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N112 > Finny 2.0 > Flashcards

Finny 2.0 Flashcards

1
Q

3 layers of the detrusor muscle

A

inner/middle/outer longitudinal layers

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2
Q

Detrusor muscle layers:
forms the internal involuntary sphincter - guards opening between the urinary bladder and urethra

A

Middle circular layer

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3
Q

The middle circular layer of the detrusor muscle is innervated by which NS

A

ANS

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4
Q

Which NS:
carries inhibitory impulses to the bladder and motor impulses to the internal sphincter

A

SNS
Detruser muscle to relax and the internal sphincter to constrict, retaining urine in the bladder

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5
Q

Which NS:
carries motor impulses to the bladder and inhibitory impulses to the internal sphincter

A

PNS
cause the detrusor muscle to contract and the sphincter to relax

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6
Q

3 parts of male urethra

A

prostatic
membranous
cavernous portions

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7
Q

Where is the External urethral sphincter in men located

A

beyond the prostatic portion; striated muscle

under voluntary control

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8
Q

Where is the external, voluntary, sphincter located- female

A

in the middle of the urethra.

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9
Q

What type of wastes does urine contain

A

organic
inorganic
liquid wastes

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10
Q

What is Micturition

A

the process of urinating; voiding

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11
Q

Process of urination- Micturition process

A

detrusor muscle contracts
internal sphincter relaxes → urine enters the posterior urethra
perineum muscles and external sphincter relax
abdominal walls constrict slightly
diaphragm lowers
urination occurs

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12
Q

Reflex urination persists until when?

A

until higher nerve centers develop after infancy leading to voluntary control

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13
Q

Autonomic bladder

A

peoples whose bladders are no longer controlled by the brain because of injury or disease void by reflex only

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14
Q

How does someone experience the need to void

A

Adult bladder fills to about 150mL-250Ml
Stretch receptors in the bladder are stimulated
adult feels desire to void

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15
Q

Pressure in the bladder during filling VS urination

A

greater during urination, then when filling

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16
Q

Voluntary control of bladder is limited to what

A

Initiating
Restraining
interrupting act

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17
Q

Factors affecting urination

A

Developmental considerations: toilet training, effects of aging
Food and fluid intake
Psychological variables
Activity and muscle tone
Pathological conditions
Medications

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18
Q

What is incontinence

A

Involuntary escape of urine

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19
Q

What are types of incontinence

A

Transient
Stress
Urge
Total

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20
Q

Transient incontinence

A

appears suddenly - GOES AWAY - lasts for 6 months or less - pregnancy, certain medications

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21
Q

Stress incontinence

A

increased intra-abdominal pressure - coughing / sneezing / laughing

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22
Q

Urge incontinence

A

involuntary - waiting TOO long - LASIX can bring it on w/increased volume

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23
Q

Total incontinence

A

continuous / unpredictable loss of urine: surgery, trauma, physical malformation, DEMENTIA

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24
Q

Effects of incontinence

A

Skin breakdown - IAD
Embarrassment / anxiety/ depression
Limits ADLs
Lowers self esteem
Lack of intimacy

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25
Q

Where are hotspots of IAD

A

perineum
thighs
buttocks

use barrier/ointment

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26
Q

TX of incontinence

A

Kagel exercises
Biofeedback devices
Medication
Surgeries - bladder lift
Stimulation devices
External barriers

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27
Q

S/S of UTI

A

Fever
urine odor
Bloody urine
Burning during urination or an ↑ frequency of urination after the catheter is removed
Changing in LOC in elderly
Burning or pain in the lower abdomen
Characteristics of urine - Turbidity / cloudy - particles floating

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28
Q

Effects of aging on urinary elimination

A

Kidney function- diminished kidneys to concentrate urine
Nocturia
Bladder muscle tone- decreased tone/ capacity to hold urine- increased frequency
Bladder contractility- decreased- urine retention/stasis-UTI
Urgency incontinence

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29
Q

TX of urge incontinence

A

provide bedpan / bed-side commode (commode needs HCP order)
Keep call light in Pt reach
Assess EVERY HOUR during 5 Ps - POSITION, POTTY, PAIN, POSSESSIONS, PUMP - you can help Pt with more frequent urination / issues during hourly rounds!

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30
Q

Anticoagulants turn urine what color

A

Red

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31
Q

Diuretics turn the urine what color

A

Pale Yellow

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32
Q

Pyridium turns the urine what color

A

Orange

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33
Q

Elavil turns the urine what color

A

Green- blue

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34
Q

Levodopa turns the urine what color

A

Brown- black

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35
Q

Cholinergic medications effect urination how

A

Stimulate contraction of the detrusor muscle, producing urination

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36
Q

Analgesics and tranquilizers affect urination how

A

suppress CNS, diminish effectiveness of neural reflex

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37
Q

pts should void how long after taking CNS suppressors

A

4 hrs

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38
Q

What is PVR

A

Post void residual
amount of urine remaining in the bladder immediately after voiding

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39
Q

PVR <50

A

Adequate voiding

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40
Q

PVR >100

A

Inadequate voiding

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41
Q

How do you measure PVR

A

Bladder scan
Catheterization

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42
Q

Criteria for catheterization

A

-surgery
-Urine retention
-Monitoring output in critically ill
-Obtaining sterile urine sample, when pt is unable to void
-Assist in healing open sacral or perineal wounds in incontinent patients
-Emptying the bladder before, during, and after select surgical procedure/ before certain diagnostic exams
-Provide improved comfort for end of life care
-Prolonged pt immobilized (potentially unstable thoracic or lumbar spine, multiple traumatic injuries)

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43
Q

How do we promote normal urination

A

normal voiding habits
Fluid intake
Strengthening muscle tone
Stimulating urination
Resolving urinary retention
Assisting with toileting

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44
Q

When do you use a bed pan

A
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45
Q

When do we use a fracture pan

A
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46
Q

.

A
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47
Q

.

A
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48
Q

.

A
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49
Q

Functions of the skin

A

Protective barrier against injuries
Prevent loss of moisture
Immune organ - detects infections
Production Vit. D
Temperature regulator
Sensory organ

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50
Q

Factors that affect skin

A

Developmental
Fluid loss
Weight
Nutrition
Diseases
Jaundice

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51
Q

Weight factors- skin

A

Excessively thin & obese persons
MOST susceptible to skin injury

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52
Q

Developmental factors- skin

A

Babies & GERI’s have thin skin - easily injured
as babies age - skin toughens
Skin thins again with age

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53
Q

Types of wounds

A

Intentional-unintentional
Open-closed

Acute/chronic
Partial/full thickness, complex

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54
Q

Intentional wound

A

Result of planned invasive therapy or treatment

Purposefully created for therapeutic purposes

Result from surgery, intravenous therapy, lumbar puncture

-edges are clean and bleeding is usually controlled
-made under sterile conditions with sterile supplies
-risk for infection is decreased and healing is facilitated

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55
Q

Unintentional wound

A

accidents, unexpected trauma, “forcible” injuries

stabbing, gunshot, burns, falls, etc

Result from unsterile environments, contamination is likely

wound edges are typically jagged, Multiple traumas are
common, bleeding is uncontrolled

High risk for infection and longer healing time

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56
Q

Open wound

A

occurs from intentional or unintentional of trauma - can be packed “wet-to-dry”

Skin surface is broken providing a portal of entry for microorganisms

bleeding tissue, damage and increased risk for infection and delayed healing may occur in open wounds

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57
Q

Closed wound

A

A blow, force, or strain

Caused by trauma such as a fall, and assault, or motor vehicle crash

Skin surface not broken

soft tissue is damaged and internal injury and hemorrhage may occur

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58
Q

Acute wound

A

Wound that is expected to progress through phases of normal healing, resulting in wound closure - ex. SURGICAL

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59
Q

Chronic wound

A

Wounds that do not progress through normal, orderly and timely sequence of repair - Often incorrectly treated

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60
Q

Contusion

A

BRUISE caused by blunt instrument causing injury to underlying tissue - over skin intact

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61
Q

Abrasion

A

scraping of top 1-2 layers of epidermis / dermis - skin rubbed away

62
Q

Laceration

A

caused by a sharp object - no skin is missing

63
Q

Avulsion

A

Forcible tearing off of skin or other part of the body, such as an ear or finger, likely exposing muscles, tendons and tissue

64
Q

Stage 1 PI

A

Skin intact, nonblanchable erythema

65
Q

Stage 2 PI

A

partial thickness skin loss with exposed dermis

66
Q

Stage 3 PI

A

Full thickness skin loss, subcutaneous layer exposed

67
Q

Stage 4 PI

A

Full thickness skin and tissue loss, muscle, tendon, ligament, cartilage may be exposed

68
Q

Unstageable PI

A

Obscured (Covered)full thickness skin and tissue loss. Slough/ eschar (black and dry) cover pressure injury, removal of eschar or slough will reveal the pressure injury at stage 3 or 4 of PI.

69
Q

Principles of wound healing

A

Primary
Secondary
Tertiary intention

70
Q

Primary intention

A

Closing a wound with staples, sutures glue, etcetera

71
Q

Secondary intention

A

granulation - Wounds that cannot be Stitched causing a large amount of tissue loss

72
Q

Tertiary intention

A

Delayed wound closures that may need draining and other therapies before closing

73
Q

Stages of wound healing

A

Hemostasis
Inflammatory phase
Proliferation
Maturation

74
Q

Hemostasis phase

A

-blood vessels constrict - STOPPING BLOOD LOSS

-occurs immediately after initial injury

-blood clotting begins through platelet activation and clustering

75
Q

Inflammatory phase

A
  • follows hemostasis and last about 2 to 3 days

-lymphocytes and macrophages move to the wound

-leukocytes digests bacteria and cellular debris

76
Q

Proliferation phase

A
  • Fibroblastic, regenerative, or connective tissue phase
  • last for several weeks
  • new tissue is built to fill the wound space through the action of fibroblasts
  • collagen is produced 2 create new tissue
77
Q

Maturation phase

A
  • Metro or remodeling begins about three weeks after injury
  • continues for months or years
  • collagen deposits in the area is remodeled
  • healed wound becomes stronger and more like adjacent tissue
78
Q

Local factors that affect healing

A

Pressure
desiccation (dehydration)
maceration (overhydration)
necrosis
Biofilm - bacterial slime

79
Q

Systemic factors that affect healing

A

Age, circulation, oxygenation, nutritional status, wound etiology (what cause the wound), medications and health status, immunosuppression (AIDS, lupus, on chemo or other autoimmune disease) and Adherence to Treatment Plan (bad wound takes longer to heal if you don’t stick to your treatment plan)

80
Q

Wound complications

A

Infection
Hemorrhage
Dehiscence
Evisceration
Fistula

81
Q

Psychological Effects of Wounds

A

Pain
ADL’s - harder to preform
Body image issues
Anxiety & fear, depression

82
Q

Common sites for PIs

A

Head
Shoulders
Knees
Toes

Heels/feet
Hips
Groin
Elbows

Breast
Wrist
Buttocks

83
Q

Serious drainage

A

Clear

84
Q

Sanguineous

A

Bloody

85
Q

Serous Sanguineous

A

Light pink

86
Q

Purulence

A

Odor
Infection

87
Q

.

A
88
Q

.

A
89
Q

.

A
90
Q

.

A
91
Q

A condition in which the human system responds to changes in its normal balanced state.

A

Stress

92
Q

Talk to self, infection, passing a test

A

Intrapersonal

93
Q

Between individuals, worried to disappoint spouse/ others

A

Interpersonal

94
Q

Outside stressors, pandemic, isolations,

A

Extrapersonal

95
Q

Physiologic stressors

A

specific/general effect: inTRApersonal
Specific effect: an alteration of normal body structure and function
General effect: the stress response

96
Q

Causes of physiologic stressors

A

chemical agents (drugs, poisons)
physical agents (heat, cold, trauma)
Nutritional imbalances
Hypoxia
Genetic or immune disorder

97
Q

Psychological stressors

A

environment, interpersonal, relationships, or a life event

98
Q

Causes of psychological stressors

A

-Accidents

  • Horrors of history, i.e. nazi concentration camps, atomic bomb dropping, September 11th, mass shootings, etc.
  • Fear of aggression or mutilation, i.e. muggings, rape, shooting, terrorism

-Events of history brought into our homes through TV and internet, such as wars, earthquakes, violence in schools, and civil unrest

-Rapid changes in our world and the way we live, economic/political structures, rapid advances in technology

99
Q

Effects of long term stress

A

Poses a serious threat to physical and emotional health, as the duration, intensity, or number of stressors increases.

-Affects physical status- increasing the risk for disease or injury

-Recovery is compromised

-Alcoholism

-Drug abuse

-Suicide

-Eating disorder

-Depression

-Accidents

100
Q

Adaptation

A

The change that takes place as a result of the response to a stressor.

Failure of adaptive mechanisms is influenced by a person’s state of health and past experiences with stress

101
Q

Stress management

A

Relaxation
Meditation
Anticipatory guidance
Guided imagery
Biofeedback

102
Q

Crisis intervention

A

Identify the problem
List alternatives
Choose from alternatives
Implement the plan
Evaluate the outcome

103
Q

Problem identification*

A

Identify the problem
List alternatives
Choose from alternatives
Implement the plan
Evaluate the outcome

104
Q

Stressors in nursing

A
  • assuming responsibilities for which you are not prepared

-Working with unqualified personnel

-Working in an environment in which supervisors and administrators are not supportive

-Experiencing conflict with a peer

-Caring for a pt who is suffering, and caring for the patients family

-Caring for a pt during cardiac arrest of for a pt who is dying

-Providing care to a pt who is disengaged, nonadherent, or lacks the resources to participate in his or her care

-Knowing the correct, right, or ethical course of action in a situation, but but being unable to take that action (moral distress)

105
Q

Defense mechanisms

A

Compensation
Denial
Displacement
Introjection
Projection
Rationalization
Reaction formation
Regression
Repression
Sublimation
Undoing

106
Q

.

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107
Q

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108
Q

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109
Q

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110
Q

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111
Q

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112
Q

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113
Q

.

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114
Q

Factors affecting safety needs

A

Developmental
Lifestyle
Environment
Mobility
Sensory perceptions
Knowledge
Ability to communicate
Physical health state
Psychosocial health state

115
Q

Developmental safety factors

A

Education throughout the lifespan promotes safety awareness

Ensuring environment is safe requires awareness of potential hazards

116
Q

Lifestyle safety factors

A

Occupational hazards

Social Behavior such as risk taking, substance abuse, unhealthy choices

117
Q

Environment safety factors

A

Pollutants

High Crime Rates

Violence in the home

118
Q

Mobility safety factors

A

Unsteady Gait or physical limitations
Supportive Devices may prevent falls or injuries

119
Q

Sensory perception safety factors

A

Impairment in Sight, Hearing, Smell, Taste, Touch can reduce environmental awareness

120
Q

Knowledge safety factors

A

Patients need instructions to a medication regimen

Recognizing potentially unsafe circumstances r/t lack of knowledge

121
Q

Ability communicate safety factors

A

Fatigue, Stress, Medication, Aphasia, Language barriers can interfere w/ communication

122
Q

Physical health safety factors

A

Chronic illness or weakened state

123
Q

Psychosocial health state

A

Stress, Depression, & Social Isolation can lead to reduced awareness & errors in judgment

124
Q

Common safety risk factors for: infants

A

Falls, Suffocation, Drowning, Ingestion of foreign bodies

125
Q

Common safety risk factors for: toddler

A

Falls, Burns, Cuts from sharp objects, Drowning & Inhalation, Ingestion of foreign bodies or poisons

126
Q

Common safety risk factors for: school aged

A

Broken Bones, Drowning, Concussion, Substance Abuse, Guns, & Weapons

127
Q

Common safety risk factors for: adolescent

A

MVA, Drowning, Guns & Weapons, Inhalation, & Ingestion of drugs

128
Q

Common safety risk factors for: adult

A

Stress, Domestic Violence, MVA, Industrial Accidents, Drug & Alcohol Abuse

129
Q

Common safety risk factors for: older adult

A

Falls, MVA, Sensorimotor, Changes, Fires

130
Q

_____ are the leading cause of injury/fatality among adults older than 65

A

Falls

131
Q

Interventions to prevent injury

A

-Modify pts healthcare environment to reduce risks

-Place call light near the patient

-Inspect walkers, canes, & crutches

-Implement falls prevention protocol

-Complete risk assessment

-Bed locked & in low position

-Answer call light promptly

-Door Open for observation

-Hourly Rounding

-Appropriate Room Selection

-Provide non skid footwear

132
Q

Alternatives to restraints

A
  • Ask family members or significant other to stay with patient
  • Reduce stimulation, noise, & light
  • Use simple, clear direction and explanation
  • Use electric alarm system on a temporary basis to warn unassisted activity
  • Use low height beds
  • Place floor mat on each side of the bed
  • Arrange for a bedside commode
  • Use pillows wedged against the side of the chair to keep patient positioned safely
  • Offer diversional activities like books and games
  • Use therapeutic touch
133
Q

Joint commission safety goals

A
  • Identify pts correctly: Use at least two patient identifiers Ex: Pt’s name and DOB
  • Improve staff communication: Get important test results to the right staff person on time
  • Use medicines safely: Before a procedure, label medicines that are not labeled.
    -Take extra care with patients who take medicine to
    thin their blood
    -Correct and pass along correct information about a pts medicine

-Use alarm safely

-Prevent Infection: Use the hand cleaning guidelines from the CDC or WHO

-Identify pt safety risks: Reduce the risk for Suicide

  • Prevent mistakes in surgery:
    -Make sure that the correct surgery is done on the correct patient and the correct place on the pt
    -Mark the correct place on the pts body where the surgery is to be done
    -Pause before the surgery to make sure a mistake is not be made
134
Q

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135
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136
Q

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137
Q

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138
Q

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139
Q

Factors influencing communication

A
  • Developmental Level
  • Gender
  • Sociocultural Differences
  • Roles & Responsibilities
  • Space/ Territoriality/Environment
  • Physical/Mental/Emotional State
  • Values
  • Environment
140
Q

Conversation skills

A

Tone of Voice
Knowledge
Be Flexible
Be Clear & Concise
Be Truthful
Keep an open mind
Take advantage of available opportunities

141
Q

Listening skills

A
  • Sit when Communicating with a pt
  • Be alert relaxed & Take your time
  • Keep the conversation as neutral as possible
  • Maintain eye contact if appropriate
  • Use appropriate facial expressions & body gesture (Don’t cross arms or legs)
  • Think before responding to the pt
  • Do not pretend to listen
  • Listen for themes in the pts comments
  • Use, Silent therapeutic touch, & humor appropriately
142
Q

Factors that may block communications

A
  • Failure to perceive the pt as a human being
  • Failure to listen
  • Giving Judgmental Comments
  • Changing the subject
  • Gossip & Humor
  • Using of Cliches
  • Questioning with yes or no
  • Questioning with why or how
  • Using of probing questions
  • Giving false assurance
143
Q

Intrapersonal

A

People talk to themselves and form thoughts internally

144
Q

Interpersonal

A

Interaction that occurs between people/groups

145
Q

Group/Public

A

Interaction of one person with large groups

146
Q

.

A
147
Q

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148
Q

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149
Q

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150
Q

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151
Q

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A
152
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A

N112 (13 decks)

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