urinary and visual Flashcards
chemical burns to eyes management
flush with saline or water
metbaloic acid causes
GI loss such as diahrea ketoacidosis (DM, etoh, starvation) lactic acidosis (sepsis, hypoperfusion) -renal failure (hemodilasis) -salicylate toxicty
anxiety, claustroboic
resp alka
vomiting
met alkalosis
precenting UTI
increasef lfuid intake
wipe front to back
avoid synthetic dabrix such as nylon and spandex
-avoid spermicidal contraceptive jelly bc it supress the prod of protective vaginal flora
-avoid douching and using femine perineal progs
-take showers instad of baths
pursed lip breathing
helps iwth sob and prevent airway collapse
- promotes co2 elimination
- reduces air trapping in COPD
pursed lip tedchnique
Relax the neck and shoulders
Inhale for 2 seconds through the nose with the mouth closed (Option 4)
Exhale for 4 seconds through pursed lips. If unable to exhale for this long, exhale twice as long as inhaling
prior to dilausis
assess pt weight, bp, edema, lung and heart sounds
- assess fistula and graft
- vital signs
- heprain is added to the blood not given subq
important consideration before dialysis
dont give bp meds becauseit causes hpotension and during dialysis it is already making pt prone to hypotension
-also any meds that are given can be removed after dialysis
AV fistula sound
thrill can be felt when papating
briot can be heard during asuculatation
retinal detchament signs
curtain, sudden flashes of light, floaters, loss of vision
-med emergency
retinal detachment post op
avoid act that increase ICP such as rubbing eyes and straining
-report sudden pain, flashes of light , sion loss or bleeding
-avoid docused act such as reading ,sweing and writing which can cause rapid eye movmeent
-wear an eye patch or shield to prevent rubbing and scratching of the eye
-
prioirty when urinary retention suspected
assess suprapuboc area
what is an expected SE of opiod meds at renal
urinary retention
renal coloic pain
sharp, stabbing,
tossing in bed unable to find comfortable position
pain riadating to the groin area
pyleonphritis pain
flank pain back of the costvertebral angle toward the umbilicus
peritoneal dialysis insuffiecient outflow
consitpation and bowel mov should be mointored and give stool outners
- check for kinks and clots
- maintain drainge bag below the badomen
- reposition client to side lying or assist with ambulation
if none of these work then xray needed to check the location of the catheter
bladder catherization
- below the bladder
- irrgate using small amounts of sterile aline solution (<5ml) using gentle pressure to avoid damanging renal tissues
- secure it by taping to clients leg so it is below the blaffer
matureing the fistula
make the client perform hand excercises
such as sqeezing rubber ball
trill and bruit
thrill (vibration)
bruit (blowing or swooshing sound)
clot formation in the fistula signs
absence of trill or bruit
- numbess or tinlng
- decrease cap refill
during periotneal dialsysis client should be moinroted for
resp compromise such as diff breathing, rapid resp and crackles
HIGH BP IS NORMAL IN KIDNEY FAILURE
kidney biospy complication
bleeding so mointor vital signs q 15mins for the first hour and mointor for hypotension, tacy and tacypnea
before kidney biosy
discontinue all anitcog and plalets for ONE WEEKS
post op kidney biopsy
position on the affected side for 30-60 mins to provide pressure and prevent bleeding but during the procedre the are faced prone
what is normal and not normal in urinalysis
few wbc are normal
glucose is not normal and could indicate DM
comonnly held meds before dilasysi
water soluble like B AND and folic acid -abx -dignxoin -bp meds =bp lowering meds such as lasix
what med should you take before dilaysis
photphate binders because dilasysis doesnt filter it (calciym carbonate)
- lispro
- vit e can be given and it is afat souble and helps prevent leg cramps assoicate withdialysis clients
prostatectomy complications
reduced urine strwam persistent bledeing and blood clots rentention of urine fever dysruia
-REPORT ALL OF THESE TO HCP
clients should avoid what afte rprostatectomy
valsalva for 8 weeks
CKD retains
phosphours
potasium
fluid
what contains postassium
diary products such as milk and yogurt
fruits (oranges, banaas, cocunuts, watermelons, avacaods)
posphorus foods
diary
foods that are allowed CKD
apples grapes pineapple blackberries blueberries plum
what can increase ICP
coughing vomting straingng to lift obj >5 bending at the waist give antiemtic meds following opthalmic surgery
expected signs of menire disese
vertigo
NV
calcium gluconate
does not decrease potassium level but stabllizes the myocardium by raising the threshold for the dyrthmia
-after stablizaing then give the iv regular insulin with dextrose
iv dectrose inusline
temp corrects the hyperkalemia by shifting the potassium into the cells
retinal detachmened may rsult from
blunt force trauma and if not treated permanent blindness can occur
BPH signs
age >50
- urinary retention
- sensation of incmplete emptying or increased urgency to void
- strainng or diff initating voiding (hesitancy)
- weak or intermittent stream of urine
- freq voiding patterns throughout the day (urinating more than once every 2 hours)
- nocturia
- urgency
- FREQ OF SEXUAL INTERCOURSE IS NOT RELATED
CKI is at risk for
hypotensive encephalthy- HTN crisis characterized by nauea, vomiting, and headache
- need treatedment within one hour to prevent damage to teh ehart kidney and brain
Dialysis disequilibrium syndrome (DDS) can be prevented by
life threaning complication that can be prevented by slowing the rate of dilaysis or stopping
Dialysis disequilibrium syndrome (DDS) what happens
solutes such as urea are removed more quickly from the blood than from the brain cells and csf creating a concentration gradient that can lead to excess fluid in the brain cells and increased ICP
Dialysis disequilibrium syndrome (DDS) signs
NV headahcec resltness change in mentation seizure
Dialysis disequilibrium syndrome (DDS) suspected
contact HCP
trendelenburg increases
cerebral edema and dont do for pt with Dialysis disequilibrium syndrome (DDS)
cataract surgery education
avoid avt that increase ICP
-may take 1-2 weeks before viual acuity is improved
=common to exp itching (sand) in the eyem photphobia, mild pain for several days
-sleep with 2 pillows elevated to decrease ICP
CKD pt are at risk for
fluid overload and hyperkalemia
CKD diet
soidum rsitriction
potassiumum rest suchas carrots and tomatoes
-fluid restriction
-low protein diet
-low phospherous such as chicekn turkey and diary
Percutaneous nephrolithotripsy
procedure to remove large kidney stones from the renal pelvis.
Percutaneous nephrolithotripsy post procedure
temp nephrostomy tube is placed to prevent obstruction by stone fragments and to promote healing of injured tissue
-mainting tube patency is imp
Percutaneous nephrolithotripsy if no driange or flank pain is present
indicate obstruction
-irragate the nephrostomy tube with small amt of normal sterile saline
hemoldilasis and potassium
do only whenother non invasive ways werent effective and puting on a cathter takes time so not the best route if you want to get rid of K quick
peritonitis signs
low grade
cloudy
tacy
glucoma
increased intraocular pressure
- grad loss of peripheral (tunnel vision)
- normal central vision
- halo around birght lights
- sensitity to glare
macular degneration
grad loss of central vision
peripheral vision is intact and fine
catartact
cloudiness opacity older adult painless blurry vision glare and halos worse at night decreased color preception
cystoscopy complications
urinary retentioning
hemm
infection
cystoscopy notify hcp if
bright red blood blood clots inability to urinate fever greater 100.4 chills abdominal pain
cystoscopy expected finding
pink tinged urine freq dyruia are expected for 48 hours -abdominal discomfort and baldder spasms can occur up to 48 hours -
cystoscopy education
4-6 glasses water to dilute urine
avoid etoh and caff 24-48 hours
-take mild anagesic such as actea and ibuprohen and a warm tub sitz bath unless you have UTI
Overflow urinary incontinence occurs
occurs due to compression of the urethra (eg, uterine prolapse, prostate enlargement) or impairment of the bladder muscle (eg, spinal cord injury, diabetic neuropathy, anticholinergic medications).
Overflow urinary incontinence leads to
urinary retention imcomplete bladder emptying oversitening overfulling of the bladder involuntary dripping of the urine
patients with incontinence intervevntion
implement fixed voiding schedule (every 2 hours to prevent bladder overfilling)
-instrcut the client to use valsuva manuerver or crede manuever (gently applying pressure to the lower abdomen) to help emotying
-assess perneial area for break down
-measure postvoid residual volume to ensure that they are not retaining large amts of urine
-instruct to wait 20-30 seconds after voiding and then attempt to void a second time (double voiding) to help empty residual volume
DONT RESTRICT FLUIDDDD
meiere disease
excessive fluid accumlation in the inner ear
symtoms of meniere disease
vertigo tinnutius hearing loss feelings of fulnnes pressure in ear
meinere effects
only one ear and lead to permanent hering loss
what to clients report with meniere
feeling loss of propriotcepion
report feeling pulled to the ground (dropped attacks)
sp client safiety is important
meinere teaching
avoid folickering lights watching tv limits
stress incontience modifications
highest priority is preventing skin breakdown and UTI
so BLADDER TRAIN to pee every 2 hours and every 4 hours at night
-pelvic floor evecises- kegel
-natural bladder irratant (smoking, caff)
A pessary is a
non-surgical way to treat pelvic organ prolapse and sometimes incontinence.
cretiene clearance requires a
24 hour urine collection
- first urine is discarded and the time is noted
all other voided urine is collected in a container and kept cool
midstream
urinalysis or urine culture
Extracorporeal shock wave lithotripsy (ESWL)
break up kidney strones into small fragments that can be excreted in the urine
after ESWL procedure
increase fluid intake to help flush out the kidney stone frag
- expect some brusing and pain on the back or flank of the affected side
- expect to see blood in the urine for couple hours but if it is more than 24 hours then concering
- report signs of infection such as fever and chills to HCP
- ernouage abumtion NOT BED REST
BPH increased risk for
uti because of incomplete bladder emptying and retention
residual urine volume of what indicates urinary retention
> 100
what value shows uti
> 10k
cystoscopy normal
normal for burning sensation when voiding for a day or two
Transurethral resection of the prostate (TURP)
inserts scope to remove obstructing protstate itssue
Transurethral resection of the prostate (TURP) what is initated afte
Continuous bladder irrigation (CBI) with a 3-way Foley catheter
Transurethral resection of the prostate (TURP) expected
painful bladder spasms- treat with antispasmodics
- The total Foley output should be more than the CBI input, as the Foley output includes CBI fluid (not processed through the kidneys) plus the normal renal output of urine.
- An obstruction is indicated if the CBI input is equal to or greater than the Foley output.
- first 24 hours, the urine color changes from reddish-pink to pink. Small clots may occur for up to 36 hours. However, the nurse adjusts the irrigation flow to keep the urine light pink without clots.
kidney stones risk factors
fam history
dietary inbalnces
immbolization
deh
kidney stone maesfitifications
sudden severe abdominal flank pain
NV
IMMBOLITY SOOO WALKKK
kdieny stone interventions
analgesics rehydration up to 3 L ambultation heat therpy but DONT MASAGE - strain urine
retinal detachment pain
painless
ERMGENCYYYYYY
gnat or hairnet appearcne in the vision field
common clinical manifestation of UTI in the elderly
confusion
decrease ablity to see things up close
presbyopia
if something sharp gets in your eye
protect the eye using eye shield such as stryoform cup or paper cup to ensure that whatever you are sheilding does not touch the froegin body you are using to cover
0 the eyes work in synchrony to each other so the non injured eye should also be patched to prevent further eye movement
-DONT FLUSH EYES because it can move
the splinter
-dont instill antibiotic treamtent bc it inteferes the opthalmogloic med examination
Arteriovenous fistula (AVF) complication
Aterial steal syndrome where the vein steals too much arterial blood
arterial steal syndrome signs
distal ext ischemia (skill pallor, pain, numbess, tingling, diminshed pulses, poor cap refill)
-intevention is needed or limb necoriss happens
urniary retention happens afte
surgery bc of the adm of opiods
odler men who have bph
interventions for urinary retention
get the up first if they are men
- then do bladder scan if they are unable to urinate
DO LEAST INVASIVE FIRST
Asthma exacerbation signs
- accessory resp muscle use
- chest tightness
- cough
- increased mcuus prod
- diminshed breath sounds
- high pitched expiratory wheezing
- prolonged exp phase
- tacypnea
tell tale symtom of bladder cacer
PINALESS HEMATURIA
primary cuase of baldder cancer
cigar smoking or tabacoo so ask if they smoke and number (PRIORITY QUESTION)
pessary education
can remain secually aactive while wearing it
- proper fit in the HCP office but clients can remove and clean and replace themselves
- surgery not req
- can have sex with it on
side effect os pessary
vaginal discharge but not important unless odor is there
urge incontinene intevention
lose weight
- anticholingic meds can be given such as oxybutin to decrease bladder spasms and dry mouth is AE
- avoidance of bladder irrtants
- pevlic floor excecises
- bladder training
urinary retention treated with
rapid , complicate bladder decompression
manesitifcations of rapid decompression
hypotension
hematuria
and dirusis
bradycardia
glucoma characerized by
increased ictroclar presusre
can lead to peranent blindness
glucoma mesitications that are considered med emergnecy
Sudden onset of severe eye pain
Reduced central vision
Blurred vision
Ocular redness
Report of seeing halos around lightseffective tretament of osa
cpap
OSA signs
hypoxia
hypercapnia
