A nurse is assessing an older adult client who has osteoporosis.
Which of the following spinal deformities should the nurse expect to find in this client?

Choice A rationale

Obtaining a prescription for an indwelling urinary catheter in a client with a T4 spinal cord injury who is at risk for urinary tract infections (UTIs) is generally discouraged for long-term management. Indwelling catheters significantly increase the risk of UTIs due to biofilm formation and the introduction of bacteria into the sterile urinary tract. Intermittent catheterization or other bladder management strategies are preferred to minimize this risk.

Choice B rationale

Encouraging fluid intake at and between meals is a critical intervention for preventing urinary tract infections in clients with spinal cord injuries. Increased fluid intake promotes frequent bladder emptying, which helps to flush bacteria from the urinary tract, reducing bacterial stasis and colonization. Adequate hydration maintains urine flow and dilutes bacterial concentrations, thereby lowering the risk of ascending infections.

Choice C rationale

Offering the client the bedpan every 2 hours might not be an effective strategy for preventing UTIs in a client with a T4 spinal cord injury. This injury level often results in a neurogenic bladder, where the client may not have normal sensation or control over bladder emptying. Regular, scheduled emptying, often through intermittent catheterization, is more effective in preventing overdistention and residual urine, which are risk factors for UTIs.

Choice D rationale

Cleansing the perineum from back to front is an incorrect technique and significantly increases the risk of urinary tract infections. This method can introduce fecal bacteria, such as Escherichia coli, from the anal area into the urethra, leading to ascending UTIs. The correct and scientifically sound method for perineal cleansing is from front to back, which prevents the migration of enteric microorganisms to the urinary meatus.

Choice A rationale

Flushed cheeks are typically associated with conditions causing vasodilation or fever, such as infections or inflammatory responses. While a fever can occur in tuberculosis, flushed cheeks are not a primary or specific manifestation of pulmonary tuberculosis. The pallor often seen in chronic illnesses like TB is due to anemia.

Choice B rationale

Night sweats in pulmonary tuberculosis result from the body's febrile response to the chronic infection. The hypothalamus attempts to regulate body temperature, leading to peripheral vasodilation and diaphoresis, particularly during the nighttime hours when metabolic rates can shift. This is a common systemic symptom.

Choice C rationale

Weight gain is not a manifestation of pulmonary tuberculosis. Instead, clients with active tuberculosis often experience significant weight loss, known as "consumption," due to the chronic inflammatory state, increased metabolic demands, and anorexia caused by the infection and systemic cytokine release.

Choice D rationale

A low-grade fever is a common systemic manifestation of pulmonary tuberculosis. This persistent elevation in body temperature, often occurring in the afternoon or evening, is a result of the inflammatory response triggered by the Mycobacterium tuberculosis infection and the release of pyrogens.

Choice E rationale

Blood in the sputum, or hemoptysis, is a significant manifestation of pulmonary tuberculosis. It results from the erosion of blood vessels within the lung parenchyma by the granulomatous inflammation and cavitation characteristic of the disease, leading to bleeding into the airways.