Ch. 44 Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder
The nurse is caring for a school-age child diagnosed with transient synovitis. What statement by a parent indicates a need for further education regarding this diagnosis? "I'm glad to hear that this won't require any type of surgery to treat." "I will make sure my child rests as much as possible until the pain goes away." "I will get the prescription for the antibiotics filled as soon as we leave the office today." "When my child takes ibuprofen, I will make sure my child eats something so it doesn't upset the stomach."
"I will get the prescription for the antibiotics filled as soon as we leave the office today." Transient synovitis is an inflammatory disease, not an infection; therefore, antibiotics are not needed. NSAIDs such as ibuprofen and limited activity are prescribed. Surgical intervention is not needed. Ibuprofen can cause GI distress, so it should be administered with food to help reduce this distress. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1633
While caring for a child who will be undergoing an electromyography, the nurse explains the procedure to the child's mother. Which statement by the mother would indicate a need for further education? "Needles will be inserted into my child's muscle to test the electrical activity in the muscle." "Small electrical shocks will be given using the needles they put in the muscle." "I will be allowed to be with my child because my child may be scared during the test." "This test will give information about the electrical activity and nerve conduction in my child's muscle."
"Small electrical shocks will be given using the needles they put in the muscle." Explanation: Electromyography tests electrical activity and nerve conduction in skeletal muscle. Surface electrodes or needle electrodes are inserted into the muscle to record the electrical activity. Electrical shocks are not used in this test. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1595
When assisting parents in a home care plan for a child with Legg-Calvé-Perthes disease (LCPD), the nurse would teach the parents that which is anticipated? Surgery with supporting rods Passive range-of-motion exercises 3x per day A non-weight-bearing period initially occurs. Exercise to increase muscle strength of the knee joint
A non-weight-bearing period initially occurs. Explanation: Resting the affected femoral epiphysis aids healing. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1632
Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? The infant will have a poor sucking reflex. Pain will interfere with the feeding process. Assuming the usual feeding position will be difficult. Nausea and vomiting often follow repair of the cystic mass.
Assuming the usual feeding position will be difficult. Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful. Little pain will be experienced and should easily be controlled owing to loss of sensation in the area. The sucking reflex should not be affected by the myelomeningocele or its repair. Nausea and vomiting are unlikely after recovery from the anesthetic. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1596
The nurse is caring for an 8 year old in skeletal traction for a fractured femur. Which type of traction would be communicated in the shift hand-off? Buck extension traction Russell traction Bryant traction Balanced suspension traction
Balanced suspension traction Explanation: Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Examples of skeletal traction are 90-degree traction and balanced suspension traction. Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck's extension traction, and Russell traction. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1605
The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers? The nurse should provide information when the child or caregiver requests it. The nurse should be a contact person when the child is hospitalized. The nurse should support the caregivers in restricting activity during the treatment. The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.
The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. Explanation: Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1632
The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification? Type II Type I Type IV Type V
Type II Explanation: According to the Salter-Harris classification, a type II fracture is partially through the physis extending into the metaphysis. A type I fracture is through the physis, widening it. A type IV fracture is through the metaphysis, physis, and epiphysis. A type V fracture is a crushing injury to the physis. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1638-1639
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 prednisone lorazepam botulin toxin
baclofen Explanation: Baclofen is a centrally acting skeletal muscle relaxant used to 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. Botulin toxin is a neurotoxin used to relieve spasticity in cerebral palsy. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1600-1601
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 electromyogram muscle biopsy nerve conduction velocity
creatine kinase The sample for creatine kinase must be obtained before the electromyogram or muscle biopsy because those tests may lead to a release of creatine kinase and provide false results. Nerve conduction velocity tests could be done at any time. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1594-1595
The nurse is assessing a child with spastic cerebral palsy. What findings would the nurse expect to assess? Select all that apply. exaggerated deep tendon reflexes hemiplegia poor control of balance hypertonicity drooling dysarthria
exaggerated deep tendon reflexes hemiplegia poor control of balance hypertonicity Explanation: Spastic cerebral palsy is associated with exaggerated deep tendon reflexes; poor control of posture, balance, and movement; hypertonicity of the affected extremities; and hemiplegia, quadriplegia, or diplegia, based on the limbs affected. Drooling and dysarthria are associated with athetoid cerebral palsy. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1629
A nurse is conducting a physical examination of an infant with suspected metatarsus adductus. Type II metatarsus adductus is indicated when the forefoot is: inverted and turned slightly upward. flexible past neutral actively and passively. flexible passively past neutral, but only to midline actively. rigid, does not correct to midline even with passive stretching.
flexible passively past neutral, but only to midline actively. Explanation: In type II metatarsus adductus, the forefoot is flexible passively past neutral, but only to midline actively. The forefoot is flexible past neutral actively and passively in type I. The forefoot is rigid, does not correct to midline even with passive stretching in type III. An inverted forefoot turned slightly upward is indicative of clubfoot (congenital talipes equinovarus). Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1606
Through which mechanism is Duchenne muscular dystrophy acquired? virus heredity autoimmune factors environmental toxins
heredity Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1620
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? kyphosis lordosis idiopathic scoliosis sway back
idiopathic scoliosis Explanation: Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1633
A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply. prone right side lying left side lying semi-Fowler supine
prone right side lying left side lying Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1609-1610
Which type of spinal neural tube defect does the nurse recognize as common and usually benign? myelomeningocele spina bifida meningocele spina bifida occulta
spina bifida occulta Explanation: Spina bifida occulta usually is benign and is estimated to affect 10% to 20% of the population. It is a defect in the vertebral body without protrusion of the spinal cord or its coverings. Spina bifida is a general term that is often used to refer to all neural tube disorders of the spinal cord. Meningocele and myelomeningocele do involve protrusion of elements of the spinal portion of the central nervous system and require treatment. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1607
A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client? Teach the client not to rest with the crutch pad pressing on the axilla. Assess the tips of the crutches to be certain the rubber tip is intact. Be certain the child is walking with the crutches about 6 inches to the side of the foot. Caution parents to clear articles such as throw rugs out of paths at home.
Teach the client not to rest with the crutch pad pressing on the axilla. Pressure of a crutch against the axilla could lead to compression and damage of the brachial nerve plexus crossing the axilla, resulting in permanent nerve palsy. Teach children not to rest with the crutch pad pressing on the axilla but always to support their weight at the hand grip. Always assess the tips of crutches to be certain the rubber tip is intact and not worn through as the tip prevents the crutch from slipping. Be certain the child is walking with the crutches placed about 6 inches to the side of the foot. This distance furnishes a wide, balanced base for support. Caution parents to clear articles such as throw rugs, small footstools or toys out of paths at home, to avoid tripping the child. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1599
Which diagnostic measure is most accurate in detecting neural tube defects? flat plate of the lower abdomen after the 23rd week of gestation significant level of alpha-fetoprotein present in amniotic fluid amniocentesis for lecithin-sphingomyelin (L/S) ratio presence of high maternal levels of albumin after 12th week of gestation
significant level of alpha-fetoprotein present in amniotic fluid Explanation: Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1609
The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which type of traction? Skin traction Skeletal traction Dunlop traction Balanced suspension traction
Skin traction Explanation: Traction is used to provide immobilization to reduce or immobilize a fracture, align an injured extremity or allow the extremity to be restored to the normal length. The types of traction include skin, skeletal and suspension. The types of skin traction include Bryant, Russell, Buck, cervical and side arm 90-90. In these types of traction some type of tape, rubber, plastic or manufactured material is attached to the skin. A weight is attached via pulley which indirectly exerts pull on the musculoskeletal system. Dunlop is a form of skeletal traction. Balanced suspension uses a series of weights and pulleys to align the hip, femur or tibia. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1603
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 dystrophyterm-17 Facioscapulohumeral muscular dystrophy Congenital myotonic dystrophy Juvenile arthritis
Duchenne muscular dystrophy By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1620
The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningocele. They ask the nurse what exactly that means. Which would be the nurse's best reply? "It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." "The contents of the sac you see only has fluid in it and should cause the child no problem." "Your child's defect involves only the nerves to the bladder and bowel and can be easily repaired." "The sac is a very small cyst and should resolve within the first year of life."
"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." Explanation: A myelomeningocele is the more severe form of spina bifida cystica, in which the spinal cord and nerve roots herniate into the sac through an opening in the spine, compromising the meninges and usually resulting in neurological impairment. A meningocele includes the meninges and spinal fluid only. A myelomeningocele usually contains the bowel and bladder innervation but involves many more nerves also. A myelomeningocele is not just a cyst that resolves within a year. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1608
The nurse is assessing a young boy who has been brought to the health care provider for mobility and balance issues by his parents. Which findings are positively associated with the presence of Duchenne muscular dystrophy? Select all that apply. Serum creatine kinase levels are elevated. An electromyogram demonstrates the problem is within the nerves, not the muscles. A muscle biopsy shows an absence of dystrophin. The child is unable to rise easily into a standing position when placed on the floor. Genetic testing indicates the presence of a gene associated with spinal muscular atrophy.
Serum creatine kinase levels are elevated. A muscle biopsy shows an absence of dystrophin. The child is unable to rise easily into a standing position when placed on the floor. Significant muscle wasting is associated with this diagnosis. Creatine kinase levels increase with muscle wasting. A muscle biopsy will show an absence of dystrophin. Gowers sign will be positive. An electromyogram will indicate the problem is with the muscles, not the nerves. Genetic testing will reveal the presence of the gene associated with Duchenne muscular dystrophy. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1623
A child is in Buck traction to correct a hip problem. When caring for this child, it is most important for the nurse to implement which intervention? remove the boot every 8 hours keep the affected leg on a pillow administer antispasmodics every 4 hours provide diversionary activities
remove the boot every 8 hours Explanation: Buck traction is a skin traction used to treat hip and knee problems. The traction is applied in a straight line with the extremity in a boot and weights attached that hang freely off the end of the bed. It is imperative the boot be removed every 8 hours for skin assessment. Due to the weight applied to the boot, skin integrity can easily become impaired. The affected leg should not be elevated on a pillow. Antispasmodics are generally prescribed, but they would be used when needed, not scheduled. Diversionary activities should be provided, but they do not take priority over skin assessment. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1604
A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental bowlegs (genu varum)? A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray The medial surfaces of the knees are more than 2 in apart The malleoli are touching The condition is bilateral
A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray Explanation: Blount disease is retardation of growth of the epiphyseal line on the medial side of the proximal tibia (inside of the knee) that results in bowlegs (genu varum). Unlike the normal developmental aspect of genu varum, Blount disease is usually unilateral and is a serious disturbance in bone growth that requires treatment. In those with Blount disease, the medial aspect of the proximal tibia will show a sharp, beaklike appearance. The other answers all describe genu varum, not Blount disease. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1619
The nurse is reinforcing discharge teaching with the caregivers of a child who is going home after a cast has been applied. The nurse explains to the caregivers that which issues should be reported if they occur or are seen related to this child? Select all that apply. Any area on the cast that is warm to the touch A foul odor under the cast Any itching under or around the edges of the cast Drainage from under the cast Any pink color in the fingers or toes of casted extremity Looseness of the cast on the extremity
Any area on the cast that is warm to the touch A foul odor under the cast Drainage from under the cast Looseness of the cast on the extremity Explanation: In addition to the five Ps, any foul odor or drainage on or under the cast, "hot spots" on the cast (areas warm to the touch), looseness or tightness, or any elevation of temperature must be noted, documented, and reported. Family caregivers should be instructed to watch carefully for these same danger signals. Itching is common and does not need to be reported. Pink coloration of fingers and toes would be normal and not a concern. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1602
The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as: spastic. athetoid or dyskinetic. ataxic. mixed.
spastic. Explanation: Spastic involves hypertonicity and permanent contractures on both extremities on one side. Athetoid (dyskinetic) involves abnormal involuntary movements affecting 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. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1627
The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment? the presence of a waddling gait and difficulty climbing stairs a short heel cord caused by walking on the toes meeting motor milestones such as sitting, walking, and standing but at a later age than the average child when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand
when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand Explanation: A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign. Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 1620