A nurse is caring for a client who has chronic respiratory acidosis due to chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse expect with this client?

Choice A Reason:

Manual wheelchair is inappropriate. A manual wheelchair requires the use of the client's upper extremities to propel the wheelchair forward by pushing on the wheels. With a spinal cord injury at the fourth cervical level, the client may have limited or no function in their upper extremities, making it difficult to self-propel a manual wheelchair.

Choice B Reason:

Sip-and-puff device is appropriate. A sip-and-puff device allows individuals with limited or no hand function to control a powered wheelchair using their breath. This device enables the client to navigate the wheelchair by inhaling or exhaling into a straw-like device, which activates controls to move the wheelchair forward, backward, and turn.

Choice C Reason:

Drive-adapted wheelchair is inappropriate. A drive-adapted wheelchair is a powered wheelchair that can be modified with adaptive controls to accommodate individuals with limited hand function or mobility. These wheelchairs may include joystick controls, head arrays, chin controls, or other adaptive devices that allow the client to operate the wheelchair independently despite limited hand function.

Choice D Reason:

Ultra-light wheelchairs is inappropriate. Ultra-light wheelchairs are manual wheelchairs that are lightweight and often customized to fit the client's specific needs and preferences. While ultra-light wheelchairs may offer advantages in terms of maneuverability and ease of transportation, they still require sufficient upper extremity function to self-propel the wheelchair.

Choice A Reason:

"It will be necessary to take a stool softener to keep you from becoming constipated." This instruction is correct. Individuals with spinal cord injuries often experience bowel dysfunction, including constipation, due to decreased mobility and impaired bowel function. Stool softeners can help soften the stool and facilitate easier bowel movements, reducing the risk of constipation and associated complications such as fecal impaction.

Choice B Reason:

"Suprapubic catheterization might have to be done if you are unable to catheterize yourself." This instruction is correct. Suprapubic catheterization involves the insertion of a catheter through the abdominal wall directly into the bladder to drain urine. It may be necessary if the client is unable to perform intermittent catheterization independently or if other methods of bladder management are ineffective or contraindicated.

Choice C Reason:

"You will need to learn how to do self-intermittent catheterization to drain your bladder." This instruction is correct. Self-intermittent catheterization involves inserting a catheter into the bladder to drain urine at regular intervals. It is a commonly used method of bladder management for individuals with spinal cord injuries to prevent urinary retention and bladder distention.

Choice D Reason:

"Do not drink fluids excessively as this may cause diarrhea," is not typically included in bowel and bladder management instructions for individuals with spinal cord injuries. Hydration is important for overall health and may help prevent complications such as urinary tract infections, kidney stones, and constipation. Therefore, option D is not appropriate for inclusion in the teaching for a client with a complete spinal cord injury.

Choice E Reason:

"To achieve a bowel movement, daily digital stimulation will need to be done." This instruction is incorrect. Digital stimulation involves gently stimulating the rectum with a lubricated gloved finger to initiate a bowel movement. It can help individuals with spinal cord injuries who have neurogenic bowel dysfunction to stimulate bowel motility and facilitate bowel evacuation.