WEEK 13 [ADN260] "OSTEOARTHRITIS, PARKINSONS DISEASE, SPINAL CORD INJURIES"

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Mr. Lin has been hospitalized for 23 days and has been in a rehabilitation hospital for an additional 10 days after a motor vehicle crash left him with partial paralysis in both legs. He has sensation but not movement. The nurse is preparing him for discharge home. He is able to perform most​ self-care activities and can get to and from the wheelchair with assistance. Which statement by Mr. Lin makes the nurse aware of the need for a home health​ referral?

"I can wait until my wife is home from work to help me go to the​ bathroom."

Mr. Casey is a​ 34-year-old construction worker who fell from a roof as he was installing shingles. He is being cared for in the emergency department. He sustained fractures at C5 and C6. He is intubated with cardiac​ monitoring, has an intravenous​ (IV) line in​ place, and his neck is immobilized. The accident occurred about 1 hour ago. The health care provider​ states, "We need to do something about the​ swelling." Which type of medication does the nurse anticipate the health care provider will​ order?

A corticosteroid

Which describes a risk factor of Parkinson disease​ (PD)?

Age is the primary risk factor

The lack of automatic muscle movement may cause which potential problem for the client with Parkinson​ disease?

Alterations in sleep pattern

Which medication is used in addition to levodopa to treat dyskinesias associated with Parkinson​ disease?

Amantadine

Which type of medication is administered to the client with a spinal cord injury to prevent deep vein thrombosis​ (DVT) and pulmonary​ embolism?

Anticoagulants

The nurse is planning care for a client admitted with a high thoracic spinal cord injury. Which interventions would be appropriate for the nursing diagnosis of Alteration in​ Perfusion?Select all that apply.

Assess for a full bladder. Assess blood pressure every​ 2-3 minutes.

Which disorder can trigger autonomic​ dysreflexia?

Bladder infection

Mrs. Beal is a​ 75-year-old widow who was diagnosed with Parkinson disease. She moves slowly with a shuffling gait and speaks in a slurred manner with poor articulation. She tries to speak louder to accommodate for this impairment. She uses a walker. She has involuntary movements of her shoulders and arms and has difficulty with ADLs that require fine motor control. Her daughter is her primary caregiver. Mrs. Beal tells you that she has had to rely more and more on her daughter to help her with everyday tasks. She​ states, "I catch my daughter looking at me angrily​ sometimes, but she​ doesn't say anything. I try to stay out of her way when I​ don't need her​ help." What is her priority risk based on this​ information?

Caregiver role strain

A client complains of knee pain during an appointment at a medical clinic. After reviewing the client​'s medical​ record, the nurse notes the client has been taking​ over-the-counter NSAIDs, with no pain relief. The nurse can anticipate the healthcare provider writing a prescription for what medication at ​discharge?

Celecoxib​ (Celebrex)

The nurse is planning care for a client with osteoarthritis. Which potential problem is a priority for the nurse to​ address?​(Select all that​ apply.)

Chronic pain Impaired physical mobility

Which data need to be collected when completing a health history on a client with a spinal cord​ injury?

Current medications

When planning care for a client with a complete lumbar spinal cord​ injury, which problem should the nurse​ address?​(Select all that​ apply.)

Diminished sensory perception Self-care deficits Impaired urinary function

A nurse on the inpatient rehabilitation unit is preparing a​ 15-year-old female client with cervical spinal cord injury for discharge to home with her parents. What intervention should the nurse provide to facilitate this client​'s ​discharge?

Discuss ways to make the home environment accessible

A​ client, newly diagnosed with Parkinson​ disease, asks the nurse what dopamine does in the brain. What is the appropriate response by the​ nurse?

Dopamine helps maintain coordinated motor​ movement."

Which mechanism causing spinal cord injury is characterized by the head turned sharply to the left or​ right?

Excessive rotation

The nurse is preparing a presentation for a trauma symposium. When discussing clients with spinal cord injury​ (SCI), which condition is an indication for decompression​ surgery?​(Select all that​ apply.)

Facet dislocation Spinal nerve compression Progressive neurological deterioration

A client diagnosed with osteoarthritis of the hands presents with bony lumps on the end joints of her digits. How will the nurse document this finding in the medical​ record?

Heberden nodes

When reviewing the medical​ record, the nurse notes that the client experienced an incomplete cord transection of the cervical sympathetic nerves. What type of incomplete spinal cord injury did the client​ suffer?

Homer syndrome

When reviewing the medical record of a client who experienced a spinal cord​ injury, the nurse notes that the client suffered a whiplash injury. What type of excessive force was placed on the vertebral​column?

Hyperextension

A nurse is assessing a client with Parkinson disease. The nurse monitors the client for which potential complications of Parkinson​ disease?​(Select all that​ apply.)

Impaired memory Pressure ulcers Choking Falls

A client who sustained a cervical neck injury 2 days ago is demonstrating an irregular respiratory pattern with the rate of​ 8-10 breaths per minute. What would be a priority nursing diagnosis for the client at this​ time?

Ineffective Breathing Pattern

Mr. Watson is a​ 40-year-old man diagnosed with Parkinson disease. He is surprised by the diagnosis despite having trouble with his balance for several months. He also states that he has been having trouble talking and has problems resting at night. Mr. Watson says his father had Parkinson​ disease, but he was told it was not hereditary. What is your best​ response?

It is believed to have a genetic​ link, especially in those who get the disease before the age of 50​ years.

Which diagnostic test measures nerve conduction along pathways to evaluate muscle​ response?

Magnetic evoked potentials

Which nursing intervention is included in the recovery phase of a client with a spinal cord injury​ (SCI)?​(Select all that​ apply.)

Maintaining an adequate airway Improving the client​'s ability to perform​ self-care activities Preventing complications

Place each risk factor in the appropriate column:

Modifiable Risk Factor---stress Non-modifiable Risk Factor---family Non-modifiable Risk Factor---gender Modifiable Risk Factor---alcohol intake Non-modifiable Risk Factor--age Modifiable Risk Factor---diet Modifiable Risk Factor---obesity Non-modifiable Risk Factor---genetics

A nurse is providing education to a client with a spinal cord injury. What information should the nurse provide to help the client avoid autonomic​ dysreflexia?​(Select all that​ apply.)

Monitor urine for color and odor Avoid excessive exposure to the sun Change positions frequently when sitting in a chair

The student nurse is discussing the pathophysiology of Parkinson disease​ (PD) with the nurse. The nurse recognizes that the student understands the development of the disease if the student identifies which event as the first change that occurs in a client with​ PD?

Neurons in the cerebrum atrophy and dopamine pathways degenerate.

A client is taking​ carbidopa-levodopa (Sinemet) to help control the manifestations of Parkinson disease. The client is experiencing brief periods of sudden onset of manifestations followed by a return to improved function. What is causing this sudden change in​ manifestations?

On-off phenomenon

Which surgical treatment can be used to realign a joint that is affected by​ osteoarthritis?

Osteotomy

A client experiencing severe pain that cannot be managed through pain medications or nonpharmacologic therapy may need surgical intervention. Which surgical treatments will the nurse include in the teaching session with other members of the healthcare​ team?​(Select all that​ apply.)

Osteotomy Arthroplasty Joint fusion

What are the common risk factors for​ osteoarthritis?​(Select all that​ apply.)

Overuse of joints from sports or strenuous activities Obesity Activities affecting​ weight-bearing joint

The nurse is providing education at a community health fair about osteoarthritis. Which are the general clinical manifestations associated with osteoarthritis that the nurse should include when providing this​ education?​(Select all that​ apply.)

Pain and stiffness at night Joint pain with activity Crepitus with movement of joint

A nurse is preparing a presentation on Parkinson disease for a health fair at a local community center. What would the nurse include in this​ presentation?​(Select all that​ apply.)

Parkinson disease affects at least​ 500,000 individuals in the United States. Parkinson disease usually affects people older than the age of 60 years.

A nurse is providing a preventive teaching discussion with a client at risk for osteoarthritis. Which guideline should be included in this discussion related to​ exercise?

Participate in regular​ exercise, including walking or swimming

A school nurse is treating a​ school-age child who has fallen down a flight of stairs. The child is breathing but unconsciousness. After calling the​ ambulance, what should the nurse​ do?

Protect the​ client's neck and head from any movement.

The nurse is providing education to a client who is scheduled for an osteotomy. Which information should the nurse include about this​ procedure?

Realignment of the joint will occur.

What is the main pathology of Parkinson disease that causes changes in muscular and sensory​ function?

Reduction of dopamine in the brain

A nurse on the​ medical-surgical unit is providing care for a client with cervical spinal cord injury from an accident several years ago. The client reports a headache. The​ client's blood pressure is​ 230/115 mmHg. What intervention should the nurse provide for this​ client?​(Select all that​ apply.)

Remove the​ client's compression stockings Check the client for bowel impaction Check the client​'s bladder

Jackie​ Waite, age​ 44, is diagnosed with osteoarthritis. Ms. Waite wants to know how this could have happened to her. Which rationale from Ms.​ Waite's health history supports this​ diagnosis?

Repeated use of​ weight-bearing joints

A nurse is providing care for a client with Parkinson disease. When assessing the​ client's current​ condition, about which items should the nurse​ ask?​(Select all that​ apply.)

Response to medication Bowel changes Cognitive deficits

Which type of therapy is used to manage problems with eating and​ swallowing?

Speech

A client with Parkinson disease is unable to communicate because of a soft voice and poor facial muscle strength. The nurse anticipates a referral for which member of the interdisciplinary​ team?

Speech therapist

A nurse on the inpatient rehabilitation unit is providing care for an older male client with Parkinson disease. The nurse monitors the client while he is eating a sandwich and reminds the client of which strategies to facilitate​ self-feeding?

Speech therapy

Mrs. Gerry was involved in a motor vehicle crash 2 days ago and was admitted to the hospital for multiple​ injuries, including a broken right arm and fractures of L4 and L5. She has no sensation in her legs and is incontinent of bowel and bladder. Her temperature is​ labile, ranging from​ 98.0° to​ 96.9°F (36.7° to​ 37.2°C) over the past 18 hours. Her heart rate is 58​ beats/min, and her blood pressure is​ 96/60 mmHg. Her respirations are 22​ breaths/min. What condition do you anticipate Mrs. Gerry is​ experiencing?

Spinal shock

An adolescent is brought into the Emergency Department with injuries sustained from a motor vehicle crash. What should the nurse ensure while caring for this​ client?

Stabilization of the neck and spinal cord

Which diagnostic test will best determine the cause of joint damage with​ osteoarthritis?

Synovial fluid analysis

The nurse is planning care for a client with osteoarthritis of the hips. Which intervention will assist in addressing the potential problem of physical​ mobility?

Teach active and passive range of motion exercises.

A nurse on the​ medical-surgical unit is admitting an older adult client to the unit. The nurse is concerned that the client has Parkinson disease when the nurse makes which assessment​ findings?​(Select all that​ apply.)

The client does not remember what he ate for breakfast. The client​'s facial expression shows no emotion. The client has hand tremors at rest. The client has slurred speech.

The nurse is evaluating the effectiveness of interventions to address a​ client's bowel and bladder dysfunction as a result of a spinal cord injury. What would indicate that the interventions are​ successful?

The client is improving in ability to perform​ self-urinary catheterization.

A client with a​ C5-C6-C7 fracture is scheduled for placement of a halo external fixation device. Which education should the nurse provide to the client about this​ device?​(Select all that​ apply.)

The device is used to stabilize fractures of the cervical and upper thoracic region The device is used for cervical fractures without major cord damage or extradural lesions The device is applied with four pins inserted into the skull

A client admitted 3 days prior with an injury to the thoracic area of the spinal cord tells the​ nurse, "I'm getting worse.​ It's harder to​ breathe." What should the nurse suspect is occurring with this​ client?

The extent of injury cannot yet be determined.

A client is admitted to the intensive care unit with an injury in the cervical region of the spinal cord. Why must the nurse monitor the client​'s respiratory​ function?

The spinal cord will swell and affect the nerves that maintain respiratory function.

A client who sustained a gunshot wound has symptoms below the level of​ T-12 of ipsilateral motor​ paralysis, loss of proprioception and vibratory​ sense, and contralateral loss of pain and temperature sensation. Which assumptions are​ correct?Select all that apply.

These findings are consistent with​ Brown-Sequard syndrome. Hemisection of the spinal cord is likely. Some recovery of sensory function is higher. The spinal cord injury is incomplete.

A nurse in the emergency department is providing care for a client admitted with spinal cord injury. The health care provider has written an order for intravenous​ fluid, dextrose​ 5% and​ 0.45% normal saline. What is the purpose of this intravenous​ fluid?

This intravenous fluid provides fluid volume and helps maintain blood pressure.

A client with a spinal cord injury is scheduled to receive a high dose of methylprednisone. The nurse recognizes that this medication is being administered for which of the following ​reasons?

To decrease inflammation and reduce damage to surrounding nerve cells

A client with possible osteoarthritis is scheduled for a synovial fluid analysis. The nurse should explain to the client that this diagnostic test is being completed for what​ reason?

To rule out inflammatory arthritis and gout

The nurse is evaluating the success of a bowel retraining program with a client recovering from a lower motor neuron spinal cord injury. Which observations indicate that this teaching has been​ successful?Select all that apply.

Transfers to use bedside commode after breakfast to evacuate bowels. Maintains a​ high-fluid, high-fiber diet. Performs​ self-urinary catheterization every 4 hours while awake.

A client is newly prescribed trihexyphenidyl​ (Artane) for manifestations of Parkinson disease. What manifestations does Artane​ treat?​(Select all that​ apply.)

Tremors Rigidity Drooling

Which clinical manifestations would be required to confirm a diagnosis of Parkinson​ disease?

Tremors at rest and bradykinesia

A nurse in the emergency department is admitting a client who was in a motor vehicle collision. The nurse is concerned that the client has a spinal cord injury with spinal shock when the nurse makes which assessment​ findings?​(Select all that​ apply.)

Urinary incontinence Complete loss of sensation Flaccid paralysis

Which health promotion activities support a healthy lifestyle for clients with​ osteoarthritis?​(Select all that​ apply.)

Use assistive devices as needed Maintain a normal weight

The nurse is providing education about home care for a client with osteoarthritis of the knees. Which information should the nurse include during this educational​ session?​(Select all that​ apply.)

Using assistive devices to minimize stress placed on affected joint Taking pain medications as ordered Installing handrails in bathroom

Mrs. Gladek is a​ 70-year-old White woman who has experienced progressive symptoms of osteoarthritis over the past 5 years. In addition to taking prescribed analgesics and​ anti-inflammatory medications, she is discussing interventions that she implemented into her daily lifestyle to manage her disease condition. Which activity would you suggest to Mrs. Gladek to provide additional exercise opportunities for​ her?

Water aerobic activities

Mrs. Kingsley is a​ 64-year-old African American woman who has returned to the healthcare​ provider's office for​ follow-up of the osteoarthritic condition of her knees. Although both knees are​ affected, today her left knee is more swollen than the right knee. During your​ assessment, Mrs. Kingsley asks​ you, "If I am losing the cartilage in my​ knees, why do my knees look​ larger?" What would be an appropriate​ response

With​ osteoarthritis, sometimes inflammation increases the size of your knees or fluid​ build-up occurs.

Case Study: Spinal Cord Injury The nurse in the Emergency Department is preparing to administer methylprednisolone to a client with a spinal cord injury. What effect will this medication have on the​ client?

ischemia

Mr. Bradshaw is a​ 65-year-old man being seen for ongoing care of Parkinson disease that was diagnosed two years ago. He is ambulating well without​ assistance, and his speech is only slightly slurred. You note that he wipes his mouth frequently with a handkerchief. He states he is in good overall​ health, "all things​ considered." He is taking​ levodopa, tolcapone, and rasagiline. His primary care provider wants to add an anticholinergic. Mr. Bradshaw asks you why he needs this other medication. What is your best​ response?

will help reduce tremors and uncontrolled​ drooling

The nurse is providing home care teaching to a client diagnosed with osteoarthritis. Which statement is appropriate for the nurse to include in the teaching session for this​ client?

​"Balance and agility exercises can help maintain daily living skills and have been recommended by your healthcare​ provider."

The nurse is presenting a talk on spinal cord injury for a community health fair. Which statement indicates that the attendees understand the risk factors and prevention methods associated with spinal cord​ injury?

​"I'm going to spend extra time discussing this talkmy Boy Scout troop because of their higher risk for spinal cord​ injury."

A nurse has completed teaching for an older adult male client and his wife about placement of a deep brain stimulator. Which statement by the wife indicates a need for further​ instruction?

​"This device means my husband won​'t have to take medication​ anymore."

The nurse is providing education to a community group about developing osteoarthritis. What​ joints, commonly​ affected, will the nurse include in the educational​ session?

​Hands, knees, and hips


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