The nurse is caring for a school-age child with hyperthyroidism (Graves’ disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply)

Choice A reason:

Marbles are not a safe play activity for a 3-year-old in a spica cast. Marbles are small and can pose a choking hazard. Additionally, playing with marbles requires fine motor skills and movement that may be restricted by the cast.

Choice B Reason:

Watching a movie is a safe activity but does not provide developmental benefits. While it can keep the child entertained, it does not engage the child in active play or promote cognitive and motor development.

Choice C Reason:

A game of checkers may be too advanced for a 3-year-old. It requires understanding of rules and strategic thinking, which may be beyond the developmental stage of a child this age. Additionally, it may not be engaging enough to hold the child’s attention.

Choice D Reason:

Playing with a toy telephone is an appropriate activity for a 3-year-old in a spica cast. It is safe and can be done while the child is in a stationary position. This activity encourages imaginative play and can help with language development and social skills.

The correct answer is

A. Waddling gait

B. Kyphosis

C. Lordosis

D. Scoliosis

E. Gower sign

Choice A reason

Waddling gait: Children with Duchenne muscular dystrophy (DMD) often exhibit a waddling gait due to progressive muscle weakness, particularly in the pelvic girdle muscles. This gait pattern is a compensatory mechanism to maintain balance and mobility despite weakened muscles. The waddling gait is one of the early signs of DMD and typically becomes noticeable between the ages of 2 and 6 years.

Choice B Reason

Kyphosis: Kyphosis, an excessive outward curvature of the spine, can develop in children with DMD as the disease progresses. Muscle weakness and imbalance, particularly in the back muscles, contribute to this spinal deformity. Kyphosis can lead to discomfort, respiratory issues, and further mobility challenges, necessitating close monitoring and intervention.

Choice C Reason

Lordosis: Lordosis, an exaggerated inward curvature of the lower spine, is another common finding in children with DMD. This condition often develops as a compensatory mechanism to maintain an upright posture despite weakened hip and thigh muscles. Lordosis can cause lower back pain and impact overall posture and gait.

Choice D Reason

Scoliosis: Scoliosis, a lateral curvature of the spine, frequently occurs in children with DMD due to progressive muscle weakness and imbalance. As the disease advances, scoliosis can become more pronounced, leading to discomfort, respiratory complications, and further functional limitations. Early detection and management are crucial to mitigate these effects.

Choice E Reason

Gower sign: The Gower sign is a classic clinical indicator of DMD. It refers to the maneuver children with DMD use to rise from the floor, involving the use of their hands to “walk” up their legs due to proximal muscle weakness. This sign is typically observed in early childhood and is a key diagnostic feature of DMD1.