What is the reason that thyroid hormone increase ?

 An increase in thyroid hormone 

(hyperthyroidism or elevated T3/T4 levels) can occur due to several causes. The most common include:

Graves' disease – The most common cause. The immune system stimulates the thyroid gland to produce too much hormone.

Toxic multinodular goiter – Multiple overactive nodules in the thyroid produce excess thyroid hormone.

Toxic adenoma – A single thyroid nodule secretes excess hormone.

Thyroiditis – Inflammation (such as viral, postpartum, or painless thyroiditis) causes stored thyroid hormone to leak into the bloodstream.

Taking too much thyroid hormone medication (such as levothyroxine), either accidentally or intentionally.

Excess iodine intake – Large amounts of iodine from medications (such as amiodarone), supplements, or contrast dyes can trigger excess hormone production in susceptible people.

TSH-secreting pituitary adenoma – A rare pituitary tumor that produces excess thyroid-stimulating hormone (TSH), causing the thyroid to make more hormone.

Pregnancy-related hyperthyroidism – High levels of human chorionic gonadotropin (hCG), especially early in pregnancy or with conditions like molar pregnancy, can temporarily increase thyroid hormone production.

Common symptoms of high thyroid hormone

Fast or irregular heartbeat

Weight loss despite normal or increased appetite

Nervousness, anxiety, irritability

Tremors (shaky hands)

Sweating and heat intolerance

Frequent bowel movements

Difficulty sleeping

Muscle weakness

Enlarged thyroid (goiter)

Bulging eyes (especially in Graves' disease)

If you have symptoms of hyperthyroidism or your blood tests show elevated thyroid hormone levels, your healthcare provider will usually order tests such as:

1-TSH (usually low in most causes)
2-Free T4 and/or T3
3-Thyroid antibodies (to check for Graves' disease)

4-Sometimes a thyroid ultrasound or 

5-radioactive iodine uptake scan to determine the cause.

DPOA

 DPOA (Durable Power of Attorney) is a legal document that allows a person (the principal) to give another person (the agent / attorney-in-fact) authority to make decisions or handle matters on their behalf. 

DPOA (Durable Power of Attorney) is a legal document that allows a person (the principal) to give another person (the agent / attorney-in-fact) authority to make decisions or handle matters on their behalf.

Common types:

1. Durable Financial Power of Attorney
   • Allows someone to manage finances, such as:
     • Bank accounts
     • Paying bills
     • Real estate
     • Taxes
     • Investments
2. Durable Healthcare Power of Attorney (Healthcare Proxy)
   • Allows someone to make medical decisions if the person cannot communicate or make decisions.
   • Examples:
     • Surgery decisions
     • Treatment choices
     • End-of-life care preferences

Why “durable”?

• A regular Power of Attorney usually ends if the person becomes mentally incapacitated.
• A Durable Power of Attorney continues even if the person becomes unable to make decisions.

In a hospital chart, you may see:

• DPOA-HC = Durable Power of Attorney for Healthcare
• DPOA = Durable Power of Attorney
• POA = Power of Attorney

Example nursing note:

“Patient has DPOA on file; daughter is healthcare agent.”

Meaning: the daughter is legally authorized to make healthcare decisions if needed.

Yes, you can give a DPOA (Durable Power of Attorney) to a trusted person, such as a friend, family member, or another individual you choose.

However:

You usually do not give DPOA to a trust.

A trust is a legal arrangement that holds and manages assets. A person (called a trustee) manages the trust. If you want someone to manage trust assets, you normally name them as a successor trustee in the trust document.

✅ DPOA (Durable Power of Attorney)

You → appoint your friend/sibling/spouse as your agent

They can act for you in areas you authorize (banking, property, legal matters, healthcare, etc.)

✅ Living Trust

You → create the trust

You name a trustee to manage trust assets

After your death or incapacity, the successor trustee follows the trust instructions

Important:

Choose someone you strongly trust because a DPOA can give significant authority.

You can limit the powers (for example: only financial matters, only real estate, only healthcare).

You can revoke a DPOA while you have the legal capacity to do so.

If you are in California, the rules and forms are specific. I can explain the difference between California DPOA vs Living Trust vs Healthcare Directive if you want.

In California, you can create a Living Trust in two common ways:

1. Using an attorney (recommended for complex situations)

A trust attorney can:

• Prepare the trust document correctly
• Help with tax planning
• Protect against mistakes
• Handle complex assets (businesses, rental property, multiple beneficiaries, special situations)

2. Using a trust document service (or do-it-yourself)

You can create a living trust using an online service or forms, but you must be careful because mistakes can make the trust ineffective.

Notarization

A Living Trust usually should be notarized in California.

• You (the person creating the trust, called the grantor/settlor) sign the trust document.
• A notary public witnesses and notarizes your signature.
• The notary does not create or review the trust; they only verify your identity and signature.

Very important: Funding the trust

Creating the trust document is only part of the process. You usually need to transfer assets into the trust, such as:

• House/real estate → deed transfer into the trust
• Bank accounts → retitle or add trust ownership (depending on the account)
• Other assets → follow proper transfer steps

If you create a trust but do not fund it, the trust may not control those assets.

For many California homeowners, a common estate plan includes:

1. Revocable Living Trust
2. Durable Power of Attorney (financial)
3. Advance Healthcare Directive
4. HIPAA authorization
5. Pour-over will

If you tell me whether you have a house, bank accounts, investments, or children/beneficiaries, I can explain what type of trust setup usually fits.

1. Bank accounts

You can:Retitle the account in the name of the trust (example: John Smith Revocable Living Trust dated Aug. 11, 2026)

Or in some cases keep the account in your name and use beneficiary designations (depends on the account and your goals)

2. Investment accounts (brokerage accounts)

You can often:

Transfer a taxable brokerage account into the trust, or

Name beneficiaries (such as Transfer on Death (TOD) beneficiaries)

Examples:

Stocks

ETFs

Mutual funds

Brokerage accounts

3. Retirement accounts (IRA/401(k))

These are different:

Usually do not retitle them into a living trust while you are alive.

You normally use beneficiary designations.

A trust may sometimes be used as a beneficiary for special situations, but it requires careful planning.

Why people use a trust:

✅ Avoid or reduce probate for assets held in the trust

✅ Someone you choose can manage assets if you become unable to manage them

✅ More privacy than probate court

✅ Clear instructions for heirs

You would normally also have:

Durable Financial Power of Attorney → handles assets not in the trust and financial matters during your lifetime

Advance Healthcare Directive → medical decisions

Beneficiary designations → retirement accounts and insurance

Since you mentioned bank account and investments, are your investments in a brokerage account (Webull/Fidelity/Robinhood, etc.), IRA/401(k), or both? The best setup depends on which type.

Alert and Oriented

 

A&O ×4 = person + place + time + situation (understands why they are there and what is happening).

A&O ×1 = only recognizes self.

A&O ×2 = recognizes self and place, but not time.

A&O ×3= recognizes time place, person 

A&O ×0 = not oriented.

A&O ×3 means Alert and Oriented ×3.

The patient is:

1. Person – knows who they are (name/identity)
2. Place – knows where they are (hospital, clinic, home, etc.)
3. Time – knows the date/day/year or general time

It means the patient is awake, aware, and correctly answers three orientation questions.

Example nursing note:

Pt A&O ×3, follows commands, no acute distress.

Meaning:

The patient is awake and can identify self, location, and time.

A&O ×4 adds one more:
4. Situation – understands why they are receiving care (for example, “I am here because I had chest pain”).

Note: Some facilities use A&O ×4 routinely, while others document ×3 if they do not include situation as a

What causes cancer to spread once the patient has surgery?

 

What causes cancer to spread once the patient has surgery? Is it oxygen?

Oxygen doesn't cause cancer to spread. When the disease seems to explode after surgery, it's a tragic paradox: the primary tumor was actually keeping hidden, microscopic cancers dormant.

The myth that air causes cancer to spread is so widespread that many patients hesitate to undergo potentially life-saving operations. The fear is rooted in a common sequence of events: a patient undergoes surgery to remove a tumor, and shortly afterward, doctors discover cancer growing rapidly throughout the body. To family members, it looks as though exposing the tumor to the atmosphere unleashed the disease.

In reality, when cancer seems to spread immediately after surgery, it is almost always because the disease had already metastasized before the first incision was made. Cancer spreads when cells break away from the primary tumor and travel through the bloodstream or lymphatic system to other organs.

https://www.ncbi.nlm.nih.gov/ 

Foods that provide the most vitamin D

 

Foods that provide the most vitamin D

Food	Approximate vitamin D
Cooked rainbow trout, 3 oz	645 IU
Cooked sockeye salmon, 3 oz	570 IU
UV-exposed mushrooms, ½ cup	366 IU
Fortified cow’s milk, 1 cup	120 IU
Fortified soy, almond, or oat milk, 1 cup	100–144 IU
Fortified breakfast cereal, 1 serving	Around 80 IU
Two canned sardines	46 IU
One large egg	44 IU
Canned light tuna, 3 oz	40 IU
Cheddar cheese, 1.5 oz	17 IU

Fatty fish and UV-treated mushrooms are among the strongest food sources. Ordinary chicken, rice, bread, fruit, vegetables, and nuts generally contain little or no vitamin D unless fortified. Check the Nutrition Facts label because fortification varies substantially by brand.

A practical food example

A meal containing 3 ounces of salmon plus one cup of fortified milk supplies roughly 690 IU, which meets or slightly exceeds the recommended intake for most adults under age 71.

How much is normally recommended?

For generally healthy adults in the United States:

• Ages 19–70: 600 IU or 15 micrograms daily
• Over age 70: 800 IU or 20 micrograms daily

The adult Daily Value shown on U.S. food labels is 800 IU.

The Endocrine Society advises that generally healthy adults under 75 ordinarily do not need doses above the recommended dietary intake solely to prevent disease. Routine blood testing is also not recommended for every healthy person, although testing may be appropriate when symptoms or medical risk factors are present.

Who is more likely to be deficient?

Risk is higher with limited sun exposure, darker skin, older age, obesity, vegan diets without fortified products, inflammatory bowel disease, celiac disease, bariatric surgery, kidney or liver disease, and medications that interfere with vitamin D absorption or metabolism.

A clinician may order a 25-hydroxyvitamin D blood test when weakness, bone pain, malabsorption, abnormal calcium, osteoporosis, or another risk factor creates genuine suspicion.

Important supplement caution

Do not assume that more is better. The usual upper limit for adults without medical supervision is 4,000 IU daily. Excessive supplementation can raise blood calcium and cause nausea, weakness, dehydration, kidney stones, kidney damage, abnormal heart rhythm, and soft-tissue calcification.

Bottom line: Vitamin D is important for normal muscle and mitochondrial function, particularly when someone is deficient. But it is not a muscle-building shortcut. Strength training, sufficient protein, adequate calories, sleep, and correcting an actual vitamin D shortage remain the more evidence-based approach.

Possible signs you are running low vitamin D

 

Possible signs you are running low

Many people have no obvious symptoms. When symptoms occur, they can include:

• Unexplained muscle weakness, particularly in the thighs, hips, shoulders, or upper arms
• Difficulty climbing stairs or getting up from a chair
• Muscle aches, cramps, twitching, or generalized soreness
• Bone pain, especially in the back, pelvis, ribs, or legs
• Fatigue or reduced exercise tolerance
• Poor balance or a waddling-type walk in severe deficiency
• Increased fractures or falls, particularly in older adults

These symptoms are nonspecific and can also result from anemia, thyroid disease, low vitamin B12, medication effects, poor sleep, nerve disorders, or inadequate calorie and protein intake. A symptom alone cannot diagnose vitamin D deficiency. 

What vitamin D actually does for muscles

 

What vitamin D actually does for muscles

Vitamin D is not a replacement for protein, resistance training, or creatine. However, muscle cells contain vitamin D receptors, and adequate vitamin D helps support:

• Normal muscle-fiber development
• Calcium handling needed for muscle contraction
• Muscle strength and physical function
• Mitochondrial production of ATP—the usable energy that powers muscle contraction

Hospice and Morphine

 

Shaun Huger

 · 

Author 

Medicaid DirectorJun 24

What does morphine actually do for hospice patients, and why might it seem concerning to those who aren't familiar with end-of-life care?

In hospice care, morphine is surely one of the most misunderstood interventions in medicine. And that leads to huge amounts of unnecessary guilt and suspicion in the families at one of the hardest moments in their lives.

What morphine does here is control two things at once — pain and shortness of breath. 

The second one will be very surprising for most people. 

The hardest physical sensation at the end of life is when the body has the feeling of air hunger regardless of the amount of oxygen it receives.

 There is no intervention that takes away the discomfort in a similar manner to morphine. 

It does not heal the underlying condition; it takes away the suffering that this condition creates. 

That is the crucial difference.

Families' fear appears from the observation of becoming less responsive, sleeping more deeply, and breathing more slowly after the administration of morphine.

 From the perspective of the untrained mind, it may seem scary   even as if morphine hastens the process of death itself. And that is where the term "double effect" appeared in medical ethics   meaning the case when a medication used to alleviate pain and suffering inadvertently causes death slightly faster.

 Morphine for hospice care is surely one of the most misunderstood medical treatments around and that misunderstanding creates an unnecessary guilt burden and suspicions for loved ones at the most difficult time imaginable in their lives.

But scientific studies have proven again and again that morphine used correctly in hospice environments will do nothing to hasten the dying process. What it will do is take the agitation out of the equation, take away the signs of discomfort and pain and allow the body to go through the process without battling pain all the way to the end.

What families are really witnessing when morphine does its job is a peaceful process. That is all it ever intended to be.

The more basic truth of the matter that remains true here is that the capacity of the body to cope with illness, manage pain signals and retain dignity as it declines is highly related to the biological state of the body created over many years. Those who have done everything right and have nurtured themselves properly with healthy foods have a much easier experience at the end of their life than those who have neglected themselves along the way. 

Why Is Table Salt Iodized?

 Why was iodine added to salt?

Iodine is a trace mineral that the body needs to make thyroid hormones:

T3 (triiodothyronine)

T4 (thyroxine)

These hormones regulate:

Metabolism

Body temperature

Heart rate

Brain development

Growth

The thyroid gland cannot make these hormones without enough iodine.

What happened before iodized salt?

In many inland areas, especially places with iodine-poor soil, people did not get enough iodine from food.

The result was iodine deficiency disorders, including:

1. Goiter

The thyroid gland enlarges because it is trying harder to capture iodine.

Signs:

Enlarged neck

Difficulty swallowing (in severe cases)

Thyroid dysfunction

2. Brain and developmental problems

Severe iodine deficiency during pregnancy and childhood can cause:

Impaired brain development

Learning difficulties

Growth problems

Why use salt as the delivery method?

Scientists chose salt because:

✅ Almost everyone consumes it

✅ People use a fairly predictable amount

✅ Iodine can be added in very small, safe quantities

✅ It is inexpensive and stable

In the 1920s, countries including the United States began large-scale iodization programs.

The result:

Goiter rates dropped dramatically

Childhood development improved

Iodine deficiency became much less common

How much iodine do adults need?

The recommended intake for most adults is about:

150 micrograms (mcg) of iodine per day

Pregnancy:

220 mcg/day

Breastfeeding:

290 mcg/day

(Needs can vary depending on individual health.)

Sources of iodine:

🧂 Iodized salt

🐟 Seafood

🥛 Milk and dairy products

🥚 Eggs

Seaweed (very high, sometimes excessively high)

Important modern point:

Iodine is essential, but more is not always better.

Too much iodine can also affect the thyroid in some people, especially those with thyroid disorders.

Also, many people today consume less iodized salt because they eat more:

Restaurant food

Processed foods made with non-iodized salt

So a person may eat a lot of salt but still not get much iodine.

Simple takeaway:

Iodized salt is a small nutritional change that prevented millions of cases of goiter and protected brain development worldwide. It is an example of how understanding a tiny nutrient deficiency can create a huge public health impact.

7 warning signs of vitamin deficiency

 7 warning signs of vitamin deficiency

There are many cases of vitamin deficiency that start off as asymptomatic, making it particularly difficult for some to become immediately aware of the fact that they've got a nutrition problem; however, there are plenty of case in which the vitamin deficiency is marked by a number of key symptoms.

Because many of the symptoms of vitamin deficiency are shared by several slightly related conditions, it's easy for many people to get their wires crossed about determining exactly when vitamin deficiency is the key culprit.

While it's always advisable to consult your primary care provider to get any potential case of vitamin deficiency figured out with 100 percent certainty, the following are some of the most common recurrent symptoms to keep an eye out for.

Cavities

Vitamin A & D are essential for strengthening tooth enamel, and when they're not being taken in enough, the constitution and durability of the teeth will naturally start to decline.

Mental fog

Vitamin B-12 is one of the most important things that a person should be taking in on a regular basis to ensure that their nervous system is properly regulated. Without enough Vitamin B-12, subtle symptoms of mild confusion and slowed cognitive function can occur.

Skin rashes

Vitamin B-6 is highly helpful for the body's ability to keep the epidermis healthy, but without it, the skin's resilience can suffer by a fair degree. Less defensive capability in the skin cells can quickly lead to a greater susceptibility to rash outbreaks.

Fatigue

It's important to have a sufficient vitamin D intake level to keep the bones tough and capable of bearing the pressure of everyday activities for years on end. Not only does vitamin D deficiency open up the bones to much more damage susceptibility, but it's also oftentimes coupled by a persistent feeling of diminished energy.

Paleness and thinning hair

One of the most vital jobs that iron is responsible for in the body is to properly regulate oxygen transmission. Proper oxygen transmission is necessary for red blood cell synthesis, but without that, the body's skin and hair quality goes down by a huge degree. Thinning hair and paler-than-usual skin can be a subtle but sure sign of inefficient iron levels.

Inexplicable appetite reduction and weight loss

The body's proper weight regulation depends strongly on proper vitamin intake, with potassium and magnesium being two of the most essential for this job of all. Potassium is essential for correcting your metabolic regularity and magnesium plays a big role in creating a healthy appetite; when these two vitamins fall to inefficient levels, weight maintenance can spiral out of balance.

Nausea

Vitamins like niacin are vital for ensuring that the body's gastrointestinal functionality is kept in check. When vitamin deficient, it's common for a creeping sensation of stomach sickness to rise up over time and possibly continue unmitigated if the deficiency isn't corrected.

Summary

The challenge of keeping your body properly nourished today is easier to do than at any point in history, but at the same time, it can be very easy to fall off the wagon if you've got a busy schedule and are oftentimes under pressure to settle for convenience instead of eating full-course meals.

By staying on top of your awareness of the most likely symptoms above, you can at least take the first step towards becoming better: recognition of the issue. Once you've gotten ahold of the earliest signs of the symptoms, you'll be that much better at preventing them from getting much worse.

6 common warning signs of colon cancer that doctors pay attention to:

 1. Iron-deficiency anemia (low iron)

A tumor in the colon can bleed slowly over time. The blood loss may be too small to see, but it can cause:

Low hemoglobin-A blood test (CBC and iron studies) can detect this.

Important: Iron-deficiency anemia does not always mean cancer. It can also come from:

Fatigue

Weakness

Shortness of breath with activity

Pale skin

Menstrual blood loss

Low iron intake

Stomach ulcers

Other bleeding problems

2. Abdominal pain or discomfort

Colon cancer may cause:Cramping

Persistent abdominal discomfort

Bloating

A feeling that something is “not right”

Pain alone is usually not enough to diagnose colon cancer because many common conditions can cause similar symptoms:

Irritable bowel syndrome (IBS)

Gas

Constipation

Infections

3. Change in bowel habits

A new, persistent change such as:

Constipation

Diarrhea

Narrower stools

Feeling that you cannot completely empty your bowel

that lasts more than a few weeks should be evaluated.

4. Blood in stool

Possible signs:

Bright red blood

Dark or black stools

Hidden blood detected by stool tests

Not all colon cancers cause visible bleeding.

5. Unexplained weight loss

Losing weight without trying can happen because cancer may:

Increase the body's energy demands

Affect appetite

Change metabolism

6. Fatigue or weakness

This can result from:

Anemia

Inflammation caused by cancer

Poor nutrition

Sleep disruption

Who should be more alert?

Risk factors include:

Increasing age

Family history of colorectal cancer or polyps

Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)

Obesity

Smoking

Heavy alcohol use

Low physical activity

Diet high in processed meats

Screening saves lives

For average-risk adults in the U.S., colorectal cancer screening generally begins at age 45.

Common screening options:

Colonoscopy (detects and can remove polyps)

Stool-based tests (such as FIT)

Screening can prevent cancer by finding and removing precancerous polyps.

Seek medical evaluation if you have:

✅ Blood in stool

✅ Unexplained iron-deficiency anemia

✅ Persistent bowel changes

✅ Unexplained weight loss

✅ Symptoms lasting several weeks

Early colon cancer often has better treatment outcomes, which is why recognizing symptoms and getting appropriate screening are important.

If cancer needs carbs (glucose) to grow, why don't doctors change people’s diets when the cancer is first diagnosed?

 Cancer cells do use glucose — but so do normal cells

Many cancer cells rely heavily on glucose for energy through a process called the Warburg effect.

 They consume glucose at high rates even when oxygen is available.

However, glucose is also essential for:

Brain cells

Red blood cells

Immune cells

Muscles during activity

Healing and recovery

The body tightly regulates blood glucose.

 Even if someone eats almost no carbohydrates, the liver can make glucose from:

Protein (amino acids)

Glycerol from fat

Other metabolic pathways

So a low-carb diet does not mean cancer cells receive zero glucose.

2. Why don’t doctors prescribe a ketogenic diet for everyone with cancer?

A ketogenic diet (very low carbohydrate, high fat) is being researched, but it is not proven to replace standard cancer treatments.

Possible problems during cancer treatment:

Weight loss and muscle loss can worsen outcomes, especially in advanced cancers.

Chemotherapy and radiation require the body to have enough energy and protein to repair tissues.

Some patients develop cachexia (cancer-related muscle wasting), where maintaining weight is a major goal.

For many cancer patients, the priority is:

✅ maintain strength

✅ preserve muscle

✅ tolerate treatment

✅ recover after surgery/chemotherapy

3. Could diet influence cancer risk or outcomes?

Yes, nutrition matters — but in a different way.

Evidence supports:

Maintaining a healthy body weight

Eating plenty of vegetables, fruits, legumes, and whole grains

Getting adequate protein

Limiting processed meats

Limiting excessive alcohol

Regular physical activity

These can reduce cancer risk and improve general health.

But there is currently no strong evidence that eliminating carbohydrates can cure cancer.

4. Are there situations where a ketogenic diet is studied?

Yes. Researchers are studying ketogenic diets in some cancers because lowering insulin and glucose availability may affect certain tumor pathways.

Early research has explored this in cancers such as:

Brain tumors (including glioblastoma)

Some breast cancers

Some metabolic-sensitive tumors

But results are mixed, and it remains an adjunct research approach, not a replacement for chemotherapy, immunotherapy, surgery, radiation, or targeted treatments.

5. Why did the doctors in the story advise against extreme dieting?

Because a newly diagnosed cancer patient often needs more nutritional support, not restriction.

For example:

A patient undergoing chemotherapy may need extra protein to maintain muscle.

A surgical patient needs calories for wound healing.

A person losing weight unintentionally may have a worse prognosis.

A balanced diet designed around the person's cancer type, treatment, symptoms, and nutritional status is usually recommended.

Cancer cells do use glucose, but “starving cancer by removing sugar” is not realistic because the body will still make glucose and cancer cells can adapt. 

The strongest evidence still supports medical cancer treatments plus good nutrition to keep the body strong enough to fight and recover.

For someone with cancer, a good question for the oncology team is not “How do I remove all sugar?” but rather:

“What eating pattern will help me maintain muscle, energy, and tolerate my treatment best?”

Orthopedic and spine patients

 

Congratulations, you passed this test!

Question 1 of 16Correct

Orthopedic and spine patients should receive discharge instructions related to: select all that apply

Your Answer

Diagnosis and we

You did not pass this test.

You scored 12 out of 16, or 75%. To pass, you needed to correctly answer 13 questions, or 80%.

Question 1 of 16Correct

The Orthopedic service line at El Camino Health has programs certified for care of Total Hip, Total Knee, and Total Shoulder Arthroplasty at both campuses, Hip Fracture care at Mountain View campus, and Spine Fusion care at the Los Gatos campus.  

Your Answer

True

Question 2 of 16Correct

Patients and caregivers are encouraged to attend a pre-operative class to learn about:

Your Answer

All of the above

Question 3 of 16Incorrect

Certified programs, including the Orthopedic and Spine Care Programs, must meet core requirements including standards, clinical practice guidelines, and performance measurements every: 

Your Answer

3 years

Correct Answer

2 years

Question 4 of 16Correct

Orthopedic and spine patients should receive discharge instructions related to: select all that apply

Your Answer

Diagnosis and weight bearing status and precautions

Your Answer

Discharge diet, activity, bathing and incision care

Your Answer

Home medications (including “next dose due info”)

Your Answer

Signs and symptoms of possible complications and what to report to your doctor

Your Answer

Discharge therapy plan (home exercises vs. home health PT vs. outpatient PT)

Your Answer

Follow-up appointments

Question 5 of 16Incorrect

Knee precautions after surgery include avoiding: select all that apply

Your Answer

Pillows under the knee

Your Answer

Kneeling on the surgical leg

Your Answer

Exercises with high impact

Your Answer

Prolonged sitting without elevation

You Missed

Ambulation without an assistive device

Question 6 of 16Correct

Performance Measures for Total Hip and Total Knee Arthroplasty include:

Your Answer

All of the above

Question 7 of 16Correct

Post-operative treatment goals for total joint arthroplasty include: select all that apply

Your Answer

Reducing postoperative pain and discomfort

Your Answer

Reducing the risk of venous thromboembolism and infection

Your Answer

Preventing constipation

Your Answer

Promoting return to patient’s functional goal

Your Answer

Providing appropriate nutrition and emotional support

Question 8 of 16Correct

Neutral spine principles following lumbar spine fusion include all of the following except:

Your Answer

No log rolling (rolling in bed side-to-side with your shoulders, hips, and knees together as one unit)

Question 9 of 16Incorrect

Delirium is a common complication in hospitalized older adults, occurring in as much as 61% of patients with hip fracture. Nursing interventions to reduce delirium risk include the following: select all that apply

Your Answer

Using restraints to manage behaviors

Your Answer

Providing additional auditory stimulation in a darkened environment

You Missed

Considering opioid alternatives, such as, acetaminophen, anti-inflammatories and ice

You Missed

Having patient wear glasses or hearing aids

You Missed

Ensuring adequate rest

Question 10 of 16Incorrect

Performance Measures for Hip Fracture include: select all that apply

Your Answer

Early mobilization by POD 1

Your Answer

Early mobilization within 4 hours after surgery 

You Missed

Avoiding Readmissions

You Missed

Scheduled multimodal analgesic

You Missed

Nutrition Education

Question 11 of 16Correct

Performance Measures for Spine Fusion include all except:

Your Answer

Eat a Regular diet

Question 12 of 16Correct

12. A good ____________________________ assessment can alert caregivers to the development of potential complications and prevent permanent damage to the function of the limb. Assessments include pulse strength, motor strength, color, temperature, and capillary refill.

Your Answer

Neurovascular

Question 13 of 16Correct

Post surgical Total Shoulder Precautions include all except:

Your Answer

Active Range of Motion (AROM)

Question 14 of 16Correct

A potential complication after lumbar fusion is ___________________. If this complication occurs, your patient will “look sick” and have feelings of impending doom, as well as, be diaphoretic and tachycardic with decreased oxygen saturations.

Your Answer

Pulmonary embolus

Question 15 of 16Correct

An early postoperative complication of total knee arthroplasty is arthrofibrosis, which: select all that apply

Your Answer

Is the formation of excessive scar tissue after surgery or injury

Your Answer

Limits range of motion

Question 16 of 16Correct

Hip precautions after posterolateral approach surgery include avoiding:  select all that apply 

Your Answer

Hip flexion greater than 90 degrees

Your Answer

Adduction/internal rotation

Your Answer

Crossing legs

Your Answer

Pivoting or turning toes inwards on the operative leg

Your Answer

Low, soft chairs

 

Question 3 of 16Correct

Neutral spine principles following lumbar spine fusion include all of the following except:

Your Answer

No log rolling (rolling in bed side-to-side with your shoulders, hips