MDC 3 Exam 1 Study Guide - Key Concepts for multidimensional care III PDF

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Key Concepts for multidimensional care III...

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MDC3 EXAM 1 - CONCEPT GUIDE

Modules 1-3 There are a TON of topics covered in these modules / chapters. To help you focus a little, here are some of the possible topics for your upcoming exam.

You are responsible for reading the chapters assigned for this module. For all concepts, please review: Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, Physiological Adaptation, ADPIE - The Nursing Process, Priority, Complications, Patient and Family Education and Self-Management, Delegation, Cultural/Spiritual Considerations. Nutrition. Also consider the importance of therapeutic communication (if you struggle use the ATI communicator modules). Consider what nursing diagnoses may be present in the conditions covered, what interventions relate to those diagnoses. You will have select all that apply questions – make sure you review best practices for answering these questions! Pay special attention to the following concepts: Major Concept AKI (acute kidney injury) BPH (benign prostatic hyperplasia)

Subsections  Categories / causes  Lab abnormalities  Signs and symptoms Difficulty starting urine stream, decreased velocity of urine stream, intermittent voiding, dribbling at end, incomplete bladder emptying/retention, increased risk/recurrence of infection, urinary frequency/urgency/dysuria, nocturia/ incontinence, bladder or urethra pain, hematuria  Nursing care / education, including lifestyle changes & meds Restore bladder drainage and improve pt comfort is goal. Dietary changes (decrease caffeine, alcohol, & lose weight), Avoid decongestant & anticholinergic meds (dry, dry, dry). Elimination schedule (every 2-3 hrs), get screened. Focus on preoperative / postoperative care, can take up to 2 months for bladder function to return to normal, STAY HYDRATED!  Medications – all three types 5 alpha reductase inhibitors (shrink the prostate relieves obstruction & symptoms) – Finasteride & dutasteride. • Alpha blockers (meds that relax the muscles relieves the obstruction & improves symptoms, does not reduce size)Terazosin, doxazosin, Alfuzosin, silodosin, Tamsulosin PDE5 inhibitors (primarily used for ED)- Tadafil & Sildenafil Herbal supplement- Saw Palmetto (decreases manifestations but interacts & enhances anticoagulants)

MDC3 EXAM 1 - CONCEPT GUIDE

Major Concept

Breast Cancer

Cervical Cancer

Chlamydia (bacterial infection)

CKD

Cystitis (UTI) Dosage calc

Subsections  Post-operative care TURP/ TUIP- monitor for bleeding, administer CBI if ordered, monitor UOP carefully, keep catheter until removed by urologist, monitor for infection, mobilize, manage pain  Screening History- personal & family ↑ risk factor, hx of testicular cancer ↑ risk in men Physical assessment & examination- self-assessment & clinical breast exam  Diagnostics Mammogram- every year for 40-54, every 2 years for >55 Ultrasound, MRI, Biopsy, labs, pathology  Risk factors Women, slightly more white women, Aging increases risk (majority in post-menopausal women increasing after age 60), Estrogen (– as a combine post menopause therapy with progesterone, HRT or stand alone for >10 years (including oral contraceptives), History / genetics – personal history of breast, colon, endometrial & ovarian cancer; family history of breast cancer - BRCA 1 or BRCA 2 hold a 5-10% genetic risk, Alcohol (2 or more ↑ risk, Childbirth (giving birth after 30 or never having kids ↑ risk, Obesity (exercise decreases risk), Breast cellular changes – hyperplasia, atypical appearance, Breast Density, High socioeconomic status  Education / prevention Self-breast exams to catch breast cancer earlier on. Early detection improves prognosis, having a healthy life style, avoiding known risks, screening regularly, prophylactic mastectomy for high risk women.  Screening Pap smear, colposcopy, biopsy  Prevention HPV vaccination  Post-operative care (Cervical ablation) Refrain from sex, do not use tampons, do not douche, take showers NOT baths, avoid heavy lifting objects, report any heavy bleeding, foulsmelling discharge, or fever.  Treatment Regular screening essential, Antibiotics -Doxycycline or azithromycin (Avoid sex for 7 days, safe sex, partners need to be tested) Urine or swab test for NAAC  Treatment – differences at each stage  Nursing care  End stage treatment and care  Nursing care / education  You will usually have dosage calculation questions; these will be increasing in difficulty as the term progresses.

MDC3 EXAM 1 - CONCEPT GUIDE

Major Concept ED (erectile dysfunction)

Endometrial Cancer

Glomerulonephritis Lab values (normal ranges, how they might alter specific to any conditions covered, esp. AKI / CKD; when they might be ordered)

Nephrotic Syndrome Nephropathy PKD (polycystic kidney disease) Prostate CancerTypes- Adenocarcinomas (the majority),

Subsections  Risk factors / causes Impeded blood flow or nerve damage (inflammation/injury), Recent surgical procedures (prostatectomy), Certain cancer treatments, Certain medications, Trauma / orthopedic surgeries, Stress or emotional state, Smoking, drugs, alcohol, age >50, Obesity, lack of exercise, other chronic conditions (HTN, Parkinson’s, MS, Diabetes, Thyroid disorders, CAD, high cholesterol)  Treatment Oral meds- Phosphodiesterase type 5 inhibitors (Sildenafil, Vardenafil, Tadalafil) NO ALCOHOL, NO NITRATES!! Testosterone therapy, Intraurethral medications, Vacuum erection devices, Penile implants, surgery  Nursing care Assess emotional status related to body image changes, use calm and accepting approach, encourage patient to discuss feelings, refer the patient to support services.  Labs / diagnostics Transvaginal ultrasound, endometrial biopsy (gold standard), CBC, chest x-ray, abdominal ultrasound, liver/bone scans to identify metastasis, Renal scans/ function tests  Signs and symptoms Abnormal uterine bleeding, especially in post-menopausal women, pain during urination & intercourse, watery, bloody vaginal discharge, low back and abdominal pain, low pelvic discomfort  Post hysterectomy care Signs and symptoms to report: heavy vaginal bleeding, urethral burning greater than 24 hours, blood in urine, extreme fatigue, severe diarrhea, fever of 100, abdominal pain.  Signs & symptoms  BUN 10-20  Creatinine  Potassium 3.5-5.0  Calcium 9-10.5  Magnesium 1.8-2.6  Phosphorus  Bicarbonate  Components of CBC  Nursing care / education  Nursing care / education  Treatment  Lab tests PSA (prostate specific antigen), Urinalysis, biopsy, Serum Alkaline Phosphatase (indicator of bone mets)  Screening – ages and recommendations High risk -1st degree relative possibly starting @ 40, Moderate risk start

MDC3 EXAM 1 - CONCEPT GUIDE

Major Concept

Pyelonephritis Renal Cell Carcinoma STI general

Syphilis (Bacterial infection)

Subsections @ age 45, all men @ 50  Signs and symptoms None in early stages, Symptoms initially reported are like BPH, frequent bladder infections/ UTI’s, urinary retention, LATE symptomsgross hematuria, Metastatic disease may cause lumbosacral symptoms  Risk factors Age- increases after age 50, average @ 67, African American, Diet & obesity, Family History  Post-operative care – all procedures  Signs and symptoms  Risk factors / causes  Post-operative management  Nursing care / education Get a complete history (be non-judgmental) Prevention – get available vaccines, condom use, substance awareness Completing treatment plan – complete meds and follow up, Testing Don’t spread – no sex until infection clear / antibiotics done – usually at least 7 days, let partners know – the state will tell if reportable, Hygiene practices  Risk factors High risk populations- Women, sexually active gay men, less than 25, prisoners, victims of sexual assaults High risk behaviors- new or multiple sex partners, more than 1 sex partner & partners sex history, inconsistent/incorrect condom use High risk medical history- not receiving available vaccines, previous STI’s  substance abuse is a high-risk behavior that increases the change of poor decision making.  •

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Signs and symptoms Primary – sore at site of infection • Firm, round, and painless • 10-90 days after inoculation Secondary (active syphilis) – systemic infection • Skin rash, swollen lymph nodes, fever, headache, body aches – general flu-like symptoms (minus GI symptoms) • Papules may weep • Can have mucous patches • Can be mild and go unnoticed Secondary (latent syphilis) – asymptomatic – immune system has bacteria suppressed Tertiary – severe medical problems • Brain, heart, and other organs may be affected • 1-20 years after initial infection Treatment

MDC3 EXAM 1 - CONCEPT GUIDE

Major Concept

Testicular Cancer

Toxic Shock Syndrome (systemic infection)

Transgender

Urinary Incontinence

Urolithiasis (kidney stones) Uterine Leiomyoma

Subsections Antibiotics- Benzathine penicillin G (doxycycline or tetracycline in penicillin allergy), complete treatment, treat all sexual contacts from 90 days, follow up!  Nursing care / education Self-examination, all regardless of pathology or stage require follow-up monitoring and regular exams, psychological support (infertility & dysfunction can occur) High risk for infertility- discuss sensitively, discuss early, consider cryopreservation of sperm BEFORE treatment starts  Treatment Radical orchiectomy (testis, spermatic cord & lymph nodes), Radiation therapy, Chemotherapy  Patient care / education Educate client on prevention including hand washing before inserting tampon, do not use tampon if it is dirty, insert tampon carefully to avoid injury  Prevention Change tampons 3-6 hrs., careful and clean use of tampons, use pads ONLY at night, avoid superabsorbent tampons, use smallest effective possible, never using tampons is the ONLY way to eliminate risk of tampons, use condoms during sexual activity, careful use of internal contraceptives, especially up to 12 weeks postpartum  Terminology / communication Coming out, female to male, gender dysphoria, gender identity, genderqueer, male to female, sex (natal sex), gender reassignment surgery, transgender, transition, transsexual  Post-operative management Ice pack to the perineum to decrease pain & bruising, monitor pain carefully and provide adequate pain relief, monitor for bleeding, encourage PO intake & document, Verify lower-extremity neurovascular status (in lithotomy position for extended period) - May be on prolonged bedrest while full function returns to lower extremities - Numbness / alterations common for several hours - Delay in mobilizing until neurovascular status stable • Catheter care for 7-12 days  Nursing care / education Pelvic floor muscle training, time voiding, weight loss, quit smoking, stop drinking alcohol, reduce caffeine, prevent constipation, bladder retraining, regular eliminatory schedule Medications- Tolterodine, Oxybutynin, Solifenacin, Darifenacin  

Signs and symptoms Signs and symptoms

MDC3 EXAM 1 - CONCEPT GUIDE

Major Concept

Subsections Often none, Bleeding – heavy bleeding is the main reason women seek medical attention, pain/pelvic pressure  Assessment Quantity of pads/ tampons per day (assess heavy bleeding), Location, duration, quality of any pressure or pain, any issues with bladder or bowel function (constipation, difficulty starting urine stream, retention), Assess abdomen for distension, Dyspareunia (pain during intercourse), Difficulty becoming pregnant or maintaining pregnancy Physical assessment (provider) - Abdominal, vaginal, and rectal exams Psychosocial assessment Labs – look for signs of anemia

Vulvovaginitis

 Patient care / education Self-management (wear cotton underwear, avoid tight clothes, wipe front to back, cleanse inner labia w/ water not soap, do not douche, avoid sprays/ perfumes in vaginal area, treat sexual infections & abstain until treatment complete) Treatment- wet compress, sitz baths, topical medication...