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