Ch 23 - Musculoskeletal disorder

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation? a) A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. b) A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. c) A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating. d) A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs.

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Spiral fractures, which twist around the bone, are frequently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. Of the following nursing interventions, which would be most important for the nurse to include in working with this child and the child's caregivers? a) The nurse should be a contact person when the child is hospitalized. b) The nurse should support the caregivers in restricting activity during the treatment. c) The nurse should provide information when the child or caregiver requests it. d) The nurse should help the caregivers to understand and the child to effectively use the corrective devices.

The nurse should help the caregivers to understand and the child to effectively use the corrective devices. Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

A type of traction sometimes used in the treatment of the child with scoliosis is called: a) Bryant traction. b) Russell traction. c) Dunlop traction. d) halo traction.

halo traction. When a child has a severe spinal curvature or cervical instability, a form of traction known as halo traction may be used to reduce spinal curves and straighten the spine. Halo traction is achieved by using stainless steel pins inserted into the skull while counter-traction is applied by using pins inserted into the femur. Weights are increased gradually to promote correction.

The young child is experiencing muscle spasms and has been given lorazepam. Which statements by the child indicate that the child may be experiencing some common side effects? Select all that apply. a) "I feel sort of dizzy." b) "I need to take a nap." c) "My muscle cramps are getting worse." d) "My belly hurts." e) "I think I'm going to throw up."

• "I feel sort of dizzy." • "I need to take a nap." This child has taken a benzodiazepine. Common side effects associated with this medication are dizziness and sedation. The skeletal muscle relaxes and the spasms will diminish. Nausea and upper gastrointestinal pain are not common side effects associated with this medication.

The nurse is providing postoperative care for a boy who has undergone surgical correction for pectus excavatum. The nurse should emphasize which instruction to the child's parents? a) "Do not allow him to lie on either side." b) "Do not allow him to lie on his stomach." c) "Be sure to monitor his vital capacity." d) "Please watch for signs of infection."

"Do not allow him to lie on either side." The nurse should emphasize that the child should not be allowed to lie on his side for 4 weeks following the surgery to ensure the bar does not shift. The parents should be aware of signs of infection; but the position must be emphasized to protect the bar. The nurse would be expected to monitor the child's vital capacity, not the parents. The prone position is acceptable.

After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching? a) "We'll apply a warm moist compress to the wrist for 20 minutes at a time." b) "We can wrap the wrist in an elastic bandage to help reduce the swelling." c) "She'll need to limit any activity that involves the wrist." d) "We'll make sure she keeps her arm above heart level."

"We'll apply a warm moist compress to the wrist for 20 minutes at a time." Care for a sprain includes rest, ice, compression, and elevation. Cold therapy, not heat, is used for 20 to 30 minutes at a time, then removed for 1 hour and repeated for the first 24 to 48 hours. Compression via an elastic bandage, elevating above heart level, and limiting activity are appropriate measures.

A group of students are reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age? a) Toddlerhood b) Adolescence c) School age d) Preschool age

Adolescence Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.

The nurse is conducting a physical examination of a newborn with suspected osteogenesis imperfecta. Which finding is common? a) Foot is drawn up and inward b) Blue sclera c) Dimpled skin, hair in lumbar region d) Sole of foot faces backwards

Blue sclera Blue sclera is not diagnostic of osteogenesis imperfecta, but it is a common finding. Foot drawn up and inward (talipes varus) and sole of foot facing backwards (talipes equinus) are associated with clubfoot. Dimpled skin and hair in the lumbar region are common findings with spina bifida occulta.

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered? a) Pamidronate b) Diazepam c) Narcotic analgesics d) Alendronate

Diazepam Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Narcotic analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesis imperfecta.

A 14-year-old girl is diagnosed as having scoliosis. When doing scoliosis screening with her, an important observation would be to note: a) the posterior spine when she bends sideways. b) the angle of her lower chest when she sits down. c) the angle of the iliac crest when she bends forward. d) her posterior spine when she bends forward.

her posterior spine when she bends forward. A lateral curvature of the spine (scoliosis) is best revealed when the child bends forward. Bending to the side would not provide an accurate assessment of the spine nor would assessing the iliac crest or the chest.

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. a) Capillary refill b) Color c) Pulse d) Vital signs e) Sensation

• Color • Pulse • Sensation • Capillary refill 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 child has been diagnosed with slipped capital femoral epiphysis. Which of the following characteristics about the patient is risk factor associated with the development of this condition? Select all that apply. a) The child is mal b) The child is African American. c) The child's parents state that the child has recently experienced a "growth spurt." d) The child is noted to be underweight by the nurse. e) The child is 13 years old.

• The child is 13 years old. • The child is African American. • The child's parents state that the child has recently experienced a "growth spurt." • The child is male Slipped capital femoral epiphysis most often occurs in males between the ages of 12 to 15 years. It more commonly affects African American boys. The femoral plate weakens and becomes less resistant to stressors during periods of growth. Boys are more frequently affected. Obese boys are more likely to develop this condition.

A group of students are reviewing information about bone healing in children. The students demonstrate understanding of this information when they state: a) A child's bones heal more quickly than those of an adult. b) The process of breaking down and forming new bone is decreased in children compared with adults. c) A fracture closer to the growth plate heals much slower than one in the metaphysis. d) Callus production is slower but greater in amount in children than in adults.

A child's bones heal more quickly than those of an adult. Bone healing occurs in the same fashion as in the adult, but it occurs more quickly in children because of the rich nutrient supply to the periosteum. The closer a fracture is to the growth plate, the more quickly the fracture heals. The capacity for remodeling (the process of breaking down and forming new bone) is increased in children compared with adults. Children's bones produce callus more rapidly and in larger quantities than do adults' bones.

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? a) Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. b) Encourage child to stifle cough and take shallow breaths to prevent ineffective breathing patterns. c) Give the client large, frequent meals with decreased fiber and increased protein and Vitamin C. d) Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply.

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. 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 caring for a child admitted with Legg-Calvé-Perthes disease. Which clinical manifestation would likely have been noted in the child with this diagnosis? a) Poor posture and malformed vertebrae b) Difficulty standing and walking c) Inflammation of the joints d) Pain in the groin and a limp

Pain in the groin and a limp 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 neonatal nurse examines an infant and notes decreased hip motion that causes pain upon movement. This nurse suspects Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. a) False b) True

True Legg-Calvé-Perthes disease is a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. It has an incidence of 1 per 1,200 live births, with some hereditary factors influencing incidence.

A nurse is caring for a 6-year-old boy with a fractured ulna. He is fearful about the casting process and is resisting treatment. How should the nurse respond? a) "Look over there at the neon fish in our aquarium." b) "Would you like to pick out your favorite color cast?" c) "Will you please take this medicine for pain?" d) "The application of the cast will not hurt."

"Look over there at the neon fish in our aquarium." The best response for a 6-year-old is to use distraction throughout the cast application. He is resisting the application of the cast, so the best approach at this point is distraction. Telling him that application will not hurt is not helpful; nor is asking the child whether he wants pain medication. It is helpful to enlist the cooperation of the child by showing the child cast materials before beginning the procedure; but if he is resisting treatment, distraction would be the best approach.

A 5-year-old child is in traction and at risk for impaired skin integrity due to pressure. Which intervention is most effective? a) Keep the child's skin clean and dry b) Gently massage the child's back to stimulate circulation c) Inspect the child's skin for rashes, redness, irritation, or pressure sores d) Apply lotion to dry skin

Inspect the child's skin for rashes, redness, irritation, or pressure sores It is important to be vigilant in inspecting the child's skin for rashes, redness, and irritation to uncover areas where pressure sores are likely to develop. Applying lotion is part of the routine skin care regimen. Applying lotion, gentle massage, and keeping skin dry and clean are part of the routine skin care regimen.

In understanding the function of the musculoskeletal system, the nurse recognizes that which of the following allows for movement of the body parts? a) Cartilage b) Ligaments c) Joints d) Tendons

Joints Bones are attached to each other by connecting links called joints, which allow for movement of the body parts. Skeletal muscles attach to the bones, with a moveable joint between them. Tendons and ligaments hold the muscles and bones together. Cartilage is a type of connective tissue consisting of cells implanted in a gel-like substance, which gradually calcifies and becomes bone.

In caring for a child in traction, of the following interventions, which is the highest priority for the nurse? a) The nurse should provide age-appropriate activities for the child. b) The nurse should monitor for decreased circulation every four hours. c) The nurse should clean the pin sites at least once every eight hours. d) The nurse should record accurate intake and output.

The nurse should monitor for decreased circulation every four hours. 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. 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.

A nurse is setting up an electric heating pad for a 6-year-old boy requiring heat therapy. Which of the following would be the most appropriate way to engage the child during use of the heating pad? a) "Look at how the dial glows." b) "Do not unplug the heating pad." c) "Here are some crayons and paper." d) "Let's see what is on TV."

"Here are some crayons and paper." It is best to distract the child with an age-appropriate activity. Do not make a show of the set-up process by pointing out the glowing dial or how the device turns on and off. A child might be tempted to turn the heating pad on and off or unplug it, even after being instructed not to. Television is a passive activity and often overused as a distraction for children.

When helping parents plan care for a child with Legg-Calvé-Perthes disease, the nurse would teach the parents that the usual therapy for children with this disorder is: a) passive range-of-motion exercises TID. b) surgery with supporting rods. c) a nonweight-bearing period. d) exercise to increase muscle strength of the knee joint.

a nonweight-bearing period. Resting the affected femoral epiphysis aids healing.

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? a) "You and your coaches need to understand that you cannot play soccer for at least six weeks." b) "You will need to see a physical therapist for stretching and strengthening exercises." c) "NSAIDs can help with pain control and inflammation." d) "Ice will help reduce the inflammation."

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

The nurse is working with a group of caregivers of school-age children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be: a) Spiral b) Greenstick c) Complete d) Incomplete

Complete If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

Fracture of the femur typically occurs when a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step. a) False b) True

False If a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step, the head of the radius may escape the ligament surrounding it and become dislocated (nursemaid's elbow). Fracture of the femur is rare and is typically caused by an automobile accident, a fall from a considerable height, or child maltreatment.

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record? a) High serum phosphate levels b) Low serum calcium levels c) Low alkaline phosphate levels d) X-ray confirmation of adequate bone shape

Low serum calcium levels With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental genu varum? a) A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray b) The medial surfaces of the knees are more than 2 in apart c) The malleoli are touching d) The condition is bilateral

A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray Blount disease is retardation of growth of the epiphyseal line on the medial side of the proximal tibia (inside of the knee) that results in bowed legs. Unlike the normal developmental aspect of genu varum, Blount disease is usually unilateral and is a serious disturbance in bone growth that requires treatment. In those with Blount disease, the medial aspect of the proximal tibia will show a sharp, beaklike appearance. The other answers all describe genu varum, not Blount disease.

The nurse is presenting an in-service to a group of peers on the topic of traction. The nurse asks the group to give examples of types of skin traction. The following types were named by the nurses. Which is an example of a type of skeletal traction? a) Balanced suspension traction b) Russell traction c) Buck extension traction d) Bryant traction

Balanced suspension traction Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Examples of skeletal traction are 90-degree traction and balanced suspension traction. Dunlop traction, sometimes used for fractures of the humerus or the elbow, can be either skin or skeletal traction. It is skeletal traction if a pin is inserted into the bone to immobilize the extremity. 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 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as a primary nursing intervention to include in the child's plan of care? a) Maintaining intravenous antibiotic therapy b) Assisting the child with crutch walking c) Restricting fluid to encourage red cell production d) Keeping the child quiet while in skeletal traction

Maintaining intravenous antibiotic therapy Osteomyelitis is a serious infection. It is treated vigorously with intravenous antibiotics. It would not require traction. The stem does not indicate the location of the infection, so the child may not need crutches. Fluid restriction does not help red blood cell production.

When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. These variations include: a) During adolescence, muscle growth is influenced by increased production of androgenic hormones. b) The young child has rigid soft tissue, so dislocations and sprains are common occurrences. c) Rapid bone and muscle growth in adolescents increase their agility, thereby decreasing the incidence of injuries. d) The infant's muscles account for 45% of total body weight as opposed to 25% of adult body weight.

During adolescence, muscle growth is influenced by increased production of androgenic hormones. During adolescence, muscle growth is influenced by hormonal changes, primarily the increased production of androgenic hormones. The infant's muscles account for only 25% of total body weight, whereas they account for 40% to 45% in an adult. The young child has resilient soft tissue, so dislocations and sprains are unusual occurrences. Rapid bone and muscle growth may contribute to the appearance of "clumsy" and awkward motions of the adolescent who is trying to adjust to new body dimensions.

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child? a) Encouraging the child to move the arm slowly up and down to help the cast dry. b) Handling the cast with open palms when moving the arm. c) Using only a draw sheet to move the casted arm. d) Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm.

Handling the cast with open palms when moving the arm. A wet plaster cast should be handled only with open palms because fingertips can cause indentations and result in pressure points. There is no reason the arm should be restrained or the arm moved to aid in the drying process.

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. a) The outside of the boy's cast got wet and had to be dried using a hair dryer. b) New drainage is seeping out from under the cast. c) The boy's toes are light blue and very swollen. d) The boy experiences mild pain when wiggling his toes. e) 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. • The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. • New drainage is seeping out from under the cast. The parents should call the physician when the following things occur: The child has a temperature greater than 101.5F° (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.

The nurse is reinforcing discharge teaching with the caregivers of a child who is going home after a cast has been applied. The nurse explains to the caregivers that which issues should be reported if they occur or are seen related to this child? Select all that apply. a) Any pink color in the fingers or toes of casted extremity b) Any area on the cast that is warm to the touch c) A foul odor under the cast d) Drainage from under the cast e) Looseness of the cast on the extremity f) Any itching under or around the edges of the cast

• Any area on the cast that is warm to the touch • A foul odor under the cast • Drainage from under the cast • Looseness of the cast on the extremity In addition to the five Ps, any foul odor or drainage on or under the cast, "hot spots" on the cast (areas warm to the touch), looseness or tightness, or any elevation of temperature must be noted, documented, and reported. Family caregivers should be instructed to watch carefully for these same danger signals. Itching is common and does not need to be reported. Pink coloration of fingers and toes would be normal and not a concern.

The nurse is caring for a child after an accident in which the child fractured his arm. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply. a) Wear sterile gloves when removing or touching the cast. b) Document any signs of pain. c) Monitor the color of the nail beds in the right hand. d) Wear a protective gown when moving the child's arm. e) Check radial pulse in the both arms.

• Document any signs of pain. • Monitor the color of the nail beds in the right hand. • Check radial pulse in the both arms. Correct Explanation: Monitoring for signs of pain, decreased circulation, or change or variation in pulses in the extremity is important for the child in a cast. Pain can indicate serious complications, such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary. Checking posterior pulses would be appropriate when a lower extremity is casted.

The nurse is caring for an 8-year-old girl in traction. She has been in an acute care setting for two weeks and will require an additional 10 days in the hospital. She is showing signs of regression with thumb sucking and pleas for her tattered baby blanket. What would be the most helpful intervention? a) "Do you want a book to read?" b) "Let's ask your mom to bring your friends for a visit." c) "You are too big to suck your thumb." d) "Would you like a coloring book?"

"Let's ask your mom to bring your friends for a visit." After two weeks in traction, a child can become easily bored and regress in social and personal skills. A visit from friends arranged by the girl's mother or supervised by the child-life specialist would help her adapt to her immobilized state. Telling the girl she is too big to suck her thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as she has likely grown tired of books and coloring after two weeks.

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: a) "These make a smooth edge on the cast so the skin is better protected." b) "We put these on so the child will not pull the padding from under the cast." c) "In case the child has an accident and misses the bedpan, these can be changed to keep the area dry." d) "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." 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.

Maria is a 9-month-old whose babysitter brings her to the ER. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. How should the nurse respond to this situation? a) Ask the babysitter to advocate for the child and report the incident to the authorities. b) Arrange for the parents to come in for an evaluation for possible physical abuse. c) Evaluate the child for a seizure disorder as that is probably why he is injured. d) Evaluate the child for an underlying musculoskeletal disorder.

Arrange for the parents to come in for an evaluation for possible physical abuse. Any type of fracture can be the result of child abuse but spiral femur fractures, rib fractures, and humerus fractures, particularly in the child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of abuse. The parents should be contacted first, and the family should undergo an evaluation for possible physical abuse since femoral fractures in nonambulating infants, particularly spiral fractures, are believed to be highly specific for inflicted injury. If physical abuse is not found, the infant should be evaluated for an underlying musculoskeletal disorder and not a seizure disorder.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? a) Tendons b) Cartilage c) Joints d) Ligaments

Cartilage During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

An infant with a femur fracture is placed in Bryant traction. What would the nurse include in the infant's plan of care? a) Keeping the buttocks slightly elevated b) Removing the traction boot every 8 hours c) Provide range of motion to the unaffected extremity d) Wrapping the bandages from the ankle to the knee

Keeping the buttocks slightly elevated With Bryant traction, the buttocks should be slightly elevated and clear of the bed. The bandages are wrapped from the ankles to midthigh in Bryant traction. The legs are wrapped from the ankle to knee. A traction boot is not used with Bryant traction. This action would be appropriate for Buck traction. With Bryant traction, both legs are extended vertically, so range of motion would not be appropriate.

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? a) Internal fixation device b) Spica cast c) External fixation device d) Stockinette

Spica cast 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.

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be: a) Sever disease. b) epiphysiolysis of the distal radius. c) Osgood-Schlatter disease. d) epiphysiolysis of the proximal humerus.

epiphysiolysis of the proximal humerus. Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

The school nurse cares for children with overuse injuries and refers them for treatment. Which statements accurately describe conservative interventions to prevent or care for these types of injuries? Select all that apply. a) Apply ice to the injured area to reduce inflammation. b) Perform appropriate stretching during a 20-to 30-minute warmup. c) Have the coach monitor the treatment program for sports injuries. d) Avoid using NSAIDs for pain control. e) Immobilize the muscles that are involved. f) Encourage 1 to 2 days off per week of competitive athletics.

• Apply ice to the injured area to reduce inflammation. • Encourage 1 to 2 days off per week of competitive athletics. • Perform appropriate stretching during a 20-to 30-minute warmup. Conservative treatment methods for the child with an overuse injury include encouraging 1 to 2 days off per week of competitive athletics, performing appropriate stretching during a 20-to 30-minute warmup, and applying ice to the injured area to reduce the inflammation and irritation. NSAIDs (ibuprofen) are used for inflammation and pain control. The physical therapist institutes a stretching and strengthening program for the appropriate muscle groups. Parents and coaches may not understand that the level of activity that causes overuse symptoms varies from child to child. Notes or telephone conversations from the physician or nurse to the child's coach can clarify any misconceptions about what is expected during the recovery and recuperative periods

An emergency room nurse prepares a pamphlet to use as a teaching tool for the proper care of sprains. What information might be included in this guide? Select all that apply. a) Bear weight under the arms, not on the hands when crutch walking. b) Promote early motion after acute injury of the soft tissue. c) Immobilize grade I and II ankle sprains with a temporary cast. d) Perform ROM exercises for ankle and wrist injuries. e) Perform quadriceps and hamstring exercises for knee sprains. f) Wrap the extremity starting distal from the affected area.

• Promote early motion after acute injury of the soft tissue. • Perform quadriceps and hamstring exercises for knee sprains. • Perform ROM exercises for ankle and wrist injuries. • Wrap the extremity starting distal from the affected area. Early motion after acute injury of the soft tissue will help the child make a more rapid recovery. Physical therapists instruct the client in quadriceps and hamstring exercises for knee sprains and strains. For ankle and wrist injuries, a ROM program is implemented. In grade I and II ankle sprains, rehabilitation can begin immediately; prolonged immobilization is not recommended. When crutch walking, the child should bear weight on the hands and not the underarms, to avoid nerve damage. Wrapping the injury should be started distal from the affected area.