The patient's complaints suggest that they are experiencing radiation-induced xerostomia, or dry mouth caused by radiation therapy. The following measures may help improve their oral intake:
1. Sipping water or sugar-free beverages frequently throughout the day to keep the mouth moist.
2. Using saliva substitutes, such as artificial saliva or oral moisturizing gels, to help relieve dryness and improve chewing and swallowing.
3. Chewing sugar-free gum or sucking on sugar-free candies to stimulate saliva production.
4. Avoiding alcohol, tobacco, caffeine, and spicy or acidic foods, which can further irritate the mouth.
5. Eating soft, moist foods that are easy to chew and swallow, such as soups, stews, and casseroles.
6. Using a blender or food processor to puree solid foods or making smoothies and shakes to increase calorie and nutrient intake.
It is important for the patient to maintain good oral hygiene by brushing with a soft-bristled toothbrush and fluoride toothpaste, flossing gently, and using a fluoride rinse. They should also see their dentist regularly to monitor for any dental problems that may arise due to radiation therapy.
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What are the Adverse effects of drug regimens for pneumocystis pneumonia?
The drug regimens commonly used for the treatment of Pneumocystis pneumonia (PCP) include sulfamethoxazole/trimethoprim (TMP-SMX), pentamidine, atovaquone, and dapsone with or without trimethoprim. These regimens may have potential adverse effects.
The most common adverse effects of TMP-SMX include rash, fever, neutropenia, and hepatotoxicity. In addition, TMP-SMX may cause renal impairment, electrolyte abnormalities, and hypersensitivity reactions.
Pentamidine may cause hypotension, hypoglycemia, hyperglycemia, and renal impairment. It may also cause electrolyte abnormalities and pancreatitis.
Atovaquone may cause gastrointestinal disturbances such as nausea, vomiting, and diarrhea. It may also cause rash and elevated liver enzymes.
Dapsone with or without trimethoprim may cause hemolysis, methemoglobinemia, and hypersensitivity reactions. It may also cause peripheral neuropathy, rash, and hepatotoxicity.
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Stimulants "stimulate" or speed-up the central nervous system. They increase heart rate and generate a false sense of alertness and well-being. Stimulants include:
Stimulants are a class of psychoactive drugs that increase activity in the central nervous system (CNS). They work by stimulating the release of certain chemicals in the brain, such as dopamine and norepinephrine, which are associated with feelings of pleasure and arousal.
Stimulants can produce a wide range of effects, including increased heart rate, elevated blood pressure, reduced appetite, and feelings of alertness and well-being. They can also improve focus and concentration, making them popular among students and professionals who need to stay awake and alert for extended periods.
Some common stimulants include caffeine, nicotine, amphetamines, cocaine, and prescription drugs like Adderall and Ritalin. However, many of these drugs are highly addictive and can cause serious health problems if used improperly or abused.
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if a patient shows signs of life, what order do you do ABCs?
If a patient shows signs of life, the order of ABCs (Airway, Breathing, and Circulation) should be modified to CAB (Circulation, Airway, Breathing).
This modification is made because the patient is now demonstrating signs of circulation, and the priority is to maintain that circulation. First, assess for any signs of bleeding or shock and address those as needed. Next, check the airway for any obstructions or other issues that may compromise breathing. Finally, assess the breathing and provide support as needed. It is important to note that the order of ABCs versus CAB may vary based on the situation, and it is crucial to always assess and prioritize the patient's needs accordingly.
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according to recent research in healthy aging, what causes the decrease in brain volume? multiple select question.
Recent research suggests that the decrease in brain volume in healthy aging is caused by a combination of factors, including age-related changes in the brain's white matter, a decline in the number and size of neurons, and changes in the brain's blood supply.
As people age, the brain undergoes various changes that contribute to a decrease in its volume. One of the primary factors is age-related changes in the brain's white matter. White matter is responsible for transmitting signals between different parts of the brain, and it undergoes changes as people age, such as a decrease in the number and thickness of axons and myelin. These changes can affect the brain's ability to process information and communicate effectively.
Another factor is a decline in the number and size of neurons, which are the cells responsible for transmitting information throughout the brain. As people age, the number of neurons in the brain decreases, and those that remain may become less efficient at communicating with each other.
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If Pt present with thigh furuncle infection of hair follicles and then has some deep tenderness to palpation of RLQ on abd exam, what do you think?
The patient's symptoms suggest a possible complication of the thigh furuncle infection.
The deep tenderness to palpation in the right lower quadrant (RLQ) on abdominal examination is concerning for an abscess formation, which can occur due to the spread of infection through the bloodstream or lymphatic system. The RLQ is also the location of the appendix, so it is important to rule out the possibility of acute appendicitis, which can present similarly.
Therefore, further evaluation is necessary, which may include imaging studies such as an ultrasound or CT scan of the abdomen and pelvis. Appropriate treatment, such as antibiotics and/or surgical drainage of the abscess, should be initiated promptly to prevent potential complications
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the nurse instructs a 70-year-old client to dress warmly in cold weather. which physical changes seen in the client necessitate this instruction?
As we age, the body undergoes various changes that affect our ability to regulate body temperature, making older adults more vulnerable to the effects of cold weather.
One of the most significant changes is a decrease in metabolic rate, which means that older adults generate less heat than younger individuals. Additionally, the body's ability to shiver, which helps to generate heat, may also be reduced. These factors, along with decreased circulation, can increase the risk of hypothermia in older adults. Hypothermia occurs when the body's core temperature drops below 95°F (35°C) and can lead to confusion, lethargy, and even death if left untreated. Therefore, it is crucial for older adults to dress warmly in cold weather to prevent hypothermia and stay healthy. This may include wearing several layers of clothing, a hat, gloves, and warm footwear.
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Diagnosis: Potential for infection related to rupture of membranes.Provide: Goal
Diagnosis: Potential for infection related to rupture of membranes.
Goal: To prevent infection.
The goal for a potential infection related to the rupture of membranes would be to prevent the infection from occurring. This can be achieved through measures such as monitoring vital signs, administering antibiotics if necessary, and maintaining strict hygiene practices. It is important to address this potential risk early on to avoid any complications that may arise from infection. Regular monitoring and assessment should be conducted to ensure that the patient remains healthy and free from any signs of infection.Therefore, the Goal is to prevent infection and promote healing by maintaining a clean and sterile environment, monitoring for signs of infection, and administering appropriate interventions as needed.
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An unresponsive man is found lying supine in his bed. Which of the following assessment findings would indicate that his gag reflex is depressed or absent?
A) gurgling sound during breathing
B) High-pitched inspiratory stridor
C) Breathing that is slow and shallow
D) Cyanosis to the face, neck, and chest
Option A, a gurgling sound during breathing, would indicate that the man's gag reflex is depressed or absent.
The gag reflex is a protective mechanism that prevents foreign material, including food or other objects, from entering the airway. If the gag reflex is depressed or absent, the risk of aspiration and airway obstruction is increased.
Gurgling sounds during breathing can indicate that fluid or secretions are present in the airway, which may have been aspirated due to a depressed or absent gag reflex. Options B, C, and D may also indicate respiratory distress, but do not specifically indicate a depressed or absent gag reflex.
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What factors postoperatively give rise postop atelectasis?
Postoperative atelectasis is a common complication following surgery that occurs due to a combination of factors.
These include the effects of anesthesia, which can depress respiratory drive and reduce lung compliance, and decreased mobility and deep breathing due to pain, surgical site discomfort, and immobility. Additionally, the use of mechanical ventilation during surgery can lead to lung injury and inflammation, which can contribute to atelectasis.
Other contributing factors may include preexisting lung disease, obesity, and smoking. Factors that can exacerbate postoperative atelectasis include retained secretions, pneumonia, and pleural effusions. To prevent postoperative atelectasis, it is important to encourage early mobilization, deep breathing, and coughing, and to provide adequate pain control.
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Limb Ischemia (ACUTE ARTERIAL OCCLUSION)
Acute arterial occlusion is a medical emergency that occurs when there is a sudden blockage or interruption of blood flow to an extremity, most commonly the leg.
This can be due to a blood clot or embolus, trauma, or other causes. Symptoms of acute arterial occlusion include sudden onset of severe pain, pallor, coldness, and loss of sensation or motor function in the affected limb.
Immediate management of acute arterial occlusion involves restoring blood flow to the affected limb as quickly as possible, usually with surgical intervention such as embolectomy or thrombectomy. Thrombolytic therapy may also be considered in certain cases. It is important to identify and address any underlying causes of the arterial occlusion, such as atrial fibrillation or peripheral artery disease, to prevent recurrence.
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Full Question: What is acute arterial occlusion causing limb ischemia, and how is it managed?
Next Step in Patient presenting with Blunt Chest Trauma and signs of acute heart failure or shock?
A patient presenting with blunt chest trauma and signs of acute heart failure or shock requires urgent medical attention.
The first step in managing such a patient is to perform a rapid and focused assessment of their airway, breathing, and circulation, including a thorough cardiovascular exam.
The patient may require immediate resuscitation, such as with oxygen therapy, fluid resuscitation, and inotropic support if necessary. Further imaging studies, such as a chest X-ray or echocardiogram, may be necessary to assess for any cardiac or pulmonary injuries. Additionally, early involvement of a multidisciplinary team, including emergency medicine, trauma surgery, and critical care, may be necessary to optimize the patient's care and outcome.
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Diagnosis: Acute pain related to progress of laborProvide: 5th intervention
Diagnosis: Acute pain related to the progress of labor
5th intervention: Administer pain relief medications.
The epidural analgesia or IV medications, as prescribed by the healthcare provider, to manage pain and ensure the comfort of the patient during labor.This can help alleviate the pain and discomfort experienced during labor and delivery, allowing the mother to better cope with the process and focus on the birth of her baby. Additionally, providing emotional support and encouragement can also be beneficial in managing pain and promoting a positive birthing experience.Know more about interventions for Acute pain related to the progress of labor here
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As Blood Alcohol Concentration (BAC) increases, the area of the brain that controls muscular movements begins to slow down - the brain takes longer to process information and react. Muscular reactions become slow; steering and braking movements become uncoordinated.T/F
As Blood Alcohol Concentration (BAC) increases, the area of the brain that controls muscular movements begins to slow down - the brain takes longer to process information and react. Muscular reactions become slow; steering and braking movements become uncoordinated - True.
Due to the body's slow metabolism of alcohol, BAC rises steadily after alcohol ingestion. The cerebellum is the main brain region that is impacted by excessive alcohol use. The critical brain region governing movement, coordination, and motor skills is called the cerebellum. Alcohol's effects on the cerebellum cause the main functions to slow down. Muscular reaction is hampered as a result. Long-term alcohol use results in smaller neuron sizes, which affects some memories and other motor functions.Therefore, an increase in BAC affects how quickly the brain processes information and reacts, which causes a loss in muscle control. Driving when intoxicated causes accidents because it causes uncontrolled steering and braking actions.Know more about Alcohol effects on brain here
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What is hallmark of hypovolemic hypernatremia?
The hallmark of hypovolemic hypernatremia is a deficit of both water and sodium in the body. This occurs when there is a loss of both water and electrolytes, such as through severe diarrhea or excessive sweating.
The loss of water results in an increase in the concentration of sodium in the blood, leading to hypernatremia. The body responds to the decreased volume by increasing the release of vasopressin, which promotes water retention in the body.
However, if the underlying cause of hypovolemia is not addressed, the hypernatremia can persist, leading to further complications. Treatment involves restoring volume status with appropriate fluid replacement and addressing the underlying cause of fluid loss.
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when is anterior hyoid excursion (9) scored?
Anterior hyoid excursion (scored as 9) is typically scored during a swallowing study to assess the movement of the hyoid bone, which is an important indicator of the strength and coordination of the swallowing muscles.
This score is typically given when the hyoid bone moves anteriorly and superiorly during the swallow, reaching its highest point at the peak of the swallow. The amount of movement is assessed by measuring the distance the hyoid bone moves from its resting position, typically using a measurement tool such as calipers or a ruler.
A reduced anterior hyoid excursion can be indicative of weakness or poor coordination of the swallowing muscles, which can lead to swallowing difficulties or aspiration.
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An emergency department nurse moves to a new city where heat-related illnesses are common. Which clients does the nurse anticipate being at higher risk for heat-related illnesses? (Select all that apply.)
a. Homeless individuals
b. Illicit drug users
c. White people
d. Hockey players
e. Older adults
As a nurse working in an emergency department in a city where heat-related illnesses are common, the nurse should be aware of the clients who are at higher risk of developing these illnesses.
Some of the clients that the nurse should anticipate being at higher risk include older adults, people who are overweight or obese, those with chronic medical conditions such as heart disease, respiratory disease, or diabetes, people who work or exercise outdoors for prolonged periods, and individuals who are taking certain medications that can affect their ability to regulate body temperature.
It is important for the nurse to educate these clients on the signs and symptoms of heat-related illnesses, as well as ways to prevent them, such as staying hydrated, wearing appropriate clothing, and avoiding prolonged exposure to the sun. Additionally, while heat-related illnesses can affect people of any race, it is important for the nurse to be aware of the fact that certain populations, such as older adults and those with chronic medical conditions, may be at a higher risk.
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How to manage HEMODYNAMICALLY USNTABLE PATIENT WITH PENETRATING ABDOM TRAUMA?
A hemodynamically unstable patient with penetrating abdominal trauma requires immediate resuscitation and prompt surgical intervention. The primary survey, which includes assessment and management of the airway, breathing, circulation, and disability, should be performed rapidly.
Intravenous access should be established, and blood products should be administered as necessary to correct hypovolemia and coagulopathy. Diagnostic peritoneal lavage or focused abdominal sonography for trauma may be used to identify the presence of intra-abdominal bleeding.
If the patient remains unstable, emergent exploratory laparotomy is indicated to control hemorrhage and repair any injuries. Timely surgical intervention is crucial in reducing mortality in patients with penetrating abdominal trauma.
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what is ADPKD (autosomal dominant polycystic kidney disease)?
ADPKD (autosomal dominant polycystic kidney disease) is a genetic disorder characterized by the growth of multiple cysts in the kidneys.
It is inherited in an autosomal dominant pattern, meaning that if a person inherits one copy of the mutated gene from a parent with the disease, they have a 50% chance of developing the condition themselves. ADPKD can lead to progressive kidney damage and eventually end-stage renal disease.
Other complications associated with the condition include high blood pressure, liver cysts, and aneurysms in the brain. Treatment options include managing blood pressure, controlling pain, and, in some cases, kidney transplantation.
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which action would the nurse perform when providing care for a patient with a chest tube to correct a pneumothorax select all that apply
These actions are crucial to ensure the patient's safety and to promote effective recovery from the pneumothorax.
When providing care for a patient with a chest tube to correct a pneumothorax, the nurse may perform the following actions:
1. Monitor the patient's respiratory status and vital signs.
2. Assess the chest tube insertion site for signs of infection or drainage.
3. Check the suction settings and ensure proper functioning of the chest tube system.
4. Assist with chest tube dressing changes and secure the tubing in place.
5. Encourage the patient to perform deep breathing and coughing exercises to promote lung expansion.
6. Administer prescribed medications, such as analgesics or antibiotics.
7. Notify the healthcare provider immediately if there are any signs of worsening pneumothorax or other complications.
These actions are crucial to ensure the patient's safety and to promote effective recovery from the pneumothorax.
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an infant was born at community hospital by vaginal delivery and was a premature baby with tetralogy of fallot congenital heart defect and described as newborn light for gestational age. the infant was transferred to children's hospital for evaluation of the congenital heart defect, tetralogy of fallot. what is likely the principal diagnosis for the infant at children's hospital?
The principal diagnosis for the infant at Children's Hospital is likely Tetralogy of Fallot (TOF).
Tetralogy of Fallot is a congenital heart defect that affects the structure of the heart, causing a combination of four related problems. In this case, the infant was born premature and light for gestational age, which may have contributed to the severity of the condition. The infant was transferred to Children's Hospital specifically for evaluation of this congenital heart defect.
Given the information provided, Tetralogy of Fallot is the most likely principal diagnosis for the infant at Children's Hospital.
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How to handle a "difficult patient" AKA someone being agressive and hostile
Handling a difficult patient who is being aggressive and hostile can be challenging, but it is important to remember that their behavior is often a result of fear, frustration, or pain. Here are some tips for handling a difficult patient:
1. Stay calm: The first thing you should do is remain calm and composed. Do not react to their aggression, and do not raise your voice or become defensive. Instead, try to remain neutral and empathetic.
2. Listen actively: It is essential to listen actively to the patient's concerns and understand their perspective. Validate their feelings and acknowledge that you understand their frustration.
3. Set boundaries: While it is important to empathize with the patient, it is also crucial to set boundaries and let them know that their behavior is not acceptable. You can do this by using assertive language and being firm but respectful.
4. Offer alternatives: If the patient is agitated, try to distract them or offer them alternatives to their current situation. For example, you could offer them a calming activity or suggest that they take a walk outside.
5. Involve the healthcare team: If the patient's behavior becomes unmanageable, do not hesitate to involve the healthcare team, including security personnel or a mental health professional.
Remember, handling a difficult patient takes patience, empathy, and communication skills. With the right approach, you can help the patient feel heard and understood while also ensuring their safety and the safety of those around them.
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What are the Most common cause of osteomyelitis in children + adults?
The most common cause of osteomyelitis, an infection of the bone, varies between children and adults.
In children, the most frequent cause of osteomyelitis is an acute bacterial infection, often caused by the bacterium Staphylococcus aureus. This type of infection typically affects the long bones of the arms and legs. In adults, the most common cause of osteomyelitis is usually a chronic infection, often caused by the presence of an orthopedic implant, such as a prosthetic joint or hardware used to stabilize a fracture.
The bacteria causing the infection may be the patient's own skin flora or hospital-acquired organisms such as Staphylococcus aureus or Pseudomonas aeruginosa.
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nectar is associated with the worst impairment in these components
Nectar is associated with the worst impairment in component 2 (initiation of the pharyngeal swallow) and component 3 (mastication).
Nectar is a liquid consistency used in the evaluation of swallowing function, typically thicker than water but thinner than honey. While it is easier to swallow than honey, it still requires a certain level of oral and pharyngeal muscular strength and coordination. Impairment in component 2 may result in difficulty initiating the pharyngeal swallow, leading to residue in the oral cavity or aspiration. Impairment in component 3 may result in inadequate mastication of the bolus, leading to larger particle size that is more difficult to swallow safely.
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A patient experiences burns to the front and back of BOTH arms and legs. patient weights 228 lbs. How much fluid will be given in the first 24 hours of care? A. 22,464
B. 0
C.1,404
D. 11,232
To calculate the fluid resuscitation volume for a burn patient, we use the Parkland formula which states that the first 24-hour fluid requirement is equal to 4 ml of lactated Ringer's solution per kg of body weight, with half of the volume given in the first 8 hours post-burn and the remaining volume given in the next 16 hours.
Converting the patient's weight from pounds to kg (228 lbs ÷ 2.205 = 103.4 kg), the total fluid requirement in the first 24 hours would be:
4 ml/kg x 103.4 kg = 413.6 ml/hr
Half of this amount (206.8 ml/hr) is given in the first 8 hours, so the answer is C. 1,404 ml given in the first 8 hours. It's important to note that this calculation is an estimate, and the actual fluid volume requirements may vary based on the patient's response to treatment and other individual factors. Close monitoring of the patient's vital signs and fluid balance is necessary to ensure adequate resuscitation and prevent complications.
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A 17-year-old client arrives in the ED with her parents, only to discover that she is pregnant and in labor. She has not yet told her parents abou the pregnancy. The client also expresses that she has pain when urinating. the vessels in the infant's umbilical cord. These lines are referred to as an umbilical artery catheter (UAC) and umbilical venous catheter (UVC). Once these lines are placed and secured, a bedside x-ray is done to confirm placement of the E.T.T. and UAC and UVC lines. The white area noted on the x-ray in the infant's lungs reveals presence of the respiratory distress syndrome (RDS), due to the lack of surfactant. 1. The student nurse asks why they cannot give the infant more oxygen. What are the nurse's best responses? (Select all that apply. One, some, o all options may be correct.) A. If the oxygen level is too high, it can cause retinopathy of the premature. B. Too much oxygen can damage the lungs, called bronchopulmonary dysplasia. C. The pressures need to be carefully maintained to prevent a pneumothorax. D. It can cause free air in the interstitial tissue, pulmonary interstitial emphysema. E. This ventilator has high frequency ventilation and reduces the risks auma. F. The target arterial oxygen saturation is kept in the range of 88%-92%.
The nurse's best responses are mention below:
A. If the oxygen level is too high, it can cause retinopathy of the premature.
B. Too much oxygen can damage the lungs, called bronchopulmonary dysplasia.
C. The pressures need to be carefully maintained to prevent a pneumothorax.
D. It can cause free air in the interstitial tissue, pulmonary interstitial emphysema.
F. The target arterial oxygen saturation is kept in the range of 88%-92%.
The nurse should explain that giving the infant too much oxygen can cause retinopathy of the premature, which can cause blindness. Additionally, high oxygen levels can damage the lungs, causing bronchopulmonary dysplasia. The pressures need to be carefully maintained to prevent a pneumothorax, which is the presence of air in the space between the lung and chest wall. It can also cause free air in the interstitial tissue, which is called pulmonary interstitial emphysema.
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diastolic blowing murmur + acute chest pain are indication of:
A diastolic blowing murmur and acute chest pain may indicate aortic regurgitation, which is the backflow of blood from the aorta into the left ventricle during diastole.
The murmur is caused by the turbulent flow of blood during this regurgitation. Acute chest pain can also be a sign of aortic dissection, which is a medical emergency that occurs when there is a tear in the inner layer of the aorta, allowing blood to flow between the layers and potentially leading to rupture.
Both of these conditions require prompt medical attention to prevent complications and potential death.
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a patient with a chronic respiratory disease reports increasing fatigue and inability to perform activities of daily living (adls). the nurse notes that the patient walks slowly, stopping repeatedly to rest; oxygen saturation drops as walking progresses; respiratory rate is elevated; no adventitious breath sounds are heard; and the patient denies pain. which nursing hypothesis would be supported by this evidence
Based on the patient's symptoms, the nursing hypothesis that would be supported is that the chronic respiratory disease has progressed and is causing a decrease in the patient's physical functioning.
The increased fatigue and inability to perform activities of daily living (ADLs) suggest a decline in the patient's overall health status, likely due to the chronic respiratory disease. The slow walking and need for frequent rests, along with the drop in oxygen saturation, indicate that the patient's respiratory system is struggling to meet the body's demands.
The elevated respiratory rate also suggests that the patient is working harder to breathe. However, the absence of adventitious breath sounds and denial of pain suggest that there may not be an acute exacerbation of the chronic respiratory disease. The evidence points towards the need for further assessment and intervention to manage the patient's chronic respiratory disease and improve their overall quality of life.
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Effect of Arterial Oxygenation + Ventilation in Various Environments
Arterial oxygenation and ventilation are essential to maintain adequate tissue oxygenation and eliminate carbon dioxide. In different environments, such as high altitude or underwater diving, alterations in oxygenation and ventilation can have significant physiological effects.
At high altitudes, there is reduced barometric pressure, which results in a decrease in arterial oxygenation, leading to hypoxemia. This can result in acute mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. In underwater diving, the increased pressure can cause nitrogen absorption in the tissues, leading to decompression sickness or "the bends." In critically ill patients, mechanical ventilation can be used to manage respiratory failure and improve oxygenation.
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What medications does the nurse anticipate giving for a patient suffering from malignant hyperthermia? SATA
A. dantrolene
B. ibuprofen
C. amiodarone
D. insulin and D50
Patient suffering from malignant hyperthermia, the nurse would anticipate administering dantrolene (option A) as the primary medication.
This is because dantrolene specifically targets and treats malignant hyperthermia by reducing the release of calcium in the muscles, thus alleviating symptoms. Options B, C, and D are not typically used to treat malignant hyperthermia.
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how is delayed-onset muscle soreness (doms) different from muscle fatigue? how is delayed-onset muscle soreness (doms) different from muscle fatigue? muscle performance is impaired. there may be damage to the sarcolemma. delayed-onset muscle soreness involves pain. delayed-onset muscle soreness occurs a day or more after the physical exertion.
Delayed-Onset Muscle Soreness (DOMS) and muscle fatigue are different in several ways. DOMS typically occurs a day or more after the physical exertion that caused it, while muscle fatigue can occur during or immediately after the activity.
DOMS involves pain, stiffness, and tenderness in the affected muscles, while muscle fatigue is the feeling of tiredness or exhaustion during or immediately after physical exertion. Muscle performance may be impaired in both cases, but DOMS may also involve damage to the sarcolemma, the membrane that surrounds muscle fibers. DOMS can last several days to a week or more, while muscle fatigue typically resolves relatively quickly after the activity stops.It's important to note that while DOMS can cause muscle performance impairment, it is not necessarily the same as muscle fatigue.
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