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Dyspepsia
upset stomach/heart burn
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dysphagia
difficulty swallowing
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Gastrocolic and Duodenocolic Reflex
When peristalsis is stimulated in the colon after the first meal of the day.
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Stress Incontinence
losing urine while exercising, coughing, sneezing etc....puts pressure on the bladder.
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Urge Incontinence
Bladder spasms caused by the detursor muscle resulting in strong sudden urge to urinate.
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Reflex incontinence
Neurological problem....where bladder contracts uncontrollably and person doesnt get the signal.
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Functional Incontinence
Mental issue that keeps a person from getting to the toilet on time.....mentally incapacitated or even arthritis.
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cystitis
inflammation of the urinary bladder
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pyelonephritis
inflammation of renal parenchym and collecting system
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hypertrophy
thickening of the walls of the bladder from outflow being obstructed.
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hesitancy
- involuntary delay in starting the urinary systen.
- 15+ seconds
- BPH sign
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overflow incontinence
think you have gotten rid of all of your urine...but you havent.
- Normal is 50 cc
- Problem is over 200 cc's left behind
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Normal oral intake
PO and NPO
- PO-1500+/ml per day or 30-60ml/hr
- NPO-3000 ml/day or 125 ml/hr
Drink 2-3 litres of water per day
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Output Normal
Panic Value
- Normal is 50-60 ml/hr
- Panic is 30 ml/hr for two consecutive hours. Call Dr....renal failure
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Normal pH range
What happens if acidic?
Alkalitic?
4.6-8
Acidic is <4.6 -painful urination, diabetic ketoacidosis, diarrhea
Alkalitic is > 8 - kidney stones, kidney failure, UTI, vomitting
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Symptoms of urinary incontinence
Is it a normal part of aging?
- too much or too little urine,
- NO!!!!!
- urge or no urge,
- intensity or cant get started,
- burning
- color change/cloudy
- odor
- CANT VOLUNTARILY CONTROL FLOW OF URINE
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Urinalysis
- Looks at this in urine:
- WBC
- Protein
- pH
- gravity
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WBC's in urine...normal range
4,500-10,000
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Normal gravity?
What does this tell you?
1.010-1.025
If it is low then urine is concentrated and may be in renal failure.
If it is high, then the patient is dehydrated.???????
This doesnt make sense to me
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Culture & Sensitivity normal range?
What does this tell you?
over 100,000
Looks at what bug you have and what it should be treated with.
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What's PVR?
a test to see if your bladder is clearing all of its urine. Urinate...50cc's or less left is good.
Over 200 cc's is inadequate
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IVP and cystourethrogram does what?
looks at size, shape and function of urinary system
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Main cause of bladder dysfunction
- Detrusor muscle becomes unstable
- Pelvic Floor ligaments become weak
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Causes of bladder dysfunction: Reversible
- UTI's
- vaginal atrophy
- bladder inflammation
- prostate enlargement
- confusion
- obesity
- mobility or environment problems
- medications
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Causes of bladder dysfunction: Irreversible
- labor or multiple pregnancies
- bladder inflammation from stones, infection, tumor, caffeine, citrus, sugar substitutes
- obesity cuz puts added pressure on the bladder
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Etiology of urinary incontinence besides muscle issues.....
- Urethra doesnt close or open right
- pressure in the urethra must be greater than pressure in the bladder
- neurologic problems
- confusion
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Medical and Nursing interventions for urinary incontinence
- Medications
- Kegel exercise
- Bladder retraining
- Anticontinent devices
- Diet change
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Adrenergic blockers help with what kind of incintonence
reflexive and overflow
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Tricyclic antidepressants do what
decrease overactive bladder contractions...reflexive
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Calcium channel blockers do what?
relax smooth muscles in the bladder....Urge incontinence
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Pro banthine does what
stops painful bladder spasms and relaxes the bladder...urge incontinence
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Problems with using valsalva maneuver with urinary incontinence
bradycardia
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Crede method
helps with incontinence by pushing down on the bladder.
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How do you protect the skin of an incontinent patient?
- -Hygiene immediately
- -Use absorptive pads to wick away moisture
- -Let patient lay on top of a bad and naked to let skin dry
- -Reposition
- -Check patient regularly
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Complications of altered bladder elimination:
Dont go enough get a UTI
Go too much....skin problems
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Two types of bladder training...describe
Habit-used for cognitively impaired. Put on toilet on a schedule
Prompted- ask if wet or dry and if they need to use a toilet.
Want to set interval goals
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Patho of cystitis
urothelial cells produce mucin which is a sugar that protects the bladder cells from urine. Inflammation occurs and organisms are able to now invade the bladder
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Patho of polynephritis
bladder doesnt fully empty, reflux of urine and organisms occurs and invades the renal pelvis, inflammation occurs, scar tissue builds and renal function can become impaired
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Cystitis
Signs
Symptoms
Causes
May be asymptomatic
Signs: Hematuria, bladder distention, cloudy or purulent urine
Symptoms: urgency, burning, freq urination, sm amts, back pain
Cause: bacteria, fungus, virus, parasite, bad wiping, foods, chem, drugs, radiation
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Polynephritis
Signs
Symptoms
Causes
Signs: fever, vomit, chills
Symptoms: nausea, flank pain, abd pain, dysuria
Cause: inflammation or bacterial infection of renal pelvis due to cystitis not being cured
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Cystitis:
Primary and contributing causes
Primary: E Coli causes 90% of cystitis. From a disturbance in integrity of urothelial cells
Contributing: poor peri care, handwashing, careless insertion of catheter and cathers breakdown mucin barrier.
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Nursing diagnosis for urinary tract infection:
- Impaired urinary elimination
- Deficient knowledge R/T methods of prevention and treatment protocols
- pain, burning, pruritis
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Why are the elderly at risk for UTI's?
- Relaxed pelvic structure so the bladder doesnt fully empty.
- Decreased hydration bladder doesnt get flushed.
- Chronic diseases (stroke, diabetes)
- Decreased estrogen levels
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Why are women at risk for UTI's?
- Shorter urethra 1 1/2 inches
- Proximity of vagina to rectum
- Pregnancy
- Recurrent infections
- Viral infections
- Post menopause
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Why are post menopausal women susceptible to UTI's?
Reduced estrogen decreases vaginal lactobacilli which ward off infection.
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Interventions for cystitis:
good hand hygiene, wipe front to back, void frequently, drink 2-3 litres water/day, avoid certain foods
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Interventions for polynephritis:
ANTIBIOTICS
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Bladder irritating foods:
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Why do you measure abdominal girth?
larger girth is seen in pt with liver failure cuz fluids are being leaked in to the peritoneal cavity
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What causes Melena stools?
iron or Pepto Bismol
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Red streaks in the stool means
Hematochezia....passage of fresh blood thru the anus.
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Green-yellow poop
Infection
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Light or clay colored poop
lack of bile....gallbladder or liver disease
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Sigmoidoscopy vs. Colonoscopy
Sigmoidoscopy only looks at sigmoid colon, where the colonoscopy looks at the entire large intestine
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Proctoscopy
Looks at the anal cavity, rectum and sigmoid colon
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Gas producing foods
- cabbage
- onions
- cauliflower
- bananas
- apples
- beans
- spicy foods
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Galactosans (constipation causing foods)
- by products of milk....cheese!
- eggs
- bananas
- lean meat
- pasta
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Which nervous system speeds up digestion
- Parasympathetic
- It controls every day digestion and peristalsis
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Which nervous system slows down motility and can be constipating
Sympathetic
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How does secretion of toxins cause diarrhea?
the toxins produce swelling and inflammation....then diarrhea
Example toxins: E Coli and Shigella
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What bacteria attach to the intestinal wall and cause ulceration, cell destruction and bleeding
- Shigella
- E coli
- C DIFFICILE
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What virus attaches itself to the intestinal villi and destroys them leading to malabsorption
Rotavirus
Cuz villi increase absorptive area of the intestine
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Why may a person be incontinent?
- Communication problems
- Confusion
- Cant make it to the bathroom
- Neurological issues
- Laziness
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Why are diabetics more at risk for UTI's?
cuz they have sugar in their urine...and bacteria loves sugar. Infection
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Nursing Process....Asses pt for UTI
Subjective Information
- Subjective info:
- Past history of UTI's
- Prego
- Std's
- Current Meds
- Bladder cancer
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Nursing Process...assess pt for UTI
Objective information
- Objective Information
- Fever
- Chills
- dysuria
- Urine color and odor
- Urinalysis C&S
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Nursing Process....Dianose UTI
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Nursing Process....Planning for a UTI
- Patient will....
- 1 Have relief from bothersome lower urinary tract symptoms
- 2 Not have upper urinary tract involvement
- 3 be learn prevention of recurrence
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Nursing Process....Implement interventions for a UTI
- Admin Antibiotics
- Pt teaching
- Increase fluids
- avoid caffein, spicy foods, alcohol
- wipe front to back
- pee regularly
- rid of foley
- peri care
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Nursing Process....Evaluation of treatment for UTI
- Look at labs again:
- Decrease in WBC and less or no bacteria in urine
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