bladder cancer by section watson g7
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Submitted by the GROUP 7, BSN 3 WATSON
CANCER
Cancer is the growth of abnormal cells
in the body. These extra cells grow
together and form masses, called
tumors. In bladder cancer, these
growths happen in the bladder.
L A D D E R A N C E R B COVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
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THE BLADDER
• The bladder is the part of your urinary
tract that stores your urine until you are
ready to let it out.
• Bladder cancer can usually be cured if
it is found and treated early. And most
bladder cancer is found early.
L A D D E R A N C E R B C
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INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
OVERVIEW
INTRODUCTION
OVERVIEW
Bladder cancer is the rapid, uncontrolled
growth of abnormal cells in the bladder.
Cancer usually begins in the lining of the
bladder (superficial bladder cancer). The
cancerous cells may grow through the
lining into the muscular wall of the
bladder.
L A D D E R A N C E R B C
OUTPUT OF GROUP 7
ETIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
INTRODUCTION
OVERVIEW
Invasive bladder cancer may spread to
lymph nodes, other organs in the pelvis
(causing problems with kidney and
bowel function), or other organs in the
body, such as the liver and lungs.
L A D D E R A N C E R B C
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ETIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
L A D D E R A N C E R B CINTRODUCTION
OVERVIEW
Bladder cancer is classified by stage and
grade. The stage is determined by the
cancer growth in the bladder wall and
how far it has spread to nearby tissues
and other organs, such as the lungs, the
liver, or the bones.
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ETIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
INTRODUCTION
OVERVIEW
The grade of bladder cancer is
determined by how the cancer cells look
in comparison with normal bladder cells.
L A D D E R A N C E R B C
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ETIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
L A D D E R A N C E R B CETIOLOGY
OVERVIEW
INTRODUCTION• Cigarette smoking
• Chemical exposures at work
• Bladder Stones
• High Cholesterol Intake
• High Urinary Ph
• Pelvic Radiation Therapy
• Cancer Arising from the prostate,
colon and rectum in males
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PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
L A D D E R A N C E R B CETIOLOGY
OVERVIEW
INTRODUCTION NON MODIFIABLE RISK FACTORS:
• Age: Seniors are at the highest risk of
developing bladder cancer.
• Sex: Men are three times more likely
than women to have bladder cancer.
• Race: Whites have a much higher risk
of developing bladder cancer than other
races.
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PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
L A D D E R A N C E R B CETIOLOGY
OVERVIEW
INTRODUCTION
• History of bladder cancer: If you have
had bladder cancer in the past, your risk
of developing another bladder cancer is
higher than if you had never had
bladder cancer.
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PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
ETIOLOGY
OVERVIEW
INTRODUCTION
• Chronic bladder inflammation:
Frequent bladder infections, bladder
stones, and other urinary tract problems
that irritate the bladder increase the risk
of developing a cancer, more commonly
squamous cell carcinoma.
L A D D E R A N C E R B C
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PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
L A D D E R A N C E R B CETIOLOGY
OVERVIEW
INTRODUCTION • Birth defects: Some people are born
with a visible or invisible defect that
connects their bladder with another
organ in the abdomen or leaves the
bladder exposed to continual infection.
This increases the bladder's vulnerability
to cellular abnormalities that can lead to
cancer.
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PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
L A D D E R A N C E R B C
PATHOPHYSIOLOGY
OVERVIEW
INTRODUCTION
ETIOLOGY
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ASSESSMENT
COMPLICATIONS
Exposure of bladder to Carcinogen
Premalignant proliferative changes in transitional cell layer (dysplasia)
Papillary or transitional cell tumors (trigoone of the bladder & lateral walls)
Staging of the tumor (depth of penetration) & degree of metastasis
Metastasis to nearby organs
Invasion to pelvic lymph nodes& other organs
Poor prognosis (death)
ASSESSMENT
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
SYMPTOMS
L A D D E R A N C E R B C
PICTURES
• Hematuria
• Dysuria
• Oliguria
• Frequent urinary tract infections
(UTIs).
• Flank Pain
• Weight loss
• Anemia
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DIAGNOSIS
L A D D E R A N C E R B C
ASSESSMENT
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
DIAGNOSIS
SYMPTOMS
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PICTURES
• BTA – Bladder Tumor Antigen Test• NMPZZ – Nuclear Matrix Protein Test• TRAP – Telomeric Repeat Amplification Protocol Assay• IVP – Intravenous Pyelograph• XRAY• MRI – Magnetic Resonance Imaging• CT Scan – Computerized Tomography Scan• UTZ – Ultrasonography• CEA – Cerum Carcinoembryonic Antigen• Biopsy
L A D D E R A N C E R B C
ASSESSMENT
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
PICTURES
Bladder cancer : the bladder wall is massively
infiltered by an ulcerated and hemorragic tumor.
Courtesy Pierre Bedossa
SYMPTOMS
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DIAGNOSIS
L A D D E R A N C E R B C
ASSESSMENT
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
Cystoscopic view of a papillary bladder tumor
(top); the bladder wall is visible on the bottom
right.
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PICTURES
SYMPTOMS
DIAGNOSIS
L A D D E R A N C E R B C
ASSESSMENT
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
This photograph illustrates mucinous
adenocarcinoma of the urinary bladder. The tumor
has a glistening surface.
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PICTURES
SYMPTOMS
DIAGNOSIS
ASSESSMENT
OVERVIEW
INTRODUCTION
ETIOLOGY
PATHOPHYSIOLOGY
PICTURES
L A D D E R A N C E R B C
SYMPTOMSCOMPLICATIONS
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DIAGNOSIS
L A D D E R A N C E R B C
COMPLICATIONS
OVERVIEW
INTRODUCTION
ETIOLOGY
ASSESSMENT
• Metastasis to nearby organs
• Hydronephrosis
• Ascitis
• Infertility
PATHOPHYSIOLOGY
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L A D D E R A N C E R B CINTERVENTIONS 1. Chronic pain related to progression of disease
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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NURSING DIAGNOSIS
L A D D E R A N C E R B CINTERVENTIONS
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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NURSING DIAGNOSIS
L A D D E R A N C E R B CINTERVENTIONS
3. Impaired urinary elimination related
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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NURSING DIAGNOSIS
L A D D E R A N C E R B CCHEMOTHERAPY with combination of
methotrexate, 5 fluorouracil,
vinblastine, doxorubicin (Adriamycin)
and cisplatin.
• IV CHEMOTHERAPY
• TOPICAL CHEMOTHERAPY
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NURSING DIAGNOSIS
INTERVENTIONS
MEDICAL
SURGICAL
NURSING
L A D D E R A N C E R B C• Transurethral resection or fulguration
of the bladder
• Urinary Diversion
• Cystectomy
• Simple
• Radical
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NURSING DIAGNOSIS
INTERVENTIONS
SURGICAL
MEDICAL
NURSING
L A D D E R A N C E R B C
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NURSING DIAGNOSIS
INTERVENTIONS
NURSING
MEDICAL
SURGICAL
• Encourage to stop smoking (if px is a
smoker)
• Pain Management
• Proper nutrition provision
• Emotional support
• Provide Education
•Encourage decision making
E P H R E C T O M Y NDEFINITION
TYPES
INDICATION
POST OP CARE
COMPLICATIONS
NURSING DIAGNOSIS
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A nephrectomy is the surgical removal of
a kidney, the organ that filters waste
from the blood and produces urine.
E P H R E C T O M Y NDEFINITION
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TYPES
INDICATION
POST OP CARE
COMPLICATIONS
NURSING DIAGNOSIS
• Partial nephrectomy – Part of one
kidney is removed.
• Simple nephrectomy – All of one
kidney is removed.
E P H R E C T O M Y NTYPES
DEFINITION
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INDICATION
POST OP CARE
COMPLICATIONS
NURSING DIAGNOSIS
• Radical nephrectomy – All of one
kidney is removed together with the
neighboring adrenal gland (the
adrenaline-producing gland that sits on
top of the kidney) and neighboring
lymph nodes.
• Bilateral nephrectomy – Both kidneys
are removed.
E P H R E C T O M Y NTYPES
DEFINITION
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INDICATION
POST OP CARE
COMPLICATIONS
NURSING DIAGNOSIS
E P H R E C T O M Y NINDICATION
DEFINITION
TYPES
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•kidney deformities (birth defects:
congenital abnormalities)
•injury (trauma)
•disease
•infection
•hypertension
•tumor
•removal of kidney from donor for kidney
transplant
POST OP CARE
COMPLICATIONS
NURSING DIAGNOSIS
E P H R E C T O M Y N
POST OP CARE
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INDICATION • Vital Signs Monitoring
• Monitor Urine output
• Assess for bleeding
• Maintain asepsis
• Pain Management (Anagesics)
COMPLICATIONS
NURSING DIAGNOSIS
DEFINITION
TYPES
E P H R E C T O M Y N
COMPLICATIONS
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POST OP CARE
•Blood clots in the legs that may travel to
the lungs
•Breathing problems
•Infection, including in the surgical wound,
lungs (pneumonia), bladder, or kidney
•Blood loss
• Reactions to medications
INDICATION
DEFINITION
TYPES
NURSING DIAGNOSIS
E P H R E C T O M Y N
NURSING DIAG.
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COMPLICATIONS
1. Ineffective breathing pattern related to flank incision• The surgical approaches to the kidney predisposes the patient to respiratory complications and paralytic ileus. If the pleural cavity has been entered during 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.
POST OP CARE
INDICATION
DEFINITION
TYPES
E P H R E C T O M Y N
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2. Acute pain related to surgical incision.
The patient may experience acute pain
which is sudden onset of the incision site.
Acute pain is transmitted by a delta fibers
that are myelated and transmit inpulses
rapidly and thus causes the [patient to
have an increased pulse rate, BP, and RR.
NURSING DIAG.
COMPLICATIONS
POST OP CARE
INDICATION
DEFINITION
TYPES
E P H R E C T O M Y N
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3. Urinary retention related to pain,
immobility and anesthesia• Urinary retention can occur post operatively in any patient , particularly if the surgery affected the perineal or anal 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.
NURSING DIAG.
COMPLICATIONS
POST OP CARE
INDICATION
DEFINITION
TYPES
R I N A R Y I V E R S I O NUDEFINITION
TYPES
INDICATION
POST OP CARE
COMPLICATIONS
NURSING DIAGNOSIS
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Refers to diverting the urinary
stream from the bladder so that it
exits by the way a a new avenue
D
TYPES
DEFINITION
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1. Ileal conduit2. Ureterostomy3. Continent cutaneous reservoir
4. Bladder substitute
R I N A R Y I V E R S I O NU DINDICATION
POST OP CARE
COMPLICATIONS
NURSING DIAGNOSIS
INDICATION
TYPES
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POST OP CARE
COMPLICATIONS
NURSING DIAGNOSIS
• Bladder cancer requiring cystectomy
• Neurogenic bladder conditions that
threaten renal function
• Severe radiation injury to the bladder
• Intractable incontinence in females
• Chronic pelvic pain syndromes
R I N A R Y I V E R S I O NU DDEFINITION
POST OP CARE
DEFINITION
TYPES
OUTPUT OF GROUP 7
INDICATION
COMPLICATIONS
NURSING DIAGNOSIS
• Vital Signs Monitoring
• Monitor Urine output
• Assess for bleeding
• Maintain asepsis
• Pain Management (Anagesics)
R I N A R Y I V E R S I O NU D
COMPLICATIONS
DEFINITION
TYPES
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INDICATION
POST OP CARE
NURSING DIAGNOSIS
• Incontinence
• Urinary reflux
• Anastomtic leaks
• Pyelonephritis
• Bacteriuria
• Calculi Erectile Dysfunction
• Electrolyte imbalances
R I N A R Y I V E R S I O NU D
NURSING DIAG.
DEFINITION
TYPES
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INDICATION
POST OP CARE
COMPLICATIONS
1. Acute pain related to surgical
incision.
2. Impaired skin integrity related to
surgical incision.
3.. Disturbed body image related to
Urinary diversion.
R I N A R Y I V E R S I O NU D
Y S T O S T O M Y CDEFINITION
INDICATION
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Is a surgical procedure wherein a
cystostomy tube is inserted through the
abdominal wall directly into the bladder.
POST OP CARE
COMPLICATIONS
NURSING DIAGNOSIS
INDICATION
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POST OP CARE
• Acute urinary retention
• Chronic Urinary Retention
• Urinary incontinence
• Enlarged prostate
• Urethral strictures
Y S T O S T O M Y C
COMPLICATIONS
NURSING DIAGNOSIS
DEFINITION
POST OP CARE
OUTPUT OF GROUP 7
COMPLICATIONS
• Vital Signs Monitoring
• Monitor Urine output
• Assess for bleeding
• Maintain asepsis
• Pain Management (Anagesics)
Y S T O S T O M Y C
NURSING DIAGNOSIS
DEFINITION
INDICATION
COMPLICATIONS
DEFINITION
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NURSING DIAGNOSIS
• Hematuria
• Bowel perforation during trocar
insertion
• Failure of the wound to close
• Urinary fistula
Y S T O S T O M Y CINDICATION
POST OP CARE
NURSING DIAG.
DEFINITION
OUTPUT OF GROUP 7
INDICATION
POST OP CARE
COMPLICATIONS
1. Acute pain related to surgical
incision.
2. Impaired skin integrity related to
surgical incision.
3.. Disturbed body image related to
Urinary diversion.
Y S T O S T O M Y C
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