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Health Challenges > EXAM 1 > Flashcards

EXAM 1 Flashcards

1
Q

Urine output less than 100ml/24 hrs

A

anuria

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2
Q

urine output less than 30-50 ml/ hr or 100-400 ml/24 hrs

A

oliguria

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3
Q

unusually large amounts of urine output

A

polyuria

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4
Q

voiding more often than Q2H

A

frequency

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5
Q

burning pain on urination

A

dysuria

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6
Q

frequent need to urinate at night

A

nocturia

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7
Q

difficulty starting a stream of urine (BPH)

A

hesitancy

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8
Q

urine left in the bladder after voiding

A

residual

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9
Q

the amount of urine left in the bladder

A

retention

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10
Q 
Cystitis
Urethritis
Ureteritis
Urosepsis
Interstitial Cystitis
A

UTI

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11
Q

Most common type of UTI, prevalence is 8x higher in women, incidence increases in hospitals with the use of foleys

A

Cystitis

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12
Q

UTI causative organisms

A 
E-Coli
Klebsiella
Enterobacter and Proteus
Chlamydia trachomatis
trichomonad vaginalis
Neisseria gonorrhea
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13
Q

first symptom of UTI in elderly

A

mental status change

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14
Q

UTI Diagnostics

A

Urine Culture

Urine Culture and Sensitivity

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15
Q

Medications given for UTI

A

Ciprofloxacin
Sulfamethoxazole (Bactrim)
Nitrofurantoin (Macrobid)
Pyridium (for burning pain)

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16
Q

UTI Management

A

Avoid: caffeine, chocolate, alcohol, spicy food

Increase fluids 3-4 Liters/day

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17
Q

UTI Nursing management

A 
Modify diet
Inhibit bacterial growth
Increase fluid intake
Teach health promotion strategies
foley care 2-3x/day
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18
Q

signs and symptoms of urethritis

A

Dysuria, urethral drainage

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19
Q

Ureteritis signs and symptoms

A

fever, flank pain

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20
Q

A gram-negative bacterium (most common- E-coli) originating in the genitourinary tract that can cause sepsis and death if left without treatment

A

Urosepsis

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21
Q

Signs and symptoms of urosepsis of people in nursing home with foleys

A

change in mental status
hypotension
slight-fever- often no elevation at all

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22
Q

Nursing significance of Urosepsis

A

observe patient for hypotension, elevation in temperature, and changes in mental status

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23
Q

Symptoms of interstitial cystitis (IC)

A 
"painful bladder disease"
bladder tenderness
urinary frequency
nocturia
dyspareunia 
Variable manifestations
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24
Q

Damage caused by interstitial cystitis

A

ulcerations and hemorrhages in the bladder wall

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25
Q

Interstitial cystitis management

A

pain meds, antispasmodics, Elmiron to increase bladder mechanisms

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26
Q

Improving coping with interstitial cystitis

A

chronic pain medication
void by the clock, not by need
legal exercises

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27
Q

Most frequent neoplasm of the urinary tract
strong correlation with smoking and industrial exposure
Chronic cystitis
pelvic radiation

A

Bladder Cancer

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28
Q

Bladder cancer manifestations

A

painless hematuria
intermittent bleeding
obstruction- can’t urinate

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29
Q

Bladder cancer diagnostic tests

A 
Cystoscopy
biopsy
IVU
MRI
CEA (Carcino-embryonic antigen)
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30
Q

Bladder cancer management

A

chemo
radiation
surgery- transurethral resection of bladder tumor, partial or radical cystectomy.

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31
Q

Bladder Cancer palliative care

A

Nephrostomy tube- if renal pelvis through back, often flushed with sterile sailing
Ureterostomy- if tumor blocking outflow of urine from bladder

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32
Q

Urinary Calculi- stones; cause?

A 
urinary stasis, supersaturation of urine (extreme concentration of urine)
immobility
dehydration
diabetes
history
high mineral content of water
frequent UTI's
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33
Q

Types of Urinary Calculi

A 
calcium
oxalate
struvite
uric acid
cystine
xanthene
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34
Q

Urinary calculi symptoms + diagnostics

A

sharp, sudden pain
UTI + fever
nausea, vomiting

KUB (Kidney, ureter, bladder
IVU (intravenous urography)
cyst- visualize / remove stone

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35
Q

Medical management of Urinary Calculi

A 
increase fluids (3-4liters/day)
Reduce Pain (Antispasmodics)
Prevent calculi formation
Dietary changes
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36
Q

What is a Lithotripsy

A

surgical removal of urinary calculi
laser
break up stones, causes bruising

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37
Q

Post urinary calculi procedure care

A

increase fluids
monitor I&O
Monitor for infection s&s
strain urine

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38
Q

3 types of incontinence

A

stress urinary
Detrusor over-activity- “urge”
overflow urinary

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39
Q

Nursing Management of incontinence

A 
kegal exercises
bladder training
monitor fluid intake
incontinence products
coping
treat with dignity
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40
Q

Why can’t bladder empty?

A

Detrusor failure in women
enlarged prostate in men
post void residual

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41
Q

Causes of urinary incontinence

A

sensory input interruption
muscle tension, anxiety
neurologic conditions- CVA, MS
Meds: anticholinergics, antihistamines, narcotics

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42
Q

risk factors of benign prostatic hypertrophy

A

age, obesity, OTC cold meds, prostate cancer

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43
Q

Clinical manifestations of BPH

A

slow development
incomplete emptying of the bladder
urine stasis-UTI-pylonephritis
hydroureter and hydronephrosis

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44
Q

Nursing management of BPH

A

assess understanding + educate about effects of enlargement
encourage fluids- concentrated urine is an irritant
reduce caffeine and ETOH
monitor I&O

45
Q

medications that go along with BPH

A

AVOID alpha-adrenergic agonists (Catapres, Tenex, Aldomine)
AVOID benadryl
care with antidepressants

46
Q

surgical management of BPH

A

transurethral resection of prostate (TURP)

prostatectomy

47
Q

TURP post-op care

A 
vitals
continuous bladder irrigation (CBI)
document urine color
accurate I&O
pain management
48
Q

what is continuous bladder irrigation?

A

insertion of a three way catheter

continuous infusion of isotonic solution

49
Q

when performing CBI on a patients bladder, why is catheter potency important?

A

If urine is very bloody, speed up irrigation flow, so that clots do not form.

50
Q

pain management method for CBI

A

Belladonna & Opium suppository (B&O)

51
Q

what is neurogenic bladder?

A

bladder dysfunction caused by tumors of CNS or PNS.

52
Q

nursing care for neurogenic bladder

A

intermittent self cath- q 6 hr
bladder training
medications
emotional support

53
Q

this is seen in advanced bladder cancer, it is usually painless

A

Hematuria

54
Q

medications to treat neurogenic bladder

A

oxybutynin (Ditropan) (urinary antispasmodic)

bethanechol (Urocholine) (cholinergic, stimulated muscarinic receptors causing bladder contraction)

55
Q

BPH can lead to what?

A

hydronephrosis

56
Q

extra renal conditions affecting the kidneys

A 
Diabetes
Hypertension
Hypotension
Rhabdomylosis- muscle injury
cardiovascular disease
peripheral vascular disease
57
Q

what are nephrotoxins?

A 
antibiotics- ahminoglycosides, lithium
heavy metals- mercury, lead
poisons
analgesics- NSAIDS, COX2 inhibitors
contrast dyes
58
Q

what is dissension of the renal pelvis caused by obstruction of normal urine flow?

A

Hydronephrosis

59
Q

Treatment of hydronephrosis?

A 
relieve obstruction and prevent infection
possible surgical intervention
monitor fluid and electrolyte balance
manage pain
monitor I&O
watch for infections and obstruction
60
Q

Labs for hydronephritis

A 
BUN
Creatinine
GFR
Albumin
urinalysis
Electrolytes
61
Q

Test to be done for hydronephritis

A 
Xray
CT/MRI
IV Urogram
Renal biopsy
cystoscopy
renal scan
ultrasound
62
Q

is caused by immunologic reaction that produces inflammation in the glomerular structure (post strep)

A

Glomerulonephritis

63
Q

symptoms of nephrotic syndrome

A

proteinuria, hypoalbuminemia, hyperlipidemia

64
Q

causes of nephrotic syndrome

A

glomerulonephritis, allergic reactions, systemic disorders

65
Q

complications of nephrotic syndrome?

A

extracellular fluid accumulation

renal failure

66
Q

nephrotic syndrome treatment

A 
heal the leaking globular membrane and stop the protein from leaking into the urine
maintain fluid and electrolytes
prevent thrombosis
minimize protein loss
emotional support
67
Q

clinical manifestation of nephritic syndrome include?

A 
hematuria and at least one of the following:
oliguria
hypertension
elevated BUN
decreased GFR
68
Q

integration of body, mind and spirit results in more powerful and manful care

A

Holistic nursing care

69
Q

Health promotion (Primary prevention) includes

A

healthy eating, healthy activity, effective coping with stress

70
Q

behaviors that promote early detection of disease:

A

secondary prevention: PAP/ testicular exam, eye exam, annual physical, monogram, etc

71
Q

activities related to rehabilitation after disease is diagnosed:

A

tertiary prevtion: exercise, PT, rehab

72
Q

examples of Instrumental ADL’s

A

shopping, housework, managing money, food prep, transportation

73
Q

psychologic factors that influence functional status of elders

A

ageism
multiple losses can lead to depression
neglect and abuse

74
Q

physiologic factors that influence functional status in elders

A

sleep
sensory impairment
mobility and balance

75
Q

slow intellectual deterioration that is irreversible

A

dementia

76
Q

abrupt onset of cognitive impairment that is often reversible (often due to medications)

A

delirium

77
Q

occurs in 75% of elders
suicide rates increase with age
substance abuse in 50% of elders

A

depression

78
Q

responsibility of LTC nurse

A 
oversee care of assigned residents
oversee unlicensed care providers
maintain extensive paperwork
provide medication and treatments
facilitate and contribute to care plan
79
Q

for patients who are recovering from an acute illness but are not in need of acute care. Often separate parts of acute care hospital. Often includes PT, most patients are recovering from fractures or bone surgeries.

A

Subacute care

80
Q

for people who are terminally ill, not only from cancer- generally 3 months to live. care can be provided in home or free-standing facility, staff trained to care for patients and families at end of their lives

A

Hospice

81
Q

a process to manage internal or external situations that are difficult or beyond the individuals current resources

A

coping

82
Q

more emotionally and socially vulnerable, with a higher risk of suicide when the death of a spouse occurs.

A

widowers

83
Q

examples of maladaptive coping

A 
alcohol abuse
anxiety
bullying
drug abuse
excessive eating
social isolation
84
Q

what regulates fluid balance?

A

Antidiuretic Hormone (ADH) (prevents diuresis, prevents urination)
Thirst mechanism
Aldosterone (promotes sodium retention= fluid retention)
Kidneys
Atrial natriuretic peptide (causes more sodium to be released and more water built up)

85
Q

normal serum osmolarity

A

280-300 mOsm/KG

86
Q

normal urine osmo

A

200-300 mOsm/L - 24 hr urine

87
Q

normal BUN/Creatinine

A

10-20/ 0.5-1.5 mg/100ml

88
Q

normal urine specific gravity

A

1.01-1.025

89
Q

normal sodium level

A

135-145 mEq/L

90
Q

Hormone that directly affects sodium?

A

aldosterone

91
Q

hormone that indirectly effects sodium

A

ADH, BNP

92
Q

what does being hypovolemic mean?

A

dry
dehydrated
from vomiting, diarrhea, sweating, NG drainage, diuretics.

93
Q

Dehydration levels of severity

A

mild: 1-2L
moderate: 3-5L
severe: 5-10L

94
Q

normal fluid intake for an adult

A

1500-2000ml/day; 800ml from food

95
Q

what is a major indicator of extracellular FVD?

A

full and bounding pulse
drop in postural BP
elevated temp
pitting edema of lower extremities

96
Q

indicators of hypervolemia

A 
fluid overload
edema
pulmonary congestion
distended neck veins
confusion
increased BP
decreased osmolality, hematocrit, sodium and BUN
97
Q

what is an appropriate fluid restriction?

A

1500ml/day

98
Q

what is fluid spacing

A

fluid shifts into the interstitial spaces

99
Q

causes of third spacing

A

surgery
heart failure
kidney failure

100
Q

plasma sodium volume less than 135

caused by excessive fluid loss, addisons disease, and kidney disease

A

Hyponatremia

101
Q

Na above 145; sodium retention, diarrhea, lots of urine output, burns, excessive aldosterone secretion

A

Hypernatremia

102
Q

K+ below 3.4. decreased reflexes, paresthesia, irritability to seizures and coma, fibrillation, muscle weakness and cramps, anorexia, flat T waves

A

hypokalemia

103
Q

K+ above 5. changes in HR + rhythm, anorexia, diarrhea, twitching, neuromuscular irritability

A

Hyperkalemia

104
Q

hypocalcemia is associated with

A 
decreased levels of calcium + vit D
decreased parathyroid hormone
pancreatitis
GI malabsorption
medications (steroids)
cancer
105
Q

assessment findings of hypocalcemia

A 
parathesis (numbness and tingling of extremities)
vital sign changes
Chvosteks sign
tetany/seizure
low albumin levels
106
Q

assessment findings of hypercalcemia

A 
anorexia
lethargy/decreased memory
muscle weakness
bone pain/fractures
kidney stones
107
Q

magnesium is important for what function?

A

cardiac electrical functioning

108
Q

most cases of hypermagnesemia is caused by?

A

renal failure

other causes: addisons disease, magnesium enemas, antacids, IV infusion of magnesium

109
Q

hypomagnesemia is associated with a decrease in what values?

A

low potassium and low calcium

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