GERD surgical intervention
Give this one a try later!
• Big nursing assessment is constant respiratory- dyspnea, breath sounds,
watch for difficulty breathing. Listen to lungs!
• Fundoplocation: Fundus of the stomach is wrapped around lower portion
of esophagus to reinforce/repair. Cough & Deep breathing (C & DB) is very
important. Increased risk of pneumothorax, (may need a chest tube) assess
respiratory status and breath sounds (BS) carefully. Nissen-360 degree,
Toupet-270 degree wrap, less gas bloat.
• LINX: Approved 2012 by FDA, helps strengthen LES, a ring of tiny titanium
magnetic beads placed laparoscopically around the junction of the
stomach & esophagus. Because beads are magnetized, they move together
to keep the opening between stomach and esophagus closed to refluxing
acid, yet allows food to pass normally. Adverse effects: difficulty
swallowing, painful swallowing, N/V, Chest Pain. Cannot undergo an MRI
• Gastroplasty (Gastroplication): Uses gastric tissue to increase the integrity
of the LES. Plication of gastric folds with sutures, mechanically restores ant-
reflux barrier mechanism.
• Photodynamic Therapy-photofrin-activated by light rays; endoscopic
burning of spots to create a scar. Avoid sunlight for 4 weeks.
, • Radiofrequency ablation (heat): (STRETTA)A balloon-tipped, 4 needle
catheter that delivers radiofrequency energy to thesmooth muscles of the
LES which causes collagen contraction helping form a barrier against
reflux.
Stages of Cancer Development
Give this one a try later!
• Initiation- genetic or acquired mutation, gene had to change, genetic
structure changes, cells change. Some mutated cells get caught and die at
cellular gaps and check points. Defect wiped out, we hope this will
happen. If slips by, each daughter cell will have the mutation...
• Promotion- Promoters, such as dietary fat, obesity, cigarette smoking, and
alcohol, play a role. The point in cancer development that process can be
reversed with treatments. Just because cell mutates, doesn't mean you will
get cancer and develop tumor...Healthy lifestyle can help...immune system
can pick up. Some promotion can be reversed. Metaplasia seen- got drugs
and therapies- reversed. Cytotoxic T cells look for this, Natural kiler cells
help.
• Progression- increased growth rate, invasiveness, and metastasis. Where
cell increased growth rate continues and tumor is grown. Then tumor
invades surrounding areas, steals blood flow and space, can cut off
circulation and can obstruct surrounding tissues and structures,
metastasize.
Glucocorticoids
Give this one a try later!
, Used for acute management
Decrease immune response, high blood sugar, electrolyte imbalances,
osteoporosis, cause cataracts, glaucoma, can shut down adrenals
◦ Low dose or short-term pulse therapy. Have to wean off!
◦ Prednisone: causes sodium/H2O retention, long-term
complications=osteoporosis, cataracts/glaucoma, hypertension, diabetes,
suppresses immune system, electrolyte imbalances
Assess for HTN, elevated BS, visual changes, infection
Take calcium & vit D supplements, bisphosphonate; DXA scan
◦ Intraarticular corticosteroids
Ice and rest for 24 hours post injection
Infective endocarditis
Give this one a try later!
Infection inside the heart, usually of the heart valves.
IV drug users common!
Flu like symptoms, low grade fever (101-102).
Vegetations can break off to form emboli!
Left heart valves- clogs in brain (stroke), kidney (flank pain), spleen (sharp
LUQ pain).
Blood thinner won't help.
S/S: flu symptoms, arthralgias, murmurs, splinter hemorrhages, petechiae,
osler's nodes, Jane way' lesions.
Need antibiotics before dental/ surgical procedures!
Notify MD if temp elevated (101.5)
Drug therapy: IV antibiotics, antipyretic, analgesics, rest/ fluids.
IBD diet
Give this one a try later!
, avoid lactose, avoid brassica veggies, avoid caffeine, beer, MSG, sorbitol,
highly seasoned foods, concentrated fruit juices, carbonated beverages,
fatty foods.
High protein recommended. Elemental diets. TPN sometimes.
Vitamin suppliments including iron and B12. 2500 mL fluid to replace loses.
Spinal Cord Compression
Give this one a try later!
• Caused by presence of tumor in/near the epidural space of the SC
• Manifestations
- Intense, persistent, progressive & localized back pain exacerbated with
movement, when recumbent or coughing, vertebral tenderness aggravated
by Valsalva; leg pain & numbness/tingling/paresthesias, motor
weakness/dysfunction (e.g. paralysis of upper/lower extremities,
bowel/bladder dysfunction), decreased reflexes, venous stasis
• Treatment
- Radiation, high-dose corticosteroids- Dextromethazone is preferred.,
surgical decompressive laminectomy (if unstable spine)
• Nursing Implications
- Assess respiratory status
- Assess neuro & skeletal-muscular status
- Interventions R/T immobility
• Assess skin integrity; provide skin care
• Assist with ROM/ambulation if permitted
• Reposition
• Assess for s/s venous stasis
- Pain management
- Bowel & bladder management
Cervical Cancer
Give this one a try later!
Give this one a try later!
• Big nursing assessment is constant respiratory- dyspnea, breath sounds,
watch for difficulty breathing. Listen to lungs!
• Fundoplocation: Fundus of the stomach is wrapped around lower portion
of esophagus to reinforce/repair. Cough & Deep breathing (C & DB) is very
important. Increased risk of pneumothorax, (may need a chest tube) assess
respiratory status and breath sounds (BS) carefully. Nissen-360 degree,
Toupet-270 degree wrap, less gas bloat.
• LINX: Approved 2012 by FDA, helps strengthen LES, a ring of tiny titanium
magnetic beads placed laparoscopically around the junction of the
stomach & esophagus. Because beads are magnetized, they move together
to keep the opening between stomach and esophagus closed to refluxing
acid, yet allows food to pass normally. Adverse effects: difficulty
swallowing, painful swallowing, N/V, Chest Pain. Cannot undergo an MRI
• Gastroplasty (Gastroplication): Uses gastric tissue to increase the integrity
of the LES. Plication of gastric folds with sutures, mechanically restores ant-
reflux barrier mechanism.
• Photodynamic Therapy-photofrin-activated by light rays; endoscopic
burning of spots to create a scar. Avoid sunlight for 4 weeks.
, • Radiofrequency ablation (heat): (STRETTA)A balloon-tipped, 4 needle
catheter that delivers radiofrequency energy to thesmooth muscles of the
LES which causes collagen contraction helping form a barrier against
reflux.
Stages of Cancer Development
Give this one a try later!
• Initiation- genetic or acquired mutation, gene had to change, genetic
structure changes, cells change. Some mutated cells get caught and die at
cellular gaps and check points. Defect wiped out, we hope this will
happen. If slips by, each daughter cell will have the mutation...
• Promotion- Promoters, such as dietary fat, obesity, cigarette smoking, and
alcohol, play a role. The point in cancer development that process can be
reversed with treatments. Just because cell mutates, doesn't mean you will
get cancer and develop tumor...Healthy lifestyle can help...immune system
can pick up. Some promotion can be reversed. Metaplasia seen- got drugs
and therapies- reversed. Cytotoxic T cells look for this, Natural kiler cells
help.
• Progression- increased growth rate, invasiveness, and metastasis. Where
cell increased growth rate continues and tumor is grown. Then tumor
invades surrounding areas, steals blood flow and space, can cut off
circulation and can obstruct surrounding tissues and structures,
metastasize.
Glucocorticoids
Give this one a try later!
, Used for acute management
Decrease immune response, high blood sugar, electrolyte imbalances,
osteoporosis, cause cataracts, glaucoma, can shut down adrenals
◦ Low dose or short-term pulse therapy. Have to wean off!
◦ Prednisone: causes sodium/H2O retention, long-term
complications=osteoporosis, cataracts/glaucoma, hypertension, diabetes,
suppresses immune system, electrolyte imbalances
Assess for HTN, elevated BS, visual changes, infection
Take calcium & vit D supplements, bisphosphonate; DXA scan
◦ Intraarticular corticosteroids
Ice and rest for 24 hours post injection
Infective endocarditis
Give this one a try later!
Infection inside the heart, usually of the heart valves.
IV drug users common!
Flu like symptoms, low grade fever (101-102).
Vegetations can break off to form emboli!
Left heart valves- clogs in brain (stroke), kidney (flank pain), spleen (sharp
LUQ pain).
Blood thinner won't help.
S/S: flu symptoms, arthralgias, murmurs, splinter hemorrhages, petechiae,
osler's nodes, Jane way' lesions.
Need antibiotics before dental/ surgical procedures!
Notify MD if temp elevated (101.5)
Drug therapy: IV antibiotics, antipyretic, analgesics, rest/ fluids.
IBD diet
Give this one a try later!
, avoid lactose, avoid brassica veggies, avoid caffeine, beer, MSG, sorbitol,
highly seasoned foods, concentrated fruit juices, carbonated beverages,
fatty foods.
High protein recommended. Elemental diets. TPN sometimes.
Vitamin suppliments including iron and B12. 2500 mL fluid to replace loses.
Spinal Cord Compression
Give this one a try later!
• Caused by presence of tumor in/near the epidural space of the SC
• Manifestations
- Intense, persistent, progressive & localized back pain exacerbated with
movement, when recumbent or coughing, vertebral tenderness aggravated
by Valsalva; leg pain & numbness/tingling/paresthesias, motor
weakness/dysfunction (e.g. paralysis of upper/lower extremities,
bowel/bladder dysfunction), decreased reflexes, venous stasis
• Treatment
- Radiation, high-dose corticosteroids- Dextromethazone is preferred.,
surgical decompressive laminectomy (if unstable spine)
• Nursing Implications
- Assess respiratory status
- Assess neuro & skeletal-muscular status
- Interventions R/T immobility
• Assess skin integrity; provide skin care
• Assist with ROM/ambulation if permitted
• Reposition
• Assess for s/s venous stasis
- Pain management
- Bowel & bladder management
Cervical Cancer
Give this one a try later!
