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Nursing: BSN classes > Med-Surg 2: Urinary, Prostate, Diabetes > Flashcards

Med-Surg 2: Urinary, Prostate, Diabetes Flashcards

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0
Q

The most common type of UTI that is an inflammation of the bladder wall =

A

Cystitis.

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1
Q

What is the most common bacteria that causes UTI’s?

A

E coli.

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2
Q

Diagnosis of a UTI is with >___organisms/mL.

A

100,000

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3
Q

When are men most at risk for a UTI?

A

Catheters & during older years when prostate is changing (fluid in the prostate is normally beneficial for prevention).

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4
Q

Etiology/Risk Factors for UTI’s?

A

E coli, Sexually active females, chemical irritants, moisture, pregnancy (changes in pH of vagina), stasis of urine, HAI’s (Healthcare Associated Infections), Age (incontinence, changes in pH, change in prostate), Immunocompromised, Co-morbidities (DM–glucose in urine, neurogenic bladders).

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5
Q

Clinical Manifestations of UTI’s?

A

Dysuria, Hematuria, Frequency, Urgency, Pain, CVA Tenderness, Cloudy/Foul-smelling urine, Fever, chills, N/V, Malaise; geriatrics may be asymptomatic or with altered LOC.

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6
Q

Diagnostic Tests for UTI’s?

A

Urine specimen, C&S, Imaging Studies (IVP, Cystoscopy, Ultrasound).

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7
Q

Name three common antibiotics used for UTI’s.

A

Sulfonamides (Bactrim, Septra, Macrobid).

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8
Q

What are three things you need to remember about taking antibiotics?

A

Decrease effectiveness of oral birth control, photosensitivity, yeast infections (if on them for a while).

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9
Q

What is a urinary analgesic commonly used for UTI’s?

A

Pyridium (phenazopyridine hydrochloride)

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10
Q

What is a side effect of Pyridium that you need to warn patients about?

A

Turns urine orange/red color.

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11
Q

Name some bladder irritants.

A

Caffeine, tomatoes, chocolate, alcohol.

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12
Q

What are two things you can take/drink when you have a UTI?

A

Sugar-free Cranberry Juice, Ascorbic Acid (Vitamin C).

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13
Q

How much should you increase your fluid intake when you have a UTI?

A

15 mL per pound per day.

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14
Q

What are some complications that cause UTI’s or follow UTI’s?

A

Overgrowth of bacteria (ie yeast), Urolithiasis, Pyelonephritis, & CAUTI (catheter associated urinary tract infections).

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15
Q

Urolithiasis=? Nephrolithiasis=?

A

Urinary calculi (stones) in the urinary system; Ones primarily in the kidney = Nephrolithiasis

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16
Q

What are some dietary items that can cause urinary calculi (stones)?

A

High intake of cereal, tea, instant coffee, tomatoes, cola

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17
Q

Clinical manifestations of Urinary Calculi (kidney stones)?

A

Severe, intermittent pain (occurs when the stone is moving)–renal colic or ureteral colic (renal originates in lumbar region & radiates around the side and down toward testicle in male or bladder in female; Ureteral radiates toward the genitalia and thigh); N/V from pain; CVA tenderness; Tachycardia & HTN; Sometimes shock-like symptoms (clammy, pale, almost pass out, BP & HR down); Fever and elevated WBC due to inflammation.

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18
Q

An IVP (intravenous pyelogram) is contraindicated in whom?

A

Those with kidney dysfunction because they can’t flush the dye out.

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19
Q

What labs are important to monitor in someone with a UTI?

A

BUN and Creatinine (Creatinine being more important. May need to worry at a level of 1.5-2.0)

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20
Q

What is Ditropan (oxybutynin chloride)?

A

Anticholinergic & GU antispasmodic that can be used to help with overactive bladder, postoperative pain related to an indwelling catheter - radical prostatectomy

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21
Q

What diuretics can be used with kidney stones?

A

Thiazide (HCTZ0; decrease calcium load in urine.

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22
Q

What can be used for a calcium oxalate kidney stone?

A

Vitamin B6 will decrease the amount of calcium in the urine.

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23
Q

What is a medicine used for Gout?

A

Allopurinol.

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24
Q

How does the nurse handle suprapubic/urethral catheters?

A

It is a very sterile technique that the doctor uses; need to monitor positioning of catheters (twisting, kinking, dislodgement), May need to irrigate them but it has to be ordered by an MD!! (will be a very small amount of fluid); Usually don’t do much with urethral catheters except monitor the site and Urine output

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25
Q

What is a Lithotripsy?

A

Procedure using a laser or shockwaves to loosen or remove impacted kidney stones

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26
Q

What should you worry about with the patient after a Lithotripsy?

A

Patient will be in pain and can have flank bruising.

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27
Q

How long will it take after a Lithotripsy for the stone fragments to pass?

A

May take up to 3 months.

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28
Q

May need open surgical removal of a kidney stone if it is bigger than ____

A

4-5 mm

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29
Q

Etiology/Risk Factors of Bladder Cancer:

A

Cigarette Smoking!, Industrial chemical exposure (dyes used in rubber and cable industry), Catheters, recurrent stones, Artificial sweeteners?, coffee?, low fluid intake

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30
Q

What is the classic sign of bladder cancer?

A

Painless hematuria

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31
Q

What are the clinical manifestations of bladder cancer?

A

PAINLESS HEMATURIA = classic sign; dysuria, frequency, urgency, most tumors are superficial.

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32
Q

What should you have the patient do when they are getting intravesical therapy?

A

Have them move side-to-side every 15-30 mins.

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33
Q

What are three types of Urinary Diversion?

A

Ileal Conduit (most common); Continent Pouch (Indiana Pouch); Neobladder

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34
Q

With which type of Urinary Diversion type do you have to wear a bag?

A

Ileal Conduit

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35
Q

What are some disadvantages and possible complications with the Ileal Conduit?

A

Have to wear bag, skin irritation, peritonitis (s/s=distention, fever, chills, pain!, abdominal guarding)

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36
Q

What do you have to teach your patients with the Indiana Pouch?

A

They will have to learn to self-cath the nipple valve when they feel fullness in their abdomen. May take a few weeks to control continence.

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37
Q

What is the advantage of having a Neobladder?

A

You can still pee thru your urethra. Just have to “bear down” to do it.

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38
Q

After a person has Urinary Diversion, when should you report a low amount of urine?

A

<5.0 mL/kg/hr or no output for 15 minutes

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39
Q

What are some side effects of Ditropan (anticholinergic)?

A

Dry mouth/eyes, Increased BP/HR

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40
Q

What are some clinical manifestations of Pyelonephritis?

A

CVA Tenderness, Acute distress, fever, chills, nausea, dysuria, frequency, urgency, hematuria, foul-smelling urine, WBC’s in urine

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41
Q

What type of drugs will be given for Acute Pyelonephritis?

A

Antibiotics (possibly IV), Pyridium (urinary analgesic)

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42
Q

What are you concerned about if pyelonephritis becomes chronic?

A

HTN, renal failure, fluid volume excess/decreased urine output, electrolyte imbalances

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43
Q

Clinical manifestations of Glomerulonephritis:

A

Hematuria, proteinuria, low serum albumin, edema, fever, chills, n/v, ascites, HTN, abdominal or flank pain, Oliguria or anuria

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44
Q

What are some ways to manage Glomerulonephritis?

A

Plasmapheresis (to remove antibodies from blood), steroids, anti-rejection meds, antibiotics if infection present, low-to-moderate protein and high calories, daily weights, Manage HTN, rest!

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45
Q

Risk factors for BPH:

A

Risk factors not well defined; Increasing age; Smoking/ETOH; cirrhosis; Obesity; family history (asian americans have a LOWER risk)

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46
Q

What food ingredient may possibly have a role in reducing prostate problems?

A

Lycopene (red-colored fruits and veggies–tomatoes, watermelon, etc).

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47
Q

Clinical Manifestations of BPH:

A

Nocturia, frequency, decreased force of stream, difficulty starting stream, hematuria, bladder diverticuli (which can rupture), urine may dribble.

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48
Q

A PSA over __ may be significant.

A

2.0

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49
Q

What are some meds given for BPH?

A

Alpha-adrenergic blockers (Cardura, Flomax); Proscar; Avodart

50
Q

When should you take the alpha-adrenergic blockers (ie Cardura, Flomax)?

A

At nighttime because they may make you lethargic or dizzy.

51
Q

Which BPH drugs may cause sexual dysfunction (dec. libido, abnormal ejaculation, etc)?

A

Proscar, Avodart, Flomax.

52
Q

What is an herbal therapy that may help with BPH? How should you take it?

A

Saw palmetto; with food because it may cause n/v

53
Q

What is the most common type of surgery for BPH?

A

TURP (Transurethral resection of Prostate)

54
Q

At what age is TURP usually performed?

A

Not usually til later in life because it usually has to be redone in about 5 years.

55
Q

What meds may be given after a TURP?

A

Anticholinergics/Antispasmodics; stool softener; narcotic analgesics; B&O suppository

56
Q

Etiology/Risk Factors for Prostate Cancer?

A

Age (2/3 after age 65); Race (most common in AA’s); Family hx; diet high in red meat/fat dairy products

57
Q

Clinical Manifestations of Prostate Cancer:

A

Similar to BPH; feels fixed, hard, enlarged, asymmetrical

58
Q

What are the recommendations for getting a DRE and testing PSA?

A

*DRE annually after 50
*PSA “regularly” between 50-70 (want <2.6)
–Beginning at age 40 for Af. Amer. & other high risk men
–New recommendations based on initial PSA levels
*PSA < 1 retest every 5 years, PSA=1-2 (undergo annual testing)

59
Q

Which prostate surgery has the greater chance for ED (erectile dysfunction) and bowel incontinence?

A

Perineal approach.

60
Q

Which prostate surgery approach has a lesser chance of causing ED?

A

Retropubic approach.

61
Q

What do you need to worry about after prostate surgeries?

A

Incontinence (30% wear pads for 5 years post-op), Impotence, Lymphedema, Pain in shoulder/not breathe as deeply because of CO2 from surgery spreading up thru body–worry about atelectasis and pneumonia

62
Q

What is the type of radiation where they put radioactive seeds into the prostate?

A

Brachytherapy

63
Q

After Brachytherapy, how long does the man have to wait to have sex, have kids on his lap, etc?

A

1-2 months.

64
Q

What is a med used for advanced prostate cancer (won’t cure it–palliative)?

A

Lupron

65
Q

What are three side effects of Lupron?

A

Hot flashes, ED, decreased libido

66
Q

Pre-Diabetes is diagnosed with an impaired fasting glucose of ___ after 8 hours NPO.

A

100-125

67
Q

An impaired OGTT (Oral Glucose Tolerance Test) level after 2 hours is ______

A

140-199

68
Q

Etiology/Risk Factors for Type 1 DM:

A

An inherited multigenic trait; viruses/stressors trigger an autoimmune process that destroys beta cells which causes ICA’s (islet cell antibodies) to appear, increasing over months/years as beta cells are destroyed

69
Q

Etiology and Risk factors for Type 2 DM:

A

Inc. risk in AA’s, Nat. Americans, and His. Americans; CAD; Obesity; Heredity; Sedentary lifestyle; unhealthy diet; Polycystic Ovary Syndrome (often seen in obese women); had baby greater than 9 lb; Hyperlipidemia

70
Q

Clinical Manifestations of Diabetes Mellitus:

A

Symptoms at Diagnosis of DM: Polyuria, Polydipsia, Polyphagia; Type 1’s may lose weight; blurred vision; pruritis/skin infections/vaginitis; ketonuria; weakness & fatigue; dizziness; often asymptomatic

71
Q

What is a desirable HbA1c level?

A

<7%

72
Q

Things that can affect the HbA1c result?

A

bleeding disorders, Alcohol ingestion, uremia, heparin, pregnancy, asplenia (absence of spleen), high ASA doses

73
Q

How often should HbA1c be tested?

A

twice a year in those under control (<7%); quarterly in those who haven’t met goal.

74
Q

Test that indicates the amount of endogenous insulin production =

A

C-Peptide level (Connecting Peptide)

75
Q

Should test for ketonuria if the blood sugar is over ___

A

240

76
Q

Urine should be tested in those with DM for ___ annually because it may detect progression of kidney disease.

A

Protein (proteinuria).

77
Q

Who and when should you take Diabinese, Glucotrol, and/or Diabeta?

A

Type 2 diabetics; 1-2 times a day with meals.

78
Q

When should you take Prandin (repaglinide)?

A

3 times a day, RIGHT BEFORE MEALS (10-15 mins before); it acts in the presence of food. Way to remember= Prandial means of or relating to meals (ie Post-prandial).

79
Q

How often and when do you take Metformin (Glucophage)?

A

twice a day with meals.

80
Q

What are two side effects of Metformin (Glucophage)?

A

GI upset & diarrhea

81
Q

When is Metformin (Glucophage) contraindicated?

A

Renal disease; 2 days before and after IV contrast!

82
Q

What do you need to monitor when someone is taking Avandia?

A

hepatotoxicity (monitor LFT’s)

83
Q

When should you take Precose?

A

with the first bite of the meal.

84
Q

What is Precose contraindicated with?

A

Inflammatory Bowel Disease

85
Q

What are some side effects of Precose?

A

abdominal bloating, discomfort, flatulence.

86
Q

When do you give Byetta injection?

A

60 minutes before meal

87
Q

Byetta has a risk of hypoglycemia if used with what?

A

sulfonylureas or metformin

88
Q

Symlin should be taken with what?

A

CHO because it can cause n/v

89
Q

When is Symlin contraindicated?

A

–h/o hypoglycemia, peds, pregnancy, gastroparesis

90
Q

Name 3 rapid-acting insulins:

A

Humalog (insulin lispro) & Novolog (insulin aspart) (*remember: A log is floating down the rapids) & Apidra (has rapid in it)

91
Q

Name 3 regular insulins:

A

Humulin R, Novolin R, & ReliOn R (**remember=Regular people are short)

92
Q

Name 5 Intermediate-acting insulins:

A

NPH: Humulin N, Novolin N, ReliOn N; Humulin L (Lente), Humulin 70/30 (70% NPH, 30% regular)

93
Q

Name 3 long-acting insulins:

A

Humulin U (Ultralente) & Lantus (insluin glargine) & Levemir (**Levemir’s lance is Ultra long)

94
Q

Which insulins are cloudy?

A

Intermediate-acting (Humulin N (NPH), Humulin L (Lente), & Humulin 70/30).

95
Q

What are the onsets of rapid-acting insulin?

A

15 min

96
Q

What is the peak of Rapid-acting insulin?

A

60-90 min

97
Q

What is the duration of rapid-acting?

A

3-4

98
Q

What is the onset of short-acting insulin?

A

30-1hr

99
Q

What is the peak of short-acting?

A

2-3 hours

100
Q

What is the duration of short-acting insulin?

A

3-6hr

101
Q

What is the onset, peak, and duration of Intermediate-acting insulin?

A

Humulin N & L, Novolin N, ReliOn N: Onset=2-4; Peak=4-10; Duration=10-16; Humulin 70/30: Onset=30-1hr; Peak=Dual; Duration=10-16hr

102
Q

What is the onset, peak, and duration of Humulin U?

A

Onset=6-10 hr; Peak= None; Duration=18-20hr

103
Q

What is the onset, peak, and duration of Lantus (insulin glargine) & Levemir (detemir)?

A

Onset=1-2 hr; Peak=None; Duration=24 hours

104
Q

When should you give rapid-acting insulin?

A

when food is going to be there asap.

105
Q

When should you give short-acting insulin?

A

30 mins before meal.

106
Q

How do you draw up cloudy and clear insulin?

A

Inject air into cloudy, then air into clear, then draw up clear, then draw up cloudy. (**Clear to cloudy-alphabetical order)

107
Q

When is the time of administration for Intermediate-acting insulin?

A

within 30 minutes

108
Q

When is the patient most susceptible for a hypoglycemic reaction?

A

During the peak of the insulin

109
Q

When do you usually give long-acting insulins?

A

around bedtime

110
Q

What are two important things to remember about long-acting insulins?

A

don’t mix with other insulins; expiration date is only 14 days.

111
Q

What is the expiration date for most insulins (minus long-acting)?

A

30 days; long-acting is about 14 days

112
Q

Do you need to refrigerate insulin?

A

Actually no, even though it often is. It is actually more absorbable when room temp. It just can’t be exposed to extreme heat/cold.

113
Q

What would the ABG values look like during DKA (Diabetic Ketoacidosis)?

A

They would all be low.

114
Q

Clinical Manifestations of DKA (Diabetic Ketoacidosis)?

A

Dehydration, polydipsia, polyuria, warm/dry skin, anorexia/n/v, Electrolyte imbalances (labs would look hyperkalemic because K+ moved out of cell and into bloodstream), Fruity odor of breath, Kussmaul’s respirations, hypotension, tachycardia, ketonuria, decreased LOC, abnormal ABG, somnolence, thirst, visual disturbances, weakness, weight loss

115
Q

What should you remember about giving IV Potassium?

A

NEVER PUSH IT!!!; will be diluted; can burn patient if given peripherally (may give slowly, have lidocaine around area, or may need PICC line)

116
Q

During DKA, once the BS gets back down to around 250, you may start to infuse ____ so they don’t bottom out.

A

D5W

117
Q

If someone with DM is sick, what should they do?

A 
•Call health care provider if:
–Fever for 2 days, not getting better
–Vomiting or diarrhea for >6 hours
–Large amount of ketones in urine
–BS >240 – if on insulin or pills
–Symptoms of DKA or dehydration
•Prevent DKA
–Monitor BS & ketonuria
–Don’t stop insulin even if not eating – why?
–10-15 Gm. CHO  Q 1-2H & fluids Q 30minutes
118
Q

A variant of DKA, but in Type 2 diabetics =

A

Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)

119
Q

Clinical Manifestations of HHNS?

A 
–Severe hyperglycemia
–Osmotic diuresis
–Severe dehydration
–Hyperosmolality
	•Increased BUN
120
Q

S/S of hypoglycemia:

A

•Adrenergic (autonomic)
–Shaky, irritable, nervous, tachycardic, hungry, diaphoretic, pale, paresthesias ** Can self-treat

•Neuroglycopenic (< glucose to brain!!)
–H/A, confusion, lethargy, slurred speech, coma, seizure, death

121
Q

How do you manage hypoglycemia?

A

•Mild (defined by symptoms, not by BS): will ask what foods to give on test (not exact amounts)
–15-20 Gm. CHO
•4 -6 oz. juice OR 4 tsp. sugar – not both!
•8 oz. low fat milk
•4-6 oz. regular soda
–Recheck in 15-30 minutes & retreat if BS <100

•Moderate
–needs 20-30 Gm CHO or Glucagon 1mg. SQ or IM
–Glucagon (be aware of adverse effect): can cause n/v (risk for aspiration because they were passed out before)–put them on side!

•Severe
–Unresponsiveness
–D50W (25 Gm) IV push fast, or Glucagon 1 mg. IV or IM

122
Q 
• Which of the following is the most common reported symptom of hypoglycemia?
   A. Anorexia
   B. Kussmaul’s respirations
   C. Bradycardia
   D. Nervousness
A

d

Nursing: BSN classes (14 decks)

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