Reference no: EM133846673
Overview
The most frequent malignant tumor of the urinary tract is transitional cell carcinoma of the bladder. Bladder cancer occurs most commonly between the ages of 60 and 70 years and is at least three times more common in men as in women. Risk factors include cigarette smoking, exposure to dyes used in the rubber and other industries, and chronic abuse of phenacetin-containing analgesics. Patients who take the diabetes drug pioglitazone (Actos) also have an increased risk for bladder cancer.
Hematuria that is painless, either chronic or intermittent, or either microscopic or gross, is the most common clinical finding. Superficial tumors may be treated surgically with transurethral resection of the bladder tumor (TURBT) or with partial cystectomy. When the tumor is invasive or involves the trigone (the area where the ureters insert into the bladder) and there is no evidence of metastasis beyond the pelvic area, a radical cystectomy with urinary diversion is the treatment of choice.
Case Study
R.F. is a 66-year-old man who presents to the clinic for a routine physical for the first time in 6 years. He is a salesman who travels about half of each week, and his wife is a buyer for a large department store. He has always been proud of his health and family history of longevity. He has noticed an increasingly productive morning cough and some shortness of breath on exertion. He is a current smoker who has smoked 2 packs of cigarettes a day for the past 45 years (90 pack-years), and he has 1 to 2 alcoholic drinks a day. He has mild osteoarthritis of his hips and knees but refuses to use medication for pain. His only medication is 1 aspirin tablet a day because years ago a doctor told him it would help prevent heart attacks and strokes. He is overweight, with a height of 5 ft 10 in (178 cm) and a weight of 195 lbs.
R.F.'s physical examination reveals some increase in anteroposterior (AP) diameter, coarse crackles in both lungs, and a cough productive of clear sputum. His prostate is slightly enlarged, but he denies any difficulty with voiding. When questioned, he says his urine has been a dark color off and on for the past few months. A dipstick urine test done at the clinic indicates 2+ blood in the urine. Blood specimens are drawn for hematology and chemistries, and a urine specimen is taken for a urinalysis. When the urinalysis indicates marked hematuria, R.F. returns to the clinic to provide another urine specimen for cytology and culture.
Questions
1. Identify risk factors for bladder cancer.
2. Describe nursing care of a patient following a cystoscopy with biopsy.
3. Explain the TNM staging system for cancer.
4. Compare and contrast various methods for urinary diversion.
5. Develop a nursing care plan for a patient with bladder cancer.
6. Prioritize nursing care of an immediate postoperative patient following a radical cystectomy with urinary diversion.
7. Appropriately delegate postoperative tasks for a patient following a radical cystectomy with urinary diversion.
8. Develop an individualized teaching plan for a patient with an ileal conduit.