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By: A. Ramon, M.S., Ph.D.
Deputy Director, University of Puerto Rico School of Medicine
Exposure of the patient to man health summit buy 250 mg eulexin free shipping others with an active infection and to prostate cancer awareness month buy discount eulexin 250mg line crowds is avoided mens health deltafit review purchase eulexin us. These patients may also receive low-bacteria diets, avoiding fresh fruits and vegetables. Hand hygiene and appropriate general hygiene are necessary to reduce exposure to potentially harmful bacteria and to eliminate environmental contaminants. Invasive procedures, such as injections, vaginal or rectal examinations, rectal temperatures, and surgery, are avoided. The patient is encouraged to cough and perform deep-breathing exercises frequently to prevent atelectasis and other respiratory problems. Prophylactic antimicrobial therapy may be used for patients who are expected to be profoundly immunosuppressed and at risk for certain infections. The nurse teaches the patient and family to recognize signs and symptoms of infection to report, perform effective hand hygiene, use antipyretics, maintain skin integrity, and administer hematopoietic growth factors when indicated. Septic Shock the nurse assesses the patient frequently for infection and inflammation throughout the course of the disease. Septicemia and septic shock are life-threatening complications that must be prevented or detected and treated promptly. Patients with signs and symptoms of impending sepsis and septic shock require immediate hospitalization and aggressive treatment. The patient and family members are instructed about signs of septicemia, methods for preventing infection, and actions to take if infection or septicemia occurs. Septic shock is most often associated with overwhelming gram-negative bacterial infections. The nurse monitors the blood pressure, pulse rate, respirations, and temperature of the patient with shock every 15 to 30 minutes. Neurologic assessments are carried out to detect changes in orientation and responsiveness. Fluid and electrolyte status is monitored by measuring fluid intake and output and serum electrolytes. Arterial blood gas values and pulse oximetry are monitored to determine tissue oxygenation. Broad-spectrum antibiotics are administered as prescribed to combat the underlying infection (see Chap. Bleeding and Hemorrhage Thrombocytopenia, a decrease in the circulating platelet count, is the most common cause of bleeding in cancer patients and is usually defined as a count of less than 100,000/mm3 (0. Tumor infiltration of the bone marrow can also impair the normal production of platelets. In some cases, platelet destruction is associated with an enlarged spleen (hypersplenism) and abnormal antibody function that occur with leukemia and lymphoma. In addition to monitoring laboratory values, the nurse continues to assess the patient for bleeding. The nurse also takes steps to prevent trauma and minimize the risk for bleeding by encouraging the patient to use a soft, not stiff, toothbrush and an electric, not straight-edged, razor. Additionally, the nurse avoids unnecessary invasive procedures (eg, rectal temperatures, intramuscular injections, and catheterization) and assists the patient and family to identify and remove environmental hazards that may lead to falls or other trauma. Soft foods, increased fluid intake, and stool softeners, if prescribed, may be indicated to reduce trauma to the gastrointestinal tract. The joints and extremities are handled and moved gently to minimize the risk for spontaneous bleeding. Hemorrhage may be related to various underlying abnormalities, such as thrombocytopenia and coagulation disorders. These clinical situations are often associated with the cancer itself or the adverse effects of cancer treatments. Sites of hemorrhage may include the gastrointestinal, respiratory, and genitourinary tracts and the brain. Blood pressure and pulse and respiratory rates are monitored every 15 to 30 minutes when hospitalized patients experience bleeding.
Purpose Cancer is often viewed as a life-threatening disease for which there is little hope for the future and relatively little ability to prostate surgery procedure order discount eulexin on line create change androgen hormone gel purchase 250 mg eulexin otc. The purposes of this study were to prostate oncology 2 discount eulexin 250 mg with amex explore changes in hope and power among lung cancer patients who participated in a preoperative exercise program and to examine hope and power over time. To assess for changes in hope and power, the subjects were asked to complete questionnaires on hope (Health Hope Index) and power (Power as Knowing Participation in Change Test) at the time of diagnosis, on the day before surgery, and 4 to 6 days after surgery. The exercise group was instructed about the exercise by the investigator after completion of the first set of questionnaires. The exercise group performed the exercises daily before surgery and recorded their compliance in a journal. The nonexercise group received usual preoperative care that did not include a prescribed exercise program. Findings There were no statistically significant relationships between hope or power and the number of days of exercise completed. There were differences in power (defined as the capacity to knowingly participate in change) between the two groups, with power increased in the exercise group compared with the nonexercise group. Nursing Implications It is useful for the nurse to understand how patients can effectively participate in change and promote strategies that enhance wellbeing. By encouraging preoperative exercise, nurses can help patients purposefully participate in change, make decisions about their care, and determine factors that enhance and impede them from taking steps to actively participate in their care. Table 4-2 presents the general population guidelines; specific population standards and guidelines have also been recommended. Today, health promotion goes beyond the mere screening of children for disabilities and includes extensive efforts to promote positive health practices at a very young age. Because health habits and practices are formed early in life, children should be encouraged to develop positive health attitudes. For this reason, more and more programs are being offered to school-age children and to adolescents to help them develop good health habits. Although the negative results of practices such as smoking, risky sexual activities, alcohol and drug abuse, and poor nutrition are explained in these educational programs, emphasis is also placed on values training, self-esteem, and healthy lifestyle practices. Clinical work indicates that the elderly are very health-conscious and that most view their health positively and are willing to adopt practices that will improve their health and well-being (Ebersole & Hess, 1997; Staab & Hodges, 1996). Although their chronic illnesses and disabilities cannot be eliminated, these adults can benefit from activities that help them maintain independence and achieve an optimal level of health. Various health-promotion programs have been developed to meet the needs of older Americans, many of which began within the Department of Health and Human Services. Both public and private organizations continue to be responsive to health promotion, and more programs that serve the elderly are emerging. Many of these programs are offered by health care agencies, churches, community centers, senior citizen residences, and a variety of other organizations. The activities directed toward health promotion for the elderly are the same as those for other age groups: physical fitness and exercise, nutrition, safety, and stress management. Implications for Nursing Nurses, by virtue of their expertise in health and health care and their long-established credibility with consumers, play a vital role in health promotion. In many instances they have initiated healthpromotion programs or have participated with other health care personnel in developing and providing wellness services in a variety of settings. As health care professionals, nurses have a responsibility to promote activities that foster well-being, self-actualization, and personal fulfillment. Every interaction with consumers of health care must be viewed as an opportunity to promote positive health attitudes and behaviors. Chapter 4 Health Education and Health Promotion 57 Teaching aids and demonstrations enhance learning. Here a nurse (right) instructs learners during a community health education program. Often generated and developed by nurses, these programs offer the public opportunities to obtain health information about topics ranging from diet, nutrition, and hypercholesterolemia to hypertension, diabetes, cardiopulmonary resuscitation, and others.
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The distribution of cancer sites throughout the colon is shown in Figure 38-7 (Goldman androgen hormone oestrogen discount 250mg eulexin fast delivery, & Bennett mens health zma eulexin 250mg without prescription, 2000) androgenic hormone baldness order eulexin australia. The incidence of cancer in the sigmoid and rectal areas has decreased, whereas the incidence of cancer in the cecum, ascending, and descending colon has increased. Improved screening strategies have helped to reduce the number of deaths in recent years. Of the more than 148,000 people diagnosed each year, fewer than half that number die annually (Beyers et al. Early diagnosis and prompt treatment could save almost three of every four people with colorectal cancer. If the disease is detected and treated at an early stage, the 5-year survival rate is 90%, but only 34% of colorectal cancers are found at an early stage. Most people are asymptomatic for long periods and seek health care only when they notice a change in bowel habits or rectal bleeding. Prevention and early screening are key to detection and reduction of mortality rates. Assessment and Diagnostic Findings Along with an abdominal and rectal examination, the most important diagnostic procedures for cancer of the colon are fecal occult blood testing, barium enema, proctosigmoidoscopy, and colonoscopy (see Chap. As many as 60% of colorectal cancer cases can be identified by sigmoidoscopy with biopsy or cytology smears (Yamada et al. Pathophysiology Cancer of the colon and rectum is predominantly (95%) adenocarcinoma (ie, arising from the epithelial lining of the intestine). It may start as a benign polyp but may become malignant, invade and destroy normal tissues, and extend into surrounding structures. Cancer cells may break away from the primary Complications Tumor growth may cause partial or complete bowel obstruction. Extension of the tumor and ulceration into the surrounding blood vessels results in hemorrhage. Among women, only breast cancer exceeds the incidence of colorectal cancer (Lueckenotte, 2000). Cancer patients usually report fatigue, which is caused primarily by iron-deficiency anemia. In early stages, minor changes in bowel patterns and occasional bleeding may occur. The later symptoms most commonly reported by the elderly are abdominal pain, obstruction, tenesmus, and rectal bleeding. Lack of fiber is a major causative factor because the passage of feces through the intestinal tract is prolonged, which extends exposure to possible carcinogens. Excess fat is believed to alter bacterial flora and convert steroids into compounds that have carcinogenic properties. Treatment for colorectal cancer depends on the stage of the disease (Chart 38-8) and consists of surgery to remove the tumor, supportive therapy, and adjuvant therapy. Data demonstrate delays in tumor recurrence and increases in survival time for patients who receive some form of adjuvant therapy-chemotherapy, radiation therapy, immunotherapy, or multimodality therapy. Radiation therapy is used before, during, and after surgery to shrink the tumor, to achieve better results from surgery, and to reduce the risk of recurrence. For inoperative or unresectable tumors, irradiation is used to provide significant relief from symptoms. Laparoscopic colotomy with polypectomy minimizes the extent of surgery needed in some cases. A laparoscope is used as a guide in making an incision into the colon; the tumor mass is then excised. Bowel resection is indicated for most class A lesions and all class B and C lesions. Surgery is sometimes recommended for class D colon cancer, but the goal of surgery in this instance is palliative; if the tumor has spread and involves surrounding vital structures, it is considered nonresectable.
Causes of disorder and injury in the system (cell prostate pq buy generic eulexin 250 mg, tissue prostate xrt purchase generic eulexin on line, organ prostate cancer 15 year survival rate order eulexin 250mg without prescription, body) may arise from the external or internal environment. The most common causes are hypoxia (oxygen deficiency), chemical injury, and infectious agents. In addition, the presence of one injury makes the system more susceptible to another injury. For example, inadequate oxygenation and nutritional deficiencies make the system vulnerable to infection. Ischemia is commonly seen in myocardial cell injury in which arterial blood flow is decreased because of atherosclerotic narrowing of blood vessels. Ischemia also results from intravascular clots (thrombi or emboli) that may form and interfere with blood supply. For example, brain cells may succumb in 3 to 6 minutes, depending on the situation. If the condition leading to hypoxia is slow and progressive, collateral circulation may develop, whereby blood is supplied by other blood vessels in the area. Nutritional Imbalance Nutritional imbalance refers to a relative or absolute deficiency or excess of one or more essential nutrients. This may be manifested as undernutrition (inadequate consumption of food or calories) or overnutrition (caloric excess). By requiring more energy to maintain the extra tissue, obesity places a strain on the body and has been associated with the development of disease, especially pulmonary and cardiovascular disease. Specific deficiencies arise when an essential nutrient is deficient or when there is an imbalance of nutrients. Protein deficiencies and avitaminosis (deficiency of vitamins) are typical examples. An energy deficit leading to cell injury can occur if there is insufficient glucose, or insufficient oxygen to transform the glucose into energy. A lack of insulin, or the inability to use insulin, may also prevent glucose from entering the cell from the · the integrity of the cell membrane, necessary for ionic balance · the ability of the cell to transform energy (aerobic respiration, production of adenosine triphosphate) essary proteins tegrity) · the ability of the cell to synthesize enzymes and other nec· the ability of the cell to grow and reproduce (genetic in- Chapter 6 blood. This occurs in diabetes mellitus, a metabolic disorder that can lead to nutritional deficiency. Homeostasis, Stress, and Adaptation 91 Physical Agents Physical agents, including temperature extremes, radiation, electrical shock, and mechanical trauma, can cause injury to the cells or to the entire body. The duration of exposure and the intensity of the stressor determine the severity of damage. With fever induced by infections, the hypothalamic thermostat may be reset at a higher temperature, then return to normal when the fever abates. Body temperatures greater than 41°C (106°F) suggest hyperthermia, because the physiologic function of the thermoregulatory center breaks down and the temperature soars. Eventually, the high temperature causes coagulation of cell proteins, and the cells die. There is an increase in metabolic activity, and, as heat increases, protein is coagulated, enzyme systems are destroyed, and, in the extreme, charring or carbonization occurs. Burns of the epithelium are classified as partial-thickness burns if epithelializing elements remain to support healing. If the injury is severe, the entire body system becomes involved, and hypermetabolism develops as a pathophysiologic response. Blood flow becomes sluggish and clots form, leading to ischemic damage in the involved tissues. Radiation decreases the protective inflammatory response of the cell, creating a favorable environment for opportunistic infections. Electrical shock produces burns as a result of the heat generated when electrical current travels through the body. It may also abnormally stimulate nerves, leading, for example, to fibrillation of the heart. The severity of the wound, the amount of blood loss, and the extent of nerve damage are significant factors in the outcome. Some individuals are less tolerant of medications than others and manifest toxic reactions at the usual or customary dosages. Polypharmacy (taking many medications at one time) also occurs frequently in the aging population and is a problem because of the unpredictable effects of the resulting medication interactions. In the body, alcohol is broken down into acetaldehyde, which has a direct toxic effect on liver cells that leads to a variety of liver abnormalities, including cirrhosis in susceptible individuals.