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Medical-Surgical Nursing

According to the B-Train Fall 2007 - Volume I

Brief Overview

Short and sweet explanation of what my purpose is. This is to be updated as much

as possible. With notes from class, slides, and the textbook, I hope to come up withsome easy to remember study guides to help us get through this class.

I will attempt to continue to update

this guide. I, Eina Jane, am the

main editor of this project. I have

hopes of passing on whatever

knowledge I may have accrued

over the years.

Nursing school is hard. I, for one,admit having difficulty adjusting to

the pace of the program. It will take time, but it does

happen. If you need help, there are a lot of resources

available. Take advantage of our professors office

hours. If you are determined, it will happen.

Ramapos nursing program is different from other

nursing programs. It provides students a basic foun-

dation of the sciences in order to comprehend the

more advanced topics covered in nursing practicum.It provides non-science oriented students access to

the basic theories of nursing science. Although nurs-

ing may seem far from science, its foundation relies

on the laws of physics, the chemistry of compounds,

the biology of life, and the many mumbo-jumbo

that makes the sciences a difficult subject to compre-

hend. After a two year completion of these pre-

requisites, juniors are now considered to be nursing

majors. The curriculum is strict and does not allow

for a customized schedule. This is where this guide

comes in. It is in no shape or form supposed to re-

place actual textbook reading and note-taking. This

is a supplement. I hope to make this a simpler ver-

sion of the text book, and more organized than our

notes. I will try my best to make this an easy read.

Bergenfield B-Train ChroniclesThe crew: Shayne

Roselle Aca-Ac, Eina

Jane Marie Adlawan,

Ton Garcia and Karyn

Joy Jaramillo left its

mark yet again. At-

tending Englewood

Hospitals NursingProgram is one of the biggest accomplishments of

their lives. Keeping an upbeat outlook in life, they

continue to pursue their dreams of becoming nurses.

The program tests their ability to adapt and learn

new ways of surviving the real world. The real world

has forced them to use their special abilities to go out

there, work hard, and have fun.

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So how do we use this guide?Essentially this

guide is the Pow-

erpoint (C) slides

reformatted to an

easier to read

form.

Aside from the

slides, additional

information from the lecture and textbook are pro-

vided if necessary. Sample NCLEX questions are in-

cluded at the end of each volume.

These questions will be from Saunders, ATI, NCLEX

Made Easy, and other NCLEX review type books.

Alternate Format Ques-

tions will also be fea-

tured, along with ration-

ales to the answers.

LegendImportant

Keep in Mind

Refer to Book

Online / CD

2

Eina Jane & Co.Wandering Fruits, Inc.

MEDICAL SURGICAL NURSING: ACCORDING TO THE B-TRAIN SEES IT

Copyright (c) 2007 by Eina Jane & Co.

All rights reserved.

Medical Surgical Nursing: According to the B-Train Fall 2007 - Volume

Printed in the United States of America


3/15

Meet the CandidatesHey guys! A little something-something about the editors. We are students trying

to survive just like you. If you have any questions, dont hesitate to ask. ^_^

EinakinzHuh?

Ton-TonDunzo.

Ateh KarynWoof!

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nursing. Review guides. Chat rooms. Speed Uno.

Cooking. Wii. This is how we tackle the stress that

comes with the program. jk. HAHAHA. We manage.

One exam at a time; that is how we do it.

We hope you are enjoying the Philippines!!! We are

so jealous. LOL. We miss you! The crew is not the

same without you. Keep in touch! Dont forget to

share your nursing school stories with us. HAHAHA.

^_^

ShiineThis sexy nurse to be is awesome. Ar-

tistic, wonderful, funny and gorgeous.

Shiine poses the ability to kick-butt in

anything she wants. Pool. Table

Table-Tennis. Art. Dont Mess.

The sweet girl transferred to another program, but up-

dates are always an IM or Myspace away. Stay strong,

and show those Filipinos how the B-train handles

Summer 07 Karyns 21st Shannanigans

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GEnitoUrinarybased on lectures by Professor John Fajvan, RN, MSN

First chapter for the senior year.When you gotta go, you gotta go.

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Clinical Manifestations of

Cystitis include:

burning or pain during urination

frequent urination

cloudy / foul-smelling urine

pain directly above pubic bone

children under 5 - less concrete

symptoms [weakness, irritabil-

ity, reduced appetite, vomiting]

older women - NO symptoms,

looks like a part of aging [weak-

ness, falls, confusion, fever]

occasionally, blood in urine

Management of Cystitis:

drink water sufficiently to flush

bladder thoroughly

empty bladder completely when

urinating [place yourself back-

wards on the toilet, so you lean

against the wall to completely

empty bladder - hunching over

to read does not work]

cranberry juice / capsules every-

day which prevents bacteria

from sticking to the bladder wall

urinating immediately after in-

tercourse flushes most bacteria

from urethra

urinate at least once every 3hrs

First line of treatment: antibiot-

ics, depends on health of pt and

bacteria found in urine. From

simple to complex:

What is that?In the new NCLEX, they may

provide us a picture where we are

asked to point and click on the

photo.

Know what and where these fol-lowing parts:

1. Abdominal aorta

2. Right renal artery

3. Left renal artery

4. Inferior vena cava

5. Right renal vein

6. Left renal vein

7. Right adrenal gland

8. Right kidney

9. Renal cortex

10. Renal medulla

11. Renal pelvis

12. Renal pyramid

13. Renal papilla

14. Renal hilum [hilus]

15. Ureters

16. Bladder

CystitisInfection of the bladder.

BUT its usually used to call other

infections and irritations in the

lower urinary system.

- amoxicillin [Amoxil, Tri-

mox]

- ciprofloxacin [Cipro]

- nitrofurantoin [Furadantin,

Macrodantin]

- sulfamethoxazole-

trimethoprim [Bactrim, Septra]

- trimethoprim [Proloprim,

Trimpex]

Interstitial CystitisIC causes discomfort / pain in the

bladder and abdomen.

More common in women than

men. Womens symptoms get

worse during periods, pain during

intercourse.

Natural lining of bladder [epithe-

lium] protected from toxins in

urine by a coating of enzymes

[mucopolysaccharides] called the

GAG [glycoaminoglycan] layer.

In IC, protective layer is defective

allowing toxins to penetrate into

interstitial layers of bladder, de-

polarize nerve endings, thus caus-

ing severe irritative voiding symp-

toms and bladder pain.


Interstitial Cystitis in-

clude:

persistent, urgent need to urinate

frequent trickles, sometimes up

to 60x a day

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pain in suprapubic [pelvis] or

between vagina / anus in women

or scrotum / anus in men [perin-

eal]

pelvic pain during intercourse,

men have painful ejaculation

chronic pelvic pain

Management of Intersti-

tial Cystitis:

Basic concept of therapy -

modify diet to help pts avoid

foods that irritate the damaged

bladder wall.

Avoid alcohol, coffee, tea,

herbal tea, green tea, all sodas

[especially diet], concentrated

fruit juices, tomatoes, citrus

fruit, cranberries, B vitamins,

vitamin C, monosodium glu-

tamte [MSG], chocolate, potas-

sium rich foods [bananas]

Pentosan polysulfate sodium

[Elmiron (R)] - only ORAL

medication approved by FDA

for IC

- chemically similar to GAG -

helps rebuild epithelium by coat-

ing bladder wall

- take up to 6mo. to provide

symptom relief; 25% experience

significant relief within 4wks

- taken long-term to keep

symptoms from recurring

- uncommon side fx: GI dis-

comfort, reversible hair loss

Dimethyl Sulfoxide [DMSO,

Rimso-50(R)] - only FDA ap-

proved INSTILLATION treat-

ment

- instilled through urethra and

directly into bladder via catheter

- enters bladder wall, reduces

inflammation, pain, painful

muscle contractions

- may be mixed with steroids,

or other local anesthetics

- may leave garlic taste / smell

on skin / breath for up to 72hrs

- heparin similar to GAG and

may help to repair problems

caused by GAG deficiency in

bladder

- blood, liver, kidney tests re-

quired every 6mo. during

DMSO therapy

UrethritisInflammation of the urethra

caused by infection.

Although irritation of urethra

may occur in variety of clinical

conditions, its a broad term used

to describe a syndrome of STDs:

gonococcal urethritis [GU] and

nongonococcal urethritis [NGU].

Clinical Manifestations ofUrethritis include:

timing: symptoms generally be-

gin 4days to 2wks after contact

with infected partner, or patient

maybe asymptomatic [assess

sexual history]

urethral discharge: fluid may be

yellow, green, brown / tinged

with blood, production is unre-

lated to sexual activity

dysuria: localized to meatus or

distal penis, worst during firstmorning void, alcohol consump-

tion

urinary frequency and urgency

typically absent; if present, ei-

ther should suggest prostatitis or

cystitis

itching: sensation urethral itch-

ing / irritation may persist be-

tween voids, some pts have itch-ing instead of pain or burning

orchalgia: men sometimes c/o

heaviness in genitals; associated

pain in testicles should suggest

epididymitis, orchitis, or both

menstrual cycle: women occa-

sionally c/o worsening symp-

toms during menses

foreign body or instrumentation:

pt should be question about re-

cent urethral catheterization or

instrumentation, either medical

or self-induced [foreign body] -

causes traumatic urethritis

urethritis following catheteriza-

tion, occurs up to 20% of pts

receiving intermittent catheteri-zation; 10x more likely to occur

with latex catheters than sili-

cone catheters

Management of Urethri-

tis:

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objective: treat infection until

urine is sterile and at the same

time correct underlying cause

UrosepsisOccurrence of bacterial seeding

into blood stream due to an UTIcausing generalized infection

Clinical Manifestations for

Urosepsis include:

UTI - increased frequency of

urination

burning sensation on urination

flank pain

blood in urine and fever

increased heart rate [tachycar-

dia]

decreased blood pressure and

unconsciousness

What is the Prostate?Gland in male reproductive system

located just below bladder and in

front of the rectum.

About the size of a walnut. Sur-

rounds part of urethra.

Produces fluid that makes up part

of the semen.

Benign Prostatic Hy-pertrophy [BPH]Benign [non-cancerous] condition.

Overgrowth of prostate tissue

pushes against the urethra, block-

ing flow of urine.

Prostate CancerCancer that forms in tissues of

prostate.

Occurs in older men.

Estimated new cases and death

from prostate cancer in US in

2007:

New cases: 218,890

Deaths: 27,050

Clinical Manifestation of

Prostate Cancer include:

weak or interrupted flow of

urine

frequent urination [especially at

night]

trouble urinating

pain / burning during urination

blood in urine / semen

pain in back, hips, pelvis that

does not go away [metastases]

painful ejaculation

Stage 1 Prostate Cancer

Found in the prostate only.

Cannot be felt during digital

rectal exam and not visible

by imaging.

Management of Stage

I Prostate Cancer:

watchful waiting[surveil-

lance]

radical prostatectomy, usually

with pelvic lymphadenectomy,

with / without radiation therapy

after surgery. May be possible to

remove the prostate without

damaging nerves that are neces-

sary for an erection

external-beam radiation therapy

implant radiation therapy

clinical trials

- high-intensity focused ultra-

sound

- radiation therapy

- evaluating new treatment

option

Stage II Prostate Cancer

More advanced than Stage I.

Has NOT spread outside prostate.

Could be palpated during digital

rectal exam [DRE] or seen duringrectal ultrasound examination

Management of Stage II

Prostate Cancer:



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with / without radiation therapy

after surgery. May be possible to

remove the prostate without

damaging nerves that are neces-

sary for an erection

watchful waiting [surveillance]

external-beam radiation therapy

with or without hormone therapy

implant radiation therapy

clinical trials

- radiation therapy with or

without hormone therapy

- ultrasound-guided cryosur-

gery

- hormone therapy follwed by

radical prostatectomy


options

Stage III Prostate Cancer

Spread beyond outer layer of pros-

tate to nearby tissues.

May be found in seminal vesicles

[glands that help produce semen]

Also called Stage C Prostate Can-

cer

Management of Stage III

Prostate Cancer: external-beam radiation therapy

with or without hormone therapy

hormone therapy



with or without radiation therapy

after surgery


radiation therapy, hormone ther-

apy, transurethral resection of

the prostate as palliative therapy

to relieve symptoms caused by

cancer

clinical trial

- ultrasound-guided cryosur-

gery

- hormone therapy followed

by radical prostatectomy


options

Stage IV Prostate Can-

cer

Metastasized [spread] to lymph

nodes near or far from prostate,

or to other parts of body: blad-

der, rectum, bones, liver, lungs.

Often spreads to bones.

Also called Stage D1 Prostate

Cancer and Stage D2 Prostate

Cancer

Management of Stage IV

Prostate Cancer

hormone therapy

external-beam radiation

therapy with or without

hormone therapy

radiation therapy or

TURP of prostate as pal-

liative therapy to relieve symp-

toms caused by cancer


clinical trial of radical prostatec-

tomy with orchiectomy [testo-

terone driven cancer]

Transurethral Resec-

tion of the Prostate

[TURP]Tissue removed from prostate us-

ing resectoscope [thin, lighted tub

with cutting tool at the end] in-

serted through urethra.

Prostate tissue blocking the ure-

thra is cut away and removed

through resectoscope.

Suprapubic Pros-

tatectomySurgical pro-

cedure that

requires alarge inci-

sion in lower

abdomen,

through

which pros-

tate and

nearby

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lymph nodes can be removed.

Takes 2-3hrs to perform.

Followed by 4-6day hospital stay.

Retropubic Pros-

tatectomyProstate removed through an inci-

sion in the wall of the abdomen.

Risk for bleeding / blood clots.

Need continuous bladder irrigation

[CBI].

Perineal Prostatec-

tomyProstate removed through and in-

cision in the area between scrotum

and anus

NephrolithiasisProcess of forming a stone in the

kidney or lower down in the uri-

nary tract.

Development of stones related to:

decreased urine volume

increased excretion of stone-

forming components such as

calcium, oxalate, urate, cystine,

xanthine, phosphate

Stones form in urine collecting

area [pelvis] of the kidney and

may range from tiny to staghorn

stones the size of the renal pelvis

itself.


Nephrolithiasis include:

severe abdominal pain of sudden

onset [worse than child birth]

unilateral flank pain [one side]

lower abdominal pain

nausea / vomiting

Glomerulonephritis

Kidney disease caused by in-flammation of internal kidney

structures [glomeruli].

May be temporary / reversible

condition, or may get worse.

Progressive glomerulonephritis

may result in destruction of kidney

glomeruli and chronic renal failure

and end stage renal disease

May be caused by specific prob-

lems with immune system, but

precise cause of some cases is un-

known

diabetes mellitus

multiple sclerosis

AIDS/HIV

Renal failure = NO advil,

ibuprofen, motrin, contrast dye

must check BUN / Creati-

nine levels periodically


Glomerulonephritis in-

clude:

Initial symptoms:

- blood in urine [dark, rust-colored, brown]

- foamy urine [beer]

Progressive symptoms:

- unintentional weigh loss

- nausea / vomiting

- malaise / fatigue

- headache

- frequent hiccups

- generalized itching [uric acid

irritating skin]

- decreased urine output

-easy bruising / bleeding

- decreased alertness [unfil-

tered toxins

- may lead to eventual coma

Management of Glomeru-

lonephritis:

treatment varies depending on

cause of disorder, type, severityof symptoms

primary treatment goal: control

symptoms

high blood pressure may be dif-

ficult to control - MOST impor-

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tant aspect of treatment [avoid

stroke] - antihypertensive meds

corticosteroids [too much =

damage kidneys], immunosup-

pressives may be used to treat

some causes of chronic glomeru-lonephritis

dietary restrictions: salt, fluids,

protein, other substances to aid

control hypertension or kidney

failure

dialysis or kidney transplanta-

tion may be necessary to control

symptoms of renal failure and to

sustain life

Nephrotic SyndromeDisorder where kidneys have been

damaged, causing them to leak

protein from blood into urine.

Proteinuria [>3.5g/day], hypalbu-

mineria, hyperlipidemia, edema.

Clinical Manifestations ofNephrotic Syndrome in-

clude:

most common sign: excess

fluid in the body - takes several

forms

puffiness around eyes, especially

in the morning

pitting edema over legs

fluid in pleural cavity causing

pleural effusion

fluid in peritoneal cavity causing

ascites

Management of Neph-

rotic Syndrome:

nothing: some cases will im-

prove with time, require no spe-

cial treatment, others respond to

very poorly to any known treat-ment

oral steroids: [prednisolone] one

form of the disease [minimal

change disease] very sensitive

to steroids; short-term use

minimizes potential side-effects

immunosuppression: more diffi-

cult cases thought to be triggered

by own immune system; thera-

pies come as tablets or drips

given in the hospital - not com-

monly used because of toxicitiy

- but sometimes effective in

some pts

What is Renal Fail-

ure?Divided into two categories:

acute renal failure and chronic re-

nal failure.

Type of renal failure determined

by trend in serum creatinine.

Chronic renal failure generally

leads to anemia and small kidney

size on ultrasound.

Acute Renal FailureRapidly progressive loss of renalfunction.

Oliguria [


12/15

- obstruction of bladder must

be bilateral to cause post-renal

failure unless only one kidney is

functional

- caused by: urethral/bladder

cancer, renal/ureteral/bladderstones, atony [decreased muscle

tone] of bladder, prostatic hy-

perplasia / cancer, cervical can-

cer [metastasis], urethral stric-

ture

Phases of Oliguric Acute

Renal Failure [


13/15

All blood is filtered: risk for

shock, hypokalemia, low protein/

salt/fluids

Renal CancerForms in tissues of kidney.

Renal cell carcinoma: forms in

lining of very small tubes in kid-

ney that filter blood and remove

waste products.

Renal pelvis carcinoma: forms in

center of kidney where urine col-

lects.

Wilms Tumor: kidney cancer that

usually develops in children under5yo [removal of kidney, recur-

rence = death].

Several types of tumor: benign

and malignant may occur

Most common type: fluid-filled

area called a cyst

Simple cysts do not progress

to cancer; requires no follow-up

Complex cysts do not have

typical benign appearance and

may contain cancer

In US, kidney cancer accounts for

about 3% of all cancers, approx

12,000 kidney cancer deaths/year

Occurs more in males, diagnosed

between 50-70yo, but can occur at

any age

Adults, most common type = renal

cancer [renal adenocarcinoma or

hypernephroma]


Renal Cancer include:

Rarely causes s/s in early stages

Disease progression

- pain in back, just below ribs

that does not go away

- weight loss

- fatigue

- intermittent fever

- mass in area of kidneys

thats discovered during a physi-

cal exam

Staging of Renal Cancer

Stage I

- primary cancer 7cm [3in] or

less

- limited to kidney, with no

spread to lymph nodes or distant

sites

Stage II

- primary cancer greater than

7cm [3in]

- limited to kidney, with no

spread to lymph nodes or distant

sites

Stage III

- primary cancer less OR

greater than 7cm [3in]

- spread to SINGLE lymph

node

- primary tumor may have

spread to renal veins or vena

cava, but only spread directly

and not out of the local area of

kidney

Stage IV

- spread to distant sites

- invades directly beyond local

area

- has more than one lymph

node involved

Management of Renal

Cancer: partial or complete nephrectomy

- may include removal of ad-

reneal gland, retroperitoneal

lymph nodes, possibly tissues

involved by direct extension

[invasion] of tumor into sur-

rounding tissues

- if tumor spread into renalvein, inferior vena cava, possi-

bly right atrium [angioinvasion],

portion of tumor can be surgi-

cally removed

- for metastasis, surgical re-

section of kidney [cy;todreductiv

nephrectomy] may improve sur-

vival, as well as resection of

solitary metastatic lesion

radiation therapy = not com-

monly used because not usually

successful; may be used to palli-

ate skeletal metastases

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chemotherapy in some cases, but

unlikely cure unless all cancer

surgically removed

Testicular CancerMost common type of cancer af-

fecting men 15-35yo.

Can strike ANY male, ANY

TIME.

Almost always curable if found

early.

Most found by men themselves,

either as PAINLESS lump, or

hardening or change in size of tes-

ticle, or pain in testicle

Children born with undescended

testicle have increased risk of get-

ting testicular cancer regardless of

whether surgery is done to correct

problem. However, surgery should

still be done to preserve fertility.

Can be treated with surgery, radia-

tion therapy, chemotherapy, sur-

veillance, or a combination.


Testicular Cancer include:

enlargement of testicle

painless lump

significant loss of size in one of

testicles

feeling of heaviness in scrotum

dull ache in lower abdomen /

groin

sudden collection of fluid in

scrotum

pain or discomfort in testicle /

scrotum

enlargement / tenderness of

breasts

Who is usually affected? white males

northern European: Denmark,

Finland, Norwegian, etc

No known cause

Staging of Testicular Can-

cer

Stage I: cancer confined to testi-

cle

Stage II: spread to retropertoneal

lymph nodes, located in rear of

body below diaphragm and be-

tween the kidneys

Stage III - spread beyond lymph

nodes to remote sites in body,

including lungs, brain, liver,bones

Management of Testicular

Cancer

inguinal orchiectomy

retroperitoneal lymph node dis-

section

radiation therapy for seminoma

chemotherapy for non-

seminoma

- Platinol [cisplatin]: adminis-

tered in hospital, toxicity of

platinum solution

- Vepesid / VP-16 [etoposide]

- Blenoxane [bleomycin sul-

fate]: once a month injection at

doctors office; respiratory tox-

icity - pulmonary fibrosis

surveillance

- CBC

- LDH

- tumor markers

- beta HCG [serum pregnancy

test] = determines germ cell car-

cinoma

Iggy Text: Ch. 72-75

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NCLEX Questions

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