Tiêu đề NCM 114 RLE SEMI FI ✅

NCM 113 RLE Semi Fi BY TONS and MADS e) Once pleural space drained, chemical pleurodesis performed to obliterate pleural space and prevent reaccumulation of fluid. (1) Pleurodesis performed by thoracoscopic approach or chest tube. (2) Chemically irritating agent (talc or another irritant) instilled or aerosolized into pleural space. (3) Chest tube: after agent is instilled, chest tube is clamped for 60-90 minutes and patient is assisted to assume various positions to promote uniform distribution of agent and maximize its contact with pleural surfaces. The tube is unclamped and chest drainage continued several days longer to prevent reaccumulation of fluid and promote formation of adhesions between visceral and parietal pleurae. f) Other treatments if caused by malignancy: surgical pleurectomy, insertion of small catheter attached t drainage bottle for outpatient management (Pleurx catheter [Denver Biomedical]), or implantation of pleuroperitoneal shunt. (1) Pleuroperitoneal shunt consists of 2 catheters connected by pump chamber containing 2 one-way valves. (2) Fluid moves from pleural space to pump chamber and then to peritoneal cavity. Patient manually pumps on reservoir daily to move fluid from pleural space to the peritoneal space. 7. Nursing Management a) Implementing medical regimen, prepares & positions patient for thoracentesis, offers support, making sure thoracentesis fluid amount is recorded and sent for laboratory b) If chest tube drainage and water-seal system used, nurse monitor system’s function and recording amount of drainage at prescribed intervals. c) Care is specific to underlying condition. d) If chest tube inserted for talc instillation, pain management is priority; help patient assume positions that are least painful. e) Frequent turning and movement to facilitate adequate spreading of talc on pleural surface. CARE OF CLIENTS WITH URINARY BLADDER MALIGNANCY From 112 Lec Semis A. Cancer of the Bladder 1. More common in>55 years of age; affects more men (4:1) more common in Caucasians than African Americans. 2. Combined with prostatic cancer, is the most common urologic malignancy, 90% of all tumors seen. 3. Cancers arising from the prostate, colon, and rectum in males and from lower gynecologic tract in females may metastasize to the bladder. 4. Tobacco use continues to be a leading risk factor for all urinary tract cancers. People who smoke develop bladder cancer twice as often 5. Risk Factors a) Cigarette smoking: risk proportional to pack-years of smoking b) Exposure to environmental carcinogens: dyes, rubber, leather, ink, or paint c) Recurrent or chronic bacterial infection of urinary tract d) Bladder stones e) High urinary pH f) High cholesterol intake g) Pelvic radiation therapy h) Cancers arising from the prostate, colon, and rectum in males 6. Clinical Manifestations a) Bladder tumors usually arise at the base of bladder and involve ureteral orifices and bladder neck. b) Visible, painless hematuria - most common c) UTIs - common complication, producing frequency and urgency. d) Any alteration in voiding or change in the urine may indicate cancer of the bladder. e) Pelvic or back pain may occur with metastasis. 7. Assessment and Diagnostic Findings a) Cystoscopy (mainstay of diagnosis), excretory urography, CT, ultrasonography, and bimanual examination with patient anesthetized. b) Biopsies of tumor and adjacent mucosa definitive diagnostic procedures. c) Cytologic examination of fresh urine and saline bladder washings provide information about the prognosis and staging, 2