Professional Documents
Culture Documents
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 with
some easy to remember study guides to help us get through this class.
I will attempt to continue to update requisites, juniors are now considered to be nursing
this guide. I, Eina Jane, am the majors. The curriculum is strict and does not allow
main editor of this project. I have for a customized schedule. This is where this guide
hopes of passing on whatever comes in. It is in no shape or form supposed to re-
knowledge I may have accrued place actual textbook reading and note-taking. This
over the years. is a supplement. I hope to make this a simpler ver-
sion of the text book, and more organized than our
Nursing school is hard. I, for one, notes. I will try my best to make this an easy read.
admit having difficulty adjusting to
the pace of the program. It will take time, but it does Bergenfield B-Train Chronicles
happen. If you need help, there are a lot of resources The crew: Shayne
available. Take advantage of our professors’ office Roselle Aca-Ac, Eina
hours. If you are determined, it will happen. Jane Marie Adlawan,
Ton Garcia and Karyn
Ramapo’s nursing program is different from other Joy Jaramillo left its
nursing programs. It provides students a basic foun- mark yet again. At-
dation of the sciences in order to comprehend the tending Englewood
more advanced topics covered in nursing practicum. Hospital’s Nursing
It provides non-science oriented students access to Program is one of the biggest accomplishments of
the basic theories of nursing science. Although nurs- their lives. Keeping an upbeat outlook in life, they
ing may seem far from science, its foundation relies continue to pursue their dreams of becoming nurses.
on the laws of physics, the chemistry of compounds, The program tests their ability to adapt and learn
the biology of life, and the many ‘mumbo-jumbo’ new ways of surviving the real world. The real world
that makes the sciences a difficult subject to compre- has forced them to use their special abilities to go out
hend. After a two year completion of these pre- there, work hard, and have fun.
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Medical Surgical Nursing: According to the B-Train Fall 2007 - Volume I
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Meet the Candidates
Hey guys! A little something-something about the editors. We are students trying
to survive just like you. If you have any questions, don’t hesitate to ask. ^_^
Einakinz
“Huh?”
Ton-Ton
“Dunzo.”
Ateh Karyn
“Woof!”
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Shiine nursing. Review guides. Chat rooms. Speed Uno.
This sexy nurse to be is awesome. Ar- Cooking. Wii. This is how we tackle the stress that
tistic, wonderful, funny and gorgeous. comes with the program. jk. HAHAHA. We manage.
Shiine poses the ability to kick-butt in One exam at a time; that is how we do it.
anything she wants. Pool. Table
We hope you are enjoying the Philippines!!! We are
Table-Tennis. Art. Don’t Mess.
so jealous. LOL. We miss you! The crew is not the
The sweet girl transferred to another program, but up- same without you. Keep in touch! Don’t forget to
dates are always an IM or Myspace away. Stay strong, share your nursing school stories with us. HAHAHA.
and show those Filipinos how the B-train handles
^_^
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GEnitoUrinary based on lectures by Professor John Fajvan, RN, MSN
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What is that? Clinical Manifestations of - amoxicillin [Amoxil, Tri-
In the new NCLEX, they may mox]
Cystitis include:
provide us a picture where we are
asked to point and click on the • burning or pain during urination - ciprofloxacin [Cipro]
photo.
• frequent urination - nitrofurantoin [Furadantin,
Macrodantin]
Know what and where these fol-
• cloudy / foul-smelling urine
lowing parts:
- sulfamethoxazole-
• pain directly above pubic bone trimethoprim [Bactrim, Septra]
1. Abdominal aorta
• children under 5 - less concrete - trimethoprim [Proloprim,
2. Right renal artery
symptoms [weakness, irritabil- Trimpex]
3. Left renal artery ity, reduced appetite, vomiting]
Interstitial Cystitis
4. Inferior vena cava • older women - NO symptoms, IC causes discomfort / pain in the
looks like a part of aging [weak- bladder and abdomen.
5. Right renal vein ness, falls, confusion, fever]
More common in women than
6. Left renal vein • occasionally, blood in urine men. Women’s symptoms get
worse during periods, pain during
7. Right adrenal gland Management of Cystitis: intercourse.
8. Right kidney • drink water sufficiently to flush
Natural lining of bladder [epithe-
bladder thoroughly
lium] protected from toxins in
9. Renal cortex
• empty bladder completely when urine by a coating of enzymes
10. Renal medulla urinating [place yourself back- [mucopolysaccharides] called the
wards on the toilet, so you lean GAG [glycoaminoglycan] layer.
11. Renal pelvis against the wall to completely
In IC, protective layer is defective
empty bladder - hunching over
12. Renal pyramid allowing toxins to penetrate into
to read does not work]
‘interstitial layers’ of bladder, de-
13. Renal papilla polarize nerve endings, thus caus-
• cranberry juice / capsules every-
day which prevents bacteria ing severe irritative voiding symp-
14. Renal hilum [hilus]
from sticking to the bladder wall toms and bladder pain.
15. Ureters
• urinating immediately after in- Clinical Manifestations of
16. Bladder tercourse flushes most bacteria Interstitial Cystitis in-
from urethra
clude:
Cystitis
Infection of the bladder. • urinate at least once every 3hrs • persistent, urgent need to urinate
BUT it’s usually used to call other • First line of treatment: antibiot- • frequent trickles, sometimes up
ics, depends on health of pt and to 60x a day
infections and irritations in the
bacteria found in urine. From
lower urinary system.
simple to complex:
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• pain in suprapubic [pelvis] or Dimethyl Sulfoxide [DMSO, • urethral discharge: fluid may be
between vagina / anus in women Rimso-50(R)] - only FDA ap- yellow, green, brown / tinged
or scrotum / anus in men [perin- proved INSTILLATION treat- with blood, production is unre-
eal] ment lated to sexual activity
• pelvic pain during intercourse, - instilled through urethra and • dysuria: localized to meatus or
men have painful ejaculation directly into bladder via catheter distal penis, worst during first
morning void, alcohol consump-
• chronic pelvic pain - enters bladder wall, reduces tion
inflammation, pain, painful
Management of Intersti- muscle contractions • urinary frequency and urgency
tial Cystitis: typically absent; if present, ei-
- may be mixed with steroids, ther should suggest prostatitis or
Basic concept of therapy - or other local anesthetics cystitis
modify diet to help pts avoid
foods that irritate the damaged - may leave garlic taste / smell • itching: sensation urethral itch-
bladder wall. on skin / breath for up to 72hrs ing / irritation may persist be-
tween voids, some pts have itch-
• Avoid alcohol, coffee, tea, - heparin similar to GAG and ing instead of pain or burning
herbal tea, green tea, all sodas may help to repair problems
[especially diet], concentrated caused by GAG deficiency in • orchalgia: men sometimes c/o
fruit juices, tomatoes, citrus bladder heaviness in genitals; associated
fruit, cranberries, B vitamins, pain in testicles should suggest
vitamin C, monosodium glu- - blood, liver, kidney tests re- epididymitis, orchitis, or both
tamte [MSG], chocolate, potas- quired every 6mo. during
sium rich foods [bananas] DMSO therapy • menstrual cycle: women occa-
sionally c/o worsening symp-
Pentosan polysulfate sodium Urethritis toms during menses
[Elmiron (R)] - only ORAL Inflammation of the urethra
medication approved by FDA caused by infection. • foreign body or instrumentation:
for IC pt should be question about re-
Although irritation of urethra cent urethral catheterization or
- chemically similar to GAG - may occur in variety of clinical instrumentation, either medical
helps rebuild epithelium by coat- conditions, it’s a broad term used or self-induced [foreign body] -
ing bladder wall to describe a syndrome of STDs: causes traumatic urethritis
gonococcal urethritis [GU] and
- take up to 6mo. to provide nongonococcal urethritis [NGU]. • urethritis following catheteriza-
symptom relief; 25% experience tion, occurs up to 20% of pts
significant relief within 4wks Clinical Manifestations of receiving intermittent catheteri-
Urethritis include: zation; 10x more likely to occur
- taken long-term to keep with latex catheters than sili-
symptoms from recurring • timing: symptoms generally be- cone catheters
gin 4days to 2wks after contact
- uncommon side fx: GI dis- with infected partner, or patient
comfort, reversible hair loss
Management of Urethri-
maybe asymptomatic [assess
sexual history] tis:
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objective: treat infection until Cannot be felt during digital
urine is sterile and at the same rectal exam and not visible
time correct underlying cause by imaging.
About the size of a walnut. Sur- • trouble urinating Stage II Prostate Cancer
rounds part of urethra. More advanced than Stage I.
• pain / burning during urination
Produces fluid that makes up part Has NOT spread outside prostate.
of the semen. • blood in urine / semen
Could be palpated during digital
Benign Prostatic Hy- • pain in back, hips, pelvis that rectal exam [DRE] or seen during
does not go away [metastases]
pertrophy [BPH] rectal ultrasound examination
Benign [non-cancerous] condition. • painful ejaculation
Management of Stage II
Overgrowth of prostate tissue
Stage 1 Prostate Cancer Prostate Cancer:
pushes against the urethra, block-
ing flow of urine. Found in the prostate only. • radical prostatectomy, usually
with pelvic lymphadenectomy,
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with / without radiation therapy with or without radiation therapy liative therapy to relieve symp-
after surgery. May be possible to after surgery toms caused by cancer
remove the prostate without
damaging nerves that are neces- • watchful waiting [surveillance] • watchful waiting [surveillance]
sary for an erection
• radiation therapy, hormone ther- • clinical trial of radical prostatec-
• watchful waiting [surveillance] apy, transurethral resection of tomy with orchiectomy [testo-
the prostate as palliative therapy terone driven cancer]
• external-beam radiation therapy to relieve symptoms caused by
with or without hormone therapy cancer Transurethral Resec-
tion of the Prostate
• implant radiation therapy • clinical trial
[TURP]
• clinical trials - ultrasound-guided cryosur- Tissue removed from prostate us-
gery ing resectoscope [thin, lighted tub
- radiation therapy with or with cutting tool at the end] in-
without hormone therapy - hormone therapy followed serted through urethra.
by radical prostatectomy
- ultrasound-guided cryosur- Prostate tissue blocking the ure-
gery - evaluating new treatment thra is cut away and removed
options through resectoscope.
- hormone therapy follwed by
radical prostatectomy Stage IV Prostate Can-
- evaluating new treatment cer
options Metastasized [spread] to lymph
nodes near or far from prostate,
Stage III Prostate Cancer or to other parts of body: blad-
Spread beyond outer layer of pros- der, rectum, bones, liver, lungs.
tate to nearby tissues.
Often spreads to bones.
May be found in seminal vesicles
Also called Stage D1 Prostate
[glands that help produce semen]
Cancer and Stage D2 Prostate
Cancer
Also called Stage C Prostate Can- Suprapubic Pros-
cer
Management of Stage IV tatectomy
Surgical pro-
Management of Stage III Prostate Cancer cedure that
Prostate Cancer: • hormone therapy requires a
large inci-
• external-beam radiation therapy
• external-beam radiation sion in lower
with or without hormone therapy
therapy with or without abdomen,
hormone therapy through
• hormone therapy
which pros-
• radical prostatectomy, usually • radiation therapy or tate and
with pelvic lymphadenectomy, TURP of prostate as pal- nearby
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lymph nodes can be removed. may range from tiny to staghorn Clinical Manifestations of
stones the size of the renal pelvis
Takes 2-3hrs to perform. itself.
Glomerulonephritis in-
clude:
Followed by 4-6day hospital stay.
Clinical Manifestations of • Initial symptoms:
Retropubic Pros- Nephrolithiasis include:
- blood in urine [dark, rust-
tatectomy • severe abdominal pain of sudden colored, brown]
Prostate removed through an inci- onset [worse than child birth]
sion in the wall of the abdomen. - foamy urine [beer]
unilateral flank pain [one side]
Risk for bleeding / blood clots. • Progressive symptoms:
• lower abdominal pain
Need continuous bladder irrigation - unintentional weigh loss
[CBI]. • nausea / vomiting
- nausea / vomiting
Glomerulonephritis
Kidney disease caused by in- - malaise / fatigue
flammation of internal kidney
structures [glomeruli]. - headache
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- obstruction of bladder must - diuresis can result in output Many major organs contained in
be bilateral to cause post-renal of up to 10L [10,000mL] of di- cavity [liver, kidneys, stomach,
failure unless only one kidney is lute urine per day bowel].
functional
- usually occurs 2-6wks after Membrane has many tiny holes
- caused by: urethral/bladder onset of oliguric acute renal fail- and acts as filter, allowing waste
cancer, renal/ureteral/bladder ure and continues until BUN products and fluid from blood to
stones, atony [decreased muscle level increases to rise pass through.
tone] of bladder, prostatic hy-
perplasia / cancer, cervical can- • Recovery Phase [Convalescent
cer [metastasis], urethral stric- Phase]
ture
- pt begins to return to normal
levels of activity
Phases of Oliguric Acute
Renal Failure [<400ml/ - renal function may continue
day] to improve for up to 12mo after
oliguric acute renal failure be-
• Onset Phase gan
- begins with precipitating - pt is particularly vulnerable
event and continues until olig- to additional injury during this
uria develops time
- can last from hours to sev-
eral days Chronic Renal Failure
May develop slowly and show few Holes are too small to allow large
• Oliguric Phase initial symptoms. molecules to pass through there-
fore blood and dialysate will never
- Urine output 100-400mL/ Long term result of irreversible mix.
day that does not respond to acute disease or part of disease
fluid challenges or diuretics progression. Performed daily at home.
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All blood is filtered: risk for Clinical Manifestations of - primary tumor may have
shock, hypokalemia, low protein/ spread to renal veins or vena
salt/fluids
Renal Cancer include: cava, but only spread directly
• Rarely causes s/s in early stages and not out of the local area of
Renal Cancer kidney
Forms in tissues of kidney. • Disease progression
• Stage IV
Renal cell carcinoma: forms in - pain in back, just below ribs
lining of very small tubes in kid- that does not go away - spread to distant sites
ney that filter blood and remove
- weight loss - invades directly beyond local
waste products.
area
- fatigue
Renal pelvis carcinoma: forms in
center of kidney where urine col- - has more than one lymph
- intermittent fever node involved
lects.
- mass in area of kidneys
Wilm’s Tumor: kidney cancer that that’s discovered during a physi-
Management of Renal
usually develops in children under cal exam Cancer:
5yo [removal of kidney, recur-
• partial or complete nephrectomy
rence = death]. Staging of Renal Cancer
- may include removal of ad-
Several types of tumor: benign • Stage I
reneal gland, retroperitoneal
and malignant may occur
- primary cancer 7cm [3in] or lymph nodes, possibly tissues
Most common type: fluid-filled less involved by direct extension
area called a cyst [invasion] of tumor into sur-
- limited to kidney, with no rounding tissues
• Simple cysts do not progress spread to lymph nodes or distant
to cancer; requires no follow-up sites - if tumor spread into renal
vein, inferior vena cava, possi-
• Complex cysts do not have • Stage II bly right atrium [angioinvasion],
typical benign appearance and portion of tumor can be surgi-
may contain cancer - primary cancer greater than cally removed
7cm [3in]
In US, kidney cancer accounts for - for metastasis, surgical re-
about 3% of all cancers, approx - limited to kidney, with no section of kidney [cy;todreductiv
12,000 kidney cancer deaths/year spread to lymph nodes or distant nephrectomy] may improve sur-
sites vival, as well as resection of
Occurs more in males, diagnosed solitary metastatic lesion
between 50-70yo, but can occur at • Stage III
any age • radiation therapy = not com-
- primary cancer less OR monly used because not usually
Adults, most common type = renal greater than 7cm [3in] successful; may be used to palli-
cancer [renal adenocarcinoma or ate skeletal metastases
hypernephroma] - spread to SINGLE lymph
node
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• chemotherapy in some cases, but • significant loss of size in one of • retroperitoneal lymph node dis-
unlikely cure unless all cancer testicles section
surgically removed
• feeling of heaviness in scrotum • radiation therapy for seminoma
Testicular Cancer
Most common type of cancer af- • dull ache in lower abdomen / • chemotherapy for non-
groin seminoma
fecting men 15-35yo.
Can strike ANY male, ANY • sudden collection of fluid in - Platinol [cisplatin]: adminis-
scrotum tered in hospital, toxicity of
TIME.
platinum solution
Almost always curable if found • pain or discomfort in testicle /
scrotum - Vepesid / VP-16 [etoposide]
early.
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NCLEX Questions
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