Pediatrics Ch 22

The emergency department nurse is caring for a 3 year old child with an arm injury. The parent is very upset because the parent believes she broke her child's arm. "I was lifting her by her hands and felt a pop in her wrist. She instantly started screaming." The child is now guarding and refusing to move the arm. Which response by the nurse would be most appropriate?

" The arm isn't broken. This injury ins common and easily fixed with no complications." Rationale: The nurse should quickly reassure the parent that this is a common occurrence, seen every day in the emergency department, and is easily fixed and resolves with no complications. Although popping noise indicates entrapment of the ligament, this response does not address the parent's concerns. Although the radial head most likely dislocated, this response does not address the parent's concern. Although this condition is call nurse's elbow, telling the parent to be more careful only serves to put blame on the parent and does not address the parent's concern

The nurse is caring for a 6 year old with Russell traction applied to the left leg. Which intervention would be most appropriate to prevent complications?

Assess the popliteal region carefully for skin breakdown.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant?

Baclofen Rationale: Baclofen is a a centrally acting skeletal muscle relaxant used t treat painful spasms and decrease spasticity in children with motor neuron lesions. Prednisone is a corticosteroid that is used to help slow the progression of Duchenne muscular dystrophy. Lorazepam is a benzodiazepine used for adjunctive relief of skeletal muscle spasm associated with cerebral palsy.

A child is to undergo testing for suspected muscular dystrophy and is scheduled for the following tests Which test would the nurse identify as most important to be completed first?

Creatine kinase

the nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. Our child will never be able to walk." The nurse identifies which nursing diagnosis as the priority?

Deficient knowledge related to diagnosis and condition

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The parent is very upset and concerned about the child's prognosis? Which response by the nurse would be most appropriate?

In most cases treatment is not necessary, only observation.

A nurse is conducting a physical examination on an 11 year old child with Legg-Calve-Perthes disease. Which assessment finding would be expected?

Trendelenburg gait

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?

adolescence

A 9 year old child is scheduled for a computed tomography with contrast medium. What would be most important for the nurse to assess?

allergies

A nurse is performing a physical examination of a child with a suspected musculoskeletal dysfunction. Which assessment technique would the nurse assume would not be used?

auscultation

The nurse is caring for a 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:

epiphysiolysis of the proximal humerus

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?

low serum calcium levels

A nurse is conducting a physical examination of a 5 year old child with spinal muscular atrophy (SMA) type 2. What assessment finding would the nurse expect to find?

pectus excavatum Rationale: Pectus excavatum develops in children with SMA type 1 and type 2 who exhibit paradoxical breathing. The chest becomes funnel shaped and the xiphoid process is retracted. Pseudohypertrophy of the calves is associated with Duchenne muscular dystrophy. Loss of strength in the hip extension is associated with Duchenne muscular dystrophy. Loss of strength in ankle dorsiflexion is associated with Duchenne muscular dystrophy.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:

significant bending without actual breaking

The nurse is caring for a 2 year old child with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities of one side." Based on these findings, the nurse identifies this type of CP as:

spastic Rationale: Spastic involves hypertonicity and permanent contractures on both extremities on one side. Athetoid (dyskinetic) involves abnormal involuntary movements affection all four extremities and sometimes the face, neck, and tongue. Ataxic affects balance and depth perception. Spastic affects the lower extremities. Mixed is a combination of spastic, athetoid, and ataxic.

A nurse is assessing a newborn and observes webbing of the fingers and toes. The nurse documents this finding as:

syndactyly

The nurse is caring for a 3 year old child with a fracture of the humerus. The chart indicates, "fracture is partially through the physis extending into metaphysis:" The nurse identifies this as which Salter-Harris classification?

type II

The nurse is caring for a 14 year old child 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? SATA

-capillary refill -sensation -color -pulse

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching?

"Check the skin that is covered by the braces for redness and breakdown" Rationale: Assessing skin integrity should be the priority, as braces can lead to pressure ulcers and infection. Compliance is important, but attention to skin care is the priority teaching. Following the schedule is importance for compliance, but skin integrity is the priority. Advising the parents to remove the brace if it is painful is inaccurate, the child may require pain management or further consultation with the physical therapist

A 7 year old child is suspected of having transient synovitis of the hip. What findings would the nurse expect to assess? SATA

-History of recent otitis media -Complaint of acute onset of moderate pain -Pain worse in the morning on arising Rationale: Assessment findings associated with transient synovitis of the hip include a recent upper respiratory tract infection, pharyngitis, and otits media. Pain onset is acute and sudden, with pain ranging from moderate to severe that is worse in the morning. Temperature will be normal or a low-grade fever may be present. The child holds the affected hip flexed and externally rotated.

the nurse is caring for an infant with a myelomeningocele who has paralysis of the lower extremities. Which action would be most appropriate to help reduce friction resulting from this paralysis?

Place a folded diaper in between the legs Rationale: To protect the myelomeningocele, the child must always be placed in the prone position. Special attention the the infants legs needs to occur when positioning them. Using a folded diaper in between the legs can help reduce pressure and friction from the legs rubbing together. Placing a pad beneath the diaper area helps to keep the child clean. Using a special care mattress helps to reduce pressure. Using sheepskin under the infant's chest reduces friction on the chest area but not the legs.

The nurse is caring for a 10 year old in traction. The child is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered?

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.