# A 7-year-old child with Legg-Calvé-Perthes disease is being discharged home after initial treatment. Which instruction should the nurse prioritize when teaching the parents about home care management? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542383 > language: ko > subject: Child Health ## 문제 A 7-year-old child with Legg-Calvé-Perthes disease is being discharged home after initial treatment. Which instruction should the nurse prioritize when teaching the parents about home care management? ## 보기 1. Encourage high-impact activities like running and jumping to strengthen the hip muscles 2. Apply heat packs to the affected hip for 30 minutes three times daily to reduce pain 3. Maintain activity restrictions and use assistive devices as prescribed to protect the hip joint **✔ 정답** 4. Administer aspirin regularly for anti-inflammatory effects and pain management **정답: 3** ## 해설 Activity restriction and assistive device use are prioritized to protect the femoral head during healing in Legg-Calvé-Perthes disease. Other options (high-impact activities, heat application, aspirin) are contraindicated or less critical. ## 심화 해설 Understanding Legg-Calvé-Perthes Disease Legg-Calvé-Perthes disease is a childhood hip disorder caused by a temporary loss of blood supply to the femoral head. This avascular necrosis leads to bone death, softening, and eventual structural collapse of the femoral head. The active stages of the disease involve a cycle of bone necrosis, fragmentation, and gradual reossification over a period of 18 months to 2 years. The primary treatment goal during this vulnerable period is to maintain the femoral head within the acetabulum, a concept known as "containment," to ensure it heals in a spherical shape. If the femoral head becomes deformed, it can lead to permanent joint incongruity, early-onset osteoarthritis, and chronic pain. Prioritizing Home Care Management The correct answer is to maintain activity restrictions and use assistive devices as prescribed to protect the hip joint. This instruction directly addresses the core pathophysiological risk during the active stage of the disease. The prescribed restrictions, such as non-weightbearing or partial weightbearing with the use of crutches or a brace, are not arbitrary. They are critical for preventing mechanical stress on the softened, necrotic femoral head. Any weightbearing or high-impact force can cause microfractures and flattening of the bone before it has a chance to reharden, leading to permanent deformity. The research by Do et al. (2021) specifically highlights that these restrictions are commonly prescribed during the active stages to manage this risk, even while acknowledging their potential substantial influence on a child's physical and social health [1]. The nurse's priority is to reinforce the therapeutic rationale to ensure adherence and protect the structural integrity of the hip joint. Why Other Options Are Incorrect - Option 1 (Encourage high-impact activities): This instruction is contraindicated. High-impact activities like running and jumping would generate significant force across a hip joint with a structurally compromised femoral head. This directly opposes the principle of containment and would accelerate femoral head collapse and deformity, worsening the long-term prognosis. - Option 2 (Apply heat packs): While heat may provide temporary comfort for muscle spasms, it does not address the underlying pathology of avascular necrosis. More importantly, this instruction is not a priority compared to protecting the joint's structural integrity. Pain management is secondary to the mechanical protection of the hip joint. - Option 4 (Administer aspirin regularly): Aspirin is an antiplatelet agent and nonsteroidal anti-inflammatory drug (NSAID). Its use in children with viral illnesses is linked to Reye's syndrome, a rare but life-threatening condition. For pediatric pain and inflammation, other NSAIDs like ibuprofen or naproxen are the standard of care. This instruction is not only a lower priority but also potentially dangerous. Integrating Family Education and Self-Management Effective home management extends beyond simply stating the restrictions. Adherence can be challenging for a 7-year-old child, and the restrictions can significantly impact their quality of life [1]. The nurse should connect the prescribed restrictions to the use of engaging, age-appropriate strategies to promote adherence. The development of tools like the NON-STOP app, which incorporates exercises, educational content, and a reward system with a customizable avatar, reflects a clinical need to optimize self-management for these children . This approach helps the child understand their condition in a non-threatening way and motivates them to participate actively in their own care, turning a restrictive treatment plan into a manageable routine. The nurse's instruction should therefore include guidance on how to use prescribed assistive devices correctly and how to incorporate sedentary activities that support the child's cognitive and social development during the treatment period.References (research sources) - [1]Weightbearing and Activity Restriction Treatments and Quality of Life in Patients with Perthes Disease.Research articleDo DH, McGuire MF, Jo CH, Kim HKW. (2021) · DOI: 10.1097/corr.0000000000001608 ## 임상 시나리오 Protecting the Femoral Head in Perthes DiseaseDischarge Priorities for Containment Therapy The core of home management is containment—keeping the softened femoral head seated within the acetabulum to mold into a spherical shape. This is achieved through strict activity restriction and prescribed assistive devices (e.g., crutches, braces). Weight-bearing or high-impact forces on necrotic bone risk microfractures and permanent flattening. The reossification phase can last 18 months to 2 years, making long-term joint protection essential to prevent early osteoarthritis. CautionNever administer aspirin to children for pain due to the risk of Reye's syndrome. Use NSAIDs like ibuprofen if prescribed. Heat therapy does not address the mechanical risk of femoral head collapse. ## 핵심 개념 - **Legg-Calvé-Perthes Disease** — A childhood hip disorder caused by temporary loss of blood supply to the femoral head, leading to avascular necrosis, bone softening, and potential collapse. - **Containment** — The primary treatment principle of maintaining the femoral head within the acetabulum to ensure spherical healing and prevent permanent deformity. - **Avascular Necrosis** — Death of bone tissue due to a lack of blood supply, which in Perthes disease affects the femoral head. - **Reossification** — The stage of healing in Perthes disease where new bone gradually replaces the necrotic bone, a process that can take 18 months to 2 years. - **Reye's Syndrome** — A rare but serious condition causing swelling in the liver and brain, associated with aspirin use in children during viral illnesses. ## 같은 주제 문제 - [A 7-year-old child is brought to the pediatric clinic by their parents who report that the…](https://mymerci.kr/pages/nclex_q.php?qn_id=542380) - [A 7-year-old child is brought to the clinic by parents who report the child has been limpi…](https://mymerci.kr/pages/nclex_q.php?qn_id=542381) - [A 9-year-old child with Legg-Calvé-Perthes disease is being discharged home. 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