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Nurs. 302 > Exam 2 > Flashcards

Exam 2 Flashcards

0
Q

About how many nephrons in each kidney?

A

1 million

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1
Q

What is one of the more significant functions of the kidney?

A

To help maintain the composition and volume of body fluids. About once every 30 minutes, the body’s total blood volume passes through the kidneys for waste removal. The kidneys filter and excrete blood constituents that are not needed and retain those that are.

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2
Q

What is the nephrons role?

A

Nephrons remove the end product of metabolism, such as urea, creatine, and uric acid from blood plasma and form urine. Once formed, urine from the nephrons empties into the pelvis of each kidney. From each kidney, urine transported by rhythmic peristalsis through the ureters to the urinary bladder.

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3
Q

What is the urinary bladder ?

A

The urinary bladder is a smooth muscle sac it serves as a temporary restoring for urine

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4
Q

What are the three layers of the urinary bladder?

A

The urinary bladder is composed of three layers of muscle tissue, the inner longitudinal layer, the middle circular layer, and the outer longitudinal layer. These three layers are called the detrusor muscle

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5
Q

What are the roles of the sympathetic system and the parasympathetic system when it comes to the urinary bladder?

A

The urinary bladder muscle is innervated by the autonomic nervous system. The sympathetic system carries inhibitory impulses to the bladder and motor impulses to the internal sphincter. These impulses cause the detrusor muscle to relax and the internal sphincter to constrict, retaining urine in the bladder. The parasympathetic system carries motor impulses to the bladder and inhibitory impulses To the internal sphincter. These impulses cause the detrusor muscle to contract and the sphincter to relax.

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6
Q

What are the differences between the male and female urethra?

A

The male urethra functions in the excretory system and the reproductive system. It is about 13.7 to 16.2 cm long and consists of three parts, the prostatic, the membranous,and the cavernous portion. The external urethral sphincter consists of striated muscle is located just beyond the prostatic portion of the urethra.

In contrast, the female urethras about 3.72 6.2 cm long. The external, or voluntary sphincter is located in the middle of the urethra, no portion of the female urethra is external to the body.

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7
Q

The process of emptying the bladder is known as urination….

A

Micturition, or voiding

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8
Q

Where are the nerve centers for urination located?

A

There situated in the brain and spinal cord. Urinating is largely an involuntary reflex act but it’s control can be learned.

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9
Q

When does someone normally feel the desire to void?

A

When the bladder feels to about 150 to 250 mL in an adult

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10
Q

What happens during urination?

A

When urination is initiated, the detrusor muscle contracts, the internal sphincter relaxes, and urine enters the posterior urethra. The muscles of the perineum and the external sphincter relax, the muscle of the abdominal wall contracts slightly, the diaphragm lowers, and urination occurs

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11
Q

What is an autonomic bladder?

A

People whose bladders are no longer controlled by the brain because of injury or disease and they have to void by reflex only.

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12
Q

When does voluntary control of the urethral sphincter occur?

A

Between 18 and 24 months of age

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13
Q

What is enuresis?

A

Enuresis Is continued incontinence of urine past the age of toilet training

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14
Q

What is nocturia?

A

The diminished ability of the kidneys to concentrate urine may result in nocturia (urination during the night)

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15
Q

What are some diseases associated with renal problems?

A 
Congenital urinary tract abnormalities
Polycystic kidney disease
UTIs
Urinary calculus ( kidney stones )
Hypertension, diabetes mellitus
Gout
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16
Q

What are the differences between acute renal failure and chronic renal failure?

A

Acute renal failure is caused by conditions such as severe dehydration, anaphylactic shock, pyelonephritis and ureteral obstruction. Chronic renal Failure is caused by conditions such as diabetes, hypertension, and glomeruli nephritis

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17
Q

What does nephrotoxic mean?

A

Nephrotoxic: capable of causing kidney damage

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18
Q

What does hematuria mean?

A

Blood in the urine

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19
Q

What is Anuria?

A

24 hour urine output is less than 50 ml

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20
Q

What is dysuria?

A

Painful or difficult urination

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21
Q

What is glycosuria?

A

Presence of sugar in the urine

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22
Q

What is oliguria?

A

Scanty or greatly diminished amount of urine voided in a given time

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23
Q

What is polyuria?

A

Excessive output of urine, dieresis

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24
Q

What is proteinuria and what does it indicate?

A

It means there is protein in the urine, it indicates kidney disease

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25
Q

What does pyuria mean?

A

Pus in urine, urine appears cloudy

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26
Q

What is the normal pH of urine?

A

The normal pH of urine is about 6.0, with a range of 4.6 to 8

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27
Q

How many millimeters do you need for you urine culture?

A

Urine culture requires about 3 mL, whereas routine urinalysis requires at least 10 mL of urine

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28
Q

What is the specific gravity of urine?

A

It is a measure of the density of urine compared with the density of water. The higher the number, the more concentrated the urine, unless there are abnormal components, such as glucose or protein in the urine

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29
Q

How many fluids should people drink for optimal urinary functioning?

A

Adults with no fluid restrictions should drink 2000 to 2400 mL a day

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30
Q

Those are greatest risk for a UTI include…

A

Sexually active women, women that use diagrams for contraception, postmenopausal women, individuals with a catheter, individuals with diabetes mellitus, and elderly people

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31
Q

What are the types of urinary incontinence?

A

Transient incontinence: It appears suddenly and last for six months or less. It is usually caused by treatable factors such as confusion infection.

Stress incontinence: Occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. This commonly occurs during coughing, sneezing, laughing.

Urge incontinence: Is the involuntary loss of urine that occurs soon after feeling an urgent need to void

Mixed incontinence: Indicates that there is urine lost with features of two or more types of incontinence

Functional incontinence: Is urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, or
disorientation.

Reflex incontinence: Experience emptying the bladder without the sensation of the need to void. Spinal cord injuries may lead to this type of incontinence.

Total incontinence: Is a continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation.

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32
Q

What is PVR and when is the recommended

A

PVR or post void residual Is the amount of urine remaining in the bladder immediately after voiding

A PVR of greater than 150 mL is often recommended as a guideline for catheterization because residual urine volumes of greater than 150 mL have been associated with the development of urinary tract infection

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33
Q

What is the pyloric sphincter?

A

The pyloric sphincter, a muscular ring that regulates the size of the opening at the end of the stomach, controls the movement of chime from the stomach into the small intestine

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34
Q

What are the three parts of the small intestine?

A

The first is the duodenum, the middle section is the jejunum, and the distal section that connects with the larger intestine is the ileum

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35
Q

What is the connection between the ileum of the small intestine and the large intestine?

A

The ileocecal valve

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36
Q

Describe the large intestine

A

The large intestine, also known as the colon, extends from the ileocecal valve to the anus. The colon is about 5 feet long. Functions of the large intestine include the absorption of water, the formation of feces, and the expulsion of feces.

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37
Q

What is peristalsis?

A

Peristalsis is Contractions of the circular and longitudinal muscles of the intestine, it occurs every 3 to 12 minutes, moving waste products along the length of the intestine continuously

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38
Q

What 2 centers govern the reflex to defecate?

A

One is in the medulla and a subsidiary one in the spinal cord

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39
Q

What additional muscles aid in the process of defecation?

A

Voluntary contraction of the muscles of the abdominal wall by holding one’s breath, contracting the diaphragm, and closing the glottis increases intra-abdominal pressure up to four or five times the normal pressure, which helps expel feces. Simultaneously, the muscles on the pelvic floor contract and Aid expulsion of the fecal mass. Flexing thigh muscles and sitting also help increase downward pressure.

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40
Q

When would you not recommend the valsalva maneuver when defecating?

A

This maneuver can be dangerous in patients with cardiovascular problems because when an individual bears down to defecate, the increased pressures in the abdominal and thoracic cavities result in a decreased blood flow to the atria and ventricles, thus temporarily lowering cardiac output. Once bearing down ceases, the pressure is lessened, and a larger than normal amount of blood returns to the heart. This act may dangerously elevate blood pressure in an already hypertensive individual.

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41
Q

Infant stool characteristics : breast vs bottle fed

A

Breast milk is easier for the intestines to break down and absorb. Breast fed babies have more frequent stools, usually 2 to 10 stools daily, and stools are yellow to Golden and usually have no or little odor.
Bottle fed babies stools vary from yellow to brown and have a stronger odor because of the decomposition of protein. They usually have 1 to 2 stools daily.

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42
Q

What is paralytic ileus?

A

Direct manipulation of the bowel during abdominal surgery inhibits peristalsis causing a condition termed paralytic Ileus. This temporary stoppage of peristalsis normally last 24 to 48 hours, during this time food and fluids are withheld

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43
Q

What causes the brown color of stool and its characteristic odor?

A

Stercobilin, a bile pigment derivative causes its color

The characteristic odor is due to indole and skatole, caused by putrefaction and fermentation

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44
Q

What does endoscopy mean?

A

Endoscopy Is the direct visual examination of body organs or cavities

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45
Q

Cathartics vs. laxative

A

They are both drugs to induce emptying of intestinal tract. However, cathartics exert a stronger effect on the intestine than laxatives

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46
Q

What is the most common cause of chronic constipation?

A

The overuse of laxatives

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47
Q

How would you define diarrhea?

A

Diarrhea is the passage of more than three loose stools the day. Frequent bowel movements are not always indicative of diarrhea, but patients with diarrhea usually pass stools more frequently. Diarrhea is often associated with intestinal cramps.

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48
Q

What is bowel incontinence?

A

It’s the inability of the anal sphincter to control the discharge of fecal and gaseous matter.

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49
Q

What does ostomy mean?

A

It is a term for a surgically formed opening from the inside of an organ to the outside. The intestinal mucosa is brought out to the abdominal wall, and stoma, the part of the ostomy that is attached to the skin, is formed by suturing the mucosa to the skin.

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50
Q

What is an ileostomy?

A

An ileostomy allows liquid fecal content from the ileum of the small intestine to be eliminated through the stoma

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51
Q

What is a colostomy?

A

A colostomy permits formed feces in the colon to exit through the stoma

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52
Q

CHAPTER 36 bookmark ——————

A

iDisks

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53
Q

What is basal metabolism?

A

It’s he energy required to carry on the involuntary activities of the body at rest, the energy needed to sustain the metabolic activities of cells and tissues

Basal metabolic rate: BMR is about 1 cal/kg of body weight per hour for men and 0.9 cal/kg per hour for women

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54
Q

How do you calculate BMI?

A

BMI= weight in lbs divided by (height in inches x height in inches) all x by 703

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55
Q

What does your BMI tell you?

A

A person with a BMI below 18.5 is underweight
A BMI of 25-29.9 indicates an overweight
A BMI of 30 or greater equals obesity
A BMI of 40 or greater equals extreme obesity

56
Q

What is waist measurement an indicator of?

A

Where excess body fat Is deposited is thought to be an important and reliable indicator of risk for disease, such as type two diabetes, dyslipdemia, hypertension, and cardiovascular disease

57
Q

How many carbohydrates are needed to prevent ketosis?

A

50-100g

Ketosis: an abnormal accumulation of ketone bodies that is frequently associated with acidosis

58
Q

Describe nitrogen balance in the body

A

Nitrogen balance, a comparison between catabolism and anabolism, can be measured by comparing nitrogen intake (protein intake) and nitrogen excretion. When catabolism and anabolism are occurring at the same rate, the body is in a state of neutral nitrogen balance. A positive nitrogen balance occurs when nitrogen intake in greater than excretion, during periods of growth, pregnancy, lactation,a and recovery from illness. Negative can occur in starvation, surgery, stress.

Nitrogen remaining after protein is metabolized burdens the kidneys

59
Q

What % of calories should come from protein.?

A

10-20%

60
Q

Saturated vs. unsaturated

A

The difference in degree of saturation depends on the amount of hydrogen in fat molecules. Saturated fats contain more hydrogen than unsaturated. Most animals fats are considered saturated and have a solid consistency at room temp. Conversely , most vegetables fats are considered unsaturated. Saturated fats tend to raise serum cholesterol levels, unsaturated fats lower serum cholesterol levels.

61
Q

How many calories should you get from carbohydrates?

A

45-65%

62
Q

What is the recommended daily intake for protein?

A

56g for women
63 for men

Protein should contribute to 10-20% of total caloric intake

63
Q

True or false trans fat raises serum cholesterol

A

True

64
Q

Where in the body is cholesterol especially abundant?

A

The brain and nerve cells

65
Q

What is the daily recommendation for fat intake?

A

No more than 20-35% of total calories

66
Q

What are fat soluble vitamins?

A

A, D, E, K

67
Q

What are water soluble vitamins?

A

B, C

68
Q

What is zinc used for?

A

Wound healing

69
Q

You should not go less than ___in a diet a day

A

10% fat

70
Q

What is the daily recommendation of grains, veggies ect..

A 
Grains: 6oz
Veggies: 2.5 cups
Fruits: 2 cups
Milk: 3 cups
Meat and beans: 5.5 oz
71
Q

What are underweight, normal and obese BMIs

A 
Underweight: less than 18.5
Normal: 18.5-24.9
Overweight: 25-29.9
Class 1: 30-34.9
Class 2: 35-39.9
Extreme obesity: 40 plus
72
Q

An alcoholic would have what vitamin deficiency?

A

A vitamin B deficit

73
Q

What is kayexalate and when is it used?

A

It is used to treat a high level of potassium in the blood. Kayexalate binds with k+ in the blood and is excreted in the stool

74
Q

What is dysphasia?

A

Difficulty swallowing

75
Q

How do you check a tube feelings placement?

A

X-ray

  1. 30 ml of air (listen for whoosh)
  2. Remove aspirate (30 ml) check color, amount
  3. Check pH (anything less than 4 your good to go..acidic…your in the stomach
76
Q

What is a big complication of tube feeding?

A

Dehydration

77
Q

How many mls of urine does the bladder normally hold?

A

600 mls of urine

78
Q

How can prolonged use of an in dwelling catheter cause urinary problems?

A

Continuous drainage of urine through catheter causes loss of bladder tone and damages the urethral sphincter

79
Q

How does anesthia and narcotic analgesics alter urine formation?

A

They alter the glomerular filtration rate….reducing urine output

80
Q

A urinalysis is a general examination of Urine to establish baseline info or provide data to establish a _____ diagnosis?

A

Tentative

81
Q

During bladder distention the bladder cannot be percussed until it contains how much fluid?

A

150 ml

82
Q

Which adaptation would indicate urinary retention?

A. Wet bed, undergarments
B. burning , pain during voiding
C. Sudden overwhelming need to void
D. Bladder fullness in absence of voiding

A

D. Bladder fullness in absence of voiding

83
Q

Which is a major contributing factor to overflow incontinence?

A. Coughing
B. mobility deficit
C. Prostate enlargement
D. Urinary tract infection

A

C. Prostate enlargement

84
Q

Which Patient adaptation would cause the most concern?

A. Anuria
B. dysuria
C. Dieresis
D. Enuresis

A

A. Anuria

85
Q

What should sodium intake be limited too?

A

2300-3000 mg day

86
Q

Describe cholesterol

A

Not a fat, but a steroid
Travels through the blood attached to fatty acids
Synthesized in the liver
Comes from animal products

87
Q

LDL vs. HDL

A

LDL: low density lipoprotein- bad cholesterol

HDL: high density lipoprotein- good cholesterol

88
Q

Fat soluble vitamins and functions

A

A : vision
D: absorption of calcium and phosphorus
E: cell reproduction
K: clotting

89
Q

Which of the following individuals is likely to have a negative nitrogen balance?

A

A. An elderly patient with an open leg ulcer that is not healing
B. a young adult vegetarian
C. A preschooler with ashtma

90
Q

The general population may have what mild vitamin deficiencies ?

A

Vitamin A, C, folate, B6

91
Q

Fat soluble vitamin absorption

A

Vitamins A, D, E, K, are absorbed with fat into the lymphatic circulation. Like fat, they must be attached to a protein to be transported through the blood. The body stores excesses of fat soluble vitamins mostly in the liver and adipose tissue

92
Q

Obesity is defined as body weight _____or more above ideal weight or having a BMI of 30 or more

A

20%

93
Q

Full liquid diets

A

Contain all items on a clear liquid diet. Additional items include milk, custard, pudding, cereal gruels, pasteurized eggs

94
Q

What is a nasogastric tube?

A

For short term use ( less than 4 weeks), a nasogastric or nasointestinal route is usually selected. A nasogastric tube is inserted through the nose and into the stomach. However, The patient is at risk for aspirating the tube feeding solution into the lungs, a disadvantage for using this route. Patient with a dysfunctional gag reflex, high risk of aspiration, gastric stasis, gastroesophageal reflux, nasal injuries.
Traditional nasogastric tubes are firm and large in diameter, ex : levin tube

95
Q

What is a nasointestinal tube?

A

A nasointestinal tube is passed through the nose and into the upper portion of small intestine. It may be indicated for a patient with increased risk of aspiration due to a diminished gag reflex or slow gastric motility.

96
Q

What is the enteral feeding rate?

A

Feedings are initiated at full strength. The rate of infusion begins at 10-40 ml an hour. The rate is then advanced by 10-20 ml per hour every 8-12 hours until the desired rate is achieved

97
Q

What are some common causes of clogged enteral tubes?

A

Aspirated stomach contents, residue from medications, feeding flow rate of less than 50 ml, infrequent or inadequate addition of water to the system, and using a tube with a small lumen

98
Q

Describe parental nutrition

A

Total parenteral nutrition is a highly concentrated, hypertonic nutrient solution. TPN provides calories restores nitrogen balance, and replaces essential fluid, vitamins electrolytes. TPN can also promote tissue and wound healing and normal metabolic function. Hyperalimentarion is another term sometimes used synonymously with parental nutrition.

99
Q

Describe peripheral parenteral nutrition

A

It’s a less concentrated nutrient solution sometimes prescribed for patients who have a malfunctioning gastrointestinal tract and need short term nutrition less than 2 weeks. PPN is administered through a peripheral vein. Peripheral veins cannot tolerate highly concentrated solutions, so the solution is not as nutrient dense as TPN

100
Q

TPN vs. PPN

A

TPN solutions are hypertonic

PPN solutions are isotonic

101
Q

What is an autonomic bladder?

A

People whose bladders are no longer controlled by the brain because of injury or disease also void by reflex only

102
Q

How drugs affect urine color

A

Anticoagulants: may cause hematuria ( blood in urine) , leading to a pink or red color

Diuretics: lighten the color urine to pale yellow

Phenazopyridine ( pyridium): a urinary tract analgesic, can cause orange/ red urine

Levodopa: an antiparkinson drug, can lead to brown or black urine

103
Q

True or false

A sterile specimen is required for a routine urinalysis

A

False

104
Q

How often should you check residual?

A

Check residual before each feeding or every 4 to 6 hours during a continuous feeding. High gastric residual volumes of 200 to 250 mL or greater can be associated with high-risk for aspiration and aspiration related pneumonia.

105
Q

What is an ileal conduit?

A

An ileal conduit is a cutaneous urinary diversion. An ileal conduit involves a surgical resection of the small intestine, with transplantation of the ureters to the isolated segment of small bowel. This separated section of the small intestine is then brought to the abdominal wall, where urine excreted through the stoma, a surgically created opening on the body surface.

106
Q

How long is the small/large intestine

, and rectum?

A

Small intestine: 20 ft
Large intestine or colon: 5 ft
Rectum: 5 inches

107
Q

Hypertonic enemas

A

Is solutions draw water into the colon, which stimulates the defecation reflex. They may be contradicted in patients for whom sodium retention is a problem. They are also contradicted for patients with renal impairment or reduced renal clearance because such patients have compromised ability to excrete phosphate adequately. With resulting hyperphosphatemia

108
Q

What color do anticoagulants turn stool?

A

Pinkish/red to black stool

109
Q

What color do iron salts turn stool?

A

Black

110
Q

Emollients vs. stimulants

A

Emollients lubricate stool
Lubricants soften stool
Stimulants promote peristalsis by irritating the intestinal mucosa or stimulating the nerve endings in the intestinal wall

111
Q

Describe bowel training program

A

For bowel training program to be effective, the patient must have ample time for evacuation, usually 20 to 30 minutes. Fluid intake is increased to 2500 to 3000 mL, food high in bulk is recommended as part of the program, and a daily enema is NOT administered in a bowel training program. A cathartics suppository maybe used 30 minutes before the patient usual defecation time to stimulate peristalsis

112
Q

During removal of a fecal impaction, which of the following could occur because of vagal stimulation?

A

Removing a fecal impaction manually may result in stimulation of the vagel nerve and resulting bradycardia

113
Q

Which laboratory test result would the nurse interpreted as indicating that the patient is at risk for poor nutritional status?

A

Decreased serum albumin levels

114
Q

Parenteral nutrition provides nutrition by…

A

Intravenous access

115
Q

The patient has a nasogastric tube inserted for feeding purposes. Using the stomach as a reservoir for food is advantageous for preventing what complication?

A

Dumping syndrome

116
Q

What maintains normal RBC volume?

A

Kidneys

117
Q

Who do you commonly see Anuria in?

A

Dialysis patients

118
Q

What is our standard of care?

A

I&O every q4

@ 8 and noon

HT assessment every q8

Get it done by 10 am

119
Q

What medications cause urinary retention?

A

Anticholinergics (atropine)

Antihistamines (diphenhydramine )

120
Q

What does Cystitis mean?

A

An irritated bladder, probably infection

121
Q

Urine output

A

Less than 30 cc output for 2 hours or more is a cause for concern

122
Q

If the urine smells of acetone they most likely have…

A

Diabetic ketoacidosis

123
Q

When should you not perform the valsalva maneuver other than cardiovascular issues?

A

If you have glaucoma, cuz it causes more optic pressure and will burst blood vessels

124
Q

What is peristalsis under control by?

A

The nervous system

125
Q

True or false an ileostomy bypasses the large intestine

A

True

126
Q

What does borborygmous mean?

A

Nauseous or vomiting

127
Q

What order do you listen to bowel sounds?

A
  1. Right , lower
  2. Right, upper
  3. Left, upper
  4. Left, lower
128
Q

What are the steps of an abdominal assessment?

A
  1. Inspect first
  2. Auscultate ( begin in R lower quadrant)
  3. Palpate (note masses)
  4. Percuss last ( detect gas) tap listen for notes…dull, tympanic ect.
129
Q

What is the specific gravity of urine?

A

1.005-1.030

130
Q

Bowel sounds

A
  1. Absent
  2. Hypoactive : <5 sounds min
  3. Hyperactive : 35 or more sounds
  4. Borborygmous : constant sound
131
Q

Tap water enemas

A

Hypotonic
500-1000
15 min
Fluid and electrolyte imbalance, water intoxication

132
Q

Normal saline enemas

A

Isotonic
500-1000
15 min
Fluid and electrolyte imbalance, sodium retention

133
Q

Spam enemas

A

500-1000
10-15
Rectal mucosa damage or irritation

134
Q

Hypertonic enemas

A

Hypertonic
70-130 ml
5-10 min
Sodium retention

135
Q

Oil enemas

A

150-200 ml

30 min

136
Q

True or false hypotonic(tap water) enemas and isotonic (saline) enemas are large volume enemas that result in rapid colonic emptying

A

True

137
Q

What patients would you not recommend getting a hypertonic enema?

A

Patients with renal impairments or sodium retention

138
Q

Carminative vs. anthelminitic

A

Carminative enemas help expel flatus

Anthelminitic enemas destroy intestinal parasites

Nurs. 302 (6 decks)

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