# A nurse is caring for a 6-year-old child diagnosed with acute poliomyelitis. Which nursing intervention should be the priority during the acute phase?

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## 문제

A nurse is caring for a 6-year-old child diagnosed with acute poliomyelitis. Which nursing intervention should be the priority during the acute phase?

## 보기

1. Encourage active range of motion exercises to prevent muscle atrophy
2. Position the child to maintain proper body alignment and prevent contractures **✔ 정답**
3. Administer high-dose corticosteroids to reduce inflammation
4. Implement strict contact isolation precautions immediately

**정답: 2**

## 해설

During the acute phase of poliomyelitis, priority nursing intervention is positioning to maintain proper body alignment and prevent contractures, as muscle weakness or paralysis can lead to permanent deformities. Other options are less appropriate: active exercise may worsen inflammation, corticosteroids are not standard treatment, and strict isolation is not typically required.

## 심화 해설

Understanding the Priority During Acute Poliomyelitis

For a child in the acute phase of poliomyelitis, the primary focus of nursing care is to prevent secondary complications that arise directly from the viral attack on the anterior horn cells of the spinal cord. This infection leads to acute flaccid paralysis, characterized by asymmetric muscle weakness and loss of deep tendon reflexes. The immediate danger is not just the paralysis itself, but the rapid development of musculoskeletal deformities if the affected limbs are not properly supported.

The correct intervention is to position the child to maintain proper body alignment and prevent contractures. During the acute phase, the affected muscles are in a state of flaccid paralysis, which creates a significant imbalance in muscle tone. Unopposed pull from unaffected muscle groups can quickly force joints into abnormal, fixed positions known as contractures. A common example is the development of foot drop (plantar flexion contracture) from the weight of bed linens or an unsupported foot. Proper positioning with neutral body alignment, using supportive devices like footboards, high-top sneakers, or splints, is essential to maintain functional positioning and prevent these permanent deformities [1,4].

Let's examine why the other options are not the priority during this specific phase:

- **Option 1: Encourage active range of motion exercises.** This is contraindicated during the acute phase. The affected muscles are inflamed and highly sensitive. Active exercises would place stress on the damaged anterior horn cells and can exacerbate pain and muscle damage. Rest and pain management are the cornerstones of acute care, with gentle, passive range of motion only being initiated after the severe muscle tenderness subsides [1].

- **Option 3: Administer high-dose corticosteroids.** While poliomyelitis involves inflammation of the central nervous system, high-dose corticosteroids are not a standard treatment to alter the disease course. Management is primarily supportive. The focus is on symptom control, such as using analgesics and moist heat packs for severe muscle pain and spasm, rather than pharmacological interventions aimed at the inflammatory process itself [4].

- **Option 4: Implement strict contact isolation precautions immediately.** Poliovirus is transmitted via the fecal-oral and oral-oral routes. Therefore, the appropriate isolation is enteric precautions, not strict contact isolation. While preventing transmission is a crucial public health measure, the immediate physiological priority for the individual patient during the acute paralytic phase is preventing permanent musculoskeletal complications through proper body alignment [1].

The pathophysiological basis for this care stems from the destruction of motor neurons in the anterior horn, which results in a flaccid paralysis that is often profound and patchy in distribution. This creates an immediate risk for scoliosis and joint contractures, as the structural support from balanced muscle tone is lost. The clinical priority is to preserve function by maintaining the body in a neutral, physiological position, thereby minimizing the long-term disability associated with this condition [2,4].

References (research sources)

- [1]The Current State: Epidemiology and Working Toward Eradication.Research articleAlbanese CV, Reddy S. (2021) · DOI: 10.1016/j.pmr.2021.02.003

- [4]Acute flaccid myelitis: cause, diagnosis, and management.Research articleMurphy OC, Messacar K, Benson L, Bove R, Carpenter JL, Crawford T, Dean J, DeBiasi R, Desai J, Elrick MJ, Farias-Moeller R, Gombolay GY, Greenberg B, Harmelink M, Hong S, Hopkins SE, Oleszek J, Otten C, Sadowsky CL, Schreiner TL, Thakur KT, Van Haren K, Carballo CM, Chong PF, Fall A, Gowda VK, Helfferich J, Kira R, Lim M, Lopez EL, Wells EM, Yeh EA, Pardo CA, AFM working group. (2021) · DOI: 10.1016/s0140-6736(20)32723-9

## 임상 시나리오

Acute Poliomyelitis: Positioning PriorityPreventing Contractures in Flaccid Paralysis
During the acute phase, the priority is maintaining proper body alignment to prevent contractures. Flaccid paralysis causes an imbalance where unaffected muscles pull against paralyzed ones, rapidly leading to deformities like foot drop.

Use supportive devices such as a footboard, high-top sneakers, or splints to keep joints in a neutral position. Reposition the child every 2 hours to prevent pressure injuries without causing pain or fatigue.

CautionDo not perform active or passive range of motion exercises on affected limbs during the acute phase; this can exacerbate muscle inflammation and pain. Enteric precautions are standard, not strict contact isolation.

## 핵심 개념

- **Poliomyelitis** — A highly infectious viral disease that invades the nervous system, causing acute flaccid paralysis by destroying anterior horn cells.
- **Contracture** — A permanent shortening of a muscle or joint, often caused by unopposed muscle pull during paralysis, leading to deformity.
- **Acute Flaccid Paralysis** — A sudden onset of weakness or loss of muscle tone and reflexes, characteristic of the acute phase of poliomyelitis.
- **Foot Drop** — A plantar flexion contracture of the ankle where the foot cannot be lifted, a common complication from unsupported positioning.
- **Neutral Body Alignment** — Positioning the body to maintain natural spinal curves and joint function, minimizing stress and preventing deformities.

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