This is a lecture by Karl Lopata from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
A 7-year-old boy was admitted with facial puffiness, passing smoky urine, and decreased urine output for 1 week. Examination showed pallor, high blood pressure, and a skin lesion on his elbow. Tests found protein and red blood cells in his urine, and raised blood urea. An ultrasound showed enlarged pale kidneys. The document discusses nephrotic syndrome, including its definition, causes, presentation, diagnosis, management, and nursing care. Nephrotic syndrome results from kidney damage that allows protein to leak into the urine, lowering blood protein levels and causing edema. Management focuses on fluid control, diuretics, ACE inhibitors, and sometimes steroids to preserve kidney function.
This document discusses trachoma, a chronic follicular conjunctivitis that can lead to blindness if left untreated. It is primarily caused by Chlamydia bacteria and is spread through contact with infected eye or nasal secretions or flies. Symptoms include mild irritation, tearing, and scant discharge. Diagnosis involves examining the eyes and testing conjunctival cells. Management consists of administering topical antibiotics, improving hygiene like face washing, controlling flies, and potentially surgery to rotate eyelids if scarring has occurred.
definition of hydronephrosis,
causes and types of hydronephrosis
pathophysiology of hydronephrosis
clinical manifestation and diagnostic test for hydronephrosis
management
This document provides an overview of lower respiratory tract infections (LRTI) in children. It covers the epidemiology, pathophysiology, clinical presentation, diagnosis, and management. The most common causes of LRTI in children are viral infections like respiratory syncytial virus (RSV) and bacterial infections such as Streptococcus pneumoniae. Clinical features vary by age but may include fever, cough, tachypnea, grunting, and hypoxia. Diagnosis is usually based on symptoms and physical exam. Most children can be treated as outpatients with supportive care and antibiotics when indicated. Severe cases requiring hospital admission include those with hypoxia, respiratory distress, or comorbidities. Complications are rare but may include
This document discusses water seal drainage systems used for chest tubes. It defines water seal drainage as a closed system that allows fluid and air to drain from the pleural space during exhalation but prevents return flow during inhalation. It describes the purposes, types, principles and nursing responsibilities for water seal drainage systems. The key factors that can affect drainage are proper placement and maintenance of the chest tube and drainage apparatus.
This document discusses cystitis, an inflammation of the bladder. It describes the acute and chronic forms of cystitis, including common causes such as bacterial and fungal infections. Predisposing factors like diabetes, urinary obstruction, and immune deficiency are mentioned. Gross and microscopic findings for acute, chronic, and specific types of cystitis like schistosomal and interstitial cystitis are summarized. Complications involving fibrosis and bladder cancer are also noted. The document provides an overview of cystitis and guidance on evaluation, diagnosis, and key characteristics of different cystitis types.
The document provides tips for using a PowerPoint presentation. It recommends:
- Freely editing, modifying, and adding your name to slides.
- Not worrying about the number of slides, as many are blank except for titles to prompt discussion.
- Showing blank slides, asking students what they know, and then showing slides with content.
- Repeating this process of blank slide, questions, content slide three times for active learning.
- Using this approach also for self-study by thinking about a topic before reading the next slide.
The document then provides the objectives and some sample slides for a presentation on phimosis, including definitions, etiology, pathophysiology,
A 7-year-old boy was admitted with facial puffiness, passing smoky urine, and decreased urine output for 1 week. Examination showed pallor, high blood pressure, and a skin lesion on his elbow. Tests found protein and red blood cells in his urine, and raised blood urea. An ultrasound showed enlarged pale kidneys. The document discusses nephrotic syndrome, including its definition, causes, presentation, diagnosis, management, and nursing care. Nephrotic syndrome results from kidney damage that allows protein to leak into the urine, lowering blood protein levels and causing edema. Management focuses on fluid control, diuretics, ACE inhibitors, and sometimes steroids to preserve kidney function.
This document discusses trachoma, a chronic follicular conjunctivitis that can lead to blindness if left untreated. It is primarily caused by Chlamydia bacteria and is spread through contact with infected eye or nasal secretions or flies. Symptoms include mild irritation, tearing, and scant discharge. Diagnosis involves examining the eyes and testing conjunctival cells. Management consists of administering topical antibiotics, improving hygiene like face washing, controlling flies, and potentially surgery to rotate eyelids if scarring has occurred.
definition of hydronephrosis,
causes and types of hydronephrosis
pathophysiology of hydronephrosis
clinical manifestation and diagnostic test for hydronephrosis
management
This document provides an overview of lower respiratory tract infections (LRTI) in children. It covers the epidemiology, pathophysiology, clinical presentation, diagnosis, and management. The most common causes of LRTI in children are viral infections like respiratory syncytial virus (RSV) and bacterial infections such as Streptococcus pneumoniae. Clinical features vary by age but may include fever, cough, tachypnea, grunting, and hypoxia. Diagnosis is usually based on symptoms and physical exam. Most children can be treated as outpatients with supportive care and antibiotics when indicated. Severe cases requiring hospital admission include those with hypoxia, respiratory distress, or comorbidities. Complications are rare but may include
This document discusses water seal drainage systems used for chest tubes. It defines water seal drainage as a closed system that allows fluid and air to drain from the pleural space during exhalation but prevents return flow during inhalation. It describes the purposes, types, principles and nursing responsibilities for water seal drainage systems. The key factors that can affect drainage are proper placement and maintenance of the chest tube and drainage apparatus.
This document discusses cystitis, an inflammation of the bladder. It describes the acute and chronic forms of cystitis, including common causes such as bacterial and fungal infections. Predisposing factors like diabetes, urinary obstruction, and immune deficiency are mentioned. Gross and microscopic findings for acute, chronic, and specific types of cystitis like schistosomal and interstitial cystitis are summarized. Complications involving fibrosis and bladder cancer are also noted. The document provides an overview of cystitis and guidance on evaluation, diagnosis, and key characteristics of different cystitis types.
The document provides tips for using a PowerPoint presentation. It recommends:
- Freely editing, modifying, and adding your name to slides.
- Not worrying about the number of slides, as many are blank except for titles to prompt discussion.
- Showing blank slides, asking students what they know, and then showing slides with content.
- Repeating this process of blank slide, questions, content slide three times for active learning.
- Using this approach also for self-study by thinking about a topic before reading the next slide.
The document then provides the objectives and some sample slides for a presentation on phimosis, including definitions, etiology, pathophysiology,
This document discusses sinusitis, including definitions of types of sinusitis, causes, symptoms, signs, investigations, treatments, and complications. It defines acute, subacute and chronic sinusitis. Maxillary sinusitis is the most common type. Causes include viral and bacterial infections, mechanical obstruction, allergic rhinitis, and trauma. Symptoms vary depending on the affected sinus. Investigations include endoscopy, x-ray, and CT scan. Treatment involves antibiotics, nasal irrigation, and sometimes surgery. Complications can include orbital cellulitis if the infection spreads.
Tonsillitis slideshare for medical students NehaNupur8
Tonsillitis is an inflammation of the tonsils that is usually caused by a bacterial or viral infection. The tonsils are located in the back of the throat and help the body fight infections. There are different types of tonsillitis, including acute, subacute, and chronic, depending on the causative agent and duration of symptoms. Common symptoms include sore throat, fever, difficulty swallowing, and enlarged lymph nodes in the neck. Tonsillitis is usually diagnosed based on symptoms and signs during a physical exam. It is often treated with antibiotics, pain relievers, and gargling saline for relief. In some cases of recurring tonsillitis, surgery to remove the tonsils (tonsillectomy)
1. Bladder cancer is a type of cancer that forms in the bladder. It is more common in older males and risk factors include smoking, exposure to industrial chemicals, chronic bladder infections or irritation, and pelvic radiation.
2. Symptoms include blood in the urine, pain with urination, and low back pain. Diagnosis involves tests to detect cancer cells in urine or tissue samples.
3. Treatment depends on cancer stage and grade and may include surgery, chemotherapy, radiation therapy, immunotherapy, and intravesical therapies directly into the bladder. Ongoing monitoring is important due to the risk of recurrence.
Laryngitis is inflammation of the larynx or voice box caused by infection, irritation or overuse. It causes hoarseness, coughing and difficulty speaking. Acute laryngitis lasts less than 3 weeks and is usually caused by a cold or flu virus. Chronic laryngitis persists over 3 weeks and can be caused by smoking, acid reflux, vocal misuse or inhaled irritants. Treatment focuses on voice rest, hydration, steam inhalation and medication if caused by infection. Prevention involves avoiding irritants, smoking and overusing the voice.
This document defines nosebleed (epistaxis) as bleeding from the nose caused by rupture of small blood vessels in the nasal cavity. The most common site is the anterior septum where three major arteries enter. Causes include trauma, dry air, infections, cancers, blood disorders, and certain drugs. There are two main types - spontaneous nosebleeds common in children and hypertensive nosebleeds more common in older adults. Symptoms are nose bleeding, dizziness, and confusion. Diagnosis involves tests like CBC, PT, and imaging. Management includes direct pressure, vasoconstrictors, cauterization, packing, supplements/medications, and potentially surgery.
This document discusses paediatric asthma, including its various types, pathophysiology, clinical features, diagnosis, investigations, management, and assessment in children. It describes how asthma is common in infancy and can be transient early wheezing or persist into childhood. The diagnosis is made based on a history of recurrent wheezing and reversible airflow obstruction. Investigations include assessing symptoms, triggers, lung function tests, and ruling out other conditions. Management involves reliever medications for acute symptoms and controller medications like inhaled corticosteroids to prevent exacerbations. Assessment of asthma in children evaluates severity, control, and monitors for growth, lung function, and appropriate treatment use.
A tonsillectomy is a surgical procedure to remove the tonsils. It is usually performed under general anesthesia with the patient in the Rose's position. The surgery involves using a mouth gag, grasping the tonsil with forceps, and dissecting it from the surrounding tissue using scissors or a dissector. A wire snare is then used to ligate and remove the tonsil. Post-operative care includes monitoring for bleeding, a soft diet, oral hygiene, analgesics and antibiotics. Complications can include bleeding, injury to nearby structures, infection, or scarring.
This document discusses various post-operative complications organized into categories. It describes wound complications including seroma, hematoma, wound dehiscence, and surgical site infections. It also covers thermal regulation issues like hypothermia and malignant hyperthermia. Gastrointestinal complications involving ileus, bleeding, and leaks are outlined. Other complications discussed include DVT, pulmonary embolism, infections and fever, pulmonary issues, renal failure, cardiovascular events, neurological problems like stroke and delirium, and diabetic ketoacidosis. Prevention and management strategies are provided for each complication.
This document outlines the examination procedures for the oral cavity, oropharynx, laryngopharynx, and larynx. It describes inspection, palpation, and other examination techniques for structures like the lips, tongue, tonsils, soft palate, larynx, and lymph nodes. Examination of the oral cavity involves inspecting structures for abnormalities and palpating for lumps, swellings, or tenderness. Examination of the oropharynx and larynx can be done directly or indirectly using a laryngoscope to inspect structures like the epiglottis and vocal cords. Lymph nodes are examined based on location, size, consistency, tenderness, and mobility.
Hydronephrosis is a condition where one or both kidneys become swollen due to a blockage in the urinary system. It can be caused by a blockage in the ureters or bladder backing up urine into the kidneys. Symptoms may include flank pain, hematuria, urinary infections, or the condition may be asymptomatic. Diagnosis involves history, physical exam, ultrasound to visualize the kidneys and ureters, IVU to assess the location of blockage, and CT scan to detect stones. Treatment focuses on removing the obstruction, draining excess urine, and antibiotics to prevent infection.
Empyema is the accumulation of pus in the pleural space caused by a lung infection spreading. It is classified into three stages based on the fluid characteristics. Common causes are bacterial pneumonias like Streptococcus pneumoniae. Symptoms include fever, cough, and chest pain. Chest x-ray or ultrasound can detect fluid buildup. Treatment involves antibiotics, drainage of pus, and occasionally surgery. The goal is to clear the infection, expand the lung, and resolve symptoms. Complications may include persistent fever, abscesses, or fistulae if not properly treated.
This document discusses the management of urosepsis. It defines urosepsis and the stages of sepsis. Treatment involves cause-directed approaches like antibiotics and source control, supportive approaches like fluid resuscitation and vasopressors, and adjunctive approaches like glucocorticoids. The causative organisms are usually gram-negative bacteria like E. coli. Risk factors include indwelling catheters and urinary tract procedures or obstruction.
This document discusses tonsillitis, including its definition, types, causes, symptoms, treatments, and nursing management. Tonsillitis is an infection and swelling of the tonsils, which are located in the throat. It is usually caused by bacterial or viral infections. Common symptoms include fever, sore throat, and difficulty swallowing. Treatment involves antibiotics, pain medication, soft diet, and sometimes surgery to remove the tonsils (tonsillectomy). Nursing care focuses on pain management, adequate fluid and nutrition intake, and health education about proper diet, hygiene and medication adherence.
This document discusses tympanic membrane perforation, also known as a ruptured eardrum. It can be caused by direct force trauma to the ear such as from wax removal or skull fractures, or indirect force from barotrauma or increased violence/firearms. Infection of the middle ear from bacteria, viruses or fungi can also cause a perforation. Symptoms include ear pain, fullness, discharge from the ear, hearing loss, vertigo, and tinnitus. Diagnosis involves history, physical exam, otoscopic exam, and audiogram. Treatment involves antibiotics to prevent infection, keeping the ear canal clean, avoiding nose blowing or ear drops, and surgery if not healed after 3 months. S
Case study on Esophageal Atresia with Tracheo esophageal Fistulapabitra sharma
This case study examines a 4-day-old female infant diagnosed with esophageal atresia with tracheo-esophageal fistula (EA/TEF) who was admitted to the surgical intensive care unit of Kanti Children's Hospital. The infant presented with excessive salivation, cyanosis after feeding, and difficulty breathing. Physical examination revealed decreased weight, dry skin, and abdominal distension. The patient was diagnosed with Type C EA/TEF, the most common type involving a blind proximal esophagus connected to the trachea by a fistula. Treatment involved surgical repair of the defect. The case study aims to provide a comprehensive overview of the patient's condition, including disease background, clinical presentation, management, and
This document discusses ear wax accumulation, also known as cerumen impaction. It defines ear wax accumulation as the buildup of ear wax inside the ear canal. Some causes listed include structural defects, old age, and using ear plugs. Signs and symptoms include fullness in the ear, ringing in the ear, dizziness, itching, ear pain, odorous ear discharge, and hearing difficulty. Diagnosis involves a history and physical exam using an otoscope. Management includes irrigation with warm water or warmed oils followed by suction or instrumentation to remove the ear wax.
This document discusses dengue fever and chikungunya fever, which commonly present as acute febrile illness in children. Dengue is caused by one of four serotypes of dengue virus transmitted by Aedes mosquitoes. It presents with high fever, body aches, and potentially severe bleeding or organ dysfunction. Chikungunya causes high fever and severe joint pain transmitted by the same mosquitoes. Both require supportive care but dengue may require hospitalization and IV fluids depending on severity of symptoms and warning signs. Accurate diagnosis is important given changing epidemiology and impact on healthcare systems.
Tonsillitis is an infection of the tonsils, which are lymphoid tissue located in the throat. It can be acute or chronic. Common causes include viral or bacterial infections. Symptoms include pain and difficulty swallowing. Complications may include peritonsillar abscesses or spread of infection. Treatment involves rest, fluids, pain medications, and antibiotics. Tonsillectomy may be required in cases of recurrent infections or abscesses.
This document discusses imperforate anus, a birth defect where the anus is improperly developed such that stool cannot pass normally from the rectum. The etiology is unclear but genetic factors are involved. Diagnosis involves physical exam, radiological imaging, and other tests. Treatment involves initial colostomy if needed followed by anoplasty surgery to create an opening. Prognosis is generally good, especially for cases without additional defects.
The document defines adenoiditis as an infection of the adenoids, lymphatic tissue located in the nasopharynx, which often accompanies acute tonsillitis. Adenoiditis can be caused by bacteria like GABHS or viruses such as Epstein-Barr. Clinical features include enlarged adenoids, mouth breathing, ear ache, foul breath, nasal obstruction, colds, and impaired voice. Diagnosis involves a history and physical exam, and possibly audiometry for recurrent cases. Management consists of antibiotics, antimicrobials, and potentially adenoidectomy.
GMEC - Fluid and Electrolyte Imbalances in Emergency NursingOpen.Michigan
This document provides an overview of fluid and electrolyte imbalances in emergency nursing, focusing on sodium imbalances. It defines electrolytes and explains their importance in bodily functions. Reasons for electrolyte imbalances include kidney dysfunction, dehydration, diarrhea, and medication side effects. The document discusses sodium in detail, including its normal levels, foods high in sodium, and causes and signs of hyponatremia (low sodium). It explains that hyponatremia can be hypovolemic, euvolemic, or hypervolemic, and provides examples of signs and symptoms for hypovolemic and hypervolemic hyponatremia.
GEMC - Abdominal Emergencies- For NursesOpen.Michigan
The document provides an overview of abdominal emergencies including objectives, assessment techniques, common conditions, and management strategies. Specifically, it reviews abdominal trauma, diagnosis, abdominal focused exam, common abdominal structures, diagnostic procedures, nursing considerations, documentation, and key factors for geriatric and pediatric patients. Common conditions discussed in detail include gastritis, ulcers, bowel obstructions, and gastroenteritis.
This document discusses sinusitis, including definitions of types of sinusitis, causes, symptoms, signs, investigations, treatments, and complications. It defines acute, subacute and chronic sinusitis. Maxillary sinusitis is the most common type. Causes include viral and bacterial infections, mechanical obstruction, allergic rhinitis, and trauma. Symptoms vary depending on the affected sinus. Investigations include endoscopy, x-ray, and CT scan. Treatment involves antibiotics, nasal irrigation, and sometimes surgery. Complications can include orbital cellulitis if the infection spreads.
Tonsillitis slideshare for medical students NehaNupur8
Tonsillitis is an inflammation of the tonsils that is usually caused by a bacterial or viral infection. The tonsils are located in the back of the throat and help the body fight infections. There are different types of tonsillitis, including acute, subacute, and chronic, depending on the causative agent and duration of symptoms. Common symptoms include sore throat, fever, difficulty swallowing, and enlarged lymph nodes in the neck. Tonsillitis is usually diagnosed based on symptoms and signs during a physical exam. It is often treated with antibiotics, pain relievers, and gargling saline for relief. In some cases of recurring tonsillitis, surgery to remove the tonsils (tonsillectomy)
1. Bladder cancer is a type of cancer that forms in the bladder. It is more common in older males and risk factors include smoking, exposure to industrial chemicals, chronic bladder infections or irritation, and pelvic radiation.
2. Symptoms include blood in the urine, pain with urination, and low back pain. Diagnosis involves tests to detect cancer cells in urine or tissue samples.
3. Treatment depends on cancer stage and grade and may include surgery, chemotherapy, radiation therapy, immunotherapy, and intravesical therapies directly into the bladder. Ongoing monitoring is important due to the risk of recurrence.
Laryngitis is inflammation of the larynx or voice box caused by infection, irritation or overuse. It causes hoarseness, coughing and difficulty speaking. Acute laryngitis lasts less than 3 weeks and is usually caused by a cold or flu virus. Chronic laryngitis persists over 3 weeks and can be caused by smoking, acid reflux, vocal misuse or inhaled irritants. Treatment focuses on voice rest, hydration, steam inhalation and medication if caused by infection. Prevention involves avoiding irritants, smoking and overusing the voice.
This document defines nosebleed (epistaxis) as bleeding from the nose caused by rupture of small blood vessels in the nasal cavity. The most common site is the anterior septum where three major arteries enter. Causes include trauma, dry air, infections, cancers, blood disorders, and certain drugs. There are two main types - spontaneous nosebleeds common in children and hypertensive nosebleeds more common in older adults. Symptoms are nose bleeding, dizziness, and confusion. Diagnosis involves tests like CBC, PT, and imaging. Management includes direct pressure, vasoconstrictors, cauterization, packing, supplements/medications, and potentially surgery.
This document discusses paediatric asthma, including its various types, pathophysiology, clinical features, diagnosis, investigations, management, and assessment in children. It describes how asthma is common in infancy and can be transient early wheezing or persist into childhood. The diagnosis is made based on a history of recurrent wheezing and reversible airflow obstruction. Investigations include assessing symptoms, triggers, lung function tests, and ruling out other conditions. Management involves reliever medications for acute symptoms and controller medications like inhaled corticosteroids to prevent exacerbations. Assessment of asthma in children evaluates severity, control, and monitors for growth, lung function, and appropriate treatment use.
A tonsillectomy is a surgical procedure to remove the tonsils. It is usually performed under general anesthesia with the patient in the Rose's position. The surgery involves using a mouth gag, grasping the tonsil with forceps, and dissecting it from the surrounding tissue using scissors or a dissector. A wire snare is then used to ligate and remove the tonsil. Post-operative care includes monitoring for bleeding, a soft diet, oral hygiene, analgesics and antibiotics. Complications can include bleeding, injury to nearby structures, infection, or scarring.
This document discusses various post-operative complications organized into categories. It describes wound complications including seroma, hematoma, wound dehiscence, and surgical site infections. It also covers thermal regulation issues like hypothermia and malignant hyperthermia. Gastrointestinal complications involving ileus, bleeding, and leaks are outlined. Other complications discussed include DVT, pulmonary embolism, infections and fever, pulmonary issues, renal failure, cardiovascular events, neurological problems like stroke and delirium, and diabetic ketoacidosis. Prevention and management strategies are provided for each complication.
This document outlines the examination procedures for the oral cavity, oropharynx, laryngopharynx, and larynx. It describes inspection, palpation, and other examination techniques for structures like the lips, tongue, tonsils, soft palate, larynx, and lymph nodes. Examination of the oral cavity involves inspecting structures for abnormalities and palpating for lumps, swellings, or tenderness. Examination of the oropharynx and larynx can be done directly or indirectly using a laryngoscope to inspect structures like the epiglottis and vocal cords. Lymph nodes are examined based on location, size, consistency, tenderness, and mobility.
Hydronephrosis is a condition where one or both kidneys become swollen due to a blockage in the urinary system. It can be caused by a blockage in the ureters or bladder backing up urine into the kidneys. Symptoms may include flank pain, hematuria, urinary infections, or the condition may be asymptomatic. Diagnosis involves history, physical exam, ultrasound to visualize the kidneys and ureters, IVU to assess the location of blockage, and CT scan to detect stones. Treatment focuses on removing the obstruction, draining excess urine, and antibiotics to prevent infection.
Empyema is the accumulation of pus in the pleural space caused by a lung infection spreading. It is classified into three stages based on the fluid characteristics. Common causes are bacterial pneumonias like Streptococcus pneumoniae. Symptoms include fever, cough, and chest pain. Chest x-ray or ultrasound can detect fluid buildup. Treatment involves antibiotics, drainage of pus, and occasionally surgery. The goal is to clear the infection, expand the lung, and resolve symptoms. Complications may include persistent fever, abscesses, or fistulae if not properly treated.
This document discusses the management of urosepsis. It defines urosepsis and the stages of sepsis. Treatment involves cause-directed approaches like antibiotics and source control, supportive approaches like fluid resuscitation and vasopressors, and adjunctive approaches like glucocorticoids. The causative organisms are usually gram-negative bacteria like E. coli. Risk factors include indwelling catheters and urinary tract procedures or obstruction.
This document discusses tonsillitis, including its definition, types, causes, symptoms, treatments, and nursing management. Tonsillitis is an infection and swelling of the tonsils, which are located in the throat. It is usually caused by bacterial or viral infections. Common symptoms include fever, sore throat, and difficulty swallowing. Treatment involves antibiotics, pain medication, soft diet, and sometimes surgery to remove the tonsils (tonsillectomy). Nursing care focuses on pain management, adequate fluid and nutrition intake, and health education about proper diet, hygiene and medication adherence.
This document discusses tympanic membrane perforation, also known as a ruptured eardrum. It can be caused by direct force trauma to the ear such as from wax removal or skull fractures, or indirect force from barotrauma or increased violence/firearms. Infection of the middle ear from bacteria, viruses or fungi can also cause a perforation. Symptoms include ear pain, fullness, discharge from the ear, hearing loss, vertigo, and tinnitus. Diagnosis involves history, physical exam, otoscopic exam, and audiogram. Treatment involves antibiotics to prevent infection, keeping the ear canal clean, avoiding nose blowing or ear drops, and surgery if not healed after 3 months. S
Case study on Esophageal Atresia with Tracheo esophageal Fistulapabitra sharma
This case study examines a 4-day-old female infant diagnosed with esophageal atresia with tracheo-esophageal fistula (EA/TEF) who was admitted to the surgical intensive care unit of Kanti Children's Hospital. The infant presented with excessive salivation, cyanosis after feeding, and difficulty breathing. Physical examination revealed decreased weight, dry skin, and abdominal distension. The patient was diagnosed with Type C EA/TEF, the most common type involving a blind proximal esophagus connected to the trachea by a fistula. Treatment involved surgical repair of the defect. The case study aims to provide a comprehensive overview of the patient's condition, including disease background, clinical presentation, management, and
This document discusses ear wax accumulation, also known as cerumen impaction. It defines ear wax accumulation as the buildup of ear wax inside the ear canal. Some causes listed include structural defects, old age, and using ear plugs. Signs and symptoms include fullness in the ear, ringing in the ear, dizziness, itching, ear pain, odorous ear discharge, and hearing difficulty. Diagnosis involves a history and physical exam using an otoscope. Management includes irrigation with warm water or warmed oils followed by suction or instrumentation to remove the ear wax.
This document discusses dengue fever and chikungunya fever, which commonly present as acute febrile illness in children. Dengue is caused by one of four serotypes of dengue virus transmitted by Aedes mosquitoes. It presents with high fever, body aches, and potentially severe bleeding or organ dysfunction. Chikungunya causes high fever and severe joint pain transmitted by the same mosquitoes. Both require supportive care but dengue may require hospitalization and IV fluids depending on severity of symptoms and warning signs. Accurate diagnosis is important given changing epidemiology and impact on healthcare systems.
Tonsillitis is an infection of the tonsils, which are lymphoid tissue located in the throat. It can be acute or chronic. Common causes include viral or bacterial infections. Symptoms include pain and difficulty swallowing. Complications may include peritonsillar abscesses or spread of infection. Treatment involves rest, fluids, pain medications, and antibiotics. Tonsillectomy may be required in cases of recurrent infections or abscesses.
This document discusses imperforate anus, a birth defect where the anus is improperly developed such that stool cannot pass normally from the rectum. The etiology is unclear but genetic factors are involved. Diagnosis involves physical exam, radiological imaging, and other tests. Treatment involves initial colostomy if needed followed by anoplasty surgery to create an opening. Prognosis is generally good, especially for cases without additional defects.
The document defines adenoiditis as an infection of the adenoids, lymphatic tissue located in the nasopharynx, which often accompanies acute tonsillitis. Adenoiditis can be caused by bacteria like GABHS or viruses such as Epstein-Barr. Clinical features include enlarged adenoids, mouth breathing, ear ache, foul breath, nasal obstruction, colds, and impaired voice. Diagnosis involves a history and physical exam, and possibly audiometry for recurrent cases. Management consists of antibiotics, antimicrobials, and potentially adenoidectomy.
GMEC - Fluid and Electrolyte Imbalances in Emergency NursingOpen.Michigan
This document provides an overview of fluid and electrolyte imbalances in emergency nursing, focusing on sodium imbalances. It defines electrolytes and explains their importance in bodily functions. Reasons for electrolyte imbalances include kidney dysfunction, dehydration, diarrhea, and medication side effects. The document discusses sodium in detail, including its normal levels, foods high in sodium, and causes and signs of hyponatremia (low sodium). It explains that hyponatremia can be hypovolemic, euvolemic, or hypervolemic, and provides examples of signs and symptoms for hypovolemic and hypervolemic hyponatremia.
GEMC - Abdominal Emergencies- For NursesOpen.Michigan
The document provides an overview of abdominal emergencies including objectives, assessment techniques, common conditions, and management strategies. Specifically, it reviews abdominal trauma, diagnosis, abdominal focused exam, common abdominal structures, diagnostic procedures, nursing considerations, documentation, and key factors for geriatric and pediatric patients. Common conditions discussed in detail include gastritis, ulcers, bowel obstructions, and gastroenteritis.
This document discusses the evaluation and management of patients with kidney failure presenting to the emergency department. It covers causes of acute kidney injury including pre-renal, intra-renal and post-renal failure. It also discusses evaluation of kidney function, risks of intravenous contrast, dialysis indications and complications in chronic kidney disease patients including infection, cardiovascular issues and electrolyte abnormalities. Special considerations are outlined for resuscitating, evaluating and treating kidney failure patients in the emergency setting.
This document discusses hepatocellular liver disease, which involves injury to liver cells (hepatocytes) and is characterized by increased levels of AST and ALT on liver tests. Both acute and chronic forms of hepatocellular disease are described, with acute disease causing a short period of liver inflammation and necrosis potentially leading to liver failure, while chronic disease involves ongoing low-level liver injury and regeneration that can progress to cirrhosis over many years. Approaches to evaluating the severity, time course, etiology, and clinical presentation of hepatocellular disease are outlined.
A comprehensive metabolic panel tests various measures of liver and kidney function through a blood sample. It provides information on metabolism, and how the kidneys and liver are functioning. The test measures electrolytes, blood sugar, cholesterol, and other substances. Abnormal results can help diagnose conditions like kidney failure or diabetes complications.
This document provides an overview of cholestatic liver diseases. It defines cholestasis as impaired bile flow and classifies cholestatic diseases as involving the hepatocyte, small intrahepatic bile ducts, or large/extrahepatic bile ducts. Specific examples of intrahepatic cholestasis discussed include those caused by decreased bile formation from sepsis or estrogens, and diseases like primary biliary cirrhosis that destroy bile ducts. Extrahepatic obstruction can result from gallstones, strictures, or tumors compressing the bile ducts. The document outlines approaches to diagnosing the cause of cholestasis through imaging and biopsy and discusses consequences like secondary liver damage if cholestasis is
Renal failure occurs when the kidneys are unable to remove waste and regulate fluids and electrolytes. This leads to the accumulation of waste in the blood and disruption of other body functions. There are two main types - acute renal failure, which develops rapidly over hours to days, and chronic kidney disease, which progresses over months to years. The main symptoms include leg swelling, fatigue, vomiting and confusion. Treatment focuses on fluid balance, electrolyte control, and renal replacement therapy such as dialysis. Prognosis depends on age and treatment.
This document provides information about peritoneal dialysis (PD) for nurses, including:
- PD uses the lining of the abdomen (peritoneum) as a filter to remove wastes and excess fluid from the blood. A catheter is used to fill the abdomen with dialysis solution.
- Continuous ambulatory peritoneal dialysis (CAPD) involves manually draining and filling the abdomen with dialysis solution several times per day using gravity. Proper hand washing and sterile technique are important for preventing infection.
- Complications of a PD catheter can include hernias, lumps, or signs of peritonitis like redness, pain, fever, or cloudy dialysis fluid. Patients should
This document provides information on acute and chronic renal failure, including causes, pathophysiology, assessment, diagnosis, complications, nursing diagnoses, and nursing care. Acute renal failure can be pre-renal, intra-renal, or post-renal and is caused by decreased blood flow or obstruction. Chronic renal failure is a progressive loss of kidney function over time due to various injuries and diseases. Common complications include fluid imbalance, electrolyte abnormalities, nutritional deficits, and increased risk of infection or cardiovascular issues. Nursing focuses on monitoring fluid status, diet, nutrition, and treating related symptoms and complications.
The document provides information on assessing and managing patients with renal disorders. It discusses the functions of the kidney, methods for assessing the renal system including history, physical exam, and diagnostic tests. Nursing management is described for acute pyelonephritis, chronic pyelonephritis, and urinary tract calculi. Interventions include pain management, monitoring fluid intake and output, administering medications, nutritional therapy, and relieving symptoms.
Acute renal failure nursing care plan & managementNursing Path
Is a sudden decline in renal function, usually marked by increased concentrations of blood urea nitrogen (BUN; azotemia) and creatinine; oliguria (less than 500 ml of urine in 24 hours); hyperkalemia; and sodium retention.
Jaundice, also known as icterus, is a condition characterized by yellowish discoloration of the skin and whites of the eyes due to high bilirubin levels. It is commonly caused by liver diseases that impair the liver's ability to process bilirubin or conditions that obstruct bile flow. The document discusses the epidemiology, etiology, clinical presentation, risk factors, complications, diagnosis, and management of jaundice. Newborns and older adults are most commonly affected, with causes varying by age. Common signs include yellow skin and eyes, light stool, and dark urine. Liver function tests and imaging exams help diagnose the underlying cause of jaundice in patients. Treatment involves addressing the specific
Acute renal failure occurs when the kidneys are unable to excrete waste products from the body, causing them to accumulate in the blood. It can be caused by conditions that decrease renal blood flow or damage the kidneys. Patients are classified as oliguric, excreting less than 500mL of urine per day, or nonoliguric, excreting more than 500mL daily. Risk factors include advanced age, diabetes, heart or liver disease. Diagnosis involves urine and blood tests to check kidney function and imaging tests in some cases. Treatment focuses on treating the underlying cause, managing fluid balance and electrolytes, and dialysis in severe cases.
Age Related Changes to the Urinary System.pdfKhaileYutuc
This document discusses age-related changes to the urinary system and dysfunctions that can occur. It begins by outlining the objectives and functions of the urinary system. Key changes include decreased kidney function and loss of bladder control. Common urinary issues for older adults include incontinence, nocturia, benign hyperplasia, prostate cancer, pyelonephritis, kidney stones. Nursing interventions are provided for each issue to help patients manage symptoms and promote continence.
09.30.08(b): Approach to the Patient with Disorders of OsmoregulationOpen.Michigan
This document discusses disorders of osmoregulation and provides guidance on evaluating and managing patients with abnormalities in sodium balance and water homeostasis. It reviews key concepts such as calculating plasma osmolality, distinguishing types of polyuric states like diabetes insipidus, and developing a systematic approach to hyponatremia. Clinical cases are presented to demonstrate how to identify the etiology and determine appropriate treatment for conditions that cause hypo- and hypernatremia.
GEMC - Gastrointestinal Bleeding in the Pediatric PatientOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. James Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- The Adult Patient with Constipation- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document provides an overview of ocular emergencies. It begins with an introduction to the Project: Ghana Emergency Medicine Collaborative and author information. The bulk of the document consists of slides reviewing various eye conditions and emergencies, including styes, chalazions, conjunctivitis, iritis, orbital cellulitis, subconjunctival hemorrhages, and scleritis. Treatment approaches are provided for many of the conditions. The document concludes with a discussion of the eye examination approach and areas to be reviewed.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This document provides an overview of disorders of the pleura, mediastinum, and chest wall. It discusses several topics in 1-3 sentences each, including costochondritis (inflammation of the costal cartilages), mediastinitis (infection of the mediastinum), mediastinal masses, pneumothorax (air in the pleural space), and catamenial pneumothorax (recurrent pneumothorax associated with menstruation). The document aims to enhance understanding of the major clinical disorders commonly encountered in emergency medicine involving the pleura, mediastinum, and chest wall.
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Arthritis and Arthrocentesis- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingOpen.Michigan
This is a lecture by Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document summarizes cardiovascular topics including pericardial tamponade, pericarditis, infective endocarditis, hypertension, tumors, and valvular disorders. It provides details on the causes, signs and symptoms, diagnostic studies, and management of these conditions. The document also includes bonus sections on cardiac transplant patients, pacemakers and ICDs, and EKG morphology.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
This is a lecture by Dr. Stephen Hartsell from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Sickle Cell Disease: Special Considerations in Pediatrics- Resident Tra...Open.Michigan
This is a lecture by Hannah Smith, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
How to Setup Default Value for a Field in Odoo 17Celine George
In Odoo, we can set a default value for a field during the creation of a record for a model. We have many methods in odoo for setting a default value to the field.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
220711130088 Sumi Basak Virtual University EPC 3.pptx
GEMC - Genitourinary Emergencies - for Nurses
1. Project: Ghana Emergency Medicine Collaborative
Document Title: Genitourinary Emergencies
Author(s): Karl Lopata (University of Michigan), BSN 2012
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We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your
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Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis
or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please
speak to your physician if you have questions about your medical condition.
Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
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3. Acute Renal Failure
Acute Renal Failure or Acute Kidney Injury is a rapid loss of kidney function.
Classifications/Causes
Prerenal
ARF secondary to hypoperfusion of the kidneys.
l Excessive Fluid Loss: Dehydration, Hemorrhage, Severe Burns, Polyuria, Persistent Vomiting/
Diarrhea/Diaphoresis
l Decreased Cardiac Output: Myocardial Infarction, CHF, Shock States (hypovolemic,
cardiogenic, obstructive).
Intrinsic
ARF secondary to damage to renal parenchymal.
l Acute Tubular Necrosis
l Nephritis: Glomerulonephritis, Interstitial Nephritis, Pyelonephritis, Lupus Nephritis
l Rhabdomyolysis
l Drug Related Nephrotoxicity
Postrenal
ARF secondary to an obstruction of the outflow of urine.
l Renal Stones, Blood Clots, Tumors, Prostatic Hypertrophy, Urethral Strictures
3
4. Acute Renal Failure
Nursing Assessment
Neurological: Confusion, Lethargy (secondary to build up nitrogenous waste products).
Cardiovascular: ARF (with signs of fluid volume depletion) Tachycardia, Hypotension, Orthostatic
Vital Signs.
ARF (with signs of fluid volume fluid volume overload) Jugular vein distention, S3 Heart Sound,
Hypertension.
Pulmonary: Crackling/Rales with auscultation also known as "wet” sounding lungs (fluid overload).
Genitourinary: Urine may appear dark, concentrated, odorous (often seen with infectious
processes), Oliguria (<300-500cc of UOP daily or <0.5cc/kg/hr), Anuria (<50cc of UOP daily),
Polyuria (>2,500cc – 3,000cc of UOP daily, may be secondary to DKA, diuretics, diabetes
insipidis)
Integumentary Effects: Decreased skin turgor (if hypovolemia is present), pitting edema (if
hypervolemia is present), Skin may have a pale or even a yellow hue secondary to uremic toxins
accumulating on the skin surface (duller than jaundice and does not effect the sclera).
4
5. Acute Renal Failure
Laboratory Tests
Basic Electrolyte Panel: Abnormal concentration of extracellular electrolytes. Sodium and
Chloride may show an increase (concentrated) or decrease (diluted or flushed from serum).
Blood Urea Nitrogen (by product of and protein metabolism) and Creatinine (by product of muscle
breakdown) are increased. BUN increases proportionally quicker than Cr with ARF. Ratios of
greater than 20:1 may differentiate an acute incident verse a chronic condition.
Renal Failure may cause increases in serum Potassium level secondary to impaired excretion.
Bicarbonate is largely regulated and produced by the kidneys. ARF may cause a decrease in
production and conservation.
Phosphate may increase in the serum because the kidneys are unable to remove it. Because of
Calcium's inverse relationship to phosphate a decrease in calcium is often seen.
Complete Blood Count: Changes with Hemoglobin and Hematocrit. May be concentrated
(elevated with dehydration) or could be decreased secondary to a decrease in the kidney's ability
to produce erythropoietin.
Urinalysis: If ARF is secondary to dehydration expect concentrated urine with an increase in
Specific Gravity. If a genitourinary infection part of the ARF expect to see White Blood Cells,
Leukocytes Esterase, Nitrates, and Bacteria. Hematuria is usually present with renal stones and
Myoglobin is present with rhabdomyolysis.
Arterial and Venous Blood Gases: May show Metabolic Acidosis secondary to the kidney's ability
5
to produce Bicarbonate.
6. Acute Renal Failure
Nursing Evaluation/Monitoring/Interventions
Assist with discovering the etiology of the acute renal failure. Is it prerenal, intrinsic, or postrenal?
Obtain serum and urine samples for laboratory testing.
Establish large bore intravenous access and prepare for fluid resuscitation (when dehydration is
present).
Avoid or administer with caution drugs that are toxic to the kidneys; NSAIDS, ACE Inhibitors,
Aminoglycoside Antibiotics, Radiocontrast Dye.
Monitor electrolyte abnormalities and prepare for appropriate corrections (especially
hyperkalemia).
Treat hyperkalemia with urgency. Prepare to preform an electrocardiogram (watch for peaked twaves, widened QRS complexes, and elongated P-R intervals), and prepare to administer any or
all of the following medications; calcium gluconate IVPB, regular insulin IVP (along side dextrose
to prevent hypoglycemia) sodium polystyrene sulfonate orally, sodium bicarbonate IVP, and
nebulized beta two agonists (albuterol).
Closely monitor the patient's intake and output (Foley catheter maybe necessary to maintain
accurate records).
6
7. Urinary Tract Infection
Infectious process located in the urinary tract.
Causes/Classifications
Poor Hygiene
Sexual Activity: Not voiding after sexual activity increases risk of UTI
(especially in females).
Urinary Catheterization: Indwelling catheterization poses a greater risk than
straight catheterization.
Stagnant Urine: Secondary to renal stones or enlarged prostate.
Incomplete Bladder Emptying: Often seen with patients having spinal cord
injuries.
7
8. Urinary Tract Infection
Nursing Assessment
Genitourinary: Dysuria (difficult and painful urination) Frequent Urination,
Nocturia (interrupting sleep in order to urinate), Urinary Hesitancy (uneasy or
incomplete urination), Dark/Concentrated/Cloudy/Odorous Urine Appearance
General: Lower Abdominal Pain, Flank Pain (if related renal stone), Fever/
Chills, Malaise
8
9. Urinary Tract Infection
Nursing Evaluation/Monitoring/Interventions
Collect and Interpret Urinalysis: If UTI is present a Urinalysis may show the
following;
Bacteria
l White Blood Cells
l Red Blood Cells
l Leukocyte Esterase (an enzyme released by white blood cells)
l Nitrates (by product of certain bacterial metabolism)
l
Prepare for antibiotics: Intravenous or Oral
Elderly Consideration: Change in mental status is common when UTI are
present in elderly populations.
9
10. Pyelonephritis
Pyelonephritis is an infection of the renal pelvis.
Causes/Classifications
Ascending Urinary Tract Infection: Infection which has began in the urinary
tract which has ascended to the renal pelvis.
10
11. Pyelonephritis
Nursing Assessment
NOTE: Pyelonephritis, often can be thought of as an advanced UTI. Signs
and symptoms are very similar but tend to be more pronounced once the
infection has advanced to the renal parenchymal.
Genitourinary: Dysuria (difficult and painful urination) Frequent Urination,
Nocturia (interrupting sleep in order to urinate), Urinary Hesitancy (uneasy or
incomplete urination), Dark/Concentrated/Cloudy/Odorous Urine Appearance
Gastrointestinal: Nausea, Vomiting
Costovertebral Angle Tenderness: Tenderness to the area on either side of
the vertebral column between the last rib and the lumbar vertebrae.
General: Pain (lower abdomen and affected side's flank), Fever and Chills.
11
12. Pyelonephritis
Nursing Evaluation/Monitoring/Interventions
Similar to the Nurse's Role in Urinary Tract Infections
Collect and Interpret Urinalysis: If UTI is present a Urinalysis may show the
following;
Bacteria, White Blood Cells, Red Blood Cells, Leukocyte Esterase (an enzyme
released by white blood cells), Nitrates (by product of certain bacterial
metabolism)
Recognize the severity of pyelonephritis in debilitated, chronically ill patients
and those receiving immunosuppressive therapy. Monitor for signs of sepsis.
12
13. Urinary Calculi
Urinary Calculi - A mineral deposit located in the urinary tract.
Causes/Classifications
Supersaturation of the Urine: The urine solution contains more solutes than can be dissolved and
excreted. This may lead to the formation of crystalline structures (usually composed of calcium or
uric acid).
Deficiency of Chelating Agents: The urine solution contains chemical agents that prevent the
formation of crystalline structures. If there is a deficiency of these agents the chance of calculi
formation increases.
Contributing Factors: Dietary (excessive intake of refined sugars, animal proteins, sodium, cola
drinks), Persistent Dehydration, Calcium and Vitamin C Supplements, Hyperparathyroidism,
Crohn’s Disease, DM, Excessive Alcohol Consumption
Nephrolithiasis: Calculi formation lodged in the kidney.
Ureterolithiasis: Calculi formation lodged in the ureter.
Cystolithiasis: Calculi formation lodged in the bladder.
13
14. Urinary Calculi
Nursing Assessment
Renal Colic: Intermittent and often excruciating pain that begins on the
affected side's flank and radiates to the groin, genital area and/or inner thigh.
Genitourinary: Urinary urgency, hematuria
Gastrointestinal: Nausea and Vomiting
General: Restlessness, Fever/Chills and Malaise (with an accompanied
infection)
14
15. Urinary Calculi
Nursing Evaluation/Monitoring/Interventions
Obtain urinalysis and monitor for blood and infection.
Establish IV access if needed for hydration, antibiotics, and pain control.
Prepare for CT and US.
Obtain serum sample to monitor electrolytes and renal function.
15
16. Testicular Torsion
Testicular Torsion: Ischemia of the testicles and surrounding structures within
the scrotum secondary to twisting of the spermatic cord.
Causes/Risk Factors
Bell Clapper Deformity: A condition where the testis and epididymis fail to
anchor to the tunica vaginalis. The deformity predisposes the testis to swing
and rotate within the scrotum, increasing risk of torsion.
Other Risk Factors or Possible Causes:
Most common ages 12-16
Cold Temperatures
Physical Activities
Trauma to Scrotum
16
17. Testicular Torsion
Nursing Assessment
Sudden and severe pain/tenderness in the scrotum. Usually of duration less
than six hours.
l
Swelling within the Scrotum
l
There is often an absent or decreased cremasteric reflex (the cremasteric
reflex is elicited by lightly stroking the inner part of the thigh just above the the
scrotum. If the reflex is intact the cremaster muscle pulls the testis on the side
stroked up).
l
Abdominal Pain
l
Nausea and Vomiting
l
17
18. Testicular Torsion
Nursing Evaluation/Monitoring/Interventions
Recognize the severity of testicular torsion and if there is high suspicion (a
correlating clinical exam and/or risk factors) advocate and prepare (obtain IV
access and preoperative serum samples) for immediate surgical exploration.
When there is lower suspicion for torsion a Doppler ultrasound scan of the
scrotum should be preformed and a urine sample for urinalysis should be
gathered to rule out a urinary tract infection or epididymitis (other less
emergent genitourinary disorders).
18
19. Epididymitis
Epididymitis: Inflammation of the epididymis (a coiled structure, posterior to
the testicle where sperm is stored and matures)
Causes/Risk Factors
Infectious Epididymitis
Sexually Transmitted Infections (particularly gonorrhea and chlamydia).
Urinary Tract Infections (bacteria in the urethra travels through the urinary and
reproductive structures to the epididymis).
Non-Infectious Epididymitis
Sterile urine back-flows from the urethra to the epididymis (may be secondary
to heavy lifting, straining, sexual intercourse with a full bladder, prostatitis).
Amiodarone (antiarrhythmic drug) has been associated with inflammation of
the epididymitis.
19
20. Epididymitis
Nursing Assessment
Testicular pain/tenderness which has a gradual onset and may be worse while
bearing down.
Discharge and/or blood while urinating or ejaculating.
Pain and discomfort in the lower abdomen, pelvis and/or groin.
Pain or burning during urination and/or ejaculation.
Scrotal and/or testicular swelling and redness (may be unilateral).
Cremasteric reflex is unaffected by epididymitis.
Fever, chills, nausea and vomiting.
20
21. Epididymitis
Nursing Evaluation/Monitoring/Interventions
Distinguish from testicular torsion.
Obtain urine sample for urinalysis (observe for hematuria and markers for
infection) and possible urine culture.
Swab the urethra for chlamydia and gonorrhea.
Prepare patient for Doppler ultrasound (primary purpose is to differentiate
epididymitis from testicular torsion).
Administer oral, IM, or IV antibiotics as ordered (if the cause is secondary to
infection) and medications to remedy pain, discomfort and inflammation.
21
22. Prostatitis
Prostatitis: An inflammation of the prostate gland.
Classifications
Acute Bacterial Prostatitis: Sudden bacterial infection marked by inflammation of the prostate.
Usually associated with severe symptoms requiring emergent attention.
Chronic Bacterial Prostatitis: Develops gradually and continues for an extended time.
Chronic Prostatitis Without Infection: Also referred to as Chronic Pelvic Pain Syndrome.
Inflammation without infection. Etiology unclear.
Asymptomatic Inflammatory Prostatitis: Inflammation without symptoms. Etiology unclear.
Causes/Risk Factors of Acute Bacterial Prostatitis
Intraprostatic Ductal Reflux (urinary backflow to the prostate)
Pharoses (foreskin cannot be fully retracted)
Spreading Rectal Infection
Urinary Tract Infections
Acute Epididymitis
Indwelling Foley Catheter
Transurethral Surgery
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23. Prostatitis
Nursing Assessment
Acute Bacterial Prostatitis
Fever, chills, malaise.
Urination may be difficult, frequent, urgent, painful and may also burn.
Lower back, rectal and/or genital area pain.
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24. Prostatitis
Nursing Evaluation/Monitoring/Interventions
Acute Bacterial Prostatitis
Prepare for antibiotic administration.
Obtain urine sample for urinalysis and possible urine culture. Monitor markers
for infection.
Be prepared to for serum blood work that may indicate infection/inflammation:
Complete Blood Count (elevated WBC), C-Reactive Protein (elevated levels).
Monitor for sepsis (rare occurrence) in immunocompromised patients that
present with S.I.R.S.
Transrectal US or Pelvic CT may be preformed to rule out a prostatic abscess.
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25. Priapism
Priapism: A persistent, often painful, erection (without sexual stimulation) that
occurs for more than four hours.
Causes/Classifications/Risks
Low Flow: Low-flow priapism is usually due to persistent venous occlusion, resulting in venous
stasis and deoxygenated blood pooling within the penis tissue. Pain is usually associated.
Risk Factors
l Sickle-Cell Disease
l Leukemia
l Malaria
l Medication Side Effects: Papaverine (antispasmodic), Phentolamine (vasodilator), Prostaglandin
E1 (impotence agent)
High Flow: High-flow priapism usually is secondary to a rupture of a local artery and unregulated
flow into the penis. Pain less likely to be associated or severe.
Risk Factors
l Injury/Trauma to the Penis or the Perineum
l Spinal Cord Injury (Parasympathetic Response)
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26. Priapism
Nursing Assessment
An erection lasting greater than 4 hours without sexual stimulus or desire.
Assess for genitourinary trauma.
Compile medical history, medication list and history of present illness.
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27. Priapism
Nursing Evaluation/Monitoring/Interventions
Assist with identifying risk factors and the etiology:
l Medication Review
l Medical History
l Recent Trauma/Injuries
Depending on the cause serum (CBC, coagulation profile, sickle cell trait) and urine samples may
be collected.
If indicated oral pseudoephedrine (vasoconstrictor) or terbutaline (beta agonist) may be the first
line treatment with cases secondary to low-flow.
If indicated assist with needle aspiration or phenylephrine/epinephrine injection if a low-flow case
is not solved with oral medications.
Prepare for Color Flow Penile Doppler Imaging (in order to differentiate high-flow from low-flow).
Selective angiography (to identify the problematic vessel) or surgical ligation (of the affected
artery) may be necessary in high-flow cases that do not resolve spontaneously.
Address the various psychosocial issues that may arise.
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28. Foreign Body
A foreign body lodged (intentionally or unintentionally) somewhere in the
genitourinary tract.
Often sexual or erotic in nature.
Endoscopic and minimal invasive techniques of removal should be used
whenever possible.
Surgical retrieval of a foreign body may be required, particularly when there is
a severe associated inflammatory reaction.
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30. Urologic Injuries - Renal
Classifications
Renal Laceration
Renal tissue is cut or torn
Renal Contusion
Hematoma of renal tissue. Blood leaks from the vasculature in the
surrounding tissues.
Renal Vascular Injury
Veins and arteries involved with the kidneys are injured.
Causes
Penetrating Trauma
Gunshot wounds, Stab wounds
Blunt Trauma
Rapid deceleration (motor vehicle crash, fall from heights), Direct blow to the
flank (pedestrian struck by vehicle, sports injury)
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31. Urologic Injuries - Renal
Renal Injury Scale
Grade
Injury Description
I
Contusion: Microscopic or gross hematuria, urological studies normal
Hematoma: Sub capsular, nonexpanding without parenchymal laceration
II
Hematoma: Nonexpanding perirenal hematoma confined to renal retroperitoneum
Laceration: <1cm parenchymal depth of renal cortex without urinary extravasation
III
Laceration: >1cm depth of renal cortex, without collecting system rupture or urinary
extravasation
IV
Laceration: Parenchymal laceration extending through the renal cortex, medulla and
collecting system
Vascular: Main renal artery or vein injury with contained hemorrhage
V
Laceration: Completely shattered kidney
Vascular: Avulsion of renal hilum which devascularizes kidney
Advance one grade for multiple injuries to same organ.
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32. Urologic Injuries - Renal
Nursing Assessment
Hematuria: Blood may be present (microscopic, moderate or gross amounts).
Note: The absence of blood does not rule out renal trauma.
Abdomen and flanks may be tender to palpation.
Grey Turner's Sign: Ecchymosis may be seen over injured flank. This
represents blood that has escaped from vasculature. It may take 6-12 hours to
develop.
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33. Urologic Injuries - Renal
Nursing Evaluation/Monitoring/Interventions
Compile a history of the trauma. Including time of injury, mechanism, and
associated injuries.
Obtain IV access and urine and serum samples for laboratory testing.
Monitor patient for hemodynamic stability.
Prepare patient for ultrasound (F.A.S.T. - Focused Assessment with
Sonography for Trauma) and CT.
Prepare patient for surgical interventions when indicated.
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34. Urologic Injuries - Bladder
Classifications
Bladder Wall Contusion
Bruising to the bladder, or partial-thickness tear of the bladder mucosa.
Extraperitoneal Bladder Rupture
Injury below the pelvic peritoneum.
Intraperitoneal Bladder Rupture
Pelvic peritoneum is involved in the injury.
Causes
Blunt Injury
Assault to the lower abdomen with blunt object, deceleration (fall from great height), MVC with
impact against the steering wheel or seatbelt.
Penetrating Injuries
Gunshots, Stab Wounds
Procedure/Surgical Related Injury
Cesarean delivery, Hysterectomy, Internal fixation of pelvic fractures
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35. Urologic Injuries - Bladder
Nursing Assessment
Abdomen assessment may include:
l Pain in the suprapubic region.
l Rebound tenderness.
l Abdominal wall muscle rigidity, spasm and guarding.
Hematuria: Microscopic, moderate or gross may be present.
Blood may be visible at the urethral meatus or in the scrotum.
Patient may be unable to urinate despite feeling an urge.
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36. Urologic Injuries - Bladder
Nursing Evaluation/Monitoring/Interventions
Compile a history of the trauma. Including time of injury, mechanism, and associated injuries.
Obtain IV access and urine and serum samples for laboratory testing.
Monitor patient for hemodynamic stability.
Be aware that most ruptured bladders occur in association with pelvic factures.
Do not insert a Foley catheter when there is a suspected urethral injury or blood at the urethral
meatus. This may cause further trauma to the urethra.
Prepare patient for possible F.A.S.T. exam, CT of abdomen and pelvic, Cystography (bladder XRay with radiocontrast inserted through a Foley catheter).
If intraperitoneal bladder rupture is present anticipate surgical exploration and prepare patient
according.
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