A 12-year-old student fall off the stairs, grabs his wrist, and cries, “Oh, my wrist! Help! The pain is so sharp, I think I broke it.” Based on this data, the pain the student is experiencing is caused by impulses traveling from receptors to the spinal cord along which type of nerve fibers?
-
Solution
Type A-delta fibers
Type A-delta fibers conduct impulses at a very rapid rate and are responsible for transmitting acute sharp pain signals from the peripheral nerves to the spinal cord. Only type A-delta fibers transmit sharp, piercing pain. Somatic efferent fibers affect the voluntary movement of skeletal muscles and joints. Type C fibers transmit sensory input at a much slower rate and produce a slow, chronic type of pain. The autonomic system regulates involuntary vital functions and organ control such as breathing.
Which intervention should the nurse include as a nonpharmacologic pain-relief intervention for chronic pain?
-
Solution
Using transcutaneous electric nerve stimulation
Nonpharmacologic pain relief interventions include cutaneous stimulation, back rubs, biofeedback, acupuncture, transcutaneous electric nerve stimulation, and more. Hypnosis is considered an alternative therapy. Medications are pharmacologic measures. Although removing glaring lights and excessive noise help to reduce or remove noxious stimuli, it is not specific to pain relief.
A 50-year-old widower has arthritis and remains in bed too long because it hurts to get started. Which intervention should the nurse plan?
-
Solution
Deep pain
Deep pain has a slow onset, is diffuse, and radiates, and is marked by somatic pain from organs in any body activity. Acute pain is rapid in onset, usually temporary (less than 6 months), and subsides spontaneously. Chronic pain is marked by gradual onset and lengthy duration (more than 6 months). Superficial pain has abrupt onset with sharp, stinging quality.
The Causative agent of Tuberculosis is said to be:
-
Solution
Mycobacterium Tuberculosis
The public health nurse is providing follow-up care to a client with TB who does not regularly take his medication. Which nursing action would be most appropriate for this client?
-
Solution
Ask the client’s spouse to supervise the daily administration of the medications.
Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment.
The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB?
-
Solution
Limit alcohol intake
INH and rifampin are hepatotoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Both drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after these drugs are administered. Clients should not double the dosage of these drugs because of their potential toxicity. Clients taking INH should avoid foods that are rich in tyramine, such as cheese and dairy products, or they may develop hypertension.
INH treatment is associated with the development of peripheral neuropathies. Which of the following interventions would the nurse teach the client to help prevent this complication?
-
Solution
Supplement the diet with pyridoxine (vitamin B6)
INH competes with the available vitamin B6 in the body and leaves the client at risk for development of neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed.
A client has a positive reaction to the PPD test. The nurse correctly interprets this reaction to mean that the client has:
-
Solution
Had contact with Mycobacterium tuberculosis
A positive PPD test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists.
The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members. Which statement(s) by the client indicate(s) that he has understood the nurses instructions? Select all that apply.
-
Solution
Answer: 2, 4, 5.
Which of the following family members exposed to TB would be at highest risk for contracting the disease?
-
Solution
76-year-old grandmother
Elderly persons are believed to be at higher risk for contracting TB because of decreased immunocompetence. Other high-risk populations in the US include the urban poor, AIDS, and minority groups.
The client experiencing eighth cranial nerve damage will most likely report which of the following symptoms?
-
Solution
Vertigo
The eighth cranial nerve is the vestibulocochlear nerve, which is responsible for hearing and equilibrium. Streptomycin can damage this nerve.
Which of the following antituberculous drugs can cause damage to the eighth cranial nerve?
-
Solution
Streptomycin
Streptomycin is an aminoglycoside, and eight cranial nerve damage (ototoxicity) is a common side effect from aminoglycosides.
The nurse obtains a sputum specimen from a client with suspected TB for laboratory study. Which of the following laboratory techniques is most commonly used to identify tubercle bacilli in sputum?
-
Solution
Acid-fast staining
The most commonly used technique to identify tubercle bacilli is acid-fast staining. The bacilli have a waxy surface, which makes them difficult to stain in the lab. However, once they are stained, the stain is resistant to removal, even with acids. Therefore, tubercle bacilli are often called acid-fast bacilli.