Nursing 211

N211: Health Differences Across the Lifespan I of 148 as relaxation, guided imagery and diversional activities. Administer anti-cholinergic medications such as belladonna suppositories to relieve bladder spasms. Encourage patient to follow a plan of paced activities with periods of rest, allow patient to express feelings about the disease process. Urinary diversions stoma care includes a collection device that should fit snugly around the stoma; allowing no more than 1/8-inch margin of skin between the stoma and the faceplate. Stoma should appear light or bright red; suspect a problem if it is deep red or bluish in color. Check peristomal skin for breakdown; main cause of irritation is urine leakage; change device and cleanse skin if leakage occurs. Cleanse area with warm water and pat dry. Monitor I&O, noting change in urine color, odor or clarity. Teach client to expect stoma shrinkage within eight weeks after surgery. Encourage client to change the appliance as needed. Instruct the client to report fever, chills, flank pain, abdominal pain, and pus in the urine or blood in the urine. Ureteroenterocutaneous diversions are conventional conduit where the urine is collected in an ileostomy bag. Continent ileal urinary reservoir (Koch pouch) where the urine drains by a catheter. Ureterosigmoidoscopy where the urine drains through the colon and out of the body through the rectum. Cutaneous diversions are cutaneous ureterostomy where the ureter is detached and brought out through the abdominal wall and attached to an opening in the skin. Vesicostomy where is bladder is attached to the abdominal wall and an opening, or stoma, is created for drainage. Nephrostomy is when a catheter is inserted into the renal pelvis by a skin incision or by cutaneous catheter placement into the kidney. Wilm’s Tumor also known as a Nephroblastoma is a malignant renal tumor. This tumor most commonly occurs between 2 and 5 years of age. A small proportion of Wilm’s tumors show a genetic basis with family members being at increased risk of development. The tumor may be unilateral or bilateral; bilateral tumors have a poorer prognosis. The tumor is oft encapsulated until relatively late. Wilm’s tumors will the lungs and liver. With early detection, surgery and adjuvant chemotherapy, as well as radiation the prognosis is good. Nursing Assessment includes a mass in the flank area, confined to the midline, often discovered by parents when bathing child; fever, pallor, lethargy, elevated blood pressure because of excess renin secretion and rarely hematuria. Pain and hematuria may be seen in some children. Hypertension is present in 25% of children because of increased renin production. Avoid palpating the abdomen preoperatively to reduce the risk of rupturing the capsule and causing tumor spillage; place a sign over child’s bed with instructions “No abdominal palpation”. Diagnostics Include abdominal ultrasound and intravenous pyelogram (IVP). CT scan and MRI of the lungs may be done to detect metastasis. ©2012 Achieve Page 110

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