Module 7 Flashcards
(27 cards)
Elimination
the expulsion of waste matter from the body, could be urine or stool
Diarrhea
- an abnormal increase in the frequency of bowel movements and liquidity of the stool or in daily stool weight or volume
- Less than 2 weeks is acute and more than 4 weeks is chronic
- Daily weight is the best way to monitor fluid and electrolyte imbalance
- Metformin can cause diarrhea
Diarrhea cont’d.
risk factors- gi infection, food intolerance, stimulant use, antibiotics
manifestations- large volumes of watery stool, dehydration, impaired skin integrity, abdominal cramping
Meds. for diarrhea
antidiarrheals: only relieve symptoms not eliminate the cause (ex. loperamide) some work by bulking up stool, increasing volume with fiber, or slowing intestinal contractions and slowing movement
can also give iv fluid replacement, fiber-rich diets, probiotics
Clostridium Difficile
bacteria that causes infection of the large intestines, it is opportunistic
risk factor: antibiotic therapy (cephalosporin and quinolines), loss of gut flora, impaired immune
system
symptoms: can include abdominal cramping and tenderness, watery diarrhea, fever, dehydration, increased WBC
assessment: number of stools a day, frequency
treatment: vancomycin (usually IV) and probiotics
Don’t overuse antibiotics!
Constipation
A decrease in the frequency of bowel movements or stool that is hard, dry, and of smaller volume than normal.
patho: contents move so slowly through the intestine
risk factors: frequent laxative use, inadequate fluid intake, sedentary lifestyle, medications, pregnancy
manifestations: abdominal bloating, clamping, straining, irregular bowel movements
Meds. for constipation
Osmotic stimulants: pulls water from surrounding tissue to soften stools
Ex: Magnesium citrate
Stimulant laxative: increase muscle contractions along the intestinal wall to move stool mass
Ex: Bisacodyl (Dulcolax)
GI stimulant: increases the motility of the GI smooth muscle without acting as a purgative
Ex: Metoclopramide (Reglan)
also, enemas which are the injection of fluids to cleanse or stimulate the emptying of the bowel
Impacting and Disimpaction
- occurs when an accumulated mass of dry feces cannot be expelled, will have seepage of liquid stools around the impaction
- removal of impaction with gloved, lubricated finger; ensure no Vagal nerve stimulation
Urinary incontinence
unintentional leaking in urine
risk: female sex, chronic urinary retention, chronic cystitis, neurologic disorder
manifestations: loss of urine, bed wetting, bladder spasms, frequent urgency, and retention
Types of urinary incontinence
- stress: Loss of small amounts of urine from increased abdominal pressure with laughing, sneezing, or lifting
- urge: Inability to stop urine flow long enough to reach a bathroom
- overflow: Retention from bladder overdistention & frequent loss of small amounts of urine due to obstruction
- reflex: Involuntary loss of moderate amount of urine r/t CNS impairment
- functional: Loss of urine due to cognitive, mobility, or environmental barriers
- transient: Reversieble incontinence due to inflammation, UTI, meds, disease process, etc.
interventions for urinary incontinence
Urinalysis w/culture and sensitivity rule out UTI,
Ultrasound identify any bladder abnormalities, Provide incontinence garments, Provide incontinence care, Avoid the use of indwelling urinary catheters
Musculoskeletal review
206 bones in the body
Long- the tibia, humerus, and metatarsals in the foot
Short- metacarpals (holding cup)
Flat- sternum
Irregular- ribs and vertebrae
Inner bone: cancellous (spongy)
Outer bone: cortical (compact)
3 basic cell types:
Osteoblast- secrete bone matrix helps with bone formation and repair
Osteocytes- involved with maintenance, mature cells
Osteoclasts- dissolving old bone and reabsorbing it to make new bone
Musculoskeletal review cont’d.
~joint- junction of two or more bones
ligament- fibrous connective tissue bands binding articulating bones together
~tendon- cords of fibrous connective tissue attach muscle to bone and pass over the joint, providing joint stability
~tone-State of muscle readiness produced by maintenance of some muscle fibers in a contracted state
~paralysis- Loss of movement, possibly from nerve damage
~osteoporosis-Loss of bone mass
~Osteopenia- occurs before osteoporsis
~ flacid- picks up and it falls right back down
Bone formation (osteogenesis)
the bone matrix is formed and hard crystals of Ca+ and phosphorus are bound to these collagen fibers= ossification
Bone fracture
hematoma formation-Bleeding into injured tissue; hematoma forms and facilitates the formation of fibrin
Inflammation-New capillaries in hematoma; fibroblasts produce a soft bridge between fractured bones
reparative-Matrix vesicles regulate calcification of cartilage; replaced by woven bone
remodeling-Minerals continue to be deposited until the bone is firmly reunited
Types of fractures
Comminuted: a fracture in which bone has splintered into several fragments
Greenstick: a fracture in which one side of a bone is broken and the other side is bent
Open: fracture which damage also involves the skin and mucous membranes, also called a compound fracture
Simple: a fracture that remains contained with no disruption of the skin integrity
Stress: a fracture that results from repeated loading of bone and muscle
Transverse: a fracture that is straight across the bone shaft.
Pathologic: fracture occurs through an area of diseased bone
Compression: a fracture in which bone has been compressed
Avulsion:
Impacted:
Depressed:
Epiphyseal:
Oblique:
Spiral:
look up the definition on slide 11
Pharmacological interventions
Opioids-Morphine
Antispasmodics-Cyclobenzaprine
Biphosphates-Alendronate
Anabolics- Teriparatide
COX2-Celebrex
NSAID-Ibuprofen
Steroid- Prednisone
Analgesic- acetaminophen
Hip fracture
most common in the elderly, fracture of the proximal femur
risk factors: osteoporosis, falls, disease, advanced age
assessment: x-ray, lab results, neuro checks, stabilize the injured area
Osteoporosis
Reduction in bone density and change in bone structure, bones become progressively porous, brittle, and fragile
risk factors: small frames caucasian women, family history, poor diet, lack of exercise, and smoking
Manifestations: loss of height, progressive kyphosis, DEXA scan (T-score -1.0 or > = normal bone density
T-score -1.0 through -2.5 = osteopenia
T-score of -2.5 or < = osteoporosis)
Antiresorptive meds
inhibit osteoclasts activity
Bisphosphonates: reduce spine and hip fractures associated with w/osteoporosis by inhibiting osteoclast activity
Adequate Ca+ and Vit D intake is needed for maximum effect
SE: dyspepsia, N/D/C, flatulence, esophageal ulcers, esophagitis, gastric ulcers, osteonecrosis of the jaw
Teaching: take on an empty stomach w/full glass of water first thing in AM; sit upright x30-60min after admin
Ex: Alendronate, Ibandronate, Risedronate, Calcitonin
Anabolic meds
bone-building drugs
Ex: Teriparatide
Administered sub Q once daily for treatment of osteoporosis in postmenopausal women and men at risk for fracture
Stimulates osteoblasts to build bone matrix
Facilitates overall Ca+ absorption
SE: Confusion, headache, incoherent speech, increased urination, metallic taste, muscle weakness, nausea, stomach pain
Osteoarthritis
Progressive deterioration of articular cartilage
affects weight-bearing joints (ex. hips and knees and fingers)
the risk factors are aging, obesity, overuse of joints, and malalignment of the joints
manifestations: Finger misalignment with Heberden or Bouchard nodes
nurse management: there is no specific treatment heat application, weight reduction, accupuncture
Arthroplasty
Allows direct visualization of a joint to diagnose joint disorders, performed in sterile conditions
Internal fixation
Devices like pins, wires, screws, plates, nails, or rods are used to hold bone fragments in position until bone healing occurs
