Chapter 22 Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination?

Record and refer the finding for follow-up to the pediatrician.

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should monitor for decreased circulation every 4 hours.

The nurse is conducting a physical examination of a newborn with suspected osteogenesis imperfecta. Which finding is common?

blue sclera

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?

creatine kinase

The caregiver of a 2-year-old who has a polyurethane resin cast on her arm calls the clinic to report that her child is crying and says that the cast has sand in it. The caregiver states that she has had casts herself and knows how badly they can itch. She says she always used a hanger to scratch but is worried that it will be too sharp for the child. Which statement would be appropriate for the nurse to make to this caregiver?

"Nothing should be put into the cast. You can blow cool air into it with a hair dryer."

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response?

"The cause is unknown and there are many environmental factors that may contribute to it."

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?

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

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele?

Assuming the usual feeding position will be difficult.

A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg?

Check the infant's toes for coldness or blueness.

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy

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?

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.

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?

Handling the cast with open palms when moving the arm.

Through which mechanism is Duchenne muscular dystrophy acquired?

Heredity

A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective?

Inspect the child's skin for rashes, redness, irritation, or pressure injuries.

The parents of an infant diagnosed with anencephaly come to visit their child in the nursery. The parents stand a few feet away from the crib watching the nurse provide care for the child. Based on this information, what action(s) should the nurse take? Select all that apply.

Invite the parents to come closer to the child's bedside. Encourage the parents to hold their child as much as possible. Provide the parents with resources for future support.

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.

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 boy's toes are light blue and very swollen.

A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note?

The posterior spine when bending forward

The nurse is preparing an education program for parents of a child diagnosed with Legg-Calvé-Perthes disease (LCPD) disorder. What information does the nurse need to include? Select all that apply.

This disorder has four stages that last over several years. The initial stage symptoms include a limp and guarding of the hip while moving. If left untreated, the femur head will deform, which can lead to chronic pain.

A group of students is 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

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should the nurse use to best describe this condition?

degeneration of muscle fibers

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding?

idiopathic scoliosis

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?

presence of Moro reflex

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

unhooking a weight while providing pin care

The nurse is teaching a group of peers regarding different types of fractures seen in children. Which statement best describes a complete fracture?

A fracture in which the bone breaks into two pieces