Question

You are caring for a 78-year-old patient after the creation of an ileal conduit. What is the best description of the ileal conduit? Describe the complications that may follow the placement of an ileal conduit. What assessments do you commonly perform in the immediate post-operative period?

Enumerate the Risk Factors for Cervical Cancers.

A 55-year-old patient has been diagnosed with cervical cancer. She reports that she has a strong family history of cancer; two sisters have breast cancer. Her mother died of cancer when the patient was a child, and she is not certain of the type of cancer. Because of her strong family history, she is concerned about the health status of her twin daughters who are in their early 30s. She has asked you to discuss the risks for cancer with them. Explain what counseling and education you will provide to the patient and her daughters. Identify the evidence base for the counseling and education and the strength of that evidence. How will you approach your counseling and education?

Answer 1

Ileal conduit

It is made up of a section of the ileum,which is a part of small intestine. During an ileal conduit surgery,a segment of the ileum is removed from the bowel and one end of it is closed of while the other end is pulled through the urostomy and made into a stoma.

Ileal conduit care

It requires a different way of caring that the urine is emptied into an ostomy pouch rather than drained by a catheter.

Problems associated with ileal conduit comes with an ill- fitting pouch system results in irritated stoma and skin.

Measures to avoid skin and stoma irritation

1. Use a correct fitting pouch system. The newly made stoma is in the progress of shrinking down after surgery. Notify doctor or ostomy nurse when your stoma changes over half an inch in size over a single day.
2. A pouch opening that is too large can cause urine to leak and irritate the skin.An opening that is too small can cut or injure stoma causing it to swell.
3. Change the pouching system once a week or more to avoid leaks and skin irritation.
4. Be gentle when you remove the pouching system
5. Don't rip the skin carrier off but peel it away gently.
6. Do not remove the pouching system more than once a day unless there is an issue.
7. Cleaning the stoma and skin and water is enough rather than using mild soaps.
8. Look for allergic reactions and sensitivities.

Complications for ideal conduit

Early complications

• Bowel related
• Bowel anastomosis related
• Ureteroenteric anastomosis leakage
• Enteric fistula
• Prolonged ileus
• Conduit necrosis

Late complications

• Stoma related
• Abdominal wall related
• Conduit stenosis
• Ureteroenteric anastomotic stricture
• Hydronephrosis
• Kidney failure
• Metabolic changes

Risk factors associated with cervical cancer

The following factors may increase woman's risk of developing a cervical cancer.

1. Human papilloma virus ( HPV) infection : Most people are infected with HPV when they are sexually active. The HPV types ,or strains that are most frequently associated with cervical cancer are HPV16 and HPV18.Starting to have sex at earlier age or having multiple sexual partners puts a person in high risk.
2. Immune system deficiency : Lowered immune system have higher risk of developing cervical cancer. Lower immune system may be a result of immune suppressors,organ transplantation,chemotherapy,HIV infection.
3. Herpes : Woman having herpes have a higher risk of developing cervical cancer.
4. Smoking: Woman who smoke are twice as likely to develop cervical cancer.
5. Age : Risk lies between late teens and mid 30's. Have regular PAP test and HPV test.
6. Socio-economic factors: Cervical cancer is most common in groups of women who are less likely to have access to screening for cervical cancer.
7. Oral contraceptives: Birth control pills are associated with increased risk of cervical cancer
8. Exposure to diethyl stilbestol: Women exposed to DES should have an annual pelvic examinations include PAP test.

Evidence based counselling

• A risk factor is anything that increases a person's chance of developing cancer.
• Some people with several risk factors never develop cancer ,while others with no risk factors do.
• Most people are diagnosed with cancer don't have a family history of the disease.
• Only about 5% to 10% of all cases of cancer are inherited.
• Sometimes people in the same family get cancer because they share behaviour that raise their risk.
• Practice regular exercise and timely healthy diet.
• Include yoga to the lifestyle
• Include vegetables and fruits that are rich in antioxidants to the diet.
• Keep energetic and keep your mind positive always.