You are a nurse caring for a 10-year-old child diagnosed with Duchenne Muscular Dystrophy (DMD). The child is experiencing difficulty with walking and frequent falls.
What is the most appropriate nursing intervention to promote mobility and prevent falls for this patient?
Advise the use of a wheelchair at all times to prevent falls.
Encourage regular physical therapy sessions focusing on strengthening exercises.
Increase calcium and vitamin D intake to improve muscle strength.
Limit physical activity to prevent muscle fatigue and protect from injury.
The Correct Answer is B
Choice A rationale
While wheelchairs offer mobility assistance, their continuous use can lead to muscle atrophy and further deconditioning in individuals with Duchenne Muscular Dystrophy. Promoting some level of independent movement, even with assistive devices, is crucial for maintaining existing muscle function and delaying disease progression. Over-reliance on a wheelchair might prematurely reduce weight-bearing activities vital for bone health and circulation.
Choice B rationale
Regular physical therapy, specifically focusing on strengthening exercises adapted for Duchenne Muscular Dystrophy, is paramount. This helps maintain existing muscle strength, slow the progression of muscle weakness, improve joint flexibility, and enhance overall functional mobility. Tailored exercises can also address compensatory movements and improve balance, thereby reducing the risk of falls and promoting ambulation for as long as possible.
Choice C rationale
While calcium and vitamin D are essential for bone health, their direct impact on improving muscle strength in the context of Duchenne Muscular Dystrophy is limited. DMD is a genetic disorder characterized by the absence of dystrophin, a protein vital for muscle fiber integrity. Supplementation may support bone density, but it does not address the underlying muscular dystrophy pathology or directly enhance muscle contractility.
Choice D rationale
Limiting physical activity excessively in Duchenne Muscular Dystrophy can lead to disuse atrophy, contractures, and a more rapid decline in mobility. A balanced approach is necessary, encouraging appropriate levels of activity to maintain muscle function without causing excessive fatigue or injury. Over-restriction can negatively impact both physical and psychological well-being, accelerating the progression of immobility.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Muscular dystrophy is a progressive, incurable genetic disorder characterized by muscle degeneration and weakness. While supportive care can manage symptoms and complications, there is currently no known cure. Therefore, setting a goal to cure the disease is unrealistic and inappropriate in the nursing care plan.
Choice B rationale
Children with muscular dystrophy experience progressive muscle weakness, increasing their risk of falls, fractures, and respiratory complications. A primary nursing goal is to prevent injury by implementing strategies such as maintaining mobility within limits, providing assistive devices, ensuring a safe environment, and monitoring for complications.
Choice C rationale
Muscular dystrophy leads to progressive muscle weakness, making rapid ambulation increasingly difficult and eventually impossible. Promoting rapid ambulation as a goal is counterproductive and unrealistic, as it does not align with the progressive nature of the disease and could lead to injury. The focus shifts to maintaining mobility for as long as possible.
Choice D rationale
Reversing muscle weakness in muscular dystrophy is not possible because the disease involves the degeneration of muscle fibers due to genetic defects. Nursing interventions focus on managing symptoms, slowing progression, and maintaining function, but they cannot reverse the underlying pathological process of muscle fiber loss and replacement with connective tissue.
Correct Answer is A
Explanation
Choice A rationale
At the end of the first trimester, around 12-14 weeks gestation, the uterus is still relatively low in the pelvis. The symphysis pubis serves as a reliable anatomical landmark for locating the fundus of the uterus at this stage. Placing the Doppler just above this bony prominence allows for optimal transmission of sound waves to detect the fetal heart tones.
Choice B rationale
The right upper quadrant contains structures like the liver, gallbladder, and part of the colon. At the end of the first trimester, the uterus is not typically high enough to extend into this region. Therefore, attempting to locate fetal heart tones in this area would be ineffective and unlikely to yield a clear signal, as the fetus is not yet positioned there.
Choice C rationale
Just above the umbilicus is the general location for assessing fetal heart tones later in pregnancy, typically during the second and third trimesters when the uterus has significantly enlarged and risen out of the pelvis. At the end of the first trimester, the uterus is still too small and low for the fetal heart tones to be consistently heard at this location.
Choice D rationale
The left upper quadrant contains the stomach, spleen, and part of the colon. Similar to the right upper quadrant, the uterus is not positioned high enough in the first trimester to extend into this area. Therefore, attempting to locate fetal heart tones in the left upper quadrant would be inappropriate and unlikely to be successful.
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