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105 Cards in this Set
- Front
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Key Features of Hyperthyroidism
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Cardiovascular - Palpitations - Chest pain - Systolic hypertension - Tachycardia - Dysrhythmias
Respiratory - Dyspnea, at rest or exertional Neurological - Visual changes - Eye fatigue - Eyelid retraction, global lag - Exophthalmus (bulging eyes) - Tremors Gastrointestinal - Increased appetite - Diarrhea - Weight loss Metabolic - Increased BMR - Heat intolerance - Low grade fever Psychological - Decreased attention span - Restlessness - Irritability - Manic, labile behavior Muscle weakness, wasting. and fatigue |
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Thyroid Storm/Crisis
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Fever > 102 (can be as high as 105.3)
Tachycardia Systolic hypertension Heart failure Shock N & V Agitation confusion, seizures |
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Emergency Care of Client During Thyroid Storm
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Maintain patent airway and adequate ventilation
Medications that lower thyroid levels including: Propylthiouracil (PTU), Methimazole (Tapazole) Iodine (blocks release and inhibits T3/T4 synthesis—also decreases vasculature of thyroid gland prior to surgery) Inderal/beta blockers (to decrease heart activity) Glucocorticoids (hydrocortisone, prednisone) Antipyretics (non-aspirin based) Cardiac monitor for dysrhythmias Monitor vitals frequently IV fluids Provide comfort measures (ie. Cooling blanket) |
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Hyperthyroidism Nursing Interventions
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Monitor vital signs
Assess respiratory effort Asses energy levels and activity tolerance Diet is important (make sure they are getting enough calories during hyper metabolic state) Exophthalmos education Need for regular eye exams Report changes in vision Protect eyes with tinted glasses Moisten eyes frequently Sleep with head of bed elevated to decrease pressure on optical nerve |
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Complications From Thyroid Surgery
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Hemorrhage
Respiratory distress (due to swelling) Parathyroid gland injury resulting in hypocalcemia and tetany Damage to laryngeal nerves |
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Post Surgical Nursing Interventions
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Monitor for symptoms of respiratory distress including tachypnea and stridor
Inspect neck dressing every hour and then every 4 hours Monitor amount of drainage (bleeding), notify MD for bleeding Maintain client in semi-Fowler´s position, with ice to neck Assess for numbness, tingling, voice quality (dysphonia), dysphagia, signs of hypocalcemia Keep emergency tracheostomy kit at bedside |
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Hypothyroidism : characterized by
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Decreased production of hydrochloric acid by stomach
Reduced gastrointestinal motility Decreased heart rate and cardiac output Impaired neurological function Decreased heat production Decreased lipid metabolism cholesterol, lipids Anemia Increased interstitial fluids leading to pleural and cardiac effusions |
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Key Features of Hypothyroidism
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Cardiovascular - Hypotension - Bradycardia - Dysrhythmias - Periobital edema - Facial puffiness
Respiratory - Dyspnea - Hypoventilation - Pleural effusion Metabolic - Decreased BMR - Decreased body temp. - Cold intolerance Neurological - Slow, slurred speech - Decreased memory, concentration - lethargy, somnolence - paresthesias Gastrointestinal - Anorexia, weight gain - constipation - Abdominal distention Psychological - Apathy - Depression - Paranoia - Withdrawal |
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Care of the Client With Myxedema Coma
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Maintain patent airway
Replace fluids as ordered Give replacement thyroid hormone (levothyroxine sodium) IV as ordered Administer IV glucose as ordered Administer corticosteroids as ordered Assess vitals, temperature and blood pressure Cover with warm blankets Monitor for mental status changes |
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Nursing Interventions for Hypothyroidism
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Monitor cardiac status including blood pressure and heart rate frequently
Assess hemodynamic function including urine output and blood pressure frequently Monitor for mental status & neurologic changes Administer hypothyroid medications as ordered: - Synthroid Give 1 hour prior to meals or 2 hours after to facilitate absorption Withhold if heart rate >100 or at least notify physician Adjust environment with blankets as needed to temperature and comfort Encourage fluids of at least 2 L and diet high in fiber to promote regular bowel movements |
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Key Features of Hyperparathyroidism
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Polyuria and renal calculi
Headache Generalized bone pain Pathological fractures CNS Headache Confusion and drowsiness Lethargy and confusion Depressed deep tendon reflexes Depression , psychosis Flank pain Muscle weakness Fatigue GI disturbance Constipation N & V Cardiac Hypertension Heart block Shortened QT interval and ST segment Cardiac arrest Note: All of the above may be caused by excessive PTH or by hypercalcemia |
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Non-Surgical Management of Hyperparathyroidism
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Promote safety and comfort (prevent falls)
Strain urine to detect calcium-based urinary stones Hydration 2-3 L /day and high fiber diet Paced activity with rest periods Diuretics (Lasix, Uritol) an NS IV, to increase calcium excretion Analgesics to control pain Phosphates (oral or IV, only when rapidly lowering of calcium is necessary) Calcitonin given with glucocorticoids, increases renal excretion of calcium Mithramycin (chelating agents) - Cytotoxic agent that rapidly lowers serum calcium level within 48 hours, but causes thrombcytopenia, hepatic toxicity, renal toxicity |
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Care of the Client Receiving Non-Surgical Treatment HYPERPARATHYROIDISM
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Administer IV hydration as ordered
Monitor intake and output strictly Assess renal status Q 2-4 hours Continuous cardiac monitoring, usually indicated Assess for numbness and tingling in muscles Monitor labs - CBC - Ca++ - BUN - LFTs - Creat |
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Care of the Client Post-Parathyroidectomy
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Assess for bleeding
Monitor respiratory status, compression of trachea by hemorrhage or swelling Emergency airway management tray at bedside Monitor serum calcium levels Q4hrs, may be hypocalcemic until levels stabilize Monitor for signs of hypocalcemia (Chvostek´s, Trousseau´s, twitching, tetany) Assess for voice quality and hoarseness |
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Key Features of Hypoparathyroidism
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Tingling and numbness around mouth
Tetany Laryngospam with possible respiratory arrest Hyperactive deep tendon reflexes Muscle cramps/spasms Chvostek’s and Trousseau’s sign Hyperactive bowel sounds Abdominal cramping with diarrhea Dry brittle nails and hair CNS Irritability Depression Anxiety Confusion Hallucinations Seizures Cardiac Hypotension Decreased myocardial contractility Prolonged QT interval and lengthened ST segment Cardiac arrest |
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Care of the Client With Hypoparathyroidism
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Education regarding importance of adherence to medication regime, lifelong
Education regarding dietary modification including: - Foods high in Ca++ but low in PO4 (i.e., yogurt, processed cheeses) Monitor for signs and symptoms of hypocalcemia Monitor labs including those mentioned for hyperparathyroidism |
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Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
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SIADH is an excessive amount of serum ADH resulting in water intoxication and hyponatremia
Pathophysiology ADH is released despite normal or low plasma osmolarity (feedback mechanism does not work) Excess ADH increases permeability of renal distal tubules which leads to reabsorption of water into the plasma and suppression of the renin-angiotensin mechanism causing renal excretion of sodium leading to……... Water intoxication Cellular edema Dilutional hyponatremia |
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SIADH Clinical Manifestations
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Fluid retention (fluid volume excess)
Increase B/P Crackles in lung fields Distended jugular veins Taut skin Imbalanced I/O (more coming than going out) Headache Fatigue Anorexia Dilutional hyponatremia muscle cramps and weakness Hypochloremia Concentrated urine with low output Cerebral edema Seizures Changes in LOC Weight gain without edema (So putting someone in high fowlers would not assist) |
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DI Manifestations
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Polyuria (5-20 L in a day)
Polydipsia (drink huge amounts to keep up) Dry tenting skin Muscle fatigue Muscle twitching, agitation, hallucinations, seizures, coma N & V Dry mucous membranes Fluid volume deficits occur if one cannot keep up with fluid loss resulting in Hypotension Tachycardia Constipation Weight loss Shock due to hypovolemia |
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DI Nursing Interventions
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Water replacement-encourage fluids
Oral preferred or IV D5W (hypotonic solution) to keep lab values normal Weigh daily Monitoring Fluid status if HUGE Monitor urine specific gravity and report if it decreases Monitor serum osmolality and sodium for increases Hormones replacement primary treatments for central DI Desmopressin Acetate nasal spray In nephrogenic DI kidneys are unable to respond to ADH so patient will need to be put on thiazide diuretics, low sodium and low protein diet |
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Cushing’s Syndrome
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Hyperfunction of adrenal gland cortex resulting in elevated serum cortisol or ACTH
Incidence grater in women Usual onset 30-40 years of age Causes Prednisone use ACTH secreting pituitary tumor or adrenal tumors Usually occur between the ages of 20-40 |
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Cushing’s Syndrome Manifestations
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Hypertension
Fluid overload Weight gain Truncal obesity Moon face Thinning hair Increased body and facial hair (hirsutism) Purple striae on abdomen Emotional lability (mood swings) Edema in lower extremities Skin infection and slow wound healing Muscle wasting and weakness Hyperglycemia Thin skin with easy bruising |
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Cushing syndrome: nursing priorities
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Assess client to achieve fluid, electrolyte, glucose, and calcium balance.
Daily weights Monitor I/O Promote safety (uncluttered walking areas, adequate lighting, etc.) Pace activities Prevent infection Help client cope with changes in physical appearance |
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Cushing syndrome: post op care
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Promote effective breathing (cough and deep breath/IS use)
Explain mouth breathing due to nasal packing Turn every 2 hours (use SCDs or encourage dorsiflexion) Keep HOB elevated 30 degrees Examine pituitary surgical wound for Cerebrospinal fluid leak (how would you do this?) |
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Addison’s Disease
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Hypofunction of adrenal cortex or lack of ACTH secretion by pituitary
Body lacks corticosteroids More common in women Happens to those under the age of 60 Causes Industrialized countries—autoimmune condition where adrenal tissue is destroyed (will not notice symptoms until most of the tissue is destroyed) TB AIDS or its treatments Anitcoagulant therapy Sudden stoppage of long-term high does steroid medications |
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Addison’s crisis
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Can occur when steroids are abruptly stopped or exposure to stress.
Hypotension leading to shock Tachycardia Dehydration Plus other manifestations mentioned on the previous page |
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Addison’s Disease
trt |
Steroid replacement therapy
Treating underlying cause |
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Addison’s Disease Nursing Interventions
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Monitor vital signs
Assess LOC frequently Monitor energy level and activity tolerance Assess orthostatic hypotension Monitor fluid and electrolyte imbalances Monitor I/O Nutritional status (watch for low blood sugar) Encourage 3L of fluid intake May need added sodium in diet Promote a safe environment Protect from infection |
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Asthma: after exposure to trigger
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Wheezing with expiration
Cough Dyspnea (may be severe) Chest tightness Prolonged expiration Increased RR Tachypnea with possible use of accessory muscles Mild to greatly diminished breath sounds Increased heart rate and blood pressure Restlessness and anxiety |
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Asthma – Nursing Management & Interventions
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Assess respiratory and oxygenation status
Administer supplemental oxygen as needed ID/Avoid/Remove precipitating factors Allergy desensitization therapy if appropriate Educate on PEFR monitor to promote self management Administer medications as prescribed and instruct on their appropriate use Provide education and resources on how to manage exacerbations |
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Chronic Bronchitis-Manifestations
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Frequent cough with foul smelling sputum
Frequent pulmonary infections Blue Bloater Obseity Bluish skin from cyanosis and polycythemia Dyspnea and activity intolerance as disease progresses Increased anterior-posterior chest diameter Risk for deep vein thrombosis as H &H increases |
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Emphysemia: Manifestations
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Pink Puffer
Barrel chest Pursed lip breathing (forced exhalation) Maintain oxygenation by hyperventilating Use of accessory muscles when breathing Under weight appearance Central cyanosis & finger clubbing Progressive exertional dsypnea Persistent tachycardia due to inadequate oxygenation Diminished breath sounds (wheezes and crackles may be present) |
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COPD Nursing Interventions 1
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Smoking cessation!!!!!!!!!!
Avoid precipitating irritants Monitor oxygenation status frequently Goal is to improve ventilation and promote patent airway by mobilizing secretions Adequate fluid status (at least 2L to thin secretions) Adequate nutrition to fight infections and meet increased energy needs Bronchodilator therapy to reduce dyspnea and attempt increase FEV1 Beta adrenergic agonists (used as bronchiodialtors and administered by MDI or nebulizers) Corticosteroid therapy (useful for those with asthma or exacerbations unresponsive to therapy with beta-agonists) |
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COPD Nursing Interventions 2
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Sitting patient up in bed in fowlers or high fowlers may help dyspnea.
Chest Physiotherapy Oral care to reduce chance of infection Antibiotic therapy and importance of completing the prescribed regimen Prepare for possible surgical interventions Flu and pneumonia vaccines are very important |
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Physiologic Factors Affecting Oxygenation
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Anemia (decreased oxygen carrying capacity)
Toxic gas inhalation (ie. carbon monoxide) Cardiovascular conditions Airway obstruction Weakness High altitudes (decreased oxygen conc.) Fever (increased metabolic & oxygen demands Musculoskeletal impairments |
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Airway Management
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Head tilt/chin lift
Oropharyngeal airway (maintaining airway by preventing posterior tongue displacement) Use only on unconscious patient due to risk of vomiting and should be sized to individual Nasopharyngeal airway Airway for semi-conscious patient or whom placement via oropharygeal is not feasible Endotracheal Long cuffed tube is inserted with laryngoscope for long-term airway management Must be sized for individual Must be confirmed by x-ray Tracheostomy (many types) Surgical placement of cuffed airway into the trachea Obturator needs to be at bedside with replacement Trach-tube sized for that patient CPAP (continuous positive airway pressure) or BiPAP (bi-level….) Nasal mask that is attached to high-flow blower Blower is adjusted to maintain sufficient positive pressure in the airway to prevent airway collapse Used to treat sleep apnea (partial or complete upper airway obstruction during sleep) Signs and symptoms (frequent waking, insomnia, daytime sleepiness, witnessed apneic episodes, loud snoring, other symptoms related to inadequate sleep-irritability, inability to concentrate, depression) Affects 2-10% of population |
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Tracheostomy Complications
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Obstruction with secretions - C & DB, humidified oxygen - Periodic suctioning and trach. care
Tube dislodgment/decannulation - Secure cannula with trach. ties - Have emergency tube with obturator at bedside Pneumothorax - Monitor for sx and notify MD Subcutaneous emphysema - Inspect and palpate for air under tissues at trach site, notify MD Bleeding - Small amount ok for first few days, if constant oozing, notify MD Cuff pressure too high---what could happen????? Infection Assess stoma, keep trach. dressings C, D & I |
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Special Considerations When Suctioning
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Assess respiratory status before suctioning
Hyper-oxygenate prn before suctioning Position client accordingly Aseptic technique for nasopharyngeal, nasotracheal suctioning No more than three passes per session!!! WHY? Do not apply suction as you insert the catheter—Why??? Apply intermittent suction coming out—Why |
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Care of the Client with Oxygen
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Assess order for oxygen rate (assess when in room for first time)
Monitor respiratory status Q 4hrs & prn Assess oxygen saturation Q shift & prn Elevate HOB at least 30 degrees Encourage TC & DB Q 2- 4 hrs Around the clock Humidify oxygen whenever possible (> 2L/NC) Assess nares at least Q shift Remove oxygen, cleanse nares, apply lubricant Q 4 hrs. Document findings Q shift & prn |
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Thoracic Surgery Nursing Care
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Get base line vitals, oxygenation status, and cognitive status and monitor patient for changes
Monitor urine output <30ml/hr should raise concerns Maintain airway Position for optimal ventilation (noting any specific order) Maintain water seal if patient has chest tube and closely monitor drainage for acceptable amount which would be specified in orders Monitor operative site for bleeding/hemorrhage Administer post-op antibiotics if ordered Administer analgesics Encourage position change, incentive spirometer use, coughing and deep breathing to decrease atelectasis development |
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Pneumonia Manifestations
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Viral
Fever:low grade Cough: non-productive White blood count: normal to low elevation Chest X-ray: minimal change evident Clinical course: less severe than bacterial Bacterial Fever: high Cough: productive White blood count: high elevation Chest x-ray: infiltrates Clinical course: more severe |
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Pneumonia Nursing Care
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Maintain Airway
Administer Antibiotics if bacterial or antifungals if fungal Monitor respiratory and oxygenation status and administer O2 if indicated Provide analgesics for pain Provide fluid and nutritional support (why: fluids help mobilize secretions and when infection occurring you have higher metabolic needs) Provide adequate periods of rest between activities Prevention of pneumonia in hospital setting is worth a pound of cure ID high risk patients Flu/pneumonia vaccines updated Handwashing Maintain adequate nutrition and hydration Encourage activity and mobility after surgery |
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Pulmonary Embolism: signs and sxs
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Restlessness, anxiety, agitation
Tachycarida Tachypenia Hypotension Fever Hemoptysis Changes in LOC Cyanosis Lung crackles |
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Pulmonary Embolism: nursing interventions
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Maintain airway
Supplemental oxygen Maintain IV access Pain management Anticoagulants (heparin, coumadin) Prevention SCDs after surgery Movement after surgery |
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Care of the Patient With Chest Tubes Chest tube facts
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When your patient has a pneumothorax, expect little if any output because the tube is draining air, not fluid.
Hemothorax, a lack of drainage may indicate a clot obstructing the tube. If that occurs, try milking the tube (only if ordered to do so): Starting at the proximal end, gently squeeze and release it between your fingers along the length of the tubing. However, don't “strip” the chest tube, which means squeezing the length of the tube without releasing it. Once a common practice, stripping the tube causes a dangerous increase in intrathoracic pressure and doesn't lead to any significant increase in output. |
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Air Leak: Continuous bubbling is seen in water-seal bottle/chamber, indicating that leak is between patient and water seal
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Locate leak
(b) Tighten loose connection between patient and water seal (c) Loose connections cause air to enter system. d) Leaks are corrected when constant bubbling stops |
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Problem: Bubbling continues, indicating that air leak has not been corrected
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(a) Cross-clamp chest tube close to patient’s chest, if bubbling stops, air leak is inside the patient’s thorax or at chest tube insertion site
(b) Unclamp tube and notify physician immediately! (c) Reinforce chest dressing |
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air leak 3
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Problem: Bubbling continues, indicating that leak is not in the patient’s chest or at the insertion site
(a) Gradually move clamps down drainage tubing away from patient and toward suction-control chamber, moving one clamp at a time (b) When bubbling stops, leak is in section of tubing or connection distal to the clamp (c) Replace tubing or secure connection and release clamp (4) Problem: Bubbling continues, indicating that leak is not in tubing (a) Leak is in drainage system (b) Change drainage system |
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CDU Q&A
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Q: When should I change the CDU?
A: Change it if it breaks or it's full: * Prepare the new CDU according to the manufacturer's instructions. * Remove the current CDU from suction, clamp the chest tube with a rubber-tipped hemostat, and disconnect the connecting tube from the CDU. * Quickly connect the new CDU, unclamp the tube, and secure all connections according to your unit's policy. * Resume suction and assess the CDU chambers for normal function. Pinpointing Subcutaneous Emphysema A collection of air or gas under the skin, subcutaneous emphysema—crepitus—is usually painless and feels spongy on palpation. Small amounts of subcutaneous emphysema around the tube insertion site are commonly absorbed. However, if the tube is improperly placed or has an air leak, air may move from the insertion site into the neck, chest, and face and cause pain. In this case, notify the clinician. |
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hey
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RELAX :)
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Struvite
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infection stone or triple phosphate stone, develops when a urinary tract infection (e.g., bladder infection) affects the chemical balance of the urine. Bacteria in the urinary tract release chemicals that neutralize urinary acid, which enables bacteria to grow more quickly and promotes struvite stone development.
stones are more common in women because they have urinary tract infections more often than men. The stones usually develop as jagged structures called "staghorns" and can grow to be quite large. |
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Uric acid
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Digestion and metabolism of meat protein produces uric acid. If the acid level in the urine is high (i.e. low pH), the uric acid may not dissolve and uric acid stones will form.
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Cystine (least common)
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Cystine is an amino acid in protein that does not dissolve well. Some people inherit a rare, congenital (i.e., present at birth) condition that results in large amounts of cystine in the urine. This condition (called cystinuria) causes cystine stones that are difficult to treat and requires life-long therapy.
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Renal Calculi: Risk factors
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Dehydration: concentrates calculus-forming substances
Infection: damaged tissue and changing pH provide environment for calculi to develop Obstruction: urine stasis allows solid material to collect, which promotes infections Congenital disorders and arthritis (inflammation) High blood pressure Metabolic factors: hyperthyroidism, renal tubular acidosis, elevated uric acid levels (gout), defective oxalate metabolism, excessive vitamin D or calcium intake. |
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renal calculi Signs and symptoms
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excrutiating pain that begins in the lower back and radiates to the groin (spasm of ureter)
Blood in the urine (hematuria) Increased frequency of urination (urinary urgency) Nausea and vomiting Pain during urination (stinging, burning) Tenderness in the abdomen and kidney region UTI (fever, chills, loss of appetite) |
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renal calculi nursing interventions
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Treatment of symptoms especially pain
Monitor serum levels for calcium, phosphorous, and uric acid 24 urine Prepare for KUB, IVP, renal ultrasound, CT-scan, MRI or cystoscopy Removal of calculi Prevention of future stone development Assess urinary function (monitor I/O) Strain urine for stones to be analyzed Encourage ambulation and vigorous fluid intake |
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Renal Calculi Treatments with Nursing Care
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Lithotripsy (Extracopeal shock wave lithotripsy )
High energy shock waves to break up calculi Takes 30min -1 hr Patient will get general or epidural anesthetic Nursing care Baseline vitals Monitor I/O Maintain patency of catheter Strain urine for calculi and send fragments to lab Encourage ambulation and increase fluid intake as ordered to aide passage of calculi Medicate for pain as needed Slight hematuria is common |
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Renal Calculi Treatments with Nursing Care 2
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Ureterolithotomy/pyelolithotomy/neprolithotomy (surgery to remove calculi)
Baseline assessments (vitals, B/P, LOC) Monitor I/O Monitor consistency of urine (color, clarity, etc) Maintain patency of catheter Assess and medicate for pain Increase fluid intake for passage of calculi fragments Strain urine |
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Urinary Retention Nursing Interventions
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Palpate bladder for distension at regular intervals
Monitor I/O Monitor for signs of UTI Attempt to stimulate relaxation of urethral sphincter by running water, poor warm water over perineum Straight catheterization if ordered Evaluate medication to see if any medication could be the cause May need surgery to remove BPH obstruction |
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Urinary Incontinence Causes
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Causes of temporary urinary incontinence
Alcohol. Beer, wine and spirits are all diuretics.. Over-hydration. Drinking a lot of water or other beverages, particularly in a short period of time, increases the amount of urine your bladder has to deal with and may result in an occasional accident. Dehydration. If you have urge incontinence, you may try to limit your fluids to reduce the number of trips to the toilet. However, if you don't consume enough liquid to stay hydrated, your urine can occasionally become very concentrated. This collection of concentrated salts can irritate your bladder and worsen your urge incontinence. Caffeine. Caffeine also is a diuretic. Bladder irritation. Carbonated drinks, tea and coffee — with or without caffeine — may irritate your bladder and cause episodes of urge incontinence. Citrus fruits and juices and artificial sweeteners also can be sources of aggravation. Medications. Sedatives, such as sleeping pills, can sometimes interfere with your ability to control bladder function. Other medications — including water pills (diuretics), muscle relaxants and antidepressants — can cause or increase incontinence. Some high blood pressure drugs, heart medications and cold medicines also can affect bladder function. After surgery, some people experience temporary overflow incontinence from the lingering effects of anesthesia. Other illnesses or injuries. Any serious illness, injury or disability that keeps you from getting to the toilet in time also is a potential cause of incontinence. Urinary tract infection. Infectious agents — usually bacteria — can enter your urethra and bladder and start to multiply. The resulting infection irritates your bladder, causing you to have strong urges to urinate. These urges may result in episodes of incontinence, which may be your only warning sign of a urinary tract infection. Other possible signs and symptoms include a burning sensation when you urinate and foul-smelling urine. Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and trigger urine frequency. |
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Urinary Incontinence Causes
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Causes of persistent urinary incontinence
Pregnancy and childbirth. Pregnant women may experience stress incontinence because of hormonal changes and the increased weight of an enlarging uterus and weakened pelvic floor muscles Changes with aging. Aging of the bladder muscle affects both men and women, leading to a decrease in the bladder's capacity to store urine and an increase in overactive bladder symptoms. Hysterectomy. In women, the bladder and uterus (womb) lie close to one another and are supported by the same muscles and ligaments. Any surgery that involves a woman's reproductive can lead to incontinence. Enlarged prostate. In older men, incontinence often stems from enlargement of the prostate gland. Prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. However, more often, incontinence is a side effect of treatments — surgery or radiation — for prostate cancer. Bladder cancer or bladder stones. Incontinence, urinary urgency and burning with urination can be signs and symptoms of bladder cancer and also of bladder stones. Other signs and symptoms include blood in the urine and pelvic pain. Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence. Also changes caused by Diabetes or vascular diseases Obstruction. A tumor anywhere along your urinary tract can obstruct the normal flow of urine and cause incontinence, usually overflow incontinence. Urinary stones — hard, stone-like masses that can form in the bladder — may be to blame for urine leakage. |
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Urinary Incontinence dx tests
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Urine diary
Urinalysis Post void residuals Cystogram Blood tests Stress test (not the cardiac kind-coughing) Pelvic ultrasound MRI |
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Urinary Tract Infection UTI
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Generic term that covers any bacterial infection that affects the urinary tract
Classified according to region and primary site affected Bladder (cyctisis) Urethra (urethritis) Kidney (pyelonephritis) Note above urethra the urinary tract is sterile Pathogens enter via the perineal area or from blood stream Most commonly the ascending route Body has natural defense against bacteria ***** Urine flow (think about diseases that impede urine flow-BPH, kidney stones) pH Large urine output Causes Ecoli major culprit causiing 80-85% of cases Remaining cases caused by staphylococcus |
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Signs and Symptoms of Cystitis
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Frequent urination
Nocturia Burning or pain with urination dysuria Pain in the midline suprapubic region. Pyuria: Pus in the urine or discharge from the urethra. Hematuria: Blood in urine. Mild fever Cloudy and foul-smelling urine Increased confusion and associated falls are common presentations to Emergency Departments for elderly patients with UTI. Protein found in the urine. |
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Signs and Symptoms of Pyelonephritis
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Same as cystitis plus
Emesis: Abdominal pain or pressure. Shaking chills and high spiking fever. Night sweats Extreme fatigue |
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Glomerulonephritis
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A group of kidney diseases caused by inflammation of capillary loops in the glomeruli of the kidney.
Caused by immunologic reaction to an antigen Endogenous-antigens already in kidney or other body tissues Exogenous-infections occurring in the body Antigen-antibody complexes trapped within glomeruli produce an inflammatory response that damages the glomeruli Causes Upper respiratory infection Skin infection Autoimmune processes **Symptoms occur 2-3 weeks after original infection Occurs in men more than women |
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Glomerulonephritis Signs and symptoms
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Cola-colored or diluted iced-tea-colored urine from red blood cells in your urine (hematuria)
Foam in the toilet water from protein in your urine (proteinuria) High blood pressure (hypertension) Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen Weakness and fatigue from anemia or kidney failure Less frequent urination than usual REMEMBER symptoms develop 2-3 weeks after underlying/precipitating infection (UTI, Respiratory infection, pericarditis or endocarditis. |
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Glomerulonephritis Complications
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Acute kidney failure
May require dialysis Chronic kidney failure Kidney function at less than 10 percent of normal capacity indicates end-stage kidney disease, which usually requires dialysis or a kidney transplant to sustain life. High blood pressure Damage to your kidneys and the resultant buildup of wastes in the bloodstream can raise your blood pressure. Nephrotic syndrome characterized by high protein levels in the urine, resulting in low protein levels in the blood (** note low oncotic presuure), high serum cholesterol, and swelling of the eyelids, feet and abdomen. Acute renal failure signs and symptoms Since no treatment leads to end stage renal failure |
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Glomerulonephritis Nursing Care
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Treat underlying infection or condition
Provide appropriate diet Protein restriction if oliguria is severe High carbohydrate to provide energy Potassium usually restricted Sodium restricted for hypertension and edema Fluid restriction Bedrest during acute stage Monitor vitals frequently watching for hypertension Monitor I/O and daily weights Monitor for signs of renal failure (oliguria, azotemia-abnormal nitrogen containing wastes like BUN and creatinine, acidosis |
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Polycystic Kidney Disease
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Hereditary disease characterized by cyst formation and massive kidney enlargement affecting both children and adults
Autosomal dominant form affects adults Autosomal recessive for usually diagnosed in children Renal cysts are fluid filled sacs develop in the tubular epithelium affecting nephron function leading to enlarged kidneys. Disease is progressive and cysts are usually found in other organs such as liver, spleen, pancreas, and brain |
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Polycystic Kidney Disease: manifestations
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Flank pain
Polyuria Nocturia Signs of UTI Signs of renal Calculi Hypertension Palpable enlarged kidney Signs of chronic renal failure as client approaches 50-60 years of age |
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Polycystic Kidney Disease: dx tests
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Hematuria
Proteinuria Postive findings on Ultrasound IVP CT scan |
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Polycystic Kidney Disease Nursing Care
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Largely supportive to cope with symptoms
Encourage fluid intake to prevent UTI and calculi Antihypertensives Pain medications Diet restrictions when signs of renal failure occur Eventually will require dialysis or transplant |
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Intra-renal acute renal failure
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Damage to the kidney itself
Caused by Toxin or medications (NSAIDS/certain antibiotics-gentamicin/contrast dyes) Ischemia for greater than 2 hours (severe vascular disorders) Glomerulonephritis and other infections Blood transfusion reactions or allergies Autoimmune diseases like lupus |
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Post-renal
ARF |
Obstruction of urine flow
BPH/Trauma (including spinal cord injuries) Renal or urinary tract calculi tumors |
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Pre-renal (55%)
ARF |
Decreased blood flow to kidneys
Reversible if caught early May be caused by Severe dehydration (GI loss, Vomiting and diarrhea) Excess diuretic therapy Hypovolemia/shock Burns Sepsis Vascular problems/heart failure/thrombosis |
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Acute Renal Failure Manifestations
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3 Phases
Initiation Time of insult until symptoms develop Maintenance/Oliguric phase Oliguria due to reduction in GFR which can last 10-14 days but can last up to months. Note difference in symptoms if cause if prerenal versus intra-renal Occurs within 1 to 7 days of causative agent Note 50% of patients may not present with this symptom |
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Acute Renal Failure Oliguric Phase Manifestations
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Urinary (urinary output decreased to 400 ml/day or less)
Muscle weakness & Fatigue GI symptoms (N & V) Fluid volume excess (due to fluid retention) Metabolic acidosis (kidneys cannot synthesize ammonia which is needed for H+ ion secretion) Sodium imbalance (tubules cannot conserve sodium so may have low serum sodium) Potassium excess (kidneys cannot do there job of excreting 80-90% of body’s potassium. Hematologic (decreased renal function results in impaired RBC production) Calcium deficit and phosphate excess (why because kidneys needed to activate vitamin D so that calcium can be absorbed in the GI tract) but remember PTH will cause bones to demineralize so calcium is released) Elevated BUN and creatinine (because kidneys not getting rid of the nitrogen wastes from protein metabolism) can also lead to neurologic changes (agitation, confusion) NOTE creatinine single most important serum indicator of renal failure since it cannot be altered by other factors or disease processes |
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Diuretic phase
ARF |
may last 1- 3 weeks
Urine output begins to increase gradually but nephrons still not fully functional so still have metabolic (uremia) problems. Watch out for hypotension and hypovolemia due to fluid loss |
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Chronic Renal Failure Diagnostics
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BUN and creatinine clearance rise and urine specific gravity fixed at 1.01 (normal is 1.025)
Uremia-urine in the blood Decreased platelets anemia Loss of erythropoieten (what will this lead to ?) Inadequate clearance of fluid and electrolytes Hyperkalemia Hypermagnesemia Hyperphosphatemia Azotemia Hypocalcemia Metabolic acidosis |
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Chronic Renal Disease Manifestations
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Psychologic-denial, depression, anxiety
Cardiovascular-hypertension, heart failure, dsyrhythmias GI-anorexia, N & V, uremic fetor, GI Bleeds, peptic ulcer, gastritis Endocrine-hyperparathyroidism, thyroid abnormalities, infertility Metabolic-carbohydrate intolerance hyperlipidemia, gout Hematologic-anemia, bleeding (platelet dysfunction), infection Neuro-fatigue, headache, confusion, lethargy, seizures, coma Ocular-retinopathy Pulmonary-uremic lung, pulmonary edema, dyspnea, pneumonia Integumentary-pallor, pruitus, yellow grey discoloration (absorption of urinary pigments), dry scaly skin. Peripheral neuropathies-motor weakness, restless legs syndrome |
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Chronic Renal Failure Nursing Interventions
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Diet
Low protein with supplemental amino acids (urea nitrogen are metabolic byproducts) Once dialysis begins can lessen protein restriction Restrict fluids as ordered Provide electrolyte replacement or restriction Sodium restriction (canned soups, prepared foods, cured meats) Potassium restriction (salt sustitutes, oranges, bananas, melons, tomatoes, prunes, legumes) Replacement Bicarb to treat acidosis Replacement of calcium (but need to restrict phosphate at the same time and food high in calcium also are high in phosphate-cheese, milk, ice cream Monitor plan care for hypertension and heart failure Prepare patient for dialysis or kidney transplant Monitor I/O Monitor Vital signs Medications need to evaluated because of inability to excrete properly Monitor lab results (pH, electrolytes, BUN , creatinine, CBC) Medicate for N & V Observe for signs of infection Provide periods of rest between activities Weigh daily |
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Dialysis complications and interventions
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Peritonitis
Catheter obstruction Insufficient outflow (reposition client) Hypotension and hypovolemia (excessive fluid removal) Hyperglecemia from dialysate (watch closely in diabetic client and do not let dwell longer than ordered) Make sure you warm fluid prior to adminstering |
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Arteriovenous fistula
dialysis care |
Vascular access to a vein and artery for hemodialysis ( most commonly used are radial or brachial artery and cephalic vein)
Auscultate for bruits and palpating for thrills Lack of thrill may mean there is a clot Avoid arm for other procedures (i.e. IV starts , B/P, or venipuncture) Home care (keep fistula clean and dry, watch for redness and swelling, exercise is beneficial for vein enlargement) |
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Bladder Cancer manifestations
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*Painless* hematuria most common sign
Inflammation may mimic signs of bladder infection (frequency, urgency, dysuria) Colicky pain Diagnostic tests Urinalysis Urine ctology for presence of cancer cell MRI, CT, IVP, or cystoscopy |
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Post-op Care for Patient with Bladder or Kidney Cancer
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Care after removal of bladder/kidney
Administer antiobiotics as ordered Assess respiratory status Administer pain medicine as ordered Monitor urine output closely (<30ml/hr report ot MD) Irrigate catheter as ordered Observe for signs of hypovolemic shock (pallor, hypotension, and tachycardia) Inspect stoma if urinary diversion Monitor urine for bleeding or clots Stoma should be red or bright red Bluish or deep red stoma should be reported to MD Monitor incision for signs of infection and change dressings per MD order |
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Kidney Transplant Nursing Considerations
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Pre-op
Reducing anxiety (through teaching, medications, and just being there) Rejection education is very important Begin immunosuppressant therapy Dialysis the day before suregery Post-op Baseline assessments (VS, I/O, LOC) Frequent position changes, TC & DB, incentive spitrometer use Strict aseptic technique to minimize infection (why?) Observe for signs of tissue rejection Pain management Expect blood tinged urine for several days Live kidney (urine should be expected immediately, a cadaver kidney may take up to 2 days to 2 weeks for urine production Weigh daily) |
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Kidney Transplant Nursing Considerations
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Tissue rejection
Fever Redness, tenderness, swelling at surgical site Elevated WBC count Decreased urine output with increased protein in urine Sudden weight gain Hypertension Elevated BUN and creatinine Types Hyperacute (within hours of surgery due to antibody reaction to donor antigens) *note rare now to checking of compatabilities Acute (within days or months occurs due to body immune response against tissue in organ donor) Chronic (within months to years) |
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Jaundice (icterus)
Obstructive |
Extrahepatic (obstruction of common bile duct by gallstones or tumor)
Prevents transport of bile into the duodenum Accumulation of bile in the liver which overflows into the blood Liver cogugates this |
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Intrahepatic jaundice
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disturbance of hepatocyte function and obstruction of bile canalicculi found with drug reactions or hepatitis)
Decreases flow of conjugated bilirubin into common bile duct and thus into the intestine. If caused by hepatocyte failure there will be an increase in unconjugated bilirubin |
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Hemolytic
jaundice |
Caused by excessive breakdown of red blood cells
Amount of bilirubin produced exceeds the ability of liver to conjugate so there is and increase in unconjugated bilirubin in the blood Blood transfusion reaction, membrane defects of RBCs, severe infection, or toxic substances |
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Jaundice Diagnostic Tests
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Hyperbilirubinemia (high levels of bilirubin in the blood)
Total bilirubin (nomal .1 to 1.2 mg/dL) Direct (conjugated) bilirubin .1 to .3 Increased in obstructive jaundice Indirect (uncongugated) bilirubin .2 to .8 increased in hepatocellur failure Increased in hemolytic jaundice Note congugated bilirubin is water soluble so may show up in urine (normal is 0 -0.2 mg/dL) Increased in obstructive jaundice Other tests Alanine aminotransferase (ALT) increased in hepatocellular disease Asparate aminotransferase (AST) elevated with hepatitis and gallstones Alkaline phosphatase (ALP) increased in both types of obstructive jaundice Radiologic procedures used Abdominal ultrasound and CT scans |
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Jaundice Nursing Care
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Symptom management
May have to keep NPO because introduction of food will increase pain IV hydration and pain management Treat underlying cause Medications that sequester bile may be used Tips to ease itching Cool or tepid bath containing colloids (oatmeal, cornstarch, soybean powder) can reduce itching Cool room (68-70) Emollient lotion rather than alcohol based Topical corticosteroids |
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Hepatitis A (HAV
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Viral infection of liver causing inflammation of Hepatic tissue
Most common type of viral hepatitis Causing 40% of cases worldwide Etiology Transmitted by the fecal-oral route Unsanitary conditions Intimate contact with someone infected Sources Contaminated foods, water, and shellfish Incubation period is 4-6 weeks Most contagious 10 to 14 days prior to onset of symptoms Can cause hepatic cell necrosis and swelling and inflammation |
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Hepatitis B
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is caused by the virus HBV. It is spread by contact with an infected person's blood, semen, or other body fluid. And, it is a sexually transmitted disease (STD). You can get hepatitis B by:
Having unprotected sex (not using a condom) with an infected person. Sharing drug needles (for illegal drugs like heroin and cocaine or legal drugs like vitamins and steroids). Getting a tattoo or body piercing with dirty (unsterile) needles and tools that were used on someone else. Getting pricked with a needle that has infected blood on it (health care workers can get hepatitis B this way). Sharing a toothbrush, razor, or other personal items with an infected person. An infected woman can give hepatitis B to her baby at birth or through her breast milk. Through a bite from another person. With hepatitis B, the liver also swells. Hepatitis B can be a serious infection that can cause liver damage, which may result in cancer. Some people are not able to get rid of the virus, which makes the infection chronic, or life long. Blood banks test all donated blood for hepatitis B, greatly reducing the risk for getting the virus from blood transfusions or blood products. |
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HEP CDE
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is caused by the virus HCV. It is spread the same way as hepatitis B, through contact with an infected person's blood, semen, or body fluid (see above). Like hepatitis B, hepatitis C causes swelling of the liver and can cause liver damage that can lead to cancer. Most people who have hepatitis C develop a chronic infection. This may lead to a scarring of the liver, called cirrhosis. Blood banks test all donated blood for hepatitis C, greatly reducing the risk for getting the virus from blood transfusions or blood products.
Hepatitis D is caused by the virus HDV. You can only get hepatitis D if you are already infected with hepatitis B. It is spread through contact with infected blood, dirty needles that have HDV on them, and unprotected sex (not using a condom) with a person infected with HDV. Hepatitis D causes swelling of the liver. Hepatitis E is caused by the virus HEV. You get hepatitis E by drinking water infected with the virus. This type of hepatitis doesn't often occur in the U.S. It causes swelling of the liver, but no long-term damage. It can also be spread through oral-anal contact. |
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Hepatitis A Nursing Care
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Proper handwashing!!!
Patient will be put on contact precautions 90% of cases avoided with HAV vaccine!!! Usually managed as outpatients Educate Abstinence from alcohol Diet low in fat and high in carbohydrates (why?) Need for good breakfast because nausea worse later in the day Provide IV fluids as ordered Analgesics for pain Monitor for signs of dehydration Monitor activities due to fatigue Monitor for signs of bleeding (in stool, urine, gums if liver is severely compromised) |
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Hepatitis Manifestations and Nursing Care
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Safe sex practices
No sharing needles Need for vaccinations Don’t give blood |
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Cirrhosis Nursing Care
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Clients with Ascites are fluid restricted to prevent further fluid accumulation and decreased protein and salt intake
Administer antiemetics and diuretics Weigh daily and monitor I/O Measure abdominal girth Place in high fowlers and use supplemental O2 and encourage deep breathing Maintain skin integrity (lotion and antihistamine and turn every 2 hours May need to institute bleeding precautions (avoid injections and observe for signs and symptoms of bleeding) Monitor labs Small frequent meals |
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Hepatorenal syndrome nursing interventions
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Monitor fluid and electrolytes
Eliminate drugs that are nephrotoxic or hepatotoxic Will likely need liver transplant and hemodialysis |
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Cholelithiasis nursing care
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Patient kept NPO and given IV fluids for hydration until pain subsides
Opiods are used to control pain IV antibiotics are administered |
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Acute Pancreatitis Diagnosis
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Blood tests
During acute pancreatitis, the blood contains at least three times the normal amount of amylase and lipase, digestive enzymes formed in the pancreas. Changes may also occur in other body chemicals such as Glucose (hyperglycemia as high as 500-900 Hypocalcemia Diagnosing acute pancreatitis is often difficult because of the deep location of the pancreas. The doctor will likely order one or more of the following tests: Abdominal ultrasound. Abdominal x-ray Computerized tomography (CT) scan. Endoscopic ultrasound (EUS). Magnetic resonance cholangiopancreatography (MRCP). |
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Acute Pancreatitis Nursing care
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Goal prevent further autodigestion of pancreatic tissue and systemic complications
Patient maintained on NPO status May have NG tube if ileus or extreme vomiting occur IV hydration to prevent hypovolemia or shock TPN may be needed for prolonged episodes Surgical removal of gallstones Possible peritoneal lavage to remove toxic exudates from abdomen Adminsiter pain medications (demerol) May need insulin if hyperglycemic Antibiotics if infection present Monitor vital signs and I/O Weigh daily Monitor bowel sounds and chart stool. Monitor respiratory status Limit high fatty foods, alcohol, and smoking |
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Cirrhosis nursing care biopsy
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Biopsy only definitive way to diagnose cirrhosis type
Nursing care post biopsy Monitor VS q 15 minutes X 4, q30 X 2, q60 min X 2, q4 hrs X 4, then routine Observe dressing same intervals for oozing Monitor for signs and symptoms of bleeding Apply direct pressure to biopsy site after procedure Position on right side for compression of biopsy site Maintain NPO for 2 hours after biopsy Bed rest for 24 hours Avoid activities that increase intrabdominal pressure for 1 to weeks (coughing, lifting, straining) No lab test will diagnose cirrhosis Monitor many labs because cirrhosis affects so many organ systems |
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nursing 300
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rock it
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