CH 24 Peds- The child needing nursing care

What are appropriate interventions when caring for a child in traction? Select all that apply. Use of trapeze for positioning Neurovascular checks performed regularly Upright for 30 minutes a day Skin integrity monitored regularly Other extremities must be immobilized Liquid diet to prevent constipation

Patients have to use a trapeze and have neurovascular checks, along with close monitoring of skin integrity. Patient positioning is specific to type of traction and break. The extremities will not be immobilized. This client won't have dietary restrictions unless warranted by another condition/concern.REF: Page 563

The mother of a 3-year-old tells the nurse she is concerned about her child's bow-legged appearance. What is the best response from the nurse? "A referral to a pediatric orthopedic physician is indicated immediately." "Is your child having any pain or difficulty walking?" "Do not worry about it; this is normal." "I would be concerned if I were you."

"Is your child having any pain or difficulty walking?" Young children appear bow-legged (genu varum) or knock-kneed (genu valgum) until 5 years of age. The role of the nurse is to reassure parents that unless there is associated pain or a problem with motor or nerve functions, many minor abnormal-appearing alignments will spontaneously resolve with activity. Therefore the nurse must first determine if the child is having pain or motor and/or nerve function problems before reassuring.REF: Page 557

What is the most accurate diagnostic tool in diagnosing suspected osteomyelitis in the pediatric patient? Bone scan RBC count X-ray Serum albumin level

Bone scan There is an elevation in WBC count and sedimentation rate with osteomyelitis. X-ray may initially fail to reveal the infection. A microbiology culture of aspirated drainage or a bone scan may be diagnostic.REF: Page 567

A teenager who had a cast applied after a tibia fracture complains that his pain medication is not working and his pain is still 9 or 10. The nurse notices some edema of the toes and a capillary refills of 6 seconds. The priority action of the nurse would be: 1. call the health care provider immediately 2. check if there is an order for a stronger pain medication 3. try nonpharmacological techniques of pain relief 4. explain to the teen that a new fracture is expected to be painful the first day

Correct answer: 1 Rationale: Pain unrelieved by medication, swelling, cyanosis or pallor of digits, decreased pulse, and decreased skin temperature should be immediately reported because they may be signs of compartment syndrome. Page reference: Page 563; Safety Alert

A type of fracture to young children that may be indicative of child abuse is: 1. green stick fracture of the tibia 2. spiral fracture of the femur 3. pathological fracture of the fibula 4. aligned fracture of the wrist

Correct answer: 2 Rationale: A spiral fracture of the femur is caused by a forceful twisting motion. When the history of an injury does not correlate with x-ray findings, child abuse should be suspected because spiral fractures can be the result of manual twisting of the extremity. Page reference: Page 560

Yellow bruise is approximately: 1. 2 days old 2. 5 to 7 days 3. 7 to 10 days 4. 10 to 14 days old

Correct answer: 3 Rationale: Bruises heal in various stages, indicated by color: 1-2 days: swollen, tender 0-5 days: reddish-purple 5-7 days: green 7-10 days: yellow 10-14 days: brown 14-28 days: clear Page reference: Page 575; Safety Alert

An abnormal S shape curvature of the spine seen in school age children is: 1. sclerosis 2. sciatica 3. scabies 4. scoliosis

Correct answer: 4 Rationale: Scoliosis refers to an S-shaped curvature of the spine. Page reference: Page 570

A "neurovascular check" for tissue perfusion includes which of the following observations (select all that apply) 1. pulse 2. color and capillary refill 3. movement and sensation 4. equal pupil size of eyes

Correct answers: 1, 2, 3 Rationale: A neurovascular assessment includes pulse, color and capillary refill, and movement and sensation. Assessment of pupil size is included in a neurological assessment. Page reference: Page 563; Skill 24-1

What terminology applies when there is an intentional omission of verbal or behavioral actions that are necessary for development of a healthy self-esteem, including social or emotional isolation of a child? Physical neglect Emotional abuse Physical abuse Emotional neglect

Emotional neglect Emotional neglect is defined as an intentional omission of verbal or behavioral actions that are necessary for development of a healthy self-esteem, including social or emotional isolation.REF: Page 573

The nurse is caring for a 15-year-old boy after left lower extremity amputation surgery after a diagnosis of osteosarcoma. The patient reports that his "left foot is in severe pain." What should the nurse do first? Remind him that he no longer has a left foot Provide emotional support Medicate for pain as ordered Reposition for comfort

Medicate for pain as ordered Phantom limb pain is likely to be experienced after amputation surgery. This is the continued sensation of pain in the limb even though the limb is no longer there. This pain is very real, and an analgesic may be necessary.REF: Page 568

What is the most important nursing intervention to identify and minimize compartment syndrome? Apply BP cuff above the cast. Treat pain with minimum amount needed to control it. Elevate arm at least 30 min/hr. Perform frequent neurovascular checks.

Perform frequent neurovascular checks. Frequent neurovascular checks alert the nurse to decreasing blood flow secondary to the constriction of compartment syndrome. Identifying it early will help minimize the risk.REF: Page 563

A 14-year-old girl has been diagnosed with scoliosis with a curve of 30 degrees. What medical intervention will treatment include for this patient? Transcutaneous electrical muscle stimulation (TENS) Only exercise to increase muscle tone and posture Surgery with insertion of a Harrington rod Use of a Milwaukee brace

Use of a Milwaukee brace Treatment of scoliosis is aimed at correcting the curvature and preventing more severe scoliosis. Curves up to 20 degrees do not require treatment but are followed carefully with exercise to increase muscle tone and posture. Curves between 20 and 40 degrees require the use of a Milwaukee brace. Transcutaneous electrical muscle stimulation (TENS) and exercise have not proven to be effective in treatment of scoliosis. Severe scoliosis requires surgery to fuse the bones.REF: Page 570