The nurse is assessing a 4-year-old boy in a pediatric clinic. Which behaviors by the client would concern the nurse for possible Duchenne muscular dystrophy? Select all that apply.

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11ecbb05_cae9_e7d8_b433_4ff29d6ad802_MD0009_00 Duchenne muscular dystrophy is an X-linked recessive (carried by females and affecting males) disorder that causes the progressive replacement of dystrophin, a protein needed for muscle stabilization, with connective tissue. The proximal lower extremities and pelvis are affected first. In response to proximal muscle weakness, the calf muscles hypertrophy (pseudohypertrophy) initially and are later replaced by fat and connective tissue. Children with Duchenne muscular dystrophy raise themselves to a standing position using the classic Gower sign/maneuver (placing hands on the thighs to push up to stand) and walk on tiptoes (Options C and E). Parents may also report frequent tripping and falling (Option A). (Option B) Joint pain that is worse in the morning is a symptom of juvenile idiopathic arthritis. Children with this type of arthritis also experience symptoms of joint swelling and stiffness, high fever, and skin rash. (Option D) Rigid extension of the arms and legs is seen in the tonic phase of a tonic-clonic seizure. During this time, muscles become stiff, the jaw becomes clenched, and pupils can be fixed and dilated. Educational objective: Duchenne muscular dystrophy is an X-linked recessive disorder characterized by progressive replacement of muscle tissue with connective tissue. Classic signs include Gower sign/maneuver (placing hands on the thighs to push up to stand), enlarged calves, walking on tiptoes, and frequent tripping/falling.

The Nurse Is Assessing a 4-Year-Old Boy in a Pediatric