Exam 2 Flashcards
(139 cards)
0
Q
About how many nephrons in each kidney?
A
1 million
1
Q
What is one of the more significant functions of the kidney?
A
To help maintain the composition and volume of body fluids. About once every 30 minutes, the body’s total blood volume passes through the kidneys for waste removal. The kidneys filter and excrete blood constituents that are not needed and retain those that are.
2
Q
What is the nephrons role?
A
Nephrons remove the end product of metabolism, such as urea, creatine, and uric acid from blood plasma and form urine. Once formed, urine from the nephrons empties into the pelvis of each kidney. From each kidney, urine transported by rhythmic peristalsis through the ureters to the urinary bladder.
3
Q
What is the urinary bladder ?
A
The urinary bladder is a smooth muscle sac it serves as a temporary restoring for urine
4
Q
What are the three layers of the urinary bladder?
A
The urinary bladder is composed of three layers of muscle tissue, the inner longitudinal layer, the middle circular layer, and the outer longitudinal layer. These three layers are called the detrusor muscle
5
Q
What are the roles of the sympathetic system and the parasympathetic system when it comes to the urinary bladder?
A
The urinary bladder muscle is innervated by the autonomic nervous system. The sympathetic system carries inhibitory impulses to the bladder and motor impulses to the internal sphincter. These impulses cause the detrusor muscle to relax and the internal sphincter to constrict, retaining urine in the bladder. The parasympathetic system carries motor impulses to the bladder and inhibitory impulses To the internal sphincter. These impulses cause the detrusor muscle to contract and the sphincter to relax.
6
Q
What are the differences between the male and female urethra?
A
The male urethra functions in the excretory system and the reproductive system. It is about 13.7 to 16.2 cm long and consists of three parts, the prostatic, the membranous,and the cavernous portion. The external urethral sphincter consists of striated muscle is located just beyond the prostatic portion of the urethra.
In contrast, the female urethras about 3.72 6.2 cm long. The external, or voluntary sphincter is located in the middle of the urethra, no portion of the female urethra is external to the body.
7
Q
The process of emptying the bladder is known as urination….
A
Micturition, or voiding
8
Q
Where are the nerve centers for urination located?
A
There situated in the brain and spinal cord. Urinating is largely an involuntary reflex act but it’s control can be learned.
9
Q
When does someone normally feel the desire to void?
A
When the bladder feels to about 150 to 250 mL in an adult
10
Q
What happens during urination?
A
When urination is initiated, the detrusor muscle contracts, the internal sphincter relaxes, and urine enters the posterior urethra. The muscles of the perineum and the external sphincter relax, the muscle of the abdominal wall contracts slightly, the diaphragm lowers, and urination occurs
11
Q
What is an autonomic bladder?
A
People whose bladders are no longer controlled by the brain because of injury or disease and they have to void by reflex only.
12
Q
When does voluntary control of the urethral sphincter occur?
A
Between 18 and 24 months of age
13
Q
What is enuresis?
A
Enuresis Is continued incontinence of urine past the age of toilet training
14
Q
What is nocturia?
A
The diminished ability of the kidneys to concentrate urine may result in nocturia (urination during the night)
15
Q
What are some diseases associated with renal problems?
A
Congenital urinary tract abnormalities Polycystic kidney disease UTIs Urinary calculus ( kidney stones ) Hypertension, diabetes mellitus Gout
16
Q
What are the differences between acute renal failure and chronic renal failure?
A
Acute renal failure is caused by conditions such as severe dehydration, anaphylactic shock, pyelonephritis and ureteral obstruction. Chronic renal Failure is caused by conditions such as diabetes, hypertension, and glomeruli nephritis
17
Q
What does nephrotoxic mean?
A
Nephrotoxic: capable of causing kidney damage
18
Q
What does hematuria mean?
A
Blood in the urine
19
Q
What is Anuria?
A
24 hour urine output is less than 50 ml
20
Q
What is dysuria?
A
Painful or difficult urination
21
Q
What is glycosuria?
A
Presence of sugar in the urine
22
Q
What is oliguria?
A
Scanty or greatly diminished amount of urine voided in a given time
23
Q
What is polyuria?
A
Excessive output of urine, dieresis
24
What is proteinuria and what does it indicate?
It means there is protein in the urine, it indicates kidney disease
25
What does pyuria mean?
Pus in urine, urine appears cloudy
26
What is the normal pH of urine?
The normal pH of urine is about 6.0, with a range of 4.6 to 8
27
How many millimeters do you need for you urine culture?
Urine culture requires about 3 mL, whereas routine urinalysis requires at least 10 mL of urine
28
What is the specific gravity of urine?
It is a measure of the density of urine compared with the density of water. The higher the number, the more concentrated the urine, unless there are abnormal components, such as glucose or protein in the urine
29
How many fluids should people drink for optimal urinary functioning?
Adults with no fluid restrictions should drink 2000 to 2400 mL a day
30
Those are greatest risk for a UTI include...
Sexually active women, women that use diagrams for contraception, postmenopausal women, individuals with a catheter, individuals with diabetes mellitus, and elderly people
31
What are the types of urinary incontinence?
Transient incontinence: It appears suddenly and last for six months or less. It is usually caused by treatable factors such as confusion infection.
Stress incontinence: Occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. This commonly occurs during coughing, sneezing, laughing.
Urge incontinence: Is the involuntary loss of urine that occurs soon after feeling an urgent need to void
Mixed incontinence: Indicates that there is urine lost with features of two or more types of incontinence
Functional incontinence: Is urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, or
disorientation.
Reflex incontinence: Experience emptying the bladder without the sensation of the need to void. Spinal cord injuries may lead to this type of incontinence.
Total incontinence: Is a continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation.
32
What is PVR and when is the recommended
PVR or post void residual Is the amount of urine remaining in the bladder immediately after voiding
A PVR of greater than 150 mL is often recommended as a guideline for catheterization because residual urine volumes of greater than 150 mL have been associated with the development of urinary tract infection
33
What is the pyloric sphincter?
The pyloric sphincter, a muscular ring that regulates the size of the opening at the end of the stomach, controls the movement of chime from the stomach into the small intestine
34
What are the three parts of the small intestine?
The first is the duodenum, the middle section is the jejunum, and the distal section that connects with the larger intestine is the ileum
35
What is the connection between the ileum of the small intestine and the large intestine?
The ileocecal valve
36
Describe the large intestine
The large intestine, also known as the colon, extends from the ileocecal valve to the anus. The colon is about 5 feet long. Functions of the large intestine include the absorption of water, the formation of feces, and the expulsion of feces.
37
What is peristalsis?
Peristalsis is Contractions of the circular and longitudinal muscles of the intestine, it occurs every 3 to 12 minutes, moving waste products along the length of the intestine continuously
38
What 2 centers govern the reflex to defecate?
One is in the medulla and a subsidiary one in the spinal cord
39
What additional muscles aid in the process of defecation?
Voluntary contraction of the muscles of the abdominal wall by holding one's breath, contracting the diaphragm, and closing the glottis increases intra-abdominal pressure up to four or five times the normal pressure, which helps expel feces. Simultaneously, the muscles on the pelvic floor contract and Aid expulsion of the fecal mass. Flexing thigh muscles and sitting also help increase downward pressure.
40
When would you not recommend the valsalva maneuver when defecating?
This maneuver can be dangerous in patients with cardiovascular problems because when an individual bears down to defecate, the increased pressures in the abdominal and thoracic cavities result in a decreased blood flow to the atria and ventricles, thus temporarily lowering cardiac output. Once bearing down ceases, the pressure is lessened, and a larger than normal amount of blood returns to the heart. This act may dangerously elevate blood pressure in an already hypertensive individual.
41
Infant stool characteristics : breast vs bottle fed
Breast milk is easier for the intestines to break down and absorb. Breast fed babies have more frequent stools, usually 2 to 10 stools daily, and stools are yellow to Golden and usually have no or little odor.
Bottle fed babies stools vary from yellow to brown and have a stronger odor because of the decomposition of protein. They usually have 1 to 2 stools daily.
42
What is paralytic ileus?
Direct manipulation of the bowel during abdominal surgery inhibits peristalsis causing a condition termed paralytic Ileus. This temporary stoppage of peristalsis normally last 24 to 48 hours, during this time food and fluids are withheld
43
What causes the brown color of stool and its characteristic odor?
Stercobilin, a bile pigment derivative causes its color
The characteristic odor is due to indole and skatole, caused by putrefaction and fermentation
44
What does endoscopy mean?
Endoscopy Is the direct visual examination of body organs or cavities
45
Cathartics vs. laxative
They are both drugs to induce emptying of intestinal tract. However, cathartics exert a stronger effect on the intestine than laxatives
46
What is the most common cause of chronic constipation?
The overuse of laxatives
47
How would you define diarrhea?
Diarrhea is the passage of more than three loose stools the day. Frequent bowel movements are not always indicative of diarrhea, but patients with diarrhea usually pass stools more frequently. Diarrhea is often associated with intestinal cramps.
48
What is bowel incontinence?
It's the inability of the anal sphincter to control the discharge of fecal and gaseous matter.
49
What does ostomy mean?
It is a term for a surgically formed opening from the inside of an organ to the outside. The intestinal mucosa is brought out to the abdominal wall, and stoma, the part of the ostomy that is attached to the skin, is formed by suturing the mucosa to the skin.
50
What is an ileostomy?
An ileostomy allows liquid fecal content from the ileum of the small intestine to be eliminated through the stoma
51
What is a colostomy?
A colostomy permits formed feces in the colon to exit through the stoma
52
CHAPTER 36 bookmark ------------------
iDisks
53
What is basal metabolism?
It's he energy required to carry on the involuntary activities of the body at rest, the energy needed to sustain the metabolic activities of cells and tissues
Basal metabolic rate: BMR is about 1 cal/kg of body weight per hour for men and 0.9 cal/kg per hour for women
54
How do you calculate BMI?
BMI= weight in lbs divided by (height in inches x height in inches) all x by 703
55
What does your BMI tell you?
A person with a BMI below 18.5 is underweight
A BMI of 25-29.9 indicates an overweight
A BMI of 30 or greater equals obesity
A BMI of 40 or greater equals extreme obesity
56
What is waist measurement an indicator of?
Where excess body fat Is deposited is thought to be an important and reliable indicator of risk for disease, such as type two diabetes, dyslipdemia, hypertension, and cardiovascular disease
57
How many carbohydrates are needed to prevent ketosis?
50-100g
Ketosis: an abnormal accumulation of ketone bodies that is frequently associated with acidosis
58
Describe nitrogen balance in the body
Nitrogen balance, a comparison between catabolism and anabolism, can be measured by comparing nitrogen intake (protein intake) and nitrogen excretion. When catabolism and anabolism are occurring at the same rate, the body is in a state of neutral nitrogen balance. A positive nitrogen balance occurs when nitrogen intake in greater than excretion, during periods of growth, pregnancy, lactation,a and recovery from illness. Negative can occur in starvation, surgery, stress.
Nitrogen remaining after protein is metabolized burdens the kidneys
59
What % of calories should come from protein.?
10-20%
60
Saturated vs. unsaturated
The difference in degree of saturation depends on the amount of hydrogen in fat molecules. Saturated fats contain more hydrogen than unsaturated. Most animals fats are considered saturated and have a solid consistency at room temp. Conversely , most vegetables fats are considered unsaturated. Saturated fats tend to raise serum cholesterol levels, unsaturated fats lower serum cholesterol levels.
61
How many calories should you get from carbohydrates?
45-65%
62
What is the recommended daily intake for protein?
56g for women
63 for men
Protein should contribute to 10-20% of total caloric intake
63
True or false trans fat raises serum cholesterol
True
64
Where in the body is cholesterol especially abundant?
The brain and nerve cells
65
What is the daily recommendation for fat intake?
No more than 20-35% of total calories
66
What are fat soluble vitamins?
A, D, E, K
67
What are water soluble vitamins?
B, C
68
What is zinc used for?
Wound healing
69
You should not go less than ___in a diet a day
10% fat
70
What is the daily recommendation of grains, veggies ect..
```
Grains: 6oz
Veggies: 2.5 cups
Fruits: 2 cups
Milk: 3 cups
Meat and beans: 5.5 oz
```
71
What are underweight, normal and obese BMIs
```
Underweight: less than 18.5
Normal: 18.5-24.9
Overweight: 25-29.9
Class 1: 30-34.9
Class 2: 35-39.9
Extreme obesity: 40 plus
```
72
An alcoholic would have what vitamin deficiency?
A vitamin B deficit
73
What is kayexalate and when is it used?
It is used to treat a high level of potassium in the blood. Kayexalate binds with k+ in the blood and is excreted in the stool
74
What is dysphasia?
Difficulty swallowing
75
How do you check a tube feelings placement?
X-ray
1. 30 ml of air (listen for whoosh)
2. Remove aspirate (30 ml) check color, amount
3. Check pH (anything less than 4 your good to go..acidic...your in the stomach
76
What is a big complication of tube feeding?
Dehydration
77
How many mls of urine does the bladder normally hold?
600 mls of urine
78
How can prolonged use of an in dwelling catheter cause urinary problems?
Continuous drainage of urine through catheter causes loss of bladder tone and damages the urethral sphincter
79
How does anesthia and narcotic analgesics alter urine formation?
They alter the glomerular filtration rate....reducing urine output
80
A urinalysis is a general examination of Urine to establish baseline info or provide data to establish a _____ diagnosis?
Tentative
81
During bladder distention the bladder cannot be percussed until it contains how much fluid?
150 ml
82
Which adaptation would indicate urinary retention?
A. Wet bed, undergarments
B. burning , pain during voiding
C. Sudden overwhelming need to void
D. Bladder fullness in absence of voiding
D. Bladder fullness in absence of voiding
83
Which is a major contributing factor to overflow incontinence?
A. Coughing
B. mobility deficit
C. Prostate enlargement
D. Urinary tract infection
C. Prostate enlargement
84
Which Patient adaptation would cause the most concern?
A. Anuria
B. dysuria
C. Dieresis
D. Enuresis
A. Anuria
85
What should sodium intake be limited too?
2300-3000 mg day
86
Describe cholesterol
Not a fat, but a steroid
Travels through the blood attached to fatty acids
Synthesized in the liver
Comes from animal products
87
LDL vs. HDL
LDL: low density lipoprotein- bad cholesterol
HDL: high density lipoprotein- good cholesterol
88
Fat soluble vitamins and functions
A : vision
D: absorption of calcium and phosphorus
E: cell reproduction
K: clotting
89
Which of the following individuals is likely to have a negative nitrogen balance?
A. An elderly patient with an open leg ulcer that is not healing
B. a young adult vegetarian
C. A preschooler with ashtma
90
The general population may have what mild vitamin deficiencies ?
Vitamin A, C, folate, B6
91
Fat soluble vitamin absorption
Vitamins A, D, E, K, are absorbed with fat into the lymphatic circulation. Like fat, they must be attached to a protein to be transported through the blood. The body stores excesses of fat soluble vitamins mostly in the liver and adipose tissue
92
Obesity is defined as body weight _____or more above ideal weight or having a BMI of 30 or more
20%
93
Full liquid diets
Contain all items on a clear liquid diet. Additional items include milk, custard, pudding, cereal gruels, pasteurized eggs
94
What is a nasogastric tube?
For short term use ( less than 4 weeks), a nasogastric or nasointestinal route is usually selected. A nasogastric tube is inserted through the nose and into the stomach. However, The patient is at risk for aspirating the tube feeding solution into the lungs, a disadvantage for using this route. Patient with a dysfunctional gag reflex, high risk of aspiration, gastric stasis, gastroesophageal reflux, nasal injuries.
Traditional nasogastric tubes are firm and large in diameter, ex : levin tube
95
What is a nasointestinal tube?
A nasointestinal tube is passed through the nose and into the upper portion of small intestine. It may be indicated for a patient with increased risk of aspiration due to a diminished gag reflex or slow gastric motility.
96
What is the enteral feeding rate?
Feedings are initiated at full strength. The rate of infusion begins at 10-40 ml an hour. The rate is then advanced by 10-20 ml per hour every 8-12 hours until the desired rate is achieved
97
What are some common causes of clogged enteral tubes?
Aspirated stomach contents, residue from medications, feeding flow rate of less than 50 ml, infrequent or inadequate addition of water to the system, and using a tube with a small lumen
98
Describe parental nutrition
Total parenteral nutrition is a highly concentrated, hypertonic nutrient solution. TPN provides calories restores nitrogen balance, and replaces essential fluid, vitamins electrolytes. TPN can also promote tissue and wound healing and normal metabolic function. Hyperalimentarion is another term sometimes used synonymously with parental nutrition.
99
Describe peripheral parenteral nutrition
It's a less concentrated nutrient solution sometimes prescribed for patients who have a malfunctioning gastrointestinal tract and need short term nutrition less than 2 weeks. PPN is administered through a peripheral vein. Peripheral veins cannot tolerate highly concentrated solutions, so the solution is not as nutrient dense as TPN
100
TPN vs. PPN
TPN solutions are hypertonic
| PPN solutions are isotonic
101
What is an autonomic bladder?
People whose bladders are no longer controlled by the brain because of injury or disease also void by reflex only
102
How drugs affect urine color
Anticoagulants: may cause hematuria ( blood in urine) , leading to a pink or red color
Diuretics: lighten the color urine to pale yellow
Phenazopyridine ( pyridium): a urinary tract analgesic, can cause orange/ red urine
Levodopa: an antiparkinson drug, can lead to brown or black urine
103
True or false
| A sterile specimen is required for a routine urinalysis
False
104
How often should you check residual?
Check residual before each feeding or every 4 to 6 hours during a continuous feeding. High gastric residual volumes of 200 to 250 mL or greater can be associated with high-risk for aspiration and aspiration related pneumonia.
105
What is an ileal conduit?
An ileal conduit is a cutaneous urinary diversion. An ileal conduit involves a surgical resection of the small intestine, with transplantation of the ureters to the isolated segment of small bowel. This separated section of the small intestine is then brought to the abdominal wall, where urine excreted through the stoma, a surgically created opening on the body surface.
106
How long is the small/large intestine
| , and rectum?
Small intestine: 20 ft
Large intestine or colon: 5 ft
Rectum: 5 inches
107
Hypertonic enemas
Is solutions draw water into the colon, which stimulates the defecation reflex. They may be contradicted in patients for whom sodium retention is a problem. They are also contradicted for patients with renal impairment or reduced renal clearance because such patients have compromised ability to excrete phosphate adequately. With resulting hyperphosphatemia
108
What color do anticoagulants turn stool?
Pinkish/red to black stool
109
What color do iron salts turn stool?
Black
110
Emollients vs. stimulants
Emollients lubricate stool
Lubricants soften stool
Stimulants promote peristalsis by irritating the intestinal mucosa or stimulating the nerve endings in the intestinal wall
111
Describe bowel training program
For bowel training program to be effective, the patient must have ample time for evacuation, usually 20 to 30 minutes. Fluid intake is increased to 2500 to 3000 mL, food high in bulk is recommended as part of the program, and a daily enema is NOT administered in a bowel training program. A cathartics suppository maybe used 30 minutes before the patient usual defecation time to stimulate peristalsis
112
During removal of a fecal impaction, which of the following could occur because of vagal stimulation?
Removing a fecal impaction manually may result in stimulation of the vagel nerve and resulting bradycardia
113
Which laboratory test result would the nurse interpreted as indicating that the patient is at risk for poor nutritional status?
Decreased serum albumin levels
114
Parenteral nutrition provides nutrition by...
Intravenous access
115
The patient has a nasogastric tube inserted for feeding purposes. Using the stomach as a reservoir for food is advantageous for preventing what complication?
Dumping syndrome
116
What maintains normal RBC volume?
Kidneys
117
Who do you commonly see Anuria in?
Dialysis patients
118
What is our standard of care?
I&O every q4
@ 8 and noon
HT assessment every q8
Get it done by 10 am
119
What medications cause urinary retention?
Anticholinergics (atropine)
| Antihistamines (diphenhydramine )
120
What does Cystitis mean?
An irritated bladder, probably infection
121
Urine output
Less than 30 cc output for 2 hours or more is a cause for concern
122
If the urine smells of acetone they most likely have...
Diabetic ketoacidosis
123
When should you not perform the valsalva maneuver other than cardiovascular issues?
If you have glaucoma, cuz it causes more optic pressure and will burst blood vessels
124
What is peristalsis under control by?
The nervous system
125
True or false an ileostomy bypasses the large intestine
True
126
What does borborygmous mean?
Nauseous or vomiting
127
What order do you listen to bowel sounds?
1. Right , lower
2. Right, upper
3. Left, upper
4. Left, lower
128
What are the steps of an abdominal assessment?
1. Inspect first
2. Auscultate ( begin in R lower quadrant)
3. Palpate (note masses)
4. Percuss last ( detect gas) tap listen for notes...dull, tympanic ect.
129
What is the specific gravity of urine?
1.005-1.030
130
Bowel sounds
1. Absent
2. Hypoactive : <5 sounds min
3. Hyperactive : 35 or more sounds
4. Borborygmous : constant sound
131
Tap water enemas
Hypotonic
500-1000
15 min
Fluid and electrolyte imbalance, water intoxication
132
Normal saline enemas
Isotonic
500-1000
15 min
Fluid and electrolyte imbalance, sodium retention
133
Spam enemas
500-1000
10-15
Rectal mucosa damage or irritation
134
Hypertonic enemas
Hypertonic
70-130 ml
5-10 min
Sodium retention
135
Oil enemas
150-200 ml
| 30 min
136
True or false hypotonic(tap water) enemas and isotonic (saline) enemas are large volume enemas that result in rapid colonic emptying
True
137
What patients would you not recommend getting a hypertonic enema?
Patients with renal impairments or sodium retention
138
Carminative vs. anthelminitic
Carminative enemas help expel flatus
Anthelminitic enemas destroy intestinal parasites
