Which client would be the most likely person to be diagnosed with idiopathic scoliosis that requires treatment?

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.
Correct response:
Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.
Explanation:
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.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, Care Plan 40-1, p. 846.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 846

prevent edema.
Correct response:
prevent edema.
Explanation:
Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling from the injury. Elevation of the arm would not promote healing or discourage infection. The cast will maintain proper bone alignment.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 843-844.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 843-844

wait to be log rolled before turning from one side to the other.
Correct response:
wait to be log rolled before turning from one side to the other.
Explanation:
Spinal instrumentation means rods are placed beside the spine, and the vertebrae are fused. Log rolling is necessary to prevent injury until the fusion is complete. She will be flat for a specific period of time depending on the amount of fusion in the surgery; she will be allowed to sleep in different positions, and the hospital stay is not 6 months.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 854.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 854

Capillary refill
Sensation
Color
Pulse
Correct response:
Color
Sensation
Pulse
Capillary refill
Explanation:
A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 844-845.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 844-845

Risk for impaired skin integrity due to cast and location
Correct response:
Risk for impaired skin integrity due to cast and location
Explanation:
Although deficient knowledge, risk for delayed development, and self-care deficit may be applicable, the child is at increased risk for skin breakdown due to the size of the cast and its location. In addition, the cast has an opening, which allows for elimination. Soiling of cast edges or leakage of urine or stool can lead to skin breakdown.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 842-844.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 842-844

Spiral fracture
Correct response:
Spiral fracture
Explanation:
A spiral fracture is very rare in children. A spiral femoral or humeral fracture, particularly in a child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse. Plastic, buckle, and greenstick fractures are common in children and do not usually suggest child abuse.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 842.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 842

True
Correct response:
True
Explanation:
Idiopathic scoliosis, with the majority of cases occurring during adolescence, is the most common scoliosis.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 852.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 852

Gower sign
Correct response:
Gower sign
Explanation:
Children with Duchenne muscular dystrophy usually have a history of meeting motor milestones, but by about 3 years of age, symptoms are more acute and obvious. Rising from the floor is done by rolling onto the stomach and then pushing up to the knees. To stand, the hands are pressed against the ankles, knees, and thighs. This is Gower sign. Facial weakness and inability to whistle are manifestations of facioscapulohumeral muscular dystrophy. Inadequate use of respiratory muscles is a manifestation of congenital myotonic dystrophy.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 848.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 848

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though."
Correct response:
"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though."
Explanation:
Osteosarcoma does not result from bone injuries but may be diagnosed when there is a fracture secondary to bone weakening from the tumor. Playing sports has no effect on development of osteosarcoma.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 850.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 850

"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it."
Correct response:
"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it."
Explanation:
A positive self-image is very important for adolescents wearing a brace. They want to look like their peers and wear the same clothing, but often that is not possible when wearing a brace. Assisting the adolescent in selecting clothing that looks stylish but still hides the brace is one of the best ways to help this client. Telling her she looks fine, to be confident, or bringing up the times she has been embarrassed does not help the client.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 855.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 855

Notify the health care provider of the findings immediately.
Correct response:
Notify the health care provider of the findings immediately.
Explanation:
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.

Reference:
Hatfield, N. T., Kincheloe, C. A. (2018). Introductory Maternity & Pediatric Nursing, 4th ed, Philadelphia: Wolters Kluwer, Chapter 40: The Child with a Musculoskeletal Disorder, p. 843.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 843

"It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms."
Correct response:
"It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms."
Explanation:
It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 855.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 855

Impaired physical mobility related to a cast on the leg
Correct response:
Impaired physical mobility related to a cast on the leg
Explanation:
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.

Reference:
Hatfield, N. T., Kincheloe, C. A. (2018). Introductory Maternity & Pediatric Nursing, 4th ed, Philadelphia: Wolters Kluwer, Chapter 40: The Child with a Musculoskeletal Disorder , p. 846.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 846

when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand
Correct response:
when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand
Explanation:
A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.

Reposition the child's foot on a pressure-reducing device.
Correct response:
Reposition the child's foot on a pressure-reducing device.
Explanation:
The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, Care Plan 40-1, p. 846.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 846

Epiphysis
Correct response:
Epiphysis
Explanation:
Growth of the bones occurs primarily in the epiphyseal region. This area is vulnerable and structurally weak. Traumatic force applied to the epiphysis during injury may result in fracture in that area of the bone. The growth plate refers to the combination of the epiphysis, the end of a long bone, and the physis, a cartilaginous area between the epiphysis and the metaphysis.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 841.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 841

Duchenne muscular dystrophy
Correct response:
Duchenne muscular dystrophy
Explanation:
By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 848.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 848

Advise the child that this is to be expected.
Correct response:
Advise the child that this is to be expected.
Explanation:
Plaster becomes hot as it sets. Even with fiberglass casts, there will be a warm feeling inside the cast when it is drying. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, the nurse should notify the health care provider. Infection would not present in this way with a cast application. A cast should not be moistened. If it does become wet, the cast should be dried with a hair dryer. There are some newer types of casts which can get wet but the nurse should know this before applying any moisture.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 854-855.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 854-855

Correct response:
back with hips up off the bed.
Explanation:
Bryant traction is used to reduce fractures or with developmental dysplasia of the hips in children younger than 2 years of age. In this type of traction both legs are extended vertically with the child's weight serving as the counterbalance. For there to be traction, the infant's hips must be off the bed. The position of having the child on the back with the hips flat is describling Buck's traction. The position where the hip is flexed on the injured side and the uninjured extended is 90-90 traction. There is no traction when the child would be on the stomach.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, Fig. 40-7, p. 845.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 845

Auscultation
Correct response:
Auscultation
Explanation:
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.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 842-844.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 842-844

Correct response:
Perform pin-site care on a daily or weekly basis after the first 48 to 72 hours.
Explanation:
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.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 845, 847.

Skin traction
Correct response:
Skin traction
Explanation:
Traction is used to provide immobilization to reduce or immobilize a fracture, align an injured extremity or allow the extremity to be restored to the normal length. The types of traction include skin, skeletal and suspension. The types of skin traction include Bryant, Russell, Buck, cervical and side arm 90-90. In these types of traction some type of tape, rubber, plastic or manufactured material is attached to the skin. A weight is attached via pulley which indirectly exerts pull on the musculoskeletal system. Dunlop is a form of skeletal traction and balanced suspension uses a series of weight and pulleys to align the hip, femur or tibia.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 844.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 844

"Let's ask your mom to bring your friends for a visit"
Correct response:
"Let's ask your mom to bring your friends for a visit"
Explanation:
After two weeks in traction, a child can become easily bored and regress in social and personal skills. The child is most likely needs some diversional activity. A visit from friends arranged by the girl's mother or supervised by the child-life specialist would help her adapt to her immobilized state. Telling the girl she is too big to suck her thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as she has likely grown tired of books and coloring after two weeks.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, Care Plan 40-1, pp. 846-847.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 846-847

Children's bones heal faster than adults.
Correct response:
Children's bones heal faster than adults.
Explanation:
Fractures in children heal faster, are generally less complicated, and occur for different reasons than fractures in adults. Thus, children rehabilitate faster than most adults. Children feel pain just like adults. Weight does not lessen the time required for crutches. Compliance is not an issue.

Reference:
Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 841.

Chapter 40: The Child with a Musculoskeletal Disorder - Page 841