Chapter 20 21 22 23 24 25 26 27 28 29

urinary incontinence

Is treated with a catheter

bowel elimination

It is the excretion of wastes from the gi system

A person has an indwelling catheter. Which is not correct?

Keep the drainage bag above the level of the bladder

Mrs rose has a picc line in her right arm you need to check her blood pressure how should you proceed

Measure blood pressure in right arm

A person has an indwelling catheter you are going to turn the person from left side to the right side what should you do with the drainage bag

Move it to the right side

The risk of regurgitation is the greatest with

NG and gastrostomy tubes

comfort measures

Oral hygiene every two hours Lubricant for lips every two hours Mouth rinses every two hours Clean nose every 4 to 8 hours Secure tube to the nose

preventing aspiration

Position in Fowler or semi Fowler position before feeding Maintain the position 1 to 2 hours after feeding Avoid left lying position

Complications from bed rest

Pressure ulcers Constipation Fecal impaction Uti Kidney stones Blood clots Pneumonia

The purpose of bedrest is to

Reduce pain and promote healing

A person has an NG tube. The care plan includes the following measures to prevent nasal irritation. Which measure should you question?

Remove the tube every 4 hours

Which is not a rule for normal elimination?

Stay with the person who uses the bedpan

A person has an indwelling catheter. Which is not correct? 2

Tape any leaks at the connection site

A nurse asks you to give a tube feeding what procedure is not in your job description

Tell the director of nursing

Which does not promote comfort and safety for bowel elimination

Telling the person you will return very soon

Peristalsis

The alternating contraction and relaxation of intestinal muscles

Contracture

The lack of joint mobility caused by abnormal shortening of a muscle

These statements are about enemas which is false

The solution should be cool

Which is not a cause of functional incontinence

UTI

An ostomy pouch is usually emptied

When stools are present

syncope

a brief loss of consciousness; fainting

Colostomy

a surgically created opening between the colon and abdominal wall

ileostomy

a surgically created opening between the ileum and the abdominal wall

orthostatic hypotension

abnormally low blood pressure when the person suddenly stands up; postural hypotension

ADL

activities of daily living

When applying an incontinence product what part should you place in the persons perineal area

center

After a person uses a commode, you should

clean and disinfect the container, seat, and commode parts

ROM

range of motion

Formula for a tube feeding is given

room temperature

overflow incontinence

small amounts of urine leak from a full bladder

Sse

soap suds enema

Mr Cooper has a condom catheter. You apply elastic tape

spiral fashion

These statements are about ostomies which is false

stools are liquid

Twe

tap water enema

You note that an IV bag is almost empty. What should you do?

tell the nurse

You note bleeding from an IV insertion site. Which action is correct?

tell the nurse at once

transient incontinence

temporary or occasional incontinence that is reversed when the cause is treated

mixed incontinence

the combination of stress incontinence and urge incontinence

atrophy

the decrease in size or the wasting away of tissue

Calorie

the fuel or energy value of food

Deconditioning is

the loss of muscle strength from inactivity

urge incontinence

the loss of urine in response to a sudden, urgent need to void; the person cannot get to a toilet in time

functional incontinence

the person has bladder control but cannot use the toilet in time

Nutrition

the process involved in the ingestion, digestion, absorption, and use of foods and fluids by the body

Protein is needed for

tissue growth and repair

After using the urinal, the man should

to use call light

Tpn

total parenteral nutrition

internal rotation

turning the joint inward

reflex incontinence

urine is lost at predictable intervals when the bladder is full

stress incontinence

when urine leaks during exercise and certain movements that cause pressure on the bladder

Factors affecting bowel elimination

• privacy • habits • diet • fluids • exercise • medication • disability • aging

Drainage bags are emptied and urine is measured:

At the end of every shift When changing from a leg bag to a drainage bag When changing from a drainage bag to a leg bag When the bag is becoming full

I&o

intake and output

Bowel training is aimed at

Bowel control and regular elimination

aspiration

Breathing fluid, food, vomitus, or an object into the lungs

A person is receiving TPN the person complains of chest pain and difficulty breathing what should you do

Call for the nurse

Proper use of cane

Cane is held on strong side

Urinary incontinence

involuntary leakage of urine

A person is receiving TPN you know that Tpn

involves a nutrient solution

Hyperextension

Excessive straightening of a body part

Continuous tube feeding are given with a

Feeding pump

Which of the following is incorrect when performing rom

Force the joint beyond its present ROM

Which position prevent regurgitation after a tube feeding

Fowler semi Fowler

For a tube feeding, the person is positioned in

Fowler's or semi-Fowler's position

The person using a standard bedpan is in the

Fowler's position

Hipaa

Health Insurance Portability and Accountability Act

In adults, the enema tube is inserted

2-4 inches

The oil retention enema is retained for at least

30-60 minutes

On a 2000 calorie a day diet what is the amount of protein foods needed by an adult man

5 1/2 to 6 1/2 oz

indwelling catheter

A catheter left in the bladder so urine drains constantly into a drainage bag; retention or Foley catheter

Jejunostomy tube

A feeding tube inserted into a surgically created opening in the jejunum of the small intestine

nasogastric tube

A feeding tube that is inserted into the nose and goes to the stomach.

Nutrient

A substance that is ingested, digested, absorbed, and used by the body

Catheter

A tube used to drain or inject fluid through a body opening

Which is a peripheral iv site

A vein on the back of the hand

Which is true about the use of walkers

A walker gives more support than a cane

Dehydration

An abnormally low amount of water in the body.

The nurse checks feeding tube placement to prevent

aspiration

The IV flow rate is

b. The number of gtt/min

A person is taught to ignore the urge to void. This type of bladder training is called

bladder retraining

dysphagia

difficulty swallowing

The prolonged retention and buildup of feces in the rectum is called

fecal impaction

which helps prevent plantar flexion

foot board

When giving catheter care, you clean the catheter

from the meatus down the catheter about 4 inches

The goal of bladder training is to

gain control of urination

The process of giving a tube feeding is called

gavage

A person with a feeding tube is NPO. You should do the following except

give the person hard candy or gum

intravenous therapy

giving fluids through a needle or catheter inserted into a vein

enteral nutrition

giving nutrients into the gastro-intestinal tract through a feeding tube

parenteral nutrition

giving nutrients through a catheter inserted into a vein

enteral nutrition

is given into the GI tract

Which foods provide the most protein?

meats and fish

Mg

milligram

Ml

milliliter

Abduction

moving a body part away from the midline of the body

Adduction

moving a body part toward the midline of the body

Ng

nasogastric

Npo

nothing by mouth

Which is not used for a cleansing enema

oil

PEG

percutaneous endoscopic gastrostomy