NURB 3040 Exam 3 Comprehensive Review: Oxygenation, Skin & Wound Care, Nutrition, and Urinary Elimination

Comprehensive vocabulary flashcards covering Cardiopulmonary Oxygenation & Perfusion, Skin Integrity & Wound Care, Nutrition & Metabolic Support, and Urinary Elimination based on NURB 3040 course lecture notes and exam guides.

Surfactant

A detergent-like phospholipid produced by alveolar cells in the lower respiratory tract that reduces surface tension across the alveolar air-liquid interface, preventing the alveoli from collapsing during exhalation.

External Respiration

The microscopic chemical gas exchange process occurring at the alveolar-capillary membrane where oxygen moves down its concentration gradient by passive diffusion into pulmonary capillary blood, and carbon dioxide diffuses from blood into alveoli to be exhaled, requiring zero $ATP$.

Internal Respiration

The passive diffusion of gases between systemic capillary blood and metabolizing body tissues at the cellular level, delivering oxygen for cellular metabolism and picking up carbon dioxide waste.

Pulmonary Ventilation

The mechanical process of moving air into and out of the lungs; consists of inspiration (an active phase where the diaphragm contracts and flattens, generating negative intrathoracic pressure) and expiration (a passive phase at rest where the diaphragm relaxes and domes upward).

Perfusion

The continuous flow of oxygenated blood through arterial networks and capillary beds delivering nutrients and oxygen to cells, mathematically defined by the product of stroke volume and heart rate: $\text{Cardiac Output (CO)} = \text{Stroke Volume (SV)} \times \text{Heart Rate (HR)}$.

Crackles (Rales)

Adventitious fine-to-coarse popping or crackling breath sounds auscultated on inspiration, caused by fluid accumulation in the alveoli and small airways in conditions like heart failure, pneumonia, and atelectasis; does not clear with coughing.

Wheezes

Continuous, high-pitched musical or whistling adventitious breath sounds produced as air flows through constricted or narrowed small airways, commonly heard in asthma, COPD, and bronchospasm.

Rhonchi

Low-pitched, continuous snoring or rattling adventitious breath sounds caused by thick mucus and secretions obstructing larger airways; a hallmark feature is that they frequently diminish or clear after coughing.

Stridor

A harsh, high-pitched crowing adventitious breath sound auscultated predominantly on inspiration, signaling an acute, severe upper airway obstruction (such as croup, epiglottitis, or a foreign body) that represents a medical emergency.

Pleural Friction Rub

A grating, rubbing adventitious sound caused by inflamed visceral and parietal pleural surfaces rubbing against each other during respiration, characteristic of pleurisy.

Arterial Blood Gas (ABG) Reference Values

The diagnostic standard for acid-base and gas exchange status: $\text{pH: } 7.35\text{--}7.45$, $\text{PaCO}_2\text{: } 35\text{--}45\,\text{mmHg}$, $\text{PaO}_2\text{: } 80\text{--}100\,\text{mmHg}$, $\text{HCO}_3^-\text{: } 22\text{--}26\,\text{mEq/L}$, and $\text{SaO}_2 \ge 95\%$.

Capnography (EtCO2)

The continuous, noninvasive monitoring of end-tidal carbon dioxide levels in exhaled air; provides an immediate, real-time assessment of alveolar ventilation and detects respiratory depression from opioids long before oxygen desaturation registers on a pulse oximeter.

Pulse Oximetry (SpO2)

Noninvasive measurement of arterial oxyhemoglobin saturation using red and infrared light absorption ($\text{normal: } 95\%\text{--}100\%$; $\text{COPD target: } 88\%\text{--}92\%$); desaturation is a late sign of hypoxia and readings may be biased by low perfusion, cold extremities, motion artifact, or skin pigmentation.

Thoracentesis

A surgical puncture of the chest wall into the pleural cavity to aspirate fluid for diagnostic or therapeutic relief; post-procedure emergence of sudden dyspnea and absent breath sounds on the affected side indicates a pneumothorax complication requiring immediate provider notification.

Pursed-Lip Breathing

A breathing technique where the patient inhales slowly through the nose and exhales slowly through pursed lips (1:2 ratio); establishes mild back-pressure within airways, preventing small-airway collapse and air trapping in COPD.

Incentive Spirometry

A visual feedback lung-expansion device used postoperatively where the patient inhales slowly and deeply to raise a visual piston, holding maximal inspiration for several seconds to prevent atelectasis and pneumonia (performed $5\text{--}10\text{ times}$ every $1\text{--}2\text{ hours}$ while awake).

Venturi Mask

A high-precision oxygen delivery device delivering fixed, reliable concentrations ($24\%\text{--}40\%$ at $4\text{--}6\,\text{LPM}$) via interchangeable color-coded valves or entrainment ports; regarded as the gold standard for COPD patients vulnerable to losing their hypoxic respiratory drive.

Non-Rebreather Mask

A high-concentration low-flow oxygen delivery system delivering $80\%\text{--}100\%$ $\text{FiO}_2$ at $10\text{--}15\,\text{LPM}$ equipped with one-way valves that prevent rebreathing of room and exhaled air; requires the reservoir bag to remain fully inflated at all times.

High-Flow Nasal Cannula (HFNC)

An advanced oxygen system delivering heated, humidified gas blends ($21\%\text{--}100\%$ $\text{FiO}_2$) at flow rates up to $60\,\text{LPM}$, which flushes anatomical dead space and generates mild positive end-expiratory pressure (PEEP).

Peak Expiratory Flow Rate (PEFR)

A point-of-care test using a peak flow meter to measure the maximum speed of forced exhalation during asthma monitoring; the patient blows forcefully three consecutive times, and the nurse records only the highest single reading rather than an average.

Two Buckets Prioritization Model

A clinical judgment prioritization framework that mandates addressing physiologic ABC-level Bucket 1 problems (Impaired Gas Exchange, Ineffective Airway Clearance) before treating downstream Bucket 2 secondary diagnoses (Activity Intolerance, Fatigue, Knowledge Deficit).

Maceration

The softening, overhydration, and breakdown of skin integrity caused by prolonged exposure to fluids, such as perspiration, wound exudate, or urinary/fecal incontinence, classified as Moisture-Associated Skin Damage (MASD).

Desiccation

The localized dehydration of a wound bed that causes cellular death, crust formation, and delayed epidermal cell migration during the healing process.

Primary Intention Healing

Wound repair occurring in clean surgical incisions with well-approximated edges secured by sutures, staples, or adhesive strips; characterized by minimal tissue loss, rapid healing, and minimal scar tissue formation.

Secondary Intention Healing

Healing of wounds with large, irregular margins and extensive tissue loss (e.g., pressure injuries, burns) that cannot be approximated; wounds heal from the base upward via granulation tissue, taking longer and forming larger scars.

Tertiary Intention (Delayed Primary Closure)

Wound repair where contaminated or edematous wounds are left open deliberately for several days to resolve infection and edema before being surgically closed and approximated.

Granulation Tissue

New, highly vascular, beefy-red tissue with a moist, granular appearance formed by proliferating fibroblasts and new capillary beds during the proliferation phase of wound healing.

Dehiscence

The partial or total accidental separation of wound or incisional layers resulting from excessive mechanical strain or stress placed on an unhealed incision.

Evisceration

A surgical emergency representing the complete separation of an abdominal wound with protrusion of internal viscera through the incisional opening; emergency nursing care requires covering the organs with sterile saline-moistened towels, placing the patient in low Fowler's position with knees flexed, and immediate provider notification.

Fistula

An abnormal passage or tract extending from an internal organ or blood vessel to the surface of the body, or connecting two internal organs to one another, often resulting from infection and abscess formation.

Shear Force

A mechanical force generated when deep skeletal structures slide downward with gravity while superficial skin layers remain stationary against a surface, causing twisting, stretching, and tearing of deep microvessels and resulting in deep tissue ischemia.

Stage 1 Pressure Injury

Localized, intact skin exhibiting non-blanchable erythema (redness that does not turn white when micro-pressure is applied); the area may be painful, firmer, softer, warmer, or cooler compared to surrounding tissue.

Stage 2 Pressure Injury

Partial-thickness loss of skin with exposed dermis, presenting as a viable, pink or red, moist wound bed or as an intact or ruptured serum-filled blister; adipose tissue and deeper structures are not visible.

Stage 3 Pressure Injury

Full-thickness skin loss in which adipose tissue is distinctly visible within the ulcer bed, often with granulation tissue, epibole (rolled edges), undermining, or tunneling; fascia, muscle, tendon, ligament, cartilage, and bone are not exposed.

Stage 4 Pressure Injury

Full-thickness skin and tissue loss with directly exposed or palpable fascia, muscle, tendon, ligament, cartilage, or bone; slough, eschar, epibole, undermining, and tunneling occur frequently, conferring a severe risk of osteomyelitis.

Unstageable Pressure Injury

Full-thickness skin and tissue loss in which the actual depth and base of the wound cannot be confirmed because it is completely obscured by slough or eschar; stable, dry, adherent eschar on the heel serves as biological cover and must not be debrided.

Deep Tissue Pressure Injury (DTPI)

Intact or non-intact skin displaying localized, persistent, non-blanchable deep red, maroon, or purple discoloration, or epidermal separation revealing a dark wound bed or blood-filled blister from intense pressure/shear at the bone-muscle interface.

Braden Scale

A standardized clinical risk assessment tool evaluating 6 subscales (sensory perception, moisture, activity, mobility, nutrition, friction/shear) yielding scores from 6 to 23, where lower scores indicate higher pressure injury risk ($\le 9$ indicates very high risk).

PUSH Tool 3.0

The Pressure Ulcer Scale for Healing; a validated tool used over time to monitor pressure injury healing trajectory by categorizing and scoring Surface Area ($\text{Length} \times \text{Width}$ in $\text{cm}^2$), Exudate Amount, and Tissue Type.

Wound Exudate Classifications

Categorization of wound drainage: Serous (clear, watery plasma), Sanguineous (bright red frank blood indicating active vascular damage), Serosanguineous (pale, pink, watery mixture of serum and RBCs), and Purulent (thick, viscous pus that is yellow, green, tan, or brown, signaling active infection).

RYB Wound Classification

A color-based wound management framework where Red tissue is protected with moist gentle dressings, Yellow slough is cleansed through irrigation, and Black necrotic eschar is debrided; multi-colored wounds are treated in the priority hierarchy of Black, then Yellow, then Red.

Jackson-Pratt (JP) Drain

A closed, active drainage system consisting of perforated tubing connected to a bulb-shaped reservoir that is compressed to create constant, low negative-pressure suction for removing internal wound fluids.

Montgomery Straps

Adhesive strips attached to skin on either side of an open wound with holes laced with cloth ties, used to secure bulky dressings that need frequent changing without repeatedly taping and damaging the surrounding skin.

Alginate Dressings

Highly absorbent dressings derived from brown seaweed capable of absorbing up to 20 times their weight in drainage, facilitating autolytic debridement and maintaining moisture in heavily draining Stage 3 and 4 pressure injuries.

Hydrocolloid Dressings

Thick, occlusive or semi-occlusive adhesive dressings that provide cushioning, thermal insulation, and moderate absorption while maintaining a moist bed for Stage 2 and shallow Stage 3 pressure injuries.

Hyperbaric Oxygen Therapy (HBOT)

An advanced wound intervention where a patient breathes $100\%$ pure oxygen in a pressurized chamber above atmospheric pressure, drastically increasing dissolved plasma oxygen to promote angiogenesis, fibroblast proliferation, and bacterial killing.

Negative Pressure Wound Therapy (NPWT / Wound VAC)

An advanced wound therapy applying controlled, continuous or intermittent sub-atmospheric negative pressure through sealed foam and occlusive drape to evacuate drainage, reduce local edema, and stimulate cellular granulation.

Suture and Staple Removal Protocol

The procedural standard requiring clean incisional prep and the removal of every other suture or staple first to confirm wound approximation before taking out the remainder, followed by the application of Steri-Strips.

Rebound Phenomenon (Thermal Therapy)

The physiological reversal occurring when heat or cold is applied beyond $15\text{--}20\text{ minutes}$, wherein continued heat induces secondary vasoconstriction and continued cold triggers reflex vasodilation, increasing tissue injury risk.

Micturition

The physiological act of emptying the urinary bladder, synonymous with urination and voiding, initiated when stretch receptors in the adult bladder wall signal the urge to void at approximately $150\text{--}250\,\text{mL}$.

Autonomic Bladder

A condition resulting from spinal injury or disease where voluntary brain control of micturition is lost, causing urination to occur purely by involuntary reflex arc without voluntary sphincter control.

Anuria

A $24\text{-hour}$ total urinary output of less than $50\,\text{mL}$, typically signaling end-stage renal disease (ESRD), renal shutdown, or severe circulatory collapse.

Oliguria

A markedly diminished urinary output of less than $400\,\text{mL}$ in a $24\text{-hour}$ period, indicating acute kidney injury, renal hypoperfusion, or fluid volume depletion.

Polyuria

The excessive excretion of large volumes of urine (diuresis) occurring in conditions such as uncontrolled diabetes mellitus or following diuretic therapy.

Dysuria

Painful, burning, or difficult urination commonly associated with urinary tract infections or urethral inflammation.

Pyuria

The presence of pus and white blood cells in the urine, giving it a cloudy appearance and indicating an active urinary tract infection.

Glycosuria

The presence of glucose in the urine, which occurs when blood glucose levels exceed the renal reabsorption threshold (as in uncontrolled diabetes), predisposing to bacterial proliferation.

Nocturia

The frequent awakening from sleep during the night to void, commonly linked to age-related decline in renal concentrating ability or late-day diuretic administration.

Enuresis

Involuntary urination occurring past the age when voluntary bladder control is expected; nocturnal bedwetting is considered developmentally normal up to age 6, after which it warrants clinical evaluation.

Urinary Retention

The inability to completely empty the bladder of urine despite ongoing production, resulting in a firm, rounded, palpable bladder rising above the symphysis pubis, commonly induced by anticholinergics, opioids, or BPH.

Postvoid Residual (PVR)

The volume of urine remaining in the bladder immediately following micturition, measured via ultrasound bladder scanner; $< 50\,\text{mL}$ indicates adequate emptying, while $> 100\,\text{mL}$ is abnormal and $> 150\,\text{mL}$ may warrant catheterization.

Pelvic Floor Muscle Training (Kegel Exercises)

Therapeutic isometric contractions of the levator ani and pelvic floor muscles (contracting for $5\text{--}10\text{ seconds}$, relaxing for $10\text{ seconds}$) to strengthen periurethral support and treat stress and urge incontinence.

Stress Incontinence

Involuntary leakage of urine occurring with sudden increases in intra-abdominal pressure (e.g., coughing, sneezing, laughing, lifting), resulting from weak pelvic floor muscles, childbearing, or obesity.

Functional Incontinence

Involuntary loss of urine in a person with normal bladder control caused by environmental barriers, severe physical immobility (e.g., arthritis), or cognitive impairments that prevent reaching the toilet in time.

Incontinence-Associated Dermatitis (IAD)

Inflammation, erythema, and epidermal maceration resulting from contact with urine and stool; managed by immediate post-episode cleansing with pH-balanced cleansers and the application of thick moisture-barrier ointments.

PureWick System

An external female urinary collection device consisting of a soft, porous wick placed between the labia against the urethral meatus, connected to continuous low wall suction to draw urine into a collection canister.

Suprapubic Catheter

A surgically placed indwelling urinary drainage catheter inserted through a small abdominal incision directly into the bladder above the symphysis pubis, favored for long-term diversion when the urethra is compromised.

Triple-Lumen Indwelling Catheter

A retention urinary catheter featuring three internal channels: one for balloon inflation, one for continuous urine drainage, and a third lumen for continuous or intermittent bladder irrigation/instillation.

Ileal Conduit

An incontinent cutaneous urinary diversion where the ureters are surgically implanted into an isolated, resected segment of the ileum brought through the abdominal wall as a stoma, characterized by normal presence of mucous shreds in the urine.

Basal Metabolic Rate (BMR)

The energy expended to maintain involuntary life-sustaining cellular and physiological activities at rest following a 12-hour fast, averaging $1.0\,\text{cal/kg/hr}$ in men and $0.9\,\text{cal/kg/hr}$ in women; decreased by aging, prolonged starvation, and sleep.

Ideal Body Weight (IBW) Rule-of-Thumb

A clinical estimation method calculating IBW as $100\,\text{lb}$ for the first $5\,\text{ft}$ of height plus or minus $5\,\text{lb}$ per additional inch for adult females, and $106\,\text{lb}$ for the first $5\,\text{ft}$ plus or minus $6\,\text{lb}$ per additional inch for adult males.

Body Mass Index (BMI)

An anthropometric calculation of body fat stores defined as weight in kilograms divided by height in meters squared: $\text{BMI} = \frac{\text{Weight (kg)}}{(\text{Height (m)})^2}$; adult obesity is defined as a BMI of $30.0$ or greater.

Waist Circumference

An anthropometric measurement taken at the level of the umbilicus indicating visceral/abdominal fat; clinical high-risk thresholds of $> 40\,\text{inches}$ in men and $> 35\,\text{inches}$ in women correlate with elevated risks of type 2 diabetes, dyslipidemia, and cardiovascular disease.

2025–2030 Dietary Guidelines Inverted Food Pyramid

The updated nutritional model emphasizing whole grains over processed options, increased intake of animal-derived proteins, and full-fat dairy, with guidance centered on selecting healthy processed foods.

Dysphagia

Difficulty swallowing or the inability to swallow; symptoms include choking, coughing during meals, frequent throat clearing, pocketing of food, and a wet/gurgling vocal tone post-swallow.

Enteral Nutrition

The delivery of liquid formula nutrients directly into the gastrointestinal tract via nasogastric (NG), nasointestinal (NI), gastrostomy (G-tube/PEG), or jejunostomy (J-tube) tubes; initial placement must be confirmed by radiographic X-ray.

Total Parenteral Nutrition (TPN)

A concentrated, hypertonic intravenous nutrient solution of amino acids, dextrose, and lipids infused via an electronic pump through a Central Venous Access Device (CVAD); requires bag and tubing changes every $24\text{ hours}$ and blood glucose checks every $6\text{ hours}$.

Prealbumin

A sensitive serum biochemical marker with a normal range of $19\text{--}38\,\text{mg/dL}$; levels below $19\,\text{mg/dL}$ indicate acute protein-calorie depletion and impaired cellular wound healing capacity.

Blood Urea Nitrogen (BUN)

A serum laboratory test reflecting nitrogenous protein breakdown with a normal range of $6\text{--}20\,\text{mg/dL}$; elevated levels indicate dehydration, starvation, or high protein intake, whereas decreased levels reflect malnutrition or overhydration.

Voluntarily Stopping Eating and Drinking (VSED)

An autonomous decision made by a patient with full decision-making capacity to refuse oral nutrition and hydration to hasten death, which according to the American Nurses Association (ANA) remains binding even if the patient subsequently loses capacity.