Ch 55 14th Ed study gudie

And the nurse is educating a patient with urolithiasis about preventative measures to avoid another occurrence. What should the patient encouraged to do? A. Increase fluid intake so that the patient can excrete 2500 to 4000 ML every day, which will help prevent additional stone formation B. Participate in strenuous exercise is so that the tone of smooth muscle in the urinary track can be strengthened to help propel calculi C. Add calcium supplements to the diet to replace losses to renal calculi D. Limit avoiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the system system

A. Increase fluid intake so that the patient can excrete 2500 to 4000 ML every day, which will help prevent additional stone formation

The nurse is caring for a patient with dementia in the long-term care facility and the patient has a change in cognitive function. What should the nurse expect this patient may be experiencing? A. UTI B. Stroke C. Aneurysm D. Fecal impaction

A. UTI

Explain the general principles/guidelines that the nurse should follow to prevent infection and a patient with an indwelling urinary catheter

Avoid contamination of the drainage spout. A receptacle in which to empty the bag is provided for each patient. Avoid routine catheter changes. The catheter is changed only to correct problems such as leakage, blockage, or encrustations. Avoid unnecessary handling or manipulation of the catheter by the patient or staff. Carry out hand hygiene before and after handling the catheter, tubing, or drainage bag. Ensure a free flow of urine to prevent infection. Improper drainage occurs when the tubing is kinked or twisted, allowing pools of urine to collect in the tubing loops. Evaluate the benefit of placing an indwelling urinary catheter versus the risk the patient developing a catheter-associated urinary tract infection. If the collection bag must be raised above the level of the patient's bladder, clamp the drainage tube. This prevents backflow of contaminated urine into the patient's bladder from the bag. Monitor the patient's voiding when the catheter is removed. The patient must void within 8 hours; if unable to void, the patient may require catheterization with a straight catheter. Never disconnect the tubing to obtain urine samples, to irrigate the catheter, or to ambulate or transport the patient. Never irrigate the catheter routinely. If the patient is prone to obstruction from clots or large amounts of sediment, use a three-way system with continuous irrigation. Never leave the catheter in place longer than is necessary to decrease the risk of CAUTI. Obtain a urine specimen for culture at the first sign of infection. To prevent contamination of the closed system, never disconnect the tubing. The drainage bag must never touch the floor. The bag and collecting tubing are changed if contamination occurs, if urine flow becomes obstructed, or if tubing junctions start to leak at the connections. To reduce the risk of bacterial proliferation, empty the collection bag at least every 8 hours through the drainage spout—more frequently if there is a large volume of urine. Use scrupulous aseptic technique during insertion of the catheter. Use a preassembled, sterile, closed urinary drainage system of the smallest catheter size possible to minimize trauma. Wash the perineal area with soap and water at least twice a day; avoid a to-and-fro motion of the catheter. Dry the area well, but avoid applying powder because it may irritate the perineum.

Three organisms usually found and UTIs are _________, _________, and _________

E. Coli Pseudomonas Enterococcus

Patient Hwy has been treated with your guy said for stones is being discharged from the hospital. What type of diet is a nurse discuss is the patient? A. Low-calcium diet B. High-protein diet C. Low-phosphorus diet D. Low-purine diet

D. Low-purine diet

New patient forms in the restaurant every time she sneezes or coughs, she urinates in her pants. What type of incontinence there's a nurse recognize the patient is experiencing? A. Urge incontinence B. Functional incontinence C. Stress incontinence D. Iatrogenic incontinence

C. Stress incontinence

What are six categories of risk factors for UTIs?

1. Contributing conditions such as: Female gender Diabetes Pregnancy Neurologic disorders Gout Altered states caused by incomplete emptying of the bladder and urinary stasis 2. Decreased natural host defenses or immunosuppression 3. Inability or failure to empty the bladder completely 4. Inflammation or abrasion of the urethral mucosa 5. Instrumentation of the urinary tract (e.g., catheterization, cystoscopic procedures) 6. Obstructed urinary flow caused by: Congenital abnormalities Urethral strictures Contracture of the bladder neck Bladder tumors Calculi (stones) in the ureters or kidneys Compression of the ureters

Fluid management as a method of behavioral therapy for incontinence requires a daily liquid intake of _________ ml

1.5

A woman and start to catheterize herself by inserting the catheter _________ inches into the urethra

3

The nurse is educating a patient who will be performing self Catheterization at home. One formation provided by the nurse will help reduce the incidence of infection? A. Clean the catheter with antibacterial soap, thoroughly rinse and dry before reinsertion B. Analyze the catheter by boiling it in water for 20 minutes C. Insert the catheter for a year and drainage three times per day D. A new catheter must be used each time catheterization is required

A. Clean the catheter with antibacterial soap, thoroughly rinse and dry before reinsertion

A patient has had surgery to create an illegal conduit for urinary diversion. What is a priority intervention by the nurse in the postoperative phase of care? A. Turn the patient every two hours around the clock B. Administer pain medication every two hours C. Monitor urine output hourly and report output greater than 30 ml/hr D. Clean the stoma with soap and water after the patient voids

C. Monitor urine output hourly and report output greater than 30 ml/hr

The most common sight of a lower UTI is the _________

Bladder

The patient has been diagnosed with a UTI is prescribed an antibiotic. What first line Fluoroquinolone Antibacterial agent for UTIs has been found to be significantly effective? A. Co-trimoxazole (Trimethoprim-sulfamethoxazole) B. Ciprofloxacin (Fluoroquinolone antibiotic) C. Nitrofurantoin (Anti-infective, urinary tract) D. Phenazopyridine (Urinary analgesic agent)

B. Ciprofloxacin (Fluoroquinolone antibiotic)

The nurse is providing an education program for the nursing assistance in a long-term care facility in order to decrease the number of UTIs in the female population. What intervention should the nurse introduced in the program? Select all that apply A. Those patients who are in continent, insert indwelling catheters B. Perform hand hygiene prior to patient care C. Assist the patients with frequent toileting D. Provide careful perineal care E. Encourage patients to wear briefs

B. Perform hand hygiene prior to patient care C. Assist the patients with frequent toileting D. Provide careful perineal care

The nurses educating a female patient with a UTI and the pharmacologic regimen for treatment. What is important for the nurse to instruct patient to do? A. Take the antibiotic as well as an antifungal for the yeast infection she will probably have B. Take the antibiotic for three days as prescribed C. I understand that it the infection reoccurs, the dose will be higher next time D. Sure to take the medication with grapefruit juice

B. Take the antibiotic for three days as prescribed

The patient has a suprapubic catheter inserted post operatively. What would be the advantage of the super pubic catheter in versus urethra catheter? Select all that apply A. The suprapubic catheter can be kept in longer than a urethral catheter B. The patient can void sooner then with a urethral catheter C. That's suprapubic catheter and allows for more mobility D. The patient is not at risk for a UTI with a suprapubic catheter E. The suprapubic catheter the permits measurement of residual you're in without a reasonable instrumentation

B. The patient can void sooner then with a urethral catheter C. That's suprapubic catheter and allows for more mobility E. The suprapubic catheter the permits measurement of residual you're in without a reasonable instrumentation

If patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI with a nurse recognize from the assessment data gathered? A. Rebound tenderness at McBurney point B. An output of 200 ML with each avoiding C. Cloudy urine D. You're in with a specific gravity of 1.005 to 1.002

C. Cloudy urine

The nurse is caring for a patient with severe pain related to ureteral colic. What medication to the nurse administer with a physician order I will inhibit the synthesis of prostaglandin E., reducing swelling and facilitating passage of the stone? A. Morphine sulfate B. Aspirin C. Ketorolac D. Meperdine

C. Ketorolac

A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms? A. Sulfamethoxazole/trimethoprim B. Levofloxacin C. Phenazopyridine D. Amoxicillin

C. Phenazopyridine

The most common cause of recurrent UTIs an older adult males is _________

Chronic bacterial prostatitis

What are the eight risk factors for bladder cancer?

Cigarette smoking Exposure to environmental carcinogens Recurrent or chronic bacterial infections of the urinary tract Bladder stones High urine pH High cholesterol intake Pelvic radiation Other cancers r/t the urinary tract

The patient has been diagnosed with urge incontinence. What classification of medication does the nurse expect the patient will be placed on to alleviate the symptoms? A. Anti-spasmodic agents B. Urinary analgesics C. Antibiotics D. Anticholinergic agents

D. Anticholinergic agents

Patient taking an alpha-adrenergic medication for the treatment of hypertension is having a problem with incontinence. What does the nurse to patient? A. The medication has caused permanent damage to the bladder sphincter and will require surgical correction B. Relaxation of the supporting ligaments has occurred in the patient will need to perform pelvic floor exercises to strengthen them C. The patient will require a medication regimen to decrease the overactivity of the bladder D. When the medication is discontinued or changed, the incontinence will resolve

D. When the medication is discontinued or changed, the incontinence will resolve

What are the various causes of transient incontinence?

Delirium/confusion UTI Atrophic vaginitis Urethritis Prostatitis Medications Psychological factors Excessive urine production Limited or restricted activity Stool impaction/constipation

The three natural defenses to bacterial invasion of the urinary tract are _________ (protein), _________ (immunoglobulin), and _________, which interfere with the adherence of E.coli

Glycosaminoglycan (GAG) Urinary immunoglobulin (IgA) Normal bacterial flora of the vagina and the urethral area

What factors, and they contribute to UTIs an older adult patients?

High incidence of multiple chronic medical conditions Frequent use of anti-microbial agents Presence of infected pressure ulcers Immunocompromised Cognitive impairment next line Immobility Incomplete bladder emptying

The major complications of neurogenic bladder is _________

Infection

The major cause of death for patients with neurologic impairment of the bladder is_________

Kidney failure

What are the specific medications used to treat UTIs and pyelonephritis

Nitrofurantoin (Anti-infective, urinary tract) Cephalexin (Bacterial antibiotic) Ciprofloxacin (Fluoroquinolone antibiotic) Ampicillin (Penicillin antibiotic) Co-trimoxazole (Trimethoprim-sulfamethoxazole) Phenazopyridine (Urinary analgesic agent)

A major clinical manifestation of renal stones is _________

Pain

What common receptors are responsible for urinary incontinence?

Pregnancy Menopause GI surgery Pelvic muscle weakness Incompetent urethra Immobility High-impact exercise Diabetes Stroke Cognitive disturbance Medications (diuretics, sedatives, etc.) Caregiver or toilet unavailable

The type of incontinence that results from a sudden increase in intra-abdominal pressure is _________

Stress incontinence