urinary and visual Flashcards
1
Q
chemical burns to eyes management
A
flush with saline or water
2
Q
metbaloic acid causes
A
GI loss such as diahrea ketoacidosis (DM, etoh, starvation) lactic acidosis (sepsis, hypoperfusion) -renal failure (hemodilasis) -salicylate toxicty
3
Q
anxiety, claustroboic
A
resp alka
4
Q
vomiting
A
met alkalosis
5
Q
precenting UTI
A
increasef lfuid intake
wipe front to back
avoid synthetic dabrix such as nylon and spandex
-avoid spermicidal contraceptive jelly bc it supress the prod of protective vaginal flora
-avoid douching and using femine perineal progs
-take showers instad of baths
6
Q
pursed lip breathing
A
helps iwth sob and prevent airway collapse
- promotes co2 elimination
- reduces air trapping in COPD
7
Q
pursed lip tedchnique
A
Relax the neck and shoulders
Inhale for 2 seconds through the nose with the mouth closed (Option 4)
Exhale for 4 seconds through pursed lips. If unable to exhale for this long, exhale twice as long as inhaling
8
Q
prior to dilausis
A
assess pt weight, bp, edema, lung and heart sounds
- assess fistula and graft
- vital signs
- heprain is added to the blood not given subq
9
Q
important consideration before dialysis
A
dont give bp meds becauseit causes hpotension and during dialysis it is already making pt prone to hypotension
-also any meds that are given can be removed after dialysis
10
Q
AV fistula sound
A
thrill can be felt when papating
briot can be heard during asuculatation
11
Q
retinal detchament signs
A
curtain, sudden flashes of light, floaters, loss of vision
-med emergency
12
Q
retinal detachment post op
A
avoid act that increase ICP such as rubbing eyes and straining
-report sudden pain, flashes of light , sion loss or bleeding
-avoid docused act such as reading ,sweing and writing which can cause rapid eye movmeent
-wear an eye patch or shield to prevent rubbing and scratching of the eye
-
13
Q
prioirty when urinary retention suspected
A
assess suprapuboc area
14
Q
what is an expected SE of opiod meds at renal
A
urinary retention
15
Q
renal coloic pain
A
sharp, stabbing,
tossing in bed unable to find comfortable position
pain riadating to the groin area
16
Q
pyleonphritis pain
A
flank pain back of the costvertebral angle toward the umbilicus
17
Q
peritoneal dialysis insuffiecient outflow
A
consitpation and bowel mov should be mointored and give stool outners
- check for kinks and clots
- maintain drainge bag below the badomen
- reposition client to side lying or assist with ambulation
if none of these work then xray needed to check the location of the catheter
18
Q
bladder catherization
A
- below the bladder
- irrgate using small amounts of sterile aline solution (<5ml) using gentle pressure to avoid damanging renal tissues
- secure it by taping to clients leg so it is below the blaffer
19
Q
matureing the fistula
A
make the client perform hand excercises
such as sqeezing rubber ball
20
Q
trill and bruit
A
thrill (vibration)
bruit (blowing or swooshing sound)
21
Q
clot formation in the fistula signs
A
absence of trill or bruit
- numbess or tinlng
- decrease cap refill
22
Q
during periotneal dialsysis client should be moinroted for
A
resp compromise such as diff breathing, rapid resp and crackles
HIGH BP IS NORMAL IN KIDNEY FAILURE
23
Q
kidney biospy complication
A
bleeding so mointor vital signs q 15mins for the first hour and mointor for hypotension, tacy and tacypnea
24
Q
before kidney biosy
A
discontinue all anitcog and plalets for ONE WEEKS
25
post op kidney biopsy
position on the affected side for 30-60 mins to provide pressure and prevent bleeding but during the procedre the are faced prone
26
what is normal and not normal in urinalysis
few wbc are normal
| glucose is not normal and could indicate DM
27
comonnly held meds before dilasysi
```
water soluble like B AND and folic acid
-abx
-dignxoin
-bp meds
=bp lowering meds such as lasix
```
28
what med should you take before dilaysis
photphate binders because dilasysis doesnt filter it (calciym carbonate)
- lispro
- vit e can be given and it is afat souble and helps prevent leg cramps assoicate withdialysis clients
29
prostatectomy complications
```
reduced urine strwam
persistent bledeing and blood clots
rentention of urine
fever
dysruia
```
-REPORT ALL OF THESE TO HCP
30
clients should avoid what afte rprostatectomy
valsalva for 8 weeks
31
CKD retains
phosphours
potasium
fluid
32
what contains postassium
diary products such as milk and yogurt
| fruits (oranges, banaas, cocunuts, watermelons, avacaods)
33
posphorus foods
diary
34
foods that are allowed CKD
```
apples
grapes
pineapple
blackberries
blueberries
plum
```
35
what can increase ICP
```
coughing
vomting
straingng to lift obj >5
bending at the waist
give antiemtic meds following opthalmic surgery
```
36
expected signs of menire disese
vertigo
| NV
37
calcium gluconate
does not decrease potassium level but stabllizes the myocardium by raising the threshold for the dyrthmia
-after stablizaing then give the iv regular insulin with dextrose
38
iv dectrose inusline
temp corrects the hyperkalemia by shifting the potassium into the cells
39
retinal detachmened may rsult from
blunt force trauma and if not treated permanent blindness can occur
40
BPH signs
age >50
- urinary retention
- sensation of incmplete emptying or increased urgency to void
- strainng or diff initating voiding (hesitancy)
- weak or intermittent stream of urine
- freq voiding patterns throughout the day (urinating more than once every 2 hours)
- nocturia
- urgency
- FREQ OF SEXUAL INTERCOURSE IS NOT RELATED
41
CKI is at risk for
hypotensive encephalthy- HTN crisis characterized by nauea, vomiting, and headache
- need treatedment within one hour to prevent damage to teh ehart kidney and brain
42
Dialysis disequilibrium syndrome (DDS) can be prevented by
life threaning complication that can be prevented by slowing the rate of dilaysis or stopping
43
Dialysis disequilibrium syndrome (DDS) what happens
solutes such as urea are removed more quickly from the blood than from the brain cells and csf creating a concentration gradient that can lead to excess fluid in the brain cells and increased ICP
44
Dialysis disequilibrium syndrome (DDS) signs
```
NV
headahcec
resltness
change in mentation
seizure
```
45
Dialysis disequilibrium syndrome (DDS) suspected
contact HCP
46
trendelenburg increases
cerebral edema and dont do for pt with Dialysis disequilibrium syndrome (DDS)
47
cataract surgery education
avoid avt that increase ICP
-may take 1-2 weeks before viual acuity is improved
=common to exp itching (sand) in the eyem photphobia, mild pain for several days
-sleep with 2 pillows elevated to decrease ICP
48
CKD pt are at risk for
fluid overload and hyperkalemia
49
CKD diet
soidum rsitriction
potassiumum rest suchas carrots and tomatoes
-fluid restriction
-low protein diet
-low phospherous such as chicekn turkey and diary
50
Percutaneous nephrolithotripsy
procedure to remove large kidney stones from the renal pelvis.
51
Percutaneous nephrolithotripsy post procedure
temp nephrostomy tube is placed to prevent obstruction by stone fragments and to promote healing of injured tissue
-mainting tube patency is imp
52
Percutaneous nephrolithotripsy if no driange or flank pain is present
indicate obstruction
| -irragate the nephrostomy tube with small amt of normal sterile saline
53
hemoldilasis and potassium
do only whenother non invasive ways werent effective and puting on a cathter takes time so not the best route if you want to get rid of K quick
54
peritonitis signs
low grade
cloudy
tacy
55
glucoma
increased intraocular pressure
- grad loss of peripheral (tunnel vision)
- normal central vision
- halo around birght lights
- sensitity to glare
56
macular degneration
grad loss of central vision
| peripheral vision is intact and fine
57
catartact
```
cloudiness
opacity
older adult
painless
blurry vision
glare and halos
worse at night
decreased color preception
```
58
cystoscopy complications
urinary retentioning
hemm
infection
59
cystoscopy notify hcp if
```
bright red blood
blood clots
inability to urinate
fever greater 100.4
chills abdominal pain
```
60
cystoscopy expected finding
```
pink tinged urine
freq
dyruia
are expected for 48 hours
-abdominal discomfort and baldder spasms can occur up to 48 hours
-
```
61
cystoscopy education
4-6 glasses water to dilute urine
avoid etoh and caff 24-48 hours
-take mild anagesic such as actea and ibuprohen and a warm tub sitz bath unless you have UTI
62
Overflow urinary incontinence occurs
occurs due to compression of the urethra (eg, uterine prolapse, prostate enlargement) or impairment of the bladder muscle (eg, spinal cord injury, diabetic neuropathy, anticholinergic medications).
63
Overflow urinary incontinence leads to
```
urinary retention
imcomplete bladder emptying
oversitening
overfulling of the bladder
involuntary dripping of the urine
```
64
patients with incontinence intervevntion
implement fixed voiding schedule (every 2 hours to prevent bladder overfilling)
-instrcut the client to use valsuva manuerver or crede manuever (gently applying pressure to the lower abdomen) to help emotying
-assess perneial area for break down
-measure postvoid residual volume to ensure that they are not retaining large amts of urine
-instruct to wait 20-30 seconds after voiding and then attempt to void a second time (double voiding) to help empty residual volume
DONT RESTRICT FLUIDDDD
65
meiere disease
excessive fluid accumlation in the inner ear
66
symtoms of meniere disease
```
vertigo
tinnutius
hearing loss
feelings of fulnnes
pressure in ear
```
67
meinere effects
only one ear and lead to permanent hering loss
68
what to clients report with meniere
feeling loss of propriotcepion
report feeling pulled to the ground (dropped attacks)
sp client safiety is important
69
meinere teaching
avoid folickering lights watching tv limits
70
stress incontience modifications
highest priority is preventing skin breakdown and UTI
so BLADDER TRAIN to pee every 2 hours and every 4 hours at night
-pelvic floor evecises- kegel
-natural bladder irratant (smoking, caff)
71
A pessary is a
non-surgical way to treat pelvic organ prolapse and sometimes incontinence.
72
cretiene clearance requires a
24 hour urine collection
- first urine is discarded and the time is noted
all other voided urine is collected in a container and kept cool
73
midstream
urinalysis or urine culture
74
Extracorporeal shock wave lithotripsy (ESWL)
break up kidney strones into small fragments that can be excreted in the urine
75
after ESWL procedure
increase fluid intake to help flush out the kidney stone frag
- expect some brusing and pain on the back or flank of the affected side
- expect to see blood in the urine for couple hours but if it is more than 24 hours then concering
- report signs of infection such as fever and chills to HCP
- ernouage abumtion NOT BED REST
76
BPH increased risk for
uti because of incomplete bladder emptying and retention
77
residual urine volume of what indicates urinary retention
>100
78
what value shows uti
>10k
79
cystoscopy normal
normal for burning sensation when voiding for a day or two
80
Transurethral resection of the prostate (TURP)
inserts scope to remove obstructing protstate itssue
81
Transurethral resection of the prostate (TURP) what is initated afte
Continuous bladder irrigation (CBI) with a 3-way Foley catheter
82
Transurethral resection of the prostate (TURP) expected
painful bladder spasms- treat with antispasmodics
- The total Foley output should be more than the CBI input, as the Foley output includes CBI fluid (not processed through the kidneys) plus the normal renal output of urine.
- An obstruction is indicated if the CBI input is equal to or greater than the Foley output.
- first 24 hours, the urine color changes from reddish-pink to pink. Small clots may occur for up to 36 hours. However, the nurse adjusts the irrigation flow to keep the urine light pink without clots.
83
kidney stones risk factors
fam history
dietary inbalnces
immbolization
deh
84
kidney stone maesfitifications
sudden severe abdominal flank pain
NV
IMMBOLITY SOOO WALKKK
85
kdieny stone interventions
```
analgesics
rehydration up to 3 L
ambultation
heat therpy but DONT MASAGE
- strain urine
```
86
retinal detachment pain
painless
ERMGENCYYYYYY
gnat or hairnet appearcne in the vision field
87
common clinical manifestation of UTI in the elderly
confusion
88
decrease ablity to see things up close
presbyopia
89
if something sharp gets in your eye
protect the eye using eye shield such as stryoform cup or paper cup to ensure that whatever you are sheilding does not touch the froegin body you are using to cover
0 the eyes work in synchrony to each other so the non injured eye should also be patched to prevent further eye movement
-DONT FLUSH EYES because it can move
the splinter
-dont instill antibiotic treamtent bc it inteferes the opthalmogloic med examination
90
Arteriovenous fistula (AVF) complication
Aterial steal syndrome where the vein steals too much arterial blood
91
arterial steal syndrome signs
distal ext ischemia (skill pallor, pain, numbess, tingling, diminshed pulses, poor cap refill)
-intevention is needed or limb necoriss happens
92
urniary retention happens afte
surgery bc of the adm of opiods
| odler men who have bph
93
interventions for urinary retention
get the up first if they are men
- then do bladder scan if they are unable to urinate
DO LEAST INVASIVE FIRST
94
Asthma exacerbation signs
- accessory resp muscle use
- chest tightness
- cough
- increased mcuus prod
- diminshed breath sounds
- high pitched expiratory wheezing
- prolonged exp phase
- tacypnea
95
tell tale symtom of bladder cacer
PINALESS HEMATURIA
96
primary cuase of baldder cancer
cigar smoking or tabacoo so ask if they smoke and number (PRIORITY QUESTION)
97
pessary education
can remain secually aactive while wearing it
- proper fit in the HCP office but clients can remove and clean and replace themselves
- surgery not req
- can have sex with it on
98
side effect os pessary
vaginal discharge but not important unless odor is there
99
urge incontinene intevention
lose weight
- anticholingic meds can be given such as oxybutin to decrease bladder spasms and dry mouth is AE
- avoidance of bladder irrtants
- pevlic floor excecises
- bladder training
100
urinary retention treated with
rapid , complicate bladder decompression
101
manesitifcations of rapid decompression
hypotension
hematuria
and dirusis
bradycardia
102
glucoma characerized by
increased ictroclar presusre
| can lead to peranent blindness
103
glucoma mesitications that are considered med emergnecy
```
Sudden onset of severe eye pain
Reduced central vision
Blurred vision
Ocular redness
Report of seeing halos around lights
```
104
effective tretament of osa
cpap
105
OSA signs
hypoxia
| hypercapnia
