NURS 3630 Blueprint – Final Exam PDF

NURS 3630 Blueprint – Final Exam https://quizlet.com/860928656/med-surg-final-flash-cards/?funnelUUID=3a523acf-027b-45e9-9 52a-c6d37ed2c135 Unit 1: Care of Client with IV Therapies Plan nursing management for patients...

NURS 3630 Blueprint – Final Exam https://quizlet.com/860928656/med-surg-final-flash-cards/?funnelUUID=3a523acf-027b-45e9-9 52a-c6d37ed2c135 Unit 1: Care of Client with IV Therapies Plan nursing management for patients receiving intravenous therapy including parenteral 2 therapy. Assess the site each time you access the IV Remove if signs of phlebitis ○ Warmth ○ Tenderness ○ Palpable venous cord Flush saline lock every shift and prn Hand Hygiene Compare the bag with the order to make sure they match Aseptic Technique when inserting Change IV site every 72-96 hrs to reduce risk of infection and phlebitis Change IV tubing every 96 hrs Use needles connectors/tubing If the bag runs out before you have a new bag, start with 10% dextrose to ensure blood sugar doesn't drop Discuss teaching plans for a patient receiving intravenous therapy including parenteral 1 therapy. Refrigerated until 30 mins before use and are good for 24 hours at room temp Follow proper aseptic technique to reduce infection Set the alarm to alert for tubing obstruction Teach the patient not to lay on tubes or notify if tubes are kinked Periodically check the volume infused because pump malfunctions can change the route Check the solution for color changes or leaks, particulate matter, clarity, and fat emulsions separate. If present promptly return it to the pharmacy for replacement. If you need to increase the flow rate you need to do so slowly ⭐Check glucose levels at the bedside every 4 to 6 hours Identify and prevent complications for a patient receiving intravenous therapy including 1 parenteral therapy. Phlebitis Fluid overload Hyperglycemia Hypoglycemia infection/sepsis Feeding Syndrome- people who are severely malnourished who get nutrients can have electrolyte issues and fluid overload IV complications: Phlebitis- ○ inflammation of the inner layer of the vein ○ Caused by movement, antibiotics, and bacteria ○ Assessment findings- Redness Pain Swelling Warmth Vein might be hard ○ Nursing interventions- Stop infusion and make a new IV site on another extremity Elevate the extremity Infiltration- ○ Leakage of IV fluids outside the vein into the subcutaneous tissue ○ non -vesicant fluids don't cause damage ○ Assessment findings- Swelling Leaking near the IV site Cool to the touch ○ Nursing interventions- Stop the iv Start new IV on different extremities Extravasation- ○ Leakage of vesicant fluids outside the vein into the subcutaneous tissue ○ Vesicant fluids- Damage Tissues EX: chemo and antibiotics ○ Assessment findings- Blistering  Pain Swelling Necrosis Compartment syndrome ○ Nursing interventions- Stop Follow agency policy Maybe need antidote Elevate Warm compress Restart at a different site Local infection- ○ Caused by bad aseptic technique or the same IV site for too long ○ Assessment findings- Redness Fever Heat Pain Swelling Tachycardia Hypotension ○ Nursing interventions- Good aseptic technique Rotate sites Fluid overload- ○ Caused by infusions at a rapid pace, or just too much fluid ○ Assessment findings- Edema Confusion Jvd Pulmonary congestion Increased bp Anorexia Tachycardia Crackles ○ Nursing interventions- Assessment I’s and O’s (STRICT)  Daily weights Vital signs Raise the head of the bead Administer diuretics as ordered Air embolism ○ Air in the vein Improper priming of tubing ○ Assessment findings Sudden onset Hypotension Tachycardia Dyspnea Loss of consciousness ○ Nursing interventions Prevention is key Place on the left side Prime tubing Don't let IV bags run dry *Whenever you discontinue an IV make sure the whole thing comes out PN complications: Phlebitis Fluid overload Hyperglycemia Hypoglycemia AccuCheck every 6 hours TPN complications: infection/sepsis Hyperglycemia Hypoglycemia Refeeding syndrome Unit 2&3: Care of the Client with Cardiovascular Disease and Vascular Disorders Assess clients with cardiovascular disease or vascular disorders. Page 773 1 Subjective data History of present illness - Ask the patient what problem has led to seeking health care.  Health history - Ask the patient about a history of angina, diabetes, alcohol and tobacco use, anemia, rheumatic fever, streptococcal throat infections, congenital heart disease, stroke, hypertension, thrombophlebitis, dysrhythmias, and varicosities. Medications - Assess the patient’s current and past use of medications. Surgery or other treatments - Ask the patient about specific treatments, surgeries, or hospital admissions related to cardiovascular problems. Health perception–health management pattern - Ask the patient about the presence of major cardiovascular risk factors. These include abnormal serum lipids, hypertension, a sedentary lifestyle, diabetes, obesity, and tobacco use. Nutritional-metabolic pattern - Being underweight or overweight may indicate potential cardiovascular problems. Assess the patient’s weight history (e.g., over the past year) in relation to height. Elimination pattern - The patient taking diuretics may report increased voiding and/or nocturia. Ask about incontinence or constipation, including the use of prescribed and OTC drugs for constipation. Teach patients with heart problems to avoid straining (Valsalva maneuver) during a bowel movement. Ask patients if they have swelling of the lower extremities and if it resolves when their feet are elevated. Activity-exercise pattern - The benefit of exercise for cardiovascular health is clear, with aerobic exercise being the most beneficial. Record the types, duration, intensity, and frequency of exercise. Ask about symptoms during exercise (e.g., chest pain, dyspnea, claudication) that may indicate a cardiovascular problem. Sleep-rest pattern - The benefit of exercise for cardiovascular health is clear, with aerobic exercise being the most beneficial. Record the types, duration, intensity, and frequency of exercise. Ask about symptoms during exercise (e.g., chest pain, dyspnea, claudication) that may indicate a cardiovascular problem. Cognitive-perceptual pattern - Cardiovascular problems such as dysrhythmias, hypertension, and stroke may cause difficulties with syncope, language, and memory. Self-perception–self-concept pattern - Acute cardiovascular events may affect the patient’s self-perception. Invasive diagnostic procedures often lead to body image concerns. Role-relationship pattern - Gender, race, and age are related to cardiovascular health. The patient’s marital status, role in the household, employment status, number of children and their ages, living environment, and caregivers help you to identify strengths and support systems in the patient’s life. Assess the patient’s satisfaction with life roles. Sexuality-reproductive pattern - Ask the patient about the effect of the cardiovascular problem on sexual activity. Because some patients fear sudden death during sexual intercourse, they may change their sexual behavior. Fatigue, chest pain, or dyspnea may limit activity. Erectile dysfunction (ED) may be a symptom of peripheral vascular disease (PVD) and/or a side effect of some drugs used to treat CVD (e.g., β-blockers, diuretics). Coping–stress tolerance pattern - Ask the patient to identify sources of stress and the usual methods of coping with stress. Potentially stressful areas include health concerns, marital relationships, family and friends, occupation, and finances.  Values-belief pattern - Individual values and beliefs, which are greatly affected by culture, may play a key role in the real or potential conflict that a patient faces when dealing with CVD. Some patients may attribute their illness to punishment; others may think that a “higher power” can help them. Information about a patient’s values and beliefs will help you to provide support during periods of crisis. Objective Data Vital signs - Observe the patient’s general appearance and obtain vital signs. Measure BP bilaterally. Readings can vary from 5 to 15 mm Hg between arms. Use the arm with the highest BP for later measurements. Obtain an orthostatic (postural) BP and HR while the patient is supine, sitting with legs dangling, and standing. SBP should not decrease more than 20 mm Hg from the supine to the standing position. HR should not increase more than 20 beats/min from the supine to the standing position. Peripheral vascular system Inspection - ​Inspect the skin for color, hair distribution, and venous pattern. Check the extremities for edema, dependent rubor, clubbing of the nail beds, varicosities, and lesions such as stasis ulcers. Edema in the legs can be caused by gravity, varicosities, or right-sided HF. Inspect the large neck veins (internal and external jugular) while gradually moving the patient from a supine position to an upright (30 to 45 degrees) position. Right-sided HF can cause distention and prominent pulsations of the neck veins referred to as jugular venous distention (JVD). Palpation - Palpate the upper and lower extremities for temperature, moisture, pulses, and edema bilaterally to assess for symmetry. Look for edema by depressing the skin over the tibia or medial malleolus for 5 seconds. Normally, there is no depression after you release pressure. If pitting edema is present, grade it from 1+ (mild pitting, slight brief indentation) to 4+ (very deep pitting, indentation that lasts a long time). Palpate the pulses in the neck and extremities for rhythm and force of arterial blood flow. Palpate each carotid pulse separately to avoid vagal stimulation and dysrhythmias. Compare the characteristics of the arteries in the right and left extremities simultaneously to determine symmetry. When palpating rate the force of the pulse using the following scale: 0 = Absent 1+ = Weak 2+ = Normal 3+ = Increased, full, bounding. Note the rigidity (hardness) of the artery. The normal pulse feels like a tap, but a narrowed or bulging vessel wall vibrates. The term for a palpable vibration is a thrill. We use capillary refill to assess arterial flow to the extremities. Position the patient’s hands near the level of the heart and squeeze a nail bed briefly to produce blanching. Color should return to the nail bed in less than 2 seconds after release. Auscultation - An artery that is narrowed or has a bulging wall may create turbulent blood flow. This abnormal flow can cause a buzzing or humming termed a bruit. We can hear it with the bell of the stethoscope over the vessel. Thorax Inspection and palpation Auscultation Assessing a patient with hypertension - History and physical examination - RETINAL EXAM - Laboratory test: urinalysis and blood chemistry - EKG Apply knowledge of cardiovascular medications to the care of patients with cardiovascular 1 disorders. Hypertension Patient with Stage 1 HTN: nonpharmacologic treatment +1 first-line pharmacologic drug Patient with Stage 2 HTN: nonpharmacologic therapy + 2 antihypertensives from two different classifications (Ace Inhibitors, ARBs, Beta Blockers, Calcium Channel blockers, digoxin and diuretics) Heart Failure ****LMNOP Loop Diuretic: decrease volume overload Morphine: reduces pre & after load, reduces anxiety and dyspnea Nitro: reduces circulating blood volume and improves coronary artery circulation Oxygen Position and Positive: sit up in bed/legs dangling Drug therapy RAAS Inhibitors: ACE, ARNI, MRAs Diuretics B-adrenergic blockers Vasodilators SGLT2 inhibitors Combination therapy (BiDil) Position Inotropic Agents (digitalis) Inhibitors of cardiac sinus node (Ivabradine) Coronary Artery Disease (CAD) HMG- CoA reductase inhibitors - statins Niacin Fabric Acid derivatives ATP- Citrate lyase inhibitors Bile Acid sequestrants Proprotein convertase Subtilisin/Kexin 9 (PCSK9) Ezetimibe Antiplatelet Therapy Peripheral Artery Disease  ACE Statins Antiplatelets Plan nursing management of a patient with a cardiovascular disease or vascular disorder. 1 Hypertension GOAL: is to achieve and maintain 130/80 Reduce CV risk factors and target organ disease Heart Failure Monitor VS, O2, Output High Fowler's Position Oxygen via NC, Bipap, Mech Vent I&O is so important Possible fluid restriction Coronary Artery Disease (CAD) Health Promotion Managing high-risk pts Physical activity Nutritional therapy Drug therapy Prevent progression Ask the patient what they are willing to change. —— What can they modify? What are they willing to modify? Unstable Angina Call a rapid response — get the team involved Monitor the pt - Get them on the monitor and get a 12 lead - May call to STEMI Oxygen Nitroglycerin — dilates coronary arteries IV Access — make sure they have it and it is patent! ASA — if not contraindicated give ASA Atrial Fibrillation (AFIB) Monitor HR — (keep 120 Heart Failure Echocardiogram: measures the % of blood that leaves the ventricle when it contracts ECG, ambulatory heart monitoring  Chest X-Ray/MRI Cardiopulmonary exercise stress test Cardiac catheterization/angiogram EMB Labs- BNP, CMP, CBC Angina: Cardiac enzymes Troponin (heart distress) CK-MB myoglobin Cardiac monitoring It needs to be continuous via 3 or 5 lead Record & interpret a 6-second strip every 4 hours Monitor ST segment Monitor dysrhythmias Daily 12 lead ECG for cardiac patients A-fib Continuous ECG EKG Holter Echocardiogram Peripheral artery disease Doppler Angiography Magnetic resonance angiography Chronic venous insufficiency Duplex ultrasound  CT of the venous system Discuss teaching plans for clients with, or who are at risk for, cardiovascular disease or 2 vascular disorders. Hypertension Non Modifiable Risk Factors: age, family hx, ethnicity, gender Modifiable: Alcohol Use, obesity, tobacco use, sedentary lifestyle, socioeconomic status, excessive dietary sodium, Elevated dietary sodium, Elevated serum lipids, Diabetes, stress. Teach how to manage BP, reduce blood sugar, eat better, stop smoking, control cholesterol, get active, lose weight Dash diet, decrease sodium Heart Failure FACES!! Contact cardiologist -F=Fatigue -A= Limitations -C= Chest congestion/cough -E=edema -S=shortness of breath Coronary Artery Disease Modifiable Risk -Increased Blood Pressure -Diabetes -Increased lipid levels -Metabolic Syndrome -Obesity -Physical Interactivity -Tobacco use Nonmodifiable Risk -Increasing age -Ethnicity -Gender -Genetic predisposition Peripheral Artery Disease Risk Factors Cigarette Smoking Hyperlipidemia  Hypertension Diabetes Mellitus Education on cardiovascular health Explain CVD and Vascular disorders: help clients understand their specific conditions, including risk factors, symptoms, and potential complications Lifestyle modifications - Encourage a heart-healthy diet. — a diet rich in fruits/veggies, whole grains, lean proteins, and healthy fats and a reduced salt and sugar intake to manage blood pressure and weight - Physical activity — develop fitness plans tailored to their fitness level and any physical limitations - Weight management - set realistic weight loss or maintenance goals for achieving and sustaining a healthy weight - Smoking cessation - Alcohol consumption - educate on the limits of alcohol consumption Medication management - Explain the purpose of each medication to the pt, potential side effects, and the importance of adherence - Routine monitoring — encourage regular follow-up appointments to monitor effectiveness and adjust medications as necessary - Manage side effects Regular monitoring and follow-up - monitoring blood pressure and cholesterol - Teach them to recognize warning signs such as chest pain, SOB, or sudden weakness Behavioral and emotional support - Stress management— introduce stress-reduction techniques or counseling Individualized care plans - Cultural sensitivity — consider cultural and personal preferences when making recommendations Unit 4: Care of the Client with Upper/Lower Pulmonary & Obstructive Pulmonary Diseases Assess the respiratory system. 1 Important Health History Past Health History Medication Surgery or other treatments Respiratory assessment findings CNS: apprehension, restlessness, irritability, confusion, lethargy, combativeness, coma Cardiovascular: tachycardia/HTN, dysrhythmias, cyanosis, clammy skin, hypotension Respiratory: tachypnea, dyspnea, accessory muscle use, retraction Other: diaphoresis, fatigue, decreased urine output Plan nursing management of a patient with a respiratory disease. 2 Pneumonia Supportive care - Oxygen for hypoxemia - Analgesics for chest pain - Antipyretics - Individualized rest and activity - There is no definitive treatment for the majority of viral pneumonia - Antivirals for influenza pneumonia Promote Nutrition - Adequate hydration - High Caloric small frequent meals - Promote health and prevention of pneumonia in high-risk populations Prevent HAP - Elevate HOB 30 degrees and have sat up for all meals - Assess for gag reflex - Early mobilization - Incentive spirometry - Twice-daily oral hygiene Tuberculosis Airborne precaution: clean hands, gown, N95, eye protection, gloves Pleurisy Listen for a pleural friction rub Asthma Triggers - Allergens, exercise, air pollutants, respiratory infection, etc. Indication for hospitalization - PEFR 126 2 hour plasma glucose level during OGTT greater than 200 Fructosamine Islet cell Autoantibody Other  Lipids, BUN, creatinine, electrolytes Albuminuria, and urine acetone BP, ECG, eye exam, foot exam, neurologic exam, ABI, weight Interventions Insulin therapy - nurse responsibilities Proper administration, assessing the patient's response Patient or caregiver education Evaluate and implement medical interventions, oral medication, and insulin therapy for a client 2 with diabetes mellitus. Rapid Acting Insulin - LOG Lispro (humalog) Aspart ( Novolog) Glulisine (Apidra) -ONSET: 10-30 minutes -PEAK: 30 min- 3 hours -DURATION: 3-5 hours Short Acting - LIN R Regular (Humulin R and Novolin R) -ONSET: 30 min - 1 hour -PEAK: 2-5 hours -DURATION: 5-8 hours Intermediate Acting - LIN N NPH (Humulin N, Novolin N) -ONSET: 1.5 - 4 hours -PEAK: 4-12 hours -DURATION: 12-18 hours Long Acting Glargine (Lantus) Detemir (Levemir) Degludec (Treseiba) -ONSET: 0.8 -4 hours -PEAK: less defined or no pronounced peak -DURATION: 16-24 hour Inhaled Insulin Afrezza -ONSET: 12-15 minutes -PEAK: 60 minutes -DURATION: 2.5 - 3 hours Oral Diabetic Meds Metformin (glucophage)  Sulfonylureas- hypoglycemia Meglitinides A- Glucosidase Inhibitors: precose Thiazolidinediones- not used often due to side effects Dipeptidyl Peptidase- 4 (DDP-4) inhibitors SGLT2 Inhibitors GLP1 Amylin Analogs Evaluate diagnostic testing, nursing interventions, assessment data, and medical interventions 1 related to hypothyroidism. Hypothyroidism Assessment finding Fatigue Thin, dry hair/skin Thick brittle nails Constipation Periorbital edema/facial edema Cold intolerance Weight gain Dull emotion and mental processes Husky voice Slow speech Myxedema Tender thyroid gland Diagnostic Studies History and Physical Assessment TSH and free T4 - TSH increases with primary hypothyroid - TSH decreases with secondary hypothyroidism Thyroid antibodies - Autoimmune origin High cholesterol High triglycerides High creatine kinase Low RBCs (anemia) Interprofessional Care Treatment goal is to restore the euthyroid state as safely and rapidly as possible Hormone therapy Low-calorie diet Medication Levothyroxine (Synthroid) - Start with low-dose - Monitor for chest pain, weight loss, nervousness, tremors, insomnia - Increased dose in 4 to 6 weeks intervals as needed based on TSH levels - Lifelong therapy Care Plan Have relief of symptoms Maintain a euthyroid state Maintain a positive self-image Adhere to lifelong therapy Plan teaching and postoperative care for a client with hyperthyroidism and pituitary disorder. 1 Teach High-calorie diet (4000 to 5000 cal/day) 6 full meals/day with snacks in between Protein intake: 1-2 g/kg ideal body weight Increased carbohydrates intake Avoid highly seasoned and high-fiber foods, caffeine Dietitian referral Hyperthyroid Post Op Care Monitor: labs, laryngeal nerve damage, infection, hemorrhage, thyrotoxicosis, infection AIRWAY MAINTAIN: O2, suction equipment, tracheostomy tray at the bedside Monitor for laryngeal stridor IV calcium is readily available Unit VI: Care of the Client with Neurological Problems Relate the role of the professional nurse in the care of clients with neurological problems in the 2 acute and long-term health care settings. Apply knowledge of the pathophysiology of Neurological diseases to the plan of care for clients with 1 neurological problems. Formulate an appropriate nursing plan of care for clients with selected neurological problems. 1 Identify common medical and surgical modalities of care used in the care of clients with 1 neurological problems. Care of the Client with Disorders of the Auditory, Visual, and Integumentary Systems Care of the Client with Integumentary Disorders A/V System Evaluate the significant subjective and objective assessment data related to the visual and auditory 1 systems obtained from the patient. Hordeolum (Stye) Affects the bottom lid Infection of the meibomian gland Tender Chalazion  Affects the upper lid normally Inflammation of the granuloma if meibomian glands Tender or Non tender Blepharitis Chronic bilateral inflammation of the lid margins Crusting on the margin and lashes Itching is the main complaint Photophobia Bacterial Conjunctivitis (pink eye) Bacterial infection (S.Aureus) Discomfort, purulent drainage, and redness, typically begin in one eye and spread to another Viral conjunctivitis Caused by Adenovirus Watery drainage Foreign body sensation Photophobia Affects one eye Allergic Itching, burning, redness Sneezing Tearing Runny nose Affects both eyes Chlamydia The major cause of blindness but not common Muco-purulent drainage Swelling and redness Cataracts Decreased vision (gradual) Abnormal color perception Glare that is worse at night Glaucoma Gradual loss of field Eventual loss of peripheral vision (tunnel vision) Colored halos around lights Retinopathy Cotton wool spots Retinal hemorrhages on eye exam Macular edema Severe vision lost ** Non proliferated, Proliferated, HTN Retinal detachment Flashes of light Floaters Loss of peripheral or central vision Curtain over the lens Age-related macular degeneration Blurred vision Scotomas Metamorphopsia (visual distortion) External Otitis (swimmer's ear) Otalgia Swelling Muffled hearing Drainage Fever Acute Otitis Media Inflammation, red, bulging, painful tympanic membrane Pain Fever Malaise Drainage Reduce hearing Chronic Otitis Media and Mastoid Often painless Hearing loss Nausea and Dizziness Cholesteatoma may develop (mass of cholesterol) Otosclerosis  Schwartz sign: reddish, bluish tympanic membrane caused by vascular changes in the middle ear Hereditary disorder where spongy bone Meniere Disease (unknown cause) Episodic vertigo: severe and sudden N/V Nystagmus Tinnitus Drop attacks: feeling pulled to the ground Ages 40-60 is when symptoms usually begin Benign Paroxysmal Positional Vertigo (free-floating debris causing vertigo) Nystagmus Vertigo Lightheadedness/loss of balance No hearing loss associated Acoustic Neuroma Unilateral benign tumor Progressive Unilateral hearing loss, tinnitus, mild vertigo, reduced touch sensation Examine the role of the professional nurse in the care of clients with auditory or visual disorders 1 and their patient teaching needs. Integumentary System Compare and contrast benign and malignant critical components for describing primary and 1 secondary lesions. A: Asymmetry (one half is unlike the other) B: Border irregularity (indistinct, blurred edges) C: Color (varied pigmentation) D: Diameter (greater than 6 mm) E: Evolving (changing appearance) A primary lesion is an initial skin abnormality that develops on previously healthy skin, directly caused by a disease process, while a secondary lesion arises from a pre-existing primary lesion, often due to manipulation like scratching or rubbing, or as a result of the natural progression of the primary lesion itself Explain the etiology, clinical manifestations, and nursing care for the management of bacterial, 1 viral, and fungi infections of the integumentary system. Bacterial Skin Infections  Cellulitis - Affects the dermis and the subcutaneous fat Treatment: immobilization and elevation of the affected area and antibiotics Folliculitis - Small pustules that form hair follicle opening - Tender with pus Treatment: topical antibiotics and systemic antibiotics if extensive infection Teach: hand hygiene and warm compress Impetigo - Strep or staph infection that is most prevalent in kids - Vesicular papular lesions with honey-colored crust and redness Treatment: topical antibiotics Viral Skin Infection HSV 1: oral lesions HSV 2: genital lesions - Localized pain around the lesion with symptomatic treatment - Lifelong infections that are contagious through respiratory droplets or cervical secretions s/s grouping of vesicles on the body Herpes Zoster - Contagious to anyone who has not had varicella or is immunosuppressed s/s linear distribution along dermatome - Grouped with vesicles and pustules, redness of the skin, unilateral and does not cross midline, burning, itching rash, very painful Treatment: antivirals within 72 hours of onset, analgesics, shingles vaccine Warts - Flesh-colored papules with a rough surface Treatment: liquid nitrogen, surgery Unit VIII: Care of Clients with HIV, Cancer, and Hematologic Disorders Analyze lab and diagnostic testing for clients with HIV, cancer, and hematologic disorders. 1 HIV  The CD4 + T cell (CD4 cell), a type of lymphocyte, is the target cell for HIV. HIV destroys about 1 billion CD4 cells every day. For many years, the body can make new CD4 cells to replace the destroyed cells. However, over time HIV destroys more CD4 cells than the body can replace. The decline in the CD4 cell count impairs immune function. In general, the immune system remains healthy with more than 500 CD4 cells/μL. Immune problems begin to occur when the count drops below 500 CD4 cells/μL. Severe problems develop with fewer than 200 CD4 cells/μL. As the CD4 cell count declines closer to 200 cells/μL and the viral load increases, HIV advances to a more active stage. Symptoms such as persistent fever, frequent night sweats, chronic diarrhea, recurrent headaches, and severe fatigue may develop. Cancer Pathologic evaluation (biopsy) of a tissue sample is the only definitive way to diagnose cancer. Patients may undergo several days to weeks of diagnostic studies. During this time, fear of the unknown may be more stressful than the actual diagnosis of cancer. Diagnostic studies depend on the suspected primary or metastatic site(s) of the cancer. Examples include: Cytology studies (e.g., Pap test, bronchial washings) Chest x-ray Complete blood count (CBC), chemistry profile Liver function studies (e.g., aspartate aminotransferase [AST]) Endoscopic examination: upper GI, sigmoidoscopy, or colonoscopy (including guaiac test for occult blood) Radiographic studies (e.g., mammography, ultrasound, CT scan, MRI) Radioisotope scans (e.g., bone, lung, liver, brain) PET scan Tumor markers (e.g., CEA, AFP, PSA, CA-125) Genetic markers (e.g., BRCA1, BRCA2) Molecular receptor status (e.g., estrogen and progesterone receptors) Bone marrow examination Plan the care of clients with HIV, cancer, and hematologic disorders. 2 Discuss teaching plans for clients with HIV, cancer, and hematologic disorders. 1 Cancer Warning Signs C.A.U.T.I.O.N. Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge from any body orifice Thickening or a lump in the breast or elsewhere Indigestion or difficulty in swallowing Obvious change in a wart or mole Nagging cough or hoarseness Unit IX: Care of the Client with a Musculoskeletal Disorder Assess clients with musculoskeletal disorders. 1 Bursitis Symptoms ○ Warmth ○ Pain ○ Swelling ○ Limited ROM Fractures Pain and tenderness over the involved area Decrease or loss of muscular strength or function Obvious deformity of the affected area Crepitation, erythema, edema, or bruising Muscle spasm and neurovascular impairment Degenerative Disc Disease Results in radiculopathy and radiating pain, numbness, tingling, decreased strength, and/or range of motion Most common sites: L4-5, L5-S1, C5-6, C6-7 Osteoporosis Risk factors ○ >65 years old ○ Females ○ Low body weight  ○ White or Asian ○ Current cigarette smoker ○ Prior fracture ○ Sedentary lifestyle ○ Estrogen deficiency ○ Family history ○ A diet low in calcium/vitamin D deficiency ○ Excessive use of alcohol (>2 drinks a day) ○ Low testosterone in men ○ Long-term use of corticosteroids, thyroid replacement, heparin, long-acting sedatives, or antiseizure drugs Osteoarthritis Signs and symptoms ○ Stiff joints ○ Joint pain with movement or weight-bearing ○ Crepitus ○ Pain relief with rest ○ Heberden’s nodes ○ Bouchard’s nodes Clinical manifestations ○ Joints affected: Hips Knee Metatarsophalangeal Cervical vertebrae Lumbar vertebrae Distal interphalangeal Proximal interphalangeal Metacarpophalangeal Rheumatoid Arthritis Morning stiffness in joints due to inflammation Enlarged joints from swelling Pain when moving due to stiffness Limited ROM because of inflammation and pain Fever, malaise, & weight loss Gout Caused by: ○ Metabolic syndrome  ○ Increased intake of high-purine foods (meats, cheeses, wines) ○ Prolonged fasting ○ Excessive alcohol use 2 processes must occur: ○ Crystallization ○ Inflammation Phagocytosis causes increased inflammation and tissue damage Systemic Lupus Erythematosus (SLE) Multisystem involvement ○ Integumentary Alopecia Butterfly rash Discoid erythema Palmar erythema Mucosal ulcers ○ Cardiopulmonary Endocarditis Myocarditis Pericarditis Pleural effusion Pneumonitis Raynaud’s phenomenon ○ Urinary Glomerulonephritis Hematuria Proteinuria ○ Musculoskeletal Arthritis Myositis Synovitis ○ Neurologic Stroke Seizures Peripheral neuropathy Psychosis Cognitive impairment ○ Hematologic Anemia  Leukopenia Lymphadenopathy Splenomegaly Thrombocytopenia ○ Gastrointestinal Abdominal pain Diarrhea Dysphagia N/V ○ Reproductive Menstrual abnormalities Apply knowledge of medications to the care of clients with musculoskeletal disorders. 1 Bursitis NSAIDs Osteoporosis Bisphosphonates ○ Inhibit bone reabsorption and slow remodeling ○ Rare side effect: osteonecrosis (bone death of the jaw, at risk if a person has cancer, dental, pagets, or renal disease) take off med if the reports jaw pain ○ Take with a full glass of water ○ Take 30 minutes before food and other meds ○ Remain upright for at least 30 mins ○ Continue treatment for 5 years Estrogen ○ No longer used after menopause to prevent osteoporosis ○ Increased risk for heart disease, breast cancer, uterine cancer Corticosteroids ○ The lowest effective dose for the shortest possible time ○ Adequate calcium and vitamin D intake ○ May start bisphosphonate if the patient has osteopenia Osteoarthritis  Oral NSAID therapy ○ Start low dose, increase if needed ○ Ibuprofen 200 mg up to 4 times per day ○ Misoprostol to decrease GI side effects ○ Arthrotec (combination of misoprostol and NSAID diclofenac) ○ Avoid both oral and topical NSAIDs together ○ High risk for bleeding with anticoagulant therapy COX-2 inhibitor celecoxib (Celebrex) ○ If NSAIDs affect cartilage metabolism ○ Aspirin is no longer a common treatment ○ Response to and cost of NSAIDs vary Intraarticular corticosteroid injections ○ 4 or more injections without relief suggest the need for additional intervention ○ Systemic corticosteroids may hasten the disease process Hyaluronic acid injection - knee OA ○ Viscosupplementation ○ No longer recommended ○ Research continues Rheumatoid Arthritis DMARDS Methotrexate ○ Early treatment ○ Lower toxicity ○ Side effects (rare): bone marrow suppression and hepatotoxicity Sulfasalazine (Azulfidine) and hydroxychloroquine (plaquenil) ○ Used for mild to moderate disease ○ Rapidly absorbed, relatively safe, well-tolerated ○ Plaquenil has to get regular eye exams every 6-12 months Leflunomide (Arava) ○ Blocks immune cell overproduction ○ Not used during pregnancy; teratogenic BRMs Biological response modifiers Classified based on mechanism of action All inhibit the inflammatory response Gout Oral colchicine: anti-inflammatory NSAIDs: analgesia Corticosteroids: intra articular injection, orally tapered dosing, systemic options only if routine therapies are contraindicated or ineffective ACTH: if NSAIDs, colchicine, or steroids may be problematic Systemic Lupus Erythematosus (SLE) NSAIDs ○ Mild joint pain ○ May need to try several to find the most effective ○ Monitor for GI and renal effects long-term Antimalarial drugs ○ fatigue, skin, and joint problems: reduce flares ○ Monitor for retinopathy with high doses Corticosteroids ○ Lowest dose for the shortest possible time ○ Taper of slowly Immunosuppressive drugs ○ Suppresses immune system, reduces end-organ damage ○ Monitor for toxicity and side effects Anticoagulants ○ Prevent life-threatening blood clots Topical immunomodulators ○ Serious skin conditions ○ Suppress immune activity of the skin ○ Butterfly rash ○ Discoid lesions Plan nursing management of a patient with a musculoskeletal problem. 1 Bursitis Identify and correct the cause Rest with immobilization Ice NSAIDs Surgery: bursectomy Fractures Immobilization & traction  ○ Bucks traction: traction that is used to treat fractures, realign broken bones, correct contractures or deformities, and for knee immobilization Ambulatory cast care ○ DO: Dry thoroughly after getting wet Report increasing pain despite elevation, ice, and analgesia Report swelling associated with pain and discoloration or movement Report burning or tingling under the cast Report sores or foul odor under the cast ○ DO NOT: Elevate if compartment syndrome is suspected Get plaster cast wet Remove padding Insert objects inside the cast Bear weight for 48 hours Cover cast with plastic for prolonged periods Degenerative Disc Disease Surgical therapy ○ Intradiscal electrothermal plasty (IDET) ○ Radiofrequency discal nucleoplasty (coblation nucleoplasty) ○ Interspinous process decompression system (X stop) ○ Laminectomy ○ Discectomy ○ Artificial disc replacement ○ Spinal fusion Osteoporosis Adequate calcium intake ○ 1000 mg per day for women 19-50 and men 19-70 ○ 1200 mg per day for women 51 and older and men 71 and older Supplemental calcium ○ Take in divided doses **your body can only handle 500mg at a time** ○ Calcium carbonate: 40% elemental calcium, taken with meals ○ Calcium citrate: 20% elemental, less dependent on stomach acid (no meal) Osteoarthritis Surgical therapy ○ Symptoms often managed conservatively for many years ○ Surgery considered for loss of joint function, unmanaged pain, increased dependence on self-care  ○ Reconstructive surgeries: hip and knee replacements Complementary and alternative therapies ○ Acupuncture ○ Massage ○ Tai Chi ○ Nutritional supplements: fish oil, ginger, SAM-e, glucosamine, and chondroitin (results mixed, not recommended by ACR or AAOS) ○ Any supplements or therapies should be researched and discussed with HCP to avoid drug interactions Rheumatoid Arthritis Surgical therapy ○ Relieve severe pain ○ Improve function of severely deformed joints: synovectomy, total joint replacement Physical therapy Occupational therapy Cold and heat therapy Splints Exercises Gout Maintenance xanthine oxidase inhibitor: decreases uric acid production, allopurinol used most often as first choice, febuxostat if allopurinol ineffective or problematic Uricosuric: increases urinary excretion of uric acid (probenecid), aspirin inactivates effect, must be avoided, can safely use acetaminophen for analgesia Monitor serum uric acid regularly Diet restrictions: limit alcohol and food high in purine, adequate urine volume, weight reduction Precipitating events: Fasting drug use, major medical events Nursing Interventions: supportive care of inflamed joints, assess motion limitations, and pain Systemic Lupus Erythematosus(SLE) Multisystem inflammatory autoimmune disease that leads to necrosis and inflammation in blood vessels Subjective and Objective: pain and fatigue, ability to perform ADLs, disease flare-ups ○ Fever patterns joint inflammation limitations of motion location and degree of discomfort fatigue ○ Monitor weight fluid intake and output ○ 24-hour urine samples for protein creatinine clearance ○ Observe for signs of bleeding Discuss teaching plans for a client with a musculoskeletal problem. 1 Bursitis Rest with immobilization Ice Bursectomy Fractures DO: Dry thoroughly after getting wet Report increasing pain despite elevation, ice, and analgesia Report swelling associated with pain and discoloration OR movement Report burning or tingling under cast Report sores or foul odor under the cast DO NOT: Evelvate if compartment syndrome is suspected Get plaster cast wet Remove padding Insert objects inside cast Bear weight for 48 hours Cover cast with plastic for a prolonged period S/S of compartment syndrome ○ Unrelieved or increased pain in the limb, the distal area becomes pale, dusty, or edematous, pain with passive movement, loss of sensation, pulseless (late sign) Osteoporosis Adequate calcium intake ○ 1000 mg per day for women 19-50 and men 19-70 ○ 1200 mg a day for women 51 or older and men 71 and older Supplemental calcium ○ Take in divided doses (the body can only handle 500 mg at a time) ○ Calcium carbonate: 40% elemental calcium, taken with meals ○ Calcium citrate: 20% elemental calcium, less dependent on stomach acid (no meals) Osteoarthritis Complementary and alternative therapies Acupuncture Massage Tai chi Nutrition supplements: fish oil, ginger, SAM-e, Glucosamine, and chondroitin Rheumatoid Arthritis Surgical therapy ○ Relieve severe pain ○ Improve fxn of severely deformed joints Other therapy ○ PT ○ OT ○ Cold and heat therapy ○ Splints ○ Exercises Gout Prevention!!! Monitor serum uric acid regularly Diet restrictions: limit alcohol and food high in purine, adequate urine volume, weight reduction Systemic Lupus Erythematosus (SLE) Disease flare symptoms Monitor weight, fluid intake, and output Observe for signs of bleeding Nursing Care of the Client with Gastrointestinal System Diseases Plan nursing interventions for clients with gastrointestinal and hepatic-biliary problems. 2 GERD Causes: ○ Lower esophageal sphincter dysfunction Causes of the sphincter relaxing: alcohol, muscle relaxers, gastric bypass surgery, obesity, calcium channel blockers, older age ○ Hiatal hernia Contents in the stomach back up into the diaphragm  ○ NSAIDs Peptic Ulcer Disease Causes: ○ NSAIDs, Aspirin, Alcohol, Caffeine, H. pylori Types: ○ Acute ulcers Severe pain in the stomach ○ Chronic ulcers Gradual onset of pain ○ Duodenum ulcers Occur further down the intestinal tract Makes up 80% of all peptic ulcers Risk factors: cirrhosis, kidney disease, COPD, 35 or older Pain comes 3-4 hours after eating Burning sensation in the lower stomach ○ Gastric ulcers Pain 15-30 mins after eating Pain occurs in the upper part of the stomach Burning sensation Lots of gas ○ Upper GI bleed Severity depends on which vessel is bleeding ○ Artery bleeding Bright red blood Lots of bleeding Problem with the liver ○ Bleeding stomach ulcer Acute or chronic Caused by drugs such as NSAIDs and Aspirin C.Diff Infection Clinical manifestation ○ Watery diarrhea ○ Abdominal pain ○ N/V ○ Fever ○ Foul smelling stool Treatment ○ Fecal microbiota transplantation  ○ Clean equipment with bleach (spores can survive up to 70 days on surfaces) ○ Any nonessential antibiotics, laxatives, stool softeners, or antidiarrheals need to be stopped Drug therapy ○ PO vancomycin Most common 3-4 times a day May be given as an enema ○ Fidaxomicin ○ Metronidazole Peritonitis Clinical manifestation ○ Severe and continuous abdominal pain (main complaint) ○ Tenderness over the involved area ○ Rebound tenderness ○ Rigidity (key symptom) and spasm ○ Abdominal distension ○ Fever ○ Tachycardia ○ tachypnea Nursing care ○ Assess pain, bowel sounds, and vital signs The location of their pain is important! Look for shock symptoms ○ Maintain IV access for fluids and antibiotics ○ Pain management IV opioids ○ Monitor I&O’s and electrolyte balance ○ Antiemetics ○ NG tube Monitor for leakage May need to be NPO ○ Oxygen as needed Inflammatory Bowel Disease Crohn’s Disease ○ Diarrhea, cramping, abdominal pain (main complaints) ○ Weight loss: if it involves the small intestine ○ Rectal bleeding sometimes Ulcerative Colitis  ○ Bloody diarrhea ○ Abdominal pain ○ Severity varies Drug therapy ○ Aminosalicylates: suppresses inflammatory response ○ Biologics: reduces inflammation ○ Corticosteroids: reduces inflammation; use the lowest dose for the shortest amount of time ○ Immunomodulators: given during times of remission to reduce flare-ups Surgical therapy ○ Surgery if the patient does not respond to drug therapy, has an obstruction or a fistula formation, or needs to cut out the disease portion and attach the remaining parts ○ Taking out part of the GI tract can result in short bowel syndrome (not enough bowels to have normal nutrition) Nutrition ○ Most of these patients are malnourished so promote a healthy diet with protein, nutrients, and supplements (iron, zinc, folate, calcium) ○ Acute exacerbation might need enteral feedings Nursing Management: Acute care ○ Focus on hemodynamic stability, pain control, fluid and electrolyte balance, and nutritional support ○ Accurate I&O’s ○ Number and appearance of stools ○ Monitor labs and vital signs ○ Meticulous skincare Increased risk for skin breakdown, so use plain water to clean and barrier creams ○ Maintain adequate caloric intake ○ Daily weights Nursing Management: Ambulatory care ○ Rest and diet management ○ Perineal care ○ Medication management ○ Teach symptoms and when to seek medical care ○ Stress reduction Colorectal Cancer Clinical manifestations ○ Early nonspecific findings ○ Fatigue and weight loss ○ Later findings:  Abdominal pain and tenderness Palpable mass Changes in bowel habits Bleeding Fresh bright red blood indicated left-side cancer (descending colon) Diarrhea Indicated right-side cancer (ascending colon) Interprofessional care ○ Surgical therapy Depending on the stage and location of the cancer Stages 1 and 2 ○ Chemotherapy Stage 3 ○ Radiation therapy Nursing management ○ Health promotion ○ Identify high-risk patients ○ Provide patient teaching ○ Acute care ○ Routine post-op care ○ Ambulatory care ○ Psychological support Hepatitis Clinical Manifestations: Acute Hepatitis ○ Some are asymptomatic ○ Anorexia, N/V ○ Clay-colored stools, dark urine ○ Fatigue ○ RUQ tenderness and hepatomegaly ○ Jaundice ○ Joint pain ○ Pruitis Clinical Manifestations: Chronic Hepatitis ○ Abnormal labs: increased AST, ALT, bilirubin ○ Ascites (fluid in the peritoneal cavity) and LE edema ○ Bleeding: thrombocytopenia ○ Fatigue ○ Hepatic encephalopathy (toxins build up due to liver failure)  ○ Jaundice ○ Joint pain ○ Spider angiomas Interprofessional Care ○ Well-balanced diet ○ Vitamin supplements ○ Rest (helps the liver regulate itself) ○ Avoidance of alcohol and drugs detoxified by the liver ○ Drug therapy for chronic HBV and HCV (inhibit the replication of virus) Nucleoside and nucleotide analogs Interferon DAA (direct-acting antivirals) Acute Pancreatitis Clinical manifestations ○ Abdominal pain: LUQ or mid-epigastric; sudden onset, severe, continuous pain; worsened by eating ○ Nausea and vomiting ○ Low-grade fever ○ Hypotension and tachycardia ○ Jaundice ○ Decreased bowel sounds ○ Grey turner sign (bruising in the flank area) and Cullen sign (bruising around the umbilical area) Interprofessional care ○ Conservative treatment Hydration, pain management, O2, NPO, NG suction ○ Surgical therapy Cholecystectomy ○ Drug therapy PPI, morphine, insulin ○ Nutrition therapy TPN or enteral nutrition may be needed Nursing management ○ Monitor VS and fluid and electrolytes ○ Pain management ○ Assess for complications Chronic Pancreatitis Clinical manifestations  ○ Abdominal pain ○ Weight loss ○ Constipation ○ Jaundice with dark urine ○ Steatorrhea: fatty, foul-smelling stools ○ Diabetes Care ○ Prevent further attacks and ensure pain relief ○ Small bland frequent meals that are low in fat, no caffeine, no alcohol ○ Pancreatic enzyme replacement: medications to replace the enzymes are given with food Pancreatic Cancer Clinical manifestations ○ Abdominal pain ○ Anorexia ○ Rapid, progressive weight loss ○ Nausea ○ Jaundice Care ○ Surgery: only some patients have a tumor that can be resected ○ Whipple procedure ○ Chemotherapy ○ Radiation therapy ○ Symptomatic and supportive nursing care Cholelithiasis & Cholecystitis Clinical manifestations ○ RUQ severe abdominal pain ○ Dark urine ○ Bloating ○ Nausea and vomiting ○ Fever and chills ○ Pain in the right shoulder and spine ○ Bloating, belching ○ Biliary colic 3-6 hours after a high-fat meal; Interprofessional care ○ Conservative management Bile acids can dissolve gallstones but they may reoccur Control infection and pain (antibiotics) Maintain fluid and electrolyte imbalances  ○ Cholecystectomy: surgery of choice ○ Drug therapy Pain meds, anticholinergics (relax muscles), fat-soluble vitamins, bile salts (help with digestion and vitamin absorption) ○ Nutrition Small frequent meals low in saturated fats and high in fiber Nursing care ○ Routine post-op care if the gallbladder is removed ○ Dietary teaching: low-fat diet ○ Avoid heavy lifting after surgery ○ Relieve N/V ○ Pain management ○ Fluid and electrolyte balance ○ I&O’s Analyze and interpret lab and diagnostic findings in clients with gastrointestinal and 2 hepatic-biliary disorders. Inflammatory Bowel Disease CBC and iron studies Electrolyte levels ○ Na, K+, Cl, Mg ○ Imbalances due to diarrhea and vomiting Stool examination and culture: determines if there is blood or infection Small bowel follow-through ○ The patient drinks a contrast drink and the radiologist takes X-rays at different intervals to watch it move through the GI tract US, CT, MRI Colonoscopy and endoscopy WBC needs to be monitored in case there is an infection Colorectal Cancer Screening beginning at age 45 until 75 Biopsies ○ Sigmoidoscopy: done every 5 years to examine the sigmoid colon and rectum ○ Colonoscopy: should be done every 10 years if at risk; examines the entire colon and rectum CT, PET, or MRI: detect depth of penetration of the tumor Carcinoembryonic antigen (CEA): a marker for certain types of cancer but may produce false positives Hepatitis  Antigen or antibody testing Liver function tests RNA testing: chronic infections Viral genotype testing: determines treatment Liver biopsy Fibroscan: used for patients who are at risk for bleeding from biopsy Acute pancreatitis Serum amylase and lipase (high) Other blood tests Abdominal ultrasound CT scan ERCP: camera into the mouth to check for obstructions or leakage Chest x-ray Cholelithiasis & Cholecystitis Ultrasound: diagnoses ERCP Percutan transhepatic cholangiography ○ A needle is inserted into the gallbladder and dye is injected to check for blockages and leaks Lab tests ○ AST, ALT, and bilirubin all increased and amylase may be increased if the pancreas is involved Formulate teaching plans for patients with gastrointestinal and hepatic-biliary disorders. 1 Unit XI: Care of the Client with Urinary Disease and Male Reproductive Disorders Urinary Disease and Renal Disorders Plan nursing interventions for clients with urinary disease and renal disorders. 1 Urinary Tract Infections Interprofessional care ○ Patient teaching about adequate hydration ○ Drug therapy: Phenazopyridine and antibiotics for days ○ If UTI is recurrent or complicated, susceptibility testing and suppressive oral prophylactic antibiotics may be used for 7-10 days Nursing management  ○ Common nursing diagnosis: impaired urinary system function, acute pain, lack of knowledge ○ Adequate fluids ○ Avoid irritating foods ○ Apply a heating pad to the lower back ○ Warm shower ○ Void regularly ○ Teach drugs and side effects ○ Teach what to look for in improvement ○ Teach prevention measures ○ Prevent CAUTI Acute Pyelonephritis Interprofessional care ○ Mild symptoms: fluids, NSAIDs, follow-up cultures and imaging, antibiotic 7-14 days or IV to oral 14-21 days ○ Severe symptoms: IV fluids until able to tolerate oral, combination antibiotics ○ Watch for relapses or recurrence ○ Monitor for urosepsis ○ Risk for chronic pyelonephritis (>3 months) Nursing management ○ Teach disease process ○ Take all medications as prescribed ○ Keep follow-up appointments ○ Teach s/s of recurrence ○ Adequate fluid intake and rest Urinary Tract Calculi Nephrolithiasis Analgesics NSAIDs, alpha-adrenergic blockers (tamsulosin) Hydration, antiemetics Possible antibiotics Surgical intervention: lithotripsy, ureteral stent placement Eventually needs metabolic work-up to prevent further stone formation Ureteral Strictures Surgical bypass with stent or nephrostomy tube placement Ureteroureterostomy, endoureterotomy, ureteroneocystostomy Urethral Strictures Dilation  Urethroplasty Resection and anastomosis of the urethra Kidney Cancer (urinary tract tumors) Partial nephrectomy, total or radical nephrectomy Requires long-term surveillance post-intervention Bladder Cancer (urinary tract tumors) TURBT with post-op intravesical chemotherapy, BCG; partial cystectomy or radical cystectomy with creation of urinary diversion Requires long-term surveillance monitoring Urinary Incontinence Depends on type PFPT, bladder training, avoiding bladder irrigants, pessary, intermittent catheterization, indwelling bladder catheter Anticholinergics, beta-3 adrenergic agonist, tamsulosin, botox SNS, PTNS, TVT slings, urethral bulking agents, anterior/posterior prolapse repairs, AUS Urinary Retention Acute: urethral catheter insertion, possible suprapubic in an emergent situation Chronic: behavioral modifications, intermittent self-catheterizations, long-term indwelling catheter, timing voiding Acute Kidney Injury Prevention and early recognition Hospitalized patients risk factors Fluid balance Replace significant fluid loss as indicated Calculated based on output Maintain renal perfusion Caution: aggressive diuretic therapy for fluid overload may lead to reduced renal blood flow Monitor comorbidities Watch for signs and symptoms of infection Provide good skin care and oral hygiene Acute Poststreptococcal Glomerulonephritis (ASPGN) Early recognition is key Management: ○ Symptom relief ○ Rest ○ Restrict Na+ and fluids, administer diuretics to decrease edema ○ Restrict dietary protein if BUN is elevated  ○ Administer antibiotics if streptococcal infection is still present 95% of cases have complete and rapid recovery Prevention: ○ Early diagnosis and treatment of strep throat and skin lesions ○ Treat strep-positive cultures with antibiotics ○ Good personal hygiene Chronic Glomerulonephritis Depends on cause: provide symptomatic and supportive care Goodpasture Syndrome Corticosteroids, immunosuppressive drugs, plasmapheresis, rituximab, dialysis, renal transplant Nurse teaching on smoking cessation Be prepared to provide nursing care for AKI and respiratory distress May be fatal due to hemorrhage Rapid Progressive Glomerulonephritis Correct fluid overload, HTN, uremia, and renal injury Corticosteroids, cyclophosphamide, plasmapheresis, dialysis (RRT), renal transplant Polycystic Kidney Disease Often progressing to CKD and ESRD by age 60 in 50% of patients Dialysis or renal transplant Medullary Cystic Disease End-stage renal disease Dialysis or renal transplant Alport Syndrome/Chronic Hereditary Nephritis Supportive care Renal transplant Chronic Kidney Disease Management ○ Correction of extracellular fluid volume overload or deficit ○ Dialysis, kidney transplant ○ Nutritional therapy ○ Measures to lower potassium Drug therapy ○ Calcium supplementation, phosphate binders, or both ○ Antihypertensive therapy ○ ACE inhibitors or ARBs ○ Erythropoietin therapy ○ Lipid-lowering drugs  ○ Adjustment of drug dosages to the degree of renal function Implementation ○ In-hospital care only PRN complications and possible renal transplant ○ Prevention is the best intervention ○ Catch at-risk patients early before CKD develops ○ CVD is the most common cause of death for patients with CKD Nephrotic Syndrome Dependent on causes Formulate teaching plans for patients with urinary diseases and renal disorders. 1 Male Reproductive Disorders Identify abnormal assessment findings for patients with male reproductive disorders. 1 Objective assessment Pubis Course and diamond-shaped hair pattern (normal finding) Absence of hair is not a normal finding Assess skin irritation or inflammation Penis and Scrotum Lesions, bleeding, swelling of the penis Retract foreskin if present and inspect glans and meatus - Replace foreskin after inspection Scrotal Sac Anus Lesions, swelling, inflammation of buttocks Anal sphincter and perineal BPH nursing assessment Current medication: testosterone supplements Previous surgeries /or treatments Good health history Bladder distention on palpation Enlarged smooth, firm prostate on rectal exam PCA nursing assessment Good health history Assess for pelvic lymphadenopathy, bladder distention, musculoskeletal pain  Plan nursing interventions for clients with male reproductive disorders. 1 BPH The goal is to restore bladder drainage, relieve symptoms, and prevent/treat complications Treat based on how bothersome the symptoms, and the presence of complications Teach patient: - If obstructive symptoms, urinate every 2-3 hours and with first urge/desire - Minimizes urinary stasis and acute urinary retention - Adequate fluid intake: restricting fluids increases the risk of infection TURP Pre-Op Care Treat and manage UTI (antibiotics and good hydration 2-3 L daily unless contraindicated) Restore Urinary Drainage - Use an aseptic technique to avoid infection Inform patient of possible complications of procedures Turp Post Op Care Assess for complications Postoperative bladder irrigation Manual, intermittent irrigation Continuous bladder infection Minimize risk of bladder infections - use aseptic techniques Monitor for hemorrhage Hemorrhage: if loss of counter pressure by catheter balloon on the operative site - call the surgeon Avoid increased intraabdominal pressure - Straining with BMs, prolonged sitting, standing, Valsalva Bladder spasms - assess for clots Remove catheter 2-4 days post-op Urinary incontinence - perform Kegels Monitor for S/S of infections PCA Preoperative and postoperative care for radical prostatectomy Radiation and chemotherapy Cancer diagnosis: provide sensitive, caring support to patients and family to help them cope Support groups: provide information about active participation in their care Catheter care and signs of infection Manage Incontinence - Teach pelvic floor muscle exercise (kegel)  - Incontinence products Palliative and end-of-life care - Management of fatigue, obstriction, bone pain, fractures, spinal cord compression, leg edema PAIN MANAGEMENT Erectile Dysfunction Goal- achieve a satisfactory sexual relationship Treatment - determines if reversible Refer them to a sex therapist (psychological issues) Drug therapy Vacuum erection devices Intraurethral devices and intracavernosal injections Vasoactive drugs Surgery- penile implants Prostatitis Antibiotics - oral or IV Pain management - anti-inflammatories, warm sitz baths, alpha-adrenergic blockers Acute Urinary retention: SP catheter, repetitive prostate massage, ejaculation Good hygiene Fever - antipyretics Testicular Cancer One of the most curable cancers Prognosis - 95% have complete remission if found in early stages Drugs for testicular cancer have serious long-term effects Secondary cancers can occur due to chemo Follow-up care to detect relapse Vasectomy Alternate contraception is required until no sperm - 15-20 ejaculations or 6 weeks MED CALC 4 TOTAL 50