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?