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319 Cards in this Set
- Front
- Back
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Endocrine dysfunction can be caused by?
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–gland absent or hypoplastic
–gland removed or damaged by surgery –gland functions autonomously –gland unable to respond –increase or decrease in receptor sites in gland –prolonged suppression by exogenous hormones -body produces antibodies against the gland –disease elsewhere influence function |
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S/S of pituitary tumors?
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–headaches
–loss of peripheral vision –unstable temperature –neurological manifestations, emotional changes –hydrocephalus –signs associated with excessive growth hormone, prolactin, ACTH |
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Dx of pituitary tumors?
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–CT/MRI
–Visual fields –Hormone levels •growth, prolactin, cortisol |
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Etiology of diabetes insipidus?
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–cranial surgery
–head trauma –brain tumors –infections of the CNS –drugs •dilantin, lithium, ETOH -renal disease –idiopathic |
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S/S of diabetes insipidus?
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–polyuria, thirst, signs of dehydration
–nocturia –polydipsia –weight loss –increased serum Na: czez confusion –neuro changes •irritable, hyperthermia, mental dullness –cardiac, hypotension, tachycardia |
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Pathophysiology of SIADH?
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–increased ADH
–kidneys reabsorp water –hypervolemia –hyponatremia |
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S/S of SIADH?
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–decreased LOC, irritability, anxiety
–N&V, anorexia –oliguria -weight gain –seizures, coma, death |
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Pathophysiology of Diabetes Insipidus?
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-deficiency of antidiuretic hormone
-kidneys unable to concentrate urine -may be temporary or permanent |
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What is the end result of the pathophysiology of diabetes insipidus when the kidneys are unable to concentrate urine?
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-water not reabsorbed by the kidney
-continuous excretion of large volumes of dilute urine (up to 15 L/day) -only water excreted, not electrolytes -hypovolemia -hypernatremia |
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Dx of diabetes insipidus?
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-water deprivation test
-ADH given SQ & urine checked for conc. |
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Tx for diabetes insipidus?
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-ADH replacement,IM,SQ,nasal spray,po
*desmopressin (DDAVP)(DOC) -dose must be titrated to symptoms: if still having symptoms, would need to incr dose |
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Nursing implications for diabetes insipidus?
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-fluids, I & O
-weight -S/S of dehydration -S/S of hypernatremia -education: report incr thirst,weight gain,nasal symptoms, edema, medic alert |
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What is SIADH?
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syndrome of inappropriate ADH
-ADH secretion occurs w/o regard to serum osmolality |
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Etiology of SIADH?
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-ectropian synthesis of ADH - tumors
*80% assoc w/ oat cell carcinoma of the lung -pulmonary dz -CNS dysfunction,infections -drugs: thiazides (diuretics), morphine, general anesthesia, opioids, TCA -stressors-OR pain, trauma |
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Dx of SIADH?
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-decreased serum sodium
-decreased serum osmolality |
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Tx for acute SIADH?
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-hypertonic saline (3%) IV
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Tx for chronic SIADH?
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-fluid restriction
-high sodium diet -demeclocycline (blocks the action of ADH on the renal tubule) -lasix -- goal is to return Na to normal slowly |
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Nursing concerns w/ SIADH?
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-VS
-weight -I & O, fluid restriction -neuro status -monitor labs |
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What is hypothyroidism?
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-Insufficient thyroid hormone
*severe called myxedema |
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Etiology of hypothyroidism?
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-congenital
-female > male, age > 40 -autoimmune (US)(Hashimoto's thyroiditis) -surgery/txment for hyperthyroidism (US) -iodine deficiency (most common worldwide) -Meds: amiodarone (Cordarone) -idiopathic |
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Pathophysiology of hypothyroidism?
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-generalized slowing of all body functions
*may be confused w/ normal aging -autoimmune form czed by invasion of the gland by antibodies -altered CHO,fat,protein metabolism -symptoms suggest pathophysiology |
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S/S of hypothyroidism?
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-mental retardation in infants
-intolerant to cold, low temp, dry skin, thin hair -weight gain, decr appetite, constipation -incr interstitial fluid (myxedema) -anemia -bradycardia,enlarged heart,hypotension -apathy,slow speech,lethargy,parasthesia -reproductive abnormalities -goiter, may or may not be present |
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Dx tests for hypothyroidism?
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-TSH elevated (thyroid stimulating hormone)
-T3, T4 decreased -presence of thyroid antibodies -CBC: anemia -high cholesterol, high TG |
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Tx for hypothyroidism?
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-gradual restoration of the euthyroid state
-levothyroxine (synthroid) -thyroiditis sometimes tx w/ NSAIDS and/or steroids -tx for life (in majority of pts) |
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About levothyroxine (synthroid) as a tx for hypothyroidism?
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-best absorbed if taken on an empty stomach, iron definitely interferes w/ absorption (so cannot take multivitamin @ same time)
-dose incr slowly esp in the elderly -half life is 8 days |
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Complications of hypothyroidism?
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-myxedema coma
*severe symtoms of hypothyroidism precipitated by stressor such as inf, surgery *hypothermia,hypotension,brady- cardia,coma *tx w/ IV levothyroxine |
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Nursing concerns w/ hypothyroidism?
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-activity intolerance
-nutrition,weight loss -drug metabolism impaired -temperature instability -safety -elimination -respiratory depression,goiter -cardiac output -education.slow improvement of symptoms,signs of hyperthyroidism |
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Prevention/early recognition of hypothyroidism?
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-newborn screening: bc babies can be born w/o thyroid
-adequate iodine in diet -screening after age 50 |
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What is hyperthyroidism?
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chronic excess of thyroid hormone
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Etiology of hyperthyroidism?
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-females > males
-autoimmune (Grave's dz) 60-90% -inherited tendency -can be czed by euthyroid persons taking thyroid hormone for weight loss |
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Pathophysiology of hyperthyroidism?
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-normal regulatory control of the thyroid gland is lost (stimulated by thyroid antibodies)
-incr manifestations of thyroid hormone excess -increased metabolic rate -increased sympathetic activity -symptoms suggest pathophysiology -elderly may have atypical symptoms (A-fib) |
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S/S of hyperthyroidism?
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-goiter
-incr body temp, intolerant to heat -incr appetite,weight loss,weakness, diarrhea -decr TG, cholesterol -tachycardia,incr BP,CHF,A-fib,DOE,CP -nervous,restless,insomnia,tremors -osteoporosis -exopthalmos (vol expansion of muscle tissue) -altered reproductive function |
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New onset ____ should be tested for hyperthyroidism immediately?
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A-fib
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Dx of hyperthyroidism?
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-decreased TSH
-elevated T3, T4 -thyroid antibodies -ultrasound -thyroid scan |
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What is hypoparathyroidism?
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-decreased parathyroid hormone (low Ca level)
-usually caused by surgery |
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Pathophysiology of hypoparathyroidism?
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-inability to maintain normal serum Ca levels
*tetany,laryngospasms,seizures,EKG changes |
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Dx of hypoparathyroidism?
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-serum Ca
-serum PTH |
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Tx for hypoparathyroidism?
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-IV Ca gluconate
-PO therapy |
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What is hyperparathyroidism & what is it usually caused by?
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-increased parathyroid hormone
*high Ca level -usually caused by a tumor |
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Pathophysiology of hyperparathyroidism?
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-hypercalcemia
-osteoporosis -kidney stones -PUD |
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S/S of hyperparathyroidism?
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usually found on labs
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Dx of hyperparathyroidism?
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-serum Ca
-serum PTH -DEXA -CT |
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Tx for hyperparathyroidism?
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-OR
-calcitonin -phosphates -loop diuretics -hydration |
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What adrenal gland diseases stem from the adrenal cortex?
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-Addison's disease
-Cushing's disease |
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What adrenal gland disease stems from the adrenal medulla?
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pheochromocytosis
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What is Addison's disease?
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hyposecretion of adrenocortical hormones primarily cortisol & aldosterone
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Etiology of Addison's disease?
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-80% autoimmune
-female > males -30-50 years -AIDS -drug withdrawal -surgical removal |
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Dx of Addison's disease?
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-low cortisol
-high ACTH -ACTH simulation test -presence of auto-antibodies against 21-hydroxylase |
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Pathophysiology of Addison's disease?
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-life threatening
-cortisol deficiency - incr ACTH -incr melanocytes: Addisonian tan, hypoglycemia -aldosterone deficiency (mineralcorticosteroids) |
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About aldosterone deficiency as a pathophysiology of Addison's disease?
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-kidney unable to retain Na & excrete K
-water goes w/ Na -dehydration,hyponatremia,hyperkalemia |
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S/S of Addison's disease?
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-hypotension,tachycardia,decr CO
-dehydration -cardiac arrhythmias -N,V, diarrhea, anorexia -weak,fatigue,emotional instability -difficulty handling stress -pigmentation changes -hypoglycemia |
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Tx for Addison's disease?
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-lifelong replacement
*hydrocortisone -dose must be adjusted w/ stress *increased sodium intake *florinef for pts not controlled w/ above |
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Complications of Addison's disease?
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-Addisonian crisis
*triggered by stress *life threatening hypotension, hyponatremia,hyperkalemia,dehydration *treated w/ IV steroid replacement, normal saline glucose, electrolytes |
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Nursing implications of Addison's disease?
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-electrolyte imbalance
-dehydration -VS, include orthostatic BP -body image -Education: diet, meds, stress, medic alert, report infection, stress |
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Prevention (iatrogenic) of Addison's disease?
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-tapering of oral or parenteral steroids if given for > 2 weeks
-medic alert bracelet for those on steroids |
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What is Cushing's disease?
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long term excessive levels of glucocorticoids (cortisol)
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Etiology of Cushing's disease?
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-tumor (ACTH secreting or adrenal)
-females > males (8X the incidence) -20-40 yrs -iatrogenic most common cause |
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Dx of Cushing's disease?
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-increased cortisol
-decreased ACTH -dexamethasone suppression test -24 hr urine for 17 ketosteroids -Na, K -GTT -CT/MRI |
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Tx for Cushing's disease?
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-depends on cause
-surgery if tumor -drug therapy: tx symptoms, don't cure -iatrogenic & steroids are necessary tx symptoms |
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What is pheochromocytoma?
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tumor of the adrenal medulla which secretes epinephrine/norepinephrine (can be ectopic tumor which produces these substances)
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S/S of pheochromocytoma?
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severe hypertension not responsive to meds
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Tx for pheocromocytoma?
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control BP & remove tumor
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Tx for pituitary tumors?
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-radiation
-drug therapy: bromocriptine *monitor for hypertension |
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Surgical tx for pituitary tumors?
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-surgery: transphenoidal hypophysectomy
*thru the upper gum *dura is punctured *tissue 4m elsewhere in the body used to patch dura to prevent CSF leakage. *nasal packing in place for 2-5 days *hormone replacement will be necessary until edema subsides & maybe for life -cortisol of greatest concern immediately postop, ADH, thyroid also necessary |
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Growth hormone deficiency?
(midgets/dwarfs) |
-prior to closure of growth plate can be txed w/ growth hormone, after only surgically
-midgets: normal proportion just short, tx w/ GH -dwarfs: adult trunk size, short extremities, normal GH, inherited |
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Excess growth hormone?
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-gigantism: prior to puberty
-acromegaly: after puberty, usually adults age 30-50 & czed by a tumor |
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About acromegaly?
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-increased ring, hat, shoe size
-change in facial appearance -HTN, DM, CV disease -dx w/ hormone levels, CT/MRI -treated w/ radiation, surgically, & w/ meds (octreotide) |
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What is prolactin?
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hyperprolactinemia czed by tumors & drugs (BCP, aldomet, phenothiazines, opiates)
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S/S of prolactin?
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-galactorrhea
-decreased libido -erectile dysfunction -menstrual irregularity -decreased visual fields |
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Tx for prolactin?
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-bromocriptine, inhibits prolactin secretion
-surgery |
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What is a thyroid storm?
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-complication of hyperthyroidism
-severe manifestations of hyperthyroidism -hyperthermia -tachycardia -arrhythmias -hypertension |
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What is a thyroid storm precipitated by?
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stressor such as OR, trauma, infection
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How is a thyroid storm treated?
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IV PTU, corticosteroids, B blockers, iodide preparations IV or PO
-tx underlying cz |
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Nursing implications (medical mgmt) of hyperthyroidism?
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-rest
-cardiac status, temperature -diet -eye care -meds, watch for hypothyroidism |
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Pathophysiology of Cushing's disease in the cardiovascular system?
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-Na & water retention: hypertension, edema
-K loss: dysrhythmias -increase in clotting factors: DVT |
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Pathophysiology of Cushing's disease in the immune system?
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-suppressed immune response
-increased risk of infection -decreased inflammation which masks signs of infection |
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Pathophysiology of Cushing's disease in the musculoskeletal system?
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-protein wasting
-bone loss |
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Pathophysiology of Cushing's disease in the skin?
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-increased capillary fragility
-increased fatty tissue -increased androgens |
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Pathophysiology of Cushing's disease on endocrine system?
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-diabetogenic effect
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Pathophysiology of Cushing's disease on renal system?
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kidney stones
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Pathophysiology of Cushing's disease on hematology?
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increased RBC, WBC, platelets
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Pathophysiology of Cushing's disease on psychological status?
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-depression, mood swings, etc.
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S/S of Cushing's disease?
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-hypertension
-edema -abnormal fat distribution -weight gain -dysrhythmias -DVT -infection, slow to heal -fractures -bruising, striae, hirsutism, acne -diabetes -flank pain -mental status changes |
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What endocrine glands are not under hypothalmic control?
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-parathyroid
-pancreas |
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What does parathyroid do?
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-PTH (parathormone)
-maintains serum Ca levels -controlled by serum Ca levels |
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What does pancreas do?
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-insulin: maintains normal blood glucose levels
-glucagon -controlled by blood glucose levels |
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What does the hypothalmus do?
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-secretes stimulating & inhibiting hormones
*GNRH -controls the pituitary *called the master gland due to its influence over so much of the body's functioning -operates on the principle of negative feedback |
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About pituitary tumors?
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-18% of all brain tumors arise in the pituitary
-most are benign, may be asymptomatic -may affect hormones, or give rise to sx due to location -80-90% are pituitary adenomas which produce at least 1 pituitary hormone *growth,prolactin,ACTH most common |
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Urinary diagnostic tests for bone?
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uric acid may be elevated in bone demineralization
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What is a bone densitometry?
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measures bone density to help in the dx of osteoporosis, predict risk of fractures & monitor txments
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Why is a systemic radiological exam done?
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done to check for other diseases
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Radiologic exam with xrays of bones & joints?
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no prep needed, will identify fractures & the presence of disease
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What is an arthrogaphy?
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allows for visualization of joints not seen with x-rays
-check for allergies |
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What is a CT scan?
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xrays that shows slices of tissue
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What is a MRI?
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uses magnetic forces to obtain cleared images that CT scans. Pts may not have any metal clips in place.
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What is an electromyography?
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study of & interpretation of electromyogram
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What is an electromyogram?
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EMG: measures the electrical activity of the muscles
-is used to dx muscle disease -no prep is needed -needles are inserted in the muscle & the muscle is stimulated -differentiaties bw nerve or muscle probs -give pt small amts of electricity into muscle. -explain to pt that procedure is painful |
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What is a manual muscle test (MMT)?
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-test which estimates the strength of muscle groups, rate the muscle strength from 1-5
-just a subjective eval of how pt uses muscle groups. -basically just seeing how strong this person's muscle group is |
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What can a biopsy be done on?
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can be done on skin, muscle, bones
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What is a joint aspiration?
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-test used for arthritis
-procedure involves removing synovial fluid 4m the joint under local anesthetics under sterile conditions. -after the procedure the pt should be encouraged to rest the joint for 8-24 hrs. |
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What is an arthroscopy?
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allows for visualization of the joint
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Benign bone tumors include?
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-tumors that come 4m the cartilage (chondrogenic)
-tumors that come from the bone (osteogenic) -tumors that come from fibrous tissue (fibrogenic) -often asymptomatic & are found by accident |
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Malignant bone tumors will be either?
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-primary: cancer starts in the bone OR
-secondary: cancer started some place else & spread to the bone |
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In whom do primary & secondary tumors usually develop?
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-primary: usually develop in young ppl
-secondary: usually develop in older ppl |
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About osteosarcoma as a malignant bone tumor?
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-most common
-most often involved in the distal femur -clinical manifestation: pain & swelling of involved area -metastasis to lung common w/ death w/in 2 years: so prognosis is poor |
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Ewings's sarcoma as a malignant bone tumor?
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-very malignant, swelling, pain, younger ppl
-usually involves the pelvis & lower extremities -x-ray has characteristic "onion skin" appearance -metastasis to lung common w/ death: has poorest prognosis out of all these |
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Clinical manifestations of Ewing's sarcoma?
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-pain
-swelling -low grade fever -leukocytosis -anemia |
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Chondrosarcoma as a malignant bone tumor?
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-tumor that comes 4m cartilage tissue
-usually found in the pelvis & proximal end of the femur -usually have a better prognosis |
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Clinical manifestations of chondrosarcoma?
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-dull pain
-swelling for a long time |
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Fibrosarcoma?
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Not very common
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Non surgical treatment for metastatic bone disease?
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-chemotherapy w/ or w/o radiation
*may be done b4 and/or after surgery |
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What is rheumatoid arthritis?
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- a chronic, systemic (usually seen in joints of hands/feet first), progressive inflammatory dz that czs symmetrical joint involvement w/ remissions & exacerbations
-unsure of the exact cz of RA |
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Complications of rheumatoid arthritis?
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just know that if affects all the systems
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Early clinical manifestations of rheumatoid arthritis?
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-fever
-weight loss -fatigue -generalized aching -early morning stiffness lasting a few minutes to an hr or more |
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About early morning stiffness w/ rheumatoid arthritis?
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-probably earliest sign pt will have that they have RA
-make sure that you tell pt that they need to work thru that stiffness or it will just get worse. May help if they get up & take a warm shower right away. |
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Later clinical manifestations of RA?
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-frank articular inflammation
-joint swelling: dx if 3 or more joints are involved for at least 6 mo, joint swelling should be symmetrical. Hands & feet usually first involved. -pain -tenderness -warmth -reddness -rheumatoid nodules: DIAGNOSTIC |
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Dx test for RA?
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-history
-physical exam -Labs: incr ESR & mild leukocytosis -anemia -positive rheumatoid factor -xrays -biopsy -aspiration |
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About positive rheumatoid factor as a dx test for RA?
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anything greater than a 1-40 ratio is considered positive. Used to help make the dx but is not specific for making the dx.
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About x-rays as a dx test for RA?
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will show narrowing of spaces bw joints
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What will aspiration of joint fluid show when doing as a RA dx test?
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fluid will be very thick
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What are degenerative joint disorders?
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-may also be called osteoarthritis (more appropriate, more a condition of the elderly)
-hypertrophic changes in the joints |
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Clinical manifestations of degenerative joint disorders?
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-pain
-swelling & joint enlargement -decreased ROM -muscular atrophy -crepitus: almost like a grating sound of the bones rubbing together -joint stiffness which is worse in the morning, or after use or disuse |
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Causes of DJD?
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-primary: age
-secondary: due to damage to the cartilage. May include: trauma, long term mechanical stressors (ex: dancers, gymnasts) |
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Tx for Degenerative joint disease?
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-Meds
-Rest -Weight loss: to decr the stress on their joints -ambulatory devices to decrease weight bearing (canes, walkers) -ROM -surgical mgmt: usually done when joint probs decrease ADL's |
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Meds to tx degenerative joint disease?
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-salicylates, NSAIDS
-intraarticular injections of steroids -analgesics |
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Importance of a continuous passive motion machine (CPM) after a total knee replacement?
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-decreases post-op swelling
-prevents adhesions (scar tissue that binds things together) -decreases pain -helps w/ early ambulation -prevents contractures -helps w/ healing -make sure you check the sling beneath them |
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What should be done about a fat embolism?
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-occurs 1-7 days after injury
-notify the MD -tx w/ oxygen, PEEP (positive & expiratory pressure), fluids, steroids |
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Clinical manifestations of a fat embolism?
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-hypoxemia
-tachypnea -tachycardia -petechiae (often develops on trunk) -fever -lipuria -chest pain -change in LOC |
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What are degenerative disorders of the spine?
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-disease that occurs as part of the aging process in which the disk space narrows & loses it's resiliency
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Clinical manifestations of degenerative disorders of the spine?
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-back pain: usually severe & unrelenting
-decreased ROM -numbness -tingling -paralysis |
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Tx for degenerative disorders of the spine?
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-meds: NSAIDS, avoid narcotics ( is potential for addiction since long term therapy), skeletal muscle relaxants
-other: heat, traction |
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Dx of systemic lupus?
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-labs: immunological testing similar to RA, newer tests being developed
-tests to check on organ function |
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Tx of systemic lupus?
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-goal: tx the dz aggresively: prevent renal involvement if possible, try to prevent Raynaud's phenomenon
-topical cortisone creams for rash -hydroxychloroquine (Plaquenil): same as RA (remember it requires eye exam) -steroids -immunosuppressive agents |
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Patient education for systemic lupus?
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-skin protection
-monitor for temp: sign of exacerbation -psychological support during exacerbations -counseling regarding pregnancy: very often pts dx w/ this are of pregnancy bearing age. Make sure that pts understand this will likely cz an exacerbation. |
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What is scleroderma?
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-hardening of the skin
-AKA progressive systemic sclerosis (PSS) -a chronic connective tissue dz char by infl, fibrosis, & sclerosis of the skin & vital organs. -often mistaken for SLE (systemic lupus) but has higher mortality rate |
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Clinical manifestations of gout?
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-painful joint inflammation
-Tophi: deposits of sodium urate crystals: hard, irregularly shaped areas often found on the fingers or ears -renal calculi |
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Interventions of gout?
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-depends on if the gout is acute or chronic
-usually use a combo of colchicine (Colsalide, Novocolchicine) & NSAID -allopurinol (Zyloprim) drug of choice for maintenance of disorder -diet: controversial: controversy about low purine diet -should not take aspirin or diuretics bc they can precipitate an attack -should drink lots of fluids: to prevent kidneys stones -stress & activity may exacerbate the problem |
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What is systemic necrotizing vasculitis & what is it tx with?
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-prob where the walls of the arteries become inflamed & cz ischemia to the tissues involved
-treated w/ steroids |
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What is ankylosing spondylitis?
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-a chronic inflammatory disorder that starts in the sacroiliac joint & moves upward until there is a fusion of the entire spine.
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Early clinical manifestations of ankylosing spondylitis?
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-low back pain
-swelling of hips, knees & shoulders -mild fever -loss of appetite -fatigue |
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Later clinical manifestations of ankylosing spondylitis?
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-pain stops
-motion of back is restricted |
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Dx tests for ankylosing spondylitis?
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-presence of HLA-B27 in serum
-xray shows bamboo spine: spinal column becomes fused. Lose elasticity & mvmt in spine. -increased ESR |
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Tx for ankylosing spondylitis?
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-maintain mobility
-heat -cervical traction -surgery |
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Pt education for ankylosing spondylitis?
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-promote mobility: exercise
-firm mattress or bed board, no pillows: encourage pt to not be in position where this would happen. Sleep w/o pillow in bed so that they will be totally flat. -occupational therapy -good posture/stand erect |
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What is Marfan syndrome?
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-an inherited disorder which has skeletal, ocular, cardiopulmonary & CNS symptoms
-individual is excessively tall w/ elongated hands & feet, have scoliosis, a funneled shaped chest, decreased vision, glaucoma -death usually occurs due to cardiac involvement |
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What is a myelography-myelogram-radiologic exam (x-ray) of the spinal canal?
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-radiopaque dye is injected in the arachnoid space: so check allergies
-used for herniated discs, tumors -watch for side effects: seizures, N/V -pt education is important |
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Why is a bone scan done & about it?
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-done to check for tumors, osteomyelitis
-an isotope is injected which shows up as "hot spots" where there is increased bone turnover (fractures, bone healing, inflammation). Scans whole body so is good to show metastasis. |
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What do increased muscle enzymes (SGOT, CPK) mean?
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-increased w/ muscle disease
-may also have elevated CKMM bands |
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What is the STS serologic test?
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-false positive results w/ CT diseases
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What is the FTA-ABS test?
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for syphilis also
-will show false positive results w/ CT disease |
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What is the rheumatoid factor or latex fixation?
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positive if found to be greater than 1:40 ratio
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The ANA serologic test is positive when?
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positive in systemic lupus & scleroderma
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When is the serum complement test decreased?
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decreased in systemic lupus & scleroderma
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When is hematocrit decreased?
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in anemia & systemic lupus
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Calcium is increased when?
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increase seen w/ bone demineralization
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Phosphorus as a bone serologic test?
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an increased Ca results in a decreased phosphorus
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About metastatic bone disease?
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more common than primary bone cancers
-cancer cells spread 4m somewhere else to the bone (thru the bldstream or lymphatic system) -breast,kidney,thyroid & lung are cancers that often spread to the bones (called bone seeking cancers) |
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Dx tests for bone tumors?
(primary & secondary) |
-often happening to young adults: remember to consider the emotional state
-Labs: *elevated alkaline phosphatase (ALP) tells about osteoblastic activity *elevated leukocytosis *elevated lactate dehydrogenase (LDH) *elev. Ca level (bc Ca comes out of bone into serum) *elev ESR & C-reactive protein, will be elev if infl present. -x-rays: lesion visible on CT scan/MRI |
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Surgical tx for metastatic bone dz?
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-tx of choice for primary tumors w/ or w/o radiation & chemo
-pre-op care: routine (remember psychosocial prep) -prodecure: depends on the extent of tumor: may be extensive |
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Post-op care for metastatic bone dz?
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-pressure dressing w/ drain
-ROM/PT/CPM -cast care if applicable -assistance w/ ADL's -neurovascular assessment: if all of sudden no pulse, need to call doc -psychosocial support |
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End result in the pathophysiology of RA?
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end result is an infl of joints that leads to decreased joint mvmt
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Meds for RA?
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-salicylates
-NSAIDS -potent antiinflammatory drugs (steroids) -slow acting antiinflammatory drugs -immunosuppressive therapy -biological response modifiers - |
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Why are salicylates not usually used as a med for RA first?
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not usually used first tx bc of the GI probs that can come with that.
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About NSAIDS as a med for RA?
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nonsteroidal anti-inflammatory drugs
-usually start off w/ these. Start w/ lowest possible does bc of all SE |
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When are potent anti-inflammatory drugs (steroids) used as a med for RA?
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only use these if have to
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About slow acting anti-inflammatory drugs as a med for RA?
(Plaquenil) |
AKA DMARDS (disease modifying antirheumatic drugs)
-antimalarials- Plaquenil: 1st prob is takes so long to be effective. *takes bw 6-12 months to work *SE are GI upset & retinal edema (need eye exams Q 6 mo) bc of possible retinal damage |
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3 examples of immunosuppressive therapy as meds for RA?
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-methotrexate (Rheumatrex)
-azathoprine (Imuran) -cyclophosphamide (Cytoxan) |
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3 ex of biological response modifiers as a med for RA?
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-many insurance co won't pay for bc so expensive
*etanercept (Enbrel) *infliximab (Remicade) *adalimumab (Humira) *anakinra (Kineret) |
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Pt teaching for rheumatoid arthritis?
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-don't become immobile
-balance rest & activity -protect joints (braces/splints) & conserve energy -learn about meds -participate in exercise program: swimming is best -apply hot & cold packs: paraffin wax -learn about assistive devices -safety measures: no throw rugs, bars in bathtubs, get rid of clutter, etc. -application of braces & splints -good nutrition: some research says fish oil helps -follow up: best cared for by person who specializes in RA -support groups |
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Post op care for a total knee replacement?
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-positioning: elevate leg on pillows for 48 hrs, turn
-wound care: drains, watch for blding, bulky dressing at first -activity: CPM (continous passive motion machine), ROM exercises,light weight bearing in 1st post-op day,sit in chair w/ legs elevated, knee brace -pain control: PCA, epidural, ice |
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Discharge care for a post-op total knee replacement?
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-partial weight bearing & assisstive devices (some type of walker)
-exercise (possible rehab, taught not to bend knee @ 90 degree angle) -prophylaxis -antibiotics |
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Possible complications for a total knee replacement post-op?
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-infection (looks red,swelling,drainage)
-DVT: may be on SCD/heparin or lovenox -fat embolism: antime reaming down into bone, are at risk for this |
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Post-op care for a total hip replacement?
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-positioning: flexion limited, no adduction (need to keep legs apart, not cross midline)
-wound care: drains -activity: no severe flexion w/ elev HOB (don't want this person in high fowler's), ROM, turn w/ abduction pillow, partial weight bearing w/ walkers & crutches, elevated chair/toilet seat -meds: anticoagulant therapy, pain control |
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Discharge teaching for a post-op total hip replacement?
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-use of ambulatory devices
-limited flexion & adduction -raise toilet seat -prophylaxis antibiotics |
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Possible complications post-op for a total hip replacement?
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-dislocation:severe, sudden onset of pain, may say felt something pop & dislocated extremity shorter
-DVT -fat embolism |
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What is systemic lupus erythematosus?
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-chronic,progressive,inflammatory disorder that czs multiple organ failure (usually kidney involvement is what leads to pts death)
-char by remissions & exacerbations (could be bc of stress, inf, not taking meds well) -survival rate is better today: bc of better tx modalities |
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What type of disorder is systemic lupus erythematosus?
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-an autoimmune disorder which czs infl & damage to body organs (inside of bld vessels becomes infl so less bld gets to organs czing ischemia, necrosis
-kidneys most commonly involved & the major cz of death. |
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Family history assessment for reproductive disorders?
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•cancer of the reproductive tract
–esp breast, ovarian, prostate, testicular •osteoporosis: runs in families •premature menopause |
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Medical history assessment for reproductive disorders?
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•childhood illnesses esp mumps in men
•endocrine disorders esp diabetes, thyroid •STD •surgeries •medications •reproductive history and care |
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When doing a medical history assessment for reproductive disorders what should you look for r/t meds?
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–HRT
–diuretics, B blockers, anti-depressants can cause sexual dysfunction (loss of libido) |
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When doing a med history assessment for reprod. disorders what should you look for r/t reproductive history & care?
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–LMP( last menstrual period)
-abnormal paps, last exam, mammograms, prostate exams, PSA (prostate specific antigen), |
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What should you ask when doing a psychosocial/sexual history?
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•ETOH use (can affect sexual functioning, particularly in men), tobacco: has an effect on estrogen production
•sexual preferences: do you have sex w/ men, women or both? •family planning method •sexual practices, safe sex |
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What should you ask r/t occupation when doing an assessment for reprod. disorders?
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–Occupational/military history: certain chemicals can have an effect
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What should you ask children/adolescents when doing an assessment for reprod. disorders?
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•onset of secondary sexual characteristics: when did they start?
•menarche in females: first period? |
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What should you ask about health care practices when doing a reprod disorder assessment?
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•BSE (breast self-exam), TSE (testicular self exam) testicular cancer is primarily young men
•Diet: primarily a prob in young women w/ eating disorders, very high risk bc don’t have enough body fat to have normal menses •Exercise: weight bearing exercises necessary for normal bone health. Excessive exercise in women is bad. •complimentary practices |
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What should you ask about complimentary health care practices in your reprod disorder assessment?
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–vitamins: better to get nutrients from food.
–Calcium: supplementation is necessary, may need Vitamin D supplementation –ASA –folic acid –herbs, soy: used to alleviate some of symptoms of menopause. Can overdose on these. Too much soy can cz endometrium to rebuild itself which is a precursor for cancer. |
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When taking a history of your pts reprod disorder prob, what do most pts present w/?
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–Current problem- most present with pain, bleeding, discharge, mass, urinary changes (hard time starting a stream/weak stream) or change in reproductive functioning
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When taking a history of your pts current reprod disorder prob, what questions should you ask?
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•What is pts primary concern?
•length of time present •size of mass and progression •amount and quality of bleeding, any associated symptoms •characteristics of discharge: how much/odor, etc? |
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About a reproductive disorder exam?
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•usually done by MD/ARNP
–Advise women not to douche or have sex 24 hours prior to exam –Inspection, Tanner Staging for children/adolescents –Palpation –Hernia check for men –Rectal with hemoccult if 40 or over –Prostate for men if over age 40 –Pap for women |
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What dx studies may be done for reproductive disorders?
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-pap smear
-hormone levels -STD testing -Imaging studies, mammography, DEXA (to ID probs w/ osteoporosis, etc) -laparoscopy, hysteroscopy -cancer markers -biopsies |
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About a pap smear as a reproductive dx test?
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•Papanicolaou smear: screening test not diagnostic, only about 80% accurate
–cervical cancer –colposcopy: look at cervix w/ microscope if pap smear shows abnormal cells |
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Hormone levels as a dx test for reproductive disorders?
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–estrogen, progesterone, testosterone, FSH (follicle stimulating hormone)
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About laparoscopy/hysteroscopy as a reproductive disorder dx test?
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•Laparoscopy( look into abdominal area if have ab/pelvic pain), hysteroscopy (look at uterus from inside)
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About cancer markers as a dx test for reproductive test?
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•CA125 (cancer antigen 125, cancer marker for some ovarian cancers)
-PSA (can be elevated w/ just enlargement of prostate though) -HCG (human chorionic gonadotropin, shows if woman pregnant but can also be made by tumors) -AFP (alpha fetal protein) can also show tumor or pregnancy. If markers go down, responding to tx, if goes up, relapsing. |
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Health teaching for reprod. disorders in puberty?
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–before age 9-10 precocious and often pathological
–age 10-12 no change in external genitalia need to be referred –isolated gynecomastia in adolescent males is normal –first change will be testicular enlargement then phallic growth and pubic hair, then growth spurt •TSE |
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Testicular cancer is the leading cz of death in?
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•Leading cause of cancer deaths age 15-35 and on the increase: so really need to educate/talk to them about it.
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Etiology of testicular cancer?
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–trauma
-orchitis -family history -cryptochidism (undescended testes) -DES exposure (hormone used to be given to women to prevent miscarriage) -exposure to carcinogens : some have been assoc/ w/ testicular cancer |
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S/S of testicular cancer?
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–often subtle: pain not usually a common symptom seen
–mass or swelling: don’t biopsy, considered malignant 100% of the time. Will check tumor markers and remove testicle. –heavy or dragging sensation |
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Dx of testicular cancer?
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–Workup done for mets
–Biopsy will not be done –AFP, HCG can be produced by the tumor –Any testicular mass is considered malignant |
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Tx for testicular cancer?
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–Orchiectomy: removal of testicles, try to preserve 1 functioning testicle if can
–radiation/chemotherapy determined by cell type |
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Nursing considerations for testicular cancer?
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–body image/ effect on reproduction
•sperm banking may be done –radical node dissection •high risk for bleeding, DVT •may have ejaculatory dysfunction –education regarding follow up |
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Prevention of testicular cancer?
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–TSE (testicular self exam) If found early, testicular cancer can usually be cured.
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Gen. info about prostate cancer?
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•Most common cancer in American men
•Second cancer killer of men (lung cancer is the 1st cancer killer) •Usually men over 40 |
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Etiology/risk factors for prostate cancer?
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•may be part of normal aging process
•diet high in animal fat •smoking •environment/occupational exposure •hormones •STD •family history •AA race |
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Prevention of prostate cancer?
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–DRE (digital rectal exam) yearly after age 40
–PSA •yearly after age 50 •family history/AA start at age 40 –selenium supplementation: may deter the development of prostate cancer. |
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S/S of prostate cancer?
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–often none early
–similar to BPH (benign prostatic hypertrophy). Men often think it’s normal part of aging –often presents with back pain (or hip pain) due to mets |
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Dx of prostate cancer?
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–Exam and PSA
–Transrectal ultrasound –Biopsy •antibiotics, coag studies, enema as prep –Mets workup will be done prior to intervention |
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Tx for prostate cancer?
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–more men die with the disease than of the disease: in a lot of men it’s not an aggressive cancer.
–watchful waiting -radiation -chemo |
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What are they looking for when taking a watchful waiting approach in the tx of prostate cancer?
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•low PSA (under 10), age >80 (so will prob die of something else), poor surgical risk, live <10yrs. If PSA not terribly high, will most likely just watch & wait
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What type of radiation will be done to tx prostate cancer?
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•external/internal-SE cystitis, proctatitis
–seed implants (capsules of radiation directly into prostate) often have voiding problems post procedure |
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About chemo to tx prostate cancer?
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•limited effect
•last resort: bc usually has limited effect |
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Medical tx for prostate cancer?
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•anti-androgens (block normal hormones prod. By men), estrogens, GNRH analog (lupron)
•can be used instead of more aggressive therapy, with other therapies, and after other therapies fail –gynecomastia, liver impairment, impotence, DVT (bc estrogen stimulates clotting factors)<--(SE of using some of these substances) |
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Surgical tx for prostate cancer?
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•perineal, retropubic, or suprapubic
•preop may include enemas, antibiotics |
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Major concerns postop for prostate cancer?
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–major concerns are hemorrhage, infection, urine leakage
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Tx postop for prostate cancer?
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–low residue diet: so don’t have to strain during BM
–catheter 2-3 weeks –will have some urine leakage immediately postop and should decrease rapidly: will usually come out on dressing so reassure pt that it’s normal –temporary urinary incontinence common »prosthesis can be considered in 6 mo if necessary –fecal incontinence usually temporary –efforts made to spare nerves to maintain sexual functioning (prosthesis can be considered) |
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Why may tested be removed to tx prostate cancer?
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•removal of the testes to eliminate androgen stimulation of the tumor: not done as often anymore bc usually not a candidate by this time and doesn’t usually improve prognosis.
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Prevention of osteoporosis?
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•Maximize bone density in early years
•HRT, calcium, exercise (running, walking on treadmill), meds, red meat (assoc w/ incr risk), ETOH, smoking •Identification and treatment of eating disorders –includes prevention |
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Normal findings on a breast self-exam?
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»one breast larger than the other
»bilateral nipple retraction (flat or retracted) usually born with this. If it’s only on 1 side, is a sign of breast cancer »*bilateral milky discharge: milky kind of white, bilateral is normal. »Fibrocystic changes: peas on a plate = not a solitary mass. Breast cancer is usually 1 firm mass. |
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When should breast cancer screening be done?
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–BSE (on monthly basis) and yearly physical (by someone trained in doing breast exam)
–mammogram yearly starting at age 40 –if first degree relative has premenopausal breast cancer start 10 years before their cancer |
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When should pap smear screening be started/stopped?
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–start at 18 or when sexually active
–can probably stop at age 65: unless swinger |
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Health teaching r/t menarche?
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–onset of signs of sexual maturity before age 8 need to be referred
•thelarche, then adrenarche then menarche –average age of menarche is 12 (8-16 nl range) –no menses by age 14 without secondary sexual characteristics warrants evaluation –no menses by age 16 with secondary sexual characteristics warrants evaluation |
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Health teaching r/t menopause?
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–average age is 51
–declining estrogen levels actually begins at about age 35 with bone loss –defined as 6 months without a period (definition of menopause) –can be diagnosed with FSH>30 -risks |
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Health teaching for menopause risks?
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•menopausal symptoms: greatest loss of bone is 5 years after start menopuase
•osteoporosis •CV disease: begins to equal men after lose estrogen. Anytime estrogen is given it increases the risk for DVT. •colon ca, Alzheimer's, macular degeneration, edentia (loss of teeth bc are rooted in bones so when lose bone density, nothing to hold teeth in) |
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HRT therapy as a tx for menopause?
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–treats hot flashes, vaginal dryness, urinary symptoms (bc estrogen receptors in bladder), osteoporosis
–contraindicated in breast ca, uterine cancer, active liver disease, thromoembolic disease –must take estrogen and progesterone if uterus is present: if don’t can develop uterine cancer bc of unopposed estrogen stimulation. Estrogen only will be rxed for women w/ no uterus –estrogen sources –Now recommended only for short term use for menopausal symptoms |
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Osteoporosis tx in menopuase?
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–calcium supplementation, Vit D
–weight bearing exercise –drugs »HRT, calcitonin (Miacalcin), alendronate (Fosamax),), risedronate(Actonel), raloxifene(Evista), lbandronate (Boniva) (drugs currently on the market for osteoporosis). Make sure pts understand to take 1st thing in morning before eaten w/ full glass of water & must be able to sit upright for 30 min after taking. |
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Cardiovascular dz tx in menopuase?
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–antioxidants
–ASA (have them discuss w/ doc if they should be on aspirin prophylaxis) |
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Risk factors for breast cancer?
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•Age (#1 risk factor. Longer you live, greater your risk)
•previous breast cancer •family history •nulliparity •early menarche, late menopause: bc never have periods in life where they are not ovulating. •diet high in animal fat •ETOH •Obesity: heavier you are, more estrogen you make •exogenous hormones •atypical hyperplasia: biopsy is assoc w/ risk of breast cancer •lactation decreases risk |
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S/S of breast cancer?
|
–palpable lump
•non-tender, firm, fixed, irregular •has been there for > 8 yrs if palpable –UOQ (upper outer quadrant) most common site (50%), under nipple next most common (18%) –unilateral nipple discharge –retraction or dimpling of the skin –positive axillary nodes |
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Surgery as a tx for breast cancer?
|
•mastectomy partial mastectomy (lumpectomy and nodes)
•modified radical mastectomy (breast and nodes) •radical –chemo and radiation may be done before or after surgery |
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Tamoxifen as a tx for breast cancer?
|
•anti-estrogen
•causes menopausal symptoms •monitor for DVT, abnormal vaginal bleeding |
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Discharge teaching r/t breast cancer?
|
•wound care
•exercises •lymphedema: swelling in arm on affected side, cuffs can be worn to help w/ lymph circulation •no bra until incision healed •no shaving for 2 weeks, prob shouldn’t use deodorant either •source of prosthesis •reconstructive OR will usually be discussed prop by the surgeon •Reach for Recovery •medications –tamoxifen for 5 years |
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Nursing Implications for breast cancer?
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–body image/sexuality: many pts will choose a less aggressive approach w/ a prognosis that isn’t as good to maintain body.
–pain –wound care –position •lie on unoperative side •affected arm higher than heart –exercises |
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Wound care for breast cancer postop?
|
•drains: usually Hemo-vac
•elastoplast dressing: pressure dressing over area •check circulation and sensations to hand: encourage opening & closing of hand to help w/ circulation •no BP, injections, blood draws on affected side: FOR REST OF LIFE! |
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Breast cancer prognosis?
|
–improving
–no positive nodes 35% risk of recurrence after 10 years –1-3 nodes, 55% –4-10 nodes 70%: more nodes involved, worse the prognosis is. |
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Breast cancer prevention?
|
–BSE and mammography
–Tamoxifen for 5 yrs in high risk women: like fam history. Will do as a prophylaxis/preventative –diet, exercise etc |
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What are Uterine fibroids (leiomyoma)?
|
–Benign growths stimulated by estrogen
–Regress after menopause –pt usually presents with abnormal bleeding: such as bleeding again after menopause •menorrhagia, metrorrhagia –treated medically (GNRH) or surgically (myomectomy or TAH) |
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Endometrial cancer is usually seen in?
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–Usually in older women (50-64 yrs)
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Risk factors for endometrial cancer?
|
•obesity
•nulliparity •late menopause •unopposed estrogen stimulation: increases risk of endometrial cancer |
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S/S of endometrial cancer?
|
•abnormal uterine bleeding
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Dx of endometrial cancer?
|
pap (typically), endometrial biopsy (sometimes)
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Tx for endometrial cancer?
|
TAH-BSO (total abdominal hysterectomy-bilateral salpingoophectomy), radiation, chemo
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When does cervical cancer peak & what is it associated with?
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–Peaks age 40-45, on the increase
–STD, associated with HPV |
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Risk factors for cervical cancer?
|
•early first intercourse, multiple partners
•cigarette smoking (make HPV grow faster) H/O STD’s |
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S/S of cervical cancer?
|
•discharge
-dysparunia (pain w/ intercourse) -metrorrhagia (spotting bw periods) |
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Dx of cervical cancer?
|
–Pap
-colposcopy -biopsy |
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Tx for cervical cancer?
|
-Laser
-cryo -LEEP -cone -radiation -TAH |
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Prevention of cervical cancer?
|
•Condoms
•Routine pap smears •Vaccine against HPV |
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What is the vaccine against HPV?
|
–Gardasil (prevents infection with HPV types 6, 11, 16, 18)
»Recommended for girls age 9-26 »3 injections, initial, second in 2 months, third 4 months after second »Because on the multiple strains even girls who have been diagnosed with HPV should get the vaccine »expensive |
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When does ovarian cancer peak?
|
–Peak age 60-70 yrs
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Risk factors for ovarian cancer?
|
•family history
•high fat diet •nulliparity •early menarche, late menopause |
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S/S of ovarian cancer?
|
none early, GI sx,
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Dx of ovarian cancer?
|
•Exam
-ultrasound -MRI -CA125 |
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Tx for ovarian cancer?
|
•radical surgery to remove as much tumor as possible
•chemo •follow CA125 levels if elevated |
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Prognosis of ovarian cancer?
|
-same cure rate as 30 years ago
-60% dead in 5 yrs |
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Prevention of ovarian cancer?
|
•recommendations for women with family history
•breastfeeding decreases the risk |
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S/S of ovarian cancer?
|
none early, GI sx,
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|
Dx of ovarian cancer?
|
•Exam
-ultrasound -MRI -CA125 |
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Tx for ovarian cancer?
|
•radical surgery to remove as much tumor as possible
•chemo •follow CA125 levels if elevated |
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|
Prognosis of ovarian cancer?
|
same cure rate as 30 years ago
|
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Prevention of ovarian cancer?
|
•recommendations for women with family history
•breastfeeding decreases the risk |
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What general things do you need to be concerned about after surgery of reproductive tract?
|
–body image
–sexual function –hormone replacement •surgical menopause severe symptoms |
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Surgical issues r/t vaginal surgery?
|
–infection
•douches prior to OR, bowel prep, peri care –foley for several days •may have difficulty voiding due to edema –avoid pressure on suture line •prevent constipation •avoid heavy lifting |
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Surgical issues r/t abdominal surgery for reprod. disorders?
|
-GI tract
-circulation –Activity tolerance, blood loss •may be anemic prior to OR •vaginal drainage –Prevention of infection •bowel preps, drains |
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|
GI tract issues after abdominal surgery for reprod. disorders?
|
–GI tract: remember a lot of displacement of intestines that’s why have ileus. Get pt moving, need pos bowel sounds
•high risk for ileus |
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|
Circulation issues after abdominal surgery for reprod. disorders?
|
•high risk for DVT: operating on pelvis czs probs w/ normal circulatory return 4m lower extremities
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|
Where may urothelial & bladder cancer occur?
|
-May occur anywhere in the urinary tract but found most often in the bladder
-Has a high rate of recurrence and metastasis |
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Risk factors for urothelial/bladder cancer?
|
-Exposure to toxins: hair dyes
-Tobacco use-greatest risk factor -Long term use of cyclophosphamide (Cytoxan): chemo agent that kills cancer but long term puts at risk for bladder cancer |
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|
Clinical manifestations of urothelial/bladder cancer?
|
-Hematuria-common
-Other changes in urine -Dysuria -Changes in frequency and urgency -Painless hematuria occurs in about 75% of all patients |
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|
Dx of urothelial/bladder cancer?
|
-Assess for risk factors: smoking & textile workers bc of toxins
-Routine urinalysis will show hematuria -Bladder biopsy-done during cystoscopy |
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Non-surgical tx of urothelial/bladder cancer?
|
-Superficial cancers are treated with intravesical instillation of bacille calmettee guerin (BCG)
-Chemotherapy with multi agents when there is metastasis -Radiation |
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|
Surgical tx for urothelial/bladder cancer?
|
-Depends on the type and stage of cancer
-Cystectomy-removal of bladder -Will have some type of diversion created *Ileal conduit *Continent pouch *Bladder reconstruction *ureterosigmoidostomy |
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|
Pre-op care for urothelial/bladder cancer?
|
-Routine surgical care
-Should visit with ET nurse |
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|
Postop care for urothelial/bladder cancer?
|
-Routine post op surgical care
-Ostomy care |
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What is a ureterostomy?
|
-type of urinary diversion
--ureter is brought out thru the abdominal wall and a stoma created (must wear pouch) |
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What is a conduit (ileal or colon)?
|
-type of urinary diversion
-urine is collected in a pouch made from part of the intestines which is brought out thru the abdominal wall and a stoma is created (must wear pouch) |
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What is a sigmoidostomy?
|
urine is diverted into the large intestines. Urine and stool is eliminated at the same time. (no pouch)
-Reservoir (Kock’s pouch)-a bladder is surgically created and forms a reservoir for urine. (must self catheterize) |
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What is nephrotic syndrome?
|
-Condition in which glomerali become more permeable allowing large molecules (usually protein) to be passed thru the membrane into the urine
-Loss of protein causes edema and decrease plasma albumin levels |
|
|
Czs of nephrotic syndrome?
|
-Often a immune or inflammatory problem
|
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|
Clinical manifestations of nephrotic syndrome?
|
-Severe proteinuria
-Hypoalbuminemia: low protein in bld -Hyperlipidemia: incr lipids in bld -Lipiduria: fat in urine -Edema -Hypertenstion: worry most about this!!! |
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|
Dx tests for nephrotic syndrome?
|
-Pronounced proteinuria, hypoalbuminemia and hyperlipidemia
-Positive renal biopsy |
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Tx for nephrotic syndrome?
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-Prevent ESRD-develops in at least 30% of these patients
-Treat the cause -Immune problems-steroids, cytotoxic or immunosuppressive agents -Proteinuria-ACE inhibitors, heparin -Hyperlipidemia-cholestol lowering agents -Diet changes/fluid restrictions |
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Renal carcinoma aka adenocarinoma of the kidney will cause?
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-Anemia
-Erythrocytosis : high RBC’s. Always either/or. Never both. -Hypercalcemia: incr in secretion of PTH which means more Ca in or out of bones. -Liver dysfunction with elevated liver enzymes -Hormonal effects -Increased sedimentation rate -Hypertension: elevated renin causes this |
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Causes of renal cell carcinoma?
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-Unknown
-Increased risk with tobacco use, and lead, phosphate and cadmium use |
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Clinical manifestations of renal cell carcinoma?
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-Asymptomatic initially
-Dull, aching flank pain -Abdominal mass in flank area (use only gentle palpation) -Renal bruit -Hematuria-late sign -Other late signs-pallor, darkening of nipples, breast enlargement in males (increase in hormone levels), muscle wasting, weakness, poor nutritional status, weight loss |
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Dx testing for renal cell carcinoma?
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-Red blood cells in urine
-Labs-decrease H and H, increased calcium, ESR, ACTH, human chorionic gonadotopin, cortisol, renin, parathyroid hormone -Surgical exploration, IV urogram with nephrograms, or sonography will all show a mass -CTscan with contrast/MRI |
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Non-surgical tx for renal cell carcinoma?
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-Radiofrequency ablation-minimally invasive procedure that is showing promise
-Chemo has limited effectiveness |
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Surgical tx for renal cell carcinoma?
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-Nephrectomy-removal of kidney
-Radical nephrectomy-removal of kidney and lymph nodes -Adrenal gland is left -Surgery may be followed after radiation therapy: bc kidneys are avascular so radiation sclerotic to min blding |
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Post-op care for renal cell carcinoma?
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-Routine-T, C, and DB
-Monitor for hemorrhage (kidney is very vascular) and adrenal insufficiency-Decreased BP-early sign: Increased HR is the first sign -Monitor UO with hourly output-remaining kidney should function adequately -Monitor labs for 1st post op day-H/H, lytes, CBC -Monitor VS, UO, weight -Will most likely be in ICU: check for blding on pts back postop -Pain management important -Prevention of complications -Antibiotics: possible to be nephrotoxic, monitor or will lose last remaining kidney. -Steroid therapy |
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What is polycystic kidney disease?
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-Inherited disorder
-Fluid filled cysts develop in kidneys (Cysts can also be found in other organs) -More and more nephrons develop cysts as person gets older -The cysts get bigger and more widespread and damage the kidneys. Cysts eventually replace normal kidney tissue -Kidneys keep getting larger displacing other organs in the abdomen causing pain, discomfort and pressure -Hypertension results due to the tissue ischemia and becomes the top priority |
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Clinical manifestations of polycystic kidney dz?
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-Hypertension-as renal function gets worse
-Abdominal or flank pain-dull ache (cyst or full of fluid & may be infected) or sharp (indicates rupture) with intermittent discomfort -Distended abdomen/increased abdominal girth -Nocturia-early symptoms, kidneys can not concentrate urine -Constipation -Bloody or cloudy urine -Kidney stone |
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4 types of dx tests for polycystic kidney dz?
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-urinalysis
-labs -renal sonogram -CT scan/MRI |
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What will a urinalysis show in polycystic kidney dz?
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-proteinuria-indicates that the glomeruli are involved
-Hematuria -Bacteria in urine-indicates infection |
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What will labs show in polycystic kidney dz?
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-Increased BUN and creatinine
-Decrease creatinine clearance |
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What will renal sonogram show in polycystic kidney dz?
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Renal sonogram-provides diagnostic evidence with minimal risk: need to have full bladder, drink until can’t take it anymore
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Interventions for polycystic kidney dz?
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-Will depend on the problem-if UTI treat with antibiotics, if renal failure may need dialysis: may need dialysis, fairly common bc cysts replace healthy tissue.
-pain control -prevention of constipation -BP control |
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Pain control interventions for polycystic kidney dz?
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-Pain meds with caution
-Distraction/diversion -Heat/massage |
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Prevention of constipation as an intervention for polycystic kidney dz?
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-Fluids
-High fiber diet/roughage |
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BP control as in intervention for polycystic kidney dz?
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-Low sodium diet
-Prescribed medications -Stop smoking -Exercise -Keep track of BP -Daily weights |
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What are obstructive kidney disorders?
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-Includes hydronephrosis, hydroureter and urethral stricture: all 3 prevent urine 4m leaving kidney & kidney is not a reservoir.
-Since all of these disorders prevent outflow of urine they must be recognized and acted on to prevent kidney damage -May cause permanent damage within 48 hours or less |
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What is hydronephrosis caused by?
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-Caused by an obstruction in the upper part of the ureter
-Urine backs up into the kidney -Caused by tumors, stones, trauma, structural defects, fibrosis |
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What is hydroureter caused by?
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-Obstruction occurs in the lower part of the ureter
-Urine backs up into the ureter -Caused by the same things that cause hydronephrosis |
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What is a urethral stricture?
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-Blockage is in the urethral which causes bladder distention and eventually ureter and kidney distention
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Pathophysiology of urethral stricture?
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-Urinary obstruction (no matter what the cause) leads to increase pressure in the nephron
-This causes glomerular filtration to slow down or stop -This leads to renal failure-waste products can not be eliminated |
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Clinical manifestations of urethral strictures?
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-UTIs
-Flank/abdominal pain -Changes in color, amount, smell of urine -Asymmetry of flank |
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Dx of urethral strictures?
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-History-were there urinary tract problems in childhood
-Urinalysis-may show UTI -Elevated BUN and Creatinine -Decrease GFR -Electrolytes abnormal -Intravenous urography-will show dilation -CT scan-will show obstruction -Ultrasound-will show obstruction |
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Interventions for urethral strictures?
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-Depends on the cause
-If caused by stone-stone removed -If caused by stricture-may have a nephrostomy tube inserted which diverts urine: tube that goes 4m kidney, directly to bag. |
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Care of nephrostomy tube?
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-Measure output-should know how much to expect
-A blocked nephrostomy tube requires the physician to be notified: bc if blocked then have same effect as previous cond. -Assess for bleeding around the tube -Assess for urine leaking around the tube -Assess for signs of UTI |
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What hormones does the posterior pituitary produce?
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-oxytocin
-ADH |
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What hormones does the anterior pituitary produce?
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-TSH
-ACTH -growth hormone -FSH/LH prolactin |
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What does ADH do?
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-prod. by posterior pituitary
-regulates water excretion/resorption by the kidneys to maintain normal osmolality |
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What does TSH do?
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-prod by anterior pituitary
-thyroid gland -T3, T4 - controls metabolism of CHO,fats,protein -affects CV,neuro,GI,reproductive functioning |
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What does ACTH do?
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-prod by anterior pituitary
-adrenal gland -medulla - epinephrine, norepinephrine: SNS control -cortex: *cortisol: gluconeogenesis, decrease infl, suppress immune response *mineralcorticoids: aldosterone - Na ret, K loss, H20 ret. *androgens |
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Radioactive iodine therapy for hyperthyroidism?
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-oral
-concentrates in the gland & decreases functioning -effect starts in 3 wks but may take 6 mo to normalize -may become hypothyroid |
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Radiation precautions when pt is receiving radioactive iodine therapy for hyperthyroidism?
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-P891
-small amts in saliva -avoid close contact w/ kids -no pregnancy or breastfeeding for 6 mo |
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Med treatment for hyperthyroidism?
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-thioamides (PTU, tapazole)
*2-4 wks for improvement *blocks hormone synthesis *continued for 6-18 mo. *risk is agranulocytosis -Lugol's solution (SSKI) decreases vascularity of the gland -beta blockers *decrease symptoms *not in asthmatics, COPD, diabetics |
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Surgical tx for hyperthyroidism?
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-cancer, goiter
-euthyroid state restored prior to OR to prevent thyroid storm -complications: *damage to laryngeal nerve: in most pts, voice returns after edema goes down *hypoparathyroidism |
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Nursing implications for hyperthyroidism surgery?
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-bleeding, tissue edema
-calcium deficiency -thyroid storm -pain: support head when moving, analgesics -voice quality -nutrition: high protein, high calorie -eye care, body image issues -education: meds |
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Bleeding, tissue edema concerns after hyperthyroidism surgery?
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-check back of neck
-difficulty swallowing or breathing -dressing -semi-fowlers -trach set available |
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Calcium deficiency concerns after hyperthyroidism surgery?
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-tingling around mouth,toes,fingers = low serum Ca
-tx w/ Ca gluconate |
