A 14-year-old female is brought to the clinic by her mother, who is concerned that her daughter's shoulders appear uneven.

The adolescent denies pain but reports feeling self-conscious during gym class.

The nurse performs a forward bend test and notes an asymmetry in the rib cage.

The provider diagnoses idiopathic scoliosis.

The adolescent is prescribed a thoracolumbosacral orthosis (TLSO) brace.

Which nursing action is most appropriate in promoting adherence to treatment and psychosocial well-being?

The nurse should determine that the FHR pattern represents Early decelerations due to Fetal head compression during contractions.

Rationale for correct answers:

Early decelerations are a gradual decrease and return to baseline of the fetal heart rate (FHR) associated with uterine contractions. They mirror contractions, beginning and ending with the contraction. This pattern is physiologic and typically benign.

Fetal head compression during contractions causes a vagal response leading to early decelerations. At a station of +4 and full dilation, fetal descent is significant, making head compression the most likely cause.

Rationale for incorrect Response 1 Options:

Late decelerations occur after the peak of the contraction and are due to uteroplacental insufficiency. These are non-reassuring and do not mirror contractions, unlike what is noted in the case.

Variable decelerations are abrupt drops in FHR and vary in timing, shape, and duration. They are not mirror images and are often associated with cord compression, which is not supported by this case’s findings.

Prolonged decelerations last >2 minutes and <10 minutes. The decelerations in this case are transient (to 105 bpm) and resolve before the end of the contractions, ruling out prolonged patterns.

Rationale for incorrect Response 2 Options:

Umbilical cord compression leads to variable decelerations, which are abrupt and not aligned with contraction timing, unlike the current pattern.

Uteroplacental insufficiency results in late decelerations, which occur after the contraction ends. These are non-reassuring and not consistent with the current findings.

Maternal hypotension due to epidural could cause late decelerations from reduced placental perfusion. However, despite a BP drop at 0900 (100/52 mm Hg), the FHR deceleration pattern does not match.

Take home points:

• Early decelerations are benign and typically reflect fetal head compression during contractions.
• Differentiate early from late decelerations based on timing relative to contractions—early mirrors, late lags.
• Variable decelerations are abrupt and typically linked to umbilical cord compression, not head compression.
• Maternal hypotension from epidural requires close monitoring, but it leads to uteroplacental insufficiency and late decelerations, not early.

Choice A rationale

Low potassium (hypokalemia) and ECG rhythm changes, such as QT prolongation or arrhythmias, are critical and life-threatening complications of bulimia nervosa due to fluid and electrolyte imbalances from purging behaviors. Hypokalemia can directly impair cardiac function, necessitating immediate medical intervention to prevent fatal arrhythmias.

Choice B rationale

Erosion of dental enamel and constant vomiting are chronic manifestations of bulimia nervosa. While they indicate ongoing disordered eating and require dental intervention, they are not acutely life-threatening and do not represent the same level of immediate physiological instability as severe electrolyte imbalances affecting cardiac function.

Choice C rationale

Menstrual irregularities, including amenorrhea, are common in individuals with bulimia nervosa due to hormonal disruptions from malnutrition and stress. While indicative of chronic health impact, they are not an immediate life-threatening concern requiring emergency intervention compared to acute cardiac complications.

Choice D rationale

Calluses on knuckles (Russell's sign) and skin breakdown are physical signs of repeated self-induced vomiting. These are chronic cutaneous manifestations reflecting the mechanical trauma from purging. While they require attention, they are not acute physiological emergencies demanding immediate intervention.