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

The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which response from his mother indicates a need for further teaching?

"A product's label indicates whether it is latex-free."

The nurse is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the mother indicates a need for further teaching?

"I must carefully lift the baby from under the armpits."

The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate?

"I will help you become comfortable in caring for your daughter."

A pediatric client diagnosed with Duchenne muscular dystrophy is prescribed a corticosteriod. 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."

A newborn is diagnosed with metatarsus adductus. The parents ask the nurse how this occurred. Which response by the nurse would be most appropriate?

"It's most likely from how the baby was positioned in utero."

The nurse is caring for a 14-year-old client in traction prior to surgery. The client has been in the hospital for 2 weeks and will require an additional 10 days in the hospital following surgery. The client states, "I feel isolated and I am refusing any more treatment." Which response by the nurse is most appropriate?

"Let's come up with things for you to do and see if your friends can come visit."

The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns?

"Let's talk to another boy with scoliosis, who is winning trophies for his swim team."

The nurse is caring for a female infant with torticollis and is providing instructions to the parents about how to help their daughter. Which statement by the parents indicates a need for further teaching?

"We must apply firm pressure and stretching every other day."

The nurse is caring for a 14-month-old boy with rickets who was recently adopted from overseas. His condition was likely a result of a diet very low in milk products. The nurse is providing teaching regarding treatment. Which response by the parents indicates a need for further teaching?

"We must give him calcium and phosphorus with food every morning."

A nurse is providing instructions to the parents of a 3-month-old infant with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statement(s) by the parents demonstrates understanding of the instructions? Select all that apply.

"We should change the diaper without taking our infant out of the harness." "We need to check the area behind our infant's knees for redness and irritation." "We need to call the health care provider if our infant is not able to actively kick the legs."

A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement by the parents indicates the need for additional teaching?

"We should give this drug before he eats anything."

The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. Her parents are upset by their toddler's limited mobility. Which response by the nurse would be most appropriate?

"You are doing a great job. Let's put our heads together on how to keep her busy."

A 6-year-old child with cerebral palsy has been admitted to the hospital for some tests. The child's condition is stable. A parent remains with the child, but the parent is obviously exhausted and stressed. Which response by the nurse would be most appropriate?

"Your child is in good hands; consider going home to get some sleep."

The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which finding would help confirm this diagnosis?

A distinct "clunk" is heard with Barlow and Ortolani maneuvers.

When teaching a group of parents about the skeletal development in children, what information is most helpful?

A young child's bones commonly bend instead of break with an injury.

The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. What word would the nurse use when documenting these observations?

Athetoid

When assessing a child for slipped capital femoral epiphysis, what would the nurse identify as possible risk factors? Select all that apply.

Black race Obesity

What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele?

Covering the sac with saline-soaked nonadhesive gauze

A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which instruction would the nurse include when teaching the parents about caring for their child?

Discourage the child from stretching or bending forward for 4 weeks.

A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area?

Epiphysis

The nurse is assessing a newborn who was delivered after a prolonged labor due to an abnormal presentation. The newborn sustained a cranial nerve injury. The nurse would most likely expect to assess deficits related to which cranial nerve?

Facial

A child is brought to the clinic after tripping over a rock. The child states "I twisted my ankle" and is given a diagnosis of a sprain. What intervention is most important for the nurse to include in the discharge instructions for this child?

For the first 24 hours apply ice for 20 minutes and remove for 60 minutes

A nurse is preparing a program for a group of parents about injury prevention. What would the nurse include as an important contributing factor for cervical spine injury in a child?

Increased mobility of the spine

A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route?

Intramuscular injection

An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority?

Notifying the doctor immediately

A nurse is caring for a 14-year-old girl following myelography. What is the priority nursing action?

Observing for signs of meningeal irritation

The school nurse is presenting a class to a group of students about common overuse disorders. Which disorder would the school nurse include?

Osgood-Schlatter disease

The nurse is assessing a child with a possible fracture. What would the nurse identify as the most reliable indicator?

Point tenderness

The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury?

Recommend raising the bed's side rails when a caregiver is not present.

The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first?

Reposition the child's foot on a pressure-reducing device.

The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis?

Risk for impaired skin integrity due to cast and location

A group of nursing students are reviewing information about types of skin traction and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction?

Side arm 90-90 traction

A child has undergone surgery using steel bar placement to correct pectus excavatum. What position would the nurse instruct the parents to avoid?

Side-lying

When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely?

Skeletal traction

The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding?

Sluggish deep tendon reflexes

The nurse is developing a teaching plan for a child who is to have his cast removed. What instruction would the nurse most likely include?

Soaking the area in warm water every day

An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal?

Spiral fracture

An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. What information would the nurse include when teaching the child about the cast?

The child initially may experience a very warm feeling inside the cast.

The school nurse has performed scoliosis screening. Based on this assessment, which children require the nurse to implement a referral to the healthcare provider? Select all that apply.

The child with asymetric shoulder elevation The child with a limb length discrepancy The child with a lateral curve of the spine The child with a one-sided hump upon bending over

The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful?

The process occurs in a head-to-toe fashion.

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

Upright positioning

A nursing instructor is preparing for a class discussion on spinal muscular atrophy (SMA). When describing type 2 SMA, which information would the instructor include? Select all that apply.

Weakness most severe in shoulders and hips Slowly progressing condition Genetic disease with autosomal recessive inheritance