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87 Cards in this Set

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What is Peristalsis?
A wavelike movement that occurs in the large intestines and propels the intestinal contents forward
What is Haustral churning or shuffling?
Movement of the chyme back and forth within the haustra. Mixes contents, and aids in the absorption of water, moves contents forward
What is Mass peristalsis?
A wave of powerful muscular contraction that moves over large areas of the colon
List the four steps in order to assessing the abdomen
1 - Inspect the abdomen
skin integrity, rash or other lesions; contour & symmetry – look for distention, obesity, ascites, tumors; abdominal movement –limited mvmt D/T pain or disease process, Visible peristalsis, Marked aortic pulsations; vascular pattern – visible venous pattern(dilated veins) associated with liver disease, ascites & venocaval obstruction
2 - Auscultate for bowel & vascular sounds
Absent, hypoactive, hyperactive bowel sounds; Loud bruit over aortic area; Bruit over renal, iliac or femoral arteries
3 - Percuss several areas in each of the 4 quadrants
Tympany – gas in stomach and intestines
Dullness – decrease, absence or flatness of resonance heard over solid masses or fluid
Percuss the liver to determine its size
4 - Palpate the Abdomen
Light palpation: tenderness, hypersensitivity, superficial masses, localized areas of increased tension or tenderness
Deep palpation: Generalized or localized areas of tenderness, mobile or fixed masses, muscle tightness, guarding & pain
Palpate the bladder above the pubic symphysis for distention & tense mass
What is the recommended daily fluid intake for an adult?
2000-3000 ml of fluid daily
Three common drugs that cause constipation are?
Pain Medications such as morphine and codeine as well as Iron
What medication can turn the stool RED?
Aspirin
What medications can turn the stool whitish?
Antacids
What medications can turn the stool BLACK?
Iron
Aspirin
What medications can turn the stool gray-green?
Antibiotics
General Anesthesia can block what stimulation and cause constipation? How long can this last?
Parasympathetic stimulation to the muscles of the colon. Paralytic ileus lasts 24-48 hours post surgery. Normal bowel function will resume with food intake
Constipation is described as fewer than ____ weekly bowel movements?
Three
True / False
Opiates and Iron Salts can cause diarrhea
False. The use of opiates and iron salts as well as frequent enema use can cause chronic constipation
Use Valsalva maneuver with caution in these patients
heart disease
brain injuries
respiratory diseases
Take care not to cause _________ when performing a digital exam of the rectum
A drop in patient's heart rate.
Perform a digital exam gently to avoid over stimulation of the vagus nerve in the rectal wall
This is a loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter
Bowel Incontinence
Inability to control flatus or minor soiling is called _________
Partial Bowel Incontinence
Inability to control feces of normal consistency is called ____________
Major Bowel Incontinence. This is associated with impaired functioning of the anal sphincter or nerve supply caused by neuromuscular disease, spinal cord trauma or tumors of the external anal sphincter muscle
This is an opening through the abdominal wall for the elimination of feces or urine
Ostomy
This is an opening through the abdominal wall into the stomach
Gastrostomy
This opening is made through the abdominal wall into the jejunum
Jejunostomy
This opening is made into the ileum or small bowel
Ilestomy
This opening is made into the colon or large bowel
Colostomy
This opening is made into the ureter
Ureterostomy
This procedure is performed for traumatic injuries or due to inflammatory conditions of the bowel
Temporary colostomies
This procedure is performed when the rectum or anus is nonfunctional as a result of a birth defect or disease such as cancer of the bowel
Permanent colostomies
This procedure produces a constant liquid fecal drainage. It contains digestive enzymes which are damaging to the skin. Odor is minimal because few bacteria are present
Ileostomy
This Colostomy causes the drainage of liquid with digestive enzymes present. There is an increased odor that requires a deodorant to be utilized inside the appliance due to the presence of bacteria
Ascending Colostomy
This procedure causes the removal of malodorous mushy drainage with no control
Transverse Colostomy
This colostomy produces an increasingly solid fecal drainage
Descending Colostomy
After this procedure, stool will be normal and have a formed consistency. Frequency can be regulated. Patient may not have to wear appliance at all times and odors can usually be controlled
Sigmoidostomy
During the assessment of a patient with an ostomy, the RN should _____________
nursing history, performing a physical examination of the abdomen, rectum and anus and inspecting the feces for color, consistency, shape, amount, odor and the presence of abnormal constituents
True / False
During the physical exam of a patient with an ostomy, Auscultation should take precedence over palpation?
True.
Auscultation precedes palpation because palpation can alter peristalsis
The primary regulators of fluid and acid-base balance in the body
Kidneys
This hormone is released from the adrenal cortex and causes sodium and water to be reabsorbed in greater quantities which in turn increases blood volume and decreases urine output
Aldosterone
This is the reservoir for urine and is the organ of excretion
Bladder
The wall of the bladder is made up of how many layers?
Four
1 - Inner mucous layer
2 - Connective tissue layer
3 - Three layers of smooth muscle fibers
4 - Outer serous layer
Where is the voiding reflex center located at in the body?
Second to Fourth sacral vertebra
This substance will cause a retention of urinary fluids
Sodium
These substances will cause an excessive amount of urinary fluids to be excreted from the body
Alcohol and Caffeine
The abnormal production of large amounts of urine is called __________
Polyuria
Excessive fluid intake
Polydypsia
Low urine output is called ___________
Oliguria. Usually indicated impaired blood flow to the kidneys or impending renal failure
Oliguria is defined as eliminating < or > __ ml daily or __ ml/hr of urine
< 500 ml a day or 30 ml/hr
Voiding of urine more than usual is also known as
Frequency
Enuresis
The involuntary urination in children beyond the age of normal bladder control (usually age 4-5)
Dysuria
Painful or difficult voiding possibly caused by a UTI or injury to the bladder and urethra
Urgency to urinate can be caused by _____________
Psychological stress, irritation of the trigone and urethra, poor external sphincter control
Voiding of urine more than twice nightly is also known as _________
Nocturia
This is a symptom, not a disease. It can be caused from stress, sneezing, coughing, laughing and lifting as well as other more serious conditions
Urinary Incontinence
Urinary incontinence that follows a strong sense of urgency is called ______
Urge urinary incontinence
This urinary incontinence occurs at predictable intervals when a specific bladder volume is reached
Reflex urinary incontinence
This urinary incontinence occurs from sneezing, coughing and lifting
Stress urinary incontinence
This type of urinary incontinence occurs involuntary. It is the unpredictable passage of urine
Functional urinary incontinence
This type of urinary incontinence is continuous and occurs at unpredictable times
Total urinary incontinence
Over distension of the bladder can cause poor contraction of the detrusor muscle, also known as ______ ______ and can be caused by surgery, enlarged prostrate or by use of certain medications.
Urinary retention
Caused when a person has no perception of bladder fullness and lacks the ability to control their urinary sphincters
Neurogenic bladder
Normal urine consists of ___% water?
96%
Normal urine consists of ___% solutes?
4%
Urea, ammonia, creatine, uric acid, sodium, chloride, potassium, sulfate, magnesium and phosphorus
The urine retained after voiding is called ________
Residual urine
Measurement of the concentration of solutes present in urine
Specific gravity - normal range 1.010 - 1.025
What findings would you expect with a person experiencing dehydration or fluid deficit? Specifically related to the concentration of their urine (specific gravity)
Concentrated urine would have an increased specific gravity
Normal pH for Urine
6, slightly acidic
When fatty acids are broken down in the body, the byproducts excreted in urine are also known as ________?
Ketones
Certain populations may have an increased risk of producing ketones in their urine. List some
Poorly controlled diabetes
Alcoholics
Fasting or starving persons
Consumption of very high protein diet
Normally these are too large to escape from glomerular capillaries into the filtrate
Proteins
This test is conducted to determine the presence of blood in the urine/stool
Occult blood - urine / Occult blood - stool
Both are a good indication of infection
This is the end product of protein metabolism. It is produced in relatively constant quantities by the muscles
BUN
As an important part of the muscle, this byproduct is excreted exclusively through the urine. This test is a sensitive indicator of renal function
Creatinine, a breakdown product of creatine
Normal creatinine values can range from 500 to 2000 mg/day
Results depend greatly on age and amount of lean body mass
14 to 26 mg per kg of body mass per day for men
11 to 20 mg per kg of body mass per day for women
This type of urinary catheter remain in the bladder to drain urine
Retention catheter
What is the most important excretory organ?
The kidneys
List some functions of the kidneys
1 - Eliminate nitrogenous waste, water, electrolytes, toxins and drugs, regulates blood volume, balances pH and blood pressure and helps with red blood cell production
List the three regions of the kidneys
Renal Cortex
Renal Medulla
Renal Pelvis
This is the functional unit of the kidney and is responsible for making urine
Nephron unit - composed of tubular and vascular structures
Hormone that stimulates the distal tubule to reabsorb Na+ and H2O and excrete K+
Aldosterone - secretion is regulated by the renin-angiotension-aldosterone system
This hormone stimulates the collection duct to reabsorb water as it is released from the posterior pituitary gland in response to low blood volume and increased concentration of solute in the plasma
Antidiuretic Hormone (ADH)
Inhibits the reabsorption of Na+ and H2O causing natriuresis
Atrial natriuretic factor
Stimulates the renal absorption of calcium and the excretion of phosphate
Parathyroid hormone
These vegetables are considered laxatives stimulating the intestinal mucosa and increasing motility and secretion
Figs, prunes, pears, raisins, and rhubarb. The active ingredient of rhubarb, oxalic acid, is concentrated in the plant’s leaves, a serious threat of poisoning if eaten. Rhubarb also contains tannin, an astringent that produces constipation as a side-effect
Glycerine, Sorbitol, Lactulose and saline (magnesium cations and phosphate anions) are all forms of what type of laxative?
Hyperosmotic laxative
These are the most physiologic of laxatives mimicking the action of dietary fiber in the digestive tract. They are not absorbed, rather carried out of the body as feces.
Bulk-forming Laxatives
Contraindicated in patients with dysphasia
Various oils that retard the re-absorption of water from fecal mass in the colon. Can interfere with absorption of fat-soluble nutrients (A,D,E,K)
Lubricant laxatives
Moistening agents. Best used 2-3 days in advance of anticipation of constipation
Stool softerners
Sodium phosphate has a major activity as a ______ ______
Saline cathartic
Most common side effect of Sucralfate
Constipation
Adverse effects of Metoclopramide
Dystonic or extrapyramidal effects
List some appropriate uses of laxatives
Prevent straining in patients with cardiovascular disease
Bulk forming agents for diverticulitis
Treatment for certain drug overdoses