Transcript Interferences to nurtritional elimination needs:

INTERFERENCES TO
NURTRITIONAL ELIMINATION
NEEDS:
Intestinal and Urinary Diversions
COLORECTAL CANCER
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Major health problem – one of the most prevalent
malignancies in US
95% are adenocarcinomas
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Risk factors:
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Thought to develop from adenomatous polyps
Liver is the most common site of metastasis
May also metastasize to lungs, brain, bones, adrenals
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
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Stool tests that check for signs of cancer:
Fecal occult blood test (FOBT).
 Fecal immunochemical test (FIT).
 Stool DNA test (sDNA).
 Carcinoembryonic antigen (CEA)
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Colonoscopy/sigmoidoscopy/barium enema
 CT scan of the abdomen
 Interventions
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Staging done first
 Radiation tx: to local area, may be palliative
 Meds: 5 FU, leucovorin, oxaliplatin, irinotecan,
bevacizumab, cetuximab
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Watch for side effects, dose limiting signs
Surgical removal of tumor
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Colostomies
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Placement of ostomy in relation to where it is placed in the
intestine
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What is the difference between a colostomy and an
ileostomy?
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Ascending
Descending
Transverse (double barreled)
Sigmoid
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
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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)?
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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?
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Interventions
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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?
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Is there a special diet RF patients need to follow?
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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?
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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 (preop)?
 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?
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