Urinary Elimination
What is an acceptable urinary output amount per hour?
30mL or greater per hour
Difference between enteral and parenteral nutrition
Enteral is delivering nutrients directly to GI tract, while parenteral is delivering nutrients directly to the bloodstream
Potassium plays a large role in which body system?
Cardiac
You have a patient who does not speak the same language as you do. What is your priority?
Obtaining a licensed interpreter when communicating with the patient
This type of incontinence is characterized by loss of small amounts of urine when coughing, laughing, exercising or walking
stress incontinence
Which route (enteral or parenteral) requires a functioning GI tract?
Enteral
When calcium increases, which electrolyte decreases at the same time?
Phosphate
Nursing considerations for maintaining therapeutic communication with patients
1. Validate feelings/concerns
2. Ask open ended questions
3. Listen attentively, allow for periods of silence
This type if incontinence occurs from causes outside of the urinary tract such as altered mobility, cognitive impairments or environmental barriers
Functional incontinence
How to prevent/lessen the risk for aspiration when delivering a feeding via NG tube?
1. Elevate HOB 30-45 degrees
2. Check gastric residual volumes
3. Flush tubing before and after feedings
4. Keep patient upright/HOB elevated for 30min to 1 hour after a feeding
What symptoms are you most likely to see in a patient with hypermagnesemia?
Low everything!
Decreased energy, decreased HR/BP/RR, decreased bowel sounds, decreased deep tendon reflexes
**Magnesium controls muscles so when there is too much magnesium in the body, muscles are too relaxed
Examples of non-therapeutic communication techniques
1. Asking "why" questions -- sounds like an interrogation or implies wrong doing
2. Providing false reassurance -- "you'll be fine"
3. Answering for a patient or telling them how to feel/what to do
4. Using distraction techniques -- "watch tv and maybe you'll stop worrying"
Nursing considerations for preventing catheter-associated UTIs
1. Sterile technique when inserting catheter
2. Maintain a closed-drainage system
3. Keep drainage bag below level of bladder
4. Assess need for catheter and remove as soon as no longer necessary
5. Perform catheter care and pericare
X-ray
(after initial verification by x-ray, ongoing placement checks are performed through pH and tube placement markings)
Nursing priorities for a patient experiencing hyperkalemia?
Monitor EKG
Discontinue potassium supplements
Give potassium-excreting diuretic
IV calcium gluconate or IV sodium bicarb
Potassium-restricted diet
Specify if the following IV solutions are isotonic, hypotonic or hypertonic:
1. Lactated Ringers
2. 0.45% Normal Saline
3. 5% dextrose in normal saline
1. Isotonic
2. Hypotonic
3. Hypertonic
**Remember, 0.9% is isotonic, so anything above 0.9% is hypertonic and anything below 0.9% is hypotonic**
Interventions to help with urge incontinence
assess for symptoms of UTI, avoid bladder irritants (coffee or alcohol), pelvic muscle exercises
Why do we need to monitor glucose levels when administering TPN?
Which two electrolyte imbalances can cause seizures?
Hypocalcemia and hypomagnesemia
Why would you give a hypertonic solution to a patient having a seizure or brain injury?
Hypertonic solutions pull fluid out of the cells, making the cell shrink -- this will prevent cerebral edema (brain swelling) so that the condition does not worsen