Final Flashcards
(258 cards)
1
Q
Renal dysfunction may produce tenderness at what specific area?
A
The costovertebral angle
2
Q
What is overflow incontinence?
A
The release of urine from an overly full bladder
3
Q
Urinary retention can lead to what two complications and why?
A
Can lead to UTIs and renal stone formation d/t urinary stasis
4
Q
What is urinary retention defined as?
A
Inadequate bladder emptying
5
Q
What kind of bath should be provided to someone with urinary retention?
A
A warm sitz bath
6
Q
What is urinary incontinence defined as?
A
The involuntary loss of urine
7
Q
What are two main treatments for urinary incontinence?
A
Behavioral treatments and neuromodulation
8
Q
What is stress incontinence?
A
Losing urine without meaning to during physical activity such as sneezing, laughing, exercise
9
Q
What is urge incontinence?
A
Sudden, strong need to urinate d/t bladder spasms or contractions
10
Q
What is reflex incontinence?
A
When bladder contracts and expels urine without the urge to urinate
11
Q
What is functional incontinence?
A
Person is aware of the need to urinate, but cannot get to the bathroom for physical or mental reasons
12
Q
What is mixed incontinence?
A
A combination of stress and urge incontinence
13
Q
Cystitis, urethritis, and prostatitis are three examples of upper or lower UTIs?
A
Lower UTIs
14
Q
What is pyelonephritis?
A
Inflammation of the renal pelvis
15
Q
What is interstitial nephritis?
A
Inflammation of the kidney
16
Q
Renal abscess, pyelonephritis, and interstitial nephritis are examples of upper or lower UTIs?
A
Upper UTIs
17
Q
What is a major symptom of complicated UTIs?
A
Urosepsis (septic shock)
18
Q
Is urosepsis d/t gram neg. or gram pos. bacteria?
A
Gram negative
19
Q
What bacteria most commonly causes urosepsis?
A
E. coli
20
Q
What is the most common manifestation of urosepsis?
A
Fever
21
Q
How long are IV antibiotics usually administered for in urosepsis?
A
3-5 days or until afebrile
22
Q
What is the most common cause of sepsis in those over 65?
A
UTIs
23
Q
Why should urine be collected in cystitis?
A
For a culture and sensitivity
24
Q
How much fluid should be forced in cystitis?
A
Up to 3,000 mL/day
25
What kind of diet should a cystitis pt follow?
Acid ash
26
What are the two most frequent causes of urethritis in men?
Gonorrhea and chlamydia
27
What is one difference in how urethritis presents in men and women?
In men, presents as penile discharge; in women, as lower abdominal discomfort
28
What is BPH?
An increased number of prostate cells
29
Prostatitis could be caused by what two broad things?
Bacterial infection or tissue hyperplasia
30
Abacterial inflammation of the prostate often follows what two things?
Viral illness or a decrease in sexual activity
31
What type of prostatitis is characterized by fever, chills, and a boggy, tender prostate?
Bacterial
32
What type of prostatitis is characterized by backache, perineal pain, and an enlarged, firm prostate?
Abacterial
33
What are two "prostate-draining" activities that should be encouraged in pts who have prostatitis?
Masturbation and sex
34
What does TURP stand for? What is it used for?
Transurethral resection of the prostate. It relieves urinary symptoms caused by an enlarged prostate
35
How many lumens are used in continuous bladder irrigation? What is each used for?
Three -- one to inflate the balloon, one for outflow, and one to instill water
36
After TURP, fluids should be increased to what?
2,400 to 3,000 mL/d
37
Post-TURP, when should the pt ambulate?
As soon as urine is cleared
38
How does arterial bleeding after TURP appear?
Bright red with numerous clots
39
What two things should the nurse do for arterial bleeding with TURP?
Notify the physician and increase continuous bladder irrigation
40
How does venous bleeding after TURP appear?
As burgundy-colored urine output
41
What should you expect the physician to do if there is venous bleeding after TURP?
Apply traction to the catheter
42
Why should catheter traction be maintained after TURP and how should the pt be instructed to maintain their leg?
To prevent bleeding; pt should be told to keep leg straight
43
What must be obtained before catheter traction is released after TURP?
An MD order
44
CBI should be run at a rate that keeps urine what color?
Pink
45
What should happen to CBI if urine is bright red?
It should be run at a faster rate
46
What should the nurse do if the catheter becomes obstructed during CBI?
Should turn off CBI, irrigate with 30-50mL of NS, and notify provider if this doesn't work
47
What electrolyte imbalance may occur as a result of CBI?
Hyponatremia
48
Urine will be red to light-pink for how long after TURP?
The first 24 hours
49
What color will urine be three days after TURP?
Amber
50
Is a feeling of continuous urge to void normal after TURP?
Yes
51
What are the usual symptoms of pyelonephritis?
There are no symptoms usually, unless there is an acute exacerbation.
52
Polyuria, weight loss, excessive thirst and fatigue are symptoms of what?
Acute exacerbation of pyelonephritis
53
What is pyuria?
Urine that contains pus
54
What is azotemia?
Abnormally elevated BUN and Cr levels
55
How much fluid/day should be encouraged in pyelonephritis?
3,000 mL/day
56
What kind of diet should a pt with pyelonephritis follow?
High-calorie, low protein
57
What is chronic kidney disease defined as?
An umbrella term for kidney damage or decrease in glomerular filtration rate for greater than 3 months
58
If untreated, what can chronic kidney disease lead to?
End stage renal disease
59
What occurs during stage 1 of chronic renal disease?
Slight renal damage with GFR above 90
60
What occurs during stage 5 of chronic renal disease?
End stage renal disease
61
What are the main goals of hemodialysis?
To remove nitrogenous wastes and water from the blood
62
How long does peritoneal dialysis take?
36-48 hours
63
How long does hemodialysis take?
6-8 hours
64
In acute intermittent peritoneal dialysis, how long is the infusion time, dwell time, and draining time?
Infusion=10 mins; dwell=30 mins; drain=20 mins
65
Is acute intermittent peritoneal dialysis done with aseptic or sterile technique?
Aseptic
66
If dialysate does not drain after acute intermittent peritoneal dialysis, how can the nurse facilitate drainage?
By turning the pt side to side or raising the head of the bed
67
In acute intermittent peritoneal dialysis, should the nurse push the catheter further into the peritoneal cavity?
No
68
Where is continuous ambulatory peritoneal dialysis performed and how many times per day?
At home, 4-5 times per day
69
Why does continuous cyclic peritoneal dialysis have a lower infection rate?
Because of fewer bag and tubing changes
70
Continuous ambulatory peritoneal dialysis and continuous cyclic peritoneal dialysis both require careful monitoring of what vital sign?
Blood pressure
71
How often should the nurse palpate for a thrill on a pt undergoing hemodialysis?
At least every 8 hours
72
What does it mean if the nurse cannot find a thrill on a pt on hemodialysis?
There may be a blockage or a clot
73
A pt on hemodialysis presents with substernal chest pain, low grade fever, and pericardial friction rub. The nurse suspects what?
Pericarditis
74
A pt on hemodialysis presents with distant heart sounds, pulsus paradoxus, and a disappearing friction rub. What does the nurse suspect?
Pericardial effusion
75
Where does renal colic originate and where does it radiate in men and women?
It originates in the lumbar region and radiates to the testicles in men and bladder in women
76
Where does ureteral colic radiate?
To the genitalia and thigh
77
Describe the pain felt with urinary stones.
Sharp, severe, sudden onset
78
How much fluid should be forced for someone with urinary stones?
3,000 mL/day
79
Why are IV fluids given to a pt with urinary stones?
To increase urine flow and facilitate passage of the stone
80
A cytoscopy is performed for urinary stones located where?
Bladder or lower ureter
81
How is a cytoscopy performed to remove urinary stones?
By inserting 1-2 catheters past the stone and then guiding them downward to remove the stone
82
Why are catheters left in place for 24 hours during a cytoscopy?
To dilate the ureters and drain any trapped urine
83
What is Extracorporeal Shock Wave Lithotripsy?
The use of sound waves to break kidney stones into smaller pieces
84
For how long should a pt by NPO prior to Extracorporeal Shock Wave Lithotripsy?
8 hours
85
Why should a pt be instructed to increase fluid intake after
Extracorporeal Shock Wave Lithotripsy?
To wash out any stone fragments
86
Why might a nephrostomy tube be placed after Extracorporeal Shock Wave Lithotripsy and for how long?
For chemical irrigation to further break up kidney stones; for 1-5 days
87
How much fluid should a pt drink per day after
| Extracorporeal Shock Wave Lithotripsy?
3,000 - 4,000 mL/day
88
What is a ureterolithotomy?
Open or laprascopic removal of stone from the ureter.
89
What is a nephrolithotomy?
An incision made into the kidney to remove a kidney stone
90
What is a pyelolithotomy?
An incision made into the kidney to remove stones from the renal pelvis
91
What is done as a last resort for incontinence?
Urinary diversion
92
What position should the pt be in after a kidney transplant?
Semi-Fowler's
93
Immediately after a kidney transplant, what color will the urine be?
Pink & bloody
94
Where is the liver located?
In the right upper quadrant of the abdomen
95
The portal vein supplies blood that is ____ rich and _____ poor to the liver.
Nutrient rich and O2 poor
96
The hepatic artery supplies blood that is _____ rich and _____ poor.
O2 rich and nutrient poor
97
How does the liver regulate glucose metabolism?
By storing glucose as glycogen
98
What does the liver do to ammonia?
Converts it to urea, which is then excreted by the kidneys
99
Ammonia is a byproduct of the breakdown of what?
Proteins
100
How is the liver involved in clotting?
It makes the proteins involved in clotting
101
How is the liver involved in fat metabolism?
It stores fat and breaks it down for energy use
102
The liver stores what three vitamins?
A, B and D
103
What is bilirubin? What does the liver do to it?
It is what is left after RBCs break down; it is excreted by the liver in the stool
104
The presence of carcinoembryonic antigen may indicate what?
Liver cancer
105
What may happen to protein studies (such as albumin) in liver dysfunction? Why?
Levels may drop, since the liver manufactures proteins
106
What happens to cholesterol levels in biliary obstruction?
May rise
107
What happens to cholesterol levels in diseases that affect liver cells?
May decrease
108
What happens to ammonia levels in liver disease and why?
May rise, since the liver converts ammonia to urea
109
What are two complications of liver biopsy?
Bleeding and bile peritonitis
110
What is bile peritonitis?
When the gallbladder is damaged, and bile spills into the peritoneum, causing inflammation
111
What side should a pt be placed on after a liver biopsy?
On their right side
112
After a liver biopsy, a pillow should be placed where, and why?
Should be placed under the right costal margin to provide compression
113
Vitals should be done Q____ for the first hour after liver biopsy, then Q____ for 1-2 hours after that
Q 10-15 mins, then Q30 mins
114
Pt should avoid heavy lifting for how long after a liver biopsy?
For one week
115
What is jaundice caused by?
Bilirubin seeping into the dermis when the liver cannot excrete it
116
Why is muscle atrophy a sign of liver disease?
B/c of the liver's decreased abilities to make proteins
117
Why are vitamin deficiencies a sign of liver disease?
B/c the liver has a decreased ability to store vitamins
118
What happens to platelet numbers in liver disease?
They decrease
119
What are spider angiomas and why do they increase in liver disease?
They are abnormal collection of vessels near the surface of the skin, and occur in liver disease b/c the liver metabolizes estrogen and estrogen causes vessel dilation
120
Males specifically may have what symptom in liver disease and why?
Gynecomastia, d/t estrogen imbalance
121
Retention of ammonia in liver disease may cause what?
Neurological changes
122
What does the child-pugh classification measure?
The outcomes of pts with liver disease
123
What does a higher score on the child-pugh classification mean?
Poorer prognosis
124
When bilirubin content is above _____, it infiltrates into body tissues.
2.5
125
What is hemolytic jaundice?
There is an increased destruction of RBCs, so bilirubin cannot be excreted as fast as it is formed, resulting in jaundice
126
Can conjugated bilirubin be excreted from the liver? What about unconjugated?
Conjugated can be excreted from the liver but unconjugated cannot be
127
What occurs in hepatocellular jaundice?
Liver cells are damaged, so they cannot excrete bilirubin
128
A pt with malaise, weakness and anorexia likely has what type of jaundice?
Hepatocellular jaundice
129
What causes obstructive jaundice?
Occlusion of the bile duct by gallstones, tumors etc
130
Pts will have an intolerance to fatty foods with what type of jaundice?
Obstructive jaundice
131
A pt with obstructive jaundice will have what color urine and why?
Orange, foamy urine b/c the body tries to excrete bilirubin in the urine
132
A pt with obstructive jaundice will have what type of stools?
Clay-colored
133
What are the four types of jaundice?
Hereditary, obstructive, hepatocellular, hemolytic
134
What two types of jaundice are most commonly associated with liver disease?
Hepatocellular and obstructive
135
What are the two main consequences of portal hypertension?
Ascites and varices
136
What happens to the spleen and platelets in portal hypertension?
Splenomegaly and thrombocytopenia
137
What is ascites?
Shift of fluid into the peritoneal cavity
138
A pt presents with stretch marks, visible veins, umbilical hernia and shortness of breath. The nurse suspects what?
Ascites
139
What will be percussed on the abdomen of a pt with ascites and what does this mean?
"Shifting dullness" -- means that area of dullness shifts as the pt moves
140
Where will edema be seen on a pt with ascites?
Will see flank edema
141
Fluid wave will be seen in a pt with what?
Ascites
142
What is the major complication of ascites?
Spontaneous bacterial peritonitis
143
What occurs in spontaneous bacterial peritonitis?
Bacteria is translocated to the peritoneal cavity, which then becomes infected
144
How is spontaneous bacterial peritonitis treated?
With antibiotics
145
What complication may occur if spontaneous bacterial peritonitis is not treated?
Hepatorenal syndrome (kidney failure without pathological changes to the kidneys)
146
How much sodium per day should someone with ascites consume?
500mg-2g per day
147
What general class of meds is someone with ascites usually put on?
Diuretics
148
What is paracentesis and for what medical condition is it performed?
The removal of fluid via a puncture in the peritoneal cavity, done for ascites
149
Why should the pt be kept upright during paracentesis?
To keep fluid as close as possible to the front of the abdominal wall
150
How does TIPS treat ascites?
By decreasing portal hypertension
151
What is the most common cause of ascites? What is the main contributor?
Cirrhosis. Main contributor is portal hypertension
152
What is the first line treatment for ascites?
Low-sodium diet and diuretics (spironolactone)
153
After spiro, which diuretic is tried next for management of ascites?
Lasix
154
If the first line of treatment does not work for ascites, what is done next and in what order?
Paracentesis, TIPS, liver transplant
155
What are varices and why do they occur?
Dilated, torturous veins from portal hypertension
156
Is a ruptured varix a medical emergency?
Yes
157
A pt presents with hematemesis, melena, and shock. What does the nurse suspect?
A ruptured varix
158
What unit of the hospital cares for a ruptured varix?
ICU
159
How does a balloon tamponade for a bleeding varix work?
It is a nasogastric tube that sits in the stomach and compresses bleeding
160
What should the nurse do if a pt has s/sx of asphyxia with a balloon tamponade in place?
Cut the tube to deflate the balloon
161
Why is cardiac monitoring essential with a balloon tamponade?
Because it may stimulate the vagus nerve
162
Why is vasopressin given during a bleeding varix?
To compress the vessels and control bleeding
163
What does "banding" a bleeding varix involve?
Placing a rubber band over the end of the bleeding varix so that the tissue necroses
164
Hepatic encephalopathy has what general types of symptoms?
Neuropsychiatric
165
What are the two possible explanations for hepatic encephalopathy?
The liver stops detoxifying, so ammonia levels build, causing neurotoxicity, OR elements of portal blood (which has toxins) enter the systemic circulation
166
A pt with hepatic encephalopathy will have constructional apraxia. What does this mean?
The inability to produce a simple figure in two or three dimensions
167
Why is IV glucose given for hepatic encephalopathy?
It will minimize protein breakdown, thus reducing the amount of ammonia in the blood
168
What kind of diet is contraindicated in hepatic encephalopathy and why?
High-protein, because it will increase ammonia in the blood
169
What is viral hepatitis, in general?
A systemic infection that causes inflammation of the liver cells
170
Which hepatitis is chronic and has a long incubation phase?
Hep B
171
Which hepatitis has two phases, the second of which includes jaundice?
Hep A
172
In order to contract Hep D, the pt must also have which other type of hepatitis?
Hep B
173
What is nonviral hepatitis?
Inflammation of the liver from hepatotoxins (may be caused by drugs such as ibuprofen)
174
What is fulminant hepatic failure?
Sudden and severe liver dysfunction in a previously healthy person
175
Jaundice progresses to encephalopathy within how many days in fulminant hepatic failure?
7-72 days
176
What is the most common cause of fulminant hepatic failure?
Viral hepatitis
177
What is cirrhosis defined as?
Scarring of the liver that disrupts its function
178
What is the most common type of cirrhosis?
Alcoholic cirrhosis
179
Postnecrotic cirrhosis usually occurs after what?
After hepatitis
180
Biliary cirrhosis involves scarring where?
Around the biliary duct
181
What does hepatorenal syndrome cause, in general?
A decrease in renal function caused by liver disease
182
What is hepatopulmonary syndrome, in general?
A decrease in lung function caused by liver disease
183
Benign liver tumors are common in women who take what kind of meds?
OCPs
184
What is the most common type of liver cancer?
Hepatocellular carcinoma
185
A pt presents with liver pain, weight loss and anorexia. The nurse suspects what?
Liver cancer
186
Serum alpha-fetoprotein and carcinoembyronic antigen are elevated in what?
Liver cancer
187
What is done to treat end-stage liver disease with no other cure?
Liver transplant
188
What is used to measure the degree of need for a liver transplant?
The MELD score
189
Liver transplant success depends on ...
Immunosuppresion
190
What is vulnerability defined as?
Susceptibility to actual or potential stressors that may lead to an adverse effect.
191
What are the four "types of risk" that can make someone more vulnerable?
Environmental hazards, social hazards, personal behavior, and biological/genetic makeup.
192
What does a case finder do?
Identifies vulnerable individuals and encourages them to seek out health services
193
What are the three ways that a case finder might identify vulnerable individuals?
Outreach, surveillance, and screening
194
What does a health educator do?
Devises strategies to prevent illness
195
What does a population health advocate do?
Works with local, state and national groups to develop and implement public policy
196
What does a community assessor and developer do?
Monitors and evaluates care and health programs
197
What does a case manager do?
Provides referrals and links to community resources; help guide people to the resources that they need
198
What does an advocate do?
Refers people to other agencies
199
Why do mentally ill people have limited access to care?
Both because they do not seek care at a high rate and because there are limited resources available
200
A pt presents with cough, weight loss, fatigue and fever. The nurse suspects what?
TB
201
How is TB treated?
Antimicrobial drugs
202
What are older adults defined as?
65 and older
203
What are the "five I's" that can adversely affect the aging experience?
Intellectual impairment, immobility, instability, incontinence, and iatrogenic drug reactions (adverse reactions)
204
What are the "three D's" of intellectual impairment?
Dementia, depression, delirium
205
What is an infant defined as?
One month to one year
206
What is a newborn defined as?
Birth to one month
207
What age is a child defined as?
Up to age 10, or when puberty begins
208
What is the "5H" club when referring to children?
Hungry, hopeless, homeless, hugless, without healthcare
209
A child under one year presents with failure to thrive, diarrhea, and developmental delays. The nurse suspects what?
HIV
210
What is the number one cause of death in children up to age 21?
Injuries
211
What age group of children are at highest risk for pedestrian and bike accidents?
School age
212
The airway is easily occluded in what age group?
Infants
213
A pt presents with impaired vision, headache and clear nasal discharge. The nurse suspects what?
Pituitary gland adenoma
214
In which endocrine condition will the pt excrete a large amount of diluted urine?
Diabetes insipidus
215
What happens to serum sodium in syndrome of inappropriate antidiuretic hormone (ADH) secretion?
It is diluted
216
Is myxedema crisis caused by under- or overproduction of thyroid hormone?
Underproduction
217
Are thyroid enlargements caused by too little or too much thyroid hormone?
May be caused by either
218
What happens to serum and bone calcium in hyperparathyroidism?
Serum calcium increases and bone calcium decreases
219
What happens to serum calcium in hypoparathyroidism?
It decreases
220
What occurs in pheochromocytoma?
There is too much epinephrine in circulation
221
What happens if pheochromocytoma is not treated?
May be fatal
222
A pt presents with headache, diaphoresis and palpitations. What endocrine disorder does the nurse suspect?
Pheochromocytoma
223
What is Addison's disease?
Too little cortisol, aldosterone, androgens
224
What is Cushing's disease?
Too much cortisol
225
When does a pituitary adenoma usually manifest?
Early adulthood
226
What is a hypophysectomy and what is one thing it may be done for?
Surgical removal of the pituitary gland - may be done for pituitary adenoma
227
Diabetes insipidus is caused by an underproduction of what hormone?
ADH
228
A pt presents with polyuria, extreme thirst for cold drinks, headache and visual disturbances. The nurse suspects what?
Diabetes insipidus
229
Urine specific gravity in diabetes insipidus will be what?
1.005 or less
230
What electrolyte imbalance should be monitored for in diabetes insipidus?
Hyponatremia
231
Why should a pt with diabetes insipidus avoid hot weather and extreme exertion?
May lead to dehydration
232
What is another name for ADH?
Vasopressin
233
A pt presents with headache, flu-like symptoms, and N/V. What endocrine disorder does the nurse suspect?
SIADH
234
What happens to T3 and T4 levels in hyperthyroid?
They will be high
235
What kind of meals should hyperthyroid pts eat and how often?
Should eat small meals often
236
What is thyrotoxicosis caused by?
Excess thyroid hormone
237
Is thyrotoxicosis a serious condition?
Yes, it is life-threatening
238
What is thyrotoxicosis normally precipitated by?
Infection
239
A pt presents with tachycardia, high fever and hypertensive crisis. The nurse suspects what?
Thyrotoxicosis
240
What is the most common form of hypothyroid?
Hashimoto's
241
The effects of what three classes of meds will be prolonged with hypothyroid?
Analgesics, anesthetics and sedatives
242
What dangerous symptom can myxedema crisis cause?
Respiratory depression
243
What is a normal serum calcium level?
9-10.5 mg/dL
244
Painful bones and renal stones are symptoms of what?
Hyperparathyroidism
245
Serum calcium will be above what in hyperparathyroidism?
Above 10.5
246
Why should a pt with hyperparathyroidism be kept hydrated?
To avoid kidney stones
247
Why should mobility be encouraged in pts with hyperparathyroidism?
To maintain bone density
248
What is the major symptom of hypoparathyroidism?
Muscle spasms
249
What is hypoparathyroidism treated with?
Vitamin D supplements
250
What type of diet should someone with a pheochromocytoma be on?
High sodium
251
Which endocrine disorder involves adrenal gland insufficiency?
Addison's disease
252
A pt presents with muscle weakness, fatigue, salt craving, irritability. The nurse suspects what?
Addison's disease
253
What is the treatment for Addison's disease?
Hormone replacement therapy
254
What happens to BP in Addisonian crisis?
Shock
255
What is Addisonian crisis often precipitated by?
Infection
256
What are the "Five S's" in the treatment of Addisonian crisis?
Salt, sugar, steroids, support, and search for precipitating illness.
257
A pt presents with backache, fatigue, headache and disturbed sleep. Which endocrine disorder does the nurse suspect?
Cushing's syndrome
258
Which endocrine disorder is characterized by upper body obesity, thin arms and legs, and a "moon face"?
Cushing's syndrome
