N380 Objectives to Guide Study for UNIT #1 PDF

Objectives to Guide Study for UNIT #1 Expect that N380 QUIZ/EXAM Items will consistently assess your knowledge of & ability to use critical-thinking, & Clinical Decision Model (Nursing Process) to apply theory pertaining to the nursing management of patients with each of the diagnoses we will cover...

Objectives to Guide Study for UNIT #1 Expect that N380 QUIZ/EXAM Items will consistently assess your knowledge of & ability to use critical-thinking, & Clinical Decision Model (Nursing Process) to apply theory pertaining to the nursing management of patients with each of the diagnoses we will cover this semester. This includes knowledge of diagnostics, expected normal/abnormal findings, focused assessment, plan of care/appropriate interventions (including Pharmacologic & non-Pharmacologic), expected outcomes & evaluation of effectiveness of care. Specific Objectives that can guide your study for QUIZ #1 follow: Chapter 1: Professional Nursing 1.​ Describe the role of clinical judgment & inter-professional communication in assessing & planning for potential & actual needs for transfer to a higher level of care or discharge to the appropriate level of care. a.​ 2.​ Describe the phases of the Clinical Practice Model & identify how they relate/intersect with the steps of the Nursing Process. a.​ Assessment i.​ Both the CPM and the Nursing Process start with a thorough assessment of the patient's condition. This step is crucial for gathering the necessary information to inform the subsequent steps. b.​ Diagnosis i.​ In both models, the diagnosis phase involves analyzing the assessment data to identify the patient's health issues. This step ensures that the care provided is tailored to the patient's specific needs. c.​ Planning i.​ The planning phase in both models involves developing a strategy to address the identified problems. This includes setting goals and determining the interventions required to achieve those goals. d.​ Implementation i.​ Both models emphasize the importance of executing the planned interventions. This step involves putting the care plan into action to address the patient's needs. e.​ Evaluation i.​ Both models include an evaluation phase to assess the effectiveness of the interventions. This step ensures that the care provided is achieving the desired outcomes and allows for adjustments to be made as necessary. 3.​ Describe the roles & functions of healthcare team members who perform Case Management & Utilization Review. a.​ Utilization Review i.​ Use of established criteria for insurance review & authorization of services ii.​ Optimize hospital resources to: iii.​ Reduce cost iv.​ Improve patient satisfaction v.​ Provide care for as many people as possible  b.​ Case Management i.​ Role is to promote: 1.​ Appropriate utilization 2.​ High quality care 3.​ Cost effective outcomes ii.​ Assessment iii.​ Planning 1.​ Resource identification 2.​ Referrals iv.​ Intervention & Coordination 1.​ Communicating & facilitating plan v.​ Monitoring & Evaluation of Outcomes 1.​ Patient’s response to the plan vi.​ Quality of care & services 4.​ Identify appropriate RN delegation to LPN/LVN & assistive personnel. a.​ LPN - i.​ Assisting RN in data collection and client monitoring. ii.​ Reinforcing RN's teaching. iii.​ Administering medications. iv.​ Inserting a urinary catheter. v.​ Administering enteral tube feedings. vi.​ Dressing changes, tracheostomy care, suctioning. 5.​ Identify safety & quality improvement processes into nursing practice. a.​ 6.​ Apply concepts of evidence-based practice to nursing care for patients with a variety of diagnoses. a.​ Chapter 4: Patient & Caregiver Teaching 1.​ Apply the teaching-learning process to diverse patient populations. 2.​ Describe how the Transtheoretical Model of Change can be used to identify appropriate teaching strategies & goals. 3.​ Identify measurable outcomes that will demonstrate resolution of identified problems when developing a plan of care. 4.​ Identify appropriate, individualized strategies that will support & facilitate patient learning. 5.​ Identify the role of the caregiver in patient teaching. 6.​ Describe physical, psychologic, & sociocultural characteristics of the patient and caregiver that can impact the teaching–learning process. 7.​ Prioritize patient teaching goals for patients & caregivers. 8.​ Describe appropriate methods to evaluate patient & caregiver teaching. Chapter 5: Chronic Illness & Older Adults 1.​ Explain the characteristics of chronic illness.  a.​ Prolonged illness, no cure; results in irreversible changes, possible disability; requires rehab and/or long-term medical management & nursing care i.​ Examples: Arthritis, COPD, diabetes, stroke, heart failure 2.​ Identify alternatives in levels of care, & requirements for transfer & appropriate placement into each level. a.​ Rural older adults b.​ Five barriers to health care access. Transportation is #1 barrier. c.​ Racial or ethnic minority more vulnerable. d.​ May be less likely to engage in health-promoting activities. e.​ Lifestyle values & rural life practices need to be recognized & considered. f.​ Alternative service approaches to promote health & screenings: Internet resources & chat rooms, radio, community centers, & church social events. g.​ Telehealth devices for monitoring those more isolated can enhance ability to provide care. h.​ Most older adults use the Internet & own a cell phone—See Informatics in Practice in the textbook. i.​ Homelessness is increasing & associated with low income, reduced cognitive capacity, living alone, & lack of affordable housing. j.​ Homeless older adults are at higher risk for more health problems, have less access to aging networks, & are less likely to use shelters or meal sites than younger homeless people (may be due to fear of institutionalization). k.​ An interprofessional approach that links shelters with outreach, primary care clinics, Medicare & Medicaid offices, pharmacies, senior centers, & Area Agencies on Aging may be required. (Health care workers may include: nurses, doctors social workers, clerical workers, transporters.) l.​ Long-term care placement is often an alternative to homelessness, especially if cognitively impaired. 3.​ Describe the nurses role in health promotion & managing the special needs of older adults. a.​ Adult day care centers provide social, recreational, and health-related services to people in a safe community-based environment. Daily supervision, social activities, social interaction, and ADL assistance for cognitively impaired and those unable to independently perform ADLs. b.​ Adult day health centers are similar but are for people with disabilities who need a higher level of care, such as health monitoring, therapeutic activities, ADLs training, and personal services. c.​ For caregivers these options provide respite, allowing continued employment. May delay institutionalization of the older adult. d.​ Centers are regulated by the state. Costs are not covered by Medicare but are tax-deductible. e.​ Nursing: Assist caregivers and adults by knowing available centers as possible resources. f.​ PACE Services include primary care including i.​ Prescription medications and wound care ii.​ Physical, occupational, recreational, and speech therapy iii.​ Adult day care  iv.​ Dental care v.​ Podiatry vi.​ Social services vii.​ Home Health care viii.​ Respite care, hospitalization, short-term rehab, and long-term care are provided as needed Chapter 17: Fluid, Electrolyte & Acid-Base Imbalances 1.​ Describe the composition of the major body fluid compartments. a.​ Total water 60% --> 33% is ECF (25% interstitial fluid, 8% plasma in blood) and 66% is ICF. 2.​ Define processes involved in regulating water & electrolyte movement between body fluid compartments. a.​ The body regulates sodium levels to control the movement of water into and out of the extracellular space due to osmosis 3.​ Describe the etiology, manifestations, & interprofessional management of: a.​ Extracellular fluid volume imbalances: Fluid volume deficit & overload. i.​ Deficit - diarrhea, vomiting, excessive sweating, fever, and poor oral fluid intake ii.​ Overload - heart failure, acute or chronic kidney failure, nephrotic syndrome, and cirrhosis b.​ Describe symptoms seen with the following electrolyte imbalances & potential interventions to address each: i.​ Hypernatremia & Hyponatremia 1.​ Hyper: muscle weakness, restlessness, extreme thirst, confusion, lethargy, irritability, seizures, unconsciousness 2.​ Hypo: nausea and/or vomiting, headache, muscle weakness, spasms (twitching), or cramps, low blood pressure, dizziness when standing up, low energy or fatigue, loss of appetite, restlessness or bad temper ii.​ Hyperkalemia & Hypokalemia 1.​ Hyper: heart palpitations, shortness of breath, chest pain, nausea, or vomiting 2.​ Hypo: muscle twitches, muscle cramps, severe muscle weakness, leading to paralysis, hypotension, lightheadedness or faintness, abnormal heart rhythms (arrhythmias), excessive urination (polyuria), excessive thirst (polydipsia) iii.​ Hypermagnesemia & Hypomagnesemia 1.​ Hyper: weakness, nausea, dizziness, and confusion, decreased reflexes, worsening of the confusional state and sleepiness, bladder paralysis, flushing, headache, and constipation. 2.​ Hypo: nausea, vomiting, sleepiness, weakness, personality changes, muscle spasms, tremors, and loss of appetite iv.​ Hypercalcemia & Hypocalcemia 1.​ Hyper: digestive symptoms, such as nausea or vomiting, poor appetite, or constipation, increased thirst or more frequent  urination, due to changes in the kidneys, muscle weakness or twitches, changes in how your brain works, such as feeling tired or fatigued or confused, bone pain and fragile bones that break more easily. 2.​ Hypo: tingling in your lips, tongue, fingers and/or feet, muscle aches, muscle spasms in your throat that make it difficult to breathe (laryngospasm), stiffening and spasms of your muscles (tetany), seizures v.​ Hyperphosphatemia & Hypophosphatemia 1.​ Hyper: bone and/or joint pain, pruritus (itchy skin), rash, small calcium deposits (hard lumps) in your skin or soft tissue (fat, muscle, tendons) 2.​ Hypo: confusion, appetite loss, muscle weakness, feeling tired and upset, bone pain and fractures, tooth decay or late baby teeth, slow growth and short height in children. 4.​ Identify the processes involved in maintaining acid-base balance. a.​ Maintenance and adaptation of acid-base homeostasis are mostly controlled by respiration and kidney. The kidney contributes to acid-base balance by reabsorbing filtered bicarbonate, regenerating bicarbonate through ammoniagenesis and generation of protons, and by excreting acid.​ 5.​ Discuss the etiology, & describe manifestations of the following acid-base imbalances: a.​ Metabolic acidosis - A condition in which too much acid accumulates in the body. i.​ Cause 1.​ can include buildup of body toxins, kidney failure, and ingestion of certain drugs or toxins, such as methanol or large doses of aspirin, can be a rare complication of diabetes ii.​ Symptom 1.​ nausea, vomiting, fast breathing, and lethargy iii.​ Treatment 1.​ depends on the cause. Sodium bicarbonate can reduce the acidity of blood b.​ Metabolic alkalosis - In metabolic alkalosis there is excess of bicarbonate in the body fluids. It can occur in a variety of conditions. It may be due to digestive issues, like repeated vomiting, that disrupt the blood's acid-base balance. It can also be due to complications of conditions affecting the heart, liver and kidneys c.​ Respiratory acidosis - Respiratory acidosis is when your lungs can't remove all the carbon dioxide that your body produces, so your blood pH is lower (more acidic) than normal. d.​ Respiratory alkalosis - Respiratory alkalosis is when hyperventilation prevents your lungs from removing excess carbon dioxide, so your blood pH is higher (more basic) than norma 6.​ Describe the composition of & indications for common IV fluid solutions. a.​ Isotonic: Most common. Fluid with the same osmolality as the cell interior. Normally the ECF and ICF are isotonic to each other. D5W, NS (0.9%), LR is isotonic with lytes. 0.9% sodium chloride lactated Ringer's solution 5% dextrose in water Ringer's solution  b.​ Hypertonic: Also known as hyperosmolality or hypersodium, has a greater concentration of sodium than plasma has. These solutions move water out of cells, which makes the cells shrink. IVF's: 3%NS, 5%NS, 3% sodium chloride, 5% sodium chloride, 5% dextrose and 0.45% sodium chloride, 5% dextrose and 0.9% sodium chloride c.​ Hypotonic: Hypo-osmolalility or hyposodium containing solutions have a lower concentration of sodium than plasma. These solutions promote movement of water into cells, making cells swell. Hypotonic IVF: 0.45%NS, 0.33% NS 0.45% sodium chloride, 0.33% sodium chloride, 0.2% sodium chloride,2.5% dextrose in water d.​ Osmotic pressure: It is the force or pressure exerted by plasma proteins (albumin) that are contained in the intravascular and interstitial compartments. This is the "something" that pulls the fluid back into the capillary. Albumin acts like a "water magnet" to attract water inside the blood vessel Chapter 49: Assessment - Urinary System 1.​ Identify the anatomic location & function of the detrusor muscles. a.​ The wall of the bladder is comprised of smooth muscle fibers oriented in multiple different directions. These smooth muscle fibers are collectively known as the detrusor muscle. This interwoven orientation provides the bladder with the ability to stretch in response to the presence of urine. b.​ The detrusor muscle is located within the walls of the bladder and is composed of smooth muscle fibers that are longitudinal and circular. The layers of the detrusor muscle start longitudinally in the inner layer, become circular in the middle layer, and then longitudinal again in the outer layer. 2.​ Explain the physiologic events involved in formation & passage of urine from glomerular filtration to voiding. a.​ The glomerulus filters water and small solutes out of the bloodstream. The resulting filtrate contains waste, but also other substances the body needs: essential ions, glucose, amino acids, and smaller proteins. When the filtrate exits the glomerulus, it flows into a duct in the nephron called the renal tubule. 3.​ Differentiate subjective & objective data related to the urinary system. a.​ Subjective Data - Ask the patient about colour of their urine. Ask about history of urinary tract infections, burning, frequency, presence of blood in urine, sediment, odour with urine, and history of kidney, renal, and genital health issues. Ask about nocturia and incomplete bladder emptying. 4.​ Identify age-related changes of the urinary system & link them to differences in assessment findings. a.​ Aging increases the risk of kidney and bladder problems such as: Bladder control issues, such as leakage or urinary incontinence (not being able to hold your urine), or urinary retention (not being able to completely empty your bladder) Bladder and other urinary tract infections (UTIs) 5.​ Describe key assessments, expected/unexpected findings, significance of results related to diagnostic procedures involving the urinary system. a.​ Calculi (Nephrolithiasis/Kidney Stones) - i.​ Commonality:  1.​ United States: 13% men, 7% women 2.​ Middle-aged; Risk increases with age 3.​ More frequent in: a.​ White than Black, Hispanic, & Asian populations b.​ Family history c.​ Southeast U.S.; followed by Southwest, & Midwest d.​ Summer (Hot climate & dehydration) e.​ Uric acid stones in Jewish men ii.​ Risk factors: 1.​ Metabolic 2.​ Climate 3.​ Dietary 4.​ Genetics 5.​ Lifestyle iii.​ Influencing factors: 1.​ Higher urinary pH: Ca+ & Phosphate less soluble 2.​ Lower urinary pH: Uric acid & cysteine less soluble 3.​ Solute load 4.​ Inhibitors in urine 5.​ Obstruction with stasis 6.​ Infection with urea-splitting bacteria (Struvite stones) 7.​ Infected stones (Staghorn) 8.​ Renal infection 9.​ Hydronephrosis 10.​Loss of kidney function iv.​ Five categories: 1.​ Calcium oxalate (most common) 2.​ Calcium phosphate 3.​ Cystine 4.​ Struvite 5.​ Uric acid v.​ Clinical Manifestations: 1.​ Sudden, severe pain (Renal colic) 2.​ Flank area, back, or lower abdomen 3.​ Ureter stretches, dilates, & spasms 4.​ May see: N/V, “kidney stone dance;” dysuria, fever, chills; moist, cool skin 5.​ Common sites of obstruction 6.​ Ureteropelvic junction (UPJ); Dull costovertebral flank pain or renal colic 7.​ Ureterovesical junction (UVJ); Lower abdominal pain; testicular or labial pain vi.​ Diagnostic Tests: Noncontrast helical (spiral) CT scan, ultrasound, urinalysis, 24-hour urine, retrieval & analysis of stones; Important to determine problem contributing to stone formation b.​ Chronic Pyelonephritis -  i.​ Diagnostic Tests: Radiologic imaging & biopsy c.​ UTI - i.​ Etiology and Patho - 1.​ Tract above urethra normally sterile 2.​ Defense mechanisms: a.​ Complete emptying with void b.​ Ureterovesical junction competence c.​ Peristalsis propels urine towards bladder d.​ Acidic pH (below 6.0) e.​ High urea f.​ Glycoproteins inhibit bacterial growth 3.​ Perineal organisms ascend urethra a.​ GI tract: Gram (-) bacilli b.​ Contributing factors: i.​ Urologic instrumentation ii.​ Sexual intercourse 4.​ Blood-borne transmission 5.​ UTI: Most common HAI a.​ CAUTI; E-coli or Pseudomonas b.​ Increased LOS, costs, morbidity & mortality ii.​ Lower Symptoms 1.​ Emptying: Hesitancy, intermittency, post-void dribbling, retention, dysuria 2.​ Storage: Frequency, urgency, incontinence, nocturia, nocturnal enuresis 3.​ Hematuria 4.​ Cloudy appearance 5.​ Many problems can produce symptoms, be confused with UTI iii.​ Upper Symptoms 1.​ May be asymptomatic 2.​ Flank pain, chills, fever 3.​ Fatigue, anorexia 4.​ Older adults: Classic symptoms may be absent a.​ General abdominal discomfort b.​ Cognitive impairment c.​ General deterioration d.​ Often afebrile 5.​ Asymptomatic bacteriuria 6.​ Bacterial colonization in bladder 7.​ Screen & treat with pregnancy iv.​ Diagnostic Tests: Initial → urine dipstick for nitrates, WBCs, & leukocyte esterase; urine culture/sensitivity; imaging: ultrasound or CT scan 6.​ Evaluate findings of a urinalysis. Chapter 50: Renal & Urologic Problems 1.​ Describe key assessments, expected/unexpected findings, & nursing responsibilities related to diagnostic & surgical procedures involving the urinary system. 2.​ Discuss the pathophysiology, clinical manifestations, interprofessional & nursing management of urinary tract infections, & pyelonephritis. a.​ Urinary Tract Infection b.​ Pyelonephritis i.​ Etiology: 1.​ Most common a.​ Intestinal bacteria - E.coli b.​ Proteus c.​ Klebsiella d.​ Enterobacter e.​ Fungi, protozoa, or viruses i.​ Other factors: Reflux, obstruction, stricture, or stones ii.​ Patho: 1.​ Initial colonization & infection of lower urinary tract from urethra 2.​ Inflammation of renal parenchyma & collecting system 3.​ Urosepsis: Systemic infection, urologic source iii.​ Risk Factors: 1.​ CAUTI: LTC residents 2.​ Pregnancy-induced changes 3.​ Starts in renal medulla, spreads to cortex iv.​ Clinical Manifestations: 1.​ Fatigue 2.​ Sudden onset: 3.​ Fever, chills 4.​ N/V 5.​ Malaise 6.​ Flank pain a.​ Costo-vertebral (CVA) tenderness 7.​ Dysuria 8.​ Urgency / Frequency 3.​ Compare & contrast the etiology, clinical manifestations, interprofessional & nursing management of various types of urinary calculi. a.​ Five categories i.​ Calcium oxalate - MOST COMMON ii.​ Calcium phosphate iii.​ Cystine iv.​ Struvite v.​ Uric acid 4.​ Describe the clinical manifestations & nursing/interprofessional management of kidney cancer. a.​ Kidney Cancer - i.​ Risk factors: 1.​ Cigarette smoking  2.​ AKI / CKD 3.​ Obesity 4.​ HTN 5.​ Exposure to asbestos, cadmium, & gasoline 6.​ 1st degree relative ii.​ Assessment and Findings: 1.​ Early - Asymptomatic; Often incidental finding for unrelated condition a.​ 25% have metastasis when diagnosed (Renal vein, vena cava, lungs, liver, & long bones) 2.​ Common symptoms: a.​ Hematuria b.​ Flank pain c.​ Palpable mass flank or abdomen d.​ Other: Weight loss, fever, HTN, anemia iii.​ Diagnostic Tests: CT scan, US, angiography, biopsy, MRI; radionuclide isotope scan 5.​ Describe the common causes & management of urinary incontinence & urinary retention. a.​ Urinary Incontinence: i.​ Bladder pressure greater than urethral closure pressure 1.​ Interference with bladder or sphincter control ii.​ DRIP 1.​ D: Delirium, dehydration, depression 2.​ R: Restricted mobility, rectal impaction 3.​ I: Infection, inflammation, impaction 4.​ P: Polyuria, polypharmacy iii.​ Diagnostic studies: Urinalysis, post void residual, urodynamic studies, ultrasound b.​ Urinary Retention: i.​ Inability to empty bladder with voiding or accumulation of urine d/t inability to void 1.​ Leakage or post-void dribbling (Overflow incontinence) ii.​ Acute urinary retention: Inability to pass urine (Medical emergency) iii.​ Chronic urinary retention: Incomplete emptying despite urination iv.​ Etiology and Patho 1.​ Bladder outlet obstruction a.​ Can’t empty d/t severe blockage b.​ Men - enlarged prostate 2.​ Deficient detrusor contraction: Can’t contract with enough force or time to empty bladder a.​ Neurologic diseases; Sacral vertebrae 2, 3, & 4 b.​ DM c.​ Over-distention d.​ Chronic alcohol use e.​ Anticholinergic drugs 3.​ Diagnostic studies (Same as UI)  a.​ Urinalysis b.​ Post void residual c.​ Urodynamic studies d.​ Ultrasound 6.​ Identify indications for & nursing responsibilities in the management of patients with urethral, & suprapubic catheters. a.​ Urethral i.​ Indications: Intermittent 1.​ Relief of urinary retention 2.​ Diagnostic study 3.​ Urodynamic testing 4.​ Sterile specimen 5.​ Medication instillation 6.​ Measure PVR ii.​ Indications: Indwelling 1.​ Relief of urinary retention 2.​ Bladder decompression pre-op or post-op 3.​ Facilitate surgery 4.​ Facilitate healing 5.​ Accurate I & O in Critical Care 6.​ Stage III or IV pressure ulcer 7.​ Terminal illness; Comfort Care b.​ Suprapubic i.​ Urinary diversion; Temporary or long-term ii.​ Insertion through abdominal wall 1.​ General or local anesthesia 2.​ May be sutured; Tape to prevent dislodgement iii.​ Care similar to urethral catheter; Use skin barrier at insertion site to protect skin iv.​ Ensure patency: Prevent kinking, turn patient side-to-side, milk tube, or irrigate (with order) using sterile technique v.​ Antispasmodics for bladder spasms 7.​ Explain the nursing management of the patient undergoing surgery for nephrectomy. a.​ Open - i.​ Potential complications 1.​ Hemorrhage (Embolization of renal artery) 2.​ Atelectasis 3.​ Pneumonia 4.​ Thromboembolism 5.​ Infection ii.​ Outcomes 1.​ Reduction of pain & hematuria 2.​ LOS: 4 – 6 Day 3.​ RTW: 4 – 8 weeks b.​ Laparoscopic i.​ Shorter procedure  ii.​ 2 hours vs 7-hours iii.​ Fewer analgesics iv.​ Resume PO sooner v.​ Faster DC & RTW vi.​ Procedure for organ donation Chapter 51: Acute Kidney Injury & Chronic Kidney Disease 1.​ Describe the phases of the clinical course of acute kidney injury. a.​ AKI: Oliguric Phase i.​ U.O. < 400 ml / day 1.​ Occurs: 1 – 7 days of injury (24-hours ischemia) 2.​ Duration: 10 – 14 days to months 3.​ Longer phase = poorer prognosis 4.​ 50% patients non-oliguric; > 400 mL urine/day ii.​ Urinalysis; Casts, RBCs, WBCs, Protein iii.​ Specific gravity 1.010 (Fixed) iv.​ Osmolality 300 mOsm/kg v.​ Hypovolemia may exacerbate AKI vi.​ Decreased U.O. leads to fluid retention 1.​ Distended neck veins 2.​ Bounding pulse 3.​ Edema 4.​ Hypertension vii.​ Fluid overload can lead to: 1.​ CHF 2.​ Pulmonary edema 3.​ Pericardial or pleural effusions viii.​ Leukocytosis: Infection may be fatal 1.​ Urinary & respiratory ix.​ Increased BUN & Cr x.​ Accumulation of waste products; Neurologic disorders 1.​ Fatigue 2.​ Difficulty concentrating 3.​ Seizures, stupor, coma xi.​ Fluid & Electrolyte Disorders 1.​ Metabolic Acidosis a.​ Kidneys cannot excrete Hydrogen (Acid products of metabolism) b.​ Na02 production decreased; Reabsorption & regeneration defective c.​ Severe acidosis develops i.​ Kussmaul respirations (Increase exhaled CO2) xii.​ xiii.​ 2.​ Explain the interprofessional & nursing management of a patient with acute kidney injury.  3.​ Define chronic kidney disease & identify its five stages based on glomerular filtration rate. 4.​ Identify & describe Pre-Renal, Intrarenal, & Post-Renal risk factors for acute & chronic kidney disease. 5.​ Explain conservative interprofessional care & related nursing management of the patient with chronic kidney disease. 6.​ Identify the options for renal replacement therapy for persons with end-stage renal disease that can be managed in the Acute Care setting. 7.​ Compare & contrast nursing interventions for patients on peritoneal dialysis & hemodialysis. Chapter 54: Endocrine Problems 1.​ Explain the pathophysiology, clinical manifestations, interprofessional & nursing management of the patient with an anterior pituitary gland problem. a.​ 2.​ Describe the pathophysiology, clinical manifestations, interprofessional & nursing management of the patient with a posterior pituitary gland problem. a.​ 3.​ Explain the pathophysiology, clinical manifestations, interprofessional & nursing management of the patient with a thyroid problem. a.​ 4.​ Describe the pathophysiology, clinical manifestations, interprofessional & nursing management of the patient with a parathyroid problem. a.​ 5.​ Identify the pathophysiology, clinical manifestations, interprofessional & nursing management of the patient with an adrenal cortex problem. a.​ 6.​ List the side effects of short & long-term corticosteroid therapy. a.​ Chapter 59: Male Reproductive Problems 1.​ Describe the pathophysiology, clinical manifestations, & interprofessional/ nursing management of benign prostatic hyperplasia & patients who have had transurethral resection of the prostate. a.​ Risk Factors: i.​ Aging ii.​ Obesity (Inc iii.​ Increased waist circumference) iv.​ Lack of physical activity v.​ Diet high in red meat & animal fat vi.​ Alcohol use vii.​ Erectile dysfunction viii.​ Smoking ix.​ DM x.​ BPH in 1st degree relative b.​ Symptoms: i.​ Irritative Symptoms 1.​ Nocturia 2.​ Urinary frequency 3.​ Urinary urgency 4.​ Dysuria 5.​ Bladder pain 6.​ Incontinence ii.​ Obstructive Symptoms 1.​ Decrease force of urinary stream 2.​ Difficulty initiating stream 3.​ Intermittent stream 4.​ Dribbling at end of urination c.​ Complications: i.​ Acute urinary retention ii.​ UTI w/ potential sepsis iii.​ Bladder calculi iv.​ Hydronephrosis v.​ Distention of kidney pelvis & calyces vi.​ Pyelonephritis vii.​ Bladder damage d.​ Digital Rectal Exam (DRE) i.​ BPH: 1.​ Symmetrical enlargement, firm, smooth 2.​ Obliterated central sulcus ii.​ Prostatitis: 1.​ Symmetric enlargement, boggy consistency 2.​ Discomfort on palpation iii.​ Prostatic CA (Adenocarcinoma): 1.​ Asymmetric enlargement 2.​ Hardened nodules, Induration e.​ Prostate Specific Antigen (PSA) i.​ Screening; Early detection 1.​ May be elevated in BPH 2.​ Transrectal Ultrasound ii.​ Monitoring 1.​ Response to treatment 2.​ Recurrence iii.​ Elevated by: 1.​ DRE within several hours 2.​ Ejaculation within 24-hours 3.​ Recent UTI or Prostatitis 4.​ Biopsy or surgery; Draw before or 6-weeks after f.​ BPH: Active Surveillance - “Watchful Waiting” i.​ Appropriate when: 1.​ Life expectancy < 10-years  2.​ Mild symptoms or low-grade, low stage tumor ii.​ Frequent PSA & DRE iii.​ Lifestyle changes 1.​ Decreasing caffeine, artificial sweeteners, spicy/acidic foods 2.​ Avoiding OTC decongestants & anticholinergics 3.​ Restricting evening fluid intake 4.​ Timed voiding schedule g.​ Transurethral Resection of Prostate (TURP) i.​ Gold standard; Marked symptom improvement ii.​ Rectoscope; No external incision iii.​ Low risk; TUR Syndrome iv.​ Complications 1.​ Bleeding 2.​ Infection 3.​ Clot retention 4.​ Incontinence (1% - 2%) 5.​ E.D. (5% - 10%) 6.​ Retrograde ejaculation a.​ Cloudy urine b.​ Alters fertility only v.​ TUR Syndrome: 1.​ Long surgical times 2.​ Extensive vascular absorption of iso or hypotonic irrigation fluid 3.​ Hyponatremia 4.​ Minimized now with use of NS 5.​ N / V 6.​ Confusion 7.​ Bradycardia 8.​ Hypertension 9.​ Notify Provider 10.​Fluid resuscitation 11.​Supportive care vi.​ TURP Post Op: 1.​ Continuous Bladder Irrigation (CBI); Control bleeding & prevent clots 2.​ Treat bladder spasms a.​ Phenazopyridine (Pyridium) b.​ Belladonna & opium (B & O) suppositories c.​ Oxybutynin (Ditropan) 3.​ Interventions: Dribbling / Incontinence a.​ Male incontinence products b.​ Kegel exercises 4.​ Measures to decrease risk of bleeding; Avoid: a.​ Prolonged sitting and/or auto rides x 2 weeks b.​ Prolonged walking c.​ Straining during defecation