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NSG-1610 Weeks 7-12 > Week 11 > Flashcards

Week 11 Flashcards

1
Q

Older adult considerations GI/GU

A
  • less saliva and stomach acid
  • decreased taste
  • slower peristalsis
  • changes in dentition
  • reduced muscle mass
  • immobility, risk of dehydration, decreased thirst sensation
  • prone to constipation
  • fat accumulates in abdomen
  • renal function declines
  • IADLs, functional health, ADLs
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2
Q

Common GI/ GU disorders

A
  • gastroesophageal reflux disease (GERD)
  • lactose intolerance
  • celiac disease
  • constipation
  • inflammatory bowel disease
  • urinary incontinence
  • urinary tract infections (UTIs)
  • urolithiasis or nephrolithiasis
  • Sepsis (delirium)
  • uretic obstruction
    -renal failure
  • kidney infections
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3
Q

What is stress incontinence

A

The involuntary release of urine during physical activities that increase pressure on the bladder

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4
Q

What is urge incontinence

A

The involuntary loss of urine or bladder control issues

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5
Q

What is overflow incontinence

A

The involuntary release of urine from an over full urinary bladder

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6
Q

What is neurogenic incontinence

A

A type of bladder dysfunction caused by nerve, brain, or spinal cord damage

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7
Q

Subjective Data: GI/Gu

A
  • nutritional assessment: appetite, dysphasia, intolerance
  • abdominal history (surgeries, treatment, trauma)
  • family history
  • medications and allergies
  • abdominal pain
    -nausea/vomiting
  • bowel patterns
    -alcohol and or drugs
    -history of blood transfusion (risk of hepatitis)
  • travel?
    -screening (colonoscopy)
    -dental assessment
    -LMP
    -enlarged prostate
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8
Q

Subjective Data: GI/Gu

A
  • nutritional assessment: appetite, dysphasia, intolerance
  • abdominal history (surgeries, treatment, trauma)
  • family history
  • medications and allergies
  • abdominal pain
    -nausea/vomiting
  • bowel patterns
    -alcohol and or drugs
    -history of blood transfusion (risk of hepatitis)
  • travel?
    -screening (colonoscopy)
    -dental assessment
    -LMP
    -enlarged prostate
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9
Q

Subjective data: Male (GI/GU)

A
  • STI
  • chronic illnesses (may risk of ED)
  • current concerns; injuries
  • medical and surgical history
  • medications
  • family history: cancer, infertility
  • additional risk factors
  • protection during sports
  • self exam
  • age appropriate exams (DRE/ PSA)
  • sexual history and sexual activity satisfaction
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10
Q

Subjective data: Female (GI/GU)

A
  • pelvic pain
  • vaginal discharge, burning, itching, dryness
  • menstrual disorders
    (How much bleeding? How many pads/tampons? Consistency? Clots? Cramps? Bloating, mood disturbance, bleeding between menstrual periods or after intercourse)
  • incontinence or other urinary symptoms
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11
Q

Recognizing an acute or emergent situation

A

Lesser urgency
- patterns of urinary elimination (colour, burning, frequency)
- urgency/frequency
- cloudy urine
- malaise
- dysuria
- incontinence
-discharge
-nausea/ vomiting
-indigestions
-dysphasia
- loss of appetite (anorexia)
- bloating/gas
- jaundice; itchiness
- incontinence
- weight changes
- chewing/swallow

URGENT/ EMERGENT
- confusions/restlessness
- hematuria (blood in urine)
- fever/chills
- abdominal pain
- constipation/ diarrhea
- blood in stool or emesis or urine
- tarry stool (when you digest your own blood)

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12
Q

Objective data: GI/GU

A

Preparation
- lighting and draping
-keep the room warm
- position patient supine
- inquire about painful areas
- observe for signs of discomfort throughout

Equipment needed
- stethoscope
- alcohol wipes
- overhead light/ penlight
- skin marking pen
- drapes

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13
Q

Inspection of Urine

A
  • Adult bladder holds approximately 400-600mL of urine
  • people empty their bladder on average 5-7 times per day
  • expected output is 0.5mL/kg/hr which is roughly 30-40mL/hr in an adult

Average daily urine output 1500-1600mL/day for adults

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14
Q

Inspection of stool

A

Bristol stool chart

Type 1
- separate hard lumps –> very constipated

Type 2
- lumpy and sausage like –> slightly constipated

Type 3
- a sausage shape with cracks in the surface –> normal

Type 4
- like a smooth soft sausage or snake —> Lacking fibre

Type 5
- Soft blobs with clear cut edges —> lacking fibre

Type 6
- mushy consistency with ragged edges —> Inflammation

Type 7
- liquid consistency with no solid pieces —> inflammation

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15
Q

Inspection of abdomen: GI/GU

A
  • contour
  • size
  • shape
  • symmetry
  • bulges
  • lesions
  • masses
  • umbilicus
  • pulsation (aorta)
  • peristaltic waves
  • urine
  • emesis
  • stool
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16
Q

Auscultation of GI/U

A

Bowel sounds
- note the character and frequency of bowel sounds
- use the diaphragm lightly, usually bowel sounds are higher pitched

Vascular Sounds
- use firmer pressure, use the bell
- usually, no sounds are present

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17
Q

Components of the RUQ

A
  • gallbladder
  • duodenum
  • right lobe of the liver
  • head of the pancreas
  • right adrenal gland
  • part of the right kidney
  • a portion of the ascending colon
  • a portion of the transverse colon
18
Q

Components of LUQ

A
  • spleen
  • stomach
  • body of the pancreas
  • left lobe of the liver
  • left adrenal gland
  • part of the left kidney
  • a portion of the transverse colon
  • a portion of the descending colon
19
Q

Components of the RLQ

A
  • appendix
  • cecum
  • portion of the ascending colon
  • right ovary
  • right ureter
  • right spermatic cord
  • lower portion of the kidney
20
Q

Components of the LLQ

A
  • sigmoid colon
  • portion of the descending colon
  • left ovary
  • left ureter
  • left spermatic cord
  • lower portion of the kidney
21
Q

Palpation: GI/GU

A
  • with four fingers close together, depress the skin 1-2cm
  • make a gently rotary motion, sliding the fingers and skin together
  • then lift the dingers and move clockwise to the next location on the abdomen
  • form an overall impression of the skin surface, tenderness, superficial muscles, swelling, rigidity, pulsations
22
Q

Percussion of abdomen for GI/GU

A
  • generally tympany over abdomen
  • dullness over liver, masses, feces, and fluid
  • bladder cannot be detected through percussion unless it extends above symphsis pubis (dull sounds)
23
Q

Genitalia: Male

A

Penis
- urethral meatus
- shaft (or body), and glans
- erection/ejaculation
- prepuce or foreskin

Scrotum
- testes, epididymis, spermatic cord

24
Q

Genitalia (vulva) female

A
  • Mons pubis
  • labia majora and labia minors
  • clitoris
  • vaginal introits (opening into vagina)
  • perineum
25
Internal genitalia female
- vagina - uterus - cervix: posterior portion of uterus protrudes into vagina - Fallopian tubes: transport ova to uterus - ovaries: Provide ova; secrete estrogen and progesterone
26
Inspection and Palpation of genitals
Male - groin, testes penis (ask pt to retract foreskin) - skin (lesions; rashes; usually asymmetrical) - hair distribution - color - glans - urethra meatus - testes: smooth? Tenderness? -perineum - spread buttocks to inspect Female - Mons Pubis (hair distribution, lice, nits) - skin (colour, redness, swelling, lesions) - labia (size, swelling, symmetry, piercings, redness) - urethral opening - discharge (amount, colour, consistency, odour) - perineum - anus
27
Older adult considerations for GU
Male - less testosterone affects sexual function (longer to obtain erection and longer to ejaculate) - pubic alopecia - sometimes prostate enlargement (assess dribbling, urgency, frequency, inability to empty bladder) - scrotum drop lower due to decreased muscle tone Female - limited/absent estrogen - menopause (1 year without menses) - ovaries and uterus shrink. Uterus may prolapse due to weak ended musculature - risk of endometrial cancers (all bleeding after menopause must be investigated) - vaginal dryness: may require supplemental lubrication - thinning hair
28
Health promotion and SDOH
-Safer sex: risk with multiple partners - intimacy concerns - STI prevention and warning signs - Hygiene (front to back) scent free, mild soap - importance of screening (PAP) - advising against douching - changes inherent during puberty and menopause - HPV vaccine - dangers of smoking and oral contraceptives - contraception: barrier, hormone, intrauterine - access to comprehensive, quality information about sex and sexuality - knowledge about risks and vulnerability to adverse consequences of unprotected sexual activity - ability to access sexual health care - living in an environment that affirms and promotes sexual health - socioeconomic status, personal determinants, social support, neighbourhood, violence, addiction, migration, stress, early life experiences and education - gender, identity
29
Subjective data: musculoskeletal
- SAMPLE - sports/hobbies - working conditions/ occupation Think about physical assessments and psychosocial assessments - coping - management - loss of independence
30
What is a functional health assessment
Measure a patients self care ability in the areas of general physical health of absence of illness
31
What are the ADLs (activities of daily living)
- bathing - dressing - toileting - eating - walking
32
What are the IADLs (instrumental activities of daily living)
- housekeeping - shopping - cooking - doing laundry - using the telephone - managing finances - nutrition - social relationships and resources - self concept and coping - home environment
33
Terms to know for MSK
- Flexion and extension - abduction and adduction - medial and lateral rotation - elevation and depression - pronation and supination - dorsiflexion and plantarflexion - inversion and eversion - circumduction - protraction and retraction - Myalgia: pain originating in muscle (often cramps) - Arthralgia: pain originating in bone or joint (often dull or achy) - contracture: shortening of tendons or muscles from injury or prolonged positioning. Difficult to stretch it out
34
More terms to know for MSK
Atony - lack of residual tensions, no tone Hypotonicity - diminished tone Spasticity - hypertonic; stiff and awkward movement Spasm - violent, involuntary contraction Fasciculation - involuntary twitching Tremors - involuntary contraction
35
ROM scale
5/5 (100%) - complete ROM against gravity and full resistance 4/5 (75%) - complete ROM against gravity and moderate resistance 3/5 (50%) - complete ROM against gravity 2/5 (25%) - complete ROM with supported joint. No ROM against gravity 1/5 (10%0 - muscle contraction but no movement 0/5 (0%) - no muscle contraction
36
Inspection in general
- size (use measuring tape) - shape - color - swelling - masses - deformity - symmetry
37
Palpation in general
- check the temp and quality of the skin, joint areas for contour, size, tenderness and swelling - palpate muscles for tone and strength (pt pull or push against resistance) - ROM: range of motion - is it the same bilaterally Crepitus: cracking or popping during movement
38
Inspection: Gait
- watch the pt walk while observing from different angles - note base width - disturbances such as hesitancy, unsteadiness, staggering, reaching for support foot scraping, limping, stooping, asymmetry predictor of falls
39
TMJ: Temporomandibular joint
Inspect: joint areas for symmetry, swelling, redness Palpate as person opens mouth: should be smooth and painless Motion and range: open mouth maximally, protrude lower jaw and move side to side Palpate muscles of mastication Provide resistance to test muscle strength (CN V: trigeminal)
40
older adult considerations for MSK
- muscle weakness - loss of bone density - kyphosis - decreased height - less flexibility joints/ ligaments - joint degeneration - less muscle mass (sarcopenia) - less subcutaneous fat

NSG-1610 Weeks 7-12 (5 decks)

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