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Medical Surgical Nursing Lecture > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

What are the most common bacterial infection in women?

A

Urinary tract infection (UTI)

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2
Q

What is the most common pathogen that causes UTIs?

A

E. coli

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3
Q

Is an infection worse if it upper or lower in the urinary tract?

A

upper

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4
Q

What is the diagnostic study for patients with UTIs?

A

urinalysis

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5
Q

How is urine collected to obtain a urine culture?

A

clean-catch urine sample

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6
Q

What is the patient teaching for a clean-catch urine sample for a woman?

A

Women:
1. spread the labia
2. wipe the periurethral area from front to back using a moistened, clean gauze sponge
(no antiseptic because it could contaminate the specimen)
3. while keeping the labia spread, start voiding, stop and collect the specimen 1 to 2 sec. after voiding starts

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7
Q

What is the patient teaching for a clean-catch urine sample for men?

A

Men:

  1. instruct them to wipe the glans penis around the urethra
  2. collect the specimen 1-2 sec after voiding begins `
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8
Q

Which patients are most at risk for developing a UTI?

A
  1. those with diabetes
  2. immunosuppressed
  3. traveled to 3rd world countries
  4. those who have undergone multiple antibiotic courses
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9
Q

What are Si/Sx of UTI?

A
  1. dysuria
  2. oliguria
  3. hesitancy
  4. fever
  5. urinary retention
  6. polyuria
  7. pain while urinating
  8. color of urine is dark red- amber
  9. hematuria
  10. cloudy from WBCs
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10
Q

What are Si/Sx of an UTI in an elderly patient?

A

they usually do not present with SI/Sx but may

  1. exhibit cognitive impairment or generalized clinical deterioration or confusion
  2. poor hygiene
  3. decreased fluid
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11
Q

IV Pyleogram

A

visualizes urinary tract after IV injection of contrast media. size, shape, position of kidneys, ureters, bladder tumor, cysts, lesions, and obstructions

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12
Q

What should you a nurse assess while taking an IV pyleogram?

A
  1. check for I- sensitivity
  2. allergies- shellfish and peniciilin
  3. warmth, flushed face and salty taste during injection
  4. force fluid after procedure to flush out contrast media
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13
Q

What are some interventions for a patient with an UTI?

A
  1. Ensure the female is wiping to front to back
  2. increase fluids to 2-3 L
  3. Drinking lots of cranberry juice
  4. Avoid unnecessary catheterization
  5. Avoid caffeine, ETHOL, citrus juices, chocolate, and highly spiced foods
  6. Medication
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14
Q

What is the medication often prescribed for those with a UTI?

A
  1. Bactrium
  2. Antibiotic- Ciproflaxcin
  3. Urinary analgesic- phenazopyridine
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15
Q

What are some patient teachings for someone taking pyridium?

A
  1. their urine will turn to orange

2. relieve pain but not remove the infxn itself

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16
Q

What is the normal range for WBCs?

A

4.0 - 11.0 x 10^9/L

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17
Q

How do you assess a UA?

A

assess for presence of bacteria, WBCS, pyuria, RBCS, and nitrates

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18
Q

In which situations should you give a pt a Foley?

A
  1. preop- day 2 the Foley should removed
  2. Urinary retention
  3. Strict I&Os
  4. S3 and S4 pressure injuries
  5. terminal illness
  6. bladder decompression
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19
Q

How to insert a catheter for a female patient?

A
  1. check for Dr. orders
  2. Clean the perineal area
  3. Setup sterile field
  4. Wipe the pt’s perineal area (farthest, closest, and middle)
  5. Insert the syringe into the port of the catheter itself (lube too)
  6. Find the urethra insert the foley until you see urine return then go an extra 2-3 in
  7. inflate the balloon then pull the catheter until you feel resistance
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20
Q

How to insert a catheter for a male patient?

A
  1. clean the penis in a circular motion
  2. when you insert the foley go all the way in until the port area
  3. inflate the balloon and pull until you feel resistance
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21
Q

When you can obtain a urine sample from a person with a Foley?

A

only upon insertion can you collect from the bag after that you have to use the port on the catheter

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22
Q

How do you collect urine from a catheter port?

A
  1. clamp for 15-30 mins
  2. if there is no urine backflow, wipe port for 15s
  3. aspirate and insert a 10 ml syringe
  4. pour in cup and unclamp
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23
Q

What is pyelonephritis?

A

an inflammation of the renal parenchyma and collecting system most commonly caused by a bacterial infection, but fungi, protozoa, or viruses

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24
Q

Etiology of pyleonephritis?

A

caused by urosepsis which can lead to septic shock. Usually begins in the lower urinary tract via the ascending urthreal route

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25
Q

What is the most important risk factor for acute pyleonephritis?

A

pregnancy- induced physiologic changes in the urinary system

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26
Q

Urethritis/ Urthritis

A

inflammation of the urethra by sexual transmission

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27
Q

How should you assess for urthritis caused by gonorrhea?

A
  1. Ask if sexually active
  2. common Si/Sx include burning during urination, later skin rashes
    Women: vaginal discharge (white), pelvic pain, & spotting
    Men: discharge from penis (white), swollen testicles
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28
Q

What is glomerulonephritis?

A

inflammation of the glomeruli caused by strep.

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29
Q

How do you assess a patient for glomerulonephritis?

A

ask the patient if they have a sore throat and check the temp for fever, get a UA ( hematuria, proteinuria, CBC, Cr BUN, and albumin) and renal biopsy to confirm

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30
Q

Nephrotic Syndrome

A

results when the glomerulus is excessively permeable to plasma protein

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31
Q

How do you assess a patient for Nephrotic Syndrome?

A
  1. UA ( proteinuria, foamy) decreased serum albumin, protein, and elevated serum cholesterol.
  2. assess for edema
  3. weight gain ( check weight daily at he same time with same clothing)
  4. ascites and anasarca ( massive generalized edema)
  5. HTN and hyperlipidemia so low Na+ diet
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32
Q

Urolithiasis

A

the formation of urinary stones in the urinary tract or bladder

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33
Q

What is a nursing action for a pt with urolithiasis?

A
  1. Encourage an increase of fluid intake
  2. Dietary restriction of purines and sodium
  3. pain management
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34
Q

PKD (polycystic kidney disease)

A

involves bot kidney’s cortex and medulla filled with large cysts with several cm each with fluid, blood or pus

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35
Q

SI/Sx of PKD

A 
Initially- asymptomatic 
When the cysts enlarge: 
1. hematuria 
2. HTN 
3. Flank pain 
4. headaches 
5. UTI or urinary calculi (1st sign)
36
Q

What is the treatment for PKD?

A

Antibiotics to prevent UTIs and

37
Q

What is the normal range for albumin?

A

3.2-4.8

38
Q

What is the normal range for Cr?

A

0.6-1.3 mg/dL

39
Q

What is the normal range for BUN?

A

6-20 mg/dL

40
Q

What is the normal range for Na+?

A

135-145 mEq/L

41
Q

What is the normal range for K+?

A

3.5-5.0 mEq/L

42
Q

What is the normal range for Ca2+?

A

8.6-10.2 mg/dL

43
Q

What is the normal range for (PO4)3-?

A

2.4-4.4 mg.dL

44
Q

What is the normal blood pH?

A

7.34-7.45; avg=7.4

45
Q

What is the normal range for CO2?

A

35-45

46
Q

What is the normal range for HCO3-?

A

22-26

47
Q

If a pt.’s CO2 level is 25 are they acidic or basic?

A

basic

48
Q

If a pt.’s CO2 level is 55 are they acidic or basic?

A

acidic

49
Q

What is the mnemonic to remember acid-base balance?

A

ROME (Respiratory Opposite Metabolic Equal)

50
Q

pH: high CO2: normal HCO3-: high

A

metabolic alkalosis

51
Q

pH: low CO2: high HCO3-: normal

A

respiratory acidosis

52
Q

pH: low CO2: normal HCO3-: low

A

metabolic acidosis

53
Q

pH: high CO2: low HCO30: normal

A

respiratory alkalosis

54
Q

Metabolic alkalosis

A

Vomiting
NG Suctioning
Diuretic therapy
Hypokalemia

55
Q

Si/Sx of metabolic alkalosis

A
  1. irritability
  2. lethargy
  3. confusion
  4. headache
  5. tachycardia
  6. nausea and vomiting
  7. tetany and tremors
56
Q

What are some pt. teachings taking furosemide (Lasix)?

A
  1. take at the same time each day
  2. take in the am to prevent nocturia
  3. Can increase blood sugar levels so monitor
  4. Limit Na+ intake
  5. Get up slowly to prevent orthostatic hypotension
  6. Eat more K+ foods or take supplement
57
Q

What are some risk factors for developing renal calculi?

A

metabolism, climate, diet and lifestyle

58
Q

What are some pt. teachings for renal calculi?

A
  1. increase fluids of water to 2-3L/day
  2. dietary Na+ restrictions
  3. meds that reduce formation
  4. surgery
59
Q

What are some Si/Sx of renal calculi?

A
  1. sharp pain
  2. fever
  3. chills
60
Q

What is the most concerning problem with arthroscope procedures?

A

pus at the incision site indicating infection. If this observed seek the MD immediately.

61
Q

What is carpal tunnel syndrome?

A

compression caused by the median nerve

62
Q

Si/Sx of Carpal tunnel Syndrome

A
  1. weakness

2. Pain and numbness or impaired sensation in the distribution of the median nerve

63
Q

How do you assess for Carpal Tunnel Syndrome?

A
  1. Tinel’s Sign: Tapping over the median nerve as it passes through the carpal tunnel in the wrist
  2. Phalen’s Sign: allowing the wrists to fall freely into maximum flexion and maintain the position for longer than 60 secs
    If you feel tingling in hand that positive
64
Q

What is a rotator cuff injury?

A

A tear in the four muscles in the shoulder caused by repetitive motion

65
Q

Si/Sx of rotator cuff injury

A
  1. shoulder weakness
  2. pain
  3. decreased ROM
66
Q

How do you assess for a rotator cuff injury?

A
  1. severe pain when the arm is abducted between 60 and 120 degrees
  2. A (+) drop arm test: the arm is abducted 90 degrees, and the patient slowly is asked to slowly lower the arm to the side. If the arm falls suddenly, then the rotator cuff is injured
67
Q

How do you assess a patient from a nephrectomy?

A
  1. assess the patients I&Os
  2. VS
  3. Urine output <30 ml
  4. weight daily
  5. infxn
  6. bleeding
  7. stool softner
  8. respiratory depression
68
Q

How do you assess a pelvic fracture?

A
  1. assess bowel and urinary elimination
  2. perform distal neurovascular assessment (capillary refill)
  3. Assess the abdomen for distention and for bowel sounds (if absent call the MD immediately)
69
Q

What is the purpose of traction?

A
  1. prevent or reduce pain
  2. immobilize a joint or part of the body
  3. reduce fracture or dislocation
  4. treat pathologic joint condition
70
Q

What are some nursing actions for skeletal traction?

A
  1. maintain counteraction by elevating HOB
  2. Keep weights off the floor
  3. reduce the risk for infection
  4. pain management
  5. make sure pins and needle remain in place
  6. check pulses
71
Q

What are some pt teaching for wearing a cast?

A
  1. do not put anything in cast (pain may get worse causing Compartment Syndrome)
  2. Monitor cast during drying and for denting or flattening
  3. assess pulses and capillary refill
  4. ROM
72
Q

What is the nursing action for ORIF?

A
  1. check 6Ps
  2. VS
  3. Monitor limitations do to turning
  4. Positioning and extremity support
  5. observe dressing or casts for drainage or bleeding
73
Q

What is the pt. teaching for external fixation?

A
  1. meticulous pain care
  2. keep hydrogen peroxide
  3. maintain alignment
74
Q

What is the nursing action for a pt with below the knee amputation?

A
  1. monitor for PTSD
  2. VS
  3. Assess dressings for hemorrhage
  4. Use sterile technique
  5. Avoid sitting in chair for more than 1 hr
  6. Reduce edema
75
Q

What are the 6 P’s?

A
  1. pallor
  2. parathesia
  3. pressure
  4. pain
  5. pulseness
  6. paralysis
76
Q

What is the nursing action for a hip fracture?

A

Assess

  1. VS
  2. I&O
  3. Respiratory fxn
  4. Encourage TDBC
  5. Administer pain med
  6. Observe dressing
  7. Edema
  8. Pulses
  9. Sensation
  10. motor function
77
Q

What do you report for a femur fracture?

A
  1. check capillary refill
  2. edema
  3. pulses
  4. perform ROM
78
Q

How do you assess elderly?

A
  1. assess urinalysis
    - foamy urine, decrease serum albumin, high cholesterol
  2. Assess for edema
  3. Weight gain
  4. low serum protein level
  5. low Na+ diet
79
Q

Si/Sx of pediculous capitits

A
  1. minute, red, noninflammatory
  2. points flush with skin
  3. progression to papular wheal-like lesions
  4. pruritus
  5. secondary excoriation
  6. nits and eggs are firmly attached to hair shaft in head and body
80
Q

How do wounds heal in diabetic pts?

A

they have a delayed healing process

81
Q

How do you assess wound healing?

A
  1. Texture
  2. Amount
  3. Color
  4. odor
  5. Length
  6. width
  7. depth
82
Q

If pain gets worse with compartment syndrome, should you elevate and apply cold?

A

do not elevate or apply cold causes vasconstriction

83
Q

What are some nursing actions for sports related injury?

A

RICE- (rest, ice, compression, elevation)

restrict movement if pain is felt

84
Q

How do you assess a dark skin pt?

A
  1. Look for areas of darker skin that surrounding skin
  2. use natural or halogen light for accurate measurement
  3. assess skin temp
  4. ask about pain or itchy sensation
  5. Assess lips and mucous membrane for cyanosis
85
Q

How do you assess skin assessment in the elderly?

A
  1. dry flaky skin
  2. bruising
  3. increased wrinkling
  4. decrease in rosy appearance of skin
  5. thick, brittle nails with diminished growth
86
Q

How do you assess for compartment syndrome?

A
  1. pain distal to injury that isn’t relieved by opioids
  2. pallor
  3. paresthesia
  4. paralysis
  5. pulselessness
  6. pressure
87
Q

What is compartment syndrome?

A

a condition in which swelling causes increased pressure within a limited space (increase size= tight and decrease in size= bleeding, edema)

Medical Surgical Nursing Lecture (4 decks)

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