Chapter 51: Nursing Care of a Family when a Child has a Musculoskeletal Disorder

The nurse is reinforcing teaching with the caregivers of a child who has had a cast on the arm removed after 6 weeks. The caregiver makes the following statements. Which statement indicates an understanding of the teaching?

*"He loves to play outside now that the weather is nice; I will have to remind him to use sunscreen."* After cast removal, sunscreen should be applied to the previously casted area when the child will have sun exposure. The casted area should be soaked in warm water to help remove the crusty layer of accumulated skin. Application of oil or lotion may prove comforting. Family caregivers and the child must be cautioned against scrubbing or scraping this area because the tender layer of new skin underneath the crust may bleed.

The emergency department nurse is caring for a 3-year-old girl with an arm injury. The mother is very upset because she believes she broke her daughter'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 her arm. Which response by the nurse would be most appropriate?

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

The nurse is caring for a school-age child diagnosed with juvenile arthritis (JA). Currently, the child's hips and knees are inflamed and painful. What statement by the parent would indicate a need for further education?

*"I will keep my child home from school when there is a flare up to help reduce the amount of time my child is in pain."* Children with JA should be encouraged to attend school, even if it is a shortened day because this increases activity. Using an elevated toilet seat may help decrease pain in the knees. A daily exercise program should be completed, and incorporating exercises into a game or dance can make them more enjoyable for the child. Warm baths can help can help reduce pain and increase movement in the involved joints.

The nurse is reinforcing teaching with the caregivers of a child who has been placed in an external fixation device for the treatment of an orthopedic condition. Which statement made by the caregivers indicates an understanding of the external fixation device?

*"It will be hard, but we know our child will be in this device for a long time."* External fixation devices are sometimes left in place for as long as 1 year. The pin sites are left open to the air and should be inspected and cleansed every 8 hours. The child and caregiver should be able to recognize the signs of infection at the pin sites. The appearance of the pins puncturing the skin and the unusual appearance of the device can be upsetting to the child.

The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention?

*"Let's ask your parents to bring your friends for a visit."* After 2 weeks in traction, a child can become easily bored and regress in social and personal skills. A visit from friends arranged by the child's parent or supervised by the child-life specialist would help the client adapt to the immobilized state. Telling the client that he or she is too big to suck the thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as the child has likely grown tired of books and coloring after 2 weeks.

The nurse is caring for a child diagnosed 3 months ago with juvenile idiopathic arthritis (JIA). The caregiver states that the child has recently reported little pain and is not currently taking aspirin or NSAIDs. The caregiver also tells the nurse that just to be on the safe side, she is continuing to keep the child from doing physical exercise. The mother states, "I think we have beaten this disease." In working with this child and the caregiver, which statement would be best for the nurse to make?

*"Let's review some of the instructions. She does need to take an anti-inflammatory every day."* Teach family caregivers the importance of regular administration of the medications, even when the child is not experiencing pain. The primary purpose of aspirin or NSAIDs is not to relieve pain but to decrease joint inflammation.

A group of nursing students are reviewing information about types of skin traction and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction?

*Side arm 90-90 traction* Side arm 90-90 traction is a type of skeletal traction with force applied through a pin in the distal femur. Russell traction, Bryant traction, and Buck traction are types of skin traction.

In caring for a child being treated for scoliosis, the highest priority goal is which of the following?

*The child will remain free of injury.* The highest priority goal for the child being treated for scoliosis is preventing injury. Other important goals, but with less priority, include minimizing the disruption of activities and maintaining skin integrity and self-image. Goals for the child and caregiver include accepting the treatment and complying with long-term care.

Which client would be the most likely person to be diagnosed with idiopathic scoliosis that requires treatment?

*a young adolescent female* Mild scoliosis occurs between the genders equally, but idiopathic scoliosis requiring treatment occurs 10 times more often in females than males. Usually, treatment is initiated during early adolescence, around age 11 to 14 years.

When assessing a child for slipped capital femoral epiphysis, what would the nurse identify as possible risk factors? Select all that apply.

*obesity, Black race* Risk factors associated with slipped capital femoral epiphysis include age between 9 and 16 years, black race, sedentary lifestyle, and being overweight or obese. A history of cystic fibrosis may contribute to rickets.

The school nurse is doing a presentation to a group of caregivers of children diagnosed with scoliosis. One of the caregivers asks the nurse about structural scoliosis. Which condition is involved with the diagnosis of structural scoliosis?

*rotated and malformed vertebrae* Structural scoliosis involves rotated and malformed vertebrae. Functional scoliosis can have several causes: poor posture, muscle spasm caused by trauma, or unequal length of legs.

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* Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze.

Legg-Calvé-Perthes disease (LCPD) is more likely to be seen in which group?

*white boys* Legg-Calvé-Perthes disease (LCPD) is an aseptic necrosis of the head of the femur. It occurs 4 to 5 times more often in boys than in girls and 10 times more often in whites than in other ethnic groups.

The nurse is caring for a child diagnosed with a sprain of the lower extremity. Which health care prescription(s) would the nurse clarify with the provider before implementing? Select all that apply.

-Apply a heating pad four times daily for 20 minutes per application -Offer aspirin (ASA) three times daily orally to the child for pain and inflammation For a sprain or strain, ice is applied to the site to reduce swelling. Heat is not applied as this would increase swelling. Aspirin is rarely used to relieve pain and swelling in children due to the risk of Reye syndrome. If the provider prescribed either heat or aspirin, the nurse would clarify these prescriptions before implementing them. Compression and rest of the extremity (non-weight bearing), and teaching about follow-up needs are typical and expected prescriptions.