Urinary fall 10_student

Urinary fall 10_student - Kimberly Glenn MN, RN, CPN...

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Kimberly Glenn MN, RN, CPN Clinical Associate Professor N312 Fall 10 1
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S AFE   System Specific Physiology  Kidneys Regulate ADH: reabsorption of H2O (& ultimately BP) Secrete renin: converts angiotensinogen to angiotensin I. (helps control BP) Regulate aldosterone: reabsorption of sodium & Regulate acid/base imbalances: ↑ or ↓ bicarb production (can take days to do this) Produce erythropoietin: RBC production (anemia) 2 Men
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S AFETY:  System Specific  Physiology:  General guidelines for  normal voiding Quiet environment Privacy Anatomically correct position (sitting upright for women; standing for men) 3
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S AFE   System Specific  Physiology:  At Risk Clients : Diseases can affect ability to void i.e. DM BPH (benign prostatic hypertrophy) Diseases can hinder physical ability to void i.e. Arthritis Parkinson’s disease Conditions can affect cognitive ability to remember i.e. Alzheimer’s disease Sociocultural factors Surgical procedures Fluid balance (nocturia, anuria) 4
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A client with an excessive alcohol  intake has a reduced amount of  antidiuretic hormone (ADH). The  nurse anticipates the client will  exhibit: 1. Hematuria 2. An increased blood pressure 3. Dry mucous membranes 4. A low serum sodium level 
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S AFE  - System Specific  Assessment Questions: Usual pattern of elimination: how frequently to you go; do you get up at night; describe your urine Recent changes in elimination: related to pattern; if they leak and if so what causes it Aids to elimination: what helps you urinate Present or past occurrence of difficulty: how it started, frequency, causes, severity, symptoms, interventions tried- successful or not 6
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S A F E COMPARISON   of initial  assessment to Evaluation    of   Expected outcome   (general) Initial assessment Expected Outcome Skin: rash, blisters, irritation, breakdown Urine output > or< 30cc/hr Bladder distention Urethral meatus: discharge, inflammation or lesions Skin: warm, dry, intact no rash Urine output at least 30 cc/hr No bladder distention No lesions or discharge from urethral meatus
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B/P Respirations and ↑ dyspnea, orthopnea crackles in lungs Pulse (may be normal) but bounding confusion weight >2lbs /24 hrs edema, S AFE - System Specific Assessment Fluid Volume Excess (Hypervolemia) R/T kidney failure 8
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S AFE  -  System Specific Assessment Fluid Volume Excess (Hypervolemia) LABS (values due to kidney failure) ↓ Hct (with corresponding ↓ Hgb) ↓ or Na (depends on cause) not testable BUN 9
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S A FETY - System Specific Assessmen t: Urine Tests Assessment of lab values Expected outcomes Specific gravity: > 1.030 Color: dark, cloudy pH: or Protein/glucose/ketones:
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Urinary fall 10_student - Kimberly Glenn MN, RN, CPN...

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