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Nursing > Bladder and Kidney Cancer > Flashcards

Bladder and Kidney Cancer Flashcards

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1
Q

Bladder cancer (urothelial cancer)

A
  • Malignant cancers of the urothelium
  • Multifocal
  • Highly invasive
  • Most urothelial cancers occur in the bladder
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2
Q

Bladder cancer: risk factors

A
  • Cigarette smoking
  • Exposure to dyes/toxins
  • Phenacetin containing analgesics
  • Radiation therapy
  • Cyclophosphamide (Cytoxan)
  • Chronic recurrent stones• Chronic lower urinary infections
  • Indwelling catheters
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3
Q

Bladder cancer S/S:

A

▫ Hematuria
▫ Dysuria
▫ Frequency
▫ Urgency

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4
Q

BC: DX

A
  1. Urinalysis: gross or microscopic hematuria.
  2. Bladder wash specimen and bladder biopsy.
  3. IV urogram, CT, MRI.
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5
Q

BC: surgical management

A

• Cystectomy
- Radical surgery plus intravesical chemotherapy
• Transurethral resection or fulguration

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6
Q

Cystectomy : partial

A

▫ Resection of the portion of the bladder wall containing the tumor
along with a portion of normal tissue

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7
Q

Complete cystectomy

A

▫ Involves the removal of:
 Bladder, prostate, and seminal vesicles
 Bladder, uterus, cervix, urethra, and the ovaries

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8
Q

Transurethral resection or fulguration

A

▫ Used for the diagnosis and treatment of superficial lesions
▫ Used to control bleeding
▫ Tumor mass is excised
▫ The remaining portion of the tumor are cauterized

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9
Q

Ileal conduit

A

▫ Ureters are surgically placed in the ileum, Urine is collected in a
pouch
▫ Continent reservoirs or “neobladders” are being used

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10
Q

Uterosigmodoistomy

A
  • Diverts urine to the large intestine, so no stoma is required
  • Client excretes urine with bowel movements
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11
Q

Neobladder

A

internal reservoir created from part of the small intestine ; because it is connected to the urethra , the patient can learn to void normally.

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12
Q

BC: Nonsurgical management

A

• Radiation Therapy
• Chemotherapy
• Intravesical Therapy:
- Prophylactic immunotherapy with instillation of bacille Calmette Guerin (BCG)

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13
Q

Radiation therapy (local)

A 
• Used with cystectomy 
• May be used as the primary therapy
• Can be combined with systemic chemotherapy
 Typical side effects:
▫ Inflammation of the rectum
▫ Incontinence
▫ Skin irritation
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14
Q

Chemotherapy (systemic)

A 
1. Chemotherapy drugs: 
▫ Cisplatin (Platinol) 
▫ Vinblastin (Velban)
▫ Doxorubicin (Adriamycin)
▫ Methotrexate
2. Successful in prolonging life
3. Rarely results in a cure
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15
Q

Chemotherapy side effects

A 
▫ Alopecia
▫ Anemia
▫ Thrombocytopenia (low platelet count )
▫ Mucositis
▫ Bruising/Excessive bleeding
▫ Neutropenia ( low count  of WBC)
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16
Q

Immunotherapy

A

• Biological therapy
▫ Treatment is used to enhance the immune system’s ability to fight
disease

17
Q

Bacille Calmette-Guérin (BCG)

A

▫ Used to prevent tumor recurrence of superficial cancers
▫ Stimulates the immune system rather than acting directly on
cancer cells in the bladder

18
Q

BCG (local)

A
  • Can be delivered directly into the bladder
  • Usually initiated at weekly intervals
  • Patient’s position can be changed every 15 minutes
  • Sometimes used with interferon
19
Q

BCG : side effects

A

▫ Inflammation of the bladder
▫ Inflammation of the prostate
▫ Flu-like symptoms
▫ Irritative voiding symptoms and hemorrhagic cystitis

20
Q

BC: nursing diagnosis

A
  • Altered pattern of urinary elimination
  • Risk for altered skin integrity
  • Risk for infection
  • Body image disturbance
  • Anxiety, anticipatory grieving
  • Pain
  • Ineffective breathing pattern
  • Knowledge deficit
21
Q

Nursing responsibilities

A
  • Increase fluid intake
  • Smoking Cessation Information
  • Assess patient for secondary (UTI)
  • Routine urologic follow-up
  • Address fears and concerns
  • Client education
22
Q

Community- based care

A
  • Electrolyte replacement
  • Foods to avoid
  • Self-care abilities
  • Pouch application
  • Skin care/Pouch care
  • Drainage mechanisms
  • Counseling
  • United Ostomy Association
  • American Cancer Society
  • The wound, Ostomy, and Continence Nurses Society
23
Q

Renal cell carcinoma

A
  • Also known as adenocarcinoma of the kidney
  • Account for about 28,800 new cases and 11,300 deaths annually
  • 5 year survival rate is 60%
  • Occurs twice as often in men than in women
24
Q

Kidney cancer: risk factors

A 
• Cigarette smoking
• Obesity
• Exposure to:
Asbestos, 
Cadmium, and 
Gasoline, 
Lead
• HTN/Treatment for HTN
25
Q

Kidney cancer: manifestations

A 
▫ Weight loss
▫ Weakness
▫ Anemias
▫ Gross hematuria
▫ Flank pain
▫ Palpable mass
26
Q

Kidney cancer complications

A

• Metastasis:
▫ Lungs, liver, and long bones (Common sites)
• Local extension of kidney cancer into the renal vein and vena cava
• Urinary tract obstruction

27
Q

KC: DX

A
  1. Urinalysis: show RBC
  2. IV urogram: detect renal masses
  3. CT with contrast or MRI: outline mass
  4. Biopsy of the tumor
28
Q

KC: Nonsurgical management

A 
• Radiofrequency ablation
▫ Minimally invasive
▫ Effectiveness undergoing evaluation
▫ Not widely available
• Radiation Therapy
• Chemotherapy
• Biological response modifiers (BRMs)
29
Q

Biological response modifiers (BRMs)

A

▫ Interferon (INF) (Most commonly used)
- Interferons have a direct antiproliferative effect on tumor cells.
▫ Tumor necrosis factor (TNF)

30
Q

KC: Surgical management

A

• Nephrectomy: Kidney removal
• Radical nephrectomy
▫ Removal of the kidney, adrenal gland, surrounding fascia, part of
the ureter, and draining lymph nodes.

31
Q

Nephrectomy : Preoperative care

A

▫ Instruct the client about surgical routines
▫ Probable site of incision
▫ Presence of dressings, drains or other equipment
▫ Reassure client about pain relief

32
Q

Nephrectomy :Operative procedure

A 
▫ Positioning
▫ Trunk area flexed to increase exposure to the kidney area
▫ Removal of the 11th or 12thrib 
▫ Nephrectomy
▫ Radiation therapy
33
Q

Nephrectomy: Postoperative care

A

▫ Assess for hemorrhage and adrenal insufficiency
▫ Inspect abdomen for distention from bleeding, check linens under
the client
▫ Second kidney: Assess urine output for the first 24 hours after surgery
▫ Drain may be placed near the surgical site to remove residual fluid
▫ Complications: Atelectasis/Pneumonia
• Pain management: Opioid analgesics (hydromorphone and morphine
sulfate)
• Prevention of complications: Antibiotics

34
Q

Ileal reservoir: Kock’s pouch

A

divert urine into surgically created pouch, or pocket that functions as a bladder. The stoma is continent, and the patient removes urine by regular self catheterization. Teach how to use the catheter to drain the pouch.

Nursing (18 decks)

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