EXAM 2 - Urine and Bowel elimination Flashcards
1
Q
what is renin?
A
Renin is an enzyme that aids in BP regulation in body
2
Q
what is erythropoietin?
A
hormone produced by kidneys in response to decreased renal blood flow
this hormone essentially makes new RBC in the body
EASY TIP
erthro= blood cells
poietin= to make
… to make blood cell
3
Q
define hyperkalemia
A
elevated K+ levels
(potassium) (normal 3.5-5.5)
4
Q
define stomatitis
A
inflammation & ulceration of the oral mucosa
5
Q
physical assessment for Urinary/ bladder evaluation (4 steps)
A
inspect, auscultate, palpation, percuss
6
Q
Define Striae
A
stretch marks
7
Q
define Bruit
A
a turbulent or whooshing sound
produced by an increase in the volume of blood traveling through a vessel or a decrease in diameter of a blood vessel.
8
Q
What does the presence of Bruit mean in a urine exam
A
altered blood flow to the kidneys
9
Q
normal creatinine levels
A
0.5 - 1.2 mg/dl
10
Q
Normal BUN levels
A
8-21mg/dl
11
Q
Uric acid levels
A
3.5-8 mg/dl
12
Q
Bicarbinate (HCO3-) normal levels
A
22-26 mg/dl
13
Q
Normal sodium levels
what does sodium do for the body
A
135-145 meq/L
maintain balance of fluids
14
Q
Normal potassium levels
what does potassium do for the body
A
3.5-5.5 meq/L
heart, muscles, and nerve function
15
Q
Normal phosphorus levels
and what does phosphorus do for the body
A
2.5-4.5 meq/L
Formation of bones and teeth
16
Q
Normal Calcium levels
and what does Calcium do for the body
A
8.2-10.2 mg/dL
Formation of bones, heart and muscles.
17
Q
Define protenuria - what does this indicate
A
proteins in the urine
indicates infections or abnormalities in the glomerular filtration.
18
Q
What are some urine tests (four examples)
A
urinalysis
culture and sensitivity
composite urine collection (24hr urine overall test)
creatinine clearance. (24 hr creatnine filteration test)
19
Q
What is Bedside sonography
A
a noninvasive imaging test to estimate the amount of contaminated urine is in the bladder.
a compact, portable ultrasound machine alongside the patient’s hospital bed, takes pictures of internal structures
20
Q
What is contrast dye and why is it injected during imaging of the urinary system structure
A
A dye injected IV to show contrast and abnormalities. Helps in imaging studies to show different structures, tumors, and surrounding tissues.
21
Q
What type of medications are toxic to the kidneys (Nephrotoxic)
A
NSAIDS
“Mypocin’s”
22
Q
Anuria
A
lack of urine
less then 100 mL urine output / 24 hours
23
Q
dysuria
A
difficulty or pain with urination
24
Q
Enuresis
A
involuntary urination at night
25
define Frequency when talking about urination
increase in incidence of voiding, usually urinating only small amounts with each void
26
Hematuria
blood in the Urine
27
Define Hesitancy
Difficulty starting the flow of urine
28
Define Incontinence
inability to voluntarily control micturition.
29
Nocturia
frequent urination at night
30
Oliguria
Decreased urine output; less then 400 ml - 24 hours
do not get confused with anuria- less than 100mL per 24 hours.
31
polyuria
increased urine output; greater then 2,000 ml - 24 hour
32
Renal colic
sharp pain radiating to the perineal or groin area due to a blockage (ex. stone) or kidney dysfunction.
33
Retention
inability to completely empty the bladder
34
define Urgency
sudden onest of the need to urinate
35
What is the kidneys job in the body
Filter the blood!
- produce urine
- Acid balance
- water balance
36
What is a Straight catheter
is for one time use collection of urine through the urethra- it does not stay in!! is only used to get a sample then taken out.
37
What is a foley catheter and when would it be used
An indwelling catheter that stays in the urethra to dispose of urine in bladder
Retention or obstruction
wounds and sanitary
pregnancy or surgeries
- numbing (epidurals)
38
TRUE or FALSE cc = mL
TRUE : CC and ML are the same measurement.
39
What are the risk factors for UTI's
GENDER: Woman anatomy
HYGIENE - infections, hospital or other
- nurses not washing hands or not following sterile protocol.
AGE: young woman due to sex behaviors, older patients due to hygiene issues or inabilities.
other :
kidney stones
enlarged prostate
40
What is the most common bacteria involved with UTI's
Ecoli
41
what do you always need to educate your patient on when taking antibiotics
Take full length of medication prescribed!! all of them!
Rational: infection will come back stronger with a tolerance to that medication.
42
What are antiemetics for?
- and what is important to remember in administration with these drugs.
Nausea and vomiting.
Do not give PO.
43
Where are Nephro kidney stone present?
in the KIDNEYS
44
Where are Urethro Kidney stones present.
In the Urethra.
45
What are the risk factors for developing Kidney stones
Gout: uric acid builds in joints and bones : causes pain - can build up anywhere... resulting in stones.
Diabetes
Malabsorption diseases.
46
What are some symptoms for someone having a kidney stone complaint?
- little to no urination (anuria)
- painful urination (dysuria)
- flank pain
- distention of the abdomen
47
Define Colic Pain
Sharp contracting - inconstant + nausea and vomiting
48
What is Hydronephrosis? and why could it be caused
A condition characterized by excess fluid in a kidney due to a backup of urine.
Hydronephrosis is caused by a blockage in the tube that connects the kidney to the bladder (ureter). Possible causes include a kidney stone,
49
what things are evaluated in a CMP test? + give normal levels
Electrolytes
- BUN (8-21)
- Creatine (0.6-1.2)
- GFR - the higher the number the better
- Liver enzymes
- ALT: 7-56
- AST - 5-40
- ALP - 40-120
50
What three major things that are evaluated on a CBC - what does CBC stand for and what are the normal levels
Complete Blood Count
RBC: 4-5 mill
WBC: 4-10 mill
PLT: 150,000-450,000
51
What does GFR stand for
Glomerular Filtration Rate
52
What is a major rule for testing 24 hour urine
IT HAS TO BE ON ICE
53
What do you need to remember to do with dye after imaging testing is done?
What is a medication you have to hold when giving a patient imagine dye IV
Flush out with water!!
Metformin - can be harmful to kidneys when mixed with the dye
54
What is Pyelonephritis? what is the most common cause?
inflammation of the upper urinary tract - Kidneys and urters from infection in the lower urinary tract- flows upwards..
the most common cause is a bacterial infection found in the urinary meatus with bacteria found in the GI tract
UTIs the travel up as they get worse
55
What common bacterias are found when dealing with Pyelonephritis
Escherichia Coli , Fungi, Protozoa, Viruses
56
Define Veslcoureteral reflux
retrograde flow of urine from bladder back into ureters.
57
What is CKD?
Chronic Kidney Disorder
- permeant damage due to poorly treated pyelonephritis or scarring.
58
Define Urosepsis
a serious condition where a infection spreads to the blood stream
59
What medications are used for Pyelonephritis
Trimethoprim - sulfamethoxazole (Bactrim)
Ciprofloxacin (Cipro)
Phenazopyridine (Pyridium)
60
In the Micturition cycle what are the 2 sections and what do they do
Sympathetic: nerve control to STOP urination using internal and external spincher contraction
parasympathetic: motor control to ALLOW urine flow. relaxing internal and external spinchers to allow voiding
61
Briefly explain the Micturition cycle
The bladder is help closed by the Sympathetic internal urethral spincher, as this fills the detrusor muscle stretches to increase in size to hold urine. When threshold is met for capacity a sympathetic message is sent to the brain via spinal cord (S2-S4) at the brain is gives the person the"urge" to go. Message is then sent back down to the PARAsympathetic to allow for relaxation and voiding.
62
What is the Sacral Micturition Center
located at S2-S4 on the spinal cord : the area for receiving signals regarding the need to empty the bladder or when the bladder is empty and needs to fill again.
63
What are injuries that occur ABOVE the Sacral Micturation Center (S2-S4) at risk for?
Incontinence.
64
What are injuries that occur at level or BELOW the Sacral Micturation Center (S2-S4) at risk for?
retention
65
List the 5 categories of incontinence
Stress incontinence
urge incontinence
overflow incontinence
reflex incontinence
functional incontinence
66
What is Stress incontinence (list risk factors as well)
increased urine leakage due to an increase in abdominal pressure
(laughing, coughing, sneezing)
Risk Factors
- woman
-pregnancy
- post menopause
- smoking
- obesity
67
What is urge incontinence (list risk factors)
Strong urge to urinate followed by involuntary release
Risk factors
- exposure to bladder irritants (caffeine, artificial sweeteners, nicotine)
68
What is overflow incontinence ( list risk factors)
frequent urination due to large bladder or obstruction.
Risk factors
- enlarged prostate
- spinal cord injury
- stroke
- diabetes
- neruological disorders
69
What is Functional incontinence (list risk factors)
Patient is normally continent but environmental factors lead them ot involuntary voiding at inappropriate times or places.
Risk factors
- unable to find or get to the bathroom
- inability to communicate the need to void
70
What is reflex incontinence (list risk factors)
bladder muscles and spinchers contract and release on their own
Risk factors
- nerve impulse disorders
- multiple sclerosis
- brain tumors
- stroke
71
What are some non-pharmacological treatments for incontinence.
pelvic floor therapy (Kegel exercises)
establishing a timed voiding schedule
moderate exercise
weight loss
Pessary device
electrical stimulation.
CIC - clean intermitten catheterization (straight cath.)
indwelling catheters
72
What are two of your biggest goals to monitor with someone who has incontinence
Skin breakdown and infection.
73
What is a Pessary device (incontinence non-pharmacological treatment)
a device that is placed in the vagina to help with bladder emptying.
74
What is a vaginal or urethral Sling (incontinence surgical management) who is this for?
For woman
a sling is used to prevent urine leakage from stress incontinence or increased abdominal pressure during activity.
75
What is an artificial urinary spincter - who is this for?
For men - severe incontinence post prostate surgery
a surgically implanted device that supports the function of the urethral spincter by restricting flow from the bladder via a saline filled cuff around urethra
when appropriate to void, man squeezes the pump located in the scrotum, allowing the saline to flow from cuff into the balloon, releasing pressure to allow urination.
76
What medication is used for incontinence AND Enlarged prostate ( list generic name, brand name and pharmacological class)
Tamsulosin (flowmax)
alpha -adrengergic blocker
77
What is classified as a uncomplicated UTI - what medication regimen is used for this.
afebrile
not pregnant
no diabetes
- antibiotics 3 days
78
What is classified as a complicated UTI - what medication regimen is used for this.
febrile
male
diabetic
-antibiotics 7 days
79
Define Cystocele
A dropped or prolapsed bladder (cystocele) occurs when the bladder bulges into the vaginal space. It results when the muscles and tissues that support the bladder & vagina are weakened.
80
What medications are used to treat UTIs (list 2)
give generic and brand name
pharmacological class
Nitrofurantoin (Macrodantin)
urinary anti-infectant (antibiotic)
Trimethoprim - Sulfamethoxazole (Bactrim)
Sulfaonamide (antibiotic)
81
What is Urolithiasis also known as
Kidney stones
82
What is Gout
Gout is a common and complex form of arthritis
uric acid build up in joints or bones (can go to kidneys causing stones)
83
What are risk factors for kidney stones
malabsorption diseases
Gout
Diabetes
84
What is the procedure Lithotripsy
breaking down of kidney stones.
85
What are nursing diagnosis for people with kidney stones (list 3)
acute pain
risk for infection
altered elimination
86
What is Benign Prostatic Hyperplasia (BPH)
Enlarged Prostate
87
What are some complications or risks for someone who has Benign Prostate Hyperplasia (BPH) - enlarged prostate
Acute urinary retention
UTI's
Bladder stones
Bladder damage
Kidney damage
88
What does an enlarge prostate mean?
the prostate gland in males is enlarged leading to blockage or pinching of the urethra, this causes urinary problems.
89
What is Transurethral resection of Prostate (TURP)
a Surgical procedure to treat an Enlarged prostate, involves a probe and cutter into the urethra, up to prostate.
- most common
- prostate is removed besides outer layer, allows for urine flow
- catheter may be needed 3-5 days post op
90
What is Transurethral incision of Prostate (TUIP)
a Surgical procedure to treat an Enlarged prostate, involves a probe and cutter into the urethra, up to prostate.
- cuts incisions into prostate to allow release.
91
What is Open Prostatectomy surgery and why is it not used as often for treatment of an enlarged prostate.
a surgical procedure that involves going into the abdomen to take out prostate.
not used as much due to HIGH RISK for retrograde ejaculation (semen flowing into bladder instead of out during orgasm) impotence, and more incontinence.
92
What is Transurethral microwave therapy TUMT (enlarged prostate)
surgical procedure placing probe in urethra to prostate glad. produces heat causing shrinkage of prostate.
93
What is Transurethral Needle Ablation (TUNA) (enlarged prostate)
surgical procedure placing probe, needles attach to prostate tissues, radio active waves cause heat to destroy prostate tissue - scarring causes prostate to shrink.
94
What is a Koch's Pouch?
The K-pouch is an ileal pouch that attaches to your stoma on the inside. Instead of an ileostomy bag, the Kock pouch collects your pee inside your body until you're ready to drain it. You can drain it into the toilet by inserting a catheter into your stoma. Digestive Care.
95
Define Mastication
chewing
96
What 3 chemicals does saliva contain?
1. amylase
2. Lipase
3. Lysozyme
97
Define Deglutition
Swallowing
98
Define Peristaltic movements
muscles the contract to move a substance through a space
examples: food down the esophagus to the stomach, or, feces through the rectum out the anus.
99
What does Chyme do?
breaks down food, aids digestion, kills bacteria, and helps prevent food infections.
100
What does Gastrin do in the stomach
enhancing gastric mucosal growth, gastric motility, and secretion of hydrochloric acid (HCl) into the stomach
^
HCI helps break down protein and absorb essential nutrients, and it helps control viruses and bacteria that might otherwise infect your stomach.
100
What does serotonin do in the stomach
Most of your body's serotonin is in your GI tract where it helps control your bowel function and plays a role in protecting your gut. Your gut can increase serotonin release to speed digestion to rid your body of irritating foods or toxic products.
101
What does histamine do in the stomach
histamine stimulates the parietal cells to produce the gastric acids required for digestion.
102
What does somatostatin do in the
somatostatin reduces gastric secretion
103
What does Rugae do in the stomach
A purpose of the gastric rugae is to allow for expansion of the stomach after the consumption of foods and liquids
104
Define hepatomegaly
enlarged liver
105
What is the liver responsible for?
producing Bile!!
absorption, synthesis of proteins, digression of toxins.
106
What is the gallbladder responsible for?
Storing Bile!! & concentrating bile
107
What two types of glands does the pancreas have? and what do they produce.
endocrine gland: produces insulin & glycogen
exocrine gland: 1200-1500 pancreatic juice.
108
What do Villi do in the Small intestine
absorb nutrients from the liquid mixture called chyme
109
What do Goblet cells do in the small intestine
secrete mucin and create a protective mucus layer
110
What are the 4 abdominal quadrants (name in order of assessment)
Right lower (RLQ)
Right upper (RUQ)
Left Upper (LUQ)
Left Lower (LLQ)
111
What are the three midline regions of the abdomen? (from top to bottom)
1. Epigastric
2. umbilical
3. Hypogastric
112
What are the three Right regions of the abdomen (top to bottom)
1. Right Hypochondriac region
2. Right lumbar region
3. Right iliac
113
What are the three left regions of the abdomen (top to bottom)
1. left Hypochondriac region
2. left lumbar region
3. left iliac
114
Define typmany
A hollow drum-like sound that is produced when a gas-containing cavity is tapped sharply
115
Define ascites
Ascites is the build-up of fluid in the space between the lining of the abdomen and abdominal organs.
116
Define organomegaly
abnormal enlargement of the viscera
117
Define peritonitis
the thin layer of tissue inside the abdomen becomes inflamed.
118
What is C-diff (briefly summarize, include risk factors, s/s & medication given)
Clostridioides Difficile is bacteria that causes inflammation of the colon. It can spread from physical contact or from feces and can be life threatening.
causes diarrhea and is resistant to many antibiotics
vancomycin given most commonly
NURSES need to wash their hands with SOAP and WATER to not infect anyone else.
119
What precautions are C.Diff
Contact precautions
120
Describes what Hernias are (briefly summarize mini concept map)
A protrusion of abdominal contents through a weak muscle in the abdominal cavity
can occur anywhere but most common 4 places
- ventral (above umbilicus)
- umbilical
- inguinal (at hip/ pubic line)
- Femoral (groin)
May go away on its own as child or may need surgery. Coughing is discouraged
121
What does strangulated mean when talking about hernias... is this a medical emergency?
means the hernia is sticking out of abdomen wall and circulation is being cut off. (medical emergency!! need surgery ASAP)
122
What are some common causes for hernias
- congenital from mother
- straining
- lifting heavy objects
- sudden twists
- pulls or muscle strains
- weight gain
- chronic coughing
- previous surgeries.
123
What hernias are more common in males
Direct inguinal
ventral
124
What hernias are more common in females
Femoral
umbilical
125
What is a Truss when talking about hernias?
Truss is a firm pad holding hernia in place. hold pressure to keep contents in.
126
What is a Herniorrhaphy?
A common surgical procedure to place a thin mesh layer over a hernia site to repair.
outpatient basis, may include temporary stoma.
127
What are Hemorrhoids
swollen or dilated veins in the anus. (become swelled and bleed)
can be internal or external.
128
What does strangulated mean when talking about hemorrhoids
hemorrhoid'c circulation is cut off by anal spincter. could become clotted or thrombosed.
129
What is Grade 1 for hemorrhoids
can be seen on anoscopy, and may bulge into lumen but do not prolapse below the dentate line.
130
What is Grade 2 on the hemorrhoid grading scale.
The hemorrhoids prolapse on deification but reduce spontaneously
131
What is Grade 3 on the hemorrhoids grading scale
the hemorrhoids prolapse on deification and must be reduced manually
132
What is Grade 4 on the hemorrhoids grading scale?
The hemorrhoids are prolapsed and cannot be manually reduced, may become strangulated.
133
What are some risk factors for hemorrhoids
- straining
- prolonged constipation
- heavy lifting
- prolonged sitting or standing
- portal hypertension
- intra- abdominal pressure
- pregnancy
- obesity
- Heart failure
134
What is the most common surgical procedure used for hemorrhoids?
Rubber band Ligation : rubber band manually placed around hemorrhoid, circulation cut, hemorrhoid will slough off in 2-4 days.
135
What is Diverticulitis? (breif concept map)
small protrusion or herniation in GI tract or on colon.
Diverticuli bacteria connect to the outside of the colon, Diverticulitis is when those get inflammed. Colon wall becomes thick and inflamed.
Can cause constipation or Fecalith (concrete like stool), straining.
136
What are the risk factors for Diverticulitis.
older people
lack of fiber
obesity
lack of physical activity
male
smoking
Medications (NSAIDs Acetaminophen, oral corticosteroids, opiates)
red meat or high fat consumption.
137
What are some clinical manifestations of diverticulitis.
abdominal pain
bloating
diarrhea or constipation
gas
mass over sigmoid colon
mental status change - older adults
138
what is the nonpharm. and pharmacological management for NON-complicated Diverticulitis.
nonpharmacological:
clear liquid diet
Pharmacological:
antibiotics 7-10 days
ex. Cipro, metronidazole, Trimethoprim - Sulfamethazole, amoxycillin, clavulanate (Augumentin), moxifloxacin.
139
what is the nonpharm. and pharmacological management for COMPLICATED Diverticulitis.
Nonpharmacological :
NPO
IV Fluids
Pharm:
antibiotics 10-14 days
follow up app
colonoscopy after healed.
140
Define Apendicitis
acute inflammation of the appendix. May occur from foreign bodies blocking appendix opening, causing bacteria to grow, inflame and even rupture (Medical emergency- life threat)
Treatment
...only... Appendectomy
141
Who is at risk for Appendicitis?
males
ages 10-19 years old
142
Define Gangrene
Gangrene is death of body tissue due to a lack of blood flow or a serious bacterial infection.
can be a serious cause of appendicitis rupture.
143
Define Perforation
a hole that develops through the wall of a body organ
can be a serious complication of appendicitis or rupture.
144
What is one thing to remember as a nurse with a patient who is suspected to have appendicitis..?
never apply heat - increases blood flow and inflammation to the area, may cause appendix to rupture.
145
Define ostomy
a surgically created opening for the expulsion of stool.
146
What quadrant is a ascending colostomy stoma present
Stoma is located in the upper section of the Right lower quadrant
147
What quadrant is a Ileostomy present - how much of the colon was removed?
midline of Right lower quadrant - full colon removed, stoma attached to small intestine.
148
Where is the stoma present in a descending colostomy?
Left lower quadrant
149
Which quadrant is a sigmoid colostomy present
midline of left lower quadrant - closest to genitals
150
Which quadrant is a transverse colostomy present
left upper quadrant on transverse colon.
151
What stool consistency is normal for a sigmoid colostomy.
Formed stool
152
What stool consistency is normal for a Descending colostomy
semisolid - formed stool
153
What stool consistency is normal for a Ilestomy
liquid - semiliquid stool
154
What stool consistency is normal for a Ascending colostomy
semiliquid stool
155
What stool consistency is normal for a Transverse colostomy
Semiliquid - semiformed stool
156
What is important to monitor for when regarding a stoma
the color of the stoma
(normal = pink and moist. Bad = red, purple or black, could indicate no blood flow)
the output of stool (COCA)
leakage or gas
157
What labs do you need to monitor when dealing with a stoma and why?
WBC: Monitor infection
CBC: monitor for anemia
Hmgb. & Hct : bleeding and profusion.
158
Define stoma
the external opening of a ostomy.
159
Signs of sepsis
Low temp, low BP, high HR, monitor kidney and liver (BUN/creatine/AAA)
160
define and describe signs of perionitis
ridged abdomen, high pain, high HR, high temp,
161
describe difference between bowel obstruction and impaction
bowl obstruction means a complete block in intestines.
162
What is Occult Blood
A fecal occult blood test looks for blood in your stool
163
What is a Barium enema
an Xray test that uses a lubricated tube, up the rectum, that inflates with balloon like a catheter. Once inside barium is released into the colon to highlight structure. X-rays then taken.
164
For a patient with an NG tube in, how high should the head of the bed remain?
at least 30 degrees
165
What is a Ileal Conduit
surgical urinary diversion procedure, passage way to excrete urine through stoma
166
what is a nephrectomy
surgical removal of one or both of the kidneys.
167
how many hours do you need to be NPO before a small bowel endoscopy?
12 hours NPO
168
How many hours do you need to be NPO before a Esophagogastroduodenoscopy
8-10 hours
169
How many hours do you have to be NPO for a colonoscopy
6-8 hours
170
How many hours do you have to be NPO for a sigmoidscopy
none, clear liquid diet.
171
What is a barium swallow and why is it used
barium is a radiographic liquid one drinks to highlight structures under an x ray. in this case they would swallow it to monitor how they swallow.
