Nursing Care Plan For Bladder Cancer

For nursing care plan for bladder cancer, please read this article completely. Let’s start at the very beginning.

Bladder cancer is papillomatous growth in the bladder urothelium that undergo malignant changes and that may infiltrate the bladder wall. Predisposing factors include cigarette smoking, exposure to industrial chemicals and exposure to radiation. Common signs of metastasis include the liver, bones, and lungs As the tumor progresses can extend to the rectum, vagina and retroperitoneal structures. because

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Assessment

  • Painless hematuria
  • Dysuria
  • Gross hematuria
  • Obstruction of urine flow
  • Development of fistula ( urine from the vagina, fecal material in the urine)

Diagnostic Evaluation

Biopsies of the tumor and adjacent mucosa are definitive, but the procedures used are cystoscopy, biopsy of the tumor and adjacent mucosa. Excretory urography, computed CT scan, ultrasonography, bimanual examination by anesthesia, cytologic evaluation of fresh urine and saline bladder washings are some other diagnostic evaluations. because
Molecular assays, bladder tumor antigens, adhesion molecules and others are being studied. because

Primary Nursing Diagnosis is the risk for altered urinary elimination related to the obstruction of urinary flow. because

Medical Management

Radiation

Most bladder cancers are poorly radiosensitive and require high doses of radiation. Radiation therapy is more acceptable for an advanced disease that cannot be eradicated by surgery. Palliative radiation may be used to relieve pain and bowel obstruction and control potential hemorrhage and leg edema caused by venous or lymphatic obstruction. Intracavitary radiation may be prescribed which protect adjacent tissues. External radiation combined with chemotherapy or surgery may be prescribed because of the external radiation alone may be ineffective. because

Complications of radiations:

  1. A bacterial cystitis
  2. Proctitis
  3. Fistula formation
  4. Ileitis or colitis
  5. Bladder ulceration and hemorrhage because
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Chemotherapy

  1. Intravesical installation
An alkylating chemotherapeutic agent is instilled into the bladder. This method provides a concentrated topical treatment with little systemic absorption. Chemotherapeutic agents used may include thiotepa, mitomycin (Mutamycin), doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and Bacillus Calmette-Guerin. The medication is injected into a urethral catheter and retain for two hours. Following installation, the client’s position is rotated every 15 to 30 minutes, starting in the supine position to avoid lying on a full bladder. After 2 hours, the client voids in a sitting position and is instructed to increase fluids to flush the bladder. Treat the urine as a biohazard and send to radioisotope laboratory for monitoring. For 6 hours following intravesical therapy, disinfect the toilet with household bleach after the client has voided. because
 2. Systemic chemotherapy
Systemic chemotherapy is used to treat inoperable or late tumors. Agents used may include, cisplatin (Platinol), doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), methotrexate (Folex) and Pyridoxine.
3. Complications of chemotherapy include bladder irritation Hemorrhagic cystitis because

Surgical Interventions

1. Transurethral resection of the bladder
Local resection and fulguration ( destruction of tissue by electrical current through electrodes placed in direct contact with the tissue). Perform for early tumor for a cure or for inoperable tumors for palliation. because
2. Partial Cystectomy
Partial cystectomy is the removal of up to half of the bladder. The procedure is done for early tumors and for clients who cannot tolerate radical cystectomy. During the initial postoperative period bladder capacity is reduced greatly to about 60 mL; however, as the bladder tissue expands, the capacity increases to 200-400 mL. Maintenance of a continuous output of urine following surgery is critical to prevent bladder distention and stress on the suture line. A urethral catheter and a suprapubic catheter may be in place, in the suprapubic catheter may be left in place for 2 weeks until healing occurs. because
3. Cystectomy and urinary diversion
The procedure involves removal of the bladder and urethra in the women, and the bladder, the urethra, and usually the prostate and seminal vesicles in men. When the bladder and urethra are removed, permanent urinary diversion is required. The surgery may be performed into stages if the tumor is expensive, with the creation of the urinary diversion first and the cystectomy several weeks later. If a radical cystectomy is performed lower extremity lymphedema may occur as a result of lymph node dissection, and impotence may occur in the may client. because
4. Ileal conduit

The ileal conduit also is called ureteroileostomy or Bricker’s procedure. Ureters are implanted into a segment of the ileum, with the formation of an abdominal stoma. The urine flows into the conduit and is propelled continually out through the stoma by peristalsis. The client is required to wear an appliance over the stoma to collect the urine. Complications include obstruction, pyelonephritis, leakage at the anastomosis site, stenosis, hydronephrosis, calculuses, skin irritation and ulceration, and stomal defects. because

5. Kock pouch 
The Koch pouch is a continent internal ileal reservoir created from a segment of the ileum and ascending colon. The ureters are implanted into the side of the reservoir, and a special nipple valve is constructed to attach the reservoir to the skin. Postoperatively, the client will have a 24 to 26 Foley catheter in place to drain urine continuously until the pouch has healed. The catheter is irrigated gently with NS to prevent obstruction from mucus or clots. Following removal of the catheter, the client is instructed in how to self-catheterize and to drain the reservoir at 4 to 6-hour intervals.
6. Indiana pouch

A continent reservoir is created from the ascending colon and terminal ileum, making a pouch larger than the Koch pouch. Postoperatively, the client will have a 24 to 26 Foley catheter in place to drain urine continuously until the pouch has healed. The Foley catheter is irrigated gently with NS to prevent obstruction from mucus or clots. Following removal of the Foley catheter, the client is instructed in how to self-catheterize and to drain the reservoir at 4 to 6-hour intervals. because

7.Creation of a neobladder

Creation of a neobladder is similar to the creation of an internal reservoir, with the difference being that instead of emptying through an abdominal stoma, the bladder empties through a pelvic outlet into the urethra. The client empties the neobladder by relaxing the external sphincter and creating abdominal pressure or intermittent self- catheterization. because

8. Percutaneous nephrostomy or pyelostomy 
When the cancer is inoperable to prevent obstruction when we use these procedures. The procedures involve a percutaneous or surgical insertion of a nephrostomy tube into the kidney for drainage. Nursing interventions involve stabilizing the tube to prevent dislodgement and monitoring output. because
9. Ureterostomy 
Ureterostomy may be performed as a palliative procedure if the ureters are obstructed by the tumor. The ureters are attached to the surface of the abdomen, where the urine flows directly into a drainage appliance without a conduit. Potential problems include infection, skin irritation, and obstruction to urinary flow as a result of strictures at the opening. because
10. Vesicostomy
The bladder is sutured to the abdomen, and a stoma is created in the bladder wall. The bladder empties through the stoma. because

Nursing Intervention

For patients who require radical cystectomy with urinary diversion, offer support and reinforcement of the information. Be sure what to expect. Involve another family member in the preoperative education. If it is needed, arrange a preoperative visit by someone who has adjusted well to a similar diversion.
If any type of stoma is to be created, arrange for a preoperative visit from the entero-stomal therapist. The entero-stomal therapist can assist in the selection and marking of the stoma site (although the stoma site is somewhat contingent upon the type of urinary diversion to be performed) and can introduce the patient to the external urine collection pouch and related care.
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Nursing Care Plan For Bladder Cancer
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