A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as a possible indication of venous insufficiency?

Choice A: Provide a brightly lit environment is not an intervention that the nurse should take. A brightly lit environment can stimulate the brain and increase intracranial pressure. The nurse should provide a quiet and dimly lit environment to reduce sensory stimuli and promote rest.

Choice B: Elevate the head of the bed is an intervention that the nurse should take. Elevating the head of the bed to 30 degrees can help reduce intracranial pressure by facilitating venous drainage from the brain and decreasing cerebral blood volume. The nurse should avoid flexing or extending the neck, which can impede blood flow and increase intracranial pressure.

Choice C: Encourage a minimum intake of 2000 mL (67.6 oz) of clear fluids per day is not an intervention that the nurse should take. A high fluid intake can increase intracranial pressure by increasing blood volume and cerebral edema. The nurse should monitor fluid balance and restrict fluid intake as prescribed to maintain normal osmolality and prevent fluid overload.

Choice D: Teach controlled coughing and deep breathing is not an intervention that the nurse should take. Coughing and deep breathing can increase intrathoracic pressure, which can increase intracranial pressure by reducing venous return from the brain. The nurse should avoid activities that can increase intrathoracic pressure, such as straining, sneezing, or blowing the nose. The nurse should also administer oxygen as prescribed to maintain adequate oxygenation and perfusion of the brain.

Choice A: Weakened gag reflex is a complication of cervical spinal cord injury. The gag reflex is a protective mechanism that prevents choking and aspiration. It is controlled by the cranial nerves IX and X, which originate from the brainstem. A cervical spinal cord injury can impair the transmission of nerve impulses from the brainstem to the pharynx and larynx, resulting in a reduced or absent gag reflex. This can increase the risk of aspiration pneumonia and respiratory failure.

Choice B: Hyperthermia is a complication of cervical spinal cord injury. Hyperthermia is an abnormally high body temperature, which can be caused by infection, inflammation, or environmental factors. A cervical spinal cord injury can disrupt the sympathetic nervous system, which regulates body temperature by controlling blood flow, sweating, and shivering. This can lead to impaired thermoregulation and hyperthermia, especially in hot and humid environments.

Choice C: Absence of bowel sounds is not a complication of cervical spinal cord injury. Bowel sounds are audible noises produced by the movement of gas and fluid through the intestines. They are influenced by factors such as diet, activity, medication, and bowel motility. A cervical spinal cord injury does not directly affect bowel sounds, but it

can cause neurogenic bowel dysfunction, which is a loss of voluntary control over bowel movements. This can lead to constipation, fecal impaction, or incontinence.

Choice D: Paralysis is a complication of cervical spinal cord injury. Paralysis is a loss of voluntary muscle movement and sensation in a part of the body. It is caused by damage to the motor and sensory neurons that carry signals from the brain to the muscles and skin. A cervical spinal cord injury can damage the neurons that innervate the arms, trunk, legs, and pelvic organs, resulting in quadriplegia or tetraplegia, which is paralysis of all four limbs and the trunk.

Choice E: Polyuria is not a complication of cervical spinal cord injury. Polyuria is an excessive production of urine, which can be caused by diabetes mellitus, diabetes insipidus, diuretics, or kidney disease. A cervical spinal cord injury does not directly affect urine production, but it can cause neurogenic bladder dysfunction, which is a loss of voluntary control over bladder function. This can lead to urinary retention, overflow incontinence, or reflex incontinence.

Choice F: Hypotension is a complication of cervical spinal cord injury. Hypotension is an abnormally low blood pressure, which can be caused by blood loss, dehydration, shock, or medication. A cervical spinal cord injury can impair the sympathetic nervous system, which regulates blood pressure by controlling heart rate, cardiac output, and vascular tone. This can lead to neurogenic shock, which is a type of distributive shock characterized by hypotension and bradycardia.