Exam 3 Flashcards
Key topics for Exam 3
Stress urinary incontinence
increased abdominal pressure; A loss of urine of less than 50 mL occurring with increased abdominal pressure
Reflex/overflow urinary incontinence
overflow-zero awareness of need; full bladder and starts to overflow-paralyzed patients; surgical patients need straight cath; An involuntary loss of urine, occurring at somewhat predictable intervals when a specific bladder volume is reached
Urge urinary incontinence
sudden desire; UTI; Involuntary passage of urine occurring soon after a strong sense of urgency to void
Functional urinary incontinence
sudden, mobility barrier; usually dementia patients that are mobile; Inability of a usually continent person to reach toilet in time to avoid unintentional loss of urine
Total urinary incontinence
Continuous; A continuous and unpredictable loss of urine
Urinary retention
Incomplete emptying of the bladder
Urinary hesitancy
refers to a delay in starting the urine stream, commonly with a decreased force of the stream.
Urinary frequency
urination that occurs at shorter-than-usual intervals without an increase in daily urine output.
Urinary urgency
a sudden, forceful urge to urinate
Dysuria
difficult or painful urination.
Oliguria
diminished, scanty amount of urine.
anuria
absence of urine, usually clinically defined as less than 100 mL in 24 hours. It occurs in renal failure, shock, or dehydration.
polyuria
an excess amount of urine; it is usually associated with diabetes mellitus (a disturbance in the utilization of glucose secondary to inadequate production of insulin) or diabetes insipidus (caused by failure of the pituitary gland to secrete the antidiuretic hormone). Polyuria also may be caused by excess intake; greater than 2000 mL in 24 hrs
Enuresis
recurrent involuntary urination that occurs during sleep.
nocturia
nighttime urination
bacteriuria
Cloudiness indicates the presence of bacteria in urine
normal urine pH
pH range for urine is 4.5 to 7.8
diuresis
increased formation and excretion of urine
Average infant urine excretion/day
6-month-old infant produces about 500 mL of urine, an amount that increases gradually until about age 14
Pyridium (phenazopyridine)
local analgesic effect to the bladder mucosa to relieve burning; used when an infection is localized to the bladder
side effect of Pyridium (phenazopyridine)
Contains azo dye that turns the urine reddish orange
B&O suppository (belladonna and opium)
Has anticholinergic effects to relieve bladder spasms, and opium to relieve the pain in an acute situation
side effects of B&O suppository
controlled substance; has anticholinergic side effects
Ditropan (oxybutynin)
Produce anticholinergic effects, which relax the detrusor muscle; used to treat hyperreflexic bladders by suppressing the unwanted contractions that occur when the bladder has only a small volume of urine; also used to treat bladder spasmDetrol (tolterodine)s
side effects of Ditropan (oxybutynin)
Dry mouth, constipation, tachycardia, urinary hesitancy and retention, impotence, and other anticholinergic effects
Antibiotics sulfamethoxazole/trimethoprim
Treatment of urinary tract infections; needs to be excreted unchanged in the urinary tract; the combination reduces the possibility of resistant strains
side effects of sulfamethoxazole/trimethoprim
Hypersensitivity to sulfa
Minipress (prazosin)
Alpha-adrenergic receptor blockers relax the smooth muscle in the bladder neck, thus facilitating urinary flow through the prostatic urethra
Side effects of Minipress (prazosin)
Side effects related to blocking the adrenergic receptors could include dizziness, postural hypotension, urinary frequency, impotence, dry mouth, blurred vision
Cardura (doxazosin)
medication for urinary problems
Flomax (tamsulosin)
medication for urinary problems
Detrol (tolterodine)
medication for urinary problems
Pro-Banthine (propantheline)
medication for urinary problems
fecal impaction
a collection of puttylike or hardened feces in the rectum or sigmoid colon that prevents the passage of a normal stool and becomes harder as the colon continues to absorb water
diarrhea
rapid movement of fecal matter through the intestine, resulting in diminished absorption of water, nutrients, and electrolytes and producing abnormally frequent evacuation of watery stools
bowel incontinence
inability to voluntarily control the passage of feces and gas.
how much fiber/day should we consume?
25g
risks for colon cancer:
- Age over 50
- A family history of polyps or colorectal cancer
- A history of inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease
- Living in an urban area
- A diet high in fat and low in fiber
bowel obstruction
Partial or complete blockage caused by a tumor, inflammation, strangulation, or adhesion that prevents the movement of chyme through the intestine. Bowel obstruction may initially present with constipation or diarrhea associated with abdominal distention, pain, and hyperactive bowel sounds in one quadrant.
Crohn’s disease
A chronic inflammatory bowel disease of unknown origin, usually affecting the ileum, the colon, or another part of the gastrointestinal tract. It is characterized by frequent attacks of diarrhea, severe abdominal pain, nausea, fever, chills, weakness, anorexia, and weight loss.
ulcerative colitis
A chronic, episodic, inflammatory disease of the large intestine and rectum. It is characterized by profuse watery diarrhea containing varying amounts of blood, mucus, and pus.
IBS
A chronic functional disorder of the bowel characterized by motor abnormalities within the gastrointestinal tract, causing variable symptoms including cramping, abdominal pain, constipation, or diarrhea. It does not result in permanent damage to the intestine. Affecting 15% of the population, it can often be managed with alternative therapies (Box 29-4).
cancer
Signs and symptoms that may indicate referral are a change in bowel habits and blood in the stool. Encourage clients to obtain routine screening tests for colon and rectal cancer.
infectious diarrhea
Sudden onset of watery diarrhea that can signal acute viral, bacterial, and protozoal infections. Most bacterial or viral diarrhea will resolve in 1 to 7 days. However, severe fluid and electrolyte disturbances can be life threatening, especially to the very young and very old.
paralytic ileus
direct handling of the bowel during abdominal surgery can temporarily stop peristalsis; when the absence of peristalsis persists beyond 3 days,
ostomy
procedure used to create a hole in the intestinal wall
ileostomy
surgical procedure involving the creation of an opening between the ileum and the abdominal wall
stoma
an opening between the abdominal wall and the intestine through which fecal material passes.
stress
occurs as a response to demands placed on one’s body and/or mind
GAS: alarm reaction
Immediately when the body encounters a stressor an alarm is initiated and the fight-or-flight response begins. The person’s resistance is decreased so ideally the body transitions to the next phase before disease or death occur
General Adaptation Syndrome
Body’s general response to stressors
GAS: resistance phase
the individual is still exposed to the stressor, but physiologic reserves are mobilized to increase the resistance to stress. This is the time of adaptation. It is during this stage that the factors that influence stress, such as attitude or coping abilities, will positively or negatively affect the resistance to the stressor. No physical signs or symptoms can be seen while an individual expends energy to adapt to a stressor, but the body will become strained over time.
GAS: Exhaustion phase
when all energy is expended, At the stage of exhaustion, it is common to become ill and even die if assistance from an outside source is not available (Fig. 8-2). This stage can often be reversed by external sources of adaptive energy, such as medication.
Three main systems in the physiologic response to stress:
nervous, immune, endocrine
Reticular Activating System (RAS)
which sends impulses contributing to alertness to the limbic system and to the cerebral cortex. When the RAS is stimulated, it increases its output of impulses, leading to wakefulness. Stress usually increases the degree of wakefulness and can lead to sleep disturbances.
coping
a person’s cognitive and behavioral efforts to manage specific external or internal stressors that seem to exceed available resources
emotion-focused coping
involves managing the emotions that an individual feels when a stressful event occurs. Examples of emotion-focused coping include discussion of feelings with a friend or taking a hot bath.
problem-focused coping
attempts to find solutions to resolve the problems causing the stress. For example, setting priorities or collecting information and seeking advice would be considered problem-focused coping.
synovium
the inner layer of the articular capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes a thick fluid to lubricate the joint and absorb shock.
Most common type of joint:
synovial, or diarthrodial, joint
synarthrodial joints
immovable joints in the skull
amphiarthrodial joints
slightly movable joints; pelvis and ribs
proprioception
sensation pertaining to stimuli originating from within the body regarding spatial position and muscular activity, or to the sensory receptors that they activate; awareness of body position, posture, and movement
gait
the manner in which we walk
stance phase of gait
heel strike through the push-off action of the first foot. An abnormality in the stance phase is called an antalgic gait.
swing phase of gait
includes the action of the second foot from acceleration through deceleration. An abnormality in this phase is called a lurch.
metatarsus varus
pigeon toe, toes pointing in
metatarsus valgus
duck walk, toes pointing out
talipes equinovarus
club foot, twisted foot
quadriplegia
When injured at the cerebral or cervical spine level
quadriparesis
a numbness or other abnormal or impaired sensation in all four limbs and the trunk
paraplegia
paralysis characterized by motor or sensory loss in the legs and trunk
paraparesis
numbness or other abnormal or impaired sensation in the legs and trunk.
hemiplegia
(paralysis of one side of the body)
hemiparesis
numbness or other abnormal or impaired sensation on one side of the body
PQRST model
P—What was the provoking incident that caused the pain, if any?
Q—What is the quality of the pain? Is it burning, throbbing, stabbing?
R—Where is the region of pain? Does it radiate? Does anything relieve the pain?
S—How severe is the pain?
T—What is the timing of the pain? When does it occur and how long does it last?
radiographs (X-ray films)
detect bone density, swelling, alignment, and continuity
Computed Tomography (CT) scan
scan provides a better picture of soft tissues and less-dense bone than standard x-rays, especially in the vertebral column. It can also identify problems of the central nervous system, such as strokes and tumors.
Magnetic resonance imaging (MRI)
often more accurate than either standard x-rays films or a CT scan for detecting soft tissue damage.
arthogram
an enhanced radiograph of a joint obtained after contrast is injected; it is performed most commonly for knees and shoulders
myelogram
a radiograph of the vertebral spine obtained after injecting a contrast medium into the lumbar subarachnoid spac
cervical myelogram
client bends the neck forward. The injection site is locally anesthetized. After the contrast medium is injected, the client is moved into various positions while radiographs are taken. After the test, the client must be properly positioned to prevent cerebrospinal fluid (CSF) leakage and subsequent headaches.
isometric exercise
a form of active exercise that increases muscle tension by applying pressure against stable resistance
normal specific gravity of urine
1.005-1.030
Normal leukocyte esterase of urine
negative; if present=UTI
Normal protein in urine
negative
normal bilirubin in urine
negative
normal glucose in urine
negative
normal ketones in urine
negative
normal occult blood in urine
negative
normal RBC’s in urine
normal is 3 (males) to 5 (females)
normal WBC’s in urine
no more than 5
normal bacteria in urine
negative
normal creatinine
0.5-1.5
normal BUN
10-30
Normal sodium
135-145mmol/L
normal potassium
3.5-5.0mEq/L
normal chloride
96-106 mEq/L
normal calcium
8.6-10.2 mg/dL
urodynamic testing
measures flow of urine through urethra-backflow
KUB
Kidnesy, ureters, bladder; xray, no contrast
IVP (IV pyelogram)
xray w/contrast; used to diagnose kidney stones; not to be used in patient with renal problems
BActrim
used for UTI treatment
normal post-void residual
<50mL
Impaired physical mobility
limited ROM
impaired bed mobility
unable to change position in bed
deconditioned mobility
disuse; deconditioned
activity intolerance
insufficient energy to perform task
Lab tests for immobility
blood chemistry; analysis of joint fluid; muscle or bone biopsy
Primary prevention for loss of mobility
includes nutrition, physical activity, ideal body weight, adequate rest, safety measures to avoid injury
Secondary prevention for loss of mobility
include screening for osteoporosis, fall risk assessment, mobility screening
External factors affecting response to stress
- Culture
- Socioeconomics
- support systems
- number of stressors
- timing of stressors
Internal factors affecting response to stress
- Hardiness
- Sense of coherence
- Resilience
- Attitude
Problem-focused coping
attempt to deal with problem to get rid of stress
Emotion-focused coping
attempt to manage emotions associated with stress
Ineffective Denial
can be positive or negative; healthy short-term
Ineffective coping
using other means to deal with stress; not beneficial; negative
Lifestyle concept of beh’l change:
healthy vs. unhealthy
Health as 2D (Tripp-Reimer):
- Etic dimension: objective interpretation of health by a scientifically trained practitioner
- Emic Dimension: refers to an individual’s /social group’s subjective perception and experiences related to health
Theory of Reasoned Action:
a human behavior framework designed to explain a person’s intention to perform a behavior; assumes people are reasonable
Transtheoretical Model for Behavioral Change:
6 stages of change in behavior:
1) precontemplation
2) contemplation
3) preparation
4) action
5) maintenance
6) termination
Precontemplation stage:
first stage in Transtheoretical Model; no intent to change high risk behavior in the near future
contemplation stage:
second phase of Transtheoretical Model; intention to change in next 6 months; takes 2 years
preparation stage:
third stage in Transtheoretical Model; intends to take action in near future; intention and action
action stage:
fourth phase in Transtheoretical Model; changes risky beh’r and makes significant efforts to reach goals; action for 1 day to 6 months
maintenance stage:
fifth phase of Transtheoretical Model; after 6 mos of changed beh’r; continuing change with less mechanisms needed to prevent relapse; 5 years
termination stage:
6th (and last) phase of Transtheoretical Model; no longer tempted to engage in risky behavior
Health belief model:
protection; provides a framework to explain why some people take specific actions to avoid/treat illness, and others don’t; 4 components:
1) perceived susceptibility
2) perceived severity
3) perceived benefits
4) perceived barriers
4 components of the health belief model:
1) perceived susceptibility
2) perceived severity
3) perceived benefits
4) perceived barriers
Key factors related to behavioral change:
- internal (within; disease process)
- external (crisis; stress)
- planned and unplanned events (surgery; accidents)
- resist change because of old habits/comfort
Order in which people seek care for behavioral changes:
1) seek alternative treatment
2) OTC self-helps
3) scientific medicine
Steps for managing change culturally:
1) view culture contextually
2) examine beliefs and behaviors
3) interpret meaning and purpose of behavior
4) recognize intercultural variations
THINK model of critical thinking:
T-total recall H-habits I-inquiry N-new ideas and creativity K-knowing how you think
Critical Thinking includes:
Clinical judgment Clinical reasoning Deliberate informed thought Controlled and purposeful Uses Strategies Analyzes Data Makes changes
Clinical Judgment includes:
Knowledge
Experience
Competence
Attitudes
Standards
Growth in critical thinking (Benner):
- Novice (relies on rules)
- advanced beginner (recognize patterns, own though)
- competent (able to analyze own thoughts)
- Proficient (intuitive thinking increases with experience)
- Expert (intuition becomes prominent thinking)
4 circle critical thinking model:
Includes Critical Thinking Characteristics, Knowledge and Intellectual Skills, Interpersonal Skills, and Technical Skills, all connected
Risk factors for altered physical mobility:
-Lifestyle Factors Environmental Factors Developmental Factors Musculoskeletal Factors Neurological Factors
Important labs for immobility:
calcium (8.6-10.2 mg/dL) phosphorus ( alkaline phosphatase muscle enzymes creatine kinase lactate dehydrogenase
Cardiovascular system complications of immobility:
Deconditioning Valsalva maneuver Deep vein thrombosis, pulmonary embolism Orthostatic intolerance Edema Diminished nutrition delivered to tissues
GI system complications of immobility:
Slowed motility Decreased nutrient absorption Alternate energy sources Malnutrition Decreased RBCs, WBCs Constipation Decreased strength and endurance
GU system complications of immobility:
Urinary stasis
Retention of urine
Kidney stones
Integumentary system complications of immobility:
Damage to skin is major complication Pressure sores Treatment is lengthy and costly Shear and friction Excoriation Maceration
genotype
genetic makeup
phenotype
observable expression of a given trait
Pharmacogenomics
the general study of all of the many different genes that determine drug behavior
Time of manifestation of genetic disorders depends on these 4 factors:
1) type and extent of alteration
2) exposure to external environmental agents
3) influence of other specific genes possessed by the individual and by his/her total genetic makeup
4) internal environment of the individual
Down syndrome:
manifested in newborns; cells contain 47 chromosomes; severe mental retardation, flat bridge of nose, slanted eyes, single crease on palm of hand
Tay-Sachs:
Genetic disorder manifested in infancy; mutation of hexa gene; progressively destroys neurons in brain and spinal cord
Duchenne muscular dystrophy
Genetic disorder manifested in Childhood; defective gene for a muscle protein; males inherit from females who are carriers
Klinefelter syndrome
Genetic disorder manifested in adolescence; males with one extra X chromosome. infertility, tall height, small testicles, and abnormally high amount of body hair
Huntington disease
genetic disorder manifested in adulthood; progressive brain disorder that causes uncontrolled movements, emotional problems, and loss of thinking ability; mutation of HTT gene
Type I DM is a result of the interaction between what 3 factors?
environment, genetics, immune system
alleles
any one of two or more alternate forms of a gene located at the same locus
locus
place on a chromosome where a gene resides
genome
the total genetic complement of an individual genotype
genomics
the study of the genome including gene sequencing, mapping, and function
MCAD deficiency:
prevents the body from converting certain fats to energy, particularly during periods without food; typically appears in infancy or early childhood and can include vomiting, lethargy, and hypoglycemia
mitochondrial inheritance
inheritance of a trait encoded in the mitochondrial genome; always related in the maternal line; no male can transmit it to his children
pharmacogenomics
the study of how an individual’s genetic inheritance affects the body’s response to drugs.
polymorphisms
genetic variation with two or more alleles that is maintained in a population so that the frequency of the most common one is not more than 0.99
geriatric nursing
branch of nursing that deals with the problems and diseases of old age and aging people
geriatrics
comprehensive study of aging and the problems of older adults
middle adulthood
can refer broadly to the period from age 35 to 64
older adult
describes a wide range of physical, mental, and psychosocial status; generally 65+
Erikson’s 8-stages of psychological development… stages effecting middle and older adults and what they mean.
Stage 7: middle adult; generativity vs. stagnation. Give self to world in a participatory way. help guide the next generation; care is primary issue
Stage 8-65+; ego integrity vs. despair; reflects on and accepts life and death; if not achieved, leads to despair and fear of death
