everything Flashcards
If protein is + in urine, what should you do?
test kidney function (24hr urine test)
What does increased levels of BUN indicate?
renal disease and dehydration
What does increased levels of Creatinine indicate?
pyelonephritis (kidney dysfunction with UTI)
What does decreased levels of Creatinine indicate?
decreased muscle mass (rare
What is the normal amount of residual urine?
50-100mL
Why do we do urine cultures?
to find out what bacteria is in the urine and what antibiotics will work
What are some causes of urinary retention?
anesthesia, surgery, obstruction (enlarged prostate), childbirth, medication (antihistamines), kidney stones, removal of catheter, STIs, constipation, sacral nerve damage
What is Crede’s method?
manually pressing on bladder to empty it
What are some causes of urinary incontinence?
decreased cognition, confusion, diabetes, depression, increased age, pregnancy, obesity, enlarged prostate
What do sedatives promote when dealing with urinary incontinence?
relaxation
What type of incontinence is often associated with a spinal cord injury, and causes incontinence at predictable intervals?
reflex
What type of incontinence causes the release of urine when coughing, sneezing, or laughing?
stress
What type of incontinence involves the ongoing unpredictable loss of urine?
continuous
What type of incontinence has a small time window to void?
urge
What should nursing care be like for acute incontinence?
change sheets/clothes, prevent skin breakdown
you can give estrogen to post-menopausal women to deal with incontinence
t
Body’s Defenses against a UTI
acidic pH of urine, one-way valves, bladder muscles, prostate gland secretions (M), vaginal pH (F)
What is the most common bacteria that causes UTI’s?
E-coil
What is “HARD TO VOID”?
Causes of UTIs
H in “HARD TO VOID”
Hormone changes (pregnancy, menopause, birth control)
A in “HARD TO VOID
Antibiotics
R in “HARD TO VOID”
Renal stones
D in “HARD TO VOID”
Diabetes (glucose in urine)
T in “HARD TO VOID”
Toiletries (baths, powders, perfumes)
O in “HARD TO VOID” (1st
Obstruction (enlarged prostate, kidney stones)
V in “HARD TO VOID”
VUR (backflow into kidneys)
O in “HARD TO VOID” (2nd)
Overextended bladder
I in “HARD TO VOID”
indwelling catheters, invasive procedures, intercourse
D in “HARD TO VOID” (2nd)
decreased immune system
What two things are elevated in a simple UTI?
leukocytes and nitrites
S/s of pyleonephritis are the same as UTI except for… (2)
fever, nausea
What is CVA tenderness? When is it seen (2)?
back pain (karate chop), pyleonephritis and renal calculi
What 4 things are increased with pyleonephritis?
leukocytes, nitrites, WBC, RBC
What is a warm sitz bath used in treatment for?
UTI
What are renal calculi?
kidney stones
What is the pneumonic CRYSTAL used for?
causes of kidney stones
Causes of renal calculi
increased protein, increased salt, recurrent infections, hypercalemia, structural blockage of urine, increased uric acid, family history of stones, low activity (immobile)
What is a stone lithotripsy?
use of ultrasound shock waves to break apart a kidney stone from the inside through warm water
use of ultrasound shock waves to break apart a kidney stone from the inside through warm water
2x, soap and water
OBjective data for urinary assessment
inspect skin (breakdown, edema), abdomen (distention), weight gain, palpate for contour/masses/tenderness, percuss bladder, ausculatate for bruit, urine testing, I&O, labs, bladder scan
What are ingestion risks?nutritional risks
nausea, vomiting, anorexia, dysphagia, NPO
What are digestion risks?
IBD, celiac, CF, lactose intolerance
What are metabolism risks?
liver diseases (increases metabolism), older adults (decreased metabolism)
T/F: Nutritional requirements change as you age
f
Reasons older adults are at risk for nutritional deficits…
decreased saliva, decreased taste, decreased thirst, decreased gag reflex, decreased peristalsis, chronic illness, medications, cognitive impairments, fixed income, decreased access to transportation
Name a screening tool for nutrition
BMI
BMI 25-29.9
overweight
BMI >30
obese
BMI < 18.5
underweight
underweight
18.5-24.9
Does albumin have a long or short half life?
long (21 days)
What lab shows chronic protein depletion?
albumin
What is an albumin level of < 2.8 indicative of?
edema
What lab indicates acute nutritional problems?
prealbumin
Does prealbumin have a long or short half life?
short (2 days)
decreased Hgb leads to.
decreased gas exchange
Name some iron rich foods
meat, fish, soy, eggs, dry fruit, broccoli, kale, spinach, nuts, seeds, PB
What is a high cholesterol level indicative of?
poor cardiovascular health
What should the total cholesterol level be below?
200 mg/dL
What should LDL be below?
100 mg/dL
What should triglyceride levels be below?
150 mg/dL
HDL levels for MEN should be above…
40 mg/dL
HDL levels for WOMEN should be above…
50 mg/dL
Diet history includes…
habits, frequency, types of food, amount of food, allergies, preferences, intolerances, symptoms, cultural factors, health factors, medications
Cachectic
sunken ribs
Bad nutrition shown in POSTURE
sunken chest, hump back
Bad nutrition shown in NEURO
irritable, weak, decreased relfexes, fatigue, confusion
Edema in lower extremities (regarding nutrition) is caused by a decreased intake of…
protein
Who is at risk for dysphagia?
stroke pts, older adults, trauma (HFN), radiation, choking, spasms
S/S of dysphagia
choking, coughing, weak voice, aspiration, increased saliva, difficulty chewing, food sticks in throat, food pocketing, facial weakness
intake is recorded for foods that become..
liquid at room temp
T/F: a mechanical soft diet has INCREASED fiber
F
SATA: What can be included in a mechanical soft diet?
a. mashed potatoes
b. raw fruits
c. milk
d. tender meat
e. nuts
a. mashed potatoes
c. milk
d. tender meat
What is considered the “starting diet”?
clear liquid diet
SATA: What can be included in a clear liquid diet?
a. coffee
b. clear broth
c. ice cream
d. popsicles
e. gelatin
a, b,d,e
SATA: which of the following CANNOT be included in a low sodium diet?
a. caffiene
b. smoked meats
c. juice
d. canned vegetables
e. soups
b, d, e
What is a fat restrictive diet used to treat?
GI disorders and obesity
how many days NPO is considered to be a nutritional risk?
4-7
How do you know when to advance a pt to the next diet?
when they are tolerant of their current diet (no nausea/vomiting/diarrhea)
Name some interventions of dysphagia
sitting upright, chin tuck, double swallowing, no talking, plenty of time
Order the following foods from BEST to WORST to consume for a pt struggling with dysphagia.
a. pudding
b. tomatoes
c. water
d. smoothies
a, d, b, c
Name some gas-producing foods
carbonated drinks, fiber, chewing gum
What is celiac?
autoimmune related intolerance to gluten
T/F: IBS is an inflammatory condition
T
how to diagnose IBS
stool analysis
mucous in a stool sample is indicative of…
intestinal wall inflammation (lower GI disorder)
blood in stool is indicative of..
colon cancer, hemorrhoids, intestinal wall irritation
frothy/bulky stool is indicative of..
malabsorption
ribbonlike stool is a telltale sign of these two things…
obstruction, colon cancer
What is Occult Blood?
“hidden” blood (inside stool)
occult blood in stool is indicative of…
hemorrhoids, IBS, infectious diarrhea, tumors, ulcers, anal fissure
epithelial cells in stool is indicative of…
inflammatory bowel disorders
Nocturnal BMs are associated with what disease?
IBS
What is tenismus?
constant feeling of needing to have a BM
SATA: Red flags for Colorectal Cancer
a. change in bowel habits
b. vomiting
c. blood in stool
d. tenismus
e. cramping
f. unexplained weight los
a, c, d, e, f
Risk factors for Colorectal Cancer…
> 50 y.o., family history (IBS), jewish, black, decreased fiber diet, obesity, smoking, alcohol use, Type 2 Diabetes
Treatments for Paralytic Ileus
NG tube, exercise, increase food and fluids
T/F: With C Diff, you will see blood and pus in stool
t
Toxic Megacolon
swelling and inflammation of colon (UC)
Treatments for C Diff
Flagyl, Vancomycin, probiotics, surgery, fecal transplant, colonoscopy
Causes for hemorrhoids
straining, constipation, on toilet for a long time, pregnancy, heart failure, liver disease
How are mild cases of hemorrhoids treated?
steroids
What is a stoma?
artificial opening in the abdominal wall
BRAT diet
bananas, rice, applesauce, toast
T/F: stimulant laxatives are safe for long-term use
f
What type of laxative is used short term for a whole bowel cleanse?
saline laxatives
SATA: large volume enemas
a. fleet
b. soapsuds
c. tap water
d. saline
c, d
which type of enema puts the pt at risk for electrolyte imbalance?
tap water
Which type of enema is an irritant that stimulates peristalsis?
soapsuds enema
Which type of enema is OTC?
fleet enema
What is Kayexelate used to treat?
hyperkalemia
What is Lactulose used for?
liver failure
Complications of enema
electrolyte imbalance, tissue trauma, vagal nerve stimulation, rigid abdomen, cramping, bleeding
When should you stop an enema?
rigid abdomen/bleeding
What should a healthy stoma look like?
pink, red, moist, some edema
Pallor in a stoma indicates…
decreased blood supply
An irritation of a stoma is caused by the leakage of..
An irritation of a stoma is caused by the leakage of..
Name the Sleep Stage:
right after you fall asleep, short, light sleep, easily awoken
N1 (Non-REM)
Name the Sleep Stage:
muscles relax (30-60 min)
N2 (Non-REM)
Name the Sleep Stage:
deep sleep, some body movements, extremely hard to wake
N3 (Non-REM)
Polysomnography
sleep study (diagnostic tests, pulse oximetry, electrocardiogram, tests for apnea/restless leg syndrome/bruxism)
When is a sleep study NOT done at home?
CHF or Central Sleep Apnea (CNS involvement)
How many hours is it recommended to exercise before sleep?
4-6 hours
SUBjective data for sleep
exercise patterns, alcohol, smoking, medications, daytime sleepiness, stressors, time went to sleep, how long it took, duration, frequency of awakenings, sleep partner reports
Absense of sleep
insomnia
complications of insomnia
daytime sleepiness, irritability, decreased LOC
those at increased risk for insomnia
geriatric pts, hospitalization
segmented sleep
keep getting woken up
failure to stay awake during the day
hypersomnia
Hypersomnia is common with…
depression, hypothyroidism, type 1 diabetes
parasomnia
anything that interferes with sleep (sleep walking/talking, bruxism, nocturnal enuresis, restless leg syndrome)
Bruxism
teeth grinding
Obstructive Sleep Apnea
apnea caused by large anatomical structures (neck, tongue, obese, smokers)
Central Sleep Apnea
common in kids, severe. CNS disturbs sleep frequency per minute
complications with sleep apnea
HTN and cardiac arrhythmias
How can you test mobility for someone who is bed-bound?
move in bed, positioning, strength and ROM (shrug shoulders, dorsiflex, plantarflex, hand grasp)
negative nitrogen balance can lead to…
muscle wasting, anorexia
What effect does immobility have on the urinary system?
increased risk for kidney stones, incontinence, UTI, retention
What effect does immobility have on the MSK system?
osteoporosis, fractures, joint stiffness, decreased weight bearing abilities, foot drop
What effect does immobility have on the respiratory system?
thickening/pooling of secretions, decreased cough, shallow breathing, decreased VC, can cause atelectasis/pneumonia/infections
What effect does immobility have on the circulatory system?
venous stasis, decreased BP, edema, clot formation, DVT, varicose veins (spider), PE (clot in lungs)
What are normal cardiovascular changes associated with aging?
decreased CO/SV/venous return (can lead to HTN, syncope, MI, stroke, PVD, renal failure, vericose veins)
What causes a decrease in height for geriatric patients?
decreased spaces between vetebral discs
Normal changes to kidney and liver associated with aging
decreased blood supply, decreased functioning
Screening tool for Melanoma
ABCDE
What is the most common type of skin cancer?
melanoma
What are two AE from polyuria?
dehydration, electrolyte imbalance
What is the feeling of needing to urinate all the time?
frequency
What is the intense and sudden need to go urinate?
urgency
If urine is cloudy, you can expect these things to show up in the lab. SATA
a. RBC
b. Protein
c. WBC
d. Bacteria
e. Mucus
f. Pus
a, c, d, f
Does lemon juice, cranberry juice, and increased protein raise or lower the pH of urine?
lowers
What color do anticoagulants make urine?
red
If ketones are + in urine, what does this indicate?
type 1 diabetes (kids), strenuous exercise
If there are + RBCs in urine, what does this indicate?
kidney stones, muscle breakdown, menstrual cycle
What does BUN measure?
urea
What is a normal BUN?
10-20 mg/dL
What does decreased levels of BUN indicate?
overhydration
What does Creatinine measure?
kidney function (polynephritis)
What do diuretics increase?
urine production
What type of incontinence is associated with not getting to the toilet in time due to decreated mobility?
functional
What is polynephritis?
kidney infection (UTI)
T/F: you can do a urine culture when a patient is on antibiotics
f
How should you wipe a patient’s perineal area?
front to back
T/F: renal calculi can ONLY form in the kidneys
f
A renal calculi can be passed independently if it is less than ___mm
5
How are most kidney stones passed?
hydration and pain management
T/F: a Foley/Retention catheter is used short term
t
T/F: A Straight/In and Out Catheter can be used multiple times
F (one-time use)
T/F: A suprapubic catheter is used long-term
t
Should the urine collection bag be below or above the bladder?
below
Dysphagia
difficulty swallowing
Who should you consult with for pts with dysphagia?
speech and language
Type 1 Bristol
constipation
Type 2-4
normal
Type 5-7
diarrhea
does stress increase or decrease peristalsis?
increase
a chronic use of laxatives can lead to…
less responsive intestine
overuse of laxatives can lead to
dehydration, electrolyte imbalances
T/F: Antibiotics cause diarrhea
t
What do NSAIDS increase the risk for (GI)?
GI bleeding
What is a good SUBjective question to ask when you are concerned about paralytic ileus for a patient who recently underwent anesthesia?
“have you passed gas yet?”
leukocytes in stool is indicative of…
traveler’s diarrhea (bacterial infection)
unintentional weight loss is a red flag for…
cancer
High pitched tinking upon auscultation of the abdomen is indicative of…
obstruction
T/F: Constipation is a diagnosis
f
constipation is defined as having LESS THAN ____ BMs per week
3
what can cause a vagal response?
straining when defacating
treatments for constipation…
increase fluid, increase fiber, exercise, laxatives, enemas
Encopresis
holding onto feces too long (bathroom in school); causes impaction
S/S of impaction
oozing, diarrhea, anorexia, nausea, vomiting, distention, cramping
how do you assess impaction?
digital rectal exam
2 treatments for impaction:
enema, digital removal (orders)
SATA: Mechanical Obstuction
a. paralytic ileus
b. tumors
c. diverticular disease
d. decreased motility
b, c
SATA: Non-Mechanical Obstuction
a. paralytic ileus
b. tumors
c. diverticular disease
d. decreased motility
a,d
What type of precautions for C Diff?
contact
What disease is an overgrowth of bacteria that attacks the lining of the intestines?
C Diff
What are dilated engorged veins in the rectal lining?
hemorrhoids
Match the stool description with the location of the colostomy.
1. ascending
2. transverse
3. descending
a. 1/2 formed stool
b. normal stool
c. semi-formed stool
1c, 2a, 3b
Which laxative can be used long term?
bulk forming
What is used as a lubricant for stool?
mineral oil
Emollients
stool softener lubricant
T/F: you CAN give anti-diarrheal medications with C Diff
f
Which position is best to give an enema?
sim’s left side lying
T/F: when performing an enema, open the clamp fast for the best effects
f
a black stoma indicates..
necrosis
What is considered the “body clock”
circadian rhythm
Which stage of sleep does dreaming occur?
REM
What is considered your “restorative sleep”?
REM
Nocturnal Enuresis
bed wetting
What effect does immobility have on the GI system?
constipation, impaction (decreased exercise, decreased peristalsis)
What effect does immobility have on the integumentary system?
skin breakdown, pressure ulcers, friction/shearing (moist)
What three things can you use to help move a patient?
trapeze bar, gait belt, lifts
Nursing Care for Respiratory system with Immobility
turn, cough. deep breathing. postural drainage, Incentive Spirometer, increase hydration, chest x-ray
What bony prominences should you check when assessing an immobile patient?
coccyx, heels, elbows
How often should you re-position an immobile patient?
every 2 hours
SCDs
pump air to prevent clots in lower extremities (immobile)
Which two medications are given to prevent DVT?
Lovenox and Heparin
Geriatric patients are above the age of…
65
Patients that are above this age are more likely to die in the hospital
85
Presbyopia
age-related farsightedness (decreased accomodation)
Presbycusis
age related hearing loss
Around what age does the size and number of neurons decrease?
mid 20s
Which population has the decreased ability to respond to multiple stimuli at once?
geriatric
syncope
passing out
T/F: geriatric patients have moist mucous membranes
f
Why do we give lower doses to the geriatric population?
decreased metabolism
T/F: turgor increases with age
f
What is the process of emptying the bladder?
micturition
How many mL does the average adult urinate per day?
250-450
What is excessive urine production
polyuria
Which of the following can cause polyuria? SATA
a. renal disease
b. diuretics
c. diabetes
d. decreased fluid intake
e. sickle cell anemia
a, b, c, e
What is diminished urine production called?
oliguria
What is no urine production?
anuria
What is urination at night?
nocturia
What is dysuria?
painful urination
What is difficulty starting urination
hesitancy
What is the medical term for bed-wetting?
enuresis
T/F: to promote urination, have the patient lay down comfortably
f
How many reps/hour should Kegel exercises be done?
10
SUBjective data for urinary assessment
past health history, medications, surgery, diet, urinary patterns, exercise, sleep, cognitive abilities
Upon urinary assessment, you percuss the bladder and there is a DULL sound. Does this tell you there is increased/decreased fluid in the bladder?
increased (full)
What is hematuria?
blood in urine
Describe the normal clarity characteristics of urine
clear/translucent
If urine has a strong ammonia smell, what does this indicate?
infection
What measures the kidney’s ability to concentrate urine/measures renal function?
specific gravity
Is the normal pH of urine more acidic, basic, or neutral?
acidic (4.6-8.0)
What color does pyridium make urine?
orange/reddish
What color do diuretics make urine?
pale yellow
Does dairy, veggies, and beans raise or lower the pH of urine?
raise
What color does B-Complex Vitamins make urine?
green/bluish
What color does iron make urine?
brown/black
Is urine dark/clear with dehydration?
dark
If urine pH is >8, what does this indicate?
infection
If urine pH is <4.6, what does this put the pt at risk for?
kidney stones
What is a normal specific gravity
1.010-1.025
If specific gravity is > 1.025, does this indicate dehydration or overhydration?
dehydration][\
If specific gravity is < 1.010, does this indicate dehydration or overhydration?
overhydration
What is the normal result for Leukocytes in urine?
negative
What is the normal result for ketones in urine?
negative
If leukocytes are + in urine, what does this indicate?
inflammation
What is the normal result for bilirubin in urine?
negative
What should you do if bilirubin is + in urine?
test liver and gallbladder function
What is the normal result for glucose in urine?
negative
If glucose is + in urine, what does this indicate
type 2 diabetes
What is the normal result for nitrites in urine?
negative
If there are + nitrites in urine, what does this indicate?
infection of kidneys
T/F: When doing a 24-hour urine test, collect the first voided sample
f
T/F: If your pt misses a urination when doing a 24-hour urine test, you can just guess the past void and move on with the collection.
f
What is the deadliest skin cancer for geriatric patients?
basal cell carcinoma
T/F: libido decreases with increasing age
f
What should we teach the geriatric population concerning sexual health?
STD/STI prevention, ED
T/F: Cognitive impairment is normal with aging
f
T/F: Delirium is reversible
t
Causes of Delirium
infection, anesthesia, stress, environment, dehydration, sleep deprivation
T/F: For a delirious patient, increase the amount of choices they have about their care
f
What can you use instead of restraints on an older adult who is showing S/S of delirium?
distracting activities (stacking towels)
Dementia has a (quick/gradual) onset, and is (reversible/irreversible)
gradual, irreversible
Nursing Care for a patient with Dementia
frequently orient, positive attitude, explain things simply, decrease paranoia, do not lie to pt, observe closely (close to nursing station)
What is the most common, yet most untreated disease in the geriatric population
depression
What are early indicators for acute illness in the elderly?
mental status change, falls, dehydration, anorexia
What is an early indicator of a UTI/Pneumonia/MI in the geriatric population?
confusion
What are geriatric LGBTQ+ patients at risk for?
isolation, depression, alcohol abuse, smoking
T/F: you are obligated to report any signs of elder abuse
t
Education strategies for the older adult
decrease distractions, involve pt directly, speak clear/slow, one idea at a time, relate to past experiences
Dysfunctional Complicated Grief
prolonged
Anticipatory grief
grief prior to loss (terminal illness/amputation
Disenfranchised grief
don’t share grief because the cause of death is deemed socially unacceptable
Public Tragedy
9/11, COVID, flood, fire
Actual loss
occurs from an actual event
Perceived loss
event perceived by client, not based in reality
Situational loss
loss of a loved one
Maturational loss
“developmental”; loss of youth
Necessary loss
expected at the end of life
Order the Kubler-Ross Grief Cycle
a. bargaining
b. acceptance
c. depression
d. anger
e. denial
e, d, a, c, b
S/S of grief
decreased immune response, anger, sleep disturbances, blame, withdrawal pain, panic, decreased neuroendocrine function
Nursing Care for a grieving person
establish trust, employ coping strategies, refer to support groups
1st Phase of the Dying Process includes…
respiratory congestion, change in respiratory pattern (Cheyne-Stokes), decreased orientation, pallor, increased sleep, anorexia, incontinence, restlessnesss, social withdrawal, hallucinations, saying “goodbye”
Palliative Care or Hospice Care?
Relieving symptoms with active treatment
Palliative Care or Hospice Care?
Relieving symptoms with active treatment
Palliative Care or Hospice Care?
provide comfort, non-curing
Hospice Care
Someone can turn to hospice care if they have less than ___ months to live
6
What is Haldol used for?
severe delirium
What are anticholinergics used for?
dry secretions
Last Will and Testament
states what you want to happen to your assets after you die
Power of Attorney
states a person to act on your behalf and handle your finances
Medical Power of Attorney
states a person to make medical decisions on your behalf
Living Will
describes your wishes for medical treatment (life suport, ventilator, feeding tube, DNR, organ donation)
When does the process of discharge begin?
a. when the patient feels better
b. after surgery
c. upon admission
d. after their first round of meds
c
T/F: home health is continuous care
f
What do Case Managers do?
help with discharge, coordinate patient care and follow-up appointments
If a person has chosen not to follow the prescribed treatment, what is this called
Nonadherance
Discharge process:
educate, communicate, document
What teaching method should you use if a patient has a low health literacy and you want to make sure they understoon their discharge instructions?
teach-back
What is discharge disposition?
the patient’s anticipated status after discharge/transfer (stable, unstable, or dead)
What department normally assesses the patient’s home environment concerning discharge?
Physical Therapy
What is the most important implementation for discharging a patient?
teaching
If a patient is readmitted to the hospital after being discharged, would you consider the discharge to be a success or failure?
failure
Payor Sources
Insurance
What is Blue Cross Blue Shield
Private Insurance
T/F: with private insurance, you get less choices for care
f
With what type of insurance is a co-pay or a precertification needed?
private insurance
What is mediCAID dependent on?
income
Who does mediCAID serve
low income people (based on monthly income
low income people (based on monthly income
mediCARE
What does the home and community based waiver program do (HCB
keeps people in their homes (homelessness prevention)
keeps people in their homes (homelessness prevention)
a, b, c, e
T/F insurance covers bathroom equipment
F
T/F: insurance CANNOT pay for BOTH a wheelchair and a walker
