Urinary EliminationScientific Knowledge BaseUrinary elimination is the last step in the removal and elimination of excess water and by products of body metabolism. Adequate elimination depends on the coordinated function of _________________________, __________________, ___________________, and _________. The kidneys filter waste products of metabolism from the blood. The ______________________________________ from the kidneys to the bladder. The bladder holds urine until the volume in the bladder triggers a sensation of urge indicating the need to pass urine. Micturition occurs when the brain gives the bladder permission to empty, the bladder contracts, the urinary sphincter relaxes, and urine leaves the body through the urethra.KidneyThe kidneys lie on either side of the vertebral column behind the peritoneum and against the deep muscles of the back. Normally the left kidney is higher than the right because of the anatomical position of the liver.Nephrons, the functional unit of the kidneys, remove waste products from the blood and play a major role in the regulation of fluid and electrolyte balance. The normal range of urine production is ______________________________. Please convert to CC/day. Erythropoietin, produced by the kidneys, stimulates red blood cell (RBC) production and maturation in bone marrow. The kidneys play a major role in blood pressure control via the renin-angiotensin system, release of aldosterone and prostacyclin. The kidneys also affect calcium and phosphate regulation by producing a substance that converts vitamin D into its active form.UretersA ureter is attached to each kidney pelvis and carries urinary wastes to the bladder.BladderThe urinary bladder is a hollow, distensible, muscular organ that holds urine. The bladder has two portions, a fixed base called the trigone and a distensible body called the detrusor. The bladder expands as it fills with urine. How much urine can the bladder hold?UrethraUrine travels from the bladder through the urethra and passes to the outside of the body through the urethral meatus. The urethra passes through a thick layer of skeletal muscles called the pelvic floor muscles. These muscles stabilize the urethra and contribute to urinary continence. The external urethral sphincter, made up of striated muscles, contributes to voluntary control over the flow of urine. The female urethra is approximately 3 to 4 cm (1 to 1.5 in) long and the male urethra is about 18 to 20 cm (7 to 8 in) long. The shorter length of the female urethra increases risk for urinary tract infection due to close access to the bacteria contaminated perineal area.Act of UrinationBrain structures influence bladder function.Voiding: Bladder contraction + urethral sphincter and pelvic floor muscle relaxationBladder wall stretching signals micturition center.Impulses from the micturition center in the brain respond to or ignore this urge, thus making urination under voluntary control.When a person is ready to void, the central nervous system sends a message to the micturition centers, the external sphincter relaxes and the bladder empties.Factors Influencing Urination (See Box 46-1)Growth and development_________________________________________________________Sociocultural factors_________________________________________________________Psychological factors_________________________________________________________Personal habits_________________________________________________________Fluid intake_________________________________________________________Pathological conditions_________________________________________________________Surgical procedures_________________________________________________________Medications_________________________________________________________Diagnostic Examinations_________________________________________________________Common Urinary Elimination ProblemsThe most common problems involve _____________________________________________ or ________________________________________. Problems can result from1. I_________________________________________________________2. I_________________________________________________________3. O_________________________________________________________4. I_________________________________________________________5. I_________________________________________________________Urinary retention_________________________________________________________Urinary tract infection_________________________________________________________CAUTIsUrinary incontinence_________________________________________________________Common forms of UI are: (See Table 46-1)1. T_________________________________________________________2. F_________________________________________________________3. U/O_________________________________________________________4. S_________________________________________________________5. U_________________________________________________________6. R_________________________________________________________Urinary diversion______________________________________________________________Two types: _____________________________________________________________A ureterostomy or ileal conduitNephrostomy tubesNursing Knowledge Base:________________________________________________________________Infection control and hygiene______________________________________________________Growth and development_________________________________________________________ (Focus on older adult Box 46-2)Psychosocial considerations________________________________________________________Critical thinking________________________________________________________________________Nursing Process: Assessment (Box 46-5)Through the patient’s eyes_________________________________________________________Self-care ability_______________________________________________________________Cultural considerations____________________________________________________________(Box 46.4 cultural aspects of care)Health literacy_______________________________________________________________Nursing history_______________________________________________________________(Box 46.5 Nursing assessment questions)Pattern of urination _____________________Symptoms of urinary alterations: (table 46-2) ___________________________________Physical assessmentKidneys___________________________________Bladder___________________________________External genitalia and urethral meatus___________________________________perineal skin___________________________________Assessment of urineIntake and output___________________________________Characteristics of urine___________________________________Color___________________________________Clarity___________________________________Odor___________________________________External genitalia and urethral meatusPerineal skinLaboratory and Diagnostic TestingDiagnostic Examination (Table 46.5 Common diagnostic tests of urinary Tract)Nursing responsibilities before testing:1. ___________________________________2. ___________________________________3. ___________________________________4. ___________________________________Responsibilities after testing include:1. ___________________________________2. ___________________________________3. ___________________________________Nursing Diagnosis: Nursing diagnoses common to patients with urinary elimination problems:Functional urinary incontinenceStress urinary incontinenceUrge urinary incontinenceRisk for infectionToileting self-care deficitImpaired skin integrityImpaired urinary eliminationUrinary retentionPlanningGoals and outcomesSet realistic and individualized goals along with relevant outcomesCollaborate with the patientSetting priorities___________________________________________________________Patient’s immediate physical and safety needsPatient expectations and readiness to perform some self-care activitiesTeamwork and collaboration______________________________________________________ImplementationHealth promotion_____________________________________________________Patient education_____________________________________________________Promoting normal micturition_______________________________________________• Maintaining elimination habits• Maintaining adequate fluid intakePromoting complete bladder emptying______________________________________________Preventing infection____________________________________________________Acute careCatheterization__________________________________________________________________Skill 46-2, Inserting and Removing a Straight (Intermittent) or Indwelling CatheterTypes of catheters _____________________________________________________________________Catheter sizes_____________________________________________________________________Catheter changes_____________________________________________________________________Catheter drainage systems____________________________________________________________________Routine catheter care_____________________________________________________________________Preventing catheter associated infection (Box 46-10) _____________________________________________________________________Catheter irrigations and instillations_______________________________________________________Removal of indwelling catheters__________________________________________________________Alternatives to catheterization____________________________________________________________Suprapubic catheters External cathetersUrinary diversionsØ Incontinent diversionsChanging a pouchGently cleanse the skin surrounding the stomaMeasure the stoma and cut the opening in the pouchRemove the adhesive backing and apply the pouchPress firmly into place over the stoma.Observe the appearance of the stoma and surrounding skin.Continent diversionsOrthopic neobladderMedicationsAntimuscarinics: treat urgency, frequency, nocturia and urgency UIBethanechol: treat urinary retentionTamsulosin and silodosin: relax smooth muscleFinasteride and dutasteride: shrink the prostateAntibiotics: treat urinary tract infectionsBe familiar with the medications and indications for all medications your patient is taking.Continuing and restorative careLifestyle changesPelvic floor muscle trainingBladder retrainingToileting schedulesIntermittent catheterization• Skin careEvaluationThrough the patient’s eyesAssess the patient’s self-image, social interactions, sexuality, and emotional statusPatient outcomesUse the expected outcomes developed during planning to determine whether interventions were effectiveEvaluate for changes in the patient’s voiding pattern and/or presence of symptomsEvaluate patient/caregiver compliance with the planSafety Guidelines for Nursing SkillsFollow principles of surgical and medical asepsis as indicatedIdentify patients at risk for latex allergiesIdentify patients with allergies to povidone-iodine (Betadine). Provide alternatives such as chlorhexidine.Bowel EliminationScientific Knowledge Base_______________________________________________________________Mouth_____________________________________________________________________Esophagus_____________________________________________________________________Stomach_____________________________________________________________________Small intestine__________________________________________________________________Large intestine__________________________________________________________________Anus_____________________________________________________________________Defecation_____________________________________________________________________Nursing Knowledge Base: Factors Affecting Bowel EliminationAge_____________________________________________________________________Diet_____________________________________________________________________Fluid intake_____________________________________________________________________Physical activity_____________________________________________________________________Psychological factors___________________________________________________________________Personal habits_____________________________________________________________________Position during defecation_______________________________________________________________Pain_____________________________________________________________________Pregnancy_____________________________________________________________________Surgery and anesthesia_________________________________________________________________Medications_____________________________________________________________________Diagnostic tests_____________________________________________________________________Common Bowel Elimination Problems_____________________________________________________Constipation (Box 47-1) ________________________________________________________________Impaction____________________________________________Diarrhea_____________________________________________________________________Incontinence_____________________________________________________________________Flatulence_____________________________________________________________________Hemorrhoids_____________________________________________________________________Bowel DiversionsTemporary or permanent artificial opening in the abdominal wall. Stoma___________________Surgical opening in the ileum or colon. Ileostomy or colostomyOstomiesSigmoid colostomyTransverse colostomyIleostomyLoop colostomyEnd colostomyOther ApproachesIleoanal pouch anastomosisContinent ileostomyAntegrade continence enema
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Combining Nursing Leader With Advocacy
/in Uncategorized /by GoodmanRate yourself using the results from the “Nurse Manager Skills Inventory”:http://www.aone.org/resources/nurse-manager-skills-inventory.pdfWrite a reflection of 750-1,000 words in which you identify your strengths and weaknesses related to the four content areas below:Personal and professional accountabilityCareer planningPersonal journey disciplinesReflective practice reference behaviors/tenetsDiscuss how you will use your current leadership skill set to advocate for change in your workplace.Identify one personal goal for your leadership growth and discuss your implementation plan to achieve that goal.While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
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SOAP NOTE Chronic Condition Gastroesophageal Reflux Disease
/in Uncategorized /by GoodmanSoap Note Rubric as a guideUse APA format and must include minimum of 2 Scholarly Citations.Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)Turn it in Score must be less than 15% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 15%. Copy-paste from websites or textbooks will not be accepted or tolerated.
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Reply
/in Uncategorized /by GoodmanRespond to 2 Peers Based on APA Guidelines. Work must be supported by peer-reviewed article published within 5 years.
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Discussion: Designing Quantitative Research
/in Uncategorized /by GoodmanIn the context of research design, two types of validity, which speak to the quality of different features of the research process, are considered: internal validity and external validity. Assuming that the findings of a research study are internally valid—i.e., the researcher has used controls to determine that the outcome is indeed due to manipulation of the independent variable or the treatment—external validity refers to the extent to which the findings can be generalized from the sample to the population or to other settings and groups. Reliability refers to the replicability of the findings.For this Discussion, you will consider threats to internal and external validity in quantitative research and the strategies used to mitigate these threats. You will also consider the ethical implications of designing quantitative research.Post1- an explanation of a threat to internal validity and a threat to external validity in quantitative research. Next, explain a strategy to mitigate each of these threats.2-Then, identify a potential ethical issue in quantitative research and explain how it might influence design decisions.3- Finally, explain what it means for a research topic to be amenable to scientific study using a quantitative approach.SOURCESBabbie, E. (2017) Basics of social research (7th ed.). Boston, MA: Cengage Learning.Chapter 3, “The Ethics and Politics of Social Research”Be sure to support your Main Issue Post and Response Post with reference to the week’s Learning Resources and other scholarly evidence in APA Style.Burkholder, G. J., Cox, K. A., Crawford, L. M., & Hitchcock, J. H. (Eds.). (2020). Research designs and methods: An applied guide for the scholar-practitioner. Thousand Oaks, CA: Sage.Chapter 12, “Quality Considerations”Chapter 13, “Ethical Considerations”
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Nursing Leadership 5
/in Uncategorized /by GoodmanUsing the readings from class, reada and respondto the items below in the discussion board for this week: a. List two reasons for and against a strike,b. Support your decision.Up to three refereances including the text for the class.
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MHA6080 WEEK 4 DISCUSSION AND PROJECT INSTRUCTIONS
/in Uncategorized /by GoodmanIn Week 4, we will conclude our discussion of strategic planning by exploring the final steps in the planning process. During this week, we will learn how to integrate the marketing plan with the business and strategic plan. Likewise, this last week will also explore the issues strategy and marketing are facing in healthcare and final thoughts on creating a mental model for market planning.Your Learning Objectives for the Week:Examine and apply business strategies necessary to define and grow a healthcare organization.Summarize the characteristics of successful service and apply these characteristics to a marketing plan for a healthcare organization.
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N. health
/in Uncategorized /by GoodmanWhat are the major problems (Cite at least 3) in the United States’ health care system? Why do you think it hasn’t been “fixed”? Do you believe that providing universal health care should be the policy of the United States? Why or why not? Cite at least 2 peer reviewed journal. Using APA format
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module 06
/in Uncategorized /by GoodmanDescribe the principles of genetics and genomics.ScenarioOne of the clients you worked with in your clinical experience is Native American, a member of the Navajo Nation. He has symptoms of neuropathy and an autoimmune disorder. He relays that it runs in his family and many Navajo people that he knows have these problems. He points out that it was worse in his parents and grandparents’ generations. You decide to do some reading and learn that members of the Navajo and Apache Tribes have a genetic predisposition for these problems.InstructionsCreate an APA formatted document to include the following content:What does natural selection mean regarding population genetics when considering the Navajo and Apache Nations?What is the difference between mutation, migration, selection, and genetic drift?How could population genetics impact care to clients?
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Just send me with fair bid and don’t accept if you don’t like the bid OK
/in Uncategorized /by GoodmanUrinary EliminationScientific Knowledge BaseUrinary elimination is the last step in the removal and elimination of excess water and by products of body metabolism. Adequate elimination depends on the coordinated function of _________________________, __________________, ___________________, and _________. The kidneys filter waste products of metabolism from the blood. The ______________________________________ from the kidneys to the bladder. The bladder holds urine until the volume in the bladder triggers a sensation of urge indicating the need to pass urine. Micturition occurs when the brain gives the bladder permission to empty, the bladder contracts, the urinary sphincter relaxes, and urine leaves the body through the urethra.KidneyThe kidneys lie on either side of the vertebral column behind the peritoneum and against the deep muscles of the back. Normally the left kidney is higher than the right because of the anatomical position of the liver.Nephrons, the functional unit of the kidneys, remove waste products from the blood and play a major role in the regulation of fluid and electrolyte balance. The normal range of urine production is ______________________________. Please convert to CC/day. Erythropoietin, produced by the kidneys, stimulates red blood cell (RBC) production and maturation in bone marrow. The kidneys play a major role in blood pressure control via the renin-angiotensin system, release of aldosterone and prostacyclin. The kidneys also affect calcium and phosphate regulation by producing a substance that converts vitamin D into its active form.UretersA ureter is attached to each kidney pelvis and carries urinary wastes to the bladder.BladderThe urinary bladder is a hollow, distensible, muscular organ that holds urine. The bladder has two portions, a fixed base called the trigone and a distensible body called the detrusor. The bladder expands as it fills with urine. How much urine can the bladder hold?UrethraUrine travels from the bladder through the urethra and passes to the outside of the body through the urethral meatus. The urethra passes through a thick layer of skeletal muscles called the pelvic floor muscles. These muscles stabilize the urethra and contribute to urinary continence. The external urethral sphincter, made up of striated muscles, contributes to voluntary control over the flow of urine. The female urethra is approximately 3 to 4 cm (1 to 1.5 in) long and the male urethra is about 18 to 20 cm (7 to 8 in) long. The shorter length of the female urethra increases risk for urinary tract infection due to close access to the bacteria contaminated perineal area.Act of UrinationBrain structures influence bladder function.Voiding: Bladder contraction + urethral sphincter and pelvic floor muscle relaxationBladder wall stretching signals micturition center.Impulses from the micturition center in the brain respond to or ignore this urge, thus making urination under voluntary control.When a person is ready to void, the central nervous system sends a message to the micturition centers, the external sphincter relaxes and the bladder empties.Factors Influencing Urination (See Box 46-1)Growth and development_________________________________________________________Sociocultural factors_________________________________________________________Psychological factors_________________________________________________________Personal habits_________________________________________________________Fluid intake_________________________________________________________Pathological conditions_________________________________________________________Surgical procedures_________________________________________________________Medications_________________________________________________________Diagnostic Examinations_________________________________________________________Common Urinary Elimination ProblemsThe most common problems involve _____________________________________________ or ________________________________________. Problems can result from1. I_________________________________________________________2. I_________________________________________________________3. O_________________________________________________________4. I_________________________________________________________5. I_________________________________________________________Urinary retention_________________________________________________________Urinary tract infection_________________________________________________________CAUTIsUrinary incontinence_________________________________________________________Common forms of UI are: (See Table 46-1)1. T_________________________________________________________2. F_________________________________________________________3. U/O_________________________________________________________4. S_________________________________________________________5. U_________________________________________________________6. R_________________________________________________________Urinary diversion______________________________________________________________Two types: _____________________________________________________________A ureterostomy or ileal conduitNephrostomy tubesNursing Knowledge Base:________________________________________________________________Infection control and hygiene______________________________________________________Growth and development_________________________________________________________ (Focus on older adult Box 46-2)Psychosocial considerations________________________________________________________Critical thinking________________________________________________________________________Nursing Process: Assessment (Box 46-5)Through the patient’s eyes_________________________________________________________Self-care ability_______________________________________________________________Cultural considerations____________________________________________________________(Box 46.4 cultural aspects of care)Health literacy_______________________________________________________________Nursing history_______________________________________________________________(Box 46.5 Nursing assessment questions)Pattern of urination _____________________Symptoms of urinary alterations: (table 46-2) ___________________________________Physical assessmentKidneys___________________________________Bladder___________________________________External genitalia and urethral meatus___________________________________perineal skin___________________________________Assessment of urineIntake and output___________________________________Characteristics of urine___________________________________Color___________________________________Clarity___________________________________Odor___________________________________External genitalia and urethral meatusPerineal skinLaboratory and Diagnostic TestingDiagnostic Examination (Table 46.5 Common diagnostic tests of urinary Tract)Nursing responsibilities before testing:1. ___________________________________2. ___________________________________3. ___________________________________4. ___________________________________Responsibilities after testing include:1. ___________________________________2. ___________________________________3. ___________________________________Nursing Diagnosis: Nursing diagnoses common to patients with urinary elimination problems:Functional urinary incontinenceStress urinary incontinenceUrge urinary incontinenceRisk for infectionToileting self-care deficitImpaired skin integrityImpaired urinary eliminationUrinary retentionPlanningGoals and outcomesSet realistic and individualized goals along with relevant outcomesCollaborate with the patientSetting priorities___________________________________________________________Patient’s immediate physical and safety needsPatient expectations and readiness to perform some self-care activitiesTeamwork and collaboration______________________________________________________ImplementationHealth promotion_____________________________________________________Patient education_____________________________________________________Promoting normal micturition_______________________________________________• Maintaining elimination habits• Maintaining adequate fluid intakePromoting complete bladder emptying______________________________________________Preventing infection____________________________________________________Acute careCatheterization__________________________________________________________________Skill 46-2, Inserting and Removing a Straight (Intermittent) or Indwelling CatheterTypes of catheters _____________________________________________________________________Catheter sizes_____________________________________________________________________Catheter changes_____________________________________________________________________Catheter drainage systems____________________________________________________________________Routine catheter care_____________________________________________________________________Preventing catheter associated infection (Box 46-10) _____________________________________________________________________Catheter irrigations and instillations_______________________________________________________Removal of indwelling catheters__________________________________________________________Alternatives to catheterization____________________________________________________________Suprapubic catheters External cathetersUrinary diversionsØ Incontinent diversionsChanging a pouchGently cleanse the skin surrounding the stomaMeasure the stoma and cut the opening in the pouchRemove the adhesive backing and apply the pouchPress firmly into place over the stoma.Observe the appearance of the stoma and surrounding skin.Continent diversionsOrthopic neobladderMedicationsAntimuscarinics: treat urgency, frequency, nocturia and urgency UIBethanechol: treat urinary retentionTamsulosin and silodosin: relax smooth muscleFinasteride and dutasteride: shrink the prostateAntibiotics: treat urinary tract infectionsBe familiar with the medications and indications for all medications your patient is taking.Continuing and restorative careLifestyle changesPelvic floor muscle trainingBladder retrainingToileting schedulesIntermittent catheterization• Skin careEvaluationThrough the patient’s eyesAssess the patient’s self-image, social interactions, sexuality, and emotional statusPatient outcomesUse the expected outcomes developed during planning to determine whether interventions were effectiveEvaluate for changes in the patient’s voiding pattern and/or presence of symptomsEvaluate patient/caregiver compliance with the planSafety Guidelines for Nursing SkillsFollow principles of surgical and medical asepsis as indicatedIdentify patients at risk for latex allergiesIdentify patients with allergies to povidone-iodine (Betadine). Provide alternatives such as chlorhexidine.Bowel EliminationScientific Knowledge Base_______________________________________________________________Mouth_____________________________________________________________________Esophagus_____________________________________________________________________Stomach_____________________________________________________________________Small intestine__________________________________________________________________Large intestine__________________________________________________________________Anus_____________________________________________________________________Defecation_____________________________________________________________________Nursing Knowledge Base: Factors Affecting Bowel EliminationAge_____________________________________________________________________Diet_____________________________________________________________________Fluid intake_____________________________________________________________________Physical activity_____________________________________________________________________Psychological factors___________________________________________________________________Personal habits_____________________________________________________________________Position during defecation_______________________________________________________________Pain_____________________________________________________________________Pregnancy_____________________________________________________________________Surgery and anesthesia_________________________________________________________________Medications_____________________________________________________________________Diagnostic tests_____________________________________________________________________Common Bowel Elimination Problems_____________________________________________________Constipation (Box 47-1) ________________________________________________________________Impaction____________________________________________Diarrhea_____________________________________________________________________Incontinence_____________________________________________________________________Flatulence_____________________________________________________________________Hemorrhoids_____________________________________________________________________Bowel DiversionsTemporary or permanent artificial opening in the abdominal wall. Stoma___________________Surgical opening in the ileum or colon. Ileostomy or colostomyOstomiesSigmoid colostomyTransverse colostomyIleostomyLoop colostomyEnd colostomyOther ApproachesIleoanal pouch anastomosisContinent ileostomyAntegrade continence enema
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Discussion 2
/in Uncategorized /by GoodmanAnswer the Discussion Board board questions in paragraph form1. Your office has a strict policy with regard to release of information in health records, and despite a state statute allowing patients access to their records, the physicians you work for will not give patients their records. An obnoxious attorney storms into the office and demands access to your files. The patient has signed a release form. You are at the front desk and the office is full of patients. What do you do?2. Your office has a relaxed policy with regard to the release of information in health records. A patient asks to see his record. You know that there is information in the record regarding telephone calls from the patient’s relatives that would interfere with the family relationship. The physician is away for a week. How would you handle the matter?3. A health record has been subpoenaed and a court order accompanies it. The physician has removed important parts of the record. You know that this information is missing. The office sends you to court as the keeper of the record. You must testify about the completeness of the record. What are you going to say?Please, put at least 3 references in APA format from 2017 up to now.
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