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Interferences to nurtritional elimination needs:. Intestinal and Urinary Diversions. Colorectal Cancer. Major health problem – one of the most prevalent malignancies in US 95% are adenocarcinomas Thought to develop from adenomatous polyps Liver is the most common site of metastasis - PowerPoint PPT Presentation
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INTERFERENCES TO NURTRITIONAL ELIMINATION NEEDS:Intestinal and Urinary Diversions
COLORECTAL CANCER Major health problem – one of the most prevalent
malignancies in US 95% are adenocarcinomas
Thought to develop from adenomatous polyps Liver is the most common site of metastasis May also metastasize to lungs, brain, bones, adrenals
Risk factors: genetics, life habits, diet, IB disease, African-american
descent Physical signs/symptoms:
Depend on location of tumor Change in stools: color, shape, gas pains, abd
cramping, feeling of incomplete evacuation of bowel, straining to defecate, dull abd pain
s/s of Anemia Abd mass
Stool tests that check for signs of cancer: Fecal occult blood test (FOBT). Fecal immunochemical test (FIT). Stool DNA test (sDNA). Carcinoembryonic antigen (CEA)
Colonoscopy/sigmoidoscopy/barium enema CT scan of the abdomen Interventions
Staging done first Radiation tx: to local area, may be palliative Meds: 5 FU, leucovorin, oxaliplatin, irinotecan,
bevacizumab, cetuximab Watch for side effects, dose limiting signs
Surgical removal of tumor
Colostomies Placement of ostomy in relation to where it is placed
in the intestine Ascending Descending Transverse (double barreled) Sigmoid
What is the difference between a colostomy and an ileostomy? When would an ileostomy be created? Is the care for one different from the other? Are there concerns specific to one that are not issues for
the other? Are there differences in stool depending on where the
stoma is? What is the nursing care for the stoma? What are the s/s of problems, when do you need to
notify the MD? What patient education needs to take place prior to
sending the patient home? How does the RN handle the psychosocial issues of
having an ostomy?
RENAL FAILURE
ARF vs CRF What are the differences? What are the causes of ARF? How can you distinguish between the various phases
of ARF (prerenal, intrarenal, postrenal)? Are the physical findings the same for each? Give examples of situations that would create a prerenal,
intrarenal and postrenal injuries Give examples of nephrotoxic agents How do the phases of oliguric acute renal failure differ
from one another? Make a chart outlining the differences/similarities.
What lab tests are done to diagnose/monitor ARF/CRF? Are they the same? How do they differ? Why do you see the changes in the lab tests?
Interventions What medications are typically used to treat renal
failure? (ARF vs CRF) What do you need to remember from NUR 101 re:
metabolization/excretion of meds? How does this impact someone with renal failure?
Why are these meds given? What are the common side effects you need to monitor
for? Is there a special diet RF patients need to follow?
Why? What is the diet? Give examples of foods that are allowed vs those not allowed/restricted.
What is dialysis? How does it work? Are all dialysis types the same? How do they differ?
What are their advantages/disadvantages? When would someone require dialysis? What patient education is required for someone on
dialysis? What do you need to know re: the care of the patient on
dialysis?
When would a renal transplant be done? When would a renal failure patient not be a
candidate for renal transplant? What needs to be done prior to the surgery
(pre-op)? What is the postoperative care needed post
transplant surgery? What are the complications following
transplant? What patient education needs to be done for
the kidney transplant patient?