Adult Quiz 3

Diet after pancreatitis

small frequent meals, bland, high protein, low fat, no stimulants (caffeine)

Assessment Q's to ask patient with Renal calculi???

-Are you urinating more frequent than usual? Does it burn or sting?? do you have a feeling that your unable to hold urine in?? -family hx (3 generations, cystine stones are autosomal recessive) -prescribed/OTC meds= NSAIDs can be nephrotoxic, antibiotics.. -dietary supplements -hyperparathyroidism, increased ca in urine, treated with Vit D or surgical removal of parathyroid gland)

What precautions are important for the arm on the surgery immediately post-op and after discharge to home for mastectomy???

-BP readings, venipuncture, and injections should not be done on affected arm -elastic bandages should not be used in early post-op period -instruct pt. to protect arm from even minor trauma (sunburn, pinprick) -advise surgeon of all trauma and observe site for inflammation -make sure pt. understands that there will always be a risk for lymphedema

Patient Teaching for GERD

-NO smoking (decreases acid clearance from LES) -avoid certain foods that can cause aggravation (peppermint, tea, coffee, chocolate, fatty foods, milk) -avoid late night snacking-no eating 3 hours before bedtime -take fluid between meals -decrease weight if needed -avoid wearing tight clothing around the waist.

laprascopic cholecystectomy POST-OP

-TCDB q 2 hrs -PREVENT pneumothorax/atelectasis- listen to lungs, O2 sat, DB and ambulation!!!! Prevent DVT -Lie patient in sim's position (on left side, flexed knees) -Common complaint is referred pain to shoulder due to CO2 used to inflate abd cavity in surgery -Assess incision site for redness, drainage (pus), presence of bile from T-tube. -May have increased bleeding, check PT coagulation -Teach patient to monitor bowel habits, eat high fiber, drink plenty of fluids, take other meds 1 hr before eating or 4-6 hr after

Lupron- nursing responsibilities when administering and teaching the patient about side effects

-This is used for advanced prostate cancer in patients who are unable to tolerate orchiectomy or estrogen therapy -Assess for increase in bone pain, monitor I & O and assess for bladder distention in patient with WTI -SE= hot flashes (flushing), decreased libido

Different types of hysterectomy?

-Vaginal hysterectomy: the uterus and cervix are removed through a cut on the top of the vagina -Abdominal hysterectomy: uterus and cervix are removed using abdominal incision (bikini cut)

Hysterectomy Post-op Assessment for the Nurse

-acute pain r/t abdominal incision if abd hyst, will have non-pressure abd dressing -assess for bleeding (check dressing) Check frequently for first 8 hours. -If vaginal hyst, will have only a sterile peri-pad (moderate amt. of serosanguineous is normal) -Patient will have temporary loss of vaginal sensation

Nursing Care for GERD

-encourage patient to follow necessary regimen -HOB elevated 30 degrees, can be done using pillow/4-6 in blocks under bed -Pt should NOT be supine for 2-3 hours after meal -Pt. on PPI should take med before 1st meal of the day -AVOID late night snacking

Key assessment for BPH-objective

-patient has enlarged prostate on DRE, the patient will bend over table or lie on side for exam -Lab tests= creatinine to rule out renal insufficiency, urinalysis, PSA -residual urine > 100 mL (bladder scan) or measure urine flow with uroflowmetry

Nissen Fundoplication POST-OP CARE

-prevent respiratory complications -TCDB q 2 hours -Assess for pneumothorax signs (dyspnea, cyanosis, chest pain) -Pt. may require medications for n/v and pain

POST OP complications that can occur with hysterectomy??

1. DVT due to lithotomy position in surgery- TEDs, SCD, Lovenox, leg exercises, ambulation. Avoid high-fowler's/pressure under the knees to minimize stasis and pooling of blood 2. Pulmonary embolism- s/s are chest pain, dyspnea tachycardia, report STAT 3. Urinary retention r/t loss of bladder tone. Check for residual urine (bladder scanner) Kegel exercises, encourage fluids when allowed post-op 4. Paralytic ileus- check bowel sounds, keep pt. NPO until they return and there is no nausea or distention. Sometimes rectal tube is used to relieve gas. encourage ambulation 5. disturbed body image r/t perceived loss of femininity and ability to conceive

PUD therapy?

1. GERD Meds.. antacids, PPI, H2 receptor blockers, anticholinergics Antibiotics (flagyl, tetracycline, amoxicillin) Anticholinergics, cytoprotective therapy Tricyclic pain relief

Possible complications of PUD

1. Hemorrhage- most common, pt. may present with coffee ground emesis, NG tube might be inserted 2. Perforation- most lethal, surgery is required, s/s= absent bowel sounds, n/v, abd muscles contracted, dramatic abd pain, sudden, rapid/shallow respirations 3. Gastric Outlet obstruction- pylorus narrows due to edema, inflammation, scar tissue. s/s= throwing up old food, pain and worsens with full stomach, wt loss, visible waves, constipation, loud peristalsis

Hysterectomy Pre-op instructions

1. teach about post-op care 2. psychological support, talk to your patient 3. Physical prep- douche and/or enema. Empty Bladder; insert catheter

PUD post op NG output should be

1500 mL/24 hr

Minimum urinary output per hour??

25-30 mL/hr

How much bile should drain from T-tube after surgery?

500 mL/24 hrs

VS in patient with renal calculi??

BP increased Glucose increased

common lab tests to evaluate urinary function??

BUN, creatinine, urinalysis

Normal level of BUN and creatinine, how do these tests rt anything that we have studied

BUN- 7 to 20 Creatinine- 0.6 to 1.4 **An increase in these show that BPH would be affecting the kidney function

BUN serum Creatinine urinary creatinine Specific Gravity

BUN= 7-20 serum Creatinine= 0.6-1.4 Urinary creatinine= 85-135 reflects GFR Specific Gravity= 1.002-1.030 substances in urine if levels are high (glucose, protein, bilirubin, WBC, RBC, crystals, bacteria)

Manifestations of patient with lithiasis??

Back pain Renal colic (smooth muscle contraction of ureters, referred pain to groin/testicles, comes in waves) Hematuria (due to stone rubbing on the lining **pain moves to lower quadrant as stone nears UVJ

Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? a. "Peppermint tea may reduce your symptoms." b. "Keep the head of your bed elevated on blocks." c. "You should avoid eating between meals to reduce acid secretion." d. "Vigorous physical activities may increase the incidence of reflux."

ANS: B Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.

An older patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place. The health care provider prescribes 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse a. monitors arterial blood gas values daily. b. periodically aspirates and tests gastric pH. c. checks each stool for the presence of occult blood. d. measures the volume of residual stomach contents.

ANS: B The purpose for antacids is to increase gastric pH. Checking gastric pH is the most direct way of evaluating the effectiveness of the medication. Arterial blood gases may change slightly, but this does not directly reflect the effect of antacids on gastric pH. Because the patient has upper gastrointestinal bleeding, occult blood in the stools will appear even after the acute bleeding has stopped. The amount of residual stomach contents is not a reflection of resolution of bleeding or of gastric pH.

6. A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed? a. "I take antacids between meals and at bedtime each night." b. "I sleep with the head of the bed elevated on 4-inch blocks." c. "I eat small meals during the day and have a bedtime snack." d. "I quit smoking several years ago, but I still chew a lot of gum."

ANS: C GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.

Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? a. Chocolate pudding c. Cherry gelatin with fruit b. Glass of low-fat milk d. Peanut butter and jelly sandwich

ANS: C Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.

10. The nurse will anticipate teaching a patient experiencing frequent heartburn about a. a barium swallow. b. radionuclide tests. c. endoscopy procedures. d. proton pump inhibitors.

ANS: D Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.

An 80-yr-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration? a. Sucralfate (Carafate) b. Aluminum hydroxide c. Omeprazole (Prilosec) d. Metoclopramide (Reglan)

ANS: D Metoclopramide can cause central nervous system side effects ranging from anxiety to hallucinations. Hallucinations are not a side effect of proton pump inhibitors, mucosal protectants, or antacids.

8. The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication a. reduces gastroesophageal reflux by increasing the rate of gastric emptying. b. neutralizes stomach acid and provides relief of symptoms in a few minutes. c. coats and protects the lining of the stomach and esophagus from gastric acid. d. treats gastroesophageal reflux disease by decreasing stomach acid production.

ANS: D The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.

Priority Assessment for cholecystitis/cholelilthias

Assess for jaundice, dark colored/amber urine, palpable gallbladder, clay or tan colored stools, bleeding tendencies (due to lack of vit K), fatty stools or steatorrhea, pruritus, leukocytosis, tachycardia, tachypnea

Pancreatitis Treatment and Goals

Assure oxygenation Manage Pain Rest Pancreas Maintains Hemodynamics Maintain electrolytes Assess glucose Prevent infection

Correct procedure for BSE

Best time is 3-5 days after period

Diagnosis of Lung Cancer

Biopsy is required for definitive diagnosis. Obtained by CT-guided needle aspiration, bronchoscopy, VATS, mediastinoscopy, If thoracentesis is performed it's also analyzed for malignant cells

What might indicate low calcium levels in pancreatitis patient??

Chvostek's sign= contraction of facial muscles in response to light tap over facial nerve in front of the ear Trousseau's sign= carpal spasm induced by inflating a BP cuff above the systolic pressure for a few mins

After a transurethral resection of the prostate (TURP), a 64-year-old patient with continuous bladder irrigation complains of painful bladder spasms. The nurse observes clots in the urine. Which action should the nurse take? a. increase the flow rate of the bladder irrigation b. administer the prescribed IV morphine sulfate c. give the patient the prescribed belladonna and opium suppository d. manually instill and then withdraw 50 mL of saline into the catheter

D.

Complications of Bilroth I/II

Dumping syndrome-after surgery a large bolus of hypertonic chyme will enter SI and pulls in fluid. Pt s/s= weakness, dizziness, sweating, palpitations, lasts an hr after meal cramps, hyperperistalsis, urge to defecate Postprandial hypoglycemia- variant of dumping syndrome... uncontrolled emptying of bolus of fluid high in CHO. Causes hyperglycemia which leads to insulin release and leads to hypoglycemia (dizziness, sweating, tachycardia, mental confusion, palpitations), 2 hrs after meal. Treatment- small meals, low CHO, dry foods, REST AFTER MEALS to prevent motility

What is the relationship of age and family hx to risk for breast cancer?

Early menarche and late menopause are risk factors for breast cancer b/c prolonged exposure of estrogen + family hx

Common female age of occurrence for fibrocystic disease, fibroadenoma, and breast cancer

Fibrocystic= 35 to 50 years old Fibroadenoma= 15 to 40 Breast cancer= 50+

Bilroth I vs. II

I- 50 to 75% removal of stomach, more severe II- 50% removed, stomach sutured to jejenum

HG/HCT WBC GFR

HG= 12-17 HCT= 37-54 WBC= 5,000-10,000 GFR= healthy > 90 (range 0-200)

Nursing care post pneumonectomy??

HOB up 30-45 degrees after VS stable, TCDB q 1-2 hrs, rotate between semi-fowlers and operative side down to maximize aeration of remaining lung, ambulate, give O2 prn, manage pain, maybeCEI (continuous epidural infusion)

Diagnostic tests used for lithiasis that is considered an OLD test?

IV pyelogram, contraindicated in obstruction, IV w/ contrast, NPO status

Nursing diagnoses for patient with renal calculi??

Ineffective management of therapeutic regimen rt lack of knowledge (diet usually moderate restiction of oxalate, drink 3L of fluid to assure output of 2,000 mL/d, meds, strain urine for analysis) Risk for infection rt introduction of bacteria into urinary stream Impaired urinary elimination rt obstruction of ureters and urethra

Indications of fluid and electrolyte imbalance in the patient with acute pancreatitis???

K+= auscultate for dysrhythmias, palpate for irregular pulses Give iv fluids to restore vascular volume Give dopamine to increase systemic vascular resistance

What is the key to urinary health??

Keep urine dilute and free flowing!!

Clinical manifestations of pancreatitis??

LUQ pain (sudden onset, deep, piercing), aggravated after eating or in recumbent position, n/v, jaundice, hypotension, tachycardia, crackles/decreased breath and bowel sounds. SEVERE= Grey Turners'-ecchymosis in the flank area, Cullen's sign- ecchymosis in the umbilical region

What is the rationale for a patient with an NGT to suction and NPO status?? in pancreatitis

NPO status minimizes pancreatic stimulation and the NG tube is to reduce pancreatic enzymes. Give antacid in NGT

laprascopic cholecystectomy PRE-OP

NPO, antiemetics and fluids, measure I & O, administer analgesics/antibiotics, Dietary consultation (low fat diet, NO butter/fried food/fast food, switch to low fat dairy) Teach what to expect after surgery such as elimination patterns, diet, activity

Antacids

Maalox, Mylanta, Gelusil, Gaviscon give 1-3 pc (after meals) & HS, space around other meds

Dietary management with cholecystitis

Obese patient should have reduced-calorie diet, Intake low saturated fats and high fiber/calcium, Avoid quick weight loss, Eat smaller more frequent meals with some fat each meal to promote gallbladder emptying. Increased risk for- 40+, fertile, family hx, flatulent, fair-skinned, forget to exercise, lipid lowering meds

Purpose of the PSA test, normal/abnormal findings

PSA escapes into blood stream when prostate is disturbed by disease -Normal= < 2.5, varies with age and race -Suspicious of Cancer= 4 to 7 -almost all levels above 10 are cancer

PPI meds

Protonix, Lansoprazole, Nexium, Aciphex MOA- decreases HCl and secretion by inhibiting proton pump responsible for secretion of H+, decreases irritation of the esophageal and gastric mucosa 80-90% more effective than H2 receptor blockers but cost more. SE are rare except for fractures. Take this med before 1st meal of the day

Top priorities in planning care of patient with renal calculi??

Relief of pain- administer opioids No obstruction- Take Flomax to help stone pass Urology and Nutrition Consult Knowledge of ways to prevent recurrence of stones

POST OP care for PUD surgery

TCDB, leg exercises, pain relief NG tube inserted..1st 24 hrs bloody/sanguineous normal... 36-48 hours later the fluid should be yellow/green **IF NG tube comes out, surgeon must reinsert to avoid damage to sutures. After NG tube removed diet progresses to 6 meals/day, cobalamin replacement

Discharge teaching for patient after hysterectomy???

Teach she will not menstruate. Report any bleeding to physician. Perform abdominal strengthening exercises. For 6-weeks avoid heavy lifting, prolonged sitting, driving, horseback riding, sexual intercourse

serum albumin?? phosphorous calcium pH

serum albumin= 3.4-5.4 phosphorous= 2.5-4.5 calcium= 8.5-10.2 pH= 7.35-45

Why do we insert an NG tube post laprascopic cholecystectomy?? Diet??

To keep GI tract from being stimulated...to promote healing Clear liquid diet, advance as tolerated may need decrease in fat

Post-op care for TURP?

Trans urethral resection of the prostate. removes small amount of prostate tissue using a scope inserted into urethra -maintain urinary drainage and observe for s/s of hemorrhage -Look for complications such as hemorrhage, bladder spasms, urinary incontinence, infection -pt. will have a catheter in place -Explain to pt. they may have sexual dysfunction

Normal POST OP Drainage in hysterectomies

Vaginal Hyst= moderate amount of serosanguineous Abd Hyst= only slight incisional bleeding, if any

To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating a. milk and cheese. b. sardines and liver. c. legumes and dried fruit. d. spinach, chocolate, and tea.

a. things high in purines= gravy, chicken, and liver

What can cause peptic ulcers

alcohol, smoking, NSAIDs, ischemia, acid bile salts, h. pylori

Nursing assessments following TRAM procedure?

assess for bleeding, hernia, infection

Why is the post-op radical prostatectomy patient at particular risk for infection?

b/c they go through the rectal wall which contains bacteria so the patient can become septic, location of incision and anus

Fibroadenoma of breast

benign, painless, round, delineated, firm, rubbery, size not affected by menstruation, usually bilateral

Best procedure for TSE

best done after warm shower. Look in mirror, touch, place index and middle fingers under the testicle with the thumb places on the top. Firm but gently roll the testicle between your thumb and fingers. Note any abnormalities, find the epididymis on the back of the testis. Lump may be small/firm/pea size in nature.

Medication for patient post laprascopic cholecystectomy with diarrhea?

bile acid binder, interferes with many drugs

Actigal is given for???

bile acid used to dissolve gallstones

How can clots be prevented in TURP

continuous bladder irrigation to prevent clots that can obstruct urine flow, ensures drainage of urine assess degree of hematuria -should be light pink within 24 hrs -report any bright red bleeding with increased viscosity (arterial) -report if there's an increase in dark red bleeding (venous); may require traction on catheter for pressure

Pt. asks the nurse what caused the renal calculi. What is the nurses response??

dehydration change in urinary pH that affects ca solubility obstruction UTI genetics young age 50% reoccurrence rate

Complications of GERD

erosive esophagitis (strictures, narrowing, scar tissue), Barrett's Esophagus- this is a precancerous lesion that can increase risk for esophageal adenocarcinoma. Chronic GERD can lead to these.

Mastectomy- Exercises indicated, when to begin, why are they needed, what do they prevent??

exercises= arm (flexing, extending), wear compression sleeve Begin= in recovery room WHY= to prevent contractures and muscle shortening, maintain muscle tone and improve circulation.

Most common cause of pancreatitis??

gallbladder disease in women and alcoholism in men

Manifestations of GERD

hot/bitter/sour liquid coming into throat or mouth (regurgitation), early fullness with meals, pc bloating, heartburn (pyrosis) is most common. If this occurs more than 2x per week than this is SEVERE.

Testicular cancer risk factors

hx of cryptorchidism (undescended testicle at birth), family hx, mumps/orchitis or inguinal hernia in childhood. 4-5x more common in white males then in black males. HIV, maternal exposure to exogenous estrogen

Labs for pancreatitis

increased amylase, lipase, glucose, liver tests (AST/ALT), WBC Decrease in calcium (due to trypsin inactivating parathyroid hormone-watch for tetany), K+, chloride and sodium if vomiting. Decrease in HG/HCT Urinary test- increased urinary amylase Other test-CT, abdominal ultrasound, CT

Ways to diagnose PUD

invasive= EGD, rapid urease test, biopsy noninvasive= Test serum for IgG and h.pylori, Breath test...this is when the patients is given carbon isotope and instructed to exhale into a bag. if urease is present it will break down co2 and ammonia, urease prevents destruction of h.pylori

Breast Cancer

malignant, hard, irregular shape, non-mobile, non-tender, unilateral

Significance of OTC medications and symptoms in BPH

many medications can influence bladder function, ex-beta blockers inhibit relaxation of detrusor muscle, CCBs may decrease bladder muscle (detrusor) tone *remember bladder must work hard to empty urine in BPH

Lifestyle changes for pt. with PUD

milk v. non-milk No smoking avoid alcohol, caffeine relaxation techniques

Drug given to pt. taking NSAID with PUD that has arthritis

misoprostol

What should you teach the patient on Herceptin to report?

notify HCP if onset or worsening of SOB, cough, swelling of the ankles/legs/face, palpitations, weight gain of 5+ pounds in 24 hours, dizziness or loss of consciousness. Avoid crowds and persons with known infections. Don't get vaccinations w/o advice of HCP

Who is at risk for BPH

older age -begins 40-46 yrs old, by 60-69 50% have enlarged prostate, by 70-80 yrs old 90% have enlarged prostate. -highest is in african american, lowest in Japanese -family hx -urinary retention

What is the purpose of a 3-way catheter in the TURP patient?

one tube in patient, one coming out of patient, one with irrigation solution. Nurse should provide irrigation to prevent clots

Explain Gastric UIcers

pain occurs 1-2 hours after eating, pain is located in the high L epigastrium, burning/gaseous pressure, hematemesis

Explain Duodenal Ulcers

pain occurs usually 2-5 hrs after meals, account for 80% of PUD and 90% are caused by H. Pylori. melena, cramping, located in midepigastrium (behind xyphoid)

fibrocystic breast disease

painful, usually bilateral, increase in size during menstruation, benign, estrogen is a strong causative factor, delineated, firm, movable, round

Key assessments that indicate BPH-Subjective

patient reports: frequent urination, NOCTURIA. Urgency, straining to urinate, hesitancy, weak urinary stream (dribbling), intermittent urinary stream, sensation of incomplete bladder emptying (retention) AUA (Am. Urology Assoc) symptom index -0 to 7 mild -8 to 19 moderate -20 to 25 severe Self administered questionnaire

Proper positioning of the arm on the surgery side after mastectomy?

place pt in semi-fowler's position and elevate arm to drain, any injury to the arm can create edema

What is PSA?

prostate-specific antigen - a protein in the prostate gland that liquefies semen. PSA escapes into blood stream when prostate is disturbed by disease. If pt has abnormal PSA & DRE then a transrectal ultrasound (TRUS) is typically ordered

Role of Viokase in the treatment of pancreatitis?? How will you know it's working??

replaces pancreatic enzymes (amylase, lipase, trypsin) Pt is able to digest foods

Risk and Teaching interventions for lung cancer?

rt exposure to tobacco smoke, measured by # of cigarettes smoked in lifetime/aging of smoke onset/depth of inhalation/tar and nicotine content/use of unfiltered cigarettes 2nd leading cause= radiation 3rd= air pollution, asbestos, family hx

Other risk factors for pancreatitis??

smoking is an independent risk most common in middle-aged men and women, higher in African Americans

What does lithiasis mean??

stone, calculi

Outpatient care for patient with symptoms of renal calculi?

strain ALL urine!! 24 hour urine test may be ordered. Discard 1st specimen, collect every drop, keep on ice for 24 hours Avoid dehydration, avoid dietary oxalate, limit caffeine/choc/nuts/beans/rhubarb/spinach/beets, keep normal/high intake of calcium, limit NA to 2 g, limit protein to 12 ounces if stones are from uric acid

Nursing responsibilities when administering trastuzumab (Herceptin)?? SE?

use with caution in women with preexisting heart disease, monitor for signs of ventricular dysfunction and heart failure SE= flu-like symptoms (fever, chills, myalgia), damage to heart

What is Nissen fundoplication?

treatment for GERD, this reduced gastric acid reflux by enhancing the integrity of LES. The fundus of the stomach is wrapped around the lower portion of the esophagus in varying positions and sutured to itself.

Cholestyramine is given for?? SE?

treatment for cholecystitis/pruritus, a resin that binds bile salts in the intestine, increasing their excretion in the feces. It's administered in powder form, mixed with juice or milk SE= nausea, vomiting, diarrhea, constipation, skin reactions, heartburn Interferes with many drugs, take other meds at least 1 hour before or 4-6 hours after the bile acid binder

Ways to assess for GERD

upper GI endoscopy with biopsy, cytologic analysis, barium swallowing, pH monitoring

After hysterectomy when should the patient void after cath is removed??

within 8 hours