Question

Identify key interventions in your practice. What evidence supports the use of the intervention?

What patient safety measures are considered?

Describe the consistency of this practice across settings (e.g., different facilities, different settings, different nurses).

Provide your responses in an APA formatted paper.

Answer 1

Age-appropriate, evidence based nursing intervention in children with musculo-skeletal abnormalities:

Nursing care of a child with musculoskeletal disorder includes five steps, i.e. assessment, nursing diagnosis, planning, interventions and evaluation. The skeletal system of pediatrics differs from the adults because their bones are no completely ossified or grown. The periosteum in pediatrics is thicker and rapidly produces callus than in the adult. The nursing care plan of an immobilized child is similar to adults, but developmental and age-appropriate interventions must be considered. Prevention of complications is the primary nursing function (Ricci & Kyle, 2009). Care related to traction is discussed below.

Nursing care of fractures with traction:

Lengthy hospitalization may be required in children with musculoskeletal deformities. Traction are used in patients according to their requirements, they are commonly used in fractures of lower extremities. The three types of traction used in children are, Bryant’s traction, Buck’s extension and Russell traction. Nursing interventions mainly focus on ability to maintain body functions because the body metabolism decreases during immobility. Range of motion (ROM) exercises prevent muscular atrophy. Constipation can be prevented by foods high in roughage because they stimulate the digestive tract. Respiratory exercises can increase the lung capacity and prevent pneumonia.

Nurses must observe the traction ropes to ensure that they are intact and the child’s body is in appropriate position. The elastic bandages must not be too tight or loose, a jacket restraint is recommended to allow the child to turn from one side to the other. Continuous traction is necessary, the weights are not removed, lifted or supported while moving the bed. Nurses must perform neuromuscular checking frequently. This includes checking the temperature of toes, color of skin, signs of numbness, irritation from bandages, pain in the bandage regions and absence or reduction of pulse rates in the extremities. Any change in the neuromuscular functioning must be immediately reported to the nurse in charge or physician. All these measures are helpful to prevent complications that are likely to increase the hospitalization for the child (Leifer, 2014).

Nursing interventions for a 5-year child with femur fracture, who is placed in traction:

Nursing diagnosis: Impaired mobility due to fixation devices

Nursing interventions	Rationale
Draw the fraction picture of the child and provide explanation of the traction apparatus	Reduces anxiety and promotes patient compliance
Place a call light within the reachable range of the child	Avoids frightening that may result from immobility and ensures the ready availability of the care
Change position for every 1 or 2 hours	Helps to prevent pressure ulcers and skin breakdown
Encourage to practice ROM exercises on unaffected extremities	Helps to prevent muscular atrophy, weakness and joint contracture
Encourage deep breathing with a toy or a spirometer	It helps to prevent atelectasis, pneumonia and also enhance lung power
Check for infections of urinary tract	During immobilization, kidney filtration slows down. This increases the risk of pooling bone minerals in the renal pelvis that enhance the risk of renal calculi.
Provide the diet rich in fiber and also include stool softeners	It helps to prevent constipation
Monitor the fluid intake and provide adequate fluids	It reduces the risk of urine stasis and constipation