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GOOD

AFTERNOON!!!!
Collecting Urine Specimens
Clean-Catch (Midstream) Specimen
• perennial area is washed
Mild antiseptic/liquid soap
• midstream urine is collected 30 ml

• avoid collecting initial & last few drops


• send specimen laboratory or within 2 hours
Collecting Urine Specimens
Sterile Specimen from Indwelling
Catheter
b. Open-System Method
a. From a closed system Method
-Place line saver under tubing at
– clamp drainage tubing about 4”
junction of catheter and
below junction of drainage tubing and
drainage tubing
catheter for 10-30 minutes
-Disinfect the junction before and
– Clean specimen collection port with
after the collection
alcohol or antiseptic solution
-Hold the disconnected tube
– Collect 3-10 ml of urine with a
(catheter and drainage tubing)
sterile syringe
1.5-2 inches from each other
-Do not allow the catheter tip to
– For self-sealing catheter, insert needle touch container
slowly at 450 angle taking care not to
puncture the other side of the tubing
Collecting Urine Specimens
24-Hour Urine Collection.

• Urine passed in a 24-hour period is collected


• Measures the amount of certain chemicals the kidneys
clean from the body.
• To see if too little or too much urine is produced.
• Decide on the day and time-usually started in the morning
• Discard the first voided urine
• Collect all the subsequent urine passed
• At the 24th hour, collect the last sample
• Urine should be kept cool, refrigerated
• Specimen sent to the laboratory within 2 hours after
collection
Intravenous pyelogram(IVP)

Visualization of the Urinary system


Kidney
Urethers
Bladders
Aka
Intravenous pyelography (IVP).
Urography.
Pyelography.
Intravenous pyelogram(IVP)
Intravenous pyelogram(IVP)

detect problems:
 kidney stones
 enlarged prostate
 tumors in the kUB
 surgery on the urinary tract
Intravenous pyelogram(IVP)
Preparation:

Enema( aperients) 24 hours


NPO 6 – 8 hours
Remove : jewelry, dentures, eye glasses and any
metal objects or clothing
Patient wears cotton examination gown.
Bladder emptied immediately before
examination.
Site: median cubital vein : 20 gauge
point of comparison…
CYSTITIS PYELONEPRHRITIS

- inflammation of the
Urinary Bladder  inflammation of Renal
- s/sx: Pelvis/ Renal Parenchyma
Dysuria  s/sx:
Freqyuency cystitis s/sx
Urgency pain: flank pain – T12 &
Noctoria L3
Pyuria : cloudy.foul odor Costovertebral Tenderness
Pain : suprapubic/hypogastric Fever: High
Fever: Low Grade
Parkinson’s Disease
Furniture:
 sturdy & stable
straight back
 seat firm should be NO lower shallow
than the knee height
 sofas & chairs - 17 inches off the ground
 heavy rocking chair with arm rest
 clear plastic chair protector for upholstered
chairs
Low purine diet……

- indicated for gout, uric acid kidney stones


and uric acid retention
- purpose is to decrease the amount of purine
FOODS:
AVOID organ meats, fish, lobsters dried
peas and beans, nuts, oatmeal, whole
wheat
Glomerulo- Nephrotic
nephritis Sydrome

 GABHS
 Inflammation of kidney  Autoimmune
 Increase glomerolar
 Periorbital Puffy eyes
permeability
 Hematuria(tea colored)
 Hallmark sings/Classics sign
 Hallmark sings/Classics sign - Protienuria
Hypertension - Edema
 Plasmapheresis - Hypercholeteremia
 Diuretics  Plasma Expanders
 Steroids  Diuretics
 Streroids
MNEMONI
CS FOR
PAIN
OLDCART METHOD
O- onset of pain ASSESSME
L- location of pain NT
D- duration of pain
C- characteristic of pain
A- aggravating factors
R –radiation of pain PQRST mnemonics
T- treatment P- provoked ( what brought
about pain)
Q- quality of pain
R- region or radiation of pain
S- severity
T- timing
Pulmonary Wedge Pressure
aka: Pulmonary capillary wedge pressure (PCWP)
Pulmonary artery occlusion pressure ( PAOP)
 Catheter Swan-Ganz
 Indication - Diagnose the severity of left ventricular failure

- Check if Left Ventricle is over stretched, under

stretched or appropriately stretched


- Quantify the degree of mitral valve stenosis

- Physician can calculate the dose of diuretic drugs


- Evaluating pulmonary hypertension
- diagnosis of acute respiratory distress syndrome
• Normal PAWP : 8-12 mmHg
• Above 20 mmHg : Acute Pulmonary edema
Pulmonary Wedge Pressure
aka: Pulmonary capillary wedge pressure (PCWP)
Pulmonary artery occlusion pressure ( PAOP)
 Catheter Swan-Ganz
 Indication - Diagnose the severity of left ventricular failure

- Check if Left Ventricle is over stretched, under

stretched or appropriately stretched


- Quantify the degree of mitral valve stenosis

- Physician can calculate the dose of diuretic drugs


- Evaluating pulmonary hypertension
- diagnosis of acute respiratory distress syndrome
• Normal PAWP : 8-12 mmHg
• Above 20 mmHg : Acute Pulmonary edema
skeletal traction
Thomas splint
Benign
Prostatic Hyperplasia

Dribbling, Difficulty starting urine stream


Retention
Inability to void after alcohol & cold exposure
Frequency
Urgency
Small less forceful urine
Nocturia
Elevated WBC, and BUN
Prostate specific antigen (PSA)
T.U.R.P.
ASYMPTOMATIC for 5 or more years after
Early symptoms resemble a FLULIKE illness
MALIGNANCIES: Kaposi’s sarcoma, skin cancer
laboratory tests

- Enzyme-linked immunosorbent assay (ELISA)


- Western Blot
- Rapid HIV tests (30 minutestest)
Pregnancy Induced Hypertension

Types BP Proteinuria Edema Other S/Sx

Mild 140/90
(increase 1+ to 2+ Slight in
upper
Wt gain
2nd tri 2 lbs/week
of 30/15)
extermities 3rd tri 1 lb/week

Severe 3 to 4 + Pulmonary
Peripheral
Epigastric Pain
Hepatic Dysfunction
160/110
Edema Oliguria<500ml/24

up 4+ -same- CONVULSION
COMA
Eclampsia
Anorexia Nervosa Bulimia Nervosa
15% loss of BW  binge-purge
BMI<17.5 kg/m Russel’s sign
Strict dieters Teeth missing lower incisors
Indulges in strenous Abusive of laxative, enema,
exercises diuretics
Pre-occupation with foods Rectal bleeding/constipation
Amenorrhea for 3 cycles
Do’s Don’ts
•Small frequent feedings •Express feeling of
•Monitor I&O, weight gain shock/disgust
•Stay with client during meal •Don’t compare with others
or atleast 1 hr after •Don’t allow long time meals
•Accompany to the bathroom (set 30 mins. meal time)
 
Spina Bifida
The difference IV Therapy
between Phlebitis
and Infiltration
Inflammatory response to damage to Phlebitis Scale
the intimal layer of the vein caused by 0 = No Symptoms
mechanical or physiochemical forces. 1 = Erythema
2 = Pain
Phlebitis S/sx of infection 3 = Streak Formation, venous
A palpable venous cord indicates cord
advanced stage of phlebitis. When identified, 4 = Purulent Drainage,
remove the PIV . palpable venous cord

Inadvertant administration of Infiltration Scale


medication or solution into tissue 0 = No Symptoms
surrounding the vein. It’s called 1 = Some Edema, Cool
Extravasion if vesicant medication is 2 = 1-6 inch Edema, Cool,
Infiltration administered into the surrounding Pain
tissue. 3 = > 6 inch edema, pain,
Infiltration: Most commonly identified numb
complication of PIV therapy with a 4 = Pitting Edema,
reported incidence of 23% to 78%. Circulatory impairment
.
Radiation Dermatitis
…just remember this
rADiAtIoN SaFeTy
- Label potentially radioactive material
- Limit time spent near the source 30 mins/day
- Distance from the source 6 feet away
- Shield Device Lead Apron
- Room Private Room
- Dislodge Implant
1. Long handle forceps
2. place in lead lined container
3. report
Nerve Paralysis/Effects
Injury
C1 to C5 Paralysis of muscles used for breathing and of all arm and leg muscles; usually
fatal.
Legs paralyzed; slight ability to flex arms.
C5 to C6 C5: Weakness - shoulder abduction (raising the arm).
C6: Weakness: elbow flexion, wrist extension.
Paralysis of legs and part of wrists and hands; shoulder movement and elbow
C6 to C7 bending are relatively preserved.
Weakness: shoulder abduction.
C7: Weakness in elbow extension, wrist flexion
C8 to T1 Legs and trunk paralyzed; eyelids droop; loss of sweating on the forehead
(Horner's syndrome); arms relatively normal; hands paralyzed.
C8: Weakness in thumb extension, wrist ulnar deviation (rotate away from the
thumb)

T2 to T4 Legs and trunk paralyzed; loss of feeling below nipples.


T5 to T8 Legs and lower trunk paralyzed; loss of feeling below the rib cage.
T9 to T11 Legs paralyzed; loss of feeling below umbilicus (belly button).
T12 to L1 Paralysis and loss of feeling below the groin.
L2 to L5 Different patterns of leg weakness and numbness.
S1 to S2 Different patterns of leg weakness and numbness
S3 to S5 Loss of bladder and bowel control; numbness in the perineum.
Bronchial Hygiene Therapy (BHT)
Chest physiotherapy
includes postural drainage, chest percussion and
vibration, and breathing exercises
to remove bronchial secretions, improve ventilation,
and increase the efficiency of the respiratory
muscles
Postural drainage uses specific positions that allow
the force of gravity to assist in the removal of
bronchial secretions; before meals and at bedtime;
remain in each position for 10 to 15 minutes
Chest physiotherapy
Percussion is carried out by cupping the hands and
lightly striking the chest wall; 3 to 5 minutes;
percussion over chest drainage tubes, the sternum,
spine, liver, kidneys, spleen, or breasts is avoided
Vibration is the technique of applying manual
compression and tremor to the chest wall during
the exhalation phase of respiration; helps to
increase the velocity of the air expired from the
small airways, thus freeing the mucus.
…tractions & pins
BMI vs Weight to Height Table
BMI
 Imperial BMI Formula
The imperial bmi formula accepts weight measurements in pounds &
height measurements in either inches or feet.
1 foot = 12 inches
inches² = inches * inches
Imperial BMI ( lbs/inches² ) = (weight in pounds * 703 )
height in inches²
 Metric Imperial BMI Formula
The metric bmi formula accepts weight measurements in
kilograms & height measurements in either cm's or meters.
1 meter = 100cms
meters² = meters * meters
Metric BMI ( kg/m² ) = weight in kilograms
height in meters²
Enteral Nutrition
provides liquefied feeding into the
gastrointestinal tract via a tube
for patient who have a functioning GI tract but
cannot ingest food by MOUTH
Feeding tubes:
- short-term: nasogastric tube
- long-term: esophagostomy, gastrostomy,
enterostomy tube
Enteral Nutrition

Nasogastric Route Nasoduodenal Route

Nasojejunal Route Esophagostomy Route

Gastrostomy Route Jejunostomy Route


Nasogastric Tube
 Insertion:
- NEX
- High Fowler’s position
- Sips of water and advance tube as client swallows
- Do not force the tube!
 Confirm placement of NGT
 Monitor and record residual volume q4h by aspirating stomach content with a syringe.
A residual volume of >100-150 ml indicates delayed gastric emptying. Notify MD.
 During and after feeding keep HOB 30 degrees to prevent aspiration; For continuous
feedings, keep the patient in a semi-Fowler’s position at all times
 Flush/Irrigate tube feeding with 30-60ml of water q4h during continuous feeding,
before and after each intermittent feeding, before and after administering meds, after
each time you check residual volume
 Feeding set changed q24h.
 Bag rinsed q4h.
 Medications:

◦ Liquid medications should be diluted with water


◦ Mixing medications with the feeding should be avoided
◦ Avoid diluting capsules in water
◦ She should consult with the pharmacist to coordinate timing of meds
epidural hematoma
BURNS
Digital Rectal
Exam
Hodgkin’s Disease
Glasgow Coma Scale
Points for quick thinking…
Natremias

D
hypErnatremia
hydration

hypOnatremia
verload

I was taught that kalemias do the same as the prefix except for heart rate and urine
output.

EX: HYPERkalemia: bradycardia, oliguria, restlessness,diarrhea,


hyperglycemia,hyperreflexia, increased BP, peaked T waves
HYPOkalemia: tachycardia, polyuria, constipation, hypoglycemia

Calcemias do the opposite of the prefix

EX: HYPOcalcemia causes neuromuscular irritability


……any question?
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