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