Question 1

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?

Accepted Answer

Initially,assessment is the priority.Because the child is alert but upset,the nurse should work to gain the child's trust.Initial data are gained by observing the child's ability to move the fingers and to point to the pain.Other important observations at this time are pallor and paresthesia.The child needs to be sent for radiography,but initial assessment data need to be obtained.Sending the child for radiography will increase the child's anxiety,making the examination difficult.It is inappropriate to ask parents to restrain their child.These parents are upset about the injury.If restraint is indicated,the nurse should obtain assistance from other personnel.

Question 2

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?

Accepted Answer

The child was involved in a motor vehicle collision and at this time is not able to move his extremities.The child needs immediate attention at a hospital for assessment of the possibility of a spinal cord injury.Because the child cannot move his extremities,the child should not be moved until his cervical and vertebral spines are stabilized.The EMS team can appropriately stabilize the spinal column for transport.Although it is important to notify the parents,the EMS system should be activated and transport arranged for serious injuries.The only indication to move the child is to prevent further trauma.

Question 3

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?

Accepted Answer

This type of brace has several contact points with the child's skin.To minimize the risk of skin breakdown and facilitate use of the brace,vigilant skin monitoring is necessary.Alcohol should not be used on the skin.It is drying.Parents are capable of checking and tightening the screws when necessary.If a burning sensation occurs,the brace should be removed.If several complaints of burning occur,the orthotist should be contacted.

Question 4

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?

Accepted Answer

The injured extremity should be kept elevated while resting and in a sling when upright.This will increase venous return.The child should not engage in strenuous activity for the first few days.Rest with elevation of the extremity is encouraged.Joints above and below the cast on the affected extremity should be moved.Swelling of the fingers may indicate neurovascular damage and should be reported immediately.Permanent damage can occur within 6 to 8 hours.

Question 5

What finding is characteristic of fractures in children?

Accepted Answer

Healing is more rapid in children.The younger the child,the more rapid the healing process.Nonunion of bone fragments is uncommon except in severe injuries.The epiphyseal plate is the weakest point of long bones and a frequent site of injury during trauma.Children's bones are more pliable and porous than those of adults.This allows them to bend,buckle,and break.The greater porosity increases the flexibility of the bone and dissipates and absorbs a significant amount of the force on impact.The adult periosteum is thinner,is weaker,and has less osteogenic potential than that of a child.

Question 6

What is an appropriate nursing intervention when caring for a child in traction?

Accepted Answer

Traction places stress on the affected bone,joint,and muscles.The nurse must assess for tightness,weakness,or contractures developing in the uninvolved joints and muscles.The adhesive straps should be released or replaced only when absolutely necessary.Active,passive,or active with resistance exercises should be carried out for the unaffected extremity only.Movement is expected with children.Each time the child moves,the nurse should check to ensure that proper alignment is maintained.

Question 7

The nurse is caring for an immobilized preschool child.What intervention is helpful during this period of immobilization?

Accepted Answer

Transporting the child outside of the room by stretcher,wheelchair,or wagon increases environmental stimuli and provides social contact.Street clothes are preferred for hospitalized children.This decreases the sense of illness and disability.The child needs appropriate limits for both adherence to the medical regimen and developmental concerns.It is not necessary to keep the child away from other immobilized children.

Question 8

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?

Accepted Answer

A tourniquet is applied only as a last resort,and then it is left in place and not loosened until definitive treatment is available.After the tourniquet is applied,skin and tissue necrosis occur below the site.Loosening or removing the tourniquet allows toxins from the tissue necrosis to be released into the circulation.This can induce systemic,deadly tourniquet shock.

Question 9

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?

Accepted Answer

Soft tissue injuries should be iced immediately.In addition to ice,the extremity should be rested,be elevated,and have compression applied.The nurse observes for the edema while placing a cold pack.The applying of ice can reduce the severity of the injury.Maintaining the ankle at a position elevated above the heart is important.The nurse helps the child be comfortable with this requirement.The nurse obtains parental permission for administration of acetaminophen or aspirin after ice and rest are assured.

Question 10

Immobilization causes what effect on metabolism?

Accepted Answer

Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake.Immobilization leads to hypercalcemia and a negative nitrogen balance secondary to muscle atrophy.Decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

Question 11

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?

Accepted Answer

This type of fracture (Salter type III)can cause problems with growth in the affected limb.Early and complete assessment is essential to prevent angular deformities and longitudinal growth problems.The difficulty for the child does not depend on the location at the epiphyseal plate.Any fracture of the dominant arm presents obstacles for the individual.Healing is usually rapid in the epiphyseal plate area.Complete immobilization is not necessary.Often these injuries are surgically repaired with open reduction and internal fixation.

Question 12

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?

Accepted Answer

Simply soaking in the bathtub is usually sufficient for removal of the desquamated skin and sebaceous secretions.Several days may be required to eliminate the accumulation completely.The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding.Oil or lotion,but not powder,may provide comfort for the child.

Question 13

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?

Accepted Answer

Fat emboli are of greatest concern in individuals with fractures of the long bones.Fat droplets from the marrow are transferred to the general circulation,where they are transported to the lung or brain.This type of embolism usually occurs within the second 12 hours after the injury.Sepsis would manifest with fever and lethargy.Osteomyelitis usually is seen with pain at the site of infection and fever.A child with an acute respiratory tract infection would have nasal congestion,not chest pain.

Question 14

What measure is important in managing hypercalcemia in a child who is immobilized?

Accepted Answer

Vigorous hydration is indicated to prevent problems with hypercalcemia.Suggested intake for an adolescent is 3000 to 4000 ml/day of fluids.Diuretics are used to promote the removal of calcium.Changing position is important for skin and respiratory concerns.Calcium in the diet is restricted when possible.A high-protein diet served as frequent snacks with favored foods is recommended.A high-calorie diet without adequate protein will not promote healing.

Question 15

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?

Accepted Answer

Standard seat belts and car seats may not be readily adapted for use by children in some casts.Specially designed car seats and restraints meet safety requirements.The child must have position changes much more frequently than every 8 hours.During feeding and play activities,the child should be moved for both physiologic and psychosocial benefit.Diapers and other strategies are necessary to maintain cleanliness.The abduction bar is never used as an aid for turning.Putting pressure on the bar may damage the integrity of the cast.

Question 16

What statement is correct regarding sports injuries during adolescence?

Accepted Answer

Injuries occur when the adolescent's body is not suited to the sport or when he or she lacks the insight and judgment to recognize that an activity exceeds his or her physical abilities.More injuries occur when an adolescent's muscles and body systems (respiratory and cardiovascular)are not conditioned to endure physical stress.Injuries do not occur from fatigue but rather from overuse.All sports have the potential for injury to the participant,whether the youngster engages in serious competition or in sports for recreation.More injuries occur during recreational sports than during organized athletic competition.

Question 17

What condition can result from the bone demineralization associated with immobility?

Accepted Answer

Bone demineralization leads to a negative calcium balance,osteoporosis,pathologic fractures,extraosseous bone formation,and renal calculi.Pooling of blood is a result of the cardiovascular effects of immobilization.Urinary retention is secondary to the effect of immobilization on the urinary tract.Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

Question 18

What is a physiologic effect of immobilization on children?

Accepted Answer

The physiologic effects of immobilization,as a result of decreased muscle contraction,include venous stasis.This can lead to pulmonary emboli or thrombi.The metabolic rate decreases with immobilization.With the loss of muscle contraction,there is a decreased venous return to the heart.Calcium leaves the bone during immobilization,leading to bone demineralization and increasing the calcium ion concentration in the blood.

Question 19

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?

Accepted Answer

Adults close to sports activities need to be aware of the early warning signs of fatigue,dehydration,and risk for injury.School policy should require mandatory use of protective equipment.Proper sports medicine therapy does not support "working through" overuse injuries.Too many students involved in different activities create distractions,which contribute to the child losing focus.This is a contributing factor to injury.

Question 20

The nurse uses the five Ps to assess ischemia in a child with a fracture.What finding is considered a late and ominous sign?

Accepted Answer

Paresthesia distal to the injury or cast is an ominous sign that requires immediate notification of the practitioner.Permanent muscle and tissue damage can occur within 6 hours.The other signs of ischemia that need to be reported are pain,pallor,pulselessness,and paralysis.Petaling is a method of placing protective or smooth edges on a cast.Posturing is not a sign of peripheral ischemia.Finding a position of comfort can be difficult with a fracture.It would not be an ominous sign unless pain was increasing or uncontrollable.

Quiz 34: The Child With Musculoskeletal or Articular Dysfunction