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Bladder cancer by section Watson G7

  1. 1. KEY FEATURES: Just Press Down Submitted by the GROUP 7, BSN 3 WATSON
  2. 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. 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. OUTPUT OF GROUP 7
  4. 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. OUTPUT OF GROUP 7
  5. 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. OUTPUT OF GROUP 7
  6. 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. OUTPUT OF GROUP 7
  7. 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. OUTPUT OF GROUP 7
  8. 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. 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. OUTPUT OF GROUP 7
  10. 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. OUTPUT OF GROUP 7
  11. 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. 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. 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) OUTPUT OF GROUP 7
  14. 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 OUTPUT OF GROUP 7
  15. 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. 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 OUTPUT OF GROUP 7
  17. 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. OUTPUT OF GROUP 7
  18. 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. 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. 20. LA D D E R A N C E R OVERVIEW INTRODUCTION ETIOLOGY PATHOPHYSIOLOGY • Metastasis to nearby organs ASSESSMENT • Hydronephrosis COMPLICATIONS • Ascitis • Infertility OUTPUT OF GROUP 7
  21. 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. OUTPUT OF GROUP 7
  22. 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. OUTPUT OF GROUP 7
  23. 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. OUTPUT OF GROUP 7
  24. 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 OUTPUT OF GROUP 7
  25. 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 OUTPUT OF GROUP 7
  26. 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 OUTPUT OF GROUP 7
  27. 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 OUTPUT OF GROUP 7
  28. 28. E P H R E C T O M Y DEFINITION TYPES INDICATION POST OP CARE COMPLICATIONS NURSING DIAGNOSIS OUTPUT OF GROUP 7
  29. 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. OUTPUT OF GROUP 7
  30. 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. OUTPUT OF GROUP 7
  31. 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 OUTPUT OF GROUP 7
  32. 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) OUTPUT OF GROUP 7
  33. 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. 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. OUTPUT OF GROUP 7
  35. 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. 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. OUTPUT OF GROUP 7
  37. 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. 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. 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. 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) OUTPUT OF GROUP 7
  41. 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. 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. 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. OUTPUT OF GROUP 7
  44. 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. 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. 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. 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. 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

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