Endometriosis,

1) endometrial tissue-> outside the uterus

2) possible site of implantation→ intestines
3) Definitie diagnosis→ laparoscopy
4) dysmenorrhea, dyspareunia, pelvic pain
5) hormone theory→ danazol
6) surgery-> only cure
7) pain manage→ NSAIDS
8) increase risk of ovarian cancer
9) complication→ infertility

Cervical cancer
1) risk factor→ HIV
2) most important modifiable risk→ multiple sex partners
3) Diagnosis →abnormal Pap smear
4) Definitie diagnosis→ colposcopy, biopsy
5) Vaccines

Uterine cancer
1) major risk factor→ estrogen
2) CM→ post-menopausal bleeding
3) primary diagnostic→ endometrial biopsy

Ovarian cancers
1) cause more death than any other cancer of the female reproductive system
2) difficult to detect because the organs are usually deep in the pelvis
3) symptoms: non specific and include bloating and indigestion and persistent GI system
4) BRCA
5) no screening mechanism exist at present
6) if abdominal pain, bloating--> pelvic exam advice to be done
7) no screening test
8) high risk women→ yearly pelvic exam, ultrasonography
9) prophylactic oophorectomy and oral contraceptives

hysterectomy discharge teaching

1) no menstruation
2) activity restriction->intercourse 4-6 weeks
3) vaginal hysterectomy: temporary loss of vaginal sensation
4) avoid heavy lifting for 2 months
5) avoid dancing, walking swiftly; encourage swimming

brachytherapy
1) principle time, distance, shielding
2) lead-line private room, absolute bed rest
3) minimum time in direct contact, <30 min per day, per nurse.
4) limited visitor→ 2m from bed, <3 hours per day
5) minimal care in close proximity, foot of bed or entrance of room
6) shielding, wearing film badge

Brest cancer
1) risk factor: BRCA→Prophylactic mastectomy, prophylactic oophorectomy
2) chief location: upper, outer quadrant
3) common complication: recurrence
4) teaching (had cancer): monthly self examination-> know what is normal looks and feel
if not know→ mammogram
Lymphedema
1. Restoring arm function on affected side after mastectomy and axillary lymph node dissection
- Place in a semi-Fowler’s position with the arm on the affected side elevated on a pillow.
- Flexing and extending fingers should begin in recovery room, and progressive increase in activity should be
encouraged
2. Restore arm function
- Postoperative arm and shoulder exercises are instituted gradually at the surgeon's direction.
- Exercises are designed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and
blood circulation
3. Nurses should use and teach patients to take measures to prevent or decrease lymphedema after ALND.
4. Blood pressure readings, venipunctures, and injections should not be done on the affected arm.
5. Elastic bandages should not be used in early postoperative period
6. Acute lymphedema
- Complete decongestive therapy
- Elevation of arm (level with heart)
- Diuretics
- Isometric exercises
- Wearing a fitted elastic pressure gradient sleeve during waking hours
7. Instruct patient to protect arm from even minor trauma (e.g., sunburn, pinprick).
8. Advise surgeon of all traumas, and observe sites for inflammation.
9. Make sure patient understands that there will always be a risk for lymphedema

BPH,
1. CM:Irritative→ frequency, urgency, dysuria, acute urinary retention
2. diagnostic studies: Digital rectal examination DRE→ abnormal→ trans rectal ultrasound + biopsies during ultrasound
prostate specific antigen PSA -> to determine complication
3. watchful waiting
4. dietary changes->Decrease intake of caffeine, artificial sweeteners, limiting spicy or acidic foods, high fat
Avoid decongestants and anticholinergics
Restricting evening fluid intake
Timed voiding schedule
5. therapy→ Transurethral Resection of the Prostrate TUPR→Minimal Invasive Therapy
→ Surgical procedure: removal of prostate →resectoscope → the urethra
→ Gold standard treatment for BPH
→ Low risk, no external surgical incision
→ post op complication: first: hemorrhage→ prevent: anticoagulate→ stop; avoid constipation→ infection
6. CBI continuous bladder irrigation
→ 3 way indwelling catheter
→CBI 1st 24 hours continuous or intermittent
→ prevent blocking
→rate of fluid based on the color of drainage. →day 1 pigmen,cloudy→ run fast; day 2 light pink→ slow
→If outflow is less than inflow→Assess bladder immediately
Check patency
Blocked outflow→ Manual Irrigation→ Stop CBI→Notify Physician
7. Prevent Bladder spasms
→Pt not to urinate around catheter
→Check catheter for clots Irrigation
→ Antispasmodics
8. manage urinary incontinent
→kegel exercise
→ ↑fluid
→ no drink
→ no fat
9. prior to the surgery→ sexual counselling

Prostate Cancer,
1. risk factor: high fat, BRCA
2. CM:frequency, urgency, dysuria, hesitancy, dribbling, hematuria, nocturia, retention
3. diagnostic studies-> Digital rectal examination DRE→ confirm diagnosis → biopsy
prostate specific antigen PSA -> to evaluate treatment
4. surgical therapy: radical prostatectomy→ retropubic approach→ abdominal surgery
→ perineal approach → infection
5. Complications: incontinent. erectile dysfunction
6. brachytherapy
Testicular Cancer
1. Monthly to check what is normal to be able identify changes
→ after taking shower→ warm temperature→ easy to look for
→ rolling in hand to find mass
2. fertility and sperm banking→ sexual conselling

AKI: ↓Proteins(oliguric phase), ↓ potassium(banana, citrus fruits, juices, deep green, yellow veg; beens,coffee), ↓ Na; ↑ carbohydrate
CKD: ↓Proteins; ↓ potassium, ↓ Na; ↓ phosphate (milk, ice cream, cheese, yogourt);↑ carbohydrate,↑ fat
peritoneal dialysis→ ↑ protein-> adequate calories to prevent catabolism of protein

diet: low protein

kussmaul breathing: resp status
anemia: tiered ,confuse
fluid overload: weight daily, monitor I & O closely

UTI
1. pain that indicate upper urinary tract infection→ flank pain
2. characteristics of the urinary tract→ sterile 无菌
3. what to avoid→ caffeine, alcohol
4. clinical manifestation→ urgency
5. promotes milking of bacteria from the vagina→ intercourse
6. cause of urinary tract infection→ instrumentation
7. upper urinary tract infection→ pyelonephritis
8. lower urinary tract infection→ cystitis
9. treatment for urinary tract infection→antimicrobial
10. what to promote —> fluid
11. diagnostic test→ MSU
12. what to report promptly→ fever(continue to have fever, cloudy urine, pain on urination after taking all medication→ contact
your healthcare provider)
13. caused by most common pathogen→ E. coli
14. Urinary tract infection in the elderly→ confusion
15. high risk groups→ HIV

DO’S
1. Take full course of antibiotic
2. Empty bowel & bladder frequently and completely
3. Empty bowel & bladder before and after sexual intercourse.
4. Hygiene: Wipe perineum front to back; thorough care
5. Adequate fluid intake if not indicated, 2-3 L of water and juices. Daily intake 33 ml/kg
6. body weight per day
7. Cranberry Juice

DON’S
1. Avoid unnecessary catheterizations and early removal of catheter
2. Avoid bladder irritants→caffeine/alcohol/chocolate/citrus juices/highly spiced
3. avoid vaginal douches冲洗, harsh soaps, bubble baths, powders, sprays in genital area

Upper GI- GERD

1. incompetent lower oesophageal sphincter-> primary fator
2. decreased LES pressure: caffeine, chocolate, milk, peppermint, fat,(orange juice,
3. CM: heartburn (pyrosis) most common
4. oesophageal stricture,
barrett’s oesophagus→ risk for oesophageal cancer
respiratory complication
5.diagnostic studies: endoscopy, barium swallow, biopsy
6. drug therapy: 99% treated by meds
7. teaching:
1) Avoid foods that cause reflux; foods that decrease LES
2) Fatty foods (decrease gastric emptying), chocolate, peppermint tea, caffeinated beverages (coffee, cola, tea)
 3) Avoid milk before bedtime (milk↑ gastric acid secretions)
4) Avoid foods that irritate acid sensitive oesophagus (orange juice, tomato-based products)
5) Encourage small frequent meals to avoid over-distension
6) Avoid late meals and nocturnal snacking 夜食
7) Avoid fluids with meals
8) Reduce weight if overweight
9) Stop Smoking, stop drinking alcohol
10) —Head elevated 2-3 hours after eating
11) —Avoid food & activities that cause reflux
12) —Continue with meds even when symptoms are under control

GI Bleed pgs
1. common cause: NSAID, corticosteroids
2. hypovolemic shock→ ↓BP, rapid weak Pause
3. respiratory assessment
4. the presence or absence of bowel sounds
5. blood transfusions→ 2 IV
6. acute bleeding→ NPO
7. teaching
1) no meds other than prescribed
2) no smoking, no alcohol
3) position: sideline
4) take meds with food
5) auscultation of breath sounds are important,
6) no red drinking
7) elderly in risk

Lower GI→Inflammatory Bowel Disease UC Disease Crohn's Disease

IBD: symptom management, NPO, IV, let GI tract to rest, TPN, pain management, surgery or ostomy, high protein high calory, low
fiber diet
Ulcerative colitis Crohn’s

Defin/ - cause: diet (high fat), milk allergy, stress, illness viral/ - all layers of bowel wall (colon)
patho/ RF bacterial, NSAID use - any part of GI tract, oral→ anus
- internal mucosa, submucosa, lining - ulceration: cobblestone appearance
- begin from rectum-> colon - intermittent
- continuous

S&S - Urgent BMs - lots of diarrhea but not bloody

- Low RBCs (anemia), Loss of weight - abdo pain (right lower side)
- Cramps in abdomen (very painful) - ulcer (mouth and GI tract)
- Electrolyte imbalance, Elevated temp. - diarrhea
- Rectal bleeding - loss weight + malnourishment, electrolyte issues
- Severe diarrhea w/blood, pus, mucus (bloody diarrhea), - fissure (anal, will bleed)
hypovolemic shock (decrease BP, increase HR & RR) - bloating in abdo
- complication: rupture (peritonitis) - complication: perforation abscess
- risk for colon cancer
- lost appetite, malnutrition, weight loss

Dx - colonoscopy: examine colon w/ scope - difficulty of fat absorption

- barium enema: X-ray to assess colon, enema of contrast
given into rectum to line colon to show the colon anatomy

Rx - NPO + NG suction - No cure (bowel resection, medication, diet, partial

- Surgery can cure or total removal colon ileostomy
proctocolectomy: removal of rectal and colon, pt have - surgery improve quality of life and symptoms
permanent ileostomy - fat soluble vitamin such as B12
- Medication: corticosteroid
Nursing - monitor VS, BM assess blood, bowel sound, palpate - goal: help pt understand diet, medication, surgery
intervention abdo, GI assessment, watch out for peritonitis (abdo pain, - monitor I & O, ask about BM (assess blood), bowel
bloating, fever, increased HR /RR) sound, palpate abdo
- NPO w/IV hydration as ordered - educate: avoid high fiber food, hard to digest food,
- gradual diet: clear liquid, full liquid, solid diet spicy or high fat
- educate: avoid high fiber food, hard to digest food, spicy - Eat low fiber, high protein.
or high fat - no dairy
- Eat low fiber, high protein. Stay hydrated, Vitamin B12
- have milk if tolerate, limited amount
- Regular colon cancer screening,Colorectal Cancer
- ostomy care, pre & post op. care

Bowl Obstruction
1) GI complication who had surgery→ nausea, vomiting
2) what is the nurse do first→ check bowel sound→ high pitch sound over the area of obstruction
3) NG tube to decompress the bowel, stomach, relieve distension
4) intervention→ ambulation

Diverticulosis, Diverticulitis
1) colonoscopy
2) high fiber
3) NPO
4) Diverticulosis: non inflamed, free symptoms
5) Diverticulitis: inflammation

Hepatitis
A→ fecal-oral route, contaminated food, water; wash hand
B→ vaccine
C→ no vaccine

Cirrhosis
hepatic encephalopathy→ ammonia, metal change, lactulose, safety is priority; constipation should report
ascites→ ↓sodium , diuretics, paracentesis; daily weights
esophageal varices→ airway maintenance. hypovolemic shock→ ↓BP, rapid weak Pause;2IV,
cirrhosis(esophageal varices) , upper GI bleeding: hypovolemic shock→ ↓BP, rapid weak Pause

Acute Pancreatitis →supportive care

1. LUQ
2. pain management-> abdo pain,
3. respiratory assessment is important→ semi or high fowler, prevent resp infection
4. reduction of pancreatic secretions→ NPO, NG tube suction
5. control of fluid and electrolyte
6. high calorie, low fat
7. no alcohol, smoking

Chronic Pancreatitis
pancreatic enzyme replacement
tylenol

Gall Bladder (Cholecystitis & Cholelithiasis):

Cholelithiasis is the formation of gallstones. worse after fatty meal. female >40 risk increase. laparoscopic, remove gallbladder.
longlife hard to digest fat. need lifestyle change
Cholecystitis is the inflammation of the gallbladder.

RSV
Bronchiolitis

Caused by Virus, Acute viral infections,

greater risk for hospitalization
upper respiratory tract infection(runny nose, cough)
→ lower respiratory tract

Copious nasal secretions (suction-use nomal saline)

Wheezing, crackles, dyspnea, decreased respiratory
entry, periods of apnea

Droplet,contact, routine precautions-(need isolation)

Racemic epinephrine

Low grade fever, substernal retractions, X-rays may show

overinflated lungs

Prevent with Palvizumad

Increase fluids
Maintain airway
Obstruction in the larynx
Encourage breastfeeding
humidified oxygen fluid airway patency
because this is viral → don't need antibiotics or steroids
self-limiting treatment, supportive treatment