# A 4-month-old infant is being treated for developmental dysplasia of the hip (DDH) with a Pavlik harness. The parents report that the infant has been crying more than usual and seems uncomfortable. During the assessment, the nurse notices redness and skin breakdown on the infant's thighs. What is the most appropriate nursing intervention?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542352  
> language: ko  
> subject: Child Health

## 문제

A 4-month-old infant is being treated for developmental dysplasia of the hip (DDH) with a Pavlik harness. The parents report that the infant has been crying more than usual and seems uncomfortable. During the assessment, the nurse notices redness and skin breakdown on the infant's thighs. What is the most appropriate nursing intervention?

The nurse is caring for an infant with developmental dysplasia of the hip who is experiencing complications from Pavlik harness treatment.

## 보기

1. Adjust the harness straps to reduce pressure and provide skin care education to the parents **✔ 정답**
2. Remove the harness immediately and contact the orthopedic surgeon
3. Apply topical antibiotic ointment to the affected areas and continue current treatment
4. Increase padding under the harness straps and schedule a follow-up appointment in one week

**정답: 1**

## 해설

Adjusting harness straps reduces pressure on skin while maintaining therapeutic positioning, and educating parents prevents future complications. Other options either disrupt treatment or fail to address the underlying pressure issue.

## 심화 해설

Understanding the Complication

When an infant in a Pavlik harness develops skin breakdown on the thighs accompanied by increased crying, the priority is to address a common and preventable complication: pressure injury from an improperly fitted device. The harness works by maintaining the hips in a flexed and abducted position to facilitate spontaneous reduction of the femoral head into the acetabulum. If the straps are too tight or incorrectly positioned, they create sustained pressure on soft tissues, compromising microcirculation and leading to ischemia, redness, and eventually skin breakdown. The infant’s increased crying is a key behavioral cue indicating discomfort or pain, which in this context is highly suggestive of excessive strap pressure rather than a new underlying pathology. The foundational principle of nonsurgical management, as highlighted in the provided research on bracing for developmental dysplasia of the hip (DDH), is that treatment success depends on maintaining the correct hip position while avoiding complications like skin injury or, more critically, femoral head avascular necrosis (AVN) [1].

Analyzing the Options

The correct intervention is to adjust the harness straps to reduce pressure and provide skin care education to the parents. This directly targets the root cause—mechanical pressure—and empowers the caregivers with the knowledge to prevent recurrence. The skin should be kept clean and dry, and a protective barrier, such as a soft cotton onesie worn under the straps, can be recommended. This conservative, nurse-driven intervention is the appropriate first-line response for a stage 1 pressure injury.

The other options are incorrect for the following reasons:

- Removing the harness immediately and contacting the orthopedic surgeon is an overreaction for localized, non-infected skin redness. Abruptly discontinuing treatment disrupts the critical maintenance of hip reduction, which is the cornerstone of successful DDH management in children under 18 months [1]. This action is reserved for severe complications like femoral nerve palsy, significant vascular compromise, or a failure to achieve and maintain reduction.

- Applying topical antibiotic ointment is not indicated because the assessment findings describe redness and breakdown, which is a pressure injury, not a bacterial skin infection. Applying an unnecessary antibiotic does not relieve the causative pressure and can contribute to antimicrobial resistance.

- Increasing padding under the harness straps is counterproductive. Adding bulky material can alter the mechanical dynamics of the harness, potentially reducing its effectiveness at maintaining the hip in the correct flexed and abducted position. It may also create new pressure points and trap moisture, worsening skin integrity. The solution is to correctly adjust the existing straps, not to pad them.

Clinical Reasoning and Safe Practice

The nursing process guides this decision. During the assessment, the nurse identifies a localized injury (redness and breakdown on thighs) linked to a therapeutic device. The diagnosis is "Impaired Skin Integrity related to mechanical pressure from the Pavlik harness." The planning and implementation must first involve removing the source of pressure through proper strap adjustment. This approach aligns with the broader safety and efficacy goals of DDH bracing, which aim to achieve hip reduction while minimizing iatrogenic harm [1]. Parental education is a critical component of nursing care for DDH, as the family is responsible for the infant’s 23-hour-per-day wear schedule and must be able to perform daily skin assessments and basic harness care. By teaching the parents how to identify early signs of pressure and maintain skin hygiene, the nurse prevents the progression of the injury and avoids a treatment interruption that could compromise the long-term outcome of hip development.References (research sources)

- [1]Evaluation of Safety and Efficacy of Traction, Closed Reduction, and Subsequent Hip Fixation in Hilgenreiner Brace in Patients with Severe Forms of Hip Developmental Dysplasia.Research articleGharaibeh A, Sepitka R, Pobeha J, Schreierova D, Habinakova M, Vasko G, Lacko M. (2022) · DOI: 10.1155/2022/8688770

## 임상 시나리오

Pavlik Harness Skin Care & Fit AdjustmentManaging pressure and irritation in DDH treatment
The most common cause of skin breakdown is excessive strap tension. Adjust straps so they are snug but allow two fingers to fit between the strap and the infant's skin.

Always place a soft cotton onesie or liner under the harness to wick moisture. Keep the skin clean and dry; avoid using lotions, powders, or ointments under the straps unless specifically ordered, as they can macerate the skin.

CautionDo not remove the harness without a direct order from the orthopedic surgeon. Interruption of treatment can lead to loss of reduction. Increased crying and skin redness are signs of a fitting problem, not necessarily a reason to discontinue bracing.

## 핵심 개념

- **Pavlik Harness** — A dynamic flexion-abduction orthosis used to treat developmental dysplasia of the hip (DDH) in infants, maintaining the femoral head within the acetabulum.
- **Pressure Injury** — Localized damage to the skin and underlying soft tissue, usually over a bony prominence, resulting from intense and/or prolonged pressure.
- **Developmental Dysplasia of the Hip (DDH)** — A spectrum of abnormalities involving the developing hip joint, ranging from mild acetabular dysplasia to complete hip dislocation.

## 같은 주제 문제

- [A 6-month-old infant is being evaluated for developmental dysplasia of the hip (DDH). Whic…](https://mymerci.kr/pages/nclex_q.php?qn_id=542350)
- [A nurse is assessing a 4-month-old infant for developmental dysplasia of the hip (DDH). Wh…](https://mymerci.kr/pages/nclex_q.php?qn_id=542351)
- [A 4-month-old infant is being treated for developmental dysplasia of the hip (DDH) with a …](https://mymerci.kr/pages/nclex_q.php?qn_id=542353)
- [A 2-year-old toddler diagnosed with developmental dysplasia of the hip (DDH) is being trea…](https://mymerci.kr/pages/nclex_q.php?qn_id=542354)
- [A 9-month-old infant is being evaluated for developmental dysplasia of the hip (DDH). The …](https://mymerci.kr/pages/nclex_q.php?qn_id=542355)
- [A 6-month-old infant is being evaluated for developmental dysplasia of the hip (DDH). The …](https://mymerci.kr/pages/nclex_q.php?qn_id=542356)
- [A 3-month-old infant is being evaluated for developmental dysplasia of the hip (DDH). The …](https://mymerci.kr/pages/nclex_q.php?qn_id=542357)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._