NURS111 Exam 2 Review PDF

**NURS111 EXAM 2 REVIEW** **END OF LIFE CARE** **DYSPNEA:** Shortness of breath - Can feel like tightness in the chest, a need for more air, or labored breathing. **CHEYENE STOKES:** a gradual increase in the depth and sometimes rate of breathing, followed by a decrease, resulting in a tem...

**NURS111 EXAM 2 REVIEW** **END OF LIFE CARE** **DYSPNEA:** Shortness of breath - Can feel like tightness in the chest, a need for more air, or labored breathing. **CHEYENE STOKES:** a gradual increase in the depth and sometimes rate of breathing, followed by a decrease, resulting in a temporary stop in breathing (apnea). - Alternates between deep, rapid breaths and periods of no breathing. **AGONAL BREATHING:** Labored gasping breaths caused by O2 deprivation. - Sounds like gasping, snorting, or a deep, irregular intake of breath. - Breaths are slow and irregular, with long pauses between them. - Can appear weak or shallow and may not bring in enough oxygen. **LEADING CAUSE OF DEATH IN ADULTS** - \#1 Cardiovascular disease - \#2 Cancer - \#2 COVID 19/Conditions associated w/ Covid 19 ( Stroke, MI, Respiratory Failure) **LEADING CAUSE OF INFANT DEATH** - \#1 Congenital Malfunctions - \#2 Preterm birth/ low birth weight - \#3 SIDS **LEADING CAUSE OF CHILDREN DEATH** - \#1 Accidents - \#2 Congenital Malfunction/ Chromosomal Disease - \#3 Cancer - \#4 Suicide **SIGNS AND SYMPTOMS OF DEATH** - Dyspnea - Agonal breathing - Cheyne-Stokes respirations - Hypotension - Anorexia - Nausea - Dehydration - Altered LOC - Pain **LEGAL CONSIDERATION** - Full Code - Use all life saving measure - DNR - Do nor Resuscitate (NO CPR)/Do not intubate - DNI - Do not Intubate/ Can perform CPR - Chemical Code Only - Medicine treatment only - Comfort Measure Only - Focus is to provide comfort/ no aggressive treatments - Living Will - Document that outlines a person wished such as life sustaining treatment - POA - Power of Attorney: Legal document allowing someone to make decisions on the behalf of someone in case they are unable - Healthcare POA/PROXY - The individual is appointed through a Healthcare Power of Attorney or proxy to make medical decisions on behalf of a patient who can no longer make their own choices. **PASSIVE EUTHASIA** - The voluntary withdrawal or withholding of life-sustaining measures to allow for natural death. - Commonly occurs in cases where there is a Do Not Resuscitate (DNR) order or a living will specifying that the patient does not want life support. **ACTIVE EUTHASISA** - The administration of drugs or other interventions that directly ends the person\'s life. - Provided by healthcare team - Illegal and all 50 states **ASSISTED SUICIDE** - When a provider gives a terminally ill patient the means to end their life, but the patient takes the final step. - PT has to administer the "dose" themselves **PALLIATIVE** - The goal is to enhance the quality of life for patients facing serious illness by alleviating symptoms, managing pain, and addressing emotional, spiritual, and psychological needs - Begins at time of diagnose - Can be provided alongside curative treatment - Holistic approach **HOSPICE** - Must have a terminal disease and less than 6 months to live - Symptom management -- pain and dyspnea - Administer opioids - The goal is comfort care - Curative treatment cannot be provided with hospice care **EXAMPLE QUESTION:** "A PT is diagnosed with chronic liver disease. Will you put the PT in palliative or hospice? **ANSWER:** Chronic conditions are to be place in palliative care because they are not yet terminal **EXAM TIP:** Visiting the ER often=palliative care **EXAM TIP:** For hospice pain, we administer morphine/Percocet **GRIEF S/S** - Sleep disturbances - Anger - Denial - Depression - Personality changes - Mourning **NORMAL S/S** - All of the above - Intense feeling last between 3-6 months - typically resolve within 1-2 years **ABNORMAL S/S OR COMPLICATED GRIEF** - **ABSENT GRIEF:** A lack of visible signs of mourning or emotional response to the loss - **DELAYED GRIEF:** Grief that is postponed or doesn't emerge until a later time - **INHIBITED GRIEF:** Grief that is consciously or unconsciously suppressed - **UNANTICIPATED GRIEF:** Grief following an unexpected or sudden loss - **DISENFRANCHISED GRIEF:** Grief that isn't openly acknowledged, validated, or supported by society. - Example: loss of a pet or miscarriage, leaving the person feeling isolated in their experience of grief - **MALADAPTIVE:** An unhealthy, prolonged response to loss that impedes one's ability to function and adapt **EXAMPLE QUESTION:** A PT experienced a recent loss. The PT is constantly sad, cries every night, and refuses food. Which stage is the PT in? **ANSWER:** Depression **EXAM TIP:** You have too differentiate between absent and inhibit grief - **ABSENT:** The person shows little or no reaction to the loss, appearing emotionally unaffected. - **INHIBITED:** The person is aware of the loss but actively or unconsciously suppresses their grief, often feeling they \"shouldn't\" grieve or fearing intense emotions. **PERINATAL LOSS** - Allow PT to have time with baby - Open questions to see what they need **PAIN** MEMORIZE EACH LEVEL OF MASLOW\'S HIERARCHY OF NEEDS  **PAIN DEFINITION** - Pain is a **perceptual and emotional experience** that is highly **subjective to** - Unpleasant sensory and emotional experience associated with actual or **ACUTE** - type of pain that typically comes on suddenly and is often a direct response to an injury, illness, or surgery - **MANIFESTATIONS:** - Elevated BP - Elevated HR. - Muscle tension - Crying, grimacing, groaning - Guarding the injury site. - Slow movement, compensatory postures. **CHRONIC** - a long-lasting pain that persists for months or even years, often continuing beyond the normal healing time of an injury or illness - **MANIFESTATIONS:** - May show few visible signs - Changes in behavior (depression, withdrawal, fatigue, hopelessness) - Muscle tension, guarding, compensatory postures - Clenched teeth, decreased quality of life **NOCICEPTIVE PAIN** - type of pain that results from the activation of pain receptors (nociceptors) in response to actual or potential tissue damage. - Muscle strain - Cut/Laceration - Back pain from lifting heavy objects - Fractured bone - Post surgical pain - Pain from inflammation - Arthritis - Dental pain - Chest Pain - Headache/Migraine **NOCICEPTIVE PAIN CHARACTERISTICS:** - - - - - **NEUROPATHIC PAIN:** - a type of pain caused by damage or dysfunction in the nervous system, including the peripheral nerves, spinal cord, or brain - Diabetic neuropathy - Phantom limb pain - Multiple Sclerosis - Never compression (ex. Carpal tunnel) - Chemotherapy **NEUROPATHIC CHARACTERISTICS:** - - - **EXAM TIP:** Neuropathic Pain is to use use co-analgesic ### **ACUTE PAIN** - **SOMATIC PAIN:** Originates from nociceptors in the skin and musculoskeletal tissue; localized and sharp - **EXAMPLES:** Bursitis, muscle pain, broken bones, cuts, bruises. - **VISCERAL PAIN:** Originates from internal organs and body cavity linings; dull, deep, and aching - **EXAMPLES:** Appendicitis, gastroenteritis ### **REFERRED PAIN** - Pain sensed in a region other than the site of origin. - **Examples**: Sinusitis pain referred to the jaw/teeth, cardiac pain referred to the left arm. ### **CHRONIC PAIN** - **CHRONIC RECURRENT PAIN**: Characterized by intense episodes of pain followed by periods without pain. - **EXAMPLES**: Chronic back pain. - **CHRONIC INTRACTABLE PAIN**: Pain that is always present, though intensity may vary. - **EXAMPLES**: Fibromyalgia. - **CHRONIC PROGRESSIVE PAIN**: Pain associated with a chronic condition that worsens over time. - **EXAMPLES**: Osteoarthritis. ### **BREAKTHROUGH PAIN:** Manifests between scheduled doses of pain medication. - **INCIDENT PAIN**: Short-term, predictable pain associated with movement or activity. - **EXAMPLES**: Surgical site pain that worsens with coughing or movement. - **IDIOPATHIC PAIN**: Pain with no known cause. - **EXAMPLES**: Unexplained pain, such as migraines. - **END-OF-DOSE PAIN**: Pain experienced at the end of a medication dose period, causing a loss of baseline pain control. - **EXAMPLES**: Common in conditions needing constant opioid or chronic pain medication use. **EXAM TIP:** For incident, idiopathic, and End-of-Dose pain, use **TIMELEY DOSES.** ### **CENTRAL PAIN:** Pain originating from the central nervous system, occurring shortly after or delayed following an injury. - **CHARACTERISTICS**: Described as pins and needles, aching, or lacerating. - **EXAMPLES**: Pain following a spinal cord injury or multiple sclerosis. ### **PHANTOM PAIN:** Pain felt in an amputated body part, often described as stabbing, shooting, squeezing, throbbing, or burning.o - **EXAMPLES**: Limb amputation. ### **PSYCHOGENIC PAIN:** Pain associated with psychological factors rather than a physical condition. - **EXAMPLES**: Headaches, stomach pain, back pain without a physical cause. **PAIN RISK FACTORS** - Lifestyle - Medical history/illness - Demographic factors - Barriers to pain management **PAIN PREVENTION** - External factors - Environment: calm & safe - Ergonomics: proper body mechanics - Lifestyle choices: regular exercise, balanced diet, avoiding tobacco - Internal factors - Mental Health: managing stress and anxiety - Coping Strategies - Physical Health: Healthy weight, flexibility, & strength - Managing existing pain - Medications - Therapies - Lifestyle adjustment **PAIN HEALTH PROMOTION** - Self-management - Physical activity - Nutrition - Sleep hygiene - Stress reduction - Primary prevention: vaccines, education & awareness - Secondary prevention: screenings **PAIN NURSING INTERVENTIONS** - Basic care and comfort - Positioning - Hygenige - Nutrition and hydration - Pain management - Assessing and monitoring - Comfort measures - Psychosocial - Health promotion and education - Risk reductions - Medications management - Collaborative interventions **NUMERIC: GENERAL ADULT/TEENS** "How would you rate your pain on a scale 0-10, 0 being no pain and 10 being the worst pain you ever felt". **PEDIATRIC PAIN ASSESSMENT: FACES (3 YEARS AND OLDER/NON-VERBAL)**  **MEMORIZE: PEDIATRIC PAIN ASSESSMENT: FLACC (2 MONTHS- 7 YEARS)** **COMFORT:** - Comfort definition: - "The immediate state of being strengthened by having the needs for relief, ease, and transcendence addressed in the four contexts of holistic human experience: physical, psycho-spiritual, sociocultural, and environmental" --Kolbaca's Comfort Theory - **Comfort is different for each individual!** - Comfort stages: Maslow's Hierarchy of needs (bottom to top) - [Physiological] - Basic needs such as water, food, air, shelter and sleep - [Safety/Security] - Employment, health, property, stability - [Social (Love and belonging)] - Friendship, family, intimacy, sense of connection - [Self-esteem/ego] - Confidence, achievement, the need to be unique, power, recognition/respect - [Self actualization] - Morality, creativity, meaning, development **a breakdown of different factors that alter comfort:** - **Pain** - **Fatigue: Fatigue refers to a \*\*lack of energy and motivation\*\*, which can be both physical and mental.** **   - It can affect daily functioning and reduce a person's ability to rest or recover, leading to discomfort.** - **Sleep and Rest Disorders** - Insomnia\*\*: Difficulty falling or staying asleep. -    - \*\*Sleep Apnea\*\*: Breathing repeatedly stops and starts during sleep, causing disrupted rest. -    - \*\*Narcolepsy\*\*: A disorder where a person experiences excessive daytime sleepiness and suddenly falls asleep. -    - \*\*Parasomnias\*\*: Unusual behaviors during sleep, such as sleepwalking or nightmares. -    - \*\*Restless Leg Syndrome (RLS)\*\*: An uncomfortable sensation in the legs, often accompanied by an irresistible urge to move them, especially at night. - - These disorders can severely impact rest and lead to physical and mental discomfort. - - \#\#\# **4. \*\*End of Life Care\*\*** -    - This is the care provided to patients and their families when a person is nearing the end of life. -    - **It focuses** on providing comfort by addressing pain, emotional support, and any specific needs related to physical, psycho-spiritual, social, and environmental well-being. -    - The goal is to improve the quality of life during the final stages, offering relief from suffering a - **MEMORIZE: DEMENTIA PAIN ASSESSMENT: PAINAD**  **MEMORIZE: ICU PAIN ASSESSMENT: CPOT (CRITICAL CARE PAIN OBSERVATION TOOL)** **EXAM TIP:** Questions will ask which Pain scale is to be used for what type of PT **EXAM TIP:** Ask PT to report their pain first **TENS THERAPY:** A non-invasive method that uses low-voltage electrical currents for pain relief. - Commonly used to manage pain conditions such as: - Arthritis - Back pain - Neck pain - Fibromyalgia - Neuropathic pain - **CONTRAINDICATIONS:** - **Do not use if** the patient has: - A cardiac pacemaker or defibrillator - A spinal cord stimulator - In-dwelling pumps or monitors (to prevent interference with these devices) **EXAM TIP:** TENS can be use at hospital and in home **PAIN MEDICATIONS** ### **NSAIDS AND ACETAMINOPHEN** - Aspirin, Naproxen, and Ibuprofen are Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) with analgesic, anti-inflammatory, and antipyretic properties, while Acetaminophen is an analgesic and antipyretic without anti-inflammatory effects - **PRIMARY ACTIONS**: - **NSAIDs** (Aspirin, Naproxen, Ibuprofen): Pain relief, anti-inflammatory, Antipyretic - **Acetaminophen**: Pain relief, Antipyretic, (not an anti-inflammatory). ### **ASPIRIN (ACETYLSALICYLIC ACID)** - **USES**: - Pain relief, anti-inflammatory**, fever reduction.** - Blood thinner for cardiovascular protection (low-dose aspirin therapy). - **SIDE EFFECTS**: - Stomach irritation, GI bleeding risk. - **CONSIDERATIONS**: - Avoid children with viral infections (risk of Reye's syndrome). - Not recommended for patients with bleeding disorders because of Antiplatelet effect ### **NAPROXEN (ALEVE)** - **USES**: - Long-lasting pain relief for arthritis, muscle aches, menstrual cramps, etc. - **SIDE EFFECTS**: - Stomach irritation, risk of GI bleeding. - **CONSIDERATIONS**: - Take with food; avoid those with GI bleeding history. ### **IBUPROFEN (ADVIL, MOTRIN)** - **USES**: - Short-term pain relief for headaches, cramps, arthritis, etc. - **Side Effects**: - Stomach upset, GI bleeding risk. - **Considerations**: - Take with food; avoid if PT have Hx of kidney or GI issues. ### ### **ACETAMINOPHEN (TYLENOL)** - **CLASSIFICATION**: Analgesic and antipyretic (does not reduce inflammation). - **USES**: - Pain relief for mild-to-moderate pain, fever reduction. - Preferred for headache, toothache**, cold/flu symptoms**, and for those unable to take NSAIDs. - **SIDE EFFECTS**: - Generally fewer GI side effects compared to NSAIDs. - Hepatotoxicity - **CONSIDERATIONS**: - Maximum daily dose should not exceed 4,000 mg to avoid liver damage. - **Avoid combining with alcohol to reduce liver strain.** - Safe for children and during pregnancy (consult with a healthcare provider). ### **GENERAL PRECAUTIONS** - **NSAIDs** (Aspirin, Naproxen, Ibuprofen): Increased risk of GI bleeding, kidney impairment, and cardiovascular risks. - Nephrotoxicity - **ACETAMINOPHEN**: Risk of liver toxicity; avoid exceeding the recommended dose, especially in patients with liver disease. - Hepatotoxicity ### **SUMMARY** - **ASPIRIN**: Antiplatelet effect; risk of GI bleeding. - **NAPROXEN**: Long-acting; effective for chronic pain. - **IBUPROFEN**: Short-acting; effective for acute pain. - **ACETAMINOPHEN**: Safer for stomach, no anti-inflammatory action, avoid high doses to prevent liver damage. **CEILING EFFECT** - Occurs when increasing a drug\'s dose beyond a certain point does not enhance therapeutic effects or pain relief but raises the risk of side effects. **SIDE EFFECTS OF OPIOIDS** - **SLOW CENTRAL NERVOUS SYSTEM** - Sedation ○ التخدير - Sleep (Insomnia) - Weakness - Dizziness - Orthostatic hypotension - **LOW VITAL SIGNS** - Decrease in heart rate (bradycardia) - Decrease in blood pressure (hypotension) - Decrease in respiratory rate - Respiratory Depression - **SLOW GI FUNCTION** - Constipation - Patients will not build tolerance to this side effect. Wil occur no matter the amount taken - **NAUSEA & VOMITING** - Antiemetics - Medications used to prevent or treat nausea and vomiting. They are commonly prescribed for various conditions - **PRURITUS (ITCHING)** - Use moisturizers & antihistamines **EXAM TIP:** If a patient develops **Pruritus**, use a moisturize first at a first option **EXAM TIP:** Remember the ABC'S **EXAM TIP:** Antidepressants can be used for neuropathic pain. - It can be use as an co-analgesic alongside opioids/NSAIDs **EXAM TIP:** PCA Pump- Patient push button **N-Acetylcysteine (NAC)\*\* show in the test** ** ** **- \*\*Purpose\*\*: NAC is an antidote, mainly used to treat acetaminophen (Tylenol) overdose.** **- \*\*How it works\*\*: It helps protect the liver by restoring glutathione levels, which breaks down harmful substances.** **- \*\*When it\'s given\*\*: NAC is most effective if taken within 8-10 hours of an acetaminophen overdose but can still be helpful later.** **- \*\*Forms\*\*: It can be given orally or through an IV, depending on the situation.** ** ** **\*\*Example\*\*:** **If someone accidentally takes too much acetaminophen, NAC can be used to prevent liver damage and improve recovery.** **FATIGUE** - A feeling of tiredness or low energy that usually points to an underlying issue, like illness, lack of sleep, overexertion, or imbalances in hormones or brain chemicals. **ETIOLOGY (CAUSES)** - Anemia - Depression or grief - Medications - Persistent pain - Sleep disorders - Thyroid disorders - Alcohol or drug use - Chronic diseases like: - Arthritis - Cancer - Fibromyalgia **RISK FACTORS** - **MODIFIABLE:** - Lifestyle factors: Alcohol use, excessive activity or inactivity, lack of sleep, irregular sleep schedule - Medications - **NON-MODIFIABLE:** - Mood disorders - Medical procedures - Genetics - Female gender ### **ACUTE FATIGUE** - **DEFINITION:** Mental or physical exhaustion linked to temporary life events or changes. - **EXAMPLES**: Planning a wedding, studying for an exam, or having an acute illness. - **RESOLUTION**: Typically resolves after the event ends and can be relieved with sleep and rest. ### **CHRONIC FATIGUE** - **DEFINITION**: Mental or physical exhaustion related to long-term, ongoing conditions. - **EXAMPLES**: Chronic illness or caregiver fatigue. - **RESOLUTION**: Does not improve simply with rest or the completion of a life event and often requires ongoing management. **FATIGUE S/S** - Drowsiness - Exhaustion - Lack of motivation - Physical signs: - Lethargy - Muscle weakness - Blurred vision **ELIMINATION** The **Concept of Elimination** refers to the process of removing waste from the body through the kidneys and intestines. It includes: - **URINARY ELIMINATION**: The removal of solute waste from the bloodstream and excess liquid to maintain homeostasis. - **BOWEL ELIMINATION**: The excretion of unused portions of solid food. **URINARY ELIMINATION: ALTERED URINE PRODUCTION** - **POLYURIA (DIURESIS)**: Production of abnormally large amounts of urine. - **EFFECTS**: Can lead to excessive fluid loss, causing intense thirst, dehydration, and **weight loss.** - **POLYDIPSIA**: Extreme thirst. - **ASSOCIATION**: Often linked with polyuria. - **ANURIA**: Absence of urine production less than 100 mL per day. - Acute or chronic kidney failure -   - Severe dehydration -   - Urinary tract obstruction (e.g., kidney stones, tumors) - \- \*\*Complications\*\*: -   - \*\*Life-threatening\*\* condition as waste products build up in the body, indicating severe kidney dysfunction or failure - **OLIGURIA**: Scant/little urine production. - **INDICATORS**: - Adults: Less than 400 mL per day. - Infants: Less than 1 mL per kilogram (kg) per hour. - **SIGNIFICANCE**: May signal impending renal failure. **URINARY ELIMINATION: ALTERED URINE ELIMINATION** - **URINARY FREQUENCY**: the need to urinate more often than usual - **NOCTURIA**: frequent urination at night - **URGENCY**: a strong, sudden need to urinate - **DYSURIA**: pain or discomfort during urination - **URINARY HESITANCY**: difficulty starting the flow of urine - **NEUROGENIC BLADDER**: A condition in which there is impaired bladder control due to nervous system issues. - **CHARACTERISTICS**: - No perception that bladder is full - Unable to control urinary sphincters, leading to involuntary leakage or retention. **NURSING ASSESSMENT FOR URINARY ELIMINATION** - **OBSERVATION AND PATIENT INTERVIEW**: - **VOIDING PATTERN**: Assess the frequency, timing, and regularity of urination. - **DESCRIPTION OF URINE**: Note color, clarity, odor, and any changes from normal. - **URINARY ELIMINATION PROBLEMS**: Ask about any issues such as frequency, urgency, dysuria, nocturia, or incontinence. - **FACTORS INFLUENCING URINARY ELIMINATION**: Identify lifestyle, medical conditions, medications, and dietary factors that may affect urinary patterns. **EXAM TIP:** Bladder scans are use to check urine retention **BOWEL ELIMINATION \-\-- you have to know** - **NORMAL BOWEL ELIMINATION**: The regular expulsion of feces from the body, known as defecation. - **DEFECATION**: The act of expelling feces from the anus and rectum, also referred to as a bowel movement or stool. - **FREQUENCY AND VOLUME**: Highly individual and varies from person to person. - **VOLUME AND CONSISTENCY**: Influenced by dietary intake and the time feces spends moving through the intestines (intestinal transit time). **EXAM TIP:** NEED TO MEMORIZE STOOL CHART  **FACTORS AFFECTING BOWEL ELIMINATION\#** - Diet and fluids - Activity - Defecation habits - Medications and diagnostic procedures - Anesthesia and surgical procedures - Pathologic conditions - Pain - Psychological factors **ALTERATIONS AND MANIFESTATIONS IN BOWEL ELIMINATION \*** - **DIARRHEA** - **DEFINITION**: Passage of liquid feces with increased frequency due to rapid movement through the large intestine. - **SYMPTOMS**: Urgent, often uncontrollable urge to defecate; cramps; increased bowel sounds. - **CONSEQUENCES**: Fluid and electrolyte losses, risk of skin breakdown - **FLATULENCE** - **DEFINITION**: Excessive gas in the intestines or colon. - **CAUSES**: - Bacterial action on chyme - Swallowed air - Gas diffusion from the bloodstream - Certain foods, abdominal surgery, and narcotic use - **CONSTIPATION** - **DEFINITION**: Fewer than three bowel movements per week or difficulty in passing stools, which may be hard and dry. - **CAUSES**: - Decreased intestinal motility - Slow transit time through the large intestine - May be a primary issue or indicate an underlying disorder - **BOWEL INCONTINENCE (FECAL INCONTINENCE) سلس البراز** - **DEFINITION**: Inability to voluntarily control the passage of feces or intestinal gas through the anal sphincter. - **ASSOCIATED CAUSES**: - Often a symptom of another underlying disorder, such as: - Neurologic disorders - Depression - Traumatic injuries - Inflammatory processes - Physical obstructions or deformities, such as masses or hemorrhoids, in the anal area **MODIFIABLE RISK FACTORS** - Poor Diet - Long-term Medication Use - Traveling - Poor Hygiene - Lower Socioeconomic Status and Education Level **NON-MODIFIABLE RISK FACTORS** - Age - Genetics الوراثة - Medical conditions - Gender **NURSING ASSESSMENT** - **OBSERVATION AND PATIENT HISTORY** - Defecation pattern - Description of feces, any changes - Fecal elimination problems - Factors influencing elimination - Use of elimination aids - Diet, fluid, exercise, medications, stress - **PHYSICAL EXAMINATION** - Inspection, auscultation التسمع, percussion قرع الطبول palpation تحسس لمس of the abdomen (auscultation before palpation) - Inspection and palpation of the rectum and anus - **STOOL OBSERVATION** - Color - Consistency - Shape - Amount - Odor - Presence of abnormal constituents **NEWBORNS AND INFANTS: BOWEL ELIMINATION** - **STOOL PROGRESSION**: Meconium → transitional stools → entirely fecal - **FREQUENCY**: Varies, often influenced by breast or formula feeding - **COLOR**: Ranges from tan to yellow to green - **CONSISTENCY**: Soft and liquid, becoming firmer as solids are introduced - **ODOR**: Faint until the introduction of solid foods **TODDLERS**: Daytime bowel control is typically achieved by 2.5 years, following toilet training. **SCHOOL-AGE CHILDREN AND ADOLESCENTS**: Bowel habits become similar to adults, with frequency, quantity, and consistency varying. **PREGNANT WOMEN** - Elevated progesterone levels → delayed gastric emptying, decreased peristalsis - Can result in bloating and constipation - Enlarging uterus aggravates symptoms - Hemorrhoids may develop late in pregnancy\-\-\-- As the uterus grows, it can press on nearby organs, causing discomfort. This can lead to symptoms like: - **Pelvic pressure:** A feeling of heaviness or fullness in the pelvis. - **Frequent urination:** The uterus can press on the bladder, making it difficult to hold urine. - **Constipation:** The uterus can press on the intestines, making it harder for stool to pass. - - Sluggish بطيئ bowels after childbirth - Pain may cause delayed elimination - Flatulence is common after cesarean birth **ELDERS** - **Constipation** is common due to: - Reduced activity levels - Inadequate fluid and fiber intake - Muscle weakness - Medication side effects - **Laxative Use** - Can inhibit natural reflexes and potentially worsen constipation. - Consistent laxative use may **lead to chronic constipation, electrolyte** imbalances, and reduced vitamin absorption. - **Recommendations** - Encourage responding to the gastrocolic reflex promptly. - Changes in bowel habits over weeks should be referred to a primary care provider. \--If you notice changes in your bowel habits that last for several weeks, see a doctor. Constipation Diarrhea, beelding - **EXAM TIP:** Elders have a higher risk of bowel eliminations disorders **BOWEL ELIMINATION: HEALTH PROMOTION** - **HEALTHY LIFESTYLE HABITS** - Maintain a healthy weight. - Exercise regularly. - Practice good toileting habits: - Avoid delayed voiding and defecation. - Avoid using pelvic floor muscles to force urine flow. - Ensure adequate fluid and fiber intake. - Address constipation or diarrhea as they occur. - **DIETARY RECOMMENDATIONS** - Follow a high-fiber diet. - Avoid smoking. - Drink enough fluids. - Avoid bladder and bowel irritants in food and drinks. - **MODIFIABLE RISK FACTORS** - Medical procedures requiring anesthesia. - Medications for other health conditions. - Lower socioeconomic status and education levels. - Poor hygiene and diet. - Traveling, especially to developing countries. **URINARY INCONTINENCE** - Involuntary urination **CONTRIBUTING FACTORS** - Relaxation of pelvic musculature - Disruption of cerebral and nervous system control - Disturbances of bladder and its musculature\-\-- **TYPES OF URINARY INCONTINENCE**: - **STRESS INCONTINENCE**: - Leakage during activities that increase abdominal pressure (e.g., coughing, sneezing, laughing) - Often due to weakened pelvic floor muscles - **URGE INCONTINENCE**: - Sudden, intense urge to urinate followed by involuntary urine loss - Often associated with an overactive bladder - **OVERFLOW INCONTINENCE**: - Leakage due to an overfilled bladder that cannot empty completely - May result from obstruction or weak bladder muscles - **NEUROGENIC BLADDER**: - Loss of bladder control due to neurological issues, causing either retention or incontinence - Common in conditions like spinal cord injuries or multiple sclerosis **EXAM TIP:** They will give us an example and you will have to apply the concept and choose the correct type of incontinence **ETIOLOGY (cause ) علم الأسباب OF URINARY INCONTINENCE** - **ACUTE (SELF-LIMITING) VS. CHRONIC** - **ACUTE**: Often temporary and may resolve partially or completely. - **CHRONIC**: Persistent and typically requires long-term management. - **CONGENITAL VS. ACQUIRED** - **CONGENITAL**: Present from birth. - **ACQUIRED**: مكتسب Develops due to factors such as aging, injury, or disease. - **Reversible vs. Irreversible** - **REVERSIBLE**: Often related to temporary conditions and may resolve with treatment. - **IRREVERSIBLE**: Linked to congenital disorders of nervous system disorders, where full recovery is less likely. **ETIOLOGY OF ACUTE, REVERSIBLE URINARY INCONTINENCE** - Polyuria (excessive urine production) - Exposure to Irritants (e.g., caffeine, alcohol, acidic foods) - Urinary Retention (incomplete emptying of the bladder) - Stool Impaction or Constipation (especially common in children) - Restricted Mobility or Dexterity (limiting access to toileting) - Psychological Conditions or Delirium هذيان - Medications (e.g., diuretics, sedatives) - Urinary Tract Infection (UTI) **EXAM TIP:** CONGENITAL disorders is a factor that affects urinary incontinence **ETIOLOGY OF CHRONIC, ACQUIRED IRREVERSIBLE URINARY INCONTINENCE** - Central Nervous System (CNS) and Spinal Cord Trauma - Stroke - Multiple Sclerosis - Parkinson\'s Disease **RISK FACTORS FOR URINARY INCONTINENCE** - **AGE**: Older adults are more at risk than younger individuals. - **GENDER**: Women are at higher risk than men. - **LIVING SITUATION**: Homebound individuals and those in long-term care (LTC). - **LIFESTYLE AND HEALTH** - Obesity - Smoking - Diabetes - Pregnancy and vaginal delivery - Inactivity\-\-- ○ عدم النشاط - **MENTAL AND PHYSICAL HEALTH** - Depression - Neurological disorders - Urinary Tract Infection (UTI) - Certain medications **PRIMARY PREVENTION OF URINARY INCONTINENCE** - **LIFESTYLE MODIFICATIONS** - Maintain a healthy weight - Follow a high-fiber diet - Avoid bladder irritants (e.g., caffeine, alcohol) - Consume adequate, but not excessive, fluid - Engage in regular exercise - Review medications for potential side effects - **ENVIRONMENTAL ADAPTATIONS** - Reduce physical barriers to toileting for individuals with limited mobility\-\-\-\-\-- making changes to a physical environment to make it easier for people with limited mobility to use the toilet. This could include things like installing grab bars, raising toilet seats, or widening doorways. - **MANIFESTATIONS OF URINARY INCONTINENCE مظاهر سلس البول** - Inability to delay urination - Increased frequency of urination - Urine leakage - Uncontrollable wetting - Frequent bladder infections **NONPHARMACOLOGIC THERAPY FOR URINARY INCONTINENCE** - **PELVIC FLOOR MUSCLE EXERCISES** (Kegel exercises) - **BEHAVIORAL MODIFICATION**: - Scheduled toileting - Habit training - Bladder training - **ABSORBENT PRODUCTS**: Pads and adult briefs - **DEVICES**: - Pessary (vaginal support device for the bladder) - Urethral insert (to prevent leaks) - **CATHETERIZATION**: For managing severe retention **catheterization is a method used to manage severe urinary retention.** **Here\'s a breakdown:** - **Catheterization: This refers to the process of inserting a thin tube (catheter) into the urethra to drain urine from the bladder.** - **Severe Retention: This means the bladder is unable to empty itself properly, leading to a buildup of urine.** **In cases where a person cannot urinate on their own, catheterization provides a way to relieve the bladder and prevent complications.** **EXAM TIP:** External catheter is for urinary retention (استبقاء) while internal is urethral (external) is for urinary incontinence **PEDIATRIC URINARY INCONTINENCE (ENURESIS)** - **AGE OF URINARY CONTINENCE**: Varies by child; most incontinence cases resolve on their own. - **DIURNAL ENURESIS (DAYTIME INCONTINENCE)** - **DIAGNOSIS**: Not typically diagnosed until age 5 or 6. - **CAUSES**: - Bladder irritability - Weak detrusor muscle - Constipation الإمساك - Structural abnormalities - Sexual abuse - UTI - Infrequent voiding التبول غير المتكرر - **NOCTURNAL ENURESIS (NIGHT-TIME INCONTINENCE) سلس البول الليلي** - **DIAGNOSIS**: Not typically diagnosed until age 7. - **TYPES**: - **PRIMARY**: Child has never achieved night-time control. - **SECONDARY**: Occurs after achieving 6 months of night-time dryness; often related to other issues like constipation, illness, developmental delay, or emotional stress. **Nocturnal Enuresis:** - **Night-time Incontinence:** This means the child is unable to control their bladder at night. - **Diagnosis:** Typically, doctors don\'t diagnose this condition until a child is 7 years old. - **Types:** - **Primary:** The child has never been able to stay dry at night. - **Secondary:** The child was previously dry at night but has started bedwetting again. This can be due to various reasons like constipation, illness, developmental delays, or emotional stress. - **ASSOCIATIONS**: - Daytime incontinence, encopresis (fecal incontinence), fecal impaction\-\-\--  Daytime **Incontinence:** This refers to the inability to control urine leakage during the day. -  **Encopresis:** This is a condition where a child has difficulty controlling their bowel movements and may have accidents. -  **Fecal Incontinence:** This is the inability to control bowel movements, leading to accidental bowel leaks. -  **Fecal Impaction:** This occurs when stool becomes hard and compacted in the rectum, making it difficult to pass. - Bladder dysfunction, male gender - Genetically linked decrease in antidiuretic hormone (ADH) production - **IMPACT**: Can lead to anxiety, stress, low self-esteem, and financial burden for families. - **TREATMENT FOR ENURESIS**: - Biofeedback - Acupuncture - Bladder training - Moisture alarms - Medications - Behavioral modification, including urgency containment exercises - **Biofeedback:** This involves using electronic devices to help children learn to control their bladder muscles. - **Acupuncture:** This involves inserting thin needles into specific points on the body to stimulate the nervous system. - **Bladder Training:** This involves teaching children to hold their urine for longer periods of time. - **Moisture Alarms:** These are devices that sound an alarm when the child starts to wet the bed, helping them to wake up and use the bathroom. - **Medications:** Certain medications can help reduce urine production at night. - **Behavioral Modification:** This involves teaching children healthy bladder habits and using techniques like urgency containment exercises. **URINARY INCONTINENCE IN PREGNANCY AND POSTPARTUM** - **Pregnancy:** - Caused by hormonal changes and the uterus pressing on the bladder. - **POSTPARTUM WOMEN**: النساء بعد الولادة: - Incontinence may be temporary or permanent. - Causes: - Edema from local trauma - Weakened bladder muscles - Nerve and structural damage - Pelvic organ prolapse, pushing organs into the vagina and preventing proper urethral closure. - **MANAGEMENT**: - Pelvic floor exercises - Bladder training **EXAM TIP:** Stress incontinence is the more common in pregnant women due to the increase abdominal pressure **URINARY INCONTINENCE IN THE ELDERLY** - **FUNCTIONAL INCONTINENCE**: - Common in older adults, especially in institutional settings. - **Contributing Factors**: - Limited mobility - Impaired vision - Dementia - Lack of access to toileting facilities - Lack of privacy **URINARY RETENTION** - Inability to empty the bladder **EXAM TIP:** Urinary incontinence is **most common in men with benign prostatic hyperplasia (BPH)** (large prostate) often presenting as: - **ACUTE**: Complete inability to urinate - **CHRONIC**: Persistent small residual volume of urine after voiding, leading to frequent, incomplete emptying ### ### ### **ETIOLOGY** - **Mechanical Obstruction or Functional Issues**: - **BPH** (most common cause) - Acute inflammation - Scarring from repeated UTIs - Bladder calculi (stones) - Anesthesia during surgery - Medication side effects ### **RISK FACTORS:** **عوامل الخطر** - Advanced age, male gender - History of prostate, bladder, or voiding problems - Urinary incontinence - Voluntary urinary retention - Surgery, brain or spinal cord injury/infection - Cognitive impairment, diabetes, constipation, immobility ### **TYPES OF URINARY RETENTION** - **ACUTE RETENTION**: - Sudden, painful inability to void a full bladder (medical emergency) - **CAUSES**: Surgical procedures, medications, UTI, fluid or alcohol intake, BPH - May include symptoms like bloating. - **CHRONIC RETENTION**: - Painless, often with increased residual urine volume\-\-\-- This text describes a condition where a person may have a lot of urine left in their bladder after they pee, but they don\'t feel any pain. This can be a sign of a bladder problem. - - Difficulty starting/maintaining urination, weak flow, frequent voiding with little output - Continuing sensation of needing to void and overflow incontinence ### **NONPHARMACOLOGIC TREATMENT** - Immediate bladder emptying via **catheterization** - Possible use of indwelling or intermittent catheterization to prevent future retention and bladder overdistention until the underlying issue is resolved **PREGNANCY** - Related to childbirth and obstetrical procedures - Risk factors: Epidural analgesia, birth weight of child, emergency C-section, prolonged surgery, postoperative analgesia - Early detection can prevent long-term issues. - **\*\*Pregnancy\*\*** - \- \*\*What it involves\*\*: Giving birth and any medical procedures related to it. - \- \*\*Things that can increase risk\*\*: - \- \*\*Epidural\*\*: Pain relief given during labor. - \- \*\*Baby\'s birth weight\*\*: Higher weight can make childbirth more challenging. - \- \*\*Emergency C-section\*\*: A quick surgery to deliver the baby if there are complications. - \- \*\*Long surgeries\*\*: The longer the surgery, the higher the risk of issues. - \- \*\*Pain relief after surgery\*\*: Medication to manage pain after childbirth can also increase risks. - - \- \*\*Why it matters\*\*: Finding problems early can help prevent serious health issues later. - - \*\*Example\*\*: - Sarah had an emergency C-section and used an epidural during delivery. Her doctors watched her closely afterward to catch any possible issues early. **ELDERS** - High risk due to chronic disease, polypharmacy - Common perioperative complication - Pelvic organ prolapse or detrusor underactivity - May involve underactive bladder due to neuronal signaling issues, ischemia, or weakened muscles\-\-\-- - \- \*\*High risk factors\*\*: - \- Long-term health issues (chronic disease) - \- Taking multiple medications (polypharmacy) - \- \*\*Common problem\*\*: - \- Complications during surgery (perioperative complication - \- \*\*Bladder issues\*\*: - **- Pelvic organs may shift out of place (pelvic organ prolapse)** - \- Bladder muscles may be too weak or slow to function normally (underactive bladder) - \- \*\*Why it happens\*\*: - \- Nerve signal problems - **- Poor blood flow (ischemia)** - \- Weak muscles - \*\*Example\*\*: - Maria, who has diabetes and takes several medications, had surgery. Afterward, her bladder felt weak because of nerve and muscle issues. **DISORDERS CONSTIPATION/IMPACTION & INCONTINENCE** **CONSTIPATION** - Fewer than three bowel movements per week or difficult passage of stools - Passage of dry, hard stool or no stool - Slow movement of feces through the large intestine, leading to more fluid reabsorption( **What happens**: Waste (feces) moves too slowly through the large intestine. -  **Result**: The body absorbs more water from the waste, which can make it harder to pass (constipation). - May feel incomplete evacuation after defecation ### **ETIOLOGY** - Factors slowing intestinal peristalsis: - Psychological factors: anxiety, depression - Behavioral factors: unhealthy lifestyle, voluntary stool retention, prior uncomfortable defecation, lack of opportunity to defecate ### **RISK FACTORS** - **LIFESTYLE AND PHYSICAL**: - Insufficient activity, immobility - Irregular defecation habits, changes in routine, lack of privacy - Chronic use of laxatives or enemas - **MEDICAL AND EMOTIONAL**: - Irritable bowel syndrome, pelvic floor dysfunction - Poor motility or slow transit, older age - Neurological conditions, emotional disturbance - **History of sexual assault, cognitive disturbance** - Medication side effects ### **PREVENTION** - **DIETARY METHODS**: - High-fiber diet, drinking plenty of fluids, fiber supplements - **BEHAVIORAL METHODS**: - Regular exercise, responding to the urge to defecate - Stool softeners, laxatives (stimulant laxatives for short-term use only) ### **CLINICAL MANIFESTATIONS** - Fewer bowel movements than usual - Frequent gas (flatus) - Abdominal discomfort, diminished appetite - Straining during defecation, hard, dry stools - Distended abdomen, reduced bowel sounds **FECAL IMPACTION** - Mass or collection of hardened feces in the rectum or colon. - In severe cases, feces may accumulate up into the sigmoid colon and beyond. - Recognized by the passage of liquid or foul-smelling material (diarrhea) in the absence of formed stool due to fecal seepage around the impacted mass. - **Symptoms**: - Odorous leakage - Constipation of solid stool - Rectal pain - Frequent, nonproductive urge to defecate - General feeling of illness - Abdominal distention and cramping - Sensation of fullness in the rectal area **CAUSES OF FECAL IMPACTION** - Poor defecation habits - Long-term dependence on laxatives or enemas - Constipation - Barium from radiologic gastrointestinal (GI) exams **CONSTIPATION IN PREGNANCY: TREATMENT** - **INITIAL TREATMENT**: - Increase activity - Increase fluid intake - Add dietary fiber **CONSTIPATION IN ELDERS** - **PREVALENCE**: Affects 24--50% of older adults; many use laxatives daily. - **AGE-RELATED CHANGES: Fecal transit in the large intestine slows with aging.** - **INCREASED INCIDENCE OF CONSTIPATION**: - Often related to: - Impaired general health - Increased medication use - Decreased physical activity - **CONTRIBUTING FACTORS**: - **Lack of teeth, ill-fitting or broken dentures** - Periodontal disease - Low dietary bulk and fiber intake - Self-limitation of fluid intake **FECAL INCONTINENCE** - **FECAL INCONTINENCE**: Loss of voluntary control over the discharge of feces and gas through the anal sphincter. - **PREVALENCE**: Less common than urinary incontinence. - **OCCURRENCE**: May happen at specific times or irregularly. - **PATIENT RELUCTANCE**: Patients often hesitate to disclose the issue, leading to overlooked treatment. - **ASSESSMENT**: Directly inquire about symptoms, especially with older adults and high-risk individuals. **ETIOLOGY** - **INTERFERENCE WITH SENSORY OR MOTOR CONTROL** of the rectum and anal sphincters - Paralysis from spinal cord injury or disease - Diarrhea - Stool impaction - Tumor - Pelvic floor relaxation - **LOSS OF SPHINCTER TONE العضلة العاصرة** due to: - Neurological factors - Local trauma - Inflammatory processes - Psychological factors ### **RISK FACTORS** - Nerve damage - Multiple sclerosis (MS) - Spinal cord injury - Diabetes - Older age and age-related changes - Female gender - Dementia - Physical disability ### **PREVENTION** - **ADDRESSING CAUSES**: - **CONSTIPATION**: Increase physical activity, fiber intake, and fluid intake. - **DIARRHEA**: Treat and eliminate underlying causes. - Avoid straining during defecation. - Perform pelvic floor exercises. ### **CLINICAL MANIFESTATIONS** - **LOSS OF VOLUNTARY BOWEL CONTROL**: - Stool or mucus leakage from the anus. - **MINOR INCONTINENCE**: Passing gas or small amounts of liquid fecal material. - **MAJOR INCONTINENCE**: Loss of entire bowel contents. - **ACCOMPANYING SYMPTOMS**: - Constipation - Diarrhea - Gas - Bloating - Abdominal cramping - Urinary incontinence - Emotional distress **ENCOPRESIS**: - Abnormal elimination pattern characterized by recurrent soiling or inappropriate stool passage in children who should have achieved bowel continence. - More common in boys, especially with a history of constipation. - **TYPES OF ENCOPRESIS**: - **PRIMARY**: Child has never achieved bowel control. - **SECONDARY**: Child had bowel continence for several months but regressed. **ETIOLOGY** - **VOLUNTARY OR INVOLUNTARY RETENTION**: - Often due to being \"too busy\" to use the toilet. - Results in constipation, dilation of the lower bowel, and sphincter incompetence. - Leads to irregular, painful, small, hard bowel movements and offensive body odor, which can impact social interactions and school performance. - **UNDERLYING CAUSES OF CONSTIPATION**: - Life changes (e.g., birth of a sibling, moving to a new home or school) - Emotional issues related to bowel training (e.g., anger, control issues) - Diet, busy schedules, and genetic predisposition ### **INTERVENTION AND THERAPIES** - **NURSING CARE**: - Educating the child and parents about the disorder and treatment options. - Providing emotional support. - **THERAPIES**: - Behavior modification techniques - Dietary changes - Psychotherapy Catheterization is used when the client **is unable to voi**d, not when they are incontinent. Diarrhea The immobile client is more likely to experience slowed motility and constipation. - PT bed and is immobile -   - Urinary tract infections\ \ Immobility affects nearly every organ system, including the cardiovascular, musculoskeletal, respiratory, central nervous, gastrointestinal, and genitourinary systems.  The increased risk of renal stones and urinary stasis lead to more frequent urinary tract infections. - Increased risk of kidney stones\ Kidney stones increase in likelihood in the client who is immobile. - Urinary stasis\ \ The ability to be mobile helps facilitate urine flow. When a client is immobile, urinary stasis occurs