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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Prolonged immobilization alone is not the primary treatment for osteosarcoma. While immobilization may be used temporarily for symptom management or post-surgically, it does not address the underlying malignant tumor, which requires definitive intervention to prevent local progression and systemic metastasis.
Choice B rationale
Chemotherapy alone is typically used as an adjunct to primary surgical treatment for osteosarcoma, not as the sole primary treatment. While it plays a crucial role in eradicating micrometastases and improving overall survival rates, it is insufficient to cure the primary tumor without surgical resection.
Choice C rationale
Radiation therapy is generally less effective than surgery for primary osteosarcoma because the tumor cells are often radioresistant. While it may be used in specific situations, such as for palliative care or when surgical resection is not feasible, it is not the primary curative treatment.
Choice D rationale
Removal of the bone or limb, often through surgical resection or amputation, is the primary treatment for osteosarcoma. This approach aims to achieve complete macroscopic tumor removal, which is crucial for preventing local recurrence and maximizing the chances of long-term disease-free survival.
Correct Answer is A
Explanation
Choice A rationale
Persistent fever, elevated white blood cell count (normal range: 4,000-11,000 cells/µL), and increased pain after 72 hours of antibiotic treatment for osteomyelitis indicate a lack of therapeutic response. This suggests the current antibiotic regimen may be ineffective, or the infection is not responding as expected. Prompt notification of the provider is crucial for re-evaluation of the treatment plan, potential antibiotic adjustment, or further diagnostic investigation to prevent complications like sepsis or chronic osteomyelitis.
Choice B rationale
While pain management is important, requesting only oral analgesics addresses a symptom without addressing the underlying lack of improvement in the infection. Untreated or inadequately treated osteomyelitis can lead to significant morbidity. Prioritizing symptomatic relief over addressing the root cause can delay appropriate medical intervention and worsen the patient's condition.
Choice C rationale
While calcium (normal range: 8.5-10.5 mg/dL) is vital for bone health, encouraging calcium-rich foods is a long-term supportive measure for bone healing. It does not address the immediate and concerning signs of ongoing, uncontrolled infection. Addressing the active infection takes precedence over nutritional support for healing at this stage.
Choice D rationale
While antibiotic therapy does take time to show full effect, 72 hours with worsening symptoms, including elevated WBC, suggests the current therapy is failing. Reassuring the family without addressing these objective signs of non-improvement can delay necessary medical intervention and potentially harm the patient by allowing the infection to progress further.
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