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24-hour urine output is less than 50mL; synonyms are complete kidney shutdown or renal failure
painful or diffiuclt urination
increased incidence of voiding
presence of sugar in the urine
awakening at night to urinate
scanty or greatly diminished amount of urine voided in a give time; 24-hour urine output is less than 400 mL
excessive output of urine (diuresis)
protein in the urine; indication of kidney disease
pus in the urine; urine appears cloudy
stoppage of urine production; normally the adult kidneys produce urine continuously at the rate of 60 to 120 mL/h
strong desire to void
involuntary loss of urine
Act of Micturition
- -Process of emptying the bladder
- - detrusor muscle contracts, internal sphincter relaxes, urine enters posterior urethra
- -muscles of perineum & external sphincter relax
- -muscle of abdominal wall contracts slightly
- -diaphragm lowers, micturition occurs
- -Inhibits bacterial enzymes & metabolism
- -Side effects/adverse reactions; dizziness, HA, drowsiness, rust-colored/brown urine, rash, pruritus, GI distress
- -Interventions; take with food to decrease GI distress, avoid antacids, do not crush or open capsules, shake liquid suspension well, rinse mouth after taking drug, increase fluid intake, consume cranberry juice, plums, proteins, vitamin C
- Stage 1:
- 5% of sleep (lasts only minutes)
- between awake & sleep
- involuntary muscle jerking
- Stage 2:
- 50-55% of sleep
- light sleep
- Stage 3:
- 10% of sleep
- arousal becomes increasingly difficult
- Stage 4: delta sleep10% of sleep
- everything decreases (brain waves, P, R, BP, T)
- muscles are relaxed
- help feel refreshed, gives you energy
- 20-25% of sleep
- everything increases (T, P, R, BR, gastric secretions, metabolism)
- large muscle immobility
Adverse Effects of Sleep Meds
- Hangoverresidual drowsiness from medication.
- Dependence"need of meds" to prevent withdrawal syndrome.
- Tolerancetake more drugs (dose) to take effect.
- Withdrawal Symptomssweat, tremors, orthostatic HTN, hallucinations, anxiety, & seizure
- REM reboundlacking REM sleep
- spends more time in REM sleep on successive nights
- allows the total amount of REM sleep to remain fairy constant over time.
Stages of Illness Behavior
- 1. Experiencing symptoms; pain, rash, fever, bleeding, or cough.
- 2. Assuming the sick role; gives up normal activities, focus on their symptoms & bodily functions.
- 3. Assuming a dependent role; pt.'s decision to accept the Dx & follow the prescribed treatment.
- 4. Achieving recovery & rehabilitation; person gives up the dependent role & resumes normal activities.
Effects of Stress on Basic Human Needs
- Physiologicchange in appetite, activity, or sleep
- change in elimination patterns
- increased P, R, BP
- Safety/Securityfeels threatened or nervous
- uses ineffective coping mechanisms
- is inattentive
- Love/Belongingwithdrawn & isolated
- blames others for own faults
- demonstrates aggressive behaviors
- becomes overly dependent on others
- Self-Esteembecomes a workaholic
- exhibits attention-seeking behaviors
- Self-Actualizationrefuses to accept reality
- centers on own problems
- demonstrates lack of control
Adaptation to Acute & Chronic Illness
- General tasks
- Ex: maintaing self-esteem & personal relationships (situational stress)
- Illness-related tasks
- Ex: handling pain & disability (loss of independence & control)
Types of Stressors: Physiologic
- Physiologicchemical agents (ex. drugs, poison)
- physical agents (ex. heat, cold, trauma)
- infectious agents (ex. viruses, bacteria)
- nutritional imbalances
- genetic or immune disorders
Types of Stressors: Psychosocial
- Psychosocialincludes real & perceived threats
- stressful or traumatic experiences of family members and friends.
- horrors of history (ex. Nazi concentration camps, 9/11)
- fear of aggression or mutilation (muggings, rape, murder)
- evetns of history that are brought into our homes through TV (wars, earthquakes, violence in schools)
- rapid changes in our world & the way we live (economic & political structures & rapid advances in technology)
Health-Illness Continuum Model
- measures a person's level of health on a graduated scale.
- views health as a constantly changing state with high-level wellness & death on opposite sides of a continuum.
- illustrates the dynamic (ever-changing) state of health.
*Agent-Host-Environment Model (Leavell & Clark)
- risk factors that must be examined!
- agent & stressor must be present to occur.
- examines the causes of disease in an individual.
- host reaction is influenced by; family history, age, & health habits.
- environment includes; physical, social, biologic, & cultural factors.
Health Promotion Model (Pender)
- illustrates how people react to their environment as they pursue health.
- incorporates individual characteristics & experiences & behavior-specific knowledge & beliefs, to motivate health-promoting behavior (ex. "I want to give up fast food, so I can loose weight.")
*Health-Belief Model (Rosenstock)
- concerned with what people believe to be true about their health.
- Perceived susceptibility to a disease: belief that one either will or will not contract a disease.
- Perceived seriousness of a disease: concerns the perception of the threat to health posed by the disease & its effect on the person's lifestyle.
- Perceived benefits of action: how effective the individual believes measures will be in preventing illness.
Normal WBC count
5,000 - 10,000/mm3
- very specific & delayed
- humoral immunity (Pertaining to elements in the blood or other body fluids).
- defense against antigens & pathogenic organisms in body fluids
- B-lymphocytes (B cells makes plasma cells, plasma cells make antibodies).
- happens right away - STAT & non-specific
- cellular immunity
- defense against abnormal cells & pathogens inside living cells.
- 1. initial vasoconstriction
- 2. vasodilatation-redness & warmth of tissues
- 3. increased nutrients to area
- 4. increased permeability, blood plasma leaks into interstitial space (swelling)
- 5. fibrinogen clots - wall off & keep infection local
- 6. attraction of neutrophils
- 7. regeneration or scar tissue
Inflammatory Response (Police)
- early response, walling off
- cell-mediated (T lymphocytes - abnormal cells)
- non-specific defense mechanisms
Immune Response (SWAT team)
- late response, most effective
- Antigen-antibody (B lymphocytes - organisms in body fluids)
- specific defense mechanisms
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