LPN Nursing · GI and Renal Disorders in Children · Practice question
A nurse has assisted with collecting data from a child and is reviewing their electronic health record (EHR). Select one condition and one child finding to fill in each blank in the following sentence. The nurse should identify that the child is displaying manifestations of ____ as evidenced by their ____.
Nurse’s Notes
Day 1, 1000:
10-year-old child presents to orthopedic office for 2 week follow up appointment following open reduction surgery of left tibia fracture. Child is accompanied by their parents. Child is alert and responsive to stimuli. Child reports pain in their left leg and rates it as 7 on a scale from 0 to 10. Capillary refill less than 2 seconds. S1 and S2 regular. Respirations even and non-labored. Lungs clear anterior and posterior. Radial and pedal pulse 2+ bilateral. Abdomen soft, flat, and non-distended. Bowel sounds active in all 4 quadrants. Surgical wound edges well-approximated. Localized edema and warmth present over surgical incision. Tenderness noted to light palpation of left lower leg with limited range of motion. Weight 36.3 kg (80 lb).
Vital Signs
Day 1, 1000:
Temperature 38.6° C (101.4° F)
Heart rate 116/min
Respiratory rate 22/min
Blood pressure 100/68 mm Hg
Pulse oximetry 96% on room air
Provider Prescriptions
Day 1, 1100:
Direct admit to inpatient pediatric unit to rule out osteomyelitis
MRI of lower extremities (left leg)
Acetaminophen 325 mg every 4 to 6 hr as needed for pain or fever
Obtain blood culture
Obtain CBC, erythrocyte sedimentation rate, C-reactive protein
Answer & explanation
Correct:
Osteomyelitis is a bone infection that can develop following open reduction surgery, particularly of the tibia. The child's clinical picture strongly supports this diagnosis: fever of 38.6°C, tachycardia of 116/min, localized warmth, edema over the surgical incision, tenderness to palpation, and limited range of motion of the left lower leg are all classic manifestations of osteomyelitis. The evidence that confirms this suspicion comes from the surgical incision findings — specifically the localized edema, warmth, tenderness, and wound-site changes — which directly reflect a localized bone and soft tissue infection at the operative site. The provider has already ordered workup to rule out osteomyelitis, reinforcing this clinical suspicion. Paralytic ileus would present with absent bowel sounds and abdominal distension; the child's bowel sounds are active in all four quadrants, making this incorrect. Pulmonary embolism would present with respiratory compromise, chest pain, decreased oxygen saturation, and tachycardia, but this child's lungs are clear and respirations are non-labored. Respiratory findings are not specific to osteomyelitis in this case. Bowel sounds being active is actually a normal finding and does not support any of the conditions listed. Therefore, osteomyelitis evidenced by surgical incision findings is the correct pairing.
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