exam 2
Blood pressure control goals for a person with diabetes?
130/80 for patients with existing ASCVD or 10 year risk greater than 15% 140/90 for lower risk patients and no ASCVD
Hypoglycemia Trx
15 g fast-acting carbohydrate (if person can swallow) glucagon emergency kit (SQ) 50% dextrose solution (IV) inpatient or EMS
When assessing for infectious disease what are some things to ask?
Hx- do they have a history fever? Cough/sputum? pain? swelling? tests? draining lesion? wound? N/V/D? sexual history? meds?
which unique response is associated with DKA vs HHNS?
Kussmaul respirations this is the bodies way of attempting to correct a low pH caused by accumulation of ketones. HHNS affects people with type 2 diabetes who still have some insulin production, the insulin prevents the breakdown of fats into ketones
How may antibiotics impair immune function?
bone marrow suprression
Polyuria
excessive urination cause: diabetes diabetes insipidus diuretics excess fluid lithium toxicity hypercalcemic/hypokalemic neuropathy (kidney disease)
Portal of exit for infectious organism and how we break chain?
excretions secretions skin droplets hand hygiene, control of excretions and secretions, trash and waste disposal
How do urolithiasis/nephrolithiasis manifest?
excruciating pain -occurs more often in men than women -infections, urinary stasis, and periods of immobility increase risk hematuria pyuria diarrhea
hypoglycemia high risk times
fasting delaying or skipping meals alcohol consumption intense exercise sleep
Risk factors for lower UTI
female pregnancy diabetes neurological disorders gout altered states caused by icomplete emptying of the bladder urinary stasis immunosupression inflammation or abbrasion of urethral mucosa instrumentation in the urinary tracts (catheters) obstruction of flow (strictures, stones, tumors, other) STIs (acute urethraltitis - chlamydia, gonorrhea and herpes) Acute vaginitis can be similar
CLABSI assessment
fever chills pain redness swelling discharge from insertion site blood culture and CBC
constipation
fewer than 3 bowel movements per week bowel movement that are hard, dry, small, difficult to pass
what are some disease prevention can you take for a person with diabetes?
flu vaccine pneumonia vaccine
Complications of diarrhea
fluid and electrolyte imbalances (especially worried about Sodium and K+) dehydration cardiac dysrhythmias
Susceptible host and control method
immunodepression, diabetes, surgery, burns, elderly popuation recognition of high-risk patients, treatment of underlying diseases
androgens and the immune system
immunosuppressant
antineoplasti agents and the immune system
immunosuppression
how do adrenal corticosteroids impair immune function?
immunosupression
chronic urinary retention can lead lead to
overflow incontinence
Management of kidney stones
pain management strain urine- catch kidney stones (determines type of stone to help aid in prevention
Tenesmus
painful, ineffective defecation
disuria
painful/difficulty voiding cause:lower UTI inflammation (bladder or urethra) stones tumors in bladder
Trx of diabetic retinopathy
panretinal laser photocoagulation intravitreous injections:antivascular endothelial growth factor or corticosteroids
what is usually the MNT for type 2?
portion control: planning in increments of 15 g of carbs quality meal planning: prep ahead focus on macros ADA's diabetes plate method
COPD can cause
recurrent respiratory tract infections due its nature of altered inspiratory and expiratory function and ineffective airway clearance
stomas how to assess and what are we expecting to see
red/pink moist should not be protruding
OSHA
regulated to prevent exposure to bloodborne pathogens and hazardous substances
GU system problems that pertain only to older adult females?
relaxed perineal muscles detrusor instability (urge incontinence) urethral dysfuntion (stress urinary inontinence)
inpatients on standard precautions. what action is required by you?
standard precautions are used for all patients hand hygeine, gloves, and barriers proper handling of care equipment and linens environmental control (cleaning) sharp injury prevention
CLABSI prevention
staff development procedures/checklists patient/family education
2 tiers of precautions
standard precautions transmission based precautions
Chronic kidney disease (diabetes) Screening
urinary albumin with a spot urinary albumin-to-cretinine ratio estimated glomerular filtration rate
1 in 4 women suffer from
urinary incontinence
oliguria
urine output<400mL in 24 hours OR about <0.5 mL/kg/h over 6 hours cause: acute kidney injury chronic kidney disease inadequate fluid intake
Assessment for Urinary Diversion
urine volumes are monitored hourly urine output below 0.5mL/kg/hour indicates dehydration or obstruction in ileal conduit stoma is frequently inspected for color and viability skin around stoma is checked frequently for irritation or bleeding alkaline urine in contact with skin and wound infections
Diarrheal Parasites
Giardia Cryptosporidium Entamoeba histolytica
When do you have sick day rules for diabetics:
illness temporary diet interruptions (surgery, dental work)
positive pressure isolation
immunocompromised organ transplants we need to protect the patient from what we are bringing into the room
iatrogenic incontinence
the involuntary loss of urine due to extrinsic medical factors, predominantly medications
Renal calculi diagnosis
ultrasound, CT scan IVP Renal stone analysis retrograde pyelogram cystoscopy urinalysis (pH)
Salem Sump tube
*double lumen nasogastric tube with an air vent *used for decompression with intermittent continuous suction 2 lumens, one for feeding and one for suctioning
Levin tube
*single lumen nasogastric tube *used to remove gastric contents via intermittent suction or to provide tube feedings 1 way (mainly for suctioning) intermittent
Intervention for patient getting parenteral nutrition: preventing infection (goal)
- appropriate catheter and IV site care - strict sterile technique for dressing changes (don't change too often because the more we open to air the more chance we have in infection - wear mask when changing dressing - assess insertion site - assess for indicators of infection - proper IV and tubing care
care of patient with intestinal obstruction
-maintain function of NG tube - assess and measure NG output - assess for fluid and electrolyte imbalance - monitor nutritional status - assessing for resolutions: normal bowel sounds, decreased distention, subjective improvement in ab pain, passage of flatus or stool
Protein
10-20% of daily cal no need to restrict for pt with kidney disease QUALITY (lean vs fatty... try some non-animal sources) consistency in timing and portion
Care of a patient with an Enteral tube: Focus of Potential Goals and of Assesments/Monitoring
-tube placement (NG tube for feedings and aspirations) - pt's ability to tolerate formula and the amount - clinical response - signs of dehydration - worrisome signs: elevated BG, decreased urinary output, sudden weight gain, periorbital/dependent edema - infection control - i/o
intervention for patient getting parenteral nutrition: maintaining fluid balance=goal
-use infusion pump. flow rate should not be increased or decreased rapidly. fluid runs out, hang 10% dextrose solution - monitor indicators of fluid balance and electrolyte levels - i and O - weights -monitor blood glucose
Non-proliferative diabetic retinopathy
1) microaneurysms (sacular outpouchings) 2) intraretinal hemorrhages (dots, flame shape, & cotton wool spots) 3) retinal vascular leakage (permeability) 4) CSME (clinically significant macular edema) - retinal thickening and/or hard exudates that either involve center of macula or threaten to infiltrate it 5) venous beading - signs of ischemia 6) retinal hemorrhages and exudation
proliferative diabetic retinopathy
1) neovascularization - growth of new blood vessels along the surface of the retina; fragile and rupture easily 2) vitreous hemorrhage 3) retinal detachment
CAUTI bundle: 4 components needed to prevent/reduce risk of CAUTI
1. avoid unnecessary urinary catheters 2. use aseptic technique 3. maintenance based on guidelines 4. review necessity for the catheter daily and remove ASAP id no longer needed
how many people need to sign off on TPN
2 RN's
the gi tract recieves about ____% of the total cardiac ouput
20
FIBER
25 g/day improves satiety promotes regularity binds dietary cholestrol in gut
How many of us are colonized already with staph?
30%
How many mLs of residual urine is considered normal?
50-60mL use bladder scanner to detect
pre-meal glucose goal for diabetic pt.?
70-130mg/dL
peak post meal glucose goal for diabetic pt
<180 mg/dL this is taken 1-2 hours after a meal
glycemic targets
HBA1C < 7% greater than 70% of time in range for glucose less than 4% of time in hypoglycemia preprandial (fasting bg) 80-130mg/dL 2hr PPBG < 180mg/dL
Jejunostomy tube
A feeding tube inserted into a surgically created opening in the jejunum of the small intestine long term
Somogyi phenomenon
A rebound hyperglycemia induced by severe hypoglycemia
percieved constipation
A subjective problem in which the person's elimination pattern is not consistent with what he or she believes is normal is known as _____________________?
Macrovascular complications of diabetes
Accelerated atherosclerosis because glycation of lipoproteins and increased platelet adhesiveness/aggregation and fibrinolysis is impaired Leads to CAD (most common cause of death in diabetes), peripheral vascular disease, cerebrovascular disease
flatulence
Accumulation of gas in the intestines causing the walls to stretch
Maintaining feeding equipment and nutritional balance ADAM or AF (as fuk) AW(and what) DO NOT MD(must do)
Administer feeding at presribed rate and method according to tolerance administer water before and after each medication and each feeding, every 4-6 hours, and whenever the tube feeding is discontinued or interrupted Do not mix meds with feedings Maintain delivery system as required. to avoid baterial contam. do not hang more than 4-8 hours in open system
Hypoglycemia tools to detect pending event
BGM CGM balance with insulin and carbs
organisms of hospital acquired infection
C.diff- most common MRSA- healthcare and community associated Vancomycin resistant enterrococcus (VRE) Multidrug resistant organism MDROs
What might be necessary to detect pylenephoritis or abscesses?
CAT scan
Sterile body sites
Cerebrospinal fluid Blood Pleural fluid Pericardial fluid Bones and bone marrow Synovial fluid Peritoneal fluid
Urinary Diversion Patient education
Changing the appliance (general care) controlling the odor relieving the pain managing/cleaning the appliance potential long-term complication maintaining skin integrity body image characteristics of normal stoma: red/pink, moist (like the inside of a mouth) should be insensitive to pain= no nerve endings might bleed a little when cleaned mucus can be visible in the urine
the nurse is completing a focused assessment addressing a client's immune function. what should the nurse prioritize in the physical assessment? a. percussion of the client's abdomen b. palpation of liver c. ausculation of the apical heart rate d. palpation of the client's lymph nodes
D. lymph nodes
lipid management lifestyle modification (diabetes)
DASH or mediteranean diet weight loss if indicated exercise
How can we educate a patient to change their lifestyles to manage blood pressure to prevent ASCVD
DASH- Dietary Approaches to Stop Hypertension reduction in sodium increase in potassium moderation of alcohol exercise weight loss if indicated
Which signs and symptoms would the nurse include when teaching a client about ketoacidosis? - confusion - hyperactivity - excessive thirst - fruity breath - decreased urinary output
DKA S/S excessive thirst, frequent urination N/V abdominal pain weakness or fatigue shortness of breath fruity breath confusion
if patient cannot eat or drink during sick days or has V/D what should they do?
ER you are at a high risk for acute complications and need to be monitored closeley
Long term tubes
Gastrostomy (G tube) Gastrojejunal (G-J tube) Jejunostomy (J tube)
T/F: measuring gastric residual volume by removing gastric contents with a large syringe at routine intervals is common practice and recommended nursing management for patients recieving enteral nutrition?
False, it use to be but is not anymore
manifestations of constipation
Fewer than 3 bowel movements per week Abdominal distention Decreased appetite abdominal pain bloating A sensation of incomplete evacuation Straining at stool Elimination of small-volume, hard, dry stools
What is imperative to document, as a nurse when dealing with the GU system?
I's and O's intake: oral OR parenteral intake of fluid (PO or G-tube/IV) Outake: fluid loss via voiding, vomit, diarrhea, blood loss, diaphoresis (excessive sweating)
DKA Mx
ICU admission in the ICU we will: lower blood sugar with insulin replace fluid correct electrolyte imbalance correct acidosis frequent blood sugar monitoring Treat the underlying cause: stress, illness, meds that promote
HHS Mx
ICU admission we will: lower blood sugar with insulin replace fluid correct electrolye imbalance correct acidosis frequent blood sugar monitoring treat underlying cause often fatal caution with comorbidities
syringe pump is designated for... but used for what?
IV use but some nurse will use it for enteral feeds to delier small quantities of G tube feeds to infants (mostly seen in peds)
Methods of tube feeding
Intermittent bolus feedings Intermittent gravity drip Continuous infusion Cyclic feeding
A client with type 1 diabetes has dry, hot, flushed skin; a fruity odor to the breath; and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing?
Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases breakdown of protein and fat, causing deep, rapid respirations (Kussmaul), decreased alertness, decreased circulatory volume, metabolic acidosis and an acetone breath
continent ileostomy
Koch pounch. Creates an internal pouch to collect ileal drainage. free of ostomy appliance
What are the two of the most common GI suction tubes?
Levin- single lumen intermittent suctioning salem sump- double lumen, one for suctioning and one to vent
manifestations of fecal incontinence
Minor soiling Occasional urgency Loss of control Complete incontinence
It would be more convenient to insert a catheter but not necessarily needed, should we insert a catheter?
NO, a catheter should never be inserted for convenience. Alternatives should be considered first: condem catheter or purewick
Airborne precautions
Negative pressure rooms (tissue test) procedure area: 2 HEPA filters from pt. equipment and place one at head of bed and what at door to room HEPA filter must remain on for 30 minutes after patient has left and no other patient may enter suspected or confirmed TB wear N-95 respirator families wear surgical mask while in room
Upper UTI's include (think above the bladder)?
Pyelonephritis- acute/chronic interstitial nephritis renal abscess perirenal abscess
hematuria
RBC in urine cause: - cancer - renal stones - extrem exercise - rheumatic fever - hemaphelia - sickle cell disease
What options does pt have for MNT?
RD DSMES
Diarrheal Diseases Viral
Rota Noro (Calici) associated with outbreaks in long-term care facilities and cruise ships
the nurse is preparing to insert a nasogastric tube for a client to allow continuous sution. which tube would the nurse select?
Salen sump has a vent that prevents suction from pulling at the GI mucosa and should be used for clients requiring continuous suction
Sick day rules for diabetics
Take insulin or oral antidiabetic agents as usual. you may need supplemental doses of regular insulin every 3-4 hours. Test blood glucose and test urine ketones every 3-4 hours. If vomiting, diarrhea, or fever persists, take liquids (e.g., ½cup regular cola or orange juice, ½ cup broth, 1 cup sports drink [Gatorade]) every ½ to 1 hour to prevent dehydration and to provide calories. Report nausea, vomiting, and diarrhea to your primary provider, because extreme fluid loss may be dangerous. If you are unable to retain oral fluids, you may require hospitalization to avoid diabetic ketoacidosis and possibly coma.
epidemic
The occurrence in a community or region of cases of an illness, specific health-related behavior, or other health-related events clearly in excess of normal expectancy
Most common infection of older adults as well as most common nosocomial infection?
UTI
Which GU factor contributes to urinary incontinence in older adult clients and needs to be considered by the nurse when planning the care for these clients? - sensory deprivation - UTI - frequent use of diuretics - inaccessibility of a bathroom
UTI affect GU tract and interfere with voluntary control of micturation
Where can I go to look up information on infectious diseases?
WHO (world health organization) CDC (Center for Disease Control) IDSA (infectious disease society of ameria) NFID (national foundation for infectious diseases) OSHA (occupational safety and health admin) NIH (National institute of Allergy and INfectious Diseases)
Who sets guidelines on infection control?
WHO and CDC
Care of a patient with an Enteral tube: Assessment
What does the pt. know? is the pt. able to take care of themselves and has support? INSPECT skin around the tube I's and O's (nutrition and fluid status) INSPECT tube and equipment Monitor for complications
bolus feeding
a feeding given into the stomach in large amounts and at designated intervals
Gastric tube (G tube)
a feeding tube that is placed directly into the stomach through an incision in the skin long term
Parenteral nutririon
a method to provide nutrients to the body via IV route long term complex mixture containing proteins, carbs, fats, electrolytes, vitamins, trace minerals, and sterile water is administered in a single container can be delivered peripherally or via a central line, depending on the solution's hypertonicity
detached retina
a separation of the neural retina from the pigmented retina
central line
a special type of iv catheter that is placed in larger veing near the heart and lasts longer than a peripheral iv
a nurse is caring for a pt. who was admitted to the unit with infectious diarrhea. the nurse should be alert to what assessment finding as an indicator of dehydration. labile BP weak pulse fever diaphoresis
a. labile BP b. weak pulse c. fever d. diaphoresis
What routine lab work should be considered in a diabetic pt.?
a1c, lipid, metabolic panel
goals for people with diabetes management at home
a1c<7% premeal glucose 70-130 peakpost meal glucose< 180 control symptoms of high blood sugar promote health by preventing complications empower the patient for self care honor the patient's preferences
The normal urinary tract is sterile where?
above the urethra, one of the reasons why catheter insertion needs to be a sterile technique; it goes beyond the urethra and into the bladder
anuria
absence of urine urine production <50mL per day cause: acute kidney disease chronic kidney disease obstruction
Diabetic ketoacidosis
acute onset hyperglycemia abdominal pain, altered mental status, ketone breath, N/V, ketonuria glucose> 250 Acidotic pH can be precipitated by illness/stress, insulin withholding Diabetes type 1
which nursing intervention is appropriate when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?
administering fluid replacement as a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated the client must recieve fluid and then insulin
the nurse provides education to a client who is learning to self-administer gastronomy tube feedings and would include which instruction? - administering water after the feeding is completed - maintaining supine position during feeding - heating the feeding solution to slightly above body temp - determining tube placement by instilling water before feeding
administering water after the feeding is completed this prevents the thicker feeding solution from obstructing the lumen of the tube
Forms exercise recommended for a patient with diabetes?
aerobic exercise: improves CV conditioning walking, riding bike, swimming, endurance anaerobic exercise: Improves muscle strength resistance training (weights), flexibility training (stretching, yoga)
Health care associated MRSA
affinity for skin colonization colonization can become infection due to invasive procedures shortened lengths of hospital stays can decrease risk
lipid management primary prevention (diabetes)
age 40-75 with no ASCVD- moderat intensity statin age 20-39 with high ASCVD risk factors (the 15% people)- consider statin age 50-79 with multiple ASCVD risk factors- high intensity statin
lipid management secondary prevention (diabetes)
all adults with ASCVD- high intensity statin additional agents for LDL goal of less than 70mg/dL
standard precautions
all patients are colonized or infected with mircobes and use of appropriate barrier precautions for all patient interactions hand hygiene glove use needle-stick prevention avoidance of splash/spray of body fluids
PEG tube (percutaneous endoscopic gastrostomy)
an endoscopic procedure in which a tube is passed into a patient's stomach through the abdominal wall and mostly provides a means of feeding or oral intake
Which information would the nurse include in explaining glaucoma to a client? - an increase in the pressure within the eyeball - an opacity of the crystalline lens or its capsule - a curvature of the cornea that becomes unequal - a separation of the neural retina from the pigmented retina
an increase in the intraocular pressure results from a resistance of aqueous humor outflow. open angle glaucoma= most common results from increased resistance to aqueous humor outflow
Causes of fecal incontinence
anal sphincter weakness Traumatic (rectal surgery) Nontraumatic (scleroderma) Neuropathies disorders of pelvic floor (rectal prolapse) inflammation (radiation proctitis, IBD) CNS disorders (dementia, stroke, spinal cord injury, MS) diarrhea fecal impaction with overflow behavioral disorders
How do prevent foot ulcers in a diabetic patient?
annual comprehensive exam inspection at every visit in patients with sensory loss (neuropathy) or prior foot complications ( deformities, foot ulcers, amputations) daily home inspection by patient smoking cessation therapeutic foot wear for high risk patient (can be gotten and fit for at a medical supply store)
How often should you screen for neuropathy?
annually people with T1DM > 5 years duration people with T2DM
CLABSI Trx
antibiotic therapy catheter removal
Drug categories that may impair immune function
antibiotics antithyroid NSAIDs Adrenal corticosteroids antineoplastic agents (cytoxic agents) antimetabolites (inhibits the use of a certain metabolite leading to a cytotoxic effect)
Priority nursing concerns with a stoma?
anxiety related to surgical procedures, leakage or odors potential for skin break down body image concerns post op education
large intestine
ascending transverse descending sigmoid
how do you determine placement of gastrostomy tube?
aspirating the stomach NOT instilling fluid before the feeding
The nurse is providing care to a client who is recieving enteral feedings via a NG tube. Which serious complication would the nurse take measures to prevent? - skin breakdown - aspiration pneumonia - rentention ileus - profuse diarrhea
aspiration pneumonia care should be taken to prevent dislodging of the tube or vomitting proper positioning= supine or side lying, semi-fowler or higher skin breakdown may result but is not the immediate threat
anti-plateley secondary prevention (diabetes)
aspirin 81 mg for people with ASCVD dual therapy for 1 year after acute coronary syndrome dual therapy long term for CHD with intervention and high ASCVD risk
anti-platelet therapy primary prevention (diabetes)
aspirin 81 mg for people with increased ASCVD risk
A1C goals for patients with diabetes
at 7% or below avg blood glucose of 150
When do you starts MNT?
at diagnosis of diabetes and/or any point a patient displays lack of knowledge
What should we educate the patient on how to do physical activity?
at least 3x a week, spread out be consistent- time, duration, intensity proper equipment- shoes, water bottle Start slow and work your way up gradually
nocturia
awakened from sleep because of the urge to void cause: - heart failure - diabetes - incomplete bladder emptying - excess fluid intake at bedtime - nephrotic syndrome - cirrhosis w/ascites
infectious agent and what could break this part of the chain of infection?
bacteria fungi virus rickettsiae protozoa rapid identification/accurate
bacteriuria
bacteria in the urine; bacterial count higher than 100,000 colonies/mL cause: infection
If a patient is using multiple insulin injection or insulin pumps when should they test for BG?
before meals and snacks before bed and tasks like driving
While obtaining the client's health history, which factor would the nurse identify that predisposes the client to type 2 diabetes? - having diabetes insipidus - eating low-cholesterol foods - being 20 lbs overweight - drinking a daily alcoholic beverage
being 20 lbs overweight excessive body weight= predisposing factor to type 2 diabetes
GU system problems that pertain only to older adult males?
benign prostatic hyperplase BPH (enlarged prostate)
Hyperglycemia diabetes
blood glucose is above the decided goal OR high for the patient baseline
Hypoglycemia in a diabetic pt.
blood glucose<70 or presence of neuroendocrine response to falling glucose (signs and symptoms of hypoglycemia)
patient learning needs for fecal incontinents
bowel training program skin care emotional support
chronic complications of diabetes
brain stroke Cerebrovascular disease diabetic retinopathy cataract glaucoma cardiovascular disease peridontal disease diabetic nephropathy peripheral vascular disease diabetic neuropathy foot damage
What kind of foods should a person with diarrhea avoid?
caffeine carbonated beverages extreme temp foods temporarily: milk, fat, whole grains, fresh fruit, and veggies
nephrolithiasis
calculi or stones in the kidney
Diarrheal Diseases bacterial
campylobacter salmonella shigella e. coli
diabetes and infections it can cause
can make infections worse due to vascular insufficiency, neuropathy and the poor control of serum glucose levelss
What is usually the MNT for type 1?
carb counting strategies: - meal timing - carb load - macronutrient balance - insulin to match carbs - consider physical activity
What can electrolyte imbalances effect (when there is something wrong with the kidney)?
cardiac function and rhythms neurological status other systems
CAUTI
catheter acquired urinary tract infection most common DEVICE related HAI (~30%)
what changes in the immune system in the older adult increase the incidence of infection and cancer in this popuation?
cellular changes: impaired neutrophil function decreased macrophages impaired dendritic function reduced T-cell activation capacity for self-renewal of hematopoeitic stem cells decreases cytotoxicity of NK cells decreases = decline in humoral immunity inflammatory cytokines increases acquired immunity is negatively effected as efficacy of vaccines decreases
CLABSI
central line associated blood stream infection not related to an infection at another site that develops within 48 hours of central line placement
TPN/lipids must go through
central line... we need a big vein
if a patient is on basal insulin and oral agents only, when should they test their glucose?
check preprandial (fasting) glucose
What are some precautions to educate our patient on in regards to physical activity?
check your feet stress test prior to starting the new routine if high-risk for CV avoid exercising with ketones or with glucose> 250 hypoglycemia could happen, make sure to have 15 grams of carbs prior to exercise
How do you safely intitiate TPN?
checked by 2 RNs before handing then signed off by both nurses again after pump is started is individualized 1-3mL to begin with... start slow
aspirate has 2 definitions
choke suctioning
Increased risk for CLABSI
chronic illness: -hemodialysis -malignancy - GI tract disorders - pulmonary hypertension immunosupression - organ transplant - diabetes mellitus malnutrtition Total parenteral nutrition extremes of age loss of skin integrity: burns prolonged hospitalization before line insertion
which responses would the nurse expect a client experiencing hypoglycemia to exhibit?
cold, clammy skin numbness of fingers, toes, mouth rapid heartbeat (tachy) emotional changes headache nervousness, tremors faintness, dizziness unsteady gait, slurred speech hunger changes in vision seizures, coma
With older population, since they have a decreased febril rxn, they may not present with fever... what are some other signs that your older patient may have an infection like a UTI happening?
confusion or agitation that is not baseline think: are they always like this or did something change in their behavior
Common bowel elimination problems
constipation diarrhea flatulence impaction incontinence hemorrhoids
enteral tube feeding complications
constipation impaired nutrition infection disturbed body image impaired skin integrity diarrhea aspiration refeeding syndrome hyperglycemia dehydration
Atherosclerotic cardiovascular disease and macrovascular complications caused by diabetes
coronary heart disease cerebrovascular disease peripheral arterial disease heart failure
Lower UTI's include (think what can be inflamed below the bladder)?
cystitis prostatitis urethritis
Purpose/possible functions of GI intubation?
decompression of stomach because of gas/distention lavage the stomach diagnose GI disorders administer meds and feeding separately to compress a bleeding site to aspirate gastric contents for analysis
complications of constipation
decreased cardiac output fecal impaction hemorrhoids fissures rectal prolapse megacolon
Older adults can have issues with their GU system, what are some of those problems?
decreased filtration rate of kidneys diminished tubular function with less efficiency in reabsorbing and concentrating the urine slower restoration of acid-base balance in response to stress decreased bladder capacity decline of sphinctoral muscle control decline of voiding senses increase in nocturnal voiding
What things do older adults have issues with regarding the GI system?
decreased sense of thirst, smell, taste decreased salivation difficulty chewing and swallowing food (loose/absent teeth) delays esophageal, gastric emptying diminished secretion of gastric acid and pepsin reduced GI motility
gerontological considerations with ostomies
decreased vision impaired hearing difficulty with fine motor coordination skin care is also a major concernt in older patients epithelial and subq fatty layers become thin, and the skin is irritated easily
astigmatism
defective curvature of the cornea or lens of the eye
kidney injury and infections it can cause
deficiency in circulating lymphocytes immune defenses may be altered by acidosis and uremic toxins (accumulation of substances due to altered filtering)
hesitancy
delay or difficulty in initiating voiding cause: - BPH - compression of urethra - obstruction -neurogenic bladder
A client who was involved in a motor vehicle crash reports seeing flashes of light. which condition would the nurse be prepared to address? - glaucoma - scleroderma - detached retina - cerebral concussion
detached retina caused by vitreous traction on the retina
DKA
develops quickly, within 24 hours occurs when body produces high levels of ketones (blood acids). Body is unable to produce enough insulin and without enough insulin body begins to break down fat as an alt fuel which leads to the build up of ketone in blood
what is the leading cause of kidney failure, nontraumatic amputations, and blindness in adults?
diabetes
Which factors in a client's health history increase the risk of hearing loss? SATA - diabetes - noisy environments - ear infections - vitamin c deficiency - loud music
diabetes: can decrease blood supply to the ears leading to decrease hearing acuity loud noise/music- hearing loss ear infections: may lead to decrease in hearing acuity B12 and folic acid can cause hearing loss but NOT vitamin C
a nurse educator is developing a care plan concerning a risk of infection related to vascular insufficiency. Which disease and/or injury would most likely align with this nursing care plan? TIA (transient ischemic attack) major burns chronic obstructive pulmonary disease (COPD) diabetes
diabetes?
hemorrhoids
dilated, engorged veins in the lining of the rectum
Means of infection transmission and how break this part of chain?
direct contact, ingestion, fomites, airborne isolation, food handling, airflow control, standard precautions, sterilization, hand hygiene
Where can a catheter be inserted?
directly into the bladder, ureter or renal pelvis
endemic disease
disease constantly present in a population EX: common cold
diabetic retinopathy
disease of the retina in diabetics characterized by capillary leakage, bleeding, and new vessel formation (neovascularization) leading to scarring and loss of vision
general infection control at home , what to teach patient and family?
disinfect surfaces, keep distance, perform hand hygiene
Scrub the hub- special caps
disinfects in 1 minute protects port up to 7 days easy to apply stays securely in place connects to commonly used needleless connectors brightly colored effective against 6 CLABSI associated microorganisms 70% isopropyl strips or caps
ileal conduit
diverting ureter into 12 cm loop of ileum that is let out through the abdominal wall complications: wound infection, urinary leakage, uretal obstruction, small bowel leakage, gangrene stoma
hypoglycemia S/S
dizziness (disoriented, light headed) HUNGER irritability (anxiety and confusion) clammy skin (sweaty hands) mood swings
Bolus Gastrostomy Feeding by Gravity
don't let your patient cough.... good for venting: liquid goes in and air comes out
if patient cannot eat during sick days what should they do?
drink calorie-containing liquids every half-1 hour aim for 50g of carbs every 4 hours
What are some good ideas for foods to consume on sick days every 4 hours?
drinks: soda, gatorade, juice, popsicles broth, soup crackers, dry cereal pudding, yogurt, gelatin applesauce unsweetened
Hyperglycemia symptoms
dry mouth increased thirst weakness headache blurred vision frequent urination
small intestine Dont Jump In
duodenum jejunem illeum
risk factor assessment for cardiovascular issues in diabetic patient
duration of diabetes overweight/obesity hypertension dyslipidemia smoking family Hx of premature CHD Chronic kidney disease CKD albuminuria (protein in urine)
estrogen tends to __________ immunity
enhance
Patients with kidney disorders are at a higher risk for
fluid imbalances- fluid overload and defecit and electrolyte imbalances
foot complications of diabetes
foot ulcer charcot joint hammer toe
which type of position is reccommended for gastrostomy tube feedings?
fowler position, to prevent regurgitation and aspiration
diarrhea
frequent passage of loose, watery stools more than 3 bowel movements in a day with altered consistency associated with urgency, perianal discomfort, incontinence, or a combo may be acute, persistent or chronic
G-J tube
gastric tube that allows for simultaneous gastric suction and small bowel feeding (give food and meds to "J" part, suction from the "G" part) long term
Neuropathy- Autonomic Nervous System
gastroparesis: delayed emptying, N/V sexual dysfunction urinary retention hypoglycemic unawareness
How do we reduce diabetic complications?
glycemic Mx BP Mx lipid Mx Agents with Cardiovascular and Kidney benefit LIFESTYLE MODIFICATION AND DIABETES EDUCATION
prevention of diabetic retinopathy
good blood sugar blood pressure and lipid mx
Chronic Kidney disease treatment (diabetes)
good glucose control via SGLT-2 inhibitors can slow progression of CKD Good BP control via ACE or ARB for high BP associated with CKD
15-20 grams of glucose for oral hypoglycemic trx
half a can of coke orange juice hard candy glutose 15 honey glucose tablets
Education of routine practices at home a patient can do
hand hygiene PPE (when applicable) keep open and draining wounds covered evironmental controls such as cleaning equipment and environmental cleaning as required clothes, household linens, including cleaning cloths, WASHED
Why do you have sick day rules for diabetics?
high risk for acute, severe complications patients need guidance for medications and food intake
nosocomial infection
hospital acquired health care facilities worldwide issue, USA costs is in billions for extended care and trx A leading cause of death spread by healthcare workers who fail to wash hands (properly or at all) or change gloves
How do you educate your patients as to not cause a UTI?
hygiene: - take a shower instead of a bath - cleaning urethral meatus from front to back Fluid intake: - drink liberal amounts of fluid daily (flushes out bacteria) - cranberry juice can be helpful (1 per day) - avoid coffee, tea, other caffeinated fluids that can be urinary tract irritants Voiding habits: - pt. should void every 2-3 hours - completely empty bladder - women should void immediately after sex Medication Trx (if you currently have one): - take meds exactly as prescribed - consider daily consumption of cranberry juice/capsules -notify primary care if fever or systemic signs of an infection occurs - longterm antimicrobials may be prescribed
The nurse is caring for a client who is receiving TPN. Which complications may be caused by the TPN?
hyperglycemia infection hyperglycemia- high concentration of dextrose in TPN. common complication of TPN and must be monitored infection- catheter related infection is frequently seen and must be monitored
Hyperglycemic Hyperosmolar Syndrome
hyperglycemia insidious onset altered mental status, dehydrated no ketones because insulin is still present glucose>600 normal pH (no ketones) precipitated by illness, stress, medications that promote hyperglycemia Type II
Acute complications of diabetes
hypoglycemia hyperglycemia DKA Hyperglycemic Hyperosomolar syndrome (HHS)
the nurse is assessing a client admitted with DKA. which statement by the client indicated a need for further education on sick day management? - i will stop taking my insulin when i am ill because i am not eating - i will check my urine for ketones when my blood sugar is over 250 - i will alternate drinking gatorade and water throughout the day while ill - i will continue all my insulin including my glargine when i am sick
i will stop taking my insulin when i am ill because I am not eating metabolic needs still require insulin and sometimes more in a stressed state that illness brings on.
Hyperglycemia MX
identify cause monitor trend no "extra" meds unless plan in place prevention- adherence to medications and lifestyle change
How can we medically aid a person in controlling their blood pressure due to diabetes?
if CAD or albuminuria- ACE inhibitor or angiotensin receptor blocker if no CAD or albuminaria- ACE or ARB, diuretic, or calcium channel blocker
if a patient is only using noninsulin therapies to manage their diabetes, or medical nutrition therapy alone when should they test their glucose?
if they are able to manage without there is a limited benefit as far as when to medicate. However, it can show the impact/trends of diet, exercise and the noninsulin medication
Types of urinary diversions
ileal conduit cutaneous ureterostomy vesicostomy nephrostomy
Nursing diagnosis for patients with enteral tubes
impaired nutrition risk for infection risk for impaired skin integrity/skin breakdown disturbed body image related to presence of tube risk for diarrhea risk for constipation risk for aspiration
Nursing (priority) Problems for patients obtaining parenteral nutrition
impaired nutrition risk for infection (specifically CLABSI) disturbed body image realted to central line risk of fluid volume overload risk for electrolyte imbalance
neurogenic bladder
impairment of bladder control as a result of spinal cord injury, herniated verterbral disc (pinches off nerves), MS, congenital disorders (spina bifida), infection or complications of diabetes
How does physical activity help with diabetes?
improves insulin sensitivity increases sense of well being increases flexibility and muscle strength diminishes potential for injury and fall in older adults (due to strength building)
incontinence
inability to control bladder and/or bowels urine from bladder to urethra to out OR passage of feces and gas to anus
urinary retention
inability to empty the bladder during attempts to void
manifestations of diarrhea
increased frequency and fluid content of stools abdominal cramps distention borborygmus anorexia and thirst painful spasmodic contractions of the anus tenesmus
Renal Calculi Signs/Symptoms
increased risk in males N/V agonizing flank pain; can radiate to groin, testicles and abdominal area Sharp, sudden, severe pain (could be intermittent depending on stone movement/positioning) Hematuria dysuria pyuria urinary frequency
continent urinary diversion
indiana pouch kock pouch uretherosigmoidostomy
goals of medical nutritional treatment of diabetes
individualized- pt needs, preferences, culture considers- health literacy, access, readiness for change, barriers maintains pleasure of eating- positivity around food choices, don't cancel out categories unless have to Practical- meal planning strategies
Major complications of neurogenic bladder
infection renal calculi impaired skin integrity urinary incontinence OR retention
what can cause diarrhea?
infection meds tube feeding formula metabolic and endocrine disorders various disease processes
renal calculi risk factors
infection urinary stasis/retention immbolitiy dehydration increase uric acid increase urinary oxalate family history
how may NSAIDs impair immune function?
inhibit prostaglandin synthesis/release
how do antimetabolites impair immune function?
inhibits the use of a certain metabolite-->cytoxic effect immunsuppression
What is the correct order to complete an abdominal assessment?
inspection ausculation percussion palpation
Why would we use parenteral nutrition? (Indications)
intake is insufficient to maintain anabolic state impaired ability to ingest food orally or by tube pt. is un-interesed/willing to take in the adequate amount of nutrients underlying medical condition precludes oral or tube feeding preoperative and postoperative nutritional needs are prolonged
levin tube does not have a vent and should be used for
intermittent suction
this continuous glucose monitoring type is continuously measuring BG but requires scanning to store the information?
intermittently scanned
overflow incontinence
involuntary loss of urine associated with overdistention and overflow of the bladder
Enuresis
involuntary voiding during sleep bed wetting cause: - functional maturation delay of CNS because bladder - - control begins around 5 yrs old - obstructive disease of lower UT - genetic factors - failure to concentrate urine - UTI - psyche traumas
Important things to educate a patient on who has urinary incontinence?
it is not inevitable (normal) and is treatable via specialized pelvic floor physical therapists (females) management of incontinence does take time... it is okay i am here to provide encouragement or support it helps to keep a voiding log/journal educate the pt. on their medication for pharmalogical therapy/control go over strategies for promoting continence educate pt. on behavioral interventions
parenteral
iv route
major chronic illnesses that increase one's risk of infection
kidney injury diabetes respiratory tract infection organ transplant
Physical Assessment of urinary function
kidney: palpate urinary bladder: palpation/percussion; bladder scanner urethral orifice: inspect for infection, discharge, or odor skin: assess color, texture, turgor, waist excretion urine: assess for color, odor, clarity and sediment
needle stick prevention
know your institutions policies recap clean needles after drawing up meds, use one-handed technique safety mechanisms/be familiar with devices know sharps location raise bed to you anchor hand giving injection recap dirty needles if no available sharps
Fats
less than 30% of daily cal less than 10% should come from sat fats limit dietary cholesterol of 300 mg/day QUALITY (mono and polyunsaturated fats and omega 3 fatty acids)
how may antithyroid drugs impair immune function?
leukopenia= low white blood cell count
How do you decide on a tube type (GI)?
location- where does it need to go? tolerance- will the patient tolerate it? LOC- is the patient conscious? convenience cost age length of time- long term or short term
Neuropathy sensory loss in diabetes
loss of "protective senses" - painful numbness, burning, tingling - generally "distal" affecting hands and feet - leading cause of nontraumatic amputating in US - leads to ulcerations and foot deformaties
Common autoimmune diseases
lupus erythematsosus rheumatoid arthritis MS Psoriasis
Functional constipation
majority of constipation easily treatable opioids, diseases that affect bowel function
airborne diseases
measles, varicella, tuberculosis
What am I assessing for neurogenic bladder?
measurement of fluid intake and urine output residual urine volume urinalysis sensory awareness of bladder fullness and degree of motor control comprehensive neurodynamic studies can be performed
BGM
measures capillary glucose requires individual sample for each reading require patient initiation to find BG excursions provide only data the patient initiates
CGM
measures interstitial glucose uses one device for several days to obtain continuous sampling real-time can provide warning to pt of BG excursions intermittent scanning require pt. initiation real-time can provide extensive data about trends and patterns
What are some disparities related to infectious disease in our community?
medically underserved populations racial and ethnic minority groups people living in rural areas may experience high risk of exposure, infection, hospitalization, and mortality disproportionate rates of chronic diseases
constipation causes
meds chronic laxative use weakness immobility fatigue inability to increase intra-abdominal pressure diet ignoring urge to defecate lack of regular exercise
a client is admitted to the hospital with a diagnosis of Crohn disease. Which is important for the nurse to include in the teaching plan for the client? -controlling constipation - meeting nutritional needs - preventing increased weakness - anticipating a sexual alteration
meeting nutritional needs to avoid gi pain and diarrhea, these clients often refuse to eat and become malnourished. high-calorie, high-protein diet
Community asscociated MRSA
molecularly distinct from HA MRSA produce more toxins and can lead to localized skin and soft tissue infections--> necrotizing fascititis bacteremia
Why might a pt need a urinary diversion?
most commonly for bladder cancer or other pelvic malignancies birth defects, trauma, strictures, neurogenic bladder, chronic infection or intractable cystitis used as a last resort for incontinence
Handwashing - Infection Control
most important defense in infection prevention
portal of entry transmission and control methods?
mucous membrane, GI tract, GU, tract, respiratory tract, broken skin wound care, catheter care, aseptic technique
Short-term tubes
nasogastric, nasoenteral, orogastric tubes
is incontinence normal?
no
Patient education 41-2
normal variants of bowel patterns establish of normal bowel routine high reside, high fiber foods and increased fluid intake responding to the urge to defecate exercise and activity limit laxative use
enteral tube feeding
not through mouth G tubes, NG tube
community associated MRSA
now ocurring in people who havent been hospitalized within a year or even had a medical procedure (dilalysis, catheter placement)
Diabetes mx general
nutrition medication selfmonitoring physical activity health maintenance activities
pandemic
occurring over a wide geographic area and affecting an exceptionally high proportion of the population malaria
When assessing transient episodes of urinary incontinence in an older patient, what should we ask/look for?
onset S/S changes in medical status: constipation, fluid intake, elevated blood glucose, decrease in estrogen levels, change in medications/ current medications that may cause urinary incontinence
how to autoimmune disorders manifest?
onset severe remission/exacerbation functional limitations treatments family history
cataract
opacity of the crystalline lens or its capsule
colostomy
opening into the colon needs to be irrigated in order to empty gas, mucus and feces irrigation allows for regular passing of fecal material
ileostomy
opening into the small intestine allows fecal content from the ileum to be eliminated through the stoma
Goals for a person recieving TPN
optimal level of nutrition absence of infection adequate fluid volume optimal level of activity positive nitrogen balance maintain muscle mass promote weight maintenance/muscle gain enhance healing process
Knowledge needed to care for pt with enteral tube? (specific to N330)
patient eduation and preparation what to monitor regularly as a part of your patient assessment preventing and managing complications
Who is given TPN?
patients unable to tolerate enteral/oral feeds
One of the most widely used behavioral interventions for incontinence Mx is?
pelvic floor exercises, such as kegals gently tighten the muscles to stop flatus (stream of urine) for 5-10 second increments 10 second resting phase perform 2-3 times a day for at least 6 weeks
Reservoirs of infection and how we break this chain?
people, equipment, water employee health, environmental sanitation, disinfection/sterilization
What should a normal stoma look like?
pink or red
Why is aspiration such a high priority when it comes to NG tube placement?
pneumonia caused by aspiration
collaborative problems and potential complications d/t parenteral nutrition table 41-7
pneumothorax/air embolism (injecting air into blood) clotted or displaced catheter sepsis hyperglycemia rebound hypoglycemia fluid overload
What puts you at greater risk for diabetic foot ulcer
poor glycemic control peripheral neuropathy (don't feel it and WAM) smoking foot deformities preulcerative callous PAD Hx of foot ulcer, amputation visual impairment CKD
an older client is admitted to the hospital for rehydration therapy after 3 days of diarrhea. in addition to sodium, which electrolyte would the nurse be most concerned about?
potassium, sodium, and bicarbonate most often lost in diarrhea. excreted before absorbed hypkalemia- cardiac dysrhythmias
Mx of neurogenic bladder is long term
preventing bladder overdistention by emptying the bladder regularly and completely maintaining urine sterility with no stone formation maintain adequate bladder capacity with no reflux
nursing interventions for TPN
preventing infections by cleaning catheter (Central line), sterile techniques, assessments of site and observe for indication of infection maintaining fluid balance by using infusion pump and if done hang 10% dextrose, record I/Os, keep track of weight, BG levels, and take notice of any indications of electrolyte imbalance
Diabetic neuropathy management
prevention- glycemic control pain Mx- pregabalin, duloxetine, gabapentin gastroparesis: low fiber, low fat diet small, frequent meals erectile dysfunction: meds BP mx
Carbohydrates
primary source of energy 45% of total calories QUALITY (more whole, less processed) Consistency is important 2-4 servings per meal (depends on needs)
As a nurse, what can I do to encourage normal voiding patterns to avoid urinary retention?
privacy- if i have to escort a pt to the bathroom, if I can step out, close curtains, turn back, even turn on a water faucet to mask sounds if that makes the pt. feel better ensure body position conducive to voiding
Contact precautions
private room when: multi-drug resistant organisms (MDRO)- MRSA, ORSA, VRE, all patients with cystic fibrosis wear gown and gloves educate family on the importance of hand hygiene
Droplet Precautions
private room when: respiratory viruses, confirmed or suspected meningococal meningitis, Parvovirus B-19 wear a surgical mask family/guest: surgical mask
Enteric Precautions
private room, clean room and equipment with BLEACH when: suspected or confirmed C. diff Gastroenteritis- norovirus, rotavirus, adenovirus gown, gloves and hand hygiene with soap and hot water
if a stone doesn't pass on own what might the patient have to do
procedure such as lithotripsy
this continuous glucose monitoring type is placed and measured by a clinician. The pt. will wear the glucose level for a short period of time for diagnostic purposes?
professional
proteinuria
protein in the urine
Chronic Kidney disease lifestyle Mx (diabetes)
protein intake about 0.8g/kg/day less than 2000 mg sodium/day
object of sheduled voiding
purposefully empty bladder before critical volume is reached every 2 hours
if a patient has an insulin pump they can measure their BG levels in
real time
interventions for needlestick injuries
recap needles and put in sharp bin one hand approach
If a patient has a UTI, what are the interventions/goals you need to impement/help with as a nurse?
relieve their pain and discomfort: - effective antimocrobial therapy - antispasmotic agents for bladder irritability and pain -analgesic agents (pain and spasms) - heat to perineum (pain and spasms) educate your patient on prevention: - practicing careful personal hygiene - promoting fluid intake to promote voiding and dilution of urine - avoid UT irritance: coffee, tea, citrus, spices, cola, alcohol - urinating fully/frequently -adhere to provider's treatment EXACTLY (antimicrobial)
urinary retention, if unresolved can lead to risk of:
renal calculi pylenephritis sepsis
urolithiasis
renal calculi or stones in the urinary tract
impaction
results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel
What screenings should a patient recieve regularly with diabetes?
retinopathy nephrophathy neuropathy
screening for diabetic retinopathy
screen with annual dilated retinal exam first exam within 6 months of T2DM diagnosis first exam within 5 years of T1DM diagnosis
What should be considered with physical activity and people with diabetes?
should be appropriate for lifestlye and condition proper footwear should be fitted and worn medic-alert ID adequate nutrition and hydration is necessary you need to make alternate plan if you are on vacation or it is a rainy day
How can a patient's self monitoring help me and the patient?
shows trends shows how food, meds, exercise, and stress affect the blood sugars determines the effectiveness of new regimen
What can incontinence lead to?
skin breakdown skin irritation urinary tract infections
chroni diarrhea complication
skin care issues related to irritant dermatitis
S/s of community associated MRSA
skin infections pimples boils seen most often in children, sports teams, prison inmates and confused as spider bites
What do you examine in a neuropathy examination?
skin inspection vascular assessment inspect for deformities pinprick and temp (small fiber function) vibration, proprioception, 10g monofilament (larger fiber function) 10g monofilament- protective sensation
Ted Moore, a 72-yr old patient, presents to the clinic for an annual checkup. The nurse performs a detailed history and physical assessment. Explain what the nurse should include in the physical assessment to evaluate the patient's immune system?
skin: lesions, dermatitis, purpura, urticaria, inflammation, discharge vital signs/fever/diaphoresis/chills lymph nodes joints body systems neurosensory, respiratory, cardiac, GU/GI
organ transplantation can cause immunosuppression as well as the removal of
spleen thymus lymph nodes
Why does risk for UTI increase with age?
structural abnormalities can lead to decreased bladder tone neurogenic bladder neurological changes male- prostatic secretions decrease lack of protection most common UTI in older male is chronic bacterial prostatitis female- postemenopause- absence of estrogen increases susceptibility to colonization increases adherence of the bacteria to the vagina and urethra
why may older adults have decreased inflammatory responses?
suppression of phagocytic response leads to the absence of typical clinical manifestations of infection and inflammation this also results in dissemination of organisms that usually destroyed or suppressed by phagocytes
-stomy, -ostomy
surgical creation of an opening
ostomy
surgical opening
What do you need in order for an infection to occur?
susceptible host causative organism a reservoir of available organisms a portal of exit from the reservoir a mode of transmission from the reservoir to the host mode of entry
mixed incontinence
symptoms of urge and stress incontinence are present, although one type may predominate
Sick day rules general principles to educate patients?
take the usual diabetes meds drink 4-6 oz of fluids every 30 minutes check blood sugar every 3-4 hours check ketones (type 1, blood sugar >240) every 3-4 hours
Why are older adults at increased risk of gastroenteritis and diarrhea secondary to proliferation of intestinal organisms?
the increased risk of GI changes is related to decreased gastric secretions and delayed GI motility that allows proliferation of normal flora
the nurse is preparing discharge instructions for a client who acquired C. diff. Which would the nurse include in the instructions? - anticipate the nausea and vomiting will continue until the infection is no longer present - the infection causes diarrhea accompanied by flatus and abdominal discomfort - consume a diet high in fiber and low in fat - other than routine handwashing you don't need to clean
the infection causes diarrhea accompanied by flatus and abdominal discomfort
borborygmus
the rumbling noise caused by the movement of gas in the intestine
ileostomy
the surgical creation of an artificial excretory opening between the ileum, at the end of the small intestine, and the outside of the abdominal wall
the client with a permanent sigmoid colostomy has colostomy irrigations prescribed and inquired as to why they are are prescribed. Which response would the nurse use? - the irrigations provide electrolytes and lessen intestinal fluid loss - the irrigations help establish an elimination schedule - the irrigations decrease the amount of flatus in the bowel - the irrigations assist in minimizing bowel movement straining
they help to establish an elimination schedule irrigations regulate bowel to function at a specific time for the convenience of the client
If a person with a catheter begins to experience signs of infection?
think CAUTI and assess and evaluate for potential of urosepsis. infection of urinary tract in the bloodstream can be deadly
NG tube
through the nose into the stomach
Urinary diversion procedure purpose?
to divert urine from bladder into a new exit site, usually a surgically created opening.
What is the general goals of perenteral nutrition?
to improve nutritional status, establish a postive nitrogen balance, maintain muscle mass, promote weight maintenance or gain, and enhance the healing process
If not convenience, why would we insert a urinary catheter?
to relieve urinary retention prolonged pt immobilization (like my epidural) obtaining a sterile urine speciment when pt, is unable to void voluntarily/naturally accurate measurement of urinary output in critically ill patients assisting in healing open sacral or perineal wounds in incontinent pt emptying bladder before, during, or after select surgical procedures and before certain diagnostic exams providing improved comfort during EOL care
hyperglycemia causes
too much carbs skipped or not enough meds illness/stress (stress reaction)
causes of hypoglycemia
too much insulin or hypoglycemic agents (diabetes drugs) too little food intake more physical activity than normal
hypoglycemia Mx
treat: check glucose if pt. can swallow use fast acting carbohydrate 15-20 grams wait 15 minutes recheck glucose if still <70, repeat if >70, eat a small snack with carbs and protein AVOID binge eating or foods high in fat and protein
Danger signs for a diabetic patient and family to look out for during sick days?
trouble breathing moderate to high ketonuria cannot keep liquids down >4 hrs weight loss of 5 or more lbs HYPOGLYCEMIA too nauseated to eat for >24 hrs V/D >6 hrs temp> 101 F for 24 hrs AMS
During sick days how should you consume fluids and calories?
usual meal plan if able soft, easy to digest foods and carb-containing liquids every 4 hours fluids frequently to prevent dehydration
MRSA culture
usually collected as nasal or nasopharyngeal
Other behevioral interventions besides kegals?
voiding diary biofeedback verbal instructions with prompted voiding physical therapy (specialized pelvic floor therapists) voiding on a schedule intake of 50-60 oz in small increments between meals helps reduce incontinence, UTI and keeps urinary functions going
frequency
voiding more than every 3 hours cause: - infection - obstruction of lower UT leading to residual urine and overflow - anxiety -diuretics -BPH - urethral stricture - diabetic neuropathy
CDC
weekly morbidity and mortality report significant cases, outbreaks, updated guidelines 2 tiers of isolation precaution recomendation
What is another important thing to document that may be more accurate than I's and O's when assessing fluid loss/gain?
weight trend monitoring; repeat same factors every time for accuracies (bedding, clothing, pillows) Helps determine daily fluid intake allowance and if any restriction is needed more accurate d/t potential inaccuracies in documenting I's and O's
Autoimmune disease are more common in
women
Can you be asymptomatic and still have neuropathy
yes
