Week 6 Flashcards
Elimination
removal, clearance, or separation of matter
excretion of waste product
how does the human body eliminate waste
through skin, kidneys, lungs, and intestines
Bowel elimination
the process of expelling stool (feces)
a term used to describe the process of bowel elimination
defecation, defecate, or bowel movement
urine elimination
the process of expelling urine
what terms is used to describe urine elimination
micturition
urination
continence
the purposeful control of urinary or fecal elimination
impaired elimination
one or more problem associated with the elimination process
anuria
absence of urine
dysuria
painful urination
polyuria
multiple episode of urination (diabetes)
urinary frequency
multiple episodes of urination with little urine produced in a short period of time.
urinary hesitancy
the urge to urinate exists, but the person has difficulty starting the urine stream
Kidney’s role in elimination
removal of metabolic waste and other element from the blood in the form of urine
what is the role of the gastrointestinal tract in the process of elimination
responsible for the removal of digestive waste in the form of stool
urinary elimination involve what structures?
the kidney
ureters
bladder
urethra
main functional unit of the kidneys?
the nephron
nephron
the main functional unit of the kidney
what are the nephron composed of?
blood vessels and renal tubules
formation of urine involves what 3 processes
glomerular filtration
tubular reabsorption
tubular secretion
where does the blood enter the kidney?
renal artery then branches into smaller arteries, arterioles, and finally a cluster of capillary known as glomerulus
glomerulus
semi-permeable membrane that serves to filter the blood into a C-shape structure of the renal tubule know as the Bowman’s capsule
what represent the beginning of urine formation
glomerular filtration
what does filtrate contain
water
electrolyte
waste
all removed blood
what does the filtrate pass through?
a sequence of renal tubules (Bowman’s capsule to the proximal convoluted tubule, the loop of Henle, and the distal convoluted tubule.
where does the water in the filtrate gets absorb?
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
tubular secretion
secondary process in which substances (potassium, hydrogen, ammonia, and drugs) moved from the blood in the capillaries surrounding the tubules into the tubules.
the amount of electrolytes reabsorbed into the blood or exreted int he renal tubules is controlled by what hormones?
aldosterone
antidiuretic hormone
parathyroid hormone
renin
atrial naturiuretic factor
after the renal tubules, where does the urine go?
moves into the collecting duct and then into the renal pelvis, the ureter, and the bladder where it is stored until urination occur
how many mL does the bladder hold in adults?
300 to 500 mL
what does pressure in the bladder stimulate?
stimulate stretch receptors in the bladder wall
receptors send impulses through the spinal cord to signal the need for urination.
what prevents urine from leaking out of the bladder?
internal sphincter, composed of involuntary smooth muscle
external sphincter
located below the internal sphincter and surrounding upper urethra
made of voluntary skeletal muscle
micturition reflex
cause the internal sphincter to relax and the bladder wall to contract.
relaxation of the external sphincter, urine pass through the urethra.
continence
control of urinary control
what is the function of the gastrointestinal system?
breakdown and absorption of nutrient from food ingested and the elimination of waste in the process
extends from mouth to the anus
what is the first part of the GI tract consist of?
mouth, esophagus, stomach, and small intestine
involved in digestion and absorption of nutrients
what other organ is also included in digestive organ?
liver
gall bladder
pancreas
where does waste formation occur
in the colon
what are waste product called
stool or feces
what is waste product made of?
water
bile
undigested food matter
unabsorbed mineral
bacteria
mucous
epithelial cells from the lining of the intestine
what helps fecal matter move through the GI tract?
smooth muscle within intestinal tract stimulate peristalsis
how long is the large intestine?
5 or 6 feet long and 2 inches in diameter
how many part is the large intestine made of?
(4) cecum (appendix)
colon
rectum
anus
what is the function of the large intestine?
absorb water and electrolyte as fecal matter move through its walls
what helps lubricate the walls in the intestine?
mucus
help aid in expulsion of the stool
if excessive peristalsis and stool move through quickly, less water is absorbed resulting in loose stool
defecation
process of expelling stool
involves voluntary and involuntary muscle
at what age do children be able to identify the urge to urinate and defecate?
18 to 24 months
when are children ready to potty train
2-3 years
what age does renal bloodflow reduce?
80 years
how much is bloodflow reduced to in later years?
600mL
reason why nephron function is reduced to 50%?
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
what happen to bladder due to age?
bladder retains tone
volume of urine decrease causing urine frequency
urethra becomes weak, increase risk of incontinence
what happens to bowel due to age?
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.
what contributes to urinary and GI function?
incontinence
retention
discomfort
infection
inflammation
neoplasms
organ failure
incontinence
loss of control of either urine or bowel elimination
what does incontinence lead to?
skin break down
changes in daily activity, functional activity, and social relationship
urinary incontinence
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
fecal incontinence
involuntary passage of stool and ranges from an occasional leakage of stool while passing gas to complete loss of bowel control
retention
unintentional retention of urine or stool
associated with obstruction, inflammation, or ineffective neuromuscular activation within the bladder or GI tract
type of incontinent
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)
what happens as a result of constipation?
difficult passage of hard, dry stool
loss of appetite
discomfort
fecal impaction
largest cavity in the human body?
abdominal cavity
what does the abdominal cavity contain?
- stomach
- small/large intestine
- liver
- gall bladder
- pancreas
- spleen
- kidneys
- ureters
- bladder
- adrenal glands
- major vessels
what is the abdominal lining called
peritoneum
what is the peritoneum made of?
serous membrane forming a protective cover.
how many layers is the peritoneum divided into?
two:
parietal peritoneum - lines abdominal wall
visceral peritoneum - covers organs
what is the space between the parietal peritoneum and the visceral peritoneum called?
peritoneal cavity
contains small amount of serous fluid to reduce friction between abdominal organs
what muscle is found in the anterior border of the abdomen
rectus abdominis
what is found on the posterior border?
the vertebral column and lumbar muscle
what provides lateral support to the stomach
internal and external oblique muscle
what muscle lies under the oblique?
transverse abdominis
Linea alba
a tendinous band that protect the midline of the abdomen between the rectus abdominis muscle.
extends from xiphoid process to symphysis pubis
how long is the alimentary tract
27 feet
what does the alimentary tract include?
- mouth
- esophagus
- stomach
- small/large intestine
- rectum
- anal canal
what is the main function of the alimentary tract?
ingest and digest food
absorb nutrients, electrolyte, and water
excrete waste products.
peristalsis
controlled by ANS and wave-like movements that moves food along the digestive tract
where does the breakdown of carbs begin?
in the mouth
how long is the esophagus?
about 10 inches
what does the esophagus connect?
connect the pharynx to the stomach
found posterior to the trachea
what is used to breakdown protein and fats in the stomach?
digestive enzymes and hydrochloric acid
turns food into chyme and propels it to the duodenum
what is the pH of the stomach?
2.0-4.0
what regulates outflow of chyme into the duodenum
pyloric sphincter
what produce bowel sounds?
the movement of air and fluid through he stomach and small/large intestine.
what is the largest alimentary tract?
small intestine
about 21 feet.
where does the small intestine begin and end?
pyloric orifice and the ileocecal valve
what are the 3 segment of the small intestine?
duodenum(1 foot), jejunum (8 feet), and ileum (12 feet)
with pH of 6.0-7.4
how long is the large intestine?
5 feet
what is the large intestine consist of?
cecum
appendix
colon
rectum
anal canal
how many parts is the colon divided into
ascending colon
transverse colon
descending colon
what is the end of the colon called?
sigmoid colon
what connects the sigmoid colon and the pelvic floor
rectum
with a pH of 6.7
where does the ileal content empty into?
the cecum (beginning of large intestine
what does the large intestine absorb?
water and electrolytes
what are the accessory organs of the GI tract?
salivary gland
liver
gall bladder
pancreas
what is the largest organ in the body?
the liver which weighs 3.5 pounds and found under diaphragm
divided into right and left lobe
what is the function of the liver?
- bile production and secretion
- production of clotting factors and fibrinogen
- synthesis of most plasma proteins (albumin and globulin)
- detoxification of a variety of substances, including drugs and alcohol
what is the function of the gall bladder?
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
what is the function of the pancreas
endocrine secretion- release insulin, glucagon, somatostatin, and gastrin for carb metabolism
exocrine secretion- bicarbonate and pancreatic enzyme that flow to duodenum.
what does lipase do?
break down fat
what does amylase do?
break down carbohydrate
what does protease do?
break down protein
what is the function of the spleen?
removal of old or agglutinated erythrocytes and platelets
activation of B and T lymphocytes
what is the spleen made up of ?
white pulp - lymphatic nodules and diffuse lymphatic tissue
red pulp -venous sinusoids
what does the urinary tract include?
kidneys
ureters
urinary bladder
urethra
where are the kidneys located
posterior abdominal wall on either side of the body
what is the function of the kidneys?
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.
what does antacid do?
neutralize acidity (hydrochloric acid)
lower pepsin activity
raise the gastric pH which inactivates pepsin
what are the 4 types of antacid?
non systemic antacid:
aluminum compound
magnesium compound
systemic antacid:
calcium compound
sodium compound
what does accessive amount of sodium bicarbinate do?
cause metabolic alkalosis
what does excessive calcium carbonate do?
cause hypercalcemia
what does aluminum hydroxide do?
cause constipation
what does magnesium hydroxide do?
cause diarrhea
what is aluminum hydroxide’s absorption?
minimal absorption through intestine
in feces binds to phosphate; small amount in urine
where is calcium bicarbonate absorbed?
occurs mostly in duodenum and depends on calcitriol and vitamin D. Food increases absorption by 10-30%.
what does pepsin do?
cause mucosal damage.
what is a contraindication of antacid?
electrolyte imbalance
renal failure
GI obstruction due to antacide stimulating motility
contraindications and precautions for aluminum hydroxide?
contra: hypersensitivity to aluminum products and hypophosphatemia
precaution: hepatic and renal disease, older adults, children and pregnancy
contraindications and precautions for Magnesium hydroxide?
contra: GI obstruction
precaution: myasthenia gravis, renal impairment, diarrhea, and older adults
contraindications and precautions for calcium carbonate?
contra: none
precaution: renal impairment, hypercalcemia, and hypothyroid disease
aluminum hydroxide dosage
adult 600-1200 mg PO QID
between meals and at bedtime
magnesium hydroxide dosage
adult: 400-1200 PRN quid
Calcium carbonate
adult: 500-3000 mg PO prn
Absorption of glucocorticoid
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
destribution of glucocorticoids
highly protein bound, but depends on specific drug
metabolism of glucocorticoid
metabolized primarily by the liver, resulting are inactive
excretion of glucocorticoid
metabolite in renal
mechanism of glucocorticoid
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.
duration of glucocorticoid
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
Leukotriene modifier
need if glucocorticoid does no provide adequate symptom management
absorption of leukotriene
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
Distribution of leukotreine
montelukast high bound >99 to plasma protein
zafirlukast is highly bound>99% to plasma protein
zileuton is 93% bound to protein
metabolism of leukotriene
montelukast by hepatic cytochrome p450 enzyme
zafirlukast undergo hepatic metabolism
zileuton metabolize by liver
excretion of leukotriene
montelukast is excreted in bile
zafirlukast is fecal excretion
zileuton excreted in urine
leukotriene subclass
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
pharmacodynamic profile of leukotriene
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
beta2-adrenergic agonist
cause bronchodilation in chronic and acute asthma patient.
short acting beta agonists/ long acting beta agonists/ oral beta agonists
most commonly used beta2-adrenergic agonist
albuterol - short acting beta2 adrenergic agonist
salmeterol- long acting adrenergic agonist
absorption for adrenergic agonist
albuterol has 105-20% bioavailability when inhaled and low systemic levels
salmeterol has little systemic absorption
distribution of adrenergic agonist
albuterol is unknown
salmeterol is 96% protein bound
metabolism of adrenergic agonist
albuterol metabolize in gastointestinal tract by the enzyme sultia3
salmeterol is metabolize by hydroxylation with involvment by CYP3A4
excretion of adrenergic agonist
albuterol undergo renal excretion
salmeterol is excreted in feces
when is beta2 adrenergic agonist used
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
albuterol pharmcodynamic
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
salmerterol pharmacodynamic
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.
anticholinergic type
short acting (Ipratropium) and long acting choloinergic (tiotropium)
absorption of anticholinergics
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%
distribution of anitcholinergic
Ipratropium is minimal protein bound
tiotropium is protein bound
metabolism of antiholinergics
ipratropium undergo partial metabolism to inactivate ester hydrolysis product
tiotropium metablism is minimal. fraction of drug ungergoes CYp 450 oxidation and glutathion conjugation
excretion of anticholinergic
Ipratropium from IV admin is in urine
Tiotropium is mainly in urine
Theophylline
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.
Therapeutic use of Theophylline
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.
Mechanism of Theophylline
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
epigastrium
pancreas
umbilical
small intestine
hypogastric
bladder, uterus
right hypochondriac
liver, glass bladder
left hypochondriac
spleen
right lumbar
ascending colon
left lumbar
descending colon
right inguinal
overy, ureter, appendix
left ingunal
overy, ureter
what is used to ascultate the abdomen
the diaphragm for frequeny and character of bowel sounds
what are the liver and spleen auscultated for?
friction rub
what is the bell of the stethoscope used for?
vascular sounds, including bruits and venous hums
when inspecting the abd, which surface characteristics would the nurse observe?
striae
lesions and scars
tautness
venous return
which region of the abdomen would the nurse palpate the pancreas
epigastric
om auscultation, which elements of a patient’s bowel sound should be assessed
frequency and character
over which abdomen structure should the nurse auscultate for friction rubs
liver
spleen
ascites
presence of fluid
percussion is used to assessed what element of abdominal examination
- size and density (liver, spleen, kidneys, gastric bubble)
- presence of ascites
- presence of gatric distention (air)
- presence of fluid-filled or solid masses
why do the nurse palpate abdomen for
temperature
texture
presence of masses
vascular thrills
what does the nurse palpation assess for
location
size
shape
consistency
tenderness
pulsation
mobility
movement with respiration
what organ can be felt as masses
liver
gallbaldder
spleen
left and righ kidneys
aorta
urinary bladder
light palpation
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
moderate palpation
abdomen is soft or rigid
reveals presence of tenderness
use palmer surface of fingers
deep palpation
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
palpate around umbilicus
umbilical rign is incomplete or soft in center
palpate the liver
is edge palpable and repeat medially and laterally to the costal margin
palpate gallbladder
below margin at the lateral border of the rectus abdominus muscle for tenderness in the area.
palpate spleen
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
palpate kidneys
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
palpate the bladder
done over suprapubic area for distention and tenderness
palpation of aorta
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
the nurse percuss the abdomen to obtain which information
presence of masses
presence of ascites
gastric distention
size of organ
which abdominal structures are assessed through percussion
splee
liver
kidneys
which type of palpation is necessary to delineate abdominal organs and detect masses?
deep palpation
alvarado score
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
pediatric sppendicitis score
eval pain with cough or hopping or rebound tenderness with the percussion of the RLQ
Ohmann score
use patient age, history, and physical exam and laboratory finding to identify risk of appendicitis
rebound tenderness (McBurney Sign)
press gently on abdomen, then rapidly withdraw hands and fingers and note if pain increase when hand is released
iliopsoas muscle test
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
Obturator muscle test
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
Ballotement
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
how should the nurse assess for ascites
look for fluid wave
identifying shifting dullness on percussion
which test should be performed if the nruse suspects a rupture appendix
obturator muscle test
ausculatio of bowel sound
5-35 irregular clicks and gurgles per minutes
Borborygmi (increased sounds) may be present with hunger
ausculate vascular assessment
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
percussion of abdomen
- tympany as the predominant sound
- dullness over organs and solid masses
- dullness over suprapubic region from distended bladder
- lower border of liver beginning as costal margin
- upper border of the liver beginning at the 5th or 6th intercostal space
- liver span abouit 6-12 cm
- spleen small area of dullness from 6th - 10th rib with typmpany before and after deep breath
- stomach: tympany of gastric bubble
which finding regarding movement would be considered normal on inspection of the abdomen
smooth movement
even movement
pulsation
an abnormal finding and indicate increased pulse pressure or an aortic aneurysm
limited movement
abnormal finding and may indicate peritonitis
rippling movement
may be seen in thin individuals but often abnormal, suggesting intestinal obstruction
auscultation of the abdomen, which findings related to bowel sounds would be considered normal
gurgles
clicks
irregular
high pitch tinkling bowel sound
irregular finding and may suggest an early obstruction
absense of bowel sound
irregular finding and is a medical emergency
verticle span of th eliver is expected to be 6 to ___ cm
12
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
lack of bulges
lack of nodules
round umbilical ring
inverted umbilicle ring
which finding would be considered normal on inspection of the abdomen of an infant
dome shape
on auscultatio of infant’s abdomen, peristalsis should be heardhow often
10-30 seconds
how are the palpation findings of older adults different from those of younger patients?
softer due to decrease muscle tone and mass
which normal finding in older adults predispose this patient population to intestinal disorders
decrease intestinal motility
peritoneum
abdominal lining
serous membrane forming a protective cover
parietal peritoneum
line abdominal walls
viscerla peritoneum
covers organsp
peritoneal cavity
space between parietal and visceral layer
contains serous fluid that reduces friction between organs and membranes
pepsin
break down protein to peptone and amino acid
gastric lipase
emulsify fats
triglycerides to fatty acis or glycerol
pH of stomach
2-4
what system control peristalsis
Autonomic nervous system
nephrons
functional units of the kidneys
remove waste products from blood
regulatio of fluids and electrolyte balance
protenuria
protein in urine
suspected injury to glomerulus
hematuria
blood in urine
glomerular filtrate
excreted as urine
99% reabsorbed into the plasma by proximal convuluted tubules, the loope of Henle, and distal convuluted tubles.
1% excreted as urine
normal range of urine production
1-2 L/day
what factors influence production of urine
fluid intake and temperature
Erythropoietin
produced by kidneys
stimulate red blood cell production and maturation in bone marrow
renin-angiotensin system
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
prostaglandin and prostacyclin
maintain renal blood flow through vasodilation
increase arterial blood pressure and renal blood flow
kidney impairment
problems with anemia, hypertension, and electrolyte imblance
ureters
attached to each kidneys and carry urine from kidney pelvis to bladder
urine drainage from ureter to bladder is sterile
contraction of bladder
compress lower part of ureters to prevent backflow into ureters
urinary reflux
backflow of urine into the ureters
hydroureter/hydronephrosis
distention of pelvis of kidney due to backflow
cause permanent damage to sensitive kidney structures and functions
bladder
lies in pelvic cavity behind symphysis pubis
has two part: trigone–fixed base
detrusor-distensible body
pressure in bladder
remains low while filling, preventing backflow
urethra
passes through thick layer of skeletal muscle called pelvic floor muscles
pelvic floor muscle
stabilize the urethra and contribute to urinary continence
external urinary sphincter
made up of striated muscles
contribute to voluntary control over the flow of urine
female urethra
3-4 cm (1-1 1/2 inches) long
male urethra
18-20 cm (7-8 inches) long
urination
process of bladder emptying
also known as micturation and voiding
bladder fills
400-600 mL
urinary retention
inability to empty the bladder partially or completely
acute or rapid onset urinary retention
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
postvoid residual (PVR)
amount of urine left in the bladder after voiding and is measured with ultrasonography or straight cath
overflow incotinence
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
transient incontinence
cause by medical condition and in many cases are treatable and reversible
Functional incontinence
loss of continence because of cause outside urinary tract
due to altered mobility, cognitive impairment, environmental barriers
stress urinary incotinence
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
urge or urgency incontinence
passage of urine often associated with strong sense of urgency related to overactive bladder cuased by neurological problems, bladder inflammation, or bladder outet obstruction
reflux urinary incontinence
loss of urine occuring at somewhat predictable intervanls when patient reaches specific bladder volume related to spinal cord damage between c1 and s2
bacteriuria
bacteria in urine
can be asymptomatic bacteriuria
pyelonephritis
upper UTI
bacteremia
life-threatening bloodstream infection
dysuria
burning or pain with urination
cysitis
irritation of the bladder
cauti
catheter associated urinary tract infection
most common hospital acquired infection
urinary incontinence
complaint of involuntary loss of urine
Types of UI
urgency
stressed
overflow
cystectomy
bladder removal
urinary diversion
procedure that diverts urine to the outside of the body through an opening in the stomach wall called a stoma
oxybutynin
antimuscarinic agent
treatment of urinary urgency
cause dry mouth, constipaton, and blurred vision
cause congnitive impairment
nitrofurantoin
antibiotic used to treat UTI
Nethanechol
used to treat urinary retention
cause nausea, vomiting, diarrhea, and increase salivation
phenazopyridine
analgesiac
patient with painful urination associated with uti
turn urine orange
a patient who undergone urological surgery is prescribed cath. which diameter of cath does the nurse anticipate to used for this patient
greater than 16 Fr
patient has a full bladder, and is having difficulty voiding. which instruction would the nurse provide patient?
use crede method
put pressure on the suprapubic area with each attempted void. relax sphincter
post op patient has not voided for 6 hours which method would benefit in assisting patient to void
standing at bedside
man void more easier in standing position
squatting position when voiding does what in female
promotes compete bladder emptying
overflow UI
characterized by nocturia, frequency and distended bladder on palpation
instruction regarding bladder training would be included in the teaching plan for the family of a patient who is incontinent because of a stroke
offer patient the commode or urinal every 2 hours
positive keytones in urine
keytone is byproduct when body use fat for energy production
starvation
dehydration
uncontrolled diabetes mellitus
UTI infection
symptoms dysuria, urgency, frequency, and nocturia
normal patient should consume how much fluid
2300 mL
ventilation
movement of air from the atmosphere thorugh the upper and lower airway to the alveoli
respiration
process where gas exchange occurs at the alveolar-capillary memnrane
perfusion
involves blood flow at the alveolar-capillary bed
diffusion
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.
upper respiratory infection
common cold
acute rhinitis
sinusitis
acute pharyngitis
most preventative type of URI
common cold
adult have average 2-4 colds per year
children have 4-12 colds per year
Acute rhinitis
inflammation of the mucous membranes of the nose, usually accompanies the common cold
allergic rhinitis
known as hay fever
caused by pollen or a foreign substance such as animal dande
drug used to manage cold symptoms
antihistamine (H1 blockers), decongestant (sympathomimetic amines), antitussive, and expectorants
rehinorrhea
watery nasal discharge
symptoms of common cold
rhinorrhea
nasal confestoin
cough
increase mucosal secretions
antihistamine
H1 blockers or H1antagonists
compete with histamine for receptor sites and prevent a histamine response
diphenhydramine pharmacokinetic
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
diphenhydramine side effect
drowsiness, dizziness headache, weakness, insomnia, fatigue, urinary retention, blurred vision, dry mouth, dermititis, rash, paresthesia, abdominal pain, restlessness, confusion, diarrhea, constipation
therapeutic effect/ use of diphenhydramine
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
adverse reaction of diphenhydramine
seizuress life threatening
thromnocytopenia
second generation antihistamine
cetirizine
fexofenadine
azelastine
desloratadine
loratadine
