COTAC Obesity, Diabetes, & Genitourinary Exam

A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what?

"I will make sure to follow the weight-loss plan designed by the dietitian."

Which of the following statements made by a diabetic patient would indicate the need for further teaching?

"I will stop taking my insulin when I am sick because I won't be eating."

The nurse has completed the admission assessment of a patient and has determined that the patient's body mass index (BMI) is 33.5 kg/m2. What first-line health promotion advice should the nurse provide to the patient?

"It would be very helpful if you could integrate more physical activity into your routine.

A patient with obesity has recently begun treatment with phentermine/topiramate-ER. The patient tells the nurse, "I'm eating a lot of spinach and other leafy green vegetables, both cooked and in salads." What is the nurse's best response?

"That's great. Spinach has a lot of vitamins and nutrients and very few calories."

The nurse is educating a patient with obesity about weight loss with healthy dietary habits. What statement made by the patient indicates that further education is required?

"The only way I will be successful is if I purchase a commercial diet plan and buy a gym membership."

1 L of Fluid

1 kg (2.2 lbs)

Hypoglycemia treatment

1. Check blood glucose level a. < 70 -Take 15-20 g of a readily absorbable carbohydrate and recheck in 15 minutes. Repeat if glucose is still not above 70. b. WNL- Snack containing carbohydrates and protein. c. Unconcious/Unable to Swallow at Home- Administer glucagon SQ or IM. Repeat in 10 minutes if still unconscious. Place patient in a lateral position to prevent aspiration. d. Unconscious/Unable to Swallow in Hospital- Administer dextrose 50% IV

Hyperglycemia symptoms

1. Hot 2. Dry Skin 3. Fruity Breath

Hypoglycemia symptoms

1. Mild shakiness 2. Mental Confusion 3. Sweating 4. Palpitations 5. Headache 6. Lack of Coordination 7. Blurred Vision 8. Seizures 9. Coma

Hyperglycemia treatment

1. Oral fluid intake of sugar-free fluids to prevent dehydration 2. Administer insulin 3. Restrict exercise when blood sugar is over 250. 4. Test urine for ketones 5. Consult provider

A balanced diabetic diet is...

45% carbohydrates 15%-20% protein 20%-35% unsaturated and polyunsaturated fats

% of American adults that are overweight or obese

68.5%

Anastomosis

A bariatric surgery complication where gastric contents leak into the peritoneal cavity causing infection and possibly sepsis and death.

Metabolic syndrome

A collection of manifestations that predispose an individual to developing diabetes mellitus type II.

Explain one complication of dialysis and how to treat and avoid the issue: Hypotension

A combination of antihypertensives and rapid fluid depletion during dialysis can cause this. 1. Treat this by carefully replacing intravascular fluid volume with IV fluids or colloids 2. Avoid this by lowering the patient's dialysis exchange rate

Polycystic kidney disease (PKD)

A congenital disorder where clusters of cysts develop in the nephrons which causes healthy kidney tissue to be replaced by multiple non-functioning cysts.

Diabetes mellitus

A metabolic disorder resulting from either an inadequate production of insulin (type 1) or an inability of the body's cells to respond to insulin that is present (type 2).

The nurse coming on shift on the medical unit is taking a report on four patients. Which patient is at the greatest risk for developing end-stage kidney disease (ESKD)?

A patient with diabetes mellitus and poorly controlled hypertension

Body Mass Index (BMI)

A weight-to-height ratio; the most common measure used to classify and diagnose obesity

A nurse is teaching a client who is scheduled for a kidney transplant about organ rejection. Which of the following statements should the nurse include? (Select all that apply.)

A. "Expect an immediate removal of the donor kidney for a hyperacute rejection." C. "A fever is a manifestation of an acute rejection." D. "Fluid retention is a manifestation of an acute rejection."

A nurse is caring for several clients. Which of the following clients are at risk for developing pyelonephritis? (Select all that apply.)

A. A client who is at 32 weeks gestation. B. A client who has kidney calculi. D. A client who has a neurogenic bladder. E. A client who has diabetes mellitus.

A client who is scheduled for kidney transplantation surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increase the client's risk of surgery? (Select all that apply.)

A. Age older than 70 years. B. BMI of 41. c. Administering NPH insulin each morning. D. Past history of lymphoma.

A nurse is assessing a client who has end-stage kidney disease. Which of the following findings should the nurse expect? (Select all that apply.)

A. Anuria B. Marked azotemia C. Crackles in the lungs E. Proteinuria

A nurse is planning care for a client who has Stage 4 chronic kidney disease. Which of the following actions should the nurse include in the plan of care? (Select all that apply.)

A. Assess for jugular vein distention. B. Provide frequent mouth rinses. C. Auscultate for a pleural friction rub. E. Monitor for dysrhythmias.

A nurse is preparing educational material to present to a female client who has frequent urinary tract infections. Which of the following information should the nurse include? (Select all that apply.)

A. Avoid sitting in a wet bathing suit. C. Empty the bladder when there is an urge to void. E. Take a shower daily.

A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)

A. Check BUN and blood creatinine. B. Administer medications the nurse withheld prior to dialysis. C. Observe for findings of hypovolemia. D. Assess the access site for bleeding.

A nurse is providing discharge teaching to a client who had diabetic ketoacidosis. Which of the following information should the nurse include about preventing DKA? (Select all that apply.)

A. Drink 2 L fluids daily. B. Monitor blood glucose every 4 hr when ill. C. Administer insulin as prescribe when ill. E. Report ketones in the urine after 24 hr of illness.

A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include in the information? (Select all that apply.)

A. Eat at regular intervals. B. Decrease intake of saturated fats. C. Increase daily fiber intake. E. Include omega-3 fatty acids in the diet.

A nurse is reviewing the health history of a client who has diabetes mellitus type 2. Which of the following are risk factors for hyperglycemic hyperosmolar state (HHS)? (Select all that apply.)

A. Evidence of recent myocardial infarction. B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age 77 years

A nurse is caring for a client who has type 2 diabetes mellitus and will have excretory urography. Prior to the procedure, which of the following actions should the nurse take? (Select all that apply.)

A. Identify an allergy to seafood B. Withhold metformin for 24 hr. C. Administer an enema E. Assess for asthma

A nurse is reviewing discharge instructions with a client who had spontaneous passage of a calcium phosphate renal calculus. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

A. Limit intake of food high in animal protein. B. Reduce sodium intake. D. Report burning with urination to the provider. E. Increase fluid intake to 3 L/day.

A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? (Select all that apply.)

A. Monitor blood glucose levels B. Report cloudy dialysate return. D. Assess for shortness of breath. E. Check the access site dressing for wetness.

A nurse is planning postoperative care for a client following a kidney transplant. Which of the following actions should the nurse include? (Select all that apply.)

A. Obtain daily weights. B. Assess dressings for bloody drainage. C. Replace hourly urine output with IV fluids. E. Monitor blood electrolytes.

A nurse is planning care for a client who has postrenal AKI due to metastatic cancer. The client has a blood creatinine of 5 mg/dL. Which of the following interventions should the nurse include in the plan? (Select all that apply.)

A. Provide a high-protein diet. B. Assess the urine for blood. C. Monitor for intermittent anuria.

A nurse is planning care for a client who has chronic pyelonephritis. Which of the following action should the nurse plan to take? (Select all that apply.)

A. Provide a referral for nutrition counseling. C. Palpate the costovertebral angle. D. Monitor urinary output. E. Administer antibiotics.

A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury. Which of the following actions should the nurse take? (Select all that apply.)

A. Review the medications the client currently takes. B. Assess the AV fistula for a bruit. D. Measure the client's weight. E. Check blood electrolytes.

Kidney failure is diagnosed as....

Acute kidney injury or chronic kidney disease. Without aggressive treatment, or when complicating preexisting conditions exist, acute kidney injury can result in chronic kidney disease.

Hyperglycemic-hyperosmolar state (HHS)

An acute, life-threatening condition characterized by profound hyperglycemia, hyperosmolarity that leads to dehydration, and an absence of ketosis in type II diabetes.

Diabetic ketoacidosis (DKA)

An acute, life-threatening condition characterized by uncontrolled hyperglycemia resulting in the breakdown of body fat for energy, dehydration, metabolic acidosis, and an accumulation of ketones in the blood and urine in type I diabetes.

A nurse is completing discharge instructions with a client who has spontaneously passed a calcium oxalate calculus. To decrease the change of recurrence, the nurse should instruct the client to avoid which of the following foods? (Select all that apply.)

B. Black tea E. Spinach

A nurse is reviewing laboratory reports of a client who has HHS. Which of the following findings should the nurse expect?

B. Blood osmolarity 350 mOsm/L

A nurse is completing the admission assessment of a client who has renal calculi. Which of the following findings should the nurse expect?

B. Diaphoresis

A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? (Select all that apply.)

B. Fruity odor of breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis

A nurse is reviewing client laboratory data. Which of the following findings is expected for a client who has Stage 4 chronic kidney disease?

B. Glomerular filtration rate (GFR) 20 mL/min.

A nurse is monitoring a client who had a kidney biopsy for postoperative complications. Which of the following complications should the nurse identify as causing the greatest risk to the client?

B. Hemorrhage

A nurse is reviewing urinalysis results for four clients. Which of the following urinalysis results indicates a urinary tract infection?

B. Positive for leukocyte esterase.

Overweight

BMI 25-29.9

Class I Obesity

BMI 30-34.9

Class II Obesity

BMI 35-39.9

Obese

BMI ≥30

Class III Obesity

BMI ≥40

Treatment for morbid obesity when other weight control methods have failed

Bariatric surgeries

A patient with a body mass index of 44.5 kg/m2 has been referred to the bariatric clinic. Initial assessment reveals that the patient is a suitable candidate for bariatric surgery. What type of surgery is most likely to meet this patient's needs?

Biliopancreatic diversion with duodenal switch

Explain one complication of dialysis and how to treat and avoid the issue: Anemia

Blood and folate loss during dialysis 1. Treat with erythropoietin to stimulate the production of RBCs 2. Avoid this with adequate anticoagulants during dialysis

Explain one complication of dialysis and how to treat and avoid the issue: Infectious Diseases

Blood transfusions d/t anemia and frequent cardiovascular access d/t hemodialysis pose the risk for transmission of bloodborne infections. 1. Treatment depends on the infection acquired. 2. Avoid this by properly screening blood and properly cleansing the dialysis access site.

A nurse is teaching a client who is postoperative following a kidney transplant and is taking cyclosporine. Which of the following instructions should the nurse include?

C. "Monitor or and report a sore throat to your provider."

A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. Which of the following assessment findings is the priority for the nurse to report to the provider?

C. Absent urine output for 1 hr.

A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take?

C. Assess level of consciousness.

A nurse is preparing to administer morning doses of insulin glargine and regular insulin to a client who has a blood glucose 278 mg/dL. Which of the following actions should the nurse take?

C. Draw up and administer regular and glargine insulin in separate syringes.

A nurse administered captopril to a client during a renal scan. Which of the following actions should the nurse take?

C. Monitor for orthostatic hypotension.

A nurse is reviewing the results of a client's urinalysis. The findings indicate the urine is positive for leukocyte esterase and nitrites. Which of the following actions should the nurse take?

C. Obtain a clean-catch urine specimen for culture and sensitivity.

A nurse is planning care for a client who has prerenal acute kidney injury (AKI) following abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hr, and blood pressure is 92/58 mm Hg. The nurse should expect which of the following interventions?

C. Prepare to administer a fluid challenge.

A nurse is caring for a client who has blood glucose 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first?

C. Provide 15 g of simple carbohydrates.

A nurse is reviewing the medical record for a client who is to begin therapy for DKA. Which of the following prescriptions should the nurse expect?

C. Rapidly administer an IV infusion of 0.9% sodium chloride.

A nurse is assessing a client who has prerenal AKI. Which of the following findings should the nurse expect? (Select all that apply.)

C. Reduced urine output. D. Elevated blood creatinine.

Most clients can expel calculi without invasive procedures but if they cannot it could be because of the stone's...

Composition Size Location

A nurse is teaching a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which of the following statements by the client indicates understanding of teaching?

D. "Straining my urine following the procedure is important."

A nurse is teaching a client who will have an x-ray of the kidneys, ureters, and bladder. Which of the following statements should the nurse include in the teaching?

D. "The procedure determines whether you have a kidney stone."

A nurse is caring for a client who has a urinary tract infection (UTI). Which of the following is the priority intervention by the nurse?

D. Administer an antibiotic.

A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include in the teaching?

D. Hemodialysis returns a balance to blood electrolytes.

A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching? (Select all that apply.)

D. Trim toenails straight across. E. Wear closed-toe shoes.

Diabetic Neuropathy

Damage to sensory nerve fibers resulting in numbness and pain due to diabetes

Diabetic Nephropathy

Damage to the kidneys from prolonged elevated blood glucose levels and dehydration

Type II Diabetes

Decrease in endogenous insulin or increased with insulin resistance

Kussmaul Respirations

Deep, rapid respirations occurring in an attempt to excrete carbon dioxide when in metabolic acidosis

Diagnostic testing of an adult client reveals renal glycosuria. The nurse should recognize the need for the patient to be assessed for what health problem

Diabetes mellitus

Explain one complication of dialysis and how to treat and avoid the issue: Clotting/Infection of the Access Site

During hemodialysis the fistula, graft, or central line can become occluded or infected. 1. Avoid clots by using systemic anticoagulants 2. Avoid infection by using aseptic technique when accessing the site 3. Treat clots with tPA or surgery 4. Treat infection with antibiotics

Preoperative care includes months of

Education Counseling Evaluation

Polyuria

Excess urine production

A nurse is providing health education to an 18 year-old newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that what nonpharmacologic measures will decrease the body's need for insulin?

Exercise

Onset

First phase of acute kidney injury beginning with injury and ending when oliguria develops

Calcium oxalate

Found in spinach, black tea, rhubarb, cocoa, beets, pecans etc. and can cause the formation of renal calculi

Serum glucose in DKA

Greater than 300 mg/dL

Serum glucose in HHS

Greater than 600 mg/dL

Hypoglycemia

Having a blood glucose lower than 70 mg/dL

Struvite

High-Phosphate renal calculi

Indications for bariatric surgery include

Hx of obesity w/ unsuccessful attempts at nonsurgical weight loss and a BMI greater than 40, or greater than 34 w/ comorbidities

A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction will cause what?

Hydronephrosis

Expected findings of diabetes mellitus include...

Hyperglycemia Polyuria Polydipsia Polyphagia Lethargy

Explain one complication of dialysis and how to treat and avoid the issue: Hyperglycemia

Hyperglycemia can result from the hyperosmolarity of the dialysate so the blood can absorb glucose. 1. Treat hyperglycemia with insulin therapy 2. Avoid this by monitoring serum glucose

Explain one complication of dialysis and how to treat and avoid the issue: Hyperlipidemia

Hyperlipidemia occurs due to the long term dialysis therapy 1. Treat hyperlipidemia with antilipemic medication 2. Avoid this by monitoring blood triglycerides

The community health nurse is performing a home visit to a patient who has obesity, peripheral vascular disease, and type 2 diabetes. The patient has expressed a desire to lose weight. What is the nurse's best initial action?

Identify the patient's desired goals for weight loss

Diabetic Retinopathy

Impaired vision and blindness due to diabetes

Polyphagia

Increased appetite

Polydipsia

Increased thirst

A patient has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the patient's discharge education accordingly. What preventative measure should the nurse encourage the patient to adopt?

Increasing fluid intake

NPH (Humulin N, Novolin N)

Intermediate acting; Peak: 4-12 hrs

Peritoneal dialysis

Involves installation of hypertonic dialysate solution into the peritoneal cavity and having the peritoneum serve as the filtration membrane

A patient with class II obesity has been unable to lose weight despite trying to increase activity level and limit food intake. The health care provider has prescribed orlistat. What health education should the nurse provide to the patient?

It is important to maintain a nutrient-rich diet and take multivitamins

Restrictive bariatric surgeries include

Laparoscopic adjustable gastric band (LAGB) Laparoscopic sleeve gastrectomy (LSG)

Obesity management interventions include:

Lifestyle modification Pharmacological management Nonsurgical and surgical procedures

Cystine

Limiting animal protein and taking medications to lower urine cystine levels can prevent these types of renal calculi from forming

Calcium phosphate

Limiting animal protein, sodium, and calcium intake can prevent these types of renal calculi from forming

Type I Diabetes

Little to no endogenous insulin

A patient is newly diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.)

Low or absent endogenous insulin Prone to acidosis Younger than 30 years of age

A post-kidney transplant diet includes...

Low-fat High-fiber Adequate potassium, calcium and phosphorus Restricted sodium Avoidance of concentrated sugars or carbohydrates and magnesium supplements.

The nurse is caring for a patient with an abnormally low blood glucose concentration. What glucose level will the nurse observe when assessing laboratory results?

Lower than 50 to 60 mg/dL

HgBA1C

Measurement of glucose control over the last 120 days

Explain one complication of dialysis and how to treat and avoid the issue: Peritonitis

Micro-organisms get into the peritoneum through the peritoneal catheter. 1. Treatment depends on the organism causing the infection. 2. Avoid this by properly cleansing the peritoneal port prior to accessing

The nurse is providing care for an adult patient who has sought treatment for obesity. The nurse understand that there are multiple factors that contribute to obesity, including: (Select all that apply.)

Microbiota Environmental factors Family history and genetics Physiological factors Behavioral factors

A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline should the nurse teach the patients at this class?

Most calories should be derived from complex carbohydrates.

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer?

NPH

A nurse is assessing a 75 kg patient with acute kidney injury (AKI) at the end of a 12° shift. The nurse needs to know the patient's average urine output over the last 24 hours. This shift the patient voided as follows At 0730 the patient voided 150 in the urinal At 1315 the patient voided 75 in the urinal At 1630 the patient voided 50 in the urinal At 1855 the patient voided 40 in the urinal Which problem associated with voiding is the patient experiencing?

Oliguria

Obesity medications include:

Orlistat (Prevents digestion of fats) Lorcaserin (Stimulates serotonin receptors to curb appetite) Phentermine-topiramate (Suppresses appetite)

The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? (Select all that apply.)

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

Explain one complication of dialysis and how to treat and avoid the issue: Protein Loss

Peritoneal dialysis can remove protein from the blood as well as excess fluid, wastes, and electrolytes. 1. Treatment for this is to have the patient increase their dietary intake of protein 2. Avoid this by closely monitoring the patient's serum albumin levels

HHS S/S

Polyuria Polydipsia Polyphagia Weight loss Blurred vision Orthostatic hypotension Mental status changes Seizures/myoclonic jerking Reversible paralysis

DKA S/S

Polyuria Polydipsia Polyphagia Weight loss GI effects (n/v/abdominal pain) Blurred vision Orthostatic hypotension Fruity odor Kussmaul respirations Metabolic acidosis Mental status changes

Orlistat

Prevents digestion of fats

Untreated UTIs can lead to....

Pyelonephritis and urosepsis, which can result in sepsis/septic shock and death.

lispro (Humalog)

Rapid acting; Peak: <1 hr

Evaluate kidney function so that providers can diagnose disease and evaluate the efficacy of treatment...

Renal diagnostic procedures and laboratory assessments

Biliopancreatic Diversion with Duodenal Switch

Restrictive and malabsorptive procedure; Restrict stomach size and bypass the entire duodenum and majority of the jejunum

Roux-en-Y Gastric Bypass (RNYGB)

Restrictive and malabsorptive procedure; Restrict stomach size and bypass the majority of the duodenum

Sleeve Gastrectomy

Restrictive procedure; Removal of the portion of the stomach that secretes ghrelin

Gastric Banding

Restrictive procedure; Use of an adjustable band at the proximal portion of the stomach to restrict stomach volume

Uric acid

Results in urate renal calculi due to high intake of purines

Dialysis functions to...

Rid the body of excess fluid and electrolytes. Achieve an acid-base balance Eliminate waste products. Restore homeostasis by osmosis, diffusion, and ultrafiltration.

A patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the patient's plan of care?

Risk for infection related to presence of an indwelling urinary catheter

One malabsorptive bariatric surgery is

Roux-en-Y gastric bypass procedure, which includes restricting the volume of the stomach and bypassing the majority of the stomach and duodenum

Oliguria

Second phase of acute kidney injury where urine output is 100-400 mL in 24 hours

A nurse must ensure that the patient follows proper procedure for blood sample collection and use of the glucometer through observing their...

Self-monitored blood glucose (SMBG) proficiency

Regular (Humulin R, Novolin R)

Short acting; Peak: 2-3 hrs

Hemodialysis

Shunts blood from the body through a dialyzer and back into circulation

Lorcaserin

Stimulates serotonin receptors to curb appetite

Phentermine-topiramate

Suppresses the appetite and induces a feeling of satiety

The nurse is caring for a patient receiving hemodialysis. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient?

Taking a BP reading on the affected arm can damage the fistula

Microbiota

The complement of microbes in a given environment

Recovery

The last phase of acute kidney injury which continues until kidney function is fully restored

Kidney disease is...

The only condition that increases serum creatinine levels, but factors affecting blood urea nitrogen (BUN) are more varied, while a urinalysis evaluates waste products from the kidney and urologic disorders.

The nurse is caring for an acutely ill patient. What assessment finding should prompt the nurse to inform the physician that the patient may be exhibiting signs of acute kidney injury (AKI)?

The patient's average urine output has been 10 mL/hr for several hours

A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding?

The patient's insulin levels are inadequate.

Diuresis

Third phase of acute kidney injury when the kidneys begin to recover and process a large amount of fluid

Explain one complication of dialysis and how to treat and avoid the issue: Poor Dialysate Flow

This can occur d/t obstruction of the catheter or constipation 1. Treat this by un-twisting the catheter or through laxative use 2. Avoid this by having the patient assess the catheter each time before initiating treatment and having them use stool softeners

Explain one complication of dialysis and how to treat and avoid the issue: Disequilibrium Syndrome

Too rapid a decrease of BUN and fluid volume that can result in cerebral edema and increased intracranial pressure. 1. To avoid this, a slow dialysis exchange rate is needed, especially in older adults 2. To treat this anticonvulsants or barbiturates may be needed

A nurse's colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults?

Urinary incontinence is not considered a normal consequence of aging

Extracorporeal shock wave lithotripsy (ESWL)

Uses sound, laser, or shock-wave energies to break calculi into fragments

Nonsurgical options for weight loss include

Vagal blocking (a device is implanted to block the Vagus nerve in the stomach) Intragastric balloon therapy (a saline-filled balloon is inserted endoscopically)

glargine (Lantus)

Very long acting; Peak: Continuous (no peak)

Type 2 diabetes mellitus is...

a progressive condition

Explain how one complication of bariatric surgery occurs and can be prevented.

a. Dehydration can be avoided by establishing goals and a daily schedule for patient fluid intake. b. Malnutrition can be avoided by referring the patient to dietary management, educating the patient on the importance of vitamins and minerals, and by encouraging the patient to eat and remain in low-Fowler's for 30 minutes after eating.

Explain 5 ways to prevent getting a urinary tract infection:

a. Drink at least 3 L daily b. Empty bladder ever 3-4 hours c. Urinate before and after sexual intercourse d. Drink cranberry juice e. Empty bladder as soon as there is an urgency to void f. Women must wipe front to back g. Avoid bubble baths, feminine products, and toilet paper containing perfumes h. Avoid sitting in wet bathing suits i. Avoid tight pantyhose or slacks j. Wear cotton underwear k. Take showers, not baths, daily l. Use a catheter only when necessary and for the shortest length of time possible (Keep the catheter bag below the bladder) m. Treat renal calculi n. Treat diabetes

Explain 5 bariatric surgery preprocedural nursing actions

a. Encourage the patient to express emotions about eating behaviors, weigh, and weight loss to identify psychosocial factors related to obesity b. Ensure that the patient understands the diet and lifestyle changes needed after the surgery c. Prepare the patient for possible postop complications d. Arrange for bariatric bed and lifting devices e. Assess pertinent labs f. Apply SCDs to prevent DVT

Explain the difference between a restrictive bariatric surgery and a malabsorptive bariatric surgery.

a. Restrictive surgeries help to limit the amount of food eaten at one time due to decreased volume. Examples include laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG). b. Malabsorption surgeries interfere with the absorption of food and nutrients from the GI tract. An example being Roux-en-Y (RNYGB).

How would you educate a newly diabetic patient on the "Sick Day Rules?"

a. Take insulin or oral antidiabetic agents as usual b. Test blood glucose and urine ketones every 3-4 hours c. Report elevated glucose levels as specified or urine ketones to your primary provider d. Take supplemental doses of regular insulin every 3-4 hours if needed, if you take insulin e. Substitute soft foods 6-8 times a day if you cannot follow your usual meal plan f. Take liquids ever ½ - 1 hour to prevent dehydration and to provide calories, if vomiting, diarrhea, or fever persists g. Report nausea, vomiting, and diarrhea to your primary provider, because extreme fluid loss may be dangerous h. Be aware that if you are unable to retain oral fluids, you may require hospitalization to avoid diabetic ketoacidosis and possibly coma.

Explain the post-bariatric surgery diet.

a. The patient will need to have a diet of liquids or pureed foods for the first 6 weeks that cannot exceed 1 cup at a time. b. The patient must also take vitamin and mineral supplements daily. c. The patient should eat two servings of protein a day. d. The patient should eat only nutrition-dense foods; avoiding empty calories.

Type 1 diabetes mellitus is...

an autoimmune dysfunction

Diabetic screening is done with...

fasting serum glucose levels or glycosylated hemoglobin (A1C)

Explain how geriatric patients' genitourinary tract differs from that of younger adults.

i. Kidney size and function decrease with aging ii. Blood flow adaptability decreases, especially during a hypotensive or hypertensive crisis iii. GFR decreases by half the rate of a young adult iv. Diabetes mellitus, hypertension, and heart failure can affect GFR v. Tubular changes can cause urgency and nocturnal polyuria vi. A weak urinary sphincter muscle and a shorter urethra in women can cause incontinence and urinary tract infections vii. An enlarged prostate in men can cause urinary retention and infection

UTI

i. Lower urinary tract infection ii. When left untreated can escalate to pyelonephritis iii. More often affects women iv. Pregnancy is a risk factor v. Can experience same UA results as pyelonephritis

Pyelonephritis

i. Upper urinary tract infection ii. Repeated infections can cause scarring that changes blood flow to that area iii. Impairs filtration, reabsorption, and secretion iv. Acute: Active Bacterial Infection v. Chronic: Result of repeated infections that cause progressive inflammation and scarring vi. Frequently affects men over age 65 years vii. Pregnancy is a risk factor. viii. Same UA results as UTIs.

Clients receiving a donor kidney from a _______________ donor with matching tissue type have the greatest chance of graft survival.

living, related