Critical Thinking - Communication-Cognition

A nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by parents indicates a need for further instructions? 1."I should apply lotion under the brace to prevent skin breakdown." 2."I should avoid the use of powder because it will cake under the brace." 3."I will have my child wear soft-fabric clothing under the brace." 4."I will encourage my child to perform prescribed exercises."

1 - The use of lotions or powders should be avoided because they can become sticky and cake under the brace, causing irritation. Options 2, 3, and 4 are appropriate interventions in the care of a child with a brace.

A nurse is caring for a child after spinal fusion for the treatment of scoliosis. The child complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. Which of the following nursing actions would be most appropriate? 1.Administer an antiemetic. 2.Place the child in a Sims' position. 3.Notify the physician. 4.Increase the intravenous fluids.

3 - A complication after surgical treatment of scoliosis is superior mesenteric artery syndrome. This disorder is caused by mechanical changes in the position of the child's abdominal contents, resulting from lengthening of the child's body. The disorder results in a syndrome of emesis and abdominal distention similar to that which occurs with intestinal obstruction or paralytic ileus. Postoperative vomiting in children with body casts or those who have undergone spinal fusion warrants attention because of the possibility of superior mesenteric artery syndrome.

The mother of a child with juvenile ideopathic arthritis calls the clinic nurse because the child is experiencing a painful exacerbation of the disease. The mother asks the nurse if the child should perform range-of-motion exercises at this time. The most appropriate nursing response is 1."The range-of-motion exercises must be performed every day." 2."Avoid all exercise during painful periods." 3."Administer additional pain medication before performing range-of-motion exercises." 4."Have the child perform simple isometric exercises during this time."

4 - During painful episodes, hot or cold packs and splinting and positioning the affected joint in a neutral position help reduce the pain. Although resting the extremity is appropriate, beginning simple isometric or tensing exercises as soon as the child is able is important. These exercises do not involve joint movement.