SNLE Question Discussion -Training4Nurse Academy

طلابي ومتابعي الكرام

في هذه المدونة اقدم لكم شرح لمجموعة من الأسئلة المختلف عليها والتي دوما تسبب لكم تشتت وغالبا تجدونها باجابات مختلفة في مصادر متنوعة ولذلك احبب ان اطرح وجهة نظري العلمية بهذه الاسئلة وأنا دائما احاول شرح فكرة السؤال وتحديد اجابته من خلال معلومات علمية متأصلة مع النظر والتنبه لفكرة السؤال ولماذا تم بالاساس وضع هذا السؤال من خلال وجهة نظر من قام بتأليف السؤال .

قد أخطأ في تحليلي لان بعض الاسئلة اجتهد في تحليلها باعتماد تقنيات واستراتيجيات علمية ولكن انا حريص وبأكبر قدر ممكن على اعطاء الاجابة والتحليل الادق واسأل الله ان يعينني على ذلك لان هذه امانة .

possible nursing diagnosis post applying cast 

- Acute pain , impaired peripheral tissue perfusion , impaired physical mobility , risk for impaired skin integrity ,risk for peripheral neurovascular dysfunction .

 

Question : A 14 year old boy fractured his right radius and a fiberglass cast was applied. Twenty-six hours later,he returned to the emergency department with pain in the right lower arm . on examination,his fingers were cool and pale .

which nursing diagnosis is most appropriate ? 

A-Impaired Tissue perfusion     

B- Risk for infection    

C-Peripheral Neurovascular dysfunction 

D-Impaired skin integrity

Correct Answer :  Impaired Tissue perfusion 

The pallor and cool temperature of the fingers and the decreased return time for capillary refill and Diminished distal pulse indicate decreased arterial blood supply to the fingers (impaired circulation in the distal extremity.)

Option C is not correct --- Nerve impairment includes numbness, tingling, and impaired movement of the fingers. (peripheral neurovascular dysfunction-disruption in the circulation, sensation, and motion of an extremity, ).

burning and/or tingling sensations indicate nerve damage or ischemia

Option B is not correct --signs/symptoms of infection under the cast  include an increased temperature, hot spots on the cast, a foul odor, or changes in pain

Question : Four hours after a cast has been applied for a fractured ulna, the nurse assesses that the client's fingers are pale and cool and capillary refill is delayed for 4 seconds.

How should the nurse interpret these findings?

A. Nerve impairment is developing in the fingers.

B. Arterial blood supply to the fingers is decreased.

C. Venous stasis is occurring in the fingers.

D. The finding is normal for this recovery period.

Correct Answer : B. Arterial blood supply to the fingers is decreased.

The pallor and cool temperature of the fingers and the decreased return time
for capillary refill indicate decreased arterial blood supply to the fingers. These
findings are not normal for any time in the recovery process. 

Nerve impairment includes numbness, tingling, and impaired movement of the fingers. 

Signs of venous stasis include edema and reddening of the fingers, not pallor and cool temperature.


Question : PATIENT PRESENTS WITH UNRELIEVED & INCREASED PAIN IN HIS LEFT LEG FOLLOWING A FX, THE DISTAL TISSUE IS PALE, DUSKY & EDEMATOUS, THE CLIENT HAS PAIN WITH PASSIVE MOVEMENT, LOSS OF SENSATION & PULSELESSNESS.

WHAT DOES THE NURSE SUSPECT?

A- Disalignment 
B- Infection 
C-COMPARTMENT SYNDROME
D- Pulmonary embolism 

Correct Answer :
C-COMPARTMENT SYNDROME

Question : A 65 year-old woman presented to her care provider with complaints of bright red blood in the stool, a loss of appetite , a feeling of fullness and fatigue ,she had lost 5 kilograms in the past three weeks without dieting . A fecal occult blood test is positive and the patient is scheduled for additional screening test . (based on this case please answer Q1 and Q2 )

Q1: which of the following is most likely dignosis for this patient ?

A-Anal fissure 
B-Dudenal ulcer
C-Colon Cancer
D-ovarian cyst



Correct Answer : C-colon cancer

 العلامات الظاهرة في سيناريو السؤال تتطابق مع حالة colon cancer

Colorectal cancer is the fourth most common cancer in the U.S.

signs and symptoms of colon cancer include :

1-Blood in stool

A warning sign for colon or rectal cancer is blood in the stool. Sometimes patient may notice bright red spots, and other times it may not be visible to the naked eye

Stool could also appear very dark or black, signifying the presence of dried blood.

Bright red blood on the toilet paper after a bowel movement or red or pink water in the toilet bowl can be signs of rectal bleeding

2-Fatigue and weakness 

3-weight loss : Sudden weight loss is often a symptom of several types of cancer, including colon cancer. Unintentional weight loss is the loss of 10 pounds or more in six months or less without knowing the reason

4- loss of appetite, along with unexplained weight loss
5-abdominal pain and bloating

الخيار A غير صحيح لانه لايتزامن مع حالة Anal fissure فقدان وزن وشعور بالامتلاء وفقدان شهية ،،، صحيح انه يصاحبه وجود دم بلون احمر فاتح مع البراز ولكن بقية الاعراض لاتتزامن مع Anal fissure 

الخيار B يعتبر خاطئا لان لون الدم الذي يختلط بالبراز في أمراض الجهاز الهضمي العلوي يميل الى الاحمر الغامق او المائل الى السواد     

bleeding from the esophagus, stomach or duodenum (upper gastrointestinal [GI] tract)

is charcterized as --Black, tarry stools

الخيار D خطأ لانه يحدث زيادة في الوزن في حالة Ovarian cancer وايضا يترافق معها اضطرابات في الدورة الشهرية ولايحدث خروج دم مع البراز

Q2 :which screening test is most likely for this patient ?

A-Barium enema
B-colonoscopy
C-Endoscopy
D-Computed tomography scan

Correct Answer is :  colonoscopy

Colonoscopy : is the most widely used procedure for evaluating rectal bleeding as well as occult bleeding

colonoscopy is the most widely used procedure for the diagnosis and treatment of rectal bleeding (Colonoscopy is useful for both diagnosing the cause and determining the location of the bleeding)

 اعتمادا على تشخيص الحالة وفقا للعلامات والاعراض التي يشكو منها المريض colon cancer فان أفضل طريقة لتشخيص الحالة هي --- colonoscopy 

حيث يعتبر colonoscopy افضل اجراء تشخيصي لتشخيص سبب وتحديد موقع النزيف في الجهاز الهضمي 

A barium enema is an X-ray exam of the large intestine (colon and rectum). It may also be called a lower gastrointestinal (GI) exam - (colonoscopy has the advantage of detecting a larger number of lesions and smaller lesions, and the ability to be therapeutic as well as diagnostic)

the most logical approach is to do colonoscopy first, which avoids the repetition of bowel preparation and the cost of barium enema. If colonoscopy cannot be performed, or cannot be completed to the cecum, then the next best choice is to proceed to double contrast barium enema.

endoscopy is a procedure that enables the examiner (usually a gastroenterologist) to examine the esophagus (swallowing tube), stomach, and duodenum (first portion of small bowel) 

Additional Notes : معلومات اضافية 
 

The color of blood in the stool often depends primarily on the location of the bleeding in the gastrointestinal tract.

Generally, the closer the bleeding site is to the anus, the brighter red the blood will be.

Thus, bleeding from the anus, rectum, and the sigmoid colon tends to be bright red, whereas bleeding from the transverse colon and the right colon tends to be dark red or maroon-colored.

Blood in the stool that is red or maroon is most commonly is referred to as rectal bleeding.

bleeding from the upper GI tract and depending on how long the blood remains in the stomach and small intestine, the color in the stool will change from bright red, to maroon, to black.  

Bleeding that occurs from the stomach and duodenum frequently is black, "tarry" (sticky), and foul smelling. The black, smelly and tarry stool is called melena. Melena mostly occurs when the bleeding is in the stomach

occult blood: Occult gastrointestinal bleeding refers to a slow loss of blood into the upper or lower gastrointestinal tract that does not change the color of the stool or result in the presence of visible bright red blood

 A fecal occult blood test is used as an early screening test for colorectal cancer. It may also be used to diagnose other conditions that cause bleeding in the digestive tract

 

Color of blood stool according to problem :

1-Cancers and polyps of the colon and rectum can cause bright red rectal bleeding, maroon colored stools, and sometimes melena. The colon cancers and polyps located near the rectum and the sigmoid colon are more likely to cause mild intermittent bright red rectal bleeding, while colon cancers located in the right colon are more likely to cause occult bleeding that over time can lead to moderate or severe iron deficiency anemia

2-The amount of bleeding that occurs with an anal fissure is small and usually is noticed in the toilet bowl or on the toilet paper as bright red in color. 

3-bleeding from the esophagus, stomach or duodenum (upper gastrointestinal [GI] tract)
is charcterized as --Black, tarry stools 

Question : A 55-year-old female is receiving cyclosporine after a heart transplant. The patient exhibits a WBC of 12,000 cells/mm3, a sore throat, fatigue, and a low-grade temperature. The nurse suspects:

A-Infection.
B-Dehydration.
C-Transplant rejection.
D-Heart failure

Correct Answer : A-infection 

Rationale: Due to immune system suppression by the medication, infections are common

Question : The nurse plans long-term goals for the patient who has had a heart transplant with the knowledge that a common cause of death in heart transplant patients during the first year is:
a. infection
b. heart failure.
c. embolization
d. malignant conditions 

Correct Answer : A-infection 

Because of the need for long-term immunosuppressant therapy to prevent rejection, the patient with a transplant is at high risk for infection, a leading cause of death in transplant patients. Acute rejection episodes may also cause death in patients with transplants, but can be successfully treated with augmented immunosuppressive therapy. Malignancies occur in patients with organ transplants after taking immunosuppressants for a number of years.   

Question 1 : while reviewing stress management techniques with a patient diagnosed with multiple sclerosis ,what would the nurse identify as MOST appropriate ?

A- Relaxing in a warm bubble bath 

B-Yoga in a cool room 

C-Sunbathing 

D- cross country running 

Correct Answer : B-Yoga in a cool room

relaxation or mind-body exercises — such as deep breathing, meditation, progressive muscle relaxation, yoga or tai chi — can significantly reduce stress. Traditional exercise, such as walking or gardening, also can help relieve stress.

Studies report that about 60 to 80% of people diagnosed with MS show excessive sensitivity to heat

They are sensitive to even a slight increase in their core body temperature (0.25°C to 0.5°C) that may be due to physical exercise or a warmer environment.

It is generally recommended that people with MS who are sensitive to temperature try to avoid extremes of either hot or cold

For many years, the “hot bath” test was used to diagnose multiple sclerosis. A person suspected of having MS was immersed in a hot tub of water, and the appearance of or worsening neurologic symptoms was taken as evidence the person had MS.

Many people with MS experience a temporary worsening of their symptoms when the weather is very hot or humid

An elevated temperature further impairs the ability of a demyelinated nerve to conduct electrical impulses

Activities including sunbathing, exercise, and taking very hot showers or baths can have the same effect. For example, some people notice their vision becomes blurred when they get overheated — a phenomenon known as Uhthoff's sign. 

Yoga excercise is very helpful but during excersise patient temprature can be elevated so the patient advised when performing excercise or yoga or outdoor activity to Use cooling products such as vests, neck wraps, and bandana  

patient with multiple sclerosis is adviced to practice excersis and relaxation technique and yoga but to avoid effect of elevated temprature they advised to :  

• Use cooling products such as vests, neck wraps, and bandana  during exercise or outdoor activity.
• Wear lightweight, loose, breathable clothing.
• Icy drinks or popsicles can provide temporary relief.
• Use an oscillating fan or air conditioning during indoor exercise.
• Exercise in a cool pool (<85 degrees) or a cool environment. If you are exercising outside, pick cooler times of the day, usually early morning or evening.
• Try pre- and post-cooling to decrease the heating effects of exercise. Get into a bathtub of cool water and continue adding cooler water over a period of 20 to 30 minutes. A cool bath or shower can also help reduce core body temperature following activity or exposure to a hot environment.

 جميل جدا ،، اذ نلاحظ ان جميع المعلومات اعلاه تشير الى ان ارتفاع الحرارة لها تأثير سلبي على حالة المريض وهذه هي فكرة السؤال الاساسية ( فمن وضع السؤال أراد منك ان تعرف عدة امور )

1- ان التوتر والضغط النفسي له اثر سلبي على حالة المريض المصاب بالتصلب اللويحي
2- من أفضل الطرق بهدف تقليل التوتر لدى المريض المصاب بالتصلب اللويحي هي اساليب الاسترخاء مثل اليوغا وايضا ممارسة الرياضة
3- لكن ممارسة اليوغا او الرياضة تسبب ارتفاع في درجة حرارة المريض الداخلية واغلب الدراسات تشير الى ان مرضى التصلب اللويحي قد يكون لديهم تحسس تجاه التغير بالحرارة ويوصى بعدم تعرض المريض لدرجات حرارة مرتفعة او منخفضة بشكل شديد
4- على اي حال طالما ان المريض عندما يمارس الرياضة او اليوغا في الفالب ترتفع درجة حرارته فلابد من ان يتم الحفاظ على الجو المحيط بحيث يكون باردا نوعا ما ليتم معادلة ارتفاع درجة الحرارة

Some people with MS notice that symptoms, particularly spasticity, become worse in cold weather. It is generally recommended that people with MS who are sensitive to temperature try to avoid extremes of either hot or cold

بالرغم من وجود معلومات تشير الى ان الاجواء الباردة قد تسبب تفاقم في اعراض التصلب اللويحي عند بعض المرضى الا ان القاعدة الاكثر شمولا وعموما هي ان الاجواء الدافئة والمناطق الدافيء والنشاطات التي تسبب ارتفاع درجة حرارة المريض هي ماتجعل اعراض المرض اكثر سوءا وهذا احد اسباب اختياري للاجابة التي حددتها في الاعلى .

من ناحية اخرى فان الخيارات الثلاثة الاخرى

(  cross country running- Sunbathing-Relaxing in a warm bubble bath) تشير الى نشاطات وممارسات تساهم في رفع حرارة الجسم وطالما ان هذه الخيارات جميعها تقود الى نفس النتيجة وهي ارتفاع حرارة الجسم والمطلوب في السؤال تحديد الاجراء الانسب فهذا يعني انه سوف يتم استبعاد هذه الخيارات واختيار الخيار الذي هو نقيض لهذه الثلاثة .

الجانب الاخير قد يأتي شخص ويقول ان الخيار الاول لم يقل بانه يمارس نشاط بدني ولم يقل الاسترخاء بحمام ماء حار Hot وانما قال الاسترخاء بحمام ماء دافيء Warm وهنالك اختلاف بين كلمة warm وتعني دافيء وكلمة HOT وتعني ساخن او حار ،،، نعم هذا صحيح ولكن ايضا هنالك معلومة ان الاجواء الرطبة humidity تزيد اعراض المرض سوءا ويوصى المريض بالابتعاد عن المناطق الرطبة .

A recent study pointed out that people with MS demonstrated worsening of cognitive functions in warmer days

هذا هو تحليلي للسؤال بعد بحث وتحليل مطول وأسأل الله ان اكون قد وفقت بهذا التحليل .

والان في حال وجود اي سؤال يحتاج بحث وتحليل نتيجة لوجود تناقضات فيه اتمنى ان يطرح بالتعليقات ليتم تحليله باذن الله تعالى .

امنياتي لكم بالتوفيق 

أ.عمر حماد 

966561523465 +

@hammadjo2012