NUR 155 Foundations to Nursing EXAM 2
Question And Answers
3 types of Extracellular fluids - -interstitial, intravascular, and
transcellular
- Administering Enemas - -Guidelines (pg. 1362-1365)
Per clinical learning lab
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- Altered Nutrition - --malnutrition
-over-nutrition -obese and overweight
-undernutrition
- Altered Urinary Elimination - --Urinary frequency -where you use the
restroom a lot (more than 4-5 times a day)
-Nocturia- (urinating at least two times at night)
-Urgency- gotta go gotta go got a go right now
-Dysuria, associated with urinary hesitancy- painful urination
-Enuresis- bed-wetting
-Urinary incontinence- can't hold your urine
Transient (acute)- last less than 6 months
Established (Chronic)- caused by neurological problems
-Psychosocial aspects-embarrassment, withdraw themselves, sexual
function
-Urinary retention- holding urine
-Neurogenic bladder- not able to go because the nerve receptors are not
working properly ex: surgeries can cause it
- Altered Urine Production - -normal bladder holds 30-50 ml
300-400
-Poluria-excessive urination
-Oliguria-under urination
-Anuria-not releasing urine
, - Assessing (Fluids and Electrolytes) - --Nursing history
-Physical assessment
-Clinical measurement
-Review of laboratory test results
- Assessing Urine pg 1314 - --Volume
-Color, clarity
-Odor
-Sterility
-pH
-Specific gravity
-Glucose- not normal to find in urine
-Ketones- not normal to find in urine
-Blood- not normal to find in urine
-Measure residual urine - use bladder scanner for this and it will tell you
how much urine you have in your bladder
-Diagnostic tests
---BUN (kidney function) (10-20) and creatinine clearance
- Assessment of Bowel (pg. 1355) - -Normal bowel patterns
Changes in bowel habits
History of elimination problems
Bowel elimination aids, including diet, exercise, medications, etc
Focused physical assessment
Stool appearance
Diagnostic studies
Stool specimens (pg. 818-820) in lab
- Bowel (Fecal) Incontinence - --Loss of voluntary ability to control fecal
and gaseous discharges
-Causes
- Bowel Training Programs - --Indications
-Phases
- Calcium (Ca) - -Function: Bone and teeth formation, nerve and muscle
contraction, and heart action
Food Sources: Dairy products, sardines, green leafy vegetables, broccoli,
whole grains, egg yolks, legumes, nuts
- Carbohydrates - -They are the most important source of energy for
your body
-Sugar (simple)
-Starches (complex)
-fiber
-Food sources: bread, sugars, potatoes, cereals
, - Catherization - --Indications- urinary retention, frequency
-Types
Indwelling or foley (no balloon)
Straight (intermittent)
Suprapubic
-Complications-infections
- Characteristics of Feces - --Color
-Consistency
-Shape
-Amount
-Odor
-Constituents
- Clean intermittent Self-Catheterization - --Performed by clients with
neurogenic bladder dysfunction
-Clean or medical aseptic technique
- Cleansing Enema - --Hypotonic
Water moves out of colon after it stimulates peristalsis
-Isotonic
No fluid movement in or out of the colon
-Hypertonic
Attracts water into colon causing distention
Small volume
- Clinical Measurements (Fluid and Electrolytes) - --Daily weights
-Vital signs
-Fluid intake/output
- Components of a Nursing Diagnoses - --Problem statement (diagnostic
label)
Describes the client's health problem or response
Use of qualifiers
-Etiology (related factors and risk factors)
Identifies one or more probable causes of the health problem
Do not use medical diagnosis
- Components of a Nursing Diagnoses - -Defining characteristics for
actual problems
Cluster of signs and symptoms indicate the
presence of a particular diagnostic label
Have signs and symptoms
Question And Answers
3 types of Extracellular fluids - -interstitial, intravascular, and
transcellular
- Administering Enemas - -Guidelines (pg. 1362-1365)
Per clinical learning lab
???????????????????????????????
- Altered Nutrition - --malnutrition
-over-nutrition -obese and overweight
-undernutrition
- Altered Urinary Elimination - --Urinary frequency -where you use the
restroom a lot (more than 4-5 times a day)
-Nocturia- (urinating at least two times at night)
-Urgency- gotta go gotta go got a go right now
-Dysuria, associated with urinary hesitancy- painful urination
-Enuresis- bed-wetting
-Urinary incontinence- can't hold your urine
Transient (acute)- last less than 6 months
Established (Chronic)- caused by neurological problems
-Psychosocial aspects-embarrassment, withdraw themselves, sexual
function
-Urinary retention- holding urine
-Neurogenic bladder- not able to go because the nerve receptors are not
working properly ex: surgeries can cause it
- Altered Urine Production - -normal bladder holds 30-50 ml
300-400
-Poluria-excessive urination
-Oliguria-under urination
-Anuria-not releasing urine
, - Assessing (Fluids and Electrolytes) - --Nursing history
-Physical assessment
-Clinical measurement
-Review of laboratory test results
- Assessing Urine pg 1314 - --Volume
-Color, clarity
-Odor
-Sterility
-pH
-Specific gravity
-Glucose- not normal to find in urine
-Ketones- not normal to find in urine
-Blood- not normal to find in urine
-Measure residual urine - use bladder scanner for this and it will tell you
how much urine you have in your bladder
-Diagnostic tests
---BUN (kidney function) (10-20) and creatinine clearance
- Assessment of Bowel (pg. 1355) - -Normal bowel patterns
Changes in bowel habits
History of elimination problems
Bowel elimination aids, including diet, exercise, medications, etc
Focused physical assessment
Stool appearance
Diagnostic studies
Stool specimens (pg. 818-820) in lab
- Bowel (Fecal) Incontinence - --Loss of voluntary ability to control fecal
and gaseous discharges
-Causes
- Bowel Training Programs - --Indications
-Phases
- Calcium (Ca) - -Function: Bone and teeth formation, nerve and muscle
contraction, and heart action
Food Sources: Dairy products, sardines, green leafy vegetables, broccoli,
whole grains, egg yolks, legumes, nuts
- Carbohydrates - -They are the most important source of energy for
your body
-Sugar (simple)
-Starches (complex)
-fiber
-Food sources: bread, sugars, potatoes, cereals
, - Catherization - --Indications- urinary retention, frequency
-Types
Indwelling or foley (no balloon)
Straight (intermittent)
Suprapubic
-Complications-infections
- Characteristics of Feces - --Color
-Consistency
-Shape
-Amount
-Odor
-Constituents
- Clean intermittent Self-Catheterization - --Performed by clients with
neurogenic bladder dysfunction
-Clean or medical aseptic technique
- Cleansing Enema - --Hypotonic
Water moves out of colon after it stimulates peristalsis
-Isotonic
No fluid movement in or out of the colon
-Hypertonic
Attracts water into colon causing distention
Small volume
- Clinical Measurements (Fluid and Electrolytes) - --Daily weights
-Vital signs
-Fluid intake/output
- Components of a Nursing Diagnoses - --Problem statement (diagnostic
label)
Describes the client's health problem or response
Use of qualifiers
-Etiology (related factors and risk factors)
Identifies one or more probable causes of the health problem
Do not use medical diagnosis
- Components of a Nursing Diagnoses - -Defining characteristics for
actual problems
Cluster of signs and symptoms indicate the
presence of a particular diagnostic label
Have signs and symptoms
