Exam 2 Flashcards
What is the product of creatine metabolism in muscles
Creatinine
What are WBCs in the urine called?
Pyuria
What is an expression of the degree of concentration of the urine called?
Specific gravity or osmolality
What stores urine, has transitional epithelium allowing for distention
The bladder
What is bacteria in the urine called?
bacteriuria
What is urine output less than 0.5ml/kg/hr called?
oliguria
What is the amount of plasma filtered through the glomeruli per unit of time called?
glomerular filtration rate
what controls the formation of urine?
the kidneys
What is decreased urine output of less than 50ml in 24 hours called?
anuria
What are red blood cells in the urine called?
hematuria
What is the ratio of solute to water in urine called?
osmolarity
What is the muscle of urination?
Detrusor
What is voiding more than every 3 hours called?
urinary frequency
What is painful or difficult urination called?
dysuria
What is another term for voiding?
micturition
What is the end product of protein metabolism?
urea nitrogen
What is a circular muscle that is able to stop urine flow and maintain continence with high bladder pressures called?
external sphincter
What is the degree of dilution or concentration of urine called?
osmolality
Incontinence in the elderly increases ____, frequently leads to _____ and predisposes to ___ and ____
isolation, institutionalization, infection and skin breakdown
What are two factors contributing to incontinence?
a reduction in bladder capacity and urethral closing pressure
What muscle function regarding urination tends to change with age and may be overactive at times?
detrusor muscle
What is detrusor overactivity characterized by?
immediate urinary urgency and frequency, urge incontinence
What is a unique consideration regarding urination in men?
benign prostatic hyperplasia may lead to outlet obstruction and overflow incontinence
What leads to urine leakage?
bladder pressure exceeding closing pressure
What are factors that can lead to urinary incontinence?
restricted mobility, comorbid illness, infection, constipation or stool impaction
What are factors that might make it difficult for an elderly person to get to the bathroom in time?
arthritis/difficulty walking, or failing vision
What are factors that can lead to constipation?
Impaired thirst or limited access to fluids
What kind of obstruction does impacted stool cause?
urethral obstruction
What medications can lead to incontinence?
Diuretics, hypnotics, tranquilizers and sedatives
What does the acronym DIAPPERS stand for in nonurologic conditions that predispose the elderly to urinary incontinence and should be treated before other treatment options are explored?
D--dementia/dementias, I--infection (urinary or vaginal), A--atrophic vaginitis P--pharmaceutical agents, P-psychological causes, E--endocrine conditions (diabetes), R--restricted mobility, S--stool impaction
What is a voiding diary?
a means for a person to provide objective information about the number of bathroom visits, protective pads used and urine voided
T/F Medication can affect bladder function.
True
What are examples of conservative treatment options used for treatment in incontinence?
Changes in the physical environment, habit training (toileting every 2 to 4 hours), dietary changes, adequate fluid intake
What are three effects of aging that may affect urination in older adults?
diminished ability of the kidneys to concentrate urine, decreased bladder muscle tone, decreased bladder contractility
How can decreased bladder contractility affect urination?
It can lead to urine retention and stasis, increasing the chance of UTI
What can lead to nocturia?
The diminished ability of the kidneys to concentrate urine
What may result in increased frequency of urination?
Decreased bladder muscle tone
What are some things that may affect voluntary control and the ability to reach a toilet in time?
Neuromuscular problems, degenerative joint problems, alterations in thought processes and weakness
What is urge incontinence?
The involuntary loss of urine that occurs after feeling an urgent need to void
What are the steps to a 24 hour urine collection?
Discard first urine and start the 24 hr time; keep sample on ice and in a dark container and bring to lab when 24 hr time is completed
Why must urine be kept on ice and in a dark container for 24 hr collections?
light can alter the results of the urine
What is a 24 hr urine collection used to evaluate?
diabetic nephropathy, renal damage from HTN, lupus nephritis, nephrotic syndrome, PCKD, kidney stones, preeclampsia
What is the difference between a urine culture and routine urinalysis?
urine culture requires 3mL’s, routine urinalysis requires 10mL’s
How do you perform a closed drainage system ua?
Clamp closed system for 15-20 minutes prior to cleansing port, withdraw 3-5cc for UA/UC
What medications can cause nephrotoxicity?
analgesics (aspirin or ibuprofen), antibiotics (gentamicin)
What can anticoagulants do to urine?
Cause hematuria
What color do diuretics turn urine?
Pale yellow
What color does amitriptyline or B complex vitamins turn urine?
urine green or blue green
What color does levodopa turn urine?
brown or black
What kind of catheter should you use for a client that has BPH?
coude tip
When should you not use a catheter on a patient?
When they can voluntarily void, and for prolonged post op duration w/o appropriate indications
What kind of catheter is used for continuous bladder irrigation?
3 way
What are some nursing interventions for a person with HTN?
Support and educate client on treatment, reinforce and support lifestyle changes, take medication as prescribed
How are stage 1 and 2 hypertension diagnosed?
After 2 blood pressure readings, 1-4 weeks apart
What is recommended first before medical treatment for hypertension?
Lifestyle changes
How is blood pressure monitored after medication regimen begins?
Every month and then once desired range is reached, every 3-6 months.
What are some risk factors for hypertension?
smoking, obesity, physical inactivity, dyslipidemia, diabetes mellitus, microalbuminaria, older age, family history
What is the blood pressure that should be maintained for those over 65, CKD, HF, PAD, stable angina or transplant?
130/80
What is the blood pressure that should be maintained for those as a secondary stroke prevention?
140/90
What are lifestyle modifications for those who have hypertension?
weight reduction, DASH diet, decrease sodium consumption (no more than 100 mmol/day), increase potassium, regular physical activity, reduce alcohol consumption
What is the alcohol recommendation for those with HTN?
1/day for women, 2/day for men
What is the goal for hypertension medication?
To decrease peripheral resistance, blood volume and to decrease the strength and rate of myocardial contraction
What drug is the first choice for treatment of HTN?
Diuretics (thiazide specifically for untreated hypertension)
If blood pressure does not fall to less than ____ mm Hg, the dose is ______ gradually, and _______ are included as necessary to achieve control
140/90, increased, additional medications
What kind of medications for HTN are given to African Americans and those over 60?
Calcium channel blockers and thiazide diuretics
What kind of medications for HTN are given to non African Americans and those under 60?
ACE-I or ARBs
What medication is safe for pregnant women to take for HTN?
methyldopa, nifedipine, or labetalol
What medication is unsafe for pregnant women to take for HTN?
ACE inhibitors or ARBs
What are modifiable risk factors for CAD?
Cholesterol abnormalities, Tobacco use, Hypertension, Diabetes
What are non-modifiable risk factors of CAD?
age, male, family hx
What are other risk factors for CAD?
Metabolic syndrome, High-sensitivity C-Reactive Protein
What is the treatment goal for CAD?
To decrease oxygen supply and increase oxygen supply
What are lifestyle alterations for CAD?
DASH diet, exercise 30 mins 5x a week, smoking cessation, managing hypertension, diabetes and cholesterol levels
What are medications that may be used for treatment for CAD?
Statins, beta adrenergic blockers, calcium channel blockers, nitrates, antiplatelets, anticoagulants
Which medication class carries the risk of rhabdomyolysis?
Statins
What should be remembered with administration of nitrates?
Men should not take erectile dysfunction medication with this due to drop in blood pressure and additive effect
What is stable angina?
a predictable and consistent chest pain that occurs during exertion and is relieved by rest and nitroglycerin
What is unstable angina?
not relieved by rest or nitroglycerin, symptoms increase in frequency and severity, can occur at rest
What is variant angina?
occurs at rest, can be a coronary vasospasm
What is silent ischemia?
Occurs without signs or symptoms and can be seen on an EKG
What are signs/symptoms of angina?
Retrosternal pain which may radiate to neck, jaw, shoulders, back or arms
What is different about signs/symptoms of angina in adults?
Adults may experience diminished pain, weakness instead of pain, or silent ischemia
What are some diagnostic findings consistent with hypothyroidism?
low serum T4 levels, elevated TSH levels, Anti-TPO in hashimoto, low radioiodine uptake test
What are some diagnostic findings consistent with hyperthyroidism?
low TSH, high free T4, radioactive iodine uptake (RAIU, moderate uptake in graves, high in nodular disease, lower in thyroiditis
What are signs/symptoms of a thyroid storm?
Very high fever, tachycardia, heart failure, angina, agitation, restlessness, delirium
What are some reasons a patient may require GI intubation?
decompress the stomach/remove fluid, lavage (wash out) the stomach and remove toxins, diagnose GI disorders, administer tube feedings, fluids and medications, compress a bleeding site, aspirate GI contents for analysis
What is an indication for a client to receive enteral nutrition?
to meet nutritional requirements when oral intake is inadequate or not possible and the GI tract
is functional.
What are some advantages of tube feedings vs parenteral nutrition?
More cost effective, safer, well tolerated, easier to use in extended care and homes
What kind of tubes are preferred for nutrition and med administration when longer than 4 weeks?
gastrostomy or jejunostomy tubes
What are other indications for enteral nutrition?
prolonged anorexia, severe protein undernutrition,
coma or depressed sensorium, liver failure, inability to take oral feedings due to head or neck
trauma, critical illnesses such as burns
T/F survival is not increased with the use of tube feedings in patients with dementia or terminally ill.
True
What type of formula is 70-85% free water and is not meant to meet total fluid needs?
Enteral
What type of formula is the most common and requires a working GI system?
Polymeric
What is associated with an increased risk of aspiration?
dysphagia
Total __________ nutrition provides complete nutrition intravenously, bypassing the gastrointestinal tract for
patients who are unable to take fluid orally.
parenteral
How often are open system set tube feedings changed?
Every 24 hours
When must open exposed formulas be discarded?
Within 4 hours
What is the gold standard of placement verification for tube feedings?
An xray before feedings begin
What is the gastric pH level?
4 or less
What is the jejunum pH level?
4-6
What is the respiratory/lungs pH level?
7+
What is the mL amount of gastric residual that indicates tube feedings are ineffective and requires notification to provider?
Greater than 500 mL’s or 2 readings 1hr apart greater than 250 mL’s
T/F you should replace all removed gastric fluid.
True
What are s/s of tube feeding intolerance?
increasing gastric residual, n/v, distention, bloating, cramping, diarrhea, constipation, restlessness, tachycardia, diaphoresis
What medications cannot be crushed?
Extended release, buccal or sublingual, capsules or modified release
What type of line is Inserted in superior vena cava 6 weeks w/ 1-2 lumen, special nurse can insert, regular nurse takes out, migrates out easily, biopatch?
PICC line
What type of line is inserted in surgery underneath tissue, is a single lumen into superior vena cava, and has a Huber (non coring) needle, what is the nursing consideration and where is it located on the body?
Implanted port, check blood return (can migrate especially growing kids), location: upper right, abdomen, back
What type of catheter is inserted in surgery radiology, 1-3 lumen, has a Dacron cuff which allows tissue to adhere to line creating a barrier (less infection), and has less migration risk?
Hickman tunneled catheter
Which catheter is inserted in the ICU/ER quickly, is used for 1 week, nurse assists but doesn’t insert, subclavian or intrajugular, is a short line closer to heart and is removed by nurse?
Central Venous Catheter (CVC)
Which line is permanent access, requires 1-3 months to heal, chronic renal failure, vein connected to artery to build strength of vein for 2 needles needed for dialysis,
Arterial venous fistula
What type of catheter can you hear the bruit and feel the thrill?
Central venous dual lumen dialysis cath (hemocath)
Which lumen is closest to the heart and can be used for blood thinning?
Distal
Which lumen is the middle and used for meds and tpn?
Medial
Which lumen is closest to the patient and is used for meds, blood and tpn?
Proximal
