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Transcript
RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems 1. Behavioral Objectives Define the terms listed in the content column appropriate to the patient situations. I. Content Outline Terms A. Amenorrhea B. Bacteriuria C. Calculus/calculi D. Cellulitis E. Cryosurgery F. Cystocele/rectocele G. Dysuria H. Exudate I. Frequency J. Hematuria K. Hyperplasia L. Laser surgery M. Macule N. Menorrhagia O. Metaplasia theory P. Metrorrhagia Q. Nephrolithiasis R. Nocturia S. Oligomenorrhea T. Ovarian cyst U. Papule V. Parenchyma W. Pessary X. Purulent Y. Pustule Z. Pyuria AA. Retrograde menstruation BB. Retroversion/retroflexion CC. Toxic Shock Syndrome (TSS) DD. Toxin EE. Transplantation theory FF. Urge incontinence GG. Urolithiasis HH. Uterine prolapse II. Venereal Disease (VD) JJ. Vesicle Clinical Objectives Compare expected and achieved outcomes of nursing care. Interpret verbal and nonverbal communication. 90 Learning Opportunities READINGS: McKinney Adams Berman & Snyder Lewis RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems Behavioral Objectives 2. Compare and contrast the normal anatomy and physiology to the pathophysiology of the disease processes in the content column. 3. Identify factors included in the assessment of the patient experiencing commonly occurring problems of the genitourinary system, including the developmental and cultural considerations. Content Outline KK. Vesicoureteral reflux II. Anatomy & Physiology of selected systems A. Genitourinary B. Developmental considerations 1. Infant 2. Child 3. Adolescent 4. Adult 5. Older adult III. Initial physical assessment. A. Interview 1. Chief complaint 2. Precipitating factors 3. Medical history 4. OB/Gyn history 5. Family/social/occupational history 6. Medication history (prescription/nonprescription) 7. Knowledge of health maintenance/prevention 8. Risk factors B. Physical exam – Genitourinary System 1. Intake & Output 2. Pain/itching 3. Discharge a. Urethral b. Cervical c. Rectal 4. Change in urinary pattern a. Frequency b. Dysuria c. Retention 5. Erythema C. Diagnostic test 1. Laboratory a. Urine culture & sensitivity 91 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems Behavioral Objectives Content Outline BUN/creatinine PSA (acid phosphatase & prostate – specific antigen) d. Tissue culture e. Thyroid function f. Endocrine workup g. Serum progesterone h. Serum human chorionic gonadotropin (hCG) i. WBC j. Pregnancy test k. Urine calcium/uric acid l. Urine oxalate excretion m. Serum calcium, phosphorus, uric acid n. Gram stain of urine o. VDRL (Venereal Disease Research Laboratory) p. RPR (Rapid plasma Reagin) q. FTA-ABS (Fluorescent Treponemal Antibody Absorption) r. Immunofluorescent staining s. Darkfield microscopy t. Discharge smears u. Pap smear v. EIA (Enzyme Immunoassay, Chlamydiazyme or test patch) w. Direct immunofluorescence (Micro Trak) x. PCR (Polymerase Chain Reaction Assay) y. Urine test using PCR & LCR (Ligase Chain Reaction) z. Biopsy (if lesions bleed) Radiology studies a. Uroflowmetry (cystometry & pressure flow studies) b. c. 2. 92 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems Behavioral Objectives Content Outline Ultrasonography KUB (kidneys, ureters & bladder) IVP (Intravenous pyelogram) retrograde pyelography e. CT (Computer Tomography) MRI (Magnetic Resonance Imaging) f. Voiding cystourethrography 3. Other a. Cystoscopy b. Laproscopy D. Cultural influences 1. Heredity 2. Environmental 3. Health beliefs/practices 4. Spiritual/religious 5. Language E. Developmental 1. Age specific assessment data a. Vital signs b. Fluid/electrolytes c. Nutritional d. Physical changes F. Behavioral/emotional response 1. To health care providers 2. Family/significant others b. c. d. 4. Differentiate between the etiology, pathophysiology, and clinical manifestations of elected commonly occurring disease processes. IV. Common occurring problems A. Gender specific 1. Female a. Uterine fibroids b. Ovarian cyst c. Endometriosis d. Pelvic relaxation disorders e. Premenstrual syndrome (PMS) f. Pelvic inflammatory disease (PID) g. Active Bladder 2. Male 93 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems Behavioral Objectives 5. Discuss analysis, planning, implementation, and evaluation of the nursing management of patients Content Outline a. Prostatitis b. Benign prostatic hypertrophy (BPH) B. Non-gender specific 1. Toxic Shock Syndrome 2. Urinary calculi 3. Urinary tract infection a. Cystitis b. Pyelonephritis C. Selected surgeries 1. Lithotripsy 2. Pyelolithotomy (open) 3. Hysterectomy 4. Cystocele/Rectocele repair 5. Transurethral Resection of the Prostate (TURP) 6. Bladder Sling D. Sexually transmitted diseases 1. Developmental Considerations a. Infant/ newborn b. Child c. Adolescent d. Adult e. Pregnant patient f. Older adult 2. Disease process a. Candida b. Chlamydia c. Cytomegalovirus (CMV) d. Gonorrhea e. Herpes simplex II f. Human papilloma virus/condyloma g. Syphilis h. Trichomoniasis V. Selected nursing diagnoses/implementation A. Pain (chronic & acute) 1. Independent 94 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems Behavioral Objectives with commonly occurring selected disease processes. Content Outline Chief complaint Pain assessment scales Physiological/behavioral response Assess social support & usual methods of coping e. Respond immediately to complaints of pain f. Encourage patients to describe pain episodes to identify factors associated g. Encourage patient to actively participate in planning for pain control h. Teach and encourage the use of alternate methods of pain relief such as massage, visualization, relaxation, distraction, and touching to alter pain perception i. Position for comfort Collaborative care a. Administer prescribed medication and monitor for desired effects/adverse effects/side effects (1) Analgesics (2) Narcotics (3) Supplemental oxygen (4) Anti-virals (5) Antibacterials (6) Antifungal (7) Antiprotozoals Evaluation of outcomes: Patient will have decrease pain as evidenced by: a. Using prescribed analgesic medications correctly b. Using nonpharmacologic pain strategies as recommended c. Actively participating in pain a. b. c. d. 2. 3. 95 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems Behavioral Objectives Content Outline management regimes d. Ability to identify factors that precipitate pain. B. Potential for infection/recurrent infection 1. Dependent a. Monitor for signs of infection b. Monitor vital signs c. Monitor lab/x-ray test d. Encourage adequate fluids, and optimal nutrition e. Teach signs/symptoms/infection control measures/preventive measures f. Change dressings if applicable g. Instruct in wound care as appropriate 2. Collaborative a. Administer medication and monitor for desired effects/adverse effects/side effects b. Medications (1) Anti-infective (2) Antibiotic (3) Oxygen (4) Antiviral (5) Antibacterials (6) Antifungal (7) Antiprotozoals 3. Evaluation of outcome: Patient will have potential for infection/recurrent infection as evidenced by: a. Describing signs/symptoms b. Wound care c. Monitor signs/symptoms d. Optimal nutrition, fluids e. Prevention measures f. Describing disease process and 96 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems Behavioral Objectives Content Outline effects C. Impaired skin integrity 1. Independent a. Assess and monitor skin & mucous membranes b. Encourage mobility/turn q 2 hrs c. Provide immediate care after incontinent d. Encourage adequate nutrition e. Massage bony prominences f. Keep skin clean and dry g. Linen wrinkle free/avoid friction 2. Collaborative a. Medications as ordered b. Clean draining lesions and dress per physician order 3. Evaluation of outcomes a. Skin integrity will remain intact D. Impaired social interaction 1. Independent a. Provide a supportive environment b. Refer to counseling, support groups, community resources. c. Promote interaction between patient, significant others and family d. Assess social support and usual methods of coping e. Develop a trusting, therapeutic relationship f. Encourage the patient and significant other to discuss their fears and concerns with each other g. Provide the patient and significant other with factual information about disease and its effects 2. Evaluation of outcomes: Patient will have impaired social interaction as 97 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems Behavioral Objectives Content Outline evidenced by: a. Discussing feelings and alternatives with significant other b. Participating in community/support groups E. Altered health maintenance: Knowledge deficit regarding disease process 1. Independent a. Assess readiness to learn, ability, knowledge level b. Avoid aggravating factors c. Promotion of alleviating factors d. Reportable signs/symptoms e. Medication teaching f. Rest/activity g. Risk factors h. Prevention of spread of infection i. Life style modification j. Nutrition k. Information about disease prognosis and treatment l. Community resources 2. Evaluation of outcomes: Patient will have decreased knowledge deficit as evidenced by: a. Have counseling and support/community resources b. Have interaction with significant others and family c. Have a trusting relationship with staff, family, and significant others d. Discuss concerns/fears openly e. Describe accurate information about the disease process & outcomes of treatment. f. Verbalizes knowledge of medication g. Verbalizes understanding of 98 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems Behavioral Objectives Content Outline infection prevention h. Verbalizes understanding of nutritional needs F. Knowledge deficit about factors related to surgical procedures 1. Independent a. Assess readiness to learn, ability, and knowledge level b. Review anatomy and how they function in relation to the urinary and reproductive systems c. Provide information regarding diagnostic tests, surgery, and after care. (1) Instruct about drainage systems, anesthesia, and recovery procedures. (2) Encourage questions and provide support as needed. (3) Reportable signs and symptoms (4) Medication teaching (5) Risk factors (6) Life style changes (7) Infection prevention 2. Evaluation of outcomes: Patient will have decreased knowledge deficit as evidenced by: a. Able to describe anatomy of affected parts and how they function b. Verbalizes what to expect during test, surgery, and pre/post operatively G. High risk for sexual dysfunction 1. Independent a. Inform patient of effects of surgery on sexual function b. Allow patient/partners to verbalize 99 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of Patient Experiencing Commonly Occurring Health Care Problems Part A – Genitourinary Problems Behavioral Objectives Content Outline feelings c. Provide information about aftercare alternatives 2. Collaborative a. Participate in intra-disciplinary planning. b. Evaluation of outcomes c. Patient and significant other verbalize understanding of risk factors for sexual dysfunction H. High risk for recurrent Urinary Tract Infection (UTI), Renal colic, Pyelonephritis 1. Independent a. History of signs/symptoms b. Assess knowledge deficit of preventive measures c. Instruct on strict hygienic measures d. Instruct on bathing in shower (no tubs) e. Assess and instruct on nutrition & fluid needs f. Monitor lab/test values g. Assess need of home health follow up 2. Collaborative a. Administer medications as ordered 3. Evaluation of outcomes: Patient will have decreased risk for recurrent UTI, renal colic, pyelonephritis as exhibited by: a. Verbalizing understanding of preventive measures b. Demonstrating hygiene, care of drainage etc c. Assessing nutrition N:\ADN\Transition/RNSG1327/UnitV-A/Genitourinary Problems 100 Clinical Objectives Learning Opportunities Revised 03/12 Reviewed 03/13