Mobility, Neuromuscular Disorder peds
A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida? a) "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life." b) "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." c) "It has little influence on the intellectual and perceptual abilities of the child." d)
"Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately."
The nurse is caring for 2-year-old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? 1. "Routine catheterization will decrease the risk of infection from urine staying in the bladder." 2. "I know it will be important for me to catheterize my child for the rest of his life." 3. "I will make sure that I always use latex-free catheters." 4. "I will wash the catheter with warm soapy water a
"I know it will be important for me to catheterize my child for the rest of his life."
The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningeocele. 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." 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.
The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents? a) "Your child cannot properly control holding urine or emptying the bladder. " b) "While your child is young, urine leaking from the bladder will not be a problem because diapering is expected." c) "Your child dribbles urine because the bladder either is overactive, pushing urine out, or is not active enough, becoming overfilled and causing urine to le
"Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection."
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. The parents should call the physician when the following things occur: The child has a temperature greater than 101.5F° (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.
A group of students are 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 Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.
An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? a) Inspection of the cystic sac on the child's back for leakage b) Auscultation for bowel sounds c) Listening for a shrill cry d) Careful supine positioning
Inspection of the cystic sac on the child's back for leakage
A nurse is caring for a 10-year-old who is in skeletal traction following injuries sustained in a car accident. Which statement accurately describes a recommended nursing measure for this type of traction?
Perform pin-site care on a daily or weekly basis after the first 48 to 72 hours. At sites with mechanically stable bone-pin interfaces, pin-site care should be done on a daily or weekly basis (after the first 48 to 72 hours). The nurse should never remove or add traction weights without specific physician orders, or allow weights to touch the floor or drag on the bed parts; weights should hang free. A chlorhexidine 2 mg/mL solution may be the most effective cleansing solution for pin care.
A neonatal nurse examines an infant and notes decreased hip motion that causes pain upon movement. This nurse suspects Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity.
True Legg-Calvé-Perthes disease is a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. It has an incidence of 1 per 1,200 live births, with some hereditary factors influencing incidence.
The child has a meningocele and a neurogenic bladder. Which of the following topics should the nurse include in the teaching plan when educating the child and the child's caregivers? Select all that apply. a) Signs and symptoms of a urinary tract infection b) Different types of surgeries used to treat this condition c) The importance of antibiotic use to prevent urinary tract infections from occurring d) How and when to perform clean intermittent urinary catheterization e) How and when
• How and when to administer oxybutynin chloride • How and when to perform clean intermittent urinary catheterization • Signs and symptoms of a urinary tract infection • Different types of surgeries used to treat this condition
The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching? a) "I can palpate his abdomen to assess for constipation" b) "My son's activity is too limited to stimulate his bowels." c) "He must have an adequate amount of fluid." d) "I need to figure out his usual pattern for passing stool."
"My son's activity is too limited to stimulate his bowels."
A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?
"Pale, cool, or blue skin coloration is to be expected." It is very important to teach parents to identify the signs of neurovascular compromise (pale, cool, or blue skin) and tell them to notify the physician immediately. The other statements are correct.
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? a) "Older age at conception is one of the major causes of the defect." b) "It has been linked to maternal alcohol consumption during pregnancy." c) "It's a common complication of amniocentesis." d) "The cause is unknown and there are many environmental factors that may contribute to it."
"The cause is unknown and there are many environmental factors that may contribute to it."
A nurse is teaching the parents of a boy with a neurogenic bladder about clean intermittent catheterization. Which response indicates a need for further teaching? a) "We must be careful to use latex-free catheters." b) "My son may someday learn how to do this for himself." c) "We need to soak the catheter in a vinegar and water solution daily." d) "The very first step is to apply water-based lubricant to the catheter."
"The very first step is to apply water-based lubricant to the catheter."
The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be:
"These make a smooth edge on the cast so the skin is better protected." If the cast has no protective edge, it should be petaled with adhesive tape strips. These help keep the skin protected from the rough edge of the cast. If the cast is near the genital area, plastic should be taped around the edge to prevent wetting and soiling of the cast; petaling the cast does not provide protection to keep the cast dry.
The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond? a) "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look." b) "This is often an indicator of spina bifida occulta as opposed to spina bifida cystica." c) "This could be an indicator of spina bifida; we need to evaluate this furth
"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."
The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns?
"This is not your fault and we will help you with her care and treatment." Because the mother is crying and experiencing the initial shock of the diagnosis, the nurse's primary concern is to support the mother and assure her that she is not to blame for the DDH. While education is important, the nurse should let the mother adjust to the diagnosis and assure her that the baby and her family will be supported now and throughout the treatment period.
The nurse is teaching the parents of a female child with a myelomeningocele how to perform clean intermittent catheterization. The nurse determines that the teaching was effective when the parents return demonstrate the procedure and state: a) "Before inserting the catheter, we need to wipe her labia with normal saline from back to front." b) "We need to insert the catheter about 6 inches so that we make sure the catheter is in the bladder." c) "We need to apply some petroleum jelly to her l
"When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."
The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information? a) "Has he achieved his developmental milestones on time?" b) "Has his pace of achieving milestones diminished?" c) "Do you think he is simply fatigued?" d) "Would you please describe the weakness you are seeing in your son?"
"Would you please describe the weakness you are seeing in your son?"
The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.
- Color - Sensation - Pulse - Capillary refill A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.
The nurse is caring for a child who fractured his harm in an accident. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply.
- Document any signs of pain. - Check radial pulse in the both arms. - Monitor the color of the nail beds in the right hand. Monitoring for signs of pain, decreased circulation, or change or variation in pulses in the extremity is important for the child in a cast. Pain can indicate serious complications, such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary. Checking posterior pulses would be appropriate when a lower extremity is casted.
The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation?
A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Spiral fractures, which twist around the bone, are frequently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.
The nurse is caring for an 8-month-old in Bryant traction for developmental dysplasia of the hip and is monitoring for complications. Which assessment finding would alert the nurse to a possible complication?
A weak pedal pulse A diminished pedal pulse could be a sign of neurovascular compromise caused by pressure from the elastic bandages. Brisk capillary refill is a normal finding. Mild fussiness is to be expected and is nonspecific when an infant is immobilized and has both legs extended vertically. Bryant traction is a type of skin traction and does not use pins.
The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated?
Advise the child that this is to be expected. Plaster becomes hot as it sets. This effect is reduced with newer plastic casts. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, notify the provider. Infection would not present in this way with a cast application. Never moisten a cast.
A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. What is most important for the nurse to do when she has finished applying the cast?
Assess the fingers for warmth, pain, and function Assess fingers or toes carefully for warmth, pain, and function after application of a cast to be certain a compartment syndrome is not developing. Before a cast is applied, not after, a tube of stockinette is stretched over the area, and soft cotton padding is placed over bony prominences. A "window" may be placed in a cast for an open fracture or if an infection is suspected—not to prevent an infection—so that the area can be observed; however, a window is not indicated in this case. The x-ray should be performed before casting, to diagnose the fracture, not afterward.
Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? a) The infant will have a poor sucking reflex. b) Pain will interfere with the feeding process. c) Assuming the usual feeding position will be difficult. d) Nausea and vomiting often follow repair of the cystic mass.
Assuming the usual feeding position will be difficult.
A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used?
Auscultation The physical examination specific to fractures includes inspection, observation, and palpation. The nurse may assume that auscultation is not used; however, auscultation of the child's lungs may reveal adventitious sounds that are often present when respiratory muscle function is impaired.
A child is born with a talipes disorder. 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. Review with parents how to check the infant's toes for coldness or blueness and how to blanch a toenail bed and watch it turn pink to assess for good circulation. The other answers are other interventions pertaining to caring for a child with a talipes disorder but are not associated specifically with ensuring good circulation.
The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:
Complete If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.
A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size? a) Increasing ICP b) Leaking cerebrospinal fluid c) Increasing head circumference d) Constipation and bladder dysfunction
Constipation and bladder dysfunction
The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? a) Change position from side to side hourly b) Cover the sac with a saline-moistened dressing c) Keep the mass uncovered and dry d) Prevent cold stress using an Isolette and blankets
Cover the sac with a saline-moistened dressing
The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority? a) Risk for injury related to lack of muscle control b) Ineffective coping related to diagnosis of chronic condition c) Impaired physical mobility related to spinal cord defect d) Deficient knowledge related to diagnosis and condition
Deficient knowledge related to diagnosis and condition
The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered?
Diazepam Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Narcotic analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesis imperfecta.
The nurse is assessing a 10-year-old girl recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection?
Drainage on the cast Drainage on the cast could indicate an infection. Pale fingers would suggest impaired circulation. Delayed capillary refill would suggest impaired circulation. Diminished pulse would suggest impaired circulation.
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 should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.
Fracture of the femur typically occurs when a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step.
False If a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step, the head of the radius may escape the ligament surrounding it and become dislocated (nursemaid's elbow). Fracture of the femur is rare and is typically caused by an automobile accident, a fall from a considerable height, or child maltreatment.
The nurse is teaching a health and wellness course to young women of childbearing age. Which vitamin will the nurse encourage all to take daily? a) Folic acid b) Niacin c) Ascorbic acid d) Calcium
Folic acid
The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid? a) Folic acid above 0.4 mg/day b) Ascorbic acid to 4 mg/day c) Folic acid to 0.4 mg/day d) Ascorbic acid to 0.4 mg/day
Folic acid above 0.4 mg/day
The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?
Greenstick Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks.
The nurse is obtaining a health history on a woman of child-bearing age who wants to become pregnant. What information in her health history places her at high-risk for having a child with a myelomeningocele? a) History of a previous abdominal surgery. b) History of asthma taking montelukast. c) History of scoliosis. d) History of a seizure disorder and taking phenobarbital.
History of a seizure disorder and taking phenobarbital.
The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client?
Impaired physical mobility related to a cast on the leg Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.
Which characteristic is true of cerebral palsy? a) It's progressive. b) It's reversible. c) It results in mental retardation. d) It appears at birth or during the first 2 years of life.
It appears at birth or during the first 2 years of life.
An adolescent girl with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress her to the treatment goals?
It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms . It is important to have the adolescent understand the treatment and how the treatment will benefit them currently. Body bracing helps to hold the spine in alignment and prevent further curvature decreasing symptoms. The brace will not correct the problem. Herniation and torticollis are not associated with scoliosis.
The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?
Latex A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.
The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse?
Notify the health care provider of the findings immediately. Cool fingers or toes, extreme pain, and impaired movement are symptoms of compartment syndrome. Compartment syndrome can severely decrease blood flow to the area causing damage and necrosis to the surrounding area. If compartment syndrome occurs, the cast needs to be released immediately; therefore, the health care provider must be notified of these assessment findings immediately. Administration of pain medication, positioning, and ice are interventions that may be prescribed after a cast is placed, but they are not the first treatment for compartment syndrome.
The nurse is caring for an infant with a myelomeningocele who has paralysis of the lower extremities. Which action would be most appropriate to help reduce friction resulting from this paralysis? a) Place the child on a special care mattress. b) Place a pad beneath the diaper area and change frequently. c) Place a folded diaper in between the legs. d) Place synthetic sheepskin under the infant's chest.
Place a folded diaper in between the legs.
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? a) Inspect for precocious hair growth in the genital and underarm areas b) Record and refer the finding for follow-up to the pediatrician c) Move on to other assessments without calling attention to the difference d) Snip the tuft of hair off close to the skin for hygienic reasons
Record and refer the finding for follow-up to the pediatrician
Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?
Risk for impaired skin integrity The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.
Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele? a) Impaired physical mobility b) Delayed growth and development c) Risk for infection d) Constipation
Risk for infection
The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?
Spica cast The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.
Which type of spinal neural tube defect does the nurse recognize as common and usually benign? a) Meningocele b) Spina bifida c) Spina bifida occulta d) Myelomeningocele
Spina bifida occulta
The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. What is the most important nursing intervention for the nurse to include in working with this child and his caregivers?
The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. 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.
A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected?
Trendelenburg gait The nurse would expect to note a Trendelenburg gait due to pain. Lordosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Kyphosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Loss of strength in ankle dorsiflexion is associated with some neuromuscular disorders but not this condition.
The nurse is caring for a child who has had an open reduction with cast placement on the forearm. While assessing the cast, the nurse notes serosanguineous fluid on the cast. What action by the nurse is appropriate?
Using a ballpoint pen, outline the fluid stain. Mark the time it is outlined. Although oozing of serosanguineous fluid after an open reduction is a common, it does need to be noted and documented. The nurse should outline the stain with a ballpoint pen or crayon rather than a marker, mark the time so it can be determined how rapidly the spot is increasing. If the stain is small, notification of the health care provider and replacement of the cast is not necessary.
The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:
skeletal traction. Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. 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 extension traction, and Russell traction.
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.
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. a) Supine b) Prone c) Left side lying d) Right side lying e) Semi-Fowler
• Prone • Left side lying • Right side lying
A group of students are reviewing information about bone healing in children. The students demonstrate understanding of this information when they state:
A child's bones heal more quickly than those of an adult. Bone healing occurs in the same fashion as in the adult, but it occurs more quickly in children because of the rich nutrient supply to the periosteum. The closer a fracture is to the growth plate, the more quickly the fracture heals. The capacity for remodeling (the process of breaking down and forming new bone) is increased in children compared with adults. Children's bones produce callus more rapidly and in larger quantities than do adults' bones.
Which diagnostic measure is most accurate in detecting neural tube defects? a) Flat plate of the lower abdomen after the 23rd week of gestation b) Significant level of alpha-fetoprotein present in amniotic fluid c) Presence of high maternal levels of albumin after 12th week of gestation d) Amniocentesis for lecithin-sphingomyelin (L/S) ratio
Significant level of alpha-fetoprotein present in amniotic fluid
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. Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction.
A 5-year-old girl, diagnosed with myelomeningocele, is admitted to the hospital for a corrective surgical procedure. Choose four questions below that the nurse shouls ask when obtaining the health history that would assist in planning the child's care? 1. What is the child's current mobility status? 2. Is there a family hx of myelomeningocele? 3. What is the child's genitorurinary and bowel function and regimen? 4. Does this child have a hx of hydrocephalus with presence of shunt? 5. Does she h
What is the child's current mobility status? What is the child's genitorurinary and bowel function and regimen? Does this child have a hx of hydrocephalus with presence of shunt? Does she have kown latex sensitivity? (These questions will help develop a plan of care for the girl)
A nurse is caring for an 11-year-old with an Ilizarov fixator and is providing teaching regarding pin care. The nurse should provide which instruction?
"Cleansing by showering should be sufficient." The Ilizarov fixator uses wires that are thinner than ordinary pins, so simply cleansing by showering is usually sufficient to keep the pin site clean.
A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. What would the nurse emphasize as most important in preventing neural tube defects? a) Ultrasound screening at 16 weeks' gestation b) Folic acid supplementation c) Maternal serum α-fetoprotein levels screening d) Genetic testing for gene identification
Folic acid supplementation
The nurse is assessing a preadolescent client reporting pain and swelling just below the knee. The client states it hurts worse after running. What treatment would the nurse expect to be prescribed for this client?
NSAIDs, ice, and limiting exercise The child's symptoms suggest Osgood-Schlatter disease, which is a thickening and enlargement of the tibial tuberosity probably from overuse. Treatment includes administration of NSAIDS, ice, and limiting strenuous activity. Ankle and knee strengthening exercises, applications of ice, and use of acetaminophen is not indicated for this disorder.
The nurse is providing presurgical care for a newborn with myelomeningocele. Which action is the central nursing priority? a) Maintain infant in prone position b) Maintain infant's body temperature c) Keep lesion free from fecal matter or urine d) Prevent rupture or leaking of cerebrospinal fluid
Prevent rupture or leaking of cerebrospinal fluid
The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. What should be the first intervention?
Reposition the child's foot on a pressure-reducing device. The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease potential for skin breakdown, but the pressure must be relieved first.
Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? a) Risk for impaired skin integrity b) Disorganized infant behavior c) Peripheral neurovascular dysfunction d) Risk for activity intolerance
Risk for impaired skin integrity
The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:
epiphysiolysis of the proximal humerus. Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.