Foundations Exam 4

What is the expected urine output for a healthy person?

50-60 ml/hour or 1ml/kg/hr

Risk factors for UTI:



\-        fever, sweats, pain, CAUTI, prolonged hospital stays

o   _________ gender

o   Sexual activity

o   Spermicidal gel

o   Prostatic hypertrophy

o   Pregnancy

o   _________ catheter

o   Kidney stones

o   _________ mellitus

o   Hx of UTI

o   Immunocompromise Risk

female, indwelling, diabetes

Symptoms of UTI

o   __________ urination

o   Dysuria

o   Fever

o   Chills

o   Flank _____ (kidney infection)

o   Malodorous urine

o   Sediment in urine

o   Frequency

o   Hematuria

o   _________ urine

o   Sediment in urine

o   Frequency

o   Hematuria

o   Bladder spasm

burning, pain, malodorous

How to diagnose UTI

midstream clean catch UA, dipstick, UA with C&S(identifies)

Treatments

o   ABX

o   Symptomatic __________ requires 1-5 days of PO abx

o   Pyelonephritis will require 5-10 days or _____ abx followed by PO

o   Phenazopyridine (____) will relieve burning sensation

cystitis, IV, azos

Type of incontinence:

overactive bladder

urge

Type of incontinence:

mom laughs when she pees

stress

Type of incontinence:

CNS problems, nerve damage, cystitis, etc

reflex

Type of incontinence:

immobility, pain, external obstacles, problems with communication

functional

Type of incontinence:

UTI/medications

transient

Type of incontinence:

prostatic hypertrophy

overflow

Type of incontinence:

spinal cord injury

reflex

Treatment for retention:

o   Mechanical- Sx, or routine drainage (intermittent ____)

o   Loss of tone- Cholinergic (Urech_____)

o   Poor emptying- Alpha-1 antagonists (tam_____)

retention, cath, urecholine, tamsulosin

Treatments for UTI:

o   Analgesics (PhenazoPyradine) AZO does not treat UTI. It relieves pain

o   Diuretics (Thiazide, Loop, K+sparing) _________ is the most effective at pulling lfuid off of a patient. Risks include alkalosis, hypokalemia, and digitalis toxicity

o   Anticholinergics (__________) –Treats incontinence. (hot as a hare, dry as a bone, blind as a bat, red as a beet, mad as a hatter

o   Antidepressants (duloxetine or imipramine)- For stress incontinence

o   ______ blockers (Tamsulosin)- Treat retention

o   Muscarinic receptor antagonists (tolterodine) Treats bladder spasm or overactive bladder.

o   Antibiotics (______omycin)

furosemide, oxybutynin, alpha, vanc

Kegels:

\-        Kegels (____ seconds in the start) (takes _____ months before being effective)

3-5, 5-6

Healthy stomas are:

bright, pink, moist

Output of stoma on ascending portion of colon

liquid to semi liquid, rich in digestive enzyme

Output of stoma on transverse colon:

liquid to semi-formed

Output of stoma on descending colon:

semi-formed to formed

Output of stoma on sigmoid colon:

normal, formed in consistency

Antidiarrheal medications are not recommended for _______ diarrhea

acute

BRAT diet

* used for diarrhea

bananas, rice, applesauce, toast

cessation of bowel paralysis

o   Typically have a NG tube with low constant or intermittent suction. The NG tube removes secretions until peristalsis returns.

paralytic ileus

\-        Decrease in the frequency of BMs accompanied by incomplete passage of stool with hard dry stool. Fewer than 3 a week.

constipation

\
Fecal mass in the colon. A scant amount of Liquid stool may be present. This is dangerous because stool continues to back into the colon. Meds are not secreted. Gas is not passed…etc

impaction

What kind of enema?

* treats severe constipation, clear colon for colonoscopy, empty colon for bowel-training program, clear colon for surgeries of the lower GI tract

cleansing enema

What kind of enema?

* assist a client to pass hard stool or before digital removal of stool

oil-retention

What kind of enema?

* help expel flatus and relieve bloating and distension. This procedure is used after abdominal or pelvic surgery when peristalsis is slow to return and the client experiences pressure from gas

carminative

What kind of enema?

* may be used to instill antibiotics to treat infections in the rectum or anus to introduce anthelminthic agents for treatment of intestinal worms and parasites

medicated

What kind of enema?

* fluid and nutrition through the rectum for patients who are dehydrated and frail. Most commonly used in hospice care as a means to provide hydration to dying patients

nutritive

What kind of laxative?

* docusate sodium

stool softener

What kind of laxatives?

* polyethylene glycol

osmotics

What kind of laxative?

* mineral oil

lubricants

What kind of laxatives?

* bisacodyl

stimulants

What kind of laxatives?

* metamucil

bulking

What kind of laxatives?

* amatiza

chloride channel activators

No bowel sounds for 3-5 minutes is indicative of a _____ ______, call the doc ASAP, Do not give ______

paralytic ileus, laxatives

AWETBED function of kidneys

acid/base, water balance, electrolyte balance, toxins, BP, erythropoietin, metabolism of vitamin D

BMR is

how man calories burned at rest

Women BMR

0\.9 Kcal/Kg

Men BMR

1 Kcal/kg

BMI underweight

16-16.99

BMI overweight

25\.0-29.9

BMI Class I obesity

30\.0-34.6

BMI class II obesity

35\.0-39.9

BMI class III obesity

40\.0 or higher

Interventions for aspirations;

o   Position pt in _____ fowlers

o   Avoid using _______

o   \* Assist with forward _______ for swallowing

o   Place food in the back of the mouth at the unaffected side (CVA)

o   Monitor for pocketing, excessive drooling, coughing

o   Cue ____________

o   Have __________ available at bedside

high, straws, flexion, frequently, suction

My plate:

\-        ____ cups of fruit

\-        ___ cups of vegetables

\-        __ ounces of grains

\-        ___ ounces of protein

\-        _ cups of dairy products.

2, 2.5, 6, 5.5, 3

Calculating carbs

total carbs- fiber = net carbsThe

Order that body burns macros

carbs, fats, protein

Kcals/gm of carbs

4 Kcals/gm

Kcals/gm of lipids

9 kcals/gm

Kcals/gm of protein

4 kcals/gm

Fat soluble vitamins

a, d, e, k

What vitamin is the most prevalent fat-soluble deficiency?

vitamin D

Therapeutic diets:

* house diet

regular

Therapeutic diets:

* nothing by mouth (standard pre-op)

NPO

Therapeutic diets:

* Modified by consistency

pureed, mechanical soft, clear liquid, full liquid

Therapeutic diets:

* renal

watch electrolytes

Promote nutrition in obesity:

* set realistic goals
* encourage regular ________
* diet log
* teach my plate
* teach how to read labels
* ________ weights
* Refer to counseling
* beware of weight _____

exercise, weekly, bias

promote nutrition in malnourished pts:

§  Appetite stims

§  Counseling

§  Frequent, small nutrient dense “_______”

§  Protein supplementation

§  __________ eating

§  Restrict liquids with meals

§  _______ control

§  Educate on possible need for enteral or parenteral __________

snacks, socialize, pain, feeding

\-        associated with upper airway collapse during sleep.

o   Related to the recurrent episodes of upper airway collapse and obstruction while sleeping combined with walking from sleep

o   Causes: enlarged tonsils

o   S/S snoring

o   Tx: CPAP mask

obstructive sleep apnea

\-        associated with brain transmission of signals to the respiratory muscles

o   Causes: opioid OD and heart failure

central sleep apnea

\-        CR Melatonin (_____ line) 2 hrs bf bed

\-        Non-_______ hypnotics (Z-Drugs)

\-        Benzodiazapines (end in ________)-→reverse with ________

\-        OTC (doxylamine, succinate, diphenhydramine)

1st, benzo, pam/lam, flumazenil,

Sleep deprivation:

\-        affect higher-order ________ processes

* impair __________
* decrease response time
* trigger ________ disorders
* migraines
* tension ________.

cognitive, judgement, seizure, headaches

Sleep hygiene:

* Avoid _____, such as caffeine, alcohol, and nicotine, at least _______ hours before bedtime

stimulants, 4-6

Sleep hygiene:

* Only go to bed when tired, if clients cannot fall asleep after _____ minutes, they should go to another room and read or listen to music.

20

Brain structures for sleep: commands nerve cells,

affecting sleep and arousal

hypothalamus

Brain structures:

\-        controls shift between wake and sleep; pons and medulla oblongata influence rapid eye movement (REM)

brain stem

Brain structure: controls behavioral rhythm

directly from the eyes through light exposure

suprachiasmatic nucleus

Brain structure;

* transfers data from short- term to long term memory, blocks out external distractions during sleep; transmits images, sounds, and sensations during REM sleep

thalamus

Brain structure: manufactures melatonin (a

natural substance that helps the body prepare for sleep)

pineal gland

Stages of Sleep; ____ ___

o   The wake stage/________ stage of sleep.

o   Consists predominantly of alpha and beta electrical brain waves.

o   Alpha waves(______) are electrical brain waves in the frequency range of 8 to 12 hertz.

o   Beta waves(______) are electrical brain waves in the frequency range of 12 to 30 hertz.

o   When a person becomes drowsy and closes their eyes, the alpha waves dominate over the beta waves.

o   Breathing is normal, and skeletal muscle tone is present.

o   Can last from 1-5 minutes and is approx. ___% of total sleep cycle.

Stage 1, lightest, tired, awake, 5

Stages of Sleep: ______ ____

o   ________ sleep.

o   Consists of sleep spindles or K-complex electrical waveforms that trigger the superior temporal gyri, anterior cingulate, insular cortices, and the thalamus.

o   Client becomes challenging to awaken.

o   Heart rate and body temperature ________.

o   First sleep cycle lasts approx. _____ minutes; however, it becomes progressively longer with each successive sleep cycle.

o   Consumes approx. _____% of a total sleep cycle.

o   Number of cycles increase with _______.

Stage 2, deeper, decrease, 25, 50, aging

Stages of Sleep: ______ _______

o   Deepest, most ___________ sleep.

o   Consists of ________ electrical brain waves, which are slower frequency, higher-amplitude signals.

o   If awoken in stage three, clients may have mental ___________ for 30 to 60 minutes.

o   During this stage, immune system strengthens, and the muscles, tissues, and bones repair and regenerate.

o   Number of cycles _________ with aging.

o   Can last up to ____ minutes.

Stage 3, regenerative, delta, cloudiness, decline, 40

Stages of Sleep: ____ _____

o   Includes ______, the dreaming stage.

o   Looks like an awake cycle on an EEG; however, the skeletal muscles remain _______ (loss of muscle tone).

o   Client's breathing is irregular and erratic, and their heart rate may be __________.

o   Typically begins ____ minutes after falling asleep.

o   Initial cycle lasts 10 minutes and will become longer as the night progresses.

o   Can last up to 1 ______.

Stage 4, REM, atonic, elevated, 90, hour

Recommended hours of sleep:

\-        Newborns (birth to 28 days): 14 -17 hour

14-17 hours

Recommended hours of sleep:

Infants (1 month to 1 year): 12-15 hours

12-15 hours

Recommended hours of sleep:

Toddlers (1-3 years): 11-14 hours

11-14 hours

Recommended hours of sleep:

Preschool (3-6 years): 10-13 hours

10-13 hours

Recommended hours of sleep:

School-age children (6-12 years): 9-11 hours

9-11 hours

Recommended hours of sleep:      

  Adolescents (12-20 years): 8-10 hours

\

8-10 hours

Recommended hours of sleep:

Young adults (20-35 years): 7-9 hours

\

7-9 hours

Recommended hours of sleep:     

   Middle adults (35-65 years): 7-9 hours

\

7-9 hours

\-Recommended hours of sleep:      

  Older adults (65+): 7-8 hours

7-8 hours

\-        The ______chronotype stands in for the early bird. These individuals wake up early and are most productive in the morning, but may have more trouble following a social schedule in the evenings.

lion

\-        According to Dr. Breus, the ______ chronotype makes up about 55% of the population. People with this intermediate chronotype tend to follow the sun. They do well with traditional office hours but also have no problem maintaining a social life in the evenings.

bear

\-        The ______ chronotype is equivalent to the classic night owl, and is believed to make up approximately 15% of the population.

wolf

The ____ chronotype is based on the ability of real __ to stay alert even while sleeping. Human “________” are best described as insomniacs.

dolphin

Sleep disorders;

* is an ongoing inability to sleep despite having the opportunity to do so.

insomnia

Sleep disorders:

* is a condition in which there is an absence of inspiratory airflow for a minimum of 10 seconds.

apnea

SLeep disorders:

is associated with a decrease in oxygen saturation and lasts 10 seconds or longer.

hypopnea

SLeep disorders:

\-        is related to the recurrent episodes of upper airway collapse and obstruction while sleeping combined with waking from sleep.



o   Decreased energy levels

obstructive sleep apnea

Sleep disorders;

* Sudden sleepiness with Sudden episodic sleep

narcolepsy

Sleep disorders:

excessive daytime fatigue without improvement after more sleep.

narcolepsy

Sleep disorders;

* -        excessive daytime fatigue without improvement after more sleep.

hypersomnia

Sleep disorder:

Uncontrollable urge to move the legs. Worsens in the evening and at bedtime.

restless leg syndrome

* CPAP mask should fit ______ over patient’s nose

securely

Psychosocial Development:

* infancy

trust vs mistrust

Psychosocial Development:

* autonomy vs shame and doubt

toddlerhood