Fundamentals Exam 3

Intramuscular injection angle

90 degrees

Oxygen is needed to:

sustain life.

Nursing Interventions to promote oxygenation - Deep-breathing and coughing

teach client breathing techniques to assist in clearing fluids from the lungs and to promote oxygenation

Compliance

the ability of the lungs to distend or expand in response to increased intra-alveolar pressure. Compliance decreases in diseases such as pulmonary edema, interstitial and pleural fibrosis, and congenital or traumatic structural abnormalities such as kyphosis or fractured ribs.

Tidal volume

the amount of air exhaled after normal inspiration.

Residual volume

the amount of air left in the alveoli after a full expiration.

Patients with advanced chronic obstructive pulmonary disease (COPD) lose

the elastic recoil of the lungs and thorax. As a result, the patient's work of breathing increases.

The exchange of respiratory gases occurs between:

the environment and the blood.

Airway resistance

the increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli. Any further decrease in airway diameter by bronchoconstriction can increase airway resistance. Diseases causing airway obstruction such as asthma and tracheal edema increase airway resistance. When airway resistance increases, the amount of oxygen delivered to the alveoli decreases.

Forced vital capacity

the maximum amount of air that can be removed from the lungs during forced expiration.

The amount of energy expended on breathing depends on

the rate and depth of breathing, the ease with which the lungs can be expanded (compliance), and airway resistance.

Lung volumes

tidal, residual, forced vital capacity (FVC); spirometry

Three steps involved in the process of oxygenation

ventilation, perfusion, and diffusion.

Patient with Chronic obstructive pulmonary disease (COPD)

video

The Z-track method does not:

-provide faster absorption of the medication. -reduce discomfort from the needle. -provide a more even absorption of the drug.

Subcutaneous injection angle

45 degrees

1 tsp (teaspoon) =

5 ml

Nursing Interventions to promote oxygenation - Decrease anxiety

...

Subcutaneous Injections - Volume

0.5ml to 1ml

1,000 ml =

1 L

1,000 mg =

1 gr

60 mg =

1 grain

1,000 gr =

1 kgr

A nurse must administer 50 mg of a medication intramuscularly. The drug is available as 100 mg/2 mL. How much will the nurse administer? Desired = 50 mg Have = 100 mg Vehicle = 2 mL

1 mL

1 cc =

1 ml

1 L =

1 quart

Meeting Oxygenation Needs

-Wheezing -Cough -Hemoptysis

Insulin Syringes

*Insulin must be administered in an Insulin Syringe* -28-30 gauge -5/16-1/2" length needles -0.3- 1 ml sizes, calibrated in units

Subcutaneous Injections - needle size

-3/8" to 5/8 inch length -25 to 30 gauge (Larger # means smaller, finer needle. Gauge and length can be chosen)

Various sites for Subcutaneous Injections

-Abdomen (from costal margin to iliac crests) -Outer aspect of upper arm -Anterior aspects of thigh -Upper back -Upper ventral or dorsogluteal area

Vastus Lateralis Site

-Anterolateral aspect of thigh -No large nerves or vessels -Does not cover a joint -Preferred site for infants -Divide thigh into thirds horizontally and vertically. -Injection given in outer middle third

Physiological Factors Affecting Oxygenation

-Decreased oxygen-carrying capacity -Hypovolemia -Decreased inspired oxygen concentration -Increased metabolic rate

IF...an Error ....Safety First

-Ensure the client's safety by checking his/her condition immediately, and observe for adverse effects -Notify nurse manager and physician -Write description of error and remedial steps taken on medical record -Complete an incident report (remember this does not go in chart)

Signs and symptoms of hypoxia

-Rapid pulse -Rapid shallow respirations -Dyspnea -Flaring of the nostrils -Restlessness and Confusion -Lightheadedness -Cyanosis

0.1 mg =

100 mcg

Intradermal injection angle

15 degrees

How long do you apply intermittent suction for during catheter removal from nasotreacheal area?

15 second intervals, allow patient to rest inbetween

1,000 micrograms (mcg) =

1mg

1 kgr =

2.2 pounds (lbs)

8 oz =

240 ml

1 oz =

30 ml

A patient complains of chest pain. When assessing the pain, you decide that its origin is cardiac—rather than respiratory or gastrointestinal—when it A. Does not occur with respiratory variations. B. Is peripheral and may radiate to the scapular region. C. Is aggravated by inspiratory movements. D. Is nonradiating and occurs during inspiration.

A. Does not occur with respiratory variations.

A patient with a tracheostomy has thick tenacious secretions. To maintain the airway, the most appropriate action for the nurse includes A. Tracheal suctioning. B. Oropharyngeal suctioning. C. Nasotracheal suctioning. D. Orotracheal suctioning.

A. Tracheal suctioning.

Influences of chronic diseases

Any condition that affects cardiopulmonary functioning directly affects the body's ability to meet oxygen demands.

Alterations in respiratory functioning - Hypoxia

Causes: anemia, pulmonary edema, heart failure, drugs such as anesthetics

When evaluating a post-thoracotomy patient with a chest tube, the best method to properly maintain the chest tube would be to A. Strip the chest tube every hour to maintain drainage. B. Place the device below the patient's chest. C. Double clamp the tube except during assessment. D. Remove the tubing from the drainage device to check for proper suctioning.

B. Place the device below the patient's chest.

Alterations in respiratory functioning - Hyperventilation

Causes: stress, metabolic acidosis

The primary care provider prescribed 5 mL of a medication to be given deep IM for a 40-year old female who is 5'7" tall and weighs 135 pounds. Which of the following is the most appropriate method of administration? A. A tuberculin syringe, #25-#27 gauge, ¼ -5/8 inch needle. B. Two 3-mL syringes, #20-#23 gauge, 1 ½ inch needle. C. Two 2-mL syringes, #25 gauge, 5/8-inch needle. D. Two 2-mL syringes, #20-#23 gauge, 1-inch needle.

B. Two 3-mL syringes, #20-#23 gauge, 1 ½ inch needle. 5 mL is too much to inject into one site and needs to be divided into two 2.5 mL doses. Therefore a 3-mL syringe can be used.

A patient with a long-standing history of diabetes mellitus is voicing concerns about kidney disease. The patient asks the nurse where urine is formed in the kidney. The nurse's response is the A. Bladder. B. Kidney. C. Nephron. D. Ureter.

C. Nephron.

Which of the following sites is recommended for administration of intramuscular injections to 2 year old infant? A. Vastus Lateralis B. Dorsogluteal Site C. Ventrogluteal Site D. Deltoid

C. Ventrogluteal Site This site is suitable for children over 1 year. Provides the greatest thickness of gluteal muscle consistency.

Alterations in respiratory functioning - Hypoventilation

Causes: alveolar collapse, airway obstruction, side effects of some drugs

Surfactant

Chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing.

Atelectasis

Collapse of the alveoli that prevents the normal exchange of oxygen and carbon dioxide.

Patient with Tuberculosis

Collect sputum specimen for acid-fast bacillus diagnosis test.

A young girl is having problems urinating postoperatively. You remember that children may have trouble voiding A. In bathrooms other than their own. B. In a urinal. C. While lying in bed. D. In the presence of a person other than their parents.

D. In the presence of a person other than their parents.

A health care provider may suspect that a patient is experiencing urinary retention when the patient has A. Large amounts of voided cloudy urine. B. Pain in the suprapubic region. C. Spasms and difficulty during urination. D. Small amounts of urine voided 2 to 3 times per hour.

D. Small amounts of urine voided 2 to 3 times per hour.

Dyspnea

Difficulty breathing

Carbon dioxide transport

Diffuses into red blood cells and is hydrated into carbonic acid

BUCCAL

Drug is held against the mucous membrane between the cheek and teeth and absorbed through the mucous membranes of the mouth.

IM sites - Deltoid

Easily accessible but muscle not well developed in most clients Used for small amounts of medications Not used in infants or children with underdeveloped muscles Potential for injury to radial and ulnar nerves or brachial artery Used for immunization for toddlers, older children, and adults Recommended site for Hep B vaccine and rabies injections

Steps in Oxygenation - Diffusion

Exchange of respiratory gases in the alveoli and capillaries

Nursing Interventions to promote oxygenation - Positioning

Fowlers' position allows maximum chest expansion that eases respiration in patients with dyspnea

Oxygen transport

Lungs and cardiovascular system

Pulmonary circulation

Moves blood to and from the alveolar capillary membranes for gas exchange

Conditions affecting chest wall movement

Pregnancy, obesity, neuromuscular disease, musculoskeletal abnormalities, trauma, CNS alterations

Respiratory Physiology

Pulmonary circulation begins at the pulmonary artery, which receives poorly oxygenated mixed venous blood from the right ventricle. Blood flow through this system depends on the pumping ability of the right ventricle. The flow continues from the pulmonary artery through the pulmonary arterioles to the pulmonary capillaries, where blood comes in contact with the alveolar capillary membrane, and the exchange of respiratory gases occurs. The oxygen-rich blood then circulates through the pulmonary venules and pulmonary veins, returning to the left atrium.

Steps in Oxygenation - Perfusion

The ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs

Work of breathing

The effort required to expand and contract the lungs.

Steps in Oxygenation - Ventilation

The process of moving gases into and out of the lungs

A nurse must administer 25 mg of a medication. The dose on hand is 50 mg per tablet. How many tablets would the nurse administer? Desired = 25 mg Have = 50 mg Vehicle = tablet

We set up the problem as follows: 25 mg X 1 tablet = 0.5 tablet or ½ tablet

IM sites - Ventrogluteal

a deep site, situated away from major nerves and blood vessels Less chance of contamination in incontinent clients or infants Easily identified by prominent bony landmarks preferred site for medications (e.g. antibiotics) that are larger in volume, more viscous, and irritating for adults, children, and infants

Expiration

a passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work. Changes in intrapleural and intra-alveolar pressures and lung volumes cause the processes of inspiration (active process) and expiration (passive process).

Cyanosis is:

a very late indicator of hypoxia.

Normal lung values are determined by

age, gender, and height.

Inspiration

an active process, stimulated by chemical receptors in the aorta.

Patients with certain pulmonary diseases have decreased surfactant production and sometimes develop:

atelectasis

The lungs transfer oxygen from the

atmosphere to the alveoli, where the oxygen is exchanged for carbon dioxide.

Chest pain

can impair breathing patterns and respiratory functioning Causes: Respiratory diseases such as pneumonia, pulmonary embolism, advanced bronchogenic carcinoma

One of the most characteristics signs of Cyanosis

bluish mucous membranes.

When patients take opioids, their respiratory center is:

depressed.

The cardiovascular system provides transport mechanisms to:

distribute oxygen to cells and tissues of the body.

A Ureterostomy is performed to:

divert the flow of urine away from the bladder when the bladder is not functioning or has been removed.

Oral routes

drugs administered through the mouth

Nursing Interventions to promote oxygenation - Incentive spirometer

encourages voluntary deep breathing by providing visual feedback to clients about inspiratory volume. promotes deep breathing oand prevents or treats atelectasis in the postoperative client

MID-STREAM URINE COLLECTION for female clients instruct to clean the urinary meatus from:

front to back, initiate a urine stream, and then collect urine after the initial urine stream has been passed

pH

indicates acidity or alkalinity, normal 4.5 to 8

IM sites - Vastus Lateralis

lacks major nerves and blood vessels rapid drug absorption site frequently used in infants (less than 12 months) receiving immunizations (thigh)

Spirometry

measures the volume of air entering or leaving the lungs.

Nursing Interventions to promote oxygenation - Suctioning

oro/nasopharyngeal, tracheal. Patients with decreased cough ability and thick sputum are in need for airway suction.

Respiration is the exchange of:

oxygen and carbon dioxide during cellular metabolism.

The cardiac and respiratory systems supply the:

oxygen demands of the body.

Pneumothorax signs and symptoms

painful respiration, dyspnea, low O2 sat reading (bellow 90%)

Variations in tidal volume and other lung volumes are associated with alterations in:

patients' health status or activity, such as pregnancy, exercise, obesity, or obstructive and restrictive conditions of the lungs.

Nursing Interventions to promote oxygenation - Chest physiotherapy

percussion, vibration, postural drainage. Chest percussion will be indicated and appropriate for clients with increased resp. secretions such as patients with Cystic Fibrosis.

Neural and chemical regulators control the:

rate and depth of respiration in response to changing tissue oxygen demands.

Cyanosis Causes:

severe anemia, respiratory tract obstruction, heart disease, cold environment

Urinary Infection Prevention Measures

-Drink 8 glasses of water daily (at least) -Empty bladder at least 2 to 4 hours while awake, avoiding voluntary retention -For women, wear cotton briefs, cleanse perineal area from front to back -Unless contraindicated teach client to maintain acidity in urine by drinking at least two glasses of cranberry juice per day and avoiding excess milk products

Subcutaneous injection tips

-Inject medication slowly (10 seconds per ml) -Withdrawing needle & apply gentle pressure. -Do not massage (can damage underlying tissue) -Rotate sites

Intradermal Injections

-Into the dermis, just below epidermis -Longest absorption time -Used for: Sensitivity tests (TB test, allergy tests), local anesthesia -Site: Inner surface of forearm, upper back -Needle size: Short and fine - ¼" to ½" - 26 or 27 gauge -Small amt of fluid: less than 0.5 ml -Flat angle: 10-15 degrees

The Ventrogluteal Site position of hands

-Palm of hand over greater trochanter -Right hand on Left hip -Fingers facing patient's head -Index finger on the antero-superior iliac spine -Middle finger on iliac crest. -Injection given in the center of the triangle. -Before injecting medication, aspirate. If blood noticed then discard the medication and prepare a new injection.

Signs and Symptoms of adverse allergic reactions

-Rash, tingling in the mouth, swelling of the lips, face and eyes, hives or welts, abdominal pain and/or vomiting, anaphylactic reaction

Each drug can have three types of names

-The chemical name -The brand/trade name (the trade name is the brand name copyrighted by the company that sells the drug) -The generic name (the generic name is assigned by the manufacturer that first developed the drug)

Heparin

-Use abdomen, -Avoid area 2" around umbilicus -Gently pinch; insert at 90 degree angle into fat pad -Never massage

Sites for Intramuscular Injections

-Vastus lateralis -Ventrogluteal (this site is found by locating the greater trochanter, anterior iliac spine, and iliac crest) -Deltoid -Dorsogluteal (No longer recommended because of significant injury, pain and paralysis due to damage of sciatic nerve)

SIX "RIGHTS" OF DRUG ADMINISTRATION

1. Right medication 2. Right dose 3. Right client (check client's name band and ask him/her to repeat his/her name) 4. Right route 5. Right time 6. Right documentation

Ophthalmic drops

1. Tilt the client's head slightly backward and ask the client to look up 2. Hold eyedropper ½ to ¾ inch above eye ball 3. Expose lower conjunctival sac and drop prescribed number of drops while applying pressure to inner canthus to reduce systemic absorption of medication

Subcutaneous Injections - Angle

45-90 degree

Drug

A term that is sometimes used interchangeably with medication

Drugs are prepared in a variety of forms

Aerosol spray or foam, Caplet (solid form, shaped like a capsule, coated and easily swallowed), Capsule, Cream, Gel or jelly, Lotion, Pills, Powder, Suppository, Syrup, Tablet, Transdermal patch

NURSE'S ROLE IN ADMINISTERING MEDICATIONS - Nursing Process - Assessment

Allergies, it includes client's allergic responses to drugs, food, products, or environmental allergens; obtain specific information about the type of reaction; an allergy to one prototype drug will often cause an allergic reaction with other prototype drug within the same class. When a medication is going to be administered and the patient tells the nurse that he/she is allergic to the drug, then the nurse has to withhold the medication.

Signs and Symptoms of Chronic Kidney Dysfunctions:

Anemia Fatigue and weakness Swelling of the feet and ankles Persistent itching Chest pain, if fluid accumulates around the lining of the heart Shortness of breath, if fluid accumulates in the lungs Hypertension that's difficult to control

The Ventrogluteal Site

Gluteus medius and gluteus minimus Large muscle mass No major nerves or blood vessels Patient can be on back, abdomen, or side

Common urinary elimination problems - INCONTINENCE

INVOLUNTARY URINATION

Recurrent Urinary Tract Infections can lead to:

Chronic Kidney Dysfunctions

TOTAL INCONTINENCE

Continuous and unpredictable involuntary loss of urine

SUBLINGUAL

Drug is placed under the tongue and absorbed through the mucous membranes of the mouth; uncoated tablets dissolve in the mouth and are absorbed quickly into the bloodstream.

ORAL

Drug is swallowed and drug is absorbed from the GI system; common forms of oral drugs include tablets, capsules, and liquid preparations.

NURSE'S ROLE IN ADMINISTERING MEDICATIONS

ENSURE PATIENTS SAFETY

Signs and Symptoms of Urinary Retention

Feeling of pressure Voiding small amounts Lower pelvic pain

Ventrogluteal site

Figure 34-24

Types of Medication Errors

Inappropriate prescribing of drug, Extra, omitted, or wrong dose, Wrong patient, Wrong route or rate, Late or wrong time, Incorrect preparation of drug, Improper technique, Deteriorated or outdated drug

Common urinary elimination problems - URINARY TRACT INFECTIONS (UTI)

Infectious process leads to inflammation in any portion of the urinary tract

Mideciations that now require a second nurse verification

Insulin, Heparin, Lovenox

REFLEX INCONTINENCE

Involuntary loss of urine at predictable intervals when bladder reaches a specific volume

STRESS INCONTINENCE

Involuntary loss of urine of less than 50 ml, occurring with increased abdominal pressure through coughing, laughing, or lifting

URGE INCONTINENCE

Involuntary loss of urine soon after strong urge to void

FUNCTIONAL INCONTINENCE

Involuntary unpredictable passage of urine

Urinalysis

Macroscopic analysis of urine to determine physical and chemical characteristics; finding include: pH, specific gravity, glucose, ketones, proteins, occult blood

Common urinary elimination problems - URINARY RETENTION

Occurs when bladder emptying is impaired, urine accumulates and bladder becomes overdistended; causes include prostatic hypertrophy, surgery, medications such as anticholinergics, antidepressants, antipsychotics, antiparkisonian agents, antihypertensives.

Nephrostomy

Opening of the kidney to the outside of the body.

Common assessment findings - DYSURIA

Painful or difficult voiding

Subcutaneous Injections - Equipment

Pick right size syringe for volume of med being delivered.

Pinching while administering subcutaneous injections

Pinch for thinner patients and when longer needles are used to lift adipose tissue away from underlying muscle and tissue. If pinching, release flesh after needle is in to avoid injecting into compressed tissue.

Lovenox

Pre-filled syringe; do not expel air bubble prior to administration

Teaching/health promotion for urinary elimination - Emptying bladder completely

Regular exercise increases muscle tone that is important to maintain the ability to contract the detrusor muscle of the bladder for complete emptying; abdominal muscle contraction assists in bladder emptying; teach Kegel exercises (contract perineal muscles and hold for a count of 3 to 5 seconds and relax); do ten contractions five times daily

Common assessment findings - URGENCY

Strong desire to void may be caused by inflammation or infection in the bladder or urethra

Normal Urinary Function

The normal output of urine is 60 ml/hr or 1500 ml/day; should remain > 30 ml/hr to ensure continued normal kidney function

Common Urinary test - Urine culture/sensitivity

To identify the infecting organism and the most effective antibiotic; a clean- catch specimen or catheterized specimen is needed; culture requires 24 to 72 hours to organism growth and identification

Topical routes

Transdermal, Inhalation, Ophthalmic, Otic, Nasal

_____________ ___________________ are responsible for majority of Health care associated urinary tract infections

Urinary catheterizations

Know Box 35-26, Characteristics of IM Sites and Indications for Use

Vastus Laterus Ventrogluteal Deltoid

Common assessment findings - FREQUENCY

Voiding that occurs more than usual when compared with the person's regular pattern or the generally accepted norm of voiding once every 3 to 6 hours.

Fremitus

a palpable vibration from the spoken voice felt over the chest wall

Subcutaneous Injections are injected into:

adipose tissue (below epidermis and dermis)

Nursing Consideration for Transdermal topical route

avoid applying topical medication to broken skin in order to prevent systemic absorption

Nurse Claudine is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way? a. Fluid intake should be double the urine output. b. Fluid intake should be approximately equal to the urine output. c. Fluid intake should be half the urine output. d. Fluid intake should be inversely proportional to the urine output.

b. Fluid intake should be approximately equal to the urine output. Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. For example, fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally, fluid intake isn't inversely proportional to the urine output.

When a female client with an indwelling urinary (Foley) catheter insists on walking to the hospital lobby to visit with family members, nurse Rose teaches how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? a. The client sets the drainage bag on the floor while sitting down. b. The client keeps the drainage bag below the bladder at all times. c. The client clamps the catheter drainage tubing while visiting with the family. d. The client loops the drainage tubing below its point of entry into the drainage bag.

b. The client keeps the drainage bag below the bladder at all times. To maintain effective drainage, the client should keep the drainage bag below the bladder; this allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because it could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.

A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should nurse Katrina conclude? a. The skin wasn't lubricated before the pouch was applied. b. The pouch faceplate doesn't fit the stoma. c. A skin barrier was applied properly. d. Stoma dilation wasn't performed.

b. The pouch faceplate doesn't fit the stoma. If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered.

Cyanosis

bluish color of the skin, nail beds, and/or lips due to an insufficient amount of oxygen in the blood

When administering subcutaneous injections avoid sites that are:

bruised, tender, hard, swollen, inflamed, or scarred.

Both __________ and ___________ administration bypass the GI tract and the liver.

buccal; sublingual

pneumothorax

collection of air in the pleural space

When preparing to administer a medication to a patient, the nurse always has to:

compare the written order with the medication administration record (MAR)

Parenteral routes - Intramuscular

injection into a muscle for rapid absorption into the blood stream; some drugs may contain a substance to delay absorption; most intramuscular dosing patterns are bolus dosing.

Parenteral routes - Intravenous

injection into a vein; the onset of action is more rapid than oral or intramuscular; various dosing patterns are available such as bolus and continuous infusions; requires close monitoring due to immediacy of effect. Intravenous medication administration will provide the quickest desired effect (e.g. pain relief)

Parenteral routes - Intradermal

injection into the dermal layer of the skin just under the surface of the skin (dermis); this method is primarily used to evaluate sensitivity to different agents (e.g., PPD skin test, and allergy sensitivity tests). The angle of injection that is most often used for an intradermal injection is 15 degrees.

Parenteral routes - Subcutaneous

injection into the subcutaneous tissue that is the third layer of tissue below skin; subcutaneous injections can be bolus or continuous infusions, volumes to be administered must be limited.

Parenteral routes

injection of drugs administered by any route other than the alimentary canal (Digestive system)

The Z-track method to administer intramuscular medication prevent the drug from

irritating sensitive tissue. The angle of injection that is used for an intramuscular injection is 90 degrees.

Shorter needles =

less painful; smaller chance of accidentally injecting into muscle

To prevent UTI's instruct clients to:

maintain adequate fluid intake, urinate when urge arises, take showers instead of bath, and promote complete emptying of the bladder

Occult blood

maybe present in chronic renal failure

Eupnea

normal breathing

Teaching/health promotion for urinary elimination - Adequate hydration

normal daily intake of 1500 ml of measurable fluids recommended; if prone to development of stones or infections, increase fluids intake to 2000 to 3000 ml per 24 hr.

Glucose

normally negligible amounts; done to screen clients for diabetes mellitus and to assess pregnant clients for glucose tolerance

Proteins

not normally found in urine but proteins escapes if there is damage in the glomerular membrane

Arterial blood gases normal values

pH normal = 7.35-7.45 PaCO2 = 35-45 HCO3 normal = 22-26

When administering subcutaneous injections, you can:

pinch or bunch skin fold or spread skin taut at the site

Orthopnea

positional breathing discomfort associated with lying down

Ketones

product of the breakdown of fatty acids, not normally found in urine but present in clients with poorly controlled diabetes mellitus

Upper UTI

pyelonephritis (inflammation of the renal pelvis and parenchyma). Flank pain is a sign of kidney infection

Specific gravity

reflects ability of kidney to concentrate or dilute or may reflect degree of hydration or dehydration; normal 1.010 to 1.025

Client needs be instructed that when changing the ostomy bag he/she should observe skin for:

signs of irritation caused by urinary drainage in the area surrounding the ostomy.

Topical routes - Transdermal

surface application of a medication designed to provide a slow release of the drug; usually applied as a patch (e.g., nitroglycerine, estrogens, and nicotine)

Teaching/health promotion for urinary elimination - Personal hygiene

teach client to maintain cleanliness by washing perineal area with soap and water daily, or after defecation; instruct female clients to wipe from front to back (urinary meatus toward the anus) after voiding and discard after each wipe; if recurrent infections are occurring, avoid tub bath.

In the topical route the drugs are administered on:

the body surfaces that are intended for surface use only and are not meant for ingestion or injection such as creams, lotions, ointments, powders, and patches.

Ureterostomy

the creation of a stoma (a new, artificial outlet) for a ureter or kidney.

Lower UTI

urethritis (inflammation of the urethra); cystitis (inflammation of the bladder); prostatitis (inflammation of the prostate gland)

When administering subcutaneous injections, if there is more adipose tissue:

use a lesser angle.

Z-track Method

used to minimize local skin irritation by sealing the medication in muscle tissue.