Which are appropriate interventions for the nurse to include in the plan of care for a child who is receiving traction? Select all that apply
1. Monitoring breath sounds
2. Assessing neurovascular status every 2 hours
3. Repositioning every 2 to 3 hours
4. Using moleskin to protect the skin from rough edges
5. Encouraging the parents cuddle with their child
1, 2, 5
Explanation:
1. Children who are receiving traction are at risk for atelectasis and pneumonia; therefore, the nurse should monitor breath sounds frequently.
2. Child who are receiving traction are at risk for circulatory compromise; therefore, the nurse should perform neurovascular checks every 2 hours.
3. Repositioning every 2 to 3 hours is more appropriate for a child who is casted.
4. Using moleskin to protect the skin from rough edges is more appropriate for a child who is casted.
5. Children who are receiving traction should be allowed up to 1 hour per day without the traction device, at which time the child can eat and cuddle with parents.
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