NECC Theory 2-2
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miakimball1 on March 5, 2012
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223 terms
Terms | Definitions |
|---|---|
 Stomatitis | inflammation of the oral cavity TX: -mouthwash CAUSES: -aphthous stomatitis (canker sores) -herpes simplex virus type 1 (cold sores) |
| Hiatal hernia | lower esophagus/ stomach slides up through hiatus of diaphragm into thorax OCCURS IN: -women -those over 60 -obesity -pregnancy DIAGNOSIS: -x-ray -fluroroscopy (barium swallow) |
| Hiatal hernia signs and symptoms | -none (rare) -pain -heartburn -fullness -reflux |
| Hiatal hernia interventions | -antacids -small meals -no reclining after 1 hour of eating = stop back up -raise head of bed 6-12 inches -no bedtime snacks, spicy foods, alcohol, caffeine, smoking= irritants -surgical management= fundoplication (wrap up part of stomach and wrap around esophagus to prevent sliding |
| Gastroepophageal reflux disease | GERD -gastric secretions reflux into esophagus -esophagus damaged -lower esophageal sphincter (LES) doesn't close tightly = cause DIAGNOSIS: -barium swallow -esophagoscopy (endoscope down the esophagus) -esophy x -endoscopic procedures -fundoplication |
| GERD signs and symptoms | -heartburn -regurgitation -dysphasia (difficulty speaking) -bleeding |
| GERD complications | -*aspiration -scar tissue (narrowing esophagus) -esophagitis (erosion of tissue) -barretts esophagus (precancerous) -bronchospasm -esophageal cancer (result of inhaling gastric secretions) -larygeospasm (result of inhaling gastric secretions) -aspiration pnemonia |
| GERD interventions | -lifestyle changes -medications: antacids H2 receptor antagonists (for acid reduction), prilosec proton pump inhibitors prokinetic agents |
| GERD care | -education -lose weight -low fat, high protein diet -avoid caffeine, milk products, spicy foods |
| Esophageal varices | dilated blood vessels in esophagus CAUSE: -portal hypertension (pressure increases causing back up) -rupture= life threatening |
| Gastritis | NOT ulcers! inflammation of the stomach -protective mucosal barrier breakdown -autodigestion -severe -perforation (extreme cases) -scarring (nutritional status decreases and motility issues) -acute (infectious or autoimmune) or chronic |
| Gastritis signs and symptoms | -abdominal pain (mostly left upper quadrant) -nausea, vomiting -anorexia -abdominal tenderness -feeling of fullness -reflux -belching |
| Gastritis interventions | -treat cause -bland diet (tolerable diet) -antacids -anti-emetics |
| Chronic gastritis type A | autoimmune gastritis (cant be cured) -in fundus SIGNS AND SYMPTOMS: -asymptomactic -leads to pernicious anemia (vit. B12 def. = B12 therapy therapy forever) |
| Chronic gastritis type B | from infection with helicobacter pylori (H. pylori) -lower stomach SIGNS AND SYMPTOMS: -anorexia -heartburn -belching -sour taste -nausea/ vomiting TX: -antibiotics (**why it differs from type A) |
| Peptic ulcer disease | erosion of GI lining PRIMARY CAUSE: -H. pylori -influenced by smoking and alcohol = irritants DIAGNOSIS: -H. pylori -upper GI series -EGD TREATMENT: -bland diet, avoid food that causes pain -avoid smoking, caffeine, alcohol= irritants |
| Peptic ulcer disease types | 1. Gastric: -high left epigastric, upper abdominal burning, gnawing pain -increased 1-2 hours after meals or with food (digestion) 2. Duodenal: -midepigastric, upper abdominal burning, cramping pain in middle of the night -increased 2-4 hours after meal (empty stomach/ acid) -relieved with food or antacids |
| Peptic ulcer disease signs and symptoms | -anorexia -nausea/ vomiting -bleeding emesis= slow bleeding, coffee ground vomiting perforated= bright red blood |
| Peptic ulcer disease interventions | -antibiotics -proton pump inhibitors (to decrease acid production) -histimine H2 antagonists -bismuth subsalicylate -sucralfate/ carfate (coats mucosa) -antacids |
| Peptic ulcer disease complications | -bleeding -perforations (causing peritinitus) -obstruction |
| Stress ulcers | stress to the body -ischemia damaging mucous barrier -acid secretions create ulcers -barrier compromised because of lack of blood supply = result of trauma PREVENTATIVE TX: -quick trauma care -early feeding (enteral feeding) -testing gastric pH (keep above 5) -antacids, histimine blockers, sucralfate |
| Gastric bleeding | from ulcer perforation, tumor, gastric surgery -occult or observable -symptoms vary by severity -treat hypovolemic shock if present (not enough fluids) -NPO, IV fluids, blood, NG tube, oxygen |
| Subtotal gastrectomy | partial removal of the stomach -cancer of the stomach -stomach ulcers 1. gastroDUODENOstomy (billroth 1) -distal stomach removed -anastomosed to duodenum -treats gastric problems 2. gastroJEJUNOstomy (billroth 2) -more distal stomach removed -anastomosed to jejunum -treats duodenal problems (no duodenum) |
| Total gasterctomy | total stomach removal -massive trauma -extensive gastric cancer -massive peptic ulcer disease -anastomosis of esophagus to jejunum |
| Gastric surgery post op care | -monitor vital signs -respiratory status -control pain -I & O -incision site -NG tube care -ambulate early -monitor abdominal status (bowel sounds, vomiting, diarrhea) -education |
| Gastric surgery complications | -hemorrhage -gastric distension -dumping syndrome -nutritional problems (pernicious anemia) -peritonitis -steatorrhea (fatty stools) -pyloric obstruction (opening to stomach) |
| Dumping syndrome | rapid entry of food into jejunum -massive vomiting and diarrhea -decreased BP -sweating -high concentration of food causes dumping of water into intestine -circulating volume drops |
| Peritonitis | infection of peritoneum -rigid, board-like abdomen -fever -shock |
| Constipation | fecal mass held in rectum -feces becomes hard and dry -many causes |
| Constipation signs ans symptoms | -abdominal pain -distention -indigestion -rectal pressure -incomplete emptying -headache -fatigue -decreased appetite |
| Constipation complications | -impaction -ulcers -straining -megacolon -chronic laxative abuse = fibrosis |
| Constipation interventions | -high fiber diet -fluids -exercise -strengthen abdominal muscles -bulk forming agents -stool softeners -education |
| Diarrhea | fecal matter passes rapidly -decreased absorption CAUSES: -bacterial/ viral infection -food allergies |
| Diarrhea signs and symptoms | -fever -foul odor -abdominal cramping -distention -anorexia -intestinal rumbling |
| Diarrhea interventions | -identify cause -replace fluids and electrolytes -increase fiber and bulk -diphenoxylate (lomtil), loperamide (immodium) -lactinex restores normal flora -antimicrobial agents |
| Appendicitis | inflammation of the appendix -increased WBCs -NPO -surgery -postop care SIGNS AND SYMPTOMS: -fever -nausea/vomiting -anorexia -pain in right lower quadrant |
| McBurney's point peritonitis | inflammation/ infection of peritoneal cavity |
| Peritonitis signs and symptoms | -abdominal pain -abdominal rigidity -nausea/ vomiting -fever |
| Peritonitis interventions | -NPO -fluid and electrolyte replacement -naso/ orogastric tube -antibiotics -surgery -pain control |
| Peritonitis complications | -intestinal obstruction -hypovolemia -septicemia |
| Diverticulitis/ diverticulosis | 1. diverticulum -outpouching of bowel mucous membrane 2. diverticulosis -multiple diverticula 3. diverticulitis -inflammation/ infection of diverticulum |
| Divertic... causes | -chronic constipation -decreased intake of dietary fiber |
| Divertic... interventions | -prevent constipation -IV antibiotics -pain conrtol -surgery |
| Chrons disease | inflammatory bowel disease -any part of the intestine -remissions and exacerbations -cause unknown -hereditary |
| Chrons disease signs and symptoms | -abdominal pain -weight loss -diarrhea -fluid and electrolyte imbalance |
| Chrons disease complications | -malnutrition -fissures -abscesses -fistulas |
| Chrons disease diagnosis | -lab testing -endoscopy with biopsy -ultrasound -multiphase CT enterography -magnetic resonance enterography |
| Chrons disease interventions | -medications: anti-inflammatory antidiarrheal antibitoics biologics corticosteroids immunosuppressants -avoid offending foods -surgery if needed -elemental formula or TPN is required -support and education |
| Ulcerative colitis | inflammatory bowel disease -colon and rectum -remissions and exacerbations |
| Ulcerative colitis signs and symptoms | -abdominal pain -5- 20 stools daily -rectal bleeding -fecal urgency -anorexia -weight loss -cramping -vomiting -fever -dehydration |
| Ulcerative colitis interventions | -avoid offending foods -medications: anti-inflammatories antidiarrheal immunosuppressants corticosteroids -surgery if necessary -elemental formula or TPN if required |
| Irritable bowel syndrome | IBS altered intestinal motility/ increased sensitivity to visceral sensations -bowel mucosa not changed -psychological stress -food intolerances -more common in women |
| IBS signs and symptoms | -gas -bloating -constipation -diarrhea -abdominal pain -depression -anxiety |
| IBS diagnosis | -history -physical exam -constipation -diarrhea -readiness for enhanced self health management |
| IBS interventions | -high fiber and bran diet -avoid trigger foods -smaller frequent meals -stress management -behavioral therapy -exercise -medications |
| Abdominal hernias | -protrusion of organ or structure through weakness or tear in wall of abdomen -weakness in abdominal wall with increased intra-abdominal pressure 1. inguinal 2. umbilical 3. ventral (incisional) |
| Abdominal hernias signs and symptoms | -none -bulging |
| Abdominal hernias complications | -strangulated incarcerated hernia |
| Abdominal hernias interventions | -none -observation -support devices -surgery: herniorrhaphy hernioplasty |
| Absorption disorders | inability to absorb one or more major nutrients 1. celiac disease 2. lactose intolerance |
| Absorption disorders signs and symptoms | -weight loss -weakness -general malaise |
| Absorption disorders interventions | 1. celiac disease: -high calorie diet -high protein diet -gluten free diet 2. lactose intolerance -avoid lactose foods -lactaid |
| Absorption disorders nursing care | -monitor fluids, electrolytes, and nutritional status -daily weight -I & O -education |
| Bowel obstruction | flow if intestinal contents is blocked -partial or complete 1. mechanical -blockage occurs within intestine 2. non-mechanical -peristalsis is impaired |
| Mechanical bowel obstruction signs and symptoms | -abdominal pain -blood and mucus per rectum -feces and flatus occur -fecal vomiting may occur -bowel sounds = high pitched, tinkling, or absent -abdominal distention -fluid and electrolyte imbalance |
| Mechanical bowel obstruction diagnosis | -abdominal xray -CT scan -CBC and electrolytes |
| Mechanical bowel obstruction interventions | -NPO -frequent mouth care -nasogastric tube -fluid and electrolyte replacement -medications: antibiotics anti-emetics analgesics -surgery |
| Anorectal problems | 1. hemorrhoids 2. anal fissures 3. anorectal abscess POST-OP CARE: -pain control -sitz baths -dressing changes -stool softeners |
| Lower gastrointestinal bleeding causes | 1. diverticulitis 2. polyps 3. anal fissures 4. hemorrhoids 5. inflammatory bowel disease 6. cancer NURSING CARE: -monitor stools -vitals signs -diagnostic prep -occult blood, melena, red stools -treat cause |
| Ostomy | surgically created opening diverts stool or urine to outside of body |
| Stoma | portion of bowel sutured onto abdomen |
| Abdominal ostomies | 1. ileostomy 2. colostomy 3. urostomy |
| Ileostomy | terminal ileum to abdominal wall after total colectomy 1. conventional ileostomy -small stoma RLQ -continuous flow liquid effluent 2. continent ileostomy -internal resevior with nipple valve -empty resevior 3-4 times daily |
| Colostomy | effluent becomes less liquid and more solid as location of ostomy becomes more distal in colon 1. end stoma -proximal bowel end brought to abdominal wall 2. loop stoma -loop of bowel outside abdomen with bridge under it |
| Colostomy types | 1. double barrel stoma 2. temporary ostomy 3. both ends of colon outside abdominal wall = form 2 stomas 4. proximal stoma is functioning stoma 5. distal stoma is mucous fistula |
| Pre-op ostomy care | -wound ostomy continence nurse -marks site -emotional and physical support -teaching -bowel prep -antibiotics |
| Post-op ostomy care | -vital signs -stoma: pink- red= normal bluish= inadequate blood supply black= necrosis |
| Nausea | urge to vomit |
| Vomiting | expelling stomach contents through espaphagus and mouth |
| N/V interventions | -none -protect airway (position sideline or sitting up) -medications -IV fluids (fluid replacement) -NG tube (IF there's an ileus- documented obstruction) -clear liquids, dry toast |
| Obesity | weight 20% or greater than ideal body weight -BMI -*OVERWEIGHT= 25- 29.9 kg/m2 -*OBESE= greater than 30 kg/m2 |
| BMI | carloric intake exceeds energy expenditure (90% of obesity) -comorbidies: disease associated with obesity -morbid obesity: BMI greater than 40 kg/m2 |
| Obesity interventions | -weight loss through exercise and calorie restriction -support groups -*behavior modifications -surgery |
| Obesity surgical management | 1. restrictive -laparoscopic adjustable gastric banding -(VGB) vertical banded gastroplasty (around stomach- fundus) 2. combination -roux-en-Y gastric bypass |
| Gastric restrictive surgery complications | -*vomiting -erosion of the gastric tissue -breakdown of the staple line -leaking of stomach secretions (acid) -infection -death |
| Gastric restrictive surgery post-op care | -clear liquid diet (30 ml/hr- if tolerable) -progress to full liquids or pureed foods -regular food at 6 weeks |
| Oral health care | -prophylactic antibiotics -xerostomia (dry mouth) -artificial saliva substitute -dentures -gingival recession -flossing daily -angular cheilosis -candida albicans (yeast infection= thrush) TX= nystatin |
| Accessory organs of digestion | -produce or store digestive secretions 1. liver 2. gallbladder 3. pancreas |
| Liver | -hepatic portal circulation -bile |
| Liver functions | 1. carbohydrate metabolism 2. amino acid metabolism 3. lipid metabolism 4. formation of bilirubin 5. storage 6. detoxification 7. activation of VIT. D |
| Gallbladder | stores bile |
| Pancreas | -amylase starch to maltose -lipase emulsified fats to fatty acids/ monoglycerides -trypsin polypeptides to peptides -bicarbonate juice |
| Aging effects of GI | -tooth enamel hardening= more brittle -tounge atrophy -sweet taste sensation lost -saliva production decreased 33% -esophagus motility decrease= emptying slower -weaker gag reflex -decreased motility of stomach -decreased gastric HCL production -fat absorption slows -atrophy or small and large intestine -decreased mucous secretions -decreased elasticity of rectal wall -weakness of intestinal wall -faulty absorption of VIT. B1, B12, calcium and iron -gallstones |
| GI assessment | -health history -travel -eliminations -medications -C. Diff -nutritional assessment -family history -cultural influences |
| GI physical assessment | -height and weight -BMI -oral cavity -abdomen: inspection (jaundice) auscultation percussion palpation (abdominal girth) |
| GI diagnostic tests | 1. lab tests 2. radiographic tests 3. barium impaction 4. nuclear 5. angiography 6. liver scan 7. endoscopy 8. ultrasonography 9. endoscopic ultrasonography 10. percutaneous liver biospy |
| GI lab tests | -CBC -electrolytes -carcinoembryonic antigen (CEA) -bilirubin -liver enzymes -pancreatic enzymes -stool tests -gastric analysis |
| GI radiographic tests | -flat plate of the abdomen -upper GI series (barium swallow) -lower GI series (barium enema) |
| GI barium impaction | -computed tomography (CT) scan |
| GI nuclear tests | -cholesintigraphy -DISIDA -HIDA -IDA |
| GI endoscopy | -esophagogastroduodenscopy (EGD) -endoscopic retrograde cholangiopancreatography (ERCP) -lower gastrointestinal endoscopy 1. proctosigmoidoscopy 2. colonoscopy |
| GI therapeutic measures | GI intubation PURPOSES: -stomach depression -initiation of enteral nutrition |
| Nasogastric tubes | 1. levin -low intermittent suction 2. salem pump -low continuous suction -stomach depression (normal saline) to prevent fluid imbalance -tube feeding (water) stays in body |
| Tube feeding types | 1. gravity 2. pump 3. bolus -specific amount at a specific time -check placement -check residual 4. intermittent -running for a specific amount of time 5. continuous -always running |
| Total parenteral nutrition | TPN -IV -central line |
| Enteral nutrition | right into stomach |
| Peripheral parental nutrition | PPN -PICC line -central line |
| Urinary system | COMPOSED OF: 1. kidneys -*filter the blood and form urine -pair of reddish/ brown bean shaped 2. ureters -*carry the urine to the bladder -long tubes shaped like inverted S -starts at renal pelvis and ends at base of bladder 3. bladder -*acts as a reservoir to store urine -hollow muscular organ -contains bundles of smooth muscle= detrusor muscles 4. urethra -*transports urine from bladder to outside the body -contains urinary sphincter at base of bladder |
| Urethral sphincter | tube that transports urine to outside the body -female= 1- 1.5 inches long -male= 8 inches long surrounded by muscle fibers DIVIDED INTO: 1. internal muscle sphincter (smooth muscle) 2. external muscle sphincter (striated) -both rely on supportive structures that allow them to relax and contract efficiently to induce voiding |
| Micturation | emptying the bladder (voiding, urinating) -micturation center located near the brain -occurs when patient voluntarily wishes to empty bladder |
| Factors influencing urinary elimination | -growth and devlopment -socio-cultural -personal habits -muscle tone -fluid intake -disease -surgical interventions -medications -diagnostic exams |
| Alterations in urinary elimination | 1. urinary retention 2. UTIs 3. urinary incontinence 4. urinary diversion |
| Urinary retention | urine is produced normally, but not excreted by the bladder CAUSES: -medication -enlarged prostate -vaginal prlapse |
| UTIs | bacterial infection of the urinary tract -leading cause of morbidity and health care costs in all ages -leading cause of systemic infections in older adults -may affect both the upper and lower urinary tract -E. coli = most common causal organism |
| Urinary incontinence | uncontrolled loss of urine -NOT a normal process of aging |
| Functional incontinence | transient and reversible loss of urine occurring during an acute illness or after an injury CAUSE: -factors outside the lower urinary tract -results in urinary incontinence-mnemonic |
| DIAPPERS | Delirium Infection (urinary) Atrophic urethritis and vaginitis Pharmaceuticals Psychological disorders Excessive urine output Restricted mobility Stool impaction |
| Chronic urinary incontinence types | 1. stress incontinence 2. urge incontinence (overactive bladder) 3. overflow incontinence 4. functional incontinence |
| Stress incontinence | uncontrolled loss of urine cause by physical exertion in the absence of detrusor muscle contraction -occurs with activities that increase abdominal pressure (coughing, sneezing) CAUSES: -childbirth -menopause -obesity -straining from chronic constipation |
| Urge incontinence | involuntary loss of urine due to an abrupt and strong desire to void -associated with involuntary contractions of the detrusor muscle |
| Overflow incontinence | signal to empty the bladder is slow or missing= dribbling occurs -overdistention and overflow of the bladder CAUSES: -drugs -fecal impaction -neurologic conditions |
| Mixed incontinence | symptoms of urge and stress incontinence are present |
| Urinary diversion | surgical procedure -emptied either by catheter or drains into a pouch CAUSES: -cancer of the bladder -traumatic injury to the bladder |
| Urinary assessment | -history voiding pattern mental status mobility/ dexterity past GU history fluid intake -physical exam -urine assessment -diagnostic studies |
| Urinary urgency | strong desire to void |
| Dysuria | difficulty in voiding |
| Urinary frequency | increased incidence of voiding |
| Polyuria | excessive output of urine |
| Oliguria | scanty or diminished amount of urine -less than 100- 400 cc in 24 hrs |
| Nocturia | frequency of urination in the night |
| Dribbling | involuntary leakage or urine |
| Hematuria | blood in the urine |
| Retention | urine not excreted from the bladder |
| Residual urine | urine that remains in the bladder after voiding |
| Kidney physical exam | -check for costovertebral tenderness |
| Bladder physical exam | -palpate for distension and tenderness -observe for swelling of lower abdomen |
| Urethral orifice physical exam | -check for redness -check for discharge -check for foul odor -observe for scarring and lesions -assess for skin integrity (inspect peritoneal area, groin, and butt for excoriation) |
| Urine assessment | normal urine is yellow with little to no odor ASSESS: -color -odor -cloudiness ABNORMALITIES: -foul odor -color= dark brown, deep amber, dark red -mucus shreds -sediment |
| Urine diagnostic tests | -urinalysis -specific gravity -24 hr urine collection -culture -clean voided/ midstream specimen -sterile urine specimen |
| Urinalysis | clean specimen collected and analyzed by dip stick or sent to lab for analysis CHECKS FOR: -specific gravity -pH -color -odor turbidity -blood -nitrates -bacteria -white cells |
| Specific gravity | measure of concentration of dissolved solids in urine -normal= 1.010- 1.025 |
| 24 hr urine collection | -note time of collection to begin -*discard first void prior to beginning collection |
| Urine culture | used to identify bacteria in urine -collected either by midstream catch or catheterized specimen |
| Sterile urine specimen | -obtained by straight catheterization or from indwelling catheter -indwelling catheter MUST use port to obtain specimen |
| Clean/ midstream specimen | -peritoneal area is cleaned -patient voids a small amount and discards it -then urine is collected in a sterile container |
| Urinary diagnostic studies | -KUB -IVP -CAT scan -renal ultrasound -cystoscopy -cystography -renal biopsy |
| KUB | xray of Kidney, Ureters, and Bladder -noninvasive |
| IVP | radiographic exam of kidney and ureters after IV injection of contrast material (IntraVenous Pyelogram) IMPLICATIONS: -allergy history -observe for signs of a reaction to contrast material (rash, nausea, hives) -I & O |
| CAT scan | Computer Assisted Tomography IMPLICATIONS: -allergy history if contrast is to be used -observe for delayed reaction to contrast (rash, hives, h/a, n/v) |
| Renal ultrasound | uses ultrasound to produce an image -noninvasive IMPLICATIONS: -inform patient on purpose of test |
| Cystoscopy | direct visual exam of the bladder IMPLICATIONS: -observe for tissue swelling -observe for dyuria -observe for hematuria d/t trauma -encourage fluid intake -I & O -observe for s&s of urinary retention -observe for s&s of infection |
| Cystography | xray of bladder after injection of contrast material IMPLICATIONS: -observe for reaction to contrast material |
| Renal biopsy | obtaining small piece of renal tissue with needle and syringe -invasive IMPLICATIONS: -monitor urine for hematuria -monitor vitals -monitor dressing for s&s of bleeding |
| Retrograde pyelogram | contrast material is injected through the ureter into the kidney -ureter is accessed through bladder IMPLICATIONS: -monitor vital signs -observe for reactions to contrast dye -encourage fluids after anesthesia recovery -observe for signs of: dysuria hematuria urinary retention |
| Female history | 1. personal history 2. mentrual history -onset of menarche -onset of menopause 3. OB and GYN history 4. sexual history 5. family history |
| Female physical examination | 1. breasts -self exam once a month 1 week following menses 2. external genitalia 3. internal genitalia -pelvic exam 4. perineum 5. anus 6. inguinal nodes |
| Female diagnostic test | 1. mammography ultrasound 2. MRI 3. biopsy 4. pap smear |
| Male history | 1. personal history 2. medication history 3. review of systems 4. sexual history |
| Male physical examination | 1. breasts -self exam once a month 2. penis 3. scrotum 4. testes 5. spermatic cord 6. digital rectal exam -trained personnel only |
| Male diagnostic tests | 1. testicular exam 2. ultrasound 3. hormonal tests 4. cystourethroscopy |
| Female age related changes | -decrease in estrogen -menopause cessation of menses for 12 months usually occurs between 45- 55 |
| Male age related changes | -decrease in testeosterone -decreased sperm production -hypertrophy of prostate -erectile dysfunction |
| Menopause | cessation of menses for 12 months -perimenopausal may last from months to years -irregular menses -hot flashes -night sweats -decrease in vaginal secretions |
| Female reproductive disorders | 1. dysmenorrhea 2. PMS 3. endometriosis |
| Dysmenorrhea | painful menstruation |
| PMS | -headache -irritability -water retention |
| Endometriosis | endometrial tissue outside the uterus |
| Gynecological surgeries | 1. hysterectomy -uterus removed -performed vaginally or abominably -TAH-BSO= total abdominal hysterectomy with bilateral salpingo-oophorectomy 2. salpingectomy -tube removed 3. oophorectomy -ovary removed |
| Male reproductive disorders | 1. cryptorchidism 2. hydrocele 3. phimosis/ paraphimosis 4. orchitis 5. erectile dysfunction 6. priapism |
| Cryptochidism | undecended or underdeveloped testes |
| Hydrocele | fluid surrounding the testicle |
| Phimosis | permanent narrowing of foreskin -unable to retract -treated by circumcision |
| Paraphimosis | foreskin becomes trapped behind glans -tightens -causes fluid buildup |
| Erectile dysfunction | -over 30 million men suffer from some sort of ED -may be physical or emotional in nature or a combo of both -may be treated with medication or surgical treatments |
| Male infertility | FACTORS: -endocrine disorders -testicular abnormalities -low sperm count or motility -medications -occupational exposure |
| Female infertility | FACTORS: -hormonal imbalance -anatomic abnormalities -infectious diseases -environmental factors |
| Contraception types | 1. oral 2. depot 3. barrier 4. intrauterine 5. natural family planning 6. sterilization -female= tubal ligation -male= vasectomy |
| STDs | -syphillis -gonorrhea -chlamydia -herpes -HPV -HIV -hepatitis C |
| Pregnancy termination | 1. therapeutic abortion 2. chemical abortion -plan B -RU486 3. elective abortion |
| Abortion implications | -assess for s&s of bleeding -teach s&s of infection -teach post-op care -refer to psychological counceling |
| Reproductive community resources | 1. web based 2. clinic based -community health centers -physicians office 3. community based -parish nursing -school nursing |
| Diabetes Mellitus | -glucose intolerance -faulty production of insulin -tissue insensitivity to insulin -altered CHO, fat, and protein metabolism -long term complications |
| Diabetes statistics | -20.8 million in US have diabetes -6.2 million are unaware -costs $132 billion/ year |
| Diabetes types | 1. type 1 -juvenile 2. type 2 -adult onset 3. LADA 4. gestational -pregnancy 5. prediabetes -glucose intolerance 6. secondary diabetes -drugs -pancreatic trauma |
| Type 1 diabetes | juvenile -5- 10% of diabetes -10% is genetic -autoimmune response to virus -destruction of beta cells -pancreas secretes NO insulin -more common in young and thin patients -prone to ketosis (abnormal amount of keytone bodies) |
| Type 2 diabetes | adult onset -90- 95% of diabetes -90% is genetic -decreased beta cell responsiveness to glucose -reduced number of beta cells -reduced tissue sensitivity to insulin -obesity= biggest risk factor -not prone to ketosis |
| LADA | latent autoimmune diabetes of adulthood -initial type 2 diabetes -islet cell antibodies like type 1 |
| Type 2 in youth | -more obesity in children -type 2 epidemic -nursing challenge |
| Diabetes diagnosis | -FBG -CPG -OGTT -glycohemoglobin normal= 4-6% -lipid profile -serum creatinine -urine mircoalbumin |
| FBG | fasting plasma glucose 70- 126 |
| CPG | casual plasma glucose |
| OGTT | glucose tolerance test 200 -after 2 hrs |
| Diabetes signs and symptoms | -3P's polyuria (excessive and frequent urination) polydipsia (excessive thirst) polyphasia (excessive hunger) -fatigue -blurred vision -infection prone -abdominal pain -headache -ketosis/ acidosis |
| Type 2 prevention | -lose 5- 7% of body weight -30 minutes of exercise 5 days/ week -reduce fat and calories |
| Diabetic goals of treatment | -preprandial glucose 90- 130 -peak postprandial glucose less than 180 -blood pressure less than 130/80 -glycohemoglobin less then 7% |
| Diabetes interventions | 1. medical nutritional therapy 2. exercise 3. medication 4. monitoring 5. education |
| Medical nutritional therapy | (MNT) -ADA exchange lists -carb counting -glycemic index -remember cultural dietary needs PRINCIPLES: -low fat -low sodium -limit simple sugars -use complex carbs -consistent day to day |
| Exercise r/t diabetes | -lowers glucose up to 24 hrs -lowers blood lipids -best done regularly -refer to physician or exercise physiologist -avoid exercise during acute hyperglycemia -carry fast sugar |
| Medication r/t diabetes | 1. insulin -for type 1 or 2 2. oral hypoglycemics -for type 2 |
| Insulin | -action -routes subcutaneous IM inhaled -insulin pump -site rotation -timing onset peak duration |
| Oral hypoglycemics | -NOT insulin -action depends on medication -stimulates pancreas -increases tissue sensitivity to insulin -slows CHO digestion and absorption |
| Self monitoring glucose | -test AC (before meals) and HS (hour of sleep) -record results -analyze meaning of results -know target glucose levels -call physician if out of range |
| Diabetes urine testing | -glucose -keytones if blood sugar is greater than 300 |
| Alterations in blood glucose | 1. hyperglycemia 2. hypoglycemia |
| Hyperglycemia | blood glucose greater than 126 CAUSES: -overeating -stress -illness -not enough medication |
| Hyperglycemia signs and symptoms | -3Ps -blurred vision -fatigue -lethargy -headache -abdominal pain -ketonuria -coma |
| Hyperglycemia treatment | -check blood glucose -use sliding scale insulin -if glucose is greater than 300, check keytones -determine cause eliminate -call physician is glucose is greater than 180 for 2 days -if ill or vomiting call physician |
| Hypoglycemia | blood glucose below 70 CAUSES: -too much insulin -exercise -not enough food |
| Hypoglycemia signs and symptoms | -headache -hunger -fight or flight shaky cold sweat palpitations -neuroglycopenia iriitability confusion sezures coma -autonomic neuropathy= no symptoms |
| Hypoglycemia treatment | -check blood glucose -administer 15-20 G fast acting CHO -recheck in 15 minutes -repeat PRN -snack if greater than 1 hr before meal |
| Fast sugars | -4oz orange juice -6oz regular soda (NOT diet) -mini box of raisins -commercial glucose tablets -6- 8 lifesavers |
| Diabetic ketoacidosis | (DKA) insulin deficiency -cells starving -fat breaks down -byproduct of fat breakdown is keytones -keytones are acidic CAUSES: -high blood glucose *most common in type 1 -stress -illness |
| Diabetic ketoacidosis signs and symptoms | -flu-like symptoms -hyperglycemic symptoms -kussmaul respirations -fruity breath -electrolyte imbalance -dehydration -coma -death |
| Diabetic ketoacidosis interventions | -IV fluids -IV insulin drip -frequent glucose monitoring -electrolyte monitoring |
| Diabetic ketoacidosis prevention | -check keytones if blood sugar is greater than 300 drink fluids check again call physician if still present -good diabetes control |
| Hyperosmolor hyperglycemia | blood glucose elevated -polyuria -profound dehydration -no nausea and vomiting= slower to get help CAUSES: -hyperglycemia in type 2 diabetes -stress -illness -most common in elderly |
| Hyperosmolor hyperglycemia signs and symptoms | -extreme dehydration -lethargy -blood glucose may be 1000-1500 -electrolyte imbalance -coma -death |
| Hyperosmoloar hyperglycemia prevention | -SMBG -if glucose is rising drink fluids= lower glucose |
| Diabetes long term complications | 1. macrovascular changes -stroke -MI -peripheral vascular disease 2. microvascular changes -retinopathy -neuropathy 3. neuropathy 4. infection 5. foot problems |
| Diabetic foot care | -inspect feet daily -wash and dry feet daily -wear well fitting shoes -protect feet from injury -avoid crossing legs -use caution with nail care -see physician immediately if sore develops |
| Diabetes care during surgery | -frequent glucose monitoring -sliding scale insulin or insulin drip -maintain glucose 140- 180 in critically ill |
| Reactive hypoglycemia | hyper-responsiveness of pancreas -low glucagon levels -low blood glucose -sympathetic fight or flight response |
| Reactive hypoglycemia interventions | -frequent small meals -high protein diet -low CHO diet |
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