M&P CH 57

The nurse has completed discharge teaching for the family of a child diagnosed with Legg-Calvé-Perthes disease. The nurse knows further teaching is needed about the condition if the family states: a. "We're glad this will only take about six weeks to correct." b. "We understand abduction of the affected leg is important." c. "We know to watch for areas on the skin that the brace might rub." d. "We understand swimming is a good sport for Legg-Calvé-Perthes."

a The treatment for Legg-Calvé-Perthes disease takes approximately two years. The leg should be kept in the abducted position to prevent damage to the head of the femur due to Legg-Calvé-Perthes disease. A brace is a component of the treatment of Legg-Calve-Perthes disease and is worn to prevent damage to the head of the femur, so skin irritation should be monitored. Swimming is a good activity to increase mobility in a child with Legg-Calvé-Perthes disease.

When assigned to the patient on complete bed rest for spinal fusion secondary to scoliosis, the nurse will want to intervene to prevent common complications of immobility. Nursing interventions will include: (Select all that apply.) a. Encouraging use of the spirometer every two hours while the child is awake. b. Log-rolling the patient every two hours while awake. c. Increasing intake of milk to maintain bone calcium. d. Increasing fruit and grains in the diet. e. Limiting fluid intake to reduce the need to void.

a, b, d Respiratory complications are a common complication of immobility. Turning the patient frequently will reduce pressure on bony prominences. Fruit and grains will provide extra fiber to reduce the risk of complication. Calcium will be pulled from the bones due to immobility. Adding additional calcium in the form of milk will increase the risk of kidney stones. Fluid intake should be increased to "flush" the kidneys.

An infant returns to the unit following casting of the leg for talipes equinovarus. Standing orders include monitoring the neurovascular status. In addition to color, for what will the nurse monitor the infant's foot? (Select all that apply.) a. Warmth b. Capillary refill c. Pedal pulse d. Sensation e. Movement of the toes

a, b, d, e The temperature of the foot of the casted leg should be compared to the temperature of the other foot. This indicates blood return to the tissues and is an important finding. Nerve function is evaluated by touching the toes and noting the child's response. The child is encouraged to wiggle the toes. If the patient is an infant, tickling will cause the child to respond with movement. The pedal pulse cannot be reached in the casted foot

An 18-month-old child is admitted to the hospital unit for weakness of the lower extremities. Duchenne muscular dystrophy is suspected. Which assessment finding on the admission history and physical is indicative of this disorder? a. Infant was post-mature by almost two weeks. b. The child seems very muscular. c. The child walked early and without support at 10 months. d. The child's older sister developed scoliosis in the fourth grade.

b Duchenne muscular dystrophy is also called pseudohypertrophic due to the enlarged appearance of the muscle. The pathophysiology is infiltration of the muscle fibers with fatty tissue. Post-maturity is not related to Duchenne muscular dystrophy. The older sister's scoliosis is not related to MD. Duchenne MD is sex-linked recessive and affects only boys.

A six-year-old boy is admitted to the hospital with a diagnosis of osteomyelitis of the left femur. The plan of care includes a two-week round of intravenous antibiotics. The father questions why the child must be hospitalized and why the child cannot receive oral antibiotics. The nurse explains: a. The antibiotic of choice is not available in oral form. b. This is accurate information. c. The older child can understand the reason for antibiotics and cooperate. d. Because two weeks of therapy is necessary, the intravenous route will produce fewer side effects.

b Most antibiotics are available in multiple forms. The older child can understand the reason for antibiotics and cooperate. Both oral and intravenous antibiotics may have side effects.

An infant has just returned from surgery for correction of bilateral congenital clubfeet. The infant has bilateral long-leg casts. The toes on both feet are edematous, but there is color, sensitivity, and movement to them. What should the nurse do first? a. Apply a warm, moist pack to the feet. b. Elevate the infant's legs on pillows. c. Encourage movement of the toes d. Call the physician to report the edema.

b The infant's legs should be elevated on a pillow for 24 hours to promote healing and help with venous return. This is the priority action. Warm, moist heat will increase swelling and the moisture may cause the cast to disintegrate. An infant would not be able to follow directions to move the toes, and in this case it would not be as effective as would elevating the legs on pillows. Some amount of swelling can be expected, so it would not be appropriate to notify the physician, especially if the color, sensitivity, and movement to the toes remained normal.

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat congenital developmental dysplasia of the hip. Which instruction is appropriate for the nurse to include in parental education in relation to the Pavlik harness? a. Apply lotion or powder to minimize skin irritation. b. Check at least two or three times a day for red areas under the straps. c. Put clothing over the harness for maximum effectiveness of the device. d. Place a diaper over the harness, preferably using a thin, superabsorbent, disposable diaper.

b The skin underneath the straps of the brace should be checked two or three times a day for red areas, which might indicate skin breakdown. Lotion or powder can contribute to skin breakdown and should not be used A light layer of clothing should be worn under the brace to assist in preventing skin breakdown, not over the brace. The diaper should be placed under the brace, along with a light layer of clothing.

An adolescent has just returned from surgery after spinal fusion surgery. Which assessment finding would take priority at this time? a. Sleeps when not bothered but arouses easily with stimuli b. Impaired color, sensitivity, and movement to lower extremities c. Nausea d. Pain

b When the spinal column is manipulated, there is a risk for impaired color, sensitivity, and movement to lower extremities. Nausea in the postoperative period is not uncommon, but it is not the priority at this time. Pain is a common finding in the postoperative period and should be addressed, but impaired color, sensitivity, and movement of the lower extremities is the priority at this time.

Which of the following would take priority when teaching the family how to care for an infant with osteogenesis imperfecta? a. Teaching the family how to care for an infant in a cast b. Teaching the family that the trunk and extremities should always be supported when moving this infant c. Teaching the family how to care for an infant postop spinal surgery d. Teaching the family how to care for an infant in traction

b With osteogenesis imperfecta, nursing care focuses on preventing fractures. Because the bones are fragile, the entire body must be supported when the child is moved. Traction, casts, and spinal surgery are not routinely done for osteogenesis imperfecta.

A school health nurse is screening for scoliosis. For what assessment findings would the nurse look? (Select all that apply.) a. Lordosis b. Prominent scapula c. Pain d. A one-sided rib hump e. Uneven shoulders and hips

b, d, e The classic signs of scoliosis include uneven shoulders and hips, a one-sided rib hump, and prominent scapula.

The nurse in the newborn nursery is doing the admission assessment on a neonate. Which assessment finding would lead the nurse to suspect unilateral congenital hip dysplasia? a. Lordosis b. Trendelenburg sign c. Asymmetry of the gluteal and thigh fat folds d. Telescoping of the affected limb

c A sign of congenital hip dysplasia in the infant would be asymmetry of the gluteal and thigh fat folds. Trendelenburg sign and telescoping of the affected limb are signs that present in an older child with congenital hip dysplasia.

A two-year-old child is placed in balanced Bryant's traction for a fractured right femur. Which finding by the nurse should be reported to the surgeon? a. The child keeps trying to turn and lay on his belly. b. The ropes are unequal in length. c. The child's buttocks are resting on the bed d. The ace bandage wrapping the legs is wrinkled.

c In order to provide adequate counter-traction, the buttocks should be slightly elevated off the bed. The surgeon should be notified. This child needs a jacket restraint to maintain appropriate positioning if someone cannot stay with him. It does not require notifying the surgeon. In balanced traction, the ropes and pulleys determine the traction and the length of the rope is unimportant. This is not a significant finding.

A child must wear a brace for correction of scoliosis. Which nursing diagnosis takes priority at this time? a. Impaired gas exchange, risk for b. Altered growth and development, risk for c. Impaired skin integrity, risk for d. Impaired mobility, risk for

c The skin should be monitored for breakdown in any area where the brace might rub against the skin. Risk for impaired gas exchange is a late effect of scoliosis and would not be the priority. If the patient is compliant with wearing the brace, the risk should be minimized. The diagnosis of altered growth and development would not be the priority and should be corrected by the wearing of the brace. The diagnosis of impaired mobility would not be the priority and should be corrected if the patient is compliant with wearing the brace.

A nurse is assessing a child after an open reduction of a fractured femur. Which signs indicate that compartment syndrome could be occurring? (Select all that apply.) a. Pink, warm extremity b. Dorsalis pedis pulse present c. Prolonged capillary refill time d. Pain not relieved by pain medication e. Paresthesia of the leg

c, d, e A prolonged capillary refill time is a sign of compartment syndrome. A prolonged capillary refill time with loss of paresthesia and pain not relieved by medication are signs of compartment syndrome. Paresthesia is tingling and numbness of the affected extremity and is a sign of compartment syndrome. Pink, warm extremity is a normal finding post-fracture reduction. A present dorsalis pedis pulse would be a normal finding post-fracture reduction.

A child has experienced a sprain of the right ankle. The school nurse should: a. Leave the ankle open to the air and avoid compressing the area to allow tissue swelling as necessary. b. Perform passive range-of-motion to the extremity. c. Lower the extremity below the level of the heart. d. Apply ice to the extremity.

d For the first 24 hours for a sprain, rest, ice, compression, and elevation (RICE) should be followed. Therefore, the nurse should apply ice to the extremity. The nurse should apply a compression bandage to the extremity. The nurse should apply ice to the extremity. The nurse should elevate the extremity.

The nurse has completed parent education related to treatment for a child with congenital clubfoot. The nurse knows that parents need further teaching when they state: a. "We're getting a special car seat to accommodate the casts." b. "We'll watch for any swelling of the feet while the casts are on." c. "We'll keep the casts dry." d. "We're happy this is the only cast our baby will need."

d Serial casting is the treatment of choice for congenital clubfoot. The cast is changed every one to two weeks until the corrected foot position is achieved. Using a car seat is the law. Special car seats to accommodate the casts are available and should be utilized. Parents should be watching for swelling while the casts are on. Keeping the casts dry is important to prevent complications.

While at recess, a child falls and hurts his arm. The school nurse is called and suspects a fractured arm. The nurse will apply a splint before transporting the child to the hospital. The nurse will ensure that: a. The splint is applied firmly enough to prevent swelling. b. The arm is fully extended in the splint. c. The splint is fully padded to prevent skin damage. d. The joints above and below the suspected fracture are immobilized.

d This is the important concept in splinting—immobilizing the joint above and below the fracture to prevent movement of the bones. The purpose of the splint is not to prevent swelling. The nurse will not want to manipulate the arm, so the nurse will splint the arm in the position it is found. The splint does not need to be padded.