final exam Flashcards

Question

the ultimate outcome for TJR and infection is

Answer 1

preserving the joint prosthetics

Answer 2

remove the hardware, prolong antibiotic tx, and repeat the joint repalcement

Answer 3

prophylactic antibiotics can be used before dental procedures and invasive tx

Answer 4

DVTs!!! and pulmonary emboli

Answer 5

when all are met, a blood clot can occur The Virchow’s triad consists of: 1. Alterations in normal blood flow 2. Injuries to the vascular endothelium 3. Alterations in the consistancy of blood (hypercoagulability)

Answer 6

local vessel wall damage, hypercoagulability, and venous stasis after surgery

Answer 7

use anticoagulants (coumadin), low-molecular weight heparin or unfractionated heparin post op (immediately post op and up to 14 days after surgery)

Answer 8

focuses on obtaining history and physical: past medical hx --general health, previous surgeries, hospitalizations, illnesses, immunizations, meds, allergies, hx of blood transfusions, fx status and ability to complete ADLs, transfers, and ambulation personal hx -- culture/religion, economic issues, home environment, occupation, tobacco, alcohol, drug use, diet, exercise regimen pain -- chronic vs acute, location, intensity, exacerbation, meds, home tx musculoskeletal -- inspect and palpate surgical extremity, posture, alignment, symmetry, muscle tone, ROM vial signs -- BP, temp, pulse, respiratory rate, pulse ox

Answer 9

musculoskeletal -- surgical area, incision line for intactness, redness, warmth, amt of drainage, amt of edema, sensation, pulses pain -- intensity, location, radiation, evaluation of previous interventions to treat pain vitals -- until stable function -- assess amt of help needed for bed mobility, transfers, ambulation, and ADLs

Answer 10

the preoperative setting

Answer 11

complete review of medication regimen, signs and symptoms of infection, review a surgical procedure. Physical therapy will to a musculoskeletal evaluation and instruct them to complete a preoperative home exercise program; proper transfers in and out of bed, chairs, and vehicles; instructions on use of assistive devices such as canes and walkers; and information regarding postoperative rehabilitation

Answer 12

long-term benefits

Answer 13

proper use of a long-and old sponge or stock Donner can allow the patient to safely complete activities without risk of injury

Answer 14

home needs and initiating discharge planning

Answer 15

therapeutic exercise begins shortly after surgery and continues until the patient has reached his or her maximal functional recovery Focus of inpatient rehab postop is safe mobility. Most patients are transferred out of bed and stand on day one after surgery. Early movement with prophylactic measures is essential in diminishing the risk of postoperative DVT. Proper transfer techniques can reduce aggravation of symptoms and injury. Choice of prosthetic component may affect weight-bearing status. Some surgeons may restrict weight-bearing of patients with non-cemented THA components. Cemented components generally allow immediate full weightbearing or weight-bearing as tolerated.bone grafting or fracture during surgery may limit weight bearing

Answer 16

used while in bed in an effort to improve range of motion. This is more challenging for hip replacement patients because hip precautions must be maintained at all times. For example, hip precautions for a posterolateral THA may include no hip flexion beyond 90°, no crossing of midline with the operated leg, and no rotation.

Answer 17

true. It continues to focus on addressing functional deficits the patient may have. For example, a patient with a total knee replacement will typically exhibit lower extremity edema, muscle weakness, especially in the quadriceps, range of motion limitations in the operated knee, and gait deficits requiring the use of assistive device Gait training, progressive resistive exercise, balance training, patellar mobilization, soft tissue mobilization, electrical stimulation for quadriceps, strengthening and edema control, and range of motion and stretching exercises are typical interventions for this patient Modalities, including ice and later moist heat, are commonly used to minimize edema and pain and to facilitate stretching and exercise.

Answer 18

total knee replacement

Answer 19

hip abductor musculature. This leads to significant gait deviation, known as the Trendelenburg gait pattern. The patient with this deficit will latterly deviate his or her trunk to the weakened side in an effort to decrease pelvic drop due to the hip weakness. Patients should be encouraged to use appropriate assistive devices to avoid this deviation. As with the total knee replacement patient, range of motion exercises, progressive resistive exercise, soft tissue mobilization, and balance and gait training are standard interventions. A comprehensive home exercise program is essential

Answer 20

to not bend operated hip greater than 90° do not cross legs or brain operated leg past the midline of the body do not twist or turn operated leg inward do not raise the operated leg up higher than the rest of the body ( such as a knee to chest position)

Answer 21

true of joint replacements

Answer 22

pain management with pain under control adequate range of motion return of functional mobility increased quality of life successful outcomes are measured in terms of return to maximal mobility and range motion, with a low incidence of complications

Answer 23

nurses can actively prevent common complications and reinforced what patients are taught in physical therapy

Answer 24

``` acute pain potential for infection impaired physical mobility potential for ineffective tissue perfusion constipation inffective breathing pattern ```

Answer 25

alleviate or produce pain to a level that's acceptable to the patient by proper positioning, I stood extremity, guided imagery, music therapy, or distraction. Use of IV and PO medications, patient controlled analgesia as prescribed by physician, administer before any activity

Answer 26

outcome is to have no infection at the surgical site by hand washing, universal precautions, appropriate wound care techniques, assessment of wound color temperature and drainage, appropriate antibiotic use as prescribed, teaching patient and family of proper techniques of wound care and dressing changes

Answer 27

outcome is to increase mobility and advancement to independence with or without a device by use of adaptive equipment necessary, active/active assisted/passive range of motion exercises, mobility as soon as possible, teaching patient and family of proper mobilization techniques

Answer 28

outcome is to maintain adequate tissue perfusion to extremities and to be free of thrombosis by encouraging range of motion exercises, teach ankle pumps and circular motion of feet, TED hose as appropriate, sequential devices as appropriate, frequent assessment of extremities for pulses color temperature and sensation, administer anticoagulants as ordered, monitor lab values as ordered

Answer 29

outcome is maintenance of irregular bowel pattern as per patient by encouraging activity as soon as possible, encourage fluid intake, encourage proper diet, assessed bowel sounds and monitor for nausea and vomiting, administer laxatives and stool softener as ordered

Answer 30

outcome is to maintain proper ventilation by oxygen support as needed, teaching coughing and deep breathing exercises, teaching use of incentive spirometry, teach proper positioning for effective breathing: sitting position, slightly forward, and shoulders relaxed. Assess lung sounds and pulse oximetry

Answer 31

ankle pumps: Bend ankles to move feet up and down, alternating feet. Repeat this exercise several times throughout the day Quad sets!!!: slowly tighten muscles on thigh of straight leg while counting to 5; repeat with the other leg Straight leg raise: Bend un-involved leg. Keep other leg straight as possible and tighten muscles on top of thign. Slowly lift straight leg 6 to 8 inches from bed and hold for 5 seconds; lower. Relax. Short arc quad: place large can or rolled up towel under leg. Straighten knee and leg. Hold for 5 seconds and repeat with other leg Heel slides: bend knee and pull heels towards buttocks. hold for 5 seconds. Return to starting point and repeat with other knee

Answer 32

3. When combined with a weight loss program, aquatic exercise would be best because it cushions the joints and allows the client to burn off calories. Aquatic exercise promotes circulation, muscle toning, and lung expansion, which promote healthy preoperative conditioning. Weight lifting and walking are too stressful to the joints, possibly exacerbating the client's osteoarthritis. Although tai chi exercise is designed for stretching and coordination, it would not be the best exercise for this client to help with weight loss.

Answer 33

4. Before implementing a teaching plan, the nurse should determine the client's fears about the procedure. Only then can the client begin to hear what the nurse has to share about the individualized teaching plan designed to meet the client's needs. In the preoperative period, the client needs to learn how to correctly prevent hip flexion and to demonstrate coughing and deep breathing. However, this teaching can be effective only after the client's fears have been assessed and addressed. Although the client may appreciate seeing what a hip prosthesis looks like, so as to understand the new body part, this is not a necessity.

Answer 34

1. The nurse should suspect nerve damage if numbness is present. However, whether the damage is short-term and related to edema or long-term and related to permanent nerve damage would not be clear at this point. The nurse needs to continue to assess the client's neurovascular status, including pain, pallor, pulselessness, paresthesia, and paralysis (the five P's). Bleeding would suggest vascular damage or hemorrhage. Dislocation would suggest malalignment. Pink color would suggest adequate circulation to the area. Numbness would suggest neurologic damage.

Answer 35

3. The joint has dislocated when the client with a total joint prosthesis develops severe sudden pain and an inability to move the extremity. Clinical manifestations of an infection would include inflammation, redness, erythema, and possibly drainage and separation of the wound. Bleeding could be external (e.g., blood visible from the wound or on the dressing) or internal and manifested by signs of shock (e.g., pallor, coolness, hypotension, tachycardia). The seepage of glue into soft tissue would have occurred in the operating room, when the glue is still in the liquid form. The glue dries into the hard, fixed form before the wound is closed.

Answer 36

1. An average adult requires approximately 1,100- 1,400 mL of fluids per day. In some instances, such as when a person has an increase in body temperature or has increased perspiration, additional water may be necessary. With an increase in body temperature, there is also an increase in insensible fluid loss. The increased loss of fluid causes an increased need for fluid replacement. If the loss is significant and/ or goes untreated, an individual's intake will not be balanced with output. Managing the incision, changing the bed linens, or keeping the client's skin cool are not outcomes indicative of resolution of a fluid volume deficit.

Answer 37

4. After knee arthroplasty, the knee will be extended and immobilized with a firm compression dressing and an adjustable soft extension splint in place. A sequential compression device (SCD) will be applied. The SCD can be discontinued when the client is ambulatory, but while the client is in bed the SCD needs to be maintained to prevent thromboembolism. The SCD should be positioned on the bed, but not on two pillows. Settings for the SCD are ordered by the orthopedic surgeon. Initial dressing changes are completed by the orthopedic surgeon and changed as needed per physician order.

Answer 38

1, 2, 3. The nurse should instruct the client to notify the dentist and other health care providers of the need to take prophylactic antibiotics if undergoing any procedure (e.g., tooth extraction) due to the potential of bacteremia. The nurse should also advise the client that the metal components of the joint may set off the metal-detector alarms in airports. The client should also avoid MRI studies because the implanted metal components will be pulled toward the large magnet core of the MRI. Any weight bearing that is permitted is prescribed by the orthopedic surgeon and is usually not limited to 5 lb. Post surgery, the client can resume a normal diet with regular fluid intake.

Answer 39

4. After total hip replacement, proper positioning by the nurse prevents dislocation of the prosthesis. The nurse should place the client in a supine position and keep the affected extremity in slight abduction using an abduction splint or pillows or Buck's extension traction. The client must not abduct or flex the operated hip because this may produce dislocation.

Answer 40

2, 4, 5. Following total hip replacement, the client should use the overhead trapeze to assist with position changes. The head of the bed should not be elevated more than 45 degrees; any height greater than 45 degrees puts a strain on the hip joint and may cause dislocation. To use a fracture bedpan, instruct the client to flex the unoperated hip and knee to lift buttocks onto pan. Toe-pointing exercises stimulate circulation in the lower extremities to prevent the formation of thrombi and potential emboli. The prone position is avoided shortly after a total hip replacement.

Answer 41

1, 3, 4. Administration of antibiotics as prescribed will aid in the acquisition of therapeutic blood levels during and immediately after surgery to prevent osteomyelitis. The nurse can request that a trapeze be added to the bed so the client can assist with lifting and turning. The nurse should also demonstrate and have the client practice isometric exercises (muscle setting) of quadriceps and gluteal muscles. The client will not use crutches after surgery; a physical therapy assistant will initially assist the client with walking by using a walker. The client will not use Buck's traction. The client will require anti-embolism stockings and use of a leg compression device to minimize the risk of thrombus formation and potential emboli; the leg compression device is applied during surgery and maintained per physician order.

Answer 42

1, 2, 3, 4. Client/ family teaching should include advising the client to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to healthcare provider immediately. Instruct the client not to take aspirin or nonsteroidal anti-inflammatory drugs without consulting health care provider while on therapy. A low-molecular weight heparin is considered to be a high-risk medication and the client should wear or carry medical identification. The air bubble should not be expelled from the syringe because the bubble insures the client receives the full dose of the medication. The client should allow 5 seconds to pass before withdrawing the needle to prevent seepage of the medication out of the site.

Answer 43

3. Dislocation precautions include: avoid extremes of internal rotation, adduction, and 90-degree flexion of affected hip for at least 4 to 6 weeks after the procedure. Use of an abduction pillow prevents adduction. Decreasing use of the abductor pillow does not strengthen the muscles to prevent dislocation. Informing a client to "not worry" is not therapeutic. A cushioned toilet seat does not prevent hip dislocation.

Answer 44

1, 2, 3. Dislocation of a hip prosthesis may occur with positioning that exceeds the limits of the prosthesis. The nurse must recognize dislocation of the prosthesis. Signs of prosthesis dislocation include: acute groin pain in the affected hip, shortening of the affected leg, restricted ability or inability to move the affected leg, and reported "popping" sensation in the hip. Toe wiggling is not a test for potential hip dislocation.

Answer 45

4. If a prosthesis becomes dislocated, the nurse should immediately notify the surgeon. This is done so the hip can be reduced and stabilized promptly to prevent nerve damage and to maintain circulation. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. If ordered by the surgeon, an ice pack may be applied post reduction to limit edema, although caution must be utilized due to potential muscle spasms. Some orthopedic surgeons may order the client be turned toward the side of the reduced hip but that is not the nurse's first response.

Answer 46

3. Infection is a serious complication of total hip replacement and may necessitate removal of the implant. Clients who are obese, poorly nourished, elderly, have poorly controlled diabetes, rheumatoid arthritis, or concurrent infections (e.g., dental, urinary tract) are at high risk for infection. Clients who are of normal weight and have well-controlled chronic diseases are not at risk for infection. Living alone is not a risk factor for infection.

Answer 47

3. Expected outcomes at the time of discharge from the surgical unit after a hip replacement include the following: increased independence in transfers, participates in progressive ambulation without pain or assistance, and raises the affected leg without assistance. The client will not be able to walk throughout the hospital, walk for a distance without some postoperative pain, or raise the affected leg more than several inches. The client may be referred to a rehabilitation unit in order to achieve the additional independence, strength, and pain relief.

Answer 48

1, 2, 3, 4. Postoperatively, the knee in a total knee replacement is dressed with a compression bandage and ice may be applied to control edema and bleeding. Recurrent assessment by the nurse for neurovascular changes can prevent loss of limb. Normal neurovascular findings include: color normal, extremity warm, capillary refill less than 3 seconds, moderate edema, tissue not palpably tense, pain controllable, normal sensations, no paresthesia, normal motor abilities, no paresis or paralysis, and pulses strong and equal.

Answer 49

4. The knee is usually protected with a knee immobilizer (splint, cast, or brace) and is elevated when the client sits in a chair. Pre- and post-surgery, the physician prescribes weight-bearing limits and use of assistive devices for progressive ambulation. Positioning a straight-backed chair at the foot of the bed is not an action conducive for getting the client out of bed on the evening of surgery for a total knee replacement.

Answer 50

1, 4. After a total knee replacement, efforts are directed at preventing complications, such as thromboembolism, infection, limited range of motion, and peroneal nerve palsy. The nurse should instruct the client to report signs of infection, such as an increased temperature. To prevent edema, the affected leg must remain elevated when the client sits in a chair. After discharge, the client may undergo physical therapy on an outpatient basis per physician order. The client should leave the dressing in place until the follow-up visit with the surgeon.

Answer 51

1. Deep vein thrombosis is a complication of total joint replacement and may occur during hospitalization or develop later when the client is home. Clients who are obese or have previous history of a DVT or PE are at high risk. Immobility produces venous stasis, increasing the client's chance to develop a venous thromboembolism. Signs of a DVT include: unilateral calf tenderness, warmth, redness, and edema (increased calf circumference). Findings should be reported promptly to the physician for definitive evaluation and therapy. Polyuria may be indicative of diabetes mellitus. Intussusception of the bowel and wound evisceration tend to occur after abdominal surgeries.

Answer 52

3. Typically, peripheral vascular disease is considered to be a disorder affecting older adults. Therefore, an age of 39 years would not be considered as a risk factor contributing to the development of peripheral vascular disease. Uncontrolled diabetes mellitus is considered a risk factor for peripheral vascular disease because of the macroangiopathic and microangiopathic changes that result from poor blood glucose control. Cigarette smoking is a known risk factor for peripheral vascular disease. Nicotine is a potent vasoconstrictor. Serum cholesterol levels greater than 200 mg/ dL are considered a risk factor for peripheral vascular disease.

Answer 53

2. The client with severe arterial occlusive disease and gangrene of the left great toe would have lost the hair on the leg due to decreased circulation to the skin. Edema around the ankle and lower leg would indicate venous insufficiency of the lower extremity. Thin, soft toenails (i.e., not thickened and brittle) are a normal finding. Warmth in the foot indicates adequate circulation to the extremity. Typically, the foot would be cool to cold if a severe arterial occlusion were present.

Answer 54

3. The client should be tobacco-free for 30 minutes before the test to avoid false readings related to the vasoconstrictive effects of smoking on the arteries. Because this test is noninvasive, the client does not need to sign a consent form. The client should receive an opioid analgesic, not a sedative, to control the pain as the blood pressure cuffs are inflated during the Doppler studies to determine the ankle-to-brachial pressure index. The client's ankle should not be covered with a blanket because the weight of the blanket on the ischemic foot will cause pain. A bed cradle should be used to keep even the weight of a sheet off the affected foot.

Answer 55

2. Slow, steady walking is a recommended activity for the client with peripheral arterial disease because it stimulates the development of collateral circulation needed to ensure adequate tissue oxygenation. The client with peripheral arterial disease should not minimize activity. Activity is necessary to foster the development of collateral circulation. Elevating the legs above the heart is an appropriate strategy for reducing venous congestion. Wearing antiembolism stockings promotes the return of venous circulation, which is important for clients with venous insufficiency. However, their use in clients with peripheral arterial disease may cause the disease to worsen.

Answer 56

1. Daily lubrication, inspection, cleaning, and patting dry of the feet should be performed to prevent cracking of the skin and possible infection. Soaking the feet in warm water should be avoided because soaking can lead to maceration and subsequent skin breakdown. Additionally, the client with arterial insufficiency typically experiences sensory changes, so the client may be unable to detect water that is too warm, thus placing the client at risk for burns. Antiembolism stockings, appropriate for clients with venous insufficiency, are inappropriate for clients with arterial insufficiency and could lead to a worsening of the condition. Footwear should be roomy, soft, and protective and allow air to circulate. Therefore, firm, supportive leather shoes would be inappropriate.

Answer 57

2. Encouraging the client who will be undergoing amputation to verbalize his feelings is the most therapeutic response. Asking the client to tell more about how he is feeling helps to elicit information, providing insight into his view of the situation and also providing the nurse with ideas to help him cope. The nurse should avoid value-laden responses, such as, "At least you will still have one good leg to use," that may make the client feel guilty or hostile, thereby blocking further communication. Furthermore, stating that the client still has one good leg ignores his expressed concerns. The client has verbalized feelings of helplessness by using the term "invalid." The nurse needs to focus on this concern and not try to complete the teaching first before discussing what is on the client's mind. The client's needs, not the nurse's needs, must be met first. It is inappropriate for the nurse to assume to know the relationship between the client and his wife or the roles they now must assume as dependent client and caregiver. Additionally, the response about the client's wife caring for him may reinforce the client's feelings of helplessness as an invalid.

Answer 58

2. The level of amputation often cannot be accurately determined until during surgery, when the surgeon can directly assess the adequacy of the circulation of the residual limb. From a moral, ethical, and legal viewpoint, the surgeon attempts to remove as little of the leg as possible. Although a longer residual limb facilitates prosthesis fitting, unless the stump is receiving a good blood supply the prosthesis will not function properly because tissue necrosis will occur. Although the client's ability to walk with a prosthesis is important, it is not a determining factor in the decision about the level of amputation required. Blood supply to the tissue is the primary determinant.

Answer 59

4. The priority action is to draw a mark around the site of bleeding to determine the rate of bleeding. Once the area is marked, the nurse can determine whether the bleeding is increasing or decreasing by the size of the area marked. Because the spot is bright red, the bleeding is most likely arterial in origin. Once the rate and source of bleeding are identified, the surgeon should be notified. The stump is not elevated because adhesions may occur, interfering with the ability to fit a prosthesis. The dressing would be reinforced if the bleeding is determined to be of venous origin, characterized by slow oozing of darker blood that ceases with the application of a pressure dressing. Typically, operative dressings are not changed for 24 hours. Therefore, the dressing is reinforced to prevent organisms from penetrating through the blood-soaked areas of the initial postoperative dressing.

Answer 60

4. The nurse's first action should be to administer the prescribed opioid analgesic to the client, because this phenomenon is phantom sensation and interventions should be provided to relieve it. Pain relief is the priority. Phantom sensation is a real sensation. It is incorrect and inappropriate to tell a client that it is impossible to feel the pain. Although it does relieve the client's apprehensions to be told that phantom sensations are a real phenomenon, the client needs prompt treatment to relieve the pain sensation. Usually phantom sensation will go away. However, showing the client that the toes are not there does nothing to provide the client with relief.

Answer 61

4. Use of crutches requires significant strength from the triceps muscles. Therefore, efforts are focused on strengthening these muscles in anticipation of crutch walking. Bed and wheelchair push-ups are excellent exercises targeted at the triceps muscles. Abdominal exercises, range-of-motion and isometric exercises of the shoulders, and quadriceps and gluteal setting exercises are not helpful in preparing for crutch walking.

Answer 62

4. When using crutches, the client is taught to support her weight primarily on the hands. Supporting body weight on the axillae, elbows, or upper arms must be avoided to prevent nerve damage from excessive pressure.

Answer 63

4. Before beginning dietary instructions and interventions, the nurse must first assess the client's and family's food preferences, such as pattern of food intake, life style, food preferences, and ethnic, cultural, and financial influences. Once this information is obtained, the nurse can begin teaching based on the client's current knowledge level and then building on this knowledge base.

Answer 64

1. Answer D. Exercise is important to keep the joints and muscles functioning and to prevent secondary complications. Using the overhead trapeze prevents hazards of immobility by permitting movement in bed and strengthening of the upper extremities in preparation for ambulation. Sitting in a wheelchair would require too great hip flexion initially. Asking her family to visit would not facilitate the resumption of activities. Sitting in a chair would cause too much hip flexion. The client initially needs to be in a low Fowler’s position or taking a few steps (as ordered) with the aid of a walker.

Answer 65

11. Answer A. Weight bearing exercises are beneficial in the treatment of osteoporosis. Although loss of bone cannot be substantially reversed, further loss can be greatly reduced if the client includes weight bearing exercises along with estrogen replacement and calcium supplements in their treatment protocol.

Answer 66

20. Answer D. Foods high in bulk are appropriate. Exercise should be a part of a bowel training regimen. To assess the client for a bowel training program the factors causing the bowel alteration should be assessed. A routine for bowel elimination should be based on the client’s previous bowel habits and alterations in bowel habits that have occurred because of illness or trauma. The client and the family should assist in the planning of the program which should include foods high in bulk, adequate exercise, and fluid intake of 2500-3000 ml.

Answer 67

crutches and the left leg, then advance the right leg

Answer 68

the client is taught to hold the can on the opposite side of weakness. Left hand and 6 inches lateral to the left foot

Answer 69

compartment syndrom is caused by bleeding and swelling within a compartment lined by fascia which does the expand.

Answer 70

pillow to keep the right leg abducted druing turning

Answer 71

as much as the client can tolerate

Answer 72

apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting

Answer 73

an overhead trapeze because it use could promote twisting of the spine after surgery

Answer 74

the device (back brace) is applied in the morning before getting out of bed. The back brace is fitted to the client. THe closures should be secure but not overly looses or tight. A layer of clothing is worn between the orthosis and the skin

Answer 75

a slider board and the assistance of four people

Answer 76

uric acid level of 8mg/dl gout is diagnosed by the prsence of persisitent hyperuricmia, with the uric acid level higher than 7mg/dl. Additionally uric acid in an aspirated sample of synovial fluid confirms the diagnosis

Answer 77

pain increases with activity and is relieved by rest

Answer 78

paresthesia (numbness and tingling in the fingers)

Answer 79

shorteing of the affected leg, adduction, and external rotation. The client may also report slight groin pain or pain in the medial side of the knee

Answer 80

pain with knee extension is a common compaint after knee replacement.The nurse should encourage client to keep the knee extended and administer analgesics PRN

Answer 81

rewraps the residual limb with an elastic compression bandgae otherwise excessive edema will rapidly form

Answer 82

initial action is to place the client in a fowler's position

Answer 83

following surgery to repair a fractrued hip, an abductor splint is used to maintain teh affected extremity in god alignment. An overhead tapeze and bed pillow are also use, but they are not PRIORITY item to be used

Answer 84

meat, liver, other organ meats, blackstrap molasses and oysters

Answer 85

avoid excessive use of the joint for several days, to elevate the knee while sitting, to avoid twisting the knee, and to return to the physcician for follow up in about 7 days. Ice is applied to the affected joint for pain and swelling. Administer analgesics as ordered

Answer 86

Encourage fluid intake of 3L per day. Enourage client to perform self-care activities at maximal level. Get client out of bed as soon as possible. Keep client out of bed as much as possible. Keep abductor pillow in place while client is in bed (hip replacement). Use elevated toilet seat and chairs with high seats for those who have had hip or knee replacements (prevents dislocation). Do not flex hip more than 90 degrees (hip replacement)

Answer 87

Orthopedic wounds have a tendency to ooze more than other wounds. A suction drainage device usually accompanies the client to the postoperative floor. Check drainage often. *200-400 ml in a 24 hr time frame is normal*

Answer 88

A big problem after joint replacement is infection.

Answer 89

Fractures of bone predispose the client to anemia, especially if long bones are involved. Check H&H every 3-4 days to monitor erythropoiesis. Iron can be given PO with meals. (watch for constipation)

Answer 90

After hip replacement, instruct the client NOT to lift the leg upward from a lying position or to elevate the knee when sitting. This upward motion can pop the prosthesis out of the socket.

Answer 91

Hazards of Immobility: Immobile clients are prone to complications: skin integrity problems; formation of urinary calculi (client's milk intake may be limited); and venous thrombosis (client may be on prophylactic anticoagulants).

Answer 92

Noninflammatory arthritis. OA is characterized by a degeneration of cartilage, a wear-and-tear process. It usually affects on or two joints. It occurs asymmetrically. Obesity and overuse are predisposing factors. NURSING ASSESSMENT:Joint pain that increases with activity and improves with rest. Morning stiffness. Asymmetry of affected joints. *Crepitus (grating sound in the joint).* Limited movement. Visible joint abnormalities indicated on radiographs. Joint enlargement and bony nodules. NURSING INTERVENTIONS:(same as RF) Instruct in weight-reduction diet. Remind client that excessive use of the involved joint aggravates pain and may accelerate degeneration. Teach client to: Use correct posture and body mechanics. Sleep with rolled terry cloth towel under cervical spine if neck pain is a problem. Relieve pain in fingers and hands by wearing stretch gloves at night. Keep joints in functional position. Tylenol or NSAIDs

Answer 93

In clients with hip fractures, thromboembolism is the most common complication. Prevention includes passive ROM exercises, use of ted hose, elevation of the foot of the bed 25 degrees to increase venous return, and low-dose anticoagulation therapy (lovenox IM or xarelto PO). ***hip fx compare effected to unaffected side- it will be shorter and externally rotated*

Answer 94

DESCRIPTION: Surgical removal of a diseased part or organ. Causes for amputation include the following: Peripheral vascular disease, 80% (75% ar diabetics). Trauma. Congenital deformities. Malignant tumors Infection. Amputation necessitates major lifestyle and body-image adjustments. NURSING ASSESSMENT: Prior to amputation, symptoms of peripheral vascular disease include: Cool extremity. Absent peripheral pulses. Hair loss on affected extremity. Necrotic tissue or wounds: blue or blue-gray, turning black. Drainage possible with or without odor. Leathery skin on affected extremity. Decrease of pain sensation in affected extremity. Inadequate circulation is determined by: Arteriogram and Doppler flow studies. NURSING PLANS AND INTERVENTIONS:Provide wound care: Mark dressing for bleeding, and check marking at least every 8 hours. Measure suction drainage every shift. Change dressing as needed (physician usually performs initial dressing change): ***large tourniqiet at bedside for frank hemorrhage*** Maintain aseptic technique. Observe wound color and warmth. Observe for wound healing. Monitor for signs of infection: fever, tachycardia, redness of incision area. Maintain proper body alignment in and out of bed. Position client to relieve edema and spasms at residual limb (stump) site. **Elevate stump for the first 24 hours postop** Do not continually elevate stump after 48 hrs postop. (can cause contracture). Keep stump in extended position, and turn client to prone position three times a day to prevent hip flexion contracture. Be aware that phantom pain is real; it will eventually diappear, and it responds to pain meds. Handle affected ody part gently and with smooth movements. Provide passive ROM until client is able to perform active ROM. Collaborate with rehab team members for mobility improvement. Encourage independence in self-care, allowing sufficient time for client to complete care and to have input into care.

Answer 95

The residual limb or stump should be elevated on one pillow. If the residual limb is elevated too high, the elevation can cause a contracture.

Answer 96

Elevate stump for first 24 hours. Do not elevate stump after 48 hours. Keep stump in extended position, and turn client to prone position three times a day to prevent flexion contracture.

Answer 97

Be aware that phantom pain is real and will eventually disappear. Administer pain meds; phantom pain responds to meds.

Answer 98

Passive ROM exercises, elastic stockings, and elevation of foot of bed 25 degrees to increase venous return.

Answer 99

loss of articular cartilage. Slow deterioration. Non-inflammatory. Mobile joints such as spine, knee, hip, and, foot, knees and hips are most predominant because of weight-bearing. Equal opportunity disease for men women and race.

Answer 100

yellow, opaque, rough, areas of malacia, increased cartilage growth Loose fissures and cartilage become loose and is first seen on x-ray a normal joint is smooth white and translucent cartilage

Answer 101

aging, obesity, occupations, athletic overuse, gymnastics, metabolic disease such as diabetes and hemophilia, genetics. Secondary degenerative joint disease can occur from a congenital anomaly, sepsis.

Answer 102

symptoms are initially in the joint. It is not a systemic problem. Signs and symptoms depend on the point or joint. Pain on weightbearing and motion and relieved by rest is initial symptom. As it progresses rest does not relieve the pain in the patient is often awakened at night, this is when surgery becomes an option. Fatigue, fever Will have stiffness after rest. If they sit for an hour or two and then get up you can see their symptoms in the way they get up. People with degenerative joint disease will usually use some assistance getting up and stand there for a minute or two and then go on. Weather can cause more pain in the joint as it is affected by a lowering of the barometric pressure and increased humidity. There may be crepitus and the joint when they move. There may be some malalignment so that the legs don't look symmetrical. Major point is that degenerative joint disease is not a system problem is a joint problem. Over time you will get some systemic response such as fatigue from pain and the body trying to protect itself from the pain and they will also get a fever if synovitis is going on.

Answer 103

men. Can be very disabling. It is a joint problem but is frequently seen in both hips because as you tried to splint the pain on one side, it changes your alignment and starts to break down on the other side. The patient will say that the pain is in the leg, inside of the leg, around the knee, in the client, and has general hip pain. With this kind of pain it becomes difficult to sit and stand. Important consideration of living for these patients: don't have them sit in a chair where their needs are higher than their but because this is about alignment for them and they boost the ability to get up easily because it takes more momentum. There is a decreased range of motion in the hip, crepitus, flexion deformity. Lifestyle considerations are to decreased walking. Older adults will have lots of other symptoms as well when they stopped walking With hip involvement there is pain: weight bearing, sitting and rising become difficult.

Answer 104

more common in younger people. Dancers. Softening of posterior surface of knee or patella. Seen in older female clients because of degeneration of femoral and tibial condyles

Answer 105

there are no significant lab findings or x-ray changes. X-ray changes are seen in late stages when you get cracks and fragments. The ESR may be elevated if there is synovitis.

Answer 106

medications -- effective if you add an anti-spasmodic, if there is synovitis he made need a mad that decreases inflammation. Aspirin and nonsteroidal's are used as well as injections of cortisone or hyaluron. Aspirin is used in larger amounts than normal because he can decrease joint inflammation and decreased pain but you have to teach the patient that if they get ringing in their ears they need to decrease the dose immediately. side effects include GI irritation such as ulcers skew can prescribe an enteric coated med. With osteoarthritis, nonsteroidal's are better. injection of cortisone can be very painful and the next day you may become stiff. It can only be done two times a year and the pain it may not be relieved for a long time. Injection of hyaluron prolongs the time they have to have a joint replacement because it cushions the joint. There's low adverse side effects and reduce the need for pain medication. There is a series of 3 to 4 injections and it is a technique associated paint. Decrease pain relieve spasm decrease secondary inflammation rest -- can decreased pain perception. if it is acutely inflamed you can splint it but if you splinted for too long you lose mobility in the joint Systemic -- allow for naps periods: 1 to 2 rest periods per day but this is unrealistic with employment Psychological rest will decrease pain because you are decreasing the stress in the environment You can use TENS if the pain is vertebral as other pain relief measures.acupuncture, glucosamine sulfate with condroitin, hypnosis and music therapy can also work

Answer 107

position the body for functional alignment, not for comfort so encourage patients not to put pillows under her knees and to bend the knees and encouraged them to walk CPM machines can be used because keeping the knee in constant motion prevents it from becoming staff and it decreases start pain when the patient starts weight bearing. CPMs do not replace weight-bearing walking, range of motion, and activity. Research doesn't support functional or quickness of recovery change. heat -- good for long-term pain ice -- better for acutely inflamed joints or immediately postop. Keep it on for maximum of 20 min. and leave it off for one hour. Diet therapy -- with obesity you want to decrease caloric intake. Standard postop diet should be high in proteins and high in calcium her bill and health surgery -- is done for functionality and to relieve pain. Major surgery

Answer 108

dehydration, medications, and insulin levels if the patient is a diabetic Hydration -- the patient in pain may self immobilize so they have problems with dehydration, so check blood in preop. They want to get up and go to the bathroom so they have dehydration issues. For hydration status check skin turgor, input and output, urine specific gravity, smell and look at urine, ask them if they're thirsty. In dehydration, RBCs increase, H&H increases With current medications anticoagulant ability as a concern because orthopedic surgery is bloody. Ask them if they have been taking long-term aspirin. Corticosteroids are a concern because they can delay healing. Look at their insulin Possible infection -- preop make sure you have no indwelling Foley for this patient because infection is a major postop concern. The majority of postop total joint replacement infection comes from intraoperative procedures itself such as the equipment or sterile field. Before surgery prevent infection with high-dose antibiotics. An infection in a joint replacement is more problematic or likely to occur because the peripheral vascular circulation in a joint is very minimal and antibiotic is hard to get into it and the immune system doesn't respond well to it. Sepsis can occur and this will cause if removal of the joint. You can only do one revision and then they end up with a frozen joint. You can use a clean operating room and only have nurses work in that operating room stop smoking preoperatively. If not teach them about incentive spirometers Exercise such as quad setting and gluteal setting, isometric contractions for both sides because a complication of the replacements are DVT's especially in the operative leg because it is very swollen cleaning regimen a day or two p preop must be done

Answer 109

assess cardiovascular for DVT's. The patient with varicose veins are more likely to get DVT's respiratory renal hepatic infection. You can look at the mouth preoperatively for infection indicated by gum disease, dental caries. Urine cultures can be done preop to rule out a UTI 2 to 3 days preop. Most infection however is intraoperative

Answer 110

preoperative preparation includes home of environment evaluation and norms established for postoperative period. Stairclimbing is avoided for three months postop. May have to sleep on first floor. Assess their pedal pulses and document prior to surgery because if they are absent postop it is a major concern. If they were absent preop and also postop this is not abnormal.

Answer 111

preop teaching can be done on positioning, isometric foot and ankle exercises and calf exercises, upper extremity strengthening exercises for a Walker, gait training for a Walker and assistive devices such as Fox polls were grabbers so they don't have to bend over. C & DB and IS

Answer 112

you want a firm mattress, pillows for the abduction splint so that they don't had adduct. You have to keep the legs apart and put a wedge or a pillow between the legs otherwise you can pop the full moral head out of the socket. Raise the head of the bed is more than 45°. You don't want to sit them all the way up because the full moral head will pop out to to the bending action. Have them lying or walking. If they sit in a chair postoperatively or on a commode have them recline and put a pillow behind their back study don't set up but are more at an angle, so bad posture is good for them. When you're turning them, turn them on the unaffected side. We don't want like dropping. Exercise ambulation -- when getting them out of bed by them on their unaffected side, elevate the head of the bed and give it in bed to the unaffected side and then they stand. Have bank get out more frequently because it increases movement and is good for aeration. They may experience orthostatic hypotension so be careful getting them up

Answer 113

``` teach them the importance of abduction do not sleep on the operated side keep affected leg elevated when seated do not cross the legs no stooping ```

Answer 114

worst-case scenario. Immediately stop activity and call the physician signs and symptoms include shortening of extremity which is often the right is shorter than the left and there may be a lump on the right side. They suddenly scream in pain and states they can move the extremity they don't want to go to therapy and pain meds are asked for more frequently. Immediately stop activity and call the physician. They may have a malalignment such as the turned leg, abnormal rotation

Answer 115

treat their pain. Narcotics are well used because surgery is very invasive. It is more effective with anti-spasmodic because of stretching done during surgery. Pre-Medicaid for physical therapy this is a principle of rehab. Pre-Medicaid about 30 min. prior to therapy

Answer 116

they may have a trained for the first 24 hours with 200 to 500 mL of bloody drainage in the hemovak, then 10 mL after the first day. It is a vascular supply so there is a lot of initial drainage. 47 days postop you will see a swollen extremity that is darker on one side and if you have a blowout it's terrifying because the patient has had a decrease in drainage and the train is out but there is some drainage in the knee that's been holding so when the patient then signees and blood squirts out everywhere it's scary. A blowout is not an acute hemorrhage just get some 4 x 4's and tell them that this is not uncommon that this is a blood pocket and it will allow you to live a little better now that it is out. Apply pressure. Can happen and hips and knees. Can continue to ooze for a little bit then stops. warmth decreases

Answer 117

THROMBOEMBOLISM you want to assess every day, use anti-embolic stockings, do ankle exercises. Early ambulation and anti-coagulation is extremely important. 20% of patients with a total joint replacement will have a pulmonary embolism! This is a major concern postop iNFECTION this population is at an increased risk remove their wound suction and indwelling catheter as soon as possible. Assess her temperature routinely postop. they will have a temperature elevation postop. You are looking for a temperature that is higher than this temperature to assess for infection or if it is elevated a week later With hip replacements the pain postop decreases

Answer 118

same concerns as total joint replacement postop. They will have the suction drainage up to the first day with 200 mL in the first eight hours. Use a CPM machine to keep the joy moving. You will see 10° of extension and 50° of flexion the first day and then 90° of flexion by discharge General postop ortho includes bleeding, pain, impaired mobility, and tissue perfusion. With tissue perfusion and he becomes extremely swollen. You may have a hotter need temperature in the affected knee postop and you become concerned about infection or a clot.

Answer 119

the partial or complete surgical removal of the limb as the result of an injury, intolerable pain, gangrene, vascular obstruction, uncontrollable infection, or congenital anomalies

Answer 120

provide the client with the knowledge and skills needed for physical, emotional, and social adjustment.

Answer 121

Medical (most common reason for amputation) : diabetes, peripheral vascular disease, cancer, gangrene, infection. It is usually the lower extremity for medical reasons and accounts for most amputations. Trauma such as accidents that involve a crushing injury, Burns, frostbite. It is often the upper extremity Congenital anomalies can be upper or lower extremities or birth defects. Least cause of amputations

Answer 122

aging population and the increase in dysvascular conditions such as diabetes

Answer 123

higher chance of getting amputation compared to Caucasians with diabetes.

Answer 124

among adolescents and adults younger than age 45 years

Answer 125

circulation in the witness evaluated for ample blood flow to support a wound or incision healing. As much of the length of the limb as possible is saved to increase the clients ability to use the prosthetic. It is easier for the client to use a prosthesis if they have their own knee joint (transtibial amputation)

Answer 126

obesity often results in diabetes and contributes to dysvascular disease. A minor injury to the lower extremity of the diabetic can result in infection and amputation.

Answer 127

focuses on control of diabetes, proper foot care, and foot screening to reduce the risk of foot ulcers and amputation

Answer 128

begins with daily foot inspection for discoloration and open areas of skin. But screening by a healthcare provider at least every six months includes the use of a monofiliment tto detect changes in sensation of the feet. It is applied to several locations on the bottom of the foot with enough pressure to bend filament. With eyes closed, the client asks to indicate if they can feel the monofilament. Lack of feeling indicates lack of sensation and possible diabetic neuropathy. Other studies include foot and ankle systolic blood pressure, vibration perception threshold, and thermal sense testing. A decrease in circulation may also result in subsequent or sequential amputations involving the same limb. A bypass may have to be done in order to improve blood flow

Answer 129

the first leg

Answer 130

advanced age, young age, and poly trauma.

Answer 131

``` changes in cardiopulmonary capacity reduced neuromuscular coordination visual and hearing impairments weakened musculature limited range of motion changes in memory, learning, executive function, and behavior ``` Other considerations include multiple comorbidities such as heart failure and pulmonary disease which decrease the available energy that can affect rehab outcomes. They may also have dual diagnoses such as blindness and imputation. These problems are a factor in determining if the client will be a prosthetic candidate or not.

Answer 132

true. | They may however be fitted with the prosthesis to enable transfers.

Answer 133

depression, pressure ulcers, falls, and infections

Answer 134

the parents make the decision about surgical amputation for the child and often go through the stages of grief the lost when and future consequences. Training maay be incorporated into play therapy. The child will require multiple evaluations and changes in prosthetic devices due to growth and development.

Answer 135

to a more injuries to physical regions or organ systems, one of which may be life-threatening, resulting in physical, cognitive, psychosocial, psychological impairments and functional disability. They may have to have more than one imputation. Traumatic amputation should be evaluated for other injuries that will affect their ability to participate and we have.

Answer 136

anger, crying, tremors, clenched fists, pursed lips Less obvious signs include withdrawal, denial increase, loss of appetite, insomnia, decreased energy, weight gain or loss, headache, chronic pain, and thoughts of suicide

Answer 137

the loss of function and the loss of independence. clients express fear and go three grieving process: denial, anger, are getting, and acceptance. There may be decreased energy, fatigue, weight gain or loss, restlessness, irritability, chronic pain, and fear of intimacy.

Answer 138

this is true for amputation

Answer 139

bed mobility, use of ambulatory aids such as a Walker, crutches, or wheelchair; and care of the residual limb to prevent contractures and pressure sores.

Answer 140

gait deviations should be noted and any prosthetic issues identified should be corrected

Answer 141

to be able to roll and delay prone independently can essentially determine the client prognosis in terms of other high-level activities such as walking. Transfer is out of the bed, toilet, tub, and car are all tasks that need to be practiced by the client to live as independently and safely as possible

Answer 142

teach them to check their skin of the residual land after the amputation especially when they are in the gait training fees while using a prosthesis. This is important for those with diabetes because they may be unable to feel pain and other types of sensation to their plan.

Answer 143

knee flexure contractures and to protect the land in case of a fall or impact. A knee immobilizeris a long orthopedic brace that prevents those medial or lateral movement and prevents flexion or extension

Answer 144

a hard plastic device that also serves to protect the freshly sutured limb while maintaining the extension

Answer 145

edema of the residual limb is a challenge for the treatment team. Edema is present to some extent and it makes bidding of the prosthesis challenging. If the person with an amputation has a rigid dressing and it has been removed, compression of the lamb for a prosthesis is provided prepares the residual limb. The use of elastic soft dressing is often used in lieu of a shrinker sock to manage edema. When using a soft dressing or elastic bandage, care should be taken to reapply at regular intervals about every four hours. Shrinker Sock generally maintain their position and function for a longer period

Answer 146

frigid dressing. Read wrapping of the limb should occur every 3 to 4 hours. Once there is no longer drainage and the incision is healed, shrinker stocks for the residual limb or stump shrinker's are ordered for edema control and for reshaping the limb

Answer 147

A liner is shaped like a residual limb and is of a thicker material. It is donned with the prosthetic. Once the client begins to use a liner and starts gait training using a prosthesis your she is instructed to wear the liner during the day and the shrinker at night

Answer 148

handheld mirror

Answer 149

lower extremity exercises are given to both sides. Strengthening exercises focus on the extensors of the hip and knee and the hip abductors which act to stabilize the pelvis during gait. Examples of initial exercises include quad sets, bridges, supine hip abduction, abductor pillow squeezes, single knee to chest stretch, and supine internal rotation

Answer 150

prolonged flexion and external rotation at the hip and knee flexion

Answer 151

flexion, abduction, and external rotation of the hip

Answer 152

hip flexure contractures. Clients are urged to lie prone which is on their stomach, beginning for 5 min. at a time, a pillow under the head may be added for greater comfort to the lower back. Clients are to progress from being as tolerated, up to 20 min. for 3 to 4 times a day. Laying supine, and especially sleeping, with their affected leg on a pillow should be avoided --> Leads to need flexure contractures for below the knee invitation and it leads to hip flexure contractures for above the knee amputation. They will not be able to use the prosthetic if these contractures occur.

Answer 153

client is motivated to learn and has the skills necessary for self-care client and/or family are able and willing to learn and have the skills for self-care there is absence of hip or knee contractures other medical problems such as respiratory, cardiac, stroke, or visual problems will not interfere with use of prosthetic limb. Just because a person is not a candidate for gait training with a prosthesis does not mean he or she will not receive any physical therapy. Prosthetics can be fabricated for cosmetic purposes or if they are doing transfers only

Answer 154

the feeling of pain in a lamb or portion of a lamb that is no longer there

Answer 155

massage, gentle stroking of the land, tapping on the residual limb, and ice, meds which include opioid analgesics, antidepressants, anticonvulsants, and benzodiazepines. Alternative modalities include biofeedback, transcutaneous electrical nerve stimulation (TENS), hypnosis and acupuncture There may also be residual limb pain especially to palpation. Other bodily pains can also affect a person's gait and functional ability

Answer 156

cardiac disease, diabetes, renal disease, smoking, and physiological problems can influence wound heali. Ischemia or infection may result in residual limb skin breakdown H

Answer 157

cardiopulmonary deconditioning may result from bed rest even before any amputation surgery. Deconditioning refers to a decline in ability to perform functional daily activities due to a prolonged period of inactivity. Past medical history is of any cardiac or pulmonary disease can affect outcomes after amputation, and a diagnosis of peripheral vascular disease will assess the level amputation required The age of the patient and the level of amputation are two most significant predictors of functional outcomes

Answer 158

falls, skin breakdown, and additional complications related to prosthetic use. 1 in 5 patients with lower extremity amputations would experience a fall during inpatient rehabilitation. It is important for him or her to now have to get up as independently as possible. A fall early in the recovery process can lead to the opening of the sutures and the need for revision by the surgeon. protecting the residual limb is of utmost importance, so clients are given a rigid protector to protect the land when they are out of bed. Redness, rashes, and skin lesions must be treated seriously. Clients are taught to inspect their skin before and after putting or taking off a prosthetic. It should be noted if their skin integrity is compromised especially along bony prominences and weight-bearing areas. The prosthetic can be modified to accommodate

Answer 159

front wheeled walker. If the client ambulate as well they may progress to bilateral auxiliary crutches, a single crutch, a single point cane, and finally to know assistive devices.

Answer 160

rehabilitation of the amputee is a long process. This may mean that the person goes home in a wheelchair level and comes back to therapy for prosthetic training to achieve a normalized gait.

Answer 161

not everyone is a candidate for prosthetic. The amputee must have adequate strength, range of motion, and control of the proximal joints of both lens. Balance, fear, pain, attitude, and proprioception which is the knowledge of the position of limb and joint in space. Each play a role in determining the appropriateness of a prosthetic. Other key factors include the level of the imputation, the condition of the residual land, and overall health and fitness. Individual goals of a person with the name patient was the considered. If a person with an amputation is able to ambulate on crutches or walkers before amputation here she will be able to function with a prosthetic

Answer 162

edema, reduces the possibility of contracture, generally improves overall physical condition, and improves psychological well-being.

Answer 163

it provides a means for transferring the weight of the body to the ground through the prosthesis. The shape of socket is critical to both comfort and function.

Answer 164

ventilation and general comfort. It should be put in the laundry daily.

Answer 165

also known as above the knee amputations.

Answer 166

when the prosthetists adjusts the alignment to make walking have effortless and natural as possible

Answer 167

heel heights are consistent in all shoes

Answer 168

2 to 6 weeks. During prosthetic fitting and alignment the prosthesis provide initial training in the basic principles of standing and walking. To achieve an optimal gait and prosthetic function, training in the use of the prosthesis is necessary.

Answer 169

short periods of several hours and wearing time increases as appropriate

Answer 170

there is an increase in oxygen consumption by that dysvascular amputee using the prosthesis. If the client has chronic obstructive pulmonary disease or other respiratory problems increase in energy and oxygen needs may preclude the client from being a prosthetic candidate.

Answer 171

table 19.6

Answer 172

knowledge deficit, self-care deficit, impaired mobility, body image disturbance, grieving related to loss of body part, and alteration in comfort due to phantom pain or operative stump pain.

Answer 173

involve the client, family, and caregiver in setting goals. Encourage client independence

Answer 174

Patients with an MI, ICP, or glaucoma intervene if see happening (patient alternates contraction and relaxation of muscle).

Answer 175

6" and to the side so that don't trip over

Answer 176

2" (2 fingers)

Answer 177

3 point gait

Answer 178

Outward so the pt doesn't trip on them

Answer 179

The strong side. Move with bad leg

Answer 180

Good leg 1st because up to heaven

Answer 181

Beg leg 1st because down to hell

Answer 182

pull ups on trapeze hanging on ceiling

Answer 183

Move limb/cast with palm of hand not fingers bc takes 24 hours to dry and can leave indents that can cause compression or bruising.

Answer 184

Don't stick anything down to scratch blow cool air with hair dryer down cast.

Answer 185

Warm soapy water and lotion. NO infection if smells=normal.

Answer 186

Clot slowing or decreasing venous return, it affects a vein, the leg is warm, reddened, slightly swollen, pain is moderately or easily controlled, a complication is PE, and it is treated with anticoagulants and bedrest.

Answer 187

Severe swelling after trauma or tight cast/dressing. It affects an artery, numbness and tingling will be present, the extremity will be cool and pale, pain will be severe and uncontrolled with narcotics, if untreated can lose extremity, and tx is to remove cast or flay open skin.

Answer 188

Dont bend more than 90*, keep pillow between legs and sit with knees slightly apart, sit on edge of seat and slide affected leg up slightly when getting up or down (toilet elevator), keep knee and foot facing forward, and don't slide leg off of bed (both together).

Answer 189

Side effects: ototoxicity, hepatic necrosis, nephritis, report dark tarry stools, coffee ground emesis, GI distress, or ringing in ears. Inform health care providers prior to procedures (dental/surgery) they should be discontinued 5-7 days prior to surgery to prevent bleeding, and take with food to decrease GI irritation.

Answer 190

DO not apply anything to stump (alcohol->dries, lotion ->too soft), encourage prosthesis when gets up all day to prevent swelling.

Answer 191

The pt shouldn't be up in the chair bc places at risk of contractures. Massage is encourage to aid in blood flow and decrease pain.

Answer 192

remove and call MD

Answer 193

Inflammation, slows bleeding, reduces early edema, decreases bacterial activity, and eases pain. Don't apply ice directly to patients skin, don't fill ice bag or collar with large pieces of ice-they prevent the device from molding, and don't leave the device full of air because it hampers cold conduction (squeeze to expel air).

Answer 194

Wrap the bandage upward and diagonally 2-4 turns to secure the part covering the stump, decrease tightness as wrap upward, down wrap with in dependent position, don't apply lotion to stump, don't secure the bandage to the inner part of the leg (OUTSIDE) to prevent irritation.

Answer 195

b/c they're missing a limb and need to compensate

Answer 196

like a cone???

Answer 197

rather, elevate the FOB

Answer 198

by extending the limb by placing the pt in the prone position

Answer 199

a tourniquet at the bedside in case of massive hemmorhage

Answer 200

a mechanical device designed to provide continuous motion for a particular joint using a predetermined range and speed with the knee being the most common joint treated. This prevents the formation of scar tissue the machine is set to gradually increase flexion and extension of the knee Keep CPM off of the floor

Answer 201

hyperextended or hyperflexed

Answer 202

pain relief, and do neruovascular checks. Keep CPM off the floor

Answer 203

neurovascular checks; monitor drains (don't want fluid to accumulate in tissue); over-bed trapeze to build upper body strength

Answer 204

Neutral Rotation is important - toes to the cieling; Limit flexion; we want extension of hip and abduction

Answer 205

isometric exercises while still confined to bed, b/c we want to ensure good venous return and muscle tone

Answer 206

padding placed onsides of legs and feet of a client in bed, to prevent abnormal outward rotation and related sequela. It prevents external rotation

Answer 207

No weight bearing, and minimize stress until the doctor says so, avoid crossing legs and bending over. it is NOT okay to sleep on operated side. Hydration is very important

Answer 208

dislocation; infection; avascular necrosis; and immobility problems

Answer 209

circulatory and nerve damage. you'll see shortening of leg, abnormal rotation, pt is in pain and unable to move extremity

Answer 210

so give prophylactic antibiotics (just like heart valve replacement); Remove foley and drains asap, these can serve as a portal for infection

Answer 211

death of tissue due to insufficient blood supply

Answer 212

walking, swimming, rocking chair for grandma

Answer 213

low chairs, traveling long distances, sitting more than 30 mins, lifting heavy objects, excessive bending or twisting, stair climbing

Answer 214

The foot falls down at the ankle; permanent plantar flexion, they have boards and boots and hi-tops that prevent his

Answer 215

1. Shrinking the residual limb and shaping it into a conical form help to ensure the comfort and fit of the prosthetic device; wrapping helps to shrink the size.

Answer 216

injury to the brachial plexus nerves

Answer 217

male, diabetic, African-American. Has more amputations for failed peripheral vascular surgeries.

Answer 218

phantom limb pain is actual perceived pain, Internet a cases the phantom pain doesn't last as long. And phantom limb phenomena there may not be pain he may just feel coldness, heat, numbness, tingling. It is an awareness. Stump pain is not abnormal

Answer 219

nno other general conditioning and their self-care ability. If they were not walking and doing self-care prior to the amputation they won't do it post amputation. With a below the knee amputation it takes 100% more energy to walk. With an above the knee amputation it takes 200% more energy so if they weren't walking before they won't be walking afterwards.

Answer 220

pros: it can help shape it. You can take it off and look to see what's going on. We do it because it shapes and you can have them up and walking within 72 hours. This becomes important because it increases body image and self-esteem Cons: it is not weight bearing because the can break. They cast in the OR so if the mold is interrupted it can cause indentation of the skin and skin breakdown. You can't clean inside it or see if there's an infection. It is a warm dark and moist so it can harbor bacteria

Answer 221

pros: it doesn't inhibit circulation. You can see what it's doing. It's open to air and you can check on it Cons: it is open to air and can get infected. It does not form the limb

Answer 222

micturition (urinating), defecation, coughing, yawning, crying, eject elation

Answer 223

the feeling of a shortening of the lost limb or changes shape. With phantom limb phenomena you feel that when but over time it telescopes and save away. You perceive that you can pronate and supinate the lamb but it's not there. Over time it loses distinctness and seems to retract up into the area that it was amputated

Answer 224

it occurs and telescoping when, the proximal part shortens, the distal part moves up the stump It refers to the fact that over time the fingers somewhat good together the can only have the use of three fingers, then to, then the hand. The perception of the land fades away in the brain or memory

Answer 225

the cause is unknown we should treat the symptom which is pain. Signs and symptoms include: It appears in the distal part such as the toes fingers and insipid foot The extremity feels as if it is in a variety of positions and it sometimes feels like the fingernails are digging into the palms like a vise grip Intensity ranges from discomfort to intolerable pain

Answer 226

send them to the prosthetician

Answer 227

cold or heat with manipulations Stump elevation Electrical stimulation Emotional pleasure such as ejaculation and orgasm Massage Rest because when you are tired pain gets worse Well fitted prosthesis Precaution Blood pressure cuff but tell them to inflated to the point where they can still get a blood supply down and back

Answer 228

diet. Some patients should have 60% carbs, low protein, moderate fat Analgesics because narcotics are discontinued Anticonvulsants for cramping or shooting pain GABA Tricyclic antidepressants Beta blockers (PROPRANDOL) Sympathetic block Stump manipulation such as a good fitted prosthesis Acupuncture because it releases endorphins Electrical stimulation massage (TENS)

Answer 229

use a stump shrinker. It is custom-made. Should get a new stump shrinker when the stump shrinker gets loose. It takes three days to make. They will have a lot of swelling postop so they may do it after the first week following surgery?

Answer 230

it articulates of the foot and knee. The difference is that this has a computerized chip.. They do a gait study to identify how a person walks and then they change the distribution of the body and they don't have to change the body position (hips) two sit or stand. There gait becomes more normal. You can't go into water because his computerized. It is hooked up to a telephone and can make adaptations without going somewhere. The average soldier with an above the knee amputation has three different lags and eight different feet. Perfect skin: they take an impression and put it onto a plastic and covered over prosthetic. It's big for older adults but it is not popular with younger populations.

Answer 231

emotion focused behavior uses avoidance efforts to divert away from thoughts and feelings caused by stress. These are maladaptive and result in poor outcomes Problem focused behavior utilizes adaptation and results in improved outcomes

Answer 232

avoidance coping characterized by both active and passive attempts to avoid thoughts, feelings, memories, and bodily sensations the individual considers negative. This detection is critical because it can be extremely disruptive and is related to increased levels of depression. Detection can also prevent complications in selected rehabilitation outcomes. Intervention to prevent avoidance is likely to produce positive outcomes. Promotion of acceptance and encouraging a strong commitment to engage in three hours of inpatient therapy as well as outpatient settings and physician appointments is essential for long-term success

Answer 233

specific coping mechanisms of acceptance, sightings., And social reliance

Answer 234

emotional consequences to the spinal cord injury and evaluated the positive emotional outcomes of personal growth and negative outcomes of helplessness and intrusion.

Answer 235

true for multiple sclerosis patients and other persons with diagnoses that involve cognitive decline such as dramatic and non-traumatic brain injuries

Answer 236

the decree of faith and religious belief in relation to medical care.

Answer 237

nurses should use diagnostic tools to determine the degree of coping strategies. Teaching materials should be designed to encourage productive coping strategies such as problem solving, focusing on the positive, and reaction and relaxation.

Answer 238

the severity of injury and the EU chat time of injury Pneumonia, pulmonary embolism, and septicemia are leading causes of death after spinal cord injury

Answer 239

spinal tumors, degenerative changes, infections, embolic events, or congenital abnormalities

Answer 240

stabilizing respiratory, cardiac, and musculoskeletal systems. Corticosteroids are given during this phase within 48 hours of injury. The goal in stabilizing the fracture is to decompress the spinal cord and realign the vertebra

Answer 241

the absence of spinal reflex activity BELOW the level of lesion. Spinal shock can result in disruption of the autonomic system and can lead to HYPOtension and bradycardia. Spinal shock can last 812 weeks after injury. Return of reflexes below the level of injury signals of the resolution of spinal shock

Answer 242

bowel and bladder, respiratory system, sensation, muscle tone, circulation, and sexuality and fertility Secondary complications include UTIs, pressure ulcers, pain, depression, specificity, pneumonia, autonomic dysreflexia, heterotrophic bone ossification, and renal damage

Answer 243

no motor or sensory function below the level of injury

Answer 244

upper motor neuron injury or a lower motor neuron injury

Answer 245

damage to the motor pathway between the cerebral cortex and the end of spinal cord. Injuries @ T-11 to L-1 and above (cervical and thoracic) They typically demonstrate a reflexic (spastic) motor pattern.

Answer 246

represent damage to the motor neurons connecting the spinal cord to muscle fibers. Injury @ L1 and below (lumbar and sacral) Demonstrate an areflexic (FLACCID) motor pattern

Answer 247

upper motor neuron injury Has neck flexion, extension, rotation Weakness: total paralysis of trunk and upper and lower extremities VENT DEPENDENT because the diaphragm may be paralyzed and they are unable to clear secretions. TOTAL ASSISTANCE in all realms of daily care however they may be able to operate with a POWER/TILT WHEELCHAIR with a "sip 'n puff" assistive device which allows them to control devices such as a wheelchair by inhaling or exhaling through a straw Goals of rehab include bladder care, bowel regulation, pulmonary care, increasing sitting tolerance, determining and providing appropriate equipment and technology, educating the patient to direct care is needed 24 hour care is typically needed

Answer 248

upper motor neuron injury Remaining movement include neck flexion, extension, rotation, and scapular movements. Weakness: trunk, upper and lower extremity weakness, inability to cough, and respiratory reserve may be diminished secondary to paralysis of the intercostal muscles. Total assistance is needed within all rounds of daily care however this patient may be able to breathe without a ventilator. Can operate a power/tilt wheelchair. Goals of rehab include bowel and bladder care, pulmonary care including cough assist, increasing sitting tolerance, determining and providing appropriate equipment and technology, and educating patient to direct care is needed 24 hour care typically needed

Answer 249

upper motor neuron injury movements remaining include shoulder and elbow movements. Weakness: absence of elbow extension/supination and all risk/hand movements as well as total paralysis of trunk and lower extremities. Can perform self-feeding with equipment and set up as well as grooming tasks, turning pages, writing, pressing buttons with adaptive equipment. Respiratory endurance and vital capacity or diminished so they may require assistance to clear secretions. They remain dependent with bowel and bladder care. personal and home care are required

Answer 250

upper motor neuron injury Remaining movements include C5 movements (movements remaining include shoulder and elbow movements.) plus wrist extension and forearm supination. Weakness: absinthe the wrist flexion, elbow extension, and hand movement. There is a total paralysis of trunk and lower extremities. May be able to empty a leg a bag, assist with level transfers, feed self with minimal assistance, bathe and dress upper body, and drive a car from wheelchair level. They should be able to propel a wheelchair manually on indoor surfaces. Respiratory endurance and vital capacity remains diminished and they may continue to require assistance to clear secretions. Some personal and home care needed

Answer 251

upper motor neuron injury Movements remaining include C6 movements plus elbow/wrists extension and finger and thumb movements. Weakness: limited hand dexterity and paralysis of trunk and lower extremities. May require assistance with bladder, that nobility, and lower extremity dressing activities that can use the triceps are muscles and thus performed manual pressure release independently. Independent with eating, grooming, level transfers, and upper extremity dressing and may be able to drive a car from a bona fide captains chair. Is able to propel a manual wheelchair on even outdoor terrain. Respiratory endurance and vital capacity remain low and they may continue to require assistance to clear secretions.

Answer 252

LOWER motor neuron injury move the remaining includes fully intact upper extremities with limited upper trunk stability Weakness: lower trunk and lower extremity paralysis. Independent with most realms of self-care, in car with hand controls, with light housekeeping, and with management of wheelchair. Vital capacity and endurance remain compromised and they remain the wheelchair dependent. Minimal home making assistance is required

Answer 253

lower motor neuron injury remaining movement includes good chunk stability and upper extremity movement. Weakness: paralysis a lower extremities. Has same funcitonal expectations as T9. However, they have an intact respiratory function unlike T1-9

Answer 254

lower motor neuron injury Remaining movements include partial to full control of lower extremities Weakness: partial paralysis a lower extremities Expected functional outcomes include bathing with the tub bench, standing and heavy housekeeping, and functional ambulation with appropriate orthotics or assistive devices. They may still require hand controls for driving

Answer 255

complete injuries indicated total damage to the spinal cord nerve pathways Incomplete injuries present with varying degrees of sensory, motor, and autonomic function and varying degrees of recovery from partial to complete

Answer 256

hyperextension injury to cervical region and older adults Motor deficits are greater in the upper extremities and lower extremities so they present with the gate that is less affected that they have difficulty in feeding themselves, performing hygiene needs, and dressing. Degree of bowel and bladder dysfunction is variable. The functional goal of walking is usually achieved in these individuals

Answer 257

rare Occurs when there is damage to the interior spinal artery which can be caused from the fragments or a herniated disc. Results in paralysis and loss of pain, temperature, and touch sensation. However position sensors preserved. Not very many patients experience return of motor function. p. 272

Answer 258

true., Incontinence is a major contributor to psychological distress and represent a limitation factor in independence and resumption of normal activities which include sex. Bowel management programs are usually a lifelong consequence of spinal cord injury. A successful bowel program should be scheduled at the same time every day within 30 min. of ingestion of food or warm liquids which stimulate the gastrocolic reflex.

Answer 259

put patient inside line position Rectal check and manual removal if needed insertion of suppository Digital stimulation which may cause autonomic dysreflexia Assume an upright position if possible Rectal check post evacuation Repeat program is no results or if stool present post evacuation Stool should be soft

Answer 260

put the client in an upright position..or a sideline position is not possible encourage patient to perform a Valsalva maneuver or lean forward while bearing down. The bladder should be empty before performing this maneuver If evacuation does not occur perform manual removal Digital stimulation may or may not be effective Repeat manual removal and told rectum is clear Stool should be firm but not hard

Answer 261

S2-4 so most spinal cord injuries result in some type of bladder or avoiding involvement. Spinal cord injury above the level of the sacrum results in uninhibited bladder contractions also known as reflex bladder. Spinal cord injury at or below the level of the sacral cord results in an areflexic bladder pattern. They have a flaccid bladder which leads to platter over distention.

Answer 262

noncompliance with catheterization times, recurring UTIs, urethral irritation, and development of false urethral passage.

Answer 263

intercostal muscles, neck muscles, diaphragm, and abdominal muscles. After spinal cord injury in the muscles might be effective. Injuries above T 12 maintain the function of the for respiratory muscle groups. The hired injury the creative the lost respiratory muscle controls. Respiratory complications after spinal cord injury remained the number one cause of morbidity and mortality in acute and chronic spinal cord injuries.

Answer 264

Spasms may assist them with the evening, transferring, or walking. Spasticity should not be confused with the return of function or seizures. Though in voluntary due to their intensity, muscle spasms take a lot of body energy and can the person who has frequent spasms tired.

Answer 265

decreased muscle spasms. Side effect is drowsiness

Answer 266

if left untreated it can cause seizures, brain hemorrhage, and death. It occurs with spinal cord injuries at or above T6. More common in males. It is caused by anything the body interprets as a noxious stimulus below the level of injury. Most commonly caused by a distended bladder were bowel. Other triggers include ingrown toenails, tight clothing, women's, sexual activity, infection, pregnancy, fractures, DVT's. PRIMARY SYMPTOM: is rise in blood pressure of 20 to 40 above patient's baseline with an accompanying headache.. Other symptoms include bradycardia, Flushing, goosebumps, nasal congestion, and sweating above the level of injury. Every patient manifests autonomic dysreflexia differently was important to note each patient symptoms

Answer 267

finding and removing the irritating stimulus. The first step is to check the patient's blood pressure. If autonomic dysreflexia is confirmed the patient's head should be raised and their legs lowered to decreased blood pressure. The next step is to remove any type of constricting clothing which helps lower blood pressure further. Third step is to find the cause. Indeed the bladder and bowel to look for cause. If you can find a cause keep the blood pressure under control. Nitro paste or nitro pills are often used to bring the blood pressure down rapidly. Surgery may be needed if the cause is internal such as kidney stones.

Answer 268

bowel, bladder, and skin care

Answer 269

the patient is not able to adapt to changes in position. If symptoms occur the head of the bed is lowered for the wheelchair is a client in the legs or elevated. Compression stockings should be applied to the lower extremities and an abdominal binder can be used to help increase venous return. Drink adequate amts of water, slowly change positions, and do ankle pumps. ProAmatine can be administered. balanced diet. extra time may be needed for a patient to safetly attempt movement after eating. Use an TILT TABLE. after a person with a SCI is able to tolerate sitting up in a bed then sitting up in a chair, use a tilt table --stimulates a standing position by securing the pt to the table when it is flat then increasing the incline as tolerated.

Answer 270

the body's ability to maintain temperature within normal limits of 97 - 100 degrees Fahrenheit. With a spinal cord injury of the autonomic system may be impaired in such a way that it interrupts the normal regulatory functions of the body. The spinal cord injury patient becomes POIKILOTHERMIC --so they have a body temperature that varies with the temperature of their environment

Answer 271

use a fan or application of ice packs if not contraindicated room decreased sensation. if they are too hot you can't remove blankets or heavy clothing, spray the body with cold water, stay in the shade, or drink cool liquids. Body temperature is below 97 that occur in colder climates can be managed by adding coverings or covering the had. Hot and cold liquids should be used with caution because of the risk of burns. Do not place hot packs or cold packs directly on the skin of a person with a spinal cord injury.

Answer 272

difficult problem after spinal cord injury. The experience neuropathic and musculoskeletal pain. Chronic pain is from abnormal communication and processing between the brain and the rest of the body. Musculoskeletal pain results from overuse of tissues in the body such as bones, joints, and muscles. This type of pain is usually relieved with narcotics and nonsteroidals. Neuropathic pain is unrelated to movement and often worsens with infections. It is a pins and needles pain. It is associated with allodynia which is pain from something that is usually not painful. It is also from hyperalgesia which is extreme pain from something that normally causes little pain. Anticonvulsants or antidepressants may help manage it. TENS, acupuncture, massage, and relaxation

Answer 273

level: generally a complete lower level injury precludes the ability to have an erection. Patients with an upper level injury can have erections. The higher the injury the more chance of achieving and maintaining a complete erection severity: if the injury is incomplete there is a better chance for a complete erection Time elapsed since injury; men who are unable to have an erection shortly after the injury may regain the capability during the first year Type: spastic paraplegics have a much greater chance of achieving an erection than individuals with flaccid paraplegia

Answer 274

common. Chronic pain sufferers often experience depression. It is important to alleviate pain to help with the patient's psychological well-being

Answer 275

age-related changes have been found to occur as early as 15 years after injury and around 45 years of age. The experience high rates of shoulder dysfunction, overuse syndrome, and carpal tunnel syndrome. They're more likely to develop pressure ulcers, osteoporosis, and fractures and more likely to have decreases in pulmonary function, insulin resistance, cancer, gallstones, pancreatitis, coronary artery disease and paint. This may result in the need for more assistance with self-care, new equipment, and changes in the working and living environment.

Answer 276

true. Page 475 has, diagnoses addressed by life care partner.

Answer 277

Teach the purpose of a prescribed bowel program. rationale: Fecal impaction is a common stimulus for autonomic dysreflexia. The other actions may be included in the plan of care but will not reduce the risk for autonomic dysreflexia.

Answer 278

The patient has continuous drooling of saliva. rationale: Drooling indicates decreased ability to swallow, which places the patient at risk for aspiration and requires rapid nursing and collaborative actions such as suctioning and possible endotracheal intubation. The foot pain should be treated with appropriate analgesics, and the BP requires ongoing monitoring, but these actions are not as urgently needed as maintenance of respiratory function. Absence of the reflexes should be documented, but this is a common finding in Guillain-Barré syndrome.

Answer 279

IV infusion of immunoglobulin (Sandoglobulin). rationale: Because the Guillain-Barré syndrome is in the earliest stages (as evidenced by the symptoms), use of high-dose immunoglobulin is appropriate to reduce the extent and length of symptoms. Mechanical ventilation and tube feedings may be used later in the progression of the syndrome but are not needed now. Corticosteroid use is not helpful in reducing the duration or symptoms of the syndrome.

Answer 280

hypotension, bradycardia, and warm extremities. rationale: Neurogenic shock is characterized by hypotension, bradycardia, and vasodilation leading to warm skin temperature. Spasticity and hyperactive reflexes do not occur at this stage of spinal cord injury. Lack of movement and sensation indicate spinal cord injury, but not neurogenic shock.

Answer 281

Positioning the patient's right leg when turning the patient rationale: The patient with Brown-Séquard syndrome has loss of motor function on the ipsilateral side and will require the nurse to move the right leg. Pain sensation will be lost on the patient's left leg. Left arm weakness will not be a problem for a patient with a T7 injury. The patient will retain position sense for the left leg.

Answer 282

full function of the patient's arms will be retained. rationale: The patient with a T1 injury can expect to retain full motor and sensory function of the arms. Use of only the shoulders is associated with cervical spine injury. Loss of respiratory function occurs with cervical spine injuries. Bradycardia is associated with injuries above the T6 level.

Answer 283

Teach the patient how to self-catheterize. rationale: Because the patient's bladder is spastic and will empty in response to overstretching of the bladder wall, the most appropriate method is to avoid incontinence by emptying the bladder at regular intervals through intermittent catheterization. Assisting the patient to the toilet will not be helpful because the bladder will not empty. The Credé method is more appropriate for a bladder that is flaccid, such as occurs with a reflexic neurogenic bladder. Catheterization after voiding will not resolve the patient's incontinence.

Answer 284

push a manual wheelchair on flat, smooth surfaces. rationale: The patient with a C6 injury will be able to use the hands to push a wheelchair on flat, smooth surfaces. Because flexion of the thumb and fingers is minimal, the patient will not be able to grasp a wheelchair during transfer, drive a car with powered hand controls, or turn independently in bed.

Answer 285

Ask for the patient's input into the plan for care. rationale: The patient is demonstrating behaviors consistent with the anger phase of the mourning process, and the nurse should allow expression of anger and seek the patient's input into care. Expression of anger is appropriate at this stage and should be tolerated by the nurse. Reassurance about the competency of the staff will not be helpful in responding to the patient's anger. Ignoring the patient's comments will increase the patient's anger and sense of helplessness.

Answer 286

develop a plan to increase the patient's independence in consultation with the patient and the spouse. rationale: The best action by the nurse will be to involve all the parties in developing an optimal plan of care. Because family members who will be assisting with the patient's ongoing care need to feel that their input is important, telling the spouse that the patient can perform activities independently is not the best choice. Reminding the patient about the importance of independence may not change the behaviors of the spouse. Supporting the activities of the spouse will lead to ongoing dependency by the patient.

Answer 287

Assessment of respiratory rate and depth rationale: Edema around the area of injury may lead to damage above the C4 level, so the highest priority is assessment of the patient's respiratory function. The other actions also are appropriate but are not as important as assessment of respiratory effort.

Answer 288

observing respiratory rate and effort. rationale: The most serious complication of Guillain-Barré syndrome is respiratory failure, and the nurse should monitor respiratory function continuously. The other assessments also will be included in nursing care, but they are not as important as respiratory assessment.

Answer 289

place the hands on the epigastric area and push upward when the patient coughs. rationale: Since the cough effort is poor, the initial action should be to use assisted coughing techniques to improve the ability to mobilize secretions. Administration of oxygen will improve oxygenation, but the data do not indicate hypoxemia. The use of the spirometer may improve respiratory status, but the patient's ability to take deep breaths is limited by the loss of intercostal muscle function. Suctioning may be needed if the patient is unable to expel secretions by coughing but should not be the nurse's first action.

Answer 290

Leg strength and sensation rationale: The purpose of methylprednisolone administration is to help preserve motor function and sensation. Therefore the nurse will assess this patient for lower extremity function. The other data also will be collected by the nurse, but they do not reflect the effectiveness of the methylprednisolone.

Answer 291

Check the blood pressure (BP). rationale: The BP should be assessed immediately in a patient with an injury at the T6 level or higher who complains of a headache to determine whether autonomic dysreflexia is occurring. Notification of the patient's health care provider is appropriate after the BP is obtained. Administration of an antiemetic is indicated after autonomic dysreflexia is ruled out as the cause of the nausea. The nurse may assess for a fecal impaction, but this should be done after checking the BP and lidocaine jelly should be used to prevent further increases in the BP.

Answer 292

The patient has new onset weakness of both legs. rationale: The new onset of symptoms indicates cord compression, an emergency that requires rapid treatment to avoid permanent loss of function. The other patient assessments also indicate a need for nursing action but do not require intervention as rapidly as the new onset weakness.

Answer 293

Passive range of motion to extremities q8hr rationale: Assisting a patient with movement is included in nursing assistant education and scope of practice. Administration of tube feedings, administration of ordered medications, and assessment are skills requiring more education and scope of practice, and the RN should perform these skills.

Answer 294

Multiple options are available to maintain sexuality after spinal cord injury. rationale: Although sexuality will be changed by the patient's spinal cord injury, there are options for expression of sexuality and for fertility. The other information also is correct, but the choices will depend on the degrees of injury and the patient's individual feelings about sexuality.

Answer 295

a) Urinary catheter care c) Continuous cardiac monitoring d) Avoidance of cool room temperature e) Administration of H2 receptor blockers rationale: The patient is at risk for bradycardia and poikilothermia caused by sympathetic nervous system dysfunction and should have continuous cardiac monitoring and maintenance of a relatively warm room temperature. Gastrointestinal (GI) motility is decreased initially and NG suctioning is indicated. To avoid bladder distention, a urinary retention catheter is used during this acute phase. Stress ulcers are a common complication but can be avoided through the use of the H2 receptor blockers such as famotidine.

Answer 296

e) Immobilize the patient's head, neck, and spine. c) Administer O2 using a non-rebreather mask. b) Monitor cardiac rhythm and blood pressure. a) Infuse normal saline at 150 mL/hr. d) Transfer the patient to radiology for spinal computed tomography (CT). rationale: The first action should be to prevent further injury by stabilizing the patient's spinal cord. Maintenance of oxygenation by administration of 100% O2 is the second priority. Because neurogenic shock is a possible complication, monitoring of heart rhythm and BP are indicated, followed by infusing normal saline for volume replacement. A CT scan to determine the extent and level of injury is needed once initial assessment and stabilization are accomplished.

Answer 297

Degenerative Nuerological disorder- S/S: Hypokinesia, Microghraphia, Dysphonia, Dysphagia, sweating, urinary retention, Dementia, Stooped posture, slow tremors, abnormal movements.- Tx: Give MAOI- Maintain Joint mobility, high fiber diet, avoid thin liquids, speech therapy.

Answer 298

progressive decrease in muscle strength; activity resumes and strength returns after a period of rest- S/S: weak muscles, loss of facial expression, and risk for respiratory failure. -

Answer 299

an acute exacerbation of disease caused by inadequate amount of meds, infection fatigue, stress, or hot temperature

Answer 300

Too much medication-N&V, diarrhea, cramps hypotension. TX: Tensilon to distinguish from Myasthenia Crisis, Atropine to reverse, Respiratory support may be needed

Answer 301

Give medication ON TIME, Frequent rest periods, soft foods, pureed diet, (Crisis): Respiratory function is priority, suction and postural drainage, I & O, Wt. daily.

Answer 302

Rapidly ascending progressive paralysis or weakness that leads to respiratory failure- starts from legs to face.

Answer 303

a degenerative disease which patients become progressively weaker until they are completely paralyzed- S/S: facial twitching, loss of coordination, voice change, repetitive movements.- Enteral feedings, Rehab

Answer 304

Caused from bladder distention- Sudden and dangerous increase in blood pressure

Answer 305

emergency situation-hypertensive crises (elevated systolic pressures of 260-300mm Hg), bradycardia, severe headache and possibly stroke or seizure activity- S/S: full bladder, fecal impaction, wrinkle in clothing, cramps, ingrown toenail, etc. Drug of choice is nitroprusside sodium (Nipride) or Nifedipine (procardia)

Answer 306

Raise the head of the bed immediately to 90 degrees

Answer 307

A client with a high cervical spine injury

Answer 308

noxious stimuli

Answer 309

Put the client in the high-Fowler's position

Answer 310

Quadriplegia with gross arm movement and diaphragmic breathing

Answer 311

Limiting bladder catherization to once every 12 hours

Answer 312

Inability to elicit a Babinski's reflex

Answer 313

Correct Answer: B Rationale: Guillain-Barré syndrome is believed to result from an immunologic reaction that damages the myelin sheath of the peripheral nerves. Acute infection or inflammation of the nerves is not a cause. The peripheral nerves are not destroyed and do not degenerate.

Answer 314

Correct Answer: D Rationale: The most serious complication of Guillain-Barré syndrome is respiratory failure, and the nurse should monitor respiratory function continuously. The other assessments will also be included in nursing care, but they are not as important as respiratory assessment.

Answer 315

Correct Answer: D Rationale: Because the Guillain-Barré syndrome is in the earliest stages (as evidenced by the symptoms), use of high-dose immunoglobulin is appropriate to reduce the extent and length of symptoms. Mechanical ventilation and tube feedings may be used later in the progression of the syndrome but are not needed now. Corticosteroid use is not helpful in reducing the duration or symptoms of the syndrome.

Answer 316

Correct Answer: D Rationale: Clinical manifestations of spinal shock include decreased reflexes, loss of sensation, and flaccid paralysis below the area of injury. Hypotension, bradycardia, and warm extremities are evidence of neurogenic shock. Involuntary spastic movements and hyperactive reflexes are not seen in the patient at this stage of spinal cord injury.

Answer 317

Correct Answer: B Rationale: The nurse has identified that the cough effort is poor, so the initial action should be to use assisted coughing techniques to improve the ability to mobilize secretions. Administration of oxygen will improve oxygenation, but the data do not indicate hypoxemia, and oxygen will not help expel respiratory secretions. The use of the spirometer may improve respiratory status, but the patient's ability to take deep breaths is limited by the loss of intercostal muscle function. Suctioning may be needed if the patient is unable to expel secretions by coughing but should not be the nurse's first action.

Answer 318

Correct Answer: C Rationale: The patient with Brown-Séquard syndrome has loss of motor function on the ipsilateral side and will require the nurse to move the right leg. Pain sensation will be lost on the patient's left leg. Left arm weakness will not be a problem for a patient with a T7 injury. The patient will retain position sense for the left leg.

Answer 319

Correct Answer: B Rationale: The patient with a T1 injury can expect to retain full motor and sensory function of the arms. Use of only the shoulders is associated with cervical spine injury. Total loss of respiratory function occurs with injuries above the C4 level and is permanent. Bradycardia is associated with injuries above the T6 level.

Answer 320

Correct Answer: C Rationale: The purpose of methylprednisolone administration is to help preserve neurologic function; therefore, the nurse will assess this patient for lower-extremity function. Sympathetic nervous system dysfunction occurs with injuries at or above T6, so monitoring of BP and heart rate will not be useful in determining the effectiveness of the medication. Respiratory and GI function will not be impaired by a T10 injury, so assessments of these systems will not provide information about whether the medication is effective.

Answer 321

Correct Answer: A Rationale: Because the patient's bladder is spastic and will empty in response to overstretching of the bladder wall, the most appropriate method is to avoid incontinence by emptying the bladder at regular intervals through intermittent catheterization. Assisting the patient to the toilet will not be helpful because the bladder will not empty. The Credé method is more appropriate for a bladder that is flaccid, such as occurs with a reflexic neurogenic bladder. Catheterization after voiding will not resolve the patient's incontinence.

Answer 322

orrect Answer: B Rationale: The BP should be assessed immediately in a patient with an injury at the T6 level or higher who complains of a headache to determine whether autonomic dysreflexia is causing the symptoms, including hypertension. Notification of the patient's health care provider is appropriate after the BP is obtained. Administration of an antiemetic is indicated after autonomic dysreflexia is ruled out as the cause of the nausea. The nurse may assess for a fecal impaction, but this should be done after checking the BP and lidocaine jelly should be used to prevent further increases in the BP.

Answer 323

Correct Answer: D Rationale: The patient with a C6 injury will be able to use the hands to push a wheelchair on flat, smooth surfaces. Because flexion of the thumb and fingers is minimal, the patient will not be able to grasp a wheelchair during transfer, drive a car with powered hand controls, or turn independently in bed.

Answer 324

Correct Answer: A Rationale: The patient is demonstrating behaviors consistent with the anger phase of the mourning process, and the nurse should allow expression of anger and seek the patient's input into care. Expression of anger is appropriate at this stage and should be tolerated by the nurse. Refusal to acknowledge the patient's anger by telling the patient that the anger is just a phase is inappropriate. Continuing to perform needed assessments and care is appropriate, but the nurse should seek the patient's input into what care is needed.

Answer 325

Correct Answer: D Rationale: Maintenance of sexuality is an important aspect of rehabilitation after spinal cord injury and should be handled by someone with expertise in sexual counseling. Although the patient should discuss these issues with his wife, open communication about this issue may be difficult without the assistance of a counselor. Sildenafil does assist with erectile dysfunction after spinal cord injury, but the patient's sexuality is not determined solely by the ability to have an erection. Reflex erections are common after upper motor neuron injury, but these erections are uncontrolled and cannot be maintained during coitus.

Answer 326

Correct Answer: D Rationale: The best action by the nurse will be to involve all the parties in developing an optimal plan of care. Because family members who will be assisting with the patient's ongoing care need to feel that their input is important, telling the family that the patient can perform ADLs independently is not the best choice. Reminding the patient about the importance of independence may not change the behaviors of the family members. Supporting the activities of the spouse and parents will lead to ongoing dependency by the patient.

Answer 327

Correct Answer: A Rationale: The new onset of symptoms indicates cord compression, an emergency that requires rapid treatment to avoid permanent loss of function. The other patient assessments also indicate a need for nursing action but do not require intervention as rapidly as the new onset weakness.

Answer 328

Correct Answer: D Rationale: Assisting a patient with movement is included in nursing assistant education and scope of practice. Administration of tube feedings, administration of ordered medications, and assessment are skills requiring more education and scope of practice, and the RN should perform these skills.

Answer 329

Correct Answer: C Rationale: Edema around the area of injury may lead to damage above the C4 level, so the highest priority is assessment of the patient's respiratory function. The other actions are also appropriate but are not as important as assessment of respiratory effort.

Answer 330

Correct Answer: B, C, E, F Rationale: The patient is at risk for bradycardia and poikilothermia caused by sympathetic nervous system dysfunction and should have continuous cardiac monitoring and maintenance of a relatively warm room temperature. Gastrointestinal (GI) motility is decreased initially and NG suctioning is indicated. To avoid bladder distension, a retention catheter is used during this acute phase. Stress ulcers are a common complication but can be avoided through the use of the H2 receptor blockers such as famotidine.

Answer 331

Correct Answer: C, A, B, D Rationale: The first action should be to prevent further injury by stabilizing the patient's spinal cord. Maintenance of oxygenation by administration of 100% O2 is the second priority. Because neurogenic shock is a possible complication, continuous monitoring of heart rhythm and BP is indicated. CT scan to determine the extent and level of injury is needed once initial assessment and stabilization is accomplished.

Answer 332

Correct Answer: 3 Rationale: Ineffective Airway Clearance is the priority nursing diagnosis for this patient. The nurse utilizes the ABCs (airway, breathing, circulation) to determine priority. With Ineffective Airway Clearance, the patient is at risk for aspiration and therefore, impaired gas exchange. Fluid Volume Deficit is the nurse's next priority (circulation), and then Altered Tissue Perfusion. If the patient does not have enough volume to circulate, then tissue perfusion cannot be adequately addressed. The last priority for this patient is Impaired Physical Mobility.

Answer 333

Correct Answer: 2 Rationale: Autonomic dysreflexia occurs in patients with injury at level T6 or higher, and is a life-threatening situation that will require immediate intervention or the patient will die. The most common cause is an overextended bladder or bowel. Symptoms include hypertension, headache, diaphoresis, bradycardia, visual changes, anxiety, and nausea. A calm, soothing environment is fine, though not what the patient needs in this case. The nurse should recognize this as an emergency and proceed accordingly. Once the assessment has been completed, the findings will need to be communicated to the healthcare provider.

Answer 334

Correct Answer: 4 Rationale: Spinal shock is a condition almost half the people with acute spinal injury experience. It is characterized by a temporary loss of reflex function below level of injury, and includes the following symptomatology: flaccid paralysis of skeletal muscles, loss of sensation below the injury, and possibly bowel and bladder dysfunction and loss of ability to perspire below the injury level. In this case, the nurse should explain to the patient what is happening.

Answer 335

Correct Answer: 2,4,5 Rationale: The healthcare provider is responsible for initial applying of the traction device. The weights on the traction device must not be changed without the order of a healthcare provider. When caring for a patient in traction, the nurse is responsible for assessment and care of the skin due to the increased risk of skin breakdown. The patient in traction is likely to experience pain and the nurse is responsible for assessing this pain and administering the appropriate analgesic as ordered. Passive range of motion helps prevent contractures; this is often performed by a physical therapist or a nurse.

Answer 336

Correct Answer: 2 Rationale: A common side effect of corticosteroids is hyperglycemia. Stress as well as the medication could cause this person to have periods of elevated blood sugars.

Answer 337

Correct Answer: 1 Rationale: The three major risk factors for spinal cord injuries (SCI) are age (young adults), gender (higher incidence in males), and alcohol or drug abuse. Females tend to engage in less risk-taking behavior than young men.

Answer 338

Correct Answer: 2 Rationale: Within 24 hours necrosis of both gray and white matter begins if ischemia has been prolonged and the function of nerves passing through the injured area is lost. Because the edema extends above and below the area affected, the extent of injury cannot be determined until after the edema is controlled. Neurons do not regenerate, and the edema is the factor that limits the ability to predict extent of injury.

Answer 339

Correct Answer: 1 Rationale: Be attuned to the prevention of a distended bladder when caring for spinal cord injury (SCI) patients in order to prevent this chain of events that lead to autonomic dysreflexia. Track urinary output carefully. Routine use of bladder scanning can help prevent the occurrence. Other causes of autonomic dysreflexia are impacted stool and skin pressure. Autonomic crisis, autonomic shutdown, and autonomic failure are not terms used to describe common complications of spinal injury associated with bladder distension.

Answer 340

Correct Answer: 3 Rationale: Autonomic dysreflexia is an emergency that requires immediate assessment and intervention to prevent complications of extremely high blood pressure. Additional nursing assistance will be needed and a colleague needs to reach the physician stat.

Answer 341

Correct Answer: 2 Rationale: Spinal shock is common in acute spinal cord injuries. In addition to the signs and symptoms mentioned, the additional sign of absence of the cremasteric reflex is associated with spinal shock. Lack of respiratory effort is generally associated with high cervical injury. The findings describe paralysis that would be associated with spinal shock in an spinal injured patient. The likely cause of these findings is not hypovolemia, but rather spinal shock.

Answer 342

Correct Answer: 1,2,5 Rationale: In the emergency setting, all patients who have sustained a trauma to the head or spine, or are unconscious should be treated as though they have a spinal cord injury. Immobilizing the neck, maintaining a supine position and securing the patient's head to prevent movement are all basic guidelines of emergency care. Placement on the ventilator and raising the head of the bed will be considered after admittance to the hospital.

Answer 343

Correct Answer: 2,5 Rationale: Autonomic dysreflexia can be caused by kinked catheter tubing allowing the bladder to become full, triggering massive vasoconstriction below the injury site, producing the manifestations of this process. Acute symptoms of autonomic dysreflexia, including a sustained elevated blood pressure, may indicate fecal impaction. The other answers will not cause autonomic dysreflexia.

Answer 344

false. Flaccidity is a common and potentially disabling phenomena

Answer 345

cannot sweat below the level of lesion.

Answer 346

increasing age ( bimodal) 18-25 yo and elderly Males because of their risky behavior Caucasians

Answer 347

due to a penetrating injury or tumor. That occurs when there is damage to one side of the spinal cord. On the damage side there is a loss of motor function, proprioception, and vibratory sense below the level of injury. On the opposite side there is a loss of pain and temperature sensation. The patient with this type of syndrome can only feel pain on one side of the body. They may experience more return of function than most with SCI

Answer 348

lasts 1 to 6 weeks. The higher the lesion the longer it lasts. Gradual reflex activity returns and begins the periphery then works its way to the core. Plantar flexion of the great toe is the first return. Nursing issues: I spinal shock starts to occur from the point of injury there is a 10 fold increase in spinal cord injury so postinjury assess them for edema Immediately postop be concerned breathing if it is a cervical or thoracic injury During spinal shock you have to compensate for two functions which are bowel and bladder because you can stretch it during shock.

Answer 349

loss of vasomotor control and sympathetic control. They have the potential for autonomic hyperreflexia

Answer 350

they lose intercostal muscles and restoration starts to become a problem

Answer 351

the court is hyper flex with damage to the interior part. They will have anterior paralysis immediately and it will be below the level of injury. Decreased pain sensation below and hypoaesthesia

Answer 352

postemployment if they were not employed prior than they will not be employed after. Paraplegics have a higher incidence of employment postinjury than quadriplegics

Answer 353

electrical wheelchair with high back, portable respirator, mouth stick control. No bowel or bladder fx

Answer 354

electric wheelchair with high back, powered hand splints to allowed to feed themselves, you need to do quad coughing because they can't cough themselves

Answer 355

some self-care Can push self on a flat surface The thumb is weak but they have bicep fx Watch for skin shearing unless they have good arm strength

Answer 356

can roll over and sit up in bed. They have a grasp but not very strong. more independence decreased respiratory is preserved (anything T10 and above has respiratory issues

Answer 357

Grasp full strength Decreased trunk stability They need anti-tipping devices on the wheelchair because they don't have good trunk stability and they can bend over and saw that the wheelchair

Answer 358

wheelchair independent Can stand erect with full body brace (long leg braces). They can walk with a swing through gate or crutches if they don't have a heavy bottom but it takes a lot of energy. However they cannot climb stairs even with braces because they don't have the stability

Answer 359

good sitting balance--full use of wheelchair. may have lower back stability varying control of legs and pelvis

Answer 360

independent in relating with short leg braces. they can use canes and short leg braces and be independent with ambulation. However they do not have good standing balance for a long period of time Continent of bowel and bladder

Answer 361

found with lesions T4-6 and above Hypotension with bradycardia. May have postural hypotension. put them on a tilt table and slowly raise their head. Ephedrine can be used. abdominal binder, elastic stockings, wheelchair tilt. Problems with suctioning d/t bradycardia Do not try to over hydrate DVT --Anticoagulants for spinal cord injury patient is not good. Prevent DVT is by using compression stockings, ambulation or range of motion exercises. No pillows underneath the knees; dont bend the knees too much. maintain good hydration. Ask women with birth-control they are on. Wont be able to feel pain associated with DVT. Check the skin and Mark spots. If one gets bigger than the other and it can be DVT. Increased specificity after that. No spinal shock in one leg may be a sign of DVT. HOMAN SIGN IS NOT GOING TO BE PRESENT Poikilothermia Aging -- body temp decreases with age. they are prone to heat stroke. The higher the level of lesion the more of a problem

Answer 362

ideal environmental temp is 70- 72. We want a lower body temp initially because it decreases the basal metabolic rate Use warm blanket. Do not use heat packs They have excessive sweating around had and upper shoulders. This goes away after six months. It can make them angry and frustrated. They can become dehydrated so push fluid and watched urine output

Answer 363

Flexor -- by noxious stimuli. If we can control it early on makes it easier to control pressure sores and UTIs. Control these flexor spasms by passive range of motion and anatomical positioning. Do not treat spasticity unless there is pain and interferes with therapy. First of of choice is baclofen

Answer 364

the higher the level of lesion the less caloric intake requirement. The of the potential to put on a lot of weight. Obesity decreases mobility. Hyperchlorhydra --increased hyperacidic contents. Treatment?????? G.I. peristalsis is unchanged after spinal shock

Answer 365

smoking contributes to congestion, increased mucus production, more potential for pneumonia and spinal cord patients can't cough, pressure sores are more likely because of the vasoconstriction

Answer 366

Shearing, abrasions, friction. Encourage them to do wheelchair push-ups and pressure release. Put them on their stomach in a prone position even if on a ventilator because it gets them off their butt

Answer 367

mechanical pain is due to an incomplete healing of the bone in the spinal column. It's worse with activity. It is a aching muscle fatigue likely work out too hard. It's worse when you set. Position changes can help as well as TENS and anti-inflammatory medications This role pain occurs a few weeks to a few months postinjury it is uncommon. It is a constant ache discomfort in the abdominal area for the pelvis. It feels like the bowel or bladder is filled. It may be associated with hyper reflexia. Make sure they are not constipated or have a UTI Spinal cord pain--we see this with incomplete injuries. It is felt in the area of the body with decreased sensation. It is due to injury of the spinal cord. It is a tingling sharp burning pain. Distended bladder and spasticity can make it worse. It's uncomfortable but it can be decreased over time up to 20 years. It is like phantom limb pain Segmental nerve- Cauda Equina pain --is a sharp stabbing radiating pain due to a bone fragment. during spinal shock this is not felt because it is masked. You can do surgery and get rid of the bone fragment. Meds do not do well but this but TEGRETOL and NERVE BLOCKS work Overuse pain--is due to the use of other muscles. You most likely get in the arms. It is not due to the injury. They exacerbate carpal tunnel to to the pressure they put on their breasts when trying to push themselves in a wheelchair. If they had tennis elbow before they can get it again because of the weight bearing Psyche pain--idiopathic pain. No treatment. Have to learn to deal with chronic pain

Answer 368

denial phase--consistent supportive interactions are needed. Prism glasses. You want an early sense of control Anger phase--they refuse therapy, complain of intolerable pain, demand constant attention. You want to handle their issues realistically as possible. Get their issues fixed immediately. Allow verbalization. They are angry if the system not you. Never promise in full recovery. Treat them to adapt. Uses are corrected Bargaining phase--may renew vigorous efforts so they will jump into therapy and want to be there every minute, but there adaptive devices make them angry because they wanted on their own but they could before. The experience normal depression of any loss. It is normal and situational. Help talk them through it.

Answer 369

research shows that synchronous activity with involuntary simply event. Will be able to walk following CSI there is potential

Answer 370

functional electrical stimulation--small electrodes stuck into muscle. Stimulates contraction relaxation. Allows them to exercise and strengthen muscles independently. side effects is increase immunity to infections or diseases Diaphragm pacer--radio transmitter implanted understand and place on phrenic nerve. Raises and lowers the diaphragm. Can breathe on their own and be off the vent. Cant speed up or slow down breathing Bladder control--allow the patient to voluntarily control bladder function with the stimulation of the sacral nerve route at base of spine. M these from relaxation sphincters and the bladder contracts may void on their own. Take care problems with skin Hand control--implant electrodes in paralyzed fingers and thumbs and allow their hands to grasp. More independence. Can't do a lot of that is because you need wrist and elbow function to feed yourself

Answer 371

4-aminopryidine --Ca channel blocker. dont use with acute SCI. Methyprednisolone if given within 8 hrs of injury can improve motor and sensory theophyline ******** there are drugs being used to help, but not cure. Here is regeneration and we're working on this.

Answer 372

originating brain and travel and spinal cord. If the press or inhibit lower motor neuron so they do not become hyperactive to local stimuli. Damage to upper motor neurons destroys cerebral influence or control over lower motor neurons. It results in a spastic paralysis due to loss of coordinated and integrated cerebral control over all reflex activity below the level of injury. Experience spasticity of limbs and of bowel and bladder function. Men experience reflex erections.

Answer 373

originated spinal cord and travel outside the central nervous system to form spinal nerves of branches of systemic nervous system. Cell bodies angry matter along spinal cord. Part of the reflex arc. Damage can occur at any segment the significant clinical manifestations results from damage to sacral portion of cord. Sacral damage results in damage to major body functions such as bowel, bladder, sexual response. You have a floppy paralysis of lower limbs. Loss of bowel and bladder tone. The eventual muscle atrophy or wasting. Reflex erections are not possible. Circulatory problems can be more serious because of passive vasodilation and lack of muscle tone. Retention of stool makes a bowel program or just called to regulate.

Answer 374

central system ( brain and spinal cord) Progressive degeneration of neurons No muscle nourishment third atrophies and wastes away and I've Upper motor neuron to lower motor neuron messages are gone Cognition is intact It is my atrophic Idiopathic cause but it can be due to familial inherited gene mutations for a sporadic ALS which is most common and occurs randomly with no identifiable cause for risk factors Excess glutamate can be a cause to little there is no transmission or signal and with too much it kills the nerve cell the other side

Answer 375

men Caucasian Age 56 for predominantly 40- 70 yo It is a variable disease so different for all people. Progression differs. Mean survival time is rated five years. burnout cases have been reported where they were diagnosed the and it goes away

Answer 376

Rilutek can lengthen quality of life

Answer 377

muscle weakness starts and hands arms or legs this is a hallmark sign. Can be speech muscles. An experienced swallowing and breathing problems later Twitching or cramping of muscles special in the hands and feet Thickening of speech is difficult to project their voice Shortness of breath with progression of disease. They have dysphasia and dysarthria Upper motor neuron symptoms result and spasticity of muscles, hyper reflexia, and gag reflex. Babinski is POSITIVE Lower motor neuron symptoms result in atrophy and weakness of muscles, cramping, the fasciculations

Answer 378

``` it is a rule out disease .Do an EMG and conduction velocity of nerves Thurough neuro exam Serum protein electrophoresis Thyroid for parathyroid hormone levels 24 hour urine MRI Muscle or nerve biopsy ```

Answer 379

there is no treatment it is preserving, Rilutek Can use baclofen for muscle spasms. Altrem for muscle cramps. Meds to dry up flag and excess saliva. Nonsteroidal for general discomfort Side effects of meds are liver damage, leukocytes in blood Stem cells may be a treatment Preserved and function, mobility, communication, nutrition, respiratory, bowel and bladder, emotional well-being, pharmaceuticals such as antidepressants help with depression nonsteroidals for discomfort

Answer 380

hand splint. zipper poles. can be fitted

Answer 381

caner brace in early stages. AFO as condition progresses. Electric powered wheelchair with a high back. Low impact exercises such as stationary bike, swimming, walking maintains cardioid sites depression and fatigue. Range of motion helps with spasticity contractures

Answer 382

record speech at an early time it can be programmed into a computer. The fourth necessary decide how you'll communicate before you can speak such as what is yes then what is no. Get things in writing for your safety

Answer 383

patient and family needs to talk about what's to be done and if the client wants a peg or not when they can no longer swallow. Fidelity watch before they lose the ability to speak. Given the numerous small feedings during the day. They had problems with choking and this is an emergent condition so use suctioning. When they cancel all of their devices that can be used to suctioning saliva. Following is a huge problem like communication and respiratory function

Answer 384

usually die of pneumonia. Use BiPAP at night.

Answer 385

Correct Answer: B Rationale: ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help to maintain strength as long as possible. Psychotic symptoms such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.

Answer 386

a degenerative disease which patients become progressively weaker until they are completely paralyzed- S/S: facial twitching, loss of coordination, voice change, repetitive movements.- Enteral feedings, Rehab Progressive (inevitably fatal; usually 3-5 yrs) muscular weakness, wasting, atrophy, spasticity tongue fatigue, nasal speech, dysarthria, dysphasia, aspiration, respiratory insufficiency (usual cause of death), emotional lability, cognitive dysfunction "Lou Gehrig's disease" amyotrophic= muscle wasting; sclerosis= degenerative hardening of lateral cortocospinal tracts, affects upper motor neurons in cerebral cortex & lower motor neurons in brainstem & spinal cord S/S spastic paralysis, hyperreflexia

Answer 387

self-limiting autoimmune disease triggered by bacterial or viral infection. Peripheral neuropathy causes limb weakness. Dresses up to four weeks before reaching plateau. Symptoms caused by inflammation, demyelination, axonal degeneration or both. They think above the sound and bacterial gastroenteritis caused this w/ URI Demyelinating neuropathy MEN Peripheral nervous system involved

Answer 388

rapid progression from weakness paralysis. Hard time moving leg symmetrical. Weakness to paralysis to muscle atrophy to Plato. Initially deep tendon reflexes decrease and then disappear in the involved areas Severity depends upon which nerves are involved Sensory losses variable. There Moorad advantage because they have reduced sensation of pain, temperature, vibration, or physician. those who don't have sensory loss will always be calling into the Van because everything hurt them Autonomic disturbances include tachycardia bradycardia, labile BP, flushing her sweating which lasts about two weeks Respiratory weakness is the number one concern. peripheral Effects can be reversible and it resides after 24 weeks 5% die of respiratory or cardiovascular complications or problems related to immobility such as DVTs The shorter the plateau time the better prognosis for recovery. When they go up quickly to quadriplegia than plateau that will take them a year or more to get back to function Residual is most common is weakness of the foot 4 foot drop. It's worse when they're tired

Answer 389

supportive care Plasmapheresis which exchanges plasma or IgG. It works well in first two weeks of severe upward progression of symptoms but it shortens the duration and decreases the time needed for a ventilator and get the patient walking quicker Bowel and bladder support. Opiates and bed rest make a potential for adynamic ileus greater. watch and listen to bowels because you don't want to continue feeding the patient if their getting an adynamic ileus. stop thieves if there is a decrease in bowel sounds DVT prophylaxis Cardiac and homodynamic monitoring--monitor them for arrhythmias. Bradycardia needs to be treated. May need temporary pacemakers. Suction them but watch affects of suctioning on bradycardia Respiratory issues. If they are having and a sending paralysis and it is above the waist you have respiratory involvement at T4-6, 10. They might have compromised respiratory function and Cough, have an increased risk of aspiration, and fatigue of respiratory muscles pain management--pain is not well controlled. Nonsteroidal's and Tylenol is used. Tricyclic antidepressants can work. GABA. If using narcotics monster effects on bradycardia and respirations

Answer 390

pacing and fatigue If too fatigued there is a paradoxical weakening of the muscles. They may lose weight during the upward swing of the disease. Use assistive devices and make sure they fit well Many report extreme fatigue with no symptoms. Fatigue affects social interactions. Need lifestyle modifications ``` Ascending = plateau? Descending = respiratory? ```

Answer 391

Answer A. The nurse should inform the client that the paralysis that accompanies Guillain-Barré syndrome is only temporary. Return of motor function begins proximally and extends distally in the legs.

Answer 392

Answer D. Guillain-Barré syndrome is a clinical syndrome of unknown origin that involves cranial and peripheral nerves. Many clients report a history of respiratory or gastrointestinal infection in the 1 to 4 weeks before the onset of neurological deficits. Occasionally, the syndrome can be triggered by vaccination or surgery.

Answer 393

Answer C. The client with Guillain-Barré syndrome experiences fear and anxiety from the ascending paralysis and sudden onset of the disorder. The nurse can alleviate these fears by providing accurate information about the client's condition, giving expert care and positive feedback to the client, and encouraging relaxation and distraction. The family can become involved with selected care activities and provide diversion for the client as well.

Answer 394

Begins in extremities: weakness, paralysis, respiratory failure Progressive ascending muscle weakness of the limbs with: symmetric flaccid paralysis; paresthesias or numbness; loss of tendon reflexes. Autonomic nervous system involvement causes postural hypotension, dysrrhythmias, facial flushing, diaphoresis, and urinary retention. Pain occurring with the slightest of movements is a common feature. Crisis: will progress to medical emergency, likely respiratory failure.

Answer 395

D- Electrocardiographic monitoring electrodes and intubation tray

Answer 396

chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of skeletal or voluntary muscles in the body. Variable Hallmark is muscle weakness that increases during periods of activity and did proves after rest. Muscles that control eye and eyelid movements, facial expression, chewing, talking and swallowing are often involved may complain of PTOSIS of EYELID. VI works in the amount of spare. If there is a lesson on the night droops Progresses 5 to 10 years No sensory loss Reflexes are normal Muscle atrophy is not common Rare so it can be misdiagnosed

Answer 397

antibodies attack AChRs which causes fatigue and neuromuscular symptoms Erratic symptomatology and frequently presents and women of 20 to 30 years old HIGH STRUNG FEMALE damages receptor sites and decreases the number of receptor sites

Answer 398

Mestinon Take the medication exactly when due otherwise they can have a myasthenia crisis. Take with milk or crackers to inhibit the GI s/e of abd cramps, N/V, diarrhea side effect: Muscarinic effects: N/V, diarrhea, abd cramps, increased salivation, increased bronchial secretions, diaphoresis. Nicotinic effects: Muscle cramps, fasciculations, weakness

Answer 399

ocular involvement which affects facial expression, chewing, talking. They get tired a lot after a while of chewing Ocular: diplopia and ptosis @ onset. worse in evening because you are tired

Answer 400

Gaze test -- have them look up and you'll see a drooping of the eyelid if they have ocular involvement *******Tensilon (edrophonium chloride) test****** You get the drug IV. It increases the strength 5 to 10 min. after administered. Doesn't last very long it is gone 10 to 15 min. but it is the best test Serum testing you're looking for antibodies Electromyography is harder to get done

Answer 401

quick onset Precipitated by emotional stress, pregnancy, illness or trauma, hypokalemia, surgery Assess the patient Major complications include respiratory because they are at risk for aspiration and it can start within minutes With this crisis they have increased muscle weakness. Calcium channel blockers beta blockers anti-arrythmics

Answer 402

it is the same thing as myasthenic crisis BUT too little or too much?

Answer 403

have ambu bag and intubation ready if they get better they have myasthenic crisis If they get worse they have cholinergic crisis 1. injected intravenously 2. atropine sulfate is antidote for overdose 3. to diagnose MG - most clients will see improvement in 30-60sec/lasts 4-5 min Edrophonium chloride is used. --Decreases amount of cholinesterase(inhibits the enzyme that breaks down Ach) at neuromuscular junction while making Ach avail to muscles and improving muscle contractility within 30-60 seconds

Answer 404

cholinesterase inhibitors --Prevent degradation of ACh. Pyridostigmine bromide. Side effects are muscarinic or nicotinic. Muscarinic -- nausea vomiting diarrhea, abdominal cramps, increased bronchial secretions, diaphoresis. Nicotinic side effects -- muscle cramps, fasciculations, weakness. As they start to get better they have the side effects and you get compliance issues****** Immunosuppressive drugs--prednisone (narrow therapeutic range) ** thymectomy --the removal of the finest land may cause permission of the symptoms. Any patients will want this but they anesthetic drugs are very problematic for this patient. They are at extreme risk for complications Plasma exchange -- plasmapheresis. Use for acute exacerbation. They will only last three months IV IgG --relief is temporary drying out** -- if they need an increased amount of the strength of the drug and they're getting side effects are bed. You hospitalize them and drive them out with a drug holiday. They will be hospitalize that they have respiratory involvement

Answer 405

adjust eating routine Small and frequent meals for less chewing Don't want a lot of hard chewing Avoid soft sticky foods want a high potassium level so have broccoli and bananas want safety at home so card frills and no clutter Electrical or power tools you don't get tired Using eyepatch Plan things ahead of time so by things from the same store instead of going to multiple stores Don't plan on shopping after work because you're tired Get frequent rest periods and explained to the employer that you need 5 to 10 min. rest periods Don't be afraid to ask for help

Answer 406

defect in the transmission of nerve impulses to muscles antibodies block/alter/destroy the receptors for acetylcholine at neuromuscular junction, preventing muscle contraction autoimmune disease that prevents muscle contration Auto immune dz that attacks the receptor sites of Ach in the neuromuscular junction. T cells are attacking these receptors in turn causing m muscle contraction. Only effects skeletal muscle-NOT smooth muscle of organs like bladder or heart Extreme muscular weakness & easy to fatigue-SYMMETRICALLY involved. Gets worse with activity and improves with rest. Leg weakness is less common, but can progress to walking difficulty. Weakness and easy fatigue of arm and hand muscles. Progressive weakness of diaphragm, intercostal and abdominal muscles. DOES NOT ALTER INTELLECTURAL FUNCTIONING OR AWARENESS Affects: 1. voluntary muscles 2. eye control 3. eyelid movement, double vision (diplopia) 4. facial expression 5. swallowing

Answer 407

1. eye weakness (ptosis) 2. difficulty chewing/swallowing (dysphasia) 3. slurred speach

Answer 408

the muscles controlling respiratory function become too weak to provide adequate ventillation Under medication

Answer 409

medication overdose with anticholinersterase They were in a cholinergic crisis and had too much mestinon in their system and you need to give them atropine to reverse it

Answer 410

The eye muscles s/s=diplopia, ptosis

Answer 411

BRADYCARDIA, Weakness, respiratory distress, inability to speak or swallow, restless, increased salivation, lacrimation, bronchial secretions, sweating, GI symptoms (n/v, diarrhea)

Answer 412

Weakness respiratory distress, inability to speak or swallow, TACHYCARDIA, restless

Answer 413

Bradycardia, bronchospasm, neuromuscular, cardiovascular, & ocular reactions

Answer 414

Antibiotics, beta blockers, Ca++ channel blockers, lithium, Mg++, procaine, prednisone, Anticholinergics, muscle relaxers, anesthetics

Answer 415

Rationale: The primary group of medications used to treat myasthenia gravis is the anticholinesterases. Selective serotonin reuptake inhibitors are used to treat depression, neuroleptics are used in psychopharmacology, and anticholinergics are used to treat Parkinson’s disease.

Answer 416

Rationale: Dysphagic clients are at risk for aspiration; matching food consistency to the client’s ability to swallow enhances safety. The dosage of medication may require adjustments. Heimlich’s maneuver will have no effect unless the client has solid food lodged in the trachea. Meals should be scheduled when the client is rested. Pyridostigmine (Mestinon) is given through daily dosage and administration is not associated with meal schedule.

Answer 417

Rationale: The usual cause of cholinergic crisis is overmedication while the cause of myasthenic crisis is under medication. Manifestations of cholinergic crisis include gastrointestinal manifestations, severe muscle weakness, vertigo, and respiratory distress.

Answer 418

the muscles controlling respiratory function become too weak to provide adequate ventillation

Answer 419

1. take meds on time to maintain blood level 2. take w/ small amount of food 3. eat meal w/in 45min-1hr after taking med to decrease risk of aspiration 4. have ER rescuscitation equip/atrophine sulfate for cholinergic crisis

Answer 420

slow, progressive, degenerative disease caused by the depletion of dopamine resulting in the inhibition of excitory muscles

Answer 421

1. falls 2. self-care deficits 3. failure of body systems 4. depression 5. mental deterioration (late in the process)

Answer 422

1. bradykinesia (slow motor movements) 2. sluggishness of physical/mental responses 3. akensia (absence/poverty of movement) 4. monotonous speach 5. tremors in hands/fingers (pill rolling) 6. drooling 7. aphasia/dysphagia 8. shuffling/stooped posture 9. restlessness/pacing 10. loss of coordination/balance

Answer 423

``` assess neuro status assess ability to swallow/chew provide high-calorie/protein/fiber diet provide soft diet w/small frequent feedings increase fluids to 2000 ml/day monitor for constipation assist w/ambulation provide assistive devices instruct client to wear low healed shoes avoid prolonged sitting ```

Answer 424

1. tremors/rigidity/drooling 2. inhibit the action of acetylcholine Contraindicated with: - glaucoma - COPD (can develop dry, thick mucous secretions)

Answer 425

orrect Answer: B Rationale: Rocking the body from side to side stimulates balance and improves mobility. The patient should initially be ambulated with assistance but might not require continual assistance with ambulation. The patient should maintain a wide base of support to help with balance. The patient should lift the feet and avoid a shuffling gait.

Answer 426

Correct Answer: B Rationale: After the dopamine receptor agonists begin to fail to relieve symptoms, the addition of L-dopa with carbidopa can be added to the regimen. Complete drug withdrawal will result in worsening of symptoms. Anticholinergic therapy should be continued to help maintain the balance between the actions of dopamine and acetylcholine. Increasing the dose of bromocriptine will increase the risk for toxic effects.

Answer 427

Correct Answer: C Rationale: The inability to use the tongue and facial muscles decreases the patient's ability to socialize or communicate needs. Disuse syndrome is not an appropriate nursing diagnosis because the patient is continuing to use the muscles as much as possible. There is no indication in the stem that the patient has a self-care deficit, bradykinesia, or rigidity. The oral mucous membranes will continue to be moist and should not be impaired by the patient's difficulty swallowing.

Answer 428

Correct Answer: D Rationale: Hypotension is an adverse effect of L-dopa, and the nurse should check with the health care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not associated with L-dopa use.

Answer 429

Correct Answer: C Rationale: The diagnosis of Parkinson's is made when two of the three characteristic signs of tremor, rigidity, and bradykinesia are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered. This patient has symptoms of tremor and bradykinesia; the next anticipated step will be treatment with medications. MRI and EEG are not useful in diagnosing Parkinson's disease, and corticosteroid therapy is not used to treat it.

Answer 430

Correct Answer: C Rationale: Parkinson's disease and depression are both potentially reversible conditions, and the patient's symptoms that are caused by these two conditions will improve with appropriate treatment. Anticholinergic agents are likely to worsen the patient's condition because they will block the effect of acetylcholine at the synaptic cleft. There is no indication that the patient needs an antipsychotic agent at this time. A selective serotonin reuptake inhibitor (SSRI) may be effective for the depression, but it does not address the patient's other conditions.

Answer 431

Report immediate heart rate

Answer 432

3. The client's postural (orthostatic) vital signs Rationale: Clients with Parkinson's disease are at risk for postural (orthostatic) hypotension from the disease. This problem worsens when L-dopa is introduced because the medication can also cause postural hypotension, thus increasing the client's risk for falls. Although knowledge of the client's use of assistive devices and history of falls is helpful, it is not the most important piece of data based on the information in this question. Clients with Parkinson's disease generally have resting rather then intention tremors.

Answer 433

Correct answer b Rational: the client with Parkinson's disease experiences stiffness/rigidity due to inadequate dopamine production. Dopamine is a neurotransmitter that promotes muscle relaxation. High toilet seat facilitates the client's ability to sit during elimination.

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