The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition?

Choice A: Apply antibiotic ointment to pin sites daily

Applying antibiotic ointment to pin sites daily is not relevant in the context of Buck extension traction. Buck’s traction is a type of skin traction, which does not involve pins or pin sites. Pin site care is typically associated with skeletal traction, where pins are inserted directly into the bone.

Choice B: Remove the traction boot during baths

Removing the traction boot during baths is not recommended. The traction boot should remain in place to maintain the alignment and immobilization of the affected limb. Removing the boot can disrupt the traction and potentially worsen the condition.

Choice C: Assess neurovascular status every 2 hours

Assessing neurovascular status every 2 hours is crucial for a child in Buck extension traction. This involves checking the circulation, sensation, and movement of the affected limb to ensure there are no complications such as nerve damage or impaired blood flow. Regular neurovascular assessments help in early detection and prevention of complications.

Choice D: Reduce fluid intake

Reducing fluid intake is not a standard care practice for a child in Buck extension traction. Adequate hydration is important for overall health and recovery. There is no indication that fluid intake should be restricted in this scenario.

Choice A reason:

Compartment syndrome is a condition where increased pressure within a muscle compartment leads to decreased blood flow, which can cause muscle and nerve damage. It is typically associated with severe trauma, fractures, or crush injuries. The symptoms include severe pain, swelling, and decreased sensation or movement in the affected limb. In this case, the child’s symptoms of redness, swelling, and tenderness following a spider bite, along with an elevated WBC, are more indicative of an infection rather than compartment syndrome.

Choice B Reason:

Osteomyelitis is an infection of the bone, which can occur following an injury or infection elsewhere in the body. The symptoms include redness, swelling, tenderness, and pain in the affected area, along with fever and elevated WBC. Given the child’s history of a spider bite and the presence of redness, swelling, tenderness, and elevated WBC, osteomyelitis is the most likely diagnosis. The unremarkable X-ray does not rule out osteomyelitis, as early stages of the infection may not show changes on X-ray.

Choice C Reason:

Osteogenesis imperfecta, also known as brittle bone disease, is a genetic disorder characterized by fragile bones that break easily. It is not associated with infections or elevated WBC. The symptoms of osteogenesis imperfecta include frequent fractures, blue sclerae, and hearing loss. The child’s symptoms of redness, swelling, and tenderness following a spider bite, along with an elevated WBC, are not consistent with osteogenesis imperfecta.

Choice D Reason:

Juvenile idiopathic arthritis (JIA) is a type of arthritis that occurs in children. It is characterized by persistent joint inflammation, pain, and swelling. While JIA can cause joint tenderness and swelling, it is not typically associated with a recent injury or infection, such as a spider bite. Additionally, JIA does not usually cause elevated WBC. The child’s symptoms are more indicative of an infection, making osteomyelitis the more likely diagnosis.