Acute Care Nursing Exam 2

Polyuria Increased urine production mL Oliguria Decreased urine production 500 mL day 30 mL hr Anuria No urine production - Dialysis patient - Kidney failure Frequency Voiding 4-6 daily Often small quantity 50-100 mL Causes - Pregnancy - UTI - Increased fluid intake - Stress Nocturia Awaken at night to urinate Greater than or equal to 2x nightly Urgency Strong desire to void Causes - Irritation of trigone and urethra - Poor sphincter control - Unstable bladder contraction - Stress Dysuria Painful urination Causes - Urinary infection - Bladder or urethra injury Dysuria S/S Need to push to void Burning with or after urination (often associated with hesistancy) Urinary Incontinence Inability to control bladder Not a disease Infectious Cystitis Causes Small urine volume or infrequent voiding Sex Catheter not drained to gravity r/t upward migration of microorganisms (E.coli) Cystitis and Catheters Indwelling Suprapubic Intermittent Condom Pure Wick Assessing Cystitis Frequency Urgency Dysuria Hesitancy/difficulty starting stream Cloudy, foul smell Hematuria Assessing Cystitis in Older Adult Confusion Falls Incontinence Decreased appetite Urosepsis - Fever - Tachycardia - Tachypnea - Hypotension Routine Urinalysis 10 mL minimum No feces Note if on period Aseptic No room temp for prolonged time due changes in concentration (process within and hour) Clean Catch/Midstream Sterile Discard small amount (30mL) Void into sterile container (10mL) Stop collecting urine before patient empties bladder Patient can collect on own if proper technique Sterile Specimen Obtain by catheterizing patient or taking from indwelling catheter Use cath port, no drain bag Syringe Antiseptic swab Clamp Nonsterile gloves 24 Hour Specimen Discard first urine, and collect rest for 24 hours. Specific Gravity 1.010-1.025 Increased shows dehydration Cytoscopy Visual of bladder and urethra Liquids allowed on am of Tissue swelling, dysuria, and hematuria may occur Increased fluid intake post procedure and observe output 24 hours Pyelogram Not for patients with increased BUN/creat Not for pregnant women Renal Ultrasound Non invasive visual Catheter Care Peri care Alternatives Change bag Oxybutynin (Ditropan) Antispasmodic Decrease muscle spasm of bladder and urine tract Side Effects - Abd pain - Decreased diaphoresis - Dry eyes - Constipation - Dehydration Cystitis Intervention Fluids Warm sitz bath 2-3x daily for 20 min Clean front to back Shower before and after sex No scented TP, BB, or nylon panties HH Fluid Intake Void q4h Assessing BPH Hematuria Dribbling Frequency and Nocturia Urgency Straining to void Incomplete emptying Retention/Inability to void (EMERGENCY) BPH Labs/Diagnostics Urinalysis and Urine Culture WBC BUN/Creatinine PSA (prostate specific antigen) BPH Intervention Increased fluid intake but slowly, no large amount at short time No - ETOH - Diuretic - Caffeine - Meds causing retention (antihistamine & decongestant) Void as soon as urge appears BPH Meds Finasteride (Proscar) Takes a long time to kick in, no results til about 6 mon Women of childbearing ages must wear gloves to handle drug Side Effects - Decreased libido - Erectile dysfxn - Dizziness TURP (BPH) Assessment Pain Anxiety Bleeding (H&H) (patient may go through repeatedly) Edema Discharge Urine Color Platelet WBC TURP Interventions I&O q2 Discard thinners Reduce anxiety Pain manage Fluids Continuous bladder irrigation Prevent - Bleeding (PRIORITY) - Infection - Cath obstruction TURP Education Cath with be in place for several days Cath traction may be in place CBI with NaCl may be in place for several days Increase fluids 2-2.5 L/daily Constipation Fewer than 3 BM weekly Passing dry hard stool Prolonged constipation can result in impaction Risk for Impaction Poor poop habits Anticholinergics Anthistamines Constipation S/S Distention Increased effort/straining Feeling of incomplete poop Hypoactive bowel Impaction S/S Seepage Rectal pain Freq. non productive urge to poop Stool Culture Obtain before antibx therapy No contaminated feces Guaiac Test Chem that test blood in poop Occult Test Shows blood that's hidden in stool Can be collected at home then sent to facility Period? wait 3 days Stool Specimen Pee first Don't poop in toilet-- use pan, hat, etc No tissue or soap Include blood, pus, mucus that's already present in stool Lab ASAP 1 in or 15-30 mL liquid stool Constipation Intervention Fluid Fiber Activity Prune Juice Hot coffee Laxative (metamucil) Oil retention enema (lubricates stool)- retain for 30 min Suppositories Stool softener (docusate sodium) Diarrhea Liquid feces & increased frequency Common cause = C.diff C. Diff Foul smelling mucoid diarrhea C.Diff Risk Elders Immunosuppressed Recently on antibx r/t underlying dz or exposure to hosital/ltc Assessing Diarrhea Frequency Liquid stool Cramping Hyperactive bowel Electrolyte imbalance Skin breakdown Diarrhea Intervention Watch electrolyte imbalance C.diff Prevent/Manage - HH - Contact Isolation - Gloves using soiled linen - Clean w/ bleach (Cavi Wipes) Loperamide (Imodium A-D) No tonic water Side Effects - Rash - QT/QTC interval prolongation - Torsade's de pointes - Ventricular Arrhythmias - Cardiac arrest Psyllium Fiber (Metamucil) Side Effects - Stomach Pain - Bloating - Cramps Take w full glass of h20