Oncology Flashcards
7 signs of Cancer remember pneumonic CAUTION (For O think of what Eric has a lot of on his back :D)
C-Change in bowel or bladder habit
A- A lesion that does not heal
U- Unusual bleeding or discharge
T- Thickening or lump in breast or elsewhere
I- Indigestion or difficulty swallowing
O- Obvious changes in warts or mole
N- Nagging cough or persistent hoarseness
Where else can cancer cells spread
Blood and lymph systems
What is remission
Disappearance of abnormal cells in bone marrow or blood
What type of diagnostic tests are taken for cancer
- Biopsy
- Bone marrow exam
- Chest x-ray
- CBC
- CT scan
- Cytology (like pap smear)
- Liver function studies
- MRI
- Evaluation of serum tumor markers (Carcinoembryonic and alpha-fetoprotein
- Guaiac test for occult blood
- Radiographic (Mammogram)
- Radioscope scanning ( Liver, brain, bone, lung)
- Tumor markers
What is important in cancer Pts in pain
ALWAYS assess client pain, how Pt describes the pain, do not under medicate cancer client who is in pain
What can you give the Pt if in pain medications
- Salicylates
- Acetaminophen
- NSAIDS (aspirin, ibuprofen) these three are given in mild - moderate pain
Severe pain
- Opioids (Codeine sulfate, morphine sulfate, methadone and hydromorphone (Dilaudid)
For neuropathic
- Anticonvulsants
- Antidepressants
- Opioids
Subcut inj and cont IV of opioids for rapid pain control
What is radiation ?
- Destroys cancer cells (minimal exposure to normal cells)
- Cells unable to divide because they are damaged
- Effective on tissues directly
What are side/adverse effects of radiation ?
- Alopecia
- Fatigue
What are the most common types of radiation used ? (2 types)
- External
- Brachytherapy
What is external beam radiation ?
- Radiation is external to the client
- Uses high - energy rays to kill cancer cells (may be used after breast cancer surgery to wipe out any cancer cells that remain)
Can radiation be used at the same time as Chemotherapy ?
Yes, for treatment of cancer that has spread to other body parts
Can external beam radiation be hazardous to others ?
No, The client does not emit radiation to others
What are side effects of external beam radiation ?
- Fatigue
- Swelling
- Itching
- Redness to peeling skin
- A sunburned like feeling in the treated area (of radiation)
Other therapy for radiation ?
Hormonal therapy with tamoxifen (anti- estrogen) for positive estrogen effect
Side effects of radiation to Abd
Nausea
Side effects of radiation to pelvis
Diarrhea
Is redness and sloughing of tissue expected in Pt on radiation ?
Yes
How long does radiation treatment therapy take ?
5-7 days
Care for radiation treated area ?
- Wash with plain water and pat dry
- DO NOT use soap over treated area (dries skin, may wash of markings for radiation)
- Avoid scrubbing or scratching
- NO lotions or powders
- AVOID sun exposure at least for a year after the completion of treatment
How long do you provide nursing care in a Pt receiving radiation ? what must you wear to determine amount of radiation, Distance between the Pt and nurse ?
- Provide nursing care for 30 min each shift
- Wear film badge to determine amount of radiation
- Distance between the Pt and nurse should be at least 4-8 ft
Brachytherapy ( Internal radiation )
- Direct contact, continuous contact with tumor for a specific time
Does the Pt emit radiation ( can it spread to others) ?
Yes, They can emit radiation for a specific amount of time
What is unsealed radiation ?
- Administer via oral or IV route by instillation into body cavities
Is unsealed radiation completely confined to one body area ?
No, It enters body fluids and eventually is eliminated
Explain removal of the seal radiation
- Client is no longer radioactive
- Inform to the client that cancer is no longer contagious
- Inform that sexual intercourse may be resumed after 7-10 days (If implant was cervical or vaginal)
- Provide douche if prescribed, if implant was placed in the cervix
- Administer ready to use saline enema as prescribed
- Client needs to notify MD if nausea, vomiting, diarrhea, frequent urination, vaginal or rectal bleeding, hematuria, foul smelling vaginal discharge, Abd pain or distention or a fever occurs
Explain brachytherapy in cervical cancer (internal radiation) Where is the implant placed and for how many days ?
- Radioactive implants such as pellets, rods, seeds, ribbons, wires, needles, capsules, balloons, or tubes are inserted
- Directly placed into the cervix for 1-3 days
What is HDR (high dose rate) brachytherapy ? How long is it applied for ?
A newer technique to avoid hospitalization, but not widely available
It is applied for 30 min- 1 Hr
What is LDR ( low dose rate) brachytherapy ?
This is usually used and requires hospitalization but it is not widely available
In what position should you be laying down when there is a radiation implant ? Can you have a pillow ? Are you allowed to go to the restroom ?
- Lying flat
- No pillow
- No restroom, it may dislodge
What should the nurse do when a radiation rod is displaced ? Think nursing safety
- Call radiation team
- Use gloves
- Use forceps
- Place rod in a lead container
What is bone marrow transplantation and peripheral blood stem cell transplantation most commonly used for ?
- Treatment for leukemia and lymphoma (cancer of lymph system)
What can BMT and PBSCT also be used to treat ?
- Neuroblastoma ( cancer of immature nerve cells from adrenal gland, ganglia, neck)
- Multiple myeloma (malignant plasma cells found in bone marrow)
What is the goal of treatment of BMT and PBSCT ?
- Get rid of all leukemic or malignant cells through high doses of chemotherapy
Where is transplantation administered through ?
- Central line
What does the Pt remain without during post transplantation period ? * Think of what high does of chemotherapy will cause the Pt. to lack of*
- The Pt remains without any natural immunity until donor stem cells begin to spread and grow
What are major concerns post transplantation ? think with a lack of natural immunity you are prone to get sick
- Neutropenia
- Severe thrombocytopenia
How to care for a patient with a radiation implant ?
- Lying supine (prevents dislodgement)
- No bearing down
- No bladder distension
What kind of diet are radiation implant Pt’s put on ?
Low fiber
Can a client undergoing radiation have sex ? Can it spread to the partner ?
Yes, Partner is not exposed with radiation
What is important if child bearing age when undergoing radiation ?
Where a condom
Can you have sex after chemotherapy ?
- Depends on WBC numbers
- Area being treated
Where is chemotherapy excreted and for how many hours ?
- Can be excreted through vaginal secretions
- Excreted for 48-72 hrs
Explain bone marrow aspiration procedure
- Pt under anesthesia
- Needle inserted in rear hipbone ( iliac crest ), this is where a large amount of bone marrow is located
- Extracted via needle and syringe
- Several skin and bone punctures to each hip is required in aspiration of bone marrow
Any surgical incisions or stitches after a bone marrow aspiration ?
None needed, only skin punctures where needle was inserted
At what age can person become a bone marrow donor ? What is important of the donor to be considered?
< 40
Must be the same ethnicity
Genetics should be the same
What is bone marrow harvest ?
Amount of bone marrow harvested depends on the size of the Pt and concentration of blood marrow cells in donor’s blood
How much bone marrow is usually harvested
1 or 2 quarts of marrow and blood are harvested this is only 2% of a person’s bone marrow, body will replace in 4 weeks
What may the Pt feel after anesthesia wears off ? (from BMT)
- Discomfort at harvest site
- Pain is similar to feeling of falling on hard ice can be controlled by Tylenol
Donors who are not also the BMT patient are usually discharged when ?
- After an overnight stay and can fully resume activities
What medication is not allowed to be taking in Pt receiving BMT
Motrin , due to risk of bleeding
What are 4 common types of leukemia * think ALL, CLL.
AML, CML*
- Acute lymphocytic leukemia
- Chronic Lymphocytic leukemia
- Acute Myeloid Leukemia
- Chronic Myeloid Leukemia
Which type of leukemia is common in children ? at what age usually ?
- Acute lymphocytic
- Age is < 15
what are signs and symptoms of leukemia which diagnostic blood tests are they low in ?
- Fever and chills
- Fatigue and weakness (ongoing)
- Frequent infections
- Losing weight without trying
- Swollen lymph nodes
- Enlarged liver or spleen
- Bleeds easily (ecchymosis and petechiae, bleeding under the skin), red tiny spots
- Overt bleeding ( Hematuria, nose bleeds, bleeding gums, increased menstrual flow, occult blood)
- Excessive sweating especially at night
- Bone pain and tenderness
Diagnostic Blood Tests:
- Low WBCs
- Low RBCs
- Low Platelets
- Decreased hemoglobin and hematocrit
What is the major cause in death in leukemia *Think what are you low in if you are prone to getting infections *
- Immunosuppression
List some things that important in protecting a leukemia Pt * think about what are things to prevent them from further getting sick and what to avoid*
- Protective isolations
- Frequent handwashing
- No visitors who are infectious
- Aseptic technique
- Keep all supplies separate from other Pts supplies
- No raw fruits and veggies ( on low bacteria diet)
- No fresh flowers or plants
- Do not leave water standing in room for more than 15 min
- Daily bathing using antimicrobial soap
- Avoid any invasive procedures ( injections, rectal thermometer, enemas, catheters)
- Change would dressings daily
- Monitor for cloudiness in urine
- Monitor skin and oral mucous membranes for signs of infection
What kind of medications would be prescribed in leukemia Pts ?
- Antibiotics
- Antiviral
- Antifungal
What are concerns about bleeding in leukemia Pts ? Think blood tests
- Risk for bleeding, if platelet count is less than 50,000 cells/mm
- If platelet count falls below 20,000 cell/mm Pt may need a platelet transfusion
- For anemia and fatigue packed red blood cells may need to be prescribed
Fatigue and nutrition for leukemia Pt. * What diet and how care for*
- Small frequent meals that are high in (Calories, protein, and carbohydrates), require little chewing to reduce using up energy
- Assist in self- care and mobility activities
- ## Rest periods
Multiple Myeloma
- Increased plasma cells and tumors within the bone
- These cells invade the bone marrow and soft tissues and develop into tumors that will destroy the bone (osteopenia to pathological fractures)
Lab tests for Multiple Myeloma
- Increase protein but decrease in: Hemoglobin Hematocrit White cells Low platelets
Early signs of MM ?
Bone pain and anemia
Clinical manifestations of Pt with multiple myeloma Think how is blood, bones, and organs effected
- Bone pain (mainly back)
- Anemia, decrease in WBC, decrease platelets (thrombocytopenia), hypercalcemia (renal failure), elevated protein
- Thinning of the bones, kidney and renal failure, high levels or uric acid
- painful cervical lymph nodes
What are diagnostic tests that should be taken for Pt. who has Multiple myeloma ?
- Radiographic films
- CBC and serum protein
- Bence Jones test ( 24 urine collection) - for protein, a gram of protein is very serious
- Bone marrow aspiration
What is treatment given to a Pt with multiple myeloma ?
Chemo and radiation or a combination of both
Nursing management in Pt with multiple myeloma Pt care ( what will you give and help to avoid for the Pt)
- Increase fluids to prevent calcium crystallization in the kidneys
- Blood transfusion for anemia
- Analgesics (bone pain), Drug of choice is usually morphine
- Protect from falls and no lifting more the 10lbs
- Thalidomide ( used to treat MM) DO NOT take if pregnant or getting pregnant, will cause congenital disorders
Hodgkin’s Lymphoma
- Malignancy of lymph nodes that is in a single lymph node of chain of nodes and eventually invades non lymphoid tissue
What parts of the body usually involve Hodgkin’s ? What is the hallmark sign ?
- Lymph nodes
- Spleen
- Tonsils
- Bone marrow
The hallmark sign are Reed- Sternberg cells in the nodes
How do you confirm Hodgkin’s ?
Biopsy
Non Hodgkin’s Lymphoma
- Painless and enlarged cervical and supraclavicular lymph nodes
What is the reason for the use of Neupogen (Filgrastim) in Hodgkin’s ?
- Treatment used for severe neutropenia induced chemotherapy
- Reduces risk of infection in Pts with some tumors **DOES NOT prevent infection only reduces
Neupogen is administered via ?
- Sub cut
- IV ( May dilute to 5% dextrose but not saline)
How long does a vial or pre-filled syringe have to be left out to be discarded ?
- If greater than 24 hours
What are common side effects when taken neupogen ?
- Abd pain
- Nausea
- Vomiting
- Bleeding gums
- Nose bleeds
- Hematuria ( blood in urine)
- Rectal bleeding
- Prolonged bleeding from cuts
- Diarrhea
- Redness and pain to injection site
Side effects of chemo ?
- Alopecia
- GI disturbances
- Bone marrow depression
Pancytopenia
- Decreased in platelets
- Decreased in WBCs
- Decreased in RBCs
Side effects of radiation therapy
- Fatigue
- Hair loss on treated body part
- Nausea/Vomiting/Diarrhea If Abd is treated
- Mouth sores/Dry mouth/ if head/neck is treated
How often should TSE’s be performed ?
Monthly, on same day each month
What are common signs of testicular cancer ?
- Painless testicular swelling
- “Dragging” or “Pulling” feeling in the scrotum
- Palpable masses
What are late signs of testicular cancer ?
- Back pain
- Respiratory symptoms
What organs can metastasis occur in in testicular cancer ?
- Liver
- Lung
- Bone
- Adrenal glands via blood
- Lymphatic channels
Nursing interventions for Testicular cancer
- Chemo may be prescribed
- Radiation may be prescribed
- Prepare for orchiectomy if prescribed
- Retroperitoneal lymph node dissection if prescribed (This reduces tumor volume and chemo and radiation will be more effective)
- Reproduction, sexuality, fertility info and options will be discussed
Post-op interventions for testicular cancer what are you monitoring for what kind of medications will be prescribed
- Monitor for bleeding
- Infections
- Antibiotics may be prescribed
- Explain and provide pain management methods to reduce swelling ( icepack may be prescribed, make sure it is wrapped in cloth)
- Sutures removed in 7-10 days
When do you notify the RN for post op in testicular cancer ?
- Fever
- Chills
- Increasing pain
- Tenderness at incision site
- Drainage at incision site
Cervical Cancer
- Cancer in the cervix and other pelvic structures
- Spread of cancer usually confined to pelvis but can spread to lymph
What are risk factors in Cervical cancer ? * such as common infections how you can get it*
- HPV ( Human Papilloma Virus ) , is an infection
- Cigarette smoking
- Early intercourse (before age of 17)
- Multiple partners
Signs of Cervical cancer
- Painless vaginal bleeding ( post menstruation and after sex)
- Foul smelling or serosanguineous vaginal discharge
- Pelvic, lower back, leg, or groin pain
- Anorexia and weight loss
- Leakage of urine and feces from vagina
- Dysuria ( painful urination)
- Hematuria
- Pap Smear ( not normal result)
Endometrial (uterine cancer)
- Slow growing tumor arising from endometrial mucosa of uterus ( mostly common in menopause )
Risk factors of endometrial cancer
- Use of estrogen replacement therapy
- Nulliparity ( Never gave birth
- Increased age
- Menopause
- Family history or heredity
- Obesity
- Hypertension
- Diabetes mellitus
What are risk factors of endometrial cancer ?
- Abnormal bleeding especially in post menopausal women
- Vaginal discharge
- Low back
- Pelvic or abdominal pain (this happens late in disease)
- Enlarged uterus
Breast Cancer, How can you diagnose it ?
Diagnosed by biopsy through a needle aspiration or surgical removal of the tumor
What are risk factors of breast cancer ?
- Age
- Family history
- Early menstruation
- Previous cancer of the breast, uterus, or ovaries
- Late in age for first birth
- Obesity
- High dose radiation exposure of the chest
- Race and ethnicity (Caucasians and African American women)
- Dense breast tissue (less fatty tissue)
Data collection ( how to detect signs of breast cancer)
- Mass felt during a BSE
- Lesion is present during mammogram
- Asymmetry ( affected breast is higher than the other )
- Nipple retraction or elevation
- Bloody or clear discharge
- Skin dimpling
- Skin edema (lymphatic involvement)
- Axillary lymphadenopathy ( appears swollen)
- Lymphedema of affected arm (swelling)
What is a late stage symptom in breast cancer ?
metastasis to bone and lung
Breast Self Examination (BSE) when to do it
- Should be done 3-4 days after period (for younger women)
- Every first day or end of month ( for irregular periods)
- Should be done same day each month ( post menopausal)
How to perform BSE
- Use 3 middle fingers in dime size circles from periphery (outer) going towards the center of the breast in circular motion
- This can be done standing
Mammography
- Age 35 is typically when to start
- At risk age 30
- Age 40 up Annually
- Age 50 to 74 every 2 years
- May have before 50 if history of breast cancer
Ultrasound for breast cancer, what does it detect ?
- Ultrasound can detect weather a mass is solid or fluid filled cyst
Pt Teaching ( When not to have a mammogram and what not to wear when you do have the test)
- During or 1 week before your period (due to tenderness of breasts)
- On day of test Pt is not to wear deodorant, perfume, powder ( They show up as white spots on the x-ray
- No dresses ( You will need to be undressed waist up)
3 Types of surgical breast procedures (explain each)
- Lumpectomy ( removal of lump and surroundings, and breast tissues with biopsy to lymph nodes)
Simple Mastectomy ( Removal of breast including nipple with only biopsy to lymph nodes
- Radical mastectomy ( Removal of the breast to breast muscle layer of the chest including axillary lymph nodes)
What to remember post surgical breast procedure
Arm is raised to prevent lymphedema
Post mastectomy axillary exercises
- Arm swing
- Hand climbing
- Pulley motion
- Hand squeezing
- Bra Fastening
- Toweling
- Hair brushing
These are stress related to mastectomy, may last a year or more
What to avoid post mastectomy
- Using razors to shave under arms
- Avoid venipunctures
- Taking blood pressure on the affected arm
- Taking blood on affected arm
- Insect bites ( Use protective clothing and use repellent)
- Heavy lifting for at least 6 weeks or until MD approves
Gastric Cancer
Malignant growth of mucosal cells in inner lining of stomach ( invades muscle and beyond in advanced disease )
Helicobacter Pylori
May be linked to gastric cancer
What are complications of gastric cancer ? What is the goal of treatment
- GI Hemorrhage
- Obstruction
- Metastasis
- Dumping syndrome
- Goal of treatment is to remove tumor and provide nutritional program
Early signs of gastric cancer Think when you feel bloated the food did not _____ well, and how do you feel where is the pain
- Indigestion
- Abd discomfort
- Full feeling
- Epigastric back or retrosternal pain
Late signs of gastric cancer
- Weakness and fatigue
- Anorexia and weight loss
- Nausea/vomiting
- Pressure in stomach
- Dysphagia and obstructive symptoms
- Iron deficiency anemia
- Ascites
- Epigastric mass felt
Nursing interventions
- Vitals
- HgB and Hematocrit
- Administer pain meds
- Prepare for chemo and radiation
- Prepared for surgical resection of the tumor(s)
What are surgical procedures for gastric cancer ?
Subtotal Gastrectomy
Gastroduodenostomy (Billroth 1)
Partial gastrectomy, remaining is anastomosed to the duodenum
Gastrojenostomy (Billroth 2) Partial gastrectomy remaining is anastomosed to the jejunum
Total Gastrectomy (esophagojejunostomy) - Removal of the stomach with the attachment of the esophagus to the jejunum or the duodenum
What is important to monitor in for Post op in Gastric cancer
- Place in fowler’s position
- Analgesics/antiemetics
- I/O , electrolyte replacement
- Maintain NPO for 1-3 days until peristalsis
- NG tube
- Complications such as
Hemorrhage
Dumping syndrome
Diarrhea
Hypoglycemia
Vit B12 deficiency
Pancreatic Cancer (data collection)
- Nausea/vomiting
- Jaundice ( obstruction in bile duct and will retain in body without it leaving from bile duct skin turns yellow)
- Clay colored stools
- Glucose intolerance
- Abd pain
What is pancreatic cancer associated with ?
- Aging
- Eating foods high in fat
- Diabetes
- Alcohol use
- Smoking
- Exposure to environmental chemicals
Nursing interventions for pancreatic cancer
- Radiation
- Chemo
- Whipple procedure
What is a Whipple procedure
- Removal of:
- Head of the pancreas
- First part of small intestine (duodenum)
- Gallbladder
- Bile duct
remaining organs are reattached to allow for digestion of food
Post op Whipple surgery (what to monitor)
- Blood glucose
- Hyper/Hypoglycemia from surgical manipulation
Lung Cancer
Malignant tumor of the bronchi and peripheral lung tissue
Causes of lung cancer
- Smoking
- Exposure to environmental and occupational pollutants
How can you diagnose lung cancer Think diagnostic tests
- Chest x-ray
- Ct scan
- MRI
- Sputum studies
Data collection
- Cough
- Wheezing/Dyspnea
- Hoarseness
- Hemoptysis ( Blood-tinged or purulent sputum)
- Chest pain
- Anorexia/weight loss
- Weakness
- Diminished or absent breath sounds
- Respiratory changes
Interventions (What to monitor) positioning
- Vitals
- Breathing patterns
- Breath sounds
- Hemoptysis
- Fowler’s position
- O2 and humidification to moisten secretions
- Pulse Ox
- Provide activity as tolerated (active and passive ROM)
What kind of medications are prescribed for lung cancer ?
- Bronchodilators
- Corticosteroids ( decreases inflammation, bronchospasm, edema)
Surgical procedures for Pt. with lung cancer
- Laser Therapy: Relieve endobronchial obstruction
- Ablation Therapy: Destroy tumor
- Thoracentesis and pleurodesis: remove pleural fluid and relieve hypoxia
- Thoracotomy ( opening into the thoracic cavity ) with pneumonectomy ( surgical removal of the lung )
Post-op lung cancer interventions
- Monitor VS
- Monitor for cardiac and respiratory statuses
- Monitor lung sounds
- Chest tube drainage system (will drain air or blood that accumulates in the pleural space
- Monitor for excess bleeding
- Monitor for chest tube insertion site for crepitus (subcutaneous air) and drainage
- Administer 02
- Complete lateral turning must be avoided
- Pulse Ox
- Activity as tolerated
- active ROM on operative shoulder, as prescribed
Prostate Cancer
- Slow growing malignancy of the prostate gland
- Risk in men 50 and over
- Can spread to surrounding tissues or by metastasis through bloodstream and lymph to bony pelvis and spine
What is a concern in bone metastasis in Prostate cancer ?
- Metastasis in bone can spread to the liver, lungs, and kidneys
Data Collection for prostate cancer
- Early stages is asymptomatic
- Hard, pea-sized nodule (bump) palpated on rectal examination
- Late symptoms (weight loss, urinary obstruction, pain radiating for the lumbosacral down the leg)
How is prostate cancer diagnosed ?
Biopsy of the prostate
What medications could be prescribed for a Pt with prostate cancer ?
- Pain medications
- Bisphosphonates
- Corticosteroids
Surgical procedures for Pt. who has prostate cancer
- Orchiectomy ( both testicles are removed )
- Prostatectomy
- TURP
What is TURP ? (explain procedure and what to monitor )
- Involves insertion of a scope into the urethra to excise (remove) prostatic tissue
- Monitor for hemorrhage, bleeding is common right after TURP
What else may be prescribed for prostate cancer? think what kind of catheter
- Continuous bladder irrigation (prevents catheter obstruction
Explain what a continuous bladder irrigation
- 3- way lumen irrigation used to decrease bleeding and to keep bladder free from clots or obstruction
- One lumen is for inflating the balloon (30 mL)
- One lumen is for instillation (inflow)
- One lumen is for outflow
Nursing interventions for continuous bladder irrigation
- Maintain traction on the catheter if applied to prevent bleeding by pulling the catheter and taping to the abdomen or thigh
- Keep leg straight if traction is applied to catheter and it is taped to the thigh
- Cath traction is not released without MD prescription
- Cath is usually released after bright red drainage is gone
- Use only bladder irrigation solution
- Run solution at a rate that will keep the urine PINK
- Run solution rapidly if there is bright red drainage or clots
What will the nurse do if the urinary catheter becomes obstructed ?
- Notify RN
- Turn off irrigation
- Assist to irrigate 30- 50 mL of normal saline
- Notify RN again if the obstruction continues
Ileal conduit explain what it is *think of as colostomy for ureters think of nikki
- Ureteroileostomy or (Bricker’s Procedure) - Ureters connected to ileum ( which the last portion of the small intestine )
- Ureters are brought out and through a stoma (opening) in the lower abd
- Bag placed outside of stoma for urine to fall into
- Urine comes out by peristalsis (contraction of muscles)
What are complications with having an ileal conduit ?
- Obstruction
- Pyelonephritis ( inflammation in kidneys)
- Leakage at stoma site
- Hydronephrosis ( swelling of kidneys do to urine buildup )
- Calculi (stones)
- Skin irritations
- Ulcerations
Kock pouch
- Continent internal illeal reservoir ( meaning patients can empty themselves)
- ileal reservoir is created from a segment of the ileum and the ascending colon
Where are the ureters implanted in a kock pouch procedure ?
- Ureters and implanted into the side of the reservoir, nipple valve is to attach the reservoir to the skin
What will a patient with a kock pouch have post- op ?
- Indwelling urinary catheter
- Cath irrigated GENTLY with normal saline to prevent obstruction from mucous and clots
What is instructed to the Pt. after removal of the catheter
- Pt. how to self catheterize and how to drain reservoir for 4-6 hour intervals
Teaching Pt. about how to care for their urinary stoma ?
- Instruct how to change appliance
- Self care ( use a mirror)
- May be drained by a bedside bag or leg bag ( especially at night)
- Empty bag when its 1/3 full ( prevents pulling of appliance and leakage)
- Check for perspiration around the seal of the bag
- Pouch to remain in place as long as it is not leaking
- Encourage to drink fluids ( help in controlling odor )
- Wash with soap lukewarm water
- Soak appliance in dilute vinegar for 20-30 min
- When taking baths level of water should be below the stoma ( avoid oily soaps)
- For showers direct the flow of water away from the stoma
What to teach Pt about bathing with the Urinary stomas ? ( bath tubs and showering what kind of soap to avoid)
- Wash with soap and lukewarm water
- When taking baths make sure that level of the water is below the stoma
- avoid oily soaps
- When taking a shower flow of water must be directed away from stoma
What is important to monitor in a Pt. after bladder surgery ?
- Urinary output
- Assist RN in irrigating the catheter ( if cath is present )
- ## Irrigate cath slowly to prevent obstruction
Preoperative interventions for bladder surgery ( How to what to educate Pt. Pre and Post Op)
- Educate Pt. about what is to be expected in preop and postop surgery like : Medications NG tube IV lines PO status Pain Coughing Deep breathing Leg exercises Post op activities
Interventions cont. ( pre/post op bladder cancer, nursing demonstrations on stoma and appliance care )
- Demonstrate about appliance and how to apply it
Post op interventions (what to monitor) for urinary stoma
- Vital signs
- Incision site
- Check the stoma every hour for the first 24 hours
- Color of stoma should be red and moist
- Monitor for edema in stoma ( may be present in immediate post op period)
- NOTIFY if stoma color is dark and dusky ( INDICATES NECROSIS)
- Monitor for prolapse or retraction of stoma ( NOTIFY RN )
- Monitor for return of bowel function (peristalsis), this returns in 3-4 days
- Maintain NPO status until bowel sounds return
- Urine flow should be 30-60 mL/ hour (notify if less or none for more than 15 min
What are cancer Pt’s most at risk of ?
- Most at risk for infection particularly ( gram negative organisms in the blood stream )
- Sepsis or septicemia
- DIC in sepsis
What kind technique will you maintain in Pts with sepsis ?
- Strict Aseptic technique
What medications may be prescribed to a Pt with Sepsis and DIC
- Antibiotics
- Anticoagulants
