Fundamentals Exam 3 Study Guide PDF

Fundamentals Exam 3 Bowel Elimination Overview - Process of bowel elimination: mouth, esophagus, stomach, small intestine, large intestine, anus, defecation - Factors that impact elimination: age, diet, fluid intake, exercise, medications, pregnancy, surgery, anesthetic...

Fundamentals Exam 3 Bowel Elimination Overview - Process of bowel elimination: mouth, esophagus, stomach, small intestine, large intestine, anus, defecation - Factors that impact elimination: age, diet, fluid intake, exercise, medications, pregnancy, surgery, anesthetics, pain, etc. - Infants: depends on the formula or breast feeding - Toddler: physiological maturity priority for bowel training - Child/adolescent: defecation vary- quantity and frequency - Older adult: constipation is usually a chronic problem- incontinence or diarrhea could become an issue with decreased physiologic or lifestyle changes - MORE STOOL: regular water and food, magnesium, high fiber food (fruit and veggies), - LESS STOOL: calcium, low or high fluid, antacids, opioids Stool Collection - Void urine, defecate noe tissue, avoid disinfectants, notify nurse when need lab - gFOBT: see if there is blood in the stool- blue is positive - Privacy, timing, positioning, nutrition to promote passage, exercise- ab muscles and thigh strengthening Diarrhea/Constipation - Prevention Interventions: wash hands, provide information about foods that can cause diarrhea- spiced, high fat foods, large quantities of fruits and vegetables - Prevent Food poisoning: non damaged packs of food, wash hands and surfaces, put items in fridge, wash fruits and vegetables, temperature for cooked foods - Managing diarrhea: imodium, lomotil, pepcid, clear liquids, BRAT diet  - Constipation risk: depressed, not eating or drinking, not exercising, bed rest a[patient taking constipation meds, patients with reduced fluids or bulk, local lesions that hurt when defecating, patients with CNS diseases - Managing Constipation: increase high fiber foods, increase fluids, defecation privacy, position defecation help, offer stool softeners, laxatives, enemas Enema Administration - Types: cleansing, retention, large volume, small volume - Left side sims position - Clean technique- used for last resort constipation Fecal incontinence - Consider the feelings of a patient who is incontinent - Monitor defecation patterns and provide toileting opportunities - Monitor skin for any breakdown or prevention- respotion,etc - May require fecal tube collection device to prevent skin breakdown Ostomy Care - Stoma: site of the port should be beefy red, moist, with pink, dry, intact skin around it - Sigmoid ostomy: formed stool - Transverse colostomy: thick liquid soft stool - Ileostomy: fecal content not enter colon- free liquid stool - Loop colostomy: reversible stomas that may be constructed in the ileum or colon - 1/8th around the stoma for sizing Nutrition Overview - BMR: basal metabolic rate - Dietary tools: 24 recall, food frequency record, input and output, calorie count - Nutritional assessment: history taking, physician assessment, lab data - Nutrition related issues: risk of aspiration, diarrhea, constipation, feeding deficit, impaired swallowing, lower nutritional level Enteral Nutrition - Nutrition through the GI tract for patients who are unable to digest foods - Types: NG, NIT, PEG - Need placement with an x-ray - Check gastric content: should be a PH lower than 5.5 and green color - Want to secure the NG to the nose- measure nose to ear to sternum process Total Parenteral Nutrition TPN - Nutrients provided intravenously via central line - For patients who are unable to digest or absorb enteral feed and are in highly stressed physiological stress - Potential TPN complications: insertion, infection, sepsis, metabolic alterations, fluid or electrolyte imbalances, phlebitis, hyperlipidemia, liver or gallbladder disease Types of Diets - Clear liquid: non creamy fluids- no milk, clear juices without pulp, soda, water, broth, black tea, coffee - Full liquid: all clear fluids plus creamy, strained soup, pudding, ice cream, thin cereal, custard, juices with pulp, tea or coffee with milk - Mechanical soft: poor dental/dysphagia, smooth yogurt, chopped meat, meatloaf, noodles, eggs, cakes, pies, pancakes, cheese, ice cream  - Dysphagia: thick liquids, cooked cereals, pureed foods, minced casseroles, soft cheeses, cooked eggs, chopped cooked vegetables- UPRIGHT POSITION, DO NOT MIX, NO POCKET FOOD, STRONG SIDE, CHIN DOWN - Renal diet: reduce stress on kidneys- sodium, potassium, fluid, protein restrictions- lab work closely - Heart Health diet: low fat, low sodium, health fats, fish, fruits, vegetables - Consistent carb: diabetic management- goal is for carbohydrates eaten each day remain the same - stabilizes carb intake which stabilizes the blood glucose level - Other possible diets: sodium restricted, kosher, gluten free, halal Urinary elimination Overview - Normal output is 50-60mL per hour or 1500mL per day- absolute minimum is 30mL per day - Most people void 5-6 times per day when awakening and after meals usually - Sometimes frequent urination could indicate diabetes, UTI, etc. - Functions of the kidneys: urine formation, regulation of blood volume and fluid balance, blood pressure regulation, excretion of waste production, acid-base balance, electrolyte regulation, bone metabolism, regulation of red cell production - Excretion of waste: urea BUN (8-20) and creatinine (0.6-1.2) - Factors impacting urination: development, physiological variables, medications, food and fluid intake, exercise and muscle tone Renal Medications - Diuretics: prevent reabsorption of water and electrolytes and increase urine output  - Cholinergic medications: stimulate contraction of detrusor muscles and promote urination - Analgesics and tranquilizers: suppress CNS, diminish effectiveness of neural reflex Urine color - Diuretics: pale yellow urine - Pyridium: orange to orange-red urine - Antidepressant amitriptyline or b complex vitamins: green or blue-green urine - Levodopa: brown or black urine Urine sampling - Intake and output - Characteristics of urine- color, clarity, odor, concentration, - Dipstick testing: PH, proteins, ketones, glucose - Specific gravity- 1.01-1.03 - Sterile sample: clamp 15-30 mins, don gloves and clean port with alcohol wipes, sterile syringe to the port for get 30ml specimen, specimens to container and release clamp, never disconnect the catheter- closed system CAUTI - Risk: sexually active women, women who use contraceptives, postmenopausal women, people with indwelling catheter, people with diabetes mellitus, older adults - Prevention: clean urinary meatus, maintain catheter system integrity, remove ASAP, clean catheter and genitalia every shift Pain Overview  - Pain can be a protective mechanism and a warning signal - Pain is most subjective and can be felt in many different ways depending on the patient - Factors impacting pain could be cognitive, affective, behavioral, and sensory - Complications with pain: sleep loss, irritability, cognitive impairment, immobility Pain Scales - Numerical scale - Faces scale - Behavioral indicators Nonpharmacological Interventions - Positioning - Cutaneous stimulation - Heat and cold therapy, touch, message - Hypnosis, electronic stimulation unit Sleep Physiology of sleep - Biorhythms: biological clocks are 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: assists the body to remember to sleep after a given time Stages of sleep - NREM: non- rapid eye movement sleep that involves restful phase of the body where physiological function is slow - NREM 1: transition between wakefulness and sleep, slow eye movement - NREM 2: light sleep, easily aroused, HR BP slightly decreased  - NREM 3: deep sleep, difficult to arouse, low vitals, important for healing and growth - REM: rapid eye movement- essential for mental and emotional restoration where brain is highly active Factors that affect sleep - Age , alcohol, environment, physical activity, diet, medications, illness Common sleep disorders - Insomnia, sleep wake schedule disorders, restless legs syndrome, night terrors, sleep apnea, narcolepsy Sexulity - Self concept is established from one’s identity, body image, role performance, and self esteem combined - Sexuality: part of someone's personality and important for overall health - Role of the nurse: be comfortable with their own sexual identity, be knowledge about sexual function or issues, approach with matter of fact manner, put away bias, use therapeutic communication, medical conditions can make people uncomfortable with sexual activity - Assessment of sexual health: observe demeanor, discuss self concept and identity, sexual history, ask about sexual orientation, cultural background, quality of relationships, evaluation of self worth.