Question

Chapter 45: Nursing Care of the Child With a Musculoskeletal Disorder

1. Dustin Timmons, 13 years old, was born with pectus excavatum. It is progressing and Dustin has been brought to the clinic for further evaluation. (Learning Objectives 1, 2, 3, 4, 6, and 7)

a. What information would the nurse know to include in the health history?

b. What diagnostic tests should the nurse expect to be ordered?

It is determined that Dustin will be admitted to the hospital for surgical steel bar placement.

c. What would be important to teach Dustin and his family preoperatively?

d. What should the nurse include when planning discharge teaching for Dustin and his family?

Answer 1

(a) Pectus excavatum is a depression of the sternum and costal cartilages which may present at birth, or more commonly during the teenage growth spurt.

-Symptoms of lack of endurance, shortness of breath with exercise, or chest pain are frequent. Although pectus excavatum may be a component of some uncommon syndromes, patients usually are healthy.

(b) DIAGNOSTIC TOOLS:-

- Chest X-ray- it can visualize the dip in the breastbone and often shows the heart being displaced into the left side of the chest

- Computerized tomography (CT) scan

- Electrocardiogram (ECG)

- Echocardiogram

- Lung function tests

- Exercise test

(c) PRE OPERATIVE EDUCATION:-

- patients should avoid all oral intake for 12 hours before general anesthesia.

- Gentle bowel preparation with magnesium citrate.

(d) DISCHARGE NURSING EDUCATION:-

-call the surgeon for any trauma to the chest, pain or numbness of the arms, or pain that is not relieved by oral medications.

-Sports may be resumed as soon as the surgeon determines this is safe.

-the bar may prevent adequate chest compressions during CPR and defibrillation requires paddle adjustment to be effective.

-No MRI should be done while the Pectus bar in in place.

-Physical therapy may be helpful in improving posture.

-Use of a medical alert bracelet or necklace is recommended at all times in order to notify emergency providers of the presence of a Pectus bar.

-Recommended bracelet text as "Steel bar in chest".