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Nur 111 > Week 6 > Flashcards

Week 6 Flashcards

1
Q

Elimination

A

removal, clearance, or separation of matter

excretion of waste product

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2
Q

how does the human body eliminate waste

A

through skin, kidneys, lungs, and intestines

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3
Q

Bowel elimination

A

the process of expelling stool (feces)

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4
Q

a term used to describe the process of bowel elimination

A

defecation, defecate, or bowel movement

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5
Q

urine elimination

A

the process of expelling urine

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6
Q

what terms is used to describe urine elimination

A

micturition

urination

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7
Q

continence

A

the purposeful control of urinary or fecal elimination

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8
Q

impaired elimination

A

one or more problem associated with the elimination process

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9
Q

anuria

A

absence of urine

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10
Q

dysuria

A

painful urination

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11
Q

polyuria

A

multiple episode of urination (diabetes)

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12
Q

urinary frequency

A

multiple episodes of urination with little urine produced in a short period of time.

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13
Q

urinary hesitancy

A

the urge to urinate exists, but the person has difficulty starting the urine stream

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14
Q

Kidney’s role in elimination

A

removal of metabolic waste and other element from the blood in the form of urine

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15
Q

what is the role of the gastrointestinal tract in the process of elimination

A

responsible for the removal of digestive waste in the form of stool

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16
Q

urinary elimination involve what structures?

A

the kidney

ureters

bladder

urethra

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17
Q

main functional unit of the kidneys?

A

the nephron

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18
Q

nephron

A

the main functional unit of the kidney

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19
Q

what are the nephron composed of?

A

blood vessels and renal tubules

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20
Q

formation of urine involves what 3 processes

A

glomerular filtration

tubular reabsorption

tubular secretion

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21
Q

where does the blood enter the kidney?

A

renal artery then branches into smaller arteries, arterioles, and finally a cluster of capillary known as glomerulus

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22
Q

glomerulus

A

semi-permeable membrane that serves to filter the blood into a C-shape structure of the renal tubule know as the Bowman’s capsule

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23
Q

what represent the beginning of urine formation

A

glomerular filtration

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24
Q

what does filtrate contain

A

water

electrolyte

waste

all removed blood

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25
Q

what does the filtrate pass through?

A

a sequence of renal tubules (Bowman’s capsule to the proximal convoluted tubule, the loop of Henle, and the distal convoluted tubule.

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26
Q

where does the water in the filtrate gets absorb?

A

a network of capillaries surrounding the renal tubules reabsorb most of the water, electrolytes, and other necessary element back into the blood.

also known as tubular reabsorption

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27
Q

tubular secretion

A

secondary process in which substances (potassium, hydrogen, ammonia, and drugs) moved from the blood in the capillaries surrounding the tubules into the tubules.

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28
Q

the amount of electrolytes reabsorbed into the blood or exreted int he renal tubules is controlled by what hormones?

A

aldosterone

antidiuretic hormone

parathyroid hormone

renin

atrial naturiuretic factor

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29
Q

after the renal tubules, where does the urine go?

A

moves into the collecting duct and then into the renal pelvis, the ureter, and the bladder where it is stored until urination occur

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30
Q

how many mL does the bladder hold in adults?

A

300 to 500 mL

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31
Q

what does pressure in the bladder stimulate?

A

stimulate stretch receptors in the bladder wall

receptors send impulses through the spinal cord to signal the need for urination.

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32
Q

what prevents urine from leaking out of the bladder?

A

internal sphincter, composed of involuntary smooth muscle

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33
Q

external sphincter

A

located below the internal sphincter and surrounding upper urethra

made of voluntary skeletal muscle

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34
Q

micturition reflex

A

cause the internal sphincter to relax and the bladder wall to contract.

relaxation of the external sphincter, urine pass through the urethra.

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35
Q

continence

A

control of urinary control

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36
Q

what is the function of the gastrointestinal system?

A

breakdown and absorption of nutrient from food ingested and the elimination of waste in the process

extends from mouth to the anus

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37
Q

what is the first part of the GI tract consist of?

A

mouth, esophagus, stomach, and small intestine

involved in digestion and absorption of nutrients

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38
Q

what other organ is also included in digestive organ?

A

liver

gall bladder

pancreas

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39
Q

where does waste formation occur

A

in the colon

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40
Q

what are waste product called

A

stool or feces

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41
Q

what is waste product made of?

A

water

bile

undigested food matter

unabsorbed mineral

bacteria

mucous

epithelial cells from the lining of the intestine

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42
Q

what helps fecal matter move through the GI tract?

A

smooth muscle within intestinal tract stimulate peristalsis

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43
Q

how long is the large intestine?

A

5 or 6 feet long and 2 inches in diameter

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44
Q

how many part is the large intestine made of?

A

(4) cecum (appendix)
colon
rectum
anus

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45
Q

what is the function of the large intestine?

A

absorb water and electrolyte as fecal matter move through its walls

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46
Q

what helps lubricate the walls in the intestine?

A

mucus

help aid in expulsion of the stool

if excessive peristalsis and stool move through quickly, less water is absorbed resulting in loose stool

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47
Q

defecation

A

process of expelling stool

involves voluntary and involuntary muscle

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48
Q

at what age do children be able to identify the urge to urinate and defecate?

A

18 to 24 months

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49
Q

when are children ready to potty train

A

2-3 years

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50
Q

what age does renal bloodflow reduce?

A

80 years

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51
Q

how much is bloodflow reduced to in later years?

A

600mL

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52
Q

reason why nephron function is reduced to 50%?

A

change in the size of the kidney due to age and sclerosis

absence of disease, reduction in renal reserve makes older adult more susceptible to electrolyte imbalace and kidney damage due to medications

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53
Q

what happen to bladder due to age?

A

bladder retains tone

volume of urine decrease causing urine frequency

urethra becomes weak, increase risk of incontinence

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54
Q

what happens to bowel due to age?

A

atrophy of smooth muscle layer in colon reduced mucous secretion

reduced tone of internal and external sphincter

reduced neural implulses, more susceptible to constipation or incontinence.

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55
Q

what contributes to urinary and GI function?

A

incontinence

retention

discomfort

infection

inflammation

neoplasms

organ failure

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56
Q

incontinence

A

loss of control of either urine or bowel elimination

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57
Q

what does incontinence lead to?

A

skin break down

changes in daily activity, functional activity, and social relationship

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58
Q

urinary incontinence

A

disruption in the storage or emptying of the bladder with involuntary release of urine usually associated with dysfunction of the external and/or internal urinary sphincters

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59
Q

fecal incontinence

A

involuntary passage of stool and ranges from an occasional leakage of stool while passing gas to complete loss of bowel control

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60
Q

retention

A

unintentional retention of urine or stool

associated with obstruction, inflammation, or ineffective neuromuscular activation within the bladder or GI tract

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61
Q

type of incontinent

A

stressed -leakage of small amount during physical movement

urge-large amt unexpected at times, including sleep

overactive bladder- frequency and urgency with or without urge incontinence

functional- untimely urination because of physical disability, external obstacle, or cognitive

overflow- leakage due to full bladder

mixed- stress and urge incontinence together

transient - leakage the will temporarily passed (infection or taking new med)

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62
Q

what happens as a result of constipation?

A

difficult passage of hard, dry stool

loss of appetite

discomfort

fecal impaction

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63
Q

largest cavity in the human body?

A

abdominal cavity

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64
Q

what does the abdominal cavity contain?

A
  1. stomach
  2. small/large intestine
  3. liver
  4. gall bladder
  5. pancreas
  6. spleen
  7. kidneys
  8. ureters
  9. bladder
  10. adrenal glands
  11. major vessels
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65
Q

what is the abdominal lining called

A

peritoneum

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66
Q

what is the peritoneum made of?

A

serous membrane forming a protective cover.

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67
Q

how many layers is the peritoneum divided into?

A

two:
parietal peritoneum - lines abdominal wall

visceral peritoneum - covers organs

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68
Q

what is the space between the parietal peritoneum and the visceral peritoneum called?

A

peritoneal cavity

contains small amount of serous fluid to reduce friction between abdominal organs

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69
Q

what muscle is found in the anterior border of the abdomen

A

rectus abdominis

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70
Q

what is found on the posterior border?

A

the vertebral column and lumbar muscle

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71
Q

what provides lateral support to the stomach

A

internal and external oblique muscle

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72
Q

what muscle lies under the oblique?

A

transverse abdominis

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73
Q

Linea alba

A

a tendinous band that protect the midline of the abdomen between the rectus abdominis muscle.

extends from xiphoid process to symphysis pubis

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74
Q

how long is the alimentary tract

A

27 feet

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75
Q

what does the alimentary tract include?

A
  1. mouth
  2. esophagus
  3. stomach
  4. small/large intestine
  5. rectum
  6. anal canal
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76
Q

what is the main function of the alimentary tract?

A

ingest and digest food

absorb nutrients, electrolyte, and water

excrete waste products.

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77
Q

peristalsis

A

controlled by ANS and wave-like movements that moves food along the digestive tract

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78
Q

where does the breakdown of carbs begin?

A

in the mouth

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79
Q

how long is the esophagus?

A

about 10 inches

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80
Q

what does the esophagus connect?

A

connect the pharynx to the stomach

found posterior to the trachea

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81
Q

what is used to breakdown protein and fats in the stomach?

A

digestive enzymes and hydrochloric acid

turns food into chyme and propels it to the duodenum

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82
Q

what is the pH of the stomach?

A

2.0-4.0

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83
Q

what regulates outflow of chyme into the duodenum

A

pyloric sphincter

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84
Q

what produce bowel sounds?

A

the movement of air and fluid through he stomach and small/large intestine.

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85
Q

what is the largest alimentary tract?

A

small intestine

about 21 feet.

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86
Q

where does the small intestine begin and end?

A

pyloric orifice and the ileocecal valve

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87
Q

what are the 3 segment of the small intestine?

A

duodenum(1 foot), jejunum (8 feet), and ileum (12 feet)

with pH of 6.0-7.4

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88
Q

how long is the large intestine?

A

5 feet

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89
Q

what is the large intestine consist of?

A

cecum
appendix
colon
rectum
anal canal

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90
Q

how many parts is the colon divided into

A

ascending colon
transverse colon
descending colon

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91
Q

what is the end of the colon called?

A

sigmoid colon

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92
Q

what connects the sigmoid colon and the pelvic floor

A

rectum

with a pH of 6.7

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93
Q

where does the ileal content empty into?

A

the cecum (beginning of large intestine

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94
Q

what does the large intestine absorb?

A

water and electrolytes

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95
Q

what are the accessory organs of the GI tract?

A

salivary gland
liver
gall bladder
pancreas

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96
Q

what is the largest organ in the body?

A

the liver which weighs 3.5 pounds and found under diaphragm

divided into right and left lobe

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97
Q

what is the function of the liver?

A
  1. bile production and secretion
  2. production of clotting factors and fibrinogen
  3. synthesis of most plasma proteins (albumin and globulin)
  4. detoxification of a variety of substances, including drugs and alcohol
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98
Q

what is the function of the gall bladder?

A

store biles produced by the liver (found inferior of liver)

the cystic duct combine with the hepatic duct form the common bile duct and drains into duodenum

bile gives stool brown color

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99
Q

what is the function of the pancreas

A

endocrine secretion- release insulin, glucagon, somatostatin, and gastrin for carb metabolism

exocrine secretion- bicarbonate and pancreatic enzyme that flow to duodenum.

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100
Q

what does lipase do?

A

break down fat

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101
Q

what does amylase do?

A

break down carbohydrate

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102
Q

what does protease do?

A

break down protein

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103
Q

what is the function of the spleen?

A

removal of old or agglutinated erythrocytes and platelets

activation of B and T lymphocytes

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104
Q

what is the spleen made up of ?

A

white pulp - lymphatic nodules and diffuse lymphatic tissue

red pulp -venous sinusoids

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105
Q

what does the urinary tract include?

A

kidneys
ureters
urinary bladder
urethra

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106
Q

where are the kidneys located

A

posterior abdominal wall on either side of the body

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107
Q

what is the function of the kidneys?

A

secretion of erythropoietin to stimulate red blood cell production and production of a biologically active form of vitamin D

nephrons regulate fluids and electrolyte balance through microscopic filter and pressure system to eventually produce urine.

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108
Q

what does antacid do?

A

neutralize acidity (hydrochloric acid)
lower pepsin activity
raise the gastric pH which inactivates pepsin

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109
Q

what are the 4 types of antacid?

A

non systemic antacid:
aluminum compound
magnesium compound

systemic antacid:
calcium compound
sodium compound

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110
Q

what does accessive amount of sodium bicarbinate do?

A

cause metabolic alkalosis

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111
Q

what does excessive calcium carbonate do?

A

cause hypercalcemia

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112
Q

what does aluminum hydroxide do?

A

cause constipation

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113
Q

what does magnesium hydroxide do?

A

cause diarrhea

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114
Q

what is aluminum hydroxide’s absorption?

A

minimal absorption through intestine

in feces binds to phosphate; small amount in urine

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115
Q

where is calcium bicarbonate absorbed?

A

occurs mostly in duodenum and depends on calcitriol and vitamin D. Food increases absorption by 10-30%.

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116
Q

what does pepsin do?

A

cause mucosal damage.

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117
Q

what is a contraindication of antacid?

A

electrolyte imbalance
renal failure
GI obstruction due to antacide stimulating motility

118
Q

contraindications and precautions for aluminum hydroxide?

A

contra: hypersensitivity to aluminum products and hypophosphatemia

precaution: hepatic and renal disease, older adults, children and pregnancy

119
Q

contraindications and precautions for Magnesium hydroxide?

A

contra: GI obstruction
precaution: myasthenia gravis, renal impairment, diarrhea, and older adults

120
Q

contraindications and precautions for calcium carbonate?

A

contra: none
precaution: renal impairment, hypercalcemia, and hypothyroid disease

121
Q

aluminum hydroxide dosage

A

adult 600-1200 mg PO QID
between meals and at bedtime

122
Q

magnesium hydroxide dosage

A

adult: 400-1200 PRN quid

123
Q

Calcium carbonate

A

adult: 500-3000 mg PO prn

124
Q

Absorption of glucocorticoid

A

depends on the route of administration

intended to exert a localized effect in the lungs

can cause systemic effects if swallowed

minimal oral bioavailability of 1%

fluticasone propionate has <1%, budesonide 11%, flunisolide 20%

oral admin. absorption is rapid and nearly complete

IM depends on glucocorticoid-some immediately while others longer time for absorption

depends on the salt in which med is combined

125
Q

destribution of glucocorticoids

A

highly protein bound, but depends on specific drug

126
Q

metabolism of glucocorticoid

A

metabolized primarily by the liver, resulting are inactive

127
Q

excretion of glucocorticoid

A

metabolite in renal

128
Q

mechanism of glucocorticoid

A

exert antiinflammatory action to decrease asthma symptoms

block luekotrienes, histamines, and prostaglandins

block infiltration of esoinophils and leukocytes-mediator in inflammatory process

reduce permeability to yield reduction in edema in the airway.

reduce hyper activity and mucus production in the airway.

129
Q

duration of glucocorticoid

A

depends on dosage, route, and drug solubility.

IV determined by half life
IM by water solubility-high solubility mean shorter duration; less solubility means longer duration

fluticasone half life is 7.8 to 10 hours; onset and peak unknown. duration is 24 hours

130
Q

Leukotriene modifier

A

need if glucocorticoid does no provide adequate symptom management

131
Q

absorption of leukotriene

A

montelukast bioavailability is 64% oral

zafirlukast is rapid-food decrease 40%; administered 1h AC or 2 hours PC

zileuton is rapid with presence and absence of food

132
Q

Distribution of leukotreine

A

montelukast high bound >99 to plasma protein

zafirlukast is highly bound>99% to plasma protein

zileuton is 93% bound to protein

133
Q

metabolism of leukotriene

A

montelukast by hepatic cytochrome p450 enzyme

zafirlukast undergo hepatic metabolism

zileuton metabolize by liver

134
Q

excretion of leukotriene

A

montelukast is excreted in bile

zafirlukast is fecal excretion

zileuton excreted in urine

135
Q

leukotriene subclass

A

first is zileuton
indirect mechanism that inhibit enzyme 5-lipoxygenase which leukotriene needs for synthesis

second is montelukast zifirlukast
directly bind to D4 leukotriene receptors in lungs and circulating immune cells.

result induce inflam response- which prevent smooth muscle contraction of bronchial airway, reduce mucous secretion and decrease vascular permeability

136
Q

pharmacodynamic profile of leukotriene

A

montelukast has 0.5 hours onset; 3-4 hours peak and last for 24 hours and has half life of 2.7 to 5 hours

zafirlukast onset unknown; peak 3 hours; duration unknow and has 8-16 hours half life

zileuton onset unknown; peak 1.7 hours and duration is 2.5 hours and half life unknown

137
Q

beta2-adrenergic agonist

A

cause bronchodilation in chronic and acute asthma patient.

short acting beta agonists/ long acting beta agonists/ oral beta agonists

138
Q

most commonly used beta2-adrenergic agonist

A

albuterol - short acting beta2 adrenergic agonist
salmeterol- long acting adrenergic agonist

139
Q

absorption for adrenergic agonist

A

albuterol has 105-20% bioavailability when inhaled and low systemic levels

salmeterol has little systemic absorption

140
Q

distribution of adrenergic agonist

A

albuterol is unknown
salmeterol is 96% protein bound

141
Q

metabolism of adrenergic agonist

A

albuterol metabolize in gastointestinal tract by the enzyme sultia3

salmeterol is metabolize by hydroxylation with involvment by CYP3A4

142
Q

excretion of adrenergic agonist

A

albuterol undergo renal excretion

salmeterol is excreted in feces

143
Q

when is beta2 adrenergic agonist used

A

short acting beta 2 adrenergic agonist is used in acute phase of asthmatic attack to reduce airway constriction and restore airflow

long-acting beta 2 adrenergic agonist are used in the chronic management of airway symptoms

144
Q

albuterol pharmcodynamic

A

has an immediate onset of action when inhaled. peaks at 10-25 min after administration and last 3-4 hours with a plasma half-life of 3-4 hours. dosed based on symptoms

145
Q

salmerterol pharmacodynamic

A

salmeterol onset of action and peak plasma concentration depends on if the patient has asthma or COPD.

asthma begins to work in 5-48 minutes peaking at 3-4.5 hours. salmuter half life is 5.5 hours and last for 12 hours. allowing for twice daily dosing.

146
Q

anticholinergic type

A

short acting (Ipratropium) and long acting choloinergic (tiotropium)

147
Q

absorption of anticholinergics

A

Ipratropium-after inhalation is deposited in the GI tract and lungs. drug is quaternary amine so it does not readily absorb in systemic circulation

Tiotropium-after inhalation bioavailabilty is 19.5%

148
Q

distribution of anitcholinergic

A

Ipratropium is minimal protein bound

tiotropium is protein bound

149
Q

metabolism of antiholinergics

A

ipratropium undergo partial metabolism to inactivate ester hydrolysis product

tiotropium metablism is minimal. fraction of drug ungergoes CYp 450 oxidation and glutathion conjugation

150
Q

excretion of anticholinergic

A

Ipratropium from IV admin is in urine

Tiotropium is mainly in urine

151
Q

Theophylline

A

class of drug known as methyxanthine, including caffeine

sustained release is slow but plasma level is stable than the immediate release.

absorption is affected by food

40% prtoein bound

metabolize in liver; half life in plasma varies

half life of theophylline is excreted in adults unchanged and in noenate only 10% unchanged. which requires careful monitoring

blood level monitored. dosage adjusted level for peds is 5 and 15mcg/mL and adults 10 and 20 mcg/mL

therapeutic is narrow.

152
Q

Therapeutic use of Theophylline

A

used with chronic stable asthma with inadequate symptom improvement of other treatment

modest bronchodialtor effect in stable COPD and may be combined with beta 2 agonist for greater clinical effects.

153
Q

Mechanism of Theophylline

A

relax bronchial smooth muscle to yield bronchodiolation. suppress airway stimuli and increase contractual force of diaphragm muscle.

onset is unknown. peaks at 1-2 hours
half life of 7-9 hours and last for 12 hours

154
Q

epigastrium

A

pancreas

155
Q

umbilical

A

small intestine

156
Q

hypogastric

A

bladder, uterus

157
Q

right hypochondriac

A

liver, glass bladder

158
Q

left hypochondriac

A

spleen

159
Q

right lumbar

A

ascending colon

160
Q

left lumbar

A

descending colon

161
Q

right inguinal

A

overy, ureter, appendix

162
Q

left ingunal

A

overy, ureter

163
Q

what is used to ascultate the abdomen

A

the diaphragm for frequeny and character of bowel sounds

164
Q

what are the liver and spleen auscultated for?

A

friction rub

165
Q

what is the bell of the stethoscope used for?

A

vascular sounds, including bruits and venous hums

166
Q

when inspecting the abd, which surface characteristics would the nurse observe?

A

striae
lesions and scars
tautness
venous return

167
Q

which region of the abdomen would the nurse palpate the pancreas

A

epigastric

168
Q

om auscultation, which elements of a patient’s bowel sound should be assessed

A

frequency and character

169
Q

over which abdomen structure should the nurse auscultate for friction rubs

A

liver
spleen

170
Q

ascites

A

presence of fluid

171
Q

percussion is used to assessed what element of abdominal examination

A
  1. size and density (liver, spleen, kidneys, gastric bubble)
  2. presence of ascites
  3. presence of gatric distention (air)
  4. presence of fluid-filled or solid masses
172
Q

why do the nurse palpate abdomen for

A

temperature
texture
presence of masses
vascular thrills

173
Q

what does the nurse palpation assess for

A

location
size
shape
consistency
tenderness
pulsation
mobility
movement with respiration

174
Q

what organ can be felt as masses

A

liver
gallbaldder
spleen
left and righ kidneys
aorta
urinary bladder

175
Q

light palpation

A

texture of skin
presence of masses
tenderness
muscle rigidity

use palmar surface of fingers and depressing the abdominal wall 1 cm with light, even, circular motion

176
Q

moderate palpation

A

abdomen is soft or rigid
reveals presence of tenderness

use palmer surface of fingers

177
Q

deep palpation

A

used to palpate liver
differentiate abdominal organs from pathologic masses

bimanual technique used, exerting pressure with the top of the hand and concentrating on sensation with the bottom hand

178
Q

palpate around umbilicus

A

umbilical rign is incomplete or soft in center

179
Q

palpate the liver

A

is edge palpable and repeat medially and laterally to the costal margin

180
Q

palpate gallbladder

A

below margin at the lateral border of the rectus abdominus muscle for tenderness in the area.

181
Q

palpate spleen

A

place right hand on the abdomen below the left costal margin and gently pressing fingertips inward while the patient take a deep breath.

patient lying on the right side and hip and knee flexed

182
Q

palpate kidneys

A

place hand over flank, then place other hand at the coastal margin. while patient exhales, the nurse should elevate the hand on the flank and palpate deeply with the other hand

palpate for texture and character of kidneys

tenderness in the flank area

183
Q

palpate the bladder

A

done over suprapubic area for distention and tenderness

184
Q

palpation of aorta

A

palpate left of midline, feeling for aortic pulsation

alternate - place palmer surface of hand on the midline and press deeply inward on each side of the aorta, feeling for pulsation

can used one hand with thumb and fingers on either side of the aorta

185
Q

the nurse percuss the abdomen to obtain which information

A

presence of masses
presence of ascites
gastric distention
size of organ

186
Q

which abdominal structures are assessed through percussion

A

splee
liver
kidneys

187
Q

which type of palpation is necessary to delineate abdominal organs and detect masses?

A

deep palpation

188
Q

alvarado score

A

eval migration of pain, anorexia, nausea/vomiting, tenderness in lower quad, rebound pain, temp. leukocytosis, and left shift

used to diagnosis appendicitis in both children and adult

189
Q

pediatric sppendicitis score

A

eval pain with cough or hopping or rebound tenderness with the percussion of the RLQ

190
Q

Ohmann score

A

use patient age, history, and physical exam and laboratory finding to identify risk of appendicitis

191
Q

rebound tenderness (McBurney Sign)

A

press gently on abdomen, then rapidly withdraw hands and fingers and note if pain increase when hand is released

192
Q

iliopsoas muscle test

A

patient raise right leg from hip while nurse press downward against it. then extend right leg by drawing backward with the patient lying on their left side

indicate irritation of the iliopsoas muscle and appendicitis

193
Q

Obturator muscle test

A

patient lying supine, patient flex right leg at hip to 90 degree and rotate leg medially, then laterally. Pain in right hypogastric region indicate irritation of obturator muscle, a rupture appendix or pelvic mass

194
Q

Ballotement

A

nurse place extended fingers, hand, and forearm at 90n degree angle to the abdomen and pushes toward the organ or mass with fingertips. if mass freely moveable, it will float upward and touch fingertip as fluid and other structure are displaced

assess a mass

195
Q

how should the nurse assess for ascites

A

look for fluid wave
identifying shifting dullness on percussion

196
Q

which test should be performed if the nruse suspects a rupture appendix

A

obturator muscle test

197
Q

ausculatio of bowel sound

A

5-35 irregular clicks and gurgles per minutes

Borborygmi (increased sounds) may be present with hunger

198
Q

ausculate vascular assessment

A

done over arota, renal, artery, iliac artery, and femoral artery using the bell of stethoscope
Liver and spleen
silent
no bruits, venous hum, friction rub

199
Q

percussion of abdomen

A
  1. tympany as the predominant sound
  2. dullness over organs and solid masses
  3. dullness over suprapubic region from distended bladder
  4. lower border of liver beginning as costal margin
  5. upper border of the liver beginning at the 5th or 6th intercostal space
  6. liver span abouit 6-12 cm
  7. spleen small area of dullness from 6th - 10th rib with typmpany before and after deep breath
  8. stomach: tympany of gastric bubble
200
Q

which finding regarding movement would be considered normal on inspection of the abdomen

A

smooth movement
even movement

201
Q

pulsation

A

an abnormal finding and indicate increased pulse pressure or an aortic aneurysm

202
Q

limited movement

A

abnormal finding and may indicate peritonitis

203
Q

rippling movement

A

may be seen in thin individuals but often abnormal, suggesting intestinal obstruction

204
Q

auscultation of the abdomen, which findings related to bowel sounds would be considered normal

A

gurgles
clicks
irregular

205
Q

high pitch tinkling bowel sound

A

irregular finding and may suggest an early obstruction

206
Q

absense of bowel sound

A

irregular finding and is a medical emergency

207
Q

verticle span of th eliver is expected to be 6 to ___ cm

A

12

208
Q

on palpation of a patient’s umbilical ring, the nurse notes slight granulation but no bulges or nodules. additionally, the umbilical ring is round and slightly inverted. which finding are considered normal

A

lack of bulges
lack of nodules
round umbilical ring
inverted umbilicle ring

209
Q

which finding would be considered normal on inspection of the abdomen of an infant

A

dome shape

210
Q

on auscultatio of infant’s abdomen, peristalsis should be heardhow often

A

10-30 seconds

211
Q

how are the palpation findings of older adults different from those of younger patients?

A

softer due to decrease muscle tone and mass

212
Q

which normal finding in older adults predispose this patient population to intestinal disorders

A

decrease intestinal motility

213
Q

peritoneum

A

abdominal lining

serous membrane forming a protective cover

214
Q

parietal peritoneum

A

line abdominal walls

215
Q

viscerla peritoneum

A

covers organsp

216
Q

peritoneal cavity

A

space between parietal and visceral layer

contains serous fluid that reduces friction between organs and membranes

217
Q

pepsin

A

break down protein to peptone and amino acid

218
Q

gastric lipase

A

emulsify fats
triglycerides to fatty acis or glycerol

219
Q

pH of stomach

A

2-4

220
Q

what system control peristalsis

A

Autonomic nervous system

221
Q

nephrons

A

functional units of the kidneys

remove waste products from blood

regulatio of fluids and electrolyte balance

222
Q

protenuria

A

protein in urine

suspected injury to glomerulus

223
Q

hematuria

A

blood in urine

224
Q

glomerular filtrate

A

excreted as urine

99% reabsorbed into the plasma by proximal convuluted tubules, the loope of Henle, and distal convuluted tubles.

1% excreted as urine

225
Q

normal range of urine production

A

1-2 L/day

226
Q

what factors influence production of urine

A

fluid intake and temperature

227
Q

Erythropoietin

A

produced by kidneys
stimulate red blood cell production and maturation in bone marrow

228
Q

renin-angiotensin system

A

renin released from juxtaglomerular as enzyme to convert antiotensinogen (synthesized by liver) into angiotensin I. and Angiotensin II (in lungs) causes vasoconstriction and stimulate aldosterone release from adrenal cortex.

aldosterone cause retention of water which increase blood volume and blood pressure

229
Q

prostaglandin and prostacyclin

A

maintain renal blood flow through vasodilation

increase arterial blood pressure and renal blood flow

230
Q

kidney impairment

A

problems with anemia, hypertension, and electrolyte imblance

231
Q

ureters

A

attached to each kidneys and carry urine from kidney pelvis to bladder

urine drainage from ureter to bladder is sterile

232
Q

contraction of bladder

A

compress lower part of ureters to prevent backflow into ureters

233
Q

urinary reflux

A

backflow of urine into the ureters

234
Q

hydroureter/hydronephrosis

A

distention of pelvis of kidney due to backflow

cause permanent damage to sensitive kidney structures and functions

235
Q

bladder

A

lies in pelvic cavity behind symphysis pubis

has two part: trigone–fixed base
detrusor-distensible body

236
Q

pressure in bladder

A

remains low while filling, preventing backflow

237
Q

urethra

A

passes through thick layer of skeletal muscle called pelvic floor muscles

238
Q

pelvic floor muscle

A

stabilize the urethra and contribute to urinary continence

239
Q

external urinary sphincter

A

made up of striated muscles

contribute to voluntary control over the flow of urine

240
Q

female urethra

A

3-4 cm (1-1 1/2 inches) long

241
Q

male urethra

A

18-20 cm (7-8 inches) long

242
Q

urination

A

process of bladder emptying

also known as micturation and voiding

243
Q

bladder fills

A

400-600 mL

244
Q

urinary retention

A

inability to empty the bladder partially or completely

245
Q

acute or rapid onset urinary retention

A

stretches bladder causing feeling of pressure, discomfort/pain, tenderness over symphysis pubis, restlessness, and sometimes diaphoresis

no urine output over several hours

frequency, urgency, incontinence, sensation of incomplete emptying

246
Q

postvoid residual (PVR)

A

amount of urine left in the bladder after voiding and is measured with ultrasonography or straight cath

247
Q

overflow incotinence

A

incontinence caused by urinary retension

pressure in bladder exceeds the ability of the sphincter to prevent passage of urine, and the patient will dribble urine

248
Q

transient incontinence

A

cause by medical condition and in many cases are treatable and reversible

249
Q

Functional incontinence

A

loss of continence because of cause outside urinary tract

due to altered mobility, cognitive impairment, environmental barriers

250
Q

stress urinary incotinence

A

involuntary leakage of small volume of urine associated with increased intraabdominal pressure related to either urethral hypermobility or an incompetent urinary sphincter, weak pelvic floor muscles, trauma after childbirthu

251
Q

urge or urgency incontinence

A

passage of urine often associated with strong sense of urgency related to overactive bladder cuased by neurological problems, bladder inflammation, or bladder outet obstruction

252
Q

reflux urinary incontinence

A

loss of urine occuring at somewhat predictable intervanls when patient reaches specific bladder volume related to spinal cord damage between c1 and s2

253
Q

bacteriuria

A

bacteria in urine

can be asymptomatic bacteriuria

254
Q

pyelonephritis

A

upper UTI

255
Q

bacteremia

A

life-threatening bloodstream infection

256
Q

dysuria

A

burning or pain with urination

257
Q

cysitis

A

irritation of the bladder

258
Q

cauti

A

catheter associated urinary tract infection

most common hospital acquired infection

259
Q

urinary incontinence

A

complaint of involuntary loss of urine

260
Q

Types of UI

A

urgency
stressed
overflow

261
Q

cystectomy

A

bladder removal

262
Q

urinary diversion

A

procedure that diverts urine to the outside of the body through an opening in the stomach wall called a stoma

263
Q

oxybutynin

A

antimuscarinic agent

treatment of urinary urgency

cause dry mouth, constipaton, and blurred vision

cause congnitive impairment

264
Q

nitrofurantoin

A

antibiotic used to treat UTI

265
Q

Nethanechol

A

used to treat urinary retention

cause nausea, vomiting, diarrhea, and increase salivation

266
Q

phenazopyridine

A

analgesiac

patient with painful urination associated with uti

turn urine orange

267
Q

a patient who undergone urological surgery is prescribed cath. which diameter of cath does the nurse anticipate to used for this patient

A

greater than 16 Fr

268
Q

patient has a full bladder, and is having difficulty voiding. which instruction would the nurse provide patient?

A

use crede method

put pressure on the suprapubic area with each attempted void. relax sphincter

269
Q

post op patient has not voided for 6 hours which method would benefit in assisting patient to void

A

standing at bedside
man void more easier in standing position

270
Q

squatting position when voiding does what in female

A

promotes compete bladder emptying

271
Q

overflow UI

A

characterized by nocturia, frequency and distended bladder on palpation

272
Q

instruction regarding bladder training would be included in the teaching plan for the family of a patient who is incontinent because of a stroke

A

offer patient the commode or urinal every 2 hours

273
Q

positive keytones in urine

A

keytone is byproduct when body use fat for energy production

starvation
dehydration
uncontrolled diabetes mellitus

274
Q

UTI infection

A

symptoms dysuria, urgency, frequency, and nocturia

275
Q

normal patient should consume how much fluid

A

2300 mL

276
Q

ventilation

A

movement of air from the atmosphere thorugh the upper and lower airway to the alveoli

277
Q

respiration

A

process where gas exchange occurs at the alveolar-capillary memnrane

278
Q

perfusion

A

involves blood flow at the alveolar-capillary bed

279
Q

diffusion

A

movement of molecules from higher to lower concentration, takes place when oxygen passes into the capillary bed to be circulated and CO2 elaves the capillary bed and diffuses into the alveoli for ventilation excretion.

280
Q

upper respiratory infection

A

common cold
acute rhinitis
sinusitis
acute pharyngitis

281
Q

most preventative type of URI

A

common cold

adult have average 2-4 colds per year

children have 4-12 colds per year

282
Q

Acute rhinitis

A

inflammation of the mucous membranes of the nose, usually accompanies the common cold

283
Q

allergic rhinitis

A

known as hay fever

caused by pollen or a foreign substance such as animal dande

284
Q

drug used to manage cold symptoms

A

antihistamine (H1 blockers), decongestant (sympathomimetic amines), antitussive, and expectorants

285
Q

rehinorrhea

A

watery nasal discharge

286
Q

symptoms of common cold

A

rhinorrhea
nasal confestoin
cough
increase mucosal secretions

287
Q

antihistamine

A

H1 blockers or H1antagonists
compete with histamine for receptor sites and prevent a histamine response

288
Q

diphenhydramine pharmacokinetic

A

first generation antihistamine

oral, IM, or IV

absorbed well through GI, minimal with topical

98% protein bound

half life of 2-8 hours

metabolizzed through liver and excreted in urine

289
Q

diphenhydramine side effect

A

drowsiness, dizziness headache, weakness, insomnia, fatigue, urinary retention, blurred vision, dry mouth, dermititis, rash, paresthesia, abdominal pain, restlessness, confusion, diarrhea, constipation

290
Q

therapeutic effect/ use of diphenhydramine

A

treat insomnia and allergic reaction including rhinitis, the common cold, cough, sneezing, pruritus, and urticaria and to prevent motion sickness

mechanism of action: compete with histamine for binding at h1 receptor sites and antagonize histamine effects

291
Q

adverse reaction of diphenhydramine

A

seizuress life threatening
thromnocytopenia

292
Q

second generation antihistamine

A

cetirizine
fexofenadine
azelastine
desloratadine
loratadine

Nur 111 (6 decks)

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