NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023, Exams of Nursing

Download NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 and more Exams Nursing in PDF only on Docsity! NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR1023C: Study Guide: Modules 3/4 for Exam 2 Urine Elimination: Normal daily output 1440ml/day and 60ml/hr • Anuria: is the failure of the kidneys to excrete urine. It occurs as a result of any process that limits effective blood flow through the kidneys. Diagnosed when a catheter is passed into the bladder and no urine is present. Inadequate flow or complete obstruction by anything (stones, tumors, etc.) that blocks both ureters and the bladder, or obstructs the urethra, can lead to an anuric state, result in an acute or chronic renal failure. Risk for coma or death. Artificial filtering of waste products using renal dialysis may be necessary. Dialysis id a technique by which fluids and molecules pall through an artificial semipermeable membrane and are filtered by means of osmosis. • Polyuria: is an excessive volume of urine formed and excreted each day. For an adult, this would be 2500ml or more of urine per day. May be caused by consumption of a large amount of fluids, especially fluids that contain caffeine or alcohol, which have a natural diuretic effect, ingestion of too much salt or glucose, use of diuretic medications; diabetes; imaging tests that involve contrast media or dye, or other disease processes. • Oliguria: is defined as reduced urine volume less than 1ml/kg/h in NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 an infant, less than 0.5ml/kg/h in children, and less than 400ml/day in adults. Most easily observed by the nurse through frequent monitoring of the patient’s urinary output. Signs and symptoms vary according to underlying cause, patient may breathless, with pale, clammy, and cool skin, and have low blood pressure; may be signs of edema or anemia; and changes in the heart rhythm, hematomegaly. Symptom of acute or chronic renal failure, which can be classified as prerenal, renal, or postrenal failure. o Prerenal: occurs as a result of reduction in blood flow to the kidneys. Causes: dehydration, vascular collapse, and low cardiac output. o Renal: seen in patients with acute kidney damage. Causes: structural issues from primary glomerular diseases or vascular lesions. o Postrenal: related to a mechanical or functional obstruction of the flow of urine. • Urge incontinence: involves sudden strong urge to void, followed by rapid bladder contraction. The affected person does not have enough time for toileting between recognition of the urge to urinate and the onset of voiding. • Risk of having a urinary catheter: primary cause of UTIs; blockage; trauma to the urethra. • Urinary frequency: COCA : Color, odor, consistency, amount. NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 vegetables flushes fats and waste products more efficiently and helps keep stool soft. With consumption of gas- producing foods such as onions, cauliflower, and beans, intestinal walls can become distended, increasing colon motility. Food intolerance (e.g., lactose intolerance) results in digestive upset and, in some instances, the passage of watery stools, diarrhea, cramps, or flatulence. Fluid intake or loss affects characteristics of feces. Increased water intake eases the passage of stools. Poor fluid intake increases the risk of constipation because passage of stool is slower, promoting additional water reabsorption with resultant harder stools. Spicy foods produce diarrhea and flatus in some people. Cheese, pasta, eggs, and lean meats can be constipation-producing foods. Bran, prunes, figs, chocolate, and alcohol have a laxative effect. Many people whose lifestyle includes the same mealtimes daily exhibit a regularly timed response to food and a regular pattern of peristaltic activity in the colon. Fiber intake has been shown to assist the prevention of stool retention, especially when implemented with adequate water intake and exercise. Fiber creates enough friction along the bowel surface that it can assist in the production of a bowel movement. Fiber should be slowly added to the diet to prevent abdominal discomfort and excessive gas formation in the intestine. The American Dietetic Association recommends 14g of fiber per 1000 kcal intake. The average is 25g for adult women and 38g for adult men. • Normal bowel elimination: The small intestine is primarily NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 responsible for digestion and adsorption of nutrients in food. Along the lining of the intestinal tract are villi that help propel the food as it is metabolized and formed into a waste product. The large intestine has four parts: the cecum (and attached vermiform appendix), the colon, the rectum, and the anus. The function of the large intestine is to absorb water and electrolytes as the fecal matter moves through its walls. Mucus in the intestine helps lubricate the walls and aids in the expulsion of the stool. If there is excessive peristalsis and the stool moves through the large intestine quickly, less water is absorbed, resulting in a loose stool. If the peristalsis is reduced, feces pass through the large intestine slowly, resulting in greater absorption of water and a harder stool. When stool reaches the rectum, pressure stimulates the urge to defecate through stimulation of the intestinal smooth muscle and its stretch response. The urge to defecate can be suppressed until an appropriate environment is obtained. Avoidance of NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 contaminated water and foods can assist in maintaining consistent bowel habits. Bacteria in water or food can cause diarrhea and colitis. • Enemas: are the introduction of solutions into the rectum and sigmoid colon via the anus. Common use of enemas include relief of constipation, removal of impacted feces, emptying of the bowel before diagnostic testing or surgery, and beginning a program of bowel training. Patients should be placed in the Sims (left side- lying) position. Instruct patient to lie down on left side with lower leg extended and upper leg flexed for support; or place the patient in the knee-chest position. o Cleansing enemas: ▪ Hypertonic: DESCRIPTION: Work by osmotic pressure, drawing fluid out of interstitial spaces into the colon, which then fills with fluids and distends. VOLUME: 120-1000mL. USES: Empty the bowel and remove feces through instillation of fluid. PRIMARY ACTION: peristalsis stimulation. ▪ Isotonic: DESCRIPTION: Work by expanding the colon, thus promoting peristalsis. VOLUME: 120- 1000mL. USES: Empty the bowel and remove feces through instillation of fluid. PRIMARY ACTION: peristalsis stimulation. o Oil retention enemas: DESCRIPTION: The feces absorb the NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 Albumin is synthesized in the liver and accounts for almost half of the total serum protein in the human body. Decreased levels may be caused by renal and liver disorders, altered fluid status, medications, chronic diseases, and malnutrition. Elevated levels may result from decreased fluid balance (dehydration), exercise, or medications. Abdominal assessment • Assessing bowel sounds: Auscultation is limited to the abdomen to listen to bowel sounds. Bowel sounds should be heard in all four quadrants. An absence of bowel sounds may be associated with paralytic ileus; hyperactive bowel sounds may be noted with gastrointestinal inflammation or with intestinal obstruction. Normal bowel sounds are irregular, high-pitched, and gurgling and occur every 5 to 15 seconds. Hyperactive bowel sounds tend to be loud, high- pitched and rushing; they are commonly heard with diarrhea or inflammatory disorders. Hypoactive bowel sounds are slow and sluggish, with occurrence of less than five sounds per minute. Decreased bowel sounds are common after surgery. Absence of sounds may be a sign of obstruction or paralytic ileus. Patients with ileus or intestinal obstruction require immediate medical attention. The nurse listens for 5 full minutes before documenting the absence of sounds. • Post surgery: Decreased bowel sounds are common after surgery. NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 Surgery that requires manipulation of the intestines causes temporary cessation of intestinal movement. The stoppage is called paralytic ileus, which lasts 24 to 48 hours. For patients who remain inactive or are unable to eat after surgery, return of bowel function may be further delayed. Patients whose surgery was conducted with use of spinal or local anesthesia are less likely to experience this problem. Early activity and frequent assessment of bowel sounds are important during this period. • Long-term use of antibiotics: Antibiotics contribute to diarrhea by interfering with the normal bacterial flora in the GI tract. In elderly patients, this can lead to C. diff. • Gastroenteritis treatment: Oral rehydration therapy, plenty of rest, reintroduction of foods. Electrolytes SODIUM (Na+): NORMAL LEVEL: 135-145 mEq/L: principal ion responsible for resting membrane potential of cells, essential in depolarization needed for nerve and muscle function, principle cation of the ECF- accounts for 90% to 95% of osmolarity, Na-K pump important mechanism for producing body heat, essential element for acid-base buffering. NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 • HYPONATREMIA (Na+ < 135 mEq/L) o UNDERLYING CAUSES: Hypovolemic hyponatremia, Diuretics, GI fluid loss (vomiting, diarrhea), Profuse diaphoresis, Hypervolemic hyponatremia, Water intoxication, Prolonged use of hypotonic IV solutions, SIADH o CLINICAL MANAFESTATIONS: Lethargy (confusion, weakness), Muscle cramping, Seizures, Anorexia (nausea, vomiting), Serum osmolarity <280 mOsm/kg • SALT LOSS: o S- Stupor/coma o A- anorexia, N&V o L- lethargy o T- tendon reflexes decreased o L- limp muscles (weakness) o O- orthostatic hypotension o S- seizures/headache o S- stomach cramping o INTERVENTIONS: Monitor vital signs, Monitor intake and output, Monitor lab results (especially serum sodium and serum osmolality), Encourage foods high in sodium, Restrict water intake, Administer hypertonic IV saline solutions as ordered. NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 • A- alkalosis • S- shallow respirations • I- irritability • C- confusion • W- weakness • A- arrhythmias • L- lethargy • T- thread pulse o INTERVENTIONS: Monitor vital signs (especially heart rate and rhythm), Monitor cardiac rhythm with ECG, Monitor lab results for serum potassium levels, Assess for signs of digitalis toxicity, Encourage foods high in potassium, Administer potassium supplements as ordered; IV potassium is diluted properly and administered slowly, usually by infusion. NEVER administer potassium as an IV bolus or IV push! • HYPERKALEMIA (K+ > 5.0 mEq/L) o UNDERLYING CAUSES: Renal failure, Massive trauma (crushing injuries, burns), Hemolysis, IV potassium, Potassium-sparing diuretics, Acidosis (especially diebetic ketoacidosis) NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 o CLINICAL MANIFESTATIONS: Anxiety, irritability, confusion, Dysrhythmias (including bradycardia and heart block), Muscle weakness, flaccid paralysis, Paresthesia, Abdominal cramping ▪ MURDER: • M- muscle cramps • U- urine abnormalities • R- respiratory distress • D- decreased cardiac contractility • E- EKG changes • R- reflexes o INTERVENTIONS: Monitor vital signs (especially heart rate and rhythm), Monitor cardiac rhythm with ECG, Monitor laboratory results for serum potassium-rich foods, Administer cation- exchange resins (Kayexalate) as ordered, Administer glucose and insulin as ordered (potassium moves back into cell). CALCIUM (Ca2+): NORMAL LEVEL: 8.5-10.5 mq/dL: along with phosphate, the primary component of bones and teeth- up to 99% of calcium is found in teeth and bones, role in blood clotting, nerve impulse transmission, cardiac conduction, and muscle contraction. • HYPOCALCEMIA (Ca2+ < 8.5 mg/dL) o UNDERLYING CAUSES: Hypoparathyroidism, NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 Pancreatitis, Vitamin D deficiency, Inadequate intake of calcium-rich foods, Hyperphosphatemia, Chronic alcoholism o CLINICAL MANIFESTATIONS: Confusion, anxiety, Numbness and tingling of extremities, Muscle cramps that progress to tetany and convulsions, Hyperactive reflexes, Cardia dysrhythmias, Positive Chvostek and Trousseau signs ▪ CATS: • C- convulsions • A- arrhythmias • T- tetany • S- stridor and spasms o INTERVENTIONS: Monitor heart rate and rhythm, Monitor cardiac rhythm with ECG, Institute fall and seizure precautions, Administer oral and/or IV calcium supplements as ordered, Encourage calcium-rich foods. • HYPERCALCEMIA (Ca2+ > 10.5 mg/dL) o UNDERLYING CAUSES: Prolonged bed rest, Hyperparathyroidism, Bone malignancy, Paget disease, Osteoporosis NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 Dysrhythmias (especially bradycardia and heart block), Slow, shallow respirations; respiratory arrest NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 ▪ Low “everything” bp, hr, resp, energy and reflexes ▪ Vasodilation ▪ Diaphoresis ▪ Skeletal muscle weakness o INTERVENTIONS: Assess vital signs (especially heart rate and rhythm), Monitor cardiac rhythm with ECG, Assess mental status (changes in level of consciousness), Assess neuromuscular strength and activity, Encourage increased IV fluids, Administer loop diuretics as ordered, Provide respiratory support (supplemental oxygen or mechanical ventilation) as needed. CHLORIDE (Cl-): NORMAL LEVEL: 95-105 mEq/L: most abundant anion in the ECF, key role in maintaining serum osmolarity, required for formation of stomach acid, buffering role in acid-base balance PHOSPHATE (PO43-): NORMAL LEVEL: 1.7- 2.6 mEq/L: most abundant anion in the ICF, along with calcium, helps maintain bone and teeth structure, role in cellular metabolism and ATP production, essential for carbohydrate metabolism • Chvostek’s sign: spasm of the facial muscle after tapping on the facial nerve. Hypocalcemia NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 • Trousseau’s sign: spasm of the muscles in the hand and wrist from pressure on the nerves of the upper arm. Hypocalcemia • Protecting from injury: the goal for nursing is to prevent imbalances whenever possible. This includes ongoing assessment and instruction to patients, families, and other health care providers on adequate fluid intake and dietary requirements of electrolytes. The nurse should remember that fluid and electrolyte imbalances affect function in other areas. Intake and output • Intake: Compromises all fluids and foods that become liquid at room temperature (including gelatin, popsicles, ice cream, and ice chips). Other sources of fluid intake include enteral tube feedings, nasogastric or bladder irrigations, and large-volume enemas. • Output: Consists of body fluids and drainage that can be measured. This includes: urine, emesis, liquid stool, wound drainage, and drainage from suction devices. • Measured: When assessing intake and output, the nurse documents over a 24-hour period. The fluid balance is positive when intake exceeds output, and it’s negative when output exceeds intake. To measure output in infants and incontinent adults, the diapers or disposable briefs are weighed to determine fluid amount. For critically NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 • Thickened liquids: used for patients who have difficulty swallowing and are at risk for aspiration. Liquids can be thickened by adding a commercially prepared thickening agent. Nuts, seeds, and other hard or raw foods should be avoided, to decrease the risk of aspiration. • Diabetic (ADA): diets are prescribed to control the amount of calories by controlling the carbohydrate intake. Foods that have a high glycemic index and rapidly raise the body’s blood glucose concentration should be avoided. High-fiber complex carbohydrates from vegetables and fruits are preferred to simple carbohydrates, sugars, and starchy foods such as bread or pie. • Cardiac: diets are used to control the dietary intake of foods that contribute to conditions affecting the cardiovascular system. They typically consist of low- cholesterol and low-sodium dietary items. They minimize the intake of animal products, which contain cholesterol, and soups and processed foods such as pickles and lunchmeats, which are high in sodium. Patients with hypertension, high cholesterol, atherosclerosis, chronic renal failure, or similar disease may be placed on some type of cardiac (low-cholesterol, low- sodium) diet. • Renal: diets restrict potassium, sodium, protein, and phosphorus intake. Fresh fruits (except bananas) and vegetables are excellent dietary choices for people on a renal diet. Meats, processed foods, and peanut butter, cheese, nuts, caramels, ice cream, and colas NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 typically are allowed in limited quantities or contraindicated. Diagnostic testing • Colonoscopy: a procedure performed to visualize inflamed tissue, ulcers, and abdominal growths in the anus, rectum, and colon. The procedure is used to look for early signs of early signs of colorectal cancer and to diagnose unexplained changes in bowel habits, abdominal pain bleeding from the anus, and weight loss. Before the procedure, the patient performs bowel preparation to empty solids from the GI tract by following a clear liquid diet for 1 to 3 days. The patient should not drink beverages containing red or purple dye. A laxative or enema may be required the night before the colonoscopy. Patients should inform the PCP of all medical conditions and any medications, vitamins, or supplements taken regularly, including aspirin, arthritis medications, anticoagulants, diabetes medications, and vitamins that contain iron. Patients usually are on NPO status for several hours before the procedure. • MRI: is the most common diagnostic examination for brain pathology and joint visualization. It involves the use of a superconducting magnet and radiofrequency waves that cause hydrogen nuclei to emit signals. A computer translates the signals into a well-defined image of the structure. It allows better visualization of blood vessels and signs of hemorrhage within hours of the event. The magnet can affect the functioning of computerized equipment such as IV infusion pumps NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 and mechanical ventilators. Because the magnet can move metal objects implanted in the body, it is contraindicated for patients with pacemakers, inner ear implants, NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 • Needle aspirations and biopsies: procedures that are used to remove fluid and tissue for testing. Fine-needle aspiration is a method for obtaining samples with • minimal trauma to the underlying organ or structure. A paracentesis (site: peritoneal cavity) involves removing fluid from the peritoneal cavity; a thoracentesis (site: pleural cavity) removes fluid from the pleural space. A biopsy involves removing a larger collection of cells, as in a tumor or mass, and may be used to detect cancer in the skin, breast, or liver. Samples can be obtained from any part of the body that can be accessed by the needle. Bacteriologic examination may be conducted on the samples aspirated. Thermoregulation • Assessment of temperature: body temperature is measure in degrees on either the Fahrenheit or the Celsius scale. The reliability of temperature values depends on selecting the most appropriate site, using the correct equipment, and using the correct procedure to obtain the measurement. The five sites commonly used to measure temperature are the mouth, ear, rectum, forehead (where the temporal artery is close to the skin), and the axilla. Depending on patient status, any of these sites may be appropriate if the proper technique is used. Site selection is affected by patient age, state of consciousness, amount of pain the patient is suffering, and treatment the patient is undergoing, such as oxygen supplementation. Normal NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 temperature varies among sites. Core temperatures can be measured with specialized equipment through the esophagus or pulmonary artery sites. The measuring device used is dependent on site. o Oral: NORMAL RANGE: 96.8- 99.68 F; most common site for measuring temp; patient must be able to close mouth around thermometer; ADVANTAGES: readily accessible and comfortable for the patient; eating, drinking, smoking, and the use of oxygen by cannula or mask can affect measurements; not the preferred site for infants and young children, unconscious patients, post- oral surgery patients, or people with seizure disorders. o Axillary: NORMAL RANGE: 95.9- 98.6 F; may be used when the oral and rectal sites are contraindicated or inaccessible; frequently used for healthy newborns; acceptable for infants, children, and patients who cannot tolerate measurements by other routes. o Rectal: NORMAL RANGE: 93.92- 100.04 F; considered very accurate; not a preferred site by patients; rectal route is contraindicated in newborns, in patients who are neutropenic, and in patients with spinal cord injury; should not be used for patients with diarrhea or rectal disease, post-rectal surgery, or quadriplegic patients. o Tympanic (ear): NORMAL RANGE: 96.08- 99.32 F; core temp; easily accessed for both adults and children; appropriate for patients who are confused or NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 those who are unconscious; not appropriate for patients with ear drainage or eardrum scarring. o Temporal: NORMAL RANGE: 99.98- 99.14 F; well tolerated by infants and young children; not affected by mild perspiration when performed correctly. • Febrile: a person with a fever • Afebrile: a person who maintains normal body temperature of oral 98.6 • Changes seen throughout lifespan: newborns have unstable body temperatures because of immature regulatory mechanisms. Even a mild rise in temperature is significant in infants younger than 3 months of age. It is common for the baseline temperature to drop as the person ages. Infants and elderly people are more susceptible to environmental temperatures. Fluid balance • Osmolarity: The number of osmals per liter of solvent. Osmolarity is used to denote solute concentration. • Isotonic solution: Is an administered solution that has the same osmolarity as blood plasma. Normal Saline: 0.9% • Hypotonic solution: Solution with a lower osmolarity than normal body fluids. Excess water moves into the cells, producing cellular swelling. Half Saline 0.45% • Hypertonic solution: pulls water from the cell to the extracellular NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 o Isotonic fluid volume deficit (hypovolemia): CAUSES: hemorrhage, burns, vomiting, diarrhea, Addison disease, fever, excessive perspiration. CLINICAL MANIFESTATIONS: confusion, thirst, dry mucous membranes, orthostatic hypotension, tachycardia, week and thread pulse, decreased skin turgor, prolonged cap refill, decreased urinary output. LABORATORY FINDINGS: urine specific gravity >1.030, increased hematocrit in adult male >52 and female >48, BUN >20. o Hypertonic fluid volume deficit (dehydration): CAUSES: diabetic insipidus, diabetic ketoacidosis, administration of osmotic diuretics, hypertonic enteral tube feedings, or hypertonic intravenous fluids, prolonged vomiting and diarrhea. CLINICAL MANIFESTATIONS: similar to hypovolemia, dry sticky mucous membranes, flushed dry skin, increased body temperature, irritability, convulsions, and coma. LABORATORY FINDINGS: urine specific gravity >1.030, increased hematocrit in adult male >52 and female >48, BUN >20, serum sodium >145. • Ways to control fluid changes and assess them: maintaining adequate fluid volume requires a balance between fluid intake and output. Most of the water is brought into the body through intake of fluids or food. A small amount of water is generated through various metabolic processes, including the breakdown or carbohydrates. Fluid volume NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 and composition are regulated by several body systems, hormones, and other homeostatic mechanisms. o Homeostasis: the maintenance of fluid balance, is controlled by several physiologic mechanisms, including the renin- angiotensin system, the secretion of antidiuretic hormone, and the thirst mechanism. Monitored by the kidneys through changes in blood pressure. ▪ Renin-angiotensin system: regulates blood pressure and fluid balance through vasoconstriction and excretion or reabsorption of sodium. ▪ Antidiuretic hormone (ADH): secreted by the pituitary gland, maintains serum osmolality by controlling the amount of water excreted in the urine. ▪ Osmoreceptors: located in the hypothalamus, monitor the osmolarity of blood plasma. When osmolarity increases, the osmoreceptors stimulate the posterior pituitary to secrete ADH. ADH works on the collecting ducts of the kidneys to reabsorb more water, and less urine is produced as a result. As more water moves back into the bloodstream, the plasma osmolarity decreases and returns back to normal, and the pituitary stops releasing ADH through a negative feedback loop. ▪ Atrial natriuretic peptide (ANP): secreted by cells in the atrium of the heart in response to an increase in blood NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 pressure. When released, ANP causes an increase in the glomerular filtration rate (GFR), which NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 o This central perfusion propels blood to all organs and their tissues from patent arteries through capillaries and returns the blood to the heart through patent veins. Although the mechanics of flow are the same to each target tissue, various factors can reduce cardiac output from the heart or cause systemic vasodilation or vasoconstriction to impair central perfusion. When central perfusion is impaired, clinical manifestations are systemic; in other words, the entire body is affected. Significant reduction of central perfusion results in shock, which occurs when blood supply to tissues is impaired because of inadequate cardiac output, significant blood loss, or vasodilation throughout the body. • Lab values reflecting kidney function: High BUN is dehydration. Creatinine is used to monitor kidney function. Blood Urea Nitrogen and Creatinine: urea is the end product of protein metabolism, and is measured as BUN. Creatinine is a waste product that is produced in the blood as a by-product of muscle metabolism. Urea is cleared by the kidney, and levels me be increased in the patient who is dehydrated or who has a disease that compromises the function of the kidney. Normal levels of BUN in the blood are 7 to 20mg/dL. NCLEX: 8- 25 mg/ml. Elevated levels may indicate kidney injury or disease as well as conditions such as diabetes, high blood pressure, blockage of the urinary tract, a high- protein diet, severe burns, gastrointestinal bleeding, or problems such as dehydration or heart failure, which NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 affect blood flow. Medications also may elevate BUN levels. Low Bun values may be caused by a low protein diet, malnutrition, liver damage, or drinking excessive amounts of liquids. No pretest preparation is required; however, medications, such as certain antibiotics, corticosteroids, and diuretics, may affect test results. Creatinine is filtered along with other waste products from the blood by the kidney and eliminated in the urine. It is made at a steady rate, and levels are not affected by diet or by normal physical activities. The patient with kidney damage has decreased urinary creatinine but increased serum levels. The amount of creatinine in the blood is directly related to muscle mass; generally creatinine levels are higher in men than in women. Normal values of serum creatinine are 0.6 to 1.2mg/dL for women and 0.8 to 1.4mg/dL for men. NCLEX: 0.6- 1.3mg/ml BUN and serum creatinine are viewed in relationship to each other, sudden rises in BUN-to- NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 creatinine ratios occur in acute kidney failure associated with shock, dehydration, or severe gastrointestinal bleeding. Low BUN-to- creatinine ratios are seen in patients on low-protein diets or those with severe muscle injury, cirrhosis of the liver, or syndrome of inappropriate antidiuretic hormone (SIADH). • Urinary tract infection (UTI): infection occurs when bacteria from the digestive tract, usually E.coli, invade the urethra and multiple. UTI is the single most common hospital-acquired infection. UTI can occur in anyone, females are more vulnerable than males, with the rate of occurrence gradually increasing with age. People with an elevated risk for infection include those with any abnormality of the urinary tract that obstructs the flow of urine, those with catheters in place, those who have difficulty voiding, and elderly people with bladder control loss. Diabetes or other diseases that suppress the immune system increase the risk of UTI. o s/s in adults and older adults: frequent urination and burning during micturition. If a UTI is suspected, urine may be checked for nitrates. Nitrate levels increase when bacteria are present; changes in mental status may be a symptom of elevated nitrogenous wastes in the blood. • Characteristics of urine: urine can be produced in large or small amounts; can be dilute or very concentrated. Normal urine is sterile. It contains fluids, salts, and waste products, but it is free of bacteria, viruses, and fungi. The average adult passes one to two quarts (960 to NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 by ingestion of certain foods. A special diet is prescribed 48 to 72 hours before the test. Foods that affect the test results and therefore should be avoided are beets, broccoli, cantaloupe, carrots, cauliflower, cucumbers, fish, grapefruit, horseradish, mushrooms, poultry, radishes, red meat, turnips, and vitamin C-enriched foods and beverages. Fecal collection systems: A bag and tube system that uses a rigid tube inserted into the rectum is used to collect liquid stool in patients with incontinence who are not candidates for bowel retraining. These systems may also be used to relieve flatus. • Characteristics of loose stools: Diarrhea, loose-watery stool? Hyperactive bowel sounds, urgency, abdominal pain, and cramping are all characteristics of diarrhea. Ingested materials pass too quickly through the intestine, resulting in a decrease in the amount of time for absorption of fluids and nutrients. The patient with diarrhea produces an increased number of stools, with passage of liquid or unformed feces, and finds it difficult to control the urge to defecate. In addition to frequent liquid stools, patients often experience spasmodic cramps and increased bowel sounds. Serious fluid and electrolyte losses can develop within a short time, particularly in infants, small children, and elderly people, causing symptoms of nausea, vomiting, headache, confusion, fatigue, restlessness, and muscle weakness and spasms. C. dif most commonly affects older adults in hospitals and long-term care facilities and typically occurs after NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 use of antibiotic medications. The most common clinical picture in mild to moderate C-diff consists of occurrence of foul smelling, watery diarrhea three or more times a day for 2 or more days. o Normal- how many a day? 2-3 times a week to several times a day. Ask pt what is normal for them. • Effects of Smoking: Tobacco use (smoking) is a major factor in development of lung disease and impaired respiratory functions. Chronic exposure to tobacco smoke has been confirmed to be harmful not only to the smoker but to everyone who is exposed to secondhand smoke. The effects of chronic exposure to air pollution and environmental toxins such as housecleaning products that can cause complications in patients with chronic respiratory conditions. • Effects of increased fluid volume on heart function??? • Enzymes released from damaged cells and circulate in the blood can be measured to help confirm impaired perfusion. o Creating Kinase (CK) is an enzyme present in myocardium (CK- MB), in muscle (CK-MM), and in brain (CK-BB) tissues. When enzymes are isolated, the level of CK-MB is elevated after a myocardial infarction. o Lactate dehydration (LDH) is an enzyme found in large amounts in the heart, liver, muslces, and erythrocytes. When enzymes are isolated, the level of LDH1 isoenzyme is elevated after NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 damage to the myocardium and erythrocytes. o Natriuretic peptides include two hormones. Atrial natriuretic peptide (ANP) is a hormone secreted from right atrial cells when right atrial pressure increases; it is used to detect heart failure. Brain-type natriuretic peptide (BNP) is a hormone secreted from cardiac cells increased amounts when pressures are high; it is used to detect heart failure. o Troponin is a myocardial muscle protein released after myocardial injury. Increased blood levels of this protein are found in patients who have had a myocardial infarction. Troponin also can be used to predict the likelihood of future cardiac events. o Homocysteine (Hcy) is an amino acid produced during protein metabolism. Elevated levels of Hcy can be hereditary or acquired from dietary deficiencies such as vitamin B6, vitamin B12, or folate. The link to perfusion is that elevated levels of Hcy have been identified as a predictor of coronary artery disease (CAD), cerebrovascular accident, peripheral arterial disease, and venous thrombosis. Hcy promotes atherosclerosis by causing endothelial NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 adhesive backing and is placed o that it surrounds the genitals; when sufficient urine is NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 collected, the bag is removed and urine is put into a specimen cup to send to the lab.  The patient with an incarcerated hernia is at risk for the hernia to become: a. Strangulated. b. Indirect. c. Direct. d. Irreducible. i. The incarcerated hernia may become strangulated, which cuts off the blood supply and can lead to necrosis of the trapped bowel loop. Hernias are classified as reducible, which means the protruding organ can be returned to its proper place by pressing on the organ, and irreducible, which mean that the protruding part of the organ is tightly wedged outside the cavity and cannot be pushed back through the opening. Another name for an irreducible hernia is incarcerated hernia. An indirect hernia protrudes though the inguinal ring. A direct hernia protrudes though the posterior inguinal ring.  The nurse explains that diverticula occur in the older adult because: a. Loss of bowel tone reduces motility. b. Changes in bowel wall allow herniation. c. The diet may be deficient in bulk. d. Multipharmacy has altered bowel mucosa. NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 i. The bowel wall in the older adult becomes thickened and rigid. Intra- abdominal pressure causes herniation of the mucosa through the bowel wall, causing a small pocket in the colon.  The nurse is aware that an unresolved bowel obstruction can lead to: a. Systemic infection and fever. b. Bowel rupture and shock. c. Adhesions and pain. d. Bloating and expelling gas. i. An unresolved obstruction can cause bowel rupture, peritonitis, shock, and death.  The nurse explains that the most beneficial diet for a person with inflammatory bowel disease (IBD) is a diet. a. Low-fat, high-fiber. b. High-fiber, how-protein. c. Mechanical soft, low-sodium. d. Low-protein, low-calorie. i. A low-fat, low-fiber, high-protein, high-calorie diet is recommended for the patient with IBD to make up for the loss of fluid and nutrients in the frequent stools. NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 b. 150 mL c. 250 mL d. 300 mL i. The patient has had an oral fluid intake of 900 mL and an IV fluid intake of 150 mL, giving a total of 1050 mL. This leaves 150 mL that the patient may consume for the rest of the evening to stay within the prescribed fluid restriction.  The nurse is caring for a patient who has a history of congestive heart failure. The nurse includes the diagnosis fluid volume excess in the patient’s care plan. Which goal statement has the highest priority for the patient and nurse? a. The patient’s lung sound will remain clear. b. The patient will have urine output of at least 30 mL/hr. c. The patient will verbalize understanding of fluid restrictions. d. The patient’s pitting pedal edema will resolve within 72 hours. i. Oxygenation is the highest priority for the patient with congestive heart failure and fluid volume excess. Keeping the patient’s lungs clear is the most important goal for the nurse to consider when caring for this patient.  The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH) who has a serum sodium level of 118 mEq/dL and symptoms of fluid overload. Which IV fluid would the nurse expect to administer to this patient in order to NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 correct the patient’s fluid imbalance? a. 0.33% normal saline b. 0.45% normal saline c. 0.9% normal saline d. 3% normal saline i. A hypertonic 3% saline solution will be used to correct the patient’s hyponatremia and fluid overload that have developed as a result of SIADH. A 0.9% normal saline solution can be used once the serum sodium level has been raised near to normal range. A 0.45% or 0.33% normal saline solution is hypotonic and will only worsen the patient’s fluid overload and hyponatremia.  The nurse is caring for a patient who has a history of congestive heart failure and takes once daily furosemide (Lasix) in order to prevent fluid overload and pulmonary edema. The patient tells the nurse that she has stopped taking the medication because she has to urinate frequently during the night. What is the nurse’s best response? a. “You should ask your doctor to decrease the dose.” b. “Take the diuretic early in the morning before breakfast.” c. “Eat foods high in potassium and limit your salt intake.” d. “Restrict your fluid intake after dinner and in the evening.” NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023 i. The patient should be instructed to take the diuretic early in the morning so that the effects will wear off before the patient goes to bed at night. Decreasing the dose could lead to fluid overload and pulmonary edema.  The nurse is caring for a patient with a history of hyperparathyroidism who presents with a serum calcium level of 14.5 mg/dL. What is the highest priority nursing diagnosis for this patient? a. Risk for injury related to weakened bones that may easily fracture. b. Deficient knowledge related to need for supplemental calcium in diet. c. Risk for constipation caused by decreased gastrointestinal motility. d. Activity intolerance related to muscle cramping and spasms. i. Chronic hypercalcemia can lead to weakened bones as strengthening calcium is removed over time. Pathological fractures can easily result, so risk for injury is a high priority nursing diagnosis for this patient. The other nursing diagnoses apply but are less important than the safety of the patient.  The nurse is caring for a patient who is admitted to the hospital with dehydration and gastroenteritis. The patient attempted to walk to the NUR 1023C Second 8 Weeks Exam 2 Study Guide New Update 2022/2023