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Define urinary incontinence
Any involuntary leakage of urine.
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S/S of urinary incontinence
- Dribble,
- leakage,
- Pressure causing involuntary void
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Risks from incontinence
- Skin breakdown,
- Frequent UTI,
- Social isolation
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How is a sterile specimen collected from a catheter?
Clamp hose, clean port w/ alcohol, take sample with syringe
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24 hr urine procedure
Throw 1st urine of the day, collect all urine for the next 24 hrs, keep on ice or in refrigerator
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Nursing Diagnosis for urinary incontinence
Social isolation related to urinary incontinence manifested by unwillingness to go out into public
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Interventions to assist voiding (male)
Break Iodine capsules in urinal, have him stand, straight cath, give them privacy, run water
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Auscultate for bowel sounds…
In all four quadrants, until you hear them (up to 5 min each quadrant)
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What should you do if no bowel sounds are audible?
Document and call doctor
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How can you reduce anxiety before/during diagnostic procedures?
Explain the procedure
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What should be assessed post colon surgery?
Bowel Sounds
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Nursing diagnosis for diarrhea
Fluid imbalance r/t diarrhea manifested by…dark urine, reduced skin turgor, loose/watery stools.
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What type of stool will come from a colostomy?
Formed
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Pt.’s at risk for respiratory illness…
Immobility, age, occupation, recent surgery, where they live, illnesses
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What does pulse ox measure?
% of oxygen on each hemoglobin in the arterial blood.
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What position facilitates respirations?
Fowlers
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What is the purpose of pursed-lip breathing?
- Blows off CO2,
- Prolongs expiration to decreasing collapse of alveoli,
- Reduces airway constriction.
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How are bronchodilators administered?
Inhalers & nebulizers
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Define negligence…
Failure to perform a task that puts a pt. at risk
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What is the best defense for negligence?
Document, document, document
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Define assault…
Aggressive behavior towards another (verbal/physical)
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Define damages (in malpractice)
Damage to a pt.; What happened to the pt. (physically, monetarily, emotionally)
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What is a nursing diagnosis for physical effects dehydration & infection?
Increased body temperature r/t dehydration & infection manifested by a temp of 103.4
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What is the desired action of inhalation anesthesia?
Short-acting
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What is the nurse’s role in consent?
Witness pt.’s signature. *The person performing procedure is responsible for answering any questions & pt. teaching*
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Nursing diagnosis for someone that is overweight & recently undergone abdominal surgery…
Infection, decrease circulation, dehiscence (wound split open) r/t…
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What is the nursing action to low potassium (just prior to having surgery)
Document and call doctor
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Patient teaching to cough effectively after surgery…
Splint incision site,
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Purpose of assessment in PACU
To assess for complications with surgery, ABCs
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Nursing action for post-surgery bleeding…
Pressure and report findings
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Where should your check for bleeding post-surgery other then incision site?
Posterior of site, where gravity will draw the blood.
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Define unintentional wound…
Jagged edges, higher risk for infection, more blood loss
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Rational for semi-fowlers r/t respiratory…
Helps with lung expansion
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What is some patient teaching post-surgery?
Follow-up, about medications, avoid driving, avoid signing legal documents
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What is an important patient teaching to prevent infection?
Wash hands
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What are DRG’s
Diagnostic Related Group; Determines the time and amount of money given to hospital for a certain illness.
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Who can be admitted to a long term facility?
Anyone who qualifies regardless of age.
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How can nurses shape health reform?
Be politely active, don’t reelect Obama
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What information to pt. does HIPPA mandate?
How your information will be shared.
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What is the rational for discharge planning?
Continuity of care.
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What are some signs of invasion of personal space?
Backing away, putting up hands, they look away
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Define empathetic…
A non-judgmental approach to “feel for them”
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How can you help build relationships with pt. during orientation phase?
Introduce yourself by your name, call them by their name/ ask them their preferred name.
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What is autocratic leadership?
A dictatorship, where one person dictates what to be done w/o consideration of other’s opinions/observations
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Why give Lasix and aldactone together?
To help maintain an electrolyte balance.
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What should you do if pt. requests a medication they have no order for?
Call doctor about getting an order before administering
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Examples of medication errors…
- Wrong:
- Patient
- Dose
- Route
- Time
- Reason
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