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Adult Health 2
Stack #155565
| Question | Answer |
|---|---|
| what are the two layers of the skin? | epidermis and dermis |
| what is the function of the skin? | protection |
| what are the three pressure-related factors that contribute to pressure ulcer development? | pressure intensity, pressure duration, and tissue tolerance |
| what is pressure intensity? | the minimal amount of pressure required to collapse a capillary |
| what happens for tissue ischemia to occur? | the pressure applied over a capillary exceeds the normal capillary pressure and the vessel is occluded for a prolonged period of time |
| what is hyperemia? | redness |
| what is blanching hyperemia? | if the area blanches(turns to lighter color) and the erythema returns when you remove your finger then the hyperemia is transient and is an attempt to over come the ischemia episode |
| what is probable if area does not blanch? | if it doesnt blanch when pressure is applied then deep tissue damage is probable |
| what are the two considerations when it comes to pressure duration? | low pressures over a long period of time cause tissue damage as well as high intensity pressure over a short period of time |
| what is tissue tolerance? | the ability of tissue to endure pressure depends upon the integrity of the tissue and the supporting structures |
| what are some risk factors for pressure ulcer development? | impaired sensory perception, impaired mobility, alteration in consciousness, shear, friction, moisture |
| what is shearing? | the force exerted parallel to skin resulting from both gravity pushing down on the body and resistance |
| what is friction? | the force of two surfaces moving across one another, such as mechanical force exerted when skin is dragged across a coarse surface such as bed linens |
| why does moisture affect pressure ulcers? | the presence and duration of moisture on the skin increases the risk of ulcer formation |
| what are some intervention activities for pressure ulcers? | document skin status daily, monitor redness closly, remove excessive moisture, apply protective barriers, turn every 1 to 2 hours, inspect skin over bony prominences, position pillows to evelvate pressure point off bed, keep linens dry clean and wrinkle f |
| what is stage one of a pressure ulcer? | persistent red, blue, or purple tones; no open skin areas |
| what is stage two of a pressure ulcer? | partial thickness skin loss; presents as an abrasion or blister |
| what is a stage three pressure ulcer? | full-thickness skin loss with damage or necrosis of subcutaneous tissue; presents as deep crater |
| what is stage four pressure ulcer? | full-thickness skil loss with extensive destruction, necrosis, or damage to muscle, bone or other structures |
| how are pressure ulcers categorized? | they are staged, graded, according to the level of tissue damage involved |
| what is granulated tissue? | red moist tissue composed of new blood vessels, the presence of which indicates progression toward healing |
| what is slough? | soft yellow or white tissue |
| what is eschar? | black or brown necrotic tissue which needs to be removed for healing; eschar has to be removed before staging |
| what is exudate? | the amount, color, consistency, and color of wound drainage and is part of wound assessment |
| what is an acute wound? | wound that proceeds through an orderly and timely reparative process that results in sustained restoration of anatomical and functional integrity; caused by trauma or a surgical incisison |
| what is a chronic wound? | wound that fails to proceed through an orderly and timely process to produce anatomical and functional integrity; caused by vascular compromise, chronic inflammation, or repetitive insults to the tissue |
| what are the steps to wound healing? | primary, secondary, and tertiary intention |
| what is primary intention? | a clean surgical incision with little tissue loss will heal by primary intention |
| what is secondary intention? | a wound involving loss of tissue such as a burn, pressure ulcer, or severe laceration heals by secondary intention; the wound is left open until it becomes filled by scar tissue |
| what is tertiary intention? | wound left open for several days, the wound edges are approximated |
| what is partial thickness wound repair? | causes the inflammatory response usually in first 24 hours, the epithelal cells begin to regenerate which is epithelial proliferation and migration, then reestablishment of the epidermal layers starts which is where the cells slowly reestablish normal thi |
| what is full-thickness wound repair? | the steps are inflammatory, proliferative where the wound fills with granulation tissue and contraction occurs and resurfacing starts, and remodeling where collagen fibers undergo remodeling |
| what are complication with wound healing? | hemorrhage, infection, dehiscence, evisceration, and fistula formation |
| what is hemorrhage? | bleading from wound site, is normal during and immediatly after initial trauma |
| what is hemostasis? | occurs withing several minutes unless large blood vessels are involved or the client has poor clotting function |
| what is a hematoma? | is a localized collection of blood underneath the tissues it appears as swelling, change in color, sensation, or warmth or mass that often takes on a bluish discoloration |
| how do you know if you have wound infection? | second most common nosicomial infection that is infected if purulent material drains from it |
| when does an infection arise? | the fourth or fifth postoperative day |
| what are the signs of infection? | fever, tenderness and pain at wound site, and elevated WBC count, the edges of wound appear inflamed drainage is odorous and purulent |
| what is dehiscence? | the partial or total separation of wound layers |
| what can cause dehiscence? | obese clients, coughing, vomiting, or sitting up in bed |
| what is evisceration? | protrusion of visceral organs through a wound opening after total seperation of wound layers |
| what do you do if there is evisceration? | place sterile towels soaked in sterile saline over the extruding tissues to reduce chances of bacterial invasion and drying of the tissues; dont give anything by mouth and call for an emergency surgery |
| what is a fistula? | an abnormal passage between two organs or between an organ and the outside of the body |
| why do most fistulas form? | as a result of poor wound healing or as a complication of disease like Crohn's disease; trauma, infection, radiation, exposure, and diseases such as cancer will prevent tissue layers from closing properly and allow fistula tract form |
| what are the factory influencing pressure ulcer formation and wound healing? | nutrition, tissue perfusion, infecton, age |
| what nutrients do you need for good nutrition? | calories(for fuel), protein(wound remodeling), vitamin C, Vitamin A, Vitamin E, Zinc, Fluid |
| what is serum albumin? | the most frequent used lab test that is an indicator of malnutrition |
| what is the best measure of nutritional status? | prealbumin because if reflects not only what the client has ingested but what the body has absorbed, digested, and metabolised |
| what is tissue perfusion? | the ability to perfuse the tissues with adequate amounts of oxygenated blood is critical to wound healing |
| why is infection a factor in wound healing and pressure ulcers? | wound infection prolong the inflammatory phase, delays collagen synthesis, prevents epithelialization, and increase the production of proinflammatory cytokines that lead to additional tissue destruction |
| why is age a factor in wound healing and pressure ulcers? | age affects all phases of wound healing; a decrease in the functioning of the macrophage leads to a delayed inflammatory response, delayed collagen synthesis, and slower epithelialization |
| what are pyschosocial impact of wounds? | body image and social resources |
| what are some nonsurgical management of wounds? | dressings, physical therapy, drug therapy, diet therapy, electrical stimulation, vacuum-assisted wound closure, and hyperbaric oxygen therapy |
| how do dressing help wounds? | a proper dressing can speed healing by removing unwanted debris, protect exposed healthy tissue, and create a barrier between boy and environment |
| what is physical therapy for wounds? | the use of daily whirlpool treatments along with dressing changes for debridement |
| what is drug therapy for wounds? | clean, healthy granulation tissue has a blood supply and is capable of providing white blood cells and antibodies to the ulcer surface to combat infection |
| what is diet therapy for wounds? | successful healing depends on adequate nutritional stores for calories, proteins, vitamins, minerals, and water; bad nutrition increase risk for skin breakdown and delays healing |
| what is electrical stimulation for wounds? | apply a low voltage current to a wound area can increase blood vessel growth and promote granulation |
| what is vacuum-assisted wound closure? | has been used successfully to reduce or even close chronic ulcers by enhancing the formation of granulation tissue |
| what is hyperbaric oxygen therapy? | is the administration of oxygen under high pressure raising the tissue oxygen concentration |
| what is debridement? | the removal of nonviable, necrotic tissue |
| what are the methods of debridement? | mechanical(wet to dry saline guaze), autolytic(uses sythetic dressing over wounds to allow the eschar to be self-digested by ezymes), chemical(topical enzyme preparation), and sharp/surgical(removal of devialized tissue by scalpel, scissors, or sharp inst |
| what are surgical management? | debridement and grafting |
| what is an assessment for skin integrity? | sensation, mobility, continence, presence of wound |
| what do you assess about the skin? | color, temperature, turgor, and integrity |
| what scales are used for pressure ulcers? | norton or braden scale(measure risk for developing ulcers) |
| what are some predictive measures for pressure ulcers? | mobility , nutritional status, exposure to body fluids, and pain |
| what is the assessment of a stable wound? | apperance, size, drains, character of drainage, closures, palpation of wound, and wound cultures |
| what is serous drainage? | clear, watery plasma that is normal after surgery |
| what is purulent drainage? | thick, yellow, green, tan, or brown that means infection |
| what is serosanguineous drainage? | pale, red, watery: mixture of clear and red fluid sometimes after surgery |
| what is sanguineous drainage? | bright red: indicates active bleeding |
| what are the kind of drains? | penrose(lies under dressing) Hemovac or Jackson-Pratt(exerts constant low pressure as long as suction divice is fully depressed) |
| what are the kinds of wound closures? | staples, sutures |
| what do you look for when palpating wounds? | observe swelling or seperation of wound edges |
| what are wound cultures? | never collect a culture from old drainage; clean wound with normal saline to remove skin flora |
| what are the types of wound cultures? | aerobic(superficial wounds exposed to air) and anaerobic(grow within body cavities) |
| what is an abrasion? | superficial with little bleeding and is considered a partial thickness wound |
| what is a laceration? | sometimes bleeds more profusely depending on wound's depth and location |
| what is a puncture? | wounds bleed in relation to the depth and size of wound |
| what is important in the assessment of traumatic wounds? | amount of bleeding and size |
| what are some nursing diagnoses for impaired skin integrity and wounds? | risk for infection, imbalanced nutrition, acute or chronic pain, impaired physical mobility, impared skin integrity, risk for impared skin integrity, ineffective tissue perfusion, and impaired tissue integrity |
| what are some goals and outcomes for impaired skin integrity and wounds? | wound improvement within 2 weeks, no further skin breakdown, and increase caloric intake by 10% |
| after goals and outcomes what do you do? | set priorites and continuity of care |
| what is first aid for wounds? | control bleeding(don't remove penetrating object), cleansing(dont cause bleeding or further injury clean with normal saline), protection(with sterile or clean dressing and immobilize if needed) |
| what are the purpose of dressings? | protects from microorganisms, aids in hemostasis, promotes healing by absorbing drainage and debriding, support or splint wound site, protects from seeing wound, promotes thermal insulation, and provides moist environment |
| what is Telfa? | nonadherent gauze put over clean wounds with little or no drainage doesnt stick to wound or incision but allows drainage to pass through gauze topper |
| what is trasparent film dressing? | ideal for small, superficial wounds such as partial thickness wounds or to protect high risk skin |
| what is a hydrocolloid dressing? | dressings with complex formulations of colloids, elastomeric, and adhesive components; wound contact layer forms a gel |
| what are hydrogel dressing? | come in sheet or tube that provides moist environment, soothing and reduces pain, debrides wound, does not adhere to wound base |
| what are foam dressings? | for wounds with large amounts of exudate and for wounds that need packing and are also used around drainage tubes to absorb drainage |
| how do you change or reinforce dressing? | assess skin under tape, wash hands, wear sterile gloves, remove or change dressing |
| how do you secure a dressing? | tape, ties, or secondary dressing and cloth binders to secure dressing over site |
| how do you prepare a client for dressing change? | administer analgesic, explain steps, gather supplies, prepare sterile field, remove old dressing, assess area, provide necessary care, and answer question and document |
| what are the steps of wound care? | cleanse skin and drain site from least contaminated to most, irrigation of wound with syringe, suture/staple care and removal after doctor orders, drainage evacuation, and comfort measure |
| what are the steps of applying a binder or bandage? | inspect skin, cover exposed wound or open abrasion with steril dressing, asses condition of underlying dressing, assess skin of underlying area |
| what are the step for applying hot and cold therapy? | asses for temperature tolerance, dont cover bleeding area with heat, dont put cold on edematous or neurophathy,bodily responses to heat and cold, local effect of both, factors influencing tolerance, choice of moist and dry |
| how long do you put hot or cold? | 20-30 min for heat and 20 min for cold |
| what are the factors influencing heat and cold tolerance? | better tolerance if short exposure, exposed skin layers are more sensitive, minor temp adjustments, tolerance changes with age, uneven distributiton |
| what affects your choice of moist or dry? | type of injury, location, presence of drainage or inflammation |
| what do warm soaks do? | promotes circulation, lessens edema, increases muscle relaxation, and provides a means to debride wounds and apply medical solution |
| what is a sitz baths? | a bath in which only the pelvic area is immersed in warm or in some situations cool |
| what is a aquathermia(water flow) pads? | a waterproof plastic or rubber pad connected by two hoses to an electrical control unit that has a heating element and motor |
| what is a commercial hot pack? | prepared disposable hot pack apply warm, dry heat to an injured area |
| what is a cold, moist, and dry compress? | prepared cold pack, disposable hot packs for dry application, |
| what is a cold soak? | twenty minutes at 15 degree celcius |
| what are the steps of the last evaluation? | measure the wound, review dietary intake, client's knowledge related to prevention and care |
| what are the components of the urinary tract? | kindey, ureters, bladder, and urethra |
| what is a characteristic of the kidney? | the left is higher than the right b/c of position of liver |
| what are the ureters? | are tubular structures that enter the urinary bladder; urine drains from ureters to the bladder |
| what is a characteristic of the bladder? | when the bladder is full it expands and extends above the symphysis pubis |
| what is the urethra? | urine travels from the bladder through the urethra and passes outside the body |
| how long is the urethra in women and men? | 1-1 1/2 inches long in women and 8 inches in men |
| what is prerenal disease? | decreased blood flow to and through the kidney |
| what is renal disease? | disease conditions of the renal tissues |
| what is postrenal? | obstruction in the lower urinary tract that prevents urine flow from kidneys |
| what diseases make you more prone to loss of bladder tone? | diabetes mellitus and multiple sclerosis cause changes in nerve fuction that can lead to bladder tone loss |
| what do older men tend to suffer from? | benign prostatic hyperplasia (BPH) which makes them prone to urinary retention and incontinence |
| what are some diseases that make it difficult to make it to the bathroom? | parkinsonism and degenerative joint disease |
| what is end stage renal disease? | diseases that cause irreversible damage to kidney tissue |
| what are some sociocultural factors associated with urination? | the degree of privacy needed for urination varies with cultural norms |
| what are some physiological factors associated with urination? | anxiety and emotional stress cause a sense of urgency and increased frequency of urination |
| what is fluid balance? | the kidneys primarily maintain the balance between retention and excretion of fluids |
| what is polyuria? | excessive amount of urine output |
| what is oliguria? | a decreased urine output despite normal intake |
| what is anuria? | no urine is produced |
| what is diuresis? | increased urine formation due to caffenine |
| what are some surgical procedures that affect urination? | anesthetics and narcotic analgesics slow the glomerular filtraiton rate, reducing urine output |
| how do medication affect urination? | diuretics prevent reabsorption of water and certain electrolytes to increase urine output, anitcholinergics or antihistamines cause retention, phenazopyridine colors the urine orange to rust, amitriptyline cause it to turn green or blue, levodopa changes |
| how do diagnostic exams affect urination? | exams of the urinary system influence micurition |
| what is urinary retention? | accumulation of urine resulting from an inability of the bladder to empty properly; the bladder is unable to respond to the micturition reflex and is unable to empty |
| what are symptoms of urinary retention? | wall strech and cause pressure, discomfort, tenderness over symphysis pubis, restlessness, and diaphoresis(sweating) |
| what happens due to urinary retention? | the sphincter is unable to hold back urine and it temporary opens to allow a small amount of urine to escape |
| what are the causes of a UTI? | surgical manipulation, E.coli, poor perineal hygene, failure to wipe front to back |
| why are women more likely to have a UTI? | short urethra and the proximity to the anus |
| what are the symptoms of a lower UTI? | pain or buring during urination(dysuria) fever, chills, nausea, vomiting, malaise, an irritated bladder(cystitis) cause frequent urges to void |
| what is hematuria? | blood in urine due to irritation to bladder and urethral mucosa |
| why does urine appear cloudy ? | presence of WBC's or bacteria |
| what are the symptoms of an upper UTI? | if infection spreads to upper urinary track(kidneys-pyelonephritis), flank pain, tenderness, fever, and chills |
| what is urinary incontinence? | the involuntary leakage of urine that is sufficent to be a problem; either temporary or permanent and leakage is either continuous or intermittent |
| what is a urinary diversion? | some clients have a urinary stoma to divert the flow of urine from the kidneys directly tot he abdominal surface for several reasons trauma, cancer, radiation injury, fistulas, or chronic cystisis either temporary or permanent |
| what is dysuria? | painful or difficult urination |
| what is frequency? | voiding at frequency intervals |
| what is hesitancy? | difficulty initiating urination |
| what is polyuria? | voiding large amounts of urine |
| what is oliguria? | diminished urinary output relative to intake usually 400ml/24hrs |
| what is nocturia? | voiding one or more times at night |
| what is dribbling? | leakage of urine despite voluntary control or urination |
| what is incontinence? | involuntary loss of urine |
| what is residual urine? | volume of urine remaining after voiding |
| when measuring urine from a bag what do you put the urine in? | a seperate graduated cylinder for more accurate measurement |
| what is an extreme decrease in urine? | 30ml for more than 2 hrs is cause for concern |
| what are the characteristics of urine that should be observed? | color(range from pale straw color to amber), clarity(should be transparent), and odor(should have an odor but the longer it sits the stronger it gets),ph(4.6-8), specific gravity(1.0053-1.030) |
| what is a random sample? | collect during normal voiding |
| how do you get a clean-voided or midstream sample? | clean genitalia and then get sample while voiding |
| how do you get a sterile sample? | use port on catheter or put in an in and out catheter |
| how do you get a timed urine sample? | dispose of first urine after time starts must be free of feces or toilet tissue |
| what are some nursing interventions for urinary elimination problems? | hydration, maintaining habit, schedule, privacy, position, hygiene, preventing infection, and medication |
| how do you care for a patient with an indwelling catheter? | make sure they intake 2000-2500ml daily, perineal care 3 times a day, hold labia apart and clean catheter downward in circular motion, and prevent infection |
| what is the evaluation of urinary elimination? | pt restored usual voiding patterns without problem, pt performs toilet activities independently, pt regains usual urine output at least 150ml each voiding |
| what are the components of the GI tract? | mouth, esophagus, stomach, small intestines, large intestines, anus, defication |
| what happens in the mouth? | the teeth masticate food breaking it down into a size suitable for swallowing; saliva produced by salivary glands in mouth dilute and soften food in the mouth for easier swallowing |
| what happens in the esophagus? | the bolus of food travels down the esophagus and is pushed along by peristalsis which propels food through the length of the GI tract |
| what are the tasks of the stomach? | storing swallowed food and liquid, mixing of food liquid and digestive juices, and emptying contents into the small intestine |
| what is secreted and produced in the stomach? | hydrochloric acid, mucus, the enzyme pepsin, and the intrinsic factor |
| what do pepsin and HCL do in the stomach? | facilitate the digestion of protein |
| what is the purpose of mucus in the stomach? | protects the stomach mucosa from acidity and enzyme activity |
| what are the sections of small intestine? | duodenum, jejunum, and ileum |
| what is the main activity in the small intestine? | absorb most of the nutrients and electrolytes |
| what is the primary function of the large intestine? | bowel elimination |
| what happens in the rectum? | bacteria convert fecal matter into its final form |
| how does age affect bowel elimination? | infant has smaller stomach and less secretion of digestive enzymes, older adults have a decrease in peristalsis and esophageal emptying slows |
| how does diet affect bowel elimination? | regular daily food intake regulates peristalsis fiber helps elimination and gas producing foods stimulate peristalsis |
| how does fulid intake affect bowel elimination? | inadequate fluid intake affect the character of feces; reducing fluid intake slows passage of food through the intesting and results in hardened stool |
| how does physical activity affect bowel elimination? | promotes peristalsis |
| what psycological factors affect bowel elimination? | emotional stress makes digestion accelerate and peristalsis increase; ulcerative colitis ibs, and certain gastric and duodenal ulcers and chron's disease are associated with stress |
| how does pain affect bowel elimination? | client suppress urge to deficate to avoid pain and thus develops constipation |
| how does surgery and anesthesia affect bowel elimination? | general anesthesia agents used during surgery cause temporary cessation of peristalsis and any surgery that involves direct manipulation of bowel can stop peristalsis |
| what is a paralytic ileus? | temporary stop of peristalsis usually about 24 to 48 hours |
| how does diagnostic tests affect bowel elimination? | exams involveing visualization of GI often requires a perscribed bowel prepartion to ensure bowel is empty |
| what is constipation? | symptom not disease; the signs are infrequent bowel movements, difficulty passing stool, excessive straining, inability to deficate at will, and hard feces |
| what is a fecal impaction? | results from unrelieved constipation is a collection of hardened feces wedged in the rectum that a person cannot expel |
| what do you do if there is an impaction? | digitally remove the impaction |
| what is diarrhea? | an increase in the number of stools and the passage of liquid, unformed feces |
| what increases diarrhea? | antibiotics, food allergies, surgeries or diagnostic testing of lower gi tract, clostridium difficile |
| what is fecal incontinence? | the inability to control passage of feces and gas from anus |
| what is a hemorrhoid? | dilated, engorged veins in the lining of the rectum that are either enternal or external; if the underlying vein is hardened there is a purplish discoloration(thrombosis) |
| what is a mechanical obstruction? | the bowel is physically obstructed by disorders outside the intestine(adhesion or hernia) or by blockages in the lumen of the intestine(tumors,inflammation,strictures,or impactions) |
| what is a nonmechanical obstruction? | know as a paralytic or adynamic ileus; peristalsis is decreased or absent resulting in slowing of the movement or backup of contents |
| what is common in mechanical and nonmechanical obstruction? | contents accumulate at and above the area of obstruction |
| what is metabolic alkalosis? | an obstruction high in the small intestine causes a loss of gatric hydrochloride |
| what happens when the obstruction is below the duodenum and above large bowel? | loss of both acids and bases so that acid-base imbalance is usually not compromised |
| what is metabolic acidosis? | obstruction at the end of the small intestine and lower in the intestinal tract causes loss of alkaline fluids |
| what is a strangulated obstruction? | obstruction with compromised blood flow; the risk for peritonitis is greatly increased. bacteria without blood supply can from an endotoxin and release into the peritoneal or systemic circulation results in septic shock |
| what happens when there is a strangulated obstruction? | bacterial peritonitis can result, the bacteria will lie stagnant in the obstructed intestine, this can cause a problem if blood flow to intestine is compromised |
| what is the etiology of mechanical obstruction? | adhesions, tumors, hernias, fecal impaction, strictures from chron's disease or radiation, intussusception(telescoping a segment of intestine within itself), volvulus(twisting of intestine), fibrosis from endometriosis, and vascular disorders |
| what is the etiology of nonmechanical obstruction? | paralytic ileus, caused by an imbalance associated with decreased peristalsis from trauma, effect of toxin on autonomic intestinal control, can be caused by handling intestine in surgery |
| what are the signs and symptoms of mechanical obstruction? | sporadic abd pain or cramps, pain is more localized and steady with strangulation, vomiting more profuse in small inestine, obstipation, diarrhea in partial obstruction, abd distention |
| what is mechanical colonic obstruction and when do you get it? | milder, more intermittent colicky abdominal pain that occurs with a mechanical obstruction |
| what is a partial obstruction and when does it occur? | lower abdominal distenetion, obstipation or ribbon like stool when there is a mechanical obstruction |
| what does it sound like when there is an early obstruction? | high pitched bowel sounds |
| what does it sound like when there is a late stage obstruction? | bowel sounds are absent |
| what are signs of nonmechanical obstruction? | severe constant pain due to vascular insufficency or infarction, diffuse discomfort, abd distention, early(decreased BS), later stage(absent BS), vomiting of gastric content and bile frequent but rarely foul smellin |
| what are the lab tests for obstructions? | no definitive test to confirm obstruction, elevated HgB Hct creatinine BUN, serum sodium, chloride, and potassium decreased. increased serum amylase in strangulated obstruction |
| what are some other test that could be performed? | upright abd x-ray and CT |
| waht are some interventions for obstructions? | paralytic ileus(NPO,NG tube, IVfluid, meds for pain, semi fowlers position releaves pressure of distention, antibiotics and surgery for strangulation |
| what are the bowel diversions? | stoma(abd wall), ileostomy(ileum), and colostomy(colon) |
| what is stool like with a diversion? | ileostomy and colostomy stool if frequent and liquid and a colostomy of the transverse colon is more solid formed stool |
| what should the characteristics of stool be like? | color for adult-brown infant-yellow; odor-pungent; consistency-soft and formed; frequency-2-3 a week; amount-150g/day; shape-tubular; constituents- undigested food dead bacteria fat |
Created by:
ashtonlane