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Exam 2 CCAC
ibd ibs ulcer
| Question | Answer |
|---|---|
| Pyelonephritis and Glomerularnephritis contributing factors | Urinary Stasis Foreign Bodies Anatomic Factors Functional Disorders Other |
| UTI clinical manifestations | Chills/Fever Leukocytosis Cloudy, sedimentation Bacteremia (urine dipstick with nitrates present) Back/flank pain (Costovertebral angle figure 43-6) Nausea/vomiting Painful, frequent, urgent urination |
| Urine C&S is used to | To determine sensitivity to antibiotics |
| Intravenous Pylogram or Ultrasound CT is used to? | to detect obstruction |
| Nursing management of UTI's | 3-4 L/day and careful monitoring of I & O Antimicrobial therapy and monitoring temperature and administration of antipyretics Patient teaching Pharmacological therapy Hygiene and emptying bladder Nutritional Interventions Comfort |
| Treated on an outpatient basis if dehydration or sepsis are absent in UTI's | Antimicrobial Therapy Macrodantin and Macrobid r used to treat uncomplicated cases Ciprofloxin and Levaquin are the therapy of choice with complicated cases Gentemyacin / Ampicillian are not usually the treatment of choice because of their dosing regi |
| These are used for relaxing, antispasmodic therapy in UTI's | Pyridium or Urised (methenamine, phenyl salicylate, methalene blue, benzic acid, atropine, and hyoscyamine) |
| Bacterial infection in the renal pelvis, tubules, and interstitial tissue of one or both of the kidneys | Pyelonephritis |
| Pyelonephritis Acute | Acute Enlarged kidneys with abscesses present that eventually causes atrophy and destruction of the tubules and glomeruli |
| Pyelonephritis Chronic | Chronic Scarred kidneys from continuous damage become contracted an non-functioning – renal disease |
| Can be caused by bacterial infection (UTI) or functional sources that cause UTI (vesicourecteral reflux – retrograde movement of urine from the lower to upper urinary tract), an obstruction from BPH or a urinary stone | Acute Pylonephritis Pathophysiology |
| Acute Pyelonephritis clinical manifestations | Same s/s as UTI however, the vague symptoms usually subside with a few days but bacteremia and pyuria remain |
| Nursing/Medical Management of Acute Pyelonephritis | ABX Therapy Hydration Symptom Identification |
| A condition where the kidney has become small, atrophied, and has lost function due to scarring and fibrosis | Chronic Pyelonephritis |
| Chronic Pyelonephritis S | Fatigue Headache Poor appetite Polyuria Excessive thirst Weight loss |
| Assessment/Diagnostic Findings of Chronic Pyelonephritis | IV urogram Creatinine clearance, BUN and Creatinine and bacterial presence Complications ESRD HTN Kidney stones |
| Medical Management of Chronic Pyelonephritis | Monitoring of kidney function and long-term antimicrobial therapy |
| Nursing Management of Chronic Pyelonephritis | 3-4 L/day and careful monitoring of I & O Antimicrobial therapy and monitoring temperature and administration of antipyretics |
| Glomerularnephritis | Inflammation of the glomerular capillaries Classified by extent of the damage, cause and extent of changes |
| 1Glomerulonephritis Pathophysiology | Immune Response where antigen-antibody complexes become trapped in the capillaries (the filtering system of the kidneys) causing an inflammatory response and IgG is detected in the capillary walls |
| 2Glomerulonephritis Pathophysiology | Immune response where antibodies react with antigens and deposit them on the glomerular basement membrane |
| Acute Glomerularnephritis | Common in children older than 2 years of age but can occur at any age Group A beta hemolytic stept infections of the throat 2-3 weeks prior Acute viral infections of the upper respiratory tract Can be medication induced or outside antigens |
| Clinical Manifestations of Acute Glomerularnephritis | Hematuria May or may not be visible May be cola colored from RBC and protein Edema HTN Azotemia (urea and nitrogen in the blood) Anemia |
| Assessment/Diagnostic Findings - Acute Glomerularnephritis | H&P Renal Biopsy Urine Studies Protenuria (<3g/day) ↑ BUN ↑ Creatinine ↓ Urine output |
| Complications of Acute Glomerularnephritis | Hypertensive encephalopathy Treatment is aimed at decreasing blood pressure without impairing renal function Heart failure Pulmonary edema |
| Medical Management of Acute Glomerularnephritis | Treat symptoms Preserve kidney function Treat complications Dietary Management ↓ Protein ↓ Sodium |
| Pharmacological Treatments | PCN – if streptococcal infection is present Corticosteroids Immunosuppressant therapy Loop diuretics Antihypertensive |
| Nursing Management of Acute Glomerularnephritis | Carbohydrates to reduce catabolism of protein Patient education Diet Complications (Renal failure – fatigue, nausea & vomiting diminishing urine output or infection) Follow-up (urinalysis evaluation, blood pressure and use of medications and effective |
| Chronic Glomerularnephritis | Caused by repeated episodes of acute Glomerularnephritis, hypertensive nephrosclerosis, hyperlipidemia, glomerular sclerosis Kidney’s decreased to 1/5 their norm siz Cortex layer shrinks Rough irregular shape& texture Renal artery r thickened Result ES |
| Clinical Manifestations in Chronic Glomerularnephritis | Asymptomatic General symptoms Fatigue, swollen feet at night, irritability and nocturia |
| Chronic kidney disease symptoms | Poor nourishment, yellow-gray skin, periorbital and dependent edema, retinal changes, pale mucous membranes and cardiomegalgy (heart failure), peripheral neuropathy, decreased deep tendon reflexes |
| Assessment/Diagnostic Findings of Chronic Glomeruonephritis | Fixed specific gravity 1.010 Protenuria Urinary casts ( protein) GFR < 50mL/min Hyperkalemia Acidosis Anemia Hypoalbuminemia ↑ Phosphorus ↓ Calcium Mental status changes Impaired nerve conduction |
| Medical Management of Glomerularnephritis | Symptom management Daily weights Caloric management HTN Diuretics High protein diet Hemodyalisis |
| Inflammatory Bowel Disease (IBD) | Regional enteritis Crohn’s Disease Ulcerative enteritis |
| Facts about IBD | Persons between 15-30 years of age are at greatest risk followed by persons 5-70 years of age Strong family history predisposes risk |
| Cause is really unknown but may be associated with | Pesticides Food additives Tobacco Radiation Allergies |
| Crohn’s Disease---Pathophysiology | Occurs in the distal ileum and ascending colon Seen in smoker’s more often than non-smoker’s Characterized by edema and thickening of mucosa & formation of ulcers & fistulas, fissures and abscesses Bowel wall thicken & intestinal lumen decreases in siz |
| Primary Manifestations of Chron's | RLQ abdominal pain that occurs after meals Diarrhea unrelieved by defecation |
| Secondary Manifestations of Chron's | Malnutrition/Weight loss Anemia |
| Chronic Manifestations of Chron's | Abdominal pain Diarrhea/Steatorrhea Nutritional deficiencies/weight loss/anorexia |
| Barium study of the Upper GI Tract is the diagnostic method of choice and most conclusive | String sign |
| Endoscopy, colonoscopy and intestinal biopsies help to | confirm the diagnosis |
| Complete Blood Cell (CBC) count | ↑ WBC ↓ H/H ↑ ESR ↓ Albumin ↓ Protein |
| Complications of Crohn’s Disease | Intestinal Obstruction Abscess Fistula Enterocutaneous fistula (small bowel) Fissure Arthritis Skin lesions Conjunctivitis Oral ulcerations ↑ Risk of colon CA |
| Ulcerative Colitis | Ulcerative and inflammatory disease of the mucosal and sub mucosal layers of the colon and rectum 5% of persons with ulcerative colitis develop colon CA |
| Pathophysiology of Ulcerative Colitis to Begins in the rectum and causes narrowing, shortening and thickening of the colon due to muscular hypertrophy and fat deposits | Ulcerations causing bleeding Shedding of the colonic epithelium Crypt abscesses formation |
| Ulcerative Colitis Primary Manifestations | LLQ abdominal pain Diarrhea 10-20 liquid stools per day Intermittent tetemus Rectal Bleeding |
| Ulcerative Colitis Secondary Manifestations | Anorexia Dehydration Anemia Hypocalcemia Rebound tenderness in RLQ |
| Diagnostic Studies for Ulcerative Colitis | Colonoscopy/Sigmoidoscopy Shortening of the colon and dilatation of the bowel loops Barium enema |
| Occult blood in the stool Laboratory Findings for Ulcerative Colitis | ↓ H/H ↓ Albumin ↑ WBC |
| Complications of Ulcerative Colitis | Toxic Mega colon Perforation Bleeding Vascular engorgement |
| Medical Management of IBD---Goal is? | Reduce inflammation Provide bowel rest and healing Improving quality of life Prevention and minimization of complications |
| Nutritional Therapy of IBD | Low-residue, high-protein, high-calorie diet Vitamin supplementation Iron replacement Adequate oral intake for fluid & electrolyte balance Avoid lactose rich and cold foods Avoid smoking Parental nutrition may be necessary |
| Pharmacological Therapy of IBD | Aminosalicylate (Long-term maintenance) Azulfidine Sulfa-free aminosalic (Exacerbations) Asacol Antibiotics Flagyl Corticosteroids Predinsone, solu-cortef Monoclonal antibodies Remicade |
| Surgical Management of IBD | Strictureplasty Small bowel resection Total colectomy 25% of ulcerative colitis Intestinal transplant Regional enteritis |
| Common Surgical Procedures of IBD | Total colectomy with illiostomy Continent Ileostomy Koch Pouch Restorative protcoloectomy with ileal pouch anal anastomosis |
| Nursing Management of IBD | Education Parental nutrition IVF Emotional support Management of an ostomy |
| Nursing Management of a Client with an Ileostomy Pre-Op | Infusion of fluid, blood and protein ABX Low residue diet/small frequent feedings Teaching regarding life with a ileostomy |
| Nursing Management of a Client with an Ileostomy post op | Stoma assessment/care Fecal drainage in 72 hours/indwelling catheter for a Koch pouch IVF I & O Nasogastric suction Emotional support |
| Mechanical obstruction | Occurs from intraluminal obstruction or mural obstruction from tumors, strictures, hernias etc. |
| Functional obstruction | Occurs from the inability to propel things along the intestinal tract like Muscular Dystrophy, DM, Parkinson’s etc. |
| Causes of Intestinal Obstruction | Most occur in the small bowel Most common cause is adhesions Other causes: Hernias Intussusception Volvulus Paralytic ileus |
| Clinical Manifestations of Small Bowel Obstruction | A cramping pain in the abdomen Passage of liquids or blood but no feces or flatus Vomiting Dehydration Distended abdomen Shock if untreated |
| Assessment/Diagnostic Findings r/t Small Bowel Obstruction | Symptom related X-ray CT |
| Laboratory values Small obstruction | CBC Electrolytes Significance of findings: Dehydration, low plasma volume and potential infection |
| Medical Management of Small Bowel Obstruction | Decompression of the bowel through nasogastric suction (insertion of an NGT |
| IVF to replace ??? | A, K, Cl and volume/water |
| Surgical intervention for small bowel obstruction | Treat the underlying cause Remove a portion of the bowel |
| Nursing Management of Small Bowel Obstruction | Maintenance of the NGT tube Output Placement Electrolyte status Return of bowel sounds |
| Large Bowel Obstructions | Most occur beyond the splenic flexure of the colon Are not as significant as small bowel obstructions unless blood flow is disrupted which may result in strangulation or necrosis |
| Large Bowel Obstructions causes--- | Adenocarcinoid tumors (majority) Diverticulitis IBD Benign tumors |
| Clinical Manifestations of Large Bowel Obstruction | Symptoms progress&develop slowly Constipation only symptom if obstruction isin sigmoid colon or rectum Shape of stool is altered & may be blood weak/anorexia & weightloss Distended abdomen & marked outline of intestinal walls Crampy, lower abdominal pai |
| Medical Management of Large Bowel Obstruction | Nasogastric decompression Restoration of fluid volume and correction of electrolyte abnormalities Colonoscopy Cecostomy with a rectal tube Surgical resection with a permanent of temporary colostomy Ilioanal anastomosis |
| Monitor for signs of a worsening intestinal obstruction | Crampy, lower abdominal pain Absence of bowel sounds Dehydration Anemia |
| Appendicitis??? | Occurs commonly between the age of 10-30. The most common cause of the acute abdomen Ineffective in emptying and prone to infection/inflammation becomes kinked or occluded by fecal matter, pain in the right lower quadrant and fills rapidly with pus |
| Umbilical or vague Epigastric pain localizing to the right lower quadrant | McBurney’s Point Pain with defecation or urination due to the location of the inflammation |
| other clinical manifestations | Nausea/Vomiting Rebound tenderness Rovsing’s sign |
| Rovsing’s sign is? | an indication of acute appendicitis in which pressure on the left lower quadrant of the abdomen causes pain in the right lower quadrant |
| McBurney’s Point is??? | A point above the anterior superior spine of the ilium, located on a straight line joining that process and the umbilicus, where pressure of the finger elicits tenderness in acute appendicitis |
| When a person has fever, nausea and pain, a????? | laxative or cathartic should NEVER be given. |
| Diagnostic Findings for appendicitis | ↑ WBC ↑ Neutrophils Diagnostic Studies X-ray CT Ultrasound |
| Peritonitis/Perforation complications | Occurs within 24 hours of onset of pain Accompanied by fever > 37.7 degrees Celsius or 100 degrees Fahrenheit Increased abdominal pain and tenderness General appearance changes |
| Immediate surgery IVF Antibiotics If the appendices has already ruptured??? | a drain is placed and surgery is performed after the drainage is complete. |
| Patient Goals | Relieve pain/anxiety (Morphine Sulfate) Place in high fowler's position Reduce infection (Antibiotics) Preventing fluid & electrolyte loss or imbalance (IVF) Monitor for paralytic ileus and insert an NGT if necessary (bowel sounds) Drain care |
| Gallbladder Disease Cholesystitis | Inflammation of the gallbladder |
| Gallbladder Disease Cholelithiasis | Gallstones 90% of people have gallstones that have gallbladder disease |
| Cholecystitis Clinical mmanifestations | Acute inflammation causes pain, tenderness and rigidity in the RUQ and may radiate to mid-sternal and right shoulder pain Nausea/vomiting Signs of inflammation |
| Causes of Cholecystitis Acalculous | Occurs after major surgery or trauma without the presence of gallstones caused by alterations in fluid and electrolytes Bile stasis |
| Causes of Cholecystitis Calculous | Causes 90% of acute cases and occurs from obstruction of the bile from a gallstone Vascular supply becomes compromised and infection occurs |
| Cholelithiasis ages | Increased incidence in women after age 40 and affecting 30-40% of the population by age 80 |
| Cholelithiasis risk factors | Obesity Women Multiple Pregnancies Frequent changes in weight Rapid Weight loss Treatment with high dose estrogen Ileal resection Cystic Fibrosis DM |
| Silent | No symptoms at all and found during other surgery |
| Symptoms of disease | Occur after ingestion of fried or fatty foods including fullness, abdominal distention and pain |
| Symptoms of obstruction | Biliary Colic |
| Biliary colic | Pain and tenderness in the RUQ radiating to the back and right shoulder Jaundice Dark colored urine Clay colored stool Fat soluble vitamin deficiency (A, E, D and K) |
| Diagnostic Studies for Cholelithiasis | Ultrasonography ERCP |
| Nutritional and Supportive Therapy | Low-fat diet avoiding eggs, cream, pork, fried food, cheese, rich-dressings, gas-forming vegetables and alcohol |
| Non-Surgical | Pharmacological – Ursodeoxycholic (UDCA) |
| Surgical Removal of the Gallbladder | Laparoscopic Cholecystectomy Figure 40-5 Mini-Cholecyctectomy Choledochostomy Surgical Cholecyctectomy |
| Potential complications of gallbladder | Bleeding Gastrointestinal symptoms Injury to the bowel |
| Pre-Operative Interventions | Chest X-ray ECG Liver function tests |
| pre-op Teaching | Coughing and deep breathing Avoid smoking for optimal post-operative health and avoiding lung complications Avoid ASA |
| Patient teaching for post-operative interventions | NGT tube with suctioning Drainage tubes |
| Nursing Diagnosis for Post-Operative Patients gallbladder removal | Acute pain Impaired gas exchange Impaired skin integrity Imbalanced nutrition Knowledge deficit |
| Nursing Interventions post op gallbladder | Low Fowler's position IVF NGT Oral fluids Soft diet Turn, cough and deep breathing (splinting) and use of incentive spirometry Drain care |
| Patient Education post op gallbladder | Activity Wound Care Resuming Eating Managing Pain Follow-up Care |
| morbid obesity Applied term to persons who are 2 x their ideal body weight or BMI > 30kg/M2 | Basically > 100 Lbs greater than their ideal body weight |
| 65% of people in the united States are overweight! | They suffer from many potentially fatal physical health problems as well as many psychological issues related to their health and appearance |
| medical management for the obese | Weight loss plans Medications Meridia Xenical Treating underlying medical/psychological conditions Surgical intervention |
| bariatric surgery selection on? | Body weight and complications present History of obesity Absence of endocrine disorders Psychological stability |
| Psychological stability | A multi-disciplinary approach of surgeon, psychiatrist, social worker, dietitian and nurse for 6-12 months prior to surgery Must be able to comply with dietary and behavioral changes after surgery |
| Types of Bariatric Surgery | Restrictive Procedure Malabsorptive Procedure |
| Roux-en-Y Gastric Bypass | A combined restrictive and Malabsorptive procedure for long-term weight loss. A small pouch is isolated and the jejunum is divided and a piece is attached to the new pouch. |
| Gastric Banding | A restrictive Procedure creating a small pouch at the funds of the stomach. A silicone band is applied to the upper portion of the stomach and adjusted through laparoscopic procedures. Saline is injected to change the diameter of the band |
| Biliopancreatic Diversion with Duodenal Switch | Stomach is removed and the jejunum is restricted from the digestive tract so fewer calories are absorbed. The ileum is divided and half attached to the duodenum and the distal end to the jejunum |
| Bariatric Complications of surgery | Bleeding Blood Clots Bowel Obstruction Incisonal or ventral hernias Infection/Peritonitis |
| Pulmonary Complications of surgery | Atelectasis Pneumonia |
| Nutritional Deficiencies of surgery | Malabsorption of vitamins and minerals Iron Supplements Vitamin B12 injections due to lack of intrinsic factor |
| Bile Reflux | Burning Epigastric pain and reflux or vomiting of bilious material that occurs with removal of the pylorus |
| Bile reflux treated with | Questran Aluminum Hydroxide (Antacid) Reglan |
| Dumping Syndrome | Usually occurs in clients who had Vagotomy causing a rapid emptying of the stomach contents into the jejunum which inhibits carbohydrate and electrolyte dilution in the jejunum and increases osmostic transport of extracellular fluid into the GI tract |
| dumping syndrome signs and symptoms | S/S include: feeling of fullness, dizziness, palpitations, cramping and diarrhea/steatorrhea |
| nursing management dumping syndrome | Monitor for potential complications 6 small feeding of 600-800 calories Frequent hydration |
| patient teaching | Overeating causes distention and vomiting Report s/s dehydration (concentrated urine or excessive thirst) Psychosocial interventions |
| Nursing assessment surgery bariatric | Patient and Family knowledge Nutritional Status Abdominal Assessment Post-operative Complications |
| Dietary Management After Surgery for bariatrics | Semi-Fowler's position after eating to delay stomach emptying and dumping syndrome Antispasmodics to delay stomach emptying No fluid intake during meals; 1 hours before or after is preferred |
| Dietary Management After Surgery for bariatrics | Meals consist of dry items and not liquid items Low-carbohydrate meals Eat smaller, more frequent meals Enteral nutrition may be necessary |
| Hemorrhoid info | Dilated portions of the anorectal canal By 50 years of age, 50% of people have Hemmariods and can occur during pregnancy due to the pressure exerted on the tissue Caused by shearing the mucosa during defecation |
| Hemorrhoid types | Internal Hemorrhoids External Hemorrhoids |
| Clinical Manifestations of Hemorrhoids | Itching Burning Pain (usually with external Hemmariods) Bright-red blood with defecation |
| Surgical Rubber-Band Ligation surgery hemorrhoids | Rubber band is placed around the tissue distal to the Hemmariods and eventually become necrotic and falls off Complications - May cause severe pain, hemorrhage and infection for some people |
| Cryosurgical hemorrhiodectomy surgery hemorrhoids | Freezing of the Hemorrhoids to cause tissue necrosis Complications are rare but hemorrhage and abscesses can occur Main pitfall is foul-smelling discharge and increased time for wound healing |
| Hemarrhoidectomy surgery for hemorrhoids | For advanced disease with vein thrombosis The rectal sphincter is dilated digitally and Hemmariods are removed with a clamp or cautery |
| patient teaching hemorrhoids | Avoid straining with defecation High-Fiber diet with increased fluid intake Good personal hygiene |
| Pharmacological Interventions for hemorrhoids | Psyllium (Metamucil) |
| further treatment for hemorrhoids | Warm sitz bath Analgesic ointments/suppositories and astringents Bed rest |
| indirect hernia | abdominal intestine may remain within the inquinal canal or extrude past the external ring |
| indirect hernia is the? | most common type of hernia |
| indirect hernia is located? | located within the femoral canal |
| indirect hernia assessment | appears as swelling. During palpation, have the patient cough. You will feel pressure against your finger tip. Palpate the soft mass |
| inguinal hernias??? | extrusion of the abdominal intestine into the inquinal ring. Bulging occurs in the area around the pubis. Abdominal intestine may remain withing the inqunal ring or extrude past the external ring. |
| inquinal hernia sign and symptoms | most often painless, appears as swelling, while palpating, have the patient cough, you will feel pressure on your finger tips |
| femoral hernia is??? | A bulge that occurs over the area of the femoral artery. The right side is affected more than the left. This is the least common of the 3 hernias |
| femoral hernia S & S | MAy not be painfu;, but if strangulation occurs, there will be a lot of pain |
| The colorectal area includes the rectum and the colon | Andenocarcinoma 95% |
| Colorectal Cancer is the 3rd most common cause of cancer deaths in U.S | Incidence increases with age (>85 years old) Family history of colon cancer History of irritable bowel disease/polyps A disease of Western cultures |
| Polyps are Mass of tissue arising from bowel wall; protrudes into lumen | Most often occur in sigmoid and rectum 30% of people over 50 have polyps Most are benign but some have potential to become malignant (< 1% become malignant but all colorectal cancers arise from these polyps) |
| Polyps Manifestations | Most asymptomatic Intermittent painless rectal bleeding is most common presenting symptom |
| Polyps diagnostic findings | Diagnosis is based on colonoscopy Most reliable since allows inspection of entire colon with biopsy or polypectomy if indicated Repeat every 3 years since polyps recur |
| Symptoms are present based on: | Location of the cancer Stage of the disease Function of the respective parts Change in bowel habits/patterns Blood in the stool |
| related polyps symptoms | Anemia Anorexia Weight loss Fatigue |
| Lesions signs and symtoms | Tenesmus (ineffective, painful straining) Rectal Pain Feeling of incomplete evacuation Alternating constipation/Diarrhea Bloody stool |
| right sided lesions | Dull abdominal pain Melena Weakness Fatigue |
| Left sided lesions | Bright red blood in the stool Obstruction (s/s) Abdominal pain Cramping Narrow ribbon-like stools Constipation/ Diarrhea Distention |
| Diagnostic findings for lesions | Abdominal & rectal examination Fecal occult blood testing Barium enema Proctosigmoidoscopy Colonoscopy (Most definitive) Biopsy Carcinoembryonic antigen (CEA) |
| Lesion complications | Partial/complete bowel obstruction Ulceration/Hemorrhage Perforation Abscess Peritonitis Sepsis Shock |
| Gerontological Consideration | Incidence increases with age Common in women secondary to breast cancer and secondary to men only in prostrate and lung cancer |
| Gerontological Consideration Dietary carcinogens | Lack of fiber Excess fat intake Alcohol consumption Smoking |
| Medical Management Dependent on the stage of the disease | Dukes’ Classification |
| Dukes’ Classification a&B | Class A – tumor of muscular mucosa and submucosa Class B1 – tumor extends into the mucosa Class B2 – tumor extends through the bowel wall into fat with no nodular involvement |
| Dukes’ Classification C&D | Class C1 – Nodular involvement but tumor is limited to the bowel wall Class C2 – Nodular involvement and tumor extends through the bowel wall Class D – Advanced with metastasis |
| supportive therapy | 5-Flourouacil and Pelvic radiation (Class B or C) Mitocyin |
| Adjunctive Therapy | Radiation/Chemotherapy Inoperable tumors are given radiation Intracavitary devices |
| Palliative care | is used in Class D and can involve surgery or radiation for alleviation of symptoms |
| Surgery for lesions | Segmental Resection with anastomosis (tumor and surrounding tissues with blood vessels and lymph nodes) |
| surgery for lesions | Abdominoperineal Resection with permanent colostomy (removal of the tumor and portion of the sigmoid colon and the rectal and anal sphincter |
| surgical management | Temporary Colostomy and segmental resection and anastomosis of the colostomy Permanent colostomy or illiostomy for obstruction lesions |
| surgical management of J pouch | J Pouch (2 step process that first involves and temporary illiostomy loop to direst stool to the J pouch and then reversal of the illiostomy |
| Ileostomy | Ileostomy: opening from ileum through abdominal wall; for surgical treatment of ulcerative colitis and Crohn’s |
| Cecostomy: | Cecostomy: opening between cecum & abdominal wall; uncommon; temporary; used before surgery or for palliation |
| Colostomy: | : opening between colon & abdominal wall: Temporary: located in transverse colon Loop & double barrel temporary but can be permanent |
| Gerontological Considerations | Surgical care of the colostomy Skin care Complications to the stoma from decreased blood flow from arteriosclerosis |
| Care Planning for Colorectal Cancer S | S/S (Fatigue, abdominal or rectal pain, past and present elimination patterns, characteristics of stool) |
| Care Planning for Colorectal Cancer Health History | History (Colorectal cancer, polyps, IBD) Medication review Dietary habits (including noted weight loss) Auscultation of bowel sounds Palpation Evaluation of stool specimens |
| Nursing Diagnosis for Colorectal Cancer | Imbalanced Nutrition, less than body requirements Risk for fluid volume deficit Anxiety Risk for ineffective therapeutic regime Impaired skin integrity Disturbed body image Ineffective sexuality patterns |
| Colorectal Cancer complications | Intraperitoneal infection Complete large bowel obstruction GI bleeding Perforation Peritonitis Abscess Sepsis |
| Planning and goals for Colorectal Cancer | Nutrition Adequate hydration Knowledge regarding surgical procedure, self-care, maintenance of the ostomy Skin care (recognition and treatment of irritated areas |
| Ostomy Surgery Preparation Preop preparation | Psychological preparation ET nurse consult (mark stoma site preop) United Ostomy Association |
| Bowel prep ostomy surgery pre-op | Osmotic lavage (Go-Lytely) Nonabsorbable neomycin & erythomycin orally to decrease number of intracolonic bacteria |
| Nursing care ostomy | Osmotic lavage (Go-Lytely) Nonabsorbable neomycin & erythomycin orally to decrease number of intracolonic bacteria |
| stoma assessment | Stoma has a beefy red appearance If blood flow is restricted, it will appear light pink or grey Skin should be clean, dry and without irritation/ appliance should be fitted to the stoma without strangling the stoma |
| Nursing Management of Chronic Glomerularnephritis | Patient Teaching Compliance with follow-up care and treatment HD care (procedure, how to care for the access site, dietary restrictions and lifestyle modifications) Family involvement and electrolyte imbalance |
| Nephrotic Syndrome | Increased protein in the urine Protenuria Especially albumin Hypoalbuminemia Decreased albumin in the blood Edema Hyperlipidemia Increased serum cholesterol |
| Clinical Manifestations of Nephrotic Syndrome | Edema - soft, pitting periorbital edema and dependent edema (sacrum, ankles, hands and abdomen), anasarca and ascites Irritability Headache Malaise |
| Assessment/Diagnostic Findings of Nephrotic Syndrome | Protenuria >3.5 g/day – Hallmark diagnostic sign ↑ Albumin Needle biopsy |
| Medical Management of Nephrotic Syndrome | Goal Preserve renal function Prevent complications Dietary Management ↓ Protein ↓ Cholesterol ↓ Sodium |
| Pharmacological Interventions | Diuretics ACE inhibitors with combination loop-diuretics Antineoplastic agents and immunosuppressant Corticosteroids and NSAIDS |
| Nursing Management of Nephrotic Syndrome | Assessment and treatment of edema Patient Teaching Dietary Management Medication compliance Infections Follow-up with medical personnel |
| Testicular Cancer | Most common cancer in men age 15 to 40 Highly treatable and curable |
| Testicular Cancer risk faxtors | : undescended testicles, positive family history, cancer of one testicle, Caucasian American race |
| Testicular Cancer manifestation | painless lump or mass in the testes |
| Early diagnosis Testicular Cancer | : monthly testicular self-exam (TSE) and annual testicular exam |
| Testicular Cancer Treatment: | orchidectomy, retroperitoneal lymph node dissection (open or laparoscopic), radiation therapy, and chemotherapy |
| Testicular Cancer Nursing Management | Assess physical and psychological status Support coping ability Address issues of body image and sexuality Encourage a positive attitude Provide patient teaching Provide TSE and follow-up care |
| Factors involved in stone formation: Factors involved in stone formation | Diet, metabolism, genes, climate, lifestyle, and occupation |
| Incidence of kidney stones | Occurs in Caucasian persons 30-50 years of age Occurs most often in men Reoccurrence happens in 50% of cases |
| Urolithiasis | Renal calculi or “stones” in the urinary tract |
| Nephrolithiasis | Renal calculi or “stones” in the kidney |
| Kidney stone Patho 1 | Form in the urinary tract when levels of calcium oxalate, calcium phosphate and uric acid increase. Can be caused by obstruction Stones can vary in size |
| Kidney stone Patho 2 | Several theories regarding formation including lack of substances to dehydration Related to increased calcium concentrates in the blood |
| Types of Stones | Calcium Phosphate Calcium Oxalate Uric Acid Cystine Stuvite |
| Edications that cause kidney stones | Antacids, Diamox, Vit D, Laxatives, High doses of ASA |
| Increased uric acid level causing kidney stones | Uric acid stones occur in patients with gout and Myleoproliferative disorders |
| Increased stuvite level causing kidney stones | Struvite stones are caused by ammonia rich urine such as with infection with ureasesplitting bacteria |
| Increased cystine levels causing kidney stones | Cystine stones occur with patients who have inherited defects in renal absorption |
| Clinical Manifestations of kidney stones | Dependent on the cause: Obstruction Infection Edema Classic S/S Pain Abdominal or flank pain and does not reflect the size of the stone. Radiates to the genitals, thigh and groin Hematuria |
| diagnostic findings of kidney stones | Confirmed on X-ray Ultrasonography Blood work 24 hour urine Calcium Uric acid Creatinine Sodium pH |
| Medical management of kidney stones | Eradication the stone Determine stone type (treat underlying cause) Prevent nephron destruction Control infection Relive obstruction (if present |
| Nursing management of kidney stones | Relive the pain Pharmacological Opioid analgesics NSAIDS Inhibit the synthesis of prostaglandin E Reduce swelling to help facilitate passage of the stone Heat Increase fluid intake Reduces crystalloids in the urine Dilates the urine |
| surgical removal Only used if does not respond to traditional methods and useful to correct obstruction and damage | Nephrolithotomy Incision into the kidney to remove the stone |
| kidney Pyelolithotomy | Incision into the renal pelvis to remove the stone |
| kidney Ureterolithotomy | Incision to remove a stone in the ureter |
| kidney Cystotomy | Removed from the bladder |
| Nephrectomy | removal of the kidney |
| Nutritional Management Calcium Stones | Questionable to limit dietary intake of calcium Decrease sodium and protein Increase fluid intake Management of medications for underlying disease process High fiber diets Provides phytic acid which binds with dietary Calcium |
| Uric acid stones | Low purine diet: Avoid shellfish, anchovies, asparagus, mushrooms and organ meats |
| Cystine stones | Low protein diet < 60g/day Increased fluid intake |
| Oxalate stones | Foods to increase excretion of oxylate: spinach, strawberries, rhubarb, chocolate, tea, peanuts and wheat bran |
| Bladder cancer incidence | Age 50-70 Affects men 4:1 over women More common in Caucasians 4th leading cause of cancer in men Highest world-wide incidence Risk factors are smoking, other cancers, frequent UTI’s, and other cancers |
| Clinical manifestations of bladder cancer | Usually arise from the base of the bladder Painless Hematuria Complications: UTI Pelvic or back pain with metastasis |
| Assessment/Diagnostic Findings bladder cancer | Cystoscopy (Main Dx) Excretory urography Ultrasonography Bimannual examination Biopsies Staging – saline bladder washings |
| medical management bladder cancer | Treatment is dependent on: Grade of the tumor – cellular differentiation Stage of tumor growth – the degree of invasion and metastasis Multicentricity – multiple centers of growth |
| Intravesical Therapy (Chemotherapy | Agents are instilled into the bladder and retained for 2 hour increments. The patient’s position is changed every 2 hours to ensure contact and coating of the bladder. Typical side effects of chemotherapy are not experienced |
| Intravesical Therapy (Chemotherapy | Urinary disruptions and incontinence are common after treatment for bladder cancer |
| Radical cystectomy – most preferred | Bladder, prostrate and seminal vesicles and prevesical tissues in men Bladder, lower ureter, uterus, fallopian tubes, ovaries, anterior vagina and urethra in women |
| Transurethral resection followed by | intravesical administration of bacille Calmette-Guérin (BCG) causing local inflammatory responses |
| Radiation Therapy Pre-operative Inoperative tumors Hydrostatic Therapy Investigational Therapy | Palliative or curative Hematoporphyrin changes to a toxic medication through laser light treatment |
| Urinary Diversion | Occurs after needed cystectomy or other neurological damage, trauma or chronic and last resort of management of incontinence |
| Urinary Diversion procedure | Procedure is based on the degree of damage, age of the client and ability to learn post-operatively and the renal function of the client |
| Types of Urinary Diversions | Ileal Conduit (ileal loop) Incontinent diversionary device Cutaneous Ureterostomy Continent Nephrostomy Catheter of the kidneys |
| Complications | Wound infection Wound dehiscence Urinary leakage Urethral obstruction Hypochloremic acidosis SBO Ilius Gangrene of the stoma |
| Nursing Management Post-Operatively | Hourly urine output > 30 mL/hr to monitor for: Dehydration Obstruction of the Ileal conduit May require a catheter and irrigation of 5-10mL of NSS |
| stoma care | Monitor for; Infection Irritation and bleeding Encrustation and skin irritation (from alkaline urine |
| Monitor urine pH | < 6.5 through administration of ascorbic acid |
| Teaching | Some mucous may be present in the urine Monitor for odor of urine (could indicate infection or poor hygiene of the appliance) Encourage fluids |
| Changing of the appliance | Early am when urineamountsdecreased Skin barrier is essential Avoid moisturizing soaps Avoid asparagus, cheese & eggs (Protein)Empty pouch when 1/3 full Clean system in 3:1 solution of water/white vinegar for 30 minutes stored after powdered w cornsta |
| Continent Urinary Diversions differences | Post-Operatively there are more drains that need careful monitoring for drainage Cecostomy tube MUST be irrigated 2-3 times daily Indiana Pouch Kock Pouch |
| Patient Teaching | Esteem Catheterization every 6 hours and daily irrigation |
| Continent Urinary Diversions- Ureterosigmoidostomy drawbacks | Urinate through the rectum Have frequency/urgency |
| Ureterosigmoidostomy Advantages | No external appliance |
| Ureterosigmoidostomy disadvantages | Lifestyle changes from urgency/frequency Urinate though the rectum Cannot be used if the anal sphincter doesn’t function well |
| Ureterosigmoidostomy complications | Pyelonephritis Adenocarcinoma of the sigmoid colon |
| Ureterosigmoidostomy nursing care | Liquid diet post-operatively Antibiotics Catheter to drain the urine Tube needs irrigation Electrolyte Imbalances /Acidosis treated with low chloride diet and sodium-potassium citrate Monitor 4 s/s of UTI & drain every 2-3 hours to prevent complicat |
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lupde01
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