N432 FINAL

Breast cancer labs + dx

Mammography, galactography, US, MRI, biopsy Useful to predict risk of recurrence: Axillary lymph nodes: highly important, more + nodes= greater risk Tumor size Estrogen or progesterone receptor status (+ better, - worse) Cell proliferation indices Genomic assays Lymphatic mapping + sentinel lymph node dissection -Helps surgeon identify lymph nodes that drain 1st from tumor site -Radioisotope and/or blue dye injected into affected breast to determine sentinel lymph nodes (SLNs); 1-4 removed usually

Immune complex reaction / type III

Marked by acute inflammation resulting from formation and deposition of immune complexes >>Excess antigens cause immune complexes to form in blood and these circulating complexes usually lodge in small blood vessels >>Deposited complexes trigger inflammation, resulting in tissue or vessel damage -Joints and kidneys are particularly susceptible to this kind of reaction -Associated w systemic lupus erythematosus, serum sickness, nephritis, rheumatoid arthritis -S/s: urticaria, joint pain, fever, rash, adenopathy (swollen glands)

Central Venous Pressure (CVP) monitoring

Measurement of right ventricular preload Reflects fluid volume & functioning of right side of heart Normal is 2-6 mmHg High can be d/t right sided HF or fluid overload Low d/t dehydration Obtained from central venous catheter or pulmonary artery catheter Waveform is similar to PAWP waveform

AKI assessment

Nursing Assessments -Vital signs, labs, fluid I/O, urine characteristics -General appearance (skin color, edema, neck vein distention) -Dialysis access site (inflammation, exudate) -Mental status/LOC -Oral mucosa (dry, inflamed) -Lung sounds (crackles, rhonchi, diminished breath sounds) -Heart rhythm (dysrhythmias) Labs & Dx Thorough history to determine cause Serum creatinine: increases when kidney function loss > 50% Urinalysis (urine Na+, osmo, SG) Kidney ultrasound, renal scan, CT scan Renal biopsy Contraindicated: studies using contrast media that can be nephrotoxic

uti nursing care

Nursing Care -Adequate fluid intake: 2-3 L/day; dilutes urine, makes bladder less irritable & flushes out bacteria before they can colonize -Avoid bladder irritants: Caffeine, alcohol, citrus juices, chocolate, highly spiced foods -Application of local heat to suprapubic or lower back may relieve discomfort Patient Teaching -Drug therapy: take full course; drug side effects -Report continued lower UTI symptoms after treatment or onset of flank pain or fever (signs of upper UTI/pyelonephritis) -Regular voiding q3-4 hr as soon as urge to void -Void after intercourse -May acidify urine using OTC tablets, cranberry products -Women: clean perineum front to back; no irritants; wear loose-fitting cotton "breathable" undergarments

acs nursing care

Nursing Dx: Decreased CO, acute pain, anxiety, activity intolerance, ineffective health management Goals: pain relief, preserve myocardium, rehab, treatment, effective coping, reduction of risk factors Pain: nitroglycerin, morphine, oxygen Continuous monitoring: ECG, ST segment, heart + breath sounds, VS, pulse ox, I/O Rest + comfort: balance rest + activity + begin cardiac rehabilitation Cardiac diet: low fat, low salt Anxiety reduction: identify source, alleviate, pt. Teaching, support

acute resp failure nursing care

Nursing Management -O2 therapy: keep PaO2 at >55-60 + SaO2 > 90% at lowest O2 possible -Mobilize secretions: hydration (2-3L), humidification (aerosol mask O2), chest PT, suction, coughing, positioning -Meds: Treat underlying cause + maintain adequate CO + Hgb → bronchodilators, corticosteroids; PRN: diuretics, abx, analgesics -Nutrition: adequate protein, enteral/PN, supplements Expected Outcomes: patent airway + effective secretion removal, normal or baseline RR/rhythm/breath sounds, adequate oxygenation (baseline ABGs), hemodynamic status WNL

hemodialysis

Vascular access is one of most difficult problems Types of access: arteriovenous fistulas + grafts, temporary vascular access Dialyzers + Procedure -Before treatment, nurse assesses fluid status, condition of access, temperature, skin condition -During treatment, nurse is alert to changes in condition; measures VS q 30-60min Complications: Hypotension, muscle cramps, blood loss, hepatitis

BPH complications

r/t urinary obstruction but relatively uncommon in BPH >>Acute urinary retention: sudden, painful inability to urinate; treat w/ catheter insertion, possible surgery UTI + sepsis Incomplete bladder emptying (residual urine = medium bacterial growth) Bladder calculi: residual urine alkalinization Other:Renal failure caused by hydronephrosis, pyelonephritis, bladder damage

Acute Kidney Injury (AKI)

rapid loss of renal function due to damage to the kidneys; formerly called acute renal failure Prerenal causes: decreased renal blood flow from factors external to kidneys (dehydration, HF, low CO) > Decreased GFR leads to oliguria > Autoregulatory mechanisms attempt to preserve blood flow Intrarenal Causes (acute tubular necrosis) > Direct damage to kidney tissue (from prolonged ischemia, nephrotoxins, Hgb from hemolyzed RBCs, myoglobin released from necrotic muscle cells) > Potentially reversible Postrenal causes: BPH, prostate cancer, calculi, trauma, extrarenal tumors

kidney transplant

replacement of a diseased kidney with one that is supplied by a compatible donor; waitlist Advantages over dialysis: Reverses many of pathophysiologic changes associated w renal failure Eliminates dependence on dialysis Less expensive after first year

SCI nursing care: resp

resp dysfxn may increase during 1st 48 hrs; may need intubation + mechanical ventilation Increased risk for pneumonia + atelectasis Regular assessment (breath sounds, ABGs, Vt, Vc, breathing pattern, sputum) Interventions: Aggressive chest physiotherapy Provide O2 Proper pain management Assisted (augmented) coughing: put hands under xiphoid process + push firm pressure upward while pt. Coughs Tracheal suctioning: crackles or rhonchi Incentive spirometry

anaphylactic shock

severe allergic rxn w/ overwhelming systemic vasodilation Clinical manifestations: Anxiety, confusion Sense of impending doom Chest pain, dizziness Incontinence Angioedema (swelling of lips and tongue) Wheezing, stridor (laryngeal edema) Flushing, pruritus, urticaria Resp distress and circ failure

hemodynamic monitoring

the use of pressure monitoring devices to directly measure cardiovascular function measurement of pressure, flow, and oxygenation in the cardiovascular system: Assesses heart function, fluid balance, drug effects on CO For hemodynamic pressure monitoring system, need: IV fluid w/ tubing, transducer to transmit pressures to monitor, pressure tubing connecting transducer to hemodynamic monitoring cath in pt (pulmonary or arterial line) Ways to measure: Systemic and pulmonary arterial pressures Central venous pressure (CVP) Pulmonary artery wedge pressure (PAWP) Cardiac output (CO) / cardiac index (CI)

cervical cancer - risk

(Can be in-situ or invasive) Multiparity, < 17 yrs at first intercourse, multiple sex partners, smoking, infection with herpes simplex virus (HSV), human papilloma virus (HPV) (vaccine now), or cytomegalovirus (CMV), immunosuppression

shock tx

-ABCs: patent airway, modified trendelenburg position, optimize CO w/ fluids or drugs, increasee Hgb w/ transfusion prn -Volume expansion: cornerstone of therapy for septic, hypovolemic, anaphylactic shock -Drug therapy: primary goal to correct ↓ tissue perfusion (vasopressors-norep, vasodilators) -Nutrition: vital to reducing morbidity from shock, EN/PN, weigh, labs

SCI Clinical Manifestations (GI)

-Above T5 → hypomotility: Paralytic ileus; gastric distention- NG tube, metoclopramide -Stress ulcers: excess H+ in stomach -Intra-abdominal bleeding: may be hard to detect if no pain or tenderness -Neurogenic bowel >>Injury level of T12 or below: bowel initially areflexic w/ decreased sphincter tone. When reflexes return, sphincter tone enhanced → reflex emptying occurs >>Regular bowel program for areflexic + reflexic neurogenic bowel. Coordinate w/ gastrocolic reflex -Metabolic needs >>NG suction → metabolic alkalosis + possible Na+/K+ imbalances >>Decreased tissue perfusion → acidosis >>Increased nutritional needs → high protein diet

Anaphylactic reaction / type I

-Aka atopic allergy -Characterized by vasodilation, increased capillary permeability, smooth muscle contraction, eosinophilia Anaphylaxis: blood vessel dilation, decreased CO, bronchoconstriction >>Uneasiness, apprehension, weakness, impending doom, puritus, urticaria, erythema and angioedema, congestion, rhinorrhea, dyspnea, increasing respiratory distress w audible wheezing -Systemic reactions may involve laryngeal stridor, angioedema, hypotension, bronchial/GI/uterine spasm -Local reactions are characterized by hives -Examples: extrinsic asthma, allergic rhinitis, systemic anaphylaxis, reactions to insect stingsCytotoxic reaction / type II

obstructive shock

-Physical obstruction to blood flow occurs with decreased CO -Restricted diastolic filling of right ventricle due to compression, or abdominal compartment syndrome Patient will experience ↓ CO, ↑ afterload; variable LV filling pressure Rapid assessment and immediate treatment are important

kidney transplantation live donor

-Extensive multidisciplinary evaluation -Psychosocial and financial evaluations -Crossmatches -Advantages: better pt/graft survival rates, immediate organ availability, minimal cold time -Lab tests: 24 hr urine (creatinine clearance, total protein), CBC, chemistry and electrolytes, hep B and C, HIV, CMV testing -Nephrectomy performed by a urologist or transplant surgeon and begins 1-2 hrs before recipient's surgery is started >Rib may need to be removed for adequate view >Takes about 3 hrs -Laparoscopic donor nephrectomy is an alternative to conventional nephrectomy >Most common approach for live kidney procurement >Decreases hospital stay, pain, operative blood loss, debilitation, and length of time off work Postop care: Care similar to that for open or laparoscopic nephrectomy Close monitoring of renal function Close monitoring of hematocrit Have to stay in hospital for 2-4 days for laparoscopic procedures Can return to work 4-6 wks after

Cranial Surgery: Nursing Management

-General preop/postop care -Frequent neuro checks for 1st 48 hrs -Monitor fluids & electrolytes, serum osmo (sodium onset DI, hypovolemia) -Monitor pain & nausea (pts often have HA from edema or pain @ incision site) -Use short acting opioids & monitor neuro status -Treat postop N/V with antiemetics (not promethazine: somnolence) Positioning: -Anterior or middle fossa incision: head 30-45 degrees -Posterior fossa incision (near posterior neckline) or Burr hole: often flat or slight elevation (10-15 degrees) -If bone flap removed (craniectomy), don't place pt on operative side Dressing -Observe color, odor, amt drainage; report increased blood & any clear drainage (possibly CSF) -Check drains for placement; assess area around dressing Scalp Care -Meticulous scalp care near incision per protocol (prevent wound infection) -After dressing removed, use antiseptic soap to wash scalp -Alleviate psychological impact of hair removal w/ use of a wig, turban, scarves, or cap after incision has completely healed -Pts receiving radiation should use sunblock + head covering if any sun exposure anticipated

leukemia

-Group of malignant disorders affecting blood & blood-forming tissues of bone marrow, lymph system, spleen -Increased production of immature (dysfunctional) WBCs- "clog" bone marrow & also inhibit production of other blood cells -Fatal if untreated (infection or hemorrhage) -Manifestations r/t problems in bone marrow (RBC, WBC, platelet production) Classification Acute vs. Chronic: based on cell maturity & speed of disease onset Acute: clonal proliferation of immature hematopoietic cells Chronic: mature forms of WBC & onset is more gradual Types of WBC: Lymphocytic or Myelogenous (myeloid) Risk Factors Combination of genetic & environmental influences Oncogenes (abnormal genes) can increase risk of cancers Environmental: chemical agents, chemotherapeutic agents, viruses, radiation, immunologic deficiencies

trauma and forensics

-Handling & documentation of potential evidence is important when criminal activity is suspected -Document descriptions of all wounds, mechanism of injury, time of events, collection of evidence -When removing pt clothing, don't cut through or disrupt any tears, holes, blood stains, dirt -When taking photos of wounds or clothing, take one of each item both w/ and w/o ruler -Place each piece of clothing in an individual bag, let wet clothing air dry first, do not give to families. Follow agency policy for valuables. -Chain of custody of evidence: document officer's name, date, time when any articles given to police -When autopsy by medical examiner needed for suspected homicide or suicide, leave tubes & lines in place, cover hands in paper bags -For surviving pt, swabs from hands/nails may be taken for evidence -Document all statements made by pt in own words and use quotation marks

Acute pyelonephritis

-Inflammation of renal parenchyma, collecting system. Infection involving the upper urinary tract or kidneys. Usually starts as lower UTI & ascends through ureters -Bacteria most common cause; others fungi, protozoa, viruses Common pre-existing factors: >>Vesicoureteral reflux: backward movement of urine >>Lower urinary tract: obstruction from BPH, stricture, stone -Recurrence leads to scarred, less functioning kidney, chronic pyelonephritis Clinical Manifestations - more systemic than UTI s/s -Fever & chills -Tachycardia & tachypnea -Flank, back, loin pain; tender CVA -Abdominal discomfort, N/V -General malaise & fatigue -Urinary burning, urgency, frequency, nocturia Dx Tests: urinalysis (pyuria, bacteriuria, hematuria); WBC: elevated w/ shift to left; US or CT urography

Cytotoxic reaction / type II

-Involves the binding of either the IgG or IgM antibody to a cell bound antigen -May lead to eventual cell and tissue damage -Reaction is result of mistaken identity when the system identifies a normal constituent of the body as foregin and activates the complement cascade Examples: myasthenia gravis, goodpasture's syndrome, pernicious anemia, hemolytic disease of the newborn, transfusion reaction, thrombocytopenia >>Goodpasture's: autoimmune disease in which the immune system mistakenly produces antibodies against collagen in the lungs and kidneys

colorectal cancer labs + dx

-Lab: carcinoembryonic antigen (CEA) - tumor marker -Regular screening: flexible sigmoidoscopy every 5 years, colonoscopy every 10 yrs, double-contrast barium enemaa study every 5 yrs, CT colonography every 5 yrs -Annual screening tests: fecal occult blood, fecal immunochemical (FIT) -CT, MRI -Colonoscopy: Allows for detection; removal + analysis of polyps Dx Studies Using Barium -Upper GI + Small Bowel Series Before test: maintain NPO 8hr + withhold analgesics, anticholinergics for 24 hrs Client drinks 16 oz barium Exam done w/ rotating positions on exam table After test: give plenty of fluids + administer mild laxative or stool softener; stool may be chalky white for 24-72 hrs -Barium Enema Enhances visualization of large intestine Clear liquids 12-24 hrs before test; NPO night before; bowel cleansing prep is done After test same as above

SCI nursing care: immobilization

-Maintain neutral position -Stabilize to prevent lateral rotation: blanket or towel, hard cervical collar, backboard -Keep body correctly aligned -Log roll -Skeletal traction: >Realign or reduce injury >Gardner-Wells tongs >Rope, pulley, + weights >Traction maintained at all times >Stabilize head in neutral position if dislodged + then summon help >Pin site care per protocol Kinetic therapy -Continue side to side slow rotation ->200 turns/day -Manual or automatic -Decreases pressure sores + cardiopulmonary complications -Risk for motion sickness -SOMI brace: after cervical fusion, other stabilizing surgery -Halo Vest: no surgical stabilization; medical treatment Meticulous skin care critical w/ all types of immobilization

PUD therapeutic management

-Medical regimen: adequate rest, drug therapy, stop smoking/alcohol, stress management, dietary modification -Avoid food + bev irritating to pt -Possible short term bland diet -6 small meals/day while symptomatic -Generally treated in ambulatory care setting: ulcer healing requires many wks of therapy, pain disappears 3-6 days -Complete healing: 3-9 wks. Assessed by x ray or endoscopy -Aspirin + nonselective NSAIDs may be stopped for 4-6 wks -Smoking cessation

PUD complication: Perforation

-Most lethal complication of PUD -Common in large penetrating duodenal ulcers or lesser curvature of stomach -If large, requires open or laparoscopic repair -Small perfs seal themselves resulting in a cessation of symptoms -Ulcer penetrates serosa and spills contents into peritoneal cavity -Hypovolemia occurs as a result of third spacing -Bacterial peritonitis can occur w/in 6-12 hrs -Difficult to differentiate gastric from duodenal perforation bc clinical signs are the same Manifestations: -Sudden onset 0-2 hrs after perforation -Severe upper abdominal pain spreads through abdomen and may radiate to back or shoulder -Tachycardia, weak pulse, shallow rapid resps -Rigid, board like abdomen -Nausea, vomiting, absent bowel sounds Treatment: -inserting NGT w continuous suction -Restore blood volume w lactated ringers, albumen, RBCs -Hourly central venous pressure and urine output, ECG if cardiac history -Broad spectrum abx + pain meds should be given -Open or laparoscopic repair

pulmonary embolism

-Obstruction of 1+ branches of pulmonary artery by a thrombus (often from leg veins), fat, air, amniotic fluid, or tumor tissue. -Obstructs alveolar perfusion: Obstructed area has diminished/absent blood flow; Although local alveoli ventilated, no gas exchange occurs -Most commonly affects lower lobes -Inflammatory process causes constriction of local blood vessels & bronchioles, further increases PVR, pulmonary artery pressure, right ventricular workload -Ventilation-perfusion (V-Q) imbalance occurs + possible RV failure & shock Risk Factors DVT (90%): Virchow's triad (venous stasis, vessel wall damage, hypercoagulation) Immobility, history of DVT, clotting disorders Malignancy/tumor Obesity Oral contraceptives/hormones Smoking Heart failure/Afib Pregnancy/delivery Central venous catheters (emboli) Fractured long bones (fat emboli)

Delayed or cellular reaction / type IV

-Occurs 1-3 days after exposure to antigen -Results in tissue damage -Involves activity by lymphokines, macrophages, lysozymes -Reactive cell is T lymphocyte (T cell) -Antibodies and complement are not involved -Local collection of lymphocytes and macrophages causes edema, induration, ischemia, tissue damage at site -Erythema and itching are common Examples: contact dermatitis, graft vs host disease, hashimoto's thyroiditis, sarcoidosis, positive purified protein derivative, poison ivy skin rashes, insect stings, tissue transplant rejection

kidney transplant recipient

-Organ usually placed extraperitoneally in iliac fossa (right preferred) -Preop care: emotional and physical prep, immunosuppressive drugs, ECG, chest x ray, baseline labs -Before incision: urinary cath inserted, antibiotic solution instilled (distends bladder, decreases risk of infection) -Crescent shaped incision Rapid revascularization is critical -Donor artery and vein anastomosed to recipient external iliac artery and vein -Clamps released and blood flow reestablished -When anastomoses complete, urine may begin to flow or diuretic may be given Surgery takes 3-4 hrs Dialysis may be required before surgery for any significant problems such as fluid overload or hyperkalemia

Abdominal Aortic Aneurysm

-Outpouching/dilation of arterial wall. Aorta > 3 cm diameter = aneurysmal; risk of rupture increases w/ size. -Dilated wall is lined w/ thrombi that can embolize. -Causes: degenerative, congenital, mechanical (penetrating or blunt trauma), inflammatory, infectious -Risk Factors: increasing age in men, HTN + CAD, family history, high cholesterol + increased BMI, leg PAD, carotid artery disease, previous stroke, smoking -Often asymptomatic -Most occur below renal arteries -Frequently detected on physical exam or treatment of other problem (CT scan, abd x-ray) -May mimic pain associated w/ abdominal or back disorders -May spontaneously embolize - causing "blue toe syndrome": patchy mottling of feet/toes w/ palpable pedal pulses DON'T PALPATE! Rupture- Serious Complication >>Rupture into retroperitoneal space: Bleeding may be tamponaded by surrounding structures, thus preventing exsanguination + death -Severe back pain -May/may not have back/flank pain ecchymosis (Grey Turner sign) >>Rupture into thoracic or abd. cavity: Massive hemorrhage. Most don't survive long enough to get to hospital

mechanical ventilation types

-Positive Pressure Ventilation: used primarily in acutely ill pts; delivers air into lungs under + pressure during inspiration → intrathoracic pressure increases during lung inflation (opposite of normal); expiration occurs passively -Volume Ventilation: same predetermined tidal volume (Vt) delivered w/ each inspiration; amount of pressure needed to deliver each breath varies -Pressure Ventilation: predetermined peak inspiratory pressure; Vt varies; careful attn needed to prevent hyper/hypoventilation All alarms should be on at all times regardless of modes Modes- based on how much work of breathing pt can perform/ventilatory status, resp drive, ABGs

PUD complication: GOO

-Predisposition: ulcers in duodenum + antrum + prepyloric/pyloric areas of stomach or duodenum -Narrowing of pylorus→ obstruction d/t edema, inflammation, pylorospasm, fibrous scar tissue formation Clinical Manifestations -Pain worsens over day and stomach fills/dilates -Relief w belching or vomiting -Constipation common d/t dehydration and lack of roughage in diet -Swelling in stomach, upper abdomen that may be palpable -Loud peristalsis Treatment: -NGT continuous suction -IV fluid + electrolyte replacement -After several days, NG clamped, + residual volumes checked (often clamp overnight 8-12 hrs + measure in AM) -When aspirate less than 200 mL (WNL) begin clear liquids and watch for N/V, GI distress -As obstruction decreases, discontinue NGT and start on solid foods -Endoscopic balloon dilations or surgery may be done to remove scar tissue

ET intubation procedure

-Prep: consent + patient teaching -Equipment: self-inflating bag-valve-mask attached to oxygen, suctioning equipment, IV access Before Intubation: -Sniffing position (head extension w/ neck flexion) -Preoxygenate using BVM w/ 100% O2 for 3-5 mins -Limit each intubation attempt to <30 secs -Ventilate pt between attempts using BVM, 100% O Rapid sequence intubation (RSI): Rapid concurrent admin of sedative + paralytic agents Lower risks of aspiration + injury Not indicated in cardiac arrest or known airway deficiency Post intubation care: After intubation, inflate cuff + confirm placement of ET tube End-tidal CO2 detector Auscultation of lungs bilaterally + epigastrium Observe chest wall movement Check SpO2 After confirmation of correct placement: Connect tube to ventilator, Secure airway, Suction ET tube + pharynx, Insert oral airway - prevent biting ETT, Chest x ray, Record + mark position of tube, Cut off excess tubing, Obtain ABGs 15-30 min later, Continuously monitor SpO2 + CO2

IICP management

-Prevent infection if ICP monitoring in use (sterile technique; assess insertion site, monitor CSF for change in color/clarity) -Treat underlying cause -Adequate oxygenation (may be intubated/ventilated) PaO2 > or = to 100 mm Hg PaCO2 35-45 Surgery: remove cause ex. Tumor (craniotomy), craniectomy Drug therapy 25% Mannitol (osmotic diuretic)- reduce cerebral edema > Monitor fluid intake + electrolyte status Corticosteroids (for vasogenic edema) > Monitor fluid intake, serum sodium, blood glucose Hypertonic saline (3%)- Moves water out of cells into blood >Monitor BP + serum sodium levels Others: anti-seizure meds, antipyretics, sedatives, analgesics, barbiturates

shock nursing care

-Prevention: identify at risk pts (oldeer, immunocompromised, severe illness, surgery, or trauma) -Neuro status: orientation + LOC, reduce noise/lights, keep day-night cycle -CV status: continuous ECG, VS, capillary refill, hemodynamic parameters: CVP, PAS/PAD, CO, PAWP; heart sounds (murmurs, s3, s4) -Resp status: rate + rhythm, breath sounds, continuous pulse ox, ABGs; most pts will be intubated + mechanically ventilated -Measure urine output. I+O. Fluid + electrolyte balance -Body temp (core) -Skin: temp, pallor, flushing, cyanosis, diaphoresis -Bowel sounds, NG drainage/stools for OB -Oral care/hygiene based on O2 requirements -passive/active ROM -Emotional support/comfort EVALUATION: adequate perfusion with normal/baseline: ECG, BP, CVP, + PAWP Normal temp: warm, dry skin Urinary output > 0.5 mL/kg/hr Normal RR + Sa O2 > 90%

aki nursing care

-Prevention: lower exposure to nephrotoxic drugs, prevent prolonged hypotension/hypovolemia -Monitor I+O, electrolytes -Measure daily weight -Assess for hyper/hypovolemia -Prescribed diuretic therapy for fluid overload -Careful aseptic technique -Cautious use: nephrotoxic drugs -Skin care measures, mouth care -Nutritional Therapy: Adequate calories; ↓ sodium, adequate CHO, ↑ fat; Enteral nutrition; Regulate protein/potassium intake Gerontological considerations: More susceptible to AKI: polypharmacy, hypotension, diuretic therapy, aminoglycoside therapy, obstructive disorders, surgery, infection

dialysis nursing care

-Protect vascular access: assess site for patency and signs of infection, do not use for BP/blood draws -Monitor fluid balance indicators & IV therapy carefully; keep accurate I&O, IV administration pump records -Assess for S/S of uremia & electrolyte imbalance; regularly check lab data -Monitor cardiac/respiratory status carefully -Monitor BP, withhold antihypertensive agents prior to procedure to avoid hypotension (BV decreases) -Monitor meds/dosage and avoid meds w K + Mg -Address pain/discomfort -Implement stringent infection control measures -Monitor dietary Na, K, protein, fluid, assess individual nutritional needs -Provide skin care, prevent pruritus, keep skin clean/moisturized -Provide CAPD catheter care Excess fluid volume -Assess for s/s of fluid volume excess; record accurate I+O, daily weights -Limit fluid intake. Explain to pt/family rationale for fluid restriction. Assist w/ coping -Provide/encourage frequent oral hygiene Imbalanced nutrition -Assess nutritional status, weight changes, labs -Encourage high quality nutritional food (restrict fluid, Na, K, protein) -Assess & modify intake r/t factors that contribute to altered nutritional intake (stomatitis or anorexia) -Adjust med times r/t meals

gallbladder disease Pt Teaching

-Teach what to report, follow up care -Laparoscopic chole: remove bandages day after surgery and then can shower, report s/s of infection, gradually resume activities, return to work in 1 wk, may need low fat diet for several weeks -Open/incisional chole: discharged in 2-3 days, no heavy lifting for 4-6 wks, usual activities when feeling ready, may need low fat diet for 4-6 wks Foods to avoid: High in cholesterol: dairy products, whole milk, ice cream, butter, cream, cheese Other foods: fried and fatty foods, rich pastries, gravies, nuts, chocolate, egg yolks, avocado Gas forming veggies: cabbage, onions, broccoli, cauliflower, sauerkraut, radishes, cucumbers, beans

Gastric Surgery: Care + Prevention of Postop Complications

-Vitamin and mineral malabsorption: supplement iron, folic acid, calcium, vit D, vit B12 -Monitor CBC for megaloblastic anemia and leukopenia -Steatorrhea: reduce fat intake and administer loperamide -Dumping syndrome: d/t rapid passage of food into jejunum and drawing of fluid into jejunum d/t hypertonic intestinal contents. Causes vasomotor + GI symptoms w/ reactive hypoglycemia >>Avoid fluid w meals, avoid high CHO/sugar and salt intake >>Lie down for 20-30 mins after meals -Postprandial hypoglycemia (Variant of dumping syndrome): result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into small intestine >>Increased blood glucose causes increased release of insulin >>Secondary hypoglycemia occurs w symptoms approximately 2 hrs after meals >>S/s: sweating, weakness, mental confusion, palpitations, tachycardia, anxiety -Bile reflux gastritis: prolonged contact of bile causes damage to gastric mucosa. May result in back diffusion of hydrogen ions through gastric mucosa >>PUD may recur >>Continuous epigastric distress that increases after meals >>Administer cholestyramine (questran) to relieve irritation -Acute postop bleeding at surgical site -Acute upper GI bleeding Monitor for s/s

Cholecystitis

-inflammation of gallbladder - usually associated w/ cholelithiasis -Often occurs w/ obstruction from stones or sludge -Acalculous cholecystitis (older adults + critically ill; prolonged immobility, fasting, parenteral nutrition, DM; bacteria or chemical irritants; adhesions, neoplasms, anesthesia, opioids) -Inflammation >Confined to mucous lining or entire wall >Gallbladder edematous + hyperemic; may be distended w/ bile or pus >Cystic duct may become occluded >Scarring + fibrosis after attack

cholelithiasis

-most common disorder of biliary system - stones in gallbladder -Cause unknown; develops when altered balance of cholesterol, bile salts, + calcium in solution leading to precipitation -Bile secreted by liver is supersaturated w/ cholesterol (lithogenic) + this leads to bile stasis (biliary sludge) -Immobility, pregnancy, + inflammatory or obstructive lesions of biliary system decreases bile flow -Stones may remain in gallbladder or migrate to cystic or common bile duct -Cause pain as they pass thru ducts → may lodge in ducts + produce an obstruction

prostate cancer

1 in 6 men will develop in their lifetime; most common cancer among men besides skin cancer Androgen dependent carcinoma -Most are slow growing + occur in outer part of prostate -Bone: most common site for metastasis Spreads by 3 routes -Direct extension: involves seminal vesicles, urethral mucosa, bladder wall, + external sphincter -Through lymph system: to the regional lymph nodes -Through bloodstream: to pelvic bones, head of femur, lower lumbar spine, liver, + lungs

SCI health promotion

Identify: high risk populations, counseling, education Support legislation on seatbelt use, helmets for motor or bicyclists + child safety seats Referral to programs Facilitate wheelchair-accessible healthcare screening, exams rooms, etc

breast cancer

2nd most common cancer + cause of death; 5 yr survival rate if localized = 98% Classified as: -Ductal carcinoma: epithelial lining of (milk) ducts -Lobular carcinoma: epithelium of lobules (milk producing glands) Risk for invasive breast cancer increases if: -Ductal carcinoma in situ (DCIS)- used to be considered stage 0 -Lobular cancer in situ (LCIS)- used to be considered stage 0 Sites of metastasis: Locally in to skin, regionally to lymph nodes, distant often to bones/spinal cord/liver/lungs/brain Factors affecting prognosis: Tumor size, axillary node involvement (high metastasis risk), tumor cell differentiation (well or poorly), estrogen/progesterone receptor status, human growth factor receptors (HER2 + or -): protein that regulates cell growth

colorectal cancer risk factors

3rd most common cancer More common in men Highest mortality: African American 90% older than 50 Diet: increased intake of red or processed meat; decreased intake of fruit + veg Lifestyle: obese, inactive, alcohol, smoking Health factors: genetics, colorectal polyps, personal history of IBD Foods to avoid: red meat, animal fat + fatty foods, fried meats + fish, refined carbs (ex. Conc. sweets) Foods to consume: fruits + veg (esp. Cruciferous veg), whole grain products, adequate H2O, lean meats/fish (esp. baked/broiled)

breast cancer treatment- radiation

Adjuvant therapy: prevent recurrence, palliate pain Primary radiation therapy: Usually postop to breast, axilla, supraclavicular nodes, based on chance of residual cancer cells (tumor size, biology, # of involved lymph nodes) 5 days/wk over 5-7 wks Temporary side effects: fatigue, skin changes, breast edema Doesn't prevent distant metastasis Brachytherapy Internal radiation into post-op tumor cavity For early stage cancer: takes 5 days, minimally invasive; possible boost therapy w/ external irradiation; long term effectiveness under study

shock

A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion. Characterized by decreased tissue perfusion + impaired cellular metabolism, imbalance in supply/demand for O2 Affects all body systems: Oxygenation of organs depends on adequate blood flow- determined by MAP Underlying problems w/ all types of shock r/t effects of anaerobic metabolism

Hypersensitivity

A reflection of excessive or aberrant immune response Sensitization: initiates buildup of antibodies Types: anaphylactic/type I, cytotoxic/type II, immune complex/type III, delayed type/type IV

SCI evaluation

Adequate ventilation, intact skin, no episodes of autonomic hyperreflexia, est. bowel/bladder management program, no complications of immobility

shock assessment

ABCs Brief history: events leading to shock + onset/duration of symptoms Health history: meds, allergies, vaccinations Focused assessment of tissue perfusion: vitals, peripheral pulses, capillary refill, LOC, urine output, skin (temp, color, moisture)

primary survey

ABCs Disability, exposure, facilitation of adjuncts and family, get resuscitation adjuncts (DEFG) Uncontrolled external hemorrhage: C > ABC (reprioritized) → direct pressure followed by pressure dressing If life threatening conditions r/t ABCs are ID, interventions are started immediately before proceeding to next step of survey

acute pancreatitis clinical manifestations

Abdominal pain LUQ or midepigastrium, radiates to back, sudden onset, deep, piercing, continuous, steady, aggravated by eating, starts when recumbent, not relieved by vomiting, abdominal tenderness/guarding, decreased or absent bowel sounds

uterine cancer assessment

Abnormal bleeding; usually post-menopausal; possible are watery bloody vaginal discharge, low back or abdominal pain, low pelvic pain (enlarged uterus), palpable uterine mass (if large)

SCI Clinical Manifestations (Respiratory System)

Above level C4: total loss of resp muscle fxn → mechanical ventilation Below level C4: diaphragmatic breathing → resp insufficiency Cervical + thoracic injuries: paralysis of abdominal + intercostal muscles → ineffective cough → atelectasis or pneumonia Risk for neurogenic pulmonary edema

hypovolemic shock

Absolute hypovolemia: loss of intravascular fluid volume Hemorrhage, GI loss (vomiting, diarrhea), fistula drainage, diabetes insipidus, hyperglycemia, diuresis Relative hypovolemia (distributive/circulatory): Fluid volume moves from vascular to extravascular space(ex: intracavitary); termed third spacing Clinical manifestations: anxiety, tachypnea, increase in CO, HR, decrease in stroke volume, PAWP, urine output, if loss is >30%, blood volume is replaced

acute leukemias

Acute Myeloid Leukemia (AML) -25% of all leukemias; 80% of acute leukemias in adults -Uncontrolled proliferation of myeloblasts & hyperplasia of bone marrow & spleen -Abrupt, dramatic onset -Serious infection or abnormal bleeding Acute Lymphocytic Leukemia (ALL) -Most common in children; 20% adults affected -Immature, small lymphocytes proliferate in bone marrow (B cell origin) -Abrupt onset: fever, bleeding -Also progressive weakness, fatigue, pain -CNS manifestations common

SCI Clinical Manifestations (urinal system)

Acute Phase: Urinary retention, bladder atonic/overdistended; indwelling catheter Post Acute Phase: Bladder may become hyperirritable, loss of inhibition from brain, reflex emptying; will need self-catheterization

acute pancreatitis

Acute inflammation of pancreas Varies from mild edema to severe necrosis Most common in middle aged adults Etiology: gallbladder disease most common or chronic alcohol intake (2nd most common); smoking, hypertriglyceridemia Pathophysiology: -Cause: autodigestion of pancreas (injury to pancreatic cells, activation of pancreatic enzymes) -Activation of trypsinogen to trypsin leads to bleeding -Mild pancreatitis: edematous or intestinal -Severe pancreatitis: necrotizing, endocrine and exocrine dysfunction, necrosis, organ failure, sepsis, mortality rate 25%

acute pancreatitis nursing dx

Acute pain r/t distention of pancreas, peritoneal irritation, obstruction of biliary tract, ineffective pain and comfort measures Deficient fluid volume r/t nausea, vomiting, restricted oral intake, fluid shift into retroperitoneal space Imbalanced nutrition less than body requirements r/t anorexia, dietary restrictions, nausea, loss of nutrients from vomiting, impaired digestion Ineffective self health management r/t lack of knowledge of preventive measures, diet restrictions, alcohol restriction intake, follow up care Goals of acute pancreatitis are relief of pain, normal fluid and electrolyte balance, minimal to no complications, no recurrent attacks

colorectal cancer

Adenocarcinoma- most common (85% arise from adenomatous polyps); metastasis often to liver, lungs, bone, brain, + adjacent structures

mitral valve stenosis

Adult causes: rheumatic heart disease (scarring of valve leaflets + chordae tendineae, adhesions between commissures of leaflets) Decreased blood flow from LA → LV, increased LA pressure + volume, increased pressure in pulmonary BVs Risk for AFib Clinical Manifestations: -Exertional dyspnea, fatigue, chest pain, seizures/stroke (emboli) -Loud S1, low pitched diastolic murmur, palpitations -Possible hoarseness, hemoptysis (pulmonary HTN)

emergency nursing

After initial focused assessment to determine actual or potential threats to life, proceed w/ more detailed assessment Primary Survey: ABCDE Airway, breathing, circulation, disability (musculoskeletal/neuro), exposure/environmental control Identify life threatening conditions Secondary survey: done once primary survey completed & life threatening injuries have been treated

ovarian cancer risk

Age 55-65 or >, + family history for ovarian, breast, colon cancers; nulliparity, >30 yrs at first pregnancy ( inc # ovulatory cycles), infertility drugs, BRCA1 or BRCA2 gene mutations; high fat diet. Protective: oral contraceptives, breast feeding, multiple pregnancies

BPH risk factors

Aging Obesity (esp. increased waist circumference) Lack of physical activity Alcohol consumption, smoking Erectile dysfxn diabetes

primary survey - airway

Alertness & Airway -Determine LOC -Assess pt response to verbal/painful stimuli -AVPU: alert, responsive to voice, responsive to pain, unresponsive Airway Obstruction - cause of most immediate trauma deaths Pts at risk for airway compromise (seizures, drowning, anaphylaxis, obstruction, cardiopulmonary arrest) s/s of compromised airway: dyspnea, inability to speak, gasping (agonal) breaths, foreign body in airway, face/neck trauma Treatment: Airway Issues -Open airway: jaw thrust maneuver (avoid hyper-extending neck) -Suction and/or remove foreign body -Insert naso or oropharyngeal airway- in unconscious pts only -Endotracheal intubation -Rapid Sequence Intubation (for unprotected airway): involves sedation or anesthesia & paralysis -Suspect C spine trauma in any pt with: face/head/neck trauma & significant upper chest injuries -Stabilize cervical spine w/ cervical collar or manually hold head/neck in alignment when needed

allergy

Allergy: -An inappropriate, often harmful response of immune system to normally harmless substances -Hypersensitive reaction to an allergen initiated by immunological mechanisms that is usually mediated by IgE antibodies Allergen: substance that causes allergic reaction Atopy: allergic reactions characterized by IgE antibody action and a genetic predisposition IgE antibodies are involved in allergic disorders -Allergen triggers B cell to make IgE antibodies, which attach to mast cells -Mast cells release chemical mediators (histamine, serotonin, kinins, SRS-A, neutrophil factor) which cause reactions seen in allergic response

SCI complication - autonomic hyperreflexia

Also called autonomic dysreflexia → massive uncompensated CV reaction mediated by: -SNS: responds to stimulation of sensory receptors- parasympathetic NS unable to counteract -HTN + bradycardia result Most common precipitating factor is distended bladder or rectum Manifestations: HTN, throbbing headache, marked diaphoresis above level of injury, bradycardia, piloerection, flushing of skin above level of injury, blurred vision/spots in visual field, nasal congestion, anxiety, nausea Nursing Interventions Raise head, notify HCP Asses for + remove cause: immediate catheterization, remove stool impaction if cause, remove constrictive/tight clothing + shoes pt/ family teaching

chronic pancreatitis care

Analgesics for pain relief during acute exacerbation: morphine or fentanyl transdermal patch (duragesic) Diet: bland, low fat, small and frequent meals No smoking, alcohol, caffeine Medication therapy: -Pancreatic enzyme replacement -Bile salts -Insulin or oral hypoglycemic agents -Acid neutralizing and acid inhibiting drugs -Antidepressants for neuropathic pain (nortriptyline) Surgery -When biliary disease is present if obstruction or pseudocyst develop -Diverts bile flow or relieves ductal obstruction -Choledochojejunostomy (anastomose common bile duct to jejunum) -Roux-en-Y pancreaticojejunostomy -Pancreatic drainage -ERCP w sphincterotomy and/or stent placement

uti management

Antibiotics -Based on empiric therapy or sensitivity test results -Uncomplicated: short 1-3 days; Complicated: 7-14 days -Trimethoprim/sulfamethoxazole, nitrofurantoin, penicillins/cephalosporins (uncomplicated), fluoroquinolones (complicated) Antifungals: fluconazole, amphotericin Urinary analgesic: phenazopyridine (stains urine/clothing reddish orange) Methenamine/phenyl salicylate (with abx to relieve symptoms) Prophylactic or suppressive antibiotics sometimes if repeated UTIs Prevention: Routine infection control measures; Remove indwelling catheters ASAP

ACS

Any condition brought on by a sudden reduction or blockage of blood flow to the heart Deterioration of plaque --> rupture --> platelet aggregation --> thrombus Results in: - Partial occlusion of coronary artery (Unstable angina or NSTEMI) - Total occlusion of coronary artery (STEMI)

gastric ulcers

Any portion of the stomach. Occur less often than duodenal. Prevalent in women, older adults (peak incidence > 50 yrs age) Risk Factors: H. pylori, smoking, meds, bile reflux

Allergic disorders assessment + dx

Assess hx of allergy and s/s including severity Labs: CBC w eosinophil count, total serum IgE Skin tests: w/hold antihistamines/corticosteroids 48-96 hrs prior to avoid false negative results- can suppress skin test reactivity Positive reaction to antigen: urticarial wheal (round, reddened skin elevation), localized erythema (diffuse redness) in area of inoculation or contact, or pseudopodia (irregular projection at end of a wheal) w associated erythema

breast cancer - postop

Assessment -CV, respiratory, + urinary status: vital signs, lung sounds, bowel sounds, urinary output patterns -pain + effectiveness of analgesics -dressing + incision site for excess drainage, s/s infection, wound healing, intact staples -drainage around drain site + in drain, color/amt drainage, s/s infection -Review client's recording of drainage; evaluate ability to empty + care for drain -status of affected extremity, incl ROM, ability to perform exercise regimen, lymphedema Interventions -Inform pt common postop sensations, maintain privacy, pain control -Avoid use of arm on affected side for IVs, BP; elevate on pillow while awake -Arm + hand exercises -Monitor tissue perfusion r/t edema or bleeding; monitor VS incl temp -Provide support for mobility Monitor nutritional status: food + fluid intake; N/V; bowel sounds Assist w/ functional ability, incl ADLs, mobility Assess home environment (safety/structural barriers) Assess illness knowledge, tx plan, Drain < 30 mL/24 hrs 7-10 days Assess client/caregiver coping skills Bra with breast form

allergies nursing management

Assessment: Skin rash and inflammation, hives, flushing Itching Nasal, eye, sinus symptoms Respiratory irritation or asthma episode Shock (rare) Treatment: Detect symptoms early, institute prompt treatment Antihistamines, corticosteroids, epinephrine Avoiding allergen exposure is most effective

cervical cancer - assessment

Asymptomatic if pre-invasive; painless vaginal bleeding (classic), may start as spotting or watery blood tinged drainage that worsens. Metastasis: weight loss, pelvic pressure, dysuria, hematuria, rectal bleeding, cough; pain: late sign

artificial airways

Created by placing a tube into trachea to bypass upper airway + laryngeal structures Endotracheal intubation- via mouth or nose past larynx Tracheostomy- via stoma in neck Indications: upper airway obstruction (tumor, brain injury), apnea, unable to protect airway (high risk of aspiration), ineffective airway clearance of secretions, respiratory distress Potential Complications: unplanned extubation, aspiration, infection

cranial surgery

Burr hole- drilling into cranium to remove localized fluid & blood beneath dura → reduces ICP Craniotomy- opening into cranium to remove bone flap, open dura to remove lesion or repair damaged area, drain blood, or relieve increased ICP. Craniotomy may be indicated in patients with hemorrhagic injuries and typically involves opening of the skull and removal of blood accumulations. Brain cancer management Craniectomy- excision into cranium to cut away bone flap Cranioplasty- repair cranial defect from trauma, malformation, or previous surgery; artificial material used to replace damaged/lost bone Stereotactic procedure- precise localization of specific area of brain using a frame or frameless system based on 3D coordinates; used for biopsy, radiosurgery, or dissection Shunt procedures- alternate pathway to redirect CSF from 1 area to another using a tube or implanted device (ex. Ventricular shunt, Ommaya reservoir)

bph pt teaching

Bladder may take up to 2 months to return to normal after surgery -Urinate every 2-3 hours to flush tract after catheter removed -Adequate fluid intake (at least 2 L/day) -Self assess s/s UTI, wound infection -Prevent constipation -Avoid heavy lifting (10 lbs) -Refrain from driving, intercourse as directed Sexual counseling prn Avoid bladder irritants (caffeine, citrus juice, alcohol) Yearly DRE

primary survey - breathing

Breathing Assess for dyspnea, cyanosis, paradoxical, or asymmetric chest wall movement, decreased or absent breath sounds, visible wound to chest wall, tachycardia, hypotension Admin high flow O2 via non-rebreather mask For life threatening conditions: Bag valve mask ventilation w/ 100% O2 Needle decompression Intubation Treat underlying cause

secondary survey

Brief, systematic process to identify all injuries in this order: -History (what happened & what was done on scene) -Head, neck, face: general appearance, skin color & temp; disconjugate gaze; battle's sign & raccoon eyes; blood & CSF from ears/nose; airway -Chest: paradoxical chest movement; large sucking chest wounds; palpation, auscultation; pneumothorax, rib fractures, pulmonary contusion, blunt cardiac injury, hemothorax; obtain chest x ray and EKG -Abdomen and flanks: frequent evaluation for subtle changes; focused abdominal sonography for trauma (FAST) for intraabdominal hemorrhage; possible CT to identify bleeding -Pelvis and perineum: gently palpate and do not rock; may need x-ray; look for bladder distention, hematuria, dysuria, unable to void; genitalia/rectum -Extremities: tenderness, crepitus, deformities; immobilize and elevate injured extremities, apply ice packs; pulseless extremity is a time critical emergency; compartment syndrome compromises viability of muscles, nerves, & arteries -Inspect posterior surfaces: logroll pt while maintaining c-spine immobilization (requires 3-4 ppl), support head

kidney transplant recipient postop care

Fluid and electrolyte balance is first priority Large volumes of urine soon after transplant completed, as a result of New kidney's ability to filter BUN Large amounts of fluids during operation Initial renal tubular dysfunction UO replaced w fluids mL by mL hourly and closely measured Acute tubular necrosis can occur (may necessitate dialysis) Maintain catheter patency

prostate cancer pt teaching

Caring for urinary drainage devices, prevention of complications Regain bladder continence >Gradual regaining process (dribbling up to one year) >Perineal exercises Avoid straining, heavy lifting, long car trips for 6-8 wks Diet- fluids, avoid coffee, alcohol, spicy food Assess sexual issues + provide referrals prn

chest trauma emergency management

CAB if unresponsive Admin O2 to keep > 90%; potential intubation IV access w 2 lg bored catheters; fluid resuscitation prn Remove clothing to assess injury Cover sucking chest wound w/ non-porous dressing taped on 3 sides Stabilize impaled objects - don't remove Stabilize flail rib segment Place in semi-fowler's Prep for emergency needle decompression

SCI Labs + Diagnostics

CT scan, cervical x-rays, MRI, comprehensive neuro exam, CT angiogram

PPV complications

CV System- increased mean airway pressure in thorax leads to decreased venous return to heart, which leads to decreased CO + BP Barotrauma- air can escape into pleural space from alveoli or interstitium + l/t pneumothorax Aspiration- because epiglottis is bypassed Pneumomediastinum- rupture of alveoli into lung interstitium, subcutaneous emphysema followed by pneumothorax Ventilator-associated pneumonia -Risk factors: contaminated resp equipment, inadequate hand hygiene, environmental factors, impaired cough, colonization or oropharynx -Clinical manifestations: fever, high WBC count, purulent/odorous sputum, crackles/wheezing -Prevention: minimize sedation, early mobilization, subglottic secretion drainage port, keep HOB 30-45 degrees, strict handwashing, wear gloves Mechanical Ventilation Issues Ventilator disconnection Ventilator malfunction

aortic valve regurgitation

Can be acute or chronic Backward blood flow from aorta into LV Manifestations: chronic AR Asymptomatic for years LV dilation + hypertrophy, decreased myocardial contractility, pulmonary HTN, RHF, DOE, orthopnea, PND Angina; "water-hammer" pulse, if severe S3 or S4, murmur

MI clinical manifestations

Catecholamine release causes SNS stimulation: Release of glycogen Diaphoresis Vasoconstriction of peripheral blood vessel Skin: ashen, clammy/cool to touch CV: Initially increases HR/BP, then lowers (secondary to decreased CO) Crackles JVD Abnormal heart sounds: S3/S4, New murmur Nausea/vomiting Reflex stimulation of vomiting center by severe pain Vasovagal reflex Fever: Up to 100.4 in first 24-48 hours Systemic inflammatory process caused by myocardial cell death

Mitral valve regurgitation

Cause: Damage from MI, IE, mitral valve prolapse, chronic RHD, ischemic papillary muscle Incomplete closure → backward blood flow Acute MR: pulmonary edema Chronic MR: L atrial enlargement, ventricular hypertrophy → low CO Acute Manifestations: thready, peripheral pulses + cool/clammy extremities Chronic Manifestations: asymptomatic for years until LV failure develops (weakness, fatigue, palpitations, progressive dyspnea, peripheral edema, S3, murmur)

abdominal trauma

Causes: blunt trauma (falls, MVCs, pedestrian events, assault w blunt object, crush injuries, explosions), penetrating trauma (knife, gunshot, impalement) Hypovolemic shock: decreased LOC, tachypnea, tachycardia, decreased BP, decreased pulse pressure, abrasions or ecchymoses, open wounds, impaled objects, nausea/vomiting, hematemesis, absent or decreased bowel sounds, hematuria, abdominal distention or rigidity, pain w/ palpation, rebound tenderness Initial interventions ABCs, give O2 Control external bleeding w/ direct pressure or sterile pressure dressing Establish IV access w/ 2 large bore caths: infuse normal saline or LR Obtain blood for type/crossmatch & CBC Remove clothing Stabilize impaled objects w/ bulky dressing - do not remove Cover protruding organs w/ sterile saline dressing Insert indwelling urinary cath if no blood at meatus, pelvic fracture, or boggy prostate Obtain urine for UA Insert NG tube if no evidence of facial trauma Anticipate diagnostic peritoneal lavage Ongoing monitoring: vitals, LOC, O2 sat, UO, maintain warmth

VHD treatment

Conservative Treatment: Prophylactic abx to prevent recurrent RF, IE Depends on valve involved + severity Prevent exacerbations of HF, pulmonary edema, thromboembolism, recurrent endocarditis Na restriction Anticoagulation therapy Meds Treat/Control HF Vasodilators (nitrates, ACEIs), positive inotropes (digoxin), diuretics, BBs Antidysrhythmics - CCBs Percutaneous transluminal balloon valvuloplasty (PTBV) Surgical therapy Valve repair: surgical procedure of choice, lower mortality, may not restore total valve fxn Mechanical (Artificial) Valve Replacement: last longer; risk of thromboembolism, long term anticoagulation Biologic Valve Replacement: bovine, porcine, human; no anticoagulation but less durable

primary survey - circulation

Check central pulse & check quality/rate (peripheral pulses may be absent bc of injury or vasoconstriction) Assess skin: color, temp, moisture Assess for signs of shock: mental status, delayed capillary refill Insert 2 large bore IV caths Initiate aggressive fluid resuscitation using NS or LR solution

prostate cancer therapeutic management

Chemoprevention: active area of research >>Finasteride + other drugs to treat BPH may decrease risk of prostate cancer by up to 25%. Can increase risk developing aggressive prostate cancer Early recognition + treatment important >>90% are initially diagnosed in a local or regional stage: survival rate 100% at this stage TNM system is most commonly used to determine extent of prostate cancer Graded using Gleason scale (score range 2-20) From 1 (well differentiated) to 5 (undifferentiated) Grades are given to 2 most common patterns of cells + are added together Active surveillance Life expectancy < 10 yrs Low grade, low stage tumor Serious coexisting medical conditions

breast cancer treatment- chemo + hormonal therapy

Chemotherapy indications: -Larger tumors, aggressive growth, hormone receptor -, + lymph nodes -May be given preop to decrease size of primary tumor (neoadjuvant therapy) Drug combinations: -More effective than 1 drug (>1 actions, diff phases of cell cycle) -SE for rapidly dividing cells: GI, bone marrow, hair -Cognitive changes "chemobrain": Affects up to 83% clients, difficulty in concentration, memory, maintaining attention Hormonal therapy -Can suppress estrogen synthesis if estrogen receptor + (promote tumor regression) -adjuvant to primary treatment; for recurrence or metastasis -Types of hormonal therapy: estrogen receptor blockers or modulators, aromatase inhibitors, monoclonal antibody

chronic leukemias

Chronic Myeloid Leukemia (CML) -↑ mature neoplastic granulocytes in bone marrow -Move into blood in massive numbers; can infiltrate liver & spleen -Philadelphia chromosome: Genetic marker in >90-95% pts; chromosome 9, 22 genetic material translocated -Chronic, stable phase for years then acute, aggressive (blastic) phase Chronic Lymphocytic Leukemia (CLL) -Most common form in adults -Functionally inactive but long-lived, mature-appearing lymphocytes -B cell involvement -Lymphadenopathy body wide -Early stage complications rare but may develop as advances: pain, paralysis from pressure caused by enlarged lymph nodes

intestinal obstruction nursing assessment

Clinical Manifestations of Obstruction - Mechanical: -Mid abd pain/cramping -Vomiting, diarrhea -Obstipation; altered bowel pattern + stool -Abd distention, tenderness -Borborygmi- increased BS early then decreased to absent Clinical Manifestations of Obstruction - Non Mechanical: -Constant diffuse discomfort -Obstipation -Abd distention -Vomiting -Decreased to absent bowel sounds

lung cancer assessment

Clinical Manifestations: Persistent, chronic cough/sputum Pneumonitis Hemoptysis Dyspnea/wheezing Chest pain Later: anorexia, N/V, hoarse, palpable lymph, unilateral diaphragm paralysis, dysphagia, SVC obstruction, mediastinal involvement Nursing Assessment Subjective: PMH, meds, smoking history, fatigue, cough, dyspnea, hemoptysis, pain (chest, shoulder, arm, bone), headache Objective: fever, SIADH, jaundice, edema, club, adventitious, pleural effusions, chest pain, hemoptysis, pericardial effusion, dysrhythmias, unsteady gait Labs + Diagnostics: Screening done w/ low dose spiral CT scanning- annually in adults ages 55-74 w/ Hx smoking

SCI rehab/home care

Complex; goal to fxn at highest level of wellness Retraining focus; interdisciplinary endeavor organized around pt goals/needs Expectations of pt: be involved in therapies + learn self care Frequent encouragement needed Respiratory Rehab -Phrenic nerve stimulator -Diaphragmatic pacemaker -Mobile ventilators -Pt teaching: home ventilator care; non-vent dependent- assisted coughing, IS, DB

Diffuse (TBI)

Concussion -Brief disruption in LOC; lethargy -Retrograde amnesia -Headache -Often short duration -May result in post concussion syndrome (persistent HA, lethargy, personality + behavior changes; shortened attention span, impaired STM/intellectual ability) Diffuse Axonal Injury -Widespread axonal damage -Decreased LOC, Increased ICP -Decortication, decerebration -Global cerebral edema -90%: vegetative state

aortic valve stenosis

Congenital or degenerative Obstructs blood flow from LV to aorta, LV hypertrophy + increased myocardial O2 consumption, decreases CO, pulmonary HTN, HF Clinical Manifestations: angina, syncope, DOE, murmur, S4 Use nitro cautiously (decreased preload + BP, can worsen chest pain)

MI complications

Dysrhythmias: Most common complication- 80% of MI pts -Caused by ischemia, electrolyte imbalances, or SNS stimulation -Life threatening w anterior MI, HF, shock Heart Failure: Occurs when pumping power of heart has diminished Cardiogenic shock d/t severe LV failure. Requires aggressive management. Papillary muscle dysfunction causes mitral valve dysfxn/regurgitation: Aggravates an already compromised LV → rapid clinical deterioration Ventricular aneurysm- Myocardial wall becomes thinned/bulges out during contraction: Leads to HF, dysrhythmias, angina Acute pericarditis: Inflammation of visceral/ parietal pericardium Dressler syndrome: Pericarditis w/ effusion, fever that develops 4-6 wks post MI

chronic pancreatitis dx studies

ERCP, CT, MRI, MRCP, US, secretin stimulation Labs: Serum amylase/lipase slightly elevated Increased serum bilirubin Increased alkaline phosphatase Mild leukocytosis Increased sedimentation rate Stool samples for fat elevated Decreased fat soluble vitamin and cobalamin levels Glucose intolerance

priority setting

Deciding which needs or problems require immediate attention vs. can be delayed until a later time because they aren't as urgent Classifications -High: client needs that are life-threatening or if untreated could cause harm -Intermediate: non-emergency + non life-threatening needs r/t current health issue, other active comorbid issues -Low: client needs not directly related to client's illness or prognosis Guidelines for Prioritizing -ABC guideline: Airway, Breathing, Circulation -Maslow's Hierarchy of Needs: physiological needs, safety, love + belonging, self esteem, self-actualization Prioritizing Clients -Client w/ most life-threatening need -Client that is least stable -If all are stable, which client is most at risk for a complication to develop -Client w/ infection control issue Prioritizing Interventions -Need for more assessment before intervening (single data point vs. full data set) -Priority actions to comply w/ agency policy (ex. meds) -Least restrictive vs. more restrictive actions -If communicating, address client's feelings first -If teaching, assess motivation + readiness to learn first

pneumothorax nursing care/treatment

Dependent on severity, may resolve spontaneously Treatment: thoracentesis, chest tubes, heimlich chest drain flutter valve, pleurodesis (if repeated occurrences) Urgent needle decompression for tension pneumothorax

breast cancer clinical manifestations

Detected as lump, thickening, or mammographic abnormality in breast Most often upper-outer quadrant (dense w/ glandular tissue) May have nipple discharge or peau d'orange Rate of growth varies: slow growth associated w/ lower mortality rates

PUD labs + dx

Determine presence + location of ulcer; similar to those used for acute upper GI bleed -Endoscopy w/ biopsy: Most accurate, allows direct viewing of mucosa -Determines degree of ulcer healing after tx -During procedure, tissue specimens can be obtained to ID H. pylori + rule out gastric cancer Tests for H. pylori -Noninvasive: antibody titer IgG; urea breath test (urea is a byproduct of the metabolism of h pylori) -Invasive: endoscopy or stomach biopsy w rapid urease test >>Gastric analysis: volume and acidity; NGT inserted and samples drawn >>Barium contrast studies if endoscopy cannot be done (good to diagnose GOO) -Labs: CBC (anemia secondary to ulcer bleeding), urinalysis, liver enzymes (if caused by liver problem), serum amylase (if caused by pancreatic problem: when posterior duodenal ulcer penetration of pancreas is suspected), stool examination for blood

artificial airway nursing care

Maintain tube placement + proper cuff inflation (20-25 cm H2O, w/ cuff pressure manometer) Provide oral care + suctioning (decrease aspiration, infection) Monitor oxygenation status + VS (ABGs, SpO2, signs hypoxemia, change in mental status, anxiety, dusky skin, dysrhythmias) Provide explanation to pt + family + provide means of communication Monitor ventilation: PaCO2, end-tidal CO2, RR + rhythm, use of accessory muscles

mechanical ventilation nursing care

Diagnosis: risk for infection, respiratory dx's, impaired communication, low CO Interventions -HOB 30-45 degrees -Daily "sedation vacation" / readiness to wean assessment -Prophylactically: peptic ulcer & DVT -Oral care with chlorhexidine -Weaning >>Criteria: able to breathe spontaneously, support own oxygenation, + maintain hemodynamic stability >>Weaning methods: spontaneous breathing trial w/ pressure support, CPAP, or T-piece

primary survey DEF

Disability Measured by LOC, GCS, pupils Exposure & Environmental Control Remove clothing for physical assessment; don't remove impaled objects Prevent heat loss (Baer hugger, blankets) Maintain privacy Facilitate resuscitation adjuncts Lab studies, Monitor ECG, NG or orogastric tube, Oxygenation/ventilation assessment (pulse ox), Pain management Facilitate family presence- comfort, explain care, answer questions

pud pt teaching

Disease (basic etiology, patho) Drugs: actions, side effects; don't take any meds w/o provider approval; take ulcerogenic meds w/ food, milk Lifestyle changes: appropriate changes in diet; smoking cessation; negative effects of alcohol Importance of compliance w/ plan of care + regular follow-up

gallbladder disease drugs/nutrition

Drug therapy -Most common: analgesics (morphine, NSAIDs), anticholinergics (Atropine), fat soluble vitamins (A, D, E, K), bile salts -Cholestyramine for pruritus: given in powdered form, mixed w/ milk or juice -Monitor SE: N/V/D or constipation, skin rxns Nutritional therapy -Small, frequent meals w/ some fat -Diet low in saturated fat -High in fiber + calcium -Reduced calorie diet if obese -Avoid rapid weight loss -After laparoscopic cholecystectomy: liquids first day, light meals several days after -After incisional cholecystectomy: liquids to regular diet after return of bowel sounds, may need restrict fats for 4-6 wks

anaphylaxis common allergens

Drugs: aspirin, cephalosporins, chemo drugs, insulins, local anesthetics, NSAIDs, penicillins, sulfonamides, teracycline Foods: eggs, milk, nuts, peanuts, shellfish, fish, chocolate, strawberries Treatment measures: allergenic extracts used in immunotherapy, blood products, iodine contrast Insect venoms: wasps, hornets, yellow jackets, bumblebees, ants Animal sera: diphtheria antitoxin, rabies antitoxin, snake venom antitoxin, tetanus antitoxin

uterine cancer dx

Endometrial biopsy, pelvic ultrasound, surgical dilation and curettage (D&C)-to scrape cells for eval. To rule out metastasis: possible CXR, IVP, barium enema, and liver and bone scans

BPH

Enlargement of prostate from increased # of epithelial cells + stromal tissue Most common urologic problem in men (about 50% over lifetime) Compression of urethra leads to: -Decrease in force of urinary system -Difficulty in initiating voiding -Intermittent voiding; dribbling

Transfusion Complications

Febrile nonhemolytic reaction (>90%); increased risk if previous transfusions -Chills, fever > 1 degree C rise w/in 2 hours; muscle stiffness -Use leukocyte reduction filter to prevent + antipyretics if fever occurs Acute hemolytic rxn: incompatible blood (preventable) -Fever, chills, low back pain, nausea, chest tightness, dyspnea, anxiety, hemoglobinuria, hypotension, bronchospasm, + vascular collapse -Possible acute kidney injury + DIC -Discontinue immediately; obtain blood + urine specimens (analyze for hemolysis). Maintain blood volume + renal perfusion; prevent/manage DIC Allergic reaction (plasma protein in blood) -Hives (urticaria), itching; pretreat/treat w/ antihistamines; anaphylaxis rare -Circulatory overload (esp. Older adults) -Don't infuse too quickly; possible diuretic Others: bacterial contamination, transfusion-related acute lung injury, delayed hemolytic rxn, disease acquisition Complication of long term transfusion therapy: iron overload

gallbladder risk factors

Female Multiparity Older than 40 yrs Estrogen therapy Sedentary lifestyle, obesity

Nursing evaluation of transplant pt

Maintenance of ideal body weight Acceptance of chronic disease and life long regimen No infection or edema H&H, serum albumin levels WNL

TBI complications

Epidural hematoma: Bleeding between dura + inner surface of skull; neuro emergency -Initial period unconsciousness, then brief lucid interval followed by decreased LOC -Headache, N/V -Requires rapid evacuation Intracerebral hematoma: Bleeding w/in brain tissue; usually w/in frontal + temporal lobes Subdural hematoma: Bleeding between dura mater + arachnoid Acute subdural: w/in 24-48 hr post injury -Symptoms r/t increased ICP -Decreased LOC, headache, ipsilateral pupil dilated + fixed if severe Subacute subdural: w/in 2-14 days of injury; may appear to enlarge over time Chronic subdural: Weeks or months after injury -More common in older adults -Presents as focal symptoms

PUD

Erosion of GI mucosa from Hcl acid, pepsin Acute: superficial erosion, minimal inflammation, short duration: resolves quickly when cause is identified + removed Chronic: muscular wall erosion w/ formation of fibrous tissue, long duration: present continuously for many months or intermittently throughout person's lifetime, more common than acute erosions Develops only in acid environment Mucosal barrier protects underlying GI tissue from acid + pepsin. If mucosal barrier impaired (by H. pylori, NSAIDs/ASA, steroids, alcohol, coffee, smoking, stress) cellular destruction + inflammation can occur General s/s: pain, N/V, heartburn, full or bloated feeling, weight loss, blood in vomit or dark stools (from bleeding)

chronic pancreatitis

Etiology: alcohol, gallstones, tumor, pseudocysts, trauma, systemic disease; can be idiopathic 2 major types -Chronic obstructive: gallstones inflame sphincter of oddi -Chronic nonobstructive: most common; inflammation and sclerosis of head of pancreas and around Abdominal pain Located in same areas as in acute pancreatitis Heavy, gnawing feeling; burning and cramplike Malabsorption w/ weight loss d/t pancreatic insufficiency Constipation, jaundice, icteric urine (icteric is like jaundice- can see bile in urine), steatorrhea, DM

Acute Care & Evaluation

Evaluate need for tetanus prophylaxis Provide ongoing monitoring Evaluate pt's response to interventions Insert an indwelling cath as indicated Prepare for: diagnostics, admit to general unit or tele or ICU, transfer to another facility Gerontologic considerations -Usual interventions done regardless of age unless pre-existing terminal illness, extremely low chance of survival, advance directive -Older adults at high risk for injury and falls -Determine whether physical findings may have caused fall or d/t fall -Fully explore any complaint made by an older adult

SCI classification

Major mechanisms of injury: flexion, hyperextension, flexion-rotation, extension-rotation, compression Level of Injury -Skeletal level: most damage to bones + ligaments -Neurologic level: lowest level of cord w/ bilateral normal sensory/motor fxn -May be cervical, thoracic, lumbar Tetraplegia (quadriplegia) Paraplegia Degree of Injury Complete: total loss of sensory + motor fxn below level of injury Incomplete (partial): mixed loss of voluntary motor activity + sensation; some tracts intact

chronic pancreatitis Nursing Management

Focus on chronic care + health promotion Pt + family teaching -Dietary control -Pancreatic enzyme w/ meals + snacks -Observe for steatorrhea -Monitor glucose -Antacids after meals + at bedtime -No alcohol

cholecystitis complications

Gangrenous cholecystitis Pancreatitis Subphrenic abscess Cholangitis Biliary cirrhosis Fistulas Gallbladder rupture → peritonitis Choledocholithiasis

AAA treatment

Goal- prevent rupture; early detection + treatment imperative If small (4-5.4 cm) - conservative therapy (risk factor modification; decrease BP; US, MRI, CT scan q 6-12 months) 5.5 cm: threshold for repair; women w/ AAA- 5 cm Endovascular Aneurysm Repair (EVAR) - lasts 10 yrs -Sutureless aortic Dacron Graft delivered via sheath + placed into AAA via femoral artery cutdown -Graft deployed against vessel wall by balloon inflation; anchored to vessel by series of small hooks -Blood flows through graft; aneurysm shrinks over time since it cannot expand -Advantages: less risk than surgery, shorter recovery, higher pt satisfaction, less cost -Disadvantages: endoleak, aneurysm growth or rupture, aortic dissection, bleeding, infection Open Surgical Procedure -If ruptured, emergency surgery; 90% mortality AAAs -Preop: hydration; stabilize electrolytes, coagulation, + hematocrit -Open aneurysm repair (OAR): incise diseased segment, remove thrombus/plaque, insert graft, suture native aortic wall around graft AAA resection -Require cross clamping of aorta above + below aneurysm; can be completed in 30-45 mins; clamps are removed + blood flow to legs is restored -If extends above renal arteries or if cross-clamp applied above renal arteries: check for adequate renal perfusion after clamp removal. Risk of postop renal complications increased

crc nursing care (goals + health promo)

Goals -Normal bowel elimination pattern -QOL appropriate to disease progression -Pain relief; feeling of comfort + well-being Health Promotion -Encourage regular CRC screening > 50 yrs -Help ID those @ risk -Participate in early cancer screening to help decrease mortality rates -Realize that fear + lack of info create barriers to prevention -Colonoscopy detects polyps only when bowel is adequately prepared >>Provide teaching abt bowel cleansing for outpt procedures (clear liquid diet 24-48 hrs) >>Correctly admin cleansing preps to inpatients

ckd management

Goals: Preserve existing kidney function, reduce risk of CVD & complications, comfort Conservative therapy -Correct extracellular fluid overload/deficit -Nutritional therapy; erythropoietin therapy -Calcium supplementation, phosphate binders, measures to lower K+ -Antihypertensive therapy Drug therapy -Hyperkalemia: IV insulin & 10% calcium gluconate; Sodium polystyrene sulfonate -Antihypertensive drugs (+ weight loss, lifestyle changes, diet, sodium/fluid restriction) -Diuretics, CCB, ACEI/ARB -CKD= mineral/bone disorder: PO4 not restricted until needs renal replacement therapy; Phosphate binders; Supplement vitamin D: calcitriol -Anemia: Erythropoietin, iron, folic acid supplements, avoid blood transfusions -Dyslipidemia: statins, fibric acid derivatives Complication: drug nephrotoxicity

transplant immunosuppressive therapy

Goals: adequately suppress immune response to prevent rejection, and maintain sufficient immunity to prevent overwhelming infection

pud nursing care

Goals: adhere to tx, reduce discomfort, no GI complications, complete healing, prevent recurrence - lifestyle changes Acute Intervention: NPO, possibly NG tube IV hydration Explain tx Regular oral care Cleanse + lubricate nares if NG tube VS hourly; monitor I+O physical/emotional rest Sedatives can mask s/s of shock

bph therapeutic management

Goals: restore bladder drainage, relieve symptoms; prevent/treat complications Treatment based on: how bothersome symptoms are, any complications present Conservative therapy: Active surveillance of lack of presence of symptoms, mild s/s (AUA score 0-7), symptoms may disappear Lifestyle changes may help (less caffeine, artificial sweeteners, spicy or acidic foods; timed voiding schedule) Drug therapy: 5a-reductase inhibitors to reduce prostate size A adrenergic blockers for smooth muscle relaxation Erectogenic drugs decrease s/s of both BPH + ED Herbal therapy: successfulness varies, tell provider Minimally invasive therapies Becoming more common Destroy prostatic tissue: lasers, radiowaves, ultrasound, microwaves, needle ablation (electric current) Intraprostatic urethral stents (for poor surgical candidates)

pulmonary artery pressure monitoring

Guides management of complicated cardiopulmonary problems Pulmonary artery diastolic (PAD) pressure & PAWP can tell heart function & fluid volume status Allows for precise manipulation of preload PA flow directed catheter (aka swan ganz cath) Complications: sepsis and infection (asepsis for insertion and maintenance, change flush bag and pressure tubing and transducer and stopcock every 96 hrs); air embolus (monitor balloon integrity, luer lock connections, alarms on); pulmonary infarction of PA rupture (do not inflate balloon w more than 1.5 mL, monitor waveforms continuously, maintain continuous flush system); ventricular dysrhythmias (monitor during insertion and removal)

breast cancer complications

Hand + Arm Care: Prevent Lymphedema After lymph node dissection No BP, injections, blood draws Perform 3x day 20 minutes for increased circulation and muscle strength, prevent stiffness/contractures, restore ROM Limit lifting 5-10 lbs

Traumatic Brain Injury

Head injury: any trauma to skull, scalp brain TBI = serious head injury → high potential for poor outcome Causes: motor vehicle collisions, falls, firearm related injuries, assaults, sports-related injuries, recreational accidents, war-related injuries Deaths occur at 3 times: immediately after injury, w/in 2 hours, or 3 weeks after

prostate cancer nursing assessment

Health Hx -Meds (testosterone supplement, morphine, anticholinergic, MAOI, tricyclic antidepressant) -Family hx -High-fat, anorexia, weight loss -Urinary urgency, frequency, retention with dribbling, hematuria, nocturia -Dysuria, ↓ back pain radiating to legs or pelvis, bone pain Objective Data -Anxiety -Distended bladder; unilaterally hard, enlarged fixed prostate on rectal examination -High PSA, PAP nodular irregularities on ultrasonography, positive biopsy, anemia Clinical Manifestations -Usually asymptomatic in early stages -Dysuria, dribbling, hesitancy/interruption of urine stream, frequency or urgency, hematuria, nocturia, retention/inability to urinate -Can metastasize

Breast Cancer screening

Mammograms May begin at age 40: discuss w/ provider Age 50 + above; yearly or every other year screening depending on source Regular clinical breast exams (CBE): specific guidelines changing in last few yrs; q 2-3 yrs in 20s + 30s; yearly starting age 40 More intensive screening, testing, + exams for women at high risk: family hx, genetic link, past BC

gallbladder disease nursing care

Health Promotion -Screen disposing factors; teach at risk groups -Early detection of chronic cholecystitis (manage w/ low fat diet) Goals for acute intervention -Relieve pain, N/V; comfort/emotional support; FE balance/nutrition; accurate assessments, monitor for complications Acute Intervention pain management, comfort measures, manage N/V, pruritus relief (baking soda or alpha keri baths, lotion, soft linen, tem control, short and clean nails, scratch w knuckles), monitor for complications (obstruction, bleeding, infection) Postop Care -Laparoscopic cholecystectomy: monitor for complications, pt comfort (sims' positions, deep breathing, ambulation, analgesia); clear liquids -Incisional cholecystectomy: maintain adequate ventilation and prevent respiratory complications, general postop nursing care, maintain drainage tubes

bph nursing care

Health Promotion Early detection/treatment (DRE men > 50) Alcohol, caffeine, cold and cough meds can increase symptoms If obstructive symptoms, urinate every 2-3 hrs when first feel urge Minimizes stasis & acute urinary retention Teach need for adequate fluid

VHD nursing care

Health Promotion: Dx + treat strep, prophylactic abx for pts w/ history, encourage compliance, teach pt when to seek medical treatment (worsening symptoms) -Individualize rest + exercise to pt tolerance -Avoid strenuous activity (to avoid excess increase in CO demand) -Discourage tobacco use -Ongoing cardiac assessments to monitor drug effectiveness -Monitor INR (currently rec goal: 2.5-3.5) after mechanical valve placement Pt Teaching Drug actions + side effects Importance of prophylactic abx therapy Info r/t anticoagulation therapy When to seek medical care + follow up care

prostate cancer Nursing Care

Health promotion- annual DRE + PSA screenings starting at age 50 (earlier if at risk) Acute intervention -Provide sensitive, caring support to pt + family to cope w/ cancer dx -Encourage joining a support group + seeking info Postop -Monitor urinary drainage; keep catheter patent (irrigate as Rx) - sterile! -Assess pain and discomfort from bladder spasms -Analgesics and antispasmodics, warm compress, sitz bath -Walk, avoid prolonged sitting -Prevent constipation -Monitor for complications (hemorrhage/shock, infection, DVT, catheter obstruction, secual dysfunction)

acute pancreatitis nursing care

Health promotion: -Assess + treat early any predisposing/etiologic factors -Early diagnosis/treatment biliary tract disease -Eliminate alcohol intake Acute intervention -Monitor vitals, respiratory function -Monitor IV fluids, fluid and electrolyte balance (hypocalcemia/tetany-calcium gluconate, hypomagnesemia) -Pain assessment and management: morphine, position changes (flex trunk and draw knees to abdomen, side lying w/ HOB elevated to 45 degrees) -Frequent oral and nasal care (for NPO or NGT) -Proper administration of antacids -Observe for s/s of infection -TCDB, semi fowler's -Wound care -Observation for paralytic ileus, renal failure, mental changes -Monitor serum glucose

CKD manifestations 2

Hematologic -Anemia (↓ production of erythropoietin from ↓ functioning renal tubular cells) -Bleeding tendencies (defect in platelet function) -Infection (changes in WBC function; altered immune response and function; ↓ inflammatory response) CV: HTN, LV hypertrophy, HF, peripheral edema, dysrhythmias, uremic pericarditis Neuro: Restless leg syndrome, muscle twitching, irritability, decreased concentration, peripheral neuropathy, seizures or coma if BUN increases rapidly Respiratory: Kussmaul's respirations, Dyspnea from fluid overload, PE< uremic pleuritis Integumentary: Pruritus, uremic frost (BUN > 200) GI (from high urea levels): Mucosal ulcerations, stomatitis, uremic fetor, GI bleeding, anorexia, N/V, constipation Reproductive: Infertility (both sexes); low sperm count, low libido, sexual dysfunction Musculoskeletal -Systemic CKD= mineral/bone disorder; results in skeletal complications (osteomalacia, osteitis fibrosa) -Extraskeletal (vascular calcifications) Psychologic: Personality/behavioral changes, emotional lability, withdrawal, anxiety or depression, often d/t body image changes

pud nursing care of complications

Hemorrhage -Increase in amt/redness of NG aspirate -Decreased pain: blood neutralizes gastric acid -Maintain patency of NG tube to avoid blockage by blood clots, distention Perforation -Sudden, severe abd pain; draws up knees -Rigid, boardlike abdomen; BS absent or decreased -Shallow, grunting resps -Check VS q 15-30 mins; stop all oral, NG feeds/rx until HCP notified -IV rate may be increased; possible surgical closure Gastric Outlet Obstruction -Can occur at any time (likely if ulcer near pylorus) -Gradual onset -Begin constant NG suction -If occurs during tx of acute exacerbation: regular irrigation of NG tube + repositioning side to side -IV fluids for hydration, accurate I/O -Possible surgery

PUD drug therapy

Histamine (H2) receptor blockers: -promote ulcer healing by reducing gastric acid production PPI's: -reduce gastric acid secretion and promote ulcer healing Antibiotic therapy: -for treatment of H. Pylori (if cause) -given with antisecretory agents (PPI or H2 receptor blockers) Antacids: -used as adjunct therapy -neutralizes stomach acid cytoprotective drugs: -accelerates ulcer healing by forming ulcer-adherent complex that covers the ulcer TCAs: -have anticholinergic effects that reduce acid secretion -pain relieving effects

BPH labs + dx

History + PE Digital rectal exam (symmetrically enlarged, firm, smooth prostate) Urinalysis with culture (infection) PSA level (rule out cancer) Serum creatinine (rule out renal damage) Neurologic exam (rule out neurogenic bladder) Transrectal ultrasound scan (TRUS) to differentiate BPH from prostate cancer Uroflometry (extent of any urethral damage) Cystoscopy (uncertain diagnosis)

ckd nursing care

Identify at risk for CKD: history of renal disease, HTN, DM, repeated UTI; changes in urinary appearance, frequency, volume Acute Intervention -Daily BP, daily weight; identify s/s fluid overload or hyperkalemia -Strict dietary adherence & medication teaching -Reinforce explanations of HD, PD, + transplant as treatment options when conservative therapy no longer effective Patient Teaching: Nutrition Therapy Protein restriction Water restriction - depends on daily UO Sodium restriction (2g- no salt substitutes); depends on degree of edema + HTN Potassium restriction (2-3g) & avoid high K foods Phosphate restriction (1000 mg/day) - dairy products

Acute pyelonephritis care

Hospitalize pts with severe infections/complications (ex. N/V w/ dehydration). S/S usually ​↓ 48-72 hrs after therapy starts Drug therapy -Parenteral antibiotic to rapidly increase drug level -NSAIDs or antipyretic drugs: fever, discomfort -Urinary analgesics -Relapse may be treated with 6-week course of abx -Follow-up urine culture and imaging studies -Reinfections treated as individual episodes or managed with long-term therapy -Prophylaxis for recurrent infections >>Recurrent infections or poorly treated pyelonephritis can lead to scarring, chronic kidney disease (CKD), or permanent damage. It may also progress to urosepsis. Nursing Management -Early treatment for cystitis to prevent ascending infections -Increase fluid intake to at least 8 glasses fluid every day Ambulatory and home care -Continue drugs as prescribed. Explain rationale to increase compliance -Follow-up urine culture -Recognize manifestations of recurrence or relapse -Encourage adequate fluids; Rest -Long-term, low dose antibiotics to prevent relapses and reinfections

BPH nursing assessment

Hx: Meds incl. any estrogen or testosterone supplements, surgery or previous treatment BPH Knowledge of condition Voluntary fluid retention Symptoms: Nocturia, urinary urgency, dysuria Decrease in caliber + force of urinary system Hesitancy in initiating voiding Post-void dribbling, incontinence, sensation of incomplete voiding Anxiety r/t sexual dysfxn Distended bladder on palpation; smooth, firm, elastic enlargement on ultrasound, residual urine creatinine levels

Kidney transplant rejection

Hyperacute (antibody mediated, humoral) rejection -Occurs mins to hrs after transplant -Need to remove transplanted kidney Acute rejection -Occurs days to months post transplant -Most increase number or doses of meds Chronic rejection -Occurs over months or years -Irreversible -Possible dialysis until new kidney available

SCI therapeutic management

Immediate Goals: patent airway, adequate ventilation, adequate circulating blood volume, prevent extension of cord damage Emergency Management -Initial Care: >>ensure patent airway, ensure stable C spine, administer O2, establish IV access, assess other injuries, control external bleeding, obtain imaging, prepare for stabilization w/ tongs + traction -Ongoing Monitoring: VS, LOC, O2 sat, cardiac rhythm, UO, keep warm, monitor for urinary retention + HTN, anticipate need for intubation if no gag reflex Thoracic + Lumbar Injuries Systemic support less intense → less resp compromise, no bradycardia, treat symptomatically Acute Care When Stabilized -Obtain hx of incident + thorough assessment >Muscle groups (w/ + against gravity, alone + w/ resistance, spontaneous movements?) >Sensory exam (touch + pain from toes upward) -Moving pt: use logroll -Continuous monitoring (CV, resp, urinary, GI, neuro) -Non Operative stabilization: traction or realignment; eliminate damaging motion; prevent secondary damage -Early surgery indicated if: evidence of cord compression, progressive neuro deficit, compound fracture, bony fragments, or penetrating wounds Procedures: laminectomy, fusion, rods Meds: vasopressors → MAP 85-90 Altered drug metabolism = increased risk for interactions

Other kidney transplant complications

Infection -Most common infections in first month -Pneumonia, wound infections, IV line and drain infections, urinary tract infections -Fungal or viral infections can occur Cardiovascular disease -Increased incidence atherosclerotic disease -Immunosuppressants can worsen HTN and hyperlipidemia -Pts must adhere to antihypertensive regimen Malignancies -Primary cause: immunosuppression -Regular screening is important -Preventive care (clothing, sunscreen) Recurrence of original renal disease on transplanted organ -Glomerulonephritis; IgA nephropathy -Diabetes mellitus -Focal segmental sclerosis Corticosteroid related complications

leukemia complications

Infection (inadequate WBC function) Bleeding (impaired platelets) Tumor lysis syndrome (products of dying cells-↑K+/phosphorus/uric acid and ↓Ca++ Nutritional depletion (from anorexia, NV) Renal dysfunction (uric acid nephropathy, and acute kidney injury) Mucositis (treatment related) Depression (psychological reaction to disease)

ACS therapeutic management

Initial Interventions -12 lead ECG (compare to previous; look for changes in QRS, ST, T; decide if STEMI vs NSTEMI) -Semi-fowler's position; Oxygen; IV access -SL nitro, chewable ASA, morphine, statin Ongoing Monitoring: Treat dysrhythmias, monitor VS, bedrest/limited activity for 12-24 hours Coronary surgical revascularization: Failed medical management. Not a candidate for PCI or failed PCI. History of DM, LV dysfunction, CKD Coronary artery bypass graft surgery (CABG) -requires sternotomy & cardiopulmonary bypass (CPB) -Uses arteries/veins for grafts -Pleural/mediastinal chest tubes -Continuous ECG -ETT/mechanical ventilation -Epicardial pacing wires -Urinary catheter; NG tube Postoperative nursing care: Assess for bleeding, Monitor hemodynamic status, Assess fluid status, Replace electrolytes prn, Restore temp, Monitor for AFIB, Surgical site care, Pain management, DVT prevention, Cognitive dysfunction Possible complications: Reduced cardiac output, Pulmonary dysfunction, Infection, Neurological dysfunction, Pulmonary dysfunction, AKI, GI dysfunction, Complications of coronary bypass (bleeding, fluid/e imbalance) Drug Therapy: IV nitroglycerin, Morphine sulfate, BB, ACEI/ARB, Antidysrhythmic drugs, Lipid lowering drugs, Stool softeners, Antiplatelet agents, Anticoagulants Nutritional Therapy: Initially NPO progressing to low salt, saturated fat, low cholesterol

colostomy care teaching (crc)

Normal appearance of stoma (pink) + s/s of complications Measurement of stoma Choice, use, care, + application of appropriate appliance to cover stoma Measures to protect skin Dietary measures to control gas + odor Resumption of normal activities

leukemia management

Initial goal is to attain remission (& then maintain) Stages of Chemo -Induction: high dose chemotherapy to try to induce remission. Destroy leukemic cells in tissues, blood, + marrow. Pt may become critically ill -Post-Induction/Post-remission >Intensification therapy: high dose therapy, drugs that target cells differently may be added >Consolidation therapy: started after remission is achieved, eliminate remaining leukemic cells that may not be pathologically evident -Maintenance therapy: lower doses of the same drugs given every 3-4 weeks. Goal is to keep body free of leukemic cells Treatment Regimens -Combination chemotherapy: decrease drug resistance, decrease drug toxicity using multiple drugs, interrupt cell growth at multiple points -Corticosteroids -Radiation therapy: total body radiation in preparation for bone marrow transplantation. Organ or field specific such as liver or spleen -Biologic + targeted therapy Hematopoietic Stem Cell Transplant -Goal: Totally eliminate leukemic cells using combinations of chemotherapy w/ or w/o total body irradiation -Eradicates pt's hematopoietic stem cells -Replaced with those of an HLA-matched sibling, volunteer, or replace with own stem cells

SCI nursing care: fluid/nutrition

Initial paralytic ileus + NGT 1st 48-72 hrs Monitor fluids + electrolytes Gradually introduce oral food + fluids -High protein, high calorie diet Evaluate swallowing 1st if high cervical injury Possible enteral nutrition or TPN Inadequate nutritional intake: assess for cause, contract w/ pt, pleasant eating environment, calorie count, dietary supplements, dietary fiber to promote bowel fxn

SCI Clinical Manifestations (Cardiovascular)

Injury above level T6 decreases influence of SNS Bradycardia (atropine to increase HR prn) Peripheral vasodilation → hypotension r/t hypovolemia from increase in venous capacitance Cardiac monitoring Peripheral vasodilation: decreased venous blood return to heart + decreased CO IV fluids or vasopressor drugs to increase BP Risk for DVT + pulmonary embolus

colorectal cancer clinical manifestations

Insidious onset; often not present until advanced stages Change in bowel habits, unexplained weight loss, vague abdominal pain Symptoms appear earlier left colon Weakness, fatigue Iron deficiency anemia anemia + occult bleeding Symptoms: Rectal bleeding common Alternating constipation + diarrhea Change in stool caliber (narrow, ribbon-like) Sense of incomplete evaluation Obstruction

UTI nursing assessment

Lower UTI Dx: dipstick urinalysis (nitrites, WBCs, leukocyte esterase - pyuria), C+S if indicated Upper UTI Dx: CT or US, IVP Lower UTI: -Dysuria (pain, burning), frequency (q 2hr), urgency -Suprapubic pain, bladder spasms -Incontinence -Post void dribbling -Urine: hematuria, cloudy, foul smelling, sediment Upper UTI: -Lower UTI symptoms+ -Local signs: flank pain, tender enlarged kidney -Systemic signs: chills, fever Older adults: -May be vague: increasing mental confusion or frequent, unexplained falls; possible vague abdominal pain -Sudden onset of or worsening of current incontinence -Loss of appetite, nocturia, dysuria -Urosepsis: fever, tachycardia, tachypnea, hypotension, even without any urinary symptoms

arterial bp monitoring

Invasive Various indications: hypertension or hypotension, respiratory failure, shock, neurologic injury, coronary interventional procedures, continuous infusion of vasoactive drugs (Na nitroprusside), frequent ABG sampling -Non-tapered teflon cath into peripheral artery sutured into place to immobilize insertion site -Has high and low pressure alarm -Risks/complications: hemorrhage, infection, thrombus formation, neurovascular impairment, loss of limb Continuous flush irrigation system: -Delivers 3 mL of saline/hr, maintains line patency, limits thrombus formation -Assess neurovascular status distal to arterial insertion site hourly Arterial pressure based CO (APCO) monitoring: -Calculates continuous CO and CCI -Used to assess pt's ability to respond to fluids -Uses arterial waveform characteristics & pt demographic data to calculate SV & pulse rate to calculate CCO/CCI and SV/SVI every 20 secs

BPH invasive therapy

Invasive therapy indications -Decrease in urine flow sufficient to cause discomfort, persistent residual urine, acute urinary retention, hydronephrosis Incl. TUIP + TURP Transurethral incision of prostate (TUIP) For pts w/ small or moderately enlarged prostate Local anesthesia- small incisions made into prostate to expand urethra and improve urine flow Transurethral Resection (TURP) Uses resectoscope inserted through urethra Spinal or general anesthesia; requires hospital stay Bladder irrigated first 24 hours- prevent mucous/blood clots Complications: bleeding (stop anticoagulation 24hrs prior), clot retention, dilutional hyponatremia, retrograde ejaculation Relatively low risk; good outcomes

ECG changes associated with ACS

Ischemia -ST segment depression (at least 1 mm below isoelectric line) and/or T wave inversion -Changes reverse when adequate blood flow restored to myocardium Injury -ST segment elevation occurs (significant if > 1 mm above isoelectric line) -If treatment prompt/effective, may avoid/limit infarction -Absence of serum cardiac markers confirms no infarction

IICP Assessment

LOC, GCS (eye-opening, best verbal + motor response) Pupil checks Cranial Nerves: Eye movements, corneal reflex, oculocephalic reflex (doll's eye reflex)*, oculovestibular (caloric stimulation)* *may be tested during exam for brain death Motor strength: Squeeze hands, palmar drift test, raise foot off bed or bend knees Motor response: spontaneous or to pain Vital signs incl. abnormal respiratory patterns Labs & Diagnostics CT scan/MRI/PET EEG Cerebral angiography ICP + brain tissue oxygenation measurement IICP measurement guides clinical care. Measure mean pressure. Intracranial pressure can be monitored using a catheter or sensor placed in one of the lateral ventricles of the brain, in the brain tissue or parenchyma, or in the subarachnoid space. Doppler + evoked potential studies NO lumbar puncture: risk of cerebral herniation

acute pancreatitis labs + dx

Lab tests: Elevated serum amylase, lipase, liver enzymes, triglycerides, serum glucose, bilirubin, WBC Decreased serum calcium Dx tests: Abd ultrasound, x ray CT w/ contrast, ERCP, EUS, MRCP Angiography Chest x-ray

urolithiasis care

Labs/Dx -Non-contrast CT (CT/KUB), US, IVP, UA (hematuria, crystalluria, + retrieve stones) -24 hr urine: Ca++, phosphorus, Mg++, Na+, K+, oxalate, uric acid, total urine volume Therapeutic Management -Pain: opioids; tx infection; tx obstruction (tamsulosin, terazosin) -Assess cause & prevent further stones -Struvite stones: abx, acetohydroxamic acid, surgical removal -Indications for removal: stones too large to pass, associated w/ bacteriuria, causing impaired renal function, persistent pain, nausea, or paralytic ileus -Endourological procedures: cystoscopy (flexible ureteroscope), cystolitholapaxy, cystoscopic lithotripsy, percutaneous nephrolithotomy -Lithotripsy: laser, extracorporeal shock-wave, percutaneous ultrasonic, electrohydraulic -Surgical therapy: nephro, pyelo, ureterolithotomy Nursing Care -Monitor urine characteristics & pH; Strain all urine for stones -Pain management & comfort measures -Increase fluid intake- water preferred for oral intake; no forcing fluids if acute obstruction -Ambulation -Lifestyle + dietary changes -Adequate fluid intake: to produce approx 2L urine / day -Dietary restriction (ex. Purines - uric acid stones; low sodium to reduce calcium excretion in urine)

focal (TBI)

Lacerations -Tearing of brain tissue -With depressed + open fractures + penetrating injuries -Intracerebral hemorrhage -Subarachnoid hemorrhage -Intraventricular hemorrhage Contusion -Bruising of brain tissue -Associated w/ closed head injury -May be associated with coup-contrecoup injury -Can cause hemorrhage, infarction, necrosis, edema -Can rebleed -Focal and generalized manifestations -Monitor for seizures -↑ risk of hemorrhage if on anticoagulants Severity: minor (GCS 13-15), moderate (GCS 9-12), severe (GCS 3-8)

assessment of mass (breast cancer)

Location using "clock face" method + shape/size/consistency Fixed or movable Skin change around mass (dimpling, peau d'orange, increased vascularity, nipple retraction, ulcer) Adjacent lymph nodes (axillary + supraclavicular) Pain or soreness in area Nipple discharge (color, consistency, from one or both breasts)

pneumothorax

Mechanism: air enters pleural cavity, positive pressure in cavity causes lung to collapse, can be open or closed Clinical Manifestations: variable, mild tachycardia + dyspnea → severe resp distress, chest pain + cough (possible hemoptysis), absent breath sounds over affected area visible on CXR Types: -Spontaneous: from rupture of blebs >>Primary (healthy young) or secondary (from lung disease) >>Risk factors (tall, thin, male, fam history, previous occurrence) -Iatrogenic: from medical procedures -Open (traumatic penetrating) >>Can cause a sucking chest wound >>Apply vent dressing (occlusive dressing secured on 3 sides) >>Don't remove impaled object -Closed (traumatic blunt force): Lung laceration +/or alveolar rupture -Tension Pneumothorax: air cannot escape pleural space >>Mediastinal shift/hemodynamic instability >>From open or closed >>Tracheal deviation, neck VD, profuse diaphoresis, cyanosis >>Treat- needle decompression & chest tube

chest trauma

Mechanisms of Injury -Blunt: deceleration, acceleration, shearing, + compression; can be life threatening -Penetrating: open wound through pleural space Emergency Assessment Resp Distress: dysphagia, cough (hemoptysis), cyanosis, tracheal deviation, air escaping from wound, decreased breath sounds, decreased O2 sat, frothy secretions CV Compromise: rapid/thready pulse, low BP, narrowed pulse pressure, distended neck veins, muffled heart sounds, chest pain, dysrhythmias

mitral valve prolapse

Mitral valve leaflets prolapse up into left atrium during systole; unknown cause; familial incidence in some Usually benign (valve closes effectively); dx w/ echocardiography; treated w/ BBs or valve surgery if regurgitation Clinical Manifestations: only 10% Systolic murmur (regurgitation) Dysrhythmias (palpitations, light-headed, dizzy) Infective endocarditis can occur Chest pain unresponsive to nitrates Teaching: healthy lifestyle (diet, hydration, exercise, avoid stimulants/caffeine)

testicular cancer

Most common age 15-40 Highly treatable + curable Manifestations: painless lump in testis Risk Factors: Undescended testicles (cryptorchidism) Positive family history Cancer of one testicle Dx: monthly TSE, annual testicular exam, US, AFP/HCG tumor markers

UTI patho

Most common infection in women: -No bacteria in bladder normally -Asymptomatic bacteriuria; not treated unless pregnant -Often caused by bacteria (E. coli); fungal + parasitic infections possible Classification: upper/lower -Upper (ex. pyelonephritis): parenchyma, pelvis, ureters; often fever, chills, flank pain -Lower urinary tract: bladder (cystitis), urethra (urethritis), usually no systemic s/s Complicated vs. uncomplicated -Uncomplicated: bladder only -Complicated: obstruction, stones, catheters, or diabetes, neurologic disease, recurrent infection Women more likely Pts at risk: diabetes, immunosuppressed; h/o multiple abx courses; travel to developing countries

uterine cancer

Most common type. Risks: Age 50-70, nulliparity, DM, family history of endometrial cancer or hereditary nonpolyposis colon cancer (HNPCC), uterine polyps, late menopause, smoking, obesity (↑endogenous estrogen stores). Protective: pregnancy, oral contraceptives.

SCI risk factors

Most commonly affect men High risk physical activities such as speeding and drinking while under the influence of alcohol, substance use, and not using protective gear in sports or recreational activities Causes: motor vehicle crash, falls, violence, sports injuries Older: fall related

breast cancer risk factors

Most frequent (99%) women, advancing age Others: family history, environmental factors, genetics, early menarche (<12 yrs) or late menopause (>55 yrs) because of long menarche, 1st full-term pregnancy after age 30, nulliparity Most women no identifiable risks; others- excessive alcohol use, inactivity, obesity, unopposed estrogen hormone therapy/Prolonged exposure to unopposed estrogen 5-10% are hereditary: BRCA1, BRCA2 gene mutations >>Genetic link stronger if involved family member: hx of ovarian cancer, premenopausal, bilateral BC, 1st degree relative >>Personal history of breast, colon, endometrial, ovarian cancer: increased risk of breast cancer or recurrence- other breast Ethnicity Doesn't increase risk by itself but age modifies risk African American women younger than 50 yrs = higher risk, but over 50 = lower risk Hispanic women lower risk than whites but Asian same risk Risk Factors of men: hyperestrogenism, family history of BRCA, radiation exposure

dialysis

Moves fluid & molecules across semi-permeable membrane Used to correct fluid/electrolyte imbalance; remove waste products in renal failure, treat drug OD Initiated when uremia can no longer be adequately managed & GFR (or creatinine clearance) < 15 ESKD treated w/ dialysis because lack of donated organs & some pts physically or mentally unsuitable for transplantation or don't want transplant

gastric surgery postop nursing care

NGT to decompress stomach + decrease pressure on suture line Observe aspirate for amt, odor, color (Bright red w/ darkening in 24 hrs; Yellow-green w/in 36-48 hrs) Maintain NG patency; keep NG suction in working order Observe for decreased peristalsis + lower abd discomfort (intestinal obstruction); also signs of infection Keep accurate I/O; VS q 4 hr Frequent position changes Monitor IV therapy LT complication: pernicious anemia (lifelong Vit B12 supplementation)

intestinal obstruction care

NPO status, NG tube until bowel sounds return Measurement of abdominal girth Medical tx of cause of obstruction fluid/electrolyte replacement TPN possible Pain control after cause determined Broad spectrum abx prn Surgery: often exploratory lap Preop care: teaching, NGT intubation + suction Operative procedure:: exploratory laparotomy to determine procedure Postop care: NGT in place, usual postop care

SCI nursing care: neurogenic bladder/bowel

Neurogenic Bladder -Areflexia (flaccid), hyperreflexic (spastic), or dyssynergia -Common problems: incontinence, inability to void, + high bladder pressures resulting in reflux of urine into kidneys -Drug therapy: anticholinergics to suppress bladder contraction; alpha-adrenergic blockers to relax urethral sphincter, antispasmodics to relax pelvic floor muscles -Drainage methods: >>Bladder reflex training if partial control >>Indwelling cath, intermittent cath q3-4hrs, or external cath >>Urinary diversion surgery if repeated UTI Neurogenic Bowel -Voluntary control may be lost -High fiber diet, adequate fluid intake -Stool softener; suppositories such as glycerin or bisacodyl; small volume enemas if needed; oral stimulant laxatives only prn -Valsalva maneuver w/ manual stimulation for lower motor neuron injuries -Digital stimulation to relax external sphincter for upper motor neuron injury -Use of gastrocolic reflex (30-60 mins after 1st meal of day) -Upright position is best when able -Every other day pattern sufficient but consider pt baseline

prostate cancer risk factors

Nonmodifiable Risk Factors -Age: risk increases after age 50 -Family hx: having first degree relatives w/ prostate cancer increases risk Modifiable Risk Factors -High red meat/processed meat intake, high fat dairy products, diet low in fruit + veg, obesity -Hereditary breast + ovarian cancer syndrome -Associated w/ mutations in the BRCA1 + BRCA2 genes -Associated w/ an increased risk of breast + prostate cancer -Cause only a small % of familial prostate cancers

Leukemia Assessment

Objective Data -Fever, lymphadenopathy, lethargy -Pallor, jaundice, petechiae, ecchymoses -CV: tachycardia, systolic murmurs -GI: oral lesions or bleeding, herpes or infection, hepatomegaly, splenomegaly -Neuro: seizures, disoriented, confusion -Musculoskeletal: muscle wasting, bone or joint pain Clinical Manifestations -Varied; usually r/t bone marrow failure w/ overcrowding by abnormal cells & inadequate production of normal cells; leukemic infiltrates -Inadequate marrow leads to: anemia, thrombocytopenia, ↓ # and function of WBCs As leukemia progresses: -abnormal WBCs continue to accumulate, leukemic cells may infiltrate spleen & liver -Lymphadenopathy, bone pain, meningeal irritation, oral lesions, solid masses (chloromas) can result -Leukostasis: life-threatening complication (thickened blood blocks circulatory pathways) Diagnostic Findings: WBC may be normal or abnormal, anemia, low hct/hgb, thrombocytopenia, Philadelphia chromosome if CML, hypercellular bone marrow aspirate or biopsy

acute pancreatitis management

Objectives: relieve pain, prevent/alleviate shock, decrease pancreatic secretions, correct F/E imbalance, prevent/treat infection, remove cause Conservative therapy -Aggressive hydration -Pain management w/ morphine, antispasmodics -Manage metabolic complications w/ O2 + glucose -Minimize pancreatic stimulation (NPO, NG suction, enteral nutrition prn) -Shock: plasma or plasma volume expanders (dextran or albumin) -Fluid and electrolyte imbalance w/ LR -Ongoing hypotension - give vasoactive drugs (dopamine) -Prevent infection w/ enteral nutrition, antibiotics, endoscopically or CT guided percutaneous aspiration Surgical therapy -For gallstones: ERCP, cholecystectomy, uncertain diagnosis, not responding to conservative therapy; drainage of necrotic fluid Drug therapy: IV morphine, antispasmodics, carbonic anhydrase inhibitors, antacids, PPIs Nutritional therapy -NPO initially, enteral nutrition or TPN -Small frequent feedings when able high in carbs -No alcohol -Supplemental fat soluble vitamins

colorectal cancer complications

Obstruction, bleeding, perforation, peritonitis, fistula formation Intraperitoneal infection, complete large bowel obstruction or perforation, GI bleeding, peritonitis, abscess formation, sepsis

Nursing management for hemodynamic status monitoring

Obtain baseline observational data (general appearance, LOC, skin color & temp, vitals, peripheral pulses, UO) Correlate baseline data obtained from biotechnology (EKG, arterial pressure, CVP, pulmonary artery pressure, PAWP, SvO2/ScvO2) Monitor trends

duodenal ulcers

Occur at any age + in anyone: increased risk btwn 35-45 yrs old About 80% of all peptic ulcers Familial: blood group O at higher risk Associated w/ increased Hcl acid secretion such as from alcohol H. pylori is cause in 90-95% of pts Increased risk for duodenal ulcers (COPD, cirrhosis of liver, chronic pancreatitis, CKD, Zollinger-Ellison)

AKI clinical manifestations

Oliguric Phase -Urinary changes (<400 mL/day; starts 1-7 days after injury; lasts 10-14 days) -UA may show casts, RBCs, WBCs; fixed urine SG 1.010 -Fluid volume >>Hypovolemia may exacerbate AKI >>Fluid retention occurs (distended neck veins, bounding pulse, edema, HTN) >>Fluid overload can lead to HF, pulmonary edema, pericardial & pleural effusion -Neurologic: fatigue, difficulty concentrating, seizures, stupor, coma -Electrolyte/acid base >>Metabolic acidosis (HCO3- down, Kussmaul resps) >>Sodium excretion: can lead to cerebral edema >>Potassium excess (usually asymptomatic): possible ECG changes - peaked T wave, wide QRS, ST depression -Labs- leukocytosis, increased BUN/creatinine Diuretic Phase: Daily UO is 1-3 L; may reach 5 L or more -Monitor for hyponatremia, hypokalemia, dehydration Recovery phase may take up to 12 months

leukemia nursing care

Overall Goals: understand & cooperate w/ treatment plan, experience minimal side effects/complications of disease & treatment, feel hopeful/supported Dx: Risk for bleeding, risk for impaired skin integrity, impaired gas exchange, impaired mucous membrane, imbalanced nutrition, acute pain, hyperthermia, fatigue/activity intolerance Interventions: -Neutropenic precautions- reduce infection (handwashing, mask, private room, avoid fresh fruit/veg/flowers) -Bleeding precautions for thrombocytopenia -Mucositis: Frequent, gentle oral hygiene w/ soft toothbrush, or if counts are low, sponge-tipped applicators -Rinse w/ NS or Rx solution -Gentle but thorough perineal/rectal care Nutrition -Oral care before & after meals; analgesics before meals -Appropriate nausea treatment Small frequent feedings, soft foods, moderate in temp -Low-microbial diet -Nutritional supplements -Infection prevention: masks, handwashing -Bleeding prevention: supplements, drug therapy, blood replacement, safety precautions -psychosocial/emotional needs -Ongoing care (follow-up care) is necessary to monitor for s/s of disease control or relapse

PEEP vs. CPAP vs. BiPAP

PEEP- positive pressure applied to the airway during exhalation, prevents alveolar collapse. Increases lung volume & functional residual capacity (FRC), improves oxygenation CPAP- pressure delivered continuously during spontaneous breathing. Increased work of breathing: use with caution in patients with myocardial compromise BiPAP- delivers O2 + 2 levels of positive pressure support. Higher inspiratory pressure + lower expiratory pressure Noninvasive via tight-fitting mask, nasal mask, or nasal pillows Pt must be able to breathe spontaneously + cooperate Contraindications- shock, altered LOC, other risks for aspiration

prostate cancer labs + dx

PSA (prostate-specific antigen) blood test >Increased levels = prostate pathology; maybe not cancer >Marker of tumor volume when cancer exists >Also used to monitor success of treatment DRE (digital rectal exam) >Abnormal prostate findings incl. hardness, nodular, + asymmetric Neither of these is a definitive diagnostic test ^^^ Elevated PAP (prostatic acid phosphatase) Biopsy of prostate tissue >>Done via TRUS to visualize + pinpoint abnormalities >>Gleason score 1-5 Bone scan, CT, MRI w/ endorectal probe, + TRUS to determine location + speed

Collab Care: Cholecystitis

Pain control - NSAIDs, anticholinergics Control infection w/ abx Maintain F+E balance: NGT if severe N/V Laparoscopic cholecystectomy -Gallbladder removed using 1-4 puncture holes -Minimal post-op pain; few complications -Resume normal activities incl. work w/in 1 wk Open (incisional) cholecystectomy -Remove gallbladder via R subcostal incision -T-tube inserted into common bile duct: ensures patency of duct + allows excess bile to drain T-tube care -May stay in place for 6 wks or longer -Assess drainage and expect bloody changing to green/brown (400 ml/day w decrease report over 1000 ml/day) -Report sudden changes in bile output -Assess odor that may indicate infection -Keep drainage system below level of gallbladder -Never irrigate, aspirate, or clamp -Secure T tube -When ordered, change height of drainage bag -When oral intake resumes, clamp T tube 2 hrs before to 2 hrs after meals and assess food tolerance -Observe stool for return to brown color (should be 7-10 days postop)

cervical cancer dx

Pap test, DNA test for HPV, colposcopy (3% acetic acid applied to cervix, examined with bright filter light, biopsy of highlighted tissue

PUD nursing assessments

Past health hx, med usage, heartburn, weight loss, black tarry stools, epigastric tenderness, N/V, abnormal labs Gastric Ulcer Pain -High in epigastrium -1-2 hrs after meals -"Burning" or "gaseous" -Food aggravates pain (because of loss of stomach mucosal barrier) Duodenal Ulcer Pain -Midepigastric region beneath xiphoid process -Back pain- if ulcer is located in posterior aspect -2-5 hrs after meals or an hr or 2 before next meal -Burning or cramplike pain -Tendency to occur, disappear, occur again

colorectal cancer nursing assessment

Past health hx: previous breast or ovarian cancer, familial polyposis, villous adenoma, adenomatous polyps, IBD Weakness or fatigue Change in bowel habits High-cal, high-fat, low fiber diet Increased flatus Feelings of incomplete evacuation

peritoneal dialysis

Peritoneal access: inserting a catheter through anterior abdominal wall After catheter inserted, skin cleaned with antiseptic solution; sterile dressing applied. Connected to sterile tubing system, secured to abdomen with tape Catheter irrigated immediately Waiting period 7-14 days preferable before use. 2-4 weeks after implantation, exit site should be clean, dry, free of red/tenderness. Once site healed, pt may shower/pat dry Complications Exit site infection: peritonitis Hernias, lower back pain (Increased abdominal pressure) Bleeding Atelectasis, pneumonia, bronchitis Protein loss in dialysate

acute pancreatitis pt teaching

Physical therapy Counseling: abstain from alcohol and smoking Dietary teaching: low fat, high carb, no crash diets Pt and fam teaching: s/s of infection, DM, steatorrhea, meds/diet Expected outcomes: Adequate pain control Maintain adequate fluid volume Be knowledgeable about treatment regimen Get help for alcohol dependence

BPH s/s

Usually gradual in onset; early symptoms are usually minimal because bladder can compensate; worsen as obstruction increases Associated w/ obstruction of lower urinary tract Nocturia often 1st symptom noticed Categorized into 2 groups: obstructive + irritative -Irritative symptoms: associated w/ inflammation or infection: Urinary frequency + urgency, dysuria, nocturia, bladder pain, incontinence -Obstructive symptoms: d/t urinary retention Decrease in caliber + force of urinary stream, difficulty in initiating urination, intermittency: starting + stopping stream several times while voiding, dribbling at end of urination

SCI Clinical Manifestations (integumentary)

Potential for skin breakdown Poikilothermism- interruption of SNS, decreased ability to shiver or sweat, more common w/ high cervical injury

increased intracranial pressure

Potentially life threatening Increase in any of 3 components- brain tissue, blood, CSF Common causes: mass, cerebral edema Clinical manifestations -Change in LOC: flattening of affect, coma -Ocular signs: unilateral pupil dilation, sluggish reaction, unable to move eye upward, eyelid ptosis -Other cranial nerves: diplopia, blurred vision, EOM changes, papilledema -Change in VS: Cushing's triad (increased systolic BP w/ widened pulse pressure, bradycardia, irregular resps); change in body temp -Headache: often continuous; worse in morning -Vomiting: not preceded by nausea (unexpected vomiting), projectile -Decrease in motor fxn: hemiparesis/hemiplegia, localized response or withdrawal to pain, posturing: decorticate (flexor), decerebrate (extensor)- indicates more serious damage, opisthotonic

TURP care

Preop Care for TURP -Restore urinary drainage: coude (curved tip catheter), filiform (rigid cath), aseptic technique very important to prevent infection -Administer abx: treat UTIs -Provide pt opportunity to express concerns over alterations in sexual fxn -Inform pt of possible complications of procedures Postop TURP Care -Assess for complications: hemorrhage, bladder spasm, urinary incontinence, infection -Diet- stool softener to prevent straining -Bladder irrigation to remove clots + ensure drainage of urine -I&O -Antispasmodics -Kegel exercises

crc nursing care- acute

Preop info about prognosis, future screening; support in dealing w/ dx Reinforce extent of surgical procedure (provide care, info, + emotional support) Anticipate preop needs for pts w/ more extensive surgery: consult a wound, ostomy, + continence nurse specialist Postop care: Sterile dressing, care of drains, pt/caregiver stoma teaching Management differs depending on type of wound Assess drainage amt, color, consistency Examine wound regularly (record bleeding, excessive drainage, + odor) Monitor suture line for infection Pain control Provide sexual dysfxn edu

AAA nursing care

Preop teaching: brief explanation of disease process, planned surgical procedure, preop routines: bowel prep/NPO, shower, IV abx before incision; post-op expectations such as PACU tubes/drains, ICU, BBs AA Surgery Post-OP Care -Maintaining adequate MAP is key (fluid volume, vasopressors) -HOB not elevated more than 15-30 degrees -Hourly assessment of neurovascular status (incl. pulses) critical -Pain management -ICU monitoring: arterial line, mechanical ventilation, peripheral IV lines, ECG, pain meds, urinary catheter, NG tube, pulse ox -Maintain graft patency -Maintain normal BP; CVP or PA pressure monitoring -IV fluids + blood component therapy -Urinary output monitoring -Avoid severe HTN (drug therapy) CV status: continuous ECG monitoring electrolyte monitoring, ABG monitoring, O2 admin, antidysrhythmic meds, anti-HTN meds, resume cardiac meds Infection: abx admin, assess temp, monitor WBC, adequate nutrition, observe surgical incision GI status: record NG tube output - assess flatus, bowel sounds, signs bowel ischemia (ileus, fever, distention, diarrhea, bloody stool) Neuro Status: LOC, pupil size + response to light, facial symmetry, speech, ability to move upper extremities, quality of hand grasps Peripheral Perfusion -Pulse assessment: mark pulse locations w/ felt tip pen -Extremity assessment: neurovascular status, may need Doppler Renal Perfusion Status: urinary output, fluid intake, daily weight, CVP/PA pressure, BUN/creatinine Expected Outcome: patent arterial graft w/ adequate distal perfusion, adequate UO, no infection

pulmonary embolism management

Prevention: Compression device, Ambulation, Prophylactic anticoagulation Treat when PE suspected: Prevent further emboli, provide CP support Supportive care prn -O2 from cannula → mechanical ventilation -Pulmonary hygiene -Fluids- shock, diuretics → HF, analgesic → pain -Fibrinolysis w tPA/alteplase -Anticoagulation w Xa inhibitors Surgical treatments: Pulmonary embolectomy IVC filter insertion: prevents migration of clots to pulmonary system

aki management

Primary goals: eliminate cause, manage s/s, prevent complications -Ensure adequate intravascular volume & CO -Increase fluids if based on hypovolemia; closely monitor fluid intake in oliguric phase (previous 24 hr output + 600 mL insensible losses) -Loop diuretics & osmotic diuretics (mannitol) -Treat hyperkalemia: insulin & sodium bicarbonate, calcium carbonate; sodium polystyrene sulfonate -Indications for renal replacement therapy (RRT): volume overload, increased serum potassium level, metabolic acidosis, BUN higher than 120, significant mental status change, pericarditis, pericardial effusion, cardiac tamponade -RRT: peritoneal dialysis, hemodialysis, continuous renal replacement therapy (CRRT)- cannulated artery & vein

mechanical ventilation

Process by which FiO2 (> 21% RA) is moved into + out of lungs by mechanical ventilation Not curative- supports pt until they recover ability to breathe. May be ethical decision to use or not: encourage family discussion + advance directive Indications: apnea/inability to breathe/protect airway, acute resp. failure, severe hypoxia, respiratory muscle fatigue

ckd

Progressive, irreversible loss of kidney function Kidney damage (pathologic abnormalities; blood, urine, imaging tests) and/or low GFR (<60mL/min for 3 months+) Up to 80% of GFR may be lost w/o symptoms; leading causes of CKD are diabetes & HTN Diagnosis: with H+P, dipstick protein eval, albumin-to-creatinine ratio (first morning void), GFR, renal US or scans, CT, renal biopsy

ovarian cancer management

Prophylactic oophorectomy (reduces risk) or oral contraceptives if high risk. TAH-BSO and omentectomy. Metastasizes early: follow-up chemo all stages; possible external radiation if metastasis to adjacent abd/pelvic organs

acute pancretitis complications

Pseudocyst -Fluid, enzyme, debris, + exudates surrounded by wall -Abd pain, palpable mass, N/V, anorexia -Detected w/ imaging -Resolves spontaneously or may perforate + cause peritonitis -Surgical or endoscopic drainage Pancreatic abscess -Collection of pus; results from extensive necrosis -May perforate -Upper abd pain, mass, high fever, leukocytosis -Surgical drainage Systemic complications -Pleural effusion, atelectasis, pneumonia, ARDS -Hypotension -Hypocalcemia: tetany

kidney transplantation studies

Purpose: identify HLA antigens for both donors and potential recipients Done to prevent immediate organ rejection ECG and chest x ray done Renal ultrasonography and renal arteriography or three dimensional CT scan to ensure blood vessels supplying each kidney are adequate, no abnormalities, determine which kidney

blood transfusion

RBCs, WBCs, platelets, fresh frozen plasma (FFP) can be transfused (Specific clotting factors: VIII concentrate, IX concentrate, Cryoprecipitate) Nursing Care Pretransfusion: -Review pt history of transfusions + transfusion reactions; concurrent health problems -Obtain baseline assessment + VS. Perform pt teaching + obtain consent. -Equipment: IV (20 gauge or greater for PRBCs), appropriate tubing, + normal saline solution -Procedure to ID pt + blood product -Check blood for gas bubbles, cloudiness -*Start w/in 30 minutes of getting from blood bank * Nursing Responsibilities During + After Transfusion -Infuse @ rate ordered -Monitoring pt + VS; 1st 10-15 mins is critical period -If complaints of any symptoms, take VS -Signs of transfusion rxn → STOP transfusion -Documentation, postprocedure care -Nursing management of ADRs *Transfusions: only use Normal Saline → NaCl 0.9%*

prostate cancer radiation/drug tx

Radiation therapy -External beam radiation (5 days/week, 4-8 wks, few mins) >>Most widely used; cancer confined to prostate and/or surrounding tissue >>Side effects: skin (dry, red, irritated, pain); GI (diarrhea, abd. cramping, bleeding); urinary (dysuria, frequency, hesitancy, urgency, nocturia); ED; fatigue Brachytherapy (best in early stages) -radioactive seed planted by transrectal US; spares surrounding tissue -irritative/obstructive urinary problems common side effects; ED Drug Therapy -Androgen deprivation therapy (IADT) ↓ androgens, ↓ tumor growth; can be used preop or pre radiation to reduce tumor size -"Hormone refractory"- resistant tumors, indicated by elevated PSA -Radium RA 223 Dichloride- radiotherapy drug treating CA spreading to bone -Chemotherapy- treat late stage hormone-resistant prostate cancer, palliative -Orchiectomy- testosterone stimulates growth of cancer

breast cancer pt teaching

Reduce risk factors by: maintaining a healthy weight, exercising regularly, limit alcohol, eating nutritious food, never smoking/quitting smoking Comply w/ screening guidelines Reduce risk factors for women at high risk - genetic testing for BRCA gene mutations if family hx Consider prophylactic mastectomy or oophorectomy after counseling about risks, benefits, + fertility issues

intestinal obstruction complications

Renal insufficiency Peritonitis

mechanical ventilation settings (nurse needs to know)

Resp rate: # of breaths the vent delivers per min; usual setting: 6-20 Tidal volume (Vt): volume of gas delivered during each vent breath; usual volume 6-10 mL/kg Fraction of inspired oxygen (FIO2): oxygen delivered to pt: may be set between 21 (RA)-100%. Usually adjusted to maintain PaO2 level > 60 or SpO2 > 90% Positive end-expiratory pressure: applied at end of expiration of vent breaths; usually set at 5cm H2O Alarms: high pressure limit, low pressure limit, high TV, minute ventilation, RR, ventilator inoperative/low battery

IICP nursing care

Respiratory Function -Maintain patent airway; maintain vent -Elevate HOB 30 degrees* or greater -Suctioning -Monitor ABGs -Minimize abdominal distention (NG or orogastric tube) Minimize increases in ICP -Prevent hip flexion, extreme neck flexion, turn slowly -Avoid coughing, straining, Valsalva -Quiet non-stimulating movement Pain/anxiety management: Opioids, propofol, dexmedetomidine, neuromuscular blockers, benzodiazepines (risk for long half life + hypotension SE) Fluid/electrolyte balance -I+O, check electrolytes -Monitor for DI or SIADH -Minimize complications of immobility Protection from self injury (judicious use of restraints; sedatives; seizure precautions) Psychological considerations Complications -Inadequate cerebral perfusion -Cerebral herniation

CKD clinical manifestations

Result from effects of retained substances: Urea, creatinine, phenols, hormones, electrolytes, water, other Uremia: syndrome incorporating all bodily S/S, often when GFR 10 ml/min or less Urinary -Polyuria: kidneys unable to concentrate urine; often at night -Specific gravity fixed around 1.010 -Oliguria (<400 mL/day) occurs as CKD worsens -Anuria (UO ↓ 100 mL/24 hours) ​​-↓ serum creatinine clearance Metabolic disturbances -As GFR ↓, BUN/creatinine ↑ (retained wastes) -N/V, lethargy, fatigue, impaired thought processes, HA -Altered CHO metabolism -Impaired glucose metabolism (cellular insensitivity to normal action of insulin) >>Uremic pts w/ DM require less insulin after onset of CKD (insulin excretion dependent on kidneys) Potassium: hyperkalemia -Most serious electrolyte disorder in kidney disease -Fatal dysrhythmias (7-8); tall tented T waves) Sodium; may be ↑, normal, or ↓ -Result from effects of retained substances: Urea, creatinine, phenols, hormones, electrolytes, water, other -With impaired excretion, sodium is retained -Water is retained → Edema, HTN, CHF Calcium (↓) and phosphate (↑) alterations Magnesium alterations (↑) Metabolic acidosis: Results from kidney's inability to excrete acid load & defective reabsorption/ regeneration of bicarb

myocardial infarction

Result of sustained ischemia; irreversible myocardial cell death (necrosis) 80-90% d/t necrosis; Necrosis of entire thickness of myocardium takes 4-6 hours. Ischemia starts in subendocardium Loss of contractile function MI Pain -Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration -Heaviness, pressure, tightness, burning, constriction, crushing -Often in early morning -Possible atypical pain in women, elderly -No pain if cardiac neuropathy (diabetes) -Location: substernal, retrosternal. Epigastric area (pain may radiate to neck, jaw, arms)

acute respiratory failure

Results from inadequate gas exchange Insufficient O2 transferred to blood: hypoxemia Inadequate CO2 removal: hypercapnia Classification: *Hypoxemic respiratory failure (aka oxygenation failure): PaO2 < 60 mm Hg w/ O2 concentration > 60%* Causes: V-Q mismatch -diffusion limitation: severe COPD, recurrent PE, pulmonary fibrosis, ARDS, interstitial lung disease alveolar hypoventilation -V/Q mismatch from COPD, pneumonia, asthma, atelectasis, pain, PE *Hypercapnic respiratory failure (aka ventilatory failure): PaCO2 above normal (>48)* Causes: alveolar hypoventilation → imbalance between ventilatory supply/demand -Airways + alveoli abnormalities: asthma, COPD, cystic fibrosis -CNS abnormalities: drug OD, brainstem infarction, SCIs -Chest wall abnormalities: flail chest, kyphoscoliosis, severe obesity, fractures, mechanical restriction, muscle spasm -Neuromuscular conditions: muscular dystrophy, GBS, MS, toxins, wasting

rib fractures

Ribs 5-9 most common; Can damage pleura & lungs Manifestations- pain, splinting, shallow respirations Risk for atelectasis & pneumonia Treatments No strapping/binding chest (restricts chest movement, leads to atelectasis) NSAIDs, opioids, nerve blocks Pt education Deep breathing/coughing Incentive spirometry Appropriate use analgesics

lung cancer

Risk Factors: Smoking!, secondhand smoke, social determinants, pollutants, genetics Non-Small Cell Lung Cancer -Squamous cell carcinoma- slow growing, early symptoms -Adenocarcinoma- moderate growing; most common in nonsmokers -Large cell carcinoma- rapid growing, highly metastatic Small Cell Lung Cancer Very rapid growth, most malignant, early metastasis, associated endocrine disorders, chemotherapy + radiation, poorer prognosis

pancreatic cancer

Risk Factors: smoking, obesity, DM, chronic pancreatitis, workplace chemicals - dry cleaning + metal working Dx: ultrasound, MRI Medical Tx: chemo, radiation, surgery Tx may be palliative Pancreatic Carcinoma -Often dx late in disease -Nonsurgical management: drug therapy, radiation, biliary stent insertion -Surgical management: Preop- NGT may be inserted, TPN typically begun, may incl. Whipple procedure Multiple Sumps After Pancreatic Surgery -Post-op care Routine post-op care Observe for complications GI drainage monitoring Positioning Fluid and electrolyte assessment Glucose monitoring

SCI nursing care: CV

Risk for bradycardia + cardiac arrest; monitor increased risk for DVT → SCDs, gradient stockings, prophylactic heparin Chronic low BP w/ postural hypotension anticholinergic drug/pacemaker, vasopressor agent ROM exercises

gallbladder disease Clinical Manifestations

Vary from severe to none at all Pain more severe when stones moving or obstructing: -Steady, excruciating -Tachycardia, diaphoresis, prostration -May be referred to shoulder/scapula -Residual tenderness RUQ, abd rigidity -Occur 3-6 hrs after high fat meal or when pt lies down Others: indigestion, fear, N/V, restlessness, diaphoresis Total obstruction s/s: Jaundice, dark amber urine Clay colored stools Pruritus Intolerance to fatty foods, steatorrhea Bleeding tendencies Chronic cholecystitis: fat intolerance, dyspnea, heartburn, flatulence

stenosis and regurgitation

STENOSIS constriction/narrowing Valve orifice is smaller Forward blood flow is impeded REGURGITATION incompetence/insufficiency Incomplete closure of valve leaflets Results in backward flow of blood

prevention + treatment of anaphylaxis

Screen and prevent common causes (foods, meds, insect stings, venoms, latex) Treatment depends on severity Treat respiratory problems (O2, intubation) and CPR as needed Auto injection system: epipen IV fluids (normal saline)

ovarian cancer dx

Screening if high risk: CA-125, ultrasound, yearly pelvic exam; IVP, CT scan; exploratory laparotomy, CA125 marker (for follow-up; can elevate in benign conditions-endometriosis)

SCI nursing care: sensory deprivation/reflexes

Secondary to absent sensations: Stimulate pt above level of injury Conversation, music, strong aromas, + interesting flavors Prism glasses to read/watch TV Prevent pt from withdrawing Reflexes Return may complicate rehab: hyperactive, exaggerated responses, penile erections, spasms Antispasmodic drugs

SCI pt teaching

Skin Integrity Prevention of pressure injury, other injuries essential; regular skincare Comprehensive daily exam Carefully reposition q 2 hrs Pressure- relieving cushions, mattress Adequate nutrition Avoid thermal injury Sexuality Important issue regardless of age Nurse must: be aware of + accept, have knowledge, use medical terms Men: Level of injury affects potential for orgasm, erection, fertility Psychogenic (begins in brain w/ sexual thoughts, sent via spinal cord) + reflex (physical stimulation) erections Women: Lubrication, orgasm (50%) Fertility not affected- pregnancy complicated, risk of precipitous delivery Open discussion, alt. Methods, urinary cath, bowel evac Grief + Depression: overwhelming sense of loss, loss of control, lifsetyle adjustment Psychological support + counseling

SCI nursing care: temp, stress ulcers

Temperature control No vasoconstriction, piloerection, or perspiration- induced heat loss below level of injury Temperature control external; monitor environment + body temp; don't overload or unduly expose pt Stress Ulcers Increased risk d/t severe trauma + physiological stress Monitor stool, gastric contents, + hematocrit; prophylactic meds

Gallbladder disease nursing assessment

Subjective Data + fam history; past medical history of obesity, multiparity, infection, cancer, extensive fasting, pregnancy Meds: estrogen Previous abdominal surgery Sedentary lifestyle Weight loss, anorexia Indigestion, fat intolerance N/V, chills, dyspepsia Clay colored stools, steatorrhea, flatulence Dark urine, pain, pruritus Objective Data -Fever, diaphoresis -Restlessness -Jaundice, icteric sclera -Tachypnea, splinting

TBI assessment

Subjective Data -Past med history- mechanism of injury (MVC, sports injury, industrial accident, assault, falls) -Meds (anticoagulants) -Health management- alcohol/drug use; risk behaviors -Cognitive perceptual- headache, mood/behavior changes, mentation changes; impaired judgment, aphasia, dysphagia Objective Data -Integumentary: lacerations, contusions, abrasions, hematoma, Battle's sign, otorrhea, exposed brain -Respiratory: rhinorrhea, impaired gag reflex, altered/irregular resps -CV: Cushing's triad- systolic HTN, widening pulse pressure, bradycardia -GI/GU: vomiting, incontinence -Neuro: altered LOC, pupil dysfunction, cranial nerve deficits, seizures, possible uninhibited sexual expression -Musculoskeletal: motor deficit, palmar drift, paralysis, spasticity, posturing muscle rigidity or flaccidity, ataxia Diagnostic data: abnormal CT, MRI, EEG, positive toxicology screen or alcohol level, ↑ or ↓blood glucose level, ↑ ICP Labs & Diagnostics: CT scan- best test to determine craniocerebral trauma; MRI, PET, evoked potential studies, transcranial Doppler studies, cervical spine x-ray, GCS

acute pancreatitis nursing assessment

Subjective Data Health hx: biliary tract disease, alcohol use, abd trauma, duodenal ulcers, infection, metabolic disorders Meds: thiazides, NSAIDs Surgery ot other tx: pancreas, stomach, bowel, biliary tract FHP data: HP-HM (alcohol abuse, fatigue), nutritional metabolic (n/v, anorexia), activity exercise (dyspnea), cognitive perceptual (pain) Objective data: Restless, anxiety, low grade fever Flushing, diaphoresis Discoloration of abdomen/flank Cyanosis, jaundice Decreased skin turgor, dry mucous membranes Increase respiratory rate and pulse, decreased BP Abdomen distention, tenderness; decreased bowel sounds

SCI nursing assessment

Subjective Data/Health Hx -Health perception: alcohol/drug use, risk taking -Activity: loss of strength, movement, + sensation below level of injury; dyspnea, inability to breathe adequately ("air hunger") -Cognitive: tenderness, pain at or above level of injury;numbness, tingling, burning, twitching, of extremities -Coping: fear, denial, anger, depression Objective Data -Skin: poikilothermism; warm, dry skin (neurogenic shock) -Respiratory difficulty r/t level of injury -CV: bradycardia, hypotension -GI: decreased or absent bowel sounds (T5 or higher higher paralytic ileus) , abdominal distention, constipation, incontinence, impaction -Urinary: retention (T1-L2), flaccid or spastic bladder -Reproductive: priapism, loss of sexual fxn -Neuro: paralysis, hyperactive DTRs -Muscular: atony (flaccid), contractures (spastic)

acute resp failure clinical manifestations

Sudden or gradual onset (when compensatory mechanisms fail): a sudden drop in PaO2 or increase in PaCO2 indicates serious condition - AMS occurs early Resp: rapid, shallow breathing, orthopnea, tripod, dyspnea, intercostal retractions, pursed-lip breathing, change in I:E ratio, cyanosis- late sign CV: tachycardia, tachypnea, mild HTN Severe morning headache

Ovarian Therapeutic Management

Surgery Total abdominal hysterectomy Bilateral salpingo-oophorectomy w/ omentectomy, tumor removal Chemotherapy Intraperitoneal + systemic chemo or intraperitoneal installation of radioisotopes

cervical cancer management

Surgery: Radical trachelectomy (remove of cervix only) to preserve fertility, hysterectomy, pelvic exenteration if local metastasis with colostomy and urinary diversion Chemoradiation (at same time)

uterine cancer therapeutic management

Surgery: total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO); radiation or chemotherapy

crc therapeutic management

Surgical Goals: Completely resect tumor, explore abdomen, remove all lymph nodes that drain area, restore bowel continuity, prevent surgical complications -Surgical therapy- polypectomy during colonoscopy if CRC in situ -Preop bowel cleanse + oral abx (neomycin) to decrease bacteria -Site of cancer dictates site of resection: right or left hemicolectomy -Stage 1 tumors: Remove tumor + at least 5 cm surrounding intestine + nearby lymph nodes -Stage 2 + 3 - more involved + possible chemo -Stage 4 palliative treatments Temporary Colostomy- if perforation, peritonitis, hemodynamic instability 3 surgical options: rectal cancer -Local excision -Low anterior resection (LAR) to preserve sphincter fxn -Abdominal-perineal resection (APR) w/ a permanent colostomy Chemotherapy -Shrink tumor preop -Adjuvant tx after colon resection: stage III + high risk stage II tumors -Palliative tx unresectable CRC Targeted Therapy Radiation therapy

lung cancer management

Surgical Therapy- Treatment of choice for NSCLC; not for SCLC Includes wedge (segmental) resection, lobectomy, pneumonectomy Video assisted thoracic surgery for tumors near outside of lung Radiation Therapy: Used as curative, palliative, or adjuvant therapy; primary if unable to tolerate surgery. Palliative to relieve symptoms (dyspnea + pain) Preop to reduce tumor mass Monitor for complications (esophagitis, skin irritation, N/V, anorexia, radiation pneumonitis) Stereotactic radiosurgical therapy Chemotherapy: primary treatment for SCLC & unresectable tumors (adjuvant to surgery in NSCLC); typically 2 or more drugs Nursing Care + Teaching -Health promotion- smoking cessation -Offer support during diagnostic eval, monitor for stressors, coping strategies -Symptom management: dyspnea, cough pain relief + monitor for side effects

prostate cancer surgical therapies

Surgical therapies -Radical prostatectomy: entire gland, seminal vesicles, part of bladder neck removed, usually w/ retroperitoneal lymph node dissection; most effective for long-term survival -Pt catheterized for a few days; in hospital 1-3 days -Major complications are ED + incontinence; others: infection, hemorrhage, urinary retention, wound dehiscence, DVT, + PE Nerve Sparing Surgical Procedure -Spares nerves responsible for erection; no guarantee if maintained potency -Only for cancer for confined to prostate Cryosurgery (cryoablation) -Destroys cancer cells by freezing tissue (uses ultrasound probe + liquid nitrogen); 2 hrs; spinal or general anesthesia; no abdominal incision -Complications: damage to urethra, urethrorectal fistula, + urethrocutaneous fistula. Tissue sloughing, ED, incontinence, prostatitis, + hemorrhage can also occur

breast cancer treatment- surgery

Surgical therapy: Breast-Conserving Therapy -Lumpectomy (breast surgery- conservation): removal tumor + margin of normal tissue -Radiation therapy before (local) or after (entire breast) surgery, chemo before + after surgery -Goals of combined surgery + radiation: Minimize risks, maximize benefits + cosmetic outcome (preserves breast + nipple) Surgical therapy: Axillary Lymph Node Dissection (ALND) - Performed w/ lumpectomy; same side -Typically involves removing 12-20 nodes; used in pts w/ disease in axilla -Lymphedema: accumulation of lymph in soft tissues, possible after excision or irradiation of lymph nodes Surgery: Modified Radical Mastectomy -Removal of breast, axillary lymph nodes for tumor too large to excise w/ good margins + reasonable cosmetic result -Preserves pectoralis major muscle -Breast reconstruction may follow at same time or later date -Persistent symptoms: chest/upper arm pain, tingling down arm Numbness; shooting or prickling pain Unbearable itching -Treatment: NSAIDs, antidepressants, topical lidocaine patches/EMLA, antiseizure drugs Total mastectomy: may be done for those at very high risk to prevent breast cancer development Mammoplasty: Breast Reconstruction Achieve symmetry, restore, or preserve body image Immediate or delayed Restore breast contour Cannot restore lactation, nipple sensation, or erectility Breast implants + tissue expansion (upper right) Expander placed under pectoralis + slowly filled: weekly injections May be permanent or replaced by a permanent one; not good if extensive scar tissue Tissue flap procedures- use own tissue to recreate breast mound Nipple- areolar reconstruction

pulmonary embolism nursing (assessment/care)

Symptoms: Dyspnea (sudden), Pleuritic chest pain, Apprehension, Impending doom, Cough, Hemoptysis Signs: Tachypnea, Crackles, Pleural friction rub, Tachycardia, S3/S4 heart sound, Diaphoresis, Fever (low grade), JVD, Petechiae Care/Teaching -Semi-fowler's/IV access/O2 therapy -Assess: VS, chest pain, labs, urine output; possible bleeding precautions -Emotional support -Pt teaching: anticoagulation therapy, measures to prevent DVT, follow-ups Outcomes: Improved: tissue perfusion, CO, respiratory fxn Complications! pulmonary infarction, pulmonary HTN

cervical nursing management

Teaching After Dx Cervical Biopsy -No lifting heavy objects until site healed (2 wks) -Leave postop packing in place 8-24 hours or as directed -Don't douche, use tampons, or have vaginal intercourse until site is healed (2 wks) -Keep perineum clean and dry; use antiseptic solution rinses (as per provider) and frequently change perineal pads -Report excessive bleeding (more than normal menstrual period) or signs of infection Nursing Management -Indwelling urinary catheter -Absolute bedrest, position restrictions (head low) -Diet: low residue -Hygiene -Monitoring client -Side effects of therapy -Emotional support; address risk: social isolation

testicular cancer care

Therapeutic (medical and/or surgical) Management: Orchidectomy, retroperitoneal lymph node dissection (open or laparoscopic), radiation, chemotherapy Nursing Care: -Discuss sperm banking option prior to surgery; note ejaculation can be affected if retroperitoneal lymph node dissection -Assess physical + psychological status -Wound care -Assist w/ coping: possible issues r/t body image + sexuality Patient Teaching Signs of post-op infection, TSE other testicle, follow-up care

lung surgery + postop care

Thoracic Surgery -Thoracotomy w/ a surgical procedure: wedge resection, lobectomy, pneumonectomy -Chest tubes (not used for pneumonectomy) -Possible tracheostomy -O2 (may need permanently) Chest Tubes -Treat hemothorax + spontaneous/traumatic pneumothorax: used to re-expand lung + remove air, fluid, blood -Maintain system patency, dressing care (sterile occlusive) -Don't elevate system above chest; change when full; measure fluid level; report 100 mL/hr -If unit overturned, have pt exhale/cough, do NOT clamp- if break in system, place distal end in sterile water to maintain water-seal *Lung Surgery Post-Op Nursing Interventions* -Provide oxygen, pain management, + rx meds -Resp assessment (breath sounds, SaO2, etc) q 2-4 hrs + PRN -Maintain CT drainage system -Dressing care -Assist w/ positioning (semi-Fowlers; avoid pt lying on side of lung t risk), mobility, splinting, coughing -Small, frequent meals w/ supplements -Teach: breathing techniques/coughing, smoking cessation, nutrition, meds, pulmonary rehab

AAA nursing assessment

Thorough hx + physical; watch for s/s of cardiac, pulmonary, cerebral, + lower extremity vascular problems (est. baseline data to compare postop) Note quality + character of peripheral pulses + neuro status. Mark/doc pedal pulse sites + any skin lesions on LEs preop Monitor for indications of rupture: diaphoresis, pallor, weakness, tachycardia, hypotension, abd pain, back/groin/periumbilical pain, LOC changes, pulsating abd mass Goals: normal tissue perfusion, intact motor + sensory fxn, no complications r/t surgical repair

gastric surgery dietary management

To delay stomach emptying + prevent dumping syndrome, assume low fowlers after meals and lie down for 20-30 mins Take antispasmodics as rx Avoid fluid w meals (4 oz or less) Meals should contain more dry items than liquids Eat fat as tolerated by keep carb intake low, avoid concentrated carbs Eat small frequent meals Take supplements as prescribed

Endometrial Therapeutic Management

Total hysterectomy + bilateral salpingo-oophorectomy w/ lymph node biopsies Possible hormonal (progesterone) therapy Radiation + chemo may be administered Difficult in advanced or recurrent disease

gastric surgery

Treatment for gastric cancer, bleeding ulcers, zollinger-ellison syndrome (hypersecretory condition of stomach), PUD unresponsive to medical tx, perforation Total gastrectomy: -Esophagus anastomosed to small bowel -Lifelong tube feedings Partial gastrectomy: -Billroth I: gastroduodenostomy Remove distal ⅔ of stomach and suture gastric stomp to duodenum -Billroth II: gastrojejunostomy Remove distal ⅔ stomach and suture gastric stump to jejunum Other surgical procedures: -Vagotomy (severing of vagus nerve; total/truncal or selective) -Pyloroplasty: Surgical enlargement of pyloric sphincter; Commonly done after vagotomy >>Improves gastric motility and gastric emptying >>If accompanying vagotomy, increased gastric emptying Most common postoperative complications: Dumping syndrome, postprandial hypoglycemia, bile reflux gastritis

TBI management

Treatment principles: prevent secondary injury, timely diagnosis, surgery -Concussion/contusion: observe/manage ICP -Skull fracture: conservative treatment; surgery if depressed -Subdural/epidural hematoma: surgical evacuation >Craniotomy- burr-holes >Craniectomy if extreme swelling (don't position on side of craniectomy) Emergency Management: Patent airway Stabilized cervical spine (assume neck injury) Oxygen via nonrebreather mask; often intubate if GCS > 8 or absent gag reflex IV access- 2 large bore IVs Control bleeding; maintain warmth

triage

Triage: a hierarchical process that sorts pts based on severity of illness/injury & immediacy of need for treatment. Categories -Emergent (now), urgent (1-2 hrs), non-urgent (24 hrs) -Current ED system is 1-5 (1 is the worst) -Assess for threats to life, assess for presence of high risk situation, # of anticipated resources needed Disaster triage: Very critically ill pts who would consume most resources w/o high chance of survival even w/ best care may not be treated Red: need for immediate treatment to survive but have chance of survival Yellow: stable for now but need repeat reassessment & hospital care Green: "walking wounded", need medical care once more severely injured are treated White: minor injuries w/ no need for medical care Black: for deceased & those w/ injuries so extensive they can't survive w/ level of care available

Collab Care: Cholelithiasis

Tx depends on stage of disease Oral dissolution therapy- ursodiol or chenodiol ERCP w/ sphincter-ectomy -Visualization w/ dilation, stent replacement, + open sphincter of Oddi prn -Stone removal w/ basket or allowed to pass in stool Extracorporeal shock wave lithotripsy (ESWL) -If stones can't be removed via endoscope -High energy shock waves disintegrate stones -Takes 1-2 hrs -Used in conjunction w/ bile acids

urolithiasis

Types: Ca++ phosphate or oxalate, uric acid, cystine, struvite (magnesium, ammonium, phosphate) Common sites of obstruction: ureteropelvic junction or ureterovesicular junction Nursing Assessments -History: previous episodes, meds, dietary supplements, family history, s/s, urine characteristics, dx test results -Sudden severe pain d/t obstruction Manifestations: -Possibly asymptomatic if stone not moving -Mild shock w/ cool, moist skin -Pain moves to lower quadrant of abdomen as stone nears UVJ -Testicular or labial pain; groin pain -Possible concurrent UTI symptoms w/ dysuria, fever Risk Factors: More common in men; avg. age at onset: 20-55 yrs Increased incidence: white, + fam history, + personal history, summer (increased risk dehydration). Factors: metabolic, genetic, climate, lifestyle, infection

intestinal obstruction

Types: partial or total; mechanical or nonmechanical* (paralytic ileus, which is a result of neuromuscular disturbance) Strangulated obstruction resulting from tumors, hernias, fecal impaction, strictures, intussusception, volvulus, fibrosis, vascular disorder, + adhesions Outcome of obstruction: -Accumulation of secretions at + above obstruction -Increased peristalsis in an effort to move intestinal continents forward, which increases secretions + distention further -Moderate or severe hypovolemia

MI management

UA/NSTEMI: Dual antiplatelet therapy/heparin & Cardiac cath w/ PCI once stable STEMI/NSTEMI w/ + cardiac markers: reperfusion therapy -Emergent PCI (minimally invasive opening coronary arteries): Treatment of choice: confirmed STEMI >Balloon angioplasty & drug eluting stent -Thrombolytic therapy (for pts w/STEMI esp if no cardiac cath lab for PCI): IV within 30 mins of ED arrival >Stops infarction by dissolving thrombus Assess for reperfusion (return ST segment to baseline best marker) IV heparin to prevent reocclusion -Cardiac rehab -Physical activity >METs or Borg Scale (pt rating of perceived exertion) >Monitor HR; Low level stress test before discharge -Resumption of sexual activity >Prophylactic nitrates; ED drugs contraindicated >Typically 7-10 days post MI or when pt can climb 2 flights Evaluation: Stable vital signs, pain relief, decreased anxiety, effective management of therapeutic regimen, activity program

Labs + Diagnostics - cholecystitis

Ultrasonography ERCP (visualization of gallbladder, cystic duct, common hepatic duct, CBD) Percutaneous transhepatic cholangiography Insertion of a needle directly into gallbladder duct Labs: Increased WBC Increased serum and urinary bilirubin if obstruction Possible increased liver enzymes (alkaline phosphatase, AST, ALT) Increased serum amylase if pancreas involved

extubation

Unplanned -Prevention: ensure ET adequately secured, support ET when moving, prn sedation, soft wrist restraints if needed -Signs: pt talking, low-pressure alarm, diminished/absent breath sounds, resp distress -Actions: call for help, manually ventilate pt w/ BVM + 100% O2, provide psych support Planned -Preoxygenate + suction -Loosen ET tapes or holder -Deflate cuff + remove tube @ peak of deep inspiration -Encourage pt to deep breathe + cough, supplemental O2 -Careful monitoring after extubation

ovarian cancer assessment

Vague abdominal symptoms (gas, indigestion), bloating, pelvic or abdominal pain, urinary urgency or frequency, difficulty eating or feeling full quickly; weight change or menstrual changes (late)

TBI nursing care

When repeated neuro assessments are performed, a neurological change such as a change in level of consciousness, subtle motor weakness, or cranial nerve deficit, may be identified early enough to intervene, preventing further damage to the brain. Health Promotion -Prevent car & motorcycle accidents, wear safety helmets, use seatbelt, fall prevention -Positioning post head injury: side lying w/ head elevated 30 degrees Acute Intervention -Maintain cerebral perfusion & prevent secondary cerebral ischemia -Monitor for neuro status change -Interventions focused on decreasing ICP -Hyperthermia prevention -Leaking CSF: Elevate HOB, loose collection pad, no sneezing/blowing nose, no NG tube, nasotracheal suctioning -Meds- antiemetics, analgesics -Preop prep Ambulatory care -Acute rehab (motor + sensory deficits, communication, nutrition, intellectual) -Ongoing concerns: seizures, mental/emotional difficulties, progressive recovery, fam participation/edu

Perineal Wound Care After Abdominoperineal Resection

Wound Care Place an absorbent dressing (Kerlix, abd pain) over wound Instruct pt that they may Use sanitary napkin as dressing Wear jockey type shorts rather than boxers Comfort Measures If ordered, use sitz bath 10-20 min, 3-4x days Admin pain med as rx; assess effects Teach pt abt permitted activities Side lying position in bed; avoid sitting for long periods Use foam pads or as a soft pillow when sitting; avoid use of air rings or rubber doughnut devices

hemothorax

blood in pleural space + treat w/ chest tube

septic shock (distributive)

overwhelming infection Sepsis: systemic inflammatory response to actual/suspected infection Severe sepsis = sepsis + organ dysfunction Septic shock= sepsis with hypotension despite fluid resuscitation + inadequate tissue perfusion resulting in hypoxia 3 major pathophysiologic effects: -Vasodilation -Maldistribution of blood flow -Myocardial depression ( ↓ EF, ventricular dilation) Clinical manifestations: Tachypnea/hyperventilation Hyperdynamic state: ↑ CO and ↓ SVR, with ↓ UO GI dysfunction, bleeding, paralytic ileus, altered LOC

chronic pancreatitis complications

pseudocyst formation, bile duct or duodenal obstruction, pancreatic ascites, pleural effusion, splenic vein thrombosis, pseudoaneurysm, pancreatic cancer

SCI Clinical Manifestations

r/t level of + degree of injury Incomplete → variable Sequelae more serious w/ higher injury Impairment may be rated using ASIA scale; used by rehab team to set functional goals

unstable angina

chest pain that is new in onset, occurs at rest, has worsening pattern, or occurs with increasing frequency/duration than normal chronic stable angina pattern women may be more vague Medical emergency

spinal cord injury

damage or trauma to spinal cord SCI d/t cord compression by: bone displacement, interruption of blood supply, or traction from pulling on cord Penetrating trauma → tearing + transection Primary Injury- initial mechanical disruption of axons from stretch or laceration Secondary Injury- ongoing, progressive damage after initial Complete cord damage r/t auto-destruction: hemorrhage w/in 1 hr, infection by 4 hrs Care management critical to limit permanent loss -By less than 24 hr, permanent damage possible d/t edema -Extent of damage from both primary + secondary injuries -Prognosis cannot be determined for at least 72 hrs

cardiogenic shock

impairment/failure of myocardium (MI) Systolic or diastolic dysfxn w/ decreased CO Early manifestations: tachycardia, hypotension, narrowed pulse pressure, increased myocardial O2 consumption Physical assessment: tachypnea, pulmonary congestion, pallor, cool/clammy skin, decreased/slowed capillary refill, anxiety, confusion, agitation, ↑ PA wedge pressure, ↓ renal perfusion and UO

neurogenic shock (distributive)

loss of sympathetic tone (spinal cord injury) Hemodynamic phenomenon: Can occur from spinal anesthesia Results in massive vasodilation, leading to pooling of blood in BVs Clinical manifestations: Hypotension, bradycardia Warm dry skin at first, then poikilothermia (taking on temperature of environment from heat loss)

PUD complications: Hemorrhage

most common complication of PUD. Develops from erosion of: granulation tissue found at bas of ulcer during healing → ulcer erodes through a major blood vessel