Exam 3 NUR 326 Case study

How long should a client with reflux need to wait before lying down after eating

1-2 hours

What is a Gleason grade?

Cancer cells are graded from 1 to 5, with 1 being nearly normal and 5 being very abnormal. The grades from two different areas are added together for a Gleason score. A score of 2 to 4 is a low-grade cancer and a score of 8 to 10 is an aggressive cancer and is treated more aggressively. The more aggressive the cancer, the faster it spreads.

What is etiologies of peritonitis?

Etiologies-intestinal obstruction, perforated ulcer, breakage of anastomosis, penetrating trauma. Anything that can cause leakage into peritoneal cavity

Pre-op for cystoscopy?

Force oral/IV fluids, obtain consent, explain procedure; give preop med

Post op for large hemorrhoids?

Hemorrhoidectomy for large hemorrhoids Sitz bath 1-2 days after surgery (15 -20 mins 1-2 weeks at home) Side lying or prone position topical anesthetics stool softeners to decrease pain with first bowel movement watch for dizziness/fainting with first BM, high-fiber diet (legumes, dried beans/peas, fruits/vegetables with peelings), fluid. Give pain meds before first BM (opioids and nitroglycerin preparations).

Risk factors for hemorrhoids?

Hemorrhoids are common with chronic constipation, heavy lifting, and prolonged standing and sitting.

Manifestations of hemorrhoids?

Hemorrhoids are dilated veins and include rectal bleeding, pruritus (itching), prolapse, and pain.

What do you teach a patient about ostomy care?

How to provide ostomy care Express feelings and concerns about body images Where you can get stoma supplies Methods on reducing odor drainage may vary from diet Never irrigate stoma or use laxatives Empty pouch when it is 1/3 to 1/2 full Change pouch ever 5-7 days or if the seal is leaking Local stoma support groups

How to facilitate drainage of JP pump after emptying of the container?

After emptying the container, compress the bulb while wiping the opening of the emptying port with an alcohol swab. Continue to compress, quickly close the cap of the port. Ensure that the JP drain is secured properly to C.W.'s gown

What is the most appropriate treatment for post-op gas pains?

Ambulation and Pain medication

COLDERRA

C haracteristics, O nset, L ocation, D uration, E xacerbation, R adiation, R elief, and A ssociated S/S

What stoma changes should be reported immediately?

Necrosis Ischemia: appears cyanotic—bluish, purple, or a deep, dark red color. Although this condition could occur at any time, it would be more likely to appear during the first 3 to 5 days postop Prolapse Bleeding - causes: medications; disease such as portal HTN, polyps, IBD, or malignancy; trauma from applying or removing pouching devices. Edema

Common complications of ileostomy?

Obstruction/Blockage due to peristomal breakdown or food blocking intestines Chew food thoroughly; be careful of high fiber and remain well hydrated Dehydration Electrolyte imbalance Skin breakdown - Most common complication

Steps for changing an ileostoma bag?

Only cut 1/8 inch larger Apply the wafer to a clean, dry surface. This is a clean, not sterile, process. • Wash with plain soap and water. Use soap without oils, lanolin, or fragrance. • Completely dry the tissue, but gently. Use patting and air exposure to dry while you cut the stoma size in the wafer. • When placing the wafer, you can gently pull and stretch the abdomen upward to help create a flat surface for attachment. • Have the patient hold a hand over the pouching system for 5 to 15 minutes. The warmth of the patient's hand will allow the wafer to adhere to the skin. After placing the wafer over the stoma, gently run your finger over the wafer, next to the stoma, to assist adhesive seal and remove air bubbles—you do not have to use a great deal of pressure. • Change every 5-7 days or when there is a leak

What is an ileostomy?

Portion of the small intestine up through wall of the abdomen usually in the RLQ Needed when the entire large intestine is removed. Frequent and continuously loose stools tinged with green or yellowish cast.

What is saw palmetto?

Saw palmetto is an herbal product used to reduce prostate growth. It has antiandrogenic, anti-inflammatory, and antiproliferative properties. It causes loss of appetite, nausea, dizziness, constipation, diarrhea, headache, and impotence. The side effects might have caused him to stop taking it.

Why might famotidine (Pepcid) not work with someone who smokes?

Smoking reduces the effect of H 2 -histamine receptor antagonists (e.g., famotidine).

Side effects for Flomax

The most frequently reported side effects of this medication are dizziness, drowsiness, headache, anxiety, and orthostatic hypotension

Post-op prostatectomy?

VS Notify provider if output is <30ml/hr do not remove catheter ambulate with assistance give Oxybutynin (DItropan), Docusate (Colace) and morphine

What is carcinoembryonic antigen (CEA)

a normal CEA does not rule out cancer but is used after surgery because a previously elevated CEA that returns to normal means the tumor has been removed; in contrast, a persistent post-op elevation suggests residual tumor.

Post op patient loses 1kg and is not healing. What does this likely mean?

Poor nutrition

If you insert it, how would you as nurse check for placement of the NGT?

• X-ray confirmation is the most reliable way to determine initial NGT placement. • Aspirate and check the pH of the gastric contents (should be green-yellow bile); gastric aspirates have acidic pH values of 4 or less. • The method of briskly injecting 10 to 20 mL of air into the NGT as you listen in the epigastric area of the abdomen for a rush of air or gurgling is very unreliable because air injected into NGTs placed in the lungs or duodenum is also audible in the gastric area.

Care delegated to UAP involving catheterization?

Provide perineal care. Wash BID and after each BM with soap and water. Encourage fluids.

What is the proper size for an appliance for an ileal conduit?

1/8th-1/16th an inch around the stoma

How long does it take for urine to start breaking down skin

24 hours

What are the 2 surgical options for Prostate cancer?

: Laparoscopic radical prostatectomy (LRP) is a minimally invasive procedure that uses a robotassisted procedure. Benefits include a decreased hospital stay (1 to 2 days), smaller incisions, less postop discomfort, decreased time for the indwelling urinary catheter, and faster recovery. In addition, there are nerve-sparing advantages. Radical open prostatectomy: The patient might have blood loss during surgery and suffer incontinence and erectile dysfunction postop.

What is peritonitis?

A localized or generalized infection of the peritoneal cavity from trauma or rupture of an organ containing chemical irritants or bacteria into the peritoneal cavity. GI contents leak into peritoneal cavity, resulting in severe abdominal pain; rigid, board-like stomach, distension; absent bowel sounds; fever; hypovolemic shock, elevated WBC.

Alternatives to IVP?

A non-contrast abdominal-pelvic CT will be ordered. The images produced without dye, however, will be less distinct.

What is dumping syndrome?

A person loses 50% of small intestines or more. • Abdominal cramping, urge to defecate, borborygmi or loud gurgling sounds, and diarrhea 15-30 mins after eating, with subsequent hypoglycemia. Release of insulin causes hypoglycemia-sweating, tremors, tachycardia, confusion. Treatment is small frequent, dry meals that are low in simple CHO and concentrated sweets (eat complex CHOs); rest, drink liquids between meals; recumbent position after eating.

Characteristics of small bowel obstruction?

Abdominal discomfort pain visible peristaltic waves upper abdominal distention obstipation (no passage of stool) Nausea and profuse vomiting (may contain fecal matter)

Questions to ask before an intravenous pyelogram IVP and blood test that may need to be done?

Allergies to shellfish,iodine, and contrast dye? Diabetic or on Glucophage (must be stopped 48 hours before the study) - renal damage may occur Creatinine and BUN may be drawn Are you pregnant

Difference between an ileal conduit and an ileostomy?

An ileostomy is created when the physician cuts the ileum away from the cecum and brings the ileum to the surface of the abdomen. The large intestine is no longer available to dehydrate the stool, so ileum drains liquid or semiformed stool through the abdominal wall into an external pouch. An ileal conduit is formed when 6 to 8 inches of the ileum is removed from the bowel and brought to the abdominal wall, where an opening/stoma is made, to drain urine

What to teach patient about ileal conduit?

Avoid contact sports Commercial pouches may aid in perspiration around stoma Stoma will shrink over a period of a year Hot water locks in odors, so use tepid water to rinse the pouch if reusing It is possible to take a bath or a shower or go swimming with an ileal conduit Hydration Most common infection - peristomal yeast infection Most men become impotent after surgery if wide resection is necessary

Does BPH effect men sexually?

BPH should not affect patient's ability to have an erection or affect his sexual function; SEs of Flomax can cause rare occurrences of impotence and if it occurs, he should discuss this with his physician for a possible medication change.

Difference between Proscar and Flomax (medications to treat BPH)

Both drugs work to improve urinary flow in men with enlarged prostate glands. The 5-alpha reductase inhibitors lower the level of dihydrotestosterone (DHT), which can shrink the enlarged prostate, and prevent further growth. The alpha-blocking drugs cause the prostate gland to constrict, which leads to reduced urethral pressure and improved urine flow. It can take up to 6 months for the 5-alpha reductase inhibitors to take action, while the alpha-blocking agents can work right away.

What are the two most common types of stones?

Calcium, in the form of calcium oxalate or calcium phosphate, is the most common, and struvite is the second most common type of stone, followed by uric acid stones.

What would be ordered if clotting of the Foley catheter occurs?

Carefully irrigate with isotonic solution

Pernicious anemia

Causes: People who have pernicious anemia can't absorb enough vitamin B12 from food b/c they lack intrinsic factor, a protein made by secreting gastric cells. Pernicious anemia is caused by conditions leading to loss of intrinsic factor from secreting gastric cells (i.e., gastrectomy, gastric bypass, which can lead to loss of intrinsic factor secreting gastric mucosa cells and cause pernicious anemia). Clinical manifestations: paresthesias of hands/feet; sore, red, beefy tongue and mouth, and impaired thought processes help to differentiate pernicious anemia from other anemias. Treatment: Diet will not treat pernicious anemia, which is lack of intrinsic factor. Vit. B12 injections either given once a month (1cc given deep IM) for rest of life or intranasal gel/spray given weekly. Protect from burns due to decreased sensation; soft toothbrush; no heating pads.

What do you do with a saturated dressing?

Check for blood behind the patient Reinforce the dressing Check VS

Risk factors for bladder cancer?

Cigarette smoking, dyes in rubber industries

What is a cystoscopy?

Cystoscopy inspects the bladder with a tubular lightened scope (to remove tissue obtain biopsy, calculi)

D5 solution and peritoneum?

D5W is not an appropriate solution to infuse into this patient's peritoneum. The solution is isotonic when administered intravenously, but when instilled in the peritoneum, it becomes hyperosmolar and pulls fluid into the abdomen from the vascular system. This could cause hypovolemia. • Glucose is a good source of nutrition for any bacteria left in the peritoneum. • The IV glucose might elevate the blood glucose on a transient basis, inhibiting wound healing. • Immediately change the IV tubing and solution, monitor VS, get a fingerstick blood glucose reading, and notify the surgeon about what happened.

Suspected reports of successful Flomax treatment?

Decreased frequency, urgency, nocturia, improved stream; may report that he can void standing up.

Clinical manifestation of short bowel syndrome and treatment

Diarrhea and steatorrhea (unabsorbed fat in the stool). Signs of malnutrition as well as vitamin and mineral deficiencies include weight loss, cobalamin (B12) and zinc deficiency, and hypocalcemia. The patient is encouraged to eat 6 meals/day to increase the time of contact between food and the intestine. Oral supplements of calcium, zinc, and multivitamins are given. A diet high in complex CHO and low in fat supplemented with soluble fiber, pectin, and amino acid glutamine.

What organism form poor perineal hygiene may cause a UTI in women?

E. coli

What possible digestive problems could a post op patient have whose bowels were removed

Electrolyte imbalance dehydration short bowel syndrome (malabsorption)

What should you teach her before she receives the chemotherapy?

Empty the bladder first. Change position every 15 mins for 2 hours, then the chemotherapy will be withdrawn from the bladder.

What are the two main long-term consequences of prostatectomy?

Erectile dysfunction and urinary incontinence

Post-op for cystoscopy?

Explain that pink-tinged urine and frequency are to be expected. BRIGHT red blood is not normal. Walk with patient to prevent accident from orthostatic hypotension. Offer warm sitz baths, heat, mild analgesics (tylenol)

Pre-op for prostatectomy

Follow a clear liquid diet the day before surgery. • Use a bowel prep to evacuate stool and clear the rectum. He might be given a laxative to take the afternoon before surgery and a few doses of oral antibiotics preoperatively. This protocol might be practice-specific, so check the protocol in your area. • Remain NPO after midnight.

Discharge planning for patient with UTI?

Follow up urinalysis Increase H20 intake void every 3-4 hours wipe front to back Notify PCP of fever, change in mental status, decreased urine output, dysuria, pain in suprapubic area, malodorous urine, blood or pus in urine

What are the signs and symptoms of a urinary tract infection (UTI) in a patient with an ileal conduit?

Foul-smelling urine, blood in the urine, fever or chills, and flank pain as well as possible mental status changes and elevated serum WBCs

Pre op for patient undergoing removal of colon tumor.

General pre-op instructions. With all GI surgeries, plan to preop do a GI prep with clear liquids 1-2 days before test, cathartic OR 1 gallon of polyethylene glycol (Go-LYTELY) to eliminate stool and associated bacteria before operating on the bowel!!! Start ostomy care. Consult wound, ostomy, and continent nurse (WOC) for best site for stoma. Both radiation and chemotherapy may be used preoperatively to reduce tumor size or to reduce symptoms with advanced lesions. Taught side-to-side positioning and that short walks are better than sitting. Told that phantom rectal sensations may occur because sym nerves responsible for rectal control are not severed during surgery. Wound care post-op with dressing changes; Possible sexual dysfunction

Priority for patient with Ureteral Calculi

Give analgesics for pain 3-4 hours. After force fluids (3000-4000/day) to encourage passage

Discuss characteristics of GI bleeding in vomitus?

Hematemesis (vomiting of blood): When bleeding occurs in the stomach, the hydrochloric acid denatures the proteins in the blood, making it look like used coffee grounds. Fresh & red indicate recent bleeding from a mucosal tear (e.g., esophageal, rectal).

Characteristics of large bowel obstruction?

Intermittent lower abdominal cramping distention in lower abdomen obstipation ribbon like stools minimal/no vomiting severe fluid and electrolyte imbalance

What type of hematemesis is better to see in NG tube after surgery?

It is good to have coffee ground secretions through an NG tube after GI surgery because this means the blood is getting older after surgery (after surgery, initially secretions will be blood tinged bright red, followed by dark coffee ground material).

General rules for catheters and tubes?

Label them; secure them; do not pull, tug, or remove them, without an order and according to hospital policy of what you can remove as a registered nurse, according to practice. Notify PCP if the tube/catheter falls out. Further, certain catheters are removed in the hospital and do not go home with patients (ureteral) because of supervision needed and potential for complications

Why does the patient need to take the pantoprazole first thing in the morning?

Maximum efficacy At least 30 minutes before eating or drinking Eating or smelling food secretes HCL

Do ileal conduits eventually become continent?

No

Stoma assessment?

Observe the dressing for drainage. Look for abdominal distention signs of inflammation. Note the color of the stoma,and amount of drainage in the pouch, whether the seal is intact around the stoma whether there is any skin exposed around the stoma and the drainage bag.

• Obstructive sleep apnea

Occurs when soft tissue of the oropharynx occludes the airway, triggering pauses in respirations. The forceful inhalation often "sucks" gastric juices up into the esophagus, even over the vocal cords, into the lungs, or washing over the teeth, causing decay Common in obese patients; often weight loss recommended with CPAP

What is a PSA count?

PSA is a glycoprotein produced by prostate cells. It is unique to the prostate and is not produced anywhere else in the body. Normally, prostate cells leak a small amount of PSA into the bloodstream. An enlarged prostate naturally leaks more PSA and causes an elevated PSA level in the blood. When a prostate cell is damaged, it leaks more PSA; damage might be caused by infection, inflammation, or cancer.

Risk factor for colorectal cancer?

Red and processed meats, family history (about one third), obesity, physical inactivity, alcohol, smoking, and low intake of fruits and vegs. About 85% of CRCs arise from adenomatous polyps (growths). GO: Red/processed meats, family history, obesity, low intake of fruits/vegs

Common diagnostic test for colon cancer?

Regular screening for polyps and cancer: Colonoscopy every 10 years, beginning at age 50 yrs., unless there are risk factors then every 5 years at age 40. AA should have their first one at 45

Surgery for pilonidal cyst?

Scrape the tract out and fill with fibrin glue-much less pain than traditional surgical treatments and allowing return to normal activities after 1-2 days. In more severe cases, the cyst may be lanced or excised along with pilonidal sinus tracts. Post-surgical wound packing may be necessary, and packing typically must be replaced twice daily for 4 to 8 weeks. Patient will be more comfortable lying on the side or stomach when sleeping

Identify two methods of treating a patient with a ureteral vesicle junction stone?

Send home with pain meds and strainer as well as antiemetic Lithotripsy (shockwave) Minimal invasive surgeries including placing ureteral stents, retrograde ureteroscopy, and percutaneous ureterlithotomy Open ureterolithotomy (only for people at risk for long term damage) - Pt may have both ureteral and urethral catheters after surgery. Both have to be removed by health care provider before dishcrhage

. What is the ostomate program?

Someone of the same gender and age, with similar ostomy surgery, who belongs to an ostomy association and has had some training can be contacted through a Certified Wound and Ostomy Care Nurse (CWOCN) or local ostomy association to talk to the patient

Sigmoid colostomy characteristics?

Stool - formed no change in fluids Yes to bowel regulation maybe/maybe not - pouch and skin barrier possible irrigation q 24-48 hrs Cancer of rectum or rectosigmoidal area

Ileostomy characteristics?

Stool liquid-semiliquid, increase fluids, pouch and skin barriers, no irrigation, indication: Ulcerative colitis, Crohn's cancer

What are straining instructions?

Straining: Instruct S.R. to strain all urine (provide strainer) and keep all stones. Inform her that the urologist can examine the stones to determine the type; this information is helpful to determine the plan for preventing stones in the future. Fluids: S.R. should increase her intake to 2000 to 4000 mL/day with urinary output of at least 2000 mL/day. She should understand that this is the primary method of flushing the stone from the urinary tract. Compliance Activity: Ambulation might facilitate movement of the stone through the urinary tract. Medication: take pain meds and inc fiber intake to avoid constipation

JP assessment?

Sutured in place bulb connected to the drain appearance and amount of drainage

Temporary colostomies?

Temporary used after bowel resection or for bowel obstruction. Usually in transverse colon Loop or Double-barrel colostomies. More formed stool.

What tests can be done to determine the source of GI upset (heart burn, nausea etc)

Tests to rule out CV. abdominal US, abdominal CT scan, Helicobacter pylori antibodies test (common cause of peptic ulcer disease). May withhold food and fluids for GI; Check for allergies to contrast media (e.g., shellfish or iodine); remove all metallic materials because they interfere with the clarity of the images

Precautions to take with foley catheter?

The Foley catheter is a direct route for bacterial contamination and a potential source of infection. Contamination of the spout should not be a problem because most gravity bags have an antireflux valve that prevents bacteria from moving through the tubing in a retrograde direction into the bladder. NEVER DISCONNECT THE CATHETER FROM THE FOLEY BAG.

What is PSA?

The PSA is a glycoprotein present in all males, but greatly increased in patients with prostate cancer.

What is the blue port for on a Salem sump?

The blue "pigtail" of a Salem Sump tube is actually an air vent connected to a second lumen. It allows for free, continuous drainage of gastric contents while the first lumen is connected to the suction. The air vent must never be clamped, connected to suction or any tubing, or used for irrigation

How do you secure a foley catheter?

The catheter tubing needs to be secured (e.g., Stat Lock or Velcro leg band) to prevent bladder urethral friction/irritation/damage from the catheter moving. For women, the catheter needs to be secured to the inner thigh; for men, secure to inner thigh or the lower abdomen

In males with an enlarged prostate, what type of catheter is used to do intermittent catheterization?

The coude catheter has a curved tip at the distal end that allows for easier passage in the male around the enlarged prostate. The curve should be facing upward toward the sky when inserting a coude catheter.

Which lab values are of concern to you? Why? Sodium 130 mEq/L K 2.5 mEq/L Chloride 97 mEq/ Carbon dioxide 31 mEq/L ; BUN 38 mg/dL Creatinine 1 2.2 mg/dL Glucose 65 mg/dL Albumi 3.1 g/dL Protein 4.9 g/dL WBC 13000/ml with 80 percent neutrophils

The electrolyte of greatest concern is the potassium (K) level. C. W. is likely losing K through her nasogastric tube drainage. K of 2.5 mEq/L is life threatening, and A.G. is at risk for developing cardiac dysrhythmias. • The protein and albumin are low and indicate progressive malnutrition or poor liver function. Without them, A.G.'s colloidal oncotic pressure is decreased, and fluids leak from the cardiovascular space to the interstitial spaces. Mobilization of fluids out of the cardiovascular space can result in hypotension and shock; proteins are essential for healing. • The BUN and creatinine are elevated. This increase could indicate acute renal failure, dehydration, or increased protein catabolism as a result of malnutrition. Because A.G. has not been started on parental nutrition (PN), her body could be catabolizing protein for energy. • The Na, Cl, and glucose are decreased. A.G. could be losing Na and Cl through the nasogastric tube drainage. Glucose could be decreased because of starvation; she is not taking in the daily calories required for energy production. • Na, K, Cl, and CO 2 changes might arise from nasogastric tube drainage losses, resulting in metabolic alkalosis; ask about Mg levels. The elevated WBC is from the peritonitis and will fall over time if the antibiotics are effective. The increased neutrophils mean this patient has an active infection.

Tissue of ileal conduit?

The lining of the stoma is the same type of tissue as the inside of your mouth. It has no touch receptors, just pressure receptors, so it is numb to the touch, unless the bowel tissue is stretched like when there is a GI blockage. Lack of touch receptors makes the stoma susceptible to injury. The tissue of the stoma might bleed if bumped. The color is normally a beefy red, and it is moist or wet to the touch.

Care of an ileal conduit bag?

The pouch, or appliance, should have a spout and needs to be emptied when it is one-third to one-half full. Some appliances are closed with a clip that will need to be removed to empty the pouch. Others might have a self-sealing opening. The weight of the collected urine will pull the appliance off of the skin and break the seal, if the pouch overfills. At night, the pouch is connected to a 2-L gravity drainage bag so the person can sleep without interruption.

How do you contain a urine sample from an ileal stoma

The procedure is to catheterize gently using a 14 to 16 Fr through the stoma, using sterile technique. Care is needed to prevent trauma to the stoma or conduit; some facilities might specify that this is done only by someone with specialized training. Never force anything into the stoma because perforation can occur from the lack of pressure receptors in the mucosal tissue used to fashion the conduit.

What does a healthy stoma look like?

The stoma will be in the shape of a donut. The stoma will be a uniform medium cherry red/deep pink in color and moist. The skin around the stoma should be intact

What is the typical amount of drainage for a salem sump?

The typical NGT output is roughly 1500 mL/24 hr, but the GI tract actually produces more than 8000 mL/24 hr. The amount of drainage from the gut will vary, depending on where the obstruction is located. A sudden change in quantity should alert you to observe the canister more frequently and observe the patient for S/S of obstructed NGT.

What is the purpose of a transurerthal ultra sound (TRUS)?

This test is a good tool in early diagnosis of prostate cancer when combined with the PSA and DRE. The sound waves emitted by the ultrasound image the prostate gland. The transrectal ultrasound can also be helpful in guiding a prostate biopsy.

How will you determine the correct pouching size and system?

To determine the correct size flange, measure the size of the stoma and add 1⁄8 to 1⁄16 of an inch. If the stoma is oval, measure the greatest width. A pattern can be made of the stoma on paper then traced on to the wafer, then cut to that size.

Surgical options for BPH?

Transurethral resection of the prostate (TURP): The physician uses a monopolar instrument to enter the urethra and core the prostate. The area is then cauterized to stop the bleeding. This procedure requires inpatient hospitalization because of the increased chance of bleeding. An indwelling catheter is placed overnight or longer as needed. Gyrus TURP: A standard TURP is performed with a bipolar Gyrus instrument that both cuts and cauterizes the prostate. KTP laser: KTP is a type of laser that cores the prostate and cauterizes as the procedure is done, thereby decreasing the chances of bleeding. It can be done with a person taking warfarin (Coumadin), if stopping anticoagulants is an issue. It is an outpatient procedure. Saline TURP: A balloon is positioned inside of the prostate and inflated to open the urethra and compress the prostatic tissue away from the urethra. This procedure might require an overnight stay. Transurethral microwave thermotherapy (TUMT): Intense heat is transferred to the prostate through a urethral probe. This procedure is usually an outpatient procedure. Patients might experience an irritative voiding pattern (frequency) for months following the procedure. There is no tissue to examine for pathology after this procedure; thus, if the person has prostate cancer and BPH, the prostate cancer might go undetected. Transurethral needle ablation (TUNA): A needle is placed into the prostate and prostate tissue is ablated. Again, there is no tissue to examine for pathology after this procedure. It can be done in situations where surgery is needed, but the person might not tolerate a larger surgery like a TURP.

What is treatment for peritonitis?

Treatment-I & O, IV flds with lytes, semi-Fowler's/Fowler's position to localize peritoneal contents, frequent VS, monitor for signs of septic shock, antibiotics, NPO, NG. Priority diagnoses=pain and shock. Give scheduled pain meds, IV flds, position with knees flexed to increase comfort.

Potential problems for I's and O's

Tubing kinks or obstruction: Check tubing for kinks and blockage (follow agency policy regarding irrigation of catheter if needed); assess for bladder distention. Dehydration: Assess skin turgor and mucous membranes; monitor lab values; check total record for the last several days, including M.Z.'s daily weight. Inaccurate recording of I & O: Double-check any discrepancies

Can UAP drain and measure output of ostomy bag?

Yes

Is the red stomal opening and draining urine with mucus normal?

Yes, this is normal. A 6- to 8-inch segment of the ileum, with intact mesentery blood supply, is resected from the bowel, the end is folded over on itself and is sewn to an opening made in the abdominal wall The stoma is usually located in the RLQ of the abdomen. The segment of bowel still functions as small bowel and still produces mucus to facilitate the movement of stool through the small bowel. The stoma is red, wet, and slippery if it has good circulation and mucus drains out with the urine.

What are signs of bowel obstruction?

abdominal pain bloating distention fever, N/V, hypoactive/hyperactive bowel sounds, and constipation.

What is a loop colostomy?

bring a loop of bowel to abd wall and then open only anterior wall of bowel to provide fecal diversion. A plastic rod holds the bowel in place for 7-10 days to keep it from slipping back down into abdomen

What is a colostomy?

bringing a portion of the large intestine through the abdominal wall. Needed when a portion of the large intestine is removed. Portion of GI tract is removed (permanent) or oversewn (can be reanastomosed later.)

What is a double-barrel stoma?

brings both proximal and distal ends through abd wall as 2 separate stomas. Proximal one is functional; nonfunctional distal one is a mucus fistula to pass gas and flatus.

Clinical manifestations for left sided CRC?

change in bowel habits (alternating constipation and diarrhea), narrow, ribbon-like stools, sensation of incomplete BM evacuation, partial/total obstruction, bright red blood in stool

Common antibiotic given for UTI?

ciproflaxin also Bactrim but assess for sulfa allergy before administration Pyridium is an azo dye and urinary analgesic given for dysuria. It changes urine and sweat to a reddish color

Indication for colonscopy?

direct visualization of colon for polyps, tumors, etc. by flexible fiberoptic scope; Pre-explain knee-chest position, obtain consent, clear liquids 1-2 days before test; either cathartic OR 1 gallon of polyethylene glycol (Go-LYTELY) night before (or magnesium citrate or bisacodyl tablets + 2L of polyethylene glycol), 8 oz q 10 mins. Before procedure, adm sedation (meriperidine (Demerol) and midazolam (Versed), teach to take DBs during insertion of scope; Post-may have abd cramping, observe for rectal bleeding, perforation (spike in temp, abdominal distension), check VS CBC to check for anemia, clotting studies (PT, PTT), and liver function tests (ALT, AST, GGT, alkaline phos.) to check for metastasis to liver

AE for Ditropan?

dry mouth, dry eyes, drowsiness, anxiety, restlessness, constipation, and palpitations

What are common clinical manifestations of urinary retention

frequency, urgency, discomfort, voiding small frequent amounts (50ml). Normal post-void residual (PVR) is between 50-75 ml. If over 100ml, repeat the test. Abnormal PVR in older patients of >200 ml on 2 occasions requires further evaluation. Intermittent catheterization is used initially for urinary retention and a distended bladder.

How are hemorrhoids treated?

high-fiber diet; 2000 cc fld/day; stool softeners (e.g., Colace); anti-inflammatory creams/pads (e.g., hydrocortisone, 7 days only to prevent muscle atrophy) topical local anesthetics (e.g., dibucaine or benzocaine ointment/cream), with or without astringents (e.g., witch hazel); sitz baths

Symptoms of UTI?

history of dysuria, incontinence, and suprapubic pain, along with the appearance and odor of the urine, and the elevated pH, presence of nitrites and WBCs in the urine, and elevated WBC count points to a urinary tract infection (UTI). New onset mental changes is a classic symptom associated with UTIs in an older adult

Clinical manifestations for right sided CRC?

more insidious with vague abdominal discomfort, crampy, colicky pain, unexplained weight loss; and anemia with subsequent weakness and fatigue

Who is at risk for vitamin B12 deficiency besides people with pernicious anemia

occurs from impaired absorption in the distal ileum (patients who have a small bowel resection involving the ileum, Crohn's disease, and diverticuli). The only dietary sources of vitamin B12 are meat and dairy products. Vegans who don't eat dairy or meat products and do not supplement with B12. These individuals must take B12 supplements.

What is a pilonidal cyst

opening of sinus tract, cyst in midline just above coccyx-cause is probably congential. Treatment may include antibiotic therapy, hot compresses, and application of depilatory creams to remove hairs that may contribute to the problem

Primary problems of abdominal perineal resection?

pain - give pain med first 72 hrs; splint incision with pillow during TCDB Pain/Itching From Phantom Pain: antipyretics and no prolonged sitting Sexual Dysfunction: Erection, ejaculation, and/or orgasm involve different pathways and the surgery may affect one or more functions Discharge Planning: Teach irrigation and debridement of wound; sitz bath; shave loose hair because it may result in a chronic draining sinus; report drainage that may indicate fistula

How to label a specimen?

patient's name and information per facility policy. Patient's name, room number, date, and the time the specimen was collected need to be attached to the container. The exact origin of specimen (anatomic site) is needed, including the type of specimen, such as swab from granulation tissue or abscess fluid. The patient's diagnosis and any topical or systemic antibiotic therapy should also accompany the specimen. Facilities will have individual procedures for entering the specimen collection into the computer system.

Ascending Colostomy characteristics?

stool - semi-liquid, fluids ↑'d, no bowel regulation, pouch and skin barriers, no irrigation Indications: Tumors, trauma

Transverse colostomy characteristics?

stool semi-liquid to formed, fluid possibly ↑'d, no bowel regulation, pouch and skin barriers, no irrigation Indication: Tumors, trauma

When is abdominal perineal resection done?

when cancer is located within 5 cm of anus Care of incision: With partially closed and open wounds, assess perineal drainage and incision. Change perineal pads PRN. Drainage should be serosanguineous; tubes are removed in 3-5 days when drainage is < 50 cc/24 hrs.

What is BPH?

• BPH is caused by nodular hyperplasia (increase in the number of cells) and hypertrophy (increase in size of the existing cells) of the prostate gland. As the gland increases in size, tissues that surround the prostatic urethra compress it, causing the symptoms of urethral obstruction and secondary irritative symptoms. • Frequently, patients' biggest fear is that they have cancer. Until this fear is alleviated, they will not be ready to learn additional information. You should tell patient about PSA levels. Teach patient to leave light on into the bathroom bc of frequent urge to urinate

Four causes of breakdown from patients with stoma?

• Candida infection caused by the Candida organism • Mechanical trauma: traumatic removal of the epidermal and/or dermal layer of tissue caused by stripping or tearing of the skin • Contact or irritant dermatitis caused by contact with stool or urine, usually fom drainage/leaks between the skin barrier and the stoma. This is an inflammation but does not involve an allergic reaction. • Allergic dermatitis: inflammation that is the result of antibodies that have been produced, then stimulated, by an allergen. Allergens might include the adhesive or material used in the protective barrier products for ostomies.

How do you facilitate drainage with salem sump?

• Check the connections to source. • Make certain the tube isn't kinked. • Change patient's position (turn) to see whether this allows the tube to drain freely. • If there is a physician's order, irrigate the tube with 30 mL of normal saline, then immediately aspirate the fluid. • Change the position of the NGT and retape. Some facilities will require another x-ray to verify placement

Diet for specific stones?

• Decreasing animal protein intake is recommended for those with uric acid or cystine stones. • Avoid organ meats, poultry, fish, gravies, red wine, and sardines with uric acid stones. • Decrease sodium intake for calcium oxalate stones because high sodium intake reduces renal tubular reabsorption of calcium. Also avoid spinach, black tea, coffee, etc., because oxalates are found in these foods. • High fluid intake FOR ALL STONES keeps the urinary system flushed is BEST METHOD to prevent stone formation.

How to obtain a wound culture?

• First explain to the patient what you are doing and why. Answer her questions. Irrigate the wound thoroughly with NS (never use an antiseptic solution), and use a sterile gauze to absorb excess irrigant. Microbes that cause the infection tend to cling to healthy, viable tissue. Therefore, swab only this healthy-looking tissue for the specimen to culture. Use a prepackaged sterile culture tube with an appropriate transport medium. If microbes dry out, they die. • If medicated ointments or creams have been used on the wound, these must be thoroughly cleaned off before a reliable culture can be done.

Explain a prostate biopsy procedure and how to prepare for the procedure.

• Patients preparing for a prostate biopsy should stop all medications that increase bleeding time: warfarin (Coumadin), clopidogrel (Plavix), aspirin, or NSAIDs such as ibuprofen (Motrin, Advil) or naproxen (Naprosyn, Aleve). Warfarin and anticoagulants/ antiplatelet medications should be stopped 5 to 7 days before this procedure, so patients should talk to their provider before stopping this medication. Patients can expect to find some blood in their bowel movement for up to 2 weeks following a biopsy. • The patient will probably be sedated for this procedure and need a driver to take him home. If sedation is used, he will need to fast before this procedure but can take his other medications as usual. If not allergic, he will be medicated with an antibiotic the day before, the day of, and the day after the procedure. In addition, he can have a Fleet enema the morning of the procedure. • A prostate biopsy is performed by inserting a large US probe into the rectum. Because the prostate is located next to the rectum, the probe can be angled to visualize the prostate on the US screen. A biopsy needle is inserted through the wall of the rectum into the prostate to obtain a prostate tissue sample. The urologist will usually get six tissue samples from each side of the prostate for a total of 12 samples.

Proper care for a patient with salem sump?

• Properly tape the tube to the nose so that it does not pull on the nares or cause ulceration. • Pin the tube to gown • Regularly observe and cleanse the nares; • Provide good oral care; • Obtain an order for benzocaine spray or lozenges (such as Chloraseptic, a topical anesthetic) if C/O a sore throat; • Help patient turn in bed to avoid traction on the tube. A semi-fowler's position with knees flexed reduces the pressure of the distended abdomen.

Factors that may contribute to chest pain and nausea?

• Smoking increases gastric acidity; • Daily alcohol irritates the gastric mucosa; • Obesity slows gastric emptying, increases risk of sleep apnea; • ASA (aspirin) and NSAIDs (ibuprofen, naproxen [Aleve, Naprosyn]) block the production of prostaglandins, which decrease the production of the protective mucus coating of the stomach that acts as a buffer against hydrochloric acid. Cells that line the esophagus don't produce this protective buffer and are at risk for injury with gastric reflux.

Do steroids delay healing of wounds?

• Steroid use over 5 years a suggest that wound healing will be delayed. Steroids tend to delay healing by interrupting all phases of wound healing.

three treatment options for prostate cancer?

• Watchful waiting, which involves simply monitoring A.B.'s condition and intervention if symptoms become troublesome. • Brachytherapy: Radioactive seeds are implanted in the prostate (these people have irritative voiding symptoms [frequency] for months after the procedure), or external beam radiation can be used. • Hormone therapy: A PSA is drawn and medications are given, based on PSA levels. In some cases, medications are given to shrink the tumor before surgery. • Chemotherapy: Systemic cytotoxic chemotherapy might be done for patients whose cancer has metastasized.