Nursing Fundamentals: Elimination, Assessment, Infection Control & Immobility

Flashcards testing knowledge of urinary and bowel elimination, physical assessment techniques, infection control principles, and immobility interventions from lecture notes.

What do high and low urine specific gravity findings indicate, and what is the normal reference range?

The normal range is $1.005\text{–}1.030$. High specific gravity indicates concentrated urine (dehydration, fluid volume deficit, SIADH, glycosuria), while low specific gravity indicates dilute urine (overhydration, diabetes insipidus, renal failure where the kidney cannot concentrate urine).

What specific type of pathogen is indicated by a positive nitrite result on a urinalysis?

A positive nitrite result specifically indicates a bacterial UTI caused by gram-negative organisms, such as E. coli.

How is oliguria defined in adult patients?

Oliguria is defined as diminished urine output of less than $400\text{–}500\,\text{mL/24 hr}$ in adults.

What distinguishes the mechanism and presentation of stress incontinence from urge incontinence?

Stress incontinence is leakage caused by increased intra-abdominal pressure (coughing, sneezing, laughing, exercise) due to a weak pelvic floor/sphincter. Urge incontinence (overactive bladder) involves a sudden strong urge followed by involuntary leakage due to detrusor overactivity.

What is the single greatest risk factor for Catheter-Associated Urinary Tract Infections (CAUTI)?

The single greatest risk factor for CAUTI is the duration of catheterization.

What is the correct physical assessment sequence for the abdominal exam, and why is it unique?

The order is Inspection \rightarrow Auscultation \rightarrow Percussion \rightarrow Palpation. Auscultation is performed before percussion and palpation so manual manipulation does not alter bowel sounds.

What does a normal stoma look like, and what stoma findings require immediate provider notification?

A normal stoma is beefy red/pink and moist. A pale, dusky, or black stoma indicates ischemia/necrosis and requires immediate notification of the provider.

At what fill capacity should an ostomy pouch be emptied, and why?

An ostomy pouch should be emptied when it is $1/3\text{–}1/2$ full to prevent the weight of the pouch from pulling on the seal and causing leakage.

Why are patients with an ileostomy at higher risk for fluid and electrolyte imbalances compared to those with a colostomy?

An ileostomy bypasses the colon (where water is normally reabsorbed), resulting in continuous liquid to semi-liquid output with increased fluid, sodium, and potassium loss.

What nursing precaution is essential when administering bulk-forming laxatives like psyllium?

Ensure adequate fluid intake; without enough fluid, bulk-forming laxatives can worsen intestinal obstruction or cause fecal impaction.

What are the five cardinal signs of localized inflammation and their Latin terms?

Redness (rubor), Heat (calor), Swelling (tumor), Pain (dolor), and Loss of function (functio laesa).

What are the six links in the chain of infection, and what is the single most effective intervention to break it?

The six links are: 1. Infectious agent, 2. Reservoir, 3. Portal of exit, 4. Mode of transmission, 5. Portal of entry, 6. Susceptible host. Hand hygiene is the single most effective intervention across the entire chain.

How do local infections differ from systemic infections in clinical signs and lab findings?

Local infections are confined to one area with redness, warmth, swelling, pain, purulent drainage, and localized elevated WBC in wound culture. Systemic infections spread throughout the body, presenting with fever, chills, malaise, tachycardia, tachypnea, hypotension, elevated WBC (or leukopenia in sepsis), and positive blood cultures.

What is the key goal difference between medical asepsis and surgical asepsis?

Medical asepsis (clean technique) aims to reduce the number and spread of microorganisms. Surgical asepsis (sterile technique) aims to eliminate all microorganisms, including spores.

What outer border measurement of a sterile field is considered non-sterile/contaminated?

The outer $1\,\text{inch}$ border of a sterile field is considered contaminated.

What PPE and facility requirements are required for Airborne Precautions, and for which diseases are they used?

Airborne Precautions require an N95 or PAPR respirator, a negative-pressure room, and the door kept closed. Used for Tuberculosis, measles, varicella (chickenpox), and disseminated herpes zoster.

What distance do respiratory droplets travel under Droplet Precautions, and what PPE is required?

Large respiratory droplets ($>5\,\text{microns}$) travel $\le 3\text{–}6\,\text{ft}$. Droplet Precautions require a surgical mask, private room (or cohort), and the door may stay open.

What three factors constitute Virchow's Triad for DVT formation in immobile patients?

Virchow's Triad consists of venous stasis, hypercoagulability, and vessel wall damage.

What are the common uses and rationale for placing a patient in Sims' position?

Sims' position is commonly used for enemas, rectal exams, and unconscious patients. The rationale is that it facilitates drainage of secretions and reduces aspiration risk.

On which side of the body should a cane be held, and what is the proper sequence for walking with a cane?

The cane is held on the stronger side (opposite the weak/affected leg). Sequence: move cane forward \rightarrow move weak leg forward with the cane \rightarrow move strong leg forward past the cane.

What is the proper stepping sequence for a patient using a walker?

Sequence: lift/move walker forward a short distance \rightarrow move weaker leg forward \rightarrow move stronger leg forward to meet it.