Ch 29 The Child with MSC or Articular Dysfunction

At what age should scoliosis screening be performed? 1 Girls should be screened at ages 10 and 12, and boys should be screened once, at age 13 or 14. 2 Girls should be screened at ages 8 and 10, and boys should be screened once, at age 13 or 14. 3 Girls should be screened at ages 9 and 12, and boys should be screened once, at age 13 or 14. 4 Girls should be screened at ages 10 and 11, and boys should be screened once, at age 13 or 14.

1 According to the American Academy of Orthopedic Surgeons, girls should be screen twice, at ages 10 and 12, and boys should be screened once, at age 13 or 14.

The primary health care provider has prescribed intravenous (IV) antibiotic therapy for a child with acute osteomyelitis. After assessment, the nurse finds that the child is not responding to the therapy. Which follow-up treatment strategy does the nurse expect the primary health care provider to prescribe? 1 Surgery 2 Chemotherapy 3 Probiotic therapy 4 Oral antibiotic therapy

1 Acute osteomyelitis is infection in the bone caused by a blood-borne bacterium. Therefore, intravenous (IV) antibiotic therapy is prescribed to the child. Surgery is indicated if there is no response to oral or IV antibiotic therapy. Chemotherapy is not indicated in the treatment of osteomyelitis. Probiotic therapy is not indicated in the treatment of osteomyelitis, but it is used to prevent antibiotic-associated diarrhea. Oral antibiotic therapy is not of use; because oral therapy is initiated before IV therapy, the child will not respond to the oral antibiotic therapy.

What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle? 1 Elevation reduces edema formation. 2 Elevation raises the child's pain threshold. 3 Elevation produces deep tissue vasodilation. 4 Elevation increases metabolism in the tissues.

1 Elevating the extremity uses gravity to facilitate venous return to reduce edema. Elevation should have no significant effect on the pain threshold. Elevation should not affect metabolism. Venous return to the heart, not vasodilation, is facilitated by elevation.

What is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization? 1 Exercise intolerance 2 Enhanced metabolism 3 Improved venous return 4 Increased cardiac output

1 Muscle disuse leads to tissue breakdown and loss of muscle mass, or muscle atrophy. It may take weeks or months to recover. Metabolism decreases during periods of immobility. There is decreased venous return as a result of decreased muscle activity caused by immobility. Cardiac output is also decreased as a result of immobility.

Which is a characteristic of fractures in children? 1 Rapidity of healing is inversely related to the child's age. 2 The pliable bones of growing children are less porous than those of adults. 3 Fractures rarely occur at the growth plate site because it absorbs shock well. 4 The periosteum of a child's bone is thinner and weaker and has less osteogenic potential than that of the adult.

1 (I guessed 2) Fractures heal in less time in children than in adults. As the child ages, the healing time increases. The cartilage epiphyseal plate is the weakest point of the long bone. Therefore it is a frequent site of damage and fractures. The periosteum is thickened, and there is a great production of osteoclasts when a bone injury occurs. Bone healing in children is also rapid because of the generous blood supply.

A 5-year-old child fractured the left elbow while playing with friends. The health care provider has prescribed regular cast changes and bed rest. What should the nurse educate the parents about cast care? 1 Apply lotion to the skin after cast removal. 2 Scrub away residual material on the skin. 3 Immerse the cast briefly in a tub bath. 4 Cover the damp cast edges with adhesive.

1 (I guessed 3) After the cast is removed, the skin surface will be caked with desquamated skin and sebaceous secretions. Application of mineral oil or lotion may remove the particles and provide comfort. The parents and child should be instructed not to pull or forcibly remove this material with vigorous scrubbing because it may cause excoriation and bleeding. The skin under the cast may become macerated from inadequate drying after water immersion. Adhesive will not adhere to a damp cast even if the cast is composed of fiberglass; it takes about a half-hour for it to dry.

A child has just been fitted with a cast to heal a fracture of the arm. What findings does the nurse recognize as clinical signs of compartment syndrome? Select all that apply. 1 Pain 2 Pallor 3 Paresthesia 4 Pulselessness 5 Palpable pulses

1, 2, 3, 4 Compartment syndrome is a serious complication that results from compression of nerves, blood vessels, and muscle inside a closed space. It can occur after a cast is applied. Clinical signs of compartment syndrome include pain, pallor, pulselessness, paresthesia, paralysis, and pressure.

For what condition should children with multiple fractures be screened? 1 Skeletal limb deficiency 2 Osteogenesis imperfecta 3 Legg-Calvé-Perthes disease 4 Slipped capital femoral epiphysis

2 Children with multiple fractures should be screened for osteogenesis imperfecta. Skeletal limb deficiency is manifested by a loss of functional capacity not multiple fractures. Legg-Calvé-Perthes disease is aseptic necrosis of the femoral head and not associated with multiple fractures. Slipped capital femoral epiphysis is the spontaneous displacement of the proximal femoral epiphysis in posterior and inferior direction and is not associated with multiple fractures.

Which statement concerning osteogenesis imperfecta (OI) is true? 1 OI is easily treated. 2 OI is an inherited disorder. 3 Braces and exercises are of no therapeutic value. 4 With a later onset, the disease usually runs a more difficult course.

2 Osteogenesis imperfecta (OI) is an autosomal dominant inherited disorder, a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. OI has a predictable course that is determined by the pathophysiologic processes, not the time of onset. Lightweight braces and splints can help support limbs and fractures.

Which measure is most important in managing hypercalcemia in a child who is immobilized? 1 Changing position frequently 2 Promoting adequate hydration 3 Encouraging a diet high in calcium 4 Providing a diet high in protein and calories

2 (I put 4) Hydration is extremely important in helping remove excess calcium from the body. This can help prevent hypercalcemia. Changing the child's position frequently will help with managing skin integrity but will not affect the calcium level. The calcium will not be incorporated into bone because of the lack of weight bearing. The child is at risk for hypercalcemia. The child's metabolism is slower because of the immobilization. A diet with sufficient calories and nutrients for healing is important.

The nurse is educating a group of people about the first aid to be given in cases of fractures. A person questions how to splint a leg fracture when there is no ready-made splint available. Which statement of the nurse appropriately answers the question asked? 1 "Use a smaller splint if available." 2 "Just bandage the affected limb." 3 "Use the patient's other leg as a splint." 4 "You need not splint the leg."

3 A splint offers support and rest to the injured body part. If a ready-made splint is not available, the patient's other leg can be used as a splint to support the injured part. A splint should cover the joint above and below the fracture. Using a smaller splint or bandaging the limb may be insufficient to immobilize the fractured leg. Splinting the leg is very important, as movement in the fractured limb may further worsen the fracture.

The nurse on a home visit finds that a person has sustained a severe sprain. What suggestions are appropriate for providing first aid for sprain? 1 Provide limb movements, apply ice, and avoid splinting. 2 Provide warmth, splint, and keep the affected limb elevated. 3 Provide rest, apply ice, and provide compression. 4 Provide rest and warmth, and apply compression.

3 First aid in cases of sprains or suspected fractures involves interventions that can be remembered with the acronym RICE. R stands for rest; I stands for ice; C stands for compression; E stands for elevation. Therefore the nurse suggests that caregivers provide rest, apply ice, and provide compression to the affected limb. Providing limb movements would worsen the sprain and may lead to complete rupture of the ligament. There should be no warm application for sprains, because it can worsen the edema associated with sprains.

The nurse is caring for a child who has a loss of respiratory muscle strength and who is unable to cough. Which nursing intervention does the nurse perform to help the child clear the airway? 1 Ask the child to suppress the cough. 2 Restrict fluid intake for the child. 3 Splint the chest while the child is coughing. 4 Administer antibiotic drugs to the child.

3 In case of respiratory muscle weakness, there is difficulty in coughing. The nurse should support the child's chest by splinting with a pillow so that it is easier to cough. Coughing is a defense mechanism of the body that removes foreign irritants from the respiratory tract. Thus the nurse should encourage the child to cough. The child should be provided adequate fluids to prevent thickening of chest secretions. Antibiotic drugs should be administered only if the child shows signs and symptoms of infection.

The nurse is caring for a child who has decreased muscle strength and muscle tone. What is the most appropriate nursing intervention to ensure a sufficient venous return? 1 Immobilize the child. 2 Limit the hours of sleep. 3 Use compression stockings. 4 Ensure sufficient fluid intake.

3 In the presence of decreased muscle strength and tone, the venous return to the heart is also reduced. This stagnation of the venous blood can lead to the formation of thromboembolism, especially in the lower limbs. The best intervention in this condition is the use of compression or antiembolism stockings. The nurse encourages the child to move to improve the venous return. Immobilizing the child aggravates the condition and increases the risk of thrombus formation. The hours of sleeping are not related to thrombus formation as long as there is sufficient movement of the limb during the daytime. Adequate fluid intake is essential for the maintenance of normal health, but is not directly related to thrombus formation.

The nurse is caring for a child who has dependent edema. What interventions does the nurse perform to help reduce edema and prevent related complications? 1 Apply bandages to the lower limbs. 2 Elevate the lower limbs without knee flexion. 3 Reposition the patient every 2 hours. 4 Apply ice to the edematous area.

3 People with dependent edema are at high risk for development of pressure ulcers. In order to prevent ulcers, the nurse repositions the patient frequently. The nurse also ensures that there is no friction on the patient's skin. Using bandages and elevating the lower limbs are useful in cases of reduced venous return or venous stasis but not in dependent edema. Applying ice only helps in causing blood flow to cease; it does not decrease dependent edema.

The nurse is caring for a child who is immobilized for prolonged periods. As a result the child has decreased chest expansion and reduced tidal volume. What is the appropriate intervention to aid respiration in this child? 1 Position the child in standing position. 2 Position the child in supine position. 3 Position the child in semi-Fowler position. 4 Position the child in Trendelenberg position.

3 Prolonged immobilization can increase the risk of respiratory complications such as decreased chest expansion and reduced tidal volume. The child should be positioned well to promote adequate chest expansion. Semi-Fowler position allows lung expansion and aids in respiration. Standing allows for better respiratory status and chest expansion. In this situation, it would be difficult for the child to stand, because the child is immobilized for a long time and may not be able to bear weight. The supine and Trendelenberg positions do not allow maximum lung expansion.

A child with a fracture of the tibia is discharged from the hospital after application of a cast. The nurse explains to the parents about the cast care to be performed at home. Which statement by the child's parents indicates that they understand proper cast care? 1 Stand and walk every 30 minutes. 2 Keep the affected limb hanging down. 3 Elevate the affected limb whenever possible. 4 Relieve the itching by scratching with small stick.

3 The affected part should always be elevated whenever possible. This reduces swelling and allows venous return. Standing and walking frequently are not recommended, because the injured area requires rest. Keeping the affected limb hanging down reduces the venous return. The child should not be allowed to insert sticks or anything else inside the cast to relieve itching. This can damage the cast or cause infection.

A 3-year-old has just returned from surgery in a hip spica cast. What is the priority nursing intervention? 1 Offering sips of water 2 Elevating the head of the bed 3 Checking circulation, sensation, and motion of toes 4 Turning the child to the right side and then the left side every 4 hours

3 The chief concern is that the extremity may continue to swell. The circulation, sensation, and motion of the toes must be assessed to ensure that the cast does not become a tourniquet and cause complications. Elevating the head of the bed might help with comfort, but it is not a priority. The nurse must be alert to the risk of increased swelling in the extremities. Offering sips of water is acceptable once assessment of the extremities has been completed. The child's position should be changed every 2 hours. Correct positioning of a child with a spica cast is important to prevent injury.

The nurse is caring for a child who is unable to move and ambulate. The child also has compromised circulation due to immobility. What care does the nurse take to avoid development of ulcers or injuries to the child? 1 Reposition the child every 24 hours. 2 Transfer the child to a wheelchair. 3 Move the child every 2 to 4 hours by lifting. 4 Slide the child every 30 minutes.

3 The child is suffering from decreased circulation and is bedridden. Therefore the child is at a high risk of developing pressure ulcers or any injury to the skin. The nurse should be careful while handling this child. The nurse repositions the child frequently, at least every 2 to 4 hours to prevent the development of pressure ulcers. Repositioning the child only once in 24 hours is not sufficient to prevent pressure ulcers. If transferred in a wheelchair, the child may still develop pressure ulcers on different sites. The nurse moves the child by lifting to avoid any injury. Sliding the child may cause friction and may lead to skin break.

A home care nurse is caring for a 4-month-old infant with developmental dysplasia of the hip (DDH). The baby is in a Pavlik harness. The baby's mother tells the nurse, "I don't think my baby will be able to sleep while wearing the harness." What is an appropriate response by the nurse? 1 "The harness can be removed during a short 30-minute nap." 2 "You can reapply the harness after the baby falls asleep." 3 "It is important for the harness to be worn continuously." 4 "You can have the baby not take one of the daily naps."

3 The harness is worn continuously until the hip is proved stable on clinical and ultrasound examination, usually in 6 to 12 weeks. Some practitioners permit its removal for bathing. Removal or re-application of the harness will probably awaken the infant. Babies should not be prevented from taking naps, because such naps are essential for good health.

What does the nurse recognize as the most common cause of fractures in school-age children? 1 Snowboarding 2 Climbing trees 3 Walking up many stairs 4 Bicycle-automobile crashes

4 Bicycle-automobile crashes, playground falls, and skateboarding injuries are the most common causes of fractures in school-age children. Snowboarding injuries are more commonly the cause of fractures in adolescents. Falling from trees or down stairs is not the most common cause of the majority of fractures in school-age children.

What effect does immobilization have on the cardiovascular system? 1 Lessened need for oxygen 2 No specific primary effect 3 Negative nitrogen balance 4 Venous stasis and dependent edema

4 Immobilization physically affects the cardiovascular system by causing venous stasis and dependent edema. Decreased need for oxygen is how immobilization affects the respiratory system, not the cardiovascular system. Immobilization has a very specific effects on the cardiovascular system. Negative nitrogen balance is how immobilization affects metabolism, not the cardiovascular system.

The callus that develops at a fracture site is important because it provides what? 1 Use of the injured part 2 Means for adequate blood supply 3 Sufficient support for weight bearing 4 A means of holding bone fragments together

4 New bone cells are formed in large numbers and stimulated to maximum activity. They are found at the site of the injury. In time, calcium salts are absorbed to form the callus. Functional use cannot occur until the fracture site is stable. Sufficient support for weight bearing is not possible until the fracture site is stable. The callus does not provide an adequate blood supply.

What is the most common site of fractures in children? 1 Hand 2 Pelvis 3 Clavicle 4 Distal forearm

4 The distal forearm (radius, ulna, or both) is the most common fracture site in children. The pelvis is not the most common fracture site in children. The hand is not the most common fracture site in children. The clavicle is a commonly fractured bone but not the most common fracture site in children.

A child has pain and sacral dimpling in the lumbosacral region, a left thoracic curve, and bladder incontinence. What should the nurse do first? 1 Inform the parents that the child will outgrow this problem. 2 Refer the parents to a community-based agency for assistance. 3 Give the parents information about managing incontinence. 4 Notify the primary health care provider of the findings.

4 (I guessed 3) Diastematomyelia is an intraspinal abnormality which causes scoliosis. Signs of pain in the lumbosacral region, sacral dimpling, left thoracic curve, and bladder incontinence indicate the presence of an intraspinal abnormality. It may signify a tethered spinal cord, so the primary health care provider should be notified immediately. The problem should not be dismissed, because the child will not outgrow this condition. The parents may need community assistance, but the child needs medical attention first. The parents do need information about how to manage urinary incontinence; however, the causative problem needs to be addressed first.