A nurse is caring for a school-age child who has a prescription for a peripherally inserted central catheter (PICC). Which of the following veins shou Id the nurse anticipate being accessed for the procedure?

Buck’s traction is a form of skin traction commonly used in pediatric clients with lower extremity fractures to reduce muscle spasms, maintain alignment, and promote comfort prior to definitive treatment. It involves applying a pulling force using weights and a pulley system. Proper nursing care focuses on maintaining correct alignment, preventing complications, and ensuring adequate pain control. Because fractures and traction can cause significant discomfort, effective analgesia is an important part of care.

Rationale:
A. Adjusting the weights to allow the child to turn is incorrect because the traction system must remain continuous and properly aligned at all times. Weights should hang freely without interference to maintain consistent traction force. Altering or adjusting weights can disrupt alignment and compromise treatment effectiveness.

B. Performing pin care every 24 hours is incorrect because Buck’s traction is a skin traction system and does not involve pins. Pin care is only required for skeletal traction where pins are inserted into bone. Since Buck’s traction uses straps and adhesive, pin care is not applicable.

C. Ensuring the pulley mechanism is attached to the child’s skin is incorrect because the pulley system is not attached to the skin but to the traction frame or bed. The skin is only involved through adhesive traction materials. Attaching mechanical components to the skin would be unsafe and inappropriate.

D. Offering opioid medications frequently to reduce pain is appropriate because Buck’s traction and underlying fracture can cause significant pain. Adequate pain control promotes comfort, cooperation, and effective alignment. Opioids are commonly used for moderate to severe pain in pediatric orthopedic injuries when appropriately prescribed and monitored.

When assessing a child with suspected physical maltreatment, the nurse must create a safe, calm, and supportive environment that encourages honest communication while minimizing fear and anxiety. Preschool children may feel frightened, confused, or reluctant to speak, especially in unfamiliar emergency settings. Therapeutic communication should be developmentally appropriate and nonthreatening. Comfort measures that promote trust and emotional security help the child participate more effectively in the interview.

Rationale:
A. Documentation after the interview should focus on objective findings and the child’s exact words rather than subjective interpretation. Recording subjective information can introduce bias and may weaken the legal value of the documentation. Accurate documentation should be factual, precise, and completed promptly, but the nurse should avoid relying on subjective statements.

B. Encouraging the parent to remain with the child is inappropriate when physical maltreatment is suspected because the caregiver may be the source of abuse or may influence the child’s responses. The child should be interviewed separately in a safe environment where they can speak freely without fear of intimidation or pressure. Privacy helps improve the reliability of the information obtained.

C. Conducting the interview in a semi-private room is not appropriate because confidentiality and safety are essential during abuse assessment. A fully private setting is necessary to protect the child’s emotional well-being and to allow open communication without interruptions or exposure to others. Semi-private spaces may increase anxiety and limit disclosure.

D. Allowing the child to have their favorite stuffed animal provides comfort, reduces anxiety, and helps establish a sense of safety during the interview. Familiar objects can be especially reassuring for preschool children in stressful healthcare situations. This supports therapeutic communication and helps the child feel more secure while discussing sensitive experiences.