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Nursing care of Adults

Terms in this set (28)

What changes occur to the specific gravity and BUN as a person ages?
*has more urine that is deluded, and typically excretes lower levels of glucose, acid, and potassium.
How does fluid and electrolytes execration affect voiding patterns in the older adult?
*blood vessels supplying blood flow to the kidneys decreases which causes increased urine concentration
*a decrease in the number of nephrons decreases the filtration rate rate
*a decrease in cardiac output decreases peripheral circulation, which would decrease urinary output day & night
*kidneys excrete more fluid and electrolytes during nighttime hours than during the day, resulting in increased urine formation during sleep
*often interrupts sleep patterns related to getting up two or more times during the night to empty their bladder
The older adult is more likely to experience what electrolyte condition related to medication commonly taken by the older adult?
*become susceptible to drug overdose and other adverse effects of medication
*increase probability of hyperkalemia, particularly when potassium sparing diuretics, angiotensin converting enzyme inhibitor's, nonsteroidal anti inflammatory drugs (NSAIDS), or beta blockers
What contributes to dehydration in the older adult?
*ability to concentrate urine results
*decline in thirst response
*concerned about incontinence, because they fear of being incontinent
*these changes also produce a decline in the ability of older adults to increase urine production in response to fluid volume overload
The nurse's focused assessment related to urinary elimination would include what type of interview questions?
*how many times do you urinate during a 24 hour period?
*has this pattern changed recently?
*how would you describe your urine in terms of color, clarity (clear, transparent, or cloudy), and odor (faint or strong)?
*what problems have you had or do you now have with passing your urine?
*are you passing smaller amounts of urine than usual?
*are you voiding at intervals that are more frequent?
*do you have trouble getting to the bathroom in time or do you feel an urgent need to void?
*do you have painful voiding?
Describe the pathophysiology/ etiology of
Reflux
*during voiding increased intravesicular (within the bladder) pressure compresses the ureter, preventing, the backflow of urine toward the kidneys
Cystitis
inflammation of the urinary bladder
*most common UTI
Acute pyelonephrititis
is inflammation of the renal pelvis and parenchyma, the functional kidney tissue
*most common upper UtI
Catheter associated urinary tract infection (CAUTI)
has become a major health care concern and is on e of the major HAIs. bacteria enter the catheter system at the connection between the catheter and the drainage system or through a emptying tube of the drainage bag.
Asymptomatic
(of a condition or a person) producing or showing no symptoms.
*bacteria in the urine that actively multiply
Symptomatic urinary infection
*The presence of symptoms in a patient having infection of the urinary tract
Differentiate between upper and lower UTI symptoms?
*Lower UTI: Cystitis
*urinary frequency, dysuria, urgency, enuresis, strong smelling urine, cloudy urine, hematuria, abdominal or suprapubic pain
*Upper UTI: Pyelonephritis
*high fever, chills, abdominal pain, flank pain, persistent vomiting, moderate to severe dehydration
Risk factors for UTI's between men and women
*men require longer periods of treatment than women
*with pyelonephritis require 7-10 days course of TMP-SMZ,
*patients with sever illness may need hospilizaton
What does the presence of nitrates indicate when found in the urine?
*bacteria in the urine
What does the term midstream mean?
*urine should be obtained as a midstream clean catch specimen, if necessary use straight catherization or mini catch with strict aseptic technique
Antibotic regimes for UTI's (acute vs chronic)
*short course therapy (either a 3 day course treatment)
*upper UTIs usually require longer treatment
*antibiotic are selected base on the age of the patient, the sensitivity of the cultured organism, renal function, and the patients signs and symptoms
Describe patient teaching for the prevention of further UTIs?
*monitor color, clarity, and odor of urine ( urine should be clear)
*instruct patient to avoid caffeinated drinks (coffee, tea, cola, citrus juice, drinks containing artificial sweeteners, and alcohol)
What other measures can reduce the potential of trauma and introducing bacteria into the bladder?
*help the patient develop a plan for taking medications, such as taking them with meals or setting out all doses for the day in the morning
*instruct patient to keep appointments for follow ups and urine culture.
*follow up urine culture, often scheduled 7-10 days after completion of antibiotic therapy is vital to ensure complete ratification of bacteria and prevent relapse or recurrence
*teach measures to prevent future UTIs
Compare the risk factors for and prevention of colorectal cancer
Risk factors:
*genetic factors are strongly linked
*family history
*individuals with polyps that are not removed
*inflammatory bowl disease (crohn's disease, ulcerative colitis)
*over 50 years of age
*previous exposure to radiation
*diet plays a role
*diets high in calories (meat proteins, and fats)
Preventions of colorectal cancer
*diet high in fruit and vegetable, folic acid, and clcium
*regular exercise
*taking a daily vitamin
*the use of aspirin and other nonsteroidal anti inflammatory drugs
Identify the clinical manifestations of colorectal cancer
*a change in bowel habits (either diarrhea or constipation)
*pain
*anorexia
*weight loss
*all characteristic in patient presents with anemia from occult (not visible) bleeding
Sigmoid colostomy
*is the most common permanent colotomy, for cancer of the rectum
*created during an abdominoperineal resection
*the anal canal is closed, and a stoma is formed from the proximal
*the stoma usually is located on the lower left quadrant of the abdomen
Double barrel colostomy
*two separated stomas are created
*proximal stoma, which is functional , diverts feces to the abdominal wall
*distal stoma also called the mucous fistula, expels mucus from the distal colon
*may be creates of trauma, tumor, or inflammation
*may be temporary or permanent
Mucus fistula
*Distal end of the colon is brought to the abdominal skin as a stoma
Proximal end is brought up to the skin as an end colostomy
Temporary ostomy
done to allow the bowel to rest or due to removal of part in between and allowing the rest of the bowel to rest.
One large pouch is placed over both stomas but there is only stool from one of them.
Permanent ostomy
...
What are the focused assessments recommended for the geriatric client related to colorectal cancer
*the majority (approx. 60%) of patients with colorectal cancer are older than 70 years of age
*studies recommended the use of a geriatric assessment to evaluate a patient's functional status, physical performance, comorbidities, polypharmacy, nutrition status, cognitive function, emotional function, and social support to assist in treatment decisions
What are the best possible outcomes for the client recovering form colorectal cancer interventions
Assessment
*unusual bowel patterns, any recent changes, weight loss, fatigue, or decreased activity tolerance
*presence of blood in the stool, pain with defecation, abdominal discomfort, or perineal pain
Implementation
*provide emotional support , teaching, and direct cares
*at risk for infection
*good hygiene, promote skin integrity, avoid circumstances that elevate risk for infection
*manage pain effectively
*reduce risk for sexual dysfunction
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