Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate dehydration?

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.

Choice A reason:

A low protein diet is not a therapeutic treatment for Hirschsprung disease. Hirschsprung disease is a congenital condition characterized by the absence of ganglion cells in the distal colon, leading to a lack of peristalsis and functional obstruction. Dietary modifications, such as a low protein diet, do not address the underlying issue of the absence of nerve cells in the bowel. Therefore, this choice is incorrect.

Choice B reason:

Surgical removal of the affected section of the bowel is the primary treatment for Hirschsprung disease. This procedure, known as a pull-through surgery, involves removing the aganglionic segment of the colon and connecting the healthy part of the intestine to the anus. This surgery restores normal bowel function by allowing the passage of stool through the healthy, innervated portion of the intestine. The pull-through procedure can be performed using minimally invasive techniques, resulting in shorter recovery times and fewer complications.

Choice C reason:

A permanent colostomy is not typically the first-line treatment for Hirschsprung disease. While a temporary colostomy may be performed in some cases to allow the bowel to heal before a pull-through surgery, a permanent colostomy is usually reserved for more severe cases or when other surgical options are not feasible. The goal of treatment is to restore normal bowel function, and a permanent colostomy is generally considered a last resort.

Choice D reason:

Daily enemas are not a definitive treatment for Hirschsprung disease. While enemas may be used temporarily to relieve symptoms and manage bowel movements, they do not address the underlying cause of the condition. The absence of ganglion cells in the bowel requires surgical intervention to restore normal bowel function. Therefore, daily enemas are not a long-term solution for Hirschsprung disease.