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Flashcards in EXAM 1 Deck (109):
1

Urine output less than 100ml/24 hrs

anuria

2

urine output less than 30-50 ml/ hr or 100-400 ml/24 hrs

oliguria

3

unusually large amounts of urine output

polyuria

4

voiding more often than Q2H

frequency

5

burning pain on urination

dysuria

6

frequent need to urinate at night

nocturia

7

difficulty starting a stream of urine (BPH)

hesitancy

8

urine left in the bladder after voiding

residual

9

the amount of urine left in the bladder

retention

10

Cystitis
Urethritis
Ureteritis
Urosepsis
Interstitial Cystitis

UTI

11

Most common type of UTI, prevalence is 8x higher in women, incidence increases in hospitals with the use of foleys

Cystitis

12

UTI causative organisms

E-Coli
Klebsiella
Enterobacter and Proteus
Chlamydia trachomatis
trichomonad vaginalis
Neisseria gonorrhea

13

first symptom of UTI in elderly

mental status change

14

UTI Diagnostics

Urine Culture
Urine Culture and Sensitivity

15

Medications given for UTI

Ciprofloxacin
Sulfamethoxazole (Bactrim)
Nitrofurantoin (Macrobid)
Pyridium (for burning pain)

16

UTI Management

Avoid: caffeine, chocolate, alcohol, spicy food
Increase fluids 3-4 Liters/day

17

UTI Nursing management

Modify diet
Inhibit bacterial growth
Increase fluid intake
Teach health promotion strategies
foley care 2-3x/day

18

signs and symptoms of urethritis

Dysuria, urethral drainage

19

Ureteritis signs and symptoms

fever, flank pain

20

A gram-negative bacterium (most common- E-coli) originating in the genitourinary tract that can cause sepsis and death if left without treatment

Urosepsis

21

Signs and symptoms of urosepsis of people in nursing home with foleys

change in mental status
hypotension
slight-fever- often no elevation at all

22

Nursing significance of Urosepsis

observe patient for hypotension, elevation in temperature, and changes in mental status

23

Symptoms of interstitial cystitis (IC)

"painful bladder disease"
bladder tenderness
urinary frequency
nocturia
dyspareunia
Variable manifestations

24

Damage caused by interstitial cystitis

ulcerations and hemorrhages in the bladder wall

25

Interstitial cystitis management

pain meds, antispasmodics, Elmiron to increase bladder mechanisms

26

Improving coping with interstitial cystitis

chronic pain medication
void by the clock, not by need
legal exercises

27

Most frequent neoplasm of the urinary tract
strong correlation with smoking and industrial exposure
Chronic cystitis
pelvic radiation

Bladder Cancer

28

Bladder cancer manifestations

painless hematuria
intermittent bleeding
obstruction- can't urinate

29

Bladder cancer diagnostic tests

Cystoscopy
biopsy
IVU
MRI
CEA (Carcino-embryonic antigen)

30

Bladder cancer management

chemo
radiation
surgery- transurethral resection of bladder tumor, partial or radical cystectomy.

31

Bladder Cancer palliative care

Nephrostomy tube- if renal pelvis through back, often flushed with sterile sailing
Ureterostomy- if tumor blocking outflow of urine from bladder

32

Urinary Calculi- stones; cause?

urinary stasis, supersaturation of urine (extreme concentration of urine)
immobility
dehydration
diabetes
history
high mineral content of water
frequent UTI's

33

Types of Urinary Calculi

calcium
oxalate
struvite
uric acid
cystine
xanthene

34

Urinary calculi symptoms + diagnostics

sharp, sudden pain
UTI + fever
nausea, vomiting

KUB (Kidney, ureter, bladder
IVU (intravenous urography)
cyst- visualize / remove stone

35

Medical management of Urinary Calculi

increase fluids (3-4liters/day)
Reduce Pain (Antispasmodics)
Prevent calculi formation
Dietary changes

36

What is a Lithotripsy

surgical removal of urinary calculi
laser
break up stones, causes bruising

37

Post urinary calculi procedure care

increase fluids
monitor I&O
Monitor for infection s&s
strain urine

38

3 types of incontinence

stress urinary
Detrusor over-activity- "urge"
overflow urinary

39

Nursing Management of incontinence

kegal exercises
bladder training
monitor fluid intake
incontinence products
coping
treat with dignity

40

Why can't bladder empty?

Detrusor failure in women
enlarged prostate in men
post void residual

41

Causes of urinary incontinence

sensory input interruption
muscle tension, anxiety
neurologic conditions- CVA, MS
Meds: anticholinergics, antihistamines, narcotics

42

risk factors of benign prostatic hypertrophy

age, obesity, OTC cold meds, prostate cancer

43

Clinical manifestations of BPH

slow development
incomplete emptying of the bladder
urine stasis-UTI-pylonephritis
hydroureter and hydronephrosis

44

Nursing management of BPH

assess understanding + educate about effects of enlargement
encourage fluids- concentrated urine is an irritant
reduce caffeine and ETOH
monitor I&O

45

medications that go along with BPH

AVOID alpha-adrenergic agonists (Catapres, Tenex, Aldomine)
AVOID benadryl
care with antidepressants

46

surgical management of BPH

transurethral resection of prostate (TURP)
prostatectomy

47

TURP post-op care

vitals
continuous bladder irrigation (CBI)
document urine color
accurate I&O
pain management

48

what is continuous bladder irrigation?

insertion of a three way catheter
continuous infusion of isotonic solution

49

when performing CBI on a patients bladder, why is catheter potency important?

If urine is very bloody, speed up irrigation flow, so that clots do not form.

50

pain management method for CBI

Belladonna & Opium suppository (B&O)

51

what is neurogenic bladder?

bladder dysfunction caused by tumors of CNS or PNS.

52

nursing care for neurogenic bladder

intermittent self cath- q 6 hr
bladder training
medications
emotional support

53

this is seen in advanced bladder cancer, it is usually painless

Hematuria

54

medications to treat neurogenic bladder

oxybutynin (Ditropan) (urinary antispasmodic)
bethanechol (Urocholine) (cholinergic, stimulated muscarinic receptors causing bladder contraction)

55

BPH can lead to what?

hydronephrosis

56

extra renal conditions affecting the kidneys

Diabetes
Hypertension
Hypotension
Rhabdomylosis- muscle injury
cardiovascular disease
peripheral vascular disease

57

what are nephrotoxins?

antibiotics- ahminoglycosides, lithium
heavy metals- mercury, lead
poisons
analgesics- NSAIDS, COX2 inhibitors
contrast dyes

58

what is dissension of the renal pelvis caused by obstruction of normal urine flow?

Hydronephrosis

59

Treatment of hydronephrosis?

relieve obstruction and prevent infection
possible surgical intervention
monitor fluid and electrolyte balance
manage pain
monitor I&O
watch for infections and obstruction

60

Labs for hydronephritis

BUN
Creatinine
GFR
Albumin
urinalysis
Electrolytes

61

Test to be done for hydronephritis

Xray
CT/MRI
IV Urogram
Renal biopsy
cystoscopy
renal scan
ultrasound

62

is caused by immunologic reaction that produces inflammation in the glomerular structure (post strep)

Glomerulonephritis

63

symptoms of nephrotic syndrome

proteinuria, hypoalbuminemia, hyperlipidemia

64

causes of nephrotic syndrome

glomerulonephritis, allergic reactions, systemic disorders

65

complications of nephrotic syndrome?

extracellular fluid accumulation
renal failure

66

nephrotic syndrome treatment

heal the leaking globular membrane and stop the protein from leaking into the urine
maintain fluid and electrolytes
prevent thrombosis
minimize protein loss
emotional support

67

clinical manifestation of nephritic syndrome include?

hematuria and at least one of the following:
oliguria
hypertension
elevated BUN
decreased GFR

68

integration of body, mind and spirit results in more powerful and manful care

Holistic nursing care

69

Health promotion (Primary prevention) includes

healthy eating, healthy activity, effective coping with stress

70

behaviors that promote early detection of disease:

secondary prevention: PAP/ testicular exam, eye exam, annual physical, monogram, etc

71

activities related to rehabilitation after disease is diagnosed:

tertiary prevtion: exercise, PT, rehab

72

examples of Instrumental ADL's

shopping, housework, managing money, food prep, transportation

73

psychologic factors that influence functional status of elders

ageism
multiple losses can lead to depression
neglect and abuse

74

physiologic factors that influence functional status in elders

sleep
sensory impairment
mobility and balance

75

slow intellectual deterioration that is irreversible

dementia

76

abrupt onset of cognitive impairment that is often reversible (often due to medications)

delirium

77

occurs in 75% of elders
suicide rates increase with age
substance abuse in 50% of elders

depression

78

responsibility of LTC nurse

oversee care of assigned residents
oversee unlicensed care providers
maintain extensive paperwork
provide medication and treatments
facilitate and contribute to care plan

79

for patients who are recovering from an acute illness but are not in need of acute care. Often separate parts of acute care hospital. Often includes PT, most patients are recovering from fractures or bone surgeries.

Subacute care

80

for people who are terminally ill, not only from cancer- generally 3 months to live. care can be provided in home or free-standing facility, staff trained to care for patients and families at end of their lives

Hospice

81

a process to manage internal or external situations that are difficult or beyond the individuals current resources

coping

82

more emotionally and socially vulnerable, with a higher risk of suicide when the death of a spouse occurs.

widowers

83

examples of maladaptive coping

alcohol abuse
anxiety
bullying
drug abuse
excessive eating
social isolation

84

what regulates fluid balance?

Antidiuretic Hormone (ADH) (prevents diuresis, prevents urination)
Thirst mechanism
Aldosterone (promotes sodium retention= fluid retention)
Kidneys
Atrial natriuretic peptide (causes more sodium to be released and more water built up)

85

normal serum osmolarity

280-300 mOsm/KG

86

normal urine osmo

200-300 mOsm/L - 24 hr urine

87

normal BUN/Creatinine

10-20/ 0.5-1.5 mg/100ml

88

normal urine specific gravity

1.01-1.025

89

normal sodium level

135-145 mEq/L

90

Hormone that directly affects sodium?

aldosterone

91

hormone that indirectly effects sodium

ADH, BNP

92

what does being hypovolemic mean?

dry
dehydrated
from vomiting, diarrhea, sweating, NG drainage, diuretics.

93

Dehydration levels of severity

mild: 1-2L
moderate: 3-5L
severe: 5-10L

94

normal fluid intake for an adult

1500-2000ml/day; 800ml from food

95

what is a major indicator of extracellular FVD?

full and bounding pulse
drop in postural BP
elevated temp
pitting edema of lower extremities

96

indicators of hypervolemia

fluid overload
edema
pulmonary congestion
distended neck veins
confusion
increased BP
decreased osmolality, hematocrit, sodium and BUN

97

what is an appropriate fluid restriction?

1500ml/day

98

what is fluid spacing

fluid shifts into the interstitial spaces

99

causes of third spacing

surgery
heart failure
kidney failure

100

plasma sodium volume less than 135
caused by excessive fluid loss, addisons disease, and kidney disease

Hyponatremia

101

Na above 145; sodium retention, diarrhea, lots of urine output, burns, excessive aldosterone secretion

Hypernatremia

102

K+ below 3.4. decreased reflexes, paresthesia, irritability to seizures and coma, fibrillation, muscle weakness and cramps, anorexia, flat T waves

hypokalemia

103

K+ above 5. changes in HR + rhythm, anorexia, diarrhea, twitching, neuromuscular irritability

Hyperkalemia

104

hypocalcemia is associated with

decreased levels of calcium + vit D
decreased parathyroid hormone
pancreatitis
GI malabsorption
medications (steroids)
cancer

105

assessment findings of hypocalcemia

parathesis (numbness and tingling of extremities)
vital sign changes
Chvosteks sign
tetany/seizure
low albumin levels

106

assessment findings of hypercalcemia

anorexia
lethargy/decreased memory
muscle weakness
bone pain/fractures
kidney stones

107

magnesium is important for what function?

cardiac electrical functioning

108

most cases of hypermagnesemia is caused by?

renal failure

other causes: addisons disease, magnesium enemas, antacids, IV infusion of magnesium

109

hypomagnesemia is associated with a decrease in what values?

low potassium and low calcium