Module II - Units C, D, E

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Module II - Units C, D, E
2014-10-23 19:47:59
Elimination Sleep Pain

Nursing 110
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  1. Cystoscopy
    Procedure used to see inside bladder, urethra, ureters

    Hollow tube (cystoscope) equipped with a lens

    Inserted into urethra and slowly advanced into bladder

    Examines the lining of bladder & urethra

    Investigate causes of bladder signs and symptoms such as

    • Blood
    • in the urine         
    • Frequent UTIs
    • Incontinence                
    • dysuria
    • Overactive bladder

    • To Diagnosis Diseases Such As
    • Bladder cancer, stones
    • Bladder inflammation (cystitis)

    • Looking for Enlarged Prostate
    • (benign prostatic hyperplasia)
    • Narrowing of the urethra where it passes through the prostate gland 

    Sometimes used to remove small bladder tumors
  2. Dysuria
    • Painful urination
    • Only a little comes out and it burns
  3. Enuresis

    Continued incontinence of urine past the age of toilet training

    Occasional daytime incontinence of urine in children is not concerning
  4. Nocturnal Enuresis
    • Bed wetting at night
    • Subsides by 6 years old
  5. Nocturia

    Urination at night

    Diminished ability of the kidneys to concentrate urine
  6. Hematuria
    • Blood in urine
    • aka Presence of red blood cells in urine

    Pink, red or cola-colored but can be microscopic

    Takes very little blood to produce the color

    Usually isn't painful unless it is the passing of blood clots in urine

    • Common Causes
    • UTI
    • Inherited disorder (sickle cell, Alport Sydrome)
    • Kidney infection, disease, or injury
    • Bladder or kidney stone
    • Enlarged prostate

    A sign of advanced kidney, bladder or prostate cancer

    Medications (some chemo drugs, antibiotics, aspirin)
  7. (Urinary) Hesitancy
    Difficulty starting or maintaining a urine stream

    Most common in older men with an enlarged prostate gland
  8. Kegel Exercises
    Exercises used to strengthen perineal muscle tone 

    Target inner muscles that lie under & support the bladder

    Same muscles that contract to stop urination midstream / control defecation

    Hold for 10 seconds / relax for 10 seconds
  9. Micturition
    The process of emptying the bladder

    Nerve centers for it are in brain & spinal cord

    Involuntary reflex but control can be learned

    Voluntary control develops as higher nerve centers develop in infancy

    aka Urination, Voiding
  10. Oliguria

    Low urine output

    • Adult
    • Output (less than 400ml per day)

    • Infant
    • Output (less than 1 mL/kg/h)

    • Child
    • Output (less than 0.5 mL/kg/h)

    Clinical hallmark of renal failure
  11. Post Void Residual
    Test that measures amount of urine left in the bladder after urination

    Measured by draining the bladder with a catheter

    Can sometimes be measured with ultrasound
  12. Polyuria
    Excessive volume of urination for an adult

    Greater than 2.5 Liters / day

    • Common & Not so Common Causes
    • Diabetes (mellitus, insipidus)
    • Drinking lots of water, coffee, alcohol)
    • Diuretics or lithium medication
    • Sickle Cell Anemia
    • Ph of blood too high or low
    • Kidney failure
  13. Stress Incontinence
    Physical movement or activity (coughing, sneezing, running, heavy lifting)

    Puts pressure (stress) on bladder

    NOT related to psychological stress
  14. Urinary Incontinence
    Involuntary loss of urine

    • Common in women
    • (urethra shorter than men)

    Coughing & sneezing Increases abdominal pressure causing involuntary escape of urine
  15. Urinary Retention aka Ischuria
    • Inability to empty the bladder completely
    • Can be acute or chronic

    Acute is considered a medical emergency (cannot empty at all)

    • Chronic
    • retention means can urinate but not completely


    Obstruction of the Urethra due to

    Benign prostatic hyperplasia (BPH) aka Enlarged Prostate

    Urethral stricture due to inflammation, scarring from surgery

    Urinary tract stones

    • Cystocele
    • (bulging of the bladder into the vagina)

    • Rectocele
    • (bulging of the rectum into the vagina)


    Hard stools in the rectum push against the bladder & urethra

    Nerve damage or problems from

    Vaginal childbirth

    MS, stroke, diabetes

    Brain or spinal cord infections or injuries

    Medications (antihistamines, anticholinergics, tricyclic antidepressants)  

    Tumors & cancers
  16. Bowel Training Program
    Treatment for patients with history of chronic constipation

    Manipulate factors within patient’s control to produce soft, formed stool regularly

    Goal is to not need laxatives

    • Factors
    • include: fluid intake, food, exercise, timing
  17. Laxatives / Cathartic
    Used interchangeably but Cathartics exert a stronger effect
  18. Colonoscopy
    • Endoscopic examination of the large bowel and the distal part of the small bowel           
    • Uses CCD camera or a fiber optic camera on a flexible tube

    Tube is passed through the anus

    Provides visual diagnosis (e.g. ulceration, polyps)

    Can be used for biopsy or removal of suspected colorectal cancer lesions
  19. Constipation
    Dry, hard, stools that are difficult or incomplete to pass

    Having less than 3 bowel movements in a week
  20. Diarrhea
    The passage of three or more loose stools a day

    Cramps, nausea, vomiting, & blood in stools may occur

    Protective response to irritation in intestinal tract

    Fluids & electrolytes are lost quickly
  21. Endoscopy
    To “look inside” the body for using an endoscope

    Examines interior of a hollow organ or cavity of the body

    Are inserted directly into the organ
  22. Fecal Impaction
    Buildup of stool in the colon
  23. Flatulence / Flatus
    Intenstinal gas
  24. Hemorrhoids
    Abnormal distended rectal veins

    Vertical folds in rectum (three transverse) each contain an artery & vein
  25. Occult Blood
    Blood in stool that is hidden in the specimen and cannot be seen on gross examination
  26. Peristalsis
    Contractions of the circular & longitudinal muscles of the intestine

    Moves waste products along length of intestine continuously

    Occurs every 3 to 12 minutes
  27. Sigmoidoscopy
    Minimally invasive medical examination of the large intestine from the rectum through the last part of the colon

    Two Types

    • Flexible sigmoidoscopy, which uses a
    • flexible endoscope (preferred procedure)

    • Rigid sigmoidoscopy, which uses a rigid
    • device

    Similar to, but not the same as, a colonoscopy

    Only examines up to the sigmoid (most distal part of the colon)

    Verses a colonoscopy examines the whole large bowel
  28. Valsalva’s Maneuver
    Moderately forceful attempted exhalation against a closed airway

    Done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up a balloon

    Find avideo on YouTube
  29. Sims Position
    Used for rectal examination, treatments and enemas

    Patient lie on left side

    Left hip and lower extremity straight

    Right hip and knee bent

    • Also
    • called lateral recumbent position
  30. Increased instance of voiding

  31. Sugar in urine
  32. Protein in urine
  33. Puss in urine or cloudy urine
  34. Stoppage of urine production
  35. Adults produce urine at rate of _______ per hour
    62-120 ml
  36. Strong desire to void
  37. Involuntary loss of urine
  38. Turbidity
    How clear urine is

    Urine is clear when fresh but becomes cloudy as it stands and cools

    Urine that is cloudy fresh is abnormal

    Could be due to the urine containing the following contents

    Vaginal discharge or sperm

    White or red blood cells

  39. Normal pH of urine is

    But can range from 4.6 – 8
  40. Urine becomes ______ on standing due to CO2 diffusion into air
  41. High protein causes ___a___ urine

    Citrus, juices, dairy, veggies make urine ___b___
    a. Acidic

    b. Alkaline
  42. What is the normal Specific Gravity of urine

    High Specific Gravity means ______(a)

    Low Specific Gravity means _____ (b)
    Normal Specific Gravity of urine is 1.015-1.025

    • a. dehydration
    • b. hydration

    Concentrated means higher than normal range

    Diluted means lower than normal range
  43. Organic Constituents of urine are

    Inorganic Constituents of urine are
    Urea, uric acid, creatinine, urine pigments, nitrogen

    Ammonium, electrolytes
  44. Abnormal Constituents of urine include
    Blood, puss, albumin, ketones, glucose, bile, bacteria
  45. Cystoscopy
    • Direct visual of bladder, urethra
    • Pre-op consent, can
    • have fluids in morning but no solid food

    Sedated & ordinary painless
  46. Intravenous Pyelogram (IVP)
    Examines kidneys with IV contrast dye

    Rules out renal dysfunction or impairment
  47. Abrupt & strong desire to void

    Seen in patients with UTIs
    Urge Incontinence (Urgency)
  48. Urine loss from two or more types of incontinence
    Mixed Incontinence
  49. Type of Incontinence Associated
    with over-distended bladder
    Overflow Incontinence
  50. Inability to reach toilet due to functional barriers, memory loss, cognitive deficiency
    Functional Incontinence
  51. Incontinence that lasts for 6 months or less

    Usually due to UTIs & being on medication
    Transience Incontinence
  52. Emptying bladder without a feeling of need to void

    Seen in spinal injuries
    Reflex Incontinence
  53. Continuous & unpredictable loss of urine

    Due to trauma, surgery, physical malformation

    Urination cannot be controlled because of anatomical abnormalities
    Total Incontinence
  54. External Condom Catheter (Texas Catheter)
    • Soft pliable sheath of silicone applied externally to penis (self-adhesive) connected
    • to bag

    Used when voluntary control of urination not possible for males

    An alternative to indwelling catheter
  55. Occult Blood
    Blood that is hidden in the stool and cannot be seen on gross examination

    • May be performed by nurse at bedside
    • or by patient at home
  56. Endoscopy
    • The direct visual examination of body organs
    • Uses a fiber-optic endoscope that transmits light

    • Esophagogastroduodenoscopy
    • (visualizes esophagus, stomach, & duodenum)

    • Colonoscopy
    • (Visualizes large intestine from anus to ileocecal valve)

    • Sigmoidoscopy
    • (Visualizes sigmoid colon, rectum, & anal canal)
  57. Application of mechanical law to the human body

    Regarding structure, function, & position
    Body Mechanics
  58. Atelectasis
    Incomplete expansion / collapse of lung tissue due to areas of lung tissue not used
  59. Atrophy
    Decrease in muscle size                                   

    Happens rapidly in patients confined to a bed
  60. Ankylosis
    Consolidation & immobilization of a joint

    Increasesprocess of osteoporosis (bone de-mineralization)
  61. REM Rebound
    Phenomenon where one amount of REM sleep remain constant over time

    (If missing REM sleep for a few nights, will spent more time in  REM sleep on successive nights)
  62. Dyssomnias
    Sleep disorders characterized by insomnia or excessive sleepiness
  63. Insomnia
    Type of Dyssomnia

    Difficulty of falling asleep, intermittent sleep, or early awakening

    More common of all sleep disorders

    More in women (pre & post menopause), 60+, depression

    Can be acute or chronic

    Sleep hygiene (non-pharmacologic treatments) may help

    • Causes
    • Stress,
    • psychiatric disorders
    • obesity
    • caffeine use
    • diabetes
  64. Hypersomnia
    Type of Dyssomnia

    • Excessive sleep (particularly during the day)
    • Fall asleep during work, eating, etc.
    • Napping does not relieve symptoms
    • Feel disoriented, irritated when awake

    • Causes
    • Sleep apnea
    • alcohol & substance abuse
    • head trauma,                                                         
    • Depression
    • Obesity
    • CNS disorders
    • Medication side-effects
  65. Narcolepsy
    Type of Dyssomnia

    Neurological disorder causing uncontrolled desire to sleep

    Patients fall asleep standing up, driving, mid-conversion, swimming,

    Fall asleep quickly & hard to wake up

    Treated with medication

    Driving restrictions are placed due safety of patient
  66. Sleep Apnea
    Absence of breathing (apnea) or diminished breathing efforts (hypopnea)  during sleep between snoring intervals

    Breathing ceases for 10 seconds to 2 minutes 

    • Causes
    • irregular pulse, increase BP, irregular pulse

    Oxygen levels in blood drop

    Excessive sleepiness commonly reported

    • More common in
    • older, heavier,
    • possessing thick short necks
  67. Obstructive Sleep Apnea (OSA)
    airway blocked

    Collapsed hypo-pharynx, enlarged tonsils, deviated septum

    • Treatments
    • CPAP machine
    • Surgery (removing tonsils, & tissues)
  68. Restless Leg Syndrome (RLS)
    Inability to lie still without unpleasant creeping, crawling, tingling sensation in legs

    Associated with iron deficiency (correlation cannot be explained)

    OCT meds like antihistamines exacerbate symptoms

    • URGE acronym used
    • Urge to move legs
    • Rest induced
    • Gets better with activity
    • Evening symptoms more severe
  69. Sleep Deprivation
    Decrease in amount, consistency, or quality of sleep

    Decreased NREM & REM sleep

    Damaging mental & physically
  70. Patterns of waking behavior that during sleep
  71. What are examples of Parasomnias?
    • Somnambulism
    • (Sleepwalking)

    Sleep Talking

    Night terrors (screaming due to perceived threat)

    Bruxism (grinding teeth during sleep)

    Enuresis (urinating during sleep), usually outgrown by adulthood

    Sleep Eating Disorder (Eating during sleep and not remembering)
  72. Medical Term for Sleepwalking
  73. Nocturnal Myoclonus
    Observed in 10%-20% of chronic insomniacs

    Muscle contractions resulting in jerking of legs during sleep

    Contractions may arouse sleeper, contributing to insomnia
  74. Condition in which a muscle has lost its strength
  75. Footdrop
    Inability to lift the front part of the foot

    This causes the toes to drag along the ground while walking

    Stems from weakness or paralysis of the muscles that lift the foot
  76. The constant low-level activity of a body tissue, especially muscle tone

    The continuous and passive partial contraction of the muscles
  77. Cancer Pain
    • Could come from the cancer (tumor infiltrations) or the treatments     
    • Hormone changes, skin, nerve changes
  78. Administering sedatives to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardio respiratory function
    Conscious Sedation

    aka Procedural sedation & analgesia
  79. the point along a curve of increasing perception of a stimulus at which pain
    begins to be felt.
    pain threshold
  80. Referred Pain aka Reflective Pain
    Pain that is felt in location other than the site of the stimulus

    • Example: Ischemia brought on by MI
    • Pain is felt in neck, shoulders, and back
    • Location of stimulus is in the chest
  81. Maximum level of pain that a person is able to tolerate
    Pain Tolerance
  82. Endorphins
    aka "endogenous morphine"

    Endogenous opioid inhibitory neuropeptides

    Produced by the central nervous system and pituitary gland.
  83. Acute vs Chronic Pain
    • Acute Pain
    • Rapid in onset varying in intensity from mild to severe

    Protective in nature to alert of damage or disease

    Ends when healing is complete

    Cut finger, sore throat, surgical wounds

    • Chronic Pain
    • Lasts beyond the normal healing period

    Can be limited, intermittent, or persistent

    Difficult for patient to describe and for nurse to assess

    Often perceived as meaningless causing emotional issues for patient
  84. Remission vs Exacerbation
    • Remission
    • Disease is present but individual does not have symptoms

    • Exacerbation
    • When symptoms reappear
  85. Cutaneous Pain (Superficial Pain)
    Involves skin or subcutaneous tissue

    Example: Paper cut, skinning of knee
  86. (Deep) Somatic Pain
    Originates in tendons, ligaments, bones, vessels, & nerves

    Diffuses and scatters from origin

    Example: Ankle sprain (pressure on bone & damage to tissue)
  87. Visceral Pain
    Originates in body organs in thorax, cranium, and abdomen

    Poorly localized

    Organs become distended, ischemic, or inflamed

    Occurs due to organs stretching abnormally

  88. Neuropathic Pain –
    • Pain resulting in PNS & CNS system damage
    • Can be short duration or lingering          Described as burning or stabbing        

    Diabetic Neuropathy, carpel tunnel

    Examples listed on table 35-1 on pg. 1114
  89. Pain that is resistant to therapy and persists after variety of interventions
    Intractable (Pain)
  90. Phantom Pain
    Feel pain in amputated limb where receptors and nerves are gone

    Location & presence of pain is clear to patient

    Also called Phantom Limb Pain
  91. Physical cause for pain cannot be identified
    Caused by mental event
    Psychogenic Pain
  92. Western cousin of acupuncture

    Use fingertips to give firm pressure to acupuncture sites
  93. A Pharmaceutical agent that relieves pain
  94. Name some examples of Non-Opioids

    What are they used for?
    • acetaminophen, NSAIDs, COX-2 Inhibitors
    • Celecoxib (Celebrex)

    for mild to moderate pain
  95. What are Opioids (formally narcotics)?

    What are the side effects?
    Analgesic that attaches to opioid receptors in the brain

    Nausea, constipation, & sedation (drowsy)

    Feared respiratory depression (keep eye on patients who are on it)
  96. Opioid Polymorphism

    • Enzymes that promote binding at site may
    • be missing in some individuals          

    May explain why responses to opioid meds vary in some patients
  97. Physical Dependence vs Tolerance vs Addiction
    • Tolerance
    • Body becomes accustomed to opioid & require higher dose for pain relief

    • Physical Dependence
    • Body is physiologically accustomed to opiod
    • Suffers withdrawal symptoms if suddenly removed or dose decreases

    • Addiction
    • Pattern of compulsive opioid
    • No longer using it for pain
    • Craving, compulsive use, lack of control over use
    • Continuing use despite harm
  98. Adjuvant Drugs (regarding analgesics)
    Used for other purposes than pain

    Used to enhance effects if opioids or reduce side effects

    • Lessen anxiety about pain experience      
    • Examples
    • anti-depressants,
    • anti-convulsion, corticosteroids
    • Atropine
  99. Temporary flare-up of moderate to severe pain
    that occurs even when patient is taking ATC meds
    Breakthrough Pain (BTP)
  100. Patient-Controlled Analgesia (PCA)
    Computerized portable infusion pump with bag or syringe prefilled with opioid

    Lock-out-interval prevents over medication

    Candidates for PCA must be alert & capable with no risk of over-sedation

    • Gives patients a sense of control
    • Studies find that patients use less
  101. Epidural Analgesia
    Catheter inserted into mid-lumbar region, b/t walls of vertebral canal & dura matter

    • Provide relief during / during
    • Immediate post-op
    • (thoracic, abdominal, & vascular, ortho surgery)

    • Children with terminal cancer
    • Chronic pain situations