Elimination and Tissue Integ Flashcards
meds that can cause urinary retention
antidepressants, anticholinergics, and antihistamines, diphenhydramines- advil pm, beta-adrenergic blockers, opiods, antihypertensives, antiparkinsons
diuresis
promotion of urine output, usually with lasix (loop diuretic)
oliguria
reduced urine output
polyuria
excessive urine output
damage to spinal cord above ___ region of the spinal cord causes
sacral region. reflex blader- stimulated by reflex, not voluntary control.micturition reflex pathway still intact.
overflow incontinence
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
hyperreflexia
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
Endocrine changes in BPH
accumulation of prostatic androgen (dihydroxytestosterone) stimulated by estrogen and growth hormone
symptoms obstructive BPH
retention, decreased force, difficulty initiating, intermittency, dribbling.
irritative symptoms of BPH
inflammation/ infection, frequency/ urgency, dysuria, nocturia, incontinence
hydronephrosis
kidney swelling from urine buildup- can’t empty into bladder because full bc blocked by bph
pyelonephritis
when a UTI progresses into the kidneys and ureters
% men get BPH
50% over 50 and 90% over 80
Risk/prevention BPH
Risk- Family, diet, environment- western men more likely obstructive probs.
Prevention: maintain healthy weight, moderate alcohol, low sat fats, exercise
complications from BPH
usually from obstruction: acute retention, UTI,sepsis, residual urine, alkalization of residual urine (bladder stones), hydronephrosis, pyelonephritis, and bladder damage
pyelonephritis
Muti that progresses to kidneys
diagnostic tests for BPH
history and physical, DRE, UA and Culture, Serum creatinine, PSA, cystourethroscopy, uroflowmetry and post void residual
serum creatinine
rule out renal insufficiency when testing for bph. normal 0.6-1.2 mg.dL
psa
prostate specific antigen- protein produced by prostate- can rule out cancer
cystourethroscopy
camera used to see urethra, bladder, prostate
risk factors for pressure ulcers
advanced age, anemia, contractors, diabetes mel, elevated temp, immobility, impaired circulation, incontinence, low diastolic blood pressure
suspected deep tissue injury SDT
purple or maroon. may be painful, firm, mushy, boggy, warmer or cooler
stage 2
blister or partial thickness loss of dermis, no slough
stage 3
full thickness tissue loss, subcutaneous fat or tissue visible, but no bone or muscle. **slough may be present, may include undermining or tunneling
stage 1
no tissue loss
stage 4
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
unstageable pressure ulcer
cannot see the wound bed because of slough (yellow, tan, gray green or brown) and eschar(brown or black)
Betadine kills
aerobic bacteria
hydrogen peroxide kills
anaerobic bacteria
tissue integrity primary prevention
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
tissue integrity secondary prevention
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
tissue integrity tertiary prevention
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
age related changes in skin
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
healing process
Inflammatory phase
(heat, pain, redness-mast cells cytokines)
Fibroblastic or connective tissue repair phase
maturation or remodeling phase
pressure ulcer assessment
Location and Size Extent of tissue involvement Cell types in the wound base and margins Drainage Condition of surrounding tissue
Impetigo Contagiosa
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)
shingles
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
Tinea
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
Tinea prevention
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
candida
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)
pediculosis
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.
pediculosis tx
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
scabies
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
bed bugs
live in bedding and within 8 feet. feed on blood, itchy. topical antihistamines or steroids. heat kills. resistant to pesticides- don’t carry disease
psoriasis
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
psoriasis tx
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
Rhytidectomy
face lift- incisions at temple and ear.Edema, bruising, hematomas. Use cold packs. Drains removed 24-48 hours. Avoid coughing, it increases B/P
Blepharoplasty
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.
