A nurse is creating a plan of care for a pediatric client who has been diagnosed with Duchenne muscular dystrophy (DMD). Which of the following factors should the nurse consider when planning care?

Planning care for Duchenne muscular dystrophy involves applying knowledge of its progressive, X-linked recessive nature. Understanding the typical trajectory of muscle degeneration, including respiratory and cardiac involvement, is necessary to anticipate complications and provide appropriate multidisciplinary support. Choice A rationale Duchenne muscular dystrophy is a progressive, degenerative disease caused by the absence of dystrophin. It does not improve over time; instead, muscle weakness inevitably worsens as muscle fibers are gradually replaced by fat and connective tissue throughout the child's life. Choice B rationale Cognitive impairment in Duchenne muscular dystrophy is related to the absence of certain dystrophin isoforms in the brain. Unlike motor skills, these cognitive deficits are usually non-progressive, but they do not typically improve significantly through intensive physical or medical therapy. Choice C rationale Children with Duchenne muscular dystrophy may experience oropharyngeal muscle weakness and cognitive delays that affect speech. Planning must account for these communication barriers to ensure the child can express needs and participate in their care as the disease progresses. Choice D rationale Mobility concerns in Duchenne muscular dystrophy typically arise in early childhood, often between ages three and five. Most children require a wheelchair by age twelve. Mobility issues do not wait until adulthood but are a hallmark of early disease progression..