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255 test 3
| Question | Answer |
|---|---|
| nurse confirms | the surgery and and why its being done |
| ostomy | creates opening |
| otomy | cutting into an incision |
| plasty | repair or reconstruction of |
| what to obtain for preop interview | reason for surgery, history, medications, substance abuse, allergies, response to surgery, EKG, CXR, labs, vitals, risks, concerns |
| let doctor know of what allergy | banana, avocado, strawberries bc it shares the same protein latex has |
| pneumonia and aspiration preventions | turn, cough, deep breath, sit up while eating, check gag reflex, IS, huff cough, early ambulate |
| interventions for GI complications | clear liquids, advance diet as tolerated, fluids to flush anesthesia |
| anti depressants can | decrease resp drive |
| G HERBS | increase risk of bleeding |
| vitamin E acts as a | blood thinner and incr risk of bleeding |
| obesity needs increased | anesthesia and are more at risk for breathing issues |
| malnourished pt need | protein for wound healing. ex-albumin |
| why is a 73 yr old open abdomen surgery at risk for pneumonia | they are less likely to deep breath |
| surgery skin prep | antimicrobial cleanser, no makeup or nails |
| nurses role in obtaining consent for surgery | must witness and verify signature |
| informed consent cannot be signed until what has been discussed | procedure, risk vs benefit, alternative options |
| if pt has more questions abt procedure, the nurse has to | call the MD back and have them talk to pt |
| potential surgery position complications | pressure ulcers, skin tears, muscle soreness |
| TIME OUT | done before EVERY surgery, right pt, procedure, site, orders are complete, paperwork signed, supply count |
| moderate to deep sedation | conscious, sedated, maintains own airway |
| monitored anesthesia care | sedated, possible airway management |
| opioids use | pain |
| anti-emetics use | nausea |
| benzodiazepines use | anxiety |
| neuromuscular blocking agents use | muscle relaxation and paralysis |
| older adult surgery considerations | hypothermia-due to trouble regulating body temp, use face scale for pain |
| monitor what for older adult getting opioids | decreased bp, decreased resp drive, decreased bowel sounds and constipation |
| how to decrease risk of post op constipation | increase fluids, increase fiber, early ambulate, take a stool softener ike docusate |
| anaphylactic reactions | life threatening, pulmonary and circulatory complications, throat closing, hypotension, tachycardia, pulmonary edema, bronchospasm, common wt latex allergy |
| malignant hyperthermia | adverse reaction to anesthesia, high temp and rigid muscles, tachycardia, tachypnea, cardiac arrest, treat fever |
| PACU | immediate recovery, head to toe assessment, vitals q 15 min, I&O |
| post op precautions pt | fall, bleeding, aspiration. |
| nurse cannot do | first surgical dressing |
| safest bathroom option for pacu | bedpan/urinal |
| post op concerns | monitor vitals but expect a decr in all of them, monitor surgical dressing and teach splinting. GI-nausea, bowel sounds, vomit, I &O, GU-output, catheter, retention |
| if pt does not void in | 8 hr post op, call MD |
| likely cause for post op sore throat | intubation (airway placement) |
| likely cause for post op shoulder and stomach pain | air trapping |
| pain meds make | constipation worse |
| post op discharge criteria | stable, weaned from O2, no excess bleeding, no nausea, tolerate diet, pain managed, measure first void, teach pt |
| kidneys filter and regulate | waste, fluid, electrolytes |
| bladder relaxes to | fill and contracts to empty |
| ureters connect | kidneys to bladder |
| as GFR lowers | BUN and Cr go up (toxins) |
| if there is a build up of waste, worry about what? | mental changes |
| Calcium levels | 8.6-10.2, abnormal Ca signs-brittle bones, muscle issues, altered mental status |
| Phosphorus levels | 3-4.5 abnormal signs-brittle bones |
| potassium levels | 3.5-5 abnormal signs-arrthymias |
| sodium levels | 135-145 abnormal signs-altered neuro status |
| Erythropoietin is a | messenger hormone, tells bone marrow to go make new RBC, if not pt can have anemia |
| vitamin D helps absorb | calcium, if Ca isnt being absorbed we worry abt brittle bones |
| Ca and phosphorus needs to be | balanced for good bone health |
| With damaged kidneys, calcium levels are like to be | low, phosphorus high |
| kidneys produce and hold onto | bicarbonate and excrete acid, if this isnt happening we worry about metabolic acidosis |
| how do kidneys regulate BP | releases renin, renin vasoconstricts, increases bp and converts angiotensin into angitonensen 1 |
| angiotensin 2 causes | vasoconstriction and the release of aldosterone |
| why is an MRI avoided in kidney issues | uses dye, need to increase fluids with dye |
| kidney damage is | rapid |
| normal GFR levels | Glomerular Filtration Rate: > 60 ml/min |
| normal BUN levels | Blood urea nitrogen: 10-20 mg/dL |
| normal creatinine levels | Creatinine: 0.6-1.2 mg/dL |
| Urine specific gravity: | measures concentration (Normal 1.003-1.030) |
| whats a biopsy used for | to look at tissue |
| whats a ultrasound used for kidneys | looks at shape, size, and location |
| acute renal failure common causes | prolonged low BP, decreased blood volume, nephrotoxic agents, is reversible |
| pre-renal failure | Decreased blood flow to kidneys ▪ Examples: dehydration, heart failure, decreased cardiac output |
| Intra-renal | Causes: nephrotoxic drugs, renal trauma, renal disease like glomerulonephritis or acute tubular necrosis, etc. it can lead to severe, life-threatening complications, including irreversible chronic kidney disease (CKD) or death |
| post renal stage | Damage from mechanical obstructions ▪ Common causes: BPH, tumor, calculi, trauma, inflammation. it can lead to permanent, irreversible kidney damage, chronic kidney disease (CKD), or death, usually within a few weeks. |
| oliguric phase | low GFR, high BUN and CRvery little urine, first sign of AKI, less than 400 ml per day, high specific gravity, keeping fluid in, leeps potassium, protein, amd phosphorus in, metabolic acidosis |
| Diuretic Phase | high GFR, low Cr and BUNAble to excrete waste but can’t concentrate urine ▪ The nephrons aren’t fully functional yet ▪ Lasts 1-3 weeks, urine very dilute, weight changes quick monitor I &O |
| 1L fluid | 2.2 lbs |
| Recovery Phase | Return to normal urine output ▪ See improvement in 1-2 weeks ▪ Can take up to a year to fully stabilize |
| AKI Treatment | Eliminate cause, manage signs and symptoms, prevent complications ▪ Fix hyperkalemia ▪ Fix hyperphosphatemia ▪ Renally dose meds ▪ fluid restriction ▪ low sodium, low potassium, low protein, low phosphorous ▪ high carb |
| Risk Factors for AKI | Elderly ▪ Chronic kidney disease ▪ Massive trauma ▪ Cardiac failure ▪ Sepsis ▪ Obstructions ▪ Nephrotoxic drugs |
| What is Chronic Kidney Disease | Some form of permanent kidney damage ▪ Commonly from DM, HTN, and HLD, progresses slowly |
| cholesterol sticks to | damaged walls and causes blockages |
| Begin using term “renal failure” | GFR 30-59 |
| CKD Manifestations | Affects every body system ▪ uremia = happens when multiple body systems affected and GFR is 15 or less ▪ Uremic frost-urea leaks out of pt pores, super itchy, Caused by imbalance of fluid, electrolytes, and waste products |
| CKD Treatment | preserve remaining function, decrease complications, promote comfort ▪ Treat electrolyte imbalances, Treat HTN and hyperlipidemia ▪ Treat anemia, Modify diet: Low protein, potassium, phosphorous, and sodium. High carb |
| Risk Factors for CKD | Elderly Family HX Ethnic minorities HTN UTIs DM Nephrotic drugs Heart disease |
| Dialysis Basics | Machine acts as glomerulus, filters waste, toxins, and excess fluid from the blood, started at stage 5 failure, GFR >15 |
| Hemodialysis (HD) | Typically 14-16 gauge to allow for high-speed blood flow ( ) necessary to efficiently clean large volumes of blood in a short time ▪ Types of access: Quinton, AV fistula, AV graft ▪ Need large vessel for rapid blood flow 3 x a week 4 hrs each time |
| Quinton catheter | Temporary ▪ Location: Internal jugular with tip in right atria ▪ Red lumen pulls blood ▪ Blue lumen returns blood ▪ Has small IV lumen |
| AV fistula | Permanent ▪ Matures in 3 months ▪ Location: arm ▪ Thrill & bruit ▪ Limb alert an abnormal connection between an artery and a vein, allowing blood to flow directly between them rather than through capillaries. |
| AV graft | Permanent ▪ Matures in 2-4 weeks ▪ Location: arm ▪ Thrill & bruit ▪ Uses synthetic material ▪ Used in patients with PVD ▪ Limb alert |
| Continuous Renal Replacement Therapy | Form of HD ▪ Treats AKI ▪ Slower ▪ 80mls at a time ▪ Setting: ICU ▪ Up to 40 days ▪ Quinton catheter |
| Peritoneal Dialysis (PD) | Catheter surgically placed in the peritoneal cavity ▪ Peritoneal acts as a semi-permeable membrane automated-While sleeping ▪ Disconnect in AM ▪ Up to 6 nights/week 2. Continuous ambulatory- cycle every 4 hrs |
| HEMODIALYSIS complications | Hypotension ▪ Muscle cramps ▪ Blood loss |
| PERITONEAL DIALYSIS complications | infection (peritonitis) ▪ Hernia ▪ Back pain ▪ SOB ▪ Bleeding ▪ Protein loss* ▪ This is the exception to protein being high |
| uremia | buildup of waste products |
| ckd fluid volume excess | bp high, low iron, anemic, low Ca, high K, low RBC, high phosphorus |
| diuretics harm | kidneys |
| nephrotoxic meds | NSAIDS, antibiotics especially MYCINS, dye, street drugs |
| palpate | THRILLS |
| pressure from fluid can cause | hernias |
| what H/H to worry about | 7/25 |
| Renal Transplant | Treatment for ESRD ▪ Risk vs. benefit ▪ Reverses lifestyle and dietary restrictions ▪ Can improve quality of life ▪ Antigen considerations |
| LIVE DONOR | Medical evaluation/counseling ▪ Open or laparoscopic ▪ ICU 24 post op |
| DECEASED DONOR | Brain dead and previously healthy ▪ Vent support for organs ▪ Organs preserved up to 72 hours |
| steroid complications | brittle bones, blood sugar rises, suppresses immune system so watch WBC |
| Transplant Post-op | Strict I&Os ▪ Immunosuppressant therapy ▪ Steroids |
| Transplant Complications | Rejection ▪ Infection ▪ Acute tubular necrosis ▪ Damage from prolonged cold time (amt of time kidneys are out of the body) |
| antibodies from strep throat get lodged in | kidneys |
| ace inhibitors stops | protein from spilling out of urine |
| steroids cause | fluid retention |
| nephrotic syndrome | big holes, protein spills through, low albumin levels leads to aniscarca (total body edema) |
| what type of meds for kidney pt | statins and fibrates |
| patiromer | poop out potassium |
| Glomerulonephritis | Glomeruli inflamed ▪ Possible scarring ▪ Results from: infections, immune disease, vascular disorder ▪ Acute or chronic |
| Acute Glomerulonephritis | Temporary/reversible ▪ Ex: acute post-streptococcal glomerulonephritis (APSGN) ▪ 1-2 weeks after strep throat ▪ Antibodies in glomeruli cause damage; reason unknown oliguria bc inflammation of the glomeruli causes a significant drop in (GFR) |
| why hematuria and proteinuria in Acute Glomerulonephritis | immune-mediated inflammation damages the glomeruli (kidney filters), breaking the barrier that separates blood from urine |
| Acute Glomerulonephritis treat | ABX PRN, rest, sodium/fluid restrictions, diuretics, ace-inhibitors ▪ Strict I&Os and daily weights ▪ Education: Full course of ABX: |
| Chronic Glomerulonephritis | Permanent renal fibrosis (scarring), Can lead to ESRD ▪ Common causes: toxic drugs, viral infections like hepatitis, immune disorders like lupus ▪ Treatment: symptom management, Key strategies include limiting sodium (–2,000 mg/day), protein |
| Nephrotic Syndrome | Glomerulus is too permeable; lose protein in urine ▪ From: infections, systemic disease, cancer, NSAIDs, Anasarca: total body edema ▪ HTN ▪ Hyperlipidemia (liver: albumin, cholesterol, triglycerides) ▪ Foamy urine: from protein and fat |
| Nephrotic Syndrome treat | Steroids: decrease inflammation/shrink holes ▪ Increase protein ▪ Diuretics ▪ Limit sodium ▪ Lipid lowering drugs ▪ Ace-inhibitors ▪ ** limit protein with kidney problems EXCEPT nephrotic syndrome ▪ Strict I&Os and daily weight |
| Renal Cancer | More common in men ▪ Biggest risk factors: smoking and obesity ▪ Asymptomatic in early stages ▪ Not very responsive to chemo/radiation ▪ Partial/total nephrectomy ▪ Cryoablation: freeze ▪ Immunotherapy |
| WHAT CAN BE TRANSPLANTED | Tissue • Does not require tissue-antigen matching • Skin, cornea, bones, valves Organs • Requires tissue-antigen matching • Higher risk for rejection |
| HUMAN LEUKOCYTE ANTIGEN | Used to match organs and tissues for transplant • Each of the 6 major HLAs can have its own antigens • Zero antigen mismatch: • Decreases chance of rejection |
| Autograft | Patient’s own tissue • Most successful Example: skin graft or CABG vessel |
| isograft | Share genetic info Ex: Identical twins |
| allograft | Same species, but different genetic info Ex: Kidney transplant with strangers |
| Xenograft | From animal to human • Least successful Ex: Pig skin for human burns |
| TRANSPLANT FACTORS | Risk vs. benefit Lifestyle Blood type and antigen matching Geographic location Time on waitlist Wait list vs. immediate transplant • Emergencies • Zero antigen mismatch (all 6 HLA match |
| REJECTION | Hyper-acute Within 1st 24 hours Acute Within 1st 6 months Chronic After 6 months mmunosuppression therapy used to decreased chance of rejection Must balance rejection & infection |
| IMMUNOSUPPRESSANTS | Corticosteroids prednisone, methylprednisone Calcineurin Inhibitors Tacrolimus (Prograf) Cytotoxic Agents Mycophenolate mofetil (CellCept) |
| GRAFT VS. HOST DISEASE | Donated matter views the recipient’s body as foreign and attacks • Symptoms usually seen in skin, liver, and GI tract • Most common are: rash, jaundice, nausea, vomiting, diarrhea |
| why do we get edema in nephrotic syndrome | low albumin causes fluid shift out of vascular space into tissues |
| treat nephrotic syndrome with | steroids, incr protein |
| nephrotic syndrome liver | liver creates albumin. it also creates cholesterol causing hyperlipidemia |
| teach breathing exercises to pt who get | abdnominal surgery |
| GVHD occurs when a | immunoincompetent patient is transfused or transplanted with immunocompetent cells. Examples include blood transfusions or the transplantation of bone marrow, fetal thymus, or fetal liver |
| A systemic anaphylactic reaction starts with | edema and itching at the site of exposure to the antigen |
| UTI Manifestations | Dysuria Frequency Urgency Cloudy urine Back/flank pain Fever Sepsis (urosepsis) |
| UTI Diagnostics | WBC Urinalysis (UA) Culture and sensitivity (C&S) What is the “clean-catch” technique? Antimicrobial cleanser and midstream catch |
| UTI Treatments | Why do antibiotics help? kill bacteria Why does increasing fluids help? Flush bacteria Urinary analgesics phenazopyridine (Pyridium)-orange urine |
| Antibiotics (ABX) for UTIs | Fungal infections: fluconazole (Diflucan) Complicated: 1-2 weeks fluoroquinolones: levofloxacin, ciprofloxacin Uncomplicated: 3 days trimethoprim / sulfamethoxazole (Bactrim) nitrofurantoin (Macrodantin) cephalexin (Keflex) |
| How do antacids affect ABX? | Change ph and effectiveness of antibiotic |
| UTI Timing considerations | Give probiotics 2 hours after antibiotic Give antacids 2 hours before or after |
| At-Risk Population | Older adults-bph, incontinence, retention Debilitated-catheters, hygiene Immunocompromised CKD-anuria, oliguria |
| UTI Preventative Measures | Staying hydrated Empty bladder completely and regularly Avoid harsh soaps/perineal powders/sprays Avoid bubble baths Wiping front to back Voiding after intercourse Early catheter removal Routine perineal/catheter care |
| Pyelonephritis | inflammation of the renal tissue Usually begins with a UTI that travels to the renal tissue Presents with the same symptoms as a UTI fever, malaise, flank pain Plus more severe symptoms: nausea, vomiting, CVA tenderness |
| Urethritis | Inflammation of the urethra Common with STDs Ex: gonorrhea, chlamydia, syphilis, etc. Social history is important Presents with same symptoms as UTI Dysuria, urgency, and frequency |
| Interstitial Cystitis AKA: Painful Bladder Syndrome | inflammation of the bladder, same symptoms as a UTI.Cause unknown, no treatment Rule out possibilities Avoid irritating foods and beverages OTC: calcium glycerophosphate (Prelief) Alkalinizes the urine. |
| Urinary Tract Calculi | Calculi is another name for a stone Patient present with sharp, severe pain and N/V Diagnosed with CT or US Strain urine Risk factors: Diet UTIs Dehydration |
| Urinary Tract Calculi treat | Increase fluids Pain control & antiemetics tamsulosin (Flomax) Potassium citrate to alkalinize urine as needed Surgical intervention lithotripsy |
| Lithotripsy | Used to break up and eliminate stones Laser Electrohydraulic Extracorporeal shock wave Percutaneous ultrasonic: incision is made Can be used with scopes and saline wash-outs May use urethral stent (temporary or permanent) encourage incr fluid |
| Calcium oxalate Calcium phosphate stone | Most common More common in men Fluids Increase calcium to reduce oxalate & phos Want alkaline urine |
| Cystine stones | Rare Genetic conditions Fluids Want alkaline urine |
| Struvite stones | Associated with UTIs More common in women Large staghorn type Fluids May need surgery Want acidic urine |
| Uric acid stones | More common in men Fluids Reduce uric acid. Avoid purines Give allopurinol Want alkaline urine |
| foods high in Ca | Dairy, beans, fish, dried fruits/nuts, chocolate |
| foods high in oxalate | Spinach, asparagus, cabbage, celery, parsley, tomatoes, beets, nuts, chocolate, instant coffee, tea |
| foods high in purine | Sardines, mussels, liver, kidney, goose, venison Moderately high: chicken, pork, beef, ham, bacon, salmon, crab, veal |
| ureteral stricture | Narrowing of ureter From scarring (usually from SX) Treat with stents or urinary diversion Hint: above bladder |
| urethral stricture | Narrowing of urethra From inflammation Treat with stents or catheter Hint: below bladder |
| Bladder Cancer | Usually diagnosed early Treat with radiation and chemo Chemo can be given directly into the bladder with a 3 way catheter to decrease systemic side effects Remove tumor Remove bladder Remove bladder and surrounding structures |
| Bladder Cancer Risk Factors | UTI stones smoking Pelvic radiation Exposure to chemicals Long term catheters |
| Urinary Diversion | Urostomy Restores urine flow Strict I&Os a surgical procedure that creates a new way for urine to exit the body when the bladder is removed or malfunctioning |
| Functional incontinence | •Cognitive or physical •Timed voids-every 2hrs |
| Stress incontinence | •Sudden increased ABD pressure (cough, sneeze, heavy lifting) •Weak urinary sphincter •Kegel exercises |
| Urge (Over Active Bladder) incontinence | •Uncontrolled muscle contractions •Overactive detrusor muscle •Anticholinergics •Kegel exercises/bladder training •Avoid irritating food/drinks |
| Urinary Retention | Can’t void or fully empty the bladder Bladder scan used for post-void residual urine amounts Normal residual amount is 150 Causes: BPH Strictures Obstructions Weak muscles |
| Urinary Retention treat | Catheter Surgery (if needed) Alpha adrenergic blockers: relax urinary muscles and ureters tamsulosin (Flomax) doxazosin terazosin alfuzosin |
| BENIGN PROSTATIC HYPERPLASIA (BPH) | With BPH, the prostate gland is enlarged The enlarged prostate can partially or completed obstruct the urethra If the urethra is obstructed, urine output will decrease |
| Bph causes | BPH is caused by hormonal changes As men age, testosterone levels decrease & the concentration of estrogen increases High estrogen concentrations produce dht (dihydrotestosterone) DHT promotes prostate cell growth |
| Bph symptoms irritative | Related to inflammation/infection Dysuria Urgency Nocturia Bladder pain Incontinence Urinary frequency |
| Bph symptoms obstructive | Related to urethra Dribbling Weak urinary stream Stopping & starting of urine stream |
| Bph COMPLICATIONS | Urinary retention because the prostate squeezes the urethra UTI, Pyelonephritis, and sepsis from retention Struvite bladder stones from residual alkaline urine Hydronephrosis from urine back flow from retention |
| Bph diagnosis | History & Physical 2. Urinalysis & Culture for infection, (PSA): Normal is 0 – 4 mcg/L.Digital Rectal Exam size, symmetry, & consistency Positive if prostate is smooth, firm, symmetrically enlarged, (TRUS): determine bph vs. cancer, Post-void residuals |
| Goals of bph management without procedure | Restore urine flow Relieve symptoms Prevent and/or treat complications Prevent UTIs by increasing fluid (2-3 L/day) and encouraging frequent urination |
| BPH diet changes | . Avoid bladder irritants because they already have frequency. Before bed, restrict fluid intake Because they already have nocturia & frequency |
| BPH med considerations | . Avoid decongestants A side effect is smooth muscle contractions and BPH patients already have a compressed urethra Avoid anticholinergics A side effect is retention And BPH patients already experience retention |
| BPH 5 Alpha Reductase Inhibitors | Suppresses DHT production to the size of the prostate Delayed onset Effective in 6 months Side effects: decreased libido Common ending: “-ride” Example: finasteride |
| BPH Alpha Adrenergic Blockers | Relaxes smooth muscles to improve symptoms Quicker onset Effective in 2-3 weeks Side effects: headache, fatigue, dizziness, orthostatic hypotension, tachycardia Common ending: “-osin” Examples: Silodosin, prazosin, alfuzosin, terazosin |
| BPH minimally invasive treatment options | Transurethral Microwave Therapy (TUMT), Transurethral Needle Ablation (TUNA), Laser Prostatectomy, Destroys prostate tissue All pt come back with a catheter |
| BPH invasive treatment options | Transurethral Incision of the Prostate (TUIP)- Incisions made into the prostate to relieve pressure on the urethra Transurethral Resection of the Prostate (TURP-Surgical removal of the prostate tissue |
| Turp: post-op | large 3-way indwelling catheter for bladder irrigation to prevent blood clots Hematuria is expected for the first 24-36hrs so worry about bleeding after Post-op urinary drainage expected to be light pink because blood mix wt urine |
| When should the nurse worry about bleeding in the urinary drainage bag? TURP | After 24-36hrs Bleeding is increased Blood is bright red |
| Bladder irrigation | The purpose of bladder irrigation is to keep the catheter patent Bladder irrigation can be done manually with a syringe or run through a pump The bladder is irrigated with NS |
| Post-op catheter care | Frequent perineal hygiene, Bladder irrigation Educate to expect temporary weak urinary sphincter tone after removal with associated incontinence or dribbling can be strengthened with Kegel exercises Catheter if can’t void for 6-8 hr |
| pre-op treatment for invasive bph procedures | Give IV antibiotics to treat any infections If needed, restore urine drainage Might be done with an indwelling cathe |
| pre-op education for invasive bph procedures | Teach about post-op care: Bladder irrigation Catheter care Wound care Teach about potential complications: Incontinence for up to 2 months Erectile dysfunction for up to 1 year |
| What to monitor post-op for invasive bph procedures | Hemorrhage Bladder spasms incontinence Perineal incision/infection constipation Med: Treat bladder spasms with oxybutynin PRN |
| oxybutynin | Anticholinergic Relaxes smooth muscles Treats post-op bladder spasms Side effects: Blurry vision Urinary retention Dry mouth constipation Heart palpatations |
| BPH INVASIVE TREATMENT INFECTION RISK | There is an increased risk for infection when incisions are made in the perineal area because of the close proximity to the rectum |
| Diet changes post-op bph invasive procedure | Avoid bladder irritants Increase fluids to decrease constipation And encourage to void |
| Educational needs post-op bph invasive procedure | Prevent constipation by: Eating a diet high in fiber Taking prescribed stool softeners (Ex: senna docusate) Increase fluid intake 2-3L per day Practice abstinence for specified time by HCP Avoid increasing pressure including:lifting, straining |
| Stool softeners | Treats post-op constipation Give with fluids Side effects: Abdominal cramping & diarrhea Example: senna docusate |
| Prostate cancer | Cancer of the prostate Very treatable in the early stages Asymptomatic in the early stages & usually diagnosed with routine screening Diagnostic testing is needed because it presents with the same symptoms as bph |
| Prostate cancer diagnosis | PSA Prostatic acid phosphate (PAP) DRE is positive if prostate is hard, nodular, and asymmetric (BPH was symmetric) Biopsy to confirm diagnosis after positive psa &/or rectal exam Bone scan MRI CT |
| Prostate cancer risk factors | Older than 50 Family History African American Exposure to chemicals in pesticides Diet low in: Fruits Vegetables Diet high in: Red meat High-fat dairy Processed meat |
| Prostate cancer treatment options | Prostatectomy: (Radical or Nerve-Sparing) Cryotherapy (AKA Cryoablation) Radiation: (External Beam or Brachytherapy) Chemo Androgen Deprivation Therapy (Meds or Orchiectomy) |
| Prostatectomy radical | Prostate & surrounding structures (neurovascular bundles) removed Incision: lower abdomen or perineal, so potentially higher risk for infection Post-op catheter and drain Complications: hemorrhage, infection, urinary incontinence, erectile dysfunction |
| Prostatectomy nerve spacing | Prostate removed but surrounding neurovascular bundles are untouched Neurovascular bundles maintain erectile functioning & reduces risk of erectile dysfunction To be an option, cancer must be limited to only the prostate Incision: lower abdomen |
| Cryotherapy (cryoablation) | Liquid nitrogen freezes tissue to kill cancer cells Complications: Erectile dysfunction Hemorrhage Urinary incontinence |
| radiation external beam | Frequency: 5 days a week, 4-8 weeks Side effects: Dry, red, or irritated skin Diarrhea & stomach cramping Urgency, frequency, nocturia, dysuria Hematuria Hesitancy Erectile dysfunction |
| brachytherapy radiation | Frequency: one time More convenient Only done is cancer is not advanced Radioactive seed is implanted into the Less side effects: Urgency, frequency, nocturia, dysuria Hematuria, Hesitancy Erectile dysfunction |
| Androgen deprivation therapy (adt) | Androgen deprivation therapy deprives the body of androgens Androgens are hormones like testosterone For prostate cancer cells to grow, the cells need androgens ADT can be done with medications or surgery |
| Androgen synthesis inhibitors (MED) | Stop androgen production Examples: Leuprolide Triptorelin |
| Androgen receptor blockers (MED) | Block androgen receptors Examples: Flutamide Nilutamide Bicalutamide Enzalutamide |
| Orchiectomy (procedure) | Surgical removal of testicles to stop production of androgens Gold standard for ADT |
| Androgen deprivation therapy (adt) side effects | All forms of ADT have the same side effects Cardiac: High cholesterol, High triglycerides, CAD Musculoskeletal: Osteoporosis, bone fractures, loss of muscle mass Hormonal: Hot flashes, gynecomastia, low libido, weight gain |
| Testicular cancer | Rare & easily curable High risk for infertility Symptoms: Painless scrotal lump Dual ache in lower abdomen Scrotal swelling, heaviness, or dull ache Risk factors: HIV Family history Undescended testicles |
| Testicular cancer diagnosis | Palpation for a mass A cancerous mass will feel firm A cancerous mass will not transilluminate with a flashlight Transilluminate: light will not shine through Ultrasound Tumor markers |
| Testicular cancer treatment | Chemo Radiation Orchiectomy |
| Erectile dysfunction (ed) | Inability to attain or maintain an erection Aging Spinal cord injury Stress, anxiety, or depression Alcohol, nicotine, or substance use Prior urinary surgeries or conditions Medications (anti-hypertensives & psych meds) Diabetes, HTN |
| Erectile dysfunction treatment | Counseling Medication (PDE5 Inhibitors) Devices (vacuum or implantable pump) |
| Phosphodiesterase type 5 (PDE5) inhibitors | PDE5 Inhibitors relax smooth muscle and increase blood flow Side effects: Headache Flushing Examples: sildenafil, tadalafil, vardenafil, avanafil Education: Call HCP for erection lasting longer than 4 hours Do not take with nitrates. |
| The most common cause of postoperative hypoxemia is | atelectasis |
| Unless contraindicated by the surgical procedure, an unconscious patient is positioned in a | lateral “recovery” position. This recovery position keeps the airway open and reduces the risk of aspiration if the patient vomits. |
| Gentamicin can be toxic to the | kidneys and the auditory system. The elevated creatinine level must be reported to the provider because it probably indicates renal damage |
| Pink-tinged urine, burning, and frequency are common after a | cystoscopy |
| IV pyleogram | include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity; keep the patient NPO for 8 hours before the procedure; and advise the patient flushed face, and a salty tast |
| Normal WBC levels in urine are below | 5/hpf |
| what do kidneys do | Release of renin Activation of vitamin D Erythropoietin production |
| The incidence of testicular cancer is four times higher in | white men than in black men. Testicular tumors are also more common in men who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies |
| When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, | testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done |
| TURP unexpected finding | Continuous bladder irrigation infusing with decreased output. |
| A patient has received atropine before surgery and reports a dry mouth. Which action would the nurse take? | normal sign of anticholinergic |
| Which statement by a patient scheduled for knee surgery is important to report to the health care provider before surgery? | "I had a heart valve replacement last year." |
| On the second postoperative day, the patient's nasogastric (NG) tube is removed and the patient begins drinking clear liquids. Four hours later, the patient reports frequent, cramping gas pains. Which action would the nurse take? | ambulate pt |
| A patient who has begun to awaken after 30 minutes in the postanesthesia care unit (PACU) is restless and shouting at the nurse. the patient's oxygen saturation is 96%, and recent laboratory results are normal. Which action would the nurse take? | Assess for bladder distention. |
| A temperature of 100.8F (38.2C) in the first 48 hours is usually caused by | atelectasis, and the nurse should have the patient deep breathe, cough, and use the incentive spirometer |
| Foods high in purines (e.g., venison, crab, liver) should be avoided to prevent | uric acid calculi formation. Foods high in calcium (e.g., milk, yogurt, dried fruit, lentils, chocolate) should be avoided to prevent calcium calculi formation. |
| Foods high in oxalate (e.g., spinach, cabbage, tea, asparagus, chocolate) should be avoided to | prevent oxalate calculi formation |
| Ciprofloxacin would be used for a | complicated UTI. Fosfomycin, nitrofurantoin, and trimethoprim–sulfamethoxazole should be used for uncomplicated UTIs. |
| The nurse is providing care for a patient admitted to the hospital for treatment of nephrotic syndrome. What are the priority nursing assessments? | Daily weights and measurement of the patient’s abdominal girth |
| Which health promotion action would the nurse include in the teaching plan for a patient who has an immune deficiency involving the T lymphocytes? | screen for cancers |
| Which manifestation of pain may alert the nurse to a possible urinary system disorder? | Pain located on the side of torso below the ribs |
| Which assessment finding would the nurse observe in a patient with a urinary system disease? | Excoriations |
| Which technique would be used by the nurse to determine potential kidney infection or kidney disease? | percussion of the flank |
| A bicarbonate level of 20 mEq/L is | low and could signal the patient is experiencing metabolic acidosis. |
| Which assessment data reported by a patient is consistent with a lower urinary tract infection (UTI)? | burning when urinating |
| Which finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider? | low bp bc it can indicate urosepsis |
| normal bicarb levels | 22-29 |
| Patients often have diuresis in the hours and days immediately after | kidney transplant |
| A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium | Calcium gluconate raises the threshold at which dysrhythmias occur, temporarily stabilizing the myocardium |
| arteriovenous (AV) fistulas are much less likely to | clot than grafts. It takes longer for AV fistulas to mature to the point where they can be used for dialysis |
| Which action will the nurse include in the plan of care to maintain the patency of a patient's left arm arteriovenous fistula? | auscultate for a bruit |
| A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? | More protein is allowed because urea and creatinine are removed by dialysis. |
| The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication being taken by the patient indicates a need for patient teaching? | Magnesium hydroxide, Magnesium is excreted by the kidneys, so patients with CKD should not use over-the-counter products containing magnesium |
| Cloudy-appearing peritoneal effluent is a sign of possible | peritonitis and would be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient. |
| Erectile function is not usually | affected by a turp |
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cwehner125