Surgical Asepsis Principles

Surgical Asepsis

• Surgical asepsis refers to procedures used to eliminate all microorganisms, including pathogens and spores, from an object or area.
• Surgical asepsis is required in situations like:
• During procedures that perforate the patient's skin.
• When the skin's integrity is broken due to trauma, surgical incision, or burns.
• During procedures that involve insertion of foreign objects into the body, such as catheters or surgical instruments.

Principles of Surgical Asepsis

• A sterile object remains sterile only when touched by another sterile object.
• Place only sterile objects on a sterile field.
• A sterile object or field out of the range of vision or an object held below a person’s waist is contaminated.
• A sterile object or field becomes contaminated by prolonged exposure to air.
• When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action.
• Fluid flows in the direction of gravity.
• The edges of a sterile field or container are considered contaminated.

Preparing a Patient for a Sterile Procedure

• Explain the procedure to the patient.
• Assess the patient for any allergies, especially to antiseptic solutions such as iodine or chlorhexidine.
• Provide privacy.
• Position the patient comfortably.
• Adjust the height of the working surface to ensure proper technique and prevent contamination.

Opening a Sterile Kit

• Verify the packaging is dry and intact.
• Place the sterile kit on a clean, flat surface.
• Open the outside wrapper, pulling the top flap away from you.
• Open the side flaps, pulling them away from you.
• Pull the last flap toward you.
• Using the inner surface of the package as a sterile field.

Donning Sterile Gloves

• Perform hand hygiene.
• Open the outer package of the sterile gloves on a clean, flat surface.
• Open the inner package, exposing the gloves, being careful not to contaminate them.
• With your non-dominant hand, pick up the glove for your dominant hand by grasping the folded cuff.
• Carefully pull the glove onto your dominant hand, leaving the cuff folded.
• Slide your sterilely gloved fingers of your dominant hand under the cuff of the remaining glove.
• Carefully pull the glove onto your non-dominant hand, unfolding the cuff over your wrist.
• Adjust the gloves for comfort, touching only sterile areas.

Sterile Field Contamination

• A sterile field is contaminated when sterile saline solution is spilled on it because it creates a pathway for microorganisms to be introduced.

Actions Complying with Surgical Asepsis

• Keeping the sterile field in view at all times is a key principle.
• Considering the outer 2.5 cm (1 inch) of the sterile field as contaminated is standard practice.

Urinary Catheters: Indications

• Reasons for urinary catheterization:
• Relief of urinary retention
• Obtaining a sterile urine specimen
• Emptying the bladder before, during, or after surgery
• Monitoring urine output in critically ill patients
• Assisting in healing open perineal wounds
• Management of urinary incontinence when other measures have failed

Straight vs. Indwelling Catheters

• Straight catheters are used for single-use intermittent catheterization, while indwelling catheters remain in place for continuous drainage.

Infection Risks with Urinary Catheterization

• Concerns for infection:
• Introduction of bacteria into the bladder during insertion.
• Biofilm formation on the catheter surface.
• Disruption of the natural defense mechanisms of the urethra.

Sterile Technique in Urinary Catheterization

• Sterile technique is utilized in:
• Preparing and maintaining the sterile field.
• Using sterile gloves.
• Cleansing the periurethral area with a sterile antiseptic solution.
• Using sterile instruments and supplies.

Steps for Catheter Removal

• Necessary steps for catheter removal:
• Deflating the balloon completely.
• Instructing the patient to breathe out to relax the sphincter muscles.
• Gently withdrawing the catheter.

Keeping the Patient Comfortable During Catheterization

• Ways to keep the patient comfortable:
• Using adequate lubrication.
• Ensuring proper positioning.
• Providing privacy and reassurance.

Post-Catheter Removal Education

• Education needed after catheter removal:
• Drink plenty of fluids.
• Report any burning or difficulty with urination.
• Monitor urine output.

Continuous Bladder Irrigation

• The purpose of continuous bladder irrigation is to flush out blood clots and debris from the bladder to maintain catheter patency.

Accuracy in I&Os

• Accurate intake and output measurement is essential to monitor fluid balance and kidney function.

Patient Positioning for Insertion

• Patient positioning:
• Female: dorsal recumbent or Sims' position.
• Male: supine with legs extended.

Key Step for Indwelling Catheter Insertion (Male)

• The critical step when inserting an indwelling catheter into a male patient is advancing the catheter to the bifurcation of the drainage and balloon ports to ensure the catheter is well into the bladder neck to aid in inflation of the balloon.

Instructions to Assistive Personnel Post-Catheter Removal

• Report the time and amount of first voiding.

Managing Post-Op Pain and Distention with Three-Way Catheter

• Assess the patency of the drainage system is the initial intervention.

Delegating Post-Op Catheter Care

• Aspects of care delegated to assistive personnel:
• Assisting with patient positioning and maintaining privacy during catheter care.
• Reporting to the nurse any patient discomfort or fever.
• Reporting any abnormal color, odor, or amount of urine in the drainage bag.

Indwelling Catheter Insertion Steps (Female)

• Steps for insertion of an indwelling catheter in a female patient (in order):
• Prepare sterile field and supplies.
• Place sterile drape.
• Lubricate catheter.
• Cleanse urethral meatus with antiseptic solution.
• Insert and advance catheter.
• When urine appears, advance another 2.5 to 5 cm.
• Inflate catheter balloon.
• Gently pull catheter until resistance is felt.
• Attach drainage tubing.

Nursing Interventions for Catheter Removal

• Nursing interventions when removing an indwelling urinary catheter:
• Attach a syringe to the inflation port.
• Allow the balloon to drain into the syringe by gravity.
• Initiate a voiding record/bladder diary.

Decreasing CAUTI Risk

• Hanging the urinary drainage bag below the level of the bladder decreases the risk for CAUTI.

No Urine Return During Catheter Insertion

• The nurse should leave the catheter there and start over with a new catheter.

Pain: True or False Statements

• True or False statements about pain:
• True: Anxiety can increase a client’s perception of pain.
• False: Over medication with analgesics is a frequent, serious health care problem.
  • Correction: Under-medication with analgesics is a frequent, serious health care problem.
• False: Older clients should not be medicated for pain because of the risk of respiratory depression.
  • Correction: Older adults can be medicated, but require closer monitoring.
• False: There is a direct, predictable relationship between the stimulus and the intensity of a client’s pain.
  • Correction: The relationship is variable and subjective.
• False: Addiction is a high-risk complication of pain medication administration.
  • Correction: Addiction is a low-risk complication when opioids are used appropriately for pain management.
• True: Some clients request pain medications less frequently because of fear of addiction.
• False: Clients frequently exaggerate the intensity of their pain.
  • Correction: Pain is subjective, and clients report their individual experiences.
• True: Older clients may have a greater fear of taking opiates than younger clients.
• Objective data such as changes in blood pressure, pulse and respiration are useful to validate the severity of a client’s pain.
• Correction: Objective data is not reliable to assess pain.

Non-Adapting Pain Receptors

• Pain receptors are physiologically non-adapting, ensuring the body is alerted continuously to potential or actual tissue damage.

Dimensions of Pain and Nursing Implications

• Dimensions of pain and nursing interventions:
• Physiological: Assess pain intensity, location, and quality; administer analgesics as prescribed.
• Affective: Encourage expression of feelings, provide emotional support, and consider therapy.
• Cognitive: Educate about pain management techniques, set realistic goals, and involve the patient in care decisions.
• Behavioral: Monitor nonverbal cues and encourage activity as tolerated.
• Sociocultural: Consider cultural beliefs, involve family, and provide culturally sensitive care.

Processes of Nociception

• Processes of nociception:
• Transduction: Conversion of painful stimuli into electrical signals.
• Transmission: Movement of pain signals along nerve fibers to the spinal cord and brain.
• Perception: Conscious awareness of pain.
• Modulation: Inhibition or modification of pain signals.

Nociceptive Pain

• Nociceptive pain arises from actual or potential tissue damage. Types include:
• Somatic pain: arises from bone, joint, muscle, skin, or connective tissue and is usually described as aching or throbbing in quality and is well localized.
• Visceral pain: arises from visceral organs, such as the gastrointestinal tract and pancreas. This may be further subdivided.

Neuropathic Pain

• Neuropathic pain arises from direct injury to the peripheral nerves or the central nervous system. Types include:
• Peripheral neuropathies (e.g., diabetic neuropathy, postherpetic neuralgia)
• Central neuropathies (e.g., poststroke pain, spinal cord injury pain)

Acute vs. Chronic Pain

• Acute pain:
• Onset/Duration: Sudden, short-term (less than 3 months)
• Cause: Usually related to injury, surgery, or acute illness
• Manifestations: Increased heart rate, blood pressure, anxiety, and diaphoresis.
• Chronic pain:
• Onset/Duration: Gradual or sudden, long-term (more than 3 months)
• Cause: May be unknown or related to chronic conditions
• Manifestations: Fatigue, depression, irritability, and decreased activity.

Core Principles of Pain Assessment

• Pain is subjective and individualized.
• Patients are the best authority on their pain.
• Pain assessment should be comprehensive and include physical, emotional, and functional components.
• Regular reassessment is essential.

Basic Principles of Pain Treatment

• Follow a multimodal approach.
• Tailor treatment to the individual.
• Evaluate and adjust treatment as needed.
• Prevent or manage side effects.

Factors to Consider for a Woman in Labor

• Emotional state
• Previous experience with pain
• Sociocultural factors
• Meaning of pain
• Fatigue
• Lack of knowledge

Additional Assessment Strategies for Pain

• Use of pain scales (numeric, visual analog).
• Observation of nonverbal cues.
• Physical examination to identify potential sources of pain.
• Exploration of patient's pain history and previous pain experiences.

Priority Nursing Intervention for Epidural

• Monitoring respiratory rate and oxygen saturation.

Analgesics: NSAIDS

• NSAIDs:
• Pharmacologic Action: Reduce inflammation and pain by inhibiting prostaglandin synthesis.
• Examples: Aspirin, Ibuprofen, Celecoxib, Naproxen
• Side Effects: GI upset, bleeding, kidney damage, and cardiovascular events.
• Nursing Responsibilities: Monitor for GI bleeding, assess renal function, and educate about potential cardiovascular risks.

Analgesics: Weak narcotics

• Weak Narcotics:
• Pharmacologic Action: Bind to opioid receptors in the brain to reduce pain.
• Examples: Codeine, Oxycodone, Hydrocodone
• Side Effects: Constipation, nausea, sedation, and respiratory depression.
• Nursing Responsibilities: Monitor for respiratory depression and constipation, administer stool softeners, and educate about fall risks.

Analgesics: Strong narcotics

• Strong Narcotics:
• Pharmacologic Action: Potent opioid receptor agonists to relieve severe pain.
• Examples: Morphine, Dilaudid, Fentanyl
• Side Effects: Severe respiratory depression, hypotension, sedation, and constipation.
• Nursing Responsibilities: Monitor vital signs closely, have naloxone available, and manage side effects.

Analgesics: Antiseizure Drugs

• Antiseizure Drugs:
• Pharmacologic Action: Stabilize nerve membranes to reduce neuropathic pain.
• Examples: Gabapentin, Carbamazepine
• Side Effects: Dizziness, drowsiness, ataxia, and liver damage.
• Nursing Responsibilities: Monitor liver function, assess for neurological side effects, and educate about potential drug interactions.

Analgesics: Antidepressants

• Antidepressants:
• Pharmacologic Action: Enhance the effects of endogenous opioids and modulate pain pathways.
• Examples: Amitriptyline, Imipramine.
• Side Effects: Dry mouth, blurred vision, constipation, urinary retention, and cardiac arrhythmias.
• Nursing Responsibilities: Monitor for anticholinergic effects and cardiac side effects, and educate about delayed onset of pain relief.

Acetaminophen

• Acetaminophen does not have anti-inflammatory properties.
• The maximum amount of acetaminophen that should be taken per day is typically 4000 mg (4 grams).

Darvon and Demerol

• Darvon and Demerol should be avoided due to their potential for toxicity and limited analgesic benefit.

Influences on Pain Response

• Cultural background may shape the patient's expression and perception of pain.
• Chronic conditions like diabetes and end-stage renal disease can alter pain pathways and increase pain sensitivity.
• Physiological factors, such as elevated temperature and blood pressure, may indicate underlying infection or physiological stress related to pain.

Patient-Controlled Analgesia (PCA)

• PCA is a method of pain management that allows patients to self-administer pain medication, typically opioids, via an infusion pump.
• Advantages of using a PCA include:
• Improved pain control.
• Greater patient satisfaction.
• Reduced anxiety.

Nonpharmacologic Therapies: Acupuncture

• Acupuncture:
• Benefits: Reduces pain by stimulating the release of endorphins.
• Limitations: May not be effective for all types of pain.

Nonpharmacologic Therapies: Heat & Cold

• Heat & Cold:
• Benefits: Reduces pain and inflammation.
• Limitations: May not be suitable for certain conditions.

Nonpharmacologic Therapies: Exercise

• Exercise:
• Benefits: Improves overall health, reduces pain, and enhances mobility.
• Limitations: May be difficult for those with certain physical limitations.

Nonpharmacologic Therapies: Massage

• Massage:
• Benefits: Reduces muscle tension and promotes relaxation.
• Limitations: May not be appropriate for certain medical conditions.

Nonpharmacologic Therapies: Percutaneous Electrical Nerve Stimulation

• Percutaneous Electrical Nerve Stimulation:
• Benefits: Reduces pain by stimulating nerves.
• Limitations: Requires specialized training and equipment.

Nonpharmacologic Therapies: Transcutaneous Nerve Stimulation

• Transcutaneous Nerve Stimulation:
• Benefits: Reduces pain by stimulating nerves.
• Limitations: May not be effective for all types of pain.

Nonpharmacologic Therapies: Distraction

• Distraction:
• Benefits: Diverts attention away from pain.
• Limitations: May not be suitable for all patients or all types of pain.

Nonpharmacologic Therapies: Hypnosis

• Hypnosis:
• Benefits: Alters pain perception.
• Limitations: Requires a trained practitioner.

Nonpharmacologic Therapies: Imagery

• Imagery:
• Benefits: Promotes relaxation and alters pain perception.
• Limitations: Requires patient cooperation and cognitive ability.

Nonpharmacologic Therapies: Progressive Relaxation

• Progressive Relaxation:
• Benefits: Reduces muscle tension and promotes relaxation.
• Limitations: Requires patient cooperation and cognitive ability.

Nonpharmacologic Therapies: Biofeedback

• Biofeedback:
• Benefits: Helps patients gain control over physiological responses to pain.
• Limitations: Requires specialized training and equipment.

Tolerance

• Tolerance: Body adapts to the drug, requiring higher doses for the same effect.

Physical Dependence

• Physical Dependence: Withdrawal symptoms occur if the drug is stopped abruptly.

Addiction

• Addiction: Psychological and behavioral pattern characterized by compulsive drug use despite harm.

Herbal Tea for Pain

• The nurse should inquire about the specific herbal tea being used, its ingredients, and the patient's reason for using it.

Data to Evaluate Pain Management

• Pain intensity scores
• Functional status
• Patient satisfaction
• Side effects

Stroke: Nonmodifiable Risk Factors

• Age
• Gender
• Ethnicity
• Genetic factors

Stroke: Modifiable Risk Factors

• Hypertension
• Smoking
• Diabetes
• Hyperlipidemia
• Obesity
• Carotid stenosis
• Atrial fibrillation
• Excessive alcohol intake
• Poor diet
• Physical inactivity
• Oral contraceptive use

Highest Stroke Risk Group

• People with hypertension and diabetes.

Why Treat Transient Stroke Symptoms?

• Patient has probably had a transient ischemic attack (TIA), which is a sign of progressive cerebrovascular disease.

Stroke Type and Onset

• Embolic stroke is associated with endocardial disorders, has a rapid onset, and is likely to occur during activity.

Determinants of Neurologic Functions Affected by Stroke

• The brain area perfused by the affected artery.

Stroke Manifestations: Right vs. Left

• Manifestations of stroke:
• L: Aphasia
• R: Impaired judgment
• R: Quick, impulsive behavior
• L: Inability to remember words
• R: Left homonymous hemianopsia
• R: Neglect of the left side of the body
• L: Hemiplegia of the right side of the body

Communication Problem

• Receptive aphasia

Interventions for Patient with Dysphasia

• Consult speech therapy to help the patient learn to swallow.
• Supplement with the use of nonverbal cues.
• Ask questions that require a simple "yes" or "no" response.

Diagnostic Test to Determine size and location for a Stroke

• CT scan without contrast

Medication to Reduce Incidence of Ischemic Stroke

• Daily low-dose aspirin

Priority Intervention in ED for Stroke

• Maintaining respiratory function with a patent airway and oxygen administration

Nursing and stroke: Homonymous Hemianopsia

• Teach the patient to scan the room to see what is outside the field of vision.

Nursing Care Prior to Feeding Post-Stroke

• Check the patient’s gag reflex.

Nursing and stroke: unilateral neglect

• Teach the patient to care consciously for the affected side.

Family Teaching for a Right-Sided hemiplegic stoke

• Maintaining a calm environment and avoiding shaming or scolding the patient are important.

Delirium: Cognitive Impairments

• Manifestations of cognitive impairment:
• Reduced awareness
• Impaired judgments
• Sleep/wake cycle reversed
• Distorted thinking and perception

Dementia

• Vascular dementia can be diagnosed by brain lesions found on neuroimaging.

Alzheimer’s Disease and Depression Treatment

• Likely to not alter the course of either condition.

Mini-Mental State Examination

• Can help to document the degree of cognitive impairment in delirium and dementia.

Memory Loss

• Memory loss in mild cognitive impairment

Alzheimer's Disease Diagnosis

• All other possible causes of dementia have been eliminated.

Newly Admitted alzheimers Patient: Needs

• The patient will need help with dressing.

Inter professional Care of patients with Azheimers

• Drug therapy for cognitive problems and undesirable behaviors

Medication Used to Manage Behavioral Problems

• Risperidone

N-methyl-d-aspartate (NMDA)

• Memantine

Dealing with Alzheimer's: agitated and Wondering

• Tell the patient, “Let’s go get a snack in the kitchen.”

Ways to keep the brain healthy

• Avoid trauma to the brain.
• Recognize and treat depression early.
• Exercise regularly to decrease the risk for cognitive decline.

Moderate Alzheimer's care

• Determine possible precipitating factors for behavior changes.
• Put the patient on a toileting schedule
• Use distraction to manage agitated behavior.
• Maintain a consistent daily routine.

Confusion care

• Establish and consistently follow a daily schedule with the patient.

the family caregiver for a patient with AD

• The caregiver has symptoms of caregiver role strain.

6 risk factors for developing delirium.

• Pneumonia
• COPD
• Fever
• Intake output imbalance
• Early stage AD
• ICU admission

suspect delirium rather than dementia

• The fact that he should not have been allowed to drive if he had dementia

Management of a patient with delirium

• Identification and treatment of underlying causes when possible

nurse notices that the patient has new onset confusion

• Notify the health care provider and postpone the transfer.

A CT Scan for Alzheimer's

• CT Scan may show brain atrophy in later stages of the disease.

What Neuropsychologic testing, which includes the Mini-Cog and the Mini-Mental State Examination (MMSE), are performed to assess G.D. Use an X to indicate if the task or question is part of the Mini-Cog or part of the MMSE.

Task or Question| Mini-Cog |MMSE Repeat the 3 words previously stated at the beginning of the exam | X | Ask the patient to name an object || X Read this and do what it says ||X “What is today’s date”||X Draw a clock and put the clock hands on 11:10|X|

3 stages of AD with assessment findings. Use an X to indicate if the assessment finding is associated with the Mild stage, Moderate stage, or Severe stage of Alzheimer’s disease (AD).

Assessment Finding|Mild|Moderate|Severe Wanders out of the house at night||X| Has trouble speaking|||X Occasionally misplaces glasses|X|| Puts the car keys in the fridge|X| Has trouble recognizing his kids|||X| Becomes agitated easily||X Has trouble finding the right word |X||

What medications may be recommended to slow the progression or treat effects of the disease? Choose the most likely options for the information missing from the table below by selecting from the lists of options provided.

Drug |Drug Class|AD Problem it Treats Memantine||Decreased Cognition Risperidone | Antipsychotic |Agitation Fluoxetine| SSRI | Depression Donepezil | Cholinesterase Inhibitor |Decreased Cognition Zolpidem|Benzodiazepine Receptor Agonist|Insomnia

What would the nurse include when teaching G.D. and his wife about managing Alzheimer’s disease?

• You should select a durable power of attorney for healthcare.
• Use distraction to cope with behavior problems.
• G.D. should wear a MedicAlert bracelet.
• Join community support groups.
• Take actions like removing throw rugs to ensure safety in the home.

Nonmodifiable Risk Factors for Primary Hypertension

• Age
• Gender
• Ethnicity
• Genetic link

Secondary Hypertension

• Secondary has a specific cause, such as renal disease, that can often be treated by medicine or surgery.

Early Manifestation(s)

a. No symptoms

Main Cause of Target Organ Damage

• Atherosclerotic changes in vessels that supply the organs

As blood pressure increases, what are some medical problems associated with the increase in BP?

• Risk of myocardial infarction
• Risk of heart failure
• Stroke
• Renal disease
• Retinopathy

Stage 1 Hypertension according to the American Heart Association (AHA)?

• 144/92

Terms with their definition.

• cardiac output (CO) - Total blood flow through the system per minute
• MI - myocardial infarction - Death of heart tissue
• RAAS - Renin-Angiotensin-Aldosterone System - Vasoconstrictor that can increase blood pressure
• SVR Systemic Vascular Resistance - Force opposing the movement of blood within the Blood vessels
• HTN - hypertension - Force exerted by blood against the walls of the blood vessels
• LVH - Left Ventricular Hypertrophy - Increase in the size of the myocardium
• HDL - High density Lipoproteins - Considered “good” lipoproteins
• LDL - Low density Lipoproteins - Considered “bad” lipoproteins

heart disease: Sodium restriction guideline for

• 1500 mg

First-line Therapy for a Stage I Hypertension

• Thiazide diuretic
• Use the DASH diet plan

Side effects of furosemide (lasix)?

• Decreased potassium
• Decreased Blood Pressure (BP)

Heart Failure: Preload and Afterload

• Preload is the volume of blood in the ventricles at the end of diastole and can be decreased by diuretics and vasodilators.
• Afterload is the resistance the left ventricle must overcome to circulate blood and can be decreased by vasodilators and ACE inhibitors.

Heart Failure Pathophysiology

• Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs, leading to decreased cardiac output and tissue perfusion.

Acute Decompensated Heart Failure Symptoms

• Pink, frothy sputum results from fluid accumulation in the lungs due to increased pulmonary capillary pressure.
• Patient would appear: Short of breath, anxious, and cyanotic.

Left vs. Right Sided Heart Failure

Left Sided Heart Failure|Right Sided Heart Failure Dyspnea, cough, crackles|Peripheral edema, jugular vein distension Fatigue, weakness|Weight gain, ascites Orthopnea, paroxysmal nocturnal dyspnea|Hepatomegaly, splenomegaly

Paroxysmal Nocturnal Dyspnea

• Paroxysmal nocturnal dyspnea is sudden shortness of breath that occurs during sleep, caused by fluid redistribution from the extremities to the lungs. Happens during sleeping hours because of lying down, which increases blood return to the heart.

Management Interventions and Rationale for Heart Failure

Intervention |Rationale Elevation of head of bed, feet dangling|Reduces preload and pulmonary congestion Oxygen, mask, Bi Pap|Improves oxygenation and reduces dyspnea Morphine sulfate|Reduces anxiety, preload, and afterload Loop diuretic is furosemide (Lasix)|Reduces fluid overload and pulmonary congestion Strict I&Os|Monitors fluid balance and kidney function Diet modifications|Reduces sodium and fluid intake Health maintenance|Improves overall health and reduces risk factors Hemodynamic monitoring|Assesses cardiac function and response to treatment

Lanoxin (digoxin)

• Increases cardiac contractility and cardiac output while decreasing heart rate.

Heart Failure Diagnostic Tests

a. Exercise stress testing - Evaluates heart function during physical activity. b. Ambulatory heart monitoring - Detects arrhythmias. c. Echocardiogram - Assesses heart structure and function. d. Determination of blood urea nitrogen (BUN) and Creatinine -assesses Kidney function. Usually elevated during poor Perfusion. e. B-Type Natriuretic Peptide (BNP) - Elevated in heart failure.

Acute and Chronic Heart Failure Medications

Drug|Therapeutic Effects Spironolactone|Prevents formation of aldosterone thatdecreases preload by reducing sodium and water reabsorption Digoxin|Increases cardiac contractility and output and lows heart rate Furosemide|Primary effect to decrease intravascular fluid volume, thus decreases preload and improve left ventricular function Enalapril|Decreases afterload by reducing levels of angiotensin II and aldosterone Lisinopril |Decreases afterload by reducing levels of angiotensin II and aldosterone Metoprolol |Directly blocks sympathetic nervous system’s negative effects on failing heart Nifedipine |Relaxes blood vessels and reduces afterload Carvedilol|Blocks action of aldosterone,decreasing intravascular volume by sodium excretion, but retains potassium

Monitor the patient’s risk of digitalis toxicity.

• Potassium levels

Complications with chronic heart failures and how to prevent them

• Pleural effusion can cause shortness of breath, chest pressure, and pain related to fluid in the pleural space. Treated with Thoracentesis.
• Arrhythmias related to enlarged chambers. Treated with medication.
• Atrial fibrillation related to enlarged heart. Treated with medication.
• Thrombus formation related to large atria. Treated with anticoagulants.
• Hepatomegaly can cause liver congestion an damage related to blood backing up into the liver. Treated with medication.

Acronym FACES

• Fatigue, limitation of activities, chest congestion/cough, edema, shortness of breath

Initial Physical Assessment

• Bubbling crackles and tachycardia

Pathophysiologic Mechanism

• Increased pulmonary hydrostatic pressure

Most Common Organism for UTIs

• E. coli.

Patients at Risk for UTIs

• Women
• Sexually active individuals
• Catheterized patients
• Individuals with urinary retention
• Those with urinary tract abnormalities

Signs and Symptoms of Lower UTI

• Dysuria
• Urgency
• Frequency
• Suprapubic discomfort/pain
• Hematuria

UTI Symptoms in Older Adults

• Confusion
• Incontinence
• Loss of appetite
• New or worsening functional decline
• Afebrile

Prevention of UTIs

• Adequate hydration
• Proper hygiene
• Frequent voiding
• Cranberry juice

IVP Preparation

• NPO after midnight/bowel prep
• Assess for allergies to iodine/shellfish
• Purpose: Visualize urinary tract/detect abnormalities

KUB

• Purpose: Detects stones, calcifications, or structural abnormalities

Cystoscopy

• Purpose: Visualize bladder/urethra for diagnosis/treatment

Expected Signs and Symptoms after Cystoscopy

• Pink-tinged urine
• Frequency and dysuria
• Manage with increased fluid intake/mild analgesics

Cystoscopy Complications/Recognition

• Urinary retention
• Hemorrhage
• Infection

Renal Ultrasound

• Purpose: Imaging of kidneys for masses, obstructions, or structural abnormalities

24 Hour Urine

• Purpose: Measures components of urine over 24-hour period for diagnostic purposes

Collection of 24-Hour Urine

• Discard first void, collect all urine for 24 hours, keep specimen refrigerated

Urine Culture and Sensitivity

• Identify bacteria/determine appropriate antibiotics
• Collect urine specimen prior to administering antibiotics

TMP-SMZ (Bactrim)

• Antibiotic
• Nursing: Assess for sulfa allergies, monitor kidney function
• Teaching: Increase fluid intake/avoid prolonged sun exposure

Nitrofurantoin

• Antibiotic
• Nursing: Administer with food
• Teaching: May cause urine to turn brown/orange

Ciprofloxacin

• Antibiotic
• Nursing: Avoid antacids/dairy products
• Teaching: Risk of tendon rupture

Pyridium

• Urinary analgesic
• Nursing: Relieves dysuria
• Teaching: Turns urine orange/red

Upper Urinary Tract Infection

• Pyelonephritis
• Signs/Symptoms: fever, flank pain, nausea/vomiting, CVA tenderness.

Upper and Lower Urinary Tract Infections

• Cystitis
• Signs/Symptoms: dysuria, frequency, urgency, suprapubic discomfort

Pyelonephritis Antibiotic Therapy

• Typically requires IV antibiotics

What is the next step if acute pylohnephritis is not treated properly?

• Relapse or Chronic Kidney disease.

Urethritis

• Infection of urethra.
• Counseling/education re: STD testing/safe sex practices.

Interstitial Cystitis

• Chronic bladder pain with urinary frequency/urgency

Interstitial Cystitis Counseling

• Avoid bladder irritants (caffeine, alcohol, citrus, spicy foods)
• Stress management