Nutrition Presentation lectures

Nutrition Presentation lectures
by Dr. Scott Schaeffer
Harford Community College


Lecture notes - Unit 1

Chapter 1
Chapter 2
Chapter 3
Chapter 4

Lecture notes - Unit 2
Chapter 5
Chapter 6
Chapter 7
Chapter 8

Lecture notes - Unit 3
Chapter 9
Chapter 10
Chapter 11
Chapter 12

Lecture notes - Unit 4
Chapter 13
Chapter 14
Chapter 15
Chapter 16

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Male Reproductive System

Male Reproductive System
By:Linda Harmon

Male Reproductive System
* Several organs serve as parts of both the urinary tract and the reproductive systems.
* The structures are the tests, the vas deference and the seminal vesicles, the penis, certain accessory glands, such as the prostate and Cowper’s gland..
* Disorders in these organs may interfere with the function of either or both systems.
* Diseases are usually treated by a urologist.

Health History and Assessment
* Changes in urinary function and symptoms of obstruction caused by an enlarged prostate
* Changes in physical activity
* Sexual function and any manifestations of sexual dysfunction
* Factors that affect sexual functioning (stress, physical disease, use of medications, drugs, or alcohol)

Physical Examination
* Digital-Rectal Exam
o Recommended for every man over the age of 40
o Assess the size, shape, and consistency of the prostate
o Screening for cancer of the prostate
* Testicular Exam
o The male genitalia are inspected for abnormalities
o Note nodules, masses, or inflammation
o Instruct the patient about the technique for TSE

Diagnostic Studies
* Prostate-Specific Antigen
o The prostate gland produces a substance known as Prostate-Specific Antigen (PSA). This is measured in the blood and increases in prostate cancer. It needs to be drawn prior to a rectal exam or urinary catheterization.
* Ultrasound
o Transrectal ultrasound studies are used in detecting nonpalpable prostate cancers and in staging localized prostate cancers,. Needle biopsies of the prostate are commonly guided by ultrasound. Ultrasounds are more sensitive than a digital rectal exam.
* Prostate Fluid or Tissue Analysis
o A biopsy may be necessary to obtain tissue for histologic examination. This can be done with a prostatectomy or via a perineal or transrectal needle biopsy.
* Test of Male Sexual Functioning
o Usually conducted by a special team of health care providers.

Medications Associated with Erectile Dysfunction
* Antiadrenergics and antihypertensives
* Anticholinergics and phenothiazines
* Antiseizure agents
* Antifungals
* Antihormone
* Antipsychotics
* Antispasmodics
* Anxiollytics
* Betablockers
* Calcium channel blockers
* Carbonic anhydrase inhibitors
* H2 antagonists
* Nonsteroidal anti-inflammatory drugs
* Thiazides diuretics
* Tricyclic antidepressant

Conditions of the Prostate

Prostatitis
* Inflammation of the prostate gland caused by infectious agents or other conditions
* Clinical manifestations: perineal discomfort, burning, urgency, frequency and pain with or after ejaculation, fever, chills, rectal or low back pain, urinary tract infections.
* Complications: swelling, urinary retention, epididymitis, bacteremia, pyelonephritis.
* Management: avoid complications, broad spectrum antibiotic agent, bed rest, analgesic agents, antispasmodics, bladder sedatives, sitz baths. Chronic is difficult to treat.
* Nursing Management: antibiotics, comfort measures, analgesics, sitz baths, teaching.
* Self care: administration of antibiotics, sitz baths, fluids encouraged but not forced, foods and liquids with diuretic action or that increase prostatic secretions should be avoided.

Benign Prostatic Hyperplasia
* Enlargement of the prostate, extending upward into the bladder and obstructing the outflow of urine by encroaching on the vesical orifice.
* BPH is one of the most common pathologic conditions in men over 50
* Cause is uncertain
* Hypertrophied lobes cause incomplete emptying and urinary retention.
* Manifestations: frequency, nocturia, urgency, hesitancy, abdominal straining, decrease in volume and force of stream, interruption of stream, dribbling, urinary retention, recurrent UTI, fatigue, anorexia, nausea, vomiting, epigastric discomfort.
* Medical Management: Plan is dependent on cause, severity and condition. Immediate, hormonal, pharmacological, surgical

Cancer of the Prostate
* The most common cancer in men.
* Prostate cancer rates twice as high in African American men. They are more likely to die than men in any other racial or ethnic group.
* Risk factors: increasing age, African American, familial predisposition, diet high in red meat and fat
* Manifestations: urinary obstruction, difficulty and frequency, retention,decrease in size and force of stream, painful ejaculation, hematuria, late signs include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness
* Diagnosis: Early detection increases likelihood of cure. Over 40 requires a digital rectal exam (DRE) – early cancer may be detected as a nodule within the substance of the gland or as an extensive hardening in the posterior lobe.
* Men with prostate cancer experience sexual dysfunction before the diagnosis is made.
* Medical Management: based on the stage, age, symptoms. Surgical management, radiation therapy, hormonal therapy, others.
* Surgical Procedures: the procedure chosen depends on the size of the gland, the severity of the obstruction, the patients age, physical status, presence of associated diseases, and patient preference.
* Complications: hemorrhage, clot formation, catheter obstruction and sexual dysfunction.

Prostatectomy
* Assessment: BPH or Cancer – how has it affected lifestyle, presenting urinary problem, family history, physical condition.
* Nursing Diagnosis: Preop – anxiety, acute pain, knowledge deficit; Postop – acute pain, knowledge deficit
o Potential complications: hemorrhage and shock, infection, deep vein thrombosis, catheter obstruction, sexual dysfunction.
* Planning and Goals: Preop- reduced anxiety and knowledge about disorder and postop experience. Postop – fluid volume balance, relief of pain and discomfort, ability to perform self-care activities and absence of complications.
* Preop Nursing Interventions –reduce anxiety, relieve discomfort, provide instruction, prepare patient.
* Postop Nursing Interventions
o Fluid Balance – carefully monitor intake and output including irrigation, observe for electrolyte imbalance, elevated blood pressure, confusion and respiratory distress.
o Pain Relief – determine cause and location, obstruction may require irrigation, walk but do not sit for prolonged periods.
o Monitoring and managing complications
+ Hemorrhage – drainage normally reddish-pink then clears to light pink within 24 hours after surgery.
+ Infection – first by MD, use aseptic technique. Avoid rectal thermometers, rectal tubes and enemas, monitor for fever chills, sweats, etc.
+ Deep Vein Thrombosis – high incidence of DVT and pulmonary embolism,
+ Obstructed Catheter – observe for distention, restlessness, cold sweats, pallor, drop in blood pressure and increase pulse rate.
+ Complications after catheter removal – incontinence
+ Sexual Dysfunction –related to erectile dysfunction , decreased libido and fatigue.
o Promoting home and community based care.
+ Length of stay depends on type of surgical procedure performed.
+ Instruct on how to manage drainage system, assess for complications, promote recovery.
+ Teach about bladder control issues, perineal exercises, and avoiding activities that produce Valsalva effects.
+ Teach signs and symptoms of complications such as bleeding, clots, decrease in stream, retention or infection.
* Evaluation
o Preoperatively
+ Reduced anxiey
+ Pain and discomfort reduced
+ Understanding of procedure and postop course
o Postoperatively
+ Relief of discomfort
+ Fluid and electrolyte balance
+ Self-care measures
+ Free of complications

Conditions Affecting the Testes and Adjacent Structures

Testes and Structures
* Undescended Testis (Cryptorchidism)
o Congenital condition, failure of one or both testes to descend into the scrotum.
o Treated by orchiopexy
* Orchitis
o Inflammation of testes caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical or unknown factors. (Mumps)
o Treatment directed at infecting organism, rest, scrotal elevation, icepacks, antibiotics analgesia
* Epididymitis
o Infection of the epididymis may be due to infected prostate or urinary tract, complication of gonorrhea. Chlamydia trachomatis
o Treatment of organism, bed rest, scrotal elevation,antimicrobial agents, cold compresses, avoid straining , lifting and sexual stimulation.
* Testicular Cancer
o Most common cancer in men 15 to 35, highly treatable and usually curable
o Treatment dependent on type of cancer.
o Risk factors – undescended testis, family history, race and ethnicity (Caucasian American men 5 times greater than African American and double the risk of Asian American) ,occupational hazards
* Manifestations: mass or lump, generally painless, heaviness in scrotum, backache, abdominal pain , weight loss, general weakness. Tend to metastasize early.
* Diagnosis: monthly Testicular Self Examinations (TSE), human chorionic gonadotropin and alpha-fetoprotein and tumor markers that may be elevated in those with testicular cancer.
* Medical Management:
o Orchiectomy with gel-filled prosthesis. Retroperitoneal lymph node dissection, radiation, chemotherapy, long term side effects.
* Hydrocele
o a collection of fluid in the tunica vaginalis of the testes
* Varicocele
o Abnormal dilation of the veins of the pampiniform venous plexus in the scrotum
* Vasectomy
o Legation and transaction of part of the vas deferens with or without removal of a segment of the vas deferens.

Conditions Affecting the Penis
Penis
* Hypospadias and Epispadias
o Congenital anomalies of the urethral opening
* Phimosis
o A condition in which the foreskin is constricted so that it cannot be retracted over the glans, can occur congenitally or from inflammation and edema. Correctable by circumcision.
* Cancer of the Penis
o Mostly in uncircumcised men.
o Appears as a painless, wartlike growth or ulcer.
o Bowen’s Disease is a form of squamous cell carcinoma in the situ of the penile shaft.
o Prevention is circumcision in infancy
o Treatment by excision, topical chemotherapy, radiation, partial or total penectomy.
* Priapism
o An uncontrolled, persistent erection of the penis that causes the penis to become large, hard, and painful.
* Peyronie’s Disease
o Buildup of fibrous plaques in the sheath of the corpus cavernosum. When erect, curvature occurs.
* Urethral Stricture
o A condition in which a section of the urethra is narrowed.
o Treatment involved dilation of the urethra or urethrotomy.
* Circumcision
o The excision of the foreskin, or prepuce,of the glans penis. Usually performed in infancy

Male Reproductive System

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Management of Patients With Gastrointestinal Disorders

Management of Patients With Gastrointestinal Disorders
By:Bonnie Curry

Content Overview
* Overview of GI System
* Assessment
* Diagnostic Evaluation/Nursing Responsibilities
* Pathophysiology of GI Disorders
* Gerontologic Considerations
* Peptic ulcer disease
* GI Bleeding

Overview of GI Tract
* Anatomy
* Physiology
* Parasympathetic Nerve
* Sympathetic Nerve
* Voluntary control
* Functions

Assessment
* Health history
* Clinical manifestations
* Pain
* Indigestion
* Intestinal Gas
* Nausea/Vomiting
* Changes in bowel status

Gerontological Considerations
* Age-related changes in the mouth
* Changes in the esophagus
* Decrease gastric motility
* Decrease absorption of nutrients

Diagnostic Exams/Nursing Considerations
* Nursing Responsibilities
* Provide
* Instruct
* Alleviate
* Help
* Encourage
* Assess

Diagnostic Exams/Nursing Considerations
Endoscopic Studies
* EGD (Esophago-duodenoscopy)
* Lumen of esophagus, stomach, and duodenum
* COLONOSCOPY
* Entire large bowel
* SIGMOIDOSCOPY
* visualizes lower portion of colon-rectum and sigmoid colon

Diagnostic Exams/Nursing Considerations
Endoscopic Studies
* EGD (Esophago-duodenoscopy)
* Lumen of esophagus, stomach, and duodenum

Diagnostic Exams/Nursing Considerations
Endoscopic Studies
* COLONOSCOPY
* Entire large bowel

Diagnostic Exams/Nursing Considerations
Endoscopic Studies
* SIGMOIDOSCOPY
* visualizes lower portion of colon-rectum and sigmoid colon

Diagnostic Exams/Nursing Considerations
Endoscopic Studies
* EGD
* Indications
* Nursing interventions
* Sigmoidoscopy
* Indications
* Nursing interventions
* Colonoscopy
* Indications
* Nursing interventions
* Colon prep

Diagnostic Exams/Nursing Considerations
Radiological Studies
* Upper Gastrointestinal Tract Study (UGI)
* Aids in diagnosis of ulcers, varices, tumors, regional enteritis, and malabsorption syndromes
* Nursing Interventions
* Post Procedure
* Small Bowel Follow Through
* Aids in diagnosis of obstructions, ileitis, and diverticula
* Nursing Interventions
* Post Procedure

Diagnostic Exams/Nursing Considerations
Radiological Studies
* Lower GI Tract Study: Barium Enema (BE)
* Aids in diagnosis of polyps, tumors, other lesions, abnormal anatomy
* Contraindication
* Nursing Interventions
* Post procedure
* Gastric Analysis
* Aids in detection of pyloric or duodenal obstructions, diagnosis of Zollinger-Ellison Syndrome (ZES).
* Nursing Interventions
Diagnostic Exams/Nursing Considerations
Radiological Studies
* Gastric Stimulation Test
* Procedure
* Nursing considerations
* Information obtained
* pH Monitoring
* Procedure
* Nursing considerations
* Information obtained
* Gastric Analysis
* Fluid
* pH
* Basal acid output
* Maximum acid output

Diagnostic Exams/Nursing Considerations
Other Studies
* Ultrasound
* Nursing Interventions
* Computed Tomography (CT Scan)
* Nursing Interventions
* Magnetic Resonance Imaging (MRI)
* Nursing Interventions
* Stool Studies

Peptic Ulcer Disease
* Crater like disruption to GI tract mucosa
* Esophageal
* Gastric
* Small intestine
* Duodenal most common (closest to the stomach)
* Zollinger-Ellison syndrome (ZES)
* Several ulcers
* Extreme gastric hyperacidity
* Tumors of the pancreas
* Resistant to standard medical therapy
* Stress ulcers

Peptic Ulcer Disease
* Clinical Manifestations
* Pain
* burning, gnawing, dull
* midepigastrium or back
* relieved by eating or antacids
* Pyrosis
* Vomiting
* Change in bowel status
* Bleeding
* Gastric Ulcer
* Age 50 & over
* Male:Fem 1:1
* 15% incidence
* Norm. to hyper acid
* Weight loss
* Pain I/2-1hr. After meal
* Pain not relieved by eating
* Vomiting common
* Hemorrhage more likely
* Hematemesis more common
* Duodenal Ulcer
* Age 30-60
* Male:Fem- 2 to 3:1
* 80% incidence
* Hyper acid secretion
* May have wt. Gain
* Pain 2-3 hrs.after meal
* Pain relieved by eating
* Vomiting uncommon
* Hemorrhage less likely
* Melena more common
* Early 1900’s: key variables stress and diet
* Treatment: BR, bland food, hospitalization
* Decades later: primary cause excess gastric acid
* Treatment: antacids, drugs that protect mucosa (Pepto Bismol)
* 1970’s: Histamine receptor acts as key regulator of stomach acid secretion.
* Treatment: H2 blockers -- gastric acid neutralized and secretion reduced (tagamet, zantac, pepcid, axid)
* Newer drug class-- proton pump inhibitors -- longer & more complete blocking of acid formation (prilosec, prevacid, protonix)
* 1980’s: Discovery of Bacterium Helicobacter pylori (H. pylori)
Combination of antibiotics and acid suppressors Antacids,tranquilizers, lifestyle and dietary changes, surgery

Treatment ...
Peptic Ulcer Disease:
Advances in understanding of PUD
* Cure was short-lived
* Relapse rate 95% over two years until discovery of h. pylori bacteria factor
* National Institute of Health statement
* Currently a decrease in incidence of ulcers due to h. pylori in the U. S. but increase in incidence due to use of ASA and NSAIDS.
* Disruption of the production of hormone-like substances (prostaglandins)
Peptic Ulcer Disease: H.pylori
* Infects over half of the world’s population and is transmitted from person to person.
* Poor food handling and sanitation practices are thought to be common routes of transmission
* Thrives amid overcrowding and poor living conditions

Peptic Ulcer Disease: H.pylori
* Contributing factors:
* Many people in household
* Sharing of beds
* Limited hot water supply
* Inadequate bathroom facilities
* Decrease noted in U. S. due to:
* Improvements in socioeconomic status and sanitation
* Widespread use of antibiotics in children

Peptic Ulcer Disease: H.pylori
* Two out of three individuals that harbor H. pylori in GI tract have no symptoms
* DX tests for h. pylori:
* Stool antigen
* Biopsy of site
* Breath test
* Antibiotic drug regimen increases resistance to antibiotics
* Research – h. pylori vaccine
* Advantages: cost effective and reduce the progression of antibiotic resistant strains due to widespread use of them in treating h. pylori infection

Peptic Ulcer Disease Theurapeutic Management
* Rest and stress reduction
* Dietary Interventions
* Smoking cessation
* Pharmacologic therapy
* Surgical Management
* Long term follow-up care

Peptic Ulcer Disease:Drug Therapy
* Conventional drugs and a triple drug regimen (Amoxicillin, Flagyl, and Pepto-Bismol)
* FDA Approved in 1996 2 drug combination (newer recommendation) : Prilosec(Proton Pump Inhibitor) and Biaxin(Antibiotic) for 14 days followed by only Prilosec for additional 13 days)
* Patient compliance is a major factor in the success of treatment with drug combination therapy
* Benefits of drug combination treatment
* quick relief from symptoms
* healing of ulcer without recurrence
* savings of time and money spent on treatment
* Antibiotics & Bismuth Salts
* Tetracycline, Amoxicillin, Biaxin, Pepto-Bismol
* Histamine (H2) Receptor Antagonists
* Tagamet, Zantac, Pepcid, Axid
* Proton Pump Inhibitor
* Prilosec, Prevacid, Protonix
* Cytoprotective Medications
* Cytotec, Carafate

Peptic Ulcer Disease:Drug Therapy
* Prevacid (Lansoporazole)
* inhibits proton pumps which are responsible for acid production in the stomach
* may have some anti-bacterial action against H. pylori (bacteria involved in ulcer formation)
* absorption delayed by carafate and theophylline levels affected (lowered) by prevacid
* Prilosec (omeprazole)
* Long-term uses may cause gastric tumors & bacterial invasion
* Tagamet (cimetidine)
* Least expensive
* May cause confusion, agitation or coma in elderly or those with HI and RI
* Long-term use may cause impotence and diarrhea
* Zantac (ranitidine)
* Fewer side effects than Tagamet
* Prolonged half-life in patients with RI & HI
* Axid (nizantidine)
* Used for duodenal ulcers
* Prolonged half-life in patients with RI
* Rarely, causes sweating, increased liver enzymes, nausea, urticaria
* Pepcid
* Prolonged half life inpatients with RI
* Short-term relief for GERD
* Dilute before IV injection
* Least interaction with drugs
* Carafate
* anti-ulcer drug that has local effect and coats the stomach
* Give 1 hour before meals
* Approved for duodenal ulcers, not gastric
* Cytotec (misoprostol)
* Used as preventive method in patients using NSAIDs
* Administer with foodMay cause diarrhea & cramping
* Tetracycline (with Bismuth salts)
* May cause photosensitivity
* Effectiveness reduced if taken with milk or dairy products
* Use with caution in renal or hepatic pts.
* Amoxicillin (with Bismuth salts or high dose of Proton Pump Inhibitor)
* May cause diarrhea
* Cross-sensitivity to penicillin
* Biaxin (Clarithromycin)
* Use with proton pump inhibitor or H2 receptor antagonist
* May cause GI upset
* Pepto-Bismol (Bismuth salicylate)
* Use with antibiotics to cure H. Pylori
* Should be taken on an empty stomach

Peptic Ulcer Disease: Surgical Management
* Vagotomy- severing vagus nerve to reduce gastric secretion.
* Pyloroplasty- longitudinal incision with transverse suturing to enlarge the gastric outlet and relax the muscle.
* Antrectomy- Removal of antral portion of the stomach and portion of duodenum and pylorus. (Billroth I, Billroth II, Subtotal)
* Post op care
* Routine post surgical care
* Maintain tubes and drains
* Pain management
* Psychological support
* Fluid and blood replacement
* Assess for complications

Research
* CURE (Center for Ulcer Research and Education) UCLA
* AHCPR (Agency for Health Care Policy and Research) ahcpr.gov
* NIH (National Institute of Health) nih.gov

Acute GI Bleeding: Risk Factors
* Lower GI Bleeding
* Malignant tumors
* Polyps
* Ulcerative Colitis
* Crohns Disease
* Diverticula
* Hemorrhoids
* Rectal Fistulas
* Massive GI Bleed
* Upper GI Bleeding
* Esophageal varices
* Ulcers and tumors
* Gastric
* Ulcers and gastritis
* Tumors
* Small Intestine
* Peptic ulcers
* Crohns Disease
* Meckel’s diverticulum

Acute GI Bleeding
* Signs and Symptoms
* Abdominal/chest pain
* Nausea/vomiting
* Stools
* Change in LOC
* Assessment
* VS
* Cardiovascular/Respiratory
* GI
* s/s hypovolemic schock
* Diagnostic Tests
* CBC, chem panel, APTT, PT
* Blood type and cross
* Interventions
* Position patient
* Administer oxygen
* Monitor cardiac rhythm
* IV solutions
* Crystalloids
* Colloids
* Prevent hypothermia
* Insert NGT
* Gastric lavage
* Administer medication
* Vitamin K
* Vasopressin
* Insert F/C
* Prepare for EGD or surgery

Management of Patients With Gastrointestinal Disorders

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