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A band is then inserted that restricts food consumption and delays its passage from the pouch generic super cialis 80mg amex, causing a feeling of fullness generic 80mg super cialis amex. Staple lines Small stomach Staple lines Esophagus pouch Pouch Esophagus Duodenum A 80mg super cialis fast delivery. Duodenum Arrows show pathway of food Shortened jejunum is now connected to the small stomach pouch Connection B super cialis 80mg for sale. Stoma Colostomy performed to Colostomy bag attach healthy attached to stoma tissue to abdomen Figure 6-12. Antacids counteract or decrease excessive drugs include agents that relieve “cramping” (anti- stomach acid, the cause of heartburn, gastric dis- spasmodics) and those that help in the movement comfort, and gastric reflux. Complete each activity and review your answers to evaluate your understanding of the chapter. Learning Activity 6-1 Identifying Digestive Structures Label the illustration on page 109 using the terms listed below. Enhance your study and reinforcement of word elements with the power of DavisPlus. We recommend you complete the flash-card activity before completing Activity 6–3 below. Learning Activities 135 Learning Activity 6-3 Building Medical Words Use esophag/o (esophagus) to build words that mean: 1. Complete the termi- nology and analysis sections for each activity to help you recognize and understand terms related to the digestive system. Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appendices of this book, or other resources to define each term. Then review the pronunciations for each term and practice by reading the medical record aloud. Eventually, she was diag- nosed as having cholecystitis with cholelithiasis and underwent cholecystectomy. This pain followed a crescendo pattern and peaked several weeks ago, at a time when family stress was also at its climax. It does not cause any nausea or vomiting, does not trigger any urge to defecate, and is not alleviated by passage of flatus. While referring to Figure 6–3, describe the location of the gallbladder in relation to the liver. How does the patient’s most recent postoperative episode of discomfort (pain) differ from the initial pain she described? Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appendices of this book, or other resources to define each term. Then review the pronunci- ations for each term and practice by reading the medical record aloud. She was given nasal oxygen at 3 liters per minute and monitored with a pulse oximeter throughout the procedure. Through a previously inserted intravenous line, the patient was sedated with a total of 50 mg of Demerol intravenously plus 4 mg of Midazolam intravenously throughout the procedure. The Fujinon computed tomography scan videoendoscope was then readily introduced and the following organs evaluated. A representative biopsy was obtained from the gastric antrum and submitted to the pathology laboratory. Operative Report: Esophagogastroduodenoscopy with Biopsy 145 The patient tolerated the procedure well. Were there any ulcerations or erosions found during the exploratory procedure that might account for the bleeding? Upper Respiratory Tract • Describe the functional relationship between the Lower Respiratory Tract respiratory system and other body systems. Respiration • Pronounce, spell, and build words related to the res- Connecting Body Systems–Respiratory System piratory system. Medical Word Elements • Describe pathological conditions, diagnostic and Pathology therapeutic procedures, and other terms related to Chronic Obstructive Pulmonary Disease Asthma the respiratory system. Chronic Bronchitis • Explain pharmacology related to the treatment of Emphysema respiratory disorders. Influenza • Demonstrate your knowledge of this chapter Pleural Effusions by completing the learning and medical record Tuberculosis activities. Breathing helps cardiovascular system helps in this vital function by regulate the pH (acidity-alkalinity) of the blood, providing blood vessels for carrying these gases. Anatomy and Physiology Key Terms This section introduces important respiratory system terms and their definitions. One branch leads a chamber lined with mucous membranes and tiny to the (11) right lung and the other to the (12) left hairs called cilia (singular, cilium). The inner walls of the trachea and bronchi are filtered, heated, and moistened to prepare it for its composed of mucous membrane (mucosa) embed- journey to the lungs. This membrane traps incoming parti- into a right and left side by a vertical partition of cles, and the cilia move the entrapped material cartilage called the nasal septum. At Because they are located higher in the nasal pas- the end of the bronchioles are tiny air sacs called sage than air normally travels during breathing, a (14) alveoli (singular, alveolus). An alveolus resem- person must sniff or inhale deeply to identify weak bles a small balloon because it expands and contracts odors. The (15) pulmonary throat (pharynx), a muscular tube that serves as a capillaries lie next to the thin tissue membranes of passageway for food and air. Carbon dioxide diffuses from the blood of three sections: the (2) nasopharynx, posterior within the pulmonary capillaries and enters the alve- to the nose; the (3) oropharynx, posterior to the olar spaces, while O2 from the alveoli diffuses into mouth; and the (4) laryngopharynx, superior to the blood. It is now ready Within the nasopharynx is a collection of lym- for delivery to all body tissues. The (6) palatine tonsils, more common- the right lung and two lobes in the left lung. It contains the heart, aorta, from microscopic organisms that may attempt esophagus, and bronchi. The (7) larynx (voice box) pleura, covers the lobes of the lungs and folds over contains the structures that make vocal sounds to line the walls of the thoracic cavity. A leaf-shaped structure on top of the brane lying closest to the lung is the (17) visceral larynx, the (8) epiglottis, seals off the air passage pleura; the membrane that lines the thoracic cavi- to the lungs during swallowing. The space between ensures that food or liquids do not obstruct the these two membranes is the (19) pleural cavity. The larynx is a short pas- contains a small amount of lubricating fluid, which sage that joins the pharynx with the (9) trachea permits the visceral pleura to glide smoothly over (windpipe). The erated by these cells, are returned to the environ- diaphragm assists in changing the volume of the ment. Respiration includes four separate processes: thoracic cavity to produce the needed pressure dif- • pulmonary ventilation, more commonly ferential for ventilation. When the diaphragm con- called breathing, which is a largely involun- tracts, it partially descends into the abdominal cavi- tary action that moves air into (inspiration) ty, thus decreasing the pressure within the chest and and out of (expiration) the lungs in response drawing air into the lungs (inspiration). The intercostal muscles assist the diaphragm oxygen and carbon dioxide between the alve- in changing the volume of the thoracic cavity by ele- oli and the blood in the pulmonary capillaries vating and lowering the rib cage. Expiration: Air forced out of lungs Pectoralis minor Pectoralis minor muscles contract muscles relax Lungs expand Lungs contract Intercostal muscles contract Intercostal muscles relax Diaphragm relaxes Diaphragm contracts and moves up and flattens Figure 7-2. Connecting Body Systems–Respiratory System The main function of the respiratory system is to provide oxygen to the entire body and expel car- bon dioxide from the body. Specific functional relationships between the respiratory system and other body systems are summarized below. Blood, lymph, and immune Digestive • Tonsils, adenoids, and other immune struc- • Respiratory system provides O2 needed tures in the respiratory tract protect for digestive functions. Musculoskeletal • Respiratory system provides O2 for Female reproductive muscle contraction. Medical Word Elements This section introduces combining forms, suffixes, and prefixes related to the respiratory system. Many disorders Pulmonary Disease of the respiratory system, including bronchitis and emphysema, begin as an acute problem but Chronic obstructive pulmonary disease become chronic over time. Their damag- duce a chronic partial obstruction of the air pas- ing effects are commonly irreversible. The patient finds it difficult to breath (dys- For diagnosis, treatment, and management of pnea) especially upon exertion and usually respiratory disorders, the medical services of a spe- exhibits a chronic cough. Chronic bronchitis Excess mucus production Distended Extra mucus bronchiole Inflamed Figure 7-3.

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The indication for the use of Sulphur as a restorative is trusted super cialis 80 mg, enfeebled nutrition associated with decoloration of tissues and secretions buy super cialis american express. The skin is blanched 80mg super cialis with amex, the iris loses color super cialis 80mg without a prescription, the hair is lighter in color in the young, changes rapidly to gray in the middle aged, and the urine is light colored as is the feces. The presence of cystine in the urine is an indication for the administration of Sulphur. We also employ sulphur in those cases in which there is excessive fetor of the excretions. We will occasionally find a case of chronic disease, in which the breath, the secretion from the skin, the urine, and the feces have a peculiar cadaverous odor, and we notice that with this there is a remarkable tendency to decomposition, and to breaking down of tissue. It is possible that this may be explained, by the necessity of Sulphur in the formation of the taurine of the bile. If this secretion of the liver is the normal antiseptic, and controls putrescency in the body, we can see why a deficiency of Sulphur may lead to the condition above named, and its administration be directly curative. A tincture is prepared from the imported root (Turkestan), using alcohol of 98 per cent. It is a mild stimulant to the nerve centers, to the circulation, and to the digestive canal. When first introduced it was proposed as a specific for cholera, but it was soon found that it fell far short of what was expected from it. It may be employed to relieve irritation of the bronchial tubes and lungs, and check cough, and as a remedy for hemorrhage from either lungs, bowels, uterus, or kidneys. Though the Skunk Cabbage has been extensively used, it has been in combination with other remedies, and the reports are so vague that we can not estimate its remedial action. It exerts a very decided influence upon the nervous system, relieving irritation and promoting normal functional activity. As a local application to the throat use one part of the tincture to four to ten parts of hot water, with a spray apparatus; or not having this, vaporize the fluid and let the patient inhale the steam. In small doses the tincture as above prepared will furnish a cheap and agreeable stomachic, relieving irritation and improving functional activity. It exerts a decided stimulant influence upon the female reproductive organs, and may be employed in functional diseases when such influence is desirable. I have employed it in these cases with most marked advantage, and value it very highly. The Taraxacum loses its medical properties by drying, hence that usually supplied by the drug trade is wholly inert. It exerts a stimulant influence upon the entire gastro-intestinal tract, promoting functional activity. Whilst its action is feeble, it is very certain, and will frequently prove more desirable than the more active remedies. It is a stimulant to the nervous system, and to the urinary passages, at the same time relieving irritation. The tincture of the Aranea Diadema is employed in Germany by some Homœopaths, and cases reported in which the cure was speedy and permanent. It is stimulant and tonic, and is thought to exert a beneficial influence in nervous affections, as hysteria, epilepsy, restlessness (nervousness), and inability to sleep. The leaves of the Arbor Vitæ has been a popular remedy in the treatment of intermittent and remittent fever, rheumatism, scurvy, etc. It allays irritation, and is gently stimulant and tonic, and may be employed in colds and catarrhal conditions. The Red Clover exerts a specific influence in some cases of whooping cough, and in the cough of measles. It is not curative in all, but when it does good, the benefit is speedy and permanent. We should be able to tell the exact condition where it proves beneficial, and where it fails, but thus far the use has been wholly empirical. It has given much satisfaction thus far, and is likely to prove a very valuable remedy. The common use of Trillium in large doses obtained its astringent influence, possibly from the tannin it contains. We would employ it in disease of mucous membranes with increased secretion, and expect decided benefit. In the earlier part of my practice I used Trillium in chronic bronchitis, in chronic catarrh, in cough with free expectoration, with excellent results. It needs to be thoroughly studied, and it will probably supply a want in our materia medica. And at one time it had quite a reputation as a cure for the gravel, and there is no doubt but that it exerts a marked influence in this direction. A tincture may be prepared of the recent roots in the usual way, with alcohol of 98 per cent. This remedy is slightly sedative, and increases secretion: it lessens the frequency of the pulse, and reduces the temperature, in the febriculæ, and in slight inflammation. It will compare with the asclepias, though its influence upon the skin is not so decided. It relieves irritation of mucous membranes and may be used in bronchitis, laryngitis, pharyngitis, gastric and intestinal catarrh. The Urtica has been employed in some diseases of the bowels, with reported good results. An old practitioner informs me, that in chronic disease of the large intestine with increased mucous secretion, he has never found anything so beneficial as this remedy. It exerts a somewhat similar influence to ergot and may be used to increase the strength of the pains during labor. In the second or third dilution it may be employed to relieve false pains, and unpleasant sensations in the pelvic region, during the latter months of pregnancy. Either in infusion or tincture the Uva Ursi may be employed as a stimulant and tonic diuretic, and is indicated by an enfeebled circulation and innervation to this apparatus. A sense of weight and dragging in the perineum (not dependent upon enlargement of the prostate), may be taken as the best indication. Valerian is a cerebral stimulant, and may be employed wherever a remedy of this character is indicated. It allays nervous irritability, modifies or arrests pain, promotes rest, and favors sleep, where these conditions result from an enfeebled cerebral circulation. It is very extensively used, and many times without benefit, as the condition of the nerve centers is very rarely taken into consideration. Veratrum from Western New York furnishes an excellent remedy, as is that from North Carolina and Northern Georgia. Now, it should be immediately crushed, and the year’s supply of tincture prepared. As commonly prepared for the drug trade (Norwood’s excepted), it is made of the dried root kept in stock from year to year, and possesses very feeble, if any medical properties. In this case, as with some other remedies, the process of drying destroys that finer medical action upon which we depend to influence the sympathetic nervous system. When properly used it not only lessens the frequency of the pulse, but it removes obstruction to the free circulation of the blood, and thus gives slowness, regularity, freedom, and an equal circulation in all parts of the body. To obtain this action it is necessary that the remedy be used in small doses, frequently repeated, and that sufficient time be given to accomplish the object without disturbing function or producing depression. Veratrum is sedative in large doses, and its influence upon the heart may be speedily obtained in this way. If the influence is continued there is impairment of the circulation, with tendency to congestion. As a general rule, the influence of large doses can not be maintained; either the remedy produces irritation of the stomach, so that it will no longer be tolerated, or its depressing influence upon the circulation becomes so great that it must be suspended. Acting through the sympathetic or ganglionic system of nerves, it removes obstruction to the capillary circulation, gives tone to the vascular system, and strength to the heart. I give this as a theory of the action of Veratrum, but whether true or not, there is no question with regard to the facts as above stated.

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Should you consult a professional purchase super cialis 80mg with amex, you’ll still find this book useful because most anxiety experts are familiar with the tools that we provide purchase cheap super cialis line, and they’ll help you implement them cheap super cialis american express. Tempering perfectionist tendencies Perfectionists believe they have to be the best in everything they do order super cialis with american express. They feel horrible when they make mistakes, and if they’re not outstanding at something, they generally refrain from trying. Fortunately, a good cost/benefit analysis can often help them see that perfectionism exacts a terrible toll. Thus, if they weren’t perfect, these folks assume that they would become sloths with no standards at all. If you’re worried about giving up on your perfectionism schema, we have good news for you. You may find it helpful to copy the following statements, or what we call “balanced views” on an index card. Carry your card around with you as a reminder for those times when you start to get hung up on perfectionism. Not only that, perfectionists of perfectionism probably can improve the qual- more often develop various types of anxiety ity of your work, sports, and other endeavors disorders, depression, physical ailments, and as long as you don’t let it get out of hand. A more balanced schema is that you like doing things well, but that all humans make mistakes and so do you. For example, think about all the people you admire, yet who make numerous mistakes over time. Balancing an approval addict Approval addicts desperately want to be liked all the time. Chapter 7: Busting Up Your Agitating Assumptions 119 ✓ What other people think matters, but it’s not usually crucial. In addition, consider collecting evidence that refutes your anxious approval schema. For example, think about people whom you like and admire who manage to speak their minds and look out for their own needs. If you feel addicted to approval and assume you must have the approval of others at all times and at virtually any cost, consider a more balanced per- spective. Sure, everyone likes to be liked, but realize that no matter what you do, some people won’t like you some of the time. Try thinking that your needs matter and that what other people think of you does not define your worth. Balancing vulnerability People who hold the vulnerability schema feel unsafe and worry constantly about every conceivable mishap. They might worry about safety, health, natural disasters, or the future; they often feel like victims of life’s circum- stances. The modern world with constant news about pandemics, natural catastrophes, financial ruin, and terror probably increases everyone’s sense of vulnerability. People with this assumption fail to understand that worry has never stopped a single catastrophe. Nor does excessive worry help you prepare for the inevitable bad luck and misfortune that occur in everyone’s life. A better, alternative assumption can keep you reasonably safe without all that worry. If you want to give up your vulnerable assumption, try carrying these ideas with you and use them like mantras, repeating them to yourself frequently: ✓ I need to take reasonable precautions but stop obsessing over safety. Try thinking that no one can prevent the trials and tribulations of life, but that you can usually cope when they do occur. Collect evidence about the many unpleasant incidents that you were able to cope with in the past. For example, when you had high blood pressure, perhaps you exercised or took medication to control it, or when you lost someone whom you cared for, you grieved, but you survived. They always want to know everything that’s going on around them in their families and at work. Many highly successful, intelligent folks do, and this assumption isn’t easy to give up. As for all agitating assumptions, we have an alternative, balanced view that will serve you better than control ever did. Think of a time in your life when someone else was in charge and things turned out pretty well anyway. Diminishing dependency People with the anxious dependency schema believe they can’t make it on their own. They ask for advice when they don’t really need it and seek reas- surance that they’re loved or that what they’ve done is right. The thought of Chapter 7: Busting Up Your Agitating Assumptions 121 not having a close relationship terrifies them. You’re not likely to find someone with an agitating depen- dency assumption eating alone at a restaurant. Excessively dependent people eventually annoy and irritate those whom they depend on. Partners of dependent people often distance themselves from the relationship after they become weary of constant clinging and helplessness. If you buy into the defective dependency assumption — that you can’t be all right on your own and that you need help with all that you do — try think- ing in a more reasonable fashion. Realize that it’s nice to have someone to depend on, but that you’re capable of many independent actions. Realizing that you have taken independent action successfully and remembering that you have pulled yourself through many difficult spots all on your own can boost your confidence enough to help you take more independent action in the future. In our work with clients, we found that these anxious schemas are surpris- ingly common, and many successful people who don’t even have a full-blown anxiety disorder tend to fall under the influence of one or more of these assumptions. Therefore, it’s important that you don’t beat up on yourself for “being under the influence. Perhaps you had an unfortunate accident or trauma that caused you to feel vulnerable. Maybe your parents failed to provide you with consistent care and love, leading you to feel insecure, and, as a result, you yearn for help and affection. These represent merely a few of an infinite number of explanations for why you develop agitating assump- tions. The point is that you didn’t ask for your problematic schemas; you came by them honestly. Go slowly; take pleasure in the journey, and realize that change takes time and practice. Chapter 8 Facing Fear One Step at a Time In This Chapter ▶ Discovering how exposure works ▶ Facing fear through your imagination ▶ Confronting your fears head-on ▶ Applying exposure to your specific anxiety problem hen life hands you lemons, make lemonade. Shifting to another metaphor, if you fall off your horse, everyone knows that it’s best to jump right back into the saddle. This chapter explains how you can get back in the saddle and even make some lemonade while you’re up there (sorry). You don’t have to face them all at once, because taking small steps does the trick. This chapter provides a recipe called expo- sure for overcoming your personal anxiety problem one step at a time. Exposure: Coming to Grips with Your Fears No single strategy discussed in this book works more effectively in the fight against anxiety than exposure. Simply put, exposure involves putting yourself in direct contact with whatever it is that makes you anxious. After all, it probably makes you feel pretty anxious to even think about star- ing your fears in the face. We understand that reaction, but please realize that if you’re terrified of heights, exposure doesn’t ask you to lean over the edge of the Grand Canyon tomorrow. Or if you worry about having a panic attack in crowds, you don’t have to sit in the stands of the next Super Bowl as your first step. The following sec- tions show you how to create an exposure plan for your own fear. If you find yourself procrastinating with the recommendations in this chapter, read Chapter 4 to build motivation and overcome obstacles to change. If you still find these ideas difficult to consider, you may want to consult a profes- sional for help.

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Rectal thermometers purchase super cialis 80 mg on-line, rectal tubes generic super cialis 80mg with visa, and enemas are avoided because of the risk of injury and bleeding in the prostatic fossa buy cheap super cialis 80mg online. The patient is assessed for their occurrence; if they occur super cialis 80 mg, the nurse administers antibiotics as prescribed. Because the risk for infection continues after discharge from the hospital, the patient and family need to be instructed to monitor for signs and symptoms of infection (fever, chills, sweating, myalgia, dysuria, urinary frequency, and urgency). The patient and family are instructed to contact the urologist if these symptoms occur. The patient who is receiving heparin must be closely monitored for excessive bleeding. Furosemide (Lasix) may be prescribed to promote urination and initiate postoperative diuresis, thereby helping to keep the catheter patent. The nurse observes the lower abdomen to ensure that the catheter has not become blocked. The color of the urine is noted and documented; a change in color from pink to amber indicates reduced bleeding. Blood pressure, pulse, and respirations are monitored and compared with baseline preoperative vital signs to detect hypotension. The nurse also observes the patient for restlessness, diaphoresis, pallor, any drop in blood pressure, and an increasing pulse rate. Drainage of the bladder may be accomplished by gravity through a closed sterile drainage system. A three-way drainage system is useful in irrigating the bladder and preventing clot formation (Fig. Some urologists leave an indwelling catheter attached to a dependent drainage system. Gentle irrigation of the catheter may be prescribed to remove any obstructing clots. The drainage system is irrigated, if indicated and prescribed, to clear any obstruction. The amount of fluid recovered in the drainage bag must equal the amount of fluid injected. Overdistention of the bladder is avoided, because it can induce secondary hemorrhage by stretching the coagulated blood vessels in the prostatic capsule. To prevent traction on the bladder, the drainage tube (not the catheter) is taped to the shaved inner thigh. The nurse explains the purpose of the catheter to the patient and assures him that the urge to void results from the presence of the catheter and from bladder spasms. He is cautioned not to pull on the catheter, because this causes bleeding and subsequent catheter blockage, which leads to urinary retention. Complications With Catheter Removal After the catheter is removed (usually when the urine appears clear), urine may leak around the wound for several days in the patient who has undergone perineal, suprapubic, or retropubic surgery. The cystostomy tube may be removed before or after the urethral catheter is removed. Some urinary incontinence may occur after 255 catheter removal, and the patient is informed that this is likely to subside over time. Sexual Dysfunction Depending on the type of surgery, the patient may experience sexual dysfunction related to erectile dysfunction, decreased libido, and fatigue. These issues may become a concern to the patient soon after surgery or in the weeks to months of rehabilitation. Several options to restore erectile function are discussed with the patient by the surgeon or urologist. These options may include medications, surgically placed implants, or negative-pressure devices. Reassurance that the usual level of libido will return after recuperation from surgery is often helpful for the patient and his partner. The patient should be aware that he may experience fatigue during rehabilitation from surgery. This fatigue may also decrease his libido and alter his enjoyment of usual activities. Nursing interventions include assessing for the presence of sexual dysfunction after surgery. Providing a private and confidential environment to discuss issues of sexuality is important. The emotional challenges of prostate surgery and its consequences need to be carefully explored with the patient and his partner. Providing the opportunity to discuss these issues can be very beneficial to the patient. For patients who demonstrate significant problems adjusting to their sexual dysfunction, a referral to a sex therapist may be indicated. Promoting Home and Community-Based Care Teaching Patients Self-Care The patient undergoing prostatectomy may be discharged within several days. If a retropubic or suprapubic prostatectomy is performed, the hospital stay may extend to 5 to 7 days. The patient and family require instructions about how to manage the drainage system, how to assess for complications, and how to promote recovery. The nurse provides verbal and written instructions about the need to maintain the drainage system and to monitor urinary output, about wound care, and about strategies to prevent complications, such as infection, bleeding, and thrombosis. In addition, the patient and family need to know about signs and symptoms that should be reported to the physician (eg, blood in urine, decreased urine output, fever, change in wound drainage, calf tenderness). As the patient recovers and drainage tubes are removed, he may become discouraged and depressed because he cannot regain bladder control immediately. Furthermore, urinary frequency and burning may occur after the catheter is removed. Teaching the patient the following exercises may help him regain urinary control: Tense the perineal muscles by pressing the buttocks together; hold this position; relax. This exercise can be performed 10 to 20 times each hour while sitting or standing. It is important that the patient know that regaining urinary control is a gradual process; he may continue to ―dribble‖ after being discharged from the hospital, but this should gradually diminish (within 1 year). Lining underwear with absorbent pads can help minimize embarrassing stains on clothing. The urine may be cloudy for several weeks 256 after surgery but should clear as the prostate area heals. While the prostatic fossa heals (6 to 8 weeks), the patient should avoid activities that produce Valsalva effects (straining, heavy lifting), because this may increase venous pressure and produce hematuria. He should avoid long motor trips and strenuous exercise, which increase the tendency to bleed. He should also know that spicy foods, alcohol, and coffee may cause bladder discomfort. The patient should be cautioned to drink enough fluids to avoid dehydration, which increases the tendency for a blood clot to form and obstruct the flow of urine. Signs of complications, such as bleeding, passage of blood clots, a decrease in the urinary stream, urinary retention, or symptoms of urinary tract infection symptoms, should be reported to the physician (Chart 49-5). Continuing Care Referral for home care may be indicated if the patient is elderly or has other health problems, if the patient and family cannot provide care in the home, or if the patient lives alone without available supports. The nurse reinforces previous teaching and assesses the ability of the patient and family to manage required care. The home care nurse encourages the patient to ambulate and to carry out perineal exercises as prescribed. The patient is reminded about the importance of participating in routine health screening and other health promotion activities. If the prostatectomy was performed to treat prostate cancer, the patient and family are also instructed about the importance of follow-up and monitoring with the physician. Evaluation Expected Preoperative Patient Outcomes Expected preoperative patient outcomes may include the following: Demonstrates reduced anxiety States that pain and discomfort are decreased Relates understanding of the surgical procedure and postoperative course and practices perineal muscle exercises and other techniques useful in facilitating bladder contrlo Expected Postoperative Patient Outcomes Expected postoperative patient outcomes may include the following: Reports relief of discomfort Exhibits fluid and electrolyte balance o Irrigation fluid and urinary output are within parameters determined by surgeon o Experiences no signs or symptoms of fluid retention Participates in self-care measures o Increases activity and ambulation daily o Produces urine output within normal ranges and consistent with intake o Performs perineal exercises and interrupts urinary stream to promote bladder control o Avoids straining and lifting heavy objects Is free of complications 257 o Maintains vital signs within normal limits o Exhibits wound healing, without signs of inflammation or hemorrhage o Maintains acceptable level of urinary elimination o Maintains optimal drainage of catheter and other drainage tubes o Reports understanding of changes in sexual function 258 Chapter 54 Assessment and Management of Patients With Rheumatic Disorders Rheumatic Diseases • ―Arthritis‖ • More than 100 different disorders • Affect primary the joints, but also muscles, bone, ligament, tendons, cartilage • Classification –Monoarticular or polyarticular –Inflammatory or noninflammatory Characteristic Degenerative Changes— ―Degradation‖ Joint space narrowing and osteophytes (bone spurs) are characteristic of degenerative changes in joints. Although the cause of degeneration of the articular cartilage is poorly understood, the process is known to be metabolically active and therefore is more accurately called ―degradation.