Podcast
Questions and Answers
Which function of the kidneys is primarily responsible for regulating blood pressure?
Which function of the kidneys is primarily responsible for regulating blood pressure?
What is the typical range for blood urea nitrogen (BUN) levels in a healthy individual?
What is the typical range for blood urea nitrogen (BUN) levels in a healthy individual?
Which medication type directly promotes urination by stimulating contraction of the detrusor muscles?
Which medication type directly promotes urination by stimulating contraction of the detrusor muscles?
Which urine color change is associated with the use of pyridium?
Which urine color change is associated with the use of pyridium?
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What is one effective method to prevent catheter-associated urinary tract infections (CAUTI)?
What is one effective method to prevent catheter-associated urinary tract infections (CAUTI)?
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Which of the following is a potential complication of untreated pain?
Which of the following is a potential complication of untreated pain?
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Which sleep disorder is characterized by uncontrollable daytime sleep attacks?
Which sleep disorder is characterized by uncontrollable daytime sleep attacks?
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In which stage of sleep does dreaming primarily occur?
In which stage of sleep does dreaming primarily occur?
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Which factor is least likely to affect the quality of sleep?
Which factor is least likely to affect the quality of sleep?
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What aspect of sexuality encompasses self-esteem, body image, and identity?
What aspect of sexuality encompasses self-esteem, body image, and identity?
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What dietary factor can help increase stool formation?
What dietary factor can help increase stool formation?
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What is the purpose of the gFOBT test?
What is the purpose of the gFOBT test?
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Which of the following is a common cause of constipation?
Which of the following is a common cause of constipation?
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When administering an enema, which position should the patient be in?
When administering an enema, which position should the patient be in?
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Which type of ostomy is likely to result in liquid stool?
Which type of ostomy is likely to result in liquid stool?
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What is a crucial factor for effective enteral nutrition?
What is a crucial factor for effective enteral nutrition?
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What dietary modifications are appropriate for managing diarrhea?
What dietary modifications are appropriate for managing diarrhea?
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Which statement about TPN is accurate?
Which statement about TPN is accurate?
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What is the recommended daily urine output for a healthy adult?
What is the recommended daily urine output for a healthy adult?
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What is a common symptom of fecal incontinence?
What is a common symptom of fecal incontinence?
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Which diet is designed to lower stress on the kidneys?
Which diet is designed to lower stress on the kidneys?
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What can increase the risk of developing constipation?
What can increase the risk of developing constipation?
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Which of the following is a characteristic of a healthy stoma?
Which of the following is a characteristic of a healthy stoma?
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What should be monitored in patients with diarrhea to prevent complications?
What should be monitored in patients with diarrhea to prevent complications?
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Study Notes
Bowel Elimination Overview
- The process of bowel elimination involves a series of organs: mouth, esophagus, stomach, small intestine, large intestine, anus, and defecation.
- Factors influencing elimination include age, diet, fluid intake, exercise, medications, pregnancy, surgery, anesthetics, and pain.
- Infants' bowel elimination patterns depend on formula or breastfeeding.
- Toddlers prioritize physiological maturity for bowel training.
- Children and adolescents experience variations in defecation frequency and quantity.
- Older adults commonly face constipation, with potential for incontinence or diarrhea due to physiological or lifestyle changes.
- Foods high in fiber and fluids promote stool production.
- Calcium, low or high fluid intake, antacids, and opioids can decrease stool production.
Stool Collection
- Patients should void urine and defecate before collecting stool samples.
- Disinfectants should be avoided when collecting stool specimens.
- The gFOBT test detects blood in stool, with a positive result indicated by a blue color.
- Privacy, timing, positioning, nutrition, and exercise support bowel movement.
Diarrhea/Constipation
- Handwashing and avoiding spicy, high-fat foods, and large quantities of fruits and vegetables help prevent diarrhea.
- Food poisoning prevention measures include using non-damaged food packages, washing hands and surfaces, refrigerating items, washing fruits and vegetables, and maintaining proper temperatures for cooked food.
- Medications for managing diarrhea include Imodium, Lomotil, and Pepcid, alongside clear liquids and the BRAT diet.
- Constipation risk factors include depression, inadequate food and fluid intake, lack of exercise, bed rest, constipation medications, reduced fluids or bulk, painful bowel movements, and CNS diseases.
- Managing constipation strategies include increasing high-fiber foods and fluids, promoting defecation privacy, assisting with positioning, and offering stool softeners, laxatives, and enemas.
Enema Administration
- Enema types include cleansing, retention, large volume, and small volume.
- The left side Sims position is the preferred position for enema administration.
- Enemas are used as a last resort for constipation, applying clean technique.
Fecal Incontinence
- Nurses should consider the emotional impact on patients experiencing fecal incontinence.
- Monitor defecation patterns and provide timely toileting opportunities.
- Inspect the skin for breakdown and implement preventive measures like repositioning.
- A fecal tube collection device might be required to prevent skin breakdown.
Ostomy Care
- A healthy stoma is beefy red, moist, and has pink, dry, intact skin surrounding it.
- A sigmoid ostomy produces formed stool.
- A transverse colostomy produces thick liquid soft stool.
- An ileostomy produces free liquid stool because fecal content does not enter the colon.
- A loop colostomy is a reversible stoma constructed in the ileum or colon.
- Sizing the ostomy appliance involves measuring one-eighth of an inch around the stoma.
Nutrition Overview
- BMR (Basal Metabolic Rate) represents the body's energy expenditure at rest.
- Dietary tools used for nutritional assessment include a 24-hour recall, food frequency record, input and output monitoring, and calorie counting.
- Comprehensive nutritional assessment includes history taking, physician evaluation, and lab data analysis.
- Potential nutrition-related issues include aspiration risk, diarrhea, constipation, feeding deficit, impaired swallowing, and lower nutritional levels.
Enteral Nutrition
- Enteral nutrition provides nutrients through the GI tract for patients unable to digest food.
- Types include NG (nasogastric), NIT (nasointestinal), and PEG (percutaneous endoscopic gastrostomy).
- X-ray confirmation is necessary for placement.
Total Parenteral Nutrition (TPN)
- TPN delivers nutrients intravenously through a central line.
- It's indicated for patients unable to digest or absorb enteral feed and experiencing significant physiological stress.
- Potential complications include insertion issues, infection, sepsis, metabolic alterations, fluid and electrolyte imbalances, phlebitis, hyperlipidemia, and liver or gallbladder disease.
Types of Diets
- Clear Liquid Diet: Includes non-creamy fluids like clear juices without pulp, soda, water, broth, black tea, and coffee.
- Full Liquid Diet: Consists of all clear liquids plus creamy fluids, strained soup, pudding, ice cream, thin cereal, custard, juices with pulp, and tea or coffee with milk.
- Mechanical Soft Diet: Suitable for patients with poor dental health or dysphagia. It features smooth yogurt, chopped meat, meatloaf, noodles, eggs, cakes, pies, pancakes, cheese, and ice cream.
- Dysphagia Diet: Includes thick liquids, cooked cereals, pureed foods, minced casseroles, soft cheeses, cooked eggs, and chopped cooked vegetables. Patients should eat in an upright position, avoid mixing foods, and choose no-pocket foods and strong-side chewing.
- Renal Diet: Reduces stress on the kidneys by restricting sodium, potassium, fluids, and protein. Close monitoring of lab work is crucial.
- Heart Health Diet: Emphasizes low-fat and low-sodium options, with healthy fats from fish, fruits, and vegetables.
- Consistent Carbohydrate Diet: Manages diabetes by stabilizing daily carbohydrate intake to manage blood glucose levels.
- Other possible diets include sodium restricted, kosher, gluten-free, and halal.
Urinary Elimination Overview
- Normal urine output is 50-60 mL per hour or 1500 mL per day.
- Most individuals void 5-6 times daily, typically upon awakening and following meals.
- Frequent urination can be an indicator of diabetes, UTI, or other medical conditions.
- Kidney functions include urine formation, fluid balance regulation, blood pressure control, waste excretion, acid-base balance, electrolyte regulation, bone metabolism, and red blood cell production regulation.
- Waste excretion products include urea (BUN, 8-20) and creatinine (0.6-1.2).
- Factors influencing urination encompass development, physiological variables, medications, food and fluid intake, and exercise.
Renal Medications
- Diuretics promote urine output by preventing water and electrolyte reabsorption.
- Cholinergic medications stimulate detrusor muscle contractions, facilitating urination.
- Analgesics and tranquilizers can suppress the CNS, reducing the effectiveness of neural reflexes involved in urination.
Urine Color
- Diuretics can lead to pale yellow urine.
- Pyridium causes orange to orange-red urine.
- Antidepressant Amitriptyline or B-Complex vitamins can produce green or blue-green urine.
- Levodopa can result in brown or black urine.
Urine Sampling
- Intake and output monitoring is crucial.
- Assess urine characteristics: color, clarity, odor, concentration, etc.
- Dipstick testing measures pH, proteins, ketones, and glucose.
- Specific gravity typically ranges from 1.01 to 1.03.
- For sterile urine samples, clamp the catheter for 15-30 minutes, clean the port with alcohol wipes, aspirate 30 mL of specimen using a sterile syringe, transfer the specimen to a container, release the clamp, and avoid disconnecting the catheter (closed system).
CAUTI (Catheter-Associated Urinary Tract Infection)
- Risk factors include sexually active women, contraceptive users, postmenopausal women, indwelling catheter users, people with diabetes, and older adults.
- Prevention measures include cleaning the urinary meatus, maintaining catheter system integrity, prompt removal of catheters, and regular hygiene of the catheter and genitalia.
Pain Overview
- Pain can serve as a protective mechanism and warning signal.
- Pain is subjective and can be experienced differently by individuals.
- Factors influencing pain perception include cognitive, affective, behavioral, and sensory components.
- Pain complications encompass sleep loss, irritability, cognitive impairment, and immobility.
Pain Scales
- Pain scales include numerical scales, faces scales, and behavioral indicators.
Nonpharmacological Pain Interventions
- Non-pharmacological pain interventions include positioning, cutaneous stimulation, heat and cold therapy, touch, massage, hypnosis, and electronic stimulation units.
Sleep Physiology
- Biorhythms: Biological clocks controlled within the body and synchronized with environmental factors.
- Circadian Rhythms: A biorhythm based on the day-night pattern regulated by the hypothalamus.
- Sleep-Wake Homeostasis: A system in the body that helps it remember to sleep after a certain amount of time.
Sleep Stages
-
NREM (Non-Rapid Eye Movement): A restful phase with slower physiological functions.
- Stage 1: Transition between wakefulness and sleep, with slow eye movements.
- Stage 2: Light sleep where individuals are easily aroused, with slightly decreased heart rate and blood pressure.
- Stage 3: Deep sleep where individuals are difficult to arouse, with low vital signs. This stage is crucial for healing and growth.
- REM (Rapid Eye Movement): Characterized by rapid eye movement and essential for mental and emotional restoration, with high brain activity.
Factors That Affect Sleep
- Age, alcohol consumption, environment, physical activity, diet, medications, and illness.
Common Sleep Disorders
- Insomnia, sleep-wake schedule disorders, restless legs syndrome, night terrors, sleep apnea, and narcolepsy.
Sexuality
- Self-concept is formed by a combination of identity, body image, role performance, and self-esteem.
- Sexuality is an integral part of one's personality and essential for overall health.
- Nurses play a crucial role by maintaining comfort with their sexual identity, possessing knowledge of sexual function and issues, approaching sensitive topics with a matter-of-fact manner, eliminating bias, using therapeutic communication, and recognizing that medical conditions can impact sexual activity.
- A comprehensive sexual health assessment includes observing demeanor, discussing self-concept and identity, obtaining a sexual history, inquiring about sexual orientation, exploring cultural background, assessing relationship quality, and evaluating self-worth.
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