NUS111 Test #4 Flashcards
What are the risk factors for Benign Prostatic Hyperplasia
Increased age in Caucasian Men
African American men at a younger age
Smoking
Chronic Alcohol Use
Sedentary Lifestyle
Obesity
Poor Diet (western diet)
Diabetes Mellitus
Heart disease
Hypertension
What is the pathophysiology of BPH
Hypertrophied lobes of the prostate may obstruct the vesical neck or prostatic urethra causing incomplete emptying of the bladder and urinary retention.
What further complications can occur as a result of BPH
A gradual dilation of the ureters (hydroureter) and kidneys (hydronephrosis) can occur causing kidney infections. UTIs may result from urinary stasis
what is the International Prostate Symptom Score? (IPSS)
An assessment tool used to determine the severity of manifestations (of prostate symptoms) and their effect on the client’s quality of life
What does the IPSS ask the client to rate?
On a scale of 1-5 the severity of lower urinary tracy manifestations and how their quality of life is affected
What are the clinical manifestations of BPH
Urinary retention
Persistent UTI’s
Urinary frequency
Urinary urgency
Urinary incontinence
Kidney infections
Nocturia
Hesitancy in starting urination
Incomplete urination
Decrease in volume and force of urinary stream
Abdominal straining when urinating
Interruption of urinary stream
Dribbling
What are the Laboratory tests for BPH?
Urinalysis and culture: WBC’s elevated, hematuria and bateria present with UTI
BUN & creatinine: Elevated, indicating kidney damage
Urodynamic studies
CBC: WBC elevated if systemic infection present, RBC possibly decreased due to hematuria
culture and sensitivity of prostatic fluid: if fluid is expressed during D.R.E
what are the diagnostic procedures for BPH?
- Digital Rectal Examination (DRE)
- Transrectal Ultrasound with needle aspiration biopsy
- Early prostate cancer antigen
What will a DRE reveal in a patient with BHP?
an enlarged smooth prostate
What does the Transrectal Ultrasound with needle aspiration biopsy rule out in a patient with BHP?
prostate cancer in the presence of an enlarged prostate
What does an early prostate cancer antigen blood test rule out in patients with BHP?
presence of prostate cancer
What client education do we provide regarding BPH?
- Frequent wanks keep your prostate small
- Avoid drinking large amounts of fluid at the same time and void when you feel the urge
- Avoid bladder stimulants such as alcohol and caffeine
- avoid medications that reduce bladder tone (anticholinergenics, decongestants, antihistamines)
What is the goal of medication in a patient with BHP?
To re-establish uninhibited urine flow ou of the bladder
What are the medications we use for patients with BHP?
Finasteride (5-Alpha reductase inhibitor)
Tamsulosin (Alpha adrenergic agent)
What is the effect of finasteride on patients with BHP?
DHT medications decreases the production of testosterone in the prostate gland which often causes a decrease in the size of the prostate
what client education would we provide in relation to finasteride?
- MEdication can take up to 6 months to take effect
- impotence and decrease in libido are possible adverse effects
- Report breast enlargement to the provider
- Finasteride is teratogenic to a male fetus as potentially absorbed through the skin.
- Pregnant women should avoid contact with crushed medication or semen of a client taking the medication
What is the effect of Tamsulosin on patients with BHP?
- Causes relaxation of the bladder outlet and prostate gland
- Decreases pressure on the urethra thereby re-establishing a stronger urne flow
what client education would we provide in relation to Tamsulosin?
- Tachycardia, syncope, and postural hypotension can occur. Change positions slowly
- Drug-Drug interaction with cimetidine can potentiate hypotensive effect
What are the potential procedures for BPH?
Transurethral needle ablation
Transurethral microwave therapy
Prostatic stent
Interstitial laser coagulation
Electrovaporization of the prostate
Transurethral resection of the Prostate (TURP) **
What is a TURP procedure?
A surgical procedure to trim excess prostatic tissue emlarging the passageway of the urethra through the prostatic gland. Typically epidural and spinal anasthesia are used
What are the Pre-Op nursing interventions for TURP procedure?
Asses CV respiratory and renal systems
Education. ensure client fully understands procedure and expected outcomes (physical/social/sexual)
Insert Coude catheter
Lab values: clotting factors
Give prophylactic antibiotic
What are the post operative nursing interventions after a TURP procedure?
Continuous Bladder Irrigation (CBI)
Placement of a three way catherter for CBI
Monitoring of the CBI
Monitor I & O
Monitor CBI for excessive bleeding
Drinking 2-3L fluid per day
Administering medications for pain and bladder spasms, stool softeners to avoid straining
Helping client to ambulate as soon as possible to avoid DVT
If the CBI appears not to be draining what should we do?
Check for kinks
If still not draining, stop flow of catheter and irrigate with 50ml saline to remove blockage
How large is the balloon on a CBI catheter?
30-45ml
what are the possible complications of TURP procedure?
Urethral trauma
Urinary retention
Bleeding
Infection
What patient education do we give regarding BPH Post TURP surgery?
- Avoid heavy lifting, straining and sexual intercourse for the prescribed length of time (usually 2-6 weeks)
- Drink 12 or more 8oz glasses of water a day
- Avoud NSAIDS due to risk for increased bleeding
- If urine becomes bloody stop activity, rest and drink fluid
- contact surgeon if persistent bleeding or urinary obstruction
What is the pathophysiololgy of Rheumatoid Arthritis?
- Autoimmune inflammatory disorder
- Primarily occurs in the synovial membrane and connective tissues of the joint
- Predetermined genes contribute to the condition (antigens, smoking, environmental
factors) - Enzyme release that creates inflammation
- Unknown why the body produces rheumatoid factor (RF) against its own antibodies (IgG
= immunoglobulin)
clinical manifestations/assessments for rheumatoid arthritis
joint pain
swelling
warmth
erythema (redness)
lack of function
deformities of hands/feet
systemic condition
Morning stiffness
Often bilateral (as distinct from OA which is often unilateral)
-extra-articular symptoms - weight loss, sensory changes, lymph node enlargement and fatigue
-important to involve pt in care plan
this is an autoimmune inflammatory disorder
rheumatoid arthritis
where does rheumatoid arthritis occur at
the synovial membrane and surrounding joint tissue
what diagnostics/labs are used for rheumatoid arthritis
ESR (sed rate) and CRP (c-reactive protein) - inflammation markers
Arthrocentesis to look at Synovial fluid- looks cloudy if contains inflammatory components
what medications are used for rheumatoid arthritis
DMARDs - disease modifying anti-rheumatic drugs
ex: methotrexate
NSAIDS and Aspirin
Ex: ibuprofen
Patient education regarding DMARDS
Avoid crowds to avoid infection
Monitor for allergic reaction
Heavy on liver, avoid alcohol
Can take 3-4 months to see effects
long term NSAID/aspirin use can cause what issues
liver and kidney issues
Patient education RE: NSAIDS
Take with food or milk to reduce GI irritation
Monitor symptoms for liver and kidney damage
what are the manifestations/assessments for osteoarthritis
pain (worsened with activities, alleviated with rest)
stiffness
function disability (limited ROM)
Difficulties with ADLs
crepitus
locking of knees
Often unilateral (as distinct from RA which is often bilateral)
osteoarthritis diagnostics/labs
x-rays: most definitive/clinical evidence of diagnosis
patellar tap - analysis of synovial fluid in knee
osteoarthritis is often diagnosed by 2 things
pt’s age and medical history
osteoarthritis is known as what
degenerative joint disease
what is the biggest risk factor for osteoarthritis
age - elderly population
what is the pathophysiology of osteoarthritis
Also known as “DJD” (degenerative joint disease)
* Age is the biggest risk factor (elderly population)
* Non-inflammatory disorder
* Affects weight-bearing joints
* Has tremendous functional impact on elderly patients
* Erosion of the articular cartilage and hypertrophy of bone
* Osteophytes (bone spurs)
* Alterations of the synovial membrane and joint capsule
what are the nursing interventions of osteroarthritis
- educate pts on disease
- reduce pain/inflammation using non pharm measures to slow progression
- As using NSAIDS we also have to include preventative measures for GI upset and constipation.
- optimizing phys function
- Assistive devices
What is the pathophysiology of Gout?
Metabolic disorder characterized by urate crystals in the joints.
* Genetic defect of purine metabolism resulting in hyperuricemia.
* Results in elevated uric acid level in the blood.
* Uric acid in the deposits within a joint and “crystallizes” causing an inflammatory
response (attack of gout).
* Urate crystals are called tophi.
* Classic gout is found in the great toe (known as podagra), but can also be found in the
hands and the ears.
clinical manifestations/assessments for gout
-gouty arthritis pain
-pain, swelling, redness, warmth of affected joint
-tophi
***uric acid deposits in tissues
-kidney stones - so hydration is key
-4 phases of gout
1. asymptomatic hyperuricemia,
2. acute gouty arthritis,
3. intercritical gout and
4. chronic tophaceous gout
what can cause an attack on gout - 4
alcohol - particularly red wine and beer
trauma
diet- beef or anything high in purines
medications- aspirin, thiazide, duiretics, niacin
is acute gout a slow onset or abrupt
abrupt
why does a nurse need to do a careful assessment of pt’s acute gout
due to pt’s level of pain with acute attack
how do you diagnose gout
light microscopy of synovial fluid at involved joint
what is found at joint during light microscopy
uric acid crystals and leukocytes
pain management of gout
- discourage weight bearing on affected limb
- joint should be elevated and rested
- apply ice (NOT HEAT)
- use bed cage to keep bedding off limb
- Educate on lifestyle (no alcohol and low purine diet, no sugary drinks)
what do you teach pt about gout
- avoid alcohol, stress, smoking
- comply with medication regimen to prevent future attacks
- encourage lots of fluids - 2L/day
- Weight loss reduces stress on joints and uric acid in blood
what foods does someone with gout avoid
- organ meats
- shellfish
- sugary drinks
*restrict foods high in purines
this is treated with medications within 24 hours of acute attack. only one joint is affected
acute gout
what medications are used for acute gout
NSAIDS - ibuprofen
Colchicine - Decreases uric acid level in blood (dosage increased til pain is relieved)
repeated episodes of pain and inflammation. More than one joint may be affected
chronic gout
what medication is used for chronic gout
allopurinol
this is an infection in any part of urinary system caused by bacterium that invades urinary cells causing irritation and inflammation
UTI
what is part of the lower urinary tract
bladder, urethra
what is part of the upper urinary tract
ureters and kidneys
this type of UTI happens outside of the hospital
uncomplication upper/lower UTI - community acquired
do men or women get UTIs the most
women
-this is related to catheterization.
-occurs from something different than from standard anatomy
-recurrent UTIs
complicated upper/lower uti - hospital acquired
pregnancy, immune supression, diabetes and urologic abnormalities can cause
UTIs
modifiable risk factors for UTIs
poor hygiene
not voiding after intercourse
multiple sex partners
using contraceptive diaphragm
invasive urinary tract procedure
catheterization
habitual delay of urination
non modifiable risks for UTIs
increasing antibiotic resistance
elderly women
spinal cord injury
neurologic disorders
65+ yrs more prone to get
this is result of repeated infections that cause progressive inflammation and scarring
more common with obstructions, urinary anomaly and vesicoureteral urine reflux
chronic pyelonephritis
manifestations of lower uti
burning when you pee
this is active bacterial infection that occurs most frequently in females 20-30 yrs
acute pyelonephritis
acute pyelonephritis can cause - 4
- interstitial inflammation
- tubular cell necrosis
- abscess formation in capsule, cortex or medulla
- temp after kidney function
during the nursing assessment what do you need to obtain for UTIs
-history of UTIs, any kidney function issues, medical history with kidney/bladder
-any renal disorders in family history
-sexual activities, what kind of protection used
-polypharmacy, urine sample, swelling in genitalia
what pt education do you need to teach about UTIs
-how to prevent - clean front to back, take showers
-drink 3-3.5 L of water a day
-void after sex
-don’t hold pee all day, pee every 3-4 hours
-finish antibiotics
-dont wear wet clothing/bathing suits
-avoid bubble baths
how diagnose UTI
-urinalysis, urine culture, sensitivity test (wbc, nitrates, bacteria)
-blood culture positive for bacteria if UTI is systemic infection
-serum creatinine and BUN elevated during acute episodes
-C-reactive protein is elevated
-ESR
medications for uncomplicated UTIs
trimethoprim/sulfamethoxazole
nitrofurantoin
ampicillin, amoxicillin, cephalosporin
medications for complicated UTIs
fluoroquinolones
how long on meds for complicated UTIs
7-10 days
how long on meds for uncomplicated utis
1-3 days
what is cystitis
Cystitis is bladder inflammation, which may be caused by a bacterial infection, but may also be caused by immune dysfunction or other root causes.
symptoms of cystitis
-A strong, persistent urge to urinate.
-Pain or a burning feeling when urinating.
-Passing frequent, small amounts of urine.
-Blood in the urine (hematuria)
-Passing cloudy or strong-smelling urine.
-Pelvic discomfort.
-A feeling of pressure in the area below your belly button (abdomen)
what is urethritis
inflammation (swelling and irritation) of the urethra. The urethra is the tube that carries urine from the body
symptoms of urethritis
-Feeling the frequent or urgent need to urinate
-Difficulty starting urination
-Urethritis can also cause itching, pain, or discomfort when a person is not urinating.
Other symptoms of urethritis include:
-Pain during sex
-Discharge from the urethral opening or vagina
-In men, blood in the semen or urine
what is prostatitis
frequently painful condition that involves inflammation of the prostate and sometimes the areas around the prostate.
-freq starts with bacteria infection
symptoms of prostatitis
-Pain in the penis, testicles or perineum (area between the testicles and rectum). The pain may radiate to the lower back.
-Frequent urge to urinate.
-Painful urination (dysuria).
-Weak urine flow or urine stream that starts and stops.
-Painful ejaculation or pain during intercourse.
-Blood in semen (hematospermia).
-Erectile dysfunction.
what is pyelonephritis
a kidney infection from a UTI
symptoms of pyelonephritis
-Fever.
-Chills.
-Pain in your lower back or side.
-Pain when you pee (urinate).
-Bloody or cloudy pee (hematuria or pyuria) that might smell bad.
-Urgent or frequent need to pee.
how does a 65 yr old + present with UTI
sudden and unexplained change in their behaviour, such as increased confusion, agitation, or withdrawal, this may be because of a UTI
this is the partial or complete disruption in bone structure
fracture
at what age/stage of life do most fractures occur
older adults, over 65 years
2 Ways a fracture can occur
Trauma
Spontaneous (from osteoporosis or neoplasm)
what’s a closed fracture
the bone breaks but it does not go through the skin
whats an open fracture
bone breaks through the skin and sticks out
this is when the bones break and both ends are no longer straight
displaced fracture
this type of fracture is open, closed, and displaced, non displaced all the way across
complete fracture
this type of fracture is in one spot and the bone is still straight
non displaced fracture
these fractures are greenstick, hairline, anything that doesnt completely cross thebone
incomplete fracture
what are the risk factors for fractures
- participating in sports, physical fitness activities
- history of osteoporosis
- age
- presence of chronic medical conditions
- long term steroid use
95% of hip fractures are from…
falls
what can cause osteoporosis
long term steroid use
priority nursing assessments for fractures - 6
- airway first
- assess for s/s of infection
- assess vital signs
- assess & re-assess pain
- assess skin integrity
- assess neurovascular status
while assessing for signs and symptoms of infection from a fracture - what do you assess for
-open fracture leaves things exposed
-if traumatic there could be abrasions
-redness, swelling, fever, tachycardia, tachypnea, elevated WBC, purulent drainage
while assessing a fracture - what do you look for, for vital signs
-temperature: infection
-bp (low): internal bleeding
-HR: elevated
-RR: rapid or shallow - could be lung injury
a fractured femur could cause a …
thromboembolism or fat embolism
while assessing a pain for fracture - look at
- pain assessment scale 0-10
- facial grimacing
- location, character, site, intensity
- sudden change in pain
what is a complication of pain for fractures (2)
- compartment syndrome
- clot
what do you look for, for skin integrity of a fracture (6)
- ruptured bone
- bleeding internal
- bruising
- compartment syndrome
- red and swollen unilaterally
- pressure ulcers due to immobility
what is included in the neurovascular assessment for fractures
- compartment syndrome
- complete fractured out of alignment could be cutting off circulation
- cut off artery or caused trauma could be internally bleeding
- 6 Ps —> pain, pallor, peripheral pulses, paresthesia, paralysis, pressure
what would you report to a physician re neurovascular assessment of fractures
-report loss of sensation and tingling
-report blue/white/pale color to effected area — circulation problem
where does neurovascular fall within the ABCs
C - circulation
surgical management of fractures is what
open reduction with internal fixation (ORIF)
how long would you wait for ORIF and why
wait a day or two due to swelling to prevent compartment syndrome
is ORIF permanent or temporary
permanent for life
what is bone grafting
transplantation of a portion of bone on a site to rebuild or repair a damaged bone. bone fragment is collected to create bone graft. and then packed into affected site.
this typically harvest from hip bone and apply to broken part to try to refill broken areas
bone grafting
when having a bone graft, everything is doubled b/c of two incision sites, so you can have…
infection 2 sources, and 2 sources of pain
what is debridement re fractures
removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.
-will have pain/swelling around wound but will get better a few days after procedure
labs/diagnostics for fractures
xrays - hips, femur, pelvis and long bones
CT scans, bone scans, MRIs
CBC & BMP
CMP – kidney function
WBC & ESR (sed rate) – inflammation
*know pt’s blood type in case need blood transfusion
CK level - creatinine kinase - muscle breakdown
BUN & Creatinine - kidney function
what is the name for muscle breakdown — we need to watch for this for fractures
rhabdomyolysis
clinical manifestations for fractures
pain
loss of function
deformity
crepitis
swelling/discoloration
this is when one leg is shorter than the other; externally rotated— > hanging foot to the side
deformity from fracture
this is immediate when you get a fracture and may get muscle spasms b/c of possible displacement
pain
long bone fractures typically have a ______
shortening effect on the limb
crackling sound when touched; this is the rubbing of bone fragments on each other when bone is fractured
crepitis
when a person’s fracture hurts too much to put pressure on it or it’s out of place… that’s called
loss of function
when a fracture has swelling/discoloration - what causes that
bruising and localized edema
this is used to treat fracutres, realign broken bones, correct contractures, deformities and knee immobilization
bucks traction
this keeps alignment of bone; cannot adjust weight ; weights have to be free hanging
bucks traction
how often do you need to reposition a pt in a bucks traction – what do you use
reposition and turn every 1-2 hours; prop up with pillows/slight movements
What is the priority nursing assessment whilst a client is in Bucks traction?
Frequent and thorough skin assessments
this is too much pressure in a defined area of an extremity, often in the calf.
compartment syndrome
what is the nursing intervention for compartment syndrome
-Frequent Neurovascular check to try and catch early
-fasciotomy to fix this
-if cast is too tight, it needs to be cut off.
-needs to be managed quickly
-can lose limb due to lack of blood and oxygen —> leads to necrosis and death of limb
waht assessment is important to do when pt has compartment syndrome
neurovascular check
after getting a facture/break - how long after can you develop a blood clot
2 days to 2 weeks
what is a concern after pt breaks limb
fat embolism or VTE
nursing interventions for VTE from a fracture
-heparin
-pressure devices –> stockings, early/frequent ambulation
-ROM
-encourage fluids to keep things moving
-watch for symptoms of PE
what are symptoms of a PE
SOB, chest pain, tachycardia, hypotension, anxiety, generalized crackles (due to fluid build up)
this internal and can quickly get severe; can be identified by signs of infection
elevated WBCs
infection of the bone
what is another name for infection of the bone
osteomyelitis
who is more at risk at getting osteomyelitis
diabetics
immune compromised
malnourished
anyone with reoccurring infections
elderly
obese
how do we try to prevent osteomyelitis after surgery
give antibiotics two hours before and then a few doses afterwards to prevent it
how to prevent staff infection
clean incision with sterile technique, make sure to remove drains as soon as you can
true or false
a staff infection can lead to sepsis
true
how soon after surgery can someone get a staff infection
it can happen immediately or months after surgery
what are nursing interventions for impaired skin integrity
-re positioning
-good position to help blood flow and oxygenation
-skin care
*only document what you see yourself
what are the complications of fractures - 8
- compartment syndrome
- VTE
- osteomyelitis
- impaired skin integrity
- hemorrhage
- amputation
- pneumonia
- constipation
what can cause constipation after a fracture
immobility
opioids
nursing intervention for constipation
make sure pt is hydrated
ambulating
stool softener
high fiber diet
increase protein for healing
zinc
nursing interventions for hemorrhage
vital signs
check labs
-check for bruising for internal bleeding
this is the removal of part or whole thing due to death to tissue or bone to stop the spread and try to save as much as possible
amputation
what is phantom pain
having “pain” in removed section, severing of those nerves can cause pain — need to treat this pain
nursing intervention for pneumonia
incentive spirometer, ambulation, cough, deep breathing
what are the s/s of pneumonia after surgery
decreased oyxgenation
crackles
cough
sputum
how to diagnosis pneumonia
chest xray
sputum culture to determine what kind
what are the usual post op assessments to perform for fractured hip
vitals, neurovascular status, pain management, deep breathing, turn and reposition
priority nursing interventions for fractured hip - pre op and post op
**hip fracture def on test
1.level of consciousness - make sure anesthesia is wearing off
2. traction - skin assessment, never move weights
3. body alignment - proper positioning with pillows
4. abductor pillow - triangle keeps hips aligned while sleeping
5.pedal pulses - circulation
6. skin integrity - pressure ulcers
7. incisional site assessment - infection, appropriate healing
8. wound vac - suctioning out drainage (counts on I& O!!!)
9. I/Os - properly hydrated without going into fluid overload
monitor for post op complications
what can someone develop while anesthesia is wearing off
develop delirium
what are the teaching points for pts who are post op from femur or hip fracture
proper alignment,
ambulation,
things to watch for such as infection ,
blood clots,
compartment syndrome,
neurovascular status,
what interventions would you suggest to prevent pt falls
well lit environment
grab bars in the bathtub
no throw rugs
non slip socks
lifted toliet seats
well fitted shoes
teach about remaining active and exercise with physician monitoring
2 types of Glomerularnephritis
- Acute post-streptocccal glomerulonephritis
- chronic glomerulonephritis
-this is characterized by proteinuria usually caused by renal destruction
-kidneys are reduced to as little as 1/5 of their normal size
-they consist largely of fibrous tissue
chronic glomerulonephritis
this results in severe glomerular damage
-glomeruli and their tubules become scarred, branches of renal artery are thickened
chronic glomerulonephritis
kidney disorder that occurs after infection with certain strains of streptococcus bacteria.
acute post streptococcal glomerulonephritis
what age group does acute post streptococcal glomerulonephritis affect the most
young children - 1 to 2 weeks after they get strep throat infection
this is caused by inflammation and damage to the filtering part of the kidneys (glomerulus). It can come on quickly or over a longer period of time. Toxins, metabolic wastes and excess fluid are not properly filtered into the urine. Instead, they build up in the body causing swelling and fatigue.
glomerulonephritis
risk factors for chronic glomerulonephritis
-Chronic conditions that damage the kidneys (diabetes)
-hypertensive nephrosclerosis
-hyperlipidemia
-chronic tubulointerstitial injury
-hemodynamically mediated glomerular sclerosis
-Acute glomerulonephritis
risk factors for acute glomerulonephritis
inflammatory conditions like systemic lupus erythematosus (SLE) or vasculitis.
-in some cases: HIV.
Family History
Children
Hepatitis
Mumps
Varicella
Strep
find more
how long does it take for chronic glomerulonephritis to develop
20-30 years
when does acute glomerulonephritis occur
often occurs following an infection
Priority Labs/diagnostics for glomerulonephritis
Urinalysis (myoglobin urea)
Blood BUN creatinine
Ultrasound (are kidneys inflamed?)
GFR- lower if disease present
titer - strep present?
Renal Biopsy
how to diagnose glomerulonephritis
kidney biopsy will diagnose, determine prognosis and guide treatment
Clinical manifestations of acute glomerulonephritis
Flank pain
Nausea
High WBC
Proteinurea
Pitting Edema
Oligurea
Hypertension
Hematurea (cola urine)
Azotemia (exessive nitrogenous wastes in the body)
clinical manifestations of chronic glomerulonephritis
-some pts asymptomatic for years
-sudden, severe nosebleed
-stroke
-seizure
-feet are slightly swollen at night (edematous)
-general symptoms - loss of weight and strength; irritability; increased need to urinate at night, headaches, dizziness, digestive disturbances
how is chronic glomerulonephritis usually first found in pts
-pt is hypertensive
-elevated BUN and serum creatinine
-vascular changes found during eye exam
-retinal hemorrhages are discovered during routine eye exam
as chronic glomerulonephritis progresses the s/s of this may develop
chronic kidney failure
what are the signs/symptoms of chronic kidney failure
- pt appears poorly nourished
- yellow/gray pigmentation of skin due to uremia
- periorbital/peripheral edema w/ normal or elevated BP
- mucous membranes pale due to anemia
- cardiomegaly, distended neck veins, other signs of heart failure
- crackles in lungs
Pharmacological treatment of glomerulonephritis
- Antibiotics to treat residul infection
- Ace inhibitors to treat proteinurea
- Vasodilators such as hydralazine to treat severe Hypertension
- Diuretics for fluid retention
Dietary interventions for glomerulonephritis
dietary protein restricted to treat nitrogen retention
High Carb diet to provide energy and reduce catabolism of protein
Sodium restricted if patient has hypertension
Nursing interventions for glomerulonephritis
I & O (including insensible fluid loss)
Daily weights
Patient education regarding disease process
Fluid restriction
Monitoring for pulmonary edema (crackles)
Monitoring pitting edema (fluid retention)
Fluid and electrolytes
Labs
managing nausea
Define the Preoperative phase of the Nursing process
It begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient on to the OR table
Define the Postoperative phase of the Nursing process
Begins when the patient is transferred to the PACU and report is given by the anesthesia provider and circulating nurse to the perianesthesia nurse. The postoperative phase ends when the patient is discharged from all phases of postoperative care.
What is the main focus of preoperative nursing?
The prevention of complications
What are the three requirements of informed consent?
- Adequate disclosure of diagnosis-purpose, risks, and consequences of treatment, probability of success, prognosis if not instituted.
- **Understanding & comprehension **-patient must be drug free prior to signing consent.
- Consent given voluntarily -patient must not be persuaded or coerced to undergo the procedure
What is a preoperative checklist?
*** Lists requirements before patient goes to OR **
* diagnostic tests complete
* preoperative medication given
* Vital signs
Documents safety data
* ID band in place; 2 identifiers
* Jewelry removed
* Last void
* Dentures removed
* Informed consent verified
* Patient Allergies listed
What are the nursing interventions for each of the perioperativenursing phases?
Health history
Physical Assessment
Informed Consent
Teaching
Discharge Planning
Nutritional and fluid status
Drug and alcohol use
Labs
Medications
Psychosocial and cultural factors
What are the postoperative assessments and care?
Vital signs
Gag Reflex
Hypothermia
Hyperthermia
Utilize the nursing process.
Frequent, thorough assessment is necessary.
Interventions focus on:
Respiratory function
Circulation
Pain control
Promoting cardiac output
Activity
Wound healing (dressing changes)
Nutrition and GI function
Managing Potential Complications
What are the preventable complications a nurse should be aware of post-surgery?
Pain
Hemorrhage
Hypovolemic Shock
Thrombophlebitis-DVT
Pulmonary embolus
Fluid Overload
Atelectasis
Pneumonia
Airway Obstruction
Surgical site infection (SSI)
What steps will you take to break the chain of infection anytime sterile gloves are required?
Maintain surgical Asepsis
Perform hand hygeine
What are the key things to assess before donning sterile gloves?
Determine need for a sterile field
Does client have latex allergy or other allergies and sensitivities
What are the key points to remember when setting up a sterile field?
- Always keep the sterile field in front of you
- Never reach over a sterile field
- Keep the sterile field at waist height or above
- Consider the outer 1” of the field contaminated
- Ensure that only sterile items touch sterile items
**Put the steps in order for opening sterile gloves **
* Remove inner package
* Peel back top layer of outer wrapper
* Open the top fold, bottom fold and sides of the package
* Place the inner package on the work surface with the end marked cuffs closest to you
* Open the packet so that your hand doesnt come in to contact with the contents
- Peel back top layer of outer wrapper
- Remove inner package
- Place the inner package on the work surface with the end marked cuffs closest to you
- Open the packet so that your hand doesnt come in to contact with the contents
- Open the top fold, bottom fold and sides of the package
Put the steps in order for donning the sterile glove on the dominant hand
- Lift the glove above your waistline
- Touch only the inside surface of the glove
- Place your dominant hand into the glove and pull the glove on
- Use the thumb and forefinger of your non-dominant hand to grasp the cuff of the sterile glove for your dominant hand
- Use the thumb and forefinger of your non-dominant hand to grasp the cuff of the sterile glove for your dominant hand.
- Touch only the inside surface of the glove.
- Lift the glove above your waistline.
- Place your dominant hand into the glove and pull the glove on
Put the steps in order for donning the sterile glove on the non-dominant hand
- Lift it from the wrapper
- Hold the thumb of your gloved hand outward and place it underneath the cuff of the remaining glove
- Place your non dominant hand into the gove, taking care not to touch the outside
- Hold the thumb of your gloved hand outward and place it underneath the cuff of the remaining glove.
- Lift it from the wrapper.
- Place your non dominant hand into the gove, taking care not to touch the outside
Place the steps in order for extending the cuffs of sterile gloves
- repeat for the other hand
- adjust as needed
- fully extend the cuff down the other arm, being careful to only touch the sterile outside of the glove
- slide the fingers of one hand under the cuff of the other
- slide the fingers of one hand under the cuff of the other.
- fully extend the cuff down the other arm, being careful to only touch the sterile outside of the glove.
- Repeat for the other hand.
- Adjust as needed
Place the steps in order for removing sterile gloves
- Grasp the glove on the inside and remove it by turning it inside out over the hand and the other glove.
- Discard the gloves and perform hand hygeine.
- Slide the fingers of ungloved hand inside the remaining glove, between the glove and your skin.
- Hold the removed glove in your gloved hand
- Remove the glove by inverting it as it is pulled off, to keep the contaminated area (outside of glove) on the inside.
- Use your dominant hand to grasp the other glove near the cuff end on the outside of the glove.
- Use your dominant hand to grasp the other glove near the cuff end on the outside of the glove.
- Remove the glove by inverting it as it is pulled off, to keep the contaminated area (outside of glove) on the inside.
- Hold the removed glove in your gloved hand.
- Slide the fingers of ungloved hand inside the remaining glove, between the glove and your skin.
- Grasp the glove on the inside and remove it by turning it inside out over the hand and the other glove.
- Discard the gloves and perform hand hygeine
What if, whilst donning your sterile gloves, you inadvertantly drop one?
Remove the gloves, perform hand hygiene, and don a new pair before continuing preocedure.
What is the rationale for using deep breathing and coughing exercises post surgery?
- Deep breathing exercises hyperventilate the alveoli and prevent them from collapsing
- Deep breathing improves lung expansion and volume
- Deep breathing helps expel anasthetic gases and mucus from the airway
- Deep breathing improves oxygenation of the tissues
- coughing helps removes retained mucus from the repiratory tract
Splinting provides support to ——-
Surgical incisions
Splinting provide support to surgical incisions when..
Deep breathing
Coughing
moving in bed
getting in or out of bed
Ambulating
what assessments should the nurse do before beginning coughing and splinting with a patient?
Assess patients risk for postoperative respiratory complications
Assess vital signs and oxygen saturations
Auscultate lungs
Assess pain
Assess the operative site
What interventions can a nurse implement to prevent postoperative DVT?
OOB to chair early and often
While on bed rest change position frequently
Leg exercises
dorsiflex, rotate ankle
TED hose
Intermittent compression boot
Prophylactic SC heparin BID
How do we splint a postoperative incision?
Perform hand hygeine
Perform assessments
obtain a folded blanket or towel
Apply firm and consistent pressure to the operative site
Why is the fowlers position optimal for deep breathing and coughing?
It allows a downward shift of the diaphragm
What is the procedure for postoperative deep breathing?
- Splint incision.
- Place hand over ribcage and exhale completely.
- Inhale through nose and hold for 3-5 seconds.
- Exhale completely through mouth with lips pursed
When should the coughing procedure be performed?
Immediately after deep breathing
What is the procedure for post operative coughing exercises?
Inhale and exhale through the nose three times
Take a deep breath and hold for three seconds
Hack out three short coughs
With mouth open take a quick breath through mouth and then cough deeply and strongly once or twice followed by a deep breath
What interventions can the nurse implement to prevent postoperative repiratory complications?
Monitoring vital signs
Deep breathing
Coughing
Incentive spirometry
Turning in bed; OOB to chair
Ambulating
Maintaining hydration
Avoiding positioning that decreases ventilation
Monitoring responses to narcotic analgesics
Which leg exercises prevent venous stasis?
Bend knee and raise foot several seconds
Extend lower leg in the air and lower slowly X5 each leg
Point toes toward foot of bed
Dorsi-flex
Rotate Ankles
Which interventions should the nurse use to prevent surgical site infections?
Appropriate use of prophylactic antibiotics
Appropriate surgical site cleaning and hair removal before surgery
No shaving; use clippers when necessary
Maintaining post-op glycemic control <200
Maintaining normal body temperature
The nurse is completing a pre-operative checklist for a 27 year old female scheduled for a bowel resection. Which of the following interventions must be done prior to this patient being sent to the OR? Select all that apply.
A. Operative consent signed
B. Allergy and ID bands in place
C. Removal of gown
D. Removal of nail polish
E. Removal of jewelry
F. Evidence of advanced directive
H. Completed H & P
I. EKG
J. Anesthesia consent signed
K. Results of pre-operative diagnostic tests in chart
A. Operative consent signed
B. Allergy and ID bands in place
E. Removal of jewelry
I. EKG
J. Anesthesia consent signed
K. Results of pre-operative diagnostic tests in chart
What is the pathophysiololgy of Rheumatoid Arthritis?
- Autoimmune inflammatory disorder
- Primarily occurs in the synovial membrane and connective tissues of the joint
- Predetermined genes contribute to the condition (antigens, smoking, environmental
factors) - Enzyme release that creates inflammation
- Unknown why the body produces rheumatoid factor (RF) against its own antibodies (IgG
= immunoglobulin)
Patient education RE: NSAIDS
Take with food or milk to reduce GI irritation
Monitor symptoms for liver and kidney damage
if you suspect pt has compartment syndrome, do you elevate, lower or keep the extremity at heart level
put the extremity at heart level and keep it there
signs of fat embolism when pt has fracture
change in mental status, restlessness, high RR
