Adult Health I Exam 5 (Final) Review (1) PDF

lOMoARcPSD|37834180 AH Exam 5 (Final) Review (1) Adult Health I (The University of Texas Rio Grande Valley) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 BSN Blueprint Nurs__3411_____ Ex...

lOMoARcPSD|37834180 AH Exam 5 (Final) Review (1) Adult Health I (The University of Texas Rio Grande Valley) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 BSN Blueprint Nurs__3411_____ Exam__5 (Final)____ Date_4/30/21____ This came from the review with Dr. Yang Male Repro Prostate Health Clinical Manifestations Prostatitis = inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction, most common urologic diagnosis in men younger than 50 ○ Manifestations = sudden onset of fever, dysuria, perineal prostatic pain, severe lower urinary tract symptoms: dysuria (pain when peeing), frequency, hesitancy, nocturia (pee at night), hematuria (blood in urine) ○ From guest lecture: increased frequency, decreased force of urine stream, double or triple voiding to complete empty bladder, cloudy urine, dribbling on urine Prostate Cancer :30 Most common cancer in men other than nonmelanoma skin cancer, most common cause of cancer death in American men, Risk factors include increasing age (greater than 50), familial disposition, genes, diet high in red meat or dairy products high in fat, African American race, and endogenous hormones such as androgens and estrogen Diagnostics: ○ Abnormal finding with the digital rectal examination https://youtu.be/beqdxDlNnVs ○ Serum PSA (prostate specific antigen) ○ Ultrasound guided TRUS with biopsy ○ Routine repeated DRE with the same provider is recommended for detection Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 ○ ○ Confirmed with histologic examination of tissue removed surgically by TURP Bone scans can detect metastatic bone disease Erectile Dysfunction :50 Medications Sildenafil (Viagra) side effects Also called impotence or the inability to achieve or maintain an erect penis May report decreased frequency of erections, inability to achieve a firm erection, rapid detumescence (subsiding of erection) Has both psychogenic and organic ○ Psychogenic causes Anxiety, fatigue, depression, pressure to perform sexually, negative body image, absence of desire, and privacy, trust and relationship issues ○ Organic causes Cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, hypothyroidism), cirrhosis, chronic kidney injury, genitourinary conditions (radical pelvic surgery), hematologic conditions(Hodgkin lymphoma, leukemia), neurologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications Medications, side effects First line therapy includes Phosphodiesterase type 5 (PDE-5) inhibitors, increase blood flow to the penis Can cause headache, flushing, dyspepsia (pain or an uncomfortable feeling in the upper middle part of your stomach area), diarrhea, nasal congestion, and lightheadedness Contraindications: taking nitrate medications such as nitroglycerin, isosorbide mononitrate, high uncontrolled BP, coronary artery disease, heart attack history, cardiac dysrhythmia, kidney or liver dysfunction, diabetic retinopathy ○ Sildenafil (Viagra) Take the medication 30 mins to 4 hours before intercourse S/E: headache, flushing, indigestion, nasal congestion, abnormal vision, diarrhea, dizziness, and rash. You may also have low blood sugar and abnormal liver function tests; your primary provider can determine this. ○ Vardenafil (Levitra) Take the medication 1 hour before S/E:headache, flushing, runny nose, indigestion, sinusitis, flulike syndrome, dizziness, nausea, back pain, and joint pain. ○ Tadalafil (Cialis) Peaks at 30 minutes and may last up to 36 hours Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Testicular Cancer S/E:similar to those of sildenafil and vardenafil. Tadalafil may also cause back pain and muscle aches. 1:30 Mass or lump on the testicle, usually painless enlargement, heaviness in the scrotum, inguinal area or lower abdomen, backache, abdominal pain, weight loss, weakness Complications of CA Young male-sperm collection How does radiation treatment affect sperm Half of patients will not recover fertility as a result of radiation therapy, cytotoxic therapy, unilateral excision of a testis, and RPLND (Retroperitoneal lymph node dissection). Counseling about fertility issues may help the patient make the appropriate choices sperm banking before treatment may be considered Brachytherapy Radiation delivered only to the affected side, other testis is shielded from radiation to preserve fertility Used in patients whose disease does not respond to chemotherapy and in those whom lymph node surgery is not recommended Long-term side effects associated with treatment for testicular cancer include renal insufficiency from kidney damage, hearing problems, gonadal damage, peripheral neuropathy, and, rarely, secondary cancers. The patient may have difficulty coping with their condition, issues related to body image and sexuality need to be addressed Patients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. Educate on adhering to follow up appointments for early detection of cancer recurrence, educate on participating in healthy behaviors such as smoking cessation, healthy diet, minimization of alcohol, cancer screening activities Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 How does radiation treatment affect sperm BPH ⅔ of men newly diagnosed with cancer may be considering fatherhood, and sperm quality is reduced in men with testicular cancer, therefore sperm banking is considered Half of patients do not recover fertility as a result of radiation therapy backflow of urine 1:56 Clinical manifestations Lab values Benign prostatic hyperplasia (BPH) noncancerous enlargement or hypertrophy of the prostate, causing bothersome lower urinary tract symptoms that affect quality of life by interfering with normal daily activities and sleep patterns Manifestations: ○ Lower urinary tract symptoms ranging from mild to severe ○ Urinary frequency, urgency, nocturia, hesitancy in starting urination, decreased and intermittent force of stream and the sensation of incomplete bladder emptying, abdominal straining with urination, decrease in volume and force of the urinary stream, dribbling, recurrent UTIs, urinary retention Large residual volumes of urine can lead to azotemia = increased BUN (accumulation of nitrogenous waste products) and kidney failure ○ Generalized symptoms: fatigue, anorexia, nausea, vomiting, pelvic discomfort ○ A DRE (digital rectal exam) reveals large, rubbery, nontender prostate and a PSA level is obtained (elevated) Urinalysis is done to screen for hematuria, complete blood studies, ultrasound, cardiac status and respiratory function are assessed because cardiac or respiratory problems are likely with BPH ○ Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 TURP Post op monitoring (select all ??) Transurethral resection of the prostate, removal of the inner portion of the prostate through an endoscope inserted through the urethra Postop complications may include hemorrhage, clot formation, catheter obstruction, sexual dysfunction, anatomic changes of the posterior urethra can lead to retrograde ejaculation Major goals postoperatively include: ○ Maintenance of fluid volume balance ○ Relief of pain and discomfort ○ Ability to perform self-care activities ○ Absence of complications Nursing Interventions: ○ Observe for symptoms of urethral stricture (dysuria, straining, weak urinary stream). ○ Maintain fluid balance - risk of fluid retention, fluid imbalance due to irrigation of the surgical site, urine output and the amount of used for irrigation must be closely monitored to determine if fluid is being retained, ○ Monitor for electrolyte imbalances, increased blood pressure, confusion, respiratory distress ○ Relieve pain possibly due to kidney problem or bladder spasms ○ Monitor hemorrhaging - due to hyperplastic prostate glands being very vascular, and blood clots which may obstruct urine flow, begins as reddish pink urine to light pink within 24 hours ○ Monitor for infection - use aseptic technique for dressing changes, UTI and epididymitis are possible after prostatectomy ○ Venous thromboembolism - prevent with early post op ambulation, antithrombotic interventions ○ Potential catheter problems - catheter must drain well, lasix may be prescribed to promote urination, swelling above the pubis is shown for overdistended bladder, assess for bloody urine, blood in the dressings, and surgical incision, a 3 way drainage system is used in irrigating and gentle irrigation can be used for clots and the catheter is taped to the inner thigh Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 ○ Urinary Incontinence - Preventing incontinence involves increasing voiding frequency, avoiding positions that encourage the urge to void, and decreasing fluid intake prior to activities. Promoting continence involves pelvic floor exercises, biofeedback , electrical stimulation Sexual dysfunction - provide a private and confidential environment to discuss issues of sexuality Female Repro Menses 3:38 When it occurs (age of onset) ○ Average is 11-13 years old (aka: onset of puberty) can range anywhere from 8-17 years ○ Lasts on average 4-8 days ○ Occurs every 25-35 days ○ Amount of blood loss 50-60 mL ○ Life of egg is about 14 days ○ Female is born with 600,000 eggs. Starts puberty with 400,000 eggs ○ Onset of menstrual cycle in adolescents can vary in range and heaviness ○ Menstrual cycles becomes more regular with age Hormones involved ○ FSH (Follicle Stimulating hormone) → controls the proli昀椀c phase ○ Estrogen- thickens uterus lining ○ Progesterone- allows thickening to take places after conception Process ○ Menstrual Cycle allows women to have reproductive capacity ○ Ovaries release a few eggs every 28 days from puberty to menopause ○ Menstrual cycle is divided in 2 phases: ○ 1. Follicular phase days 1-14 of cycle Under control of the FSH hormone Stimulates the ovaries to grow egg follicles (follicles are small sacs that contain an immature egg) Once the egg follicles are growing, estrogen stimulates the endometrial lining to grow and thicken. → this prepares uterus for conception When FSH declines, the luteinizing hormone from anterior pituitary gland Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 matures the egg follicle, so when the egg follicles are released from the ovary we call this “ovulation” Once ovulation occurs: egg follicles enter fallopian tubes → travel and enter the uterus → 2nd phase ○ 2. Luteal phase from ovulation until next cycle days 15-28 Dominating hormone in this cycle is estrogen Egg sacs from ovaries now producing progesterone Progesterone allows thickening to take place after conception and allows the embedding of the egg on the endometrial wall IF the egg does not meet the sperm, the quantity of progesterone diminishes → lining not held → lining sheds → beginning of menstrual cycle complications ○ Pain with menses or intercourse ○ Discharge, odor, itching ○ What affects menstrual cycle? Fatigue, stress, diet, sleep, illness, antibiotics PCOS = PolyCystic Ovary Syndrome 3:45 Irregular menstration Enlrged ovaries Why it happens- FSH stimulates ovaries, a lot of the egg follicles are producing estrogen but are not reaching maturation. So, ovulation make take weeks to occur and then they eventually get a period Considered a metabolic disorder. Affects bone health and ability to achieve pregnancy (d/t hard to track ovulation) Can develop cysts in ovaries Imbalance between the 2 phases of the menstrual cycle. Main manifestation: lack of period ex) only 4-6 periods per year Painful period Infertility Irregular PMS= Premenstrual syndrome 4:23 this is a SATA (assessment findings)     Breast tenderness Fluid retention (bloating) Cramps Depression Usually occurs between ovulation and menstruation Severe PMS is PMDD= premenstrual dysphoric disorder Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Signs and symptoms (select all ??) s/sx depend on the time of the luteal phase and the progesterone levels ○ Bloating ○ Increased appetite ○ Tenderness ○ Crying ○ Irritability ○ Bitchyness ○ Moodiness ○ Increased fluid retention Candida 5:05 Clinical Manifestations- what do you see in a pt with yeast infection Infection Cause Candidiasis Clinical Manifestations Candida albicans, Inflammation of vaginal glabrata, or epithelium, producing itching, tropicalis reddish irritation White, cheese like discharge clinging to epithelium Perimenopause &Menopause 5:20- 7:02 (questions) What does it look like for a pt? What is Hormone replacement all about? Perimenopause- period around menopause ○ is the onset of declining hormone (estrogen) levels and FSH attempt to compensate. As estrogen levels decrease, the pituitary increases the FSH to try and stimulate more estrogen→ leads to endometrial growth and buildup. Progesterone diminishes until no period. ○ Lasts 3-6 years before last menstrual period. Irregular periods leading up to last menstrual cycles Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 ○ S/sx: Decreased vaginal lubrication Lining of urogenital tract thins Thinning of pubic hair Labia majora can shrink As estrogen diminishes, skin becomes more fragile and pale Irregular periods Hot flashes Night sweats Mood swings Increase risk of bone loss (take vit d and calcium) Increase risk for UTIs ○ Menopause- cessation of ovary function or cessation of menstrual cycles for at least 13 months Increased risk for bone loss, osteopenia, osteoporosis, higher risk for fracture (plus all perimenopause symptoms listed above) Increased risk for breast ca, MI, and stroke Changes in pH → increased risk for vaginitis, Hormone therapy → who would this help? Interventions (HRT) Hormonal Replacement Therapy ○ Talk to your Dr about risk v. benefit. ○ Helpful for those with severe symptoms, having impaired sleep, vaginal dryness with sexual activity (can benefit from a cream) ○ Contraindications: absolute and relative Absolute: hx of breast CA, strokes, clots, smoking Relative: HTn, heart disease, Preventative 7:32 Pap Smears- annually Importance, when to get them Papanicolau (Pap) smear is used to detect cervical cancer Cervical secretions are gently removed from the cervical os and transferred to a glass slide If the Pap smear shows atypical cells and no-high risk HPV types, the next Pap smear is performed in 1 year Pap smears that indicate precancerous lesions should be repeated in 4-6 months, and colposcopy performed if the lesion has not resolved If Pap smear results are abnormal→ prompt noti昀椀cation, evaluation, and treatment are crucial Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 BSE (Breast Self Examination)- Monthy When to perform, abnormal findings Regular self-examinations may result in early identification of problems and may also result in more diagnostic work-ups for benign or malignant problems. BSE is best performed after menses (day 5 to day 7, counting the first day of menses as day 1) ○ In addition, many women have grainy-textured breast tissue, but such areas are usually less nodular after menses Patients should be instructed about optimal timing for BSE (5 to 7 days after menses begin for women who are premenopausal and once monthly for women who are postmenopausal) * a painless lump or *non mobile mass with irregular edges is most indicative of abnormal finding that should be reported to Dr Abnormal Assessment Findings During Inspection of the Breasts Retraction sings ○ Include skin dimpling, creasing, changes in contour of breast or nipple ○ May be secondary to contraction of fibrotic tissue (that can occur with underlying malignancy) ○ May be secondary to scar tissue formation after breast surgery Increased Venous Prominence ○ Unilateral localized increased venous pattern associated with malignant tumors ○ Normal with: bilateral and symmetrical breast enlargement (associated with pregnancy/lactation) Peau d’Orange (Edema) ○ Caused by interference with lymphatic drainage ○ Associated with inflammatory breast cancer ○ Breast has orange peel appearance, skin pores enlarged, skin becomes thick, hard, and immobile Nipple Inversion ○ Considered normal if long-standing ○ If recent development: it is associated with fibrosis or malignancy Acute Mastitis (Inflammation of the Breasts) ○ Associated with lactation (but may occur at any age) ○ Nipple cracks or abrasions noted ○ Breast skin reddened, warm to touch, tenderness, with systemic signs of fever & increased pulse Paget Disease (Malignancy of Mammary Ducts) ○ Early signs - erythema of nipple and areola ○ Late signs - thickening, scaling, and erosion of the nipple and areola Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Contraceptives 9:45 Contraindications: who can take it? Who can’t take it and why. Different kinds of contraceptives ○ Family planning ○ Emergency contraceptives ○ Oral contraceptives- what are the high risks, who should use Abstinence Or celibacy only completely effective means of preventing pregnancy (100%) Long-Acting Reversible Contraceptive (LARC) Method Most effective reversible methods for pregnancy prevention ○ Intrauterine Device (IUD) A small usually T-shaped device inserted into the uterine cavity It is visible and palpable at the cervical os 2 types: hormonal and nonhormonal (hormonal releases progestin a 3year and 5-year type are approved for use), nonhormonal is effective for up to 10 years Disadvantages: possible excessive bleeding, cramps, backaches, slight risk of tubal pregnancy, displacement of the device, or pelvic infection on insertion Advantages: effectiveness over long period of time, few systemic effects, & reduction of patient error ○ Implants Single-rod subdermal implant, effective for 3 years Usually placed inside upper arm using small incision Possible discomforts that can be treated with NSAIDS Heavy or prolonged bleeding should be evaluated for an underlying gynecologic problem (such as interactions with other medications, STI pregnancy, or new pathologic uterine conditions) Sterilization ○ Be certain no longer wish to have children. Vasectomy (male) and tubal ligation (female) Hormonal Contraception Block ovarian stimulation (by preventing release of FSH from anterior pituitary gland). In the absence of FSH the follicle does not ripen and ovulation does not occur. Progestins suppress the LH surge, prevent ovulation, and thicken cervical mucus to make in impenetrable to sperm ○ Oral Contraceptives Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Preparations of synthetic estrogens and progestins ○ Transdermal Contraceptives Changed every week for 3 weeks, with no patch in 4th week ○ Vaginal Contraceptives NuvaRing is a combination of hormonal contraceptive that releases estrogen & progestin ○ Injectable Contraceptives IM injection of Depo-Provera (a long acting progestin) every 3 months Limited to 2 years because of loss of bone mineral density (bone regained when stopped (sometimes)) Mechanical Barriers ○ Diaphragm 50-90mm round flexible spring domelike latex rubber cup inserted deep into the vagina, covering the cervix completely. Remain in place 6hrs after coitus (no more than 12hrs) ○ Cervical Cap Much smaller 22-35mm and covers only the cervix. Advantage is it can be left for 2 days after coitus ○ Female Condom A cylinder of polyurethane enclosed at one end by a closed ring that covers the cervix, and at the other end by an open ring that covers the perineum (protection from STIs, HIV, and pregnancy) ○ Spermicides Made of nonoxynol-9 or octoxynol, and available as foams, gels, films, suppositories, and condoms. Do not protect from HIV and STIs ○ Male Condom Impermeable, snug-fitting cover applied to erect penis. Leave space for ejaculate, if no space is left ejaculation may cause tear or hole in condom Coitus Interruptus or Withdrawal - Pull out method Fertility Awareness-Based Methods ○ Knowing and recognizing when the fertile time occurs. Most common is the Standard Days method. (users must avoid unprotected sex on days 8-19 of the menstrual cycle) Emergency Contraceptives Not suitable for long-term avoidance because it is not as effective as oral contraceptives or other reliable methods used regularly, however it is valuable following intercourse when pregnancy is not intended ○ ○ Emergency Contraceptive Pills 3 kinds of pills in the US Should be taken within 5 days of unprotected intercourse Postcoital Intrauterine Device Insertion Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Postcoital IUD insertion involves insertion of copper-bearing IUD within 5 days of coitus. It prevents fertilization by causing a chemical change in sperm & egg before they can meet Contraindications Coexisting medical disorders may make contraception a complex issue Needs to be addressed individually in women with pre-existing conditions Nurses are well positioned to aid patients in choosing the safest, most effective method of contraception to meet their individual needs (with the aid of a thorough history) US Medical Eligibility Criteria (USMEC) is a valuable resource when counseling patients about contraceptive method of choice (provides guidance on safety for women with preexisting conditions) Sexual Transmitted Infections *focus on treatment 10:12 Herpes Simplex (type 2) : No cure but can be treated with Acyclovir Management meds (from the book, not lecture): acyclovir (Zovirax) and valacylcovir (Valtrex)- helps to minimize the symptoms and the duration or length of flare-up Acetaminophen can be given for analgesia For breakouts- topical anesthetics such as lidocaine (Xylocaine) can help in control of discomfort Occlusive dressings have been shown to speed the healing process○ prevent desiccation and scab formation ○ Maintain an aqueous wound environment rich in growth factors and matrix materials ○ *not practical for lip and mucosal lesions* can use for genital and anal lesions only Occlusive ointments Herpecin-L or docosanol (Abreva) for lips and mucosal lesions Trichomoniasis: Management strategies (from book not lecture) ○ Relieve inflammation ○ Restore acidity ○ Reestablish normal bacterial flora ○ Provide oral metronidazole for pt and partner Endometriosis 10:30 = benign lesion that has endometrial tissue found in pelvic cavity outside of uterus Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Signs and symptoms ○ Extensive endometriosis may cause few symptoms ○ Isolated lesion may produce severe symptoms Chronic pelvic pain infertility dysmenorrhea= painful menstruation dyspareunia= painful sex Pelvic discomfort and pain Pain with bowel movements Radiation of pain to the back or leg depression ○ pain and lesions (caused by menstruation when ectopic tissue bleeds into areas that have no outlets) ○ “Pseudocyst” = endometrial tissue formed within ovarian cyst → pain, infertility, increased risk for ovarian CA ○ Acute pain= strong clinical manifestation that needs to be treated. Treat with analgesic, prostaglandin inhibitors, hormone therapy, oral contraceptives ○ Pregnancy can alleviate symptoms bc ovulation and menstruation is not occuring Cervical Cancer 10:48 Prevention (select all ??) Pap smears for early screening (not prevention) Immunizations ○ Gardasil: vaccine preventing HPV (which can turn into cervical CA) Delaying first intercourse Not smoking Safe sex practices Uterine Fibroids (or myomas) 11:30 What do you see when a pt has uterine fyroids Clinical manifestations- symptoms result from pressure on the surrounding organs May cause no symptoms May produce other s/sx ○ abnormal vaginal bleeding ○ Pain Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 ○ ○ ○ ○ ○ ○ ○ Mastectomy Back ache Pressure Bloating Constipation Urinary problems Menorrhea ( excessive bleeding) Menorrhagia (irregular bleeding outside of regular menses)- this occurs bc fibroids disturb the uterine lining ○ fibroids can also interfere with fertility Treatment: medical or surgical intervention (hysterectomy) depending on size, s/sx, location, age, and childbearing plans Observe and follow up- fibroids can shrink after menopause when estrogen levels decrease 11:39 Education (pre-op and post-op) the post-op is SATA Goal of Sx: gain control of the disease Different types: ○ Modified radical mastectomy- pec major and minor muscles are left intact ○ Total mastectomy= treats invasive cancer. All breast tissues, nipple, areola removed, axillary lymph nodes removed If immediate reconstruction is wanted, pt sees plastic surgeon for options NO aspirin can be given post-op bc it increase the risk of hemorrhage Important for nurse to nurse to understand how the pt responds to the Dx ○ Ask about coping mechanisms ○ Assess emotional state, support system ○ What are the pt’s educational needs? ○ Is she experiencing discomfort? ○ Remember this is a physical and emotional change for the pt Post-Op self care education: SATA Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 ○ ○ ○ ○ ○ Surgical site management Care of drain (removed when output is less than 30 ml/24 hr, usually takes 7-10 days, ) Personal hygiene- can wash incision or drain site with soap and water on 2nd post op day Make sure arm exercises are done. (exercises to the affected side 3 times a day for 20 mins at a time until full ROM restored) Want to prevent lymphedema Avoid heavy lifting Hysterectomy 12:32 Related to post-op Hemmoraging??? (surgical removal of the uterus to treat CA, dysfunctional uterine bleeding, endometriosis, nonmalignant growths, persistent pain, pelvic relaxation and prolapse, previous injury to the uterus) There are different types: total, radical hysterectomies Different approaches: laparoscopic, vaginal, abdominal Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Post-op care Complications after Sx: ○ Hemorrhage= severe bleeding ○ DVT= can lead to clots ○ Bladder dysfunction ○ infection General Health Assessment 12:45 Repropductive health of a female pt Health History ○ Things to ask about: last menstrual period, how often is menstrual pd, ○ # of pregnancies, stillbirths, miscarriages, and abortions ○ sexual history, STD history How to approach healthcare ○ Always be non judgemental and provide a non judgemental environment! ○ Always ask full health history questions (above) ○ Goal: relieve discomfort, reduce anxiety, prevent reinfection, help pt gain knowledge of self care What to include in teachings ○ Maintaining self care ○ Sitz baths can remove discomfort of vaginal infections Vaginal Infections ex) vaginitis, candidiasis, bacterial vaginosis, trichomonas vaginalis 12:52 What should / or not be done to prevent vaginal infections General guidelines ○ Candidiasis: Treat with flagyl,Sexual partners should be treated as well ○ These infections can occur more commonly in pregnancy, DM, HIV, meds like oral contraceptives and corticosteroids ○ Risk Factors: women in perimenopause, menopause, pregnant, taking oral contraceptives, poor hygiene, wearing tight clothes, douching, DM, antibiotics, intercourse with sexual partner ○ Important to be seen after the onset of symptoms, instruct pt not to douche before assessment How to prevent UTIs, yeast infections, vaginitis ○ Avoid feminine products ex) sprays ○ Educate to avoid douching (but therapeutic douching may be prescribed to reduce odors and remove excessive drainage) ○ Teach proper hand hygiene Urinary 13:18 Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 If the kidney is injured going to have decreased erythropoietin, decreased RBC (anemic) A low GFR is associated with increased levels of BUN, creatinine, and potassium. GFR decreased BUN elevated Creatine elevated Hemoglobin down Potassium increased Pyelonephritis 14:55 Inflammation of the kidneys- usually UTI etc. Assessment question: What do you see with pyelonephritis?    Fever chills Coastal vertebral angle (CVA) tenderness Pyelonephri琀椀s- in昀氀amma琀椀on of the renal pellet pelvis and the parenchyma -Pathophysiology: bacteria enter causing in昀氀amma琀椀on, there is an increase in white blood cells, edema and swelling. may spread to the cortex and cause 昀椀brosis, and scar 琀椀ssue may develop Inflammation of the renal pelvis and parenchyma Focus on signs and symptoms: High fever, chills, nausea, vomiting, flank pain, headaches, muscle pains, symptoms of cystitis. Urinalysis: cloudy, bloody, foul smell,WBC’s and casts. WBC casts in urinalysis is indicative of pyelonephritis UTI (in elderly) 15:27 Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 How to prevent UTI There is a SATA ? about clinical manifestations of UTI in elderly patient Education/Prevention: Diligent hand hygiene & hygiene (shower rather than bathe, prevent bacteria entering urethra) careful perineal care (perineum from front to back) frequent toileting may decrease the incidence of UTI’s constant fluid intake to flush out bacteria (1 glass cranberry juice, avoid coffee, tea, colas, alcohol) Take medications as prescribed. (long-term pharm therapy can cause UTI as well tho) Clinical manifestations: Urinary microorganisms (colonies) > 100,000 CFU/mL Burning on urination, urinary frequency, nocturia, suprapubic or pelvic pain Incontinence (involuntary loss of urine) 15:43 Although it is COMMON it is not NORMAL part of aging. What to do with a pt w/ incontience (bowel training, having them void every 2 hours, kegel) urinary incontinence -urination, is the result of voluntary retraction of the detrusor muscle. I think of the bladder as being a muscle. incontinence, the involuntary loss of urine, it causes embarrassment. It is not a normal consequence of aging, or childbirth. It's probably one of the most under reported health problems prevalent in the elderly increases with disability neurological diseases, gynecological or urological surgeries, hospital admissions and some infections. How to Manage/prevent ○ ex) bladder training, kegel exercises, bladder neck suspensions, surgical correction for stress incontinence, artificial urinary sphincter implants (rare) Catheterization 16:12 Indwelling (stays in bladder) vs intermittent (slef-care done/ inderted then urine is drained then catherter is taken out) If done in hospital it is sterile, if at hoe it is aseptic Remember to wash hands etc. and keep bag below the bladder Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Indwelling catheters- how to manage: The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Bacteria enter the urinary drainage bag, multiply rapidly, and then migrate to the drainage tubing, catheter, and bladder. By keeping the drainage bag lower than the patient’s bladder and not allowing urine to flow back into the bladder, this risk is reduced. Hand hygiene before handling indwelling catheter, tubing, or bag Avoid routine catheter changes Ensure free flow of urine to prevent infection Empty collection bag every 8hrs Never disconnect tubing for irrigation, urine samples, ambulation, or transfer of pt Self-catheter (in and out)- pt education the nurse must use aseptic technique to minimize the risk of crosscontamination patient may use a “clean” (nonsterile) technique at home, where the risk of crosscontamination is reduced antibacterial liquid soap or povidone-iodine (Betadine) solution is recommended for cleaning urinary catheters at home. catheter is thoroughly rinsed with warm tap water after soaking in the cleaning solution. MUST be dry before re-use Kept in own container (ex: plastic food storage bag) and bladder emptied at prescribed time (4-6hrs) Female: Fowler’s position, lubricate catheters 7.5cm (3in) into urethra Male: Fowler’s position, lubricates and inserts catheter 15-20cm (6-10in) ○ https://youtu.be/JMpgeMoQS7o?t=31 Renal/Urine Assessment 16:48 What should be in urine.. and what shouldn’t be in urine (Blood in urine, glucose in urine, wbc in urine)= BAD What does it tell us about a pt’s renal health? What lab values are normal? Renal concentration: -(Specific gravity 1.010 - 1.025) -Urine osmolality: 250–900 mOsm/kg/24 hr, 50–1200 mOsm/kg random sample BUN (Blood, Urea, Nitrogen) [8-20] Serum Creatinine [0.6-1.2] Albumin/ Microalbumin ○ Detects renal function such as renal failure *GFR (what does it look like when renal failure) Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 the amount of plasma filtered through the glomeruli per unit of time GFR can vary from a normal of approximately 125 mL/min (1.67 to 2 mL/sec) to a high of 200 mL/min Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease ○ 80-120 range Urine- what should it look like? Abnormalities? In theory urine results should all be negative or not present. Usually common findings are epithelial cells and few bacteria depending on type of collection (ex. Random, clean catch, foley). To determine urinary infection, >10 wbc per high field should be observed and diagnostic is presence of leukocyte esterase. Presence of bacteria is not usually diagnostic for infection, due to normal flora and type of collection. Fluid Balance 17:16 Best way to monitor fluid balance and what that hourly fluid output should be Best way to measure? Intake and output (I&O) record is a key monitoring tool used to document important fluid parameters, including the amount of fluid taken in (orally and parenterally), volume of urine excreted and other fluid losses (diarrhea, vomiting, diaphoresis) Daily weights are also important to determine the daily fluid allowance and indicate signs of fluid volume excess or deficit Normal urine output Normal urine output is 1 to 2 L/day or (at least 30ml per hour) Nephrolithotomy 17:48 Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 If we have kidney stones that we are removing, they had to get it with a scope. (pt was not able to remove it on their own.. What is post-op care post -op assessment and care The major goals for the patient may include relief of pain and discomfort, prevention of recurrence of kidney stones, and absence of complications. Post-op complications/avoiding ○ Severe acute pain is often the presenting symptom, treated with opioids, IV NSAIDS, repositioning, ambulation ○ Increase fluid intake to prevent dehydration and increase hydrostatic pressure within the urinary tract to promote passage of stone, IV fluids may be prescribed ○ All urine is strained due to uric acid stones that may crumble and blood clots passed in urine should be crushed and the sides of the bedpan inspected for clinging stones ○ Kidney stones increase the risk for infection so patients are instructed to report decreased urine volume, bloody or cloudy urine, fever, pain, UTIs may be associated with stones ○ Observe frequently to detect the spontaneous passage of stone ○ Prevent recurrence of stones by educating the patient to increase fluid intake (excretion should be greater than 2000 mL) every 24 hours, encourage ambulation, and discourage excessive intake of vitamins and minerals ○ Minimize intake of calcium and oxalate (such as leafy greens, etc) due to most calculli crystals are a form of calcium oxalate crystals ○ Educate on signs and symptoms of stone formation, obstruction, infection ○ Bleeding is a major complication of kidney surgery and can lead to hypovolemia and hemorrhagic shock, administer prescribed parenteral fluids and blood, monitor vitals and skin condition, incision site, level of consciousness, cardiac output Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Hemodialysis & Peritoneal (18:08) The machine replaces the kidney The pt would be on dialysis due to Renal (kidney) failure which is based on GFR ESKD (end-stage kidney/renal disease) is 15 or lower GFR 22:47 (it was said after the hemo/peri section) Hemo- AV graft, replaces function of kidney 3x a week, 1. Hemo is a very long process (5 hours) lot of fluid is shifted, ‘ The patient is at increased risk for HYPOVOLEMIC SHOCK (Low BP) no hypertensive or anticoagulant medsbefore dialysis. 2. Feel a thrill, hear a bruit make sure it is patent AV graft 3. No BP or stick with side of AV graft ***Peritoneal is its own section covered at the bottom, however Yang went over both dialysis terms around this time*** AKI: Acute kidney injury (AKI) is a rapid loss of renal function due to damage to the kidneys. 23:02 When kidney isn’t working you have retention of fluid… thus having retention of sodium/potassium. HYPERKALEMIA- CARDIAC ISSUES!! Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 If pt has no output do not give them fluids with potassium, When pt moves into diuresis stage of Kidney injury then the risk of dehydration is present. What would cause Pre-Intra-or POST and what are the complications? What the diet should be (select all that apply question) Protein intake restricted to 1.2 to 1.3 g/kg ideal weight per day Sodium intake restricted to 2 to 3 g/day Fluids restricted to amount equal to daily urine output plus 500 mL/day Weight gain under 1.5kg Medications cannot have prior to hemodialysis Medications that are water soluble are readily removed during hemodialysis treatment, and those that are fat soluble or adhere to other substances (like albumin) are not dialyzed out very well. Blood pressure meds and antibiotics should be avoided. Cardiovascular meds must be held prior AKI: Acute kidney injury (AKI) is a rapid loss of renal function due to damage to the kidneys. Causes for AKI : Know the three kinds prerenal, intrinsic, and postrenal Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Prerenal- shit happens before it reaches the kidney (reduced bloodflow etc.) Intrarental- while in the kidney Postrenal- after the kidney.. stuff like kidney stones in the urethra etc. Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Complications (electrolyte imbalance, fluid balance) Hypertriglyceridemia, disturbances of lipid metabolism Heart failure, coronary artery disease, angina, stroke, peripheral vascular disease Anemia, by blood lost during hemodialysis Gastric ulcers, sleep problems Poor calcium metabolism and renal osteodystrophy can result in bone pain and fractures, interfering with mobility. Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Kidney Organ Transplant 24:24 Immune systems are suppressed, and they are at a higher risk for infection How to prevent infection Both patients (donor & recipient) must be free of infection at time of kidney transplantation After surgery: medications to prevent transplant rejection will be prescribed to the transplant recipient These meds suppress the immune response→ leaving the patient immunosuppressed & at risk for infection Both are evaluated & treated for any infections (including givival disease and dental caries) The patient is closely monitored for infection because of susceptibility to impaired healing & infection related to immunosuppressive therapy & complications to kidney disease The body’s immune system views the transplanted kidney as “foreign”; therefore, it continually works to reject it. To overcome or minimize the body’s defense mechanisms, immunosuppressive agents are given. Results of blood chemistry tests, leukocyte and platelet counts are monitored closely Patient is monitored closely for infection because of susceptibility to impaired healing and infection related to immunosuppressive therapy Manifestations: shaking chills, fever, rapid heartbeat, tachypnea, increase or decrease in WBCs (leukocytosis and leukopenia) Infection sources: high incidence of bacteriuria during early and late stages of transplant, wound drainage should be viewed as potential infection source, catheter and drain tips Protect the patient from exposure from hospital staff, visitors, other patients, hand hygiene is imperative Renal Calculi 24:40 Painful What is it? Kidney stones What causes it? precipitation of calcium phosphate in the renal pelvis and parenchyma. Stones are formed in the urinary tract when urinary concentrations of substances such as calcium oxalate, calcium phosphate, uric acid increase May be found anywhere from the kidney to the bladder and vary in size from minute granular deposits to as large as an orange Increased calcium concentration in the blood and urine promote precipitation of calcium and formation of stones (80% of stones are calcium based) Causes of hypercalcemia and hypercalciuria: ○ Hyperparathyroidism Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 ○ ○ ○ ○ Renal tubular acidosis Cancers Dehydration Granulomatous diseases, excess vitamin D intake, excessive intake of milk and alkali myeloproliferative diseases such as polycythemia vera Ileal Conduit (Stoma) 24:55 Stoma should be vasuclar etc. no purple!! What should look like Post-op assessment They are vascular, should be red in color (purple, brown, or black when not enough circulation of blood, vascular supply) Urine volumes monitored hourly (output below 0.5mL/kg/hr can mean dehydration or obstruction of ileal conduit) Providing stoma and skin care (The skin is inspected for (1) signs of irritation and bleeding of the stoma mucosa, (2) encrustation and skin irritation around the stoma (from alkaline urine coming in contact with exposed skin), and (3) wound infections ) Testing urine and caring for the ostomy Hydronephrosis 25:20 Decreased emptying of the bladder, and the bladder swells Causes: Incomplete bladder emptying due to bladder outlet obstruction (such as benign prostatic hyperplasia), causing high-pressure detrusor contractions What we see/ clinical manifestations Urosepsis Gradual dilation of kidneys Sensation of incomplete bladder, urinary frequency, urgency, nocturia, hesitancy in starting urination Pelvic discomfort Recurrent UTI’s 25:45 Get cultures, administer antibiotics What is it? the spread of infection from the urinary tract to the bloodstream that results in a systemic infection Treatment Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Renal Tumor 26:05 Specifically Renal biopsy- usually diagnosed later due to no symptoms Watch for bleeding post-biopsy (at site or in urine) S/S: occur in only 10% of patients, include hematuria, pain, and a mass in the flank. The usual sign that first calls attention to the tumor is painless hematuria Causes? Tobacco use continues to be a significant risk factor Gender—affects men more than women Obesity Occupational exposure to industrial chemicals, such as petroleum products, heavy metals, and asbestos Polycystic kidney disease Unopposed estrogen therapy Renal Biopsy After a biopsy, nursing care includes monitoring vital signs for the first 24 hours to detect signs and symptoms of bleeding or infection Assess for other signs of internal bleeding such as pallor, dizziness, flank or back pain IV fluids are given to help clear the kidneys and prevent clot formation Urine may contain blood (usually clears in 24 to 48 hours) from oozing at the site Maintain bed rest and pressure dressings to control bleeding Examine puncture sites for infection and administer analgesic agents Acute/Chronic Renal Failure 26:40 Know about the diet Know the three types (pre, intra, post) ○ Prerenal Azotemia ○ Intrarenal (Intrinsic) ○ Postrenal Azotemia Causes Complications (DM, HTN, Hyperkalemia) ○ ARF: Fluid and electrolyte imbalances Acidosis Susceptibility to infections Anemia Platelet dysfunction Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Know what GI symptoms Pericarditis Uremic encephalopathy Impaired wound healing diet ○ Chronic: high protein, fluid restriction, sodium and phosphorus restriction ○ Acute: calories from high fat to prevent nitrogen excess Prerenal ○ Decreased perfusion ○ Lowers GFR ○ Circulatory volume depletion ○ Decreased cardiac output ○ Vascular obstruction Intrarenal ○ Acute tubular necrosis ○ Impaired renal perfusion ○ Direct damage by nephrotoxins ○ Other causes Glomerulonephritis Postrenal: ○ Obstruction of the urinary collecting system anywhere from the calyces to the urethral meatus Chronic: ○ Destruction of nephrons with progressive loss of renal function ○ GFR decreases Clearance is reduced Increased BUN & Creatinine ○ Hypertrophy of functioning nephrons Inability to concentrate urine Salt wasting & polyuria ○ Damage Advance Further decrease in GFR Unable to excrete water, salt, and waste Stages of Chronic Disease ○ Reduced renal reserve ○ Renal insufficiency ○ Renal failure ○ ESRD S/S of Chronic Disease: ○ Electrolyte imbalances ○ Hyponatremia ○ Hypernatremia & FVE ○ Hyperkalemia Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Hypocalcemia & Hyperphosphatemia Hypermagnesium Metabolic changes Hypoproteinemia Elevated BUN & creatinine ratio Decreased creatinine clearance Decreased degradation of insulin Elevated triglycerides Metabolic acidosis Pericarditis Hematologic changes Anemia GI changes Depressed immune system Medication toxicity Cardiovascular changes HTN Atherosclerosis Arterial calcifications Peritoneal Dialysis 27:17 Peritoneal 21:10 PERI- done by pt at home, dialysate is infused into peritoneal cavity and then drained out. While it does allow for more independence it increases the risk for infection Teach the pt to monitor the urine output (cloudy, etc.) Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 If your pt has hyperkalemia use Kayexalate Why do you use this? To remove toxic substances and metabolic wastes and to reestablish normal fluid and electrolyte balance. PD may be the treatment of choice for patients with kidney disease who are unable or unwilling to undergo hemodialysis or kidney transplantation. Risk factors? Patients with diabetes or cardiovascular disease, many older patients, and those who may be at risk for adverse effects of systemic heparin are likely candidates for PD. Complications? Peritonitis: the most common and serious complication of PD. The first sign of peritonitis is cloudy dialysate drainage fluid. Diffuse abdominal pain and rebound tenderness occur much later. Leakage of dialysate through the catheter site may occur immediately after the catheter is inserted. Bleeding: A bloody effluent (drainage) may be observed occasionally, especially in young, menstruating women. Hyperkalemia (high potassium level) Interventions (med?) How to treat Kayexalate medication, lower K+ levels by defecation Administer cation-exchange resins (sodium polystyrene sulfonate) Kayexalate orally or retention enema Sorbitol may also be given to induce a diarrhea type effect inducing water loss in the GI tract If Kayexalate enema is given, the patient needs to retain for at least 30 to 60 minutes to promote K removal. Followed by a cleansing enema If the patient is hemodynamically unstable (low BP, changes in mental status, dysrhythmia) give IV dextrose 50% insulin and calcium replacement to shift potassium back in cells Exam 1 27:20    Abnormal Lab results Acid base balance Basic Hydration Exam 2 27:32 Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180     Complications of Traction Compartment syndrome Risk factors for osteo arthritis/ Risk factors for osteoporosis Exam 3 27:41    Chron’s Disease Diverticulosis management Macular Degeneration Exam 4 Content Review Lispro-onset, peak, duration Rapid-acting: ○ ○ ○ ○ LISPRO (Humalog) Shorter duration than regular, patients need to eat no more than 15 minutes after injection Patients with type 1 and some with type 2 require a long-acting insulin as well Onset: 15 mins, Peak: 1 hour, Duration: 2-4 hours NPH- onset, peak, duration Intermediate (NPH) ○ NPH Insulin ○ White and cloudy ○ Not crucial before meal but some food should be eaten around onset and peak ○ Onset: 2-4 hours, Peak: 4-12 hours, Duration: 16-20 hours Exam 4 missed questions: A med nurse is caring for a client with Type 1 DM. The client’s med admin record is administration of regular insulin 3 x daily. Knowing that the client’s food comes at 11:45, when do you give insulin? At 11:15 (b/c 30 minute onset) People with type 1 diabetes use ________ insulin to maintain blood glucose levels in between meals and overnight Long-acting, basal, glargine, detemir Downloaded by Nicole Gomez ([email protected]) lOMoARcPSD|37834180 Math (2) Downloaded by Nicole Gomez ([email protected])