2. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
CANCER
ETIOLOGY
Cancer is the growth of abnormal cells
PATHOPHYSIOLOGY
in the body. These extra cells grow
ASSESSMENT
together and form masses, called
COMPLICATIONS
tumors. In bladder cancer, these
growths happen in the bladder.
OUTPUT OF GROUP 7
3. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
THE BLADDER
ETIOLOGY
• The bladder is the part of your urinary
PATHOPHYSIOLOGY
tract that stores your urine until you are
ASSESSMENT
ready to let it out.
COMPLICATIONS
• Bladder cancer can usually be cured if
it is found and treated early. And most
bladder cancer is found early.
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4. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
Bladder cancer is the rapid,
ETIOLOGY
uncontrolled growth of abnormal cells
PATHOPHYSIOLOGY
in the bladder. Cancer usually begins in
ASSESSMENT
the lining of the bladder (superficial
COMPLICATIONS
bladder cancer). The cancerous cells
may grow through the lining into the
muscular wall of the bladder.
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5. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
ETIOLOGY
Invasive bladder cancer may spread to
PATHOPHYSIOLOGY
lymph nodes, other organs in the pelvis
ASSESSMENT
(causing problems with kidney and
COMPLICATIONS
bowel function), or other organs in the
body, such as the liver and lungs.
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6. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
ETIOLOGY Bladder cancer is classified by stage and
PATHOPHYSIOLOGY grade. The stage is determined by the
ASSESSMENT cancer growth in the bladder wall and
COMPLICATIONS how far it has spread to nearby tissues
and other organs, such as the lungs, the
liver, or the bones.
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7. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
The grade of bladder cancer is
ASSESSMENT
determined by how the cancer cells look
COMPLICATIONS
in comparison with normal bladder cells.
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8. LA D D E R A N C E R
OVERVIEW
• Cigarette smoking
INTRODUCTION
• Chemical exposures at work
ETIOLOGY
• Bladder Stones
PATHOPHYSIOLOGY
• High Cholesterol Intake
ASSESSMENT
• High Urinary Ph
COMPLICATIONS
• Pelvic Radiation Therapy
• Cancer Arising from the prostate,
colon and rectum in males
OUTPUT OF GROUP 7
9. LA D D E R A N C E R
OVERVIEW
NON MODIFIABLE RISK FACTORS:
INTRODUCTION
• Age: Seniors are at the highest risk of
ETIOLOGY
developing bladder cancer.
PATHOPHYSIOLOGY
ASSESSMENT
• Sex: Men are three times more likely
COMPLICATIONS than women to have bladder cancer.
• Race: Whites have a much higher risk
of developing bladder cancer than other
races.
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10. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
ETIOLOGY
• History of bladder cancer: If you have
PATHOPHYSIOLOGY
had bladder cancer in the past, your risk
ASSESSMENT
of developing another bladder cancer is
COMPLICATIONS
higher than if you had never had
bladder cancer.
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11. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
ETIOLOGY • Chronic bladder inflammation:
PATHOPHYSIOLOGY Frequent bladder infections, bladder
ASSESSMENT stones, and other urinary tract problems
COMPLICATIONS that irritate the bladder increase the risk
of developing a cancer, more commonly
squamous cell carcinoma.
OUTPUT OF GROUP 7
12. LA D D E R A N C E R
OVERVIEW
INTRODUCTION • Birth defects: Some people are born
ETIOLOGY with a visible or invisible defect that
PATHOPHYSIOLOGY connects their bladder with another
ASSESSMENT organ in the abdomen or leaves the
COMPLICATIONS bladder exposed to continual infection.
This increases the bladder's vulnerability
to cellular abnormalities that can lead to
cancer.
OUTPUT OF GROUP 7
13. LA D D E R A N C E R
OVERVIEW
Exposure of bladder to Carcinogen
INTRODUCTION
Premalignant proliferative changes in
ETIOLOGY transitional cell layer (dysplasia)
PATHOPHYSIOLOGY Papillary or transitional cell tumors (trigoone
of the bladder & lateral walls)
ASSESSMENT
Staging of the tumor (depth of penetration) &
COMPLICATIONS degree of metastasis
Metastasis to nearby organs
Invasion to pelvic lymph nodes& other organs
Poor prognosis (death)
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14. LA D D E R A N C E R
OVERVIEW
INTRODUCTION • Hematuria
ETIOLOGY • Dysuria
PATHOPHYSIOLOGY • Oliguria
ASSESSMENT • Frequent urinary tract infections
SYMPTOMS (UTIs).
DIAGNOSIS
PICTURES • Flank Pain
• Weight loss
• Anemia
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15. LA D D E R A N C E R
OVERVIEW
• BTA – Bladder Tumor Antigen Test
INTRODUCTION
• NMPZZ – Nuclear Matrix Protein Test
ETIOLOGY • TRAP – Telomeric Repeat Amplification
PATHOPHYSIOLOGY Protocol Assay
• IVP – Intravenous Pyelograph
ASSESSMENT • XRAY
SYMPTOMS • MRI – Magnetic Resonance Imaging
DIAGNOSIS • CT Scan – Computerized Tomography
PICTURES Scan
• UTZ – Ultrasonography
• CEA – Cerum Carcinoembryonic Antigen
• Biopsy
OUTPUT OF GROUP 7
16. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
SYMPTOMS
DIAGNOSIS Bladder cancer : the bladder wall is massively
PICTURES infiltered by an ulcerated and hemorragic tumor.
Courtesy Pierre Bedossa
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17. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
SYMPTOMS
DIAGNOSIS
Cystoscopic view of a papillary bladder tumor
PICTURES
(top); the bladder wall is visible on the bottom
right.
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18. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
SYMPTOMS
DIAGNOSIS
PICTURES This photograph illustrates mucinous
adenocarcinoma of the urinary bladder. The tumor
has a glistening surface.
OUTPUT OF GROUP 7
19. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
SYMPTOMS
COMPLICATIONS
DIAGNOSIS
PICTURES
OUTPUT OF GROUP 7
20. LA D D E R A N C E R
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY • Metastasis to nearby organs
ASSESSMENT
• Hydronephrosis
COMPLICATIONS • Ascitis
• Infertility
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21. LA D D E R A N C E R
NURSING DIAGNOSIS
1. Chronic pain related to progression of disease
INTERVENTIONS
process
•Direct tumor involvement is the primary cause of
cancer pain. It is believed to be the mechanical,
resulting from stretching of the tissues and
compression. Chemicals from and toxins that
activate and sensitize the nociceptors &
mechanoceptors that is also responsible for
cancer pain.
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22. LA D D E R A N C E R
NURSING DIAGNOSIS
INTERVENTIONS
2. Imbalanced nutrition: less than body
requirements related to disease
process.
• The anorexia-cachexia syndrome is the
most common cause of malnutrition in
cancer cancers parasitic activity reduces
the nutrients available to the body.
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23. LA D D E R A N C E R
NURSING DIAGNOSIS
3. Impaired urinary elimination related
INTERVENTIONS
to bladder mass as evidenced by dysuria
and oliguria
Metastasis of the bladder affects the
normal process and patterns of voiding.
Infection of the urinary tract is the
common complication, producing
frequency, surgery dysuria and even
hematuria.
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24. LA D D E R A N C E R
NURSING DIAGNOSIS
INTERVENTIONS
MEDICAL CHEMOTHERAPY with combination of
SURGICAL
NURSING
methotrexate, 5 fluorouracil,
vinblastine, doxorubicin (Adriamycin)
and cisplatin.
• IV CHEMOTHERAPY
• TOPICAL CHEMOTHERAPY
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25. LA D D E R A N C E R
NURSING DIAGNOSIS
INTERVENTIONS
MEDICAL • Transurethral resection or fulguration
SURGICAL
NURSING
of the bladder
• Urinary Diversion
• Cystectomy
•Simple
•Radical
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26. LA D D E R A N C E R
NURSING DIAGNOSIS
INTERVENTIONS • Encourage to stop smoking (if px is a
MEDICAL
smoker)
SURGICAL
NURSING • Pain Management
• Proper nutrition provision
• Emotional support
• Provide Education
•Encourage decision making
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27. E P H R E C T O M Y
DEFINITION
TYPES
INDICATION A nephrectomy is the surgical removal of
POST OP CARE a kidney, the organ that filters waste
COMPLICATIONS from the blood and produces urine.
NURSING DIAGNOSIS
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28. E P H R E C T O M Y
DEFINITION
TYPES
INDICATION
POST OP CARE
COMPLICATIONS
NURSING DIAGNOSIS
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29. E P H R E C T O M Y
DEFINITION
TYPES
INDICATION
POST OP CARE • Partial nephrectomy – Part of one
COMPLICATIONS kidney is removed.
NURSING DIAGNOSIS • Simple nephrectomy – All of one
kidney is removed.
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30. E P H R E C T O M Y
DEFINITION
TYPES • Radical nephrectomy – All of one
INDICATION kidney is removed together with the
POST OP CARE neighboring adrenal gland (the
COMPLICATIONS adrenaline-producing gland that sits on
NURSING DIAGNOSIS top of the kidney) and neighboring
lymph nodes.
• Bilateral nephrectomy – Both kidneys
are removed.
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31. E P H R E C T O M Y
DEFINITION
•kidney deformities (birth defects:
TYPES
congenital abnormalities)
INDICATION
•injury (trauma)
POST OP CARE
•disease
COMPLICATIONS
•infection
NURSING DIAGNOSIS
•hypertension
•tumor
•removal of kidney from donor for kidney
transplant
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32. E P H R E C T O M Y
DEFINITION
TYPES
INDICATION • Vital Signs Monitoring
POST OP CARE • Monitor Urine output
COMPLICATIONS • Assess for bleeding
NURSING DIAGNOSIS • Maintain asepsis
• Pain Management (Anagesics)
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33. E P H R E C T O M Y
DEFINITION
TYPES •Blood clots in the legs that may travel to
INDICATION the lungs
POST OP CARE
•Breathing problems
COMPLICATIONS •Infection, including in the surgical wound,
NURSING DIAGNOSIS
lungs (pneumonia), bladder, or kidney
•Blood loss
• Reactions to medications
OUTPUT OF GROUP 7
34. E P H R E C T O M Y
DEFINITION
TYPES 1. Ineffective breathing pattern related to
flank incision
INDICATION
• The surgical approaches to the kidney
POST OP CARE predisposes the patient to respiratory
COMPLICATIONS
complications and paralytic ileus. If the
pleural cavity has been entered during
NURSING DIAG. surgery, a pneumothorax may occur.
These factor can lead to pain and limited
chest movement during breathing and
thus increases the risk of the patient for
respiratory complication.
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35. E P H R E C T O M Y
DEFINITION
TYPES 2. Acute pain related to surgical incision.
INDICATION The patient may experience acute pain
POST OP CARE
which is sudden onset of the incision site.
COMPLICATIONS
Acute pain is transmitted by a delta fibers
NURSING DIAG. that are myelated and transmit inpulses
rapidly and thus causes the [patient to
have an increased pulse rate, BP, and RR.
OUTPUT OF GROUP 7
36. E P H R E C T O M Y
DEFINITION
TYPES 3. Urinary retention related to pain,
INDICATION immobility and anesthesia
POST OP CARE • Urinary retention can occur post
COMPLICATIONS
operatively in any patient , particularly if
the surgery affected the perineal or anal
NURSING DIAG. regions and resulted in reflex spasm of the
sphincters. General anesthesia reduces the
bladder muscle innervations and
suppresses the urge to void, impeding the
bladder emptying.
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37. RINARY IVERSION
DEFINITION
TYPES
INDICATION Refers to diverting the urinary
POST OP CARE
stream from the bladder so that it
COMPLICATIONS
exits by the way a a new avenue
NURSING DIAGNOSIS
OUTPUT OF GROUP 7
38. RINARY IVERSION
DEFINITION
TYPES 1. Ileal conduit
INDICATION 2. Ureterostomy
3. Continent
POST OP CARE
cutaneous
COMPLICATIONS reservoir
NURSING DIAGNOSIS 4. Bladder
substitute
OUTPUT OF GROUP 7
39. RINARY IVERSION
DEFINITION
TYPES
• Bladder cancer requiring cystectomy
INDICATION
• Neurogenic bladder conditions that
POST OP CARE
threaten renal function
COMPLICATIONS
• Severe radiation injury to the bladder
NURSING DIAGNOSIS
• Intractable incontinence in females
• Chronic pelvic pain syndromes
OUTPUT OF GROUP 7
40. RINARY IVERSION
DEFINITION
TYPES
INDICATION • Vital Signs Monitoring
POST OP CARE • Monitor Urine output
COMPLICATIONS • Assess for bleeding
NURSING DIAGNOSIS • Maintain asepsis
• Pain Management (Anagesics)
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41. RINARY IVERSION
DEFINITION
TYPES • Incontinence
INDICATION • Urinary reflux
POST OP CARE
• Anastomtic leaks
COMPLICATIONS • Pyelonephritis
NURSING DIAGNOSIS
• Bacteriuria
• Calculi Erectile Dysfunction
• Electrolyte imbalances
OUTPUT OF GROUP 7
42. RINARY IVERSION
DEFINITION
TYPES 1. Acute pain related to surgical
INDICATION
incision.
POST OP CARE
2. Impaired skin integrity related to
COMPLICATIONS
NURSING DIAG.
surgical incision.
3.. Disturbed body image related to
Urinary diversion.
OUTPUT OF GROUP 7
43. Y S T O S T O M Y
DEFINITION
INDICATION
POST OP CARE Is a surgical procedure wherein a
COMPLICATIONS cystostomy tube is inserted through the
NURSING DIAGNOSIS abdominal wall directly into the bladder.
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44. Y S T O S T O M Y
DEFINITION
INDICATION • Acute urinary retention
POST OP CARE
• Chronic Urinary Retention
COMPLICATIONS
• Urinary incontinence
NURSING DIAGNOSIS
• Enlarged prostate
• Urethral strictures
OUTPUT OF GROUP 7
45. Y S T O S T O M Y
DEFINITION
INDICATION
POST OP CARE • Vital Signs Monitoring
COMPLICATIONS • Monitor Urine output
NURSING DIAGNOSIS • Assess for bleeding
• Maintain asepsis
• Pain Management (Anagesics)
OUTPUT OF GROUP 7
46. Y S T O S T O M Y
DEFINITION
INDICATION • Hematuria
POST OP CARE • Bowel perforation during trocar
COMPLICATIONS insertion
NURSING DIAGNOSIS • Failure of the wound to close
• Urinary fistula
OUTPUT OF GROUP 7
47. Y S T O S T O M Y
DEFINITION
INDICATION 1. Acute pain related to surgical
POST OP CARE
incision.
COMPLICATIONS
2. Impaired skin integrity related to
NURSING DIAG.
surgical incision.
3.. Disturbed body image related to
Urinary diversion.
OUTPUT OF GROUP 7
48. Internet REFERENCES
• http://en.wikipedia.org/wiki/Suprapubic_cystostomy
• http://emedicine.medscape.com/article/451882-overview
• http://kidney.niddk.nih.gov/kudiseases/pubs/urostomy/
index.htm
• http://emedicine.medscape.com/article/451882-overview
• http://emedicine.medscape.com/article/451882-overview
Book REFERENCES
• Lemone, Burke, Medical Surgical Nursing, 2004, Third Edition
• Timby & Smith, Introductory Medical Surgical Nursing, 2005, 8th Edition
• Smeltzer, Bare, Hinkle, Cheever, Textbook of Medical Surgical Nursing, 2008,
11th Edition
• Black, Hawks, Medical Surgical Nursing, Clinical Management for Positive
Outcomes, 8th Edition
