to compression.

significant bending without actual breaking. RATIONALE: 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 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? "NSAIDs can help with pain control and inflammation." "Ice will help reduce the inflammation." "You will need to see a physical therapist for stretching and strengthening exercises." "You and your coaches need to understand that you cannot play soccer for at least six weeks."

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

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? Apply a tube of stockinette over the cast Assess the fingers for warmth, pain, and function X-ray the cast to make sure the bones are aligned properly Cut a window in the cast over the wrist

Assess the fingers for warmth, pain, and function RATIONALE: Assess fingers or toes carefully for warmth, pain, and function after application of a cast to be certain a compartment syndrome is not developing. Before a cast is applied, not after, a tube of stockinette is stretched over the area, and soft cotton padding is placed over bony prominences. A "window" may be placed in a cast for an open fracture or if an infection is suspected—not to prevent an infection—so that the area can be observed; however, a window is not indicated in this case. The x-ray should be performed before casting, not after it, in order to diagnose the fracture.

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? Adjust the weights as needed. Assess the popliteal region carefully for skin breakdown. Clean and massage his entire leg daily. Provide pin care as needed.

Assess the popliteal region carefully for skin breakdown. RATIONALE: 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.

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. Assess the hips for extension and abduction. Observe the stepping reflex.

Compare muscle strength and tone bilaterally. Observe for involuntary muscle contractions. Perform passive range-of-motion on all extremities. RATIONALE: Musculoskeletal development continues as the newborn grows. The newborn has all the ligaments, muscles, tendons and cartilage present at birth and they are functional, but the newborn does not have control over them. This comes with growth and age. It is important for the nurse to complete a musculoskeletal assessment at each clinic visit in the physical assessment. Thus, for this toddler, muscle strength and tone should be compared bilaterally. Strength is assessed by the toddler's ability to move muscles against gravity. This is done by the toddler pushing the feet against the nurse's hands or by grasp. The nurse will observe for involuntary muscle contractions. Involuntary contractions could indicate spasticity. Range-of-motion should be done to determine if a joint position is fixed. When assessing the hips, they should be flexed, abducted and externally rotated. The stepping reflex is seen when the infant is held upright and moves the legs as is stepping or walking. This reflex should be gone by about 2 months.

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? lordosis appearance of smaller than normal calf muscles indications of hydrocephalus Gowers sign

Gowers sign RATIONALE: 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.

A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective? Gently massage the child's back to stimulate circulation. Inspect the child's skin for rashes, redness, irritation, or pressure injuries. Assess neurovascular status on the affected extremity once every shift. Keep the child's skin distal to the traction clean and dry.

Inspect the child's skin for rashes, redness, irritation, or pressure injuries. RATIONALE: It is important to be vigilant in inspecting the child's skin for rashes, redness, and irritation to uncover areas where pressure injuries are likely to develop. Applying lotion, gentle massage, and keeping the skin dry and clean are part of the routine skincare regimen. However, performing these interventions without first performing a skin assessment can cause the nurse to miss important signs that can potentially result in more injury to the child. Neurovascular assessment should be performed frequently as prescribed by the health care provider or at least every 4 hours to evaluate skin integrity and venous circulation.

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? Caution parents to clear articles such as throw rugs out of paths at home. Be certain the child is walking with the crutches about 6 inches to the side of the foot. Assess the tips of the crutches to be certain the rubber tip is intact. Teach the client not to rest with the crutch pad pressing on the axilla.

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

In caring for a child in traction, which intervention is the highest priority for the nurse? 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 clean the pin sites at least once every 8 hours.

The nurse should monitor for decreased circulation every 4 hours. RATIONALE: 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.

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. back with the injured hip flexed and the uninjured one extended. stomach with both legs extended. back with hips flat on the bed.

back with hips up off the bed. RATIONALE: 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.

The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child: cannot plantarflex his foot. has a weak femoral pulse. feels increasing severe pain. has blue-looking nail beds on the toes.

feels increasing severe pain. RATIONALE: Any reports of pain in a child with a new cast or immobilized extremity need to be explored and monitored closely for the possibility of compartment syndrome.

Through which mechanism is Duchenne muscular dystrophy acquired? heredity virus environmental toxins autoimmune factors

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

Which condition would alert the nurse that a child may be suffering from muscular dystrophy? hyperactive lower extremity reflexes increased lumbar lordosis hypertonia of extremities upper extremity spasticity

increased lumbar lordosis RATIONALE: An increased lumbar lordosis would be seen in a child suffering from muscular dystrophy secondary to paralysis of lower lumbar postural muscles. Increased lower extremity support may also be seen. Hypertonia isn't seen in this disease. Upper extremity spasticity isn't seen because this disease isn't caused by upper motor neuron lesions. Hyperactive reflexes aren't indications of muscular dystrophy.

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? assessment of ambulation EEG muscle biopsy X-ray

muscle biopsy RATIONALE: Muscle biopsy provides definitive diagnosis of muscular dystrophy demonstrating the absence of dystrophin. X-ray is best for identifying an osseous deformity. Ambulation assessment alone wouldn't confirm diagnosis of this client's disorder. EEG wouldn't be appropriate in this case.

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation? absence of Moro reflex presence of Moro reflex absence of tonic neck reflex presence of symmetrical spontaneous movement

presence of Moro reflex RATIONALE: The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflexes are expected in a normally developing 9-month-old child.

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide? to wear the brace a maximum of 20 hours each day to stand absolutely still when not wearing the brace that secondary sex changes will stop until the brace is removed to continue with age-appropriate activities

to continue with age-appropriate activities RATIONALE: 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.

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. Sensation Color Capillary refill Pulse Vital signs

Sensation Color Capillary refill Pulse RATIONALE: A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.

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? using latex free sterile gloves mixing hydrogen peroxide with sterile water to make half-strength hydrogen peroxide placing sterile cotton gauze squares around the ends of the pins unhooking a weight while providing pin care

unhooking a weight while providing pin care RATIONALE: 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.

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 angle of the lower chest when sitting down The angle of the iliac crest when bending forward The posterior spine when bending sideways

The posterior spine when bending forward RATIONALE: 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.

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. The boy's toes are light blue and very swollen. New drainage is seeping out from under the cast. The boy experiences mild pain when wiggling his toes. 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. The boy's toes are light blue and very swollen. New drainage is seeping out from under the cast. RATIONALE: 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.

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 cast will need to be "petaled" to prevent skin irritation. The child initially may experience a very warm feeling inside the cast. The cast will take a day or two to dry completely. 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. RATIONALE: 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.

The nurse is observing a child walk down stairs using a swing-through gait. What action by the child is correct? Both crutches are placed on the lower step, and then the good foot is placed on the step below the crutches. The child tries to walk without the crutches. One crutch is placed on the lower step, and then the good foot is placed next to the crutch. The child places the crutches on the lower step before placing the good foot down between the crutches.

The child places the crutches on the lower step before placing the good foot down between the crutches. RATIONALE: To walk downstairs using a swing-through gait, the child places the crutches on the lower step, and then the good foot is placed on the step between the crutches. Both crutches should be moved at the same time. The good foot should not be placed on a lower step than the crutches when going down stairs.

The nurse is caring for a 10-year-old child with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? upright positioning chest percussion coughing limiting physical activity

upright positioning RATIONALE: The nurse should emphasize that the child's position should be arranged to promote maximum chest expansion. This is usually in the upright position. Coughing helps clear the airways. Chest percussion helps loosen secretions in the lungs. Physical activity should be encouraged to promote self-worth and a sense of belonging for children with muscular dystrophy.

The nurse is discussing treatment for a child diagnosed with scoliosis. Which statement indicates the parents understand the nurse's education? "The treatment for our child's scoliosis is anticipated to last between 3 to 4 months." "Because our child is being treated by using braces, the braces will have to be worn almost all the time." "The most successful treatment for scoliosis is surgery before reaching adult age." "Because our child has scoliosis, treatment will include halo traction."

"Because our child is being treated by using braces, the braces will have to be worn almost all the time." RATIONALE: The Boston or the thoracolumbosacral orthosis (TLSO) brace is made of plastic and is customized to fit the child for treatment of scoliosis. The brace should be worn constantly, except during bathing or swimming, to achieve the greatest benefit. Halo traction may be used to treat clients with severe scoliosis, but not all clients. Children will be reassessed every 4 to 6 months to determine the prognosis for continuing brace therapy and potentially refitting. Bracing may be indicated for months or years. Surgery may be indicated, depending on the severity and complications resulting from the scoliosis; however, surgery is not the best option for all clients.

A pediatric client diagnosed with Duchenne muscular dystrophy is prescribed a corticosteroid. Which statement by the caregiver indicates additional education by the nurse is needed? "If I notice my child gain weight, I will stop the medication." "I will monitor my child for signs of infection." "I will call the primary health care provider if my child develops a moon-face." "My child should take this medicine with food."

"If I notice my child gain weight, I will stop the medication." RATIONALE: Corticosteroids may be prescribed to treat Duchenne muscular dystrophy for their anti-inflammatory and immunosuppressive actions. The nurse would provide additional education if the caregiver stated the medication would be stopped. The nurse would educate the client to not stop treatment abruptly or acute adrenal insufficiency may occur. Corticosteroids may mask signs of infection; therefore, the child should be monitored for infection and the health care provider notified if any signs noted. The medication should be administered with food to decrease gastrointestinal upset. The caregiver should be taught to monitor for signs of Cushing syndrome (moon-face).

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? "If we see any drainage around the pins when we are cleaning them, we won't be concerned." "It will be hard, but we know our child will be in this device for a long time." "We will have to get some of the elastic bandages to place around the pins and pin sites." "He is very sensitive about the way the device looks. I am glad that his clothes will fully cover it so his friends won't tease him."

"It will be hard, but we know our child will be in this device for a long time." RATIONALE: External fixation devices are sometimes left in place for as long as 1 year. The pin sites are left open to the air and should be inspected and cleansed every 8 hours. The child and caregiver should be able to recognize the signs of infection at the pin sites. The appearance of the pins puncturing the skin and the unusual appearance of the device can be upsetting to the child.

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

"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." RATIONALE: 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.

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be: "These will help the cast look more attractive so the child won't feel self-conscious." "These make a smooth edge on the cast so the skin is better protected." "In case the child has an accident and misses the bedpan, these can be changed to keep the area dry." "We put these on so the child will not pull the padding from under the cast."

"These make a smooth edge on the cast so the skin is better protected." RATIONALE: If the cast has no protective edge, it should be petaled with adhesive tape strips. These help keep the skin protected from the rough edge of the cast. If the cast is near the genital area, plastic should be taped around the edge to prevent wetting and soiling of the cast; petaling the cast does not provide protection to keep the cast dry.

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? "I leave my brace on for gym at school." "I wear a t-shirt under my brace." "I check my brace daily to make sure there is no damage or change to it." "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed."

"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." RATIONALE: 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.

The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated? Suggest removal of the cast to the orthopedist. Observe the child for infection. Moisten the cast with cool water. Advise the child that this is to be expected.

Advise the child that this is to be expected. RATIONALE: Plaster becomes hot as it sets. Even with fiberglass casts, there will be a warm feeling inside the cast when it is drying. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, the nurse should notify the health care provider. Infection would not present in this way with a cast application. A cast should not be moistened. If it does become wet, the cast should be dried with a hair dryer. There are some newer types of casts which can get wet but the nurse should know this before applying any moisture.

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? Congenital myotonic dystrophy Facioscapulohumeral muscular dystrophy Juvenile arthritis Duchenne muscular dystrophy

Duchenne muscular dystrophy RATIONALE: By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints.

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors? Duchenne muscular dystrophy is diagnosed in boys who develop gait changes during the late school-age years. Duchenne muscular dystrophy is a progressive disease of muscles and nerves that affects males and females equally. Duchenne muscular dystrophy is a nonprogressive disorder that severely affects muscle function through spinal cord atrophy. Duchenne muscular dystrophy causes progressive muscular weakness that ends in death.

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. RATIONALE: Duchenne muscular dystrophy is the most common of several muscular dystrophies and is a progressive, fatal disorder. It involves mainly skeletal muscles, but other muscles are affected over time. Onset occurs in early childhood. The disorder is X-linked recessive. An enzyme is lacking that is necessary for the maintenance of muscle cells. No structural abnormalities of the spinal cord or peripheral nerves are noted.

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. Encourage child to stifle cough and take shallow breaths to prevent ineffective breathing patterns. Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply. Give the client large, frequent meals with decreased fiber and increased protein and Vitamin C.

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. RATIONALE: The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.

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 Spica cast External fixation device Stockinette

Spica cast RATIONALE: 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.

How would the nurse best describe Gowers sign to the parents of a child with muscular dystrophy? muscle twitching present during a quick stretch a transfer technique the pelvis position during gait a waddling-type gait

a transfer technique RATIONALE: Gowers sign is a description of a transfer technique present during some phases of muscular dystrophy. The child turns on the side or abdomen, extends the knees, and pushes on the torso to an upright position by walking his hands up the legs. The child's gait is unrelated to the presence of Gowers sign. Muscle twitching present after a quick stretch is described as clonus.

The nurse is caring for an 8-month-old infant in Bryant traction for developmental dysplasia of the hip (DDH) and is monitoring for complications. Which assessment finding most concerns the nurse? decreased oral intake mild fussiness a weak pedal pulse temperature 100.2°F (37.9°C)

a weak pedal pulse RATIONALE: A diminished pedal pulse could be a sign of neurovascular compromise caused by pressure from the elastic bandages. Decreased oral intake and an elevated temperature could indicate an infection. However, circulation is priority over infection in the client and would be most concerning for the nurse. Mild fussiness is to be expected and is nonspecific when an infant is immobilized and has both legs extended vertically.