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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
Interstitial cystitis management
pain meds, antispasmodics, Elmiron to increase bladder mechanisms
26
Improving coping with interstitial cystitis
chronic pain medication void by the clock, not by need legal exercises
27
Most frequent neoplasm of the urinary tract strong correlation with smoking and industrial exposure Chronic cystitis pelvic radiation
Bladder Cancer
28
Bladder cancer manifestations
painless hematuria intermittent bleeding obstruction- can't urinate
29
Bladder cancer diagnostic tests
``` Cystoscopy biopsy IVU MRI CEA (Carcino-embryonic antigen) ```
30
Bladder cancer management
chemo radiation surgery- transurethral resection of bladder tumor, partial or radical cystectomy.
31
Bladder Cancer palliative care
Nephrostomy tube- if renal pelvis through back, often flushed with sterile sailing Ureterostomy- if tumor blocking outflow of urine from bladder
32
Urinary Calculi- stones; cause?
``` urinary stasis, supersaturation of urine (extreme concentration of urine) immobility dehydration diabetes history high mineral content of water frequent UTI's ```
33
Types of Urinary Calculi
``` calcium oxalate struvite uric acid cystine xanthene ```
34
Urinary calculi symptoms + diagnostics
sharp, sudden pain UTI + fever nausea, vomiting KUB (Kidney, ureter, bladder IVU (intravenous urography) cyst- visualize / remove stone
35
Medical management of Urinary Calculi
``` increase fluids (3-4liters/day) Reduce Pain (Antispasmodics) Prevent calculi formation Dietary changes ```
36
What is a Lithotripsy
surgical removal of urinary calculi laser break up stones, causes bruising
37
Post urinary calculi procedure care
increase fluids monitor I&O Monitor for infection s&s strain urine
38
3 types of incontinence
stress urinary Detrusor over-activity- "urge" overflow urinary
39
Nursing Management of incontinence
``` kegal exercises bladder training monitor fluid intake incontinence products coping treat with dignity ```
40
Why can't bladder empty?
Detrusor failure in women enlarged prostate in men post void residual
41
Causes of urinary incontinence
sensory input interruption muscle tension, anxiety neurologic conditions- CVA, MS Meds: anticholinergics, antihistamines, narcotics
42
risk factors of benign prostatic hypertrophy
age, obesity, OTC cold meds, prostate cancer
43
Clinical manifestations of BPH
slow development incomplete emptying of the bladder urine stasis-UTI-pylonephritis hydroureter and hydronephrosis
44
Nursing management of BPH
assess understanding + educate about effects of enlargement encourage fluids- concentrated urine is an irritant reduce caffeine and ETOH monitor I&O
45
medications that go along with BPH
AVOID alpha-adrenergic agonists (Catapres, Tenex, Aldomine) AVOID benadryl care with antidepressants
46
surgical management of BPH
transurethral resection of prostate (TURP) | prostatectomy
47
TURP post-op care
``` vitals continuous bladder irrigation (CBI) document urine color accurate I&O pain management ```
48
what is continuous bladder irrigation?
insertion of a three way catheter | continuous infusion of isotonic solution
49
when performing CBI on a patients bladder, why is catheter potency important?
If urine is very bloody, speed up irrigation flow, so that clots do not form.
50
pain management method for CBI
Belladonna & Opium suppository (B&O)
51
what is neurogenic bladder?
bladder dysfunction caused by tumors of CNS or PNS.
52
nursing care for neurogenic bladder
intermittent self cath- q 6 hr bladder training medications emotional support
53
this is seen in advanced bladder cancer, it is usually painless
Hematuria
54
medications to treat neurogenic bladder
oxybutynin (Ditropan) (urinary antispasmodic) | bethanechol (Urocholine) (cholinergic, stimulated muscarinic receptors causing bladder contraction)
55
BPH can lead to what?
hydronephrosis
56
extra renal conditions affecting the kidneys
``` Diabetes Hypertension Hypotension Rhabdomylosis- muscle injury cardiovascular disease peripheral vascular disease ```
57
what are nephrotoxins?
``` antibiotics- ahminoglycosides, lithium heavy metals- mercury, lead poisons analgesics- NSAIDS, COX2 inhibitors contrast dyes ```
58
what is dissension of the renal pelvis caused by obstruction of normal urine flow?
Hydronephrosis
59
Treatment of hydronephrosis?
``` relieve obstruction and prevent infection possible surgical intervention monitor fluid and electrolyte balance manage pain monitor I&O watch for infections and obstruction ```
60
Labs for hydronephritis
``` BUN Creatinine GFR Albumin urinalysis Electrolytes ```
61
Test to be done for hydronephritis
``` Xray CT/MRI IV Urogram Renal biopsy cystoscopy renal scan ultrasound ```
62
is caused by immunologic reaction that produces inflammation in the glomerular structure (post strep)
Glomerulonephritis
63
symptoms of nephrotic syndrome
proteinuria, hypoalbuminemia, hyperlipidemia
64
causes of nephrotic syndrome
glomerulonephritis, allergic reactions, systemic disorders
65
complications of nephrotic syndrome?
extracellular fluid accumulation | renal failure
66
nephrotic syndrome treatment
``` 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
clinical manifestation of nephritic syndrome include?
``` hematuria and at least one of the following: oliguria hypertension elevated BUN decreased GFR ```
68
integration of body, mind and spirit results in more powerful and manful care
Holistic nursing care
69
Health promotion (Primary prevention) includes
healthy eating, healthy activity, effective coping with stress
70
behaviors that promote early detection of disease:
secondary prevention: PAP/ testicular exam, eye exam, annual physical, monogram, etc
71
activities related to rehabilitation after disease is diagnosed:
tertiary prevtion: exercise, PT, rehab
72
examples of Instrumental ADL's
shopping, housework, managing money, food prep, transportation
73
psychologic factors that influence functional status of elders
ageism multiple losses can lead to depression neglect and abuse
74
physiologic factors that influence functional status in elders
sleep sensory impairment mobility and balance
75
slow intellectual deterioration that is irreversible
dementia
76
abrupt onset of cognitive impairment that is often reversible (often due to medications)
delirium
77
occurs in 75% of elders suicide rates increase with age substance abuse in 50% of elders
depression
78
responsibility of LTC nurse
``` oversee care of assigned residents oversee unlicensed care providers maintain extensive paperwork provide medication and treatments facilitate and contribute to care plan ```
79
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.
Subacute care
80
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
Hospice
81
a process to manage internal or external situations that are difficult or beyond the individuals current resources
coping
82
more emotionally and socially vulnerable, with a higher risk of suicide when the death of a spouse occurs.
widowers
83
examples of maladaptive coping
``` alcohol abuse anxiety bullying drug abuse excessive eating social isolation ```
84
what regulates fluid balance?
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
normal serum osmolarity
280-300 mOsm/KG
86
normal urine osmo
200-300 mOsm/L - 24 hr urine
87
normal BUN/Creatinine
10-20/ 0.5-1.5 mg/100ml
88
normal urine specific gravity
1.01-1.025
89
normal sodium level
135-145 mEq/L
90
Hormone that directly affects sodium?
aldosterone
91
hormone that indirectly effects sodium
ADH, BNP
92
what does being hypovolemic mean?
dry dehydrated from vomiting, diarrhea, sweating, NG drainage, diuretics.
93
Dehydration levels of severity
mild: 1-2L moderate: 3-5L severe: 5-10L
94
normal fluid intake for an adult
1500-2000ml/day; 800ml from food
95
what is a major indicator of extracellular FVD?
full and bounding pulse drop in postural BP elevated temp pitting edema of lower extremities
96
indicators of hypervolemia
``` fluid overload edema pulmonary congestion distended neck veins confusion increased BP decreased osmolality, hematocrit, sodium and BUN ```
97
what is an appropriate fluid restriction?
1500ml/day
98
what is fluid spacing
fluid shifts into the interstitial spaces
99
causes of third spacing
surgery heart failure kidney failure
100
plasma sodium volume less than 135 | caused by excessive fluid loss, addisons disease, and kidney disease
Hyponatremia
101
Na above 145; sodium retention, diarrhea, lots of urine output, burns, excessive aldosterone secretion
Hypernatremia
102
K+ below 3.4. decreased reflexes, paresthesia, irritability to seizures and coma, fibrillation, muscle weakness and cramps, anorexia, flat T waves
hypokalemia
103
K+ above 5. changes in HR + rhythm, anorexia, diarrhea, twitching, neuromuscular irritability
Hyperkalemia
104
hypocalcemia is associated with
``` decreased levels of calcium + vit D decreased parathyroid hormone pancreatitis GI malabsorption medications (steroids) cancer ```
105
assessment findings of hypocalcemia
``` parathesis (numbness and tingling of extremities) vital sign changes Chvosteks sign tetany/seizure low albumin levels ```
106
assessment findings of hypercalcemia
``` anorexia lethargy/decreased memory muscle weakness bone pain/fractures kidney stones ```
107
magnesium is important for what function?
cardiac electrical functioning
108
most cases of hypermagnesemia is caused by?
renal failure other causes: addisons disease, magnesium enemas, antacids, IV infusion of magnesium
109
hypomagnesemia is associated with a decrease in what values?
low potassium and low calcium

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