Know for Exam 2 Flashcards
diurisis
increased or excessive production of urine
absence of urine output
anuria
residual
amount of urine left in the bladder after voiding
polyuria
voiding large amounts of urine
dysuria
painful or difficult urination
self care deficit
assess whether family can help. assess home environments that might affect hygiene
fibre
dietary material containing substances such as cellulose, lignin, and pectin, that are resistant to the action of digestive enzymes
vagal nerve stimulation
anytime there is a disruption in the gi tract, can drop HR and BP, can be fatal
rectal suppository
- sims position
- lubricate anus and suppository
- go as far as finger will go and press suppository against rectal wall
- ask client to hold for 15-30 mins
glycerin suppository
- contains no medication
- osmotic laxative -pulling fluid from body into bowel
- mild action, does not cause irritation
- takes 15-20 mins
dulcolax (bisacodyl) suppository
- contains medication
- increases peristalsis by irritating the rectum
- promotes fluid accumulation in the rectum (osmotic)
- takes 15-60 mins
sodium phosphate fleet enema
- sims position
- expel air
- squeeze entire contents in
- ask client to hold as long as possible
microlax enema
- must do rectal check first as it only works if there is stool in the rectum
- causes stool to break into smaller pieces; does not irritate bowel well
- maintain pressure on the container as you remove
- works in 5-20 minutes
when does someone usually feel the urge to void?
at 150-200 ml of urine
laboured breathing
increased effort to breathe
pulse deficit
ineffiencent contraction of the heart that fails to transmit a pulse waive to the peripheral pulse site. the difference between the radial and apical pulse rates
peripheral pulse
a pulse recorded in the arteries (radial or pedal) in the distal portion of the limbs
holistic/comprehensive assessment
should consider all of the patients needs in order to identify act. or pot. problems
quick priority assessment
carried out to gain an abbreviated overall assessment
focused or selective assessment
uses knowledge of the patients history and presenting problem
blood pressure
the force excerted on the walls of the arteries by the pulsing blood under pressure from the heart
optimal bp
120/80
normal bp
130/85
normal high bp
130-139/85-89
grade 1 hypertension
140-159/90-99
grade 2 hypertension
160-179/100-109
grade 3 hypertension
anything greater then 180/110
normal respirations
12-20
bad respirations
less than 10, greater than 24
apnea
no breathing
eupnea
good breathing
dyspnea
bad breathing
orthopnea
shortness of breathing when laying flat
pulse pressure
difference between systolic and diastolic. the force that the heart generates
orthostatic
low bp from standing up from sitting or laying down
normal pulse
60-100 beats per minute
normal pulse pressure
30-50 mm Hg
cyanosis
bluish cast on the skin and mucous membranes caused by low oxygen in the red blood cells
as you get older body temperature….
gradually decreases
if a person feels short of breath and has a high respiratory rate what should the nurse do
position the patient in a supported semi fowlers or high fowlers position, then retake the respiratory rate
the normal adult urine output is
1500/1600 mL per day
what is not a risk for UTI
acidic urine
hospital acquired UTIS are often related to what
poor hand hygiene and poor catheterization technique
lifestyle choices to improve incontinence include
weight loss
