NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
➢
PROSTATE CANCER
The most common cancer in men other than
nonmelanoma skin cancer
➢
A familial predisposition may occur in men who
have a father or brother previously diagnosed
with prostate cancer, especially if their relatives
were diagnosed at a young age.
➢
The risk of prostate cancer is also greater in men
whose diet contains high amounts of red meat or
dairy products that are high in fat.
➢
Endogenous hormones such as androgens and
estrogens also may be associated with the
development of prostate cancer.
•
•
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•
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•
SYMPTOMS
Frequent, sometimes urgent need to pee
especially at night
Weak urine flow or flow that starts and stops
Dysuria
Urinary incontinence
Fecal incontinence
Painful ejaculation and erectile dysfunction
Hematospermia (Blood in semen)
Pain in low back, hip, or check
•
•
•
•
RISK FACTORS
Age
Race and Ethnicity
Family history of prostate cancer
Genetics
•
2.
Robotic radical prostatectomy
Other potential risk factors include:
•
•
•
•
1.
2.
3.
4.
Smoking
Prostatitis
Having BMI >30 (Obesity)
Sexually transmitted infections
ASSESSMENT AND DIAGNOSTIC FINDINGS
Digital Rectal Exam
Prostate–specific antigen (PSA)
Imaging
Biopsy
MANAGEMENT AND TREATMENT
1.
Open radical prostatectomy
1| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
3.
Brachytherapy
➢
➢
❖
4.
Nongerminal Tumors
Account for less than 10% of testicular
cancers.
These cancers develop in the supportive
and hormone – producing tissues, or
stroma of the testicles.
Although these tumors infrequently
spread beyond the testicle, a small
number metastasize and tend to be
resistant to chemotherapy and radiation
therapy.
❖
Secondary Testicular Tumors
Are those that have metastasized to the
testicle from other organs.
Lymphoma is the most common cause of
secondary testicular cancer. Cancer may
also spread to the testicles from the
prostate gland, lung, skin (melanoma),
kidney and other organs.
The prognosis with these cancers is
usually poor because they typically also
spread to other organs.
External Beam Radiation Therapy
SIDE EFFECTS
Incontinence
Erectile dysfunction
Infertility
CLASSIFICATION OF TESTICULAR CANCER
Germinal Tumors
Makeup approximately 90% of all
cancers of the tests; germinal tumors are
further classified as seminomas (slow) or
non–seminomas.
❖
SYSTEMATIC THERAPY
•
Hormone therapy
•
Chemotherapy
•
Immunotherapy
•
Targeted therapy
•
•
•
TESTICULAR CANCER
It is the most common malignancy in those 34 to
39 years of age. For unknown reasons, the
worldwide incidence of testicular tumors has
more than doubled in the past 40 years.
Forms when malignant cells develop in the tissues
of one or (less commonly) both testicles.
•
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•
RISK FACTORS
Age
Undescended testicles
Race and ethnicity
Personal or family history
Infertility
CLINICAL MANIFESTATIONS
Painless lump on the testicle – Most common sign
Swelling or sudden fluid build-up in the scrotum
A lump or swelling in either testicle
2| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
•
•
•
A feeling of heaviness in the scrotum
Dull ache in the groin or lower abdomen
Pain or discomfort in the scrotum or testicle
Testicular atrophy
•
•
•
DIAGNOSIS
Physical exam and history
Ultrasound
Inguinal orchiectomy and biopsy
Other tests may include:
•
Serum tumor marker test
•
CT scans, X-rays, and MRIs
✓
➢
➢
➢
➢
➢
➢
Diagnosis also involves cancer staging. Staging
provides important information that will guide
treatment decisions, such a tumor size and
whether the cancer’s spread.
Stage 0
Stage I
Stage II
Stage III
MEDICAL MANAGEMENT
Testicular cancer – one of the most curable solid
tumors – is highly responsive to treatment.
Early–stage disease is curable more than 95% of
the time.
Radiation therapy is more effective with
seminomas than with non-seminomas.
Chemotherapy may be used for seminomas, nonseminomas, and advanced metastatic disease.
Even with metastatic cancer, the prognosis is
favorable because of advances in treatment.
Long-term side effects associated with treatment
for testicular cancer include renal insufficiency
from kidney damage, hearing problems, gonadal
damage, peripheral neuropathy, and rarely
secondary cancers.
SURGERY
1.
Radical Inguinal Orchiectomy
2.
➢
➢
➢
•
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•
•
•
•
•
•
•
•
•
•
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•
Retroperitoneal node dissection
PANCREATIC CANCER
Is a type of cancer that begins as a growth of cells
in the pancreas.
The most common type of pancreatic cancer is
pancreatic ductal adenocarcinoma. This type
begins in the cells that line the ducts that carry
digestive enzymes out of the pancreas.
Rarely is found at its early stages when the chance
of curing it is greatest. This is because it often
does not cause symptoms until after it has spread
to other organs.
SIGNS AND SYMPTOMS
Abdominal pain that spreads to the sides of back
Loss of appetite
Weight loss
Jaundice
Light-colored or floating stools
Dark colored urine
Itching
Pain and swelling in arm or leg, which might be
caused by a blood clot
Tiredness or weakness
RISK FACTORS
Smoking
Type 2 diabetes
Chronic inflammation of the pancreas, called
pancreatitis
Family history of pancreatic cancer
Obesity
Older age. Most people with pancreatic cancer
are over 65
Drinking a lot of alcohol
COMPLICATIONS
As pancreatic cancer progresses, it can cause complication
such as:
•
Weight loss
•
Jaundice
•
Pain
3| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
Bowel blockage
•
•
•
•
•
DIAGNOSIS
Imaging tests
A scope with ultrasound
Removing a tissue sample for testing
Blood tests
Genetic testing
TREATMENT
The first goal of pancreatic cancer treatment is to get rid of
the cancer, when possible.
SURGERY
Operations used to treat pancreatic cancer include:
•
Surgery for cancers in the pancreatic head.
•
Whipple
procedure
also
known
pancreaticoduodenectomy.
•
as
•
•
•
Surgery for cancer in the body and tail of the
pancreas.
➢
Distal pancreatectomy
•
➢
•
Surgery to remove the whole pancreas
➢
Total pancreatectomy
➢
Surgery for cancers that affect nearby blood
vessels
➢ When a cancer in the pancreas grows
to involve nearby blood vessels, a more
complex procedure might be needed.
➢ The procedure might need to involve
taking out and rebuilding parts of the
blood vessels.
Chemotherapy
➢ Uses strong medicines to kill cancer
cells. Treatment might involve one
chemotherapy medicine or a mix of
them.
➢ Is often used after surgery to kill any
cancer cells that might remain.
Immunotherapy
➢ Is a treatment with a medicine that
helps the body’s immune system kill
cancer cells.
➢ Immunotherapy helps the immune
system cells find and kill the cancer
cells.
Palliative care
➢ Is a special type of health care that
helps people with serious illness feel
better. The team’s goal is to improve
quality of life for the client and family.
➢ When palliative care is used with all the
other appropriate treatments, people
with cancer may feel better and live
longer.
COLORECTAL CANCER
Starts in the mucosa, the innermost lining of your
colon. It consists of cells that make and release
mucus and other fluids. If these cells mutate or
change, they may create a colon polyp.
Happens when there are changes in your genetic
material (DNA). These changes are also called
mutations or variants.
4| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
•
•
•
•
•
•
CLINICAL MANIFESTATIONS
Blood on or in the stool
Persistent changes in bowel habits
Abdominal pain
Bloated stomach
Unexplained weight loss
Vomiting
Fatigue and feeling short of breath
TREATMENT
➢ Polypectomy
MEDICAL CONDITION THAT INCREASES THE RISK OF
COLON CANCER
•
Inflammatory bowel disease
•
Inherited conditions
•
A family history of colon and other types of cancer
•
Family history of polyps
➢
SCREENING TESTS
Colonoscopy – most common screening test for
colon cancer.
➢
➢
➢
➢
➢
Fecal immunochemical test (FIT)
Guaiac-based fecal occult blood test (gFOBT)
Fecal DNA test
Flexible sigmoidoscopy
Virtual sigmoidoscopy
➢
Partial Colectomy
➢
Surgical resection with colostomy
5| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
➢
➢
➢
➢
➢
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➢
Radiofrequency ablation
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•
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•
•
Healthcare providers may combine surgery
adjuvant therapy. Treatments may include:
•
Chemotherapy
•
Targeted therapy
SKIN CANCER
➢
•
•
•
The abnormal growth of skin cells – most often
develops on skin exposed to the sun. But this
common form of cancer can also occur on areas
of your skin not ordinarily exposed to sunlight.
THREE MAJOR TYPES OF SKIN CANCER
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
BASAL CELL CARCINOMA
Begins in the basal cells – a type of cell within the
skin that produces new skin cells as old ones die
off.
Often appears as a slightly transparent bump on
the skin, though it can take other forms. Basal cell
carcinoma occurs most often on areas of the skin
that are exposed to the sun, such as your head
and neck.
Most basal cell carcinomas are thought to be
caused by long-term exposure to ultraviolet
radiation from sunlight.
Basal cell carcinoma is a type of skin cancer that
most often develops on areas of skin exposed to
sun, such as the face.
On white skin, basal cell carcinoma often looks
like a bump that is skin-colored or pink.
On brown and black skin, basal cell carcinoma
often looks like a bump that is brown or glossy
black and has a rolled border.
SYMPTOMS
A shiny, skin-colored bump
A brown, black, or blue lesion
A flat, scaly patch
A whole, waxy, scar-like lesion
MELANOMA
➢ The most serious type of skin cancer, develops in
the cells (melanocytes) that produce melanin –
the pigment that gives your skin its color.
➢ Can also form in the eyes and rarely inside the
body such as the nose or throat.
SYMPTOMS
The first melanoma signs and symptoms often are:
•
A change in an existing mole
•
The development of a new pigmented or unusual
looking growth on the skin.
•
Unusual moles that may indicate melanoma:
A is for asymmetrical shape
B is for irregular border
C is for changes in color
D is for diameter
E is for evolving
HIDDEN MELANOMAS
6| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
➢
➢
➢
Melanomas can also develop in areas of your
body that have little or no exposure to the sun,
such as the spaces between your toes and on your
palms, soles, scalp, or genitals
When melanoma occurs in people with darker
skin, it is more likely to occur in a hidden area.
Hidden melanomas include:
Melanoma under a nail
Melanoma in the mouth, digestive tract,
urinary tract, or vagina
Melanoma in the eye
SQUAMOUS CELL CARCINOMA
➢ Is a type of cancer that starts as a growth of cells
on the skin. It starts in cells called squamous cells.
The squamous cells make up the middle and outer
layers of the skin. Squamous cell carcinoma is a
common type of skin cancer.
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3.
Curettage and electrodesiccation
SYMPTOMS
A firm bump on the skin (nodule)
A flat sore with a scaly crust
A new sore or raised area on an old scar or sore
A rough, scaly patch on the lip that may become
an open sore
A sore or rough patch inside the mouth
A raised patch or wartlike sore on or in the anus
or on the genitals
1.
TREATMENT
Excisional Surgery
2.
Mohs Surgery
Other treatment:
•
Radiation therapy
•
Chemotherapy
•
Photodynamic therapy
•
Biological therapy
7| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
bloodstream or lymphatic
systems.
CELLULAR ABERRATION
ROLES OF THE NURSES
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Dynamically involved in preventing, detecting pr
rehabilitating
Provide adequate learning guidelines
Shares in responsibility of caring for people with
cancer: before, during, and after therapy.
Participation in research
Teaching about career is not limited to hospital or
clinic setting.
Must be aware of emotional impact on the
patient with cancer.
2.
3.
4.
5.
CLASSIFICATIONS
1.
CANCER
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Disease of cells
Abnormal growth of cells which tend to proliferate in
uncontrolled way, and in some cases to metastasize
(spread)
Also called “Malignancy” or “Neoplasm” (new growth)
Cancer can involve any tissue of the body and have
many different forms in each body area.
Three (3) parts of the body not affected by the cancer
are:
✓ Nails
✓ Teeth
✓ Hair
Cancer is a neoplastic disorder that can involve all body
organ
Cells lose their normal growth controlling mechanisms
and the growth of cells is uncontrolled.
ROLES OF THE NURSES
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•
•
•
Latin: crab
o
Crab-like tenacity
o
Cancri – stretch out too many directions
Greek: carcinoma
o
Medical term: epithelial cells
Celsus: carcinos
o
Translated
Galen: oncos
o
Root of the modern word: oncology
Malignant
o
Invades and destroy the tissue in which
originated and can spread to other sites via
bloodstream and lymphatic system.
Neoplasms
o
New and abnormal growth of cells.
Tumor
o
Abnormal solid mass
Cyst
o
Abnormal sac or closed cavity
o
Lined with the epithelium
o
Filled with: fluid or semi-solid matter
2.
3.
4.
5.
6.
7.
CARCINOMA
o
Malignant derived from epithelial cells
o
Most common cancers: breast, prostate,
lung, colon
o
Metastasize via lymphatic system
Lymphoma and Leukemia
o
Malignant: blood and bone marrow
Sarcoma
o
Malignant tumor derived from connective
tissue or mesenchymal cells
o
Metastasize via bloodstream (very fast)
Mesothelioma
o
Derived from mesothelial cells lining the
peritoneum and pleura
Glioma
o
Derived from cilia: common type of brain
cell
Germinoma
o
From germ cells
o
Normally found: testicle or ovary
Choriocarcinoma
o
Malignant derived from the placenta
MALIGNANT
1.
2.
3.
ROLES OF THE NURSES
Hepatocarcinoma
o
Malignant tumor of the liver cells
Liposarcoma
o
Malignant tumor of the fat cells
Bronchogenic carcinoma
o
Malignant of lower trachea and bronchi
BENIGN
1.
Neoplasia and Neoplasm
o
Scientific designation for cancerous diseases
▪
Benign: high risk
▪
Malignant: invades and destroys
tissues it originated from via
Name using “-oma” as suffix
1.
2.
Leiomyoma
o
Benign of smooth muscle in uterus
Fibroma
o
Anywhere
8| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
3.
Lipoma
o
o
Adipose tissue
CHARACTERISITCS
FACTORS
1.
Speed of
Growth
Benign: grow slowly; continues to grow until
surgically removed
Malignant: grows rapidly
Mode of
Growth
B: fibrous capsule; can be surgically removed.
Capsule
M: not contained in a capsule; surgical
removal is difficult.
B: well, differentiated; secrete hormones
Cell
Characteristic
Recurrence
2.
B: grow by enlarging and expanding, remains
localized, never infiltrates other tissue
M: grow by infiltrating surrounding tissues,
remaining localized but, metastasize in other
tissues.
3.
4.
5.
6.
7.
8.
9.
B: Unusual when surgically removed.
M: Common following surgery because
tumor cells spread; harmful to host, result in
death.
Environmental development/occupation
a.
Chemical carcinogen
b. Physical carcinogen (sun tanning)
c.
Viral carcinogen
Dietary factors
a.
Increase fat, decrease fiber
b.
Animal fat intake
c.
Preservative, additives
Genetic predisposition
Age
Immune function
Sex
Precancerous Lesions
Hormones intake
Unhealthy lifestyle
MODES OF METASTASIS
1.
M: poorly differentiated; large number of
normal and abnormal mitotic figures, may
secrete hormones.
Cancer has spread widely throughout the
body before it is discovered o May be
impossible to detect where it started.
2.
3.
4.
Lymphatic Spread
o
Susceptible and early cancer cells
Blood-borne
o
Enters blood
o
Tumor cells goes to the blood
Local seeding
o
Cancer cells penetrates and enters other
organs
Vascular
o
Through veins, liver, lungs
B: good prognosis
COMMON SITES
Prognosis
M: depend on cell type and speed of dx; poor
prognosis if poorly differentiated and
metastasize.
1.
Metastasis
B: never occur
M: very common
3.
Effect on
Neoplasm
B: not harmful too host unless compression
of tissues or obstruction of vital organ;
remission after treatment called recurrence.
M: Harmful
2.
4.
5.
Breast cancer
o
Bone; lungs
Lung cancer
o
Brain
Colorectal
o
Liver
Prostate
o
Bone; spine
Brain
o
Legs; CNS
SIGNS AND SYMPTOMS
RECURRENCE
1.
2.
3.
4.
Local Recurrence
o
In or near the same organ it developed.
Regional
o
Nearby lymph nodes
Distant recurrence
o
Involving any other part of the body not
included in local or regional recurrence
Unknown primary
✓
✓
✓
✓
✓
✓
✓
✓
“CAUTION US”
Changes in bowel habits
A sore that does not heal
Unusual bleeding/discharge
Thick or a lump in the breast
Indigestion or difficulty in swallowing
Obvious change in wart/mole
Nagging cough/hoarseness
Unexplained anemia
9| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
✓
Sudden weight loss
CLASSIFICATION OF CANCER BY ORGAN SYSTEM
➢
Staging and Grading
Method used to describe a tumor.
a. Extent size, involvement of regional nodes
and metastatic
GRADING: Classifies the cellular aspects of cancer.
STAGING: Classifies clinical aspects.
STAGES OF CANCER
•
•
•
•
Stage 1: small, localize and limited
Stage 2: local spreading occurs in the organ and lymph
nodes
Stage 3: Cancer cells invades neighboring tissues and
lymph nodes
Stage 4: metastasis in other tissues.
TNM SYSTEM
T
N
M
A.
Tx
T0
Tis
T1
T2
T3
T4
B.
Nx
N0
N1
N2
N3
C.
Mx
M0
M1
Most common type of system for staging
Extent of primary tumor
Absence or presence of regional lymph nodes
Absence or presence of distant metastasis
PRIMARY TUMOR
Primary tumor cannot be assessed
No evidence of primary tumor
Carcinoma in situ
Tumor 2cm or less in greatest diameter
Tumor >2cm but <5cm
Tumor >5cm
Tumor of any size with direct extension to tissue
PRIMARY LYMPH NODES
Cannot be assessed
No metastasis
Metastasis to moveable lymph node
Metastasis to lymph nodes fixed to one another
Metastasis to internal lymph nodes
DISTANT METASTASIS
cannot be assessed
No distant metastasis
Distant metastasis: anatomic site organ identified
CLASSIFICATION OF GRADING
Grade I or II
Grade III or IV
Cells are very well-differentiated and
deviated minimally from normal cells.
Most poorly-differentiated and most
aberrant
DIAGNOSTIC TEST
Depends on the suspected primary or metastatic site of cancer.
1. Biopsy
o
Surgical incision at small plea of tissue
o
To confirm a dx of malignancy
o
Types:
a.
Needle
b. Incisional: Wedge of suspected
tissue
c.
Excisional: Complete removal of
cell tissue
d. Staging: Multiple needles or
incisional
e. Sentinel Lymph Node Removal of
lymph node
f.
Transrectal: For prostate cancer
2.
Surgery
o
o
Either treatment or dx
Types:
a.
Prophylactic: Removal of tissue
or organ at risk
b. Curative
c.
Control (cysts reductive)
d. Palliative: To prolong life of pt.
To improve QOL
e. Reconstructive: Improve QOL by
restoring maximal (appearance)
function
f.
Sealing an electrosurgery vessel
with bipolar
g.
Cryo-surgery
➢ No anesthesia
➢ No hospitalization
➢ Multiple lesion:
treatable at some
time
➢ Only good for small
local cancers
➢ No touch technique
➢ Beneficial while
treating HIV and
cases
➢ Complications:
❖ Hyperpigm
entation
❖ Hypertrop
hic scars
❖ Milia
(white
pigmentati
on)
❖ Hypopigm
entation
10| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
▪
scar (long
term)
h.
i.
j.
o
Chemosurgery
Laser
Laparoscopic resection
Side Effect:
a.
b.
c.
d.
e.
f.
3.
Loss of function of specific
bod parts
Decrease function to organ
loss
Scarring
Grieving about altered
image or change in lifestyle
Endoscopy
Bronchoscopy
Chemotherapy
o
Treatment of choice: Malignant
o
Cycle q21 days
o
Biologic Safety Cabinet – place for preparing
chemo drugs
o
Contraindications:
a.
Infection: drugs are
immunosuppressive
b. Previous chemotherapy <2
weeks
c.
Recent surgery
▪
effects may delay
wound healing
d. Impaired renal and hepatic
problem
▪
chemo agents are
metabolized and
excreted in liver
e. recent radiation therapy
f.
pregnancy
▪
fetal risk in 1st
semester
g.
bone marrow depression: until
normal WBC
h. psychological problems
i.
leukopenia and
thrombocytopenia
▪
decreased WBC and
platelets
o
SIDE EFFECTS:
a.
Alopecia
▪
b.
Temporary: 3-6
months
N/V
▪
▪
Antiemetics
Food at room temp or
cold temp
c.
d.
e.
f.
g.
h.
i.
j.
k.
Rince mouth with
lemon water
▪
Drink clear liquid in
severe cases of
nausea.
▪
Sip liquids
▪
Eat bland foods
▪
Listen to relaxing
music
▪
Avoid spicy foods
▪
Avoid eating and
drinking 1-2 hrs.
before and after
chemotherapy
▪
Sleep during periods
of intense nausea
Skin changes
Anemia
Thrombocytopenia
▪
Prevent from
bleeding
▪
Report if (+) bleeding
Diarrhea and constipation
▪
Decreased fiber,
increased protein
▪
Loperamide
Mucositis/stomatitis
Maintain oral hygiene
Bone marrow suppression
▪
Decreased WBC in 714 days after chemo
▪
Fever, mouth
infections,
pneumonia
▪
Avoid crowded spaces
▪
VS q4
Fatigue
Sexual Dysfunction
Nursing Consideration:
a.
Anticipate possibility of extravasation (burning
sensation)/hypersensitivity reactions
▪
Understand procedure for managing
emergency
▪
Check IV patency and site
b. Seek assistance after 2 unsuccessful venipuncture
c.
Administer meds: quiet and unhurried movement
d. Never use chemo agents to test vein patency
e.
Stop infusion if vein patency is in question
f.
Monitor pt. closely during entire time of administration
of chemo agents.
g.
Anaphylactic reactions may occur: stop infusion
h. Handle chemo agents safely
11| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
4.
10. Large tumor masses often contain oxygen-deficient cells in
the center that are resistant to radiation therapy and
therefore not affected by the therapy.
RADIATION THERAPY
SIDE EFFECTS:
✓ Skin changes and irritation
✓ Alopecia
✓ Fatigue
✓ Altered taste sensation
TYPES:
1.
Teletherapy
•
” Beam radiation”
•
Actual radiation source is external to client
•
Client does not emit radiation and does not
pose a hazard to anyone e.g., cobalt
2.
Brachytherapy
•
Radiation towards the tissue
•
Types:
❖ Unsealed radiation source
▪
via oral or IV route or
by instillation into
body cavity.
❖ Sealed
radiation
source
(temporary or permanent)
▪
a
temporary
or
permanent radiation
source (solid implant)
implanted within the
tumor target tissues.
▪
the client's emits
radiation while this is
in place but the
excreta
are
not
radioactive.
▪
Intracavitary implants
(usually placed in the
uterus or vagina)
Possible Side Effects of RADIATION Therapy:
1. Fatigue (in part due to energy expended in replacing normal
cells killed in the process)
2. Skin irritation, redness, lesions, peeling
3. Hair loss
4. Loss of taste
5. Erectile dysfunction
6. Increased susceptibility to infection
7. Difficulty swallowing and decreased appetite
8. Oral mucositis (increased proliferation of the mouth
epithelial cells/ lining)
9. Younger patients receiving radiotherapy are more likely to
develop secondary tumors because of their longer posttreatment life span.
Selective Internal Radiation Therapy (SIRT)
•
It is generally for selected patients with unresectable
cancers, those that cannot be treated surgically,
especially hepatic cell carcinoma or metastasis to the
liver
•
is generally not regarded as a cure, but has been shown
to shrink the cancer when combined with
chemotherapy more than chemotherapy alone.
•
This can increase life expectancy and improve quality of
life
•
On occasion, patients treated with SIRT have had such
marked shrinkage of the liver cancer that the cancer can
be surgically removed at a later date. This has resulted
in a long-term cure for some patients.
•
SIRT is a non-surgical outpatient therapy that uses
radioactive microspheres, called SIR-SpheresⓇ, to
deliver radiation directly to the site of the liver tumors.
•
SIRT is one of the treatment choices for people who
have tumors in the liver.
•
It is a procedure in which radioactive spheres (very tiny
seeds) are placed into an artery in the liver. These
spheres travel through smaller arteries into the tumor.
•
Once the spheres are in the tumor, they give off
radiation. The radiation causes damage to cancer cells
with little damage to healthy liver tissue
•
The spheres used for this procedure are radioactive and
take time to become inactive. This means that for 3 days
(72 hours) after the procedure, other people that you
are around may be exposed to radiation from your
body. Please follow these simple guidelines:
o
No visitors who are pregnant.
o
No physical contact with others for longer
than 2 hours.
o
Sleep in bed alone
5.
BONE MARROW TRANSPLANT
−
(used in treatment of leukemia with closely
matched donors & experiencing remission with
chemotherapy)
Goal of treatment:
•
to rid leukemic cells through treatment with high
doses of chemo and whole-body irradiation
Types of Donor marrow
1.
Allogeneic donor is a parent, sibling with similar tissue
type 2.
2.
Syngeneic - bone marrow from identical twin
3.
Autologous -most common, marrow donor is also the
recipient. Marrow is harvested during disease
remission, and is stored (frozen), to be reinfuse later
12| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
o
Types of Transplants:
1. Allogeneic: Family/ Unrelated Donor
2. Autologous: Self-Donation
3. Syngeneic: Identical Twin
While you are awake and pain-free (using local anesthesia), bone
marrow is removed from the top of the hip bone (iliac crest) The
bone marrow is filtered, treated, and transplanted immediately.
Other times it is frozen and stored for later use. The bone marrow
is then transfused through a vein (IV line) It naturally transports
itself back into the intended bone cavities, where it grows quickly
to replace the old bone marrow.
Bone-marrow transplants prolong the life of patients. As with all
major organ transplants, however, it is difficult to find bonemarrow donors, and the cost of surgery is very high. The donor is
usually a sibling with compatible tissue Occasionally, unrelated
donors act as a source for bone-marrow transplants. The
hospitalization period is 3-6 weeks. During this time, you are
isolated and under strict monitoring because of the increased risk
of infection Attentive follow-up care is required for 2-3 months
after discharge from the hospital. It takes about 6 months to a
year for the immune system to fully recover from this procedure.
Relatively normal activities are resumed after consulting with your
doctor.
6.
CYTOLOGIC EXAMINATION/ PAP'S TEST (GEORGE N.
PAPNICOLAOU 1943)
−
−
ULTRASOUND
−
8.
−
9.
to detect lesions, non-invasive, without radiation
exposure (TRANSVAGINAL ULTRASOUND
NUCLEAR MAGNETIC RESONANCE IMAGING (NMRI)
−
−
10. MAMMOGRAPHY
•
•
used to detect early cancers cervix, digestive,
respiratory & renal tracts & breast.
evaluates responses to chemo and radiation
therapy & malignant disease
Materials that can be examined by pap smears:
•
cervical scrapping
•
bronchial secretions & washings from bronchoscopy
•
urine sediment
•
coughed-up sputum
•
aspirated gastric secrete
•
mammary gland discharge fluid
7.
−
Identifies abnormalities without use of contrast
dyes or radiation.
provides clear images of internal structures
created by harmless low energy radio waves.
•
•
•
−
Radiation - emission of waves (infrared waves, UV
light)
X-RAY EXAMS
used to detect possible abnormalities (CYST),
useful in discovering tumors too small to be felt
x-ray of the breast with a very low radiation dose
- involves taking two views of each involves
compression of the breasts by 2 platforms. This is
done to obtain the breast, and the whole
procedure lasts about 20 minutes. The process
best possible image of all breast tissue.
To lessen discomfort and pain, it is suggested that
patients avoid scheduling mammograms for the
week before or during menstruation
it is suggested not to wear deodorant, powder, or
cream under the arms so as not to interfere with
the quality of the mammogram May show
calcifications and/or the presence of a mass.
Calcifications (mineral deposits in the breast)
show up as white spots on the mammogram.
To be done every year for women 40
11. FECAL OCCULT BLOOD TEST (FOBT)
•
to check for blood present in stools, a possible
sign of colon cancer or colonic polyps (precursors
of cancer).
12. PHYSICAL EXAM (IPPA)
•
RADIODIAGNOSTIC TECHNIQUES RADIATION
−
employ high energy electromagnetic
waves absorbed by body parts as
revealed on photographic films.
o
diagnose obstructive tumors of GI,
respiratory tract, renal tracts, bone,
brain
Computerized Axial Tomography (CAT/CT SCAN
o
x-ray technique that produces
sequential cross-sectional body images
at progressive depths.
o
differentiates malignant & benign
masses, accurately identifies size &
location.
o
oral/IV contrast agent is given to
increase sensitivity of CT scan
Radioisotopes Studies (e.g., Ba enema)
o
radioactive isotope enters body abnormal tissue shows up differently
on the scan
o
thyroid, bone, brain, liver, lung &
spleen are most frequently scanned.
•
DIGITAL RECTAL EXAM - A doctor inserts a gloved,
lubricated finger in the rectum and feels for
abnormalities.
The procedure is very quick and painless, and it
provides good screening for abnormalities of the
rectum.
13| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
Recommended for every man older than 40 yrs.
of age ‣ screens for cancer of the prostate gland
assesses size, shape, and consistency of prostate
gland tenderness of prostate gland upon
palpation and presence/consistency of nodules
are noted.
15. ANTIGEN SKIN TEST DNCB
(DINITROCHLOROBENZENE)
•
16. LABORATORY TESTS
•
13. BREAST SELF-EXAMINATION
•
•
•
useful in the detection of breast cancer
performed after menstruation every month.
for menopausal women, same time, and same
date once a month.
may be done while sitting, standing" or lying
down with a pillow underneath the breast and
while in a shower.
STEPS:
1.
Begin by looking at breast in front of a mirror
with shoulders straight and arms on hips. Note
for the following changes: Dimpling Change in
size and position of nipple Redness, soreness,
rash, swelling
2.
Raise arms and look for the same changes
3.
While in mirror, gently squeeze each nipple
b/w finger and thumb and check for nipple
discharge (milky or yellow fluid or blood)
4.
Feel breast. Use right hand to feel left breast
and v.v. Use firm, smooth touch with the first
few fingers keeping it flat and together then
increase pressure to feel deeper tissue. Follow
a pattern to ensure whole breast is palpated.
o
Vertical pattern-move finger up and
down vertically in rows
o
Wedge pattern - begin from nipple
moving outward
14. TESTICULAR SELF EXAMINATION
•
•
•
•
•
Useful in detecting testicular cancer
Best time to examine is after a warm bath to
relax the scrotum
It may be done as early as 15 years of age
Normally one testicle is larger than the other.
Select a day of the month and perform the
examination on the same day each month.
Note for the ff signs of cancer:
1.
any enlargement of the testicle
2.
significant loss of size in one of the testicles
3.
a feeling of heaviness in the scrotum
4.
a dull ache in the lower abdomen or in the groin
5.
a sudden collection of fluid in scrotum
6.
pain or discomfort in a testicle or in the scrotum
7.
enlargement or tenderness of the breasts
assess whether the person has a properly
functioning immune system
•
Screens for Tumor-associated antigens produced
by neoplastic tissues
Alpha-fetoprotein (Antigen) <10ng/ml (liver Ca,
Testicular Ca, Cirrhosis, Choriocarcinoma, Benign
hepatic disease
CANCER TREATMENT
•
•
•
•
•
•
•
•
•
•
•
SURGERY
CHEMOTHERAPY
RADIATION THERAPY
IMMUNOTHERAPY/MONOCLONAL ANTIBODY also
called biologic therapy, uses the body's own immune
system to fight cancer cells or protect the body from
side effects
One of the newest treatments for breast cancer is a
monoclonal antibody called Herceptin.
the use of interferon, a naturally and synthetically
produced protein that fights disease-causing agents in
the body, particularly viruses.
HORMONE THERAPY/SUPPRESSION- The growth of
some cancers can be inhibited by providing or blocking
certain hormones
Antiestrogen drugs, such as tamoxifen and raloxifene,
given to women with breast cancer block estrogen and
inhibit its ability to stimulate cell growth.
CLINICAL TRIALS- also called research studies, test new
treatments in people with cancer.
VACCINE - to prevent infection by oncogenic infectious
agents (e.g., Gardasil)
COMPLEMENTARY & ALTERNATIVE THERAPY- to
provide or lift the spirits of the patient. complementary
measures include prayer or psychological approaches
such as "imaging" or meditation to aid in pain relief, or
improve mood.
BRAIN CANCER
•
Include:
•
•
neoplasms of central nervous system (CNS)
Those arising from cells of structure within the cranium
Those arising from cells of structure within those
arising within or outside the spinal cord.
Epidemiology
•
intracranial tumors arise from intrinsic cells of brain
tissues and the pituitary glands
•
intracranial lesions occur such as hemorrhage, abscess,
and trauma.
14| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
Pathophysiology:
•
Locally, there are infiltrations, invasions, and
Destruction of brain tissues
•
Direct pressure on nerve structures causing
Degeneration and interference with local circulation
•
edema develops
•
brain tumor situated anywhere in cranial cavity may
cause an increase in ICP
•
an increase in ICP is then transmitted throughout the
brain and the ventricular system
•
as edema increases (blood supply to the brain is
compromised and carbon dioxide is retained, the
vessels dilate to increase blood oxygen supply
Symptoms of tumor found in the specific Brain Lobes:
1. Frontal lobe -personality disturbance
2. Occipital lobe- visual disturbances
3. Temporal lobe- visual, olfactory hallucination
4. Parietal lobe- inability to replicate picture
5. Headache
Nursing Interventions:
1. Pre-operative
2. Post-operative
Diagnostic Test/ Lab Test
•
Blood test
•
Urine test
•
Cerebral fluid is obtained
THROAT CANCER
How to assess of any throat disorder:
•
Examine the posterior pharynx with a tongue
Depressor, instruct the patient to open the mouth Well
and to take a deep breath to flatten the posterior
tongue.
•
Observe color and symmetry, note for any exudates,
ulcerations or swelling
•
palpate the neck for enlarged lymph nodes
•
palpate the neck to assess position and mobility of the
trachea, lateral deviation may indicate a mass in the
neck or mediastinum.
Psychosocial Implications
•
The Patient with laryngeal cancer may experience
coping difficulties
•
The patient may also experience self-concept changes
•
Diseases related changes in social interaction patterns
LARYNGEAL CANCER
•
•
neoplasm of the larynx
laryngeal ca presents as malignant ulcerations with
underlying infiltrations
metastasis to the lung is common
Etiology and incidence:
Predisposing factors to laryngeal cancer include:
•
familial tendency
•
cigarette smoking
•
chronic vocal straining
•
prolonged alcohol ingestion
•
most common ca of the head and neck
•
incidence is highest in man between age 50 and 65
Cancer of the larynx is most commonly found in people who
smoke. The risk is even higher for smokers who drink alcohol
heavily. People who stop smoking can greatly reduce their risk of
cancer of the larynx.
As cigarette smoke is breathed in, it passes down the throat,
through the larynx (voice box) into the lungs. This exposes the voice
box to poisons in the smoke, poisons that can cause cancer. If
cancer develops, the voice box must be removed
Signs and Symptoms:
•
The earliest predominant sign of intrinsic laryngeal ca is
persistent hoarseness
•
sore throat
•
a feeling of a lump the throat
•
burning sensation in the throat
•
Dysphagia
•
change in voice quality
•
dyspnea
•
weakness and weight loss
•
Hemoptysis
•
foul breath odor
Extrinsic laryngeal CA is marked commonly by:
•
no early hoarseness
•
throat pain and burning when drinking hot or acidic
liquids
•
pain possibly radiating to the ear
•
possibly enlarged lymph nodes or lump in the neck with
metastasis
Late symptoms of both types
•
dysphagia and hoarseness
•
dyspnea, cough hemoptysis, foul smelling breath
•
weight loss
Diagnostic Test
•
Laryngoscopy
•
CT-scan
•
Laryngography
•
Tissue biopsy
•
chest radiograph
Nursing Intervention: (PRE-OP)
•
Provide information determine the pts understanding
of treatment plan
15| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
•
•
•
•
encourage the patient and family members to ventilate
feelings and concerns
prepare the pt. and family members for expected post
operative alterations
plan for an alternative means of communication before
surgery
initiate a pre-op evaluation by a speech pathologist if
indicated
refer the pt. and family to support groups
Nursing Intervention - Post operatively
•
promote adequate ventilation
•
prevent post-op infection and hemorrhage
•
provide an alternative means of communication
•
post-op encourages the pt. to work with speech
pathology
•
promote adequate nutrition
•
assist the pt. in adapting to home maintenance
management
•
teach airway care for pt discharged with laryngectomy
tube
LUNG CANCER
•
•
TYPES:
1.
2.
3.
4.
refers to malignant tumor arising within the wall or
epithelial lining of the bronchus or resulting from
metastatic spread of cancer arising elsewhere in the
body
the lungs are a common target from the metastasis of
another organ
Squamous cell (epidermoid)
Adenocarcinoma
Small cell undifferentiated (oat cell)
Large cell undifferentiated
ETIOLOGY AND INCIDENCE:
1. Predisposing factors to lung cancer:
a.
Smoking
b. occupational exposure to carcinogenic
substances c
c.
family hx of lung ca
2. The most common cause of cancer death in men is lung
ca and has a survival rate of only 13%.
PATHOPHYSIOLOGY
1. Squamous cell carcinoma
o
arise most often in the upper lobe, usually in
the main stem lobar segmented bronchi they
grow relatively slow and metastasize late in
their course.
2. Adenocarcinoma
o
tend to rise in a more peripheral lung areas
and grow even more slowly than squamous
3.
4.
cell carcinomas they metastasize relatively
early in their course
Small cell carcinoma
o
arise more peripherally than squamous cell
carcinoma grows rapidly metastasize
commonly is well established by the time of
diagnosis
Large cell carcinoma
o
arise more centrally than small cell
carcinoma and tend to metastasize early in
their course
Regardless of cell types, lung cancer produces some combination
of pulmonary effects (principally disturbance in ventilation).
TREATMENT:
Choice of treatment modalities depends on the stage of the
disease, tumor type, and the pts condition:
•
surgical resection of the tumor or lung tissue
•
radiation therapy
•
Chemotherapy
•
Immunotherapy
ASSESSEMENT/ FINDINGS:
Symptoms usually occur late and are related to tumor size and
location Common clinical manifestations include:
•
change in nature of normal cough
•
hemoptysis
•
Dyspnea
•
hoarseness and wheezing
•
chest pain
•
weight loss and fatigue
Laboratory Findings:
•
Radiograph
•
Sputum studies
•
Bronchoscopy specimen
•
CT scan of the lungs
•
Pulmonary function test/ studies
Nursing Interventions
1.
Prepare the pt for planned test and txt
2.
maintain adequate nutritional status
3.
provide emotional support to the pt and family
BREAST CANCER
•
•
•
•
Classified as invasive when it penetrates
the tissue surrounding the mammary duct and grows in
an irregular pattern
Metastasis occurs via the lymph nodes
Common sites of metastasis are the bone, lungs, brain,
and the liver
16| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
4.
TUMORS OF THE BREAST
A. Benign
o
Fibrocystic disease
o
Fibroadenoma
o
Intraductal papilloma
B. Malignant
o
includes breast cancer
o
Paget’s disease
Breast cancer
•
A primary carcinoma of breast tissue,
attaches to the chest wall, invades
surrounding tissue, and metastasize by way
of lymph channels.
ASSESSMENT FINDINGS:
1.
clinical manifestations of benign breast tumors may
include:
a.
breast pain and tenderness
o
change in mass size
o
palpable mass
2.
assessment findings for conditions affecting the nipple
include:
a.
bloody nipple discharge
b. eczematous or ulcerated nipple (pagets
disease)
c.
usually, minimal pain
3.
signs and symptoms of breast cancer may include:
a.
non-tender lump, usually in an upper outlet
quadrant
b. pain (late)
c.
axillary lymphadenopathy (late)
d. fixed, nodular breast mass (late)
ETIOLOGY AND INCIDENCE
1. Although the cause of breast cancer has not been
elucidated, the effects of estrogen may play a role
2. Risk factors include:
o
over age 40
o
familial hx of breast cancer
o
early menarche
o
late menarche
o
nulliparous or birth of first child after age 34
o
high fat diet
o
oral contraceptive use
o
radiation exposure
o
presence of other cancer
3. Worldwide breast cancer incidence is estimated 1
million annually
NURSING INTERVENTION
1.
Help allay the pts Fears
2.
minimize the discomfort
3.
reinforce information the surgeon has told the pt
4.
provide meticulous wound care
5.
Post surgery- elevate the affected side
6.
administer prescribed pain meds
7.
give health teachings
8.
provide referrals to self-help groups
9.
teach woman on self-breast exam
PATHOPHYSIOLOGY:
1. Fibrocystic disease
•
Small cyst is produced by overgrowth of
fibrous tissue around the ducts
2. Intraductal papilloma
•
A wartlike epithelial mass grows in a large
collecting ducti bleeds on trauma, and blood
collects in the duct until areolar pressure
expresses it out.
3. Paget’s disease
•
Starts an eczematous condition of the nipple
that spreads, erodes and ulcerates and
becomes cancerous
CLIENT INSTRUCTION FF A MASTECTOMY:
•
avoid overuse of the arms
•
prevent lymphedema
•
provide incision care
•
encourage use of reach recovery volunteers
•
encourage pt to perform BSE
•
protect the affected arm and hand
•
avoid strong sunlight to affected arm
•
do not let the affected arm hang independently
•
avoid trauma on affected arm
•
avoid wearing constricted clothing
•
call plans if signs of inflammation occur
Surgical Breast Procedure
1.
Lumpectomy
2.
Simple mastectomy
3.
Modified radical mastectomy
4.
Halsted radical mastectomy
17| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
cirrhosis and exposure to HEPA disease increases the
risk of liver cancer
ETIOLOGY AND INCIDENCE:
1.
Adenoma
•
a benign tumor associated with oral
contraceptives or androgens
2.
Hepatoma
•
Frequent in men
•
Been linked to various factors including hep
B,
•
Chronic liver disease, steroid use, and long
term
•
Androgen therapy.
3.
Metastatic liver cancer
o
associated with approximately one half of all
late cancer
STAGES OF LIVER DAMAGE
1.
Fatty Liver - deposits of fat causes liver enlargement
2.
Liver Fibrosis - Scar tissue forms
3.
Cirrhosis - Growth of connective tissue destroys liver
cells
LIVER CANCER
•
•
A high form of cancer with a high mortality rate
The liver is one of the most common sites of
metastasis from other primary cancers particularly:
o
Colon ○ Rectum
o
Stomach
o
Pancreas
o
Esophagus
o
Lung and breast cancer
o
Melanoma
ASSESSMENT FINDINGS
Clinical features of liver cancer include:
•
mass in the right upper quadrant
•
severe pain
•
Weight loss
•
Weakness
•
Anorexia
•
Fever
•
Dependent edema
•
Occasionally, jaundice or ascites
•
Occasionally, metastasis
DIAGNOSTIC TEST:
•
Aspartate aminotransferase (AST)
•
Alanine aminotransferase (ALT)\
•
Lactic dehydrogenase
•
Chest x-ray
•
Arteriography
•
Blood studies
Treatment:
•
Radiation therapy
•
Chemotherapy
•
Surgical procedure (if indicated)
BLADDER CANCER
•
•
•
Causes: Unknown
adult liver ca may result from environmental
carcinogens
•
Tumors can develop on the surface of the bladder wall
as Benign or Malignant
Bladder tumor mostly affect people age 50, more
common in men than women
18| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
As the tumor progresses, it can extend into the rectum,
vagina, other pelvic soft tissues, and retroperitoneal
structure.
RISK FACTORS:
1. Exposure to environmental carcinogens who are at risk:
a.
rubber workers
b. cable workers
c.
Weavers
d. aniline dye workers
e. hairdressers
f.
spray painters
2. Disease is also associated with chronic bladder irritation
and infections in with kidney stones, chemical cystitis
ASSESSMENT:
•
Gross painless hematuria
•
Gross painless hematuria
•
frequency, urgency, dysuria
•
clot induced obstruction
•
bladder biopsy
•
suprapubic pain
•
nocturia
•
dribbling of urine
•
bladder cancer
DIAGNOSTIC TEST
•
Cystoscopy and biopsy
•
IVP (intravenous pyelogram)
•
Pelvis arteriography
•
CT-scan
TREATMENT:
•
Radiation
o
Palliative radiation
o
Intracavitary radiation
o
External radiation
•
Chemotherapy
o
intravesical instillation
o
systemic chemotherapy
•
Surgical implementation
o
TURP
o
Partial cystectomy
o
Cystectomy and urinary diversion
o
Ileal conduit
NURSING INTERVENTION
•
Provide psychological support
•
Patient teaching
CANCERS OF GENITALIA
The most commonly occurring cancers of the genitalia include:
•
cancer of the prostate
•
cancer of the testes
•
•
•
ca of cervix
ca of uterus
ca of ovaries
CERVICAL CCANCER
•
the third most common cancer of the female
reproductive system
•
Cause: Unknown
CLASSIFIED INTO
•
Pre-invasive carcinoma
•
Invasive carcinoma
RISK FACTORS INVOLVES
•
Intercourse at a young age
•
multiple sexual partners
•
multiple pregnancies
•
transmitted infection
ASSESSMENT FINDINGS:
•
Pre-invasive cervical ca is asymptomatic
•
Early invasive disease may be signaled by:
o
abnormal vaginal bleeding
o
persistent vaginal discharge
o
post coital pain
o
bleeding
o
anorexia and weight loss
o
pelvic pain, lower back, leg
o
vaginal leakage
o
fatigue
o
Hematuria
OVARIAN CANCER SYMPTOMS:
•
Back Pain
•
Fatigue
•
Bloating
•
Constipation Frequent, Urgent Urination
DIAGNOSTIC TESTS
•
Cytologic examination
•
Colposcopy
•
Biopsy and histological examination
TREATMENT:
1.
Pre-invasive lesions
o
total excisional biopsy
o
Cryosurgery
o
laser destruction
o
rarely hysterectomy
2.
Invasive squamous cell carcinoma
o
radical hysterectomy
o
radiation therapy
NURSING INTERVENTIONS
•
Check vital signs
•
Watch for skin reaction
•
Abdominal discomfort
19| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
•
•
Evidence of dehydration
Assist her in ROM
Patient teaching
NURSING CARE OF CLIENTS WITH URINARY ELIMINATION
DISORDERS
ANATOMY AND PHYSIOLOGY OF THE URINARY SYSTEM
KIDNEYS
•
Located retroperitoneally on the posterior wall of
the abdomen – 12th thoracic vertebra to 3rd
lumbar vertebra.
•
113 – 170 g or 4.5 oz
•
6cm width
•
10 – 12 cm height
•
2.5 cm diameter
PROCESS OF URINE FORMATION
1.
Glomerular Filtration
•
Water and solutes smaller than
proteins are forced through the
capillary walls and pores of the
glomerular capsule into the renal
tubule.
2.
Tubular Reabsorption
•
Water, glucose, amino acids, and
needed ions are transported out of the
filtrate into the tubule cells and then
enter the capillary blood.
3.
Tubular Secretion
•
Hydrogen ions, potassium, ammonia,
uric acid, creatinine, and some drugs
are removed from the peritubular
blood and secreted by the tubule cells
into the filtrate.
FUNCTIONS OF THE KIDNEY:
•
•
•
•
•
•
•
Control blood pressure and water balance
[Medulla (vasa recta); juxtaglomerular cells]
Excretion of waste products
Regulation of electrolytes; acid-base balance
(7.35 – 7.45) and red blood cell production
Renal clearance
Secretion of prostaglandins
Synthesis of vitamin D to active form
Urine formation
URETER
•
24 – 30 cm
•
Long fibromuscular tubes that connect each
kidney to the bladder
•
Play an active role in urine transport
20| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
URINARY BLALDDER
•
Distensible muscular sac located just behind the
pubic bone
•
Reservoir for urine
•
400 – 500 mL
•
Bladder emptying (micturition) occurs 8 times in
24 hours.
URETHRA
•
Thin-walled tube that carries urine by peristalsis
from the bladder to the outside of the body.
•
In 24 hours, 150 to 180 liters of blood plasma
▪
Daily volume – 1.0 to 1.8 liters of urine
▪
Components – nitrogenous wastes and
unneeded substances
▪
Color – clear and pale to deep yellow
▪
Odor – slightly aromatic; ammonia odor
(bacteria)
▪
pH – slightly acidic (Around 6)
▪
Specific gravity – ranges from 1.001 to
1.035
▪
Solutes – sodium and potassium ions,
urea, uric acid, creatinine, ammonia,
bicarbonate ions, and various other
ions.
•
•
•
•
•
•
•
•
•
•
✓
Hesitancy, straining to urinate, or frequency of
urination
Urinary incontinence
Hematuria
Nocturia
Renal calculi
OB history (female)
Anuria
Genital lesions or STIs
Use of tobacco, alcohol, or recreational drugs
Any prescription and OTC medications
PHYSICAL ASSESSMENT
Inspection
•
Shortness of breath
•
Cyanosis
•
Pallor
•
Edema
MICTURITION or voiding is the act of emptying
the bladder:
▪
Accumulation – the bladder collects
urine until about 200 mL
▪
Activation – activates stretch receptors
▪
Transmission – impulses transmitted to
the sacral region of the spinal cord and
then back to the bladder via the pelvic
splanchnic nerves
▪
Passage – stored urine is forced past the
internal urethral sphincter into the
upper part of the urethra.
▪
External sphincter
ASSESSMENT OF THE KIDNEY AND URINARY SYSTEMS
•
Health history
•
Physical assessment
•
•
•
•
•
•
✓
Auscultation
•
Assess for renal artery bruits
✓
Palpation
HEALTH HISTORY
Patient’s chief concern
Location, character, and duration of dysuria
History of UTIs
Fever or chills
Previous renal or urinary diagnostic tests,
surgeries, or procedures; or the use of indwelling
urinary catheters
21| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
C.
✓
Percussion
INTRAVENOUS UROGRAPHY or INTRAVENOUS
PELVOGRAPHY (IVP)
•
A radiopaque contrast agent (Sodium
diatrizoate or meglumine diatrizoate)
is given IV
•
Multiple x -rays are obtained to
visualize KUB
Nursing interventions BEFORE the procedure
o Written consent
o NPO 6 to 8 hours
o Bowel preparation (Laxative as ordered)
o Assess allergy to iodine and seafoods
o Prepare epinephrine at bedside
DIAGNOSTIC EVALUATION
URINALYSIS AND URINE CULTURE AND SENSITIVITY
Nursing interventions AFTER the procedure
o Monitor VS
o Increase fluid intake to excrete the dye
o Burning sensation on voiding may be experienced
o Observe for signs of delayed allergic reaction (skin
rashes, pruritus, dyspnea)
D.
Cystography
•
Aids in evaluating vesicoureteral reflux
•
A catheter is inserted into the bladder
and a contrast agent is instilled to
outline the bladder wall.
E.
Renal Angiography
•
Provides an image of the renal arteries
•
The femoral (or axillary) artery is
pierced with a needle, and a catheter is
threaded up to through the femoral and
iliac arteries into the aorta or renal
artery
•
A contrast agent is injected to opacify
the renal arterial supply
•
Used to evaluate renal blood flow
DIAGNOSTIC IMAGING
A.
B.
KUB X – RAY and KUB ULTRASOUND
CT and MRI
22| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
Used to preoperatively for renal
transplant
biopsy) or by open biopsy through a
small flank incision
Nursing interventions BEFORE the procedure
o Cleanse the bowel (laxative as ordered)
o Shave catheter insertion site (Lumbar, femoral
area)
o Locate and mark distal pulses
Nursing interventions BEFORE the procedure
o NPO for 6 to 7 hours
o Check PTT, Pro time
o Mild sedation is done
o Place the client in prone position during the
procedure
o Ultrasound and X – ray of kidney should be readily
available
o Local anesthesia is administered
o Instruct client to hold breathe and remain still
during needle insertion
Nursing interventions AFTER the procedure
o Monitor VS until stable
o Apply cold on puncture site to prevent bleeding
o Check for swelling and hematoma
o Sandbag over catheter insertion site to further
prevent bleeding
o Palpate peripheral pulses to assess adequacy of
circulation in the involved extremity
o Check color and temperature of extremity to
assess adequacy of circulation in the involved
extremity
o Bed rest for 24 hours, no sitting
o Measure urine output to assess renal function
•
•
URULOGIC ENDOSCOPIC PROCEDURES
Used to directly visualize the urethra and bladder
A cystoscope is inserted through the urethra into
the bladder, has an optical lens system that
provides a magnified, illuminated view of the
bladder.
BIOPSY
A.
B.
Renal and Ureteral Brush Biopsy
•
Provide specific information whether a
defect is a tumor, a stone, a blood clot,
or an artifact.
•
First, a cryptoscopic examination is
conducted
•
A ureteral catheter is introduced,
followed by a biopsy brush that is
passed through the catheter
•
The suspected lesion is brushed back
and forth to obtain cells and surface
tissue fragments for histologic analysis
Kidney biopsy
•
Indications: unexplained acute kidney
injury, persistent proteinuria or
hematuria, transplant rejection, and
glomerulopathies
•
A small section of renal cortex is
obtained either percutaneous (needle
Nursing interventions AFTER the procedure
o Monitor VS
o Bed rest for 24H
o Check for pain, nausea, and vomiting
o Provide fluids up to 3000 mL
o Hct and Hgb done in 8 hours to detect bleeding
o Avoid strenuous activities for 2 weeks
o Notify the physician for the following risks:
Bleeding
Hematoma
Infection
URINARY TRACT DISORDERS
INFECTIONS OF THE URINARY TRACT / URINARY TRACT
INFECTION
➢
➢
➢
Caused by pathogenic microorganisms in the
urinary tract
E. coli, klebsiella, proteus, pseudomonas
Classifications:
Lower UTI
Upper UTI
Upper UTI
•
Kidneys (pyelonephritis)
•
Ureters (Ureteritis)
Lower UTI
•
Bladder (cystitis)
•
Urethra (urethritis)
•
Prostate (Prostatitis)
•
•
•
RISK FACTORS OF UTI
Gender (female)
Diabetes
Pregnancy
23| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
•
•
•
•
•
•
•
Neurologic disorders
Gout
Incomplete emptying of bladder
Immunosuppression
Inability or failure to empty bladder completely
Inflammation or abrasion of urethral mucosa
Instrumentation
Obstructed urinary flow
•
•
MEDICAL MANAGEMENT / PHARMACOLOGIC THERAPY
1.
Antibacterial agent
•
Nitrofurantoin
•
Ciprofloxacin
•
Ampicillin
•
Amoxicillin
•
Co – trimoxazole
2.
Analgesic
•
Phenazopyridine HCL
PATHOPHYSIOLOGY
1.
2.
3.
4.
5.
ROUTES OF URINARY TRACT INFECTION
6.
7.
✓
✓
✓
LOWER URINARY TRACT INFECTION
Cystitis
Urethritis
Prostatitis
•
•
•
•
•
CLINICAL MANIFESTATIONS
Urinary frequency
Urgency
Nocturia
Incontinence
Suprapubic or pelvic pain
Hematuria
Back pain
8.
NURSING MANAGEMENT
C and S before antibiotic therapy
Increase fluid intake to 3 to 4 liters per day
Acidify urine (cranberry juice and purine juice)
Hot sitz bath
Provide the following patient teachings:
•
Practice “3 W’s” (wash, wear, wipe)
✓ Wash
hands before and after using the toilet
Handwashing is the single most effective
practice to prevent spread of
microorganisms
✓ Wear
cotton underwear is absorbent
Nylon underwear is non-absorbent.
Moisture enhances proliferation of
microorganisms
✓ Wipe
Wiping perineum from front to back
prevents contamination the urinary
meatus with colonic bacteria from the
anus.
Avoid wearing tight clothing (e.g., tight jeans)
Empty the bladder every 2 to 3 hours. Urinary
stasis in the bladder enhances proliferation of
microorganisms
Empty the bladder before and immediately after
sec intercourse. To prevent contamination of the
urinary meatus by colonic bacteria from the anus.
UPPER URINARY TRACT INFECTION
✓ Pyelonephritis
✓ Ureteritis
PYELONEPHRITIS
Bacterial infection of the renal pelvis, and interstitial tissue
of one or both kidneys. Acute or chronic
24| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
1.
Antibacterial agent
•
Nitrofurantoin
•
Ciprofloxacin
•
Ampicillin
•
Amoxicillin
•
Co – trimoxazole
Analgesic
•
Phenazopyridine HCL
Acute Pyelonephritis
Usually leads to enlargement of the
kidneys with interstitial infiltration of
inflammatory cells
Atrophy and destruction of tubules and
the glomeruli may result
CLINICAL MANIFESTATIONS
•
Chills and fever
•
Leukocytosis
•
Bacteriuria
•
Pyuria
•
Low back pain
•
Flank pain
•
Nausea and vomiting
•
Headache
•
Body malaise
•
Painful urination
•
•
•
•
•
•
•
•
MEDICAL MANAGEMENT
•
Pharmacologic therapy
Antibacterial agent
•
Nitrofurantoin
•
Ciprofloxacin
•
Ampicillin
•
Amoxicillin
•
Co – trimoxazole
Analgesic
•
Phenazopyridine HCL
•
Hydration with oral and parenteral fluid
2.
Chronic Pyelonephritis
Repeated bouts of acute pyelonephritis
The kidneys become scarred, contracted
and non-functioning
It could cause chronic kidney disease
Hydration with oral and parenteral fluid
Monitoring of kidney function
NURSING MANAGEMENT
Measure and record intake and output
Encourage to increase oral fluid intake, 3-4 L/day
(unless contraindicated)
Monitor VS (body temp)
Administer antipyretic and antibiotic as ordered
Educate the patient to empty bladder regularly
Perform recommended perineal hygiene
NEUROGENIC DISORDERS
✓
✓
✓
Urinary Incontinence
Urinary retention
Neurogenic bladder
URINARY INCONTINENCE
➢
Unplanned, involuntary, or uncontrolled loss of
urine from the bladder
CLINICAL MANIFESTATIONS
•
Fatigue
•
Headache
•
Poor appetite
•
Polyuria
•
Excessive thirst
•
Weight loss
MEDICAL MANAGEMENT
•
Pharmacologic therapy
•
•
RISK FACTORS
Age-related changes in the urinary tract
Caregiver or toilet unavailable
25| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
•
•
•
•
•
•
•
•
•
•
•
Cognitive disturbances
Obesity
Diabetes
Genitourinary surgery
High – impact exercise
Immobility
Incompetent urethra
Medications (Diuretics)
Menopause
Pelvic muscle weakness
Pregnancy
Stroke
1.
2.
3.
4.
5.
6.
TYPES OF URINARY INCONTINENCE
Stress incontinence
Urge incontinence
Functional incontinence
Latrogenic incontinence
Mixed incontinence
Overflow incontinence
Stress Incontinence
➢ The involuntary loss of urine through intact
urethra as a result exertion, sneezing, coughing,
or changing position
➢ Affects women who had vaginal deliveries
➢ Men who had radical prostatectomy
Urge Incontinence
➢ The involuntary loss of urine associated with
strong urge to void that cannot be suppressed
➢ Aware of the need to void but is unable to reach
the toilet in time
➢
1.
a.
b.
c.
2.
•
•
•
•
Continual leakage of urine from an overdistended
bladder
MEDICAL MANAGEMENT
Behavioral Therapy – nonpharmacologic or
conservative treatments
Fluid management – 1500-1600ml
Standardized voiding frequency – schedule
voiding
PME (pelvic muscle exercise) or Kegel’s exercise –
to strengthen the voluntary muscles that assists
in bladder continence (2-3 times/day for 6 weeks)
Pharmacologic therapy
•
Anticholinergic agents – inhibits
bladder
contraction
(oxybutynin
[Ditropan], dicyclomine [antispas]
•
Tricyclic antidepressant (amitriptyline)
•
Pseudoephedrine sulfate
SURGICAL MANAGEMENT
Anterior vaginal repair, retropubic suspension or
needle suspension to reposition the urethra
(WOMEN)
Periurethral bulking – a semipermanent
procedure in which small amounts of artificial
collagen are placed within the walls of the urethra
Artificial urinary sphincter – used to close the
urethra and promote incontinence
Transurethral resection of the prostatic
enlargement
Functional Incontinence
➢ The involuntary loss of urine due to physical or
cognitive impairment
➢ The lower urinary tract function is intact but other
factors, such as severe cognitive impairment
➢ Alzheimer’s dementia
Latrogenic incontinence
➢ The involuntary loss of urine due to extrinsic
medical factors, predominantly medications
➢ Use of alpha-adrenergic agents to decrease blood
pressure
Mixed Incontinence
➢ Is involuntary leakage associated with urgency
and with exertion, effort, sneezing, or coughing
Overflow Incontinence
•
•
NURSING MANAGEMENT
Routine skin assessment
Patient education
✓ Avoid bladder irritants (caffeine,
alcohol)
✓ Avoid taking diuretic agents after 4pm
26| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
✓
✓
✓
✓
✓
Increase awareness of the amount and
timing of all fluid intake
Perform all pelvic floor muscle exercises
as prescribed, everyday
Stop smoking
Avoid constipation
Void regularly, 5-8 times a day (about
every 2-3 hours)
✓
✓
✓
✓
•
Assist with use of bathroom or bedside
commode
Apply warmth (sitz bath, warm
compress)
Simple trigger techniques
Straight catheterization
Promoting home,
transitional care
community-based
and
NEUROGENIC BLADDER
➢
URINARY RETENTION
➢
➢
➢
Inability to empty the bladder completely during
attempts to void
<60 yo – complete bladder emptying should occur
with each voiding, no residual
>60 yo (50 to 100 mL) of residual urine
➢
A dysfunction that results from a disorder or
dysfunction of the nervous system and leads to
urinary incontinence
Caused by spinal cord injury, spinal tumor,
herniated vertebral disc, multiple sclerosis,
congenital disorders, infection, and complications
of DM
TWO TYPES OF NEUROLOGIC BLADDER
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
RISK FACTORS
Diabetes Mellitus
Prostatic enlargement
Urethral pathology (infection, tumor, calculus)
Trauma (pelvic injuries)
Pregnancy
Neurologic disorders (stroke, spinal cord injury,
multiple sclerosis, and Parkinson’s disease)
Medications
1.
Spastic Bladder
▪
Caused by any spinal cord lesion above
the voiding reflex arc (upper motor
neuron lesion)
▪
The result is a loss of conscious
sensation and cerebral motor control
▪
A spastic bladder empties on reflex,
with minimal or no controlling influence
to regulate its activity
2.
Flaccid bladder
▪
Caused by a lower motor neuron lesion,
commonly resulting from trauma
▪
The bladder muscle does not contract
forcefully at any time because of
sensory loss
ASSESSMENT AND DIAGNOSTIC FINDINGS
What was the time of the last voiding, and how
much urine was excreted?
Is the patient voiding small amounts of urine
frequently?
Does the patient complain of pain or discomfort
in the lower abdomen?
Is the pelvic area swollen?
Does a post void bladder ultrasound test reveal
residual urine?
COMPLICATIONS
Chronic infection
Pyelonephritis
Sepsis
NURSING MANAGEMENT
Promote Urinary Elimination
✓ Provide privacy
✓ Ensure environment and
conducive to voiding
position
•
MEDICAL MANAGEMENT
Catheterization
27| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
•
•
•
•
Low calcium diet
Encourage mobilization and ambulation
Encourage liberal fluid liquid
Bladder retraining program
Pharmacologic
➢ Bethanechol (Urecholine)
TO CLASSIFY AKI RESULTS
o
o
KIDNEY DISORDERS
1.
2.
3.
4.
5.
6.
Acute Kidney Disease (Acute Kidney Injury – AKI)
Chronic Kidney Disease
Acute Nephritic Syndrome
Glomerulonephritis
Nephrotic Syndrome
Polycystic Kidney Disease
o
Glomerular Filtration Rate
o GFR 90-120 ml/min
Serum Creatinine Level
o Men: 0.7 to 1.3 mg/dl
o Women: 0.6 to 1.1 mg/dl
Reduction of hourly urine output
RIFLE CLASSIFICATION FOR AKI
KIDNEY DISEASE
➢
➢
1.
2.
Results when the kidneys cannot remove the
body’s metabolic wastes or perform their
regulatory functions
Urine accumulates in the body fluids as a result
of impaired renal excretion, affecting endocrine
and metabolic functions as well as resulting in
fluid, electrolyte, and acid-base disturbances
Notes:
Below 400 ml urine output = OLIGURIA
Below 100 ml urine output = ANURIA
Injury severity levels
ACUTE KIDNEY INJURY (AKI)
➢
➢
➢
Also known as Acute Renal Failure (ARF) or known
today as Acute Kidney Injury
Rapid loss of renal function due to damage to the
kidneys
Metabolic complications (metabolic acidosis, and
fluid and electrolyte imbalance
R
I
F
L
E
Identification of Aki at
these levels and proper
management can precent
progression to more
serious injury that may not
be reversible
Indicates serious injury
that
requires
renal
replacement therapy at
least on a temporary basis
28| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
CATEGORIES OF AKI
•
1.
Prerenal
•
Hypoperfusion of kidney
•
Cause: volume depletion (burns,
hemorrhage, GI losses), hypotension
(sepsis, shock)
2.
Intrarenal
•
Actual damage to kidney tissue
•
Cause: prolonged ischemia, nephrotic
agents, infectious processes (often
caused by infectious, drugs, and
invading tumors)
•
These actual damages may be either be
caused by physical, chemical, hypoxic,
or immunologic in nature which directly
affects the kidney tissue
•
The most common type of intrarenal
AKI is acute tubular necrosis (damage to
the kidney tubules)
3.
Postrenal
•
Obstruction to urine flow
•
Cause: renal calculi, blood clots, Benign
prostatic hypertrophy, malignancies,
and pregnancies
3.
Diuresis
•
Gradual increase in urine output
(10L/day)
•
Often has a sudden onset withing 2-6
weeks after oliguric stage
•
Urine flow increases rapidly over a
period of several days
4.
Recovery
•
Improvement of real function (3-12
months)
•
Laboratory values return to the
patient’s normal level
•
The patient begins to return to normal
levels of activity
PHASES OF AKI
1.
2.
Initiation
•
Initial insult and ends when oliguria
develop
•
The
gradual
accumulation
of
nitrogenous wastes, such as increasing
serum creatinine and BUN, may be
noted.
Oliguria
•
Characterized by urine output of 100400mL/24 hours that does not respond
to fluid challenges or diuretics
•
Last 1-3 weeks
•
Uremic symptoms
✓ Nausea
✓ Vomiting
✓ Fatigue
✓ Anorexia
✓ Weight loss
✓ Muscle cramps
✓ Pruritus
✓ Changes in mental status
✓ Hyperkalemia develop
Laboratory data includes:
✓ Increasing
serum
creatinine
✓ Increasing BUN levels
✓ Hyperkalemia
✓ Bicarbonate
deficit
(metabolic acidosis)
✓ Hyperpotassemia
✓ Hypocalcemia
✓ Hypermagnesemia
✓ Sodium retention occurs,
but this is masked by the
dilutional effects of water
retention
✓ Urinary
indices
are
typically low and fixed;
regulation
of
water
balance by the kidneys is
impaired, so urine specific
gravity
and
urine
osmolarity do not vary as
plasma osmolarity
•
•
•
•
•
•
•
•
•
•
CLINICAL MANIFESTATIONS
Scanty urine
Hematuria
Low urine specific gravity
Decrease sodium in urine (prerenal)
Increase sodium in urine (intrarenal)
UTZ and CT scan show evidence of anatomic
changes
BUN decrease
Decrease GFR, oliguria, anuria
Hyperkalemia
Metabolic acidosis
29| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
•
•
•
•
•
•
•
•
•
•
Blood phosphorus increase
Low calcium
PREVENTION (AKI)
Continually assess renal function when
appropriate
Monitor central venous and arterial pressure and
hourly urine output
Pay special attention to wounds, burns, and other
precursors of sepsis
Prevent and treat infections promptly
Prevent and treat hypotensive shock promptly
with blood and fluid replacement
Provide adequate hydration to patients at risk for
dehydration, including:
✓ Before, during, and after surgery
✓ Patients
undergoing
intensive
diagnostic studies requiring fluid
restriction and contrast agents
✓ Patients with neoplastic disorders or
disorders of metabolism (e.g., gout) and
those receiving chemotherapy
✓ Patients with skeletal muscle injuries
✓ Patients with heat induced illness
Give meticulous care to patients with indwelling
catheters
Closely monitor dosage, duration of use, and
blood levels of all medications metabolized or
excreted by the kidneys
1.
2.
3.
4.
5.
6.
CHRONIC KIDNEY DISEASE (CKD)
➢
➢
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MEDICAL MANAGEMENT (AKI)
1.
Is an umbrella term that describes kidney damage
or a decrease in the glomerular filtration rate
(GFR) lasting for 3 or more months
Untreated CKD can result in end-stage kidney
disease (ESKD) formerly known as end-stage renal
disease (ESRD), which is the final stage of CKD –
when function is too poor to sustain life
Usually progressive and irreversible deterioration
of kidney function without recovery
Either the presence of kidney damage or a
decreased GFR less than 60 mL/min/1.73 m2 for
longer than 3 months.
RISK FACTORS (CKD)
Hyperkalemia correction
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Sodium polystyrene sulfonate (orally or
retention enemas)
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Sorbitol – to induce a diarrhea – type
effect
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IV D50, insulin and Ca replacement – to
shift potassium back into the cells
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2.
Renal Replacement Therapy
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Hemodialysis
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Peritoneal Dialysis
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3.
Nutritional Therapy
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High protein, high carbohydrates
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Restrict foods and fluids containing
sodium, potassium, or phosphorus
(e.g., bananas, citrus fruits and juices,
dairy foods)
NURSING MANAGEMENT (AKI)
Monitoring Fluid and Electrolyte Balance
IV solutions, medications, S. K+, strict IO,
weight monitoring
Reducing metabolic rate
Monitor for fever and infections
Promoting pulmonary function
Turn, cough, and take deep breaths
frequently
Preventing infection
Providing skin care
Cool water, frequent turning, and
keeping the skin clean, and well
moisturized, fingernails trimmed
Provide psychosocial support
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Diabetes
✓ Prevention: Achieve optimal glycemic
control
Hypertension
✓ Prevention: Maintain BP in normal
range with angiotensin converting
(ACE) inhibitors or angiotensin receptor
blockers (ARBs)
Age >60 yo
✓ Prevention: prevent insult or kidney
injury
Cardiovascular disease
✓ Prevention: Institute aggressive risk
factor reduction
Family history of CKD
✓ Prevention: Teach about increased risk
and assist with appropriate screening
(BP measurement, urinalysis)
Exposure to Nephrotoxic drugs
30| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
✓
Prevention: Limit exposure and give
sodium bicarbonate as treatment
STAGES OF CKD
1.
2.
Stage 1 – At risk
A normal GFR characterized by a GFr of
more than 90 ml/min
There is still normal kidney function and
no obvious kidney disease
Reduced renal reserve may occur that
reduces kidney function without buildup
of wastes in the blood
The unaffected nephrons overwork to
compensate for the nephrons
Factors that increases the reduction of
renal reserves may include:
➢ Infection
➢ Fluid overload
➢ Pregnancy
➢ Dehydration
Stage 2 – Mild CKD
Reduced renal reserve: GFR is 35% to
50% of the normal rate
GFR is now reduced that ranges between
60 and 89 mL/min
Nephron damage has occurred and there
may be slight elevations of metabolic
wastes in the blood
Not enough healthy nephrons remain to
compensate completely for the damaged
nephrons
metabolic wastes, fluid balance, and
electrolyte balance
Restriction of fluids, proteins, and
electrolytes is needed
4.
Stage 4 – Severe CKD
Renal Reserve: GFR is 20% to water 25%
of the normal rate
GFR continues to reduce that ranges
between 15 and 29 mL/min
5.
Stage 5 – End Stage Renal Disease
Renal reserve: GFR is less than 20% of the
normal rate
GFR is now less than 15 mL/min
Excessive amounts of urea and creatinine
build up in the blood, and the kidneys
cannot maintain homeostasis
Severe fluid, electrolyte, and acid-base
imbalances occur
CLINICAL MANIFESTATIONS
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Increase creatinine level
Anemia
Metabolic acidosis
Abnormalities in calcium, phosphorus balance
Edema
Congestive heart failure
Abnormalities in electrolytes
Heart failure
Hypertension
ACUTE NEPHRITIC SYNDROME
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A type of glomerulonephritis
The kidneys become large, edematous, and
congested
Group A beta-hemolytic streptococcal infection
of the throat
Hematuria, pus, cellular, and granular casts in the
urine
CLINICAL MANIFESTATIONS
3.
Stage 3 – Moderate CKD
Renal reserve: GFR is 20% to 35% of the
normal rate
GFR continues to reduce that ranges
between 30 and 59 mL/min
Nephron damage has continued, and the
remaining nephrons cannot manage
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Hematuria
Pitting edema
Azotemia
(abnormal
concentration
nitrogenous wastes in the blood)
Proteinuria
Coca-colored urine
Hypertension
of
31| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
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Increase BUN, Creatinine
Anemia
COMPLICATIONS
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Hypertensive encephalopathy
Heart failure
Pulmonary edema
MEDICAL MANAGEMENT
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Pharmacologic therapy
✓ Corticosteroids
✓ Penicillin (streptococcal infection)
Manage hypertension – sodium restrictions
Controlling proteinuria – low protein diet
NURSING MANAGEMENT
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Providing care in the hospital
✓ Increase carbohydrates to provide
energy
✓ Measure and record I & O
✓ Manage fluids
✓ Administer diuresis as ordered
✓ Patient education (disease, laboratory,
and diagnostic tests)
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Educating Patients about self-care
✓ Manage symptoms and monitor
complications
✓ Fluid and diet restrictions
✓ Instruct verbally and in writing to notify
the primary provider if symptoms of
kidney disease occur
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Continuing and transitional care
✓ Importance of follow-up evaluations of
BP, laboratory blood studies (Bun,
creatinine, and urinalysis)
CHRONIC GLOMERULONEPHRITIS
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Due to repeated episodes of acute nephritic
syndrome,
hypertensive
nephrosclerosis,
hyperlipidemia, chronic tubulointerstitial injury,
or hemodynamically mediated glomerular
sclerosis
ASSESSMENT AND DIAGNOSTIC FINDINGS
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Urinalysis – specific gravity 1.010
Proteinuria
Urinary casts
GFR falls below 50 mL/min
✓ Anemia
✓ Decreased serum calcium level
✓ Hyperkalemia
32| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
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✓ Hypoalbuminemia
✓ Increased serum phosphorus level
✓ Impaired nerve conduction
✓ Mental status changes
✓ Metabolic acidosis
Chest x-rays – cardiac enlargement and
pulmonary edema
Electrocardiogram (ECG) – indicate left
ventricular hypertrophy
Renal ultrasound – decreased renal mass in both
kidneys
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A type of kidney disease characterized by
increased glomerular permeability and is
manifested by massive proteinuria
CLINICAL MANIFESTATIONS
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Proteinuria
Hypoalbuminemia (decrease albumin in the
blood)
Diffuse edema – periorbital, sacrum, ankles, and
hands, abdomen (ascites)
High serum cholesterol and hyperlipidemia
MEDICAL MANAGEMENT
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COMPLICATIONS
Reduce the blood pressure
✓ Sodium and water restriction
✓ Antihypertensive agents
Treat fluid overload
✓ Weight is monitored daily
✓ Diuretic medications
Promote good nutritional status
✓ Proteins (eggs, meats, fish)
Treat urinary tract infections (UTIs)
Avoid nephrotoxic medications and diagnostic
studies
✓ NSAIDS, contrast dye
Dialysis
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Hypercoagulable state
Deep venous thrombosis
Renal vein thrombosis
Pulmonary embolism
Atherosclerosis
NURSING MANAGEMENT
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Observe for common fluid and electrolyte
disturbances
Gives emotional support
Educate patients about self-care
✓ Schedule of follow-up evaluations
✓ Dialysis – educate about the procedure,
how to care for the access site, dietary
and fluid restrictions, and lifestyle
modifications
✓ Educate about worsening signs and
symptoms of kidney disease and report
to the primary provider (nausea,
vomiting, loss of appetite, and
diminished urine output)
Educate about recommended diet and fluid
modifications
Medications
Consult with renal dietitian for detailed dietary
education
MEDICAL MANAGEMENT
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Diuretic agents – edema
ACE inhibitors – reduce proteinuria
Lipid-lowering agents – hyperlipidemia
Diet – sodium restriction (approximately 2g of
sodium/day)
NEPHROTIC SYNDROME
33| Francisco, JA – 3B
NCM 112: MEDICAL - SURGICAL NURSING
MIDTERMS – THEORY
UNIVERSIDAD DE STA. ISABEL DE NAGA INC. – COLLEGE OF NURSING
1st SEMESTER A.Y. 2023 – 2024
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Loss of renal function
Increasing size of the kidneys
Hematuria
Hypertension
Renal calculi with associated UTIs
Proteinuria
Increasing abdominal fullness
Flank pain
PKD MEDICAL MANAGEMENT
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Tolvaptan – vasopressin V2 receptor antagonists
Blood pressure control
Pain management
Antibiotic agents
RRT
Genetic studies and counseling
POLYCISTIC KIDNEY DISEASE (PKD)
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Genetic disorder characterized by the growth of
numerous fluid-filled cysts in the kidneys, which
destroy the nephrons
PKD cysts can enlarge the kidneys while replacing
much of the normal structure, resulting in
reduced kidney function and leading to kidney
failure
CLINICAL MANIFESTATIONS
34| Francisco, JA – 3B