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Holistic Care (Abbott) > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Normal urinary elimination maintains the concentration of ions needed for what 3 things?

A
  • Neuro and muscle function
  • Bone strength
  • Cellular regeneration
  • Maintains homeostatic regulation of bp for adequate circulation of oxygen and nutrients
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2
Q

What organs are part of the Upper urinary tract?

A

Kidneys and Ureters

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3
Q

What is part of the lower urinary tract

A
  • Urinary bladder
  • Urethra
  • Pelvic floor
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4
Q

what is the step-by-step process of emptying the bladder?

A

Urine collects in the bladder –> Pressure stimulates stretch receptors –> Transmit impulses to the voiding reflex center of the spinal cord –> If time, the place is appropriate –> Conscious part of the brain relaxes external urethral sphincter muscle –> Urination occurs

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5
Q

Patterns of voiding (5 things)

A
  • Vary by individual
  • Everyone should void at least every 6 hours
  • Most people void 6–7 times/day
  • 4 to 10 times a day is considered normal
  • Amount varies based on age, weight, daily fluid intake, types of fluid consumed, and meds (0.5 – 1.0 mL/kg/hr)
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6
Q

What are the factors that affect urinary elimination (6 things)

A
  • Fluid and food intake
  • Muscle tone
  • Psychosocial factors
  • Pathologic conditions
  • Surgical and diagnostic procedures
  • Medications
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7
Q

What causes alteration in urinary elimination?
- older or younger?
- system problem (hint)
- 2 others

A
  • Age-related changes
  • Acute/chronic diseases and their treatment
  • pregnancy-stress incontinence
  • Arthritis-functional issues
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8
Q

What can polyuria cause?
What is it caused by?

A
  • Can cause excess fluid loss –> intense thirst, dehydration, and weight loss
  • Caused by disease: diabetes mellitus, diabetes insipidus and kidney disease
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9
Q

What leads to polydipsia; what is it associated with?

A

compulsive intake of excessive amounts of fluid. This is associated with polyuria

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10
Q

What is Anuria

A

When you urinate 100 mL or less a day

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11
Q

What is Oliguria?
What is the amount range?
What can it signal?
Does it need to be reported?

A

Scant urine production
- <400 ml/day or 30ml/hr
- may signal impending renal failure
- needs to be reported

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12
Q

What are the 4 things that cause changes in urinary frequency?

A
  • Inc. total fluid intake
  • UTI
  • stress
  • pregnancy
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13
Q

What causes a sudden strong desire to void regardless of the volume of urine present

A
  • unstable bladder contractions
  • psychologic stress
  • irritation of the urethra
  • poor external sphincter control
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14
Q

What is Dysuria?
What are the causes?

A

Pain or difficulty voiding

Causes:
- stricture of the urethra, UTI, injury to the bladder/urethra
- Often individuals express the need to “push” to void or a “burning” during or after urination

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15
Q

What is urinary hesitancy and what is it associated with?

A

delayed or difficulty in initiating the void and is often associated with dysuria

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16
Q

What is a neurogenic bladder?
- What is it often due to?

A
  • Does not perceive bladder fullness
  • Unable to control urinary sphincters
  • The bladder can be flaccid and distended, spastic with frequent involuntary urination
  • Often due to a malfunction caused by damage to the spinal cord
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17
Q

Factors related to lower urinary tract symptoms

A
  • Constipation
  • IBS
  • Sexual activity
  • Delayed/premature voiding
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18
Q

What are nonmodifiable risk factors for alteration in urinary elimination

A
  • Physical, cognitive, or developmental disability
  • Family Hx of incontinence
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19
Q

What are genetic considerations for alteration in urinary elimination

A
  • Spina bifida
  • Myelomeningocele
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20
Q

What diseases related to aging, alter the urinary elimination process

A
  • Parkinson disease
  • Alzheimer’s disease (changes in cognitive function)
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21
Q

The increase in ______ and ________ increases with age

A

Urgency; frequency

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22
Q

What is part of the nursing assessment related to urinary elimination

A
  • Check voiding pattern
  • Description of urine and any changes (color, odor, sediment, clarity, pus blood)
  • urine elimination problems (change in pattern or pain)
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23
Q

What is the physical examination for urinary elimination

A
  • Abdomen
  • Soft tissues of genitalia, perianal areas
  • Urethral meatus
  • Feces and urine
  • Fluid volume status
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24
Q

What are anticholinergic medications

A

they reduce urinary frequency, treat incontinence

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25
Q

What are cholinergic medications

A

they promote urination

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26
Q

What are urinary analgesic

A

Helps to treat pain

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27
Q

what are Urinary antispasmodics?

A

treats spasms

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28
Q

4 types of diuretics

A
  • Loop diuretics
  • Thiazide diuretics
  • Potassium-sparing diuretics
  • Carbonic anhydrase inhibitors and osmotic diuretics
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29
Q

What is hemodialysis?

A

Blood flows through an external machine, and returns to the patient’s body

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30
Q

what is Peritoneal dialysis?

A
  • Dialysis solution instilled into the abdominal cavity
  • Must be done at frequent intervals
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31
Q

fetus excretes urine at what weeks

A

11-12th week

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32
Q

Urinary elimination through the lifespan in newborns

A
  • Lower GFR
  • kidney unable to rapidly excrete fluid (overhydration)
  • Light yellow
  • prone also to dehydration
  • Can be cloudy due to mucus content and high specific gravity
  • urine is odorless
  • Tubes are short and narrow
  • Monitor dehydration
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33
Q

Urinary elimination through the lifespan For childhood

A
  • Kidney mature 1-2 year of life
  • kidneys double in size
  • urinate 6-8x a day
  • Nocturnal enuresis (bedwetting) common in deep sleepers –> not a problem until after age 7
  • Urine becomes concentrated and effectively appears as normal yellow to amber

18-24 months –> recognizes bladder fullness and is able to hold urine
2.5 – 3 years –> can perceive bladder fullness and hold urine and communicate need to void
- Daytime control –> 3years
- Full control –> 4-5 years
- Control during day precedes nighttime
- Need to remind on flushing and proper handwashing
- Teach proper wiping –> front to back!

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34
Q

Urinary elimination through the lifespan For Adults and Pregnancy

A
  • After age 50, kidneys begin to diminish in size and function
    Pregnancy: increases in frequency; GFR rises 50% (reabsorption increases)
  • Increase risk of UTI
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35
Q

Urinary Elimination through the Lifespan for Geriatric

A
  • An estimated 30% of nephrons are lost by 80 years of age
  • Renal blood flow decreases because of vascular changes and cardiac output decreases.
  • The ability to concentrate urine declines –> increasing the risk of dehydration
  • Bladder muscle tone diminishes, causing increased frequency of urination and nocturia (voiding 2 or more times at night)
  • Increase risk of UTI
  • inc. risk of hyponatremia
  • Given diuretics to treat various issues (hypertension, cardiac conditions can complicate inefficiencies in conc. of urine, electrolyte regulation
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36
Q

What is the pathophysiology of Urinary Incontinence

A
  • Results from higher-than-normal bladder pressures or reduced urethral resistance
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37
Q

What are the contributing factors for urinary incontinence

A
  • Use of diuretics
  • Pregnancy
  • Decreased levels of estrogen during menopause
  • Relaxation of pelvic musculature
  • Disruption of cerebral and nervous system control
  • Disturbances of the bladder and its musculature
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38
Q

Risk factors for urinary incontinence

A

Older more than younger
Women more than men
Especially homebound or in an LTC facility
Obesity
Smoking
Diabetes
Inactivity
Pregnancy
Depression
Constipation
Dietary bladder irritants
Neurologic disorders
Frequent UTIs
Certain medications

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39
Q

Causes of Urinary Incontinence (types of incontinence)

A

Stress Incontinence
Urge Incontinence
Mixed Incontinence
Temporary Incontinence

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40
Q

What is non-reversible for urinary incontinence

A
  • Acute confusion
  • Depending on the underlying cause
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41
Q

Chronic Urinary Incontinence examples are…

A

Congenital disorders
- Epispadias
- Meningomyelocele

Acquired irreversible factors
- Central nervous system (CNS), spinal cord trauma
- Stroke
- Multiple sclerosis
- Parkinson disease

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42
Q

Cystocele

A

a bulge of the bladder into the vagina (bladder hernia)

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43
Q

What are the 5 types of incontinence?

A
  • Stress incontinence
  • Urge Incontinence
  • Relfex incontinence
  • Overflow incontinence
  • Functional incontinence
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44
Q

What is stress incontinence

A

relaxation of the pelvic muscles and weakness of the urethra and tissue leading to decreased urethral resistance.

*may also be caused by increased pressure on the bladder from pregnancy, obesity, cystocele or urethrocele

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45
Q

What is Urge Incontinence

A
  • Overactive detrusor muscle, leading to increase in pressure within the bladder (inability to inhibit voiding)
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46
Q

What is reflux incontinence
- What neurological condition is it a result of?

A
  • condition results from a spasm of the detrusor muscle due to neurological impairment or tissue damage. Usually seen in patients with neurologic conditions such as MS and Spinal cord injury
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47
Q

What are some clinical therapies for urine incontinence

A

Medications for the underlying condition
Neuromodulation
Catheterization
Surgery
Lifestyle modifications
Behavioral therapy
Kegel exercise
Anticholinergic, Beta -3 agonist, estrogen

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48
Q

What is overflow incontinence

A

Lack of normal detrusor activity, leading to overfilling of the bladder and increased pressure.

Loss of urine is associated with an over distended bladder (urine leaks out) and urinary retention, urinary obstruction, or BPH

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49
Q

What is functional incontinence

A

Ability to respond to the need to urinate is impaired
- Seen in dementia and physical disabilities, and patients with impaired mobility

Factors outside of the urinary tract (immobility, requires assistance

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50
Q

is urinary retention more common in men or women and why?

A

Men because of BPH

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51
Q

What are several etiologies for urinary retention

A
  • Mechanical obstruction or functional problem
  • Acute inflammation
  • Infection or trauma
  • Scarring from repeated UTIs
  • Renal calculi or bladder stones
  • Anesthesia during surgery
  • BPH
  • Nerve/spine issues
  • Congenital birth defects
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52
Q

Risk factors for Urinary Retention

A

Postoperative surgical procedures
Abdominal or pelvic surgery
Accidents to the brain or spinal cord
Infections of the brain or spinal cord
Advanced age
Male gender
Cognitive impairment/confusion
Diabetes
Constipation
Immobility
Emotional distress
History of UTIs

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53
Q

How to prevent urinary retention

A
  • Void when the urge to urinate occurs
  • Avoid medications that cause urinary retention
  • Kegel exercises
  • Preventing constipation
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54
Q

What sort of collaborations are used for Urinary Retention

A
  • Diagnostic tests
  • Non-pharmacologic therapy
  • Pharmacologic therapy
  • Surgery
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55
Q

What sort of diagnostic tests are done for urinary retention

A
  • Post-void residual assessment
  • Urinalysis
  • Laboratory tests
    PSA
    Imaging scans
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56
Q

What sort of pharmacologic therapies are used for urinary retention

A
  • alpha-adrenergic blockers
  • antibiotics
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57
Q

Non-pharmacologic therapy for urinary retention

A

Treat immediately with complete emptying of the bladder via catheterization
May need an indwelling catheter or intermittent catheterization to prevent future urinary retention, and over-distention of the bladder until the underlying problem corrected

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58
Q

what would surgery help with in urinary retention

A
  • Mechanical obstructions removed or repaired when possible
  • Resection of the prostate gland for urinary retention related to BPH
  • Correct a cystocele or rectocele
    Suprapubic catheter long-term treatment
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59
Q

lifespan considerations for older adults in urine retention

A
  • Weak detrusor muscle
  • Reduced rate of urine flow
  • Reduced ability to withhold voiding
  • Enlarged prostate
    **Pelvic organ prolapse
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60
Q

how is the urinary tract kept sterile

A
  • adequate urine volume
  • free flow of urine from the kidneys through the urinary meatus
  • complete emptying of the bladder
  • bacteria/pathogens that attempt to enter the urethra are “washed out” during voiding
  • the acidity of the urine
  • bacteriostatic properties of the bladder and urethral cells
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61
Q

what is cystitis is it the most common type of UTI??

A

Inflammation of the urinary bladder

  • Yes , the most common
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62
Q

What is pyelonephritis

A

inflammation of the kidney and renal pelvis
- usually ascends to the kidney from the lower urinary tract

  • ACUTE –> BACTERIAL
    CHRONIC –> NONBACTERIAL
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63
Q

What is the most common cause of a catheter-associated UTI

A

Intra-lumen/healthcare worker caused when inserted, handled, and disconnected

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64
Q

What is a urostomy

A

surgically placed alternate route for urine via the abdominal wall
- may be temporary or permanent

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65
Q

when a patient is on bed rest, this leads to a decrease in what

A

peristalsis activity

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66
Q

what does anesthesia do to the bowels

A

it blocks the parasympathetic stimulation muscles of the colon and causes a decrease in movement

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67
Q

what is flatulence and what does it lead to?

A

excessive gases in the intestines or colon; gastric distention

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68
Q

what causes flatulence

A
  • bacterial action on chyme
  • swallowed air
  • gas diffusing from the bloodstream
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69
Q

What is diverticular disease
-what type of -itis does it cause?
- what can it cause?

A
  • Outpouching of the colon
  • Mucosal lining of the bowel herniates through the bowel wall
  • Diverticulitis
  • Diverticula inflamed
  • Can cause obstruction, perforation, bleeding
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70
Q

What is a bowel obstruction

A
  • The inability of intestinal contents to move through the small or large bowel

Mechanical:
- This may be due to adhesions, hernias, intussusception, volvulus, tumors

Functional:
The inability of peristalsis to propel intestinal contents forward

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71
Q

What is Paralytic ileus?

A
  • Intestinal muscles not moving or diminished
  • Occur after surgery or drugs
  • Risk of bowel necrosis and perforation
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72
Q

what is the biggest risk factor for bowel elimination

A

AGE

  • Young children and older adults at higher risk for diarrhea, constipation, fecal incontinence
  • Women at higher risk for fecal incontinence
  • Immobility, disability, and chronic disease increase the risk of constipation
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73
Q

What are some diagnostic tests done for bowel elimination assessments

A
  • Blood and fecal tests
  • Digital rectal exam
  • Anorectal manometry
  • Colorectal transit study
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74
Q

What are some direct visualization procedures for bowel elimination

A

Colonoscopy
- Tissue samples can be obtained during colonoscopy

Esophagogastroduodenoscopy
- Esophagus, stomach, duodenum

Sigmoidoscopy
- Sigmoid colon

Upper GI
- Esophagus, stomach, small intestines with barium

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75
Q

What are 3 indirect visualization

A

Ultrasound
MRI
CT

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76
Q

Bowel elimination treatments
(independent interventions, collaborative therapies, pharmacologic therapy, surgery in case of…)

A

Independent interventions
- personal hygiene
- bowel training
- inc. fluid and fiber intake

Collaborative therapies
- medications

Pharmacologic therapy
- Constipation (stool softener)
- Diarrhea (antidiarrheal medications)

Surgery in case of
- Obstruction
- Ulceration
- Perforation
- Cancer ostomy care

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77
Q

4 ways to empty the colon

A
  • Manual removal by a nurse
  • Enemas
  • Suppositories
  • Oral meds
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78
Q

What consists of bowel training

A

D/C or decreased use of meds
Increase the level of activity
Diet-high fiber
Fluids
(Monitor BMs!)

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79
Q

Lifespan consideration in NEWBORNS AND INFANTS for bowel elimination

A
  • bowel color depends on breastfeeding or formula feeding
  • consistently soft and liquid
  • Meconium –> transitional stool –> entirely fecal
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80
Q

Lifespan consideration in TODDLERS for bowel elimination

A
  • Some control between 1.5 – 2 years
  • Usually, control happens when the child becomes aware of the discomfort of soiled diapers
  • In the U.S. –> 24 months –> many conditions affect toilet training –> sex, race, socioeconomic status, and culture
  • Intussusception (telescoping of the intestines) is the most common cause of intestinal blockage – treated with an enema or surgery to prevent bowel perforation, infection, or necrosis.
  • Intestinal obstruction –> volvulus (twisting of the loops of the bowel around a fixed point) –> early recognition and prompt surgery are necessary to prevent bowel ischemia perforation
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81
Q

Lifespan consideration in SCHOOL-AGE CHILDREN AND ADOLESCENTS for bowel elimination

A

Bowel habits similar to adults
Patterns vary in frequency, quantity, and consistency
May delay defecation for play or another activity

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82
Q

Lifespan consideration in PREGNANT WOMEN for bowel elimination

A
  • Elevated progesterone levels –> delayed gastric emptying, decreased peristalsis
  • May lead to bloating, constipation
  • Enlarging uterus aggravates symptoms
  • Hemorrhoids late in pregnancy
  • Bowels sluggish after giving birth
  • Pain may lead to delaying elimination
  • Flatulence after cesarean birth
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83
Q

Lifespan consideration in OLDER ADULTS for bowel elimination

  • What is common?
  • what to tell older adults about laxatives?
A

Constipation is common
- Reduced activity levels
- Inadequate fluid and fiber intake
- Muscle weakness
- Medication side effects

  • Responding to gastrocolic reflexes important

Laxative use inhibits natural reflexes and may cause constipation rather than relieving it
- Advise older adults that consistent use of laxatives will cause chronic constipation, interfere with electrolyte balance, reduce absorption of some vitamins

Changes in bowel habits over weeks should be referred to a primary care provider

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84
Q

Health Promotion for Bowel Elimination

A

Healthy lifestyle habits
- weight
- exercise
- blah blah

Screenings

Modifiable risk factors
- obesity
- pregnancy
- poor hygiene

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85
Q

what are patient outcomes/goals for bowel elimination

A
  • the patient has formed stool
  • education
  • patient to absorb nutrients/fluids via the GI tract
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86
Q

how can a nurse advise a patient to eliminate the cause of diarrhea, replace lost fluids
- what foods to avoid?
- what type of diet?
- replace what?
- we should monitor what?

A
  • Avoid spicy foods, raw fruits and vegetables, and dairy (except yogurt)
  • The diet should be low residue (low fiber)-which may have a laxative effect
  • Replace fluids and electrolytes (IV fluids may be required)
  • Babies should continue to breastfeed
  • Children should resume diet as tolerated
  • Monitor labs & cultures, administer meds as needed
    Antidiarrheals (r/o bacterial infection/cause of diarrhea first!)
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87
Q

What is fecal incontinence

A

loss of voluntary control of fecal and gaseous discharge through the anal sphincter

  • Less common than urinary incontinence
  • May occur at specific times or irregularly
  • Patients often reluctant to reveal because of embarrassment or shame
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88
Q

What is the pathophysiology of fecal incontinence

A
  • Impaired functioning of the anal sphincter or its nerve supply
  • Usually manifestation of an underlying disorder

Partial
Inability to control flatus or prevent minor soiling

Major
Inability to control feces of normal consistency

  • Usually a manifestation of another disorder
  • Neurologic disorders, Depression, Traumatic injuries, Inflammatory process, Masses, hemorrhoids, or deformity in the anus
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89
Q

What are the risk factors for fecal incontinence

A
  • Older age
  • Female gender
  • Age-related changes in anal-sphincter tone
  • Response to rectal distention
  • Smoking
  • Increased BMI
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90
Q

How to prevent fecal incontinence

A

Controlling the cause of fecal incontinence
- Constipation
- Diarrhea

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91
Q

Non-pharmacologic therapies for fecal incontinence

A

High-fiber diet
Ample fluid intake
Scheduled toileting
Regular exercise
Kegel exercises
Biofeedback

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92
Q

Pharmacologic therapy for fecal incontinence

A

Medications to relieve diarrhea or constipation
Antimicrobial agent for diarrhea caused by infection
Temporary use of lubricants, bulk-forming laxatives, and stool softeners to clear impacted stool

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93
Q

Types of surgery for fecal incontinence

A

Surgical repair of damage to sphincter or rectal prolapse
Artificial anal sphincter
Dynamic graciloplasty
Radiofrequency anal sphincter remodeling
Permanent colostomy to control fecal output when other measures fail

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94
Q

what is encopresis

A

abnormal elimination pattern

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95
Q

Lifespan considerations for fecal incontinence in children and adolescents

A
  • Recurrent soiling or passage of stool at inappropriate times by a child who should have achieved bowel continence
  • More common among boys
  • More common with a history of constipation
  • Primary: Never achieved bowel control
  • Secondary: Have had bowel continence for several months
  • Underlying constipation cause
    Birth of sibling
  • Move to a new house, new school
    Anger, and control issues related to bowel training
  • Diet
  • Full schedule
  • Genetic predisposition
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96
Q

Lifespan considerations for fecal incontinence in pregnancy

A
  • More incontinent late in pregnancy than after delivery
  • Incontinence during labor, delivery
  • Fecal incontinence is probable if stool is present in the sigmoid colon or rectum
  • Incontinence due to proximity of birth canal to rectum, anus

Postpartum incontinence
- Due to biomechanical changes during pregnancy
- Changes in the function of the rectum, anus
- Sphincter disruption, nerve damage

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97
Q

Lifespan considerations for fecal incontinence in older adults

A

Multifactorial etiology
- The delicate balance between stool consistency, the physical integrity of anatomic structures involved in bowel elimination
- Not a normal change of aging
- Decreasing muscle tone, and rectal sensation from cumulative local trauma
- Chronic disease
- Polypharmacy
- Fecal impaction from inactivity, immobility, and reduced fluid intake

  • Cognitively intact, physically able older adults should be considered for treatment
  • Alleviate psychosocial effects
  • Alleviate burden to care providers, healthcare systems
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98
Q

What is a part of the observation and patient overview for fecal incontinence

A
  • Signs and symptoms of bowel elimination problems
  • Frequent, urgent, untimely requests to use the bathroom
  • Question the patient further about elimination problems
  • Presence of fecal odor, soiled clothing
  • Patient agitation
  • Extent, onset, and duration of elimination problems
  • Contributing factors
  • History of the spinal cord, anorectal injury or surgery
  • Chronic diseases
  • Medications, alternative therapies
  • Nutrition
  • Hydration
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99
Q

What is a part of the physical examination for fecal incontinence?

A
  • Palpation of abdomen
  • Bowel sounds
  • DRE
  • Assess for hemorrhoids, anal fissures
  • Assess for abnormalities of the abdomen, perineum
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100
Q

What should be implemented for fecal incontinence assessment?

A
  • Promoting regular defecation
  • Perineal skincare
  • Bowel training programs
  • Digital removal of fecal impaction
  • Use of fecal incontinence pouch
  • Teaching about lifestyle modifications
  • promote regular defecation
  • Maintain skin integrity
  • Provide emotional support
101
Q

What is part of the care following an anal sphincter surgery (3 parts)

A
  • Cuff around the anal canal
  • Pressure-regulating balloon
  • Pump that inflates the cuff

Bowel movement occurs when the cuff is deflated
The cuff automatically inflates in 10 minutes
Enemas and rectal medications harmful with this device in place

102
Q

What to educate patients for home care on fecal incontinence

A

-Topics for patient and family education
-Facilitating toileting
-Monitoring bowel elimination pattern
-Dietary alterations
-Medications
-Exercise and self-care

103
Q

What is considered constipation?

A
  • Reduce the frequency of bowel movements
  • Passage of fewer than three bowel movements/week
  • Difficult passage of dry, hard stool, or no stool
104
Q

What is the pathophysiology of constipation?
- Can it be caused by medications?

A
  • Occurs when the slow movement of feces through the large intestine –> allowing for more resorption of fluid
  • Decreased motility –> due to inactivity or other
  • Medications
  • May have feelings of incomplete stool evacuation after defecation
  • May reflect the primary problem or underlying disorder
105
Q

What is the most common type of constipation?

A

Normal-transit constipation

related to: Meds, activity level, diet, emotional factors

106
Q

What is the primary reason for constipation

A

aka functional constipation
- colonic transit time; anorectal outlet obstruction

107
Q

What is a secondary reason for constipation

A
  • Hypothyroidism, multiple sclerosis
  • Opioid medications
  • Diet
108
Q

What 3 causes of constipation (what categories do they fall in)

A
  • behavioral
  • physiological
  • Psychological
109
Q

Dietary methods to prevent constipation

A
  • High-fiber diet
  • Drinking plenty of fluids
  • Fiber supplements
110
Q

What are behavioral methods to prevent constipation

A
  • Exercising regularly
  • Not ignoring the urge to defecate
111
Q

Are stool softeners and laxatives that are used to prevent constipation okay to use for long-term use?

A

No, only for short term use

112
Q

What is considered chronic constipation

A

According to Rome IV criteria: symptoms for at least 12 weeks with onset of symptoms 6 months before diagnosis (2 or more criteria need to be met for ¼ or 25% of BMs)

113
Q

What are the symptoms of chronic constipation

A
  • Straining with defecation
  • Lumpy or hard stools
  • Sensation of incomplete emptying
  • Use of manual maneuvers to facilitate emptying –> digital evacuation, support of the pelvic floor
  • less than 3 bowel movements/week
  • Loose stools are atypical without the use of laxatives
  • Absence of IBS
114
Q

What are pharmacological therapies for constipation

A
  • Laxatives
  • Cathartics, enemas for severe constipation
115
Q

how to diagnose constipation in children and adolescents

A

-Greater than or equal to 1 episode of incontinence per week
-Hx of excessive volitional stool retention
-Hx of painful or hard bowel movements
-Presence of large fecal mass in the rectum
-Hx of large-diameter stools that may obstruct the toilet

116
Q

can iron supplements cause constipation

A

yes

117
Q

what are the contributing factors for constipation in older adults

A

Lack of teeth or ill-fitting, broken, or lost dentures

Periodontal disease

Lack of fiber

Low fluid intake

Advertising encourages overuse of laxatives, suppositories, enemas

Further, impair ability to maintain a healthy pattern of bowel movement

118
Q

What are the symptoms of fecal impaction

A
  • Odorous leakage
  • Constipation of solid stool
    -Rectal pain
  • Frequent but nonproductive desire to defecate
  • A general feeling of illness
  • Anorexia
  • Nausea and vomiting
  • Abdominal distention and cramping
  • The sensation of fullness in the rectal area
119
Q

A mass increase in pressure in the colon leads to…..

A

increase risk for ulceration and perforation

120
Q

How is fecal impaction recognized?

A
  • Recognized by the passage of liquid foul-smelling fecal material in the absence of formed stool
  • Liquid portion of feces seeps around impacted mass
  • Assessed by digital rectal examination (DRE)
121
Q

What is an ostomy

A

A surgical procedure to divert fecal matter out via abdominal wall

122
Q

What is the nursing care for a stoma?

A
  • Monitor surgical site (should heal within 8 weeks)
  • Control odor
  • Educate on care of stoma, care of skin surrounding the stoma
  • Monitor intake/output
  • Encourage the patient to look at, and care for ostomy
123
Q

What should the patient be educated about if they have a stoma?

A
  • Reason for stoma
  • Demonstrate self-care
  • Verbalize fears
  • Knows where/how to obtain supplies
  • Describe f/u care and resources
  • Demonstrates positive body image
124
Q

Promoting healthy elimination habits

A
  • Maintaining a healthy weight
  • Exercising regularly
  • Good toileting habits
  • Avoiding delayed voiding and defecation
  • Avoiding using pelvic floor muscles to force urine - flow/prevent straining
  • Adequate fluid, and fiber in the diet
  • Treating constipation or diarrhea as it occurs
    Not smoking
  • Avoiding food and drinks that contain bladder and bowel irritants
125
Q

What is metabolism?

A

collection of biochemical reactions that occur in the body’s cells
 Produce energy
 Repair cells
 Maintain life
Much of the metabolic process takes place in the digestive system

126
Q

What are hormones

A
  • chemical messengers secreted by endocrine glands to regulate:
     Regulate metabolism
     Growth
     Reproduction
     Fluid and electrolyte balance
     Sex differentiation
     Other functions within the cell
127
Q

Adrenal glands, what is the hormone that helps with glucose control

A

Mineralocorticoids (Aldosterone)
◦ Reabsorption of water and sodium in kidneys

128
Q

Glucocorticoids (cortisol and cortisone), how do they help with glucose control

A

◦ Regulate carbohydrate metabolism
◦ Suppress inflammatory response, and inhibit immune system effectiveness

129
Q

Gonadocorticoids, how does it help with glucose control

A

◦ Dehydroepiandrosterone (DHEA)
◦ Adrenal medulla
◦ Epinephrine and norepinephrine

130
Q

Pancreas, how does it help with glucose control?

A

◦ Carbohydrate metabolism,
◦ –> including blood glucose levels
◦ Alpha cells: glucagon
◦ Beta cells: insulin
◦ Delta cells: somatostatin

131
Q

What are the 2 disorders of the pancreas?

A

Type 1 and Type 2 diabetes

132
Q

Diabetes mellitus (DM)
What is it a disorder of and what are the results of the defects

A

 Disorder of hyperglycemia
 Results from defects in:
 Insulin secretion
 Insulin action
 Both
 This leads to abnormalities in carbohydrate, protein, and fat
metabolism

133
Q

What are the 4 major types of diabetes mellitus

A

 Type 1 DM (T1D)
Caused by autoimmune destruction of beta cells

 Type 2 DM (T2D)
Cased by gradual loss on insulin secretion by beta
cells

 Gestational diabetes
Diagnosed in 2nd and 3rd trimester of pregnancy
–> insulin resist

 Other specific types of diabetes –> rare

Caused by
 monogenic diabetics syndromes
 exocrine pancreas disease
 diabetes is caused by certain drugs or chemicals

134
Q

Islets of Langerhans consist of what 3 types of cells

A
  • Alpha
  • Beta
  • Delta
135
Q

What are Alpha cells

A

Alpha cells produce glucagon
 Released when blood glucose levels < 70 mg/dL
 Promotes the breakdown of glycogen
 Decrease glucose oxidation via glycogenolysis
 Increase blood glucose levels via gluconeogenesis

136
Q

What are Beta cells

A

Beta cells produce insulin
 Secreted as blood levels start to rise such as after a meal
 Facilitates movement of glucose across cell membranes into
cells
 Stimulates conversion of glucose to glycogen in the liver and
muscles
 Incretin hormones are secreted in the intestine in response to food
consumption

137
Q

What are Delta cells

A

Delta cells produce somatostatin
 Neurotransmitter that inhibits secretion of glucagon and insulin
 Slows gastric motility — increases the time available for food

138
Q

What is the name for the opposite action of insulin? when hormones increase glucose levels during increased metabolic needs, stress, growth, and hypoglycemia

A

Counterregulatory hormones

139
Q

What destroys beta cells of islets of Langerhans

A

A combination of
 genetic pre-disposition
 environmental factors –> trigger a cell-mediated autoimmune reaction
 Begins with insulitis
 Inflammation of the islets of Langerhans
- Destruction of beta cells
 Creates a need for exogenous insulin
 It is variable but tends to occur more rapidly in infants and children and slower in adults
 Hemoglobin A1c is used to measure blood glucose levels over the previous 1 to 3 months

140
Q

2 or more autoantibodies are strong predictors for…

A

hyperglycemia and diabetes

141
Q

immune-mediated diabetes occurs more frequently in older adults or children

A

Children

142
Q

Idiopathic disorder

A

 No known etiology
 Strongly familial
 Insulin deficiency and no beta-cell autoantibodies
 Prone to DKA
 Predominately African or Asian descent

143
Q

What are the 3 classic symptoms of Type 1 DM ( including 3 P’s)

A

 Polyuria
 Polydipsia
 Polyphagia

 Weight loss as fats and proteins used for energy (gluconeogenesis)

 Symptoms:
 malaise, fatigue, blurred vision,
dehydration, hypotension, tachycardia

144
Q

What are the complications of Type 1 DM

A

 Hyperglycemia
 Diabetic ketoacidosis
 Hypoglycemia
 Hyperosmolar hyperglycemic state
 Microvascular and macrovascular
complications
 Increased susceptibility to infection
 Periodontal disease
 Interactions of complications – problems in the feet
 Depression
 Diabetic distress

145
Q

Hyperglycemia, what is the dawn phenomenon

A

 Rise in blood glucose between 4 a.m. and 8 a.m.
 Not a response to hypoglycemia
 Cause unknown, might relate to nocturnal increase in growth hormone

ACUTE complication

146
Q

What is the Somogyi phenomenon aka rebound hyperglycemia

A

 Combination of hypoglycemia during the night with a rebound morning rise to
hyperglycemia

147
Q

What is DKA

A

diabetic ketoacidosis ACUTE complication

 Life-threatening metabolic disorder
 Manifested by:
 Hyperglycemia
 Metabolic Acidosis
 Ketosis - accumulation of ketone bodies
from the metabolism of fatty acids
 Can occur in both Type 1 and Type 2 DM
 Increase incidence of Type 1 DM

148
Q

What are the acute complications of Diabetic Ketoacidosis

A

ACUTE complication
- no insulin
- lack of insulin
- glucagon from the liver increases production

149
Q

What can cause insulin-related precipitating factors?

A

 Non-adherence to insulin regimen
 Under-dosing
 Skipping doses
 Insulin pump failure
 Conditions that can cause:
 infection, trauma, thyrotoxicosis, surgery, acute
MI

 Medication triggers:
 corticosteroids, sympathomimetics, atypical
antipsychotics

150
Q

What are the symptoms of hyperglycemia in DKA

A

ACUTE complication
Symptoms: polyuria, polydipsia, weakness, nausea, vomiting, abdominal pain, mental status changes, Kussmaul respirations, acetone breath
 Lab values: blood glucose > 250mg/dL
pH < 7.2
ketones in urine or blood

151
Q

What is the goal for someone who has Hyperglycemia from DKA

A

 Restore ECF volume - improve tissue
perfusion
 Reduce hyperglycemia
 flush ketones from the body
- Restore Electrolyte balances (if needed)

152
Q

What is the cause of Hypoglycemia (metabolic reason)

A

ACUTE complication

A mismatch between insulin intake, physical activity, carbohydrate availability

153
Q

What causes hypoglycemia in hospitalized patients

A

 NPO status
 Vomiting
 Abruptly stopping or reducing corticosteroid meds
 Improper timing of insulin to meal and variable
meal times

154
Q

What are the clinical manifestations of hypoglycemia

A

 The result from compensatory autonomic nervous system response
 Pallor (pale), tremors, palpitations, anxiety and diaphoresis hunger
 Vary, especially in older adults
 Sudden onset
 Severe hypoglycemia may cause death

155
Q

What are the 3 levels and ranges of hypoglycemia

A

 Level 1: Glucose > 54 mg/dL and < 70
mg/dL
 Level 2: Glucose <54 mg/dL
 Level 3: altered mental status; loss of
consciousness, seizure, coma, death

156
Q

what are the signs and symptoms of hypoglycemia

A
  • anxious
  • sweaty
  • hungry
  • confused
  • blurred vision
  • double vision
  • shaky
  • irritable
  • cool, clammy skin
157
Q

What is diabetic retinopathy

A

 Leading cause of blindness in individuals 20–74
years of age
 Vitrectomy used to treat vitreous hemorrhage

158
Q

What is the etiology of diabetic neuropathy (what is happening that causes it?)

A

 Hyperglycemia and hyperlipidemia
damage nerves and microvasculature
 Types: peripheral, focal, proximal,
autonomic
 Peripheral most common

159
Q

What is polyneuropathies

A

involve multiple nerves fibers

160
Q

What is mononeuropathies

A

affecting one nerve (peripheral)

161
Q

is proximal neuropathy common?
- what kind of pain does it cause?

A

uncommon; causes pain in the hip, buttock, thigh

162
Q

What does autonomic neuropathy affect?

A

affects sweat glands, CV, GI, and GU systems

163
Q

What is the TX for Diabetic neuropathy

A

regabalin, duloxetine, tapentadol
 Topical treatments offer some relief

164
Q

What is diabetic neuropathy

A

A disease of the kidneys characterized by
- Presence of albumin in urine
- hypertension
- edema
- progressive renal insufficiency

165
Q

is the pathologic origin of diabetic nephropathy unknown?

A

yes

166
Q

Why does Glomerulosclerosis occur

A

occurs d/t accumulation of
larger proteins – makes the basement membrane
functional leaking – allowing the protein to be lost in
the urine

167
Q

What is the major cause of heat disease in people with diabetes

A

atherosclerosis

168
Q

what are 2 additional risk factors for CAD

A
  • HTN
  • Dyslipidemia
169
Q

Are people with DM prone to MI

A

YES

170
Q

what are the numbers for hypertension

A

greater than 140/90

171
Q

Does diabetes increase the risk of a stroke?

A

Yes,  Especially in older adults with Type 2
DM
 Potentially life-threatening

172
Q

PVD is more common in people with either type 1 or type 2 diabetes?

A

type 2 diabetes

173
Q

What causes PVD in diabetic patients?

A
  • atherosclerosis development
     Impaired peripheral vascular circulation leads to PV insufficiency with intermittent
    claudication (pain) in LE and ulceration of feet
     Gangrene
     Combination of vascular disease,
    neuropathy, and increased risk for infection
     Most common cause of amputations
    for DM
174
Q

For type 1 diabetes why is there an increased susceptibility to infection?

A

 Immune system deficiencies
 Hyperglycemia
 Skin/mucous membrane
colonization
 Vascular complications
 Reduced sensation
 Autonomic neuropathy
 Hospitalized patients with glucose levels> 220 mg/dL — higher rates of infection

175
Q

Periodontal disease

A
  • Progresses more rapidly if diabetes is poorly controlled
  • d/t microangiopathy with changes in vascularization of the gums
     Gingivitis (inflammation of gums)
     Periodontitis (inflammation of the bones underlying the gums)
176
Q

Chronic complications for a diabetic foot

A

 Most common
 Cracks and fissures caused by dry skin or infections
 Blisters from improperly fitting shoes
 Pressure from stockings or shoes; foreign objects in a show
 Ingrown toenails
 Walking barefoot
 Usually begin as superficial skin ulcer
 Eventually extends deeper, into
muscle and bone
 If untreated, gangrene can develop

177
Q

Who is part of the team in collaboration with the patient’s care

A

Certified diabetes educator, nurse,
family physician, specialist, dietitian,
podiatrist and psychologist or psychiatrists
(family and friends as well

178
Q

What is the main focus of treatment for type 1 diabetes (4 things)

A

 Maintain blood glucose at nearly normal levels
 Medication
 Dietary management
 Exercise

179
Q

What are 4 diagnostic screening tests

A

 Fasting plasma glucose (F P G) >126 mg/dL
 Two-hour plasma glucose >200 mg/dL during oral glucose tolerance test (O G T T)
 Hemoglobin A1C greater than or equal to 6.5%
 Symptoms of diabetes plus casual plasma
glucose (PG) concentrations > 200 mg/dL

180
Q

What is a part of the Diabetes management monitoring related to Diagnostic tests?

A

 Fasting blood glucose (FBG or FBS)
 Hemoglobin (A1C)
 Average blood glucose over 1–3 months
 Lipid profile
 Urinary albumin/creatinine ratio (> or = 30
mg/g creatinine) - diagnosis of albuminuria
 Estimated glomerular filtration rate (GFR)
 Serum and urine ketones
 Serum electrolytes

181
Q

Difference between self-monitoring blood glucose and continuous glucose monitoring?

A

Self-monitoring blood glucose
(SMBG)
 Lancet to obtain a drop of blood to
place in a monitoring device

Continuous glucose monitoring
(CGM)
 The sensor under the skin continuously
monitors glucose levels

182
Q

When should you monitor your glucose as a diabetic patient?

A

 Before eating meals and snacks
 At bedtime
 Periodically after meals
 Before exercising
 If a low blood glucose level is suspected
 Following treatment for low blood glucose until glucose levels return to normal
 Before a safety-related activity, such as
driving.

183
Q

What are pharmacologic therapies for Type 1 diabetic patients and what are 5 types

A

Insulin
- T1D requires lifelong insulin source
- need long-acting insulin to control levels with meals and overnight
- need rapid-acting before meals to cover spikes in BG

Types of insulin:
 Rapid-acting
 Short-acting
 Intermediate-acting
 Long-acting
 Combinations

184
Q

What are the insulin regimens?

A

given first based on weight and split up throughout the day and then rest is based on the patient’s actual BG levels

185
Q

recommended nutrition management based on the ADA

A

 Healthy eating habits
 Wide variety of foods in proper
proportions
 High in nutrients, low in calories
 Processed foods and added sugar to be
avoided
 Individualize proportion of
carbohydrates, fats, and protein for the
patient

186
Q

What are the nutrition guidelines related to Carbs, proteins, and fats?

A

Carbohydrates
 Count grams of carbohydrates per
meal to determine dose of insulin

Protein
 Without renal disease: 1 to 1.5
g/kg/body weight/day or 15-20%
total calories
 Diabetic nephropathy: 0.8 g/kg body
weight/day

Fats
 20-35% total calories
 Focus on monounsaturated and
polyunsaturated fats
 Eliminate trans fats

187
Q

Nutrition management for Sodium, Fiber, alcohol, and non-nutritive sweeteners

A

 Sodium
 Limited to <2300 mg/day
 Fiber
 Increasing fiber may lower A1c
 Minimum 14 g of fiber/1000 kcal

 Alcohol
 Same as for the general public
 Women: 1 drink per day
 Men: 2 drinks per day
 Can cause hypoglycemia, weight gain,
or hyperglycemia if a large amount
ingested

 Non-nutritive sweeteners
 Reduce the use because of the potential for
weight gain

188
Q

For exercise, when should you check to monitor BG levels?

A

before, during, and after exercise

189
Q

Lifespan Considerations in Children and Adolescents

A

 T1D in Children and adolescents

Clinical manifestations
 Hyperglycemia
 Increased thirst, hunger, urination
 Fatigue
 Blurred vision
 Weight loss

 Usually acute, requires emergency intervention
 DKA: dehydration, electrolyte imbalance
 Quick diagnosis, and treatment required to prevent deterioration

 Therapy aimed at
 Correcting acidosis
 Restoring fluid and electrolyte balance
 Achieving euglycemia

Diagnostic tests
 A1C level greater than or equal to 6.5% + random blood PG level
 Greater than or equal to 200 mg/dL or fasting

190
Q

What are the risk factors for Type 1 DM

A

exposure to environmental triggers
 Drugs, pollutants, dietary considerations, stress, infections, gut flora
 No way to prevent Type 1 DM
 Identification of autoantibodies in relatives with Type 1 DM provides an opportunity for education and follow-up
for early detection

191
Q

Sick-Day Management

When an individual with diabetes is sick
or has surgery:

A

 Notify HCP if vomiting or diarrhea
persists beyond 6 hours, fever, or
sickness continues for several days
without improvement

 Seek medical attention for vomiting,
diarrhea, and symptoms of DKA

 Obtain self-monitor blood glucose levels
every 3 to 4 hours
 Notify HCP if levels are elevated despite
insulin administration

 Continue long-acting or basal insulin
 Notify HCP if levels remain > 240
mg/dL despite extra insulin

 Monitor urine or blood for ketones
 Notify HCP if moderate or large
amounts ketones present

 Drink fluids every hour to avoid
dehydration and consume carbohydrates
 Water, tea, diet soda, broth

192
Q

Why is exercise beneficial for diabetic patients (6 things)

A

 Manages glucose levels
 Improves health
 Weight loss
 Reduce insulin resistance
 Enhance emotional health
 Reduce cholesterol and triglycerides

193
Q

before exercising, what should you do to avoid injury?

A

 Wear proper footwear and examine feet before and after exercise
 Consult with HCP before starting an exercise program if autonomic neuropathy present
 Discuss the exercise with the ophthalmologist if retinopathy present

194
Q

For a diabetic patient, what is an increased risk post-surgery?

A
  • infection, delayed wound healing
  • Risk of complications
195
Q

Things to consider pre and post-surgery for a diabetic patient

A

 Achieve optimal blood glucose control before surgery
 Instructions regarding when to fast, medications to take, insulin adjustments
 Preoperative blood glucose levels between 80 and 180 mg/dL
 On the morning of surgery, reduce NPH by 50%, long-acting or basal pump by 60-80%
 Premixed Regular/NPH not given when fasting
 Check blood glucose every 4 to 6 hours while fasting
 Patients with T1D are at risk for DKA if insufficient insulin given
 Once oral intake resumes, regular dosing can begin

196
Q

Lifespan Considerations Children and Adolescents specifically on glucose monitoring and insulin

A

Glucose monitoring
 Before meals: 90-130 mg/dL
 Bedtime/overnight: 90-159 mg/dL
 Glycemic goals should be individualized
 A1c goal <7.5%
 Different targets because of erratic oral intake, activity
 By age 6–8, most children can take some responsibility for blood glucose monitoring, insulin injection

Insulin
 Exogenous insulin will be a lifelong requirement
 Newly diagnosed children may go through the partial remission phase
 Probably from the activation of remaining beta cells
 Important to take insulin to preserve beta cells as long as possible

197
Q

Lifespan Considerations for Pregnancy

A

 Preconception counseling addressing
importance of glycemic control
 Glycemic control is essential to reduce risks
 Spontaneous abortion
 Congenital anomalies
 Preeclampsia
 Intrauterine fetal demise
 Macrosomia
 Neonatal hypoglycemia
 Neonatal hyperbilirubinemia
 Target A1C in pregnancy: <6.5%
 Changes in insulin dosages may be
necessary
 Increased risk of diabetic retinopathy

198
Q

Lifespan Considerations for Older Adults

A

 Age is a risk factor for diabetes
 More likely to die prematurely and have
functional disabilities
 Muscle atrophy
 Stroke
 Cardiovascular events
 Hypertension
 Complex concerns
 Risk for polypharmacy
 Depression
 Cognitive impairment
 Urinary incontinence
 Falls
 Pain

 Manifestations
 May not include polyuria, thirst
 Signs and symptoms of hypo-,
hyperglycemia is mistaken for other
conditions
 Screening criteria
 Same as other adults
 Testing should start at age 45 and
repeated every 3 years
 Increased risk for CV disease
 Poorly controlled A1c, elevated
cholesterol and triglycerides and
hypertension
 Assess for CV disease with every
encounter

199
Q

For Nursing Process, what do we educate the patient about on Type 1 DM?

A

 Time of diagnosis
 Yearly appointments
 Complications
 Transitions in care
 Focus
 Self-management of medication, nutrition, exercise
 Reduce the risk of complications
 Achieve glycemic control
 Promote positive mental health

200
Q

For Diabetes, what should we observe during patient interviews?

A

 Symptoms of diabetes
 Knowledge of diabetes
 Self-monitoring blood glucose level
 Lifestyle habits
 Change in weight, appetite, infections, healing
 Problems with gastrointestinal (GI) function or urination
 Altered sexual function

201
Q

For Diabetes, what should we check during Physical Assessment?

A

 Height–weight ratio
 Vital signs: orthostatic blood pressure
 Visual acuity
 Sensory ability in extremities
 Touch
 Temperature
 Vibration
 Reflexes
 Cranial nerves
 Peripheral pulses
 Skin and hair

202
Q

what does ventilation consists of?

A

inspiration -> exchange of O2 exchanged for CO2
expiration -> Co2 expelled from body

203
Q

What is respiration

A

the exchange of O2 and CO2 at the cellular level

204
Q

the trachea is the entrance of…

A

air into the lungs

205
Q

What is Eupnea

A

breathing within the EXPECTED resp. rates

206
Q

alveoli is the site of…

A

gas exchange

207
Q

visceral pleura

A

covers surface of each lung

208
Q

function of parietal pleura

A

lines inside of chest wall

209
Q

function of pleural space

A

the region between them

210
Q

bronchial sounds sound like what?

A

loud, high-pitched
- longer on exhalation than inhalation

211
Q

broncho-vesicular sounds sound like what?

A

medium in loudness and pitch, heard on each side of sternum, between scapulae

212
Q

Vesicular sounds sound like what?

A

soft-low pitched
- heard over peripheral lung fields

213
Q

the drive to breathe depends on the ___ in the arterial blood

A

CO2

214
Q

HypoxEMIA leads to what?

A

Hypoxia

215
Q

dyspnea relates to what 3 things

A
  • tachypnea
  • diaphoresis
  • fluid in the lungs
216
Q

What do ABGs tell you about the blood?

A

the pH

217
Q

CO2 stimulates the ____ to breathe

A

DRIVE

218
Q

Are retractions an early or late stage of hypoxia, what is cyanosis?

A

early, cyanosis is late

219
Q

Sputum, inflammation, lung collapse, and fluid volume excess are examples of…

A

airflow in the alveolus being blocked

220
Q

Blood clots, plaque buildup, and emphysema alveoli are examples of…

A

Blood flow in capillaries being blocked

221
Q

tachypnea resp rate?

A

greater than 20

222
Q

hyperventilation def

A

rapid, deep inhalation and exhalation of air from lungs

223
Q

hypoventilation def

A

abnormally slow respiratory rate — inadequate o2 delivery to lungs

224
Q

respiratory depression def

A

decrease in the rate and depth of breathing

225
Q

bradypnea resp rate?

A

less than 10

226
Q

resp. arrest characterized by…

A

apnea

227
Q

Dyspnea

A

labored/respiratory breathing or SOB

228
Q

orthopnea def

A

difficulty breathing when supine

229
Q

Kussmaul breathing
- occurs in acidosis or alkalosis?

A
  • metabolic acidosis (DKA)
  • Deep-rapid breaths
  • Inc. elimination of CO2 - affecting the acid-base balance
230
Q

Cheyne-Stokes respiration done prior to what

A

Death

231
Q

Biot Respiration

A

shallow breathing with periods of apnea
- occurs in CNS disorder

232
Q

pneumothorax is when…

A

air enters pleural space and causes loss of negative pressure
- causes lung collapse

233
Q

pneumothorax is treated with a…

A

Chest Tube

234
Q

Factors affecting the heart’s ability to circulate blood
(3 things)

A
  • Hypertension
  • Atherosclerosis
  • CHF

extra:
- obesity
- Type 2 diabetes
- Smoking
- Stress and Anxiety

235
Q

tobacco smoking for resp causes 2 things…

A
  • Increased mucus production
  • Reduced cilia action in airway passages
236
Q

Signs of hypoxia

A
  • increased restlessness, irritability, unexplained sudden confusion
  • Rapid heart rate + rapid resp. rate
237
Q

wheeze = ?

A

= asthma

238
Q

crackles = ?

A

fluid

239
Q

Rhonchi =

A

= secretions in large airways

240
Q

pleural friction rub = ?

A

friction pleural surfaces

241
Q

asthma def

A

persistent inflammation of lungs

242
Q

** how to prevent asthma **

A

modifying the home environment ***
- control dust
- remove carpet
- remove pets
- no smoking

243
Q

common manifestations of asthma

A

coughing, wheezing, dif. breathing, chest tightness, mucus production, tachypnea, tachycardia, anxiety, stress

244
Q

what is the status asthmaticus def

A
  • Severe from of asthma that is prolonged
  • untreated leads to coma, resp. failure, death.
245
Q

Asthma diagnostic tests

A

PEFR - peak expiratory flow rate
- allergic asthma: scratch or patch testing, IgE testing

246
Q

bronchodilators function

A

relax smooth muscles of the airway

247
Q

pneumococcal or lobar pneumonia is abrupt or takes a while to develop?

A

Abrupt

248
Q
A

Holistic Care (Abbott) (4 decks)

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