Nursing 211

N211: Health Differences Across the Lifespan I as those found in rubber, dyes, leather, ink and paint. Most malignancies of the bladder are transitional cell carcinomas. The remaining tumors consist of squamous cell and adenocarcinomas. Bladder cancers can be superficial or invasive. The bladder is the common site for metastasis from the prostate, colon, rectum, and in females the lower female gynecological tract. Nursing Assessment Includes painless, gross hematuria, urinary tract infections, urinary frequency, urgency, dysuria, and changes in voiding patterns, pelvic or back pain. Diagnostics Include cystoscopy with biopsy of bladder tissue and cytological examination of urine and bladder washing, biopsy, retrograde pyelogram to detect kidney damage and CT scan or radiograph may show the tumor shadow or bone metastasis. Nursing Diagnosis • Altered urinary elimination related to obstruction by the tumor and surgery • Pain, related to growing tumor or tissue manipulation during surgery • Activity intolerance related to fatigue secondary to effects of radiation therapy, surgery, or chemotherapy. • Anxiety and knowledge deficit related to the diagnosis of cancer and treatments. Medical Int rve tio s Include transurethral resection and fulguration is an endoscopic resection performed for superficial tumors; cystectomy or surgical removal of the bladder with urinary diversion, is necessary when the tumor has penetrated the muscle wall. Nephrostomy involves insertion of nephrostomy tubes into the pelvis of each kidney. The tubes are brought through the skin and connected to a closed drainage system. Ileal conduit or ileal loop is accomplished by resecting a small segment of the ileum with its blood supply kept intact. The proximal end of the segment is closed, and the distal end is brought out as a stoma. The ileal loop is no longer connected to the intestine. Chemotherapy includes systematic MVAC, methotrexate, vinblastine (Velban), doxorubicin (Adriamycin) and cisplatin. Intravescial, which is given within the bladder, is thiotepa, mitomycin C or doxorubicin. Radiation therapy may be external or internal. Nursing Interventions Include monitoring fluid input and output, maintain patency of urinary catheter, and maintain continuous bladder irrigation as ordered. Monitor urine for decreasing hematuria, provide adequate hydration. Assist patient to a position of comfort, ass pain using a pain rating scale of 0-10. Administer analgesics as ordered and use non-pharmacological pain management techniques such


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