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NURS 3512 > Week 9 Bladder Cancer > Flashcards

Week 9 Bladder Cancer Flashcards

1
Q

What are the S&S of Bladder cancer?

A
  • Gross, painless hematuria (chronic or intermittent)

- Bladder irritability with dysuria, urinary frequency, and urinary urgency

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2
Q

what are the risk factors?

A
  • Smoking
  • exposure to dyes used in rubber and cable industries
  • chronic use of phenacetin - containing analgesics
  • individual who has recurrent stones
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3
Q

What are the 3 non-operative therapies

A
  • radiation therapy
  • chemotherapy
  • intravesical therapy
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4
Q

what is radiation therapy

A
  • used when cancer is inoperable or patient refuses surgery

- also used an conjunction for therapies (cystectomy)

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5
Q

what is chemotherapy

A
  • used preoperatively or before radiation therapy, or used ti treat distant metastases.
  • Mostly deals with metastases part not the actual bladder cancer
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6
Q

what is intravesical therapy

A
  • immune stimulating agents or chemotherapy with local instillation of chemotherapeutic is delivered directly into the bladder by urethra catheter
  • the chemotherapeutic drugs is directly instilled directly into the patients bladder and retained for about 2 hours.
  • patient position maybe changed every 15 minutes for maximum contact in all areas of the bladder.
  • usually initiated at weekly intervals for 6 to 12 weeks
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7
Q

What are the 3 ways to remove cancer areas from bladder ( not removing the whole bladder)

A
  • Transurethral resection from bladder (electrocautery)
  • Laser photocoagulation
  • Open loop resection with fulguration
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8
Q

what are the things to consider before surgery (3)

A
  1. where actually in the bladder is the cancer
  2. if cancer is spread out they may take the bladder out
  3. if cancer is small they can remove part of it or top of bladder that has cancer
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9
Q

Post op care after removing cancer areas from the bladder (6)

A
  1. Drink lots of fluid daily for the first week
  2. Avoid alcohol
  3. Self monitor urine - expect to be pink for first several days ( not bright red and should not have clots)
  4. Patient will need opioid for pain
  5. encourage stool softeners
  6. Encourage 15-20 mins sitz baths, 2-3x per day - this promotes relaxation and decrease urinary retention
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10
Q

what is the colour expected 7-10 days after removal of cancer areas from bladder

A

patient may see dark red or rust coloured flex in their urine - these are scabs from healing tumour reception sites.

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11
Q

If cancer is much involve in the bladder what are the 2 things we can do?

A
  1. Remove part of the bladder ‘partial cystectomy”

2. remove entire bladder “urinary diversion’

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12
Q

what are the 3 types of urinary diversion

A
  1. incontenent urinary diversion (ileal conduit most common)
  2. continent urinary diversion
  3. Orthopic bladder substitution ( neo bladder)
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13
Q

Total cystectomy with incontinent urinary diversion

A
  • patient is unable to control when urine would come out so patient has to wear a bag
  • Lifelong
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14
Q

Total cystectomy with incontinent urinary diversion procedure ( ileal conduit)

A
  • surgery is under general anesthesia where they remove the entire bladder
  • they use small bowel of the patient and they have been able to diver the urine that’s made from the kidneys to go down the ureter.
  • they attach a piece of small bowel inside and attach the ureters to it then they brought that up tp the abdomen and create a stoma
  • patient will have no bladder and patient will have stoma in the abdomen
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15
Q

what is urostomy bag

A

Urostomy bag is bag used to collect urine after a bladder removal surgery

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16
Q

Nursing care for illegal conduit (Incontinent urinary diversion )

what are the 5 issues?

A
  1. infection
  2. skin integrity
  3. stoma and appliance care
  4. volume status
  5. anxiety/ body image/ sexuality
17
Q

Nursing care for illegal conduit (Incontinent urinary diversion )

Care for Infection risk/prevention (3)

A
  • empty pouch every 2-3 hours or when its 1/3 to half full - this decrease risk of urinary reflux
  • use bedside drainage bag at night instead of the bag
  • Report any signs and symptoms of infection
18
Q

what are the Signs and symptoms of infection (3)

A
  1. decrease urinary output
  2. pain in the back/ flank area or abd
  3. cloudy or bloody urine
19
Q

Nursing care for illegal conduit (Incontinent urinary diversion )

Skin integrity (3)

A
  • Make sure to check that skin is intact because urine is acidic
  • look for redness or wound
20
Q

Nursing care for illegal conduit (Incontinent urinary diversion )

Stoma (4)

A
  • Empty bag regularly (q2-3 hrs or 1/3 full)
  • make sure that the bag fits correctly
  • note if theres bleeding on the stoma or eroded
  • avoid tight clothes or binders
21
Q

Nursing care for illegal conduit (Incontinent urinary diversion )

Volume status (5)

A
  • increase fluid intake
  • do regular activities
  • change positions
  • urine acidification ( Cranberry juice) - helps decrease chance of infections
  • avoid food that produces odour such as onion, fish, eggs
22
Q

Nursing care for illegal conduit (Incontinent urinary diversion )

Anxiety/ body image/ sexuality

A
  • encourage support, counselling ,and information sessions
23
Q

What is continent urinary diversion?

A
  • patients bowels are used to create a pouch like bladder inside the abdomen
  • ureters are reattached to the pouch and created a stoma
24
Q

How often do patient catheterize themselves with continent urinary diversion

A

Patient catheterize themselves into the stoma drain reservoir every 4-6 hours

25
Q

Do patient with continent urinary diversion need to wear external pouch?

A

no, they can catheterize themselves

26
Q

to have continent urinary diversion what does the patient must able to do?

A

patient must be able to manage and use catheter

27
Q

what kind of patient would benefit better with incontinent diversion instead of continent diversion?

A
  • older patients with arthritis

- they may not be able to manage and do catheterizations to themselves

28
Q

what is orthotopic bladder substitution “neo bladder’

A
  • surgeon uses a segment of patients bowel and created and constructed a new bladder in their abdomen out of that bowel
  • ureters are then attached to the bowels
29
Q

whats the advantage of orthotopic bladder substitution “neo bladder’

A

Most normal voiding pattern

30
Q

orthotopic bladder substitution “neo bladder’ when can this be done?

A

only if cancer does not involve the bladder neck or the urethra

NURS 3512 (10 decks)

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