NURS 355 Chapter 34
The nurse is teaching parents the proper use of a hip-knee-ankle-foot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by making what statement?
"Condition of the skin in contact with the brace should be checked every 4 hours."
The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching?
"I should gently massage the skin under the straps once a day to stimulate circulation."
The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home. What statement by the parent indicates a correct understanding of the teaching?
"I will use an ice pack to relieve the itching."
The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session?
"Lift the infant by the buttocks, not the ankles, when changing diapers."
Parents are considering treatment options for their 5-year-old child with Legg-Calvé-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they make what statement?
"Surgical correction requires a 3- to 4-month recovery period."
A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse?
"Until your vertebral column has reached skeletal maturity."
The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what?
"We're happy this is the only cast our baby will need."
In teaching a 16-year-old adolescent who was recently diagnosed with systemic lupus erythematosus (SLE), what statements should the nurse include?
"You should use a moisturizer with a sun protection factor (SPF) of 30." "You should avoid pregnancy because this can cause a flare-up." "You may need to modify your daily recreational activities."
The nurse is teaching a child with a cast about cast removal. What should the nurse teach the child about cast removal?
"You will feel a tickly sensation as the cast is removed."
A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long?
4 weeks
What statement is correct regarding sports injuries during adolescence?
Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.
A young girl has just injured her ankle at school. In addition to notifying the child's parents, what is the most appropriate, immediate action by the school nurse?
Apply ice
The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40° C (104° F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include what intervention?
Apply towels wet with cool water
The nurse is caring for a 14-year-old child with systemic lupus erythematous (SLE). What clinical manifestations should the nurse expect to observe?
Arthralgia Abdominal pain Glomerulonephritis
What is an appropriate nursing intervention when caring for a child in traction?
Assessing for tightness, weakness, or contractures in uninvolved joints and muscles
What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)?
Assist the child to dorsiflex the feet and rotate the ankles
Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time?
Calmly ask the child to point to where the pain is worst and to wiggle fingers.
A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). What nursing consideration should be included?
Check for abdominal pain and bloody stools
What is a physiologic effect of immobilization on children?
Circulatory stasis can lead to thrombus and embolus formation.
What is the recommended drink for athletes during practice and competition?
Cold water for gastrointestinal tract rapid absorption
What is a major goal for the therapeutic management of juvenile idiopathic arthritis (JIA)?
Control pain and preserve joint function
Transverse
Crosswise at right angles to the long axis of the bone
Immobilization causes what effect on metabolism?
Decreased metabolic rate
The school nurse recognizes that the adverse effects of performance-enhancing substances can include what?
Depression Aggressiveness Changes in libido
When does idiopathic scoliosis become most noticeable?
During the preadolescent growth spurt
The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. How should the goal be achieved?
Education of adults to recognize signs that indicate a risk for injury
A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions?
Elevate casted arm when both upright and resting.
A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care?
Elevate the arm when resting Observe the fingers for any evidence of discoloration Do not allow the child to put anything inside the cast Examine the skin at the cast edges for any breakdown
A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take?
Elevate the foot and leg on pillows
A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain?
Frequent, serial casting is tried first
An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when requested. What is the first action the nurse should take?
Have someone notify the emergency medical services (EMS) system.
What is the primary method of treating osteomyelitis?
IV antibiotic therapy
An adolescent comes to the school nurse after experiencing shin splints during a track meet. What reassurance should the nurse offer?
Ice, rest, and nonsteroidal antiinflammatory drugs (NSAIDs) usually relieve pain.
After spinal fusion surgery the nurse should check for signs of what?
Impaired color, sensitivity, and movement to the lower extremities
What statement is true concerning osteogenesis imperfecta (OI)?
It is an inherited disorder
What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?
Kyphosis
The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle. The emergency medical system (EMS) has been activated. The first person who provided assistance applied a tourniquet to the child's leg because of arterial bleeding. What should the nurse do related to the tourniquet?
Leave the tourniquet in place.
The nurse is assisting with application of a synthetic cast on a child with a fractured humerus. What are the advantages of a synthetic cast over a plaster of Paris cast?
Less bulky Drying time is faster Permits regular clothing to be worn Can be cleaned with small amount of soap and water
The nurse is caring for a child immobilized because of Russel traction. What interventions should the nurse implement to prevent renal calculi?
Monitor output Ensure adequate fluids Encourage the patient to drink cranberry juice
What nursing intervention is most appropriate when caring for the child with osteomyelitis?
Move and turn the child carefully and gently to minimize pain.
A 4-year-old child is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse. What should the nurse do first?
Notify the practitioner of the changes noted.
What condition can result from the bone demineralization associated with immobility?
Osteoporosis
The nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign?
Paresthesia
The nurse is conducting preoperative teaching to parents and their child about an external fixation device. What should the nurse include in the teaching session?
Pin care Crutch walking Modifications in activity Observing pin sites for infection
A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed?
Position changes are made by log rolling.
The nurse is teaching the girls' varsity sports teams about the "female athlete triad." What is essential information to include?
Pregnancy can occur in the absence of menstruation.
What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)?
Protection from sun and fluorescent lights to minimize rash
What measure is important in managing hypercalcemia in a child who is immobilized?
Provide adequate hydration
The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication?
Pulmonary embolism
What finding is characteristic of fractures in children?
Rapidity of healing is inversely related to the child's age.
Spiral
Slanting and circular, twisting around the bone shaft
Oblique
Slanting but straight between a horizontal and a perpendicular direction
Comminuted
Small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue
A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material?
Soak in a bathtub
The nurse is caring for a 14-year-old child with juvenile idiopathic arthritis (JIA). What clinical manifestations should the nurse expect to observe?
Soft tissue contractors Swelling in multiple joints Morning stiffness of the joints Loss of motion in the affected joints
A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include what instructions for the parents' discharge teaching?
Specially designed car restraints are necessary
A student athlete was injured during a basketball game. The nurse observes significant swelling. The player states he thought he "heard a pop," that the pain is "pretty bad," and that the ankle feels "as if it is coming apart." Based on this description, the nurse suspects what injury?
Sprain
The nurse is caring for an immobilized preschool child. What intervention is helpful during this period of immobilization?
Take the child for a "walk" by wagon outside the room
What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)?
Teach the child and family correct administration of medications.
A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture?
This type of fracture requires different management to prevent bone growth complications.
An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device?
When the infant is developmentally ready to stand up
