2-presentaion/videos Flashcards
what is endocrine system composed of
pituitary gland,
thyroid gland,
parathyroid glands,
adrenal glands,
pancreas, and
reproductive glands
pituitary gland
located
what does
located in skull-
”master”,
regulates many body functions woth hormones
anterior pituitary gland
+ hormones
several types of endocrine cells that secrete homrones
Growth Hormone,
prolactin hormone
, reproductive hormones
& Thyroid Stimulating Hormone
posterior pituitary gland
function
+
hormones function
nerve tissues//store and relase ADH and oxytocin
ADH & Oxytocin
ADH-decreases urine production
O-induces labor contractions in uterus
Thyroid gland
primary role
secretes
anterior of trachea and inferior to larnxyz
increase metabolism—made up of t3 and t4
secretes calcitonin-decreases excessive levels of calcium in blood
what is thyroid gland initated by and dependent on
Secretion of Thyroid hormone is initiated by the release of TSH by the pituitary gland
and is dependent on an adequate supply of iodine
Parathyroid Gland
secetes what
when released
what does
secretes parathyroid hormone
when calcium levels drop, parathyroid hormones secretions go up
phosphate’s metabolism
Adrenal Gland
sits where
produces what hormones
sits on top of kidneys
Produces hormones such as: epinephrine, norepinephrine & corticosteroids
where is cortisol produced and what does it do
adrenal gland
regulates stress response- controls fats, protiens and carbs/metabolism
Pancreas-what does
what its cells do
produced hormones and digestive enzymes
the cells it creates regulates carbohydrate metabolism
Alpha cells- glucagon produces
Beta cells-produces insulin
Reproductive
Testes & Ovaries
Cells within help source of steroid sex hormone,
Help promote growth cells and onset of puberty
Thyroid Tests-assessing function
RAI
Scan
Blood tests
Radioactive Iodine Uptake (RIA)-direct measure of thyroid activity- iodine uptake is measured
Thyroid Scan –looks for thyoif noduels
Thyroid-Stimulating Hormone (TSH)-blood tests- high or low levels
TSH > 3
t4 1.—2.3
T3 80-200
Assessing the Endocrine Function
Parathyroid tests
Calcium –blood test to look at calcium-
9-11 normal
hypocalcemia
Assessing the Endocrine Function
Pancreatic/endocrine tests
FBS
OGTT
HGBA1c
Fasting Blood Sugar (FBS)-measures trestment of diabetes//conforms diabetes
Oral Glucose Tolerance Testing (OGTT)-used if proior fasting blood glucose test were high//
dextroee solution is given and check back at 30-60-120 mins
Glycosylated hemoglobin (Hgb A1c)-results average blood glucse level from 120 days.
Nornal is 2-5/5.7-6.4=pre diabetec/ 6.5 or higher are diabetes
hypocalcemia
s/s
Muscle cramps
Numbness / tingling of the extremities (Trousseau Sign)
Twitching of facial muscles (Chvostek Sign) and eyelids when facial nerve is touched
hypercalcemia
s/s
ausea/Vomiting
Constipation
Bone Pain
Excessive Urination
Thirst
Confusion
Lethargy
Slurred Speech
Cardiac Arrest (SEVERE ONLY!!!!)
Assessing the Endocrine System
Health Assessment Interview
Sub/obj
Physical assessment
Subjective & Objective Data –medical/social/family gistoy/diet/eating habits,urinsting
Physical Assessment
Skin Changes: inspecting color, should be even and apporpate for age and race
Nail & Hair Assessment: should be normal and distrubted evenly
Facial Assessment:
Acromegaly-abnormal bone growth from hypersectretion
Exophthalmos –protruding eyes seen with hyperthyroidism
Thyroid Gland Assessment: size and consistency
Goiter
Motor/sensory: DTR and nurepathy and altered sensations//increase DTR is hyperthyrisond?decreased is hypothyroidism
Musculoskeletal: size and propertions of patients body structure
Trousseau’s & Chvostek’s sign
T- , tetany muscle spasm, inflating BP cuff above AC levels, cause contraction in hands/fingers and produces muscle spasms /
/C-, tapping fingers on jawline, repeated facial muscle contractions that causes twitching
Tests for hypocalcemia
Hyperthyroidism
AKA
what does
AKA Thyrotoxicosis
Excessive delivery of thyroid hormone to tissues –increased circulating thyroid hormone
what does excessive TH do to the body
alterations in
common etiologies of hyperthyroidism
Excess TH = increased metabolic rate-
alterations in cardiac output, peripheral blood flow, oxygen consumption, and body temperature
The common etiologies are Graves disease and toxic multinodular
manifestations of hyperthyroidism
Hyperactive bowels/ diahhrea
Hyper metabolism/increased appetite/weight loss
Heat intolerance
Hand tremors
Insomnia; emotional liability
Smooth/warm skin, might lose hair
exopthalamus
Causes of Hyperthyroidism:
Graves’ Disease
Most common cause of hyperthyroidism
Autoimmune disorder-more common in women
Graves disease
Patho
Antibodies that bind to TSH receptors causes thyroid cells to hyperfunction, leads to over secretion and enlargement of gland
Graves disease
manifestations
enlarged thyroid (goiter),
poptosis/exophthalmos-forward protrusion of eyeballs-sclera may also be visible above iris/bilateral-blurred vision, diplopia,eye pain, lacrimation and photophobia
Fatigue/difficulty sleeping,/weight loss,/heat intolerance /changes in menstruation
Toxic Multinodular Goiter–Causes of hyperthyroidism
thyroid tumor
manifest
etiology
Thyroid tumor–small nodules that secrete excessive amounts of th
Manifest-similar to hyperthyroidism
etiology-lack of iodine, increased iodine filtration, presence of immunilgobulans
thyroidotis -what is
manifestation
acute/chronic
causes of hyperthyroidism
viral infection of thyroid glands
causing inflammaation and increased TH effects
normally acute-when chronic can cause hashimotos
Thyroid Crisis
AKA
Extreme
Occurs d/t
Threatening
AKA thyroid storm
Extreme state of hyperthyroidism occurs less now dt treatments
Occurs due to untreated hyperthyroidism, or extreme stressor (infection, trauma, untreated DKA, manipulation of thyroid gland”
Life Threatening if not treated- rpaid icnrase in metabolic rate–MEDICAL EMERGENCY
manifestations of thyroid crisis
Hyperthermia(102-106),
tachycardia//HTN,
dyspnea,
GI distress,
seizures,
anxiety,
agitation
treatment of thyroid crisis
treatment
intrevnetions
stablaizes
cooling w/out aspirin , replacing fluids-checking glucose,electrolyes,
stabilizes cardiac function and repository function and reducing thyroid hormone secretions
maintaing vital organs
how to diagnose thyroid crisis
TH (T3 t4) levels
increased RAI intake
Hyperthyroidism: Diagnosis
Presentation of manifestations
Diagnostic Tests:
Elevated TH (t3 & t4)
Decreased TSH-low bc pit gland will try to overcompensate for high thyroid hormone-stop producing tsh in attempt to stop t3 t4
Increased radioactive iodine (RAI) uptake
Thyroid Scan- nodules, tumors
medications for hyperthyroidism
theraptuc results
Anti-thyroid medication –reduce thyroid hormone production
Cardiac manifestations –beta blocker ‘olol’
RAI-only if severe issues with swallowing/cany undue
TR -Takes several weeks because it demonstrate efect already made hormones
Hyperthyroidims treatments
RAI– how works
how long
contraindicated
devlops/requuires
Tyroid gland takes in iodine in any form, radioactive iodine damdages thyroid cells and less thyroid hormone is produces
Oral administration; 6-8 weeks result time
Contraindicated in pregnancy –crosses placenta
develop hypothyroidism-require liofelong thyroid replacement-becuase tissues cannot be replaced
thyroidectomy
indication of use
subtotal
total
hyperthyroidism
Indication - so englarged, pressure on esophagus or trachea casuing swallowing issues
Subtotal thyroidectomy: leaves enough of gland to still produces TH
Total: removal of thyroid; lifelong hormone replacement
Prior to surgery-thyroidectomy
pt should be in Euthyroid state- normal thyroid function
using antithyroid drugs or iodine preperations.
Reduces vascularity and size of gland and reducsing risk of hemorrahge
antithyroid meds
carbimazole,
methimazole,
propylthiouracil
pre operative care of hyperthyroidism
state
reduces
admisnter
support
eexpect
answer
euthyroid state,
reduces risk of complications-
administer antithyroid meds/
support neck by placing both hands on neck
/expect hoarsness/
answer questions
post operative care
hyperthyroidism
resp assess
hemorrhage
tetany
lanrygel
Resp- Assess rr, rhythm, depth,, maintain humidification, assist w/cDB, suction equipment viable/
/Hemorrhage- assess drainage from dressing, assess bp and pulse for shock/
/Laryngeal- assess for ability to speak aloud/
/assess for tetany d/t calcium deficiency-twingling toes, fingers and lips, mascular twitches, potives c and t signs iv calcium for immediate
Nursing care- Hyperthyroidims
Reduce risk of Hf
Monitor Visual changes
limit weight loss
monitor anxiety
teaching
Reduce risk of HF- Monitor Bp,p,rr breath/keep distraction free environment/rest periods
Monitor vision changes-monitor visual acuity, intergity and closure, protect eye using glasses, artificial tears, moist compressors, reporting pain
Limit weight loss-daily weights, diet high is carbs and protein, in between meal snacks, small more frequent meals, montir labs
Monitor anaxiety-ask questions-body
Teaching-lifelong treatment, wound care, manifestaions of hypothyroisim, refereal to agencies
transitions of care hyperthyroidism
mistaken
severe–inc
reabostption
dementia
provider
soemtiems mistaken for cardiac problems
severe wight loss inc risk for falls
bone reabostion inc leading to inc broken bones
palpations.tremors/anxiety are misateken for dementia
recignize/report palpations,tremor, heat intolernce, sweating, nervous, anxiety to provider
hypothyroidism
common in
decrease in
Insufficient amount of TH
-common In women 30—60
Decrease metabolic rate & heat production-affects all body systems
chronic untreated state of hypothyroidism
myxedema
edema throughout body-result of water retention-puffy face and enlarged tongue and horse voice
primary/secondary hypothyroidism
Primary:- common, congenital defects, loss of tissue dt surgery or meds
Secondary: slow onset, tsh deficiency, resistance to hormones
hypothyroidism
how does a goiter work
increased risk
TH production decreases so thyroid gland enlarges to attempt to produce more hormone- makes a Goiter
Patients are at increased risk for atherosclerosis and cardiac disorders, hyponatremia
Hypothyroidism: Manifestations
Goiter
Fluid retention; edema
Decreased appetite/weight gain
Fatigue, lethargy, listlessness
Constipation
Pallor//Dry skin
Hoarseness of voice
Abnormal lipids-high cholesterol levels
intolerance to cold
dec tast/smell
slow pulse
menstrusl, anemia, cardiac enlargment
slow onset of years or months
what to do with hypothyroidism when pateint cannot close eyes
eye drops or eye pathces
Iodine Deficiency
why is iodine necessary
meds that cause
Causes of Hypothyroidism
Iodine is necessary for TH synthesis
meds can cause iodine deficiency (goitrogenic// lithium carbonate //bipolar drugs//antithyroid drugs
Hashimotos Thyroiditis
what is
what happens
decreases
progresses
Causes of Hypothyroidism
Most common cause of goiter & Hypothyroidism-common in women
Autoimmune antibodies destroy thyroid tissue, replaced with fibrous,
TH levels decreases
Originally causes goiter to enlarge, but as progresses will shrink
Myxedema Coma
what is it
severe disorders
what can happen
Causes of Hypothyroidism
Life threatening Complication of long standing, untreated hypothyroid
Severe metabolic disorders: hyponatramia, hypoglycemia, acidosis
cardic collapse, impaired cognition and coma
Diagnosis of hypothyroidism
Clinical manifestations
Decrease in TH(esp 4)
TSH is increased
Elevated LDL, triglycerides
Medications
hypothyroidism-whats purpose
examples
Replace TH
Levothyroxine (Synthroid, levothroid, levoxyl
may need surgery to reduce goiter size
What do you need to know for med admisteration
hypothyroidism
meals
watch
heighten
treatment
alter
monitor
1 hr before meals or 2 hrs after
watch for toxicity –severe anxiety,
heighten affects of anticoagulants monitor for bleeding and bruising/
/ lifelong treatments/
/can alter amount of insulin required in diabetics
/monitor bp+pulse-report over 100
surgery
hypothyroidism
Goiter
Resp issues, dysphagia
Hypothyroidism: Nursing Care
reduce risk of HF
reduce risk of constipatoin
maintain skin intebgry
Reduce risk of heart failure-monitor bp/hr/apical pulse, suggest avoiding chilling-increasing room temp and using covers, alternate activity with rest
Reduce risk of constipation-fluids of 2000 ml day, high fiber diet, walking as tolerated
Maintain good skin intergrity-monitor surfaces for redness or lesions, turning schedule, limit time in one position, ROM, take warm not hot baths, alc free oils
hypothyroidism
/education-diet
lifetime continuity of care
education-Dietary intake adequate iodine intake, low fat,
medications and provider checks lifelong–
follow up with provider,
some dosage readjustments over time
hyperparathyroidism
typically present in
results from
typically have issues with
increased risk of
older adults and 3x more in women
Results from an increased secretion of : parathyroid hormone-PTH-regulates calcium
Issues with hypercalcemia and bone problems
increased risk of kidney stones
Diagnosis: hyperparathyroidism
6 month history of:
parathyroid levels,
serum calcium levels
manifestations of hyperparathyroidism
many are
__calcemia
what happens to Bone
whats elevated
met/ren/pol
many are asymptomatic
hypercalemia
bone reaboprtion leadinf to pathologic fractures
elevated calcium altering musclar and nueral acrivity
metabolic acidosis, renal caluli, poluria
Hyperparathyroidism
Meds+goal
drink/keep
what to avoid/
alendronate and Calcitonin—Decreasing serum calcium
drink fluid and keep active
/ avoid immobilization, thiazide diuretics, large doses of vitamins A,D, calcium antacids and supplement
Hypo parathyroidism
what is it-how would it present
what tests can you run
Low levels of PTH- low calcium levels- hypocalciam
Numbness, tingling around mouth & fingers, foot hand and larygenal spasms, tetany(continuous spasm) /
What Tests? Trassaus and chovseks//brittle nails, hair loss, dry scaly skin
How are you diagnose
how treated with
what does it do
hypoparathyroidism
Diagnosed Low serum calcium
T-Increasing Ca+ levels by: calcium gluconate iv/ inc calcium/ inc vit D
reduce tetnay
Diabetes Mellitus
what is it
what does it result from
differnce between type 1 and 2
Metabolic disease characterized by hyperglycemia
Results from : Defects in secretion of insulin and/or action of insulin
Type 1
Insulin deficient- Beta Cells destroyed-doesn’t make insulin
Type 2
Insulin resistance, body rejects insulin
hyperglycemia sstuff
DKA-fruity breath
BG>200
Long term complication of parethesia
polydypsia
polyuria
hypogylcemia stuff
BG> 50
slurred speech
decerased LOC
irratable
headache
shakiness
alpha and beta cells
Aplha cells produce glucagon,breakdwpons lipids inro glucose, increasing glucose levels
Beta cells produce insulin, moves glucose into cells, decreasing glucose levels//delta cells do both
priority outcome for diabetes
Keeping the blood glucose levels controlled at or near normal levels
People with DM are 2-4 more times likely to die from heart disease
Type 1 Diabetes
risk factors
what does it require
Genetic predisposition –most often occurs before 30
Environmental factors –viral or chemical toxin
Appears when 90% of beta cells are destroyed
Require an external source of insulin Without – ketosis
Manifestations of type 1 diabetes
results from
Polyuria inceasd urine output-loss of electrolyes”glucosuria”-glucose in urine
Polydipsia increases thirst
Polyphagia glucose enters cells w/out insulin—increased hunger
Weight loss, fatigue, malaise,
Result from the lack of insulin-destruction o beta cells
Type 2 Diabetes-what is it
risk factors
Hyperglycemia despite insulin: insulin is available but impaired function
Risk Factors
Heredity in siblings
Obesity-BMI of at least 27 and lack of exercise, poor diet
prediabetes and metbolic syndrome-what is
occurs
characterized
impaired glucose tolerance
occurs 10-20 yeaers before effect of insulin
characetrized by-central obesity, hypertenstion, high trugylceride level, high fasting blood glucose, hyperinsulemina
manifestations of type 2
gradual osnet , hyperglycemia,
polyura, polydyspia,
blurred vision
, fatigue,
skin infections
goal of type 2 diabetes
how to reach that goal
Best glycemic control
diet/ excercise
oral medcitons- maybe insulin
Diagnosis of DM-what looking for
A1c
FPG
OGTT
UT
Hemoglobin A1c-average blood glucose over 120 days
Normal 2-5%
5.7-6.4% pre-diabetes- high risk
6.5% or higher-diagnostic for diabetes
Fasting Plasma Glucose greater then 126
Oral Glucose Tolerance Test given 75 gramd of glucose, glucose should be abpve 200
Urine test looking for glucose, keotnes and albumin
Self Monitoring goal
& med Treatment-diabetes
med goal
SM- goal to achieve metabolic control & decrease complications by testing levels
Medications
Insulin: In class chart activity pg. 612
Anti-Diabetic Medication: Glipizide, glimepiride (), metformin
Medication goal – see imrovment of glucose, decrease in a1c-if not imrovinf suggest insulin changes
pharm and
non pharmacological interventions for hyperglycemia
insulin-pharm
nutrion
healthy eating
interventions for hypogylcemia
admisnter food,
administer glucagon
simple carbs/protine
check back in 15 minutes
what to educate paten on for diabetes
s/s
biguinide/metformin
aspirin
signs and symptoms of low blood glucose /
/Biguinide or metformin are not given in hospital or held 48 hrs before ct dt due to risk of kidney damage
asprin Therapy – cardiovaular disease is most common cause of mornbiltiy and moritlity-given once a day as promar prevention for pts woth heart disease
nutrition/excercise for diabetes
Nutrition
Carbs, protein, Fats, Fiber, Sodium, Sweeteners, alcohol –balance.no excess
Exercise –decrease amount of insulin when excercising
why is sick day management important for diabetes
requires use of insulin even without eating,
sickness causes stress to body, glucose may raise even without insulin
insulin still needs to be taken even with no eating
mintor ever 4 hrs or more frequently dur to risks for shifting glucoses
Diabetes and Complications
hypergylcemia
hypogylcermia
DKA
Macrovascular
microvascular
increased
delayed
Hyperglycemia above normal blood glucose levels- caused by-steroids,sickenss-
Hypoglycemia –lower glucose levels,pts with rapid pulse, irabiltoy,dif thinking, hedacheache// get glucose quick so iv or im
Diabetic Ketoacidosis –hypergylcemia-breaks down fats for energy, pts have kussmaluls and ftuiry brath,dehydration, dry mucous, weakness, n/v//replace fluids, balace electrolytes
Macrovascular Complications –peripheral vascular insufficenty/ ulcerations./gangrene of legs
Microvascular Complications –parethesia, capillary leak, decreased transport of oxygen to cells
Increased susceptibility to infection
Delayed/non- healing wounds
HHS-what is
s/s
Hyperglycemic state-type 2
urination
thirst
nausua
dry skin
disoratation/drowsiness
Functions of the Renal System
Renal system: Kidneys, ureters, bladder, and urethra
Kidneys-
contain
do what
located where
regions
contains nephrons which process the blood to make urine
Filtration system
Located outside peripternieal cavity
Highly vasucular
Three regions- each regions has 1 mill nephorons-process blood to make urine
urine formation
Urine is formed through 3 processes-filteration,reabsirbtion,secteion
Urine is 95% water, 5%solutes—(urea)
Ureters, bladder and urethra
transport
bladder
hold
urethra
Transport urine from kidney to bladder to excrete from body
Urinary bladder serves as sortage site for urine/males is infront rectum, females is in uterus
Openings are inside bladder, healthy adult can hold 300-500 before urge to void
Urethra is musulcar tube that channels out to body
Assessing Renal System Function
diagnostic tests
genetic considerations
health history interview
physical assesmsny
Diagnostic Tests used to support diagnosis,detemrain treatmetns and nsuring iunterventions
Genetic Considerations family history, kidney function, diabetes, genetic testing,
Health History Interview chief complains, asses elim status, pattern freuwncy changes in urine, color, odor, bleeding, assessing pain during urination, lifesytkle diets, exposure to pathogens, medicaitons, history of:bladder cancer, polsytic kindey disease, diabetes,polysistic kindey disease
Physical Assessment percussion, external structures and overall skin assesmwnt //pain, what kind, kindey pain and renal pain, bladder pain, pain from distended bladder
Renal/Urinary System Changes with Aging
Nocturia-night urination
Decreased Bladder Capacity
Urinary Retention–Behavior changes –Suspect uti
Weakened Sphincter muscles & shortened urethra in women
Incontinence
Cystitis-What is it?
patio
usually/
/when untreated
urethritis
Inflammation of urinary bladder, caused by uti
patho- mucosa of bladder becomes red, hemorage and bleed, inflammatory response causes pus to form
Usually uncomplicated and responds to treatment well
however, when untreated may be spread to kidney and cause ulcer formatuion
Urethritis: Inflammation of urethra
cytisis manifestations
Dysuria: -painful uraination
Urgency: sudden need to void
Nocturia: void 2 or more times a ngiht
Pyuria: foul order cloudy utine
Hematuria: bloody urine
Super pubic pain, tenderness
Cystitis: Diagnosis
Lab Testing for UTI,
Urinalysis - assement of pyurai ,bacetria and blood cells
Urine Culture & sensitivity –identifies infecting orgnims and most imacful antibotc
WBC –loukocytosis, associated with infection
IVP structural issues
Cystoscopy: Endoscopy of the bladder via the urethra
Visualizes bladder and for bladder neck obstructions
Post procedure assessment Complications or abnormals Assess and notify MD
cystisis
older adults
older men
older adults-nocturia, incontience, confusion, behavioral change, lethargy and anoerixa, hypothermia
older men enlarged protate can impede urine flow, leading to incomlete bladder emptying
Cystitis: Medications & Health Promotion
antibiotics
analgesics
Antibiotics:
Ciprofloxacin, levofloxacin, sulfamethoxazole-trimethoprim –finish entore course
Urinary Analgesic
Phenazopyridine used for relief of pain, burning–
Phenazopyridine
uses
what cant do
BPH and cystitis
if you give this then dont need to take narcotics dt dizziness
PT education cytisis
can turn
follow uo
complimentary therapies
can turn urine orange, red,and can stay in underwear
Follow up urine cultire, 10 days to 2 weeks after antibiotics
Complementary Therapies
Cranberry products, blueberry juice, herbal supplements (Saw palmetto)
Health Promotion for cytisis
Teach measures to reduce UTI
Emptying bladder
Be alert to manifestations of UTI
Urinary Calculi-what is
lithiasis
nephrolothasis
urolithiasis
Stones in the urinary tract
Lithiasis- means stone formation
Stone in kidney- nephrolithiasis
Stone anywhere else in urinary tract- urolithiasis
Risk factors- of urinary calculi
how they develop
family history,
genetic predisporiton
, dehydration and immobility
ingesting meal high in salt, decreasing urine volume, concentration develops salt. when fluid intake is adequate no stone growth occurs
when to go to ER
urianry calculi
High temp
pain
N/v
manifestations and complications of urinary calculi
Manifestations:
Symptoms vary with size and location
Renal colic-severe pain on side of stone
UTI– chills, frequency, urgency –N/V,
Complications
Obstruction of urine flow; impairs renal function –treat so no failure
hydronephrosis
can cause
urinaary statis causes
kindeys producing mroe urine, causinf increased pressure and distention
if not treated this pressure can cause kidney failure
urinary stasis can cause inc uti
Urinary Calculi : Treatment for pain
meds
tehniques
do what
strain/look
Medications(nsaids, tamsulosin),
positioning,
relaxation techniques and
hydration
Strain urine: Passing of stone is possible-look for blood in urine(hemotorria)
what foods to avoid in urniary calculi
increase what
sodium-restricted protien
calcium
caffiene
aniaml fats
increase fluid intake to 2.5-3 l
Lithotripsy
inv
takes how long
precare
post caer
contraindicated
-use of sound waves to crush stones- preferred treatment.
Noninvasive, don’t cause damage,
takes 30 mins to 2 hrs/
/Pre-withhold fluids and foods/
post-monitor vitals, monitor urine,maintain placement of catheter, administer fluids
pregnacy is contraindacted
Ureteral Sent
-thin plastic tubes, placed between kindey and bladder. Allows urine to flow through stones, can break a stone/
ureteral stent
can cause
can be removed by
can cause pain and blatter frequenct, pain in kindey when passing urine//normal to have discomfort and blood,
stent can be removed with local anathetic
ureteral stent
pre caer//montior,signed,do what
post care//moniotor/some/encourageandincrease/use
Pre Care: – vitals and assessment, knowledge, signed consent, NPO to reduce risk of aspiration
Post Care:- vitals, assesmnts, montoring urine, some bleeding is normal, encourage and increase to drink fluids, use pain meds
Dialysis Overview
what is it
Remove excess fkuid and metabolic waste prodcuts when a pt acute kifney injury ot renal failiure
what is kidney failure
what causes kidney failure
gradual decrease in kindey fnuntion, leads to metabolic waste being collevte fin blood, Bun and creatine are diagnosed for disorders,
hypertension, diabetes, infection, overdose, nephrotoxic drugs
Hemodialysis-
what is it
what is needed
tem
/perm
development
palpable
ALERT
blood passes through filter outisde of body, and filters and puts blood back in body
Vascular access is needed -
Temporary (mahurkar) or permanent (AV fistula)
–AV Fistula development: Surgical procedure- connecting an artery and vein-long term vascular access
Palpable pulsation and bruit on auscultation
Avoid vein punctures, BPs or lab draws on this side ( Limb Alert!)
Pre dialysis hemodialysis
Pre vitals
Weight
Vascular access
post dialysis
hemodialysis
mintor
monitor
assess
assess
Vitals, weight
Monitor labs BUN, Creat, electrolytes and CBC ( NA, K+, Ca)
Assess site for bleeding
Asses for headache, n/v,dehydration,muscle cramps,bleeding and provide support
hemodyalsis-how often
complications
continous
3-4 hrs a day 3-4 times a week
complications
hypotension
bleeding
infections
CRRT
if cardiac status is unstable, contious renal replacement may be needed. more gradual removal=helps remain stable
Peritoneal Dialysis
what is
gradual
risk
cloudy
dextrose
drained
Peritoneal membrane serves as a dialyzing membrane-warmed sterile dialystate is instilled
Fluid shift of solutes are more gradual is comparison
Less risk for unstable patients
If the stuff is coming back cloudy it could mean infecetion
Dextrsoe as osmotic agent to draw water into dialsytle
drained with gravity
Pre Dialysis Peritoneal
assess
measuring
empty
warmed
Vitals, weight
Abdominal girth -measure
Empty bladder prior /note bun, serum electrolye, creatinine, ph and hemaatocirt
Dialysate is warmed to prevent hypothermia
Post Dialysis Peritoneal
assess
education
timing
Access vitals, temp, weight
Educate patient on self administration –can do at home-risk for infection, looking for cloudy retirn of dialotae soluton
Time meals tp correspond with dialysis outflow
Dialysis considerations??
Fluid/electoltyes
nutrition
restore fluid/electrolyte balance-,manitain hourly I and o, weigh daily, assess vitals every 4 hrs, place in semi fowlers, restrict fluids If ordered, turn frequently
Maintain adequate nutrition- monitor food record intale, weogh daily,arrangrfor dietary conislation
Benign Prostatic Hyperplasia (BPH)
what is it
risk factors
complications
Age related, enlargement of prostate gland-common in aging male-40 ish starts
Risk factors- beong over 40,testiserone,diet high in meat/fats
Complications-diverticula on bladder wall, may obstruct ureters and ascend from bladder to kidneys
Manifestations BPH
Partial or complete obstruction of urine flow
Decreased bladder compliance and contractibility
Urine retention –may become chronic
Catheter is hard to put in because of enlargement
diagnosis of BPH
Why is urine examined
Physical examination and PSA levels (Prostate-specific antigen)
Increasing levels of PSA- need further investigation and review of symptoms
Urine is examined for WBC,RBC and bacteria
BPH Treatment
2 types of meds
Med-goal: decrease prostate size
Finasteride (Proscar)
Dutasteride (Avodart)
Med- goal: relieve obstruction and help increase urine flow
Terazosin (hytrin)
Tamsulosin (Flomax)
Surgery BPH
removed
risks
open
Transurethral Surgery (TURP) Resection of Prostate –
Obstructing tissue removed using wire loop instead through urethra
-risks of postoperative hemorrhage or clot retention, inability to void and uti
Open Procedures: For more invasive concerns
Prostate Surgery: Nursing Care
Pre-operative
Eduacte in urinary cather
Drains near incision site-if open
Wear teds and scd-up and walking
Bed rest until morning
Ensure signed form
Bowel prep
Education on questions
NPO
Prostate Surgery: Nursing Care
Post-operative
Assesmtnes/vitals
check bleeding/ dressing
Diet modications-inc fiber
Adequete I and o
Irreate cath
Mange pain
Supostory for spams-
investagte what pain
Anagesic
Fluid intake
Contious bladder irragtion
Prostate Surgery: Nursing Care
Health Promotion
FC
instruct
diet
lax
no
Foely cahter
Intruct on some dribbling, some pain, some buering, some blood–normal until infamatory pricess decresed
Diet with fiber
Laxatives-no straining
No sexual acitivy for 6 week
