Appendicitis and Gouty Arthritis

• Below are thorough concise study notes.
• These do not include references, page numbers or personal data.

Appendicitis

• Inflammation of the appendix due to obstruction of the intestinal lumen is the main problem
• Right lower quadrant abdominal pain (McBurney's point) with rebound tenderness is an initial manifestation
• Lessening of pain indicates rupture
• Laboratory data shows elevated WBC and urinalysis negative for UTI
• Nursing diagnosis includes pain, potential for injury
• Interventions include positioning for comfort; if ruptured, place in high Fowler's to prevent infection spread
• Administer antibiotics; avoid a hot compress on the RLQ
• Avoid analgesics, antispasmodics, or enemas during observation
• Prepare for appendectomy and post-op care

Gouty Arthritis

• Metabolic disorder affecting uric acid formation/excretion is the main problem
• Initially, asymptomatic, later, dusky red, hot, swollen joints, commonly in the big toe are initial manifestations
• Tophi formation (ear lobes, big toe) is a pathognomonic sign
• Elevated urate crystals in synovial fluid and high serum uric acid is shown in lab data
• Nursing diagnosis is pain
• Maintain a purine-restricted diet (avoid organ meats, alcohol, legumes, sardines)
• Increase fluid intake and avoid aspirin and diuretics
• Alkalinize urine (consume fruits, vegetables, milk)
• A bed cradle reduces painful linen contact
• Uric acid kidney stones are a possible complication
• Allopurinol blocks uric acid formation
• Colchicine is an analgesic and anti-inflammatory drug
• Probenecid/Sulfinpyrazone lowers uric acid

Osteoarthritis

• Degeneration of articular cartilage in weight-bearing joints is the main problem
• Joint pain and swelling, worsened by activity is an initial manifestation
• X-ray is part of the laboratory data
• Nursing diagnosis is pain
• Weight control, hot compress or ice packs, aspirin use, and trunk assistive devices (e.g., cane) may be helpful as an intervention

Rheumatoid Arthritis

• Systemic recurrent inflammation of synovial joints, more common in women, is the main problem
• Morning stiffness relieved by warm bath/soaks is an initial manifestation
• Elevated ESR and (+) Rheumatoid Factor is part of the lab data
• Nursing diagnosis is pain related to joint inflammation
• Regular aspirin use (warn about tinnitus side effect), apply moist heat (15–30 mins) to reduce muscle spasms, and use ice packs during acute episodes are all interventions

Asthma

• Abnormal bronchial hyperactivity is the main problem
• Dyspnea, wheezing (asymptomatic between attacks) is an initial manifestation
• Decreased FEV, elevated IgE, and ABG showing respiratory acidosis is part of the lab data
• Nursing diagnosis is ineffective breathing pattern
• Identify and eliminate triggers (exercise, environmental factors, emotional stress)
• Orthopneic positioning and pursed-lip breathing are interventions
• Administer bronchodilators, corticosteroids, and oxygen therapy

Burns

• Traumatic injury from heat, chemicals, electricity, and radiation is the main problem
• 1st-degree: Pink skin, pain
• 2nd-degree: Reddish with painful blisters
• 3rd-degree: Eschar, charred, and painless
• Hyperglycemia, anemia is shown in the lab data
• Nursing diagnosis includes decreased cardiac output due to fluid shifts
• Strict I&O monitoring is key
• Provide fluid resuscitation (Parkland formula: 4ml/kg x %TBSA burned)
• Diet consists of high-calorie, high-protein foods
• IV narcotics for pain and tetanus prophylaxis are key
• Reverse isolation in severe burns is needed

Benign Prostatic Hypertrophy (BPH)

• Enlarged prostate, obstructing urine flow is the main problem
• Decreased urinary force and amount along with nocturia are initial manifestations
• Elevated acid phosphatase is shown in the lab data
• Nursing diagnosis shows altered urinary elimination
• Pre-op: Explain TURP procedure (no incision involved)
• Post-op: Monitor pain, bleeding, and infection. Continuous bladder irrigation

Cancer of the Bladder

• Presence of malignant cells in the bladder is the main problem
• Painless hematuria (hallmark sign) is an initial manifestation
• Elevated Acid Phosphatase is shown in the lab data
• Nursing diagnosis shows altered urinary elimination
• Prepare the patient for surgery and chemotherapy
• Encourage the patient to verbalize fears about diagnosis and treatment

Cancer of the Breast

• Malignant tumors, usually in the upper outer quadrant of the left breast, is the main problem
• Risk factors include nulliparity (never given birth) or first childbirth after 35
• Painless mass (most common), skin dimpling, and edema (peau d'orange) are initial manifestations
• Mammography detects non-palpable lesions and is included in the lab data
• Screening should include; 35-40 years: Baseline mammography, 40-50 years: Every 2 years if no predisposition, high risk: Yearly, and 50+ years: Annual screening
• Nursing diagnosis includes knowledge deficit about breast cancer and mastectomy
• Teach Self Breast Examination (SBE) - Monthly, 1 week after menstruation
• Best position: Lying down with a pillow under the examined breast
• Pre-op/Post-op Care - Mastectomy: Elevate affected arm to prevent lymphedema
• Avoid BP measurement, venipuncture, and tight clothing on the affected arm

Cancer of the Cervix

• Malignant cells in the cervix, often associated with multiple sexual partners and a history of sexually transmitted diseases (STDs) is the main problem
• Initially asymptomatic and postcoital bleeding is a common sign as the initial manifestation
• Pap smear detects malignant cells
• Nursing diagnosis includes knowledge deficit about cervical cancer and chemotherapy
• Avoid douching and sexual intercourse 24 hours before a Pap smear
• Stress importance of lifelong follow-ups
• Prepare for chemotherapy, radiation, and surgery

Cancer of the Esophagus

• Malignant tumor of the esophagus associated with smoking and alcohol consumption is the main problem
• Dysphagia (difficulty swallowing)—first and most common symptom as an initial manifestation
• Barium swallow with fluoroscopy reveals large masses and a CT scan assesses tumor extent in the lab data
• Nursing diagnosis is altered nutrition
• Prepare for surgery, radiation, and chemotherapy
• Administer antacids and analgesics
• Prepare for feeding interventions includes tube feedings or gastrostomy and short-course hyperalimentation
• Avoid overeating raw fruits and vegetables post-op

Cancer of the Larynx

• Malignant cells in the larynx, linked to smoking and alcoholism is the main problem
• Hoarseness or voice change and a tickling sensation in the throat is the initial manifestation
• Laryngoscopy and biopsy confirm malignancy
• Nursing diagnosis includes knowledge deficit about laryngeal cancer
• Prepare for radiation, chemotherapy, and surgery
• Avoid exposure to cold air and take post-laryngectomy precautions
• Swimming is not permitted and alternative modes of communication should be instituted

Cancer of the Ovary

• Gynecologic cancer, associated with a high-fat diet and nulliparity is the main problem
• Initially asymptomatic and vague abdominal discomfort (e.g., indigestion) comprise initial manifestations
• Laparoscopy and ultrasound reveal a mass
• Nursing diagnosis is pain
• Prepare for surgery and chemotherapy
• Help cope with body image changes
• Implement pain management (pharmacologic & non-pharmacologic)

Cancer of the Prostate

• Malignant tumor in the prostate gland is the main problem
• Decreased urinary stream size and force are initial manifestations
• Elevated PSA (Prostate-Specific Antigen) and elevated acid phosphatase is part of the lab data
• Nursing diagnosis includes pain related to tumor and metastasis to the bone
• Radiation therapy support is key
• Inform about radical prostatectomy and possible impotence after total prostate removal

Cancer of the Colon (Colorectal Cancer / Duke's Disease)

• Primary or metastatic malignant tumor affecting the colon or rectum, leading to obstruction, ulceration, and hemorrhage is the main problem
• Changes in bowel habits, stool changes (diarrhea, constipation, fecal oozing), and melena (black stools) or hematochezia (fresh blood in stool) are initial manifestations
• Barium enema detects the mass, colonoscopy/sigmoidoscopy confirms malignancy, and fecal occult blood test positive is part of the lab data
• Nursing diagnosis includes altered bowel elimination
• Monitor for bleeding, infection, and electrolyte imbalances
• Provide post-chemo and radiation care
• Ensure adequate nutrition (antiemetics, anti-diarrheal)
• Teach ostomy self-care after surgery
• Administer Total Parenteral Nutrition (TPN) as ordered

Cancer of the Lung (Bronchogenic Carcinoma)

• Neoplasm in the respiratory tract, usually linked to smoking or asbestos exposure is the main problem
• Squamous cell carcinoma (slow-growing) and large cell & small oat cell carcinoma (fast-growing) are types
• Chronic, nagging cough ("smoker's cough") is an initial manifestation
• Sputum cytology is positive for cancer cells
• Chest X-ray (CXR) shows lesion/mass
• Biopsy confirms malignancy
• Nursing diagnoses are impaired gas exchange and impaired breathing pattern
• Monitor respiratory status and provide pain control
• Increase fluid intake & nutritional support (high-protein, high-calorie diet)
• Teach respiratory physiotherapy
• Prepare for surgery & chemotherapy

Cancer of the Testicular

• Malignancy in the testes, often linked to cryptorchidism (undescended testes) is the main problem
• Painless swelling & heaviness in the scrotum is an initial manifestation
• Elevated HCG & Alpha-fetoprotein is part of the lab data
• Knowledge deficit is the nursing diagnosis
• Prepare for surgery and chemotherapy
• Teach monthly testicular self-exam, best done in a warm bath or in front of a mirror and what suspicious findings like a spongy texture on palpation may indicate