med/surg exam 3

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katles2001
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7539
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med/surg exam 3
Updated:
2010-02-21 09:40:43
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med surg
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med surg exam 3
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  1. Risk factors of bladder cancer
    • 50-70 y/o, men: women 4:1, Caucasians: Af Am
    • 2:1, smokers twice as likely, environmental carcinogens, recurrent/chronic
    • UTIs, bladder stones, high urinary pH, high cholesterol intake, pelvic radiation,
    • primary CA in prostate/colon/rectum in males or gynecological tract in females...mets

  2. Clinical manifestations of bladder cancer
    • -visible painless hematuria
    • -UTI: dysuria, urgency, frequency (UTI sx)
    • -change in voiding patterns
    • -pelvic & back pain (could be r/t bladder/prostate cancer)
  3. Nursing education/interventions for patients undergoing surgical resection for bladder cancer
    • -ileal conduit, catheterizable pouch and neobladder to divert urine from bladder to new exit (usually through a stoma in the skin); conduit only holds 10cc and leads to bag
    • -may also require IV chemo, radiation, adjuvant intravesical drugs after TUR for large/multiple/high grade/superficially invasive tumors (drugs put into bladder for direct contact e.g. Bacille Calmette-Guerin (BCG) for activate immunologic/inflammatory response), or photodynamic techniques for superficial cancer
    • -no voiding; UTI assessment per low UO (min is 30cc/hr), concentrated urine, flank pain, fever
    • -stoma should be bright red, wet, may have no sensation
    • -RN mgmt: IVF, pain, I&O, O2,
    • H&H, electrolytes, erterostomal tx (monitor stoma and surrounding skin), recline & ambulate, TEDs/SCDs, address sexual concerns
  4. Risk factors for prostate cancer
    • -70% men>65y/o w family hx, diet high in red meat/dairy w high fat, environment
    • -common in men>50y/o
    • -mostly Af Am men
    • -high PSA levels (N PSA < 4.0,
    • intermediate 4-10, high > 10)
    • -dad/brother w dx doubles risk
    • -PSA screen @ 40y/o for high risk
    • (e.g. Am men w close relative dx), 50 y/o for men
    • w no risk
  5. Clinical manifestations with prostate cancer
    • -elevated PSA
    • -early diseaseàfew/no sx
    • -late diseaseàurinary obstruction, blood in urine/semen, painful ejaculation
    • -mets: backache, hip pain, perineal/rectal discomfort, anemia, wt loss, weakness, nausea, oliguria
  6. -Prostate screening tools and role of diagnostics in treatment
    • -screen early!
    • -PSA & DRE most common and cost
    • effective for dx (TRUS also used)
    • -most dx made when men see doctor
    • for urinary obstruction or per DRE
  7. -BPH risks and how to dx
    • -risks: smoking, heavy ETOH, HTN, heart disease & DM for Af Am, diet, family hx of BPH or enlarged prostate
    • -BENIGN! (not cancer); enlargement of prostate gland (obstruct UO)
    • -part of aging, cannot be prevented, can be tx
    • frequency & urgency esp. @ night, dribbling/leaking after urination, intermittent/weak
    • stream, straining to pee, pain/burning w pee, feeling that bladder never fully
    • empties AND fatigue, anorexia, N/V, epigastric discomfort (could also be other disorder)
    • -dx w DRE, labs for renal fxn (r/o renal prob), TRUS
    • -gold standard: TURP (transurethral resection of prostate); 1/3 pts become impotent
  8. BPH
  9. BPH

  10. Change

  11. in urinary pattern
  12. Up PSA

  13. Dx: DRE,

  14. TRUS
  15. Tx:

  16. meds, surgery (TURP)
  17. Post-op:

  18. foley 1-2 days
  • BPH

  • Prostate Cancer

  • Change

  • in urinary pattern
  • Change

  • in urinary pattern w hematuria, back/leg pain w lets
  • Up

  • PSA
  • Up

  • PSA
  • Dx:

  • DRE, TRUS
  • Dx:

  • DRE, TRUS, biopsy
  • Tx:

  • meds, surgery (TURP)
  • Tx:

  • surgery (prostatectomy), radiation
  • Post-op:

  • foley 1-2 days
  • Post-op:

  • foley 7-10 days
  • Prostate cancer
  • Prostate Cancer

  • Change

  • in urinary pattern w hematuria, back/leg pain w lets
  • Up PSA

  • Dx: DRE,

  • TRUS, biopsy
  • Tx:

  • surgery (prostatectomy), radiation
  • Post-op:

  • foley 7-10 days
  • Prostate Cancer

  • Change

  • in urinary pattern w hematuria, back/leg pain w lets
  • Up PSA

  • Dx: DRE,

  • TRUS, biopsy
  • Tx:

  • surgery (prostatectomy), radiation
  • Post-op:

  • foley 7-10 days
  • Nursing interventions and teaching
    postoperatively following prostate surgery
    • -VS & O2 -activity as ordered
    • -IVF & PCA -no straining; stool softener
    • -dressing -no other rectal procedures
    • -diet -TEDs/SCDs
    • -foley 7-10 days -H&H, lytes, PT/PTT
    • -notify for OU < 30cc/hr, absent
    • BS, SOB
  • -Common clinical manifestations of ED and
    treatment options
    • -sx: lower libido, fatigue, inability to maintain firm erection
    • -tx: oral meds, injections, negative
    • pressure device, surgical prosthetic
    • -RN mgmt: assess privately, discuss
    • time frame for return of sexual fxn and feelings,
    • refer to therapist
  • -Be prepared to briefly identify what the appropriate nursing action would be for a
    patient experiencing 1 of the 3 life threatening arrhythmias
    • 1) V fib: tx w CPR & AED asap (< 1 min)
    • 2) V tach: (may resolve spontaneously); tx based on presentation (shock,
    • cardioversion, CPR w AED for non-responsive)
    • 3) Asystole: tx w immediate external pacer or CPR &
    • epi/vasopressin
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