I NTERFERENCES TO NURTRITIONAL ELIMINATION NEEDS : Intestinal and Urinary Diversions

C OLORECTAL C ANCER Major health problem – one of the most prevalent malignancies in US 95% are adenocarcinomas Thought to develop from adenomatous polyps Liver is the most common site of metastasis May also metastasize to lungs, brain, bones, adrenals Risk factors: genetics, life habits, diet, IB disease, African-american descent Physical signs/symptoms: Depend on location of tumor Change in stools: color, shape, gas pains, abd cramping, feeling of incomplete evacuation of bowel, straining to defecate, dull abd pain s/s of Anemia Abd mass

Stool tests that check for signs of cancer: Fecal occult blood test (FOBT). Fecal immunochemical test (FIT). Stool DNA test (sDNA). Carcinoembryonic antigen (CEA) Colonoscopy/sigmoidoscopy/barium enema CT scan of the abdomen Interventions Staging done first Radiation tx: to local area, may be palliative Meds: 5 FU, leucovorin, oxaliplatin, irinotecan, bevacizumab, cetuximab Watch for side effects, dose limiting signs Surgical removal of tumor

Colostomies Placement of ostomy in relation to where it is placed in the intestine Ascending Descending Transverse (double barreled) Sigmoid What is the difference between a colostomy and an ileostomy? When would an ileostomy be created? Is the care for one different from the other? Are there concerns specific to one that are not issues for the other? Are there differences in stool depending on where the stoma is? What is the nursing care for the stoma? What are the s/s of problems, when do you need to notify the MD? What patient education needs to take place prior to sending the patient home? How does the RN handle the psychosocial issues of having an ostomy?

R ENAL FAILURE ARF vs CRF What are the differences? What are the causes of ARF? How can you distinguish between the various phases of ARF (prerenal, intrarenal, postrenal)? Are the physical findings the same for each? Give examples of situations that would create a prerenal, intrarenal and postrenal injuries Give examples of nephrotoxic agents How do the phases of oliguric acute renal failure differ from one another? Make a chart outlining the differences/similarities. What lab tests are done to diagnose/monitor ARF/CRF? Are they the same? How do they differ? Why do you see the changes in the lab tests?

Interventions What medications are typically used to treat renal failure? (ARF vs CRF) What do you need to remember from NUR 101 re: metabolization/excretion of meds? How does this impact someone with renal failure? Why are these meds given? What are the common side effects you need to monitor for? Is there a special diet RF patients need to follow? Why? What is the diet? Give examples of foods that are allowed vs those not allowed/restricted. What is dialysis? How does it work? Are all dialysis types the same? How do they differ? What are their advantages/disadvantages? When would someone require dialysis? What patient education is required for someone on dialysis? What do you need to know re: the care of the patient on dialysis?

When would a renal transplant be done? When would a renal failure patient not be a candidate for renal transplant? What needs to be done prior to the surgery (pre- op)? What is the postoperative care needed post transplant surgery? What are the complications following transplant? What patient education needs to be done for the kidney transplant patient?