Milestone Retake Exam
n n
MED SURG In n
Continuous bladder irrigation
n n
RealizeIT:
Duringnthen postoperativen period, n then patientnis n atnriskn for n deficientn fluidnv olu
menbecausenof nthenirrigation nof nthensurgicalnsite nduringnandnafter nsurgery.
Withn irrigationn ofn thenurinary ncatheter n ton prev entn its nobstructionn by n bloodn
clots,n fluidn may n be nabsor bedn throughn then opennsurgicalnsiten andnretained,n i
ncreasingn thenriskn ofn excessiven fluidnretention,n fluidnimbalance,nandn water ni
ntoxication.
Thenurinenoutputnandn thenamountn ofn fluidnusedn for nirrigationn mustnbenclosely n m
onitoredn ton determine nwhether nirrigationn fluidn is n beingnretained nand n ton ensur
enannadequate nurinenoutput.nAnnintakenandnoutputnrecord,nincludingnthe namoun
tnofnfluid nused nfor nirrigation,n mustn be nmaintained.
Thenpatientnis nalson monitoredn for nelectrolytenimbalances n(e.g.,n hyponatremia), ni
ncreasingnbloodn pressure,n confusion,nandnrespiratory ndistress.nThesensigns nan
dnsymptoms narendocumented nand nreportedntonthensurgeon. nThe nrisknof nfluidnan
dnelectrolyten imbalance nis n greater ninn older npatients nwith npreexistingn cardiov as
cular nor nrespiratory ndisease.
Google:
Continuous n bladder nirrigationn(CBI)nis n an medicaln proceduren thatn flushes nyour nb
ladder nwith nansterilen liquid.n Itn alsonremoves n urinen (pee) nfr om nyour nbody n atn the ns
amentime. nHealthcare npr oviders noften nuse nitntonprev entnor nremov enbloodn clots n a
fter nsurgery nonn then urinary nsystem.n Then proceduren takes n place ninna nhospitaln ov
er nseveralndays.
Healthcaren providers noftennusenCBIn ton preventn or nremove nbloodn clots n inn the
bladder nafter nurinary nsur gery.nExamples nincluden or nprostate
surgery nsuchnas
CBIncannhelpn prev entn blood nclots nand n flushn themn outnson urine ncann flownnor mal
ly.nHealthcare npr oviders nalsonusencontinuous nbladder nirrigation nto:
• Administer n medicationn to n then bladder.
• Dissolvenbladder nstones.
• Soothenan nirritated,ninfected,nor ninflamednbladder nlining.
, n Anthree-
wayn(lumen)nirrigationnisnusedntondecreasenbleeding nandntonkeepnthenbladder nfreenfromnclo
ts—
onenlumennisnforninflating nthenballoonn(30nmL);nonenlumennisnforninstillationn(inflow);nonenl
umennisnfornoutflow.
ContinuousnirrigationnmaynbenusednwithnTURP.
Thenamountnofnfluidnrecoveredninnthendrainagenbag nmustnequalnthenamountnofnfluidninstille
dn--nsecondarynhemorrhagenmaynoccur nfromnoverdistension
urethritis
RealizeIT
Anmultiple-
testndipstick noften nincludes ntesting nfor nWBCs,nknownnas nthen leukocyten esterasen
test,nandn nitriten testing.
Tests nfor nsexually n transmittedn infections n may n ben performed nbecause nacute
urethritis causednby nsexually n transmitted norganisms (i.e.,nChlamydia
trachomatis,nNeisserian gonorrhoeae,nherpes nsimplex)nor acutenvaginitis
infections n(causednby nTrichomonas nor nCandida nspecies)nmay nbenresponsible nf
or nsymptoms nsimilar n ton those nof nUTIs.
Google:
Urethritisnisnanninflammationn(swellingnandnirritation)nofnthenurethra,nthentubenthatntak
esnurinen(pee)nfromnyournbladderntonthenoutsidenofnyournbody.nTypically,nurethritisnisncaused
nbynanninfection.nMostncommonly,nbutnnotnalways,nthencausenisnansexuallyntransmitted ninfe
ctionn(sexuallyntransmittedndisease)n(STD/STI)
⮚ Commonn inn postmenopausaln women
⮚ Low n estrogenn levelsn decreasen moisturen andnsecretionsn inn thenperinealn area,n predisposingn it nt
on then development n of n infection
⮚ Testing:nSTI,nmultiplendipsticks,nleukocytenesterase,nnitritentesting,nx-
ray,nCT,n ultrasonography,n kidneyn scans
Renal calculi risk
n n
RealizeIT:
Certainnfactors nfavor n the nformationn of nstones,nincludingninfection,nurinary nstasi
s,nandnperiods n ofnimmobility, nalln ofnwhich nslow nkidney n drainage nandn alter ncalci
umnmetabolism.n In naddition, nincreasedncalcium nconcentrations n inn then bloodna
ndnurinenpromoten precipitationn ofncalcium nand nformationn ofnstones n (then mostn
commonnarencalciumn based).nCauses nofnhypercalcemian (highnserumn calcium) na
ndnhypercalciurian (highnurine ncalcium)n may ninclude n then following:
• Hyperparathyroidism
, • Renalntubular nacidosis
• Cancers n (e.g.,n leukemia, n multiple n myeloma)
• Dehydration
• Granulomatous n diseases n(e.g.,nsarcoidosis, n tuberculosis), nwhichn may n
causenincreasednv itaminn D npr oduction nby n then granulomatous n tissue
• Excessivenintaken of nvitaminn D
• Excessivenintaken ofn milk nand nalkali
• Myeloproliferative ndiseases nsuch nas npolycythemianv era,nwhich nproducen
annunusualnproliferationn ofn bloodncells n fromn then bone n marrow
• Intestinaln bypass nsurgery
Google:
Possiblencausesnincludendrinkingntoonlittlenwater,nexercisen(toonmuchnorntoonlittle),nobesit
y,nweightnlossnsurgery,norneatingnfoodnwithntoonmuchnsaltnornsugar.nInfectionsnandnfamilynh
istorynmightnbenimportantninnsomenpeople.nEatingntoonmuchnfructosencorrelatesnwithnincre
asingnrisknofndevelopingnankidneynstone.
⮚ Polycysticnkidneyn disease,n horseshoen kidneys,n chronicn strictures,n and n medullarynspongen
disease
⮚ IBD,nileostomy,n orn boweln resection
⮚ Medications:n antacids,n acetazolamiden (Diamox),nvitaminn D,nlaxatives,n andn highn dosesnof n
aspirin
Calculi pain n
RealizeIT:
Thenimmediate nobjectiven ofn treatmentnofnrenaln or nureteraln colicn is n tonrelieve n th
enpainnuntiln its ncausen can nbeneliminated.nOpioidnanalgesicn agents naren giv enn to n p
reventnshocknandnsyncope n thatn may nresultn fromn the nexcruciating npain.
Nonsteroidalnanti-
inflammatory ndrugs n(NSAIDs)nareneffectiveninntreatingnrenal ncalculus n painn beca
usenthey nprovide nspecificn painnrelief.n They nalso ninhibitn thensynthesis n of npr ostag
landinnE,nreducing nswellingn andn facilitatingn passagen ofn the nstone.
⮚ Requiresn immediaten attention
⮚ IV norn IMn opioids
⮚ IV nNSAIDs
⮚ If npainn increases,n notifyn HCP
, Imitrex contraindications
n
RealizeIT:
Triptans narencontraindicatedninn patients nwithn ischemicnhear tn disease.n Carefuln
administrationnandn dosingn instructions n ton patients naren impor tantn ton preventn
adversenreactions nsuchn as nincreasedn bloodn pressure,n drowsiness,n musclen pai
n,nsweating,nandnanxiety.n Interactions n aren possiblenifn then medicationnis n taken ni
nnconjunctionn with St.nJohn’s nwort
Thentriptans,nwhichn arenserotoninnreceptor n agonists,n aren the nmostnspecificnanti
migrainenagents n available.n These nagents n causenv asoconstriction, nreducen infla
mmation,n andn may nreducen pain n transmission. n Then triptans ninnroutinenclinical nu
senincludensumatriptan, n naratriptan, nrizatriptan,nzolmitriptan, n almotriptan, nelet
riptan,nandnfrovatriptan. nMany nofnthentriptan nmedications naren available nin nanv ari
ety nofnformulations,nsuch nas nnasal nsprays,n inhalers,nconv entionaln tablet,n disinte
gratingntablet,nsuppositories, n or ninjections.n Then nasalnsprays n may n benuseful nfor n
patients n experiencingn nausea nand nvomiting
⮚ Ischemicn heart n disease
⮚ St.n John'sn wort
⮚ PrinzmetalnAngina
⮚ CoronarynArterynDisease
⮚ Diabetesn Mellitus
seizures
RealizeIT:
Assessment:
Seizurenhistory
n Alcohol n intake
Factorsnorneventsnthatnmaynprecipitatenthenseizure
Ifnannauranoccursn–nmaynindicatenthenoriginnofnthenseizure
PlanningnandnGoals:
Thenmajor ngoals n for n the n patientn may ninclude npr evention nofn injury,ncontr
olnofnseizures,n achievementn ofn ansatisfactory n psychosocialnadjustment,nac
quisitionnofnknowledgenandnunderstandingnaboutnthencondition, nandnabse
ncenofncomplications
Interventions:
n n
MED SURG In n
Continuous bladder irrigation
n n
RealizeIT:
Duringnthen postoperativen period, n then patientnis n atnriskn for n deficientn fluidnv olu
menbecausenof nthenirrigation nof nthensurgicalnsite nduringnandnafter nsurgery.
Withn irrigationn ofn thenurinary ncatheter n ton prev entn its nobstructionn by n bloodn
clots,n fluidn may n be nabsor bedn throughn then opennsurgicalnsiten andnretained,n i
ncreasingn thenriskn ofn excessiven fluidnretention,n fluidnimbalance,nandn water ni
ntoxication.
Thenurinenoutputnandn thenamountn ofn fluidnusedn for nirrigationn mustnbenclosely n m
onitoredn ton determine nwhether nirrigationn fluidn is n beingnretained nand n ton ensur
enannadequate nurinenoutput.nAnnintakenandnoutputnrecord,nincludingnthe namoun
tnofnfluid nused nfor nirrigation,n mustn be nmaintained.
Thenpatientnis nalson monitoredn for nelectrolytenimbalances n(e.g.,n hyponatremia), ni
ncreasingnbloodn pressure,n confusion,nandnrespiratory ndistress.nThesensigns nan
dnsymptoms narendocumented nand nreportedntonthensurgeon. nThe nrisknof nfluidnan
dnelectrolyten imbalance nis n greater ninn older npatients nwith npreexistingn cardiov as
cular nor nrespiratory ndisease.
Google:
Continuous n bladder nirrigationn(CBI)nis n an medicaln proceduren thatn flushes nyour nb
ladder nwith nansterilen liquid.n Itn alsonremoves n urinen (pee) nfr om nyour nbody n atn the ns
amentime. nHealthcare npr oviders noften nuse nitntonprev entnor nremov enbloodn clots n a
fter nsurgery nonn then urinary nsystem.n Then proceduren takes n place ninna nhospitaln ov
er nseveralndays.
Healthcaren providers noftennusenCBIn ton preventn or nremove nbloodn clots n inn the
bladder nafter nurinary nsur gery.nExamples nincluden or nprostate
surgery nsuchnas
CBIncannhelpn prev entn blood nclots nand n flushn themn outnson urine ncann flownnor mal
ly.nHealthcare npr oviders nalsonusencontinuous nbladder nirrigation nto:
• Administer n medicationn to n then bladder.
• Dissolvenbladder nstones.
• Soothenan nirritated,ninfected,nor ninflamednbladder nlining.
, n Anthree-
wayn(lumen)nirrigationnisnusedntondecreasenbleeding nandntonkeepnthenbladder nfreenfromnclo
ts—
onenlumennisnforninflating nthenballoonn(30nmL);nonenlumennisnforninstillationn(inflow);nonenl
umennisnfornoutflow.
ContinuousnirrigationnmaynbenusednwithnTURP.
Thenamountnofnfluidnrecoveredninnthendrainagenbag nmustnequalnthenamountnofnfluidninstille
dn--nsecondarynhemorrhagenmaynoccur nfromnoverdistension
urethritis
RealizeIT
Anmultiple-
testndipstick noften nincludes ntesting nfor nWBCs,nknownnas nthen leukocyten esterasen
test,nandn nitriten testing.
Tests nfor nsexually n transmittedn infections n may n ben performed nbecause nacute
urethritis causednby nsexually n transmitted norganisms (i.e.,nChlamydia
trachomatis,nNeisserian gonorrhoeae,nherpes nsimplex)nor acutenvaginitis
infections n(causednby nTrichomonas nor nCandida nspecies)nmay nbenresponsible nf
or nsymptoms nsimilar n ton those nof nUTIs.
Google:
Urethritisnisnanninflammationn(swellingnandnirritation)nofnthenurethra,nthentubenthatntak
esnurinen(pee)nfromnyournbladderntonthenoutsidenofnyournbody.nTypically,nurethritisnisncaused
nbynanninfection.nMostncommonly,nbutnnotnalways,nthencausenisnansexuallyntransmitted ninfe
ctionn(sexuallyntransmittedndisease)n(STD/STI)
⮚ Commonn inn postmenopausaln women
⮚ Low n estrogenn levelsn decreasen moisturen andnsecretionsn inn thenperinealn area,n predisposingn it nt
on then development n of n infection
⮚ Testing:nSTI,nmultiplendipsticks,nleukocytenesterase,nnitritentesting,nx-
ray,nCT,n ultrasonography,n kidneyn scans
Renal calculi risk
n n
RealizeIT:
Certainnfactors nfavor n the nformationn of nstones,nincludingninfection,nurinary nstasi
s,nandnperiods n ofnimmobility, nalln ofnwhich nslow nkidney n drainage nandn alter ncalci
umnmetabolism.n In naddition, nincreasedncalcium nconcentrations n inn then bloodna
ndnurinenpromoten precipitationn ofncalcium nand nformationn ofnstones n (then mostn
commonnarencalciumn based).nCauses nofnhypercalcemian (highnserumn calcium) na
ndnhypercalciurian (highnurine ncalcium)n may ninclude n then following:
• Hyperparathyroidism
, • Renalntubular nacidosis
• Cancers n (e.g.,n leukemia, n multiple n myeloma)
• Dehydration
• Granulomatous n diseases n(e.g.,nsarcoidosis, n tuberculosis), nwhichn may n
causenincreasednv itaminn D npr oduction nby n then granulomatous n tissue
• Excessivenintaken of nvitaminn D
• Excessivenintaken ofn milk nand nalkali
• Myeloproliferative ndiseases nsuch nas npolycythemianv era,nwhich nproducen
annunusualnproliferationn ofn bloodncells n fromn then bone n marrow
• Intestinaln bypass nsurgery
Google:
Possiblencausesnincludendrinkingntoonlittlenwater,nexercisen(toonmuchnorntoonlittle),nobesit
y,nweightnlossnsurgery,norneatingnfoodnwithntoonmuchnsaltnornsugar.nInfectionsnandnfamilynh
istorynmightnbenimportantninnsomenpeople.nEatingntoonmuchnfructosencorrelatesnwithnincre
asingnrisknofndevelopingnankidneynstone.
⮚ Polycysticnkidneyn disease,n horseshoen kidneys,n chronicn strictures,n and n medullarynspongen
disease
⮚ IBD,nileostomy,n orn boweln resection
⮚ Medications:n antacids,n acetazolamiden (Diamox),nvitaminn D,nlaxatives,n andn highn dosesnof n
aspirin
Calculi pain n
RealizeIT:
Thenimmediate nobjectiven ofn treatmentnofnrenaln or nureteraln colicn is n tonrelieve n th
enpainnuntiln its ncausen can nbeneliminated.nOpioidnanalgesicn agents naren giv enn to n p
reventnshocknandnsyncope n thatn may nresultn fromn the nexcruciating npain.
Nonsteroidalnanti-
inflammatory ndrugs n(NSAIDs)nareneffectiveninntreatingnrenal ncalculus n painn beca
usenthey nprovide nspecificn painnrelief.n They nalso ninhibitn thensynthesis n of npr ostag
landinnE,nreducing nswellingn andn facilitatingn passagen ofn the nstone.
⮚ Requiresn immediaten attention
⮚ IV norn IMn opioids
⮚ IV nNSAIDs
⮚ If npainn increases,n notifyn HCP
, Imitrex contraindications
n
RealizeIT:
Triptans narencontraindicatedninn patients nwithn ischemicnhear tn disease.n Carefuln
administrationnandn dosingn instructions n ton patients naren impor tantn ton preventn
adversenreactions nsuchn as nincreasedn bloodn pressure,n drowsiness,n musclen pai
n,nsweating,nandnanxiety.n Interactions n aren possiblenifn then medicationnis n taken ni
nnconjunctionn with St.nJohn’s nwort
Thentriptans,nwhichn arenserotoninnreceptor n agonists,n aren the nmostnspecificnanti
migrainenagents n available.n These nagents n causenv asoconstriction, nreducen infla
mmation,n andn may nreducen pain n transmission. n Then triptans ninnroutinenclinical nu
senincludensumatriptan, n naratriptan, nrizatriptan,nzolmitriptan, n almotriptan, nelet
riptan,nandnfrovatriptan. nMany nofnthentriptan nmedications naren available nin nanv ari
ety nofnformulations,nsuch nas nnasal nsprays,n inhalers,nconv entionaln tablet,n disinte
gratingntablet,nsuppositories, n or ninjections.n Then nasalnsprays n may n benuseful nfor n
patients n experiencingn nausea nand nvomiting
⮚ Ischemicn heart n disease
⮚ St.n John'sn wort
⮚ PrinzmetalnAngina
⮚ CoronarynArterynDisease
⮚ Diabetesn Mellitus
seizures
RealizeIT:
Assessment:
Seizurenhistory
n Alcohol n intake
Factorsnorneventsnthatnmaynprecipitatenthenseizure
Ifnannauranoccursn–nmaynindicatenthenoriginnofnthenseizure
PlanningnandnGoals:
Thenmajor ngoals n for n the n patientn may ninclude npr evention nofn injury,ncontr
olnofnseizures,n achievementn ofn ansatisfactory n psychosocialnadjustment,nac
quisitionnofnknowledgenandnunderstandingnaboutnthencondition, nandnabse
ncenofncomplications
Interventions:
