176 Exam 2 Flashcards
Weeks 5-8
what are some terms associated with impaired urinary elimination?
anuria (absence of urine)
dysuria (painful urination)
polyuria (frequency of urination)
Oliguria (Low o/p)
Nocturia (Night time urination)
Hematuria (Blood in urine)
hesitancy (has urge to pee but difficulty starting stream)
What are the main parts of the digestive tract?
Mouth
* Amylase initeates breakdown of carbs
* Tongue mixes food w/ saliva & presses it against teeth
* When bolus is swallowed, tongue forces food into pharynx
Pharynx
* Shared by resp. and digestive tract
* Joins mouth and nasal passage
* When swallowing, epiglottis covers airway preventing food from entering resp. tract
esophagus
* Long muscular tube that passes through diaphram into stomach
* Wave like contractures propel food down digestive tract (peristalsis)
stomach
* 3 sections: Fundus, body, & pylorus
* Gastric secretions: Rennin (breaks down milk proteins), lipase ( breaks down fats), Pepsin/hydrochloric acid (digest protiens)
small intestines
* 3 sections: duodenum, jejunum, & illeum
* Liver and pancreas secretions leak into duodenum
large intestines
* 5 sections: cecum (appendix location), ascending colon (right side of abd.), transverse colon (across abd.),descending colon (down left side of abd.), Sigmoid colon ( between iliac crest & rectum)
anus
* Last part of large intestine
* Where waste leaves the body
What is the function of the large intestine?
Absorb water from chyme & eliminate remaining solid waste in form of feces
What are the main parts of the urinary tract?
Kidney
* Cortex receives large blood supply & is very sensitive to changes in BP and blood volume
* Medulla collects urine and drains it into calyces, which drain into renal pelvis
* Uriters carry urine from renal pelvis to bladder
Bladder
* Made of smooth mucles that strech to store urine, rests on floor of pelvic cavity behind peritoneum
* Upper portion of bladder called apex, base of bladder called fundus
Urethra
* Muscular tube lined with mucous membranes that carry urine from bladder out of body
* functions as sphincter (contracts to hold urine & relaxes to release flow)
Loss of urine during physical exertion
* Ex: coughing, sneezing, laughing
Causes
* increased abd. pressure under stress (weak pelvic floor muscle)
* urethreal trauma, sphincter injury
Nursing interventions:
* Teach kegel exercises
* Advise patient to void frequently
* Administer drugs as ordered to stimulate sphincter
Stress incontinence
Involuntary contraction of bladder muscles
* Usually follows a strong desire to void
Causes:
* Nervous system disorders
* UTI
* Bladder obstruction
Nursing interventions:
* Toilet scheduling
* Limit fluid intake 2 hrs before bed
* Admin drugs as ordered
Urge incontinence
Untimely urination d/t issues
* Ex: Cognition, obsticles, unsteadiness
Causes:
* Dementia
* Head injury
* Stroke (CVA)
Nursing interventions:
* Scheduled toileting
* Reinforce appropriate behavior
* Remove enviornmet barriers
Functional incontinence
Loss of urine associated w/ a full bladder
* Blockage of urethra
* Frequent voiding
Causes:
* urethral obstruction
* Disorders of bladder, nerves, or muscles
* Spinal cord injuries
Nursing intervention:
* Cath.
* Admin drugs as ordered
* Cutaneous triggers (teach stimulation tech.)
Overflow incontinence
(Urinary)
urine leakage that is caused by a temporary situation such as an infection or new medicine
* Temporary
* Resolves self
Transient incontinence
Uncontrolled, frequent passage of small, semi-soft stool
Cause:
* Constipation
* entire colon full of fecal matter
Nursing interventions:
* Admin laxitives & enemas as ordered
* increase fluids and fibers
Overflow bowel incontinence
Uncontrolled passage of stool several times a day
Cause:
* Weak pelvic muscles
* Loss of anal reflexes
* poor rectal sphincter
* Rectal prolapse
Nursing interventions:
* Teach kegel exercises
* Prepare for surgery if planned
Anorectal bowel incontinence
Formed stools passed after meals
* usually seen in dementia patients
Causes:
* Gastrocolic reflex stimulates defecation
* Patient does not delay until apropriate time
Nursing Interventions:
* Ensure toilet scheduling
Neurogenic bowel incontinence
Incontinet stools (usually diarrhea)
* Not related to other fecal incontinence types
Causes:
* Colon or rectal disease
Nursing Interventions:
* Provide comfort
* Proper skin care
* prepare for dx tests/ procedures
Symptomatic bowel incontinence
What is the correct order of an abdominal assessment?
- Inspect
- Ausculate
- Percuss
- Palptate
What is the lab value BUN an indicater for?
Kidneys ability to excrete urea (end product of protein metabilism)
* Nephrotoxic drugs, high protein diet, GI bleed, dehydration, MI, shock, burns, & sepsis
Lab value: 10-20
Waste product of skeletal muscle breakdown
* Renal function test
Not influenced by diet, hydration, nutritional status, or liver function
Lab value: 0.6-1.2
Cr
Elevated primarily in renal disorders and is a better measurement of kidney function
Normal functioning kidneys = very low levels & high urine levels
Serum Creatinine
Monitored in pts w/ renal issues d/t the serious consequences that occur w/ electrolytes
Renal failure = Na & K levels are elevated & Ca levels are decreased
Serum Electrolytes
Identifies microorganisms in urine
- Collect specimen first voide of the day
- Clean catch tech
- Collect before antibiodic therapy
- If cath, collect specimen after disregarding small urine amount
Nursing intervention:
* Cap specimen & refrigerate or send to lab (unless specimen has preservative)
Urine cultuer & sensitivity
Measures glomerular filtration rate; decreases w/ renal disease
* Provide specimen container
* Document first void for next 12-24hrs as ordered
* Keep specimen refrigerated
* If foley cath, place drainage bag in basin of ice & empty into refrigerated container hourly
Nursing intervention:
* No special care needed
Urine Creatinine Clearance
Detects GI bleeding when blood is not readily seen
* Advice need of stool sample
* If test is done at home, explain the procedure
Nursing intervention:
* No special care required
Occult Blood Test
Provides radiographic view of kidneys, uterus, & bladder
* No special prep
* Schedule test before studies that use contract
Nursing intervention:
* No special care required
KUB
(Kidney, urterer, bladder)
Uses radiographics and fluoroscope to outline kidneys
* Tell pt contrast will be injected & radiographs taken to study urinary tract
* Give laxitives & enemas as ordered before tests
* NPO status 8-10hrs before test
Nursing interventions:
* Encourage fluids to flush contrast
* Monitor signs of iodine allergy (urticaria, rash, n/, swollen parotid gland)
* Check injection site for inflammation
Intravenous Pyelogram
Detects abnormalities of large intestine
* Contrast admined. by enema & radiographs take w/ pt in various positions
* Radiographs taken initially & repeated 6hrs later to see how much barium has passed through the stomach
* clear liquid
* NPO after midnight
* Fluid given on morning of procedure
Nursing intervention:
* Monitor stool up to 2 days for white stool showing barium being eliminated (normal stool after 3 days)
* Laxities may be ordered to promote elimination
* Provide food, extra fluids, & rest
Barium enema
Uses lit scope inserted through the urethra, bladder, & ureteral openings
* obtain consent
* NPO if anesthesia usage
* Give laxities/enemas as ordered
* Give sedative as ordered for anxiety
* Antibiotics given 2-3 days before & continued after
Nursing intervention:
* Safety precaution d/t orthostatic hypotension
* Monitor I/O’s, vitals, urine color (may be pink)
* Report severe pain & give pain meds
* Sitz bath
* Drink 2-3 L of fluids
Cystoscopy
Visualizes esophagus, stomach, & Duodenum
* Inform pt scope will not interfere with breathing
* NPO 6-8hrs; give sedative before test if ordered
* Remove dentures
Nursing interventions:
* NPO until return of gag reflex
* Monitior for signs of trauma (bleeding), perforatium (distension/cramping)
* Warn of sore throat
* Contact PCP if severe pain, fever, dyspnea, or hematesis
Esophagogastroduodenoscopy
(EGD)
Visualizes anus, rectum, & entire colon
* NPO 6-8hrs before test
* Restricted to only liquids on previous day/evening
* Bowel cleansing done w/ cathartics, suppositories & enemas
Nursing intervention:
* Tell pt to report blood in stool (bleeding suggests perforation of colon)
* Monitor BP & HR
* Inspect abd. for distention
* Encourage fluids when fully alert to replace loss
Colonoscopy
What labs would you run in relation to elimination?
Urinalysis
Renal function test (BUN/Cr,Cr clearance)
Cultures (specific gravity, stool/urine)
Occult blood culture(done when expected GI bleed)
What radiographic tests would you run in relation to elimination?
X-ray, KUB
ultrasound
CT, MRI
What direct observation tests would you run in relation to elimination?
Colonoscopy
Cystoscopy
Esophagogastroduodenoscopy (EGD)
Bladder scanner
inflammation of bladder
* bacteria travels up urethra, infects urine & inflames the bladded lining
* Women more than men
S/s:
* low grade fever
* Pain, pelvic/abd. discomfort
* Bacteria in urine
* Urgency/frequency/dysuria/nocturia/bladder spasms/incontinence
* Dark, tea colored,cloudy urine
Dx:
* Urinalysis
* Culture & sensitivity
Tx:
* Oxybutynin chloride (Ditropan) - Antispasmotic
* Antibiodics, continuous prohylactic antibiodics
* Mild analgesics (acetaminophine)
* Teaching on peri care, avoid scents/perfumes on genitlas
* Shower instead of bath, sitz bath
* Void after sex & void frequently
* Increase fluids
Cystitis
What are risk factors for Cystitis?
Prolonged immobility
Renal calculi, urinary diverson
Indwelling cath
Radiation therapy, chemo
Gender (women more than men affected)
How would you educate a pt with Cystitis?
Teach to avoid risk of furure infection:
* Wear cotton undergarments
* Avoid tight fitting clothes in perineal area
* Avoid carbonated caffeine, tea/coffee, apple/orange/grapefruit, & tomato juice (irritated bladder)
* Drink cranberry juice
* Wipe front to back for females
* Complete entire first course of antimicrobial therapy
Inflammation of renal pelvis that may affect one or both kidneys
* Most often results from inadequate closure of ureterovesical junction during voiding
Acute: Ascending bacterial infection, may be blood born
Chronic: Persistant/recurrent; results in damage to parenchyma (functional tissue)
S/s:
* Decreased activity & urine o/p
* slight aches over kidney(s)
* Bladder irritation
* High fever, chills, n/v
* Dysuria
* Severe pain, constant, dull aches in flank area
Labs:
* BUN/Cr
* UA, culter & sensitivity
Pyelonephritis
How would you treat Pyelonephritis?
Hospitilization
IV antibiodics, UT antiseptics, analgesics (NSAIDS), antispasmotic
HTN medications
IV fluids w/ n/v
* Monitor I/O
Dietary salt & protein restriction
Assist w/ ADLs
What are risk factors for Pyelonephritis?
Long term UTIs
ESRD
Fluid and electrolyte imbalance
Dialysis
Enlarged prostate gland (men over 50)
* Cells arent malignant
Glands press against & pinch urethra
Bladder walls become thicker & may weaken to lose ability to empty completly
S/s:
* Difficulty starting urination
* Straining/ pushing out urine
* Weak/slow urine flow
* Frequency, urgency, nocturia
* Dribbling, incomplete emptying of bladder
Treatment:
* Finasteride (proscar) - Hormone
* Tamsulosin (Flomax) - BPH agent/ alpha blocker
* Transurethral resection of prostate (TURP; most recommended)
* Fluid intake of 1500-2000mL/day
* Fluid restriction 2hrs before bed
* Avoid caffeine & alco.
* Prostatectomy
Benign Prostatic Hyperplasia
(BPH)
What are some Dx tests & labs that would be obtained for BPH?
Dx:
* Digital rectal exam
* Ultrasound
* Prostate-specific antigen (PSA)
Labs:
* UA, Culture & sensitivity
What are risk factors for BPH?
Men age 40 and up
Family Hx
Obestity
T2DM
Heart & circulatory disease
used after removal of prostate to maintain continous irrigation & bladder drainage
* AKA “standard cath”
continous irrigation intended to clear bladder of blood & debris
If cath o/p is less than irrigating fluid delivered, catheter may be obstructed
* Manual irrigation is needed as ordered to clear colts & restore drainage
* Notify Dr ASAP if drainage is not restored
Triple-lumen urinary catheter
What is the normal Hemoglobin level?
12-18 combined
M : 14-18
F : 12-16
What is a normal WBC level?
5000-10,000
What is the normal platelet level?
150,000-400,000
What is the normal urine Specific Gravity level?
1.001-1.035
What is the normal PTT range?
25-35 seconds
Hormone - PO
* Used to treat BPH
reduces hyperplastic cell growth, treats male pattered baldness
CAUTION: DONT TOUCH PILL IF PREG
Adverse reactions:
* Impotence
* Decreased libido
* Decreased ejaculation
Finasteride (Proscar)
Which type of tx may be used for neurogenic incontinence?
A) Fluid restriction
B) Pelvic exercises
C) Toilet scheduling
D) Consumption of mineral oil
C) Toilet scheduling
How would you perform care after a transurethral resection of the prostate (TURP)?
Continuous/intermittent bladder irrigation
Close observation of drainage system
* Increased bladder distension causes pain & bleeding
Manage bladder spasms
Pain control w/ analgesics & decreased activity first 24hrs
Avoid straining w/ BM
How does a UTI spread?
urethra to the bladder, then ascends into kidneys
Build up of waste in blood makes it hard for kidneys to keep correct fluid balance
Arteries in renal parenchyma become narrowed d/t artherosclerosis, HTN, nephrosclerosis, or blood components (sickled RBC,Hgb or myoglobin)
S/s:
* fluid retention/ hypovolemia
* SOB, cp or pressure
* Irregular heartbeat
* edema lower extremities
* Change in urine o/p
* systolic bp > 70mm Hg
Labs/ Tests:
* UA, BUN/Cr
* CBC
* Kidney biopsy
* GFR
* Ultrasound, CT/MRI, X-ray
Acute Renal Failure
What medications will you anticipate for acute renal failure?
Oliguria:
* treat w/ diuretics
Hyperkalemia:
* Kayaxelate (PO/recal; sodium polystyrene)
* IV Insulin/glucose
* Calcium gluconate
IV fluids w/ dopamine, furosmide, or both (loop diuretics)
Amino acid supplements
TPN if GI tract not functioning
What nursing interventions/ treatements will you anticipate for acute renal failure?
Fluid restriction, direct restriction
* IV fluids w/ dopamine, furosmide, or both (loop diuretics)
Restore electrolyte imbalance
* restrict Na, K & phos intake (give kayaxelate)
* Place on cardiac monitor
* Hemodialysis
* Diet individualized by electrolyte imbalance
Avoid nephrotoxic drugs
Prevent FVO
* monitor for crackles, cyanosis, increased RR, ect.
Continuous Renal Replacement Therapy
Daily weight
* Same time, same scale, same clothing types, ect.
Monitor s/s related to immobility (constipation, skin breakdown)
What are the causes of AKI?
Prerenal:
* Decreased blood flow to glomeruli
* need to sustain systolic Bp 70mm Hg or > to sustain glomeruli function
Intrarenal:
* Nephrotoxic meds (antibiodics)
* Kidney infection (pyelonephritis, polycystic kidney disease)
* DM, trauma (bleeding/bruising)
Postrenal:
* Obstruction (kidney stones)
* BPH
* Prostate cancer
What are s/s of AKI?
Oliguric phase:
* Oliguria (urine o/p < 400mL/ day; occurs w/in 1-7 days of kideny injury)
* UA (casts, RBC/WBC, Sp. grvty fixed at 1.010)
* Metabolic acidosis, hyperkalemia, hyponatremia
* Elevated BUN/Cr
Diuretic phase:
* Gradual increase in urine o/p ( 1-3L/day)
* Hypovolemia/ dehydration, hypotension
* BUN/Cr normalize (indicate working - Dont need hospital)
Recovery phase:
* Begins when glomerular filtration rate (GRF) increases
* BUN/Cr level plateau then decrease
Kidneys damaged & cannot propperly filter blood
* progressive destruction of nephrons of both kidneys that is describes in stages 1-5
* Develops slowly
Excess fluids and waste from blood remain in body causing other problems (heart disease, stroke)
Cr clearance is important
* < 15 = stage 4, severe funtion loss
S/s:
* Elevated BUN/Cr
* Elevated serum K (hyperkalemia, hypocalcemia, high phosphate)
* Decreased GFR
* increased BP
* High LDL
* Polyuria leading to oliguria
* Change ins Sp. Grvty d/t decreased ability to concentrate urine
* hypernatremia
* Hypervolemia
Chronic Kidney disease
What are the most common causes of Chronic Kidney disease?
HTN
DM
Artherosclerosis
What labs & tests are expected to be ordered for Chronic Kidney disease?
BUN/Cr
UA
ultrasound, CT/MRI, X-ray
CBC
Metabolic panel