HPA1 - Exam 2
A client who recently had a colostomy expresses concerns about the sexual relationship with the client's spouse. Which statement made by the nurse is appropriate?
"I can refer you to a support group so that you can speak with others with similar problems."
A client is elevated for type 1 diabetes. Which client comment correlates best with this disorder?
"I'm thirsty all the time. I just can't get enough to drink."
A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)?
"I've had trouble getting started when I urinate, often straining to do so."
Hypoglycemia Symptoms
"You're not yourself without a snickers" Dizzy, grumpy, sweaty, confused, shaky, seizures, tremors A lot of neuro symptoms !
Oxybutynin
(vision changes, numerous anticholinergic effects) Adverse effects (drowsiness, dizziness, blurred vision, dry mouth, nausea, urinary hesitancy, decreased sweating)
Nursing Management of Intestinal Obstructions
* * Maintaining function of nasogastric tube * * Assessing and measuring the nasogastric output Assessing for fluid and electrolyte output Monitoring nutritional status Assessing for manifestations consist with resolution
Diagnostic Tests for BPH
** Prostate-Specific Antigen (PSA) Ultrasonography Prostate fluid or tissue analysis Tests of male sexual function
A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled?
6.5%
Normal Blood Sugar range
70-100 mg/dL
A1C range
< 6.5 keeps you alive
Hypoglycemia
< 70 mg/dL
Hypoglycemia range
<70 mg/dL
Hyperglycemia Fasting range
> 100
Hyperglycemia
> 100 mg/dL in a fasting state > 125 mg/dL not in a fasting state
Hyperglycemia Not Fasting range
> 125
The nurse is caring for a patient with dementia in the long-term care facility when the patient has a change in cognitive function. What should the nurse suspects this patient may be experiencing?
A UTI
Diabetes Mellitus
A chronic multisystem disease ** Our goal is to prevent chronic complications of diabetes since we can not prevent diabetes itself!!!
Which client is at highest risk for developing a hospital-acquired infection?
A client with an indwelling urinary catheter
Cardinal Test for Type II Diabetes
A1C Looks at BS over 3 month period < 6.5 keeps you alive
A client with type 1 diabetes is to receive a short-acting insulin and an intermediate-acting insulin subcutaneously before breakfast. The nurse administer the insulin at which site as the preferred site?
Abdomen
Factors the Influence Fecal Incontinence
Ability of the rectum to sense and accommodate stool Amount and consistency of stool Integrity of the anal spinchters and mesulature Rectal motility
Types of Prostatitis
Acute Bacterial Chronic Bacterial Chronic Prostatitis/Chronic Pelvic Pain Syndrome Asymptomatic Inflammatory Prostatitis
Pharmacological Therapy FOR Urinary Incontinence
Adjunct to behavioral therapy **Anticholinergic Agents
** Risk Factors for Urinary Incontinence
Age-related changes Caregiver or toilet unavailable Cognitive disturbances—dementia, parkinson disease Diabetes GU surgery High-impact exercise Immobility Incompetent urethra due to trauma or sphincter relaxation Medications Morbid Obesity Pelvic muscle weakness Pregnancy and Menopause Stroke
Dietary Concerns for Diabetics
Alcohol --Alcohol can cause hypoglycemia *Patients act grumpy, dizzy, confused etc. *Symptoms of hypoglycemia are similar to those of being intoxicated --Alcohol can also prevent the liver from storing glycogen Avoid saturated fats Consume whole grains
Management of BPH Medical Treatment..
Alpha-Adrenergic Blockers Medication that relaxes muscle tissue = improves flow of urine and blood Catheter for acute condition; unable to void
A client is having trouble adjusting to a colostomy surgically created 4 days ago. The nurse prioritizes which nursing diagnosis?
Altered body image
Which would be included in the teaching plan for a client diagnosed with diabetes mellitus?
An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision.
(Prostatectomy) The Nursing Process - The Diagnosis
Anxiety about outcome Acute pain preoperatively / acute pain postoperatively Risk for imbalanced fluid volume postoperatively Deficient knowledge
A client requires a change and reapplication of a colostomy bag. The nurse has never changed an ostomy bag before. What is the nurse's best course of action?
Ask a skilled nurse to assist with a procedure
Toileting Journal
Ask them to keep a food log of what foods they ate and how is made them feel after Did any of the foods make them feel like they had to go to the bathroom quickly? If so we need to avoid those foods etc.
Nursing Assessment of Patient with BPH
Asking about urinary function and symptoms --Does it hurt when they pee? Asking about sexual function and manifestations of sexual dysfunction --Does it hurt when they ejaculate? Symptoms related to urinary obstruction Increased urinary frequency Decreased force of stream "Double" or "triple" voiding --Feel like you've emptied the bladder and you feel like you have to go again Nocturia, dysuria, hematuria, hematospermia --Hematospermia - blood in the sperm / semen Presence of conditions that may affect sexual function (diabetes, cardiac disease, multiple sclerosis)
(Prostatectomy) The Nursing Process - The Assessment
Assess how the underlying disorder has affected the patient's lifestyle --What were their baseline levels of functionality before BPH or prostate cancer? Urinary and sexual function Health history Nutritional status Activity level and abilities
Mixed Urinary Incontinence
Associated with a combination of urgency, exertion, effort, sneezing and coughing Mixture of urge and stress incontinence !!
** Causes of Chronic Incontinence
Atrophic vaginitis, urethritis, prostatitis --Atrophy of urinary system which can lead to inflammation Delirium or confusion Excessive urine production --Increased fluid intake, diabetes, DKA Limited or restricted activity Pharmacologic Agents Psychological factors --Depression & Regression Stool impaction or constipation --The expansion caused by the stool impaction can put pressure on the urinary tract and this can decrease the muscle tone / PNS signals = incotinnent --After disimpaction you can sometimes instantly relieve the incontinence !! Urinary Tract Infections (UTI)
Meal Plans for Diabetics
Avoid Glycemic Index --Rise in blood glucose after consuming carbohydrate containing food --Eat carbs with other foods that help keep them in moderation (Like fiber, protein and fat!!!) Raw and whole foods have lower response then chopped / pureed If you want to eat ice cream, get some fiber in there to slow the absorption of sugar from the ice cream!!!
The nurse is educating with a new colostomy about gas-producing foods. Which gas-producing food should the client avoid to prevent gas buildup in the colostomy bag?
Baked beans
** Management of Urinary Incontinence
Behavioral Therapy (disconnect with CNS and PNS) Pharmacological Therapy Surgical Therapy
Urinary Diversion Indications
Bladder cancer or other pelvic malignancies Trauma Strictures - narrowing of any vessel in your uterine tract Neurogenic Bladder Chronic Infection or intractable cystitis Used as a last resort for incontinence
Overflow Incontinence
Bladder is overly full of urine = exceeds urethral pressure
Flavoxate
Blurred vision, dizziness, confusion
Hypoglycemia Chronic Complications
Brain death
The nurse is education a new colostomy client on gas-producing foods. Which food is gas-producing food the client may choose to avoid?
Brussels sprouts
Intestinal Obstruction
Can result from being constipated in higher GI tract Most commonly happens due to stagnant bowel which is usually due to medication issues Any patients that is on pain medications we need to make sure they have bowel movements
Large Intestine Functions
Completion of absorption of water and nutrients Manufacture of some vitamins (K and B) Formation of feces Expulsion of feces from the body
Pathophysiology of Fecal Incontinence
Conditions that alter the structure or function of the anorectal unit Sphincter weakness from trauma or non-trauma Neuropathies Pelvic Floor Disorders Inflammation Central Nervous System Disorders Diarrhea Fecal Impaction with Overflow Behavioral Disorders
Bowel Elimination Impairments
Constipation Fecal Impaction Diarrhea Hemorrhoids
Manifestations of Obstruction
Cramps Passage of mucus or blood from rectum Decrease in number of bowel movements Abdominal distention Vomiting Metabolic alkalosis from vomiting Dehydration
Indiana Pouch
Created for a patient whose bladder was removed or is no longer functional A urine pouch is created out of bowel, stores urine and is regularly drained to the outside by periodically passing a catheter through the skin, into the pouch Urine doesn't come out on it own, you have to catheterize it to get urine out If anyone other than the patient is catheterizing themselves, it is a sterile technique!!
DKA and Type I Diabetes
DKA is the result of hyperglycemia Body turns to fat for energy Byproduct of metabolizing that fat is ketones Ketones are passed in the urine and are a signal that blood sugar levels are high
A client's recent diagnosis of colorectal cancer has required a hemicolectomy (removal of part of the bowel) and the creation of a colostomy. The nurse would recognize that the client's stoma is healthy when it appears what color?
Dark pink and moist
Which age-related change may affect diabetes and its management?
Decreased renal function.
(Central Nervous System Disorders) Pathophysiology of Fecal Incontinence
Dementia, Stroke, Spinal Cord Injury, Multiple Sclerosis Afferent and Efferent Pathways --Unable to accept afferent signals being sent to them --Unable to send efferent signals as to how to act
A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate?
Diet, exercise, and weight loss can eliminate the need for medication.
Physical Assessment of BPH
Digital Rectal Exam (DRE) Testicular Exam
Bowel Elimination Impairment (Examples)
Diverticular Disease Crohn's Disease Ulcerative Colitis Colorectal Carcinoma
Prostate Cancer Manifestations:
Early disease has few or no symptoms Symptoms of urinary obstruction, blood in urine or semen, painful ejaculation Symptoms of metastasis may be the first manifestations
Type 1 Diabetes Risk Factors
Early onset, familial genetics, immunologic or environmental (viral or toxins) A virus is usually the cause when it wipes out the immune system !
Dietary Considerations (For Diversions & Ostomies)
Eat food from all food groups Low-residue & low-fiber diet for the first 6 weeks Keep food diary to see what causes more gas Eat small, frequent meals each day Introduce new foods one at a time Eat slowly and chew well Eat foods that are cooked well and tender Hydration Avoid drinking through a straw because this can increase gas Avoid gas producing foods
BPH Priorities
Elimination Infection Intake and output Pain Sexual dysfunction
Ileal Conduit--- Post-Operative Care Interventions:
Encouraging PO fluids Emotional support Self management education, educate patient on potential complications
Pancreas
Endocrine Gland - producing hormones Exocrine Function - releasing enzymes and bicarbonate to aid in digestion Islets of Langerhans --Alpha (glycogen) and Beta (insulin)
(Diabetes) Risk Factors for Urinary Incontinence
Excess amount of blood glucose, pancreas produces insulin, insulin transports glucose into cells. The more circulating glucose in your blood will desensitize the PNS, weakening signals that are able to be sent to PNS. Glucose starts to harden vessels in the peripheral vascular system, vascular system starts to constrict = decreased perfusion = desensitize nerves Diabetes leads to peripheral neuropathy = lose sensation in their peripheral body (fingers and toes) How does this lead to urinary incontinence? --Don't have signals between hands and feet = immobile --Peripheral system is getting weakened all over the body not just peripheral body including urinary system --Signals are weakened between PNS and CNS = neurogenic bladder !!!!
Exercise and Insulin
Exercise can lower blood glucose levels ! **Need several small carb snacks taken every 30 minutes during exercise to maintain normal blood sugar ranges Insulin is best after meals ** Monitor glucose levels before, during and after exercise Exercise can also elevate blood sugar levels, insulin must be adjusted But, blood sugar normally decreases with exercise!!! --Patients on insulin should eat a 15 g carbohydrate snack before moderate exercise to prevent hypoglycemia **All patients need to have snacks between meals to account for potential insulin peaks
Type 1 Diabetes. Treatment
Exogenous insulin for the rest of the person's life !
Patient and Family Education (Peristomal Skin Trauma)
Explain reason for bowel diversion Demonstrate self-care behaviors Describe care and support resources Report where to get supplies Verbalize fears and concerns Demonstrate positive body image
A nurse refers a client with a new colostomy to a support group. This nurse is practicing which aim of nursing?
Facilitating coping
** Medical Management (Fecal Incontienence)
Find the underlying cause of the incontinence --Diarrhea, Impaction, Medication Treat with adding psyllium (metamucil) - bulk forming fiber supplement Treat with loperamide if indicated (does not have central nervous system adverse effects) --Slows down diarrhea that is occurring for acute relief Treat with patient biofeedback therapy with pelvic floor muscle training Bowel training program Sacral nerve stimulator
A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings?
Finger
type 2 diabetes treatment
First we want to change the person's lifestyle through diet and exercise If diet and exercise doesn't work, oral hypoglycemic agents may need to be used Insulin is rarely used for type II diabetics
Health Promotion Interventions (Urinary Incontinence)
Fluid Management Standardized Voiding Frequency Timed voiding Prompted voiding Habit retraining Bladder retraining Pelvic Muscle Exercises (Kegel Exercises) Biofeedback Recommended Vaginal cone retention exercises Transvaginal or transrectal electrical stimulation Neuromodulation
Potential Complications - Bladder Diversions
Fluid Volume Deficit Peristomal Skin Irritation Infection / Peritonitis Ureteral Obstruction Small Bowel Obstruction Renal Calculi
Potential Complications for Bowel Diversions
Fluid Volume Deficit Skin Irritations Diarrhea Intestinal Obstruction
Chronic Prostatitis/Chronic Pelvic Pain Syndrome:
GU symptoms with no bacteria in urine Most common prostatitis
Hypoglycemia Interventions
Give glucose !!! --If they are awake, give them 15 grams of carbohydrates *Can either be: 3 - 4 glucose tablets OR ½ cup of juice or regular soda (not diet) *Retest glucose levels in 15 mins *After we provide the carbohydrate snack, we want to give them a snack with protein and carbohydrate to follow *If blood sugar is still < 70 REPEAT --If they are not awake or cant swallow (semi-conscious or the least bit not awake), give the IV dextrose Severe Hypoglycemia --Critical Rescue = unable to swallow, unconscious give > 1 mg of glucagon IM or SQ, repeat in 10 minutes and notify provider
Insulin Inhibits:
Glycogen breakdown Fat breakdown Protein breakdown
Which component of client teaching helps the nurse assist a client following treatment for cancer of the prostate gland to manage and minimize the possibility of a recurrence of the primary cancer or metastasis?
Have regular prostate-specific antigen (PSA) levels tested and repeat lymph node biopsies
Potential Complications for Post-Op
Hemorrhage and shock Infection Venous thromboembolism Catheter obstruction Complications with catheter removal --Was it painful to remove catheter, there shouldn't be pain so you want to note this to the provider Urinary incontinence Sexual dysfunction
Metabolic Syndrome and Type II Diabetes
High blood pressure High blood sugar High lipids --Only HDL should be high > 40 Obesity
Insulin
Hormone produced in pancreas Reacts to cell receptor sites Insulin stimulates uptake, use and storage of glucose
A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for Type 2 diabetes. Which information is important to include in the discharge teaching?
How to control blood glucose through lifestyle modification with diet and exercise.
A 65-year-old man complains to his health care provider that, when he urinates, he has to start and stop several times over a period of minutes in order to fully empty his bladder. The nurse is aware that this is not uncommon in men over the age of 60. This "double voiding" is directly related to which of the following?
Hyperplasia of the prostate gland
Sick Day Rules
If a patient is ill, their insulin and blood sugar with change accordingly because of the symptoms of their illness or the stress of the illness They should check their blood sugar, take their insulin, stay hydrated, continue to eat or drink, notify doctor of ketones, vomiting or diarrhea
Iatrogenic Incontinence
Incontinence caused by extrinsic medical factors --Medications
** Gerontological Considerations
Incontinence is NOT a normal consequence of aging --The older you are the more you have been exposed to certain things (environmental toxins, stress, bad sleep, sedentary lifestyle, etc) and they will wear on your body Causes Dependency on Another Person / Medications Predisposes to infection and skin breakdown May lead to institutionalization Affects 25-45% of older women Can have an abrupt onset (need to thoroughly assess) --Acute UTI Sometimes we overlook the UTI aspect of it because the way that an acute UTI shows itself in a geriatric population is in confusion!!! --Constipation --Chronic disease --Elevated glucose levels --Decrease estrogen levels Early intervention is key for treatment! Bladder more vulnerable due to altered detrusor muscle activity --Decrease in bladder capacity --Increase urine residual (50-100 ml may be left) --Increase in urgency Age alone is not a risk factor !! Medications can impact urinary incontinence
Prostate Cancer Risk Factors
Increasing age familial predisposition African American race sedentary lifestyle
A patient has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of occurrence and has planned the patient's discharge education accordingly. What preventative measure should the nurse encourage the patient to adopt?
Increasing fluid intake
Mechanical Surgical Priorities!!
Infection Wound Skin Integrity Pain Intake and Output ADL's Sexual Dysfunction
Anticholinergic Agents
Inhibit bladder contraction --Considered first-line medication for urge incontinence --Smooth muscle spasms affecting the urinary tract *Antispasmodics block parasympathetic activity, thereby relaxing detrusor and other urinary tract muscles.
Testicular Exam - Physical Assessment
Instruct on testicular self-examination (TSE)
Types of Insulin Delivery
Insulin Pen - dial in dose or hit button for each 1-2 units of insulin Insulin Pump - small catheter in abdomen administered at basal rate as well as bolus
Stress Incontinence
Involuntary loss of urine through an intact urethra --Sneezing, Coughing, Change in Position --More common in women with previous vaginal deliveries --Result of decrease ligament and pelvic floor support of the urethra --Decrease estrogen levels --Can happen in men Radical Prostatectomy
Urge Incontinence
Involuntary loss of urine with a strong urge to urinate that can't be suppressed Uninhibited detrusor muscle contraction (muscle involved with urinary system in order to contract or constrict to get urine out) Neurological dysfunction affecting inhibition of contraction Could be without neurological dysfunction Patient can't get to the toilet in time
Urinary Incontinence
Involuntary or uncontrolled loss of urine from the bladder Disconnect between CNS and PNS
Fecal Incontinence
Involuntary passage of stool for at least 3 months Can have negative impact on quality of life
Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine?
Ketones
A nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level should the nurse observe when assessing laboratory results?
Less than 7 mg/dL (3.7 mmol/L)
A school nurse is teaching a group of high school students abut risk factors for diabetes. What action has the greatest potential to reduce an individual's risk for developing diabetes?
Lose weight, if obese
Functional Incontinence
Lower urinary tract function is intact Caused by other factors --Cognitive impairment --Physical impairment Spinal cord injury, stroke, trauma to area etc.
Hyperglycemia Chronic Complications
Macrovascular Microvascular
Goal of Treatment for Diabetics
Maintain normal blood glucose levels and A1C ** Best place to do blood glucose test: sides of fingers ** Delay / Prevent onset of chronic diabetic complications !!!!! When we teach our patients, we want them to tell us what we said to ensure we know they understood
Dietary Management for Diabetes
Maintain the pleasure of eating; include personal cultural preferences Promote exercise and activity Achieve and maintain BMI < 25 Prevent large fluctuations of blood glucose levels If it's the metabolic syndrome, we want to decrease lipids, obesity and blood pressure
Which of the following would a nurse include in a teaching plan for a client with benign prostatic hyperplasia who is not yet a candidate for surgery?
Maintaining optimal bladder emptying
(Prostatectomy) The Nursing Process - The Planning
Major Pre-Op Goals: -- adequate preparation & reduction of anxiety and pain Major Post-Op Goals --Maintenance of fluid volume balance --Relief of pain and discomfort --Ability to perform self care activities --Absence of complications
Benign Prostatic Hyperplasia
Manifestations are those of urinary obstruction, urinary retention, and urinary tract infections Develops over a period of time; changes in urinary tract slow and insidious Symptoms depend on severity: dysuria, hesitancy, sensation of incomplete bladder emptying
** Prostate-Specific Antigen (PSA)
Measures the protein produced by prostate in blood Done before DRE ! Don't want to palpate prostate and have the levels change (avoid increase in PSA levels) Level > 4 ng/ml needs further evaluation
Management of BPH Surgical Treatment..
Minimal invasive therapy Surgical resection TURP - transurethral resection of prostate
PLISSIT
Model of sexual assessment and intervention Permission Limited Information Specific Suggestions Intensive Therapy
A client is being treated for renal calculi and suspected hydronephrosis. Which measure should the nurse take to help maintain a record of the kidneys' function?
Monitor the client's intake and output
A client is treated for renal calculi and suspected hydronephrosis. Therefore, the nurse should maintain a record of the kidney's function. Which measure can the nurse take to help achieve the objective?
Monitor the patient's intake and output
** Relief of Pain
Monitor urinary drainage and keep catheter patent Assessment of pain --Bladder spasms cause feelings of pressure and fullness, urgency to void, and bleeding from the urethra around the catheter Medication and warm compresses or sitz baths to relieve spasms Administer analgesics and antispasmodics as needed Encourage patients to walk but to avoid sitting for prolonged periods. Prevent constipation Irrigate catheter as prescribed
Type 1 Diabetes
NO insulin
Anticholinergic Agents Adverse Effects
Nausea & Vomiting Dry mouth Drowsiness Nervousness Tachycardia Vision Changes Flavoxate Oxybutynin
Microvascular
Neuropathies --Diabetic / Peripheral Neuropathy *High blood sugar = desensitized nerves = numbness and tingling of hands and feet *May not feel an ulcer on their foot, the wound gets worse and worse and eventually might get food cut off !! *Seen in poorly controlled diabetes *First symptoms: numbness and tingling!!!! *Falls risk! --Somatic Neuropathy *Diminished perception: vibration, pain, temperature --Autonomic Neuropathy *Inability to empty the bladder *Impaired motility of GI tract *Sexual dysfunction --Retinopathy
Hypoglycemia Causes
Not eating ** Insulin peaks
A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include?
Notify the physician if urinary urgency, burning, frequency, or difficulty occurs
Type 2 Diabetes Risk Factors
Obesity age previously identified impaired fasting glucose or impaired glucose tolerance hypertension low HDL high triglycerides
A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin?
Observe the client drawing up and administering the insulin.
Anticholinergic Agents Contraindications and Cautions
Obstructive urinary problems !! Glaucoma Myasthenia gravis Acute hemorrhage Renal and hepatic dysfunction Pregnant and lactating
When glucose is low....
Pancreas is triggered Alpha cells of the pancreas release glycogen Liver is triggered and releases glucose into blood
When glucose is high....
Pancreas is triggered Beta cells secrete insulin Fat cells take in glucose from blood
Rehabilitation and Home Care (Prostatectomy)
Patient and family education for home care, including care of urinary drainage devices and recognition and prevention of complications Regain bladder continence (only if this was a pre-op goal) --Information that regaining control is a gradual process (dribbling may continue for up to 1 year depending on type of surgery) --Perineal exercises Avoidance of straining, heavy lifting, long car trips (6 to 8 weeks) Diet: encourage fluids and avoid coffee, alcohol, and spicy foods Assessment and referral of sexual issues
Nephrostomy Post-Operative Care
Patients are at high risk for skin breakdown around the sight !! Maintaining skin integrity Relieving pain (They will have acute flank pain !!) Infection prevention Maintaining fluid balance Improving body image issues Monitoring for complications Copes with sexuality issues
Manifestations of DKA
Patients get a fruity odor to the breath Kussmaul's respirations Electrolyte imbalances of K and Na
A client has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following?
Pelvic floor exercises
A female client is undergoing a bladder training program as treatment for urinary incontinence. Which technique would be the most appropriate for the nurse to suggest?
Performing Kegel exercises
An older adult patient that has type 2 diabetes comes to the emergency department with second degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation?
Peripheral neuropathy.
The nurse is preparing to assess a client's new stoma. Which finding would the nurse include in the documentation of a healthy stoma?
Pink color
Hyperglycemia Symptoms: 3 P's
Polydipsia - need to drink often Polyphagia - need to eat often Polyuria - need to urinate often
Type 1 Diabetes Manifestations 3 P's
Polyuria Polyphagia Polydipsia
Large Intestine
Primary organ of bowel elimination Extends from the ileocecal valve to the anus
Conditions of the Prostate
Prostatitis BPH
Interventions (Prostatectomy)
Provide patient education including explanations of anatomy and function, diagnostic tests and surgery, and the surgical experience
(Neuropathies) Pathophysiology of Fecal Incontinence
Pudendal Nerve - main nerve in the perineal area Diabetes is the precursor !!
(Inflammation) Pathophysiology of Fecal Incontinence
Radiation - external cause of inflammation SIBO - small intestine bacterial overgrowth, increases inflammation = increases fecal incontinence
Digital Rectal Exam (DRE) -- Physical Assessment
Recommended annually for men > 50 years old After age of 50 you are more likely to get an enlarged prostate Recommended annually for men > 45 years of age at high risk African American & men with family history
diagnostics (fecal incontinence)
Rectal Exam Flexible Sigmoidoscopy Anorectal Manometry Anal Endosonography Pelvic MRI
(Pelvic Floor Disorders) Pathophysiology of Fecal Incontinence
Rectal Prolapse- rectal sphincter falls out of its place and protrudes out of the rectum
Surgical Procedures Fecal Incontienence
Repair of anal spinchter Artificial sphincter implantation Sphincter bulking injection Sacral nerve stimulator Fecal Diversion - ostomy
Urinary Bladder
Reservoir for urine storage Freely movable organ Posterior to the pubic symphysis
Conditions that alter the structure or function of the anorectal unit (Patho of Fecal Incontinence)
Scleroderma - autoimmune disorder, hardening and tightening of the connective tissue and muscles = decreased motility = decreased movement of bowels = diarrhea Neuropathy
Prostate Cancer
Second most common cancer and the second most common cause of cancer death in men
Risk Factors for BPH
Smoking sedentary lifestyle western diet (high in processed food and high in carbohydrates) african american men family history
The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer?
Smoking cessation
** Nursing Management
Start with thorough assessment Bowel training program Goal is to have continence, if not possible have predictable times and planned elimination Suppository may be needed --Typically given if for spinal cord injury patients !! --Because of the disconnect between central and peripheral nervous systems --For non-spinal cord patients, suppository can be given for patients who are impacted Biofeedback and pelvic exercises to increase sphincter contractibility and rectal sensation Diet high in fiber (fiber supplement / increase liquids) Avoid foods that loosen stool (prunes, plums and figs) Loperamide - diarrhea medication Skin integrity is a high priority !! Use incontinence pads for a brief time Use perineal skin cleanser Use skin protection products Foam plug Toileting schedule Fecal external device (ostomy bag) Rectal Tube - short term management Emotional support
A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patient's post procedure care?
Strain the patient's urine following the procedure
Types of Urinary Incontinence
Stress Incontinence Urge Incontinence Functional Incontinence Iatrogenic Incontinence Mixed Urinary Incontinence Overflow Incontinence
A patient informs the nurse that every time she sneezes or coughs, she urinates in her pants. What type of incontinence does the nurse recognize the patient is experiencing?
Stress incontinence
A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client?
Suggest fluid intake of at least 2 L/day
** Peripheral Nervous System - any part of NS that is not brain or spine, sends afferent neuron to CNS with information as to what's going on **CNS reviews that information and says do X, Y, Z sends efferent neuron down to PNS to react. (T/F)
T
Elimination patterns are essential (T/F)
T
Patient Teaching
Teach patient when to know when their insulin is acting and when it is peaking --REMEMBER peaks of insulin can cause hypoglycemia !! Use an action of insulin Recognize hypoglycemia and hyperglycemia Blood glucose monitoring Self-injection of insulin or insulin pump Inspect feet daily and visit a podiatrist frequently Check to see if patient is on a beta - blocker --Patient might not feel their symptoms if on a beta blocker
The nurse is caring for a 13-year-old client with ulcerative colitis who has a new temporary colostomy. Which nursing intervention is priority?
Teach the client how to perform colostomy care
The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role will the nurse have an implementing a behavioral therapy approach?
Teach the patient to perform pelvic floor muscle exercises.
When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?
The client keeps the drainage bag below the bladder at all times.
A client has a newly created colostomy. After participating in counseling with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image?
The client touches the altered body part
** Patient Education for Promoting Urinary Continence
The nurse instructs the patient to: --Avoid bladder irritants (caffeine, alcohol, and aspartame (NutraSweet) --Avoid taking diuretic agents after 4 pm. --Increase awareness of the amount and timing of all fluid intake. --Perform all pelvic floor muscle exercises as prescribed, every day. --Stop smoking (smokers usually cough frequently, which increases incontinence) Take steps to avoid constipation: --Drink adequate fluids, eat a well-balanced diet high in fiber, exercise regularly, and take stool softeners if recommended. Void regularly, 5-8 times a day (about every 2-3 hours): --First thing in the morning --Before each meal --Before returning to bed --Once during the night if necessary
When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?"
The nurse's most helpful response to this statement is: Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."
A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse should question the patient about what sign or symptom that would suggest the possible development of peripheral neuropathy?
The presence of a tingling sensation.
Cutaneous Ureterostomy
The ureter itself is brought through the abdominal wall and attaches to an opening in the skin
Diagnostic Studies (Urinary Incontinence)
Thorough history and physical --Detailed description of problem --Medication usage --Voiding history --Diary of I&O --Bedside tests (residual and stress maneuvers) Kidney, Ureter and Bladder (KUB) X-Ray General or Bladder Ultrasonography CT Scan and MRI Nuclear Scans Cystoscopy
A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband off her a complex carbohydrate snack as soon as possible?
To restore liver glycogen and prevent secondary hypoglycemia.
Functions of Insulin
Transports and metabolizes glucose for energy Stimulates storage of glucose in the liver and muscle as glycogen Signals the liver to stop the release of glycogen Enhances storage of fat in adipose tissue Inhibits the breakdown of stored glucose, protein and fat
Nephrostomy
Tube comes directly out of the kidney in the flank (area between ribs and hip) Can use a syringe to clear out any blockage
Type 2 Diabetes
Type 2 is YOU or FEW --Culprit is typically lifestyle Insulin resistance or not enough insulin is produced for the entire body Onset is typically > 30 years old
Ileal Conduit
Ureters are redirected to an isolated section of the terminal ileum bringing one end to the abdominal wall
Urinary Diversion Procedure
Urinary tract is redirected to come out of a whole in your skin!
Ileal Conduit--- Post-Operative Care Monitoring For:
Urine Output: should be 30 mL / hour Bleeding: 48 hours post op hematoma or hematuria is okay! Should be perfusion through stoma - pink & beefy Mucus mixed with urine may occur
Surgical Management (Urinary Incontinence)
Used when Behavioral and Pharmacological have not been effective !! Procedure are performed to lift and stabilize the bladder or urethra Restore normal bladder and urethral angle Lengthen urethra Anterior vaginal repair Retropubic suspension Needle suspension (repositions the urethra) Sling procedures periurethral bulking agents ---(Compress the urethra and increase resistance to urine flow) (temporary) Artificial Sphincters (Periurethral cuff and Cuff inflation pump) TURP -Transurethral resection of prostate
Symptoms of fecal incontinence
Vary from patient to patient Poor control of flatus, diarrhea or constipation Passive Incontinence - no warning Urge Incontinence
The nurse who teaches a client about preventing recurrent urinary tract infections would include which statement?
Void immediately after sexual intercourse
A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan?
Weight reduction through diet and exercise.
Treatment for Prostatitis
appropriate anti-infective agents and measures to alleviate pain and spasms
Anal Endosonography
checking nerve conduction of that area
Fecal Impaction
collection of hardened stool Have to do a digital rectal exam to disimpact patient
The nurse is assessing a client's new stoma and observes that the stoma color is now dark purple. The appropriate nursing intervention is to...
contact the physician
Asymptomatic Inflammatory Prostatitis
diagnosed incidentally, elevated PSA
Nursing management of the client with a urinary tract infection should include:
discouraging caffeine intake
The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of:
disturbed body image
BPH - Benign Prostate Hypertrophy
enlargement of prostate
Urge Incontinence (Fecal Incontinence symptoms)
have an urge but cant make it to the toilet Need to have time voiding schedule
Diarrhea
increased frequency of liquid stool
Prostatitis
inflammation caused by an infectious agent
Hyperglycemia Interventions
insulin or oral glycemic agents
Constipation
less than 3 BM/week (relative to patients normal)
Anorectal Manometry
looking to see if anal spinchter and rectum is contracting appropriatley
Passive Incontinence (Fecal Incontinence symptoms)
no warning Seen with neuro patients or patients with acute trauma to that area
Time Voiding
order put in for patient, trying to get patient into muscle memory habit of when they are going to use the bathroom Have to sit the patient on toilet whether they want to go or not (cant take no for an answer)
A client asks the nurse what PSA is. The nurse should reply that is stands for:
prostate-specific antigen, which is used to screen for prostate cancer.
Macrovascular
pulmonary artery disease, coronary artery disease, vascular disease etc.
Flexible Sigmoidoscopy
put video monitoring device onto a small tube looking at lower bowel for abnormalities
Pelvic MRI
shows the anatomy
A nurse approaches a client with a recent colostomy for a routine assessment and finds the client tearful. The nurse's most appropriate response would be to:
sit down and ask if the client would like to talk about any concerns.
Acute Bacterial:
sudden onset of fever, dysuria, pain
Hyperglycemia Causes 3 S's
surgery, stress and steroids
Prostate Cancer Treatments
therapeutic vaccine prostatectomy radiation therapy hormonal therapy chemotherapy
Chronic Bacterial:
typically asymptomatic
Hemorrhoids
veins and folds in the rectum become distended from repeated pressure
A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:
wash and inspect the feet daily.
