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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
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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?