1 month ago:

Heart rate 78/min.

Respiratory rate 20/min.

Pulse oximetry 100% on room air.

Blood pressure: 130/80 mm Hg (left arm).

Height 154.9 cm (61 inches).

Weight 42.2 kg (93 Ib).

 

Today:

Heart rate 75/min.

Respiratory rate 18/min.

Pulse oximetry 98% on room air.

Blood pressure: 148/88 left arm.

Height 154.9 cm (61 inches).

Weight 44.5 kg (98 Ib).

 

Calculate the change in pulse oximetry

Choice A rationale

Climbing stairs does not typically lead to an increase in intracranial pressure (ICP) or disrupt the surgical site following transsphenoidal hypophysectomy. Post-operative care focuses on preventing activities that strain the surgical area or elevate ICP, which could compromise healing or lead to cerebrospinal fluid (CSF) leakage. Therefore, this activity is generally not restricted.

Choice B rationale

Heavy lifting significantly increases intra-abdominal and intrathoracic pressure, which directly translates to increased intracranial pressure. This elevation in ICP can disrupt the fragile surgical site in the sphenoid sinus, leading to complications such as cerebrospinal fluid (CSF) leakage or hemorrhage, thereby impeding proper healing and recovery.

Choice C rationale

Sexual intercourse can lead to increased exertion and potential Valsalva maneuvers, which temporarily elevate intracranial pressure. While not as consistently impactful as heavy lifting, the potential for increased pressure and strain on the healing surgical site warrants restriction to minimize the risk of complications such as cerebrospinal fluid leakage.

Choice D rationale

Breathing exercises, such as deep breathing and incentive spirometry, are crucial post-operatively to prevent pulmonary complications like atelectasis and pneumonia. These exercises do not increase intracranial pressure or strain the surgical site; instead, they promote lung expansion and optimize oxygenation, aiding in overall recovery.

Choice A rationale

Allowing a child with hemophilia to participate in any sport without restriction significantly increases the risk of severe bleeding episodes, especially in contact sports. Hemophilia involves a deficiency in clotting factors, making even minor trauma potentially life-threatening due to uncontrolled hemorrhage, which can lead to joint damage, organ damage, or intracranial bleeding, severely impacting their long-term health and mobility.

Choice B rationale

Encouraging participation in age-appropriate, low-impact activities like cycling with proper protective gear promotes physical activity and psychosocial development. This approach minimizes the risk of traumatic injuries that could trigger bleeding while still fostering a sense of normalcy and social integration. Regular physical activity also helps maintain muscle strength and joint integrity, which can be beneficial in managing hemophilia.

Choice C rationale

Completely restricting a child with hemophilia from all sports or physical activity can negatively impact their physical and psychological well-being. While safety is paramount, total avoidance can lead to muscle atrophy, obesity, and social isolation. A balanced approach that allows for modified, safe activities is crucial for holistic development, promoting self-esteem and peer interaction.

Choice D rationale

Discouraging activities like bike riding or skateboarding even with classmates, implies excessive restriction. While high-risk activities should be avoided, moderate-risk activities can be managed with appropriate precautions, such as helmets and padding. This extreme limitation can hinder the child's physical development, social integration, and mental health, leading to feelings of difference and isolation from peers.