Week 2 Flashcards
1
Q
Nasal fracture
- Common facial fx
Complications
-Airway obstruction, epistaxis, meningeal tears causing CSF fluid leakage, cosmetic deformity
- CSF leak – clear or __________ colored fluid leaking from nares; Test for glucose
-Raccoon eyes – orbital or basilar skull fx
Management
-Maintain _______, reduce edema, avoid ________ due to bleeding
A
Nasal fracture
- Common facial fx
Complications
-Airway obstruction, epistaxis, meningeal tears causing CSF fluid leakage, cosmetic deformity
- CSF leak – clear or pinkish colored fluid leaking from nares; Test for glucose
-Raccoon eyes – orbital or basilar skull fx
Management
-Maintain airway, reduce edema, avoid NSAIDs due to bleeding
2
Q
Rhinoplasty
- Cosmetic or ____________
-Watch for ______________ (edema, infection, bleeding)
A
- Cosmetic or reconstructive
-Watch for complications (edema, infection, bleeding)
3
Q
Epistaxis
- Most is anterior, more _____________ is posterior
-Goal is __________________
- Assess for s/s of hypovolemia (hemorrhage)
- Risk factors – coagulopathies, medications
- Occlusive pressure
_________ (posterior bleeding)
- Admit for observation
-Pain – provide meds
-Risk for infection – antibiotics
-Education post-epistaxis and packing removal
A
- Most is anterior, more concerning is posterior
-Goal is stop bleeding - Assess for s/s of hypovolemia (hemorrhage)
- Risk factors – coagulopathies, medications
- Occlusive pressure
Packing (posterior bleeding)
- Admit for observation
-Pain – provide meds
-Risk for infection – antibiotics
-Education post-epistaxis and packing removal
4
Q
RHINITIS – ALLERGIC
- Seasonal or perennial
- Episodic, Intermittent, Persistent
Immune response from _____ to antigens
-Mast cells, basophils release ___________ , cytokines, prostaglandins, and leukotrienes –
cause ___________
- Sneezing, itchy watery eyes, thin watery nasal discharge
- Pale, boggy and swollen turbinate’s
- Avoid allergens
- Meds – antihistamines, leukotriene receptor antagonists, nasal spray corticosteroids (non-systematic absorption), decongestants
A
- Seasonal or perennial
- Episodic, Intermittent, Persistent
Immune response from IgE to antigens
-Mast cells, basophils release histamine, cytokines, prostaglandins, and leukotrienes –
cause symptoms
- Sneezing, itchy watery eyes, thin watery nasal discharge
- Pale, boggy and swollen turbinate’s
- Avoid allergens
- Meds – antihistamines, leukotriene receptor antagonists, nasal spray corticosteroids (non-systematic absorption), decongestants
5
Q
RHINITIS – Viral
-Majority rhinoviruses
-More severe illness coxsackieviruses & adenoviruses
-Spread by _____________&______________
A
-Majority rhinoviruses
-More severe illness coxsackieviruses & adenoviruses
-Spread by airborne and droplet!
6
Q
INFLUENZA
- Highly ______________
- ___________ precautions!!
- Causes significant morbidity and mortality
- 200,000 hospitalizations; ___________ deaths annually!!
-VACCINATIONS can prevent death - Some strains more virulent than other – _______ (swine flu)
Symptoms
- Abrupt; Chills, fever, anorexia, malaise, myalgia, cough, headache, sore throat
A
- Highly contagious
- Droplet precautions!!
- Causes significant morbidity and mortality
- 200,000 hospitalizations; 20,000 deaths annually!!
-VACCINATIONS can prevent death - Some strains more virulent than other – H1N1(swine flu)
Symptoms
- Abrupt; Chills, fever, anorexia, malaise, myalgia, cough, headache, sore throat
7
Q
INFLUENZA
Prevention best way to contain
- ________
- Particularly important for children, elderly, and those with chronic medical conditions
Treatment
- ___________ – fluids, rest
- Three antiviral meds: Zanamivir (Relenza), oseltamivir (Tamiflu), peramivir (Rapivab)
- Need to be started within _________ of onset of symptoms
- Shorten duration, may help prevent complications
A
Prevention best way to contain
- Vaccine
- Particularly important for children, elderly, and those with chronic medical conditions
Treatment
- Supportive – fluids, rest
- Three antiviral meds: Zanamivir (Relenza), oseltamivir (Tamiflu), peramivir (Rapivab)
- Need to be started within 48 hours of onset of symptoms
- Shorten duration, may help prevent complications
8
Q
WHO SHOULD BE PRIORITIZED FOR FLU VACCINATION DURING A VACCINE SHORTAGE (CDC)
- Children aged 6 months - 4 years (59 months);
- People aged 50+
- People w/ chronic pulmonary (including asthma), cardiovascular (except hypertension),
renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus); - People who are immunosuppressed (including immunosuppression caused by medications or by HIV);
- Women who are or will be pregnant during the influenza season;
- People aged 6 months - 18 years and receiving long-term aspirin therapy and who therefore might be at risk for experiencing Reye syndrome after influenza virus infection;
- Residents of nursing homes and other chronic-care facilities;
- American Indians/Alaska Natives;
- Morbidly obese (body-mass index is 40 or greater);
- Health-care personnel;
- Household contacts and caregivers of children younger than 5 years and adults aged 50+, with particular emphasis on vaccinating contacts of children aged younger than 6 months; and
- Household contacts and caregivers of people with medical conditions that put them at higher risk for severe complications from influenza
A
- Children aged 6 months - 4 years (59 months);
- People aged 50+
- People w/ chronic pulmonary (including asthma), cardiovascular (except hypertension),
renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus); - People who are immunosuppressed (including immunosuppression caused by medications or by HIV);
- Women who are or will be pregnant during the influenza season;
- People aged 6 months - 18 years and receiving long-term aspirin therapy and who therefore might be at risk for experiencing Reye syndrome after influenza virus infection;
- Residents of nursing homes and other chronic-care facilities;
- American Indians/Alaska Natives;
- Morbidly obese (body-mass index is 40 or greater);
- Health-care personnel;
- Household contacts and caregivers of children younger than 5 years and adults aged 50+, with particular emphasis on vaccinating contacts of children aged younger than 6 months; and
- Household contacts and caregivers of people with medical conditions that put them at higher risk for severe complications from influenza
9
Q
Sinusitis
Viral typically follows URI; No treatment
Bacterial infection treat with antibiotics
-Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis = common bacteria
______ pressure/pain, purulent drainage, __________
A
Viral typically follows URI; No treatment
Bacterial infection treat with antibiotics
-Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis = common bacteria
Sinus pressure/pain, purulent drainage, headaches
10
Q
Pharyngitis
- Inflammation of __________________
- Sore throat, pain with ______________
- Red, edematous posterior pharynx, with or without exudate
- Concern is Beta hemolytic streptococci
____________ until 24 to 48hrs on abx
A
- Inflammation of the pharyngeal walls
- Sore throat, pain with swallowing
- Red, edematous posterior pharynx, with or without exudate
- Concern is Beta hemolytic streptococci
Contagious until 24 to 48hrs on abx
11
Q
Peritonisllar Abscess
- Difficulty swallowing, pain, muffled voice
- Often caused by betahemolytic strep – requires ________________ & __________
A
- Difficulty swallowing, pain, muffled voice
- Often caused by betahemolytic strep – requires needle aspiration and antibiotics
12
Q
BRONCHITIS
- Usually a self-limiting inflammation of the ______ respiratory tract
- Usually caused by _______
Presenting Signs & Symptoms
- _______ – can last up to 3 weeks
- Clear mucoid secretions, can be green in color or purulent
- Color of sputum not an indication of bacterial infection
- Diagnosis based on physical assessment and history
Treatment
- Relieve symptoms – cough suppressants, fluid intake
- Β2 agonist if underlying lung disease
- STOP ___________!
A
- Usually a self-limiting inflammation of the lower respiratory tract
- Usually caused by a virus
Presenting Signs & Symptoms
- Cough – can last up to 3 weeks
- Clear mucoid secretions, can be green in color or purulent
- Color of sputum not an indication of bacterial infection
- Diagnosis based on physical assessment and history
Treatment
- Relieve symptoms – cough suppressants, fluid intake
- Β2 agonist if underlying lung disease
- STOP SMOKING!
13
Q
PNEUMONIA - Acute infection of the lung parenchyma
Caused in three ways
- __________
- ____________
- Hematogenous spread from primary infection elsewhere
— See Table 27-1 Risk Factors —
Presenting Signs & Symptoms
- Cough, fever, chills, dyspnea, confusion, tachypnea, pleuritic chest pain
- OLDER patients > 65 yo may not have typical signs
A
Caused in three ways
- Aspiration
- Inhalation
- Hematogenous spread from primary infection elsewhere
— See Table 27-1 Risk Factors —
Presenting Signs & Symptoms
- Cough, fever, chills, dyspnea, confusion, tachypnea, pleuritic chest pain
- OLDER patients > 65 yo may not have typical signs
14
Q
Community Acquired Pneumonia
- No hospitalization or resident of long-term care for past 14 days
- Hospitalization is based on CURB-65 criteria
Hospital Acquired Pneumonia (______________)
- Non-intubated patient 48 hours or longer after admission and was not present on admission
- VAP – Ventilator Associated Pneumonia (nosocomial) intubated patients (MCA-3)
- Associated with longer hospital stays, higher cost, sicker patients and increased morbidity and mortality !
A
Community Acquired Pneumonia
- No hospitalization or resident of long-term care for past 14 days
- Hospitalization is based on CURB-65 criteria
Hospital Acquired Pneumonia (nosocomial)
- Non-intubated patient 48 hours or longer after admission and was not present on admission
- VAP – Ventilator Associated Pneumonia (nosocomial) intubated patients (MCA-3)
- Associated with longer hospital stays, higher cost, sicker patients and increased morbidity and mortality !
15
Q
PNEUMONIA Complications
- Pleural effusion
- Acute __________ __________ – leading cause of death
- Intubation
- Sepsis
- Serious life-threatening condition (MCA-2 & 3)
A
- Pleural effusion
- Acute respiratory failure – leading cause of death
- Intubation
- Sepsis
- Serious life-threatening condition (MCA-2 & 3)
16
Q
PNEUMONIA Labs and Diagnostics
-Increased _____
-Possible ____________ imbalance due to dehydration
-ABGs depending on patient status
-Blood cultures possible – depends on clinical presentation
-Chest x-ray, possible CT
- Sputum sample for culture
A
-Increased WBC
-Possible electrolyte imbalance due to dehydration
-ABGs depending on patient status
-Blood cultures possible – depends on clinical presentation
-Chest x-ray, possible CT
- Sputum sample for culture
17
Q
PNEUMONIA Treatment
- ______ – within 4 hours in ED!
- Broad spectrum initially then can tailor after sputum culture
- IV for more serious, PO if outpatient
- PO Steroids – possible
- β-2 agonist (albuterol) – possible
A
- ABX – within 4 hours in ED!
- Broad spectrum initially then can tailor after sputum culture
- IV for more serious, PO if outpatient
- PO Steroids – possible
- β-2 agonist (albuterol) – possible
18
Q
PNEUMONIA Nursing
- Increase ________
- Rest
- Adequate nutrition
- TAKE all meds!!
-Pneumococcal _____________!!! – Best way to prevent illness!
- Influenza ________________!!! - Best way to prevent illness!
A
- Increase fluids
- Rest
- Adequate nutrition
- TAKE all meds!!
-Pneumococcal Vaccination!!! – Best way to prevent illness!
- Influenza Vaccination!!! - Best way to prevent illness!
19
Q
TUBERCULOSIS
-Infections disease caused by _______________ tuberculosis
-Usually infects _______ – but can be found in brain, kidney, bones
-More than 2 billion world wide are infected with TB
-Leading cause of mortality in people with _____ infection
-Occurs disproportionately in poor, underserved, and minority populations
-There are drug resistant strains of TB which have emerged hurting efforts to decrease spread of the disease
A
-Infections disease caused by Mycobacterium tuberculosis
-Usually infects lungs – but can be found in brain, kidney, bones
-More than 2 billion world wide are infected with TB
-Leading cause of mortality in people with HIV infection
-Occurs disproportionately in poor, underserved, and minority populations
-There are drug resistant strains of TB which have emerged hurting efforts to decrease spread of the disease
20
Q
TUBERCULOSIS Pathophysiology
-M. tuberculosis is a gram-__________, acid-fast bacillus
-Usually spread via _________ particles
-Contagious – needs close, frequent, or prolonged exposures
-Once inhaled a Ghon lesion or focus forms, which represents a calcified TB granuloma – the
hallmark of primary TB
-Body’s attempt to stop infection. Granuloma walls off infection preventing spread of disease
A
-M. tuberculosis is a gram-positive, acid-fast bacillus
-Usually spread via airborne particles
-Contagious – needs close, frequent, or prolonged exposures
-Once inhaled a Ghon lesion or focus forms, which represents a calcified TB granuloma – the
hallmark of primary TB
-Body’s attempt to stop infection. Granuloma walls off infection preventing spread of disease
21
Q
TUBERCULOSIS Classifications
- Primary – most people wall off bacteria and are ____________
- Latent – Have disease walled off , but at risk for_________________ later. If active disease
within 2-years of infection its considered Primary TB - Reactivated – Latent TB that becomes active _________ after initial infection
- Pulmonary, or Extrapulmonary
- Only _______% will develop active TB
A
- Primary – most people wall off bacteria and are asymptomatic
- Latent – Have disease walled off , but at risk for developing disease later. If active disease
within 2-years of infection its considered Primary TB - Reactivated – Latent TB that becomes active 2-years after initial infection
- Pulmonary, or Extrapulmonary
- Only 5-10% will develop active TB
22
Q
TUBERCULOSIS Signs & Symptoms
- _____ weeks after infection or reactivation
- Initial dry cough that becomes productive
- Constitutional sx (fatigue, malaise, anorexia, weight loss, low-grade fever, _______ sweats)
- Dyspnea and ___________ late symptoms
Can also present more acutely
- High fever
- Chills, generalized flulike symptoms
- Pleuritic pain
- Productive cough
- Adventitious breath sounds
A
- 2-3 weeks after infection or reactivation
- Initial dry cough that becomes productive
- Constitutional sx (fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats)
- Dyspnea and hemoptysis late symptoms
Can also present more acutely
- High fever
- Chills, generalized flulike symptoms
- Pleuritic pain
- Productive cough
- Adventitious breath sounds
23
Q
TUBERCULOSIS Diagnostic Studies
-Tuberculin skin test (TST)
- AKA: Mantoux test
-Uses _____________________ (PPD) injected intradermally
- Assess for induration in 48 – 72 hours
- Presence of ___________ (not redness) at injection site indicates development of antibodies secondary to exposure to TB.
Tuberculin skin test (TST)
-Positive if ≥____ mm induration in low-risk individuals
- Response ↓ in immune-compromised patients; Reactions ≥5 mm considered positive
-A waning immune response can cause false negative results.
- Repeating TST may boost reaction.
- Two-step testing recommended for health care workers getting repeated testing and those with decreased response to allergens
- Two-step testing ensures future positive results accurately interpreted.
A
-Tuberculin skin test (TST)
- AKA: Mantoux test
-Uses purified protein derivative (PPD) injected intradermally
- Assess for induration in 48 – 72 hours
- Presence of induration (not redness) at injection site indicates development of antibodies secondary to exposure to TB.
Tuberculin skin test (TST)
-Positive if ≥15 mm induration in low-risk individuals
- Response ↓ in immune-compromised patients; Reactions ≥5 mm considered positive
-A waning immune response can cause false negative results.
- Repeating TST may boost reaction.
- Two-step testing recommended for health care workers getting repeated testing and those with decreased response to allergens
- Two-step testing ensures future positive results accurately interpreted.
24
Q
TUBERCULOSIS Other diagnostic tests
Interferon-γ release assays ________
- Detects T-cell lymphocytes in response to mycobacteria
- Includes QuantiFERON-TB and the T-SPOT.TB tests
- Rapid results
- Several advantages over TST but more expensive
- Can’t distinguish between active or latent TB (LTBI)
_________ Cultures
- Requires 3 consecutive sputum cultures on different days – and demonstration of tuburcle bacilli which may take up to 8 weeks
- Treat regardless of sputum if warranted
_____________
- Cannot make diagnosis solely on x-ray
- Upper lobe infiltrates, cavitary infiltrates, and lymph node involvement suggest TB
A
Interferon-γ release assays (IGRAs)
- Detects T-cell lymphocytes in response to mycobacteria
- Includes QuantiFERON-TB and the T-SPOT.TB tests
- Rapid results
- Several advantages over TST but more expensive
- Can’t distinguish between active or latent TB (LTBI)
Sputum Cultures
- Requires 3 consecutive sputum cultures on different days – and demonstration of tuburcle bacilli which may take up to 8 weeks
- Treat regardless of sputum if warranted
Chest X-ray
- Cannot make diagnosis solely on x-ray
- Upper lobe infiltrates, cavitary infiltrates, and lymph node involvement suggest TB
25
TUBERCULOSIS
Pharmacology
- Active TB
- Treatment is ____________.
- Two phases of treatment
- Initial (8 weeks)
- Continuation (18 weeks)
- Four-drug regimen
__________-
___________-
__________-
___________
Know these 4 drugs! (Table 27-11)
- Orange urine
- Interaction with ______________
Primary concern with all drugs is liver / non-viral ___________
Check ______ prior to initiation and monitor throughout treatment
Pharmacology
- Active TB
- Treatment is aggressive.
- Two phases of treatment
- Initial (8 weeks)
- Continuation (18 weeks)
- Four-drug regimen
- Isoniazid (INH)
- Rifampin (Rifadin)
- Pyrazinamide (PZA)
- Ethambutol
Know these 4 drugs! (Table 27-11)
- Orange urine
- Interaction with alcohol (ETOH)
Primary concern with all drugs is liver / non-viral hepatitis
Check LFTs prior to initiation and monitor throughout treatment
26
TUBERCULOSIS
Pharmacology
- Latent TB
- Usually treated with _____ for 6 to 9 months
- HIV patients should take INH for 9 months.
- Alternative 3-month regimen of INH and rifapentine OR 4 months of rifampin
- Read about BCG vaccine in text book
- Latent TB
- Usually treated with INH for 6 to 9 months
- HIV patients should take INH for 9 months.
- Alternative 3-month regimen of INH and rifapentine OR 4 months of rifampin
- Read about BCG vaccine in text book
27
TB; Directly observed therapy (DOT)
-_____________ is major factor in multidrug resistance and treatment failures.
- Requires watching patient __________ drugs
- Preferred strategy to ensure adherence
- May be administered by public health nurses at clinic site
-Noncompliance is major factor in multidrug resistance and treatment failures.
- Requires watching patient swallow drugs
- Preferred strategy to ensure adherence
- May be administered by public health nurses at clinic site
28
TUBERCULOSIS Actions to take
Active TB (Acute care setting)
- ___________ isolation precautions
- Providers must wear _____ mask or use PAPR
- IF patient needs to leave room they need to wear a __________ mask
At home
- Close contacts evaluated for dx
- Avoid close contacts and congestion, public transport
- Open windows
-Patient be outside as much as possible
-Cover mouth/nose when sneezing/coughing
- Infectious until ___ sputum samples are negative – weeks to months
Active TB (Acute care setting)
- Airborne isolation precautions
- Providers must wear N95 mask or use PAPR
- IF patient needs to leave room they need to wear a surgical mask
At home
- Close contacts evaluated for dx
- Avoid close contacts and congestion, public transport
- Open windows
-Patient be outside as much as possible
-Cover mouth/nose when sneezing/coughing
- Infectious until 2 sputum samples are negative – weeks to months
29
PLEURAL EFFUSION
Pathology
- Pleural space normally contains 5-15ml of fluid that acts as a lubricant between chest wall and lungs
- Effusion is an abnormal ____________________ in this space
- Can be transudative or exudative
- Transudative – clear, pale yellow, caused by heart failure, decreased oncotic pressure (liver disease)
- Exudative – ___________
- Empyema – collection of purulent fluid in the pleural space
Pathology
- Pleural space normally contains 5-15ml of fluid that acts as a lubricant between chest wall and lungs
- Effusion is an abnormal collection of fluid in this space
- Can be transudative or exudative
- Transudative – clear, pale yellow, caused by heart failure, decreased oncotic pressure (liver disease)
- Exudative – infection
- Empyema – collection of purulent fluid in the pleural space
30
PLEURAL EFFUSION Signs & Symptoms
- Dyspnea, cough, sharp, non-radiating chest pain (worse on ___________)
- Decreased chest wall movement
- _____________ to percussion
- Diminished breath sounds over effusion
- Dyspnea, cough, sharp, non-radiating chest pain (worse on inhalation)
- Decreased chest wall movement
- Dullness to percussion
- Diminished breath sounds over effusion
31
PLEURAL EFFUSION
Diagnostics
- Chest x-ray
-CT scan
Procedures - Thoracentesis
- Aspiration of _______ in the pleural space
- Nursing – positioning, education, monitor VS – hypotension!
- Usually 1000 – 1200 mL removed
- ______________ – serious complication
- Puncture of the lung with deflation
- Watch for __________ at puncture site, pain, VS
Diagnostics
- Chest x-ray
-CT scan
Procedures - Thoracentesis
- Aspiration of fluid in the pleural space
- Nursing – positioning, education, monitor VS – hypotension!
- Usually 1000 – 1200 mL removed
- Pneumothorax – serious complication
- Puncture of the lung with deflation
- Watch for bleeding at puncture site, pain, VS
32
PULMONARY EMBOLISM Pathophysiology
- Blockage of _____________________ by thrombus, fat or air embolus, or tumor tissue
- Usually from ______
- Obstructs alveolar perfusion
- Most commonly affects _________ lobes
- Blockage of pulmonary arteries by thrombus, fat or air embolus, or tumor tissue
- Usually from DVT
- Obstructs alveolar perfusion
- Most commonly affects lower lobes
33
PULMONARY EMBOLISM
Signs & Symptoms
- Variable
____________ most common
- Tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, tachycardia, syncope, change in LOC
- Dependent on size and extent of emboli
Emergency
- Needs immediate intervention
-Can lead to cardiovascular collapse and ________
Signs & Symptoms
- Variable
- Dyspnea most common
- Tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, tachycardia, syncope, change in LOC
- Dependent on size and extent of emboli
Emergency
- Needs immediate intervention
-Can lead to cardiovascular collapse and death
34
PULMONARY EMBOLISM Nursing Actions
- Call for help
-Apply oxygen!
-Intubate if needed
- IV access
- Attach to a monitor
- VS!
- Call for help
-Apply oxygen!
-Intubate if needed
- IV access
- Attach to a monitor
- VS!
35
PULMONARY EMBOLISM Diagnostics
- CT with contrast - angiography
- V/Q scan – not as good a test as CT
- ABGs
- CT with contrast - angiography
- V/Q scan – not as good a test as CT
- ABGs
36
PULMONARY EMBOLISM
Treatment
- Support cardiopulmonary system
- Fluids
- Vasopressors
Anticoagulation
- MAY use tPA but rare
- LMWH (enoxaparin or fondaparinux)
- Once daily
- Warfarin (Coumadin) at diagnosis – for three months
- Monitor INR if on warfarin
-Placement of an inferior vena cava (IVC) fi lter to catch clots
Education
-Disease process
- DVTs
- Explore anxiety and concerns
Treatment
- Support cardiopulmonary system
- Fluids
- Vasopressors
Anticoagulation
- MAY use tPA but rare
- LMWH (enoxaparin or fondaparinux)
- Once daily
- Warfarin (Coumadin) at diagnosis – for three months
- Monitor INR if on warfarin
-Placement of an inferior vena cava (IVC) fi lter to catch clots
Education
-Disease process
- DVTs
- Explore anxiety and concerns
37
UTI (Urinary Tract Infections)
- Most common ___________infection in women
- _________ is most common pathogen (see Table 45-1)
>>>Upper and lower UTI
- Most common bacterial infection in women
- E. coli is most common pathogen (see Table 45-1)
>>>Upper and lower UTI
38
Lower UTI (see Table 45-3: Symptoms of a LUTI)
- Painful, frequent urination, with hesitancy
- NOT systemic (localized to _______ urinary tract)
- Treated with PO ___________ (See Table 45-4)
-Relief of symptoms in ______
- Phenazopyridine (Pyridium) - turns urine ________ color! Inform patients!
- Painful, frequent urination, with hesitancy
- NOT systemic (localized to lower urinary tract)
- Treated with PO antibiotics (See Table 45-4)
-Relief of symptoms in 24hrs.
- Phenazopyridine (Pyridium) - turns urine orange color! Inform patients!
39
Upper UTI
- More _________ !
- May be ___________
-Can lead to __________ a life-threatening infection
- Pyelonephritis – infection of the renal parenchyma
-Symptoms – fever, chills, LUTI, flank pain, bloody urine
- Depending on how ill the patient is, IV antibiotics are used to treat with possible inpatient admission for brief stay
- More serious!
- May be systemic
-Can lead to urosepsis a life-threatening infection
- Pyelonephritis – infection of the renal parenchyma
-Symptoms – fever, chills, LUTI, flank pain, bloody urine
- Depending on how ill the patient is, IV antibiotics are used to treat with possible inpatient admission for brief stay
40
UTI Diagnostics
- Urinalysis or dipstick
- WBCs, leukocyte esterase, RBCs – indicative of an infection
- Blood cultures if patient has signs of systemic infection (fever, chills, low BP)
- Urinalysis or dipstick
- WBCs, leukocyte esterase, RBCs – indicative of an infection
- Blood cultures if patient has signs of systemic infection (fever, chills, low BP)
41
UTI relief/help
Garlic
Beet
UNSWEET cranberry juice
2 liters water to flush system
Garlic
Beet
UNSWEET cranberry juice
2 liters water to flush system
42
URETHRITIS
- Think _____ (trichomonas, chlamydial, and gonorrhea infections
- Treat with ___________ (PO or IV)
- Many resistant strains of bacteria!!! Must use most recent treatment recommendations by ______ !
- Think STI (trichomonas, chlamydial, and gonorrhea infections
- Treat with antibiotics (PO or IV)
- Many resistant strains of bacteria!!! Must use most recent treatment recommendations by CDC!
43
GLOMERULONEPHRITIS
- Inflammation of the ________
- Usually in both _________
- 3rd leading cause of End-Stage Renal Disease (ESRD) in the U.S.
Acute post-streptococcal glomerulonephritis
- Children and young adults
- 1-2 weeks after a ______________ (tonsillitis, skin – impetigo )
- Symptoms – oliguria, hematuria, swelling, fatigue
- Inflammation of the glomeruli
- Usually in both kidneys
- 3rd leading cause of End-Stage Renal Disease (ESRD) in the U.S.
Acute post-streptococcal glomerulonephritis
- Children and young adults
- 1-2 weeks after a strep infection (tonsillitis, skin – impetigo )
- Symptoms – oliguria, hematuria, swelling, fatigue
44
URINARY CALCULI
_______________ (kidney stone)
- 1-2 million a year
- More frequent in _______ than in African Americans
- Review Table 45-10: Risk Factors
-There are different types of kidney stones- Review Table 45-11
-Treatment and prevention may vary depending on type of stone
Nephrolithiasis (kidney stone)
- 1-2 million a year
- More frequent in White than in African Americans
- Review Table 45-10: Risk Factors
-There are different types of kidney stones- Review Table 45-11
-Treatment and prevention may vary depending on type of stone
45
URINARY CALCULI
Causes:
- Genetics
- Diet: ________ in Ca, Vitamin D, protein, oxalate, purines, alkali
- Urinary _________ & UTI (immobilization)
- Dehydration
- Diuretic use
- Hypercalcemia & hyperparathyroidism
- Uric acid elevation (Gout)
- Genetics
- Diet: high in Ca, Vitamin D, protein, oxalate, purines, alkali
- Urinary Stasis & UTI (immobilization)
- Dehydration
- Diuretic use
- Hypercalcemia & hyperparathyroidism
- Uric acid elevation (Gout)
46
URINARY CALCULI Interventions:
- Monitor for Infection
- Nutritional therapy
- Fluids 3L/day
- Pain management [analgesics, warm baths..]
- Mobilization or repositioning
- Prep for Severe Pain
- Monitor for Infection
- Nutritional therapy
- Fluids 3L/day
- Pain management
- Mobilization or repositioning
- Prep for Severe Pain
47
URINARY CALCULI Signs & Symptoms – KNOW THESE
- __________ !
- Sharp, stabbing, severe in fl ank, low back, or pelvis/lower abd
- May be colicky (comes and goes)
- _____________ – either frank blood in urine (meaning its pink or red) or via urinalysis
-Nausea and vomiting may occur due to the pain
- IV medication required for initial pain management. PO usually inadequate for initial treatment
- Opioid meds
- Ketorolac – IV NSAID
- PAIN!
- Sharp, stabbing, severe in fl ank, low back, or pelvis/lower abd
- May be colicky (comes and goes)
- Hematuria – either frank blood in urine (meaning its pink or red) or via urinalysis
-Nausea and vomiting may occur due to the pain
- IV medication required for initial pain management. PO usually inadequate for initial treatment
- Opioid meds
- Ketorolac – IV NSAID
48
URINARY CALCULI
Diagnostics
- ___________ is the primary means to diagnose a kidney stone
Treatment
If less than 4mm
- Treat pain
-Increase fluids!!!!
- Strain urine until _____________ – may take a week or two
If larger than 4mm
- Lithotripsy
- Surgery
- Endourologic procedures
Diagnostics
- CT scan is the primary means to diagnose a kidney stone
Treatment
If less than 4mm
- Treat pain
-Increase fluids!!!!
- Strain urine until stone passes – may take a week or two
If larger than 4mm
- Lithotripsy
- Surgery
- Endourologic procedures
49
URINARY CALCULI
Prevention
- Nutrition See Table 45-12
- Increased hydration
- 2L / day normal
- 3L / day if active
- More if hot climate and lots of sweating
- Nutrition See Table 45-12
- Increased hydration
- 2L / day normal
- 3L / day if active
- More if hot climate and lots of sweating
50
Urine incontinence
Overflow
Stress
Urge
51
URINARY INCONTINENCE
Think of complications of incontinence
- Skin _____________- acidic and wet nature of urine
- ___________ and electrolyte imbalance – poor intake to avoid incontinence
- _______ isolation -- embarrassment (wet pants in public, smell, wet bed with partner, treated like baby needing ‘diaper’ by healthcare professionals, etc...)
- How do we as nurses help someone live normal life
- Planning, intake management, avoid caff eine, lifestyle changes, etc...)
- Skin Breakdown - acidic and wet nature of urine
- dehydration and electrolyte imbalance – poor intake to avoid incontinence
- social isolation -- embarrassment (wet pants in public, smell, wet bed with partner, treated like baby needing ‘diaper’ by healthcare professionals, etc...)
- How do we as nurses help someone live normal life
- Planning, intake management, avoid caff eine, lifestyle changes, etc...)
52
BENIGN PROSTATIC HYPERPLASIA (BPH)
- Common health problem
- Exact cause is unknown
- __________ units in the ____________ that undergo ____________________________ , resulting in enlargement of prostate gland
- Common health problem
- Exact cause is unknown
- Glandular units in the prostate that undergo nodular tissue hyperplasia, resulting in enlargement of prostate gland
53
BENIGN PROSTATIC HYPERPLASIA (BPH)
Presenting Signs & Symptoms
- Occurs gradually
- Nocturia, urinary frequency, urgency, dysuria, bladder pain , incontinence
-Difficulty starting urination, stopping and starting several times, dribbling at the end
- Chronic urinary retention
- UTIs, hydronephrosis
- Occurs gradually
- Nocturia, urinary frequency, urgency, dysuria, bladder pain , incontinence
-Difficulty starting urination, stopping and starting several times, dribbling at the end
- Chronic urinary retention
- UTIs, hydronephrosis
54
BENIGN PROSTATIC HYPERPLASIA (BPH)
Assessments
- PSA – some controversy around this
- DRE – again, some controversy. Not very useful exam.
Other diagnostic studies
- Transrectal ultrasound
Assessments
- PSA – some controversy around this
- DRE – again, some controversy. Not very useful exam.
Other diagnostic studies
- Transrectal ultrasound
55
BENIGN PROSTATIC HYPERPLASIA (BPH) Pharmacology
-5α-Reductase inhibitors – fi nasteride (Proscar) or dutasteride (Avodart)
- α-adrenergic receptor blockers – tamsulosin (Flomax), silodosin (Rapafl o), doxazosin (Cardura), prazosin (Minipress)
-Serenoa repens (saw palmetto) – Check with provider (otc herbal supplement
-5α-Reductase inhibitors – fi nasteride (Proscar) or dutasteride (Avodart)
- α-adrenergic receptor blockers – tamsulosin (Flomax), silodosin (Rapafl o), doxazosin (Cardura), prazosin (Minipress)
-Serenoa repens (saw palmetto) – Check with provider (otc herbal supplement
56
BENIGN PROSTATIC HYPERPLASIA (BPH)
Surgical management
- TURP
Post-surgical care
- Urinary catheter with/without 3-way continuous irrigation placed into bladder
- Bleeding
- Pain
-Infection
- Urination
- I/O
- Sexual dysfunction
Surgical management
- TURP
Post-surgical care
- Urinary catheter with/without 3-way continuous irrigation placed into bladder
- Bleeding
- Pain
-Infection
- Urination
- I/O
- Sexual dysfunction
57
Deviated Septum
-Main concern: ___________________
- Nasal septum is not ___________ , possibly from trauma or genetic
- Possible issue with airflow/drainage
-Main concern: airway obstruction
- Nasal septum is not straight, possibly from trauma or genetic
- Possible issue with airflow/drainage
58
Deviated Septum Treatments:
symptom management with saline rinses for _______________
nasal ____________
symptom management with saline rinses for inflammation
nasal septoplasty
59
Deviated septum symptoms
Minor: asymptomatic or nasal congestion, frequent sinus infections
Severe: facial pain, epistaxis (nosebleed), obstruction of the nasal airway
Minor: asymptomatic or nasal congestion, frequent sinus infections
Severe: facial pain, epistaxis (nosebleed), obstruction of the nasal airway
60
Nasal Fracture Causes:
Usually caused by ________ trauma
Classifications:
___________: unilateral/bilateral, minimal or no displacement
__________: frontal blow, possible damage to the adjacent facial structure
Risk for airway obstruction, epistaxis, meningeal tears, septal hematoma
Usually caused by blunt trauma
Classifications:
Simple: unilateral/bilateral, minimal or no displacement
Complex: frontal blow, possible damage to the adjacent facial structure
Risk for airway obstruction, epistaxis, meningeal tears, septal hematoma
61
Nasal fracture signs & symptoms:
-Nosebleed, pain, swelling, difficulty breathing, bruising, possible crepitus on palpation, edema
-Clear pink drainage indicates possible ______ leak: collect and test, high risk for meningitis/infection
-Nosebleed, pain, swelling, difficulty breathing, bruising, possible crepitus on palpation, edema
-Clear pink drainage indicates possible CSF leak: collect and test, high risk for meningitis/infection
62
raccoon eyes indicates - _____________ fracture
basilar skull
63
Rhinoplasty
-Surgical reconstruction to improve ________ function/cosmetic reasons
-May require plastic implants or nasal tissue removal
-Post-op assessment of airway patency, pain mgmt., and edema/bleeding/infection
-Pt. education about possible complications at home
-Activity restrictions to prevent bleeding and injury
-Cold compresses, elevating head to minimize swelling and pain
-Surgical reconstruction to improve airway function/cosmetic reasons
-May require plastic implants or nasal tissue removal
-Post-op assessment of airway patency, pain mgmt., and edema/bleeding/infection
-Pt. education about possible complications at home
-Activity restrictions to prevent bleeding and injury
-Cold compresses, elevating head to minimize swelling and pain
64
Epistaxis (Nosebleed)
Anterior: majority of cases
-Have pt. sit lean slightly forward, apply pressure by squeezing nostrils together for 5-15 mins
- Nasal tampon w/ anesthetic/vasoconstrictive solution
- Packing can stay in place 48-72 hrs
- Can cauterize w/ silver nitrate or heat cauterized if severe
Posterior: more concerning
- Packing w/ nasal _________ or epistaxis balloons
- Check LOC, HR, RR, O2 Sat
- Observe for dysphagia or difficulty breathing
- Treat for ______ (packing hurts!)
- Infection risk: abx may be prescribed
- Discharge education: saline spray/humidifier, avoid vigorous nose blowing or strenuous activity for 4-6 weeks
- Avoid NSAIDS (bleeding risk)
Anterior: majority of cases
-Have pt. sit lean slightly forward, apply pressure by squeezing nostrils together for 5-15 mins
- Nasal tampon w/ anesthetic/vasoconstrictive solution
- Packing can stay in place 48-72 hrs
- Can cauterize w/ silver nitrate or heat cauterized if severe
Posterior: more concerning
- Packing w/ nasal sponges or epistaxis balloons
- Check LOC, HR, RR, O2 Sat
- Observe for dysphagia or difficulty breathing
- Treat for pain (packing hurts!)
- Infection risk: abx may be prescribed
- Discharge education: saline spray/humidifier, avoid vigorous nose blowing or strenuous activity for 4-6 weeks
- Avoid NSAIDS (bleeding risk)
65
Allergic Rhinitis - Inflammation of nasal mucosa
___________ : sporadic exposure, not the normal environment for patient
____________ : less than 4 days/week or 4 weeks/year
___________ : more than 4 days/week or 4 weeks/year
Seasonal: usually spring/fall
_____________ : year-round (e.g., dander, dust mites, mold)
Episodic: sporadic exposure, not the normal environment for patient
Intermittent: less than 4 days/week or 4 weeks/year
Persistent: more than 4 days/week or 4 weeks/year
Seasonal: usually spring/fall
Perennial: year-round (e.g., dander, dust mites, mold)
66
Allergic Rhinitis - Inflammation of nasal mucosa
Cause: ___________________ from IgE antibodies to antigens
-Mast cells and basophils release histamine, cytokines, prostaglandins, leukotrienes → _____________ response
Meds to reduce inflammation and symptoms:
-Intranasal: antihistamines, anticholinergics, corticosteroids, decongestants
-*Intranasal corticosteroids not systemically absorbed
-Oral: antihistamines, decongestants, leukotriene receptor agonists
-*First generation antihistamines can cause drowsiness
-Sometimes dual approach: oral antihistamine and intranasal corticosteroid
Cause: immune response from IgE antibodies to antigens
-Mast cells and basophils release histamine, cytokines, prostaglandins, leukotrienes → inflammatory response
Meds to reduce inflammation and symptoms:
-Intranasal: antihistamines, anticholinergics, corticosteroids, decongestants
-*Intranasal corticosteroids not systemically absorbed
-Oral: antihistamines, decongestants, leukotriene receptor agonists
-*First generation antihistamines can cause drowsiness
-Sometimes dual approach: oral antihistamine and intranasal corticosteroid
67
Acute Viral Rhinitis (the common ______ )
cold
68
Acute Viral Rhinitis (the common cold)
-Very common, around 1-3x per year for adults
-Spread via airborne and droplets; higher risk in ________
-Symptoms: begin 2-3 days after infection
Runny nose, watery eyes, nasal congestion, sneezing, Fever
Usual recovery in 7-10 days
Interventions: rest, oral fluids, antipyretics, analgesics
Complications: acute bronchitis, sinusitis, otitis media, tonsillitis
S/S of complications:
-Temp over 103 F, swollen/tender glands, severe sinus or ear pain, significant worsening of sx
-Green purulent drainage is common, not necessarily bacterial
-Watch for change in volume/color/consistency of sputum
-Very common, around 1-3x per year for adults
-Spread via airborne and droplets; higher risk in winter
-Symptoms: begin 2-3 days after infection
Runny nose, watery eyes, nasal congestion, sneezing, Fever
Usual recovery in 7-10 days
Interventions: rest, oral fluids, antipyretics, analgesics
Complications: acute bronchitis, sinusitis, otitis media, tonsillitis
S/S of complications:
-Temp over 103 F, swollen/tender glands, severe sinus or ear pain, significant worsening of sx
-Green purulent drainage is common, not necessarily bacterial
-Watch for change in volume/color/consistency of sputum
69
Influenza
_________ precautions
Incubation period of 1-4 days then quick onset, symptoms last 5-7 days
S/S: Chills, fever, cough, fatigue, sore throat, myalgia (muscle aches), normal breath sounds
Prevention via vaccination and hand hygiene
Children and adults >50 yrs most vulnerable, priority vaccines
Complications: could lead to ____________
Droplet precautions
Incubation period of 1-4 days then quick onset, symptoms last 5-7 days\
S/S: Chills, fever, cough, fatigue, sore throat, myalgia (muscle aches), normal breath sounds
Prevention via vaccination and hand hygiene
Children and adults >50 yrs most vulnerable, priority vaccines
Complications: could lead to pneumonia
70
Influenza
Treatments:
Rest, hydration, analgesics, antipyretics
Antivirals may shorten duration and reduce risk of complications
*Should be started within first ___ days of onset
3 antivirals: Zanamivir, oseltamivir (Tamiflu), peramivir
*Avoid giving with milk, calcium
Treatments:
Rest, hydration, analgesics, antipyretics
Antivirals may shorten duration and reduce risk of complications
*Should be started within first 2 days of onset
3 antivirals: Zanamivir, oseltamivir (Tamiflu), peramivir
*Avoid giving with milk, calcium
71
Sinusitis - Inflammation of the mucosa blocks _______________
Viral: follows URI, usually self resolves in < 14 days
Bacterial: S. pneumoniae, H. influenzae, M. catarrhalis most likely suspects
Inflammation of the mucosa blocks the sinus opening
Viral: follows URI, usually self resolves in < 14 days
Bacterial: S. pneumoniae, H. influenzae, M. catarrhalis most likely suspects
72
Sinusitis
S/S:
Acute: pain, purulent drainage, nasal obstruction, fever, malaise, maxillary tenderness
*follows URI, lasts under 4 weeks
*subacute: progresses over _____ weeks
Chronic: non-specific, afebrile, facial pain, nasal congestion, increased drainage, similar to allergies
* > ___ weeks of persistent infection
Treatment: broad spectrum abx over longer time, possibly nasal endoscopic tx
S/S:
Acute: pain, purulent drainage, nasal obstruction, fever, malaise, maxillary tenderness
*follows URI, lasts under 4 weeks
*subacute: progresses over 4-12 weeks
Chronic: non-specific, afebrile, facial pain, nasal congestion, increased drainage, similar to allergies
* >12 weeks of persistent infection
Treatment: broad spectrum abx over longer time, possibly nasal endoscopic tx
73
Acute Pharyngitis - Inflammation of the pharynx → sore throat
______ (most common)
Bacterial is usually ______ (Beta hemolytic streptococci)
Candidiasis (oral thrush): fungal, can be d/t prolonged use of inhaled corticosteroids
Other causes: dry air, smoking, GERD, allergy w/ post nasal drip, intubation, chemical fumes
Viral (most common)
Bacterial is usually strep (Beta hemolytic streptococci)
Candidiasis (oral thrush): fungal, can be d/t prolonged use of inhaled corticosteroids
Other causes: dry air, smoking, GERD, allergy w/ post nasal drip, intubation, chemical fumes
74
Acute Pharyngitis
S/S:
Scratchy throat, pain w/ swallowing
Bacterial: fever over 100.4 F, lymph node enlargement, tonsillar/pharyngeal exudate, no cough
Fungal: white irregular patches on the oropharynx
Treatment:
Viral: no abx; _________relief
Bacterial: abx to prevent ___________ fever
Candidiasis: nystatin (antifungal abx) rinse in mouth
*can be prevented by rinsing mouth after using inhaled corticosteroids
S/S:
Scratchy throat, pain w/ swallowing
Bacterial: fever over 100.4 F, lymph node enlargement, tonsillar/pharyngeal exudate, no cough
Fungal: white irregular patches on the oropharynx
Treatment:
Viral: no abx; symptom relief
Bacterial: abx to prevent rheumatic fever
Candidiasis: nystatin (antifungal abx) rinse in mouth
*can be prevented by rinsing mouth after using inhaled corticosteroids
75
Peritonsillar Abscess
-Complication of ___________
-B-hemolytic ______
-Pain, swelling, blockage of throat (airway!), fever, muffled voice
-Requires abx and needle aspiration/drainage or emergency tonsillectomy
-Complication of tonsillitis
-B-hemolytic strep
-Pain, swelling, blockage of throat (airway!), fever, muffled voice
-Requires abx and needle aspiration/drainage or emergency tonsillectomy
76
Pneumonia
S/S:
Altered mental status: restlessness, agitation, confusion
Fever: over ______ F/ 38 C
Productive cough “_________ sputum”
Fine or Coarse Crackles
Dyspnea “shortness of breath”
“Walking pneumonia” - may just be SOB - no cough or fever
Pleuritic chest pain (pleural friction rub) → Report to HCP
Sharp chest pain upon inspiration or coughing
Altered mental status: restlessness, agitation, confusion
Fever: over 100.4 F/ 38 C
Productive cough “yellow sputum”
Fine or Coarse Crackles
Dyspnea “shortness of breath”
“Walking pneumonia” - may just be SOB - no cough or fever
Pleuritic chest pain (pleural friction rub) → Report to HCP
Sharp chest pain upon inspiration or coughing
77
Pneumonia 3 causes:
Aspiration
Inhalation
Spread from primary infection elsewhere
78
Pneumonia Risk Factors
>___ y/o
Prolonged ___________
Intubation
Chronic diseases: COPD, diabetes, CV, CKD
Abdominal or chest surgery
NG or OG tube feedings
Smoking, toxic inhalation
URI
Immunosuppressive condition
>65 y/o
Prolonged immobility
Intubation
Chronic diseases: COPD, diabetes, CV, CKD
Abdominal or chest surgery
NG or OG tube feedings
Smoking, toxic inhalation
URI
Immunosuppressive condition
79
Pneumonia prevention:
Pneumococcal vaccine
Influenza vaccine
80
Pneumonia treatment
Abx w/in ___ hrs of ED
PO steroids, albuterol
Fluids, rest, nutrition
Assess for hypoxia
Elevate HOB
Abx w/in 4 hrs of ED
PO steroids, albuterol
Fluids, rest, nutrition
Assess for hypoxia
Elevate HOB
81
Pleural Effusion
Pleural space normally has 5-15 mL of lubricating fluid
Extra fluid = ____________
Transudative: clear (from CHF or liver disease)
___________: infection
___________: collection of purulent fluid
Pleural space normally has 5-15 mL of lubricating fluid
Extra fluid = effusion
Transudative: clear (from CHF or liver disease)
Exudative: infection
Empyema: collection of purulent fluid
82
Pleural Effusion
S/S: dyspnea, cough, sharp pain worse on inhalation, dullness to percussion, diminished breath sounds
Tx: ____________ (aspiration of fluid from pleural space)
-Possible serious complication of procedure: pneumothorax from puncture → deflation of lung (collapse)
S/S: dyspnea, cough, sharp pain worse on inhalation, dullness to percussion, diminished breath sounds
Tx: thoracentesis (aspiration of fluid from pleural space)
-Possible serious complication of procedure: pneumothorax from puncture → deflation of lung (collapse)
83
Tuberculosis
______________ tuberculosis: Gram +, acid-fast, aerobic bacilli
Once inhaled, _________________ response occurs → A Ghon lesion (or Ghon focus) visible on x-ray
Ghon lesion is calcified TB granuloma, hallmark of primary TB infection
Mycobacterium tuberculosis: Gram +, acid-fast, aerobic bacilli
Once inhaled, local inflammatory response occurs → A Ghon lesion (or Ghon focus) visible on x-ray
Ghon lesion is calcified TB granuloma, hallmark of primary TB infection
84
TB Meds and s/e
Isoniazid (INH)
rifampin (Rifadin)
pyrazinamide (PZA)
ethambutol (Myambutol)
Isoniazid (INH) - hepatotoxicity, vomiting, headaches, neuropathy
Rifampin (Rifadin) - hepatotoxicity, thrombocytopenia, orange discoloration of bodily fluids
Pyrazinamide (PZA) - hepatotoxicity, hyperuricemia
Ethambutol (Myambutol) - headache, blurred vision
85
TB Mnemonic
T
B
T - terrible cough - blood tinged
B- bad infection: fever, night sweats, weight loss
85
Mnemonic for TB meds
R
I
P
E
86
Pulmonary Embolism - ____________ moves to lower lungs
Thrombus
86
Lower vs higher specific urine gravity
Low - liquidy
High- dehydrated
87
Higher creatinine levels in blood means
higher renal impairment
87
Upper UTI: Glomerulonephritis
Acute or chronic inflammation of glomeruli; usually affects both kidneys. Results from _______________ injury
Acute or chronic inflammation of glomeruli; usually affects both kidneys. Results from antibody-induced injury
88
Urinary Tract Calculi Nephrolithiasis (kidney stone)
RISK FACTORS: metabolic abnormalities, dietary, climate (increased fluid loss), lifestyle (low fluid intake, sedentary, obesity), occupational
Most common: caused by calcium oxalate: small, often possible to get trapped in the ureter. Increase hydration.
Tx: decrease animal substance intake and calcium supplements, increase calcium found in the diet.
RISK FACTORS: metabolic abnormalities, dietary, climate (increased fluid loss), lifestyle (low fluid intake, sedentary, obesity), occupational
Most common: calcium oxalate: small, often possible to get trapped in the ureter. Increase hydration.
Tx: decrease animal substance intake and calcium supplements, increase calcium found in the diet.
89
Lower UTI: Urethritis
Pathology:
Inflammation of the urethra commonly associated with _____; may occur with cystitis
(inflammation of the bladder)
Men: more associated with __________ or___________ infection
Women: associated with feminine hygiene sprays, perfumed TP or napkins, spermicidal jelly, UTI, or changes in vaginal mucosal lining
Symptoms:
Similar to UTI: clear to mucopurulent (fluid that contains mucus and pus) discharge from penis, dysuria, frequency, urgency
Teaching:
Focus on preventing STIs
Encourage use of latex condoms or abstinence
Minimize spread → notify your sexual partners
Pathology:
Inflammation of the urethra commonly associated with STIs; may occur with cystitis
(inflammation of the bladder)
Men: more associated with gonorrhea or chlamydial infection
Women: associated with feminine hygiene sprays, perfumed TP or napkins, spermicidal jelly, UTI, or changes in vaginal mucosal lining
Symptoms:
Similar to UTI: clear to mucopurulent (fluid that contains mucus and pus) discharge from penis, dysuria, frequency, urgency
Teaching:
Focus on preventing STIs
Encourage use of latex condoms or abstinence
Minimize spread → notify your sexual partners
90
Incontinence causes- Mnemonic
D
R
I
P
Causes:
D for delirium, dehydration, depression
R for restricted mobility, rectal impaction
I for infection, inflammation, impaction
P for polyuria, polypharmacy, (pregnancy)
91
Incontinence 3 types
1. overflow: urethral blockage
- bladder unable to empty properly
2. stress: relaxed pelvic floor
- increased abdominal pressure
3. urge: bladder oversensitivity from infection
- neurological disorders
92
Incontinence Interventions/Education:
_______ exercises, treating the underlying cause, scheduled ______________
Kegel exercises, treating the underlying cause, scheduled bathrooming
93
Benign Prostatic Hyperplasia (BPH)
It occurs in about 50% of men older than age _____________ & ____________________
50 years and 80% of men >80 years.
94
Benign Prostatic Hyperplasia (BPH)
-thickening, growth of tissue resulting in enlargement
-prostate gland increases in size→ disrupts ______________
-exact cause unknown.
-results from endocrine changes r/t aging process
-thickening, growth of tissue resulting in enlargement
-prostate gland increases in size→ disrupts outflow of urine
-exact cause unknown.
-results from endocrine changes r/t aging process
95
An older male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)?
A. High-purine diet
B. Sedentary lifestyle
C. Benign prostatic hyperplasia (BPH)
D. Recent use of broad-spectrum antibiotics
C. Benign prostatic hyperplasia (BPH)
It is a physical obstruction of urethra > urinary stasis > UTI
96
Which nursing diagnosis is a priority in the care of a patient with renal calculi?
A. Acute pain
B. Risk for constipation
C. Deficient fluid volume
D. Risk for powerlessness
A. Acute pain
97
A female patient with a UTI has a nursing diagnosis of risk for infection related to lack of knowledge regarding revention of recurrence. What should the nurse include in the teaching plan instructions for this patient?
A. Empty the bladder at least 4 times a day.
B. Drink at least 2 quarts of water every day.
C. Wait to urinate until the urge is very intense.
D. Clean the urinary meatus with an anti infective agent after voiding.
B. Drink at least 2 quarts of water every day.
98
Which characteristic is more likely with acute pyelonephritis than with a lower UTI?
A. Fever
B. Dysuria
C. Urgency
D. Frequency
A. Fever
99
When admitting a patient with acute glomerulonephritis, it is most important that the nurse ask the patient about:
A. recent sore throat and fever.
B. history of high blood pressure.
C. frequency of bladder infections.
D. family history of kidney stones.
A. recent sore throat and fever.
[often occurs after strep throat]
100
A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient after the procedure, what is an appropriate nursing action?
A. Milk or strip the catheter every 2 hours.
B. Measure ureteral urinary drainage every 1 to 2 hours.
C. Irrigate the catheter with 30-mL sterile saline every 4 hours.
D. Encourage ambulation to promote urinary peristaltic action.
B. Measure ureteral urinary drainage every 1 to 2 hours.
101
In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through
A. the bloodstream
B. the lymphatic system
C. a descending infection
D. an ascending infection
D. an ascending infection
102
When taking a nursing history from a patient with BPH, the nurse would expect the patient to report:
A. nocturia, dysuria, and bladder spasms.
B. urinary frequency, hematuria, and perineal pain.
C. urinary hesitancy, post void dribbling, and weak urinary stream.
D. urinary urgency with a forceful urinary stream and cloudy urine.
C. urinary hesitancy, post void dribbling, and weak urinary stream.
103
A patient who is being given Rifampin, Isonazid, and Pyrazinamide begins having light-colored stools and yellowed skin. This is a sign of?
A. Nephrotoxicity
B. Improved condition
C. Hepatotoxicity
D. An expected adverse effect
C. Hepatotoxicity
104
Which physical assessment finding in a patient with a lower respiratory problem best supports the nursing diagnosis of ineffective airway clearance?
A. Basilar crackles
B. Respiratory rate of 28
C. Oxygen saturation of 85%
D. Presence of greenish sputum
A. Basilar crackles
The presence of adventitious breath sounds indicates that there is accumulation of secretions in the lower airways. This would be consistent with a nursing diagnosis of ineffective airway clearance because the patient is retaining secretions. The rapid respiratory rate, low oxygen saturation, and presence of greenish sputum may occur with a lower respiratory problem, but do not definitely support the nursing diagnosis of ineffective airway clearance.
105
The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement made by the patient indicates that teaching was effective?
“I will avoid being outdoors whenever possible”
“My husband will be sleeping in the guest bedroom”
“I will take the bus instead of driving to visit my friends”
“I will keep the windows closed at home to contain the germs”
“My husband will be sleeping in the guest bedroom”
Teach the patient how to minimize exposure to close contacts and household members. Homes should be well ventilated, especially the areas where the infected person spends a lot of time. While still infectious, the patient should sleep alone, spend as much time as possible outdoors, and minimize time in congregate settings or on public transportation.
106
The school nurse is providing information to high school students about influenza prevention. What should the nurse emphasize in teaching to prevent the transmission of the virus (select all that apply)
Cover the nose when coughing
Obtain an influenza vaccination
Stay at home when symptomatic
Drink non-caffeinated fluids daily
Obtain antibiotic therapy promptly
Cover the nose when coughing
Obtain an influenza vaccination
Stay at home when symptomatic
Covering the nose and mouth when coughing is an effective way to prevent the spread of the virus. Obtaining an influenza vaccination helps prevent the flu. Staying at home helps prevent direct exposure of others to the virus. Drinking fluids helps liquefy secretions but does not prevent influenza. Antibiotic therapy is not used unless the patient develops a secondary bacterial infection.
107
A patient is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which question is most important for the nurse to ask the patient?
“Have you recently had strep throat?”
“Do you have susceptibility to allergies?”
“How much fluid do you drink a day?”
“Have you had any contact with anyone who has measles?”
“Have you recently had strep throat?”
Glomerulonephritis is an inflammatory process, usually resulting from antibodies reacting with group A hemolytic streptococcal antigens, the organism responsible for strep throat. Allergies, fluid intake, and measles exposure are not germane to the diagnosis of acute glomerulonephritis.
108
Specific Gravity:
1.003-1.030
109
Urine pH:
4.6-8
110
normal urinalysis:
Negative for:
bilirubin, blood, acetone/ketones, proteins, bacteria, epithelia cells, hyaline casts, WBCs (leukocyte esterase)
111
WBCs
5,000-10,000 mm3
112
Neutrophils
55-70%
113
BUN
10-20 mg/dl
114
Creatinine
0.6 - 1.2 mg/dl
