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2800 Chronic and Palliative Care > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is the product of creatine metabolism in muscles

A

Creatinine

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2
Q

What are WBCs in the urine called?

A

Pyuria

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3
Q

What is an expression of the degree of concentration of the urine called?

A

Specific gravity or osmolality

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4
Q

What stores urine, has transitional epithelium allowing for distention

A

The bladder

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5
Q

What is bacteria in the urine called?

A

bacteriuria

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6
Q

What is urine output less than 0.5ml/kg/hr called?

A

oliguria

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7
Q

What is the amount of plasma filtered through the glomeruli per unit of time called?

A

glomerular filtration rate

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8
Q

what controls the formation of urine?

A

the kidneys

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9
Q

What is decreased urine output of less than 50ml in 24 hours called?

A

anuria

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10
Q

What are red blood cells in the urine called?

A

hematuria

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11
Q

What is the ratio of solute to water in urine called?

A

osmolarity

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12
Q

What is the muscle of urination?

A

Detrusor

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13
Q

What is voiding more than every 3 hours called?

A

urinary frequency

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14
Q

What is painful or difficult urination called?

A

dysuria

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15
Q

What is another term for voiding?

A

micturition

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16
Q

What is the end product of protein metabolism?

A

urea nitrogen

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17
Q

What is a circular muscle that is able to stop urine flow and maintain continence with high bladder pressures called?

A

external sphincter

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18
Q

What is the degree of dilution or concentration of urine called?

A

osmolality

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19
Q

Incontinence in the elderly increases ____, frequently leads to _____ and predisposes to ___ and ____

A

isolation, institutionalization, infection and skin breakdown

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20
Q

What are two factors contributing to incontinence?

A

a reduction in bladder capacity and urethral closing pressure

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21
Q

What muscle function regarding urination tends to change with age and may be overactive at times?

A

detrusor muscle

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22
Q

What is detrusor overactivity characterized by?

A

immediate urinary urgency and frequency, urge incontinence

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23
Q

What is a unique consideration regarding urination in men?

A

benign prostatic hyperplasia may lead to outlet obstruction and overflow incontinence

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24
Q

What leads to urine leakage?

A

bladder pressure exceeding closing pressure

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25
Q

What are factors that can lead to urinary incontinence?

A

restricted mobility, comorbid illness, infection, constipation or stool impaction

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26
Q

What are factors that might make it difficult for an elderly person to get to the bathroom in time?

A

arthritis/difficulty walking, or failing vision

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27
Q

What are factors that can lead to constipation?

A

Impaired thirst or limited access to fluids

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28
Q

What kind of obstruction does impacted stool cause?

A

urethral obstruction

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29
Q

What medications can lead to incontinence?

A

Diuretics, hypnotics, tranquilizers and sedatives

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30
Q

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?

A 
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
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31
Q

What is a voiding diary?

A

a means for a person to provide objective information about the number of bathroom visits, protective pads used and urine voided

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32
Q

T/F Medication can affect bladder function.

A

True

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33
Q

What are examples of conservative treatment options used for treatment in incontinence?

A

Changes in the physical environment, habit training (toileting every 2 to 4 hours), dietary changes, adequate fluid intake

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34
Q

What are three effects of aging that may affect urination in older adults?

A

diminished ability of the kidneys to concentrate urine, decreased bladder muscle tone, decreased bladder contractility

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35
Q

How can decreased bladder contractility affect urination?

A

It can lead to urine retention and stasis, increasing the chance of UTI

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36
Q

What can lead to nocturia?

A

The diminished ability of the kidneys to concentrate urine

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37
Q

What may result in increased frequency of urination?

A

Decreased bladder muscle tone

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38
Q

What are some things that may affect voluntary control and the ability to reach a toilet in time?

A

Neuromuscular problems, degenerative joint problems, alterations in thought processes and weakness

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39
Q

What is urge incontinence?

A

The involuntary loss of urine that occurs after feeling an urgent need to void

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40
Q

What are the steps to a 24 hour urine collection?

A

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

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41
Q

Why must urine be kept on ice and in a dark container for 24 hr collections?

A

light can alter the results of the urine

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42
Q

What is a 24 hr urine collection used to evaluate?

A

diabetic nephropathy, renal damage from HTN, lupus nephritis, nephrotic syndrome, PCKD, kidney stones, preeclampsia

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43
Q

What is the difference between a urine culture and routine urinalysis?

A

urine culture requires 3mL’s, routine urinalysis requires 10mL’s

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44
Q

How do you perform a closed drainage system ua?

A

Clamp closed system for 15-20 minutes prior to cleansing port, withdraw 3-5cc for UA/UC

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45
Q

What medications can cause nephrotoxicity?

A

analgesics (aspirin or ibuprofen), antibiotics (gentamicin)

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46
Q

What can anticoagulants do to urine?

A

Cause hematuria

47
Q

What color do diuretics turn urine?

A

Pale yellow

48
Q

What color does amitriptyline or B complex vitamins turn urine?

A

urine green or blue green

49
Q

What color does levodopa turn urine?

A

brown or black

50
Q

What kind of catheter should you use for a client that has BPH?

A

coude tip

51
Q

When should you not use a catheter on a patient?

A

When they can voluntarily void, and for prolonged post op duration w/o appropriate indications

52
Q

What kind of catheter is used for continuous bladder irrigation?

A

3 way

53
Q

What are some nursing interventions for a person with HTN?

A

Support and educate client on treatment, reinforce and support lifestyle changes, take medication as prescribed

54
Q

How are stage 1 and 2 hypertension diagnosed?

A

After 2 blood pressure readings, 1-4 weeks apart

55
Q

What is recommended first before medical treatment for hypertension?

A

Lifestyle changes

56
Q

How is blood pressure monitored after medication regimen begins?

A

Every month and then once desired range is reached, every 3-6 months.

57
Q

What are some risk factors for hypertension?

A

smoking, obesity, physical inactivity, dyslipidemia, diabetes mellitus, microalbuminaria, older age, family history

58
Q

What is the blood pressure that should be maintained for those over 65, CKD, HF, PAD, stable angina or transplant?

A

130/80

59
Q

What is the blood pressure that should be maintained for those as a secondary stroke prevention?

A

140/90

60
Q

What are lifestyle modifications for those who have hypertension?

A

weight reduction, DASH diet, decrease sodium consumption (no more than 100 mmol/day), increase potassium, regular physical activity, reduce alcohol consumption

61
Q

What is the alcohol recommendation for those with HTN?

A

1/day for women, 2/day for men

62
Q

What is the goal for hypertension medication?

A

To decrease peripheral resistance, blood volume and to decrease the strength and rate of myocardial contraction

63
Q

What drug is the first choice for treatment of HTN?

A

Diuretics (thiazide specifically for untreated hypertension)

64
Q

If blood pressure does not fall to less than ____ mm Hg, the dose is ______ gradually, and _______ are included as necessary to achieve control

A

140/90, increased, additional medications

65
Q

What kind of medications for HTN are given to African Americans and those over 60?

A

Calcium channel blockers and thiazide diuretics

66
Q

What kind of medications for HTN are given to non African Americans and those under 60?

A

ACE-I or ARBs

67
Q

What medication is safe for pregnant women to take for HTN?

A

methyldopa, nifedipine, or labetalol

68
Q

What medication is unsafe for pregnant women to take for HTN?

A

ACE inhibitors or ARBs

69
Q

What are modifiable risk factors for CAD?

A

Cholesterol abnormalities, Tobacco use, Hypertension, Diabetes

70
Q

What are non-modifiable risk factors of CAD?

A

age, male, family hx

71
Q

What are other risk factors for CAD?

A

Metabolic syndrome, High-sensitivity C-Reactive Protein

72
Q

What is the treatment goal for CAD?

A

To decrease oxygen supply and increase oxygen supply

73
Q

What are lifestyle alterations for CAD?

A

DASH diet, exercise 30 mins 5x a week, smoking cessation, managing hypertension, diabetes and cholesterol levels

74
Q

What are medications that may be used for treatment for CAD?

A

Statins, beta adrenergic blockers, calcium channel blockers, nitrates, antiplatelets, anticoagulants

75
Q

Which medication class carries the risk of rhabdomyolysis?

A

Statins

76
Q

What should be remembered with administration of nitrates?

A

Men should not take erectile dysfunction medication with this due to drop in blood pressure and additive effect

77
Q

What is stable angina?

A

a predictable and consistent chest pain that occurs during exertion and is relieved by rest and nitroglycerin

78
Q

What is unstable angina?

A

not relieved by rest or nitroglycerin, symptoms increase in frequency and severity, can occur at rest

79
Q

What is variant angina?

A

occurs at rest, can be a coronary vasospasm

80
Q

What is silent ischemia?

A

Occurs without signs or symptoms and can be seen on an EKG

81
Q

What are signs/symptoms of angina?

A

Retrosternal pain which may radiate to neck, jaw, shoulders, back or arms

82
Q

What is different about signs/symptoms of angina in adults?

A

Adults may experience diminished pain, weakness instead of pain, or silent ischemia

83
Q

What are some diagnostic findings consistent with hypothyroidism?

A

low serum T4 levels, elevated TSH levels, Anti-TPO in hashimoto, low radioiodine uptake test

84
Q

What are some diagnostic findings consistent with hyperthyroidism?

A

low TSH, high free T4, radioactive iodine uptake (RAIU, moderate uptake in graves, high in nodular disease, lower in thyroiditis

85
Q

What are signs/symptoms of a thyroid storm?

A

Very high fever, tachycardia, heart failure, angina, agitation, restlessness, delirium

86
Q

What are some reasons a patient may require GI intubation?

A

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

87
Q

What is an indication for a client to receive enteral nutrition?

A

to meet nutritional requirements when oral intake is inadequate or not possible and the GI tract
is functional.

88
Q

What are some advantages of tube feedings vs parenteral nutrition?

A

More cost effective, safer, well tolerated, easier to use in extended care and homes

89
Q

What kind of tubes are preferred for nutrition and med administration when longer than 4 weeks?

A

gastrostomy or jejunostomy tubes

90
Q

What are other indications for enteral nutrition?

A

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

91
Q

T/F survival is not increased with the use of tube feedings in patients with dementia or terminally ill.

A

True

92
Q

What type of formula is 70-85% free water and is not meant to meet total fluid needs?

A

Enteral

93
Q

What type of formula is the most common and requires a working GI system?

A

Polymeric

94
Q

What is associated with an increased risk of aspiration?

A

dysphagia

95
Q

Total __________ nutrition provides complete nutrition intravenously, bypassing the gastrointestinal tract for
patients who are unable to take fluid orally.

A

parenteral

96
Q

How often are open system set tube feedings changed?

A

Every 24 hours

97
Q

When must open exposed formulas be discarded?

A

Within 4 hours

98
Q

What is the gold standard of placement verification for tube feedings?

A

An xray before feedings begin

99
Q

What is the gastric pH level?

A

4 or less

100
Q

What is the jejunum pH level?

A

4-6

101
Q

What is the respiratory/lungs pH level?

A

7+

102
Q

What is the mL amount of gastric residual that indicates tube feedings are ineffective and requires notification to provider?

A

Greater than 500 mL’s or 2 readings 1hr apart greater than 250 mL’s

103
Q

T/F you should replace all removed gastric fluid.

A

True

104
Q

What are s/s of tube feeding intolerance?

A

increasing gastric residual, n/v, distention, bloating, cramping, diarrhea, constipation, restlessness, tachycardia, diaphoresis

105
Q

What medications cannot be crushed?

A

Extended release, buccal or sublingual, capsules or modified release

106
Q

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?

A

PICC line

107
Q

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?

A

Implanted port, check blood return (can migrate especially growing kids), location: upper right, abdomen, back

108
Q

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?

A

Hickman tunneled catheter

109
Q

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?

A

Central Venous Catheter (CVC)

110
Q

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,

A

Arterial venous fistula

111
Q

What type of catheter can you hear the bruit and feel the thrill?

A

Central venous dual lumen dialysis cath (hemocath)

112
Q

Which lumen is closest to the heart and can be used for blood thinning?

A

Distal

113
Q

Which lumen is the middle and used for meds and tpn?

A

Medial

114
Q

Which lumen is closest to the patient and is used for meds, blood and tpn?

A

Proximal

2800 Chronic and Palliative Care (1 decks)

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