NSG 4052 Exam 2 Study Guide (Latest 2020) / NSG4052 Study Guide Exam #2: South University

NSG 4052 Exam 2 Study Guide / NSG4052 Study Guide Exam #2 1. RA/ OA::(8-10) Know signs/symptoms; RA ● The onset of RA is typically insidious. Nonspecific manifestations such as fatigue, anorexia, weight loss, and generalized stiffness may precede the onset of joint symptoms. ● Stiffness becomes more localized in the following weeks to months. Some patients report a precipitating stressful event such as infection, work stress, physical exertion, childbirth, surgery, or emotional upset. However ● Specific joint involvement is marked by pain, stiffness, limited motion, and signs of inflammation (e.g., heat, swelling, tenderness). ● OA ● Fatigue, fever, and organ involvement are not present in OA. This is an important distinction between OA and inflammatory joint disorders such as rheumatoid arthritis. ● Joint pain is the primary symptom and the typical reason the patient seeks medical attention. Pain generally gets worse with joint use. In early stages of OA, joint pain is relieved by rest. ● As OA progresses, increasing pain can contribute greatly to disability and loss of function. The pain of OA may be referred to the groin, buttock, or the outside of the thigh or knee. Sitting down becomes difficult, as does rising from a chair when the hips are lower than the knees. As OA develops in the intervertebral (apophyseal) joints of the spine, local pain and stiffness are common. ● Unlike pain, which typically worsens with activity, joint stiffness occurs after periods of rest or an unchanged position. Early morning stiffness is common but generally resolves within 30 minutes. ● Crepitation, a grating sensation caused by loose cartilage particles in the joint cavity, can also cause stiffness. nursing management; Interprofessional Care Osteoarthritis Diagnostic Assessment • History and physical examination • Radiologic studies of involved joints (e.g., x-ray, CT scan, MRI, bone scan) • Synovial fluid analysis o management • Nutritional and weight management counseling • Rest and joint protection, use of assistive devices • Therapeutic exercise • Heat and cold applications • Complementary and alternative therapies • Herbs and nutritional supplements (e.g., fish oil, ginger, Sam-e • Movement therapies (e.g., yoga, Tai Chi) • Acupuncture • Massage • Transcutaneous electrical nerve stimulation (TENS) • Reconstructive joint surgery Drug Therapy (Table 64-3) • acetaminophen • Nonsteroidal antiinflammatory drugs • Intraarticular corticosteroids OA. teaching; ● Patient & Caregiver ● Joint Protection and Energy Conservation ● Include the following instructions when teaching patients with arthritis to protect joints and conserve energy. ● Maintain healthy weight. ● Use assistive devices, if indicated. ● Avoid forceful repetitive movements. ● Avoid awkward positions that stress joints. ● Use good posture and body mechanics. ● Seek help with needed tasks that may cause pain. ● Organize routine tasks and pace yourself to decrease fatigue and joint pain. ● Modify home and work environment to perform tasks in less stressful ways. RA teaching o Patient & Caregiver Teaching o Protection of Small Joints Include the following instructions when teaching the patient with arthritis how to protect small joints. 1. Maintain joint in neutral position to minimize deformity. • Press water from a sponge instead of wringing. 2. Use strongest joint available for any task. • When rising from chair, push with palms rather than fingers. • Carry laundry basket in both arms rather than with fingers. 2. Distribute weight over many joints instead of stressing a few. 3. Slide objects instead of lifting them. • Hold packages close to body for support. 4. Change positions frequently. • Do not hold book or grip steering wheel for long periods without resting. • Avoid grasping pencil or cutting vegetables with knife for extended periods. 5. Avoid repetitious movements. • Do not knit or sew for long periods. • Rest between rooms when vacuuming. • Modify home environment to include faucets and doorknobs that are pushed rather than turned. 6. Modify chores to avoid stress on joints. • Avoid heavy lifting. • Sit on stool instead of standing during meal preparation. RA treatment; ● Management ● Nutritional and weight management counseling ● Therapeutic exercise ● Psychologic support ● Rest and joint protection, use of assistive devices ● Heat and cold applications ● Complementary and alternative therapies ● Herbal products and nutritional supplements ● Acupuncture ● Reconstructive surgery meds, o Drug Therapy (Table 64-3) o Disease-modifying antirheumatic drugs (DMARDs) o Intraarticular or systemic corticosteroids o Nonsteroidal antiinflammatory drugs (NSAIDs) o Biologic response modifiers (BRMs) diagnostic/lab tests for RA ● Table 64-7 ● Diagnostic Assessment ● History and physical examination ● Complete blood cell (CBC) count ● Erythrocyte sedimentation rate (ESR) ● C-reactive protein (CRP) ● Rheumatoid factor (RF) ● Antibody to citrullinated peptide (anti-CCP) ● Antinuclear antibody (ANA) ● X-ray studies of involved joints ● Synovial fluid analysis OA; o A bone scan, CT scan, or MRI may be used to diagnose OA. o X-rays are helpful in confirming disease and staging joint damage. o No laboratory tests or biomarkers can be used to diagnose OA. The erythrocyte sedimentation rate (ESR) is normal except during acute inflammation, when slight elevations may be seen. Other routine blood tests (e.g., complete blood count [CBC], renal and liver function tests) are useful only in screening for related conditions or for establishing baseline values before starting treatment. Synovial fluid analysis helps distinguish between OA and types of inflammatory arthritis. may include osteoporosis prevention; o Prevention of Osteoarthritis o Avoid cigarette smoking. o Promptly treat any joint injury. o Maintain healthy weight and eat a balanced diet. o Use safety measures to protect and decrease risk of joint injury. o Exercise regularly, including strength and endurance training. know sources of dietary calcium ● Nutritional Therapy ● Sources of Calcium Food Calcium (mg) Good Sources ● 1 cup milk ● Whole 279 • ● Skim 299 6 oz calcium-fortified orange juice 261 1 oz cheese ● Mozzarella 222 ● Cheddar 214 ● Cottage 138 8 oz yogurt 313-384 ● Soft serve frozen 206 1 cup ice cream 168 3 oz seafood ● Salmon 181 ● Sardines 325 1 cup almonds 304 Poor Sources Egg 28 3 oz beef, pork, poultry 10 Apple, banana 10 1 med potato 14 1 med carrot 14 head lettuce 27 ● o 2. GOUT: (6) Know signs/symptoms o o • Affected joints may appear dusky or cyanotic and are extremely tender. o o Inflammation of the great toe (podagra) is the most common initial problem. o o Olecranon bursae may also be involved. o o Symptom onset typically occurs at night with sudden swelling and severe pain peaking within several hours. o o Patients often indicate the painful area is highly sensitive to light touch. Low-grade fever is common. o Nursing management o • Joint immobilization o • Local application of heat and cold o • Joint aspiration and intraarticular corticosteroids o • Avoidance of food and fluids with high purine content (e.g., anchovies, liver, wine, beer) o Teaching- includes supportive care of the inflamed joints o • Dietary restrictions that limit alcohol and foods high in purine help minimize uric acid production (see Table 45-12). o • Instruct obese patients in a carefully planned weight-reduction program. o • Avoid causing pain by careless handling of an inflamed joint. o • Bed rest may be appropriate to immobilize affected joints as needed. o • Use a cradle or footboard to protect a painful lower extremity from the weight of bed linens. o • Assess limitation of motion and degree of pain. Document treatment effectiveness. o • Avoid starvation (fasting), drug use (e.g., diuretics), and major medical events (e.g., surgery, myocardial infarction) o Treatment o o Drug therapy is the primary way to treat acute and chronic gout. Also recommend weight reduction as needed and possible avoidance of alcohol and foods high in purine. o o Acute gout is treated with colchicine and NSAIDs. Because colchicine has anti-inflammatory effects but is not an analgesic, an NSAID is added for pain management. Oral administration of colchicine generally produces dramatic pain relief when given within 12 to 24 hours of an attack. o o Future attacks of gout are prevented in part by a maintenance dose of a drug that lowers urate such as a xanthine oxidase inhibitor (allopurinol [Zyloprim, Aloprim]), or a drug that increases the excretion of uric acid in the urine (uricosuric) (probenecid). Febuxostat (Uloric), a selective inhibitor of xanthine oxidase, is used for long-term management of hyperuricemia in people with chronic gout. o o Patients who cannot take or do not respond to drugs that lower serum uric acid may be given pegloticase (Krystexxa). Given through IV method. o o Corticosteroids given orally or by intraarticular injection also can be helpful in treating acute attacks of gout. o o For many years, the standard therapy for hyperuricemia caused by decreased urate excretion has been uricosuric drugs such as probenecid. These drugs inhibit renal tubular reabsorption of urates. Aspirin inactivates the effect of these drugs, resulting in urate retention, and should be avoided during treatment. Acetaminophen can be used safely if analgesia is required. o o Allopurinol, which blocks the production of uric acid, is especially useful for patients with uric acid stones or renal impairment. The angiotensin II receptor antagonist losartan (Cozaar) may be effective for treatment of older patients with gout and hypertension. Losartan promotes urate diuresis and may normalize serum urate. Combination therapy with losartan and allopurinol may also be used. Whatever drugs are prescribed, serum uric acid must be checked regularly to monitor treatment effectiveness. o Diet-know foods to avoid & eat o • Purines* o o High: Sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads o o Moderate: Chicken, Salmon, Crab, Veal, Mutton, Bacon, Pork, Beef, & Ham o Diagnostic tests o o In gout, serum uric acid is usually elevated above 6 mg/dL. o o However, hyperuricemia is not specifically diagnostic of gout because values may be normal during an acute gouty attack. o o Specimens may be obtained for 24-hour urine uric acid to determine if the disease is caused by decreased renal excretion or overproduction of uric acid. o o The gold standard for diagnosis of gout is synovial fluid aspiration. Affected fluid characteristically contains needle-like monosodium urate crystals. o o It is the only reliable way to distinguish gout from septic arthritis or pseudogout (calcium phosphate crystal formation). o o Aspiration also may have therapeutic value by decompressing a swollen joint capsule o o X-rays appear normal in the early stages of gout. In chronic disease, tophi may appear as eroded areas in the bone. 3. SLE: (5) Know signs/symptoms; ● nursing management; Nursing Assessment Systemic Lupus Erythematosus Subjective Data o Important Health Information o Past health history: Exposure to ultraviolet light, drugs, chemicals, viral infections. Physical or psychologic stress. States of increased estrogen activity, including early onset of menses, pregnancy, and postpartum period. Pattern of remissions and flares Medications: Oral contraceptives, procainamide (Pronestyl), hydralazine, isoniazid, antiseizure drugs, antibiotics (possibly causing symptoms of SLE), corticosteroids, NSAIDs Functional Health Patterns o Health perception–health management: Family history of autoimmune disorders, frequent infections, malaise, impact of disease on functional ability o Nutritional-metabolic: Weight loss, oral and nasal ulcers, nausea and vomiting, dry mouth (xerostomia), dysphagia, photosensitivity with rash, frequent infections o Elimination: Decreased urine output, diarrhea or constipation o Activity-exercise: Morning stiffness, joint swelling and deformity, shortness of breath (dyspnea), excessive fatigue o Sleep-rest: Insomnia o Cognitive-perceptual: Vision problems, vertigo, headache, arthralgia, chest pain (pericardial, pleuritic), abdominal pain. Painful, throbbing, cold fingers with numbness and tingling o Sexuality-reproductive: Amenorrhea, irregular menstrual periods o Coping–stress tolerance: Depression, withdrawal Objective Data o General o Fever, lymphadenopathy, periorbital edema Integumentary o Alopecia. Dry, scaly scalp. Keratoconjunctivitis, malar butterfly rash, palmar or discoid erythema, hives (urticaria), erythema at fingernails or toenails, purpura, or petechiae. Leg ulcers Respiratory o friction rub, decreased breath sounds Cardiovascular o Vasculitis, pericardial friction rub, hypertension, edema, dysrhythmias, murmurs. Bilateral, symmetric pallor and cyanosis of fingers (Raynaud's phenomenon) Gastrointestinal o Oral and pharyngeal ulcers; splenomegaly Neurologic o Facial weakness, peripheral neuropathies, papilledema, dysarthria, confusion, hallucination, disorientation, psychosis, seizures, aphasia, hemiparesis Musculoskeletal o Myopathy, myositis, arthritis Urinary o Proteinuria Possible Diagnostic Findings o Presence of anti-DNA, anti-Sm, and antinuclear antibodies. Anemia, leukopenia, thrombocytopenia. ↑ Erythrocyte sedimentation rate (ESR), ↑ serum creatinine. Microscopic hematuria, cellular casts in urine. Pericarditis or pleural effusion on chest x-ray Sm, Smith. teaching, Patient & Caregiver Teaching Systemic Lupus Erythematosus ● Include the following information in the teaching plan for a patient with systemic lupus erythematosus and the caregiver. ● Disease process ● Names of drugs, actions, side effects, dosage, administration ● Pain management strategies ● Energy conservation and pacing techniques ● Therapeutic exercise, use of heat therapy (for arthralgia) ● Relaxation therapy ● Avoidance of physical and emotional stress ● Avoidance of exposure to individuals with infection ● Avoidance of drying soaps, powders, household chemicals ● Use of sunscreen protection (at least SPF 15) and protective clothing, with minimal sun exposure from 11:00 AM to 3:00 PM ● Regular medical and laboratory follow-up ● Marital and pregnancy counseling as needed ● Community resources and health care agencies SPF, Sun protection factor. diagnostic tests; o Malar rash: fixed erythema, flat or raised (butterfly rash) o Discoid rash: raised patches with scaling follicular plugging; scarring in older lesions o Photosensitivity: skin rash as unusual reaction to light o Oral ulcers: usually painless o Nonerosive arthritis: two or more peripheral joints with tenderness, swelling, effusion o Pleuritis or pericarditis o Renal disorder: persistent proteinuria or cellular casts in urine o Neurologic disorder: seizures or psychosis (in the absence of causative drugs or known metabolic disorders) o Hematologic disorder: hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia o Immunologic disorder: anti-DNA antibody or antibody to Sm nuclear antigen or positive antiphospholipid antibodies o Antinuclear antibody: abnormal titer Sm, Smith. Precautions ● Because SLE is most common in women of childbearing age, treatment during pregnancy must be considered. The woman's primary HCP (or rheumatologist) and obstetrician should thoroughly discuss with the woman her desire to become pregnant. Infertility may have resulted from renal involvement and previous use of high-dose corticosteroid and immunosuppressive drugs. ● Renal, cardiovascular, pulmonary, and central nervous systems may be affected during pregnancy. Women who already show serious effects in these systems should be counseled against pregnancy. o 4. FIBRO: (4) -is a chronic central pain syndrome marked by widespread, nonarticular musculoskeletal pain and fatigue with multiple tender points. Know signs/symptoms; o Generalized musculoskeletal pain (widespread burning pain in body and head or facial that results from stiff or painful neck and shoulder muscles), restless legs syndrome malaise and fatigue, cognitive dysfunction (difficult concentrating to memory lapses and feeling of overwhelm), migraine headaches, sleep disturbances, depression, anxiety, and fever. o May also experience nonrestorative sleep, morning stiffness, irritable bowel syndrome, and anxiety. o Nursing management; o o Massage is often combined with ultrasound or the application of alternating heat and cold packs to soothe tense, sore muscles and increase blood circulation. o Gentle stretching to relieve muscle tension and spasm can be performed by a physical therapist or practiced by the patient at home. Yoga and Tai Chi are often helpful. o Low-impact aerobic exercise, such as walking, can help prevent muscle atrophy. o Teaching; o Encourage to limit the consumption of sugar, caffeine, and alcohol because these substances may be muscle irritants. o Encourage to consume vitamin and mineral supplements, they may help combat stress, correct deficiencies, and support the immune system. However, unproven miracle diets or supplements should be carefully investigated by the patient and discussed with the HCP before using them. o Inform the patient that some foods and supplements can cause serious or even dangerous side effects when mixed with certain drugs. o Teach how to cope with stress. Effective relaxation strategies include biofeedback, imagery, meditation, and cognitive behavioral therapy. Patients need to receive initial training for these interventions, but they can then continue to practice in their own homes. o Know about electromyogram o An electromyogram (EMG) suggestive of PM shows bizarre high-frequency discharges and spontaneous fibrillation, with positive spikes at rest. Elevation of the ESR or CRP occurs with active disease. 5 CFS a.k.a. SEID (Systemic Exertion Intolerance Disease) : (3)- formerly called chronic fatigue syndrome, is a serious, complex, multisystem disease in which exertion of any sort (physical, emotional, cognitive) can adversely affect multiple organs in a person. Women affected more than men. •Know signs/symptoms o Severe fatigue is the most common symptom of SEID and the problem that causes the patient to seek health care. o Generalized musculoskeletal pain, malaise and fatigue, cognitive dysfunction, headaches, sleep disturbances, depression, anxiety, fever oDiagnosis of SEID requires that the patient have the following three symptoms: § 1. Profound fatigue lasting at least 6 months § 2. Postexertional malaise: total exhaustion after even minor physical or mental exertion that the patient sometimes describes as a “crash” § 3. Unrefreshing sleep oAt least one of the following manifestations is also required: § 1. Cognitive impairment (“brain fog”) § 2. Worsening of symptoms upon standing (orthostatic intolerance) •Nursing management-Because no definitive treatment exists for SEID, supportive management is essential. oNSAIDs can be used to treat headaches, muscle and joint aches, and fever. oAntihistamines and decongestants can be used to treat allergic symptoms. oTricyclic antidepressants (e.g., doxepin, amitriptyline) and SSRIs (e.g., fluoxetine, paroxetine) can improve mood and sleep problems. oClonazepam (Klonopin) can also be used to treat sleep disturbances and panic disorders. •Teaching oAdvise the patient to avoid total rest because it can contribute to the self-image of the patient as an invalid. On the other hand, strenuous exertion can exacerbate the exhaustion. oUrge the patient to plan a carefully graduated exercise program. oEncourage a well-balanced diet, including fiber and fresh dark-colored fruits and vegetables for antioxidant action. oBehavioral therapy may be used to promote a positive outlook and improve overall disability, fatigue, and other symptoms. oOne of the major problems facing many patients with SEID is loss of livelihood and economic security. 6. UTI: (6-9) prevention; 1. Take all antibiotics as prescribed. Symptoms may improve after 1-2 days of therapy, but organisms may still be present. 2. Practice appropriate hygiene, including the following: • Carefully clean the perineal region by separating the labia when cleansing . • Wipe from front to back after urinating. • Cleanse with warm soapy water after each bowel movement. 3. Empty the bladder before and after sexual intercourse. 4. Urinate regularly, approximately every 3-4 hr during the day. 5. Maintain adequate fluid intake. 6. Avoid vaginal douches and harsh soaps, bubble baths, powders, and sprays in the perineal area. 7. Report to the HCP symptoms or signs of recurrent UTI (e.g., fever, cloudy urine, pain on urination, urgency, frequency). 8. Consider drinking unsweetened cranberry juice (8 oz three times a day) or taking cranberry extract tablets 300-400 mg/day for UTI prevention. (This practice may not be effective with every patient.) Know signs/symptoms; o painful urination in uncomplicated urethritis or cystitis to severe systemic illness associated with abdominal or back pain, fever, sepsis, and decreased kidney function in some cases of pyelonephritis. Hesitancy • Difficulty starting urine stream • Delay between initiation of urination (because of urethral sphincter relaxation) and beginning of flow of urine • Diminished urinary stream Intermittency o Interruption of urinary stream while voiding Post void dribbling • Urine loss after completion of voiding Urinary retention or incomplete emptying • Inability to empty urine from bladder • Caused by atonic bladder or obstruction of urethra • Can be acute or chronic Dysuria • Painful or difficult urination Urinary frequency • More than eight times in 24-hr period • Often 200 mL each voiding Urgency • Sudden, strong, or intense desire to void immediately • Commonly accompanied by frequency Incontinence • Involuntary or accidental urine loss or leakage Nocturia • Awakened by urge to void two or more times during sleep • May be diurnal or nocturnal depending on sleep schedule Nocturnal enuresis • Adults: loss of urine during sleep nursing management; o Uncomplicated UTI o Patient teaching o Adequate fluid intake (six 8-oz glasses/day) teaching; 1. Take all antibiotics as prescribed. Symptoms may improve after 1-2 days of therapy, but organisms may still be present. 2. Practice appropriate hygiene, including the following: • Carefully clean the perineal region by separating the labia when cleansing . • Wipe from front to back after urinating. • Cleanse with warm soapy water after each bowel movement. 3. Empty the bladder before and after sexual intercourse. 4. Urinate regularly, approximately every 3-4 hr during the day. 5. Maintain adequate fluid intake. 6. Avoid vaginal douches and harsh soaps, bubble baths, powders, and sprays in the perineal area. 7. Report to the HCP symptoms or signs of recurrent UTI (e.g., fever, cloudy urine, pain on urination, urgency, frequency). 8. Consider drinking unsweetened cranberry juice (8 oz three times a day) or taking cranberry extract tablets 300-400 mg/day for UTI prevention. (This practice may not be effective with every patient.) treatment; o meds, • Antibiotic: trimethoprim/sulfamethoxazole, nitrofurantoin • Sensitivity-guided antibiotic therapy: ampicillin, amoxicillin, first-generation cephalosporin, fluoroquinolones • Consider 3- to 6-mo trial of suppressive or prophylactic antibiotic regimen • Consider postcoital antibiotic prophylaxis: trimethoprim/sulfamethoxazole, nitrofurantoin, cephalexin diagnostic tests; Pyelonephritis/Cystitis: • History and physical examination • Urinalysis • Urine for culture and sensitivity • Imaging studies: ultrasound (initially), CT scan (CT urogram), cystoscopy, VCUG • CBC count with WBC differential • Blood culture (if bacteremia is suspected) • Percussion for flank (costovertebral angle [CVA]) pain acute/chronic know signs/symptoms; ● acute pyelonephritis vary from mild fatigue to the sudden onset of chills; fever; vomiting; malaise; flank pain; and the LUTS characteristic of cystitis, including dysuria, urgency, and frequency. ● Costovertebral tenderness to percussion (costovertebral angle [CVA] pain) is typically present on the affected side. Although the clinical manifestations may subside within a few days, even without specific therapy, bacteriuria and pyuria usually persist. ● In chronic pyelonephritis the kidneys become small, atrophic, and shrunken and lose function due to fibrosis (scarring). Chronic pyelonephritis is usually the result of recurring infections involving the upper urinary tract. ● The two primary clinical manifestations of cystitis are pain and bothersome LUTS (e.g., frequency, urgency). People with severe cases may urinate as often as 60 times in a day including nighttime urination. The pain is usually located in the suprapubic area but may involve the vagina, labia, or entire perineal region, including the rectum and anus. ● The pain is transiently relieved by urination. Bothersome LUTS are similar to a UTI, and the condition is often misdiagnosed as a recurring or chronic UTI or, in men, chronic prostatitis. nursing management; Mild Symptoms ● Outpatient management or short hospitalization ● Adequate fluid intake ● Nonsteroidal antiinflammatory drugs (NSAIDs) or antipyretic drugs ● Follow-up urine culture and imaging studies Drug Therapy ● Empirically selected broad-spectrum antibiotics: ampicillin, vancomycin combined with an aminoglycoside (e.g., tobramycin, gentamicin) ● Switch to sensitivity-guided therapy: trimethoprim/sulfamethoxazole (Bactrim) when results of urine and blood culture are available ● Fluoroquinolones: ciprofloxacin (Cipro), ofloxacin, gatifloxacin Severe Symptoms ● Hospitalization ● Adequate fluid intake (parenteral initially; switch to oral fluids as nausea, vomiting, and dehydration subside) ● NSAIDs or antipyretic drugs to reverse fever and relieve discomfort ● Follow-up urine culture and imaging studies Drug Therapy ● Parenteral antibiotics ● Empirically selected broad-spectrum antibiotics: ampicillin, vancomycin combined with an aminoglycoside (e.g., tobramycin, gentamicin) ● Switch to sensitivity-guided antibiotic therapy when results of urine and blood culture are available ● Oral antibiotics when patient tolerates oral intake VCUG, Voiding cystourethrogram. treatment 7. Polycystic kidney disease: (2) know signs/symptoms; nursing management; treatment ● Polycystic kidney can either be inherited or acquired. ● Slow & progressive ● fluid-filled cysts develop in nephrons (PKD) is the number four cause of kidney failure in Americans ● About half of the people diagnosed with PKD will experience end stage renal disease (ESRD) and will need dialysis or a kidney transplant. ● Inherited polycystic kidney disease can be autosomal dominant or autosomal recessive. ○ It is passed from parent to child, and the odds are 50/50 of a child inheriting it from an affected mother or father. About 10 percent of people with ADPKD have not inherited the disease from a parent, but have a gene that mutated, causing the disease. ○ (ADPKD) Autosomal dominant polycystic kidney disease is the more common type. It can also be called adult polycystic kidney disease because the symptoms begin to appear between the ages of 30 and 40. MOST COMMON ○ (ARPKD) Autosomal recessive disease occurs less commonly, and its symptoms appear at a younger age and can even begin at birth. RARE, @ BIRTH OR EVEN BEFORE BIRTH ● Acquired polycystic kidney disease occurs in people who already suffer from a kidney disease like renal failure or repeated dialysis. Signs and Symptoms: ● Abdominal or flank pain ● Hypertension ● Nocturia ● Increased abdominal girth ● Constipation ● Bloody or cloudy urine ● Kidney stones Assessment findings: ● Flank pain ● Polyuria &nocturia ● Gross hematuria, proteninuria ● Signs of UTI & renal calculi ● HTN ● Signs of CRF ● Positive findings in real ultrasound, IVP, & CT Scan Diagnostic Test: ● Routine lab work ● Urines tests ● Ultrasound ○ Ultrasound is most commonly used to detect initial-stage ADPKD ○ it can reveal cysts in a fetus’s kidneys, while it is still in the womb when detecting ARPKD ○ ultrasound imaging has no side effects and is safe for all patients ○ Sound waves pass harmlessly through the kidneys and create a picture for the doctor to examine. The doctor will be able to see the cysts if they are large enough. Nursing management: ● Provide supportive care to help patient cope w/ symptoms, no effective treatment is available Treat ● Acute and Chronic pain ● Constipation ● Hypertension ● Renal Failure Therapeutic Management ● Provide supportive care to help patient cope w/ symptoms, no effective treatment is available ● Encourage fluid intake of mL/day to help prevent UTI & calculi ● Administer antihypertensive agents as prescribed ● Discuss that HD & possibly renal transplant will be indicated as disease progresses ● Provide nursing care directed toward edema control: Na restricted diet & diuretics that block ● aldosterone formation ● Meds therapy: ACE inhibitors to control HTN, diuretics to control edema; antibiotics if infections develops. Client Education ● Maintenance of general health b/c disorder is chronic & progressive ● How to avoid UTI & recognize early signs of infection ● Avoid meds potentially toxic to kidneys & check w/ HCP before taking any new meds ● Need for genetic counseling & screening of family members for disease ● Maintain fluid intake of at least 2500 mL/day 8. Benign prostatic hyperplasia: (2) know signs/symptoms; ● Symptoms can be divided into two groups: irritative and obstructive. ● Irritative symptoms include nocturia, urinary frequency, urgency, dysuria, bladder pain, and incontinence. These symptoms are associated with inflammation or infection. Nocturia is often the first symptom that the patient notices. ● Obstructive symptoms, caused by prostate enlargement, include a decrease in the caliber and force of the urinary stream, difficulty in initiating a stream, intermittency (stopping and starting stream several times while voiding), and dribbling at the end of urination. prevention; ● diagnostic tests; ● History and physical examination ● Digital rectal examination (DRE) ● Urinalysis with culture ● Prostate-specific antigen (PSA) ● Serum creatinine ● Postvoid residual ● Transrectal ultrasound (TRUS) ● Uroflowmetry ● Cystoscopy nursing management; ● Intermittent or continuous bladder irrigation (CBI) is usually required after invasive prostate surgery to prevent bladder obstruction by clots or mucus. Role of Nursing Personnel Registered Nurse (RN) • Assess for bleeding and clots. • Assess catheter patency by measuring intake and output and presence of bladder spasms. • Manually irrigate catheter if bladder spasms or decreased outflow occurs. • Discontinue CBI and notify physician if obstruction occurs. • Teach patient Kegel exercises after catheter removal. • Provide care instructions for patient discharged with indwelling catheter. Licensed Practical/Vocational Nurse (LPN/LVN) • Monitor catheter drainage for increased blood or clots. • Increase flow of irrigating solution to maintain light pink color in outflow. • Administer antispasmodics and analgesics as needed. Unlicensed Assistive Personnel (UAP) • Clean around catheter daily. • Record intake and output. • Notify RN if large amount of bright red blood is in urine. • Report complaints of pain or bladder spasms to RN. Role of Other Team Members Physician or Advanced Practice Clinician (Nurse Practitioner or Physician Assistant) • Assess for bleeding and clots. • Assess and manage catheter if obstruction occurs. • Order antispasmodics and analgesics as needed. complications; ● Complications of BPH are relatively rare. However, some men may experience acute urinary retention. This complication is manifested by the sudden and painful inability to urinate. ● Urinary tract infection (UTI) can also be a complication of BPH ● In more severe cases, sepsis may also develop. Bladder calculi (stones) may develop in the bladder because of thealkalinization of the residual urine. ● Additional complications include renal failure caused by hydronephrosis (distention of pelvis and calyces of the kidney by urine that cannot flow through the ureter to the bladder), pyelonephritis, and bladder damage if treatment for acute urinary retention is delayed. surgery management ● The main complications after surgery are hemorrhage, bladder spasms, urinary incontinence, and infection. ● After surgery the patient will have a standard catheter or a triple-lumen catheter. Bladder irrigation is typically done to remove clotted blood from the bladder and ensure drainage of urine. The bladder is irrigated either manually on an intermittent basis or more commonly as continuous bladder irrigation (CBI) with sterile normal saline solution or another prescribed solution. If the bladder is manually irrigated (if ordered), instill 50 mL of irrigating solution and then withdraw with a syringe to remove clots that may be in the bladder and catheter. Painful bladder spasms often occur as a result of manual irrigation. ● Continuously monitor the inflow and outflow of the irrigant. If outflow is less than inflow, assess the catheter patency for kinks or clots. 9. Acute & Chronic glomerulonephritis: (3-5) know signs/symptoms; prevention; nursing management; treatment 10.MEDS: (10) at least; know what med is associated with what disorder; know precautions, nursing implications & administration (include route), and side effects 11. Bactrim 12. Rheumatrex (methotrexate)(Antimetabolite):Immunosuppressant agent Monitor CBC and hepatic and renal function. Advise patient to report signs of anemia (fatigue, weakness). Keep patient well hydrated. Due to teratogenic effects, instruct female patient to use effective contraception during and 3 mo after treatment. Nursing consideration: 1. Monitor for toxic effects such as bone marrow suppression, increased liver enzymes 13. Humira (adalimumab)(HUMIRA is given by injection under the skin.)Bind to TNF, thus blocking its interaction with cell surface receptors. Decrease inflammatory and immune responses ● Assess for decreased pain, swelling, stiffness, and increase in joint mobility. ● Advise patient of increased risk for tuberculosis. Instruct patient to have yearly PPD. ● Monitor for infection, bleeding, and emergence of malignancies. ● Advise patient injection site reaction generally occurs in first month of treatment and decreases with continued therapy. ● Advise patient to not receive live virus vaccines during treatment. 14. Colchicine (Colasalide) (Treats Gout)Because colchicine has anti inflammatory effects but is not an analgesic, and NSAID is added for pain management.Oral administration of colchicine generally produces dramatic pain relief when given within 12 to 24 hours of an attack.23 Colchicine also helps in diagnosis because good response to this drug is further evidence of gout. 15. Allopurinol (Zyloprim)( Treats Gout): Used as a maintenance medication to promote uric acid excretion and decrease its production Nursing Consideration: ● increase fluid intake ● Instruct client to take after meals and with a full glass of water 16.NSAID e.g. motrin, naproxen (Naprosyn): Analgesics 17. Etanercept (Enbrel)- Tumor Necrosis Factor (TNF) Inhibitor o Mechanism of Action: Bind to TNF, thus blocking its interaction with cell surface receptors. Decreases inflammatory and immune responses. o Nursing Consideration: o Assess for decreased pain, swelling, stiffness, and increase in joint mobility. Advise patient of increased risk for tuberculosis. Instruct patient to have yearly PPD. o Monitor for infection, bleeding, and emergence of malignancies. Advise patient injection site reaction generally occurs in first month of treatment and decreases with continued therapy. o Advise patient not to receive live virus vaccines during treatment. Given as a SubQ injection. o Drug Alert for TNF Inhibitors- • Administer tuberculin test and perform chest x-ray before starting therapy. • Monitor for signs of infection. Stop drug temporarily and notify HCP. • Instruct patients to avoid live vaccination while taking this drug. • Report bruising, bleeding, or persistent fever and other signs of infection. 18. azathioprine (Imuran) 19. hydroxychloroquine (Plaquenil)Antimalarial: 20. probenecid (Benemid)( used for Gout): Used as a maintenance medication to promote uric acid excretion Nursing Considerations: ● Monitor uric acid levels ● Instruct client not to use aspirin because it will decrease the effectiveness of the medication. ● Limit alcohol intake ● Avoid starvation diets,ASA, and diuretics ● Limit physical or emotional stress ● encourage medication adherence ● Instruct client no organ meats or shellfish 21. Gentamycin 22. Calcium-know normal levels ● 8.5-10.2 23. Vitamin D ● 24. Corticosteroids ( treatment for gout,Rheumatoid arthritis): Anti-inflammatory med that is given during acute exacerbation or advanced forms of disease. ● Not given Long Term, DO NOT STOP ABRUPTLY ● given orally or by intra articular injection also can be helpful in treating acute attacks of gout. Nursing Consideration: 1. Observe for cushingoid changes 2. Monitor weight and BP 3. Monitor for vision changes, 4. increased blood glucose, and impaired healing 5. instruct patient to avoid large crowds. 6. Monitor for fluid retention and impaired kidney function 25. Diagnostic tests: (3-5) know pre/post procedure care; indications; know range for labs o Intravenous pyelogram (IVP)- Visualizes urinary tract after IV injection of contrast media. Size and shape of kidneys, ureters, and bladder can be evaluated. Cysts, tumors, and ureteral obstructions (strictures) cause a distortion in normal appearance of these structures. Patient with decreased renal function should not have IVP because contrast media can be nephrotoxic. o Before: Cathartic or enema given night before. Assess patient for iodine sensitivity to avoid anaphylactic reaction. o During: Procedure involves lying on table and having serial x-rays taken. Advise patient that during injection of contrast material, warmth, flushed face, and a salty taste may be experienced. o After: Force fluids (if permitted) to flush out contrast media. o Renal biopsy- Can be performed with CT or ultrasound guidance.Absolute contraindications are bleeding disorders, single kidney, and uncontrolled hypertension. o Before: Type and crossmatch patient for blood. Ensure consent form is signed. Assess coagulation status through patient history, medication history, CBC, hematocrit, prothrombin time, and bleeding and clotting time. Patient should not be taking aspirin or warfarin (Coumadin). o After: Apply pressure dressing and keep patient on affected side for 30-60 min. Bed rest for 24 hr. Vital signs every 5-10 min, first hour. Assess for flank pain, hypotension, decreasing hematocrit, ↑ temperature, chills, urinary frequency, dysuria, and gross or microscopic hematuria. Urine dipstick can be used to test for bleeding in urine. Inspect biopsy site for bleeding. Instruct patient to avoid lifting heavy objects for 5-7 days and to not take anticoagulant drugs until allowed by HCP. o Cystoscopy- Inspects interior of bladder with a tubular lighted scope (cystoscope). Can be used to insert ureteral catheters, remove calculi, obtain biopsy specimens of bladder lesions, and treat bleeding lesions. Lithotomy position is used. Complications include urinary retention, urinary tract hemorrhage, bladder infection, and perforation of bladder. o Before: Force fluids or give IV fluids if general anesthesia is to be used. Ensure consent form is signed. Explain procedure to patient. Give preoperative medication. o After: Explain that burning on urination, pink-tinged urine, and urinary frequency are expected effects. Observe for bright red bleeding, which is not normal. Assist with ambulation because orthostatic hypotension may occur. Offer warm sitz baths, heat, mild analgesics to relieve discomfort. o BUN- Used to detect renal problems. Concentration of urea in blood is regulated by rate at which kidney excretes urea. Nonrenal factors may cause an increased BUN (e.g., rapid cell destruction from infections, fever, GI bleeding, trauma, athletic activity and excessive muscle breakdown). o Reference interval: 6-20 mg/dL (2.1-7.1 mmol/L). o Creatinine- More reliable than BUN as a determinant of renal function. Creatinine is end product of muscle and protein metabolism and is released at a constant rate. o Reference interval: 0.6-1.3 mg/dL (53-115 µmol/L). o BUN/Creatinine Ratio- Increased ratio may be due to conditions that decrease blood flow to kidneys (e.g., heart failure, dehydration), GI bleeding, or increased dietary protein. A decreased ratio may occur with liver disease (due to decreased urea formation) and malnutrition. o Reference interval: 12 : 1 to 20 : 1 o Sodium - Main extracellular electrolyte determining blood volume. Values usually stay within normal range until late stages of renal failure. o Reference interval: 135-145 mEq/L (135-145 mmol/L). o Potassium- Kidneys are responsible for excreting majority of body's potassium. In kidney disease, K determinations are critical because K is one of the first electrolytes to become abnormal. Elevated K levels 6 mEq/L can lead to muscle weakness and cardiac dysrhythmias. o Reference interval: 3.5-5.0 mEq/L (3.5-5.0 mmol/L).