Nutrition
Diet recommendations for IBD (crohns, colitis)
*A low residue (low fiber) ,high protein, high calorie diet is recommended.
*Oral replacement fluids may be needed
*TPN may be needed during acute phase
*avoid nicotine
Diverticulitis
For acute exacerbation clear liquid diet is recommended (low fiber)
After inflammation is reduced a high fiber, low fat diet is recommended
Avoid seeds, husks (popcorn, tomatoes, berries)
Breast Self examination
1) stand in front of mirror and check both breasts for anything unusual. Look for DISCHARGE, DIMPLING OR SCALING.
2.) put arms behind head and then om hips and observe for changes in breast
3.)palpate breasts in a circular motion for abnormalities while standing up and while lying down.
***retraction, nipple inversion, Peau d'Orange, increased venous prominence are all abnormal findings- most common location for breast cancer is the upper, outer quadrant
Name the 3 types of skin cancer and give a description of each
1) Basal cell carcinoma-generally appears on sun exposed areas of the body. Small, waxy nodule with rolled translucent, pearly borders. Rarely metastasizes
2) Squamous Cell Carcinoma- usually appears on sun damaged skin. Rough, thickened scaly tumor that may be asymptomatic or involve bleeding. May metastasize
3) Melanoma- usually affects the head, neck or trunk in men and the legs in women. Lesions tend to be circular with irregular outer portions. may be flat or elevated and may appear in mixed colors; gray, blue/black, white. Most serious form of skin cancer
** Educate patients to report changes in moles to their providers
Chest tube- If drainage system becomes compromised what should you do?
If chest tube is accidentally removed what should you do?
If you notice the patient has absent breath sounds on affected side. asymmetry of chest and their trachea has shifted to the side what should you suspect?
place end of tube into sterile water to maintain water seal
place occlusive dressing over insertion site, taped only on 3 Sides
Tension pneumothorax- EMERGENCY!!
Pancreatitis
low protein at first, THEN, consume a low fat, high protein, high carbohydrate diet.
NPO recommended during acute exacerbations, TPN may be needed. For chronic pancreatitis encourage high calorie snacks and taking enzyme preparations with meals to assist with absorption
Acute Kidney Injury
Limit protein intake
restrict fluid intake to daily urine output +500ml during oliguric phase
medication and surgical breast cancer prevention for women who are at high risk for developing breast cancer-**; multiple first degree relatives with early onset breast cancer, breast and ovarian cancer in the same family, male breast cancer, Jewish heritage and BRCA1 and BRCA2 gene mutations are all risk factors
Clinical breast exams twice a year, tamoxifen used as a chemopreventive agent (avoid pregnancy if taking this), prophylactic mastectomy.
Factors implicated or known to induce carcinogenesis include.... Give examples
VIRUSES AND BACTERIA ( HPV- cervical and head and neck, HBV-liver, Epstein-Barr-Burkitt lymphoma and nasopharyngeal cancer, H. Pylori-gastric malignancy)
CHEMICAL AGENTS (TOBACCO smoke- lung, head neck, esophagus, stomach, pancreas, cervix, kidney, bladder, AML, pesticides, formaldehydes, asbestos, alcohol)
GENETICS AND FAMILIAL FACTORS (BRCA1, BRCA2, MEN1, MEN2)
PHYSICAL AGENTS (sunlight, radiation, chronic irritation or inflammation, tobacco use)
DIETARY FACTORS( fats, alcohol, salt cured or smoked meats, nitrate containing foods, red meat, obesity)
HORMONAL AGENTS (oral contraceptives, estrogen therapy,hormonal changes)
when removing a chest tube what should you tell your patient to do?
What kind of dressing do you use after chest tube removal?
What does continuous bubbling in the water seal chamber indicate?
Take a deep breath, exhale and bear down
Apply sterile petroleum jelly gauze dressing over site
air leak
Cholelithiasis
NPO until recovered then progress clear-full liquid-bland. Low fat diet.
No spicy, greasy foods.
* May have fat 4-6 weeks after surgery
Chronic Kidney disease
Limit protein intake
Limit phosphorous intake (dairy, dark green vegetables, meat, fish, eggs, legumes, cola chocolate, beer)
limit potassium intake ( bananasm potatoes, tomatoes, oranges, cantaloupe, avocados, dark green vegetables)
limit sodium to control hypertension
what should be done to prevent skin irritation in a patient receiving radiation therapy
Avoid the use of soaps, perfumes, powders, lotions and ointments. Use only lukewarm water to bathe area. Do not rub or scratch, no straight edge razors, hot water bottles or heating pads. ONLY prescribed creams or ointments
After a ALND or mastectomy the patient is usually discharged _______ days after the surgery.
Drains are usually removed when the output is less than ______ in a ______ hour period. The drain is a measure to prevent ___or_____ formation.These are collections of _____ or _____.
1-2 days
30ml, 24
seromas, hematomas
serous fluid, blood
what 7 things must 2 RNS check at the bedside before giving blood?
1) pt. name
2) DOB or Medical ID #
3)Donor#
4) Blood type
5) Expiration date
6) Consent for blood product/ administration
7)Blood transfusion order
*also check bag for clots/bubbling
peptic ulcer disease
reduce stress, Avoid NSAIDS, alcohol and smoking.
Avoid eating frequent meals, as this increases gastric acid secretion
Avoid black pepper, spicy foods, caffeine.
End stage renal disease
Encourage HIGH protein intake after dialysis has begun due to protein being lost in dialysis
Limit phosphorous intake, take phosphate binders with meals and snacks. Ex: Os cal, Tums, Renagel, Fosrenol
Limit potassiumLimit sodium, fluids
provide calcium and vitamin D supplements
preventing drug dependancy in a person with sickle cell anemia
Some patients with sickle cell develop problems with substance abuse. This results from inadequate management of acute pain during episodes of crisis leading to the patients mistrust of health care system and results in the need to seek care from other sources. Patients should be encouraged to seek care from a single provider
what important things should a patient be taught about hand and arm care after axillary lymph node dissection
* NO BP, injections, blood draws in the affected extremity.
after surgery patients are taught arm exercises on the affected side to restore range of motion and prevent lymphydema.
Apply insect repellant, wear gloves for gardening, use oven mitts, use electric razor for shaving armpit, avoid lifting objects heavier than 5-10 pounds, if a trauma or break in the skin occurs wash with soap and water and apply antibacterial ointment.
How often are VS done for blood transfusion?
Universal donor and recipient?
Baseline set of VS before, VS every 5-15 minutes( then facility protocol) after infusion
donor- O-
recipient AB+
stomatitis ( inflamed and sore mouth, some causes include chemo, crohns, and certain antibiotics.)
Do not use alcohol based mouthwash!
Use a soft toothbrush, clean teeth after meals and at bedtime
Avoid acidic, spicy, dry, crunchy foods
Consume cold or room temperature foods
cut food into smaller bites
use a straw
prostatectomy
spicy foods, alcohol and coffee may cause bladder discomfort.
Ways to prevent a sickle cell crisis
Keeping warm and and maintaining adequate hydration can be effective in diminishing the occurrence and severity of attacks. Also reducing stress and avoiding fatigue are helpful
** daily folic acid replacements may also be required to maintain the supply required for increased erythropoiesis
what are the most common side effects associated with chemotherapy?
What are side effects associated with the myelosuppression of bone marrow from chemotherapy?
Nausea, vomiting
Decreased WBCs (leukopenia) granulocytes (neutropenia)-increased risk for INFECTION
Decreased RBCs- risk for ANEMIA
Decreased platelets- (thrombocytosis) risk for BLEEDING
when suctioning a patient how often do you hyperoxygenate?
Do you suction on the way in or out?
before, during and after
OUT only, less than 10-15 seconds only 3 suction passes per episode and 30 seconds to 1 minute between each episode