test 3 Flashcards
where is blood filtered
nephrons
3 parts of the kidney
cortex, medulla, renal pelvis
what do nephrons do
filtrate, reabsorb, secrete
renal pyramids
bundles of collecting tubules
in medulla
what does renal pelvis do
receives urine from renal pyramids, stores until ready to go to bladder
outer layer of kidney
cortex. houses nephrons
inner layer
medulla. where renal pyramids are
filtrate is removed from blood
bowmans capsule
where reabsorption in kidney occurs
convoluted tubules
controls convuluted tubules
ADH- increase water absorption
aldosterone- increase sodium reabsorption
both cause less water= less urine
what percentage of urine is filtrate
1% is filtrate, the rest is water
transports urine from renal pelvis to urinary bladder
ureters
muscular sac like organ that holds averagely 500 mL urine
urinary bladder
where do most UTIs happen
urinary bladder
transports urine to exterior
urethra
why are females more prone to UTI
due to close proximity to anus, and the short urethra (1.5 inches approximately)
is the internal urethral sphincter involuntary or voluntary
involuntary
is the external urethral sphincter voluntary or involuntary
voluntary, if you are potty trained
normal kidneys produce how much urine for avg adult
50-60 mL/hr
1500 ml/day
avg person urinates 5-6 times daily
what can cause increased urination
diabetes, UTI, tumor, pregnancy
what can cause decreased urination
kidneys aren’t functioning, blockage, dehydration
urination in infants is based on
weight.
15-60mL per Kg
they dont have voluntary control
what is needed for toilet training
a mature neuromuscular system
adequate communication skills
when do most kids have full bladder control by
4-5 years of age
enuresis
unable to hold urine, usually from holding too long.
nocturnal enuresis
bed wetting
primary nocturnal enuresis
bed wetting in a child who hasnt yet learned to hold all night
secondary nocturnal enuresis
child had no issues with bed wetting but it randomly started occurring all of a sudden. usually related to something else such as some type of trauma, or diabetes.
what happens to kidneys as they age
nephrons decrease
kidney size decreases
common urinary issues in elderly
urgency and frequency occurs
kidney function decreases
loss of bladder elasticity
nocturia
getting up to pee in night
retention
bladder can’t fully empty
nutrition factors influencing urination
high salt intake holds onto water which causes less urine
surgical factors influencing urination
anesthesia can cause urinary retention
how does pregnancy affect urination
pelvic floor muscles weaken
pyridium
medication that makes urine bright orange. Numbs urethra
amitriptyline
medication that causes a blue/green urine
levodopa
medication that causes brown or black urine
what kind of medications can be nephrotoxic
antibiotics, NSAIDs, chemo drugs
med that prevents reabsorption of water
diuretics
why does decreased blood flow affect urine
less blood, less filtration
hypertrophy of prostate
prostate to big, urine cant pass. urinary retention
neuro problems with urination
cant sense bladder is full
urethritis
uti in urethra
cystitis
uti in bladder
pyelonephritis
uti in kidney
most common cause of uti
e. coli
found in human intestinal tract
- wiping front to back helps prevent
uti risk factors
enlarged prostate
females
frequent sex
menopause
uncircumcised males
indwelling catheters
uti symptoms, treatment and diagnostic
back pain, nausea, frequency, urgency, dysuria, hematuria, pyuria, fever, cloudy urine
treatment- antibiotics. cipro is most common
drink water
analgesic for pain
diagnosed by UA and CNS
should you be able to palpate empty bladder
no
what can cause urinary retention
muscle dysfunction
enlarged prostate
anesthesia
disease
injury
infection
obstruction
sensory impairment
urinary retention symptoms and treatment
abdominal pain, bladder distention, low urine output, residual urine, frequency, urgency
treatment- straight (intermittent) catheter, indwelling catheter, suprapubic catheter
stress incontinence
urinating when laughing, sneezing, etc
common in pregnancy
urgency incontinence
overactive detrusor muscle
overflow incontinence
bladder overfills and leaks
functional incontinence
inability to get to bathroom
total incontinence
involuntary
management of incontinence
kegel exercises (women)
bladder training- increase bladder volume
lifestyle modification
prevention of skin breakdown
urinary diversion
surgical opening for urine elimination. can be permanent or temporary
urostomy
ureter to surface
continent urinary reservoir
holding bag for urine
neobladder
alternate bladder
dialysis
when we need to take filtrate out because kidneys aren’t working properly
can:
- restore fluid and electrolytes
- control acid-base balance
- remove waste and toxic materials
from movement of high to low concent
peritoneal dialysis
in abdomen. dialysis fluid in body that pushes waste out
done at home, filtered thru peritoneum
hemodialysis
cleaning the blood. shunt in arm pulls blood out, runs thru dialysis machine and cleans blood and puts it back in thru other shunt
done at a clinic
CNS
urine culture and sensitivity
cultures what is growing and what antibiotics work for it
lab test and bedside tests of urine
UA
CNS
electrolytes
blood urea/creatinine- for dehydration
input and output
daily weights - if holding fluids, more weight
mastication
chewing
what is persistalsis
muscular movement that pushes food in stomach
where is cardiac sphincter
upper part of stomach
how long does food say in stomach on average
4 hours
what does pepsin and protease do
digests proteins
what does food leave stomach as
chyme
where are most things absorbed
small intestine
why does fecal become more solid as it moves toward rectum
more absorption
what does villi and microvilli allow for
maximum absorption
main function of large intestine
water absorption
internal anal sphincter
involuntary
external anal sphincter
voluntary
breaks down carbs
salivatory amylases
how long in between peristalsis contractions
3-12 mins
mass peristalsis movement that occurs 1-4 times a day averagely
bowel movement
what helps prevent loose stools
fiber, it doesn’t digest so it helps harden and clean out the intestine
what helps prevent constipation
fluids
why do infants have watery stool
intestines aren’t mature yet
biggest risk factor for IBS
stress
foods that can cause constipation
lean meat, cheese, eggs , pasta
laxative foods
dark chocolate, fruit, veggies, bran cereal, alcohol, coffee
gas producing foods
onions, cabbage, broccoli, cauliflower, beans, sweet potatoe
prolonged use of laxatives
decreases peristalsis
what 2 most common medications cause diarrhea
iron and narcotics
what does iron do to stool
make it black
anesthesia relationship with stomach
it slows the movement and can result in paralytic ileus
how to avoid paralytic ileus
stay on NPO and NG tube
pregnancy relationship with bowels
fetus crowds and can cause constipation
elevated progesterone slows intestinal activity
iron supplement for anemia constipates
what does antibiotics do to stool
can make it green or gray
what could aspirin and anticoagulants do GI tract
possibly cause GI bleeding
flatulence
passing gas
hemmorrhoids
varicose vein in rectum
diverticulosis
pouches in intestine. can turn into diverticulitis
What is diarrhea
when the stool moves to quickly making it loose and watery.
this has to happen multiple times to be considered diarrhea
fecal impactatin
dry hard stool that becomes lodged and cant be passed
may result in enema or digital removal
diverticulosis risk factor
eating lots of red meat, low fiber, or obesity
bowel diversion
surgically created opening that brings bowel to surface
what causes diverticulitis
something getting stuck in diverticula
avoid small seeds and eat a high fiber diet
how many gurgles should you hear a minute when auscultating stomach
3-15
if there is no sound in bowel when auscultating for 3-5 mins, what should you do
notify provider
monitor blockage
how much formed stool is needed for a sample
1 inch, or 2 tablespoons
how much liquid stool is needed for sample
20-30 oz, or an ounce
how does a occult blood test work
fecal is smeared and test looks for peroxidase which is a enzyme in blood
where does a EDG look at
upper part of GI
where does colonscopy look
begining of large intestine
where does sigmoidoscopy look
end of colon near rectum
what is barium
radioactive dye
interventions for patients with diarrhea
dilute gatorade/pedialyte with water
BRAT diet
encourage clear liquids
anti diarrhea meds not recommended for acute cases
why does depression effect bowels
it slows all body processes
how long should enema be held
15 mins
digital impaction
digital removal of stool
stool softener
prevents straining
better than laxative
what does NG tube do
drains stomach and keeps it empty. allows GI tract to rest
what should stoma look like
beefy red or dark pink
shiny
what to teach patient with stoma
when and how to change it
what it should/shouldn’t look like
body positivity
the higher in tract the stoma…
the more liquidy it is and smelly
TPN
total peripheral
all feeding is from vein
PPN
parietal peripheral
only portion of feeding thru vein
why thickeners in drinks for people with swallowing issues
to prevent aspiration
3 main functions of skin
thermoregulation, protect, sensation
superficial wound depth
epidermis
partial thickness wound depth
dermis, epidermis
full thickness wound depth
down to subcutaneous tissue. muscle,
penetrating wound depth
organs
older adult skin
less elastic, drier, reduced collagen, hyperpigmentation, more prone to injury
why may tenting on elderly be normal
less elasticity
exudate
drainage
friction
rubbing together
shearing
gravity with friction
ischemia
decreased oxygenation
how does protein help the skin
building block. helps maintain, repair and reserve intravascular volume
what vitamins are associated with collagen formation
vitamin c, zinc, copper, vitamin A
What are some meds that can effect skin
blood thinners, vitamin k, steroids (reduces inflammation, inflammation is skin response to injury to help heal)
what’s maceration and what causes it
pruny skin, moisture
how do fever affect skin healing
increased metabolic rate, making more work to reduce that rather then healing skin, and they create moisture
examples of closed wound
hematoma (bleeding under skin), ecchymosis (bruising), redness
induration
hard area, gives evidence that there may be problem under skin
not breaking sterile technique in surgery
clean
higher risk body surgery (GI, GU, resp) locations whose at risk for infection
clean contaminated
pathogen growing, localized
contaminated
systemic problem throughout whole body from contamination
infection
serous exudate drainage
straw colored (clear to yellow), plasma, thin, watery
sanguineous drainage
bloody drainage
serosanguineous drainage
mix of bloody and straw colored fluid
purulent drainage
yellow, pus, usually with foul odor
regeneration
superficial, no scar
primary intention
wound closed by surgery, edges are together
secondary intention
letting wound heal from inside out, not completely closed in surgery
tertiary intention “delayed primary”
wound is left open to start with, but will eventually be fully closed in surgery
usually cause of infection/contamination
how to look for hemorrhage
Look for internal bleeding, low bp, high HR, hematoma in gravitational areas, mental status changes, low hematic hemoglobin levels
whens a fever considered concerning
101F and above
signs of infection
fever, elevated WBC, inflammation
fistula formation
connection between 2 points that typically don’t have on. usually in GI or GU
dehiscence
tissue pulls apart or splits
evisceration
protrusion of organ thru incision
what is braden scale based on
sensory perception, moisture, activity and mobility, nutrition, friction and shear
braden scale scoring
best score=23
score that is at risk= 18 and under
why does location change wound healing
places that are more vascular heal faster
debriding
removing dead, dying, or useless tissue
BEAMS acronym for debriding
B- biologic ex- maggots
E- enzymatic drug on dressing to liquefy junk on wound
A- autolysis letting the body do its own thing. Only thing we do is put dressing
M- mechanical wet to dry
S- sharp/surgical scalpel and cutting out
why should some wounds be immobilized
to prevent reopening skin
necrotic tissue that is yellow. only seen in stage 3&4 ulcers not 1&2.
slough
dead tissue that’s black or brown. typically hard
eschar
suspected deep tissue injury
Looks like stage one ulcer, but more purplish bruise looking, stage one is more pink tone
how to find stage 1 ulcer on darker skin
Palpate for temp and induration
unstageable ulcer
cant see 50% of wound bed
what causes pressure injuries
decreased blood flow
TIME acronym- assessing wounds
Tissue- what does it look like
Infection or inflammation
Moisture
Edge of wound- what does it look like
wound bed curls under. signs of inadequate nutrition, not enough hydration to wound
epiable
what to do if wound bed pink
protect, monitor blood flow.
what to do if wound bed yellow
monitor for infection, clean and debride
what to do if wound bed black
eschar, dead tissue, debride and monitor for circulation
red wound bed
usually healthy, protect
tells us about protein stores here and now
prealbumin
tells us about protein stores over time (3 weeks or so)
albumin
Phlebitis
Redness following path of vein
Purulent drainage, pain, edema
Infiltration
Bubbling at the site
Skin blanched, bruised, swollen, pitting edema, numbness, cool to touch, pain
