Chapter 34 - The Child with Musculoskeletal or Articular Dysfunction
Which of the following would cause a nurse to suspect that an infection has developed under a cast? Cold toes Increased respirations Complaint of paresthesia "Hot spots" felt on the cast surface
"Hot spots" felt on the cast surface If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. Cold toes may indicate too tight a cast and need further evaluation. Increased respirations may indicate a respiratory infection or pulmonary emboli. This should be reported, and the child should be evaluated. The five Ps of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: Problem IdentificationREF: p. 1562
Which of the following statements is correct regarding sports injuries during adolescence? Rapidly growing bones, muscles, joints, and tendons offer some protection from unusual strain. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. More injuries occur during organized athletic competition than during recreational sports participation. Adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities.
Adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities. Children and adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities. Rapidly growing bones, muscles, joints, and tendons are especially vulnerable to unusual strain. The increase in strength and vigor in adolescence may tempt adolescents to overextend themselves. More injuries occur during recreational sports participation than in organized athletic competition.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Teaching/LearningREF: p. 1544
The nurse is preparing an adolescent girl for surgery to treat scoliosis. Which of the following should the nurse include? Blood administration may be an option. Ambulation will not be allowed for up to 3 months. Surgery eliminates the need for casting and bracing. Discomfort can be controlled with nonpharmacologic methods.
Blood administration may be an option. Spinal surgery usually involves considerable blood loss. Several options are considered for blood replacement. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients are walking by the second or third postoperative day. Casting and bracing are required postoperatively. The child usually has considerable pain for the first few days after surgery. Intravenous opioids should be administered on a regular basis.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Teaching/LearningREF: p. 1589
A child, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, the nurse should consider which of the following? This type of fracture is inconsistent with a fall. Bone growth can be affected by this type of fracture. This is an unusual fracture site in young children. Healing is usually delayed in this type of fracture.
Bone growth can be affected by this type of fracture. Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma. Healing of epiphyseal injuries is usually prompt.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Teaching/LearningREF: p. 1595
A young child has recently been fitted with a knee, ankle, and foot orthosis (brace). Care of the skin should include which of the following? Apply lotion or cream to soften the skin. Contact a practitioner or orthotist if skin redness does not disappear. Place padding between the skin and brace if the child experiences a burning sensation under the brace. If a small blister develops, apply rubbing alcohol and place padding between the skin and the brace.
Contact a practitioner or orthotist if skin redness does not disappear. Redness is a sign of skin irritation from the brace. The brace needs to be adjusted to be functional. The skin should not be softened. The brace is specially designed for the child. Padding may alter the alignment of the brace. Rubbing alcohol would be painful. If the brace causes blisters, it needs to be adjusted.Level of cognitive ability: ApplicationArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: ImplementationREF: p. 1565
Immobilization causes which of the following effects on the cardiovascular system? Venous stasis Increased vasopressor mechanism Normal distribution of blood volume Increased efficiency of orthostatic neurovascular reflexes
Venous stasis The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: AssessmentREF: p. 1549
The nurse stops to assist a child who has been hit by a car while riding a bicycle. Someone has activated the emergency medical system. Until paramedics arrive, the nurse should consider which of the following in caring for this child who has experienced severe trauma? Rapid assessment should begin with ABC status: airway, breathing, and circulation. Assessment should begin with the area injured; assessment of other areas can wait. The possibility of spinal cord injury should be ruled out before transporting the child to the hospital. Temperature maintenance is more difficult than in adults because young children have a larger surface area related to body mass.
Rapid assessment should begin with ABC status: airway, breathing, and circulation. The first priority is always airway, breathing, and circulation. Assessment of the injured area occurs after the child's cardiopulmonary status has been addressed. Transport can occur by immobilizing the cervical spine. The head is maintained in a neutral position, and movement of the head or body is not allowed in any direction. Infants have the greatest discrepancy in body surface areas. Children old enough to ride bikes have similar body proportions to adults.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Reduction of Risk PotentialIntegrated process: Nursing Process: AssessmentREF: p. 1545
An important nursing consideration when caring for a child with juvenile idiopathic arthritis is which of the following? Apply ice packs to relieve stiffness and pain. Administer acetaminophen to reduce inflammation. Teach the child and family the correct administration of medications. Encourage range of motion exercises during periods of inflammation.
Teach the child and family the correct administration of medications. The management of juvenile idiopathic arthritis is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range of motion exercises should not be done during periods of inflammation.Level of cognitive ability: PlanningArea of client needs: Physiologic Integrity/Pharmacologic and Parenteral TherapiesIntegrated process: Teaching/LearningREF: p. 1603
A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include which of the following? Encourage normal activity for as long as possible. Explain the cause of the disease to the child and family. Prepare the child and family for long-term, permanent disabilities. Teach the family the care and management of the corrective appliance.
Teach the family the care and management of the corrective appliance. The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight-bearing activity, which help reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease of unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome depends on early and efficient therapy and the age of the child at onset.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/ImplementationIntegrated process: Teaching/LearningREF: p. 1595
