MED SURG EXAM 2 | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+MED SURG EXAM 2 | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 MED SURG EXAM 2 | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ what should you absolute neutrophil count be (ANC) Correct Answer: neutropenia Correct Answer: ANC <1500 moderate neutropenia Correct Answer: ANC 500-999 severe neutropenia Correct Answer: ANC < 500 things to avoid if pt is neutropenic Correct Answer: - fresh cut flowers (wilt, die, grow mold) - processed meats, undercooked meats (food bourne illness) chemo & radiation Correct Answer: cannot differentiate between good and bad cells so they kill them all - they both cause inflammation and death of WBC 2 Normal body temperature Correct Answer: 37.5 celsius, 99.5 fahrenheit Fever in an adult Correct Answer: 38.5 celsius, 101.3 fahrenheit Fever in neutropenic pt Correct Answer: 38 celsius, 100.4 fahrenheit Celsius to Fahrenheit formula Correct Answer: (Cx1.8)+32=F what is a complication of chemotherapy Correct Answer: tumor lysis syndrome Tumor Lysis Syndrome (TLS) Correct Answer: -oncologic emergency with rapid lysis of malignant cells -usually the result of chemotherapy or sometimes radiation -may occur 24 hours-7 days after antineoplastic therapy is initiated -develops when chemotherapy or irradiations causes the destruction of a large number of rapidly dividing malignant cells -intracellular contents are rapidly released into the bloodstream 3 Tumor Lysis Syndrome (TLS) part 2 Correct Answer: breakdown of tumor, cells are dying --> all their cellular contents are being released into the bloodstream --> increase in potassium (hyperkalemia), high uric acid (hyperuricemia) what should we monitor with TLS Correct Answer: BUN and creatnine TLS treatment Correct Answer: - rapid IV solution (isotonic), NS to flush this out of the body, keep them hydrated - give allopurinol prophylactically to prevent this from happening --> preventing conversion of uric acid complications of radiation Correct Answer: - esophagitis, skin irritation, N&V, anorexia, radiation pneumonitis - skin breakdown & inflammation Superior vena cava syndrome (SVC) Correct Answer: - Tumor can compress SVC and cause swelling of face, JVD, and visible chest veins 4 - something blocking blood from returning to the heart, could be a tumor, could be a prosthesis, PICC, etc. - upper trunk swelling, facial and arm swelling, flushing, redness - need to remove the tumor or shrink the size of the tumor --> can place cardiac stent - differentiate from anaphylaxis because it is localized! hematological malignancies Correct Answer: - disease of the bone marrow - RBC & WBC - in leukemia we have leukocytes - they are cancer cells - they push out all other cells like RBC and platelets - acute - if no tx they will die within a few months Acute Myeloid Leukemia (AML) Correct Answer: the most common form of leukemia in adults (50s-60s but can be anyone); develops when the bone marrow produces too many myeloblasts AML symptoms Correct Answer: - fever - "B symptoms" - fatigue - malaise - drenching night sweats, - bleeding gums 5 - hyperplasia of gums - anemic (tired, weak) AML assessment Correct Answer: - palpate enlarged spleen or on imaging due to all the leukocytes - oral assessment - bleeding gums, hyperplasia - monitor for neutropenia - infection control - handwashing - concerned about hypokalemia due to poor food intake but also hyperkalemia due to TLS AML treatment Correct Answer: - prompt, aggressive chemotherapy (die within few months of no tx) - 30-60 days in the hospital - 7 days of one type of chemo, 3 days of another type - pt is gonna have chemo, feel sick, n/v, anorexia --> not eating --> electrolyte imbalances (hyper/hypokalemia) - NADIR - give chemo, 5-7 days after the cells hit the LOWEST point, and then start to recover (neutropenic, thrombocytopenic, etc.) Thrombocytopenia interventions Correct Answer: - low platelet count (<100,000) - electric razors 6 - no rectal temps - soft bristle toothbrush - look at skin for bruising, petechiae - fall precautions - no invasive procedures - transfuse them Myeloablative Correct Answer: - High dose chemo and total body irradiation (ablation) - destroys bone marrow First sign of infection Correct Answer: - fever - start antibiotics within 30 min of fever of 38 celsius - start broad-spectrum antibiotics - Meropenem - blood cultures, urine culture, sputum culture, chest xray - not going to see pus or inflammation - no normal response to infection because no WBC Chronic Myeloid Leukemia Correct Answer: - same as AML but instead chronic - watchful waiting - same symptoms 7 - infection control - monitor for temperature changes - concerned about bleeding, TLS - pt can be home b/c not as acute - need to get rid of some WBC to make room for other cells like blood cells Acute Lymphocytic Leukemia (ALL) Correct Answer: Immature lymphocytes (lymphoblasts) predominate (too many lymphoblasts) This form is seen most often in children and adolescents Onset is sudden Acute Lymphocytic Leukemia (ALL) treatment Correct Answer: - same treatment - aggressive chemotherapy - steroids --> infection, TLS, thrombocytopenia Chronic Lymphocytic Leukemia (CLL) Correct Answer: - abnormal numbers of relatively mature lymphocytes predominate in the marrow, lymph nodes, and spleen - same tx as CML - chemo 8 Nutrition Correct Answer: high protein, high calorie diet encourage them to eat what they want but also safe foods (no raw fish, no unwashed fruits/veggies) activity tolerance Correct Answer: move it or lose it if not --> atelectasis --> pneumonia --> die moving decrease blood clots, decrease PI's oral care Correct Answer: - use sodium bicarbonate (baking soda)!! as toothpaste - minimum brush 2/day, rinse mouth after every meal, swish with normal saline or nonalcoholic mouthwash!! - do not use normal toothpaste b/c they have alcohol and can dry out mucosa --> mouth sores - mouth sores --> not gonna want to eat --> electrolyte imbalance --> die Perineal care (peri-care) Correct Answer: extremely important! swab for VRE - vancomycin resistant enterococci neutropenia precautions 9 Correct Answer: Assess skin integrity Q8H, private room, hand hygiene, no sick visitors, no standing water/flowers, clean room daily, low microbial diet (no salads, peeled fruit/veggies), deep breathing Q4H, body hygiene, inspect IV site, check temp every 4 hours, limit visitors stem cell transplants Correct Answer: - chemo doesnt work --> kill out damaged blood cells and replace with stem cells that make new blood cells - wipe bone marrow clean - transfuse them w new ones - can use a family member or MUD (matched unrelated donor)(higher risk of infection with MUD) - graft --> stem cells - host --> body HIV/AIDS Correct Answer: the virus that causes AIDS, spread through bodily fluids rather than casual contact or airborne immunocompromised (same as with cancer) standard precautions retrovirus what to do if exposed to HIV 10 Correct Answer: if you have a needlestick at work, go to urgent care and start prophylaxis tx within 72 hours HIV goal Correct Answer: reduce viral burden in our bodies b/c we cannot cure it Normal CD4-Cell count vs. AIDS CD4-Cell count Correct Answer: normal - 500-1500 AIDS - below 200 different stages based off of CD4 count (200-499 stage 2) HIV diagnosis Correct Answer: -Presumptive diagnosis made with ELISA (sensitive, high falsepositive rate and low threshold, rule out test); ⊕ results are then confirmed with Western blot assay (specific, low false-positive rate and high threshold, rule in test). -Viral load tests determine the amount of viral RNA in the plasma. High viral load associated with poor prognosis. Also use viral load to monitor effect of drug therapy. - saliva test - blood antigen test (looking for antigen itself and viral load according to CD4 count) how long does it take for HIV to show up on tests Correct Answer: 8-12 weeks, or 3 months after exposure - thats when you develop symptoms 11 Symptoms of HIV/AIDS Correct Answer: Rapid unintentional weight loss, recurring fever, night sweats, tiredness, swelling of lymph glands, (pneumocystis) pneumonia, rash (same as leukemia) Neurological changes - confusion, weakness - encephalopathy GI: mouth sores, n/v/anorexia skin: painful red rash typically back or face - herpes zoster manifestation EARLY - FLU LIKE SYMPTOMS, RASH Wasting syndrome (cachexia) Correct Answer: Condition that causes extreme weight loss and muscle wasting. It is a symptom of many chronic conditions, such as cancer, chronic renal failure, HIV, and multiple sclerosis. can be accompanied by purple raised lesions other complications of HIV Correct Answer: GI (malabsorbtion, stratorrhea, diarrhea); neurological (mild to severe dementia) B cell lymphoma encephalopathy - increased inflammation - brain swelling, confusion fungal infections depression/apathy 12 treatment for HIV Correct Answer: - antiretroviral therapy - we are not curing, we are making viral load undetectable - need at least 2-3 antivirals - a lot are in 1 combo pill - liver tests! - tx is lifelong - fluids and electrolytes. - exposure prophylaxis (involves taking one pill containing 2 HIV medications - tenofovir disoproxil fumarate 300mg and emtricitabine 200mg - daily) nutrition for HIV Correct Answer: -High calorie, high protein, low fat, high vitamins/minerals, low microbial diet. -Small frequent meals 6x/day -Rest oncology general considerations Correct Answer: worried about infection, bleeding, TLS, radiation toxicity, skin breakdown, mouth care (swish w/ NS), facial edema, head, neck Normal Intracranial Pressure (ICP) Correct Answer: 7-15 13 Signs of increased ICP Correct Answer: vomiting, altered mental state, decreased LOC, neuro changes, PERRLA changes, stroke-like symptoms (muscle weakness, resp. changes), papillary edema (nerve in eye becomes enlarged) who is at risk for increased ICP Correct Answer: adolescents - frontal lobe not fully developed until 20-25 older adults prevention Correct Answer: helmets primary cause increased ICP ex. Correct Answer: from concussion from head injury secondary cause increased ICP ex. Correct Answer: metastatic tumor on brain causing swelling on brain, stroke, hemorrhage Normal Inflammatory Response Correct Answer: 2-4 days longer suggests infection 14 sign that pt has skull based fracture Correct Answer: ecchymosis behind ears nose bleed Normal color of CSF Correct Answer: clear halo sign Correct Answer: CSF leak - ring of fluid around blood stain from drainage could be confused as nasal drainage open vs closed TBI Correct Answer: open =penetration through the skull to the brain (ex. car accident, fall) closed= injury without penetration through skull (ex. bullet pierces brain) nursing interventions for TBI Correct Answer: Establish patent airway!!!! full neuro assessment (PERRLA, orientation, pain, cranial nerve assessment, stroke scale (NIHSS), glascow coma scale CT scan Glasgow Coma Scale (GCS) Correct Answer: a neurologic scale used to assess level of consciousness 15 up to 15, the higher the better 8 and under = coma Diffuse Axonal Injury (DAI) Correct Answer: Diffuse brain injury that is caused by stretching, shearing, or tearing of nerve fibers with subsequent axonal damage. MVC accidents, lots of blunt trauma to area intracranial bleeding epidural hematoma vs subdural - epidural easier to treat, both medical emergencies diffuse axonal injury interventions Correct Answer: establish airway!!! drain in brain for bleeds - watch for pulling it out --> death meticulous drain care - mental status improves - drain working respiratory support goal - reduce icp diffuse axonal injury diagnosis Correct Answer: CT scan - CT over MRI because if pt is unresponsive, the MRI has metal - MRI takes way longer - CT scans are easier to repeat 16 subdural DAI Correct Answer: harder to get into subdural space, may need a craniotomy craniotomy interventions Correct Answer: cutting into the skull, removal of skull plate - decrease icp huge fall risk - no bones for brain, brain will smoosh if fall need a helmet! may need restraints, reorient watch for fever give mannitol (osmotic diuretic) give corticosteroid - dexamethasone high protein (wound healing) high calorie (weight) high fiber (GI motility) diet neuro check q15-30 min first 4-6 hr, q1h 24 hr may need catheterization - monitor urine output might need restraints - gonna wanna touch head infection control restraint assessment q2hr head shaved - teach to use mild shampoo - johnson&johnson reduce environmental stimuli sleep wake cycle, lighting in the room teach coughing and deep breathing dosed with antibiotics preop, intra, post cardiac monitor for at least 24h JP drain - greater than 50 ml in 8 hr is not ok! 17 expected - edema or bruising around eyes - cold compresses symptoms of DI or SIADH intracerebral hemorrhage Correct Answer: a type of hemorrhagic stroke in which bleeding within the brain caused by a rupture of a blood vessel occurs; often caused by hypertension and is associated with increased intracranial pressure usually bc pt on blood thinner or aneurysm intracerebral hemorrhage interventions Correct Answer: ICP monitor (probe in brain) huge risk infection!! keep them oriented drain care, control icp extra ventricular drain - has to be midline with the brain, use tragus as anatomical landmark clamp EVD b/c can have influx or outflux of fluid that can cause change in icp monitor electrolyte status, watch Na levels, K levels (always intervene even within range to keep perfectly in middle) give Magnesium give antihypertensive - ccb and bb ccb - nifedipine - give every 2 hours to decrease bp bb - IV - watch for brady 18 monitor what VS especially for stroke Correct Answer: hypertension patient overdose on coumadin, what do we give Correct Answer: IV vitamin k or fresh frozen plasma reversal agent for heparin Correct Answer: protamine sulfate watch PTT Concussion Education & Prevention Correct Answer: neuro assessment at home - ask questions, see if theyre confused vomiting photophobia headaches not going away wear a helmet CT scan but establish airway FIRST monitor ventilation monitor CO2 with head injury Correct Answer: major fluctuations can cause more brain injury usually 35-45, stroke pts 30-45 19 increased co2 is vasodilation decreased co2 is vasoconstriction hemorrhage signs Correct Answer: decreased BP, increased HR monitor hemoglobin hemorrhage in head Correct Answer: neuro changes --> comatose Intubation complications Correct Answer: - broken teeth and caps, swollen lip, vocal cord trauma - tracheal irritation and edema - VAP (ventilator associated pneumonia) - infection - getting them off intubation seizure precautions Correct Answer: - padded bed rails - O2 and suction at bedside - IV access - lowest bed setting - prophylactic med for seizures - keppra (Levetiracetam) 20 Nasogastric tube (NG tube) Correct Answer: tube inserted through the nose into the stomach for gastromotility, aspiration, parenteral nutrition goes into stomach so when pt lays down we need to have the feeds turned off nasal duodenal tube Correct Answer: post pyloric into the small intestine already past the stomach so cant come back up and cause aspiration dont need to shut off feeds when pt lays down tube feeds in nose Correct Answer: flush, give meds before we have to confirm placement with XRAY or pH test or if the number on the tube is consistent with the number previously documented continuous tube feed Correct Answer: elevated glucose levels (q6h glucose checks) might be on sliding scale insulin Tube feeding implications Correct Answer: prevent skin breakdown 21 worried about hypoglycemia when we stop feeds to bring them for procedures (CT, XRAY) dont give opioids b/c already cause resp. depression give acetaminophen pain support - scheduled meds Nonverbal indicators of pain Correct Answer: grimacing wincing guarding increased HR irritability spinal cord injury (SCI) Correct Answer: depends on where the injury is phrenic nerve: C3-C5 - controls diaphragm (breathing) can be degenerative nursing considerations with spinal cord injury Correct Answer: assure airway! complications: sepsis from pneumonia (immobility), UTI, pressure injury that got infected, PE (immobility) educate incentive spirometer use 10x/hr, cough, deep breathing, repositioning, turning 22 compression socks, anticoagulants, sequential compression devices passive ROM at least 4x/day - prevents contractures spinal shock Correct Answer: physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks. spinal shock presents with total flaccid paralysis and loss of all reflexes below the level of injury. more about movement/paralysis, less about vs neurogenic shock Correct Answer: a state of shock (hypoperfusion) caused by nerve paralysis that sometimes develops from spinal cord injuries decrease in HR and BP (differ from spinal shock) Autonomic Dysreflexia Correct Answer: patients with spinal cord injuries are at risk (T-7 or above) potentially life threatening emergency! over-exaggeration of ANS autonomic dysreflexia symptoms Correct Answer: tachycardia severe hypertension headache 23 constipation nursing interventions autonomic dysreflexia Correct Answer: MONITOR URINARY STATUS, bladder scan sit pt in chair - HOB elevate 90 degrees loosen constrictive clothing assess for full bladder or bowel impaction administer antihypertensives (use BB) assess RR, breathing pattern, clear lung sounds Rhonchi Correct Answer: Rattling noise of mucous in the lungs crackles (rales) Correct Answer: fluid in the lungs diminished breath sounds Correct Answer: not breathing effectively atelectasis How much urine can the bladder hold? Correct Answer: 400-600 mL, then get urge to pee 24 neurogenic bladder Correct Answer: cannot void urinary retention need straight cath --> risk of infection DVT prophylaxis Correct Answer: SQ in abd 2 in from umbilicus Meningitis Correct Answer: inflammation of the meninges of the brain and spinal cord bacteria or virus cause what precautions are for meningitis Correct Answer: droplet symptoms of meningitis Correct Answer: headache, fever, stiff neck (nuchal rigidity), fatigue, photophobia Dx of meningitis Correct Answer: •Lumbar puncture •CSF changes w/ bacterial infection show elevated WBC and low glucose (around 30- 35) 25 Meningitis interventions Correct Answer: prevention: vaccine take FULL antibiotic - typically IV though symptom support, especially if viral! electrolytes, fluids getting worse: neuro assessment, decreased LOC dexamethasone brain abscess Correct Answer: collection of pus anywhere within the brain Brain abscess symptoms Correct Answer: confusion fever brain abscess tx Correct Answer: put a drain in, remove it antibiotics - IV - need it to cross the blood brain barrier multiple sclerosis Correct Answer: - chronic disease of the CNS marked by damage to the myelin sheath - progressive muscle weakness over time (falls, BREATHING) - periods of exacerbations and remission 26 - goal: maintain independence MS symptoms Correct Answer: visual disturbances, weakness, loss of muscular control, speech disturbances, incontinence, incoordination, paresthesia, tremor, pain myasthenia gravis Correct Answer: - a chronic CNS autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles muscle with uptake of acetylcholine - gets better with rest, regain muscle strength symptoms of myasthenia gravis Correct Answer: RESPIRATORY DEPRESSION facial changes diplopia trouble swallowing trouble chewing activity - weak myasthenia gravis interventions Correct Answer: meds 4x/day ON TIME! --> keep their ADLs resp. aspiration, keep safe, improve function 27 steroids, plasma exchanges Myasthenic Crisis Correct Answer: an acute exacerbation of myasthenia gravis triggered by infection, stress on the body, diabetes, pregnancy peak flow, vital capacity, resp. efforts big concern is resp. --> may need intubation guillian-barre Correct Answer: autoimmune symmetric *ascending motor paralysis*, *fatal if respiratory muscles are affected*. d/t viral infection 2wks later. s/s: weakness, *bilateral, ascending*, loss of DTR, dysphagia Rx: LP (+protein in CSF) supportive, vent, IVF, immunoglobulin therapy, morphine for pain. Nursing: maintain resp status, provide communication needs acute starts peripherally unlike other ones they can completely recover - diff from others same as TBI for everything weve talked about trigeminal neuralgia 28 Correct Answer: a condition characterized by sudden, intense, sharp stabbing nerve pain due to an inflammation of the fifth cranial nerve affect women more than men, later in life set off by anything in face, brushing teeth, skincare, etc. face, forehead, cheek, jaw usually unilateral tx: can remove it or depress it nursing inter.: touch face - assess sensation, assess swallow/chew function, pain meds, carbmazepine (anticonvulsants), gabapentin (nerve pain) Bell's Palsy Correct Answer: temporary paralysis of the seventh cranial nerve (facial) that causes paralysis only on the affected side of the face acute 3-5 weeks process inflammation, LIPS! (droopy), ptosis (droopy eyelid), typical in younger patients, unilateral lose control of muscle sensation on one side (could be mouth, eye, whole side of face) bells palsy interventions Correct Answer: protect the eyes --> give eye patch to sleep with, eye drops aspiration risk - eat/drink on one side of the face 29 brain tumors primary vs secondary Correct Answer: primary - developed in brain itself secondary - started somewhere else and metastasized to brain low survival rate brain tumor interventions Correct Answer: seizure precautions aspiration precautions full neuro assessment worried about SIADH and DI b/c the pituitary gland is being affected --> ADH anticonvulsants (whether pt has had seizure in past or not) calorie count - maintain weight oral hygeine !! prevent thrush or sores meds for pain, headache, n/v improve nutrition, reduce anxiety, free from complications, coping strategies chemo (malignant), hormone suppressing drugs may need craniotomy brian tumor dx Correct Answer: imaging biopsy EEG (brain waves) lumbar puncture (test CSF - look for malignant cells) 30 alcohol level and tox screen to make sure theres an actual brain issue and not a substance abuse issue brain tumor s/s Correct Answer: headache, n/v, seizures, loss of balance, dizziness, vertigo, aphasia, impaired sensory perception (numbness, tingling, vision changes), changes in cognition/mentation/personality, increased ICP - papillary edema - nerve in eye becomes enlarged palliative care Correct Answer: comfort and quality of life still receiving curative care hospice care Correct Answer: usually within 6 mos of pt passing curative care stopped focus on quality of life A client diagnosed with a brain tumor is receiving phenytoin. The client's partner questions the use of the drug, since there is no history of a seizure disorder. What response will the nurse provide to be best address the partner's concern? Correct Answer: "Increased pressure from the tumor can cause seizures." 31 A nurse is completing an assessment of a client who has increased intercranial pressure (ICP). Which of the following are expected findings? (Select all that apply). Correct Answer: Increasing disorientation to time and place restlessness and irritability headache A nurse is caring for a client who has just undergone a craniotomy for a brain tumor and has a respiratory rate of 12 breaths per minute. Which of the following postoperative prescriptions shoulf the nurse clarify with the provider? Correct Answer: Morphine 2mg IV Push q2 hours PRN Pain The client with a brain tumor may be at increased risk for aspiration. What does the nurse determine is the most important nursing intervention? Correct Answer: Evaluation of gag reflex and ability to swallow The nurse teaches the client that corticosteroids will be used to treat his brain tumor to: Correct Answer: reduce cerebral edema. neurodegenerative disorders Correct Answer: parkinsons huntingtons ALS (amyotrophic lateral sclerosis) 32 Parkinson's disease Correct Answer: loss of dopamine more excitatory than inhibitory neurotransmitters parkinsons disease (BIG 4) s/s Correct Answer: muscle rigidity akinesia/bradykinesia (slow or involuntary movement) involuntary tremor (resting tremor and pin-rolling) postural instability - may also see excessive drooling, perspiration, dysphagia, constipation, urinary incontinence, slow speech and movements, shuffling, mask-like appearance parkinsons dx Correct Answer: dopa trial (medication) - if they have improvement then they have parkinsons lumbar puncture - CSF - increase in dopamine SPECT - basically CT scan, see loss of dopamine producing DaT - effects of dopamine parkinsons interventions Correct Answer: keep meds on a schedule - stick to schedule levodopa 33 drug holiday - take pt off drug for certain # of days (usually 10-14) then put back on and see if they have effects (reset button) Huntington's disease Correct Answer: uncontrolled movements larger movements than parkinsons chorea - spasmodic involuntary movements of facial muscles and/or limbs exaggerated genetic disorder (differ from parkinsons) premature death of cells huntingtons disease manifestations Correct Answer: emotional problems and dementia still having movements when sleeping slurred speech chewing and swallowing difficulty impaired gait - eventually bedbound huntingtons disease interventions Correct Answer: genetic counseling, PFH no tx stops progression meds to tx chorea - tetrabenzine, benzos, neuroleptics behavior tx - SSRIs, tricyclic antidepressants, antipsychotics 34 environmental modifications - frequent falls fall risk, aspiration risk, PI risk ALS - (Lou Gehrig's Disease) Amyotrophic Lateral Sclerosis Correct Answer: progressive muscle weakness no cognitive element!! no behavioral or cognitive changes strictly motor upper and lower motor neurons - leads to loss of movement - paralysis (parkinsons and huntingtons have both) ALS dx Correct Answer: look at electrical impulses in muscle muscle biopsy MRI ALS clinical manifestations Correct Answer: dysarthia (trouble pronouncing words) muscle weakness fatigue atrophy diaphragm also a muscle! - gonna become paralyzed - approx. 3-5 years after dx ALS interventions 35 Correct Answer: pt may have permanent tracheostomy no cure - meds slow down progression maintain function speech therapy trach care emotional support end of life care patent airway pts usually die from resp. infections, asp., resp. insufficiency A nurse teaches assistive personnel (AP) about how to care for a client with Parkinson disease. Which statement would the nurse include as part of this teaching? Correct Answer: "Allow the client to be as independent as possible with activities." A client diagnosed with Parkinson disease will be starting ropinirole for symptom control. Which statement by the client indicates a need for further teaching? Correct Answer: "I know the drug will probably make help me prevent constipation." The nurse assesses a client who has Parkinson disease. Which signs and symptoms would the nurse recognize as a key feature of this disease? (Select all that apply.) Correct Answer: Stooped posture Uncontrolled drooling Slow movements 36 A rapid, jerky, involuntary, and purposeless movement of the extremities or facial muscles is: Correct Answer: Chorea Which disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive, involuntary dancelike movements and dementia? Correct Answer: Huntington's Disease The nurse cares for a client with Huntington disease. What intervention is a priority for safe care? Correct Answer: Protecting the client from falls Which medication is the most effective agent in the treatment of Parkinson disease? Correct Answer: Levodopa herniated disc Correct Answer: disc has jelly inside to absorb shock when disc degenerates, we lose the jelly-like fluid, becomes less elastic, less flexible, less shock absorbing, starts to crack lumbar most common, cervical second most common RF - obesity, falls, lifting at work, older age 37 "slipped disc" Correct Answer: disc bulges outward between vertebrae - more symptoms radiculopathy - radiating pain, numbness, tingling, decreased strength and/or ROM - pressing on nerves and spinal cord herniated disc dx Correct Answer: XRAY - look at spine MRI - look at discs itself straight leg test - lay on back lift leg straight up, if have pain then have herniated disc herniated disc s/s Correct Answer: low back pain!! larger the herniation, more pain, more muscle weakness, more paresthesias lumbar herniated disc Correct Answer: low back pain, pain down the entire lower limb, sciatica how do you ride a horse - saddle. every nerve will be affected down there - saddle anesthesia incontinence need surgery NOW to relieve pressure - medical emergency traction 38 Correct Answer: a pulling force exerted on a limb in a distal direction in an effort to return the bone or joint to normal alignment basically a machine that stretches you out wear a brace and lay flat on a table and machine pulls your leg out herniated disc interventions Correct Answer: health body weight pelvis in neutral position pillow between knees in side-lying position williams position - sleep on back and put pillows under knees and head MAINTAIN ALIGNMENT AND STABILIZATION monitor for complications - CSF leak (halo sign), severe headache, hypotension, tachycardia - lay them FLAT Which statements would the nurse include when promoting the prevention of lower back pain? (Select all that apply.) Correct Answer: "Wear flat instead of high-heeled shoes to work each day." "Avoid prolonged standing or sitting, including driving." "Participate in an exercise program to strengthen back muscles." A nurse assesses a client who is recovering from an open traditional lumbar laminectomy with fusion. Which complications would the nurse report to the primary health care provider? (Select all that apply.) 39 Correct Answer: Incisional bulging Sudden and severe headache Clear drainage on the dressing What actions would the nurse take after discovering cerebrospinal fluid leaking onto a client's surgical dressing? (Select all that apply.) Correct Answer: Report the leak to the surgeon immediately. Place the client in a flat position.