Focused Review Guide for Exam 2 Things to Focus on from Module 3- Elimiitle of your publication

Focused Review Guide for Exam 2

Things to Focus on from Module 3- Elimination: Terms to Know:

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Acute Renal Failure: Sudden loss of kidney function caused by failure of renal circulation

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or damage to the tubules or glomeruli.

Usually reversible with spontaneous recovery in days to weeks Ischemia is primary cause, produces irreversible damage to tubules

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Anuria Absence of urine, associated with kidney failure or congested heart failure This term is used when urine output is less than 100ml in 24 hours

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Dysuria Painful urination Happens in lower UTI, intestinal cystitis, pyelonephritis, glomerulonephritis

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End-stage Renal Disease Chronic renal failure, DM and HTN are the 2 most common causes of CRF in U.S Progressive/ irreversible decline in renal function to ESRD requiring renal replacement therapy like hemodialysis or transplant

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Enuresis Bed wetting, unintentional passage of the urine Nursing intervention: bladder training, toilet schedule, Kegel exercises, monitor I&O

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Frequency Rate at which something occurs or is repeated over a particular period of time

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Hematuria Blood in the urine

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Nephrotoxic Damaging or destructive to the kidneys

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Nocturia urination at night, after waking from sleep

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Nocturnal Enuresis Involuntary urination that happens when sleeping

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Micturition Voiding of urine

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Pessary A therapeutic pessary is a medical device similar to the outer ring of a diaphragm.

Therapeutic pessaries are used to support the uterus, vagina, bladder, or rectum.

Pessaries are a treatment option for pelvic organ prolapse.

A pessary is most commonly used to treat prolapse of the uterus.

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Polyuria Production of abnormally large volume of dilute urine

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Proteinuria Protein in the urine It is a symptom of nephrotic syndrome and glomerulonephritis Pyuria PIE=PUS

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Presence of pus in the urine discharge in urine- how to document puss in urine, purgulent in urine

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Urgency Immediate strong desire to urinate Involuntary loss of urine

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Oliguria Abnormal small amount of urine Less than 500ml in 24 hour

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Nephropathy Kidney damage or disease

How does the developmental stage impact bowel and bladder elimination in infancy, children, adults, elderly, and pregnant women?

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Infants – Meconium green/black tarry, sticky, and odorless (the only time tarry stools are normal)

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Children – can control around ages 2-3

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Adults – bowel pattern remains about the same from childhood to adults

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As people age – loss of peristalsis, intestinal smooth muscle tone, perineal muscle tone and sphincter control make control of bowels more difficult

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Pregnant woman – Pregnancy-beginning; have fluid loss due to morning sickness, often experience later constipation, decrease appetite, dehydrated, increase risk for hemorrhoids

Medications that can affect elimination either to help or stop? (When medications are used to stop, think what is given for diarrhea for example)

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Stool Softeners: enable moisture and fat to penetrate the stool, thereby softening it and

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making it easier to pass.

Example: docusate sodium. – softener, know Effectiveness of stool softeners in relieving chronic constipation is being questioned, but

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they are still in use.

Osmotic Laxatives: work by drawing water into the bowel from surrounding tissue,

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resulting in bowel distention.

Examples: polyethylene glycol, lactulose.

Lubricant laxatives: coat the stool and the GI tract with a thin waterproof layer. Mineral oil is an example. Because the lubricant coats the entire GI tract, it may interfere with the

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absorption of nutrients.

Mineral oil is potentially dangerous in debilitated patients. Inhaled droplets can lead to

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a form of pneumonia.

Stimulant laxatives: are bowel irritants. They irritate the intestinal wall, stimulating

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intense peristalsis.

Examples: senna, bisacodyl, castor oil.

Bulking Agents KNOW: are high in fiber. They must be combined with sufficient fluid intake to be effective. The fiber attracts fluid into the colon, and the increased bulk of the stool stimulates the urge to evacuate. These are considered the safest form of laxative, but may interfere with absorption of some medicines. They are the drug of choice for

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chronic constipation.

Examples: Metamucil, Citrucel, psyllium, Fiber Con. SAFEST FORM OF LAXATIVES

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Chloride Channel Activators: increase intestinal fluid and motility to help stool pass.

Combination: laxatives are laxatives that contain more than one type of laxative ingredient. The most common type is a combination stimulant laxative and stool softener

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(p. 970).

Docusate and senna are example Loperamide: for diarrhea, symptoms: dizzy, drowsy, dry mouth, fatigue, headache, GI distress

Know the components of bowel diversion surgery:

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Ileostomy: Is always a liquid not formed, loose stool, exits before the colon, continuous output Colostomy: Is a diversion, anytime the fecal doesn’t go through the anus Closer to the ileum the more loose the stools Transverse colon: Double Barrel – first opening drains effluent, the second, mucous

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(mucous fistula) or LOOP Ostomy: need to be pink and moist and always protect the skin around the ostomy Colonoscopy: Formed stool

What do we ask when getting a GI/GU history?

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Health history o Chronic disease – DB and HTN o Ask about history of albumin or protein in the urine o Pregnancy history Assessment of urination patterns o Frequency o Urgency o Color & odor Medication history Environmental factors o History of altered urinary elimination o Travel to regions with infectious disease risk o Chemical or environmental toxins (occupational, diagnostic, …) (p. 1329) Changes in urination patterns o Starting or stopping a stream – problems? o Burning or other discomfort while urinating?

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o Force of the stream (men) o Persistent dribbling of urine o Pain Renal Colic – pain radiates to perineal area (groin, scrotum, labia)

How do we perform a physical assessment of the abdomen?

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Observe/Inspect o Size o Shape o Contour Auscultate o Normal, hyperactive, hypoactive, absent o Book states 3-5 minutes of listening then absent o Any bruits present-listen to bruitis femoral arties at midline o Bowel sounds indicate blood flow, need bowel sounds before you can go home after surgery, or past gas to know its moving, gas is better indication Percussion- pain? o Tympanic, dull o Presence of air or solid Palpation o Tenderness o Masses o Why can’t we palpate first? Moves everything first, least invasive to most invasive o Light Palpation, ½ to 1 inch in depth, not that deep, for NP and MD

How much urine is produced per hour in a normal patient?

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30cc/hour up to 80cc/hour

Be familiar with the followings:

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Pyelonephritis: An infection of the UPPER urinary tract. It may involve the ureters, renal pelvis, and papillary tips of the collecting ducts. Unchecked, it can extend into the

tubules of the nephron, creating a potential for renal failure. Filtration, re absorption and secretion are impaired. o Symptoms:  Bacteriuria  Flank pain at the costovertebral angle (CVA)  Fever  Chills  Colicky abdominal pain  Nausea/ Vomiting  Dysuria  Frequency  Nocturia o Diagnostic test  Urinalysis and urine culture may be sufficient in mild, initial cases of pyelonephritis in an uncomplicated presentation.  Computed tomography (CT) is the standard diagnostic tool for pyelonephritis unresponsive to 72 hours of antibiotic therapy.  Ultrasound is used when CT scanning is contraindicated, such as in pregnancy or in pre-existing renal compromise.

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Glomerulonephritis: Inflammation of the glomerular capillaries. In patients with glomerulonephritis, the glomeruli become inflamed and impair the kidney's ability to filter urine. Eventually, the glomeruli become inflamed and scarred, and slowly lose their ability to remove waste and excess water from the blood to make urine.

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Immune complex disease - NOT AN INFECTION o Symptoms:  Oliguria  Proteinuria  Dysuria  SOB  Flank pain o Diagnostic Test:  Laboratory tests include:  CBC  Electrolytes  BUN & creatinine (will be elevated)  GFR (will be decreased)  Urinalysis

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Nephrotic Syndrome: Not a single disease but a group of symptoms. Symptoms include heavy proteinuria, hypoalbuminemia, edema, hypercholesterolemia, and normal renal function. o Symptoms:  Pitting edema (ankles & legs)  Periorbital edema  Pleural effusion or ascites  Foamy urine  Anorexia  Irritability  Fatigue  Abdominal discomfort  Diarrhea Urinary Tract Calculi: are solid particles in the urinary system. They may cause pain, nausea, vomiting, hematuria, and, possibly, chills and fever due to secondary infection.

Diagnosis is based on urinalysis and radiologic imaging, usually noncontrast helical CT. o Symptoms  Severe pain (renal colic). Pain intensifies as the stone moves through the ureter. Flank pain suggests the stone is located in the kidney or ureter.

Flank pain that radiates to the abdomen, scrotum, testes, or vulva suggest the stone is in the ureter or bladder.  Frequency  Fever  Diaphoresis  Pallor  N/V  Tachycardia, tachypnea, increased BP (pain)  Decreased BP (shock)  Hematuria  Oliguira  Anuria

UTIs signs/symptoms

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Risk factors for UTI Women o Multiple sexual partners o Postmenopausal o Pregnant o FGM – Female Genital Mutilation Men o Uncircumcised

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o Enlarged Prostate Kidney Stones o Indwelling Catheter o Diabetes Mellitus o Immunocompromised o Hx of UTI Signs and Symptoms of UTI o Back or Low Abdominal Pain o Bladder Spasms o Chills o Dysuria o Edema o Fever o Foul-Smelling Urine o Hematuria o N/V o Urgency o Frequency

Things to Focus on From Module 4- Ethics, Evidence Based Practice:

Key Terms to Know: Also know examples of each

Evidence Based Practice: Best current evidence and practices to make decisions about patient care Research evidence -Clinical expertise -Patient preference Sociopolitical forces in quality of care

EBP is using the best research and proven assessments and treatments in our day-to-day clinical care and service delivery.

Why it is important to patient care: The patient gets up-to-date care that has already been done in studies.

Ethics: The study or examination of morality through a variety of different approaches.

-How you respond to an ethical situation is a reflection of the core values, beliefs, and character that make you the person who you are and, ultimately, the professional who you will become.

-Systematic study of right and wrong conduct.

-Formal process for making consistent moral decisions.

Morals: Private, personal, or group standards of right and wrong Moral behavior; in accordance with custom; reflects personal moral beliefs

Autonomy: To respect and support a client’s right to self-determination

Beneficence: To promote good for others, everything is formed, patient-centered care

Non-Maleficence: To do no harm to the patient intentional or unintentional

Fidelity: Remaining faithful/loyal. Keeping a commitment and promises

Veracity: To tell the truth to best of knowledge -promoting trust nobody is watching -actions when nobody is watching Justice: equal to all -

Fair, treated the same (gender, race, age, religion)

Paternalism: treating others like children, “trust us, we know what is good for you”

Self-Determination: AKA autonomy, obligated to protect him or her as an advocate within professional scope of practice

Negligence: taking actions that fail to maintain a standard of care that result in injury to another.

Malpractice: one source of legal liability, professional person has failed to act in a reasonable and prudent manner. If someone is harmed, professional is liable

Confidentiality: protect the patient information and medical records

HIPPA: Protects the patients

EMTALA: emergency medical treatment and active labor act -to provide emergency medical treatment to patients who seek healthcare in the emergency department regardless of their ability to pay, legal status and citizenship.

End of life care: Palliative care: Comfort care doesn’t have to be “actively dying” , cure is no longer possible or refuses treatment Curative care: Treats patients with intent of curing What does the State Board of Nursing do?

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Unsafe nurses helping patients Where you get licenses from Pass standards

What is the Nurse Practice Act? -

State laws that define nursing practice and legal standards. Varies in scope from scope to state. Safeguards public by setting for education and practice and investigating violations of standards.

Things to Focus on From Module 5- Surgical Integrity:

Key Terms to Know: Refer to the handout from class, or the terms on the Power Point

Malignant Hyperthermia: Acute, life-threatening complication, may be genetic, begins with skeletal metabolism calcium levels in muscle cells -leads to acidosis, high temps, dysrhythmias Symptoms: tachycardia, cyanosis,

Age related concerns with surgery -

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For Older Adults: o Decreased  Cardiac output, peripheral circulation  Vital capacity, blood oxygenation  Blood flow to kidneys, glomerular filtration rate Increased o Blood pressure o Risk for skin damage, infection o Sensory deficits o Deformities related to osteoporosis/arthritis For Infants: no explanation required but parents need complete preparation, feed off emotion of parent Toddler: may experience separation anxiety, allow parents to accompany patient till surgery and give a familiar item to know they are okay Preschool: may experience separation anxiety, give simple explanation to procedure and allow for play therapy to calm situation School-age: better to understand procedure, may want to use visual aids to confirm understanding of procedure Adolescent: concerns are separation from peers, body image, and ability to continue hobbies, maintain privacy

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Older adult: unable to bounce back as quick, be cautious in couples as they rely on each other

Sedation: Be familiar with the Continuum of Sedation Slide -

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General Anesthesia: o Reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of central nervous system (CNS) o Involves single or combination of agents o Depresses CNS, resulting in analgesia, amnesia, and unconsciousness with loss of muscle tone and reflexes o Administered via o Inhalation o IV injection o Balanced anesthesia:  Combination of IV drugs and inhalation agents used to obtain specific effects  Example: Thiopental for induction, nitrous oxide for amnesia, morphine for analgesia, pancuronium for muscle relaxation Stage 1—Analgesia and sedation, relaxation Stage 2—Excitement, delirium Stage 3—Operative anesthesia, surgical anesthesia Stage 4—Danger Emergence—Recovery from anesthesia

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Complications: o Malignant hyperthermia o Overdose o Unrecognized hypoventilation o Problems with specific anesthetic agents o Intubation problems

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Malignant Hyperthermia: o Acute, life-threatening complication o May be genetic o Begins with skeletal muscle exposed to specific agent o Causes increased metabolism, calcium levels in muscle cells o Leads to acidosis, high temperatures, dysrhythmias o Local Anesthesia: o Briefly disrupts sensory nerve impulse transmission from specific body area/region o Delivered topically and by local infiltration

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o Patient remains conscious, able to follow instructions - Regional Anesthesia: o Blocks multiple peripheral nerves in specific body region o Field o Nerve o Spinal o Epidural - Complications for Local or Regional o Anaphylaxis o Incorrect delivery technique o Systemic absorption o Overdose o Local complications - Treatment for Complications for R/L o Establish open airway o Give oxygen o Notify surgeon o Fast-acting barbiturate is usual treatment o Epinephrine for unexplained bradycardia o Consent: Informed: Patient has right to know risks and benefits and is able to choose to have the procedure done Implied: Assuming you have patients consent