Elimination and Tissue Integ

Question 1

meds that can cause urinary retention

Answer 1

antidepressants, anticholinergics, and antihistamines, diphenhydramines- advil pm, beta-adrenergic blockers, opiods, antihypertensives, antiparkinsons

Question 2

diuresis

Answer 2

promotion of urine output, usually with lasix (loop diuretic)

Question 3

oliguria

Answer 3

reduced urine output

Question 4

polyuria

Answer 4

excessive urine output

Question 5

damage to spinal cord above ___ region of the spinal cord causes

Answer 5

sacral region. reflex blader- stimulated by reflex, not voluntary control.micturition reflex pathway still intact.

Question 6

overflow incontinence

Answer 6

occurs when a bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine. Causes often include head injury; spinal injury; multiple sclerosis; diabetes; trauma to the urinary system; and postanesthesia sedatives/hypnotics, tricyclics, and analgesia

Question 7

hyperreflexia

Answer 7

a life-threatening problem affecting heart rate and blood pressure, is caused by an overly full bladder. It is usually neurogenic in nature; however, it can be caused functionally by blockage. (Potter 10

Question 8

Endocrine changes in BPH

Answer 8

accumulation of prostatic androgen (dihydroxytestosterone) stimulated by estrogen and growth hormone

Question 9

symptoms obstructive BPH

Answer 9

retention, decreased force, difficulty initiating, intermittency, dribbling.

Question 10

irritative symptoms of BPH

Answer 10

inflammation/ infection, frequency/ urgency, dysuria, nocturia, incontinence

Question 11

hydronephrosis

Answer 11

kidney swelling from urine buildup- can’t empty into bladder because full bc blocked by bph

Question 12

pyelonephritis

Answer 12

when a UTI progresses into the kidneys and ureters

Question 13

% men get BPH

Answer 13

50% over 50 and 90% over 80

Question 14

Risk/prevention BPH

Answer 14

Risk- Family, diet, environment- western men more likely obstructive probs.
Prevention: maintain healthy weight, moderate alcohol, low sat fats, exercise

Question 15

complications from BPH

Answer 15

usually from obstruction: acute retention, UTI,sepsis, residual urine, alkalization of residual urine (bladder stones), hydronephrosis, pyelonephritis, and bladder damage

Question 16

pyelonephritis

Answer 16

Muti that progresses to kidneys

Question 17

diagnostic tests for BPH

Answer 17

history and physical, DRE, UA and Culture, Serum creatinine, PSA, cystourethroscopy, uroflowmetry and post void residual

Question 18

serum creatinine

Answer 18

rule out renal insufficiency when testing for bph. normal 0.6-1.2 mg.dL

Question 19

psa

Answer 19

prostate specific antigen- protein produced by prostate- can rule out cancer

Question 20

cystourethroscopy

Answer 20

camera used to see urethra, bladder, prostate

Question 21

risk factors for pressure ulcers

Answer 21

advanced age, anemia, contractors, diabetes mel, elevated temp, immobility, impaired circulation, incontinence, low diastolic blood pressure

Question 22

suspected deep tissue injury SDT

Answer 22

purple or maroon. may be painful, firm, mushy, boggy, warmer or cooler

Question 23

stage 2

Answer 23

blister or partial thickness loss of dermis, no slough

Question 24

stage 3

Answer 24

full thickness tissue loss, subcutaneous fat or tissue visible, but no bone or muscle. **slough may be present, may include undermining or tunneling

Question 25

stage 1

Answer 25

no tissue loss

Question 26

stage 4

Answer 26

full thickness loss- muscle, tendon or bone. slough or eschar may be present on some parts of wound bed and often undermining and or tunneling

Question 27

unstageable pressure ulcer

Answer 27

cannot see the wound bed because of slough (yellow, tan, gray green or brown) and eschar(brown or black)

Question 28

Betadine kills

Answer 28

aerobic bacteria

Question 29

hydrogen peroxide kills

Answer 29

anaerobic bacteria

Question 30

tissue integrity primary prevention

Answer 30

Patient Education to include: Identifying risk factors for impaired skin integrity and impaired tissue integrity, the importance of nutrition, mobility, and keeping skin clean and dry to prevent skin/tissue problems. Hygiene and skin care discussed. Safety behaviors to prevent trauma

Question 31

tissue integrity secondary prevention

Answer 31

providing pain management, repositioning, using barrier creams, checking incontinent pts frequently to keep skin clean and dry, manage hygiene, provide appropriate nutrients to promote healthy skin or for wound healing, administer med, precent spread of infections or infestations, use lotions and oatmeal baths to relieve pruritus

Question 32

tissue integrity tertiary prevention

Answer 32

teach patient and care giver about home care concerning pressure relief, wound care, hygiene and incontinence care, pruritus relief with oatmeal bath products, or bath oils (keri oil) and lotion, nutrition and safety behaviors to prevent trauma, general skin care

Question 33

age related changes in skin

Answer 33

more fragile, slower wound healing, decreased vitamin d production, susceptible to dryness, decreased sensory perception, greater risk of hyper or hypothermia, decreased elasticity, decreased perspiration

Question 34

healing process

Answer 34

Inflammatory phase
(heat, pain, redness-mast cells cytokines)
Fibroblastic or connective tissue repair phase
maturation or remodeling phase

Question 35

pressure ulcer assessment

Answer 35

Location and Size
Extent of tissue involvement
Cell types in the wound base and margins
Drainage
Condition of surrounding tissue

Question 36

Impetigo Contagiosa

Answer 36

Staphlococcus, preschoolers- reddened manual becomes vesicular, honey colored crusts after blisters burst. itchy blisters, commonly around mouth- DX: physical assess and wound culture. topical antibiotics and systemic if extensive. usually clears up on own, but can lead to glomerulonephrits. burrow solution compress (aluminum acetate)

Question 37

shingles

Answer 37

herpes zoster.days to a week of buying pain and sensitive skin. starts as small blisters on a red base. with new blisters for 3-5days. blisters follow the path of individual nerves that come out of spinal cord in a specific ray like pattern. blisters pop ooze and crust contact isolation, acyclovir or famciclovir. complication- infection rarely nerve damage. vaccine over 60 yrs: zostavax

Question 38

Tinea

Answer 38

fungal infection- person to person. round hair loss in center.
pedis- athletes foot
corporis- ring worm on body
cruris- jock itch
capitis- ring worm on head/ scalpTreated with griseofulvin- weeks to months and take with high fat foods
Oral Ketoconazole
Selenium shampoos
Topical antifungals- miconazole, clotrimazole- apply 1 inch beyond lesion
Glucocorticoid compresses or creams

Question 39

Tinea prevention

Answer 39

don’t share grooming items, hats scarves, batting helmets, theater seats. family animals should be treated. linens and clothing washed with hot water, eliminate heat and perspiration, clean well ventilated footwear, compresses of glucocorticoids

Question 40

candida

Answer 40

fungal infection (yeast) can occur on skin, oral or vaginal. on skin from prolonged wetness, oral or vaginal usually due to destruction of normal flora. may appear red and scaley or inflamed with exudate and peeling.
oral (thrush) white tongueTreated with medicated powders or creams for skin form. Medicated mouthwash for the oral form
nystatin (Mycostatin) or amphotericin B (Fungizone)

Question 41

pediculosis

Answer 41

lice. capitis (head) transmitted by children or pets- itching
carpers (body) eggs laid in seams of clothing, itching and excoriation on trunk and extremities
pubis (pubic or crab lice) most common symptom is itching. infested bed linens or sex.

Question 42

pediculosis tx

Answer 42

Laundering of clothing and bed linen in very hot water > 130 degrees. Wash brushes and combs in hot water for at least 10 minutes.
Non washable items are sealed in a plastic bag for 2-3 days
Teach patient how to prevent infestation- don’t share combs and brushes, towels, hats or scarves. Don’t lie on fabrics, pillows upholstery, stuffed animals where an infected person has lain.
Teach hygiene practices
Avoid head to head contact
Vaccuum floors and surfaces where the person lay
Use pediculocide shampoos or topical sprays once and nit combs daily to eradicate the infection– lindane (Kwell)
May require repeat doses (Concern for resistance and exposure)
Don’t use fumigant sprays
ID social contacts and treat if necessary

Question 43

scabies

Answer 43

parasite, no symptoms for 2-6 wks but contagious.mite burrows under skin. itching from reaction to proteins and feces. scabicides like permethrin lotion for 3-5 ddays and treat surfaces as for pediculosis. contact precautions return to school/ work day after tx

Question 44

bed bugs

Answer 44

live in bedding and within 8 feet. feed on blood, itchy. topical antihistamines or steroids. heat kills. resistant to pesticides- don’t carry disease

Question 45

psoriasis

Answer 45

Autoimmune disorder with over production of skin cells, exacerbations and remissions do occur.
Scaling disorder with underlying dermal inflammation
Psoriasis vulgaris most often seen
Papules and plaques covered with silvery scales
Exfoliative psoriasis—an explosively eruptive and inflammatory form of the disease

Question 46

psoriasis tx

Answer 46

Topical therapy
Topical Steroids
Tar
UV light
Tazarotene (teratogenic)
Biologics to suppress immune system
Adalimumab (Humira), 
Linfliximab (Remicaid)
Enteracept (Enbrel)
Parenteral, teratogenic
If resistant give cytotoxic agents
Low dose Methotrexate
Other immune supressants
Cyclosporine (Sandimmune)
teratogenic
Emotional support

Question 47

Rhytidectomy

Answer 47

face lift- incisions at temple and ear.Edema, bruising, hematomas. Use cold packs. Drains removed 24-48 hours. Avoid coughing, it increases B/P

Question 48

Blepharoplasty

Answer 48

excess skin and fat removed from eyelids. Out patient. Keep head elevated. Limit activity for a week. Scratchy eyes from corneal swelling treated with cold wet compress.