Finny 2.0 Flashcards
3 layers of the detrusor muscle
inner/middle/outer longitudinal layers
Detrusor muscle layers:
forms the internal involuntary sphincter - guards opening between the urinary bladder and urethra
Middle circular layer
The middle circular layer of the detrusor muscle is innervated by which NS
ANS
Which NS:
carries inhibitory impulses to the bladder and motor impulses to the internal sphincter
SNS
Detruser muscle to relax and the internal sphincter to constrict, retaining urine in the bladder
Which NS:
carries motor impulses to the bladder and inhibitory impulses to the internal sphincter
PNS
cause the detrusor muscle to contract and the sphincter to relax
3 parts of male urethra
prostatic
membranous
cavernous portions
Where is the External urethral sphincter in men located
beyond the prostatic portion; striated muscle
under voluntary control
Where is the external, voluntary, sphincter located- female
in the middle of the urethra.
What type of wastes does urine contain
organic
inorganic
liquid wastes
What is Micturition
the process of urinating; voiding
Process of urination- Micturition process
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
Reflex urination persists until when?
until higher nerve centers develop after infancy leading to voluntary control
Autonomic bladder
peoples whose bladders are no longer controlled by the brain because of injury or disease void by reflex only
How does someone experience the need to void
Adult bladder fills to about 150mL-250Ml
Stretch receptors in the bladder are stimulated
adult feels desire to void
Pressure in the bladder during filling VS urination
greater during urination, then when filling
Voluntary control of bladder is limited to what
Initiating
Restraining
interrupting act
Factors affecting urination
Developmental considerations: toilet training, effects of aging
Food and fluid intake
Psychological variables
Activity and muscle tone
Pathological conditions
Medications
What is incontinence
Involuntary escape of urine
What are types of incontinence
Transient
Stress
Urge
Total
Transient incontinence
appears suddenly - GOES AWAY - lasts for 6 months or less - pregnancy, certain medications
Stress incontinence
increased intra-abdominal pressure - coughing / sneezing / laughing
Urge incontinence
involuntary - waiting TOO long - LASIX can bring it on w/increased volume
Total incontinence
continuous / unpredictable loss of urine: surgery, trauma, physical malformation, DEMENTIA
Effects of incontinence
Skin breakdown - IAD
Embarrassment / anxiety/ depression
Limits ADLs
Lowers self esteem
Lack of intimacy
Where are hotspots of IAD
perineum
thighs
buttocks
use barrier/ointment
TX of incontinence
Kagel exercises
Biofeedback devices
Medication
Surgeries - bladder lift
Stimulation devices
External barriers
S/S of UTI
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
Effects of aging on urinary elimination
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
TX of urge incontinence
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!
Anticoagulants turn urine what color
Red
Diuretics turn the urine what color
Pale Yellow
Pyridium turns the urine what color
Orange
Elavil turns the urine what color
Green- blue
Levodopa turns the urine what color
Brown- black
Cholinergic medications effect urination how
Stimulate contraction of the detrusor muscle, producing urination
Analgesics and tranquilizers affect urination how
suppress CNS, diminish effectiveness of neural reflex
pts should void how long after taking CNS suppressors
4 hrs
What is PVR
Post void residual
amount of urine remaining in the bladder immediately after voiding
PVR <50
Adequate voiding
PVR >100
Inadequate voiding
How do you measure PVR
Bladder scan
Catheterization
Criteria for catheterization
-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)
How do we promote normal urination
normal voiding habits
Fluid intake
Strengthening muscle tone
Stimulating urination
Resolving urinary retention
Assisting with toileting
When do you use a bed pan
When do we use a fracture pan
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Functions of the skin
Protective barrier against injuries
Prevent loss of moisture
Immune organ - detects infections
Production Vit. D
Temperature regulator
Sensory organ
Factors that affect skin
Developmental
Fluid loss
Weight
Nutrition
Diseases
Jaundice
Weight factors- skin
Excessively thin & obese persons
MOST susceptible to skin injury
Developmental factors- skin
Babies & GERI’s have thin skin - easily injured
as babies age - skin toughens
Skin thins again with age
Types of wounds
Intentional-unintentional
Open-closed
Acute/chronic
Partial/full thickness, complex
Intentional wound
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
Unintentional wound
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
Open wound
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
Closed wound
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
Acute wound
Wound that is expected to progress through phases of normal healing, resulting in wound closure - ex. SURGICAL
Chronic wound
Wounds that do not progress through normal, orderly and timely sequence of repair - Often incorrectly treated
Contusion
BRUISE caused by blunt instrument causing injury to underlying tissue - over skin intact
Abrasion
scraping of top 1-2 layers of epidermis / dermis - skin rubbed away
Laceration
caused by a sharp object - no skin is missing
Avulsion
Forcible tearing off of skin or other part of the body, such as an ear or finger, likely exposing muscles, tendons and tissue
Stage 1 PI
Skin intact, nonblanchable erythema
Stage 2 PI
partial thickness skin loss with exposed dermis
Stage 3 PI
Full thickness skin loss, subcutaneous layer exposed
Stage 4 PI
Full thickness skin and tissue loss, muscle, tendon, ligament, cartilage may be exposed
Unstageable PI
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.
Principles of wound healing
Primary
Secondary
Tertiary intention
Primary intention
Closing a wound with staples, sutures glue, etcetera
Secondary intention
granulation - Wounds that cannot be Stitched causing a large amount of tissue loss
Tertiary intention
Delayed wound closures that may need draining and other therapies before closing
Stages of wound healing
Hemostasis
Inflammatory phase
Proliferation
Maturation
Hemostasis phase
-blood vessels constrict - STOPPING BLOOD LOSS
-occurs immediately after initial injury
-blood clotting begins through platelet activation and clustering
Inflammatory phase
- follows hemostasis and last about 2 to 3 days
-lymphocytes and macrophages move to the wound
-leukocytes digests bacteria and cellular debris
Proliferation phase
- 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
Maturation phase
- 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
Local factors that affect healing
Pressure
desiccation (dehydration)
maceration (overhydration)
necrosis
Biofilm - bacterial slime
Systemic factors that affect healing
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)
Wound complications
Infection
Hemorrhage
Dehiscence
Evisceration
Fistula
Psychological Effects of Wounds
Pain
ADL’s - harder to preform
Body image issues
Anxiety & fear, depression
Common sites for PIs
Head
Shoulders
Knees
Toes
Heels/feet
Hips
Groin
Elbows
Breast
Wrist
Buttocks
Serious drainage
Clear
Sanguineous
Bloody
Serous Sanguineous
Light pink
Purulence
Odor
Infection
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A condition in which the human system responds to changes in its normal balanced state.
Stress
Talk to self, infection, passing a test
Intrapersonal
Between individuals, worried to disappoint spouse/ others
Interpersonal
Outside stressors, pandemic, isolations,
Extrapersonal
Physiologic stressors
specific/general effect: inTRApersonal
Specific effect: an alteration of normal body structure and function
General effect: the stress response
Causes of physiologic stressors
chemical agents (drugs, poisons)
physical agents (heat, cold, trauma)
Nutritional imbalances
Hypoxia
Genetic or immune disorder
Psychological stressors
environment, interpersonal, relationships, or a life event
Causes of psychological stressors
-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
Effects of long term stress
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
Adaptation
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
Stress management
Relaxation
Meditation
Anticipatory guidance
Guided imagery
Biofeedback
Crisis intervention
Identify the problem
List alternatives
Choose from alternatives
Implement the plan
Evaluate the outcome
Problem identification*
Identify the problem
List alternatives
Choose from alternatives
Implement the plan
Evaluate the outcome
Stressors in nursing
- 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)
Defense mechanisms
Compensation
Denial
Displacement
Introjection
Projection
Rationalization
Reaction formation
Regression
Repression
Sublimation
Undoing
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Factors affecting safety needs
Developmental
Lifestyle
Environment
Mobility
Sensory perceptions
Knowledge
Ability to communicate
Physical health state
Psychosocial health state
Developmental safety factors
Education throughout the lifespan promotes safety awareness
Ensuring environment is safe requires awareness of potential hazards
Lifestyle safety factors
Occupational hazards
Social Behavior such as risk taking, substance abuse, unhealthy choices
Environment safety factors
Pollutants
High Crime Rates
Violence in the home
Mobility safety factors
Unsteady Gait or physical limitations
Supportive Devices may prevent falls or injuries
Sensory perception safety factors
Impairment in Sight, Hearing, Smell, Taste, Touch can reduce environmental awareness
Knowledge safety factors
Patients need instructions to a medication regimen
Recognizing potentially unsafe circumstances r/t lack of knowledge
Ability communicate safety factors
Fatigue, Stress, Medication, Aphasia, Language barriers can interfere w/ communication
Physical health safety factors
Chronic illness or weakened state
Psychosocial health state
Stress, Depression, & Social Isolation can lead to reduced awareness & errors in judgment
Common safety risk factors for: infants
Falls, Suffocation, Drowning, Ingestion of foreign bodies
Common safety risk factors for: toddler
Falls, Burns, Cuts from sharp objects, Drowning & Inhalation, Ingestion of foreign bodies or poisons
Common safety risk factors for: school aged
Broken Bones, Drowning, Concussion, Substance Abuse, Guns, & Weapons
Common safety risk factors for: adolescent
MVA, Drowning, Guns & Weapons, Inhalation, & Ingestion of drugs
Common safety risk factors for: adult
Stress, Domestic Violence, MVA, Industrial Accidents, Drug & Alcohol Abuse
Common safety risk factors for: older adult
Falls, MVA, Sensorimotor, Changes, Fires
_____ are the leading cause of injury/fatality among adults older than 65
Falls
Interventions to prevent injury
-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
Alternatives to restraints
- 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
Joint commission safety goals
- 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
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Factors influencing communication
- Developmental Level
- Gender
- Sociocultural Differences
- Roles & Responsibilities
- Space/ Territoriality/Environment
- Physical/Mental/Emotional State
- Values
- Environment
Conversation skills
Tone of Voice
Knowledge
Be Flexible
Be Clear & Concise
Be Truthful
Keep an open mind
Take advantage of available opportunities
Listening skills
- 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
Factors that may block communications
- 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
Intrapersonal
People talk to themselves and form thoughts internally
Interpersonal
Interaction that occurs between people/groups
Group/Public
Interaction of one person with large groups
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