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NUR 170 -exam #4 copy/NUR 170 -exam #4 copy., Exams of Health sciences

NUR 170 -exam #4 copy/NUR 170 -exam #4 copy.

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2022/2023

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Gastroesophageal Reflux Disease (GERD)
Patho: backflow of gastric contents into the esophagus.
Causes: imcompenent weaken lower esophageal sphincter, increased intraabdominal pressure -
(pregnancy, overeating, obesity, HH), pyloric stenosis, certain medications (antihistamines, CCBs
sedatives), or mobility disorder.
Risk factors: diets that are chronically low in fresh produce. affects all ages- but elderly are more
prone to complications , food irritants - Caffeine, chocolate, citrus, tamoties, smoking/tobacco,
CCBs, nitrates, mint, alcohol. Medications: anticholinergics (delay gastric emptying), high
estrogen/ progesterone, NG tube placement.
s/s: Pyrosis (heartburn), epigastric pain, dyspepsia (indigestion), pain and difficulty
swallowing (dysphagia), hypersalivation, bitter taste in mouth, regurgitation (aspiration risk),
Dry coughing/wheezing (worst at night), belching, nausea, pharyngitis, dental caries (serve).
eledery s/s: atypical chest pain, ear, nose throat infections, pulmonary problems (aspiration
pneumonia, sleep apnea, asthma) more at risk for developing severe complications- HH and med
s/e, barrett's esophagus or erosion
Labs:
Diagnostics: esophagogastroduodenoscopy (EGD)endoscopy - assess esophagus for s/s of
narrowing and ulcers. Esophageal manometry - assesses function and ability of esophagus to
squeeze food down and how LES closes. . pH monitoring - measures acid amount in esophagus
for 24 hours (small tube stays in esophagus during.
Interventions: nutrient therapy is usually enough.
Eat 4-6 small meals a day. Low fat - high fiber
Limit or eliminate fatty foods, coffee, tea, cola, carbonated drinks , mint, chocolate
Reduce or eliminate from your diet any food that increases gastric
acid and causes pain
Limit or eliminate alcohol and tobacco, and reduce exposure to
secondhand smoke**Smoking and alcohol decrease LES pressure and irritate tissues.**
Do not eat 2-3 hours before bed
Eat slowly and chew your food thoroughly to reduce belching
Remain upright 1-2 hours after meals, if possible
Elevate HOB 6-12 inches using wooden blocks, or elevate your
head using foam wedges. Never sleep flat in bed.
If you are overweight, lose weight.
Do not wear constrictive clothing.
Avoid heavy lifting, straining, and working in a bent-over position.
Chew “chewable” antacids thoroughly, and follow with a glass of water
Do not take anticholinergics (dalay stomach emptying), NSAIDs (contains acetylsalicylic
acid).
Surgery: laparoscopic nissen fundoplication (LNF),
Medications: Take antacids (calcium carbonate) (when taking wait 1-2 hours before taking H2
blocker, antibiotics, or caratate) , H2 receptor antagonist (IV Famotidine)(reduces gastric acid)
, PPIs (IV protonix) (reduces acid, helps esophagus heal, can be given long term, long term use
complication = bone fractures; most common in elderly). Prokinetics ( oral metoclopramide)
Surgical: extreme cases only - fundoplication, wrapping gastric fundus around sphincter area of
esophagus.
Complications: Esphogitis - where the esophagus cells start to erode and become inflamed due to
acid. Barrett's esophagus - results from exposure to acid and pepsin (sometimes nitrosamines)
which changes the cells DNA making them precancerous. Strictures- build up scar tissue in the
esophagus causing narrowing. Laryngopharyneal reflux - acid going into the pharynx going into
respiratory system causing lung infections, ear infections, coughing. complications are most
common in eledery.
Hiatal Hernia
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● Gastroesophageal Reflux Disease (GERD) ○ Patho: backflow of gastric contents into the esophagus. Causes: imcompenent weaken lower esophageal sphincter , increased intraabdominal pressure - (pregnancy, overeating, obesity, HH ), pyloric stenosis, certain medications (antihistamines, CCBs sedatives), or mobility disorder. Risk factors: diets that are chronically low in fresh produce. affects all ages- but elderly are more prone to complications , food irritants - Caffeine, chocolate, citrus, tamoties, smoking/ tobacco, CCBs, nitrates, mint, alcohol. Medications: anticholinergics (delay gastric emptying), high estrogen/ progesterone, NG tube placement. s/s: Pyrosis (heartburn) , epigastric pain , dyspepsia (indigestion), pain and difficulty swallowing (dysphagia) , hypersalivation, bitter taste in mouth , regurgitation (aspiration risk) , Dry coughing/wheezing (worst at night), belching, nausea, pharyngitis, dental caries (serve). eledery s/s: atypical chest pain, ear, nose throat infections, pulmonary problems (aspiration pneumonia, sleep apnea, asthma) more at risk for developing severe complications- HH and med s/e, barrett's esophagus or erosion Labs: Diagnostics: esophagogastroduodenoscopy (EGD)endoscopy - assess esophagus for s/s of narrowing and ulcers. Esophageal manometry - assesses function and ability of esophagus to squeeze food down and how LES closes.. pH monitoring - measures acid amount in esophagus for 24 hours (small tube stays in esophagus during. Interventions: nutrient therapy is usually enough. Eat 4-6 small meals a day. Low fat - high fiber Limit or eliminate fatty foods, coffee, tea, cola, carbonated drinks , mint, chocolate Reduce or eliminate from your diet any food that increases gastric acid and causes pain Limit or eliminate alcohol and tobacco, and reduce exposure to secondhand smokeSmoking and alcohol decrease LES pressure and irritate tissues. Do not eat 2-3 hours before bed Eat slowly and chew your food thoroughly to reduce belching Remain upright 1-2 hours after meals, if possible Elevate HOB 6-12 inches using wooden blocks, or elevate your head using foam wedges. Never sleep flat in bed. If you are overweight, lose weight. Do not wear constrictive clothing. Avoid heavy lifting, straining, and working in a bent-over position. Chew “chewable” antacids thoroughly, and follow with a glass of water Do not take anticholinergics (dalay stomach emptying), NSAIDs (contains acetylsalicylic acid). Surgery: laparoscopic nissen fundoplication (LNF), Medications: Take antacids (calcium carbonate) ( when taking wait 1-2 hours before taking H blocker, antibiotics, or caratate ) , H2 receptor antagonist (IV Famotidine) (reduces gastric acid) , PPIs ( IV protonix) (reduces acid, helps esophagus heal, can be given long term, long term use complication = bone fractures; most common in elderly). Prokinetics ( oral metoclopramide) ○ Surgical: extreme cases only - fundoplication, wrapping gastric fundus around sphincter area of esophagus. Complications: Esphogitis - where the esophagus cells start to erode and become inflamed due to acid. Barrett's esophagus - results from exposure to acid and pepsin (sometimes nitrosamines) which changes the cells DNA making them precancerous. Strictures - build up scar tissue in the esophagus causing narrowing. Laryngopharyneal reflux - acid going into the pharynx going into respiratory system causing lung infections, ear infections, coughing. complications are most common in eledery. ● Hiatal Hernia

Increases risk of GERD because of increase of intra abdominal pressure. It's a hernia that is formed at the top of the stomach near the LES putting pressure on it causing it to not operate properly. Types s/s: ○ Sliding: heartburn, regurgitation, chest pain, dysphagia, belching. ○ Paraesophageal: feeling of fullness or breathlessness after eating, feeling of suffocation. Chest pain that mimics angina, s/s worse in recumbent position. Patho: (esophageal/ diaphragmatic hernia) portion of stomach herniates through diaphragm into thorax. Risk factors: Herniation results from weakening of muscles of diaphragm aggravated by that increase abdominal pressure ( pregnancy, ascites, obesity, tumors, heavy lifting ) Complications: ulceration, hemorrhage, regurgitation and aspiration of stomach contents, strangulation, and incarceration of the stomach in the chest with necrosis, peritonitis, mediastinitis. Interventions: The most important role of a nurse is health teaching for HH. small frequent meals, avoid eating at night, avoid food irritants. Sleep with the head of the bed elevated 6 inches, remain upright for several hours, avoid straining or excessive exercise, and avoid restrictive clothing. Teach patients and families that they need to follow a strict diet and exercise and should reduce body weight to reduce intra abdominal pressure. Medications: avoid anticholinergics (delay stomach emptying) ● Herniation ● Patho: weakness in abdominal muscle wall through which a segment of bowel protrudes Causes: congenital or acquired muscle weakness and increased intra abdominal pressure contribute to hernia formation. Types: Assessment: patient should be lying down and then assess when patient is standing. If hernia is reducible it may disappear when the patient is lying flat. Listen for bowel sounds (absence = GI obstruction) Interventions: truss- pad with firm support for people who can’t have surgery. Herniorrhapy - replaces contents of the hernia sac into the abdominal cavity and closing the opening. Hernioplasty - reinforces the weakened muscular wall with a mesh patch. Pre/post care: avoid coughing - but deep breath. Inguinal repair - wear scrotal support and elevate scrotum with pillow in bed. Avoid bowel or bowel distension by - stimulating voiding techniques (standing them up), avoid constipation ( avoid straining during healing) ● Intestinal obstruction = compromises elimination ● Patho: an obstruction can be partial or complete and can occur in either the small or large intestine. Types and s/s: ○ Small: abdominal discomfort or pain by visible waves in middle abdomen, upper or epigastric abdominal distention, nausea, profuse vomiting, obstipation, sever F&E imbalances, metabolic alkalosis. ○ Large: intermittent lower abdominal cramping, lower abdominal distention, no vomiting, constipation or ribbon like stools, sometimes metabolic acidosis. Diagnostics: no definitive test to confirm. CT scan , abdominal ultrasound Interventions: decompress GI tract by inserting a gastric tube (oral or nasal) ** must check placement, patency, output every 4 hours. Assess for peristalsis by auscultating for bowel sounds with suction off** monitor nasal skin around the tube. It is a surgical emergency when this is an obstruction with compromised blood flow. Perforation: Sudden change in abdominal pain from dull to sharp or local to generalized may indicate a perforation. Inform MD ASAP of pain, VS & o2 sat. perforation is an emergency. Peptic Ulcer Disease ● Patho: Ulcer formation in the upper GI that affects lining of the stomach. The ulcers form due to gastric acid and pepsin and breakdown of defenses (prostaglandins - release bicarbonate, control acid amount secreted; bicarbonate of the mucosa = protect lining of the stomach) that protect the stomach lining which signals to the parietal cells to release more HCL acid which erodes the stomach lining further..

After surgery avoid any OTCs containing aspirin or other NSAIDs. Emphasize the importance of following treatment for H.pylori, the ulcer, and keeping follow up appointments. Help patient identify situations that cause stress, describe feeling during stressful situations and develop a plan to cope with stressors. Dumping syndrome: rapid emptying of gastric contents into the small intestine that occurs following gastric resection. ● s/s: nausea, bloating, hypotension, syncope, and diarrhea. occurs 15- mins after eating, N&V, feeling of abdominal fullness, abdominal cramping, diarrhea, palpitations, tachycardia, perspiration, weakness, and dizziness, borborygmi ( loud gurgling sounds from bowel hypermotility. ) late dumping watch for s/s of hypoglycemia due to the release of insulin, sweating, weak, dizzy. Happens 3 hours after eating. ● Interventions: avoid salt, sugar, milk, or very hot or very cold foods. Eat a high protein, high fat ,low fiber, low carb diet. Eat small frequent meals, don't drink fluids with meals or after. Lay down for 30 mins after a meal. Take antispasmodic medications to delay gastric emptying. ● Irritable bowel syndrome (not inflammatory, no permanent damage) ● Patho: chronic or recurrent diarrhea, constipation, abdominal pain , and bloating. Cause: unclear, genetic, environmental, hormonal, stress s/s: abdominal pain, cramps, pain in the lower left quadrant. Changes in bowel patterns (diarrhea, constipation, or alternating pattern of both). Or consistency of stool or passing of mucous. Food intolerance. Risk factors:

Labs: serum albumin, CBC, erythrocyte sedimentation rate, and H. pylori testing (to detect infection and nutritional deficits) Diagnostics: Interventions: increase fiber 30-49 g daily.. Drink 8-10 cups of liquid per day. Food diary - help identify triggers and bowel habits. Help patient ID and eliminate foods associated with exacerbations. Medications: antidiarrheals, bulk forming laxatives. Constipation: lubiprostone, linaclotide. Diarrhea: alosetron. Probiotics, peppermint oil capsules, stress management (medication, imagery, yoga) ● Appendicitis ● Patho: inflammation of appendix. When inflamed or infected it can rupture in hours. Causes: obstruction - hard stool that blocks off the appendix. (fecalith) (causes pressure by stopping mucus secretion by the appendix) , parasites, foreign object, enlargement of lymph nodes (crohn's gastroenteritis) Pressure causes: venous obstruction - stops blood flow and the blood that's in there is stagnant = risk for blood clots. If the appendix ruptures all the juices will go all over the abdominal cavity = peritonitis. ● s/s: pain in periumbilical area to RLQ pain most intense at mcburney’s point -. Rebound pain/tenderness, (pain after you stop touching it) abdominal rigidity. Cant fart Side lying position with bent knees

Keep bathrooms clean to avoid exposure to stool. Inform MD if symptoms last longer than 3 days Do not prepare or handle food that will be eaten by others. ● Gastritis inflammation of the stomach lining specifically, and not always caused by infection. ● Patho: inflammation of stomach or gastric mucosa. Causes: ○ acute - ingestion of disease contaminated food, or food that is irritating/ over seasoned. Overuse of aspirin or NSAIDs. Excessive alcohol. Bile reflux. Radiation therapy. ○ Chronic: benign/ malignant ulcers. Bacteria H pylori. Autoimmune disease. Dietary factors, medications, alcohol smoking, or reflux. s/s: ○ Acute: rapid epigastric discomfort, hematemesis, dyspepia, N&V, gastric hemorrhage, anorexia. ○ Chronic: vague epigastric pain that is relieved by food. Anorexia, N&V. intolerance of spicy and fatty foods, pericious anemia. Prevention: eat a well balanced diet. Avoid excess alcohol and coffee. Use caution in taking large doses of aspirin or ibuprofen (NSAIDs), and corticosteroids. Avoid food poisoning. manage stress. Stop smoking. Protect yourself against the workplace (lead, nickel) . Call MD if you have s/s of esophageal reflux. Interventions: Acute: food and fluids withheld until symptoms subside, give ice chips - clear liquids- then solid foods. Chronic: monitor for s/s of hemorrhagic gastritis - hematemesis, tachycardia, hypotension, contact MD. avoid irritating foods and fluids - caffeine, spicy, high seasoned food, alcohol, nicotine. Medications: antibiotics to treat H Pylori. Antacids. B12 injections if needed. Medications: sucralfate (carafate), B ○ Teach patients to monitor for symptom relief and side effects of drugs. Call MD if adverse effects appear or worsening of gastric distress. Remind patients not to take other OTCs if they are taking a similar prescribed drug. ● Inflammatory bowel disease: comes in 2 forms UC and crohn's ○ Ulcerative colitis ■ Patho: inflammatory bowel disease that causes inflammation and ulcers in the inner lining of the colon and rectum. that results in poor absorption of nutrients. Starts in rectum. When the bowel gets inflamed it causes ulcers which release pus and mucous Cause: unknown; suspected autoimmune Risk factors: high fat diet, consuming diary, stress, genetics, illness, over usage of NSAIDs s/s: fever, anorexia, weight loss, malaise, abdominal tenderness or cramping, severe diarrhea containing blood or mucus , rectal bleeding, malnutrition, dehydration (colon cant absorb water causing diarrhea causing dehydration) , electrolyte imbalance, anemia , vitamin K deficiency. Urgent frequent bowel movements. Labs: Diagnostics: barium enema , colonoscopy Complications: “lead pipe sign” - colon smooths out, rupture of colon - causing peritonitis which can lead to sepsis and shock (life threatening), toxic megacolon - the colon is paralyzed and can't work.

Interventions: ● monitor VS, bowel sounds and movement. ● Monitor for s/s of peritonitis and toxic megacolon (extreme pain or tenderness, hyperactive bowel sounds, increased HR RR fever) ● NPO with IV fluids ● High protein diet with vitamins and iron supplements. Avoid gas forming foods - dairy, whole wheat, nuts, pop corn, raw fruits, vegetables, pepper, alcohol, caffeine. Medications: used to control flare ups. salicylates, corticosteroids, immunosuppressants. No NSAIDs, use tylenol. Stoma that is purple - black = compromised circulation, call MD asap. ○ Crohn’s Disease ■ Patho: inflammatory bowel disease that can occur anywhere in the GI tract causing inflammation and ulcers .but usually affects the terminal end of the ileum. Effects all layers of the bowel. Can be scattered in the GI tract. No cure like UC (can't just get rid of disease part of colon due to it being spread through out) Cause: unknown; potential autoimmune. Risk factors: same as UC s/s: abdominal pain (RLQ), ulcers in mouth, diarrhea, weight loss, malnourishment, fissures, bloating, Complications: high alert for peritonitis (first sign of peritonitis in elderly is confusion) .abscesses= infection pocket = sepsis= death (abscesses can turn into fistulas), fistulas = ulcer in intestinal wall connecting to another intestine or organ = sepsis. Adequate nutrtion and F&E are priorities in care of fistula. Dehydration should be treated immediately. Be sure that wound drainage is not in direct contact with the skin because the fluids are caustic(skin integrity) Malnutrition. fissure= anal tears. Stricture = narrowing of intestinal wall= obstruction of food. Arthritis, gallbladder stones, rashes, eyes problems. Interventions: no smoking makes it worse, bowel rest with TPN in severe cases. Monitor daily weights. Monitor I&O, full GI assessment (freq, description of BM, sounds of Bowels) Diet: high fiber foods - nuts, raw fruits, vegetables, spicy, fatty. Eat a low fiber diet - white rice, cook vegetables, high protein. Medications: salicylates, corticosteroids, Adalimumab ( immunosuppressants photosensitivity). No NSAIDs. ■ ● Diverticular disease ● Patho: ○ Diverticulosis : formation of hollow sac cavities found through the intestine, can happen anywhere but most common in sigmoid colon. Diverticula = pushed out areas Diverticulum = singular pushed out area s/s: usually asymptomatic, maybe have a change in bowel pattern. Only notice conditions when complications arise. Causes: low fiber diet = straining pooping causing herniations Risk factors: older age, genetics Diagnostics: colonoscopy, CT of abdomen with contrast. Barium enema Complications: Diverticular bleeding - bright blood in stool , no pain ○ Diverticulitis - hernations becomes inflamed causing pain, can rupture causing perintinis Complications: abscess = ruptures= peritonitis = sepsis. (first sign of peritonitis in elderly is confusion) s/s: pain LLQ, bloating, elevated WBC, cramps, blood in stools, constipation, fever. Tx: can drain abscess, oral antibiotics and bowel rest. Serve: IV antibiotics, fluids. Intervention: ● Initial phase: antibiotics NPO. assess for peritonitis. Monitor hydration. ● Recovery phase: start clear diet (jello, juice broth), then low fiber diet (white rice, cooked vegetables, eggs)

■ Acute and chronic infections ■ Diagnostics: anti-Hcv (positive = active) ■ Tx chronic: antivirals, DAAs ■ Prevention: no vaccine, no immune globulin , sharp precautions, hand washing ● Hepatic abscess ● Patho: Abscess cavity in the liver full of liquid contain living & dead leukocytes, liquefied liver cells and bacteria Risk factors: alcohol, malnutrition, contaminated food and water s/s: Pain in the right upper abdomen, clay colored stools, dark urine, chest pain, Fever, chills, night sweats, loss of appetite, weight loss, N&V.. ● Cholecystitis ● Patho: inflammation of the gallbladder, chemical irritation and inflammation from gallstones (cholelithiasis) that obstruct the gallbladder. Risk factors: obese women 20-60 highest risk for gallstone formation. age, native american, mexican, white, obesity, rapid weight loss, prolonged fasting, increased cholesterol, women on hormone therapy, cholesterol drugs, family history of gallstones. Prolonged TPN, chron’s, gastric bypass, sickle cell, diabetes, pregnancy, genetics. s/s: upper abdominal pain that radiates to right shoulder, pain triggered from high fat or high volume meal, anorexia, N&V, dyspepsia, belching, gas, abdominal fullness, Plumberg’s sign - rebound tenderness, fever, jaundice. eldery : absence of pain and fever. Localised tenderness might be the only sign. Confusion is the 1st sign of gallbladder disease. Biliary colic: appears with tachycardia, pallor, diaphoresis, prostration. Call RR or MD ASAP. keep HOB flat. Diagnostic: elevated WBC Interventions: nutrition is adequate they are eating (low fat) , pain management, antibiotics

UTIs = Cystitis, Urethritis, Pyelonephritis ● Cystitis / Urethritis / UTI ● Cystitis: inflammation of the bladder. Can be a complication of crohn's, diverticulitis. UTI: inflammation and infection of the bladder. Infections can be caused by bacteria, viruses, fungi, parasites. Uncomplicated UTI is usually caused by E. coli. ○ Complication: Spread of the infection from the urinary tract to the blood to the heart is termed bacteremia or urosepsis. ■ Urosepsis is associated with mortality rate of 30% timely reporting of ● abnormal urinalysis : positive nitrogen, leukocyte esterase ● Abnormal CBC results: elevated WBC Prevention of UTI: drink 2-3 liters of water daily, rest, spermicides, wipe front to back, no douches, bubble bath, tight fitting clothes. Don't delay urinating. Cranberry juice apply estrogen. s/s: frequency, urgency, dysuria, low back pain, cramping, nocturia, hematuria, pyuria, tension, suprapubic tenderness or fullness, feeling of incomplete emptying, CVA tenderness. Eldery: confusion, sudden onset of incontinence. Fever ○ Risk factors: obstructions, calculi, cathers (longer than 48 hours), diabetes, women, age (73+ greatest risk), sexualy acitvy, antibiotics. Labs: clean catch urine - urinalysis = elevated WBCs , RBCs, casts Diagnostic: urine culture= assess bacteria (take culture before antibiotics) , voiding cystourethrography, cystoscopy- hunner’s ulcers present Medications: sulfamethoxazole ( photosensitivity, crystal urine if not enough fluids) / trimethoprim - should be stopped at the first appearance of rash. Could mean Stevens-Johnson syndrome (aching joints and muscles, blistering of skin, peeling). Antibiotics are one of the drugs most frequently involved in error of administration who have allergies to these drugs. Cefaclor. Ciprofloxacin ( tendonitis/ tendon rupture) Phenazopyridine - angelsic ( orange red pee) Complications: with antibiotics candida can occur with long term use. Interventions: drug therapy, fluid intake, comfort measure- warm sitz bath, heating pad, void every 2-3 hours Urethritis: inflammation or infection of the urethra.

● Urinary Incontinence ● Patho: disrupts elimination. Can be permanent or not loss of urine. Not a normal change associated with aging. Risk Factors for eledery : imbolity (bed rest), hearing, vision impairments. (can't reach call light) getting out of bed to pee is a common cause of falls. Risk factors: childbirth, urologic procedures, dementia, stroke, MS, parkisons, UTI, mobility. african american women are at risk to be under treated. Assess: age and sex, detailed symtpoms, obtain a 24 hr I&O voiding, assess mobility, cognitive ability, communication, assess barriers to tolieting - access privacy. Labs and Diagnostic: urinalysis, bladder scan, CT kidney and ureters, EMG of pelvic muscles Interventions: pelvic muscle exercises, bladder training, nutrition therapy, drug therapy, applied devices, catheterization Medications: oxybutynin (reduces muscle spasms) , diphenhydramine ( anticholinergic effects) Types: ○ Stress: loss of small amounts during coughing sneezing, jogging, lifting. Tx: pelvic floor exercises, kegels ○ Urge: loss of urine associated with sudden, strong desire to urinate. Cannot suppress urge (overactive bladder) Tx: bladder training + drug therapy. anticholinergics : swallow tablet or capsule whole, no chewing or crushing- will absorb too fast - adverse effects. No alcohol or caffeine. Limit fluids after dinner ○ Overflow: bladder is over distended, leakage occurs when medium capacity of the bladder is reached with no contraction from the bladder. (reflex incontinence) can be caused by an obstruction like a kidney stone. Tx: bladder compression and intermittent self catheterization ○ Functional: caused by cognitive dysfunction or impaired vision or inability to reach the bathroom. Tx: make it easy to reach a toilet, habit training, briefs, catheter. Do not tell patients to wet the bed when wearing briefs, habit training is important. make a schedule

● Urolithiasis (renal calculi = kidney stones = stone disease) ● Patho: presence of calculi in the urinary tract. Usually don't have symptoms unless they go into the lower tract. Causes a lot of pain. Urinary obstruction Nephrolithiasis = stone is the kidneys Ureterolithiasis = stone in the ureter Causes: dehydration, urinary stasis, immobility, finfection, hypercalcemia, medications, supersaturation of urine with calcium or uric acid that becomes crystallized. Nidus = deposit of crystals along the lining of kidney and urinary tract. Risk factors: Always ask about family history of kidney stones. Most common in southeast US, japan, W Europe. Calcium stone disease is more common in men and occurs in young adults or middle adults. White men = most at risk. ● calculi= calcium, phosphate, oxalate, uric acid, struvite, or cystine crystals. Painful when in ureters ● Labs: specific gravity, osmolarity, increased urine pH, 24 hour urinalysis. WBC, KUB, intravenous pyelogram KUB (xray of kidneys/ureters/bladder) , IVP (dye contrast - shellfish, iodine, metformin) 24 hour urine (keep on ice/refrigerated), UA, ultrasound s/s: renal colic = serve pain- obstruction (N&V, pallor, diaphoresis) , flank pain, pyuria, hematuria, great desire to void, tachycardia, flank pain, oliguria, anuria. Interventions: teach family members and patients to avoid dehydration. pain management- opioids for renal colic, NSAIDs, allopurinol. Monitor I&O, Strain all urine, ambulate, monitor I&O, 3-4 L water daily. Lithotripsy (watch for obstruction- might have bruising and blood in urine). Medications: Toradol/ ketorolac -( pain) , allopurinol , thiazide diuretics ( help rid of calcium caused stones) ● Renal calculi= kidney stones ○ Patho: hard crystalized minerals and salts that form out of filtrate produced by the nephrons ○ Caused by too much: calcium (too much sodium), oxalate (GI disorders), uric acid (low urine pH- gout, dehydrated), cystine (too much cystine in urine lowers pH urine) struvite (chronic UTIs changed pH or urine ^) / too much protein, calcium, purine, dehydration, urinary stasis. ○ Can be found anywhere in the kidney and in the bladder. Can cause obstructions. ○ Increase fluid 2-3 L ○ Calcium = limit animal based protein and limit sodium ○ Calcium oxalate = limit oxalate - spinach rhubarb, beets, nuts, tea, strawberries ○ Uric = seafood, whole grains, legumes

● Glomerulonephritis ● Types: Acute: group of diseases that injure and inflame the glomerulus capillaries (part of the kidney that filters blood.) occurs suddenly. Pg. 1376 Types: ● Primary: caused by strep, staph, pneumonia, syphilis, TB, Hep B&C, herpes, malaria, varcellia, etc. , Excessive inflammation, or by a rapid progressive glomerulonephritis - results in rapid loss of kidney function. Risk factors: systemic disease, strep tococcal infections, or recent exposure to infection. s/s: systemic volume overload: extra heart sound (s3 gallop), enlarged neck veins, edema, crackles in the lungs, tachypnea, dyspnea, orthopnea. Changes in urine output, hypertension, weight changes , fatigue, malaise, activity intolerance. Smoke red rusty cola colored urine, hypertension Complications: edema, pulmonary edema, hypertension Eldery s/s: circulatory congestion, p ulmonary edema. - can be confused with HF. the urine elimination problem is the defining factor. Labs: increased creatine, BUN decreased GFR, decreased urine output and protein in urine. abnormal urinalysis - including leukocyte esterase, nitrogen, RBCs, WBCs, low creatinine, contains protein, casts or cells. Diagnostics: positive cultures from urine, blood, sputum, skin, or throat. Serologic testing for antistreptolysin O titers, c3 complement levels, immunoglobulin G, antinuclear bodies, and circulating immune complexes. Results of percutaneous needle biopsy of the kidney to provide a precise diagnosis. Interventions: manage infection - administer antibiotics agents. Balance I&Os, fluid intake may be restricted for the 24 hour urinary output plus 500-600 mL for insensible fluid loss. Can administer mouth swabs or moisturizer. Advise patient to measure weight and blood pressure daily; call MD of any sudden changes. Instruct patient about peritoneal or vascular access care is dialysis is required to control excess fluid volume. Chronic: changes in kidney tissue that develop over decade Risk factors: systemic disease, strep tococcal infections, or recent exposure to infection. s/s: proteinuria, hematuria, hypertension, fatigue, occasional edema. Labs: specific gravity is fixed at 1.010. Protein in urine = less than 2g in 24 hour collection Diagnostics: GFR is low. Creatinine is high 6+, BUN high 100-200. K^P^ ■ Assess for hypertension and irregular heart rhythm, monitor weight. ■ Interventions: dialysis. dietary modifications, fluid intake sufficient to prevent reduced blood flow to the kidneys. Meds for uremia diet: restrict fluids and sodium. Plasmapheresis, cortcoridsteriods , antibiotics ● Kidney trauma ● Patho: penetrating or blunt injuries to the back, flank, or abdomen Prevention: wear a seat belt, practice safe walking habits, use caution riding a bike/motorcycle, wear appropriate clothing when in contact sports. Avoid all contact sports and high risk activities if you only have 1 kidney. If the urethral opening is bleeding consult with the urologist or MD before attempting urinary catheterization to avoid worsening the injury. Medications: vitamin K (clots blood) Labs: Creatinine of 1.5 or more makes patient at risk for acute kidney injury from iodinated contrast media and some drugs. Monitor both baseline and trend values to recognise risk for and actual kidney damage, especially among patients exposed to agents that cause kidney dysfunction. contact MD of increased creatinine greater than 1.5 times than baseline and urine output values of less than 0.5 mL/ kg/ hour for 6+ hours.

● Benign prostatic hyperplasia ● Patho: when prostate gland enlarges, extends upward into bladder, causing bladder obstruction. Can cause over flow incontinence, UTIs, bladder stones which could cause chronic kidney disease. Risk factors: old, genetics, obesity, diabetes, testosterone/ androgen supplements, decreased physical activity. Urinary retention and decreased self esteem Lab diagnostics: urinalysis or urine culture, PSA and serum acid phosphatase level to rule out prostate cancer. BUN creatinine - increased Diagnostics: international prostate symptom score (I-PSS) to determine the severity of lower urinary tract symptoms. Transabdominal ultrasound and or transrectal ultrasound (TRUS), MRI s/s: straining or frequency of urination, nocturia, hesitancy, sensation of bladder fullness after voiding, post void dribbling/leaking. Bladder distention, history of enlarged prostate Interventions: improve urinary elimination - “watchful waiting” yearly exams. Monitor I&O Medications: 5 alpha reductase inhibitors (5-ARI) Finasteride ■ May need to take for as long as 4-6 months before improvement is noticed. s/e: erectile dysfunction, decreased libdo, dizziness - orthostatic hypotension. Change positions carefully and slowly. DO not handle if pregnant Alpha 1 selective blocking agents that improve urine outflow: tamsulosin. ■ Assess for orthostatic hypotension, tachycardia, and syncope (blackout), especially after 1st dose. Be careful when he changed position and report MD any weakness, lightheadedness, or dizziness. Bedtime dosing may decrease the risk for problems related to hypotension. Orthostatic hypotension Patient teaching: avoid drinking large amounts in short time, avoid alcohol, diuretics and caffeine. Void as soon as you feel the urge. Avoid anticholinergics, antihistamines, decongestants (cause urine retention) Procedures: TURP (transurethral resection of the prostate. The enlarged part of the prostate is removed through an endoscopic instrument. After TURP, monitor patient’s urine output every 2- hours and VS, including pain assessment, every 4 hours for the first post op day. Assess for post op bleeding. Patients who undergo TURP are at risk for severe bleeding or hemorrhage after surgery. Although rare, bleeding is most likely within the first 24 hours. Bladder spasms or movement may trigger fresh bleeding from previously controlled vessels. This bleeding may be arterial or venous ( venous is more common.) How to calculate output irrigation : 300 ml in , 400 ml out = 100 ml of actual urine Eldery: may become confused after surgery - reorient them frequently and remind them not to pull on catheter. If patient is restless provide distraction. Do not restrain patient if possible. Post-Op care: monitos for s/s of infection. Help patient out of bed to chair as premitted to prevent complications of immobility. Assess pain every 2-4 hours. Provide safe environment. Reorient patient if needed. Use normal saline for intermittent bladder irrigant. Monitor urine (color, consistency, amount). Check tubing for obstructions - if obstructed - irrigate with NS. Notify surgeon if obstruction does not resolve by irritation or if urinary return looks like ketchup. ■ Interventions for obstruction: irrigate with catheter with NS. if prescribed, administer aminocaproic acid. If the bleeding is venous urine is burgundy with or w/o changes in VS. still contact surgeon of any bleeding. Monitor hemoglobin and hematocrit for anemia due to blood loss. ● Interventions for patient at risk for infection ● Assess for risk of infections

● Pruritus= just itching / symptom of Urticaria ○ Patho:release of histamine with causes itching. Xerosis = dry skin. Things that make itching worse: dryness, increased temperature, perspiration, emotional stress. How to prevent dry skin: Use a humidifier in winter Shower every other day Use tepid water Use superfatted non alkaline soap Rinse skin thoroughly Add oil to bath water Pat dry Avoid clothing that rubs skin - belts, panyhose 3000 mL fluid daily No alcohol or astringents on skin Avoid caffeine and alcohol Risk factors:diabetes Interventions: cut nails rounded, cool sleeping environment Medications: antihistamines = fall risk ● Common skin inflammations pg 463 ○ Eczema ○ Dermatitis ○ Atopic dermatitis ● Pediculosis ● Patho: lice s/s: itching on scalp Risk factors: long hair Interventions: chemicals to kill lice on head or pubic area. Clothing and beds should be washed on hot. Foul smell or matting on head can indicate a secondary infection. ● Scabies ● Patho: contagious skin infection caused by mites transmitted from close contact or bedding.

s/s: curved or linear ridges in the skin. Very intense itching. Diagnostics: scraping of lesion Interventions: scabicides. Wash clothes and personal items with hot water and soap. Medications: permethrin, lindane, crotamiton, benzyl benzoate ● Bedbugs ● Patho: parasite. Does not live in humans but feeds on human blood. Risk factors: travel, resistant to pesticides. - NOT Socialeconomically related or lack of cleanliness s/s: bite mark surrounded by a wheal. That becomes itchy Interventions: home eradication Medications: antihistamines , corticosteroids ● Psoriasis ● Patho: autoimmune disorder that overstimulates immune system. Lesions are scaled with underlying dermal inflammation with abnormal growth of epidermal cells. Risk factors: genetics , skin trama (koebner’s phenomenon- this phenomenon also occurs with sun burn) Labs: s/s: thick reddened papules or plaques covered by silvery whire scales. Diagnostics: Interventions: sun light improves skin. UV therapy, emotional support - self esteem Medications: tazorac, acitretin, bexarotene is teratogenic means it can cause birth defects even when used topically. Teach sexually active women who can get pregnant using this drug to adhere to strict contraceptive guidelines. Instruct paint to discontinue biologic is s/s of infection occur. ● Pressure Ulcer ○ Stages of pressure ulcers: