what is the focus for grey
- neuro
- resp
- GU
what is BPH
- non-cancerous enlargement of the prostates
- occurs in older males due to high DHT levels causes issues in eliminating urine due to tightened urethra
what are the risk factors for BPH
- age, older men in their 40’s
- family history
- hormonal changes, like testosterone converting into DHT increasing prostate size
- lifestyle like obesity and smoking
what are the s/s of BPH
- nocturia
- dribbling urine
- weak stream
- frequency
- unable to completely empty bladder
what are the diagnostic tests to ax for BPH
- digital rectal exam: to assess for enlarged prostates
- prostate agent specific test: PSA levels increase when prostates becomes enlarged, inflamed or affected by cancer so it helps rule out other conditions
- cystoscopy: tool inserted into the urethra to visualize the urethra and bladder for how much of urethra is being blocked by prostate
what are the treatment options for BPH
- alpha blockers: relaxes prostate muscles to promote urine flow (tamsulosin)
- 5 alpha reductase inhibitors: shrinks prostate size by lowering DHT levels (finasteride)
- TURP (transurethral resection of the prostate): trim the extra prostate tissue to relieve symptoms
- lifestyle changes avoid caffeine, alcohol, and smoking as these all increase urine production
what is COPD
- chronic obstructive pulmonary disease two types are chronic bronchitis and emphysema
- lung disease that makes it hard to breath due to inflammation and mucus buildup
what are the s/s of COPD
- SOB
- productive cough
- wheezing
- use of accessory muscles
what are the risk factors for COPD
- history of asthma
- smoke exposure to chemicals, pollution and cigarettes
- genetics like alpha 1 antitrypsin deficiency makes you more prone to COPD
what are the diagnosis tests for COPD
- pulse oximetry: assesses the SPO2in the body should be from 88-92%
- arterial blood gas: to see how well O2 is going into the body and CO2 coming out
- chest x-ray: to assess for changes in the lungs caused by COPD
what are the tx options for COPD
- bronchodilators: like salbutamol to open airways and reduce inflammation
- breathing exercise: to expand lungs and strengthen the lungs
- smoking programs: smoking worsens COPD patient should quit if possible
- oxygen therapy: helps bring O2 into the blood stream so patient is more oxygenated
what are some nursing considerations with COPD
- encourage DB+C
- have patient in semi-high fowlers to expand lung expansion
- administer O2 via venturi mask and don’t over oxygenate the patient as they won’t be able to compensate for that
how would surgery effect someone with COPD
- respiratory depression: due to anesthesia and pain meds
- fluid overload: due to IV, CBI, and blood transfusion
- reduced mobility after surgery: lead to reduced lung expansion and lead to pneumonia or atelectasis
what is TURP
transurethral resection of the prostates: procedure where you insert a scope through the urethra to remove excess tissue of the prostate and relieve pressure
what are some complications post TURP
- bladder spasms is the sudden urge to void pain that is referred to the tip of the penis
- bleeding due to TURP surgery (we want to see light pink or serosanguinous coloured urine, bright red blood and large clots is not normal and could indicate active bleed)
- TURP syndrome: hypotonic fluid during irrigation is absorbed into the blood stream (fluid overload and hyponatremia)
- infection due to foley and CBI as bacteria can enter through those ports important to follow aseptic technique and be clean
what are the s/s of TURP syndrome
- restlessness
- confusion
- nauseous
- bradycardia
- hypertension
what is a B&O suppository used for
belladonna opium is used to manage bladder spasms and pain for TURP
nursing considerations:
- dry mouth
- resp depression (bc B&O is a opium)
- constipation
what are the s/s of low hgb levels
- pale skin
- dizziness
- low BP
- SOB
- tachycardia
what is a CBI
- continuous bladder irrigation to clear the bladder from clots forming and and preventing urine from flowing freely
why is Grey getting a blood transfusion
- post TURP bleeding: passing clots and blood loss
what does a blood transfusion do
helps restore blood volume and increase O2
what are the different blood transfusion reactions and list s/s
acute hemolytic reaction: blood types aren’t compatible immune system fights the donner RBC
s/s
- chills
- chest pain/ tightness
- tachycardia
- fever
fluid overload: too much fluid being given at once
s/s
- edema
- bounding pulse
- crackles in the lungs
- JVD
febrile: pt bodies attacks the WBC thinking there foreign
s/s
- spike in temperature
- headache / chills
- warm and flushed skin
anaphylactic: hypersensitivity/ abnormal reaction to the blood (transfusion)
s/s
- pruritus (itchiness)
- urticaria (hives)
- swollen lips and throat
what are the lab values for blood transfusions
RBC: 4.30-5.90
platelets: 150-400
what is the LPN scope relating blood transfusions
- RN initiates and checks VS for first 15 mins
- LPN monitors, checks vitals, reports changes
LPN takes over 30 mins and Q1H until transfusion complete
