Bladder Cancer Nursing Care Plan & Management

Notes

Description
  1. Bladder cancer is papillomatous growth in the bladder urothelium that undergo malignant changes and that may infiltrate the bladder wall.
  2. Predisposing factors include cigarette smoking, exposure to industrial chemicals and exposure to radiation.
  3. Common signs of metastasis include the liver, bones and lungs
  4. As the tumor progresses can extend to the rectum, vagina and retro- peritoneal structures.

Bladder Cancer

Assessment
  • Painless hematuria
  • Dysuria
  • Gross hematuria
  • Obstruction of urine flow
  • Development of fistula ( urine from the vagina, fecal material in the urine)
Diagnostic Evaluation

Biopsies of the tumor and adjacent mucosa are definitive, but the following procedures are also used:

  • Cystoscopy, biopsy of tumor and adjacent mucosa
  • Excretory urography
  • Computed CT Scan
  • Ultrasonography
  • Bimanual examination by anesthesia
  • Cytologic evaluation of fresh urine and saline bladder washings

Molecular assays, bladder tumor antigens, adhesion molecules and others are being studied.

Primary Nursing Diagnosis
  • Risk for altered urinary elimination related to the obstruction of urinary flow
Medical Management
Radiation
  1. Most bladder cancer are poorly radio sensitive and require high doses of radiation
  2. Radiation therapy is more acceptable for advance disease that cannot be eradicated by surgery.
  3. Palliative radiation maybe used to relieve pain and bowel obstruction and control potential hemorrhage and leg edema cause by venous or lymphatic obstruction.
  4. Intracavitary radiation maybe prescribed which protect adjacent tissues.
  5. External radiation combined with chemotherapy or surgery maybe prescribed because the external radiation alone maybe ineffective.
  6. Complications of radiations:
    1. A bacterial cystitis
    2. Proctitis
    3. Fistula formation
    4. Ileitis or colitis
    5. Bladder ulceration and hemorrhage
Chemotherapy

1. Intravesical instillation

  • An alkylating chemotherapeutic agent is instilled into the bladder
  • This method provides an concentrated topical treatment with little systemic absorption
  • Chemotherapeutic agents used may include thiotepa, mitomycin (Mutamycin), doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and bacille Calmette-Guerin.
  • The medication is injected into a urethral catheter and retain for two hours.
  • Following instillation, the clients position is rotated every 15 to 30 minutes, starting in the supine position to avoid lying on full bladder.
  • After 2 hours, the client voids in a sitting position and is instructed to increase fluids to flash the bladder.
  • Treat the urine as biohazard and send to radioisotope laboratory for monitoring.
  • For 6 hours following intravesical therapy, disinfect the toilet with household bleach after the client has voided.

2. Systemic chemotherapy

  • Systemic chemotherapy is used to treat inoperable or late tumors.
  • Agents used may include, cysplatin (Platinol), doxorubicin (Adremycin), cyclophospamide (Cytosan), methotrexate (Folex) and Pyridoxine

3. Complications of chemotherapy

  • Bladder irritation
  • Hemorrhagic cystitis
Surgical Interventions

1. Transurethral resection of the bladder

  • Local resection and fulguration ( destruction of tissue by electrical current through electrodes place in direct contact with the tissue)
  • Perform for early tumor for cure or for inoperable tumors for palliation.

2. Partial Cystectomy

  • Partial cystectomy is the removal of up to half of the bladder
  • The procedure is done for early tumors and for clients who cannot tolerate radical cystectomy.
  • During the initial postoperative period bladder capacity is reduced greatly to about 60 mL; however, as the bladder tissue expand, the capacity increases to 200 -400 mL.
  • Maintenance of a continuous output of urine following surgery is critical to prevent bladder distention and stress on the suture line.
  • A urethral catheter and a suprapubic catheter maybe in place, in the suprapubic catheter maybe left in place for 2 weeks until healing occurs.

3. Cystectomy and urinary diversion

  • The procedure involves removal of the bladder and urethra in the women, and the bladder, the urethra, and usually the prostrate and seminal vesicles in men.
  • When the bladder and urethra are remove, permanent urinary diversion is required.
  • The surgery meybe performed into stages if the tumor is expensive, with the creation of the urinary diversion first and the cystectomy several weeks later.
  • If a radical cystectomy is performed lower extremity lymphedema may occur as a result of lymp node dissection, and impotence may occur in the may client.

4. Ileal conduit

  • The ileal conduit also is called ureteroileostomy or Bricker’s procedure.
  • Ureters are implanted into a segment of the ileum, with the formation of an abdominal stoma.
  • The urine flows into the conduit and is propelled continually out through the stoma by peristalsis.
  • The client is required to wear an appliance over the stoma to collect the urine.
  • Complications include obstruction, pyelonephritis, leakage at the anastomosis site, stenosis, hydronephrosis, calculuses, skin irritation and ulceration, and stomal defects.

5. Kock pouch

  • The Koch pouch is a continent internal ileal reservoir created from a segment of the ileum and ascendingcolon.
  • The ureters are implanted into the side of the reservoir, and a special nipple valve is constructed to attach the reservoir to the skin.
  • Postoperatively, the client will have a 24 to 26 Foley catheter in place to drain urine continuously until the pouch has healed.
  • The catheter is irrigated gently with NS to prevent obstruction from mucus or clots.
  • Following removal of the catheter, the client is instructed in how to self-catheterize and to drain the reservoir at 4 to 6 hour intervals.

6. Indiana pouch

  • A continent reservoir is created from the ascending colon and terminal ileum, making a pouch larger than the Koch pouch.
  • Postoperatively, the client will have a 24 to 26 Foley catheter inplace to drain urine continuously until the pouch has healed.
  • The Foley catheter is irrigated gently with NS to prevent obstruction from mucus or clots.
  • Following removal of the Foley catheter, the client is instructed in how to self-catheterize and to drain the reservoir at 4 to 6 hour intervals.

7. Creation of a neobladder

  • Creation of a neobladder is similar to the creation of an internal reservoir, with the difference being that instead of emptying through an abdominal stoma, the bladder empties through a pelvic outlet into the urethra.
  • The client empties the neobladder by relaxing the external sphincter and creating abdominal pressure or by intermittent self- catheterization.

8. Percutaneous nephrostomy or pyelostomy

  • These procedures are used when the cancer is inoperable to prevent obstruction.
  • The procedures involve a percutaneous or surgical insertion of a nephrostomy tube into the kidney for drainage.
  • Nursing interventions involves stabilizing the tube to prevent dislodgement and monitoring output.

9. Ureterostomy

  • Ureterostomy may be performed as a palliative procedure if the ureters are obstructed by the tumor.
  • The ureters are attached to the surface of the abdomen, where the urine flows directly into a drainage appliance without a conduit.
  • Potential problems include infection, skin irritation,and obstruction to urinary flow as a result of strictures at the opening.

10. Vesicostomy

  • The bladder is sutured to the abdomen, and a stoma is created in the bladder wall.
  • The bladder empties through the stoma.
Pharmacologic Intervention
  • Chemotheraphy with a combination of methotrexate, 5-fluorouracil (5-FU), vinblastine, doxorubicin (Adriamycin), and cisplatin (M-VAC) and new agents gemcitabine and taxane, possibly by topical chemotheraphy applied directly to the bladder wall
  • Intravesical BCG (effective with superficial transitional cell carcinoma)
  • Cytotoxic agent infusions through the arterial supply of the involved organ
  • Formalin, phenol, or silver nitrate instillations to achieve relief of hematuria and strangury (slow and painful discharge of urine) in some patients
Nursing Intervention

For patients who require radical cystectomy with urinary diversion, offer support and reinforcement of the information. Be sure what to expect. Involve another family member in the preoperative education. If it is needed, arrange a preoperative visit by someone who has adjusted well to a similar diversion.

If any type of stoma is to be created, arrange for a preoperative visit from the enterostomal therapist. The enterostomal therapist can assist in the selection and marking of the stoma site (although the stoma site is somewhat contingent upon the type of urinary diversion to be performed) and can introduce the patient to the external urine collection pouch and related care.

Preoperative interventions
  1. Administer bowel preparation as prescribed, which may include a clear liquid diet, laxatives and enemas, and antibiotics to lower the bacterial count in the bowel.
  2. Assist the surgeon and the enterostomal nurse in selecting an appropriate skin site for creation of the abdominal stoma.
  3. Encourage the client to talk about his or her feelings related to the stoma creation.
Postoperative interventions
  1. Monitor Vital signs.
  2. Assess incision site.
  3. Assess stoma (should be red and moist) every hour for the first 24 hours.
  4. Monitor for edema in the stoma, which may be present in the immediate postoperative period.
  5. If the stoma appears dark and dusky, notify the physician immediately because this indicates necrosis
  6. Monitor for prolapse or retraction of the stoma.
  7. Assess for return of bowel function; monitor for peristalsis, which will return in 3 to 4 days.
  8. Maintain NPO status as prescribed until bowel sounds return.
  9. Monitor urine flow, which is continuous (30 to 60 mL per hour) following surgery.
  10. Notify the physician if the urine output is less than 30 mL an hour or if no urine output occurs for more than 15 minutes.
  11. Ureteral stents or catheters may be in place for 2 to 3 weeks or until healing occurs; maintain stability with catheters to prevent dislodgment.
  12. Monitor urinary output closely and irrigate catheter (if present ) gently to prevent obstruction, as prescribed, with 60 mL of NS.
  13. Monitor for hematuria.
  14. Monitor for signs of peritonitis.
  15. Monitor for bladder distention following a partial cystectomy.
  16. Monitor for shock, hemorrhage, thrombophlebitis, and lower extremity lymphedema following a radical cystectomy.
  17. Monitor the urinary drainage pouch for leaks, and check skin integrity.
  18. Monitor the pH of the urine (do not place the dipstick in the stoma) because strong alkali urine can cause skin irritation and facilitate crystal formation.
  19. Instruct the client regarding the potential for urinary tract infection or the development of the calculuses.
  20. Instruct the client to assess the skin for irritation and to monitor the urinary drainage pouch for any leakage.
  21. Encourage the client to express feelings about changes in body image, embarrassment, and sexual dysfunction.
Documentation Guidelines
  • Description of all dressings, wounds, and drainage-collection devices
  • Physical findings related to the pulmonary assessment, abdominal assessment, presence of edema, condition of extremities, bowel and bladder patterns of voiding
  • Response to and side effects experienced related to intravesical instillations of chemotherapy or BCG; systemic chemotherapy
  • Teaching performed, the patient’s understanding of the content, the patient’s ability to perform procedures demonstrated
Discharge and Home Healthcare Guidelines
PATIENT TEACHING
  • Following creation of an ileal conduit, teach the patient and significant others the care of the stoma and urinary drainage system. If needed, arrange for follow-up home nursing care or visits with an enterostomal therapist.
  • Teach the patient the specific procedure to catheterize the continent cutaneous pouch or reservoir. A simple stoma covering made from a feminine hygiene pad can be worn between catheterizations.
  • Stress the need for the patient to wear a medical ID bracelet.
  • Following orthotopic bladder replacement, teach the patient how to irrigate the Foley catheter. Suggest the use of a leg bag during the day and a Foley drainage bag at night. Once the pouch has healed and the Foley catheter, ureteral stents, and pelvic drain have been removed, teach the patient to “push” or “bear down” with each voiding.
  • Instruct the patient on methods for performing Kegel exercises during and between voidings to minimize incontinence. Suggest wearing incontinence pads until full control is achieved.
  • Also instruct the patient on self-catheterization techniques in case the patient is unable to void. Instruct patients where to obtain ostomy pouches, catheters, and other supplies. Teach the patient how to clean and store catheters between use following the clean technique.
CARE OF SKIN IN EXTERNAL RADIATION FIELD
  • Encourage the patient to verbalize concerns about radiation therapy, and reassure the patient that she or he is not “radioactive.” Instruct the patient to wash skin gently with mild soap, rinse with warm water, and pat the skin dry each day but not to wash off the ink marking that outlines the radiation field.
  • Encourage the patient to avoid applying any lotions, perfumes, deodorants, or powder to the treatment area.
  • Encourage the patient to wear nonrestrictive soft cotton clothing directly over the treatment area and to protect the skin from sunlight and extreme cold.
  • Stress the need to maintain the schedule for follow-up visits and disease surveillance as recommended by the physician.

 

 


Sources:
ADAM for images
Marilyn Sawyer Sommers, RN, PhD, FAAN , Susan A. Johnson, RN, PhD, Theresa A. Beery, PhD, RN , DISEASES AND DISORDERS A Nursing Therapeutics Manual, 2007 3rd ed
Handbook for Brunner & Suddarth’s, Textbook of Medical-SurgicalNursing, 11th ed

 

Exam

Welcome to your MSN Exam for Bladder Cancer! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 35 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Tumors are like the adversaries in a video game: the higher the level, the tougher they get. When it comes to resistance, consider who would be the final boss to beat.

1 / 35

1. Which tumor grade is typically known to exhibit resistance?

💡 Hint

While stepping into the fascinating and complex field of oncology, one can't help but be intrigued by the diversity of cancer types. Even within a specific organ like the bladder, cancers can have varied cellular origins, much like the many different kinds of trees in a forest, each with its unique characteristics. Understanding these types and their prevalence can be likened to learning about the ecology of this 'forest,' providing a clearer picture of the challenges faced in the field of cancer research and treatment.

2 / 35

2. Which variety of bladder cancer is most frequently diagnosed?

💡 Hint

Though all parts have important roles in the orchestra of bodily functions, not all play the leading part all the time. Squamous cell carcinoma in bladder cancer is not a frequent lead player. It's more like a rare soloist than a dominant section of the orchestra.

3 / 35

3. What proportion of bladder cancers is represented by squamous cell carcinoma?

💡 Hint

When exploring the fascinating and complex world of oncology, you'll encounter various grading systems used to classify tumors. These grades correspond to the aggressiveness of the tumor, hinting at its likely behavior. It's intriguing to understand that even within the realm of malignancies, there are varying degrees of severity, much like storms can range from a gentle drizzle to a forceful hurricane. Understanding these grades can provide a glimpse into the intricate nature of cancer diagnosis and treatment.

4 / 35

4. Which grade corresponds to a very low level of malignancy in a tumor?

💡 Hint

Chemotherapy, like many medical treatments, can be a double-edged sword, yielding beneficial effects while also potentially causing adverse reactions. Some of these side effects are akin to unwanted guests that come along with a much-needed visitor. One such uninvited guest affects a critical pair of organs responsible for filtering and purifying our blood. Understanding these adverse effects is a crucial part of appreciating the delicate balancing act involved in cancer treatment.

5 / 35

5. Besides recurring UTI, nausea/vomiting, and leukopenia, which of the following is also a known adverse reaction to chemotherapy?

💡 Hint

Cancer grading can be likened to an academic grading system. However, unlike in most educational settings, we don't have an A to F or 1 to 6 scale. Instead, consider a more condensed scale that can still capture a spectrum of severity.

6 / 35

6. What is the total number of recognized grades for categorizing cancer?

💡 Hint

Tumor grading is a bit like categorizing the severity of storms: each grade represents a different level of malignancy, giving an indication of the tumor's likely behavior. Higher grades typically indicate more aggressive cancers, just like more severe storms are associated with greater potential damage. Unraveling these complexities in cancer biology offers a profound appreciation of the challenge that oncologists face in treating different types of cancer.

7 / 35

7. Which grade corresponds to a high degree of malignancy, typically associated with anaplastic carcinoma?

💡 Hint

Navigating through the world of pharmacology is like exploring a vast forest filled with unique species of plants, each with its own specific attributes. Anticholinergics are a specific category of drugs that influence the way our body's communication systems function, particularly impacting the nervous system's control over bladder contractility. Isn't it captivating to see how altering these little chemical interactions in our bodies can lead to significant changes in bodily functions? This journey into the pharmaceutical realm certainly does offer plenty to marvel at.

8 / 35

8. What description accurately characterizes anticholinergics?

💡 Hint

In the complex landscape of medical treatments, a person's overall wellness plays a pivotal role. Think of each treatment as a voyage - would you embark on a demanding journey if your ship wasn't in good condition?

9 / 35

9. The decision to administer chemotherapy hinges on the overall health status of the patient. Is this statement:

💡 Hint

The medical realm is filled with fascinating therapies, and iridium seed implants for treating cancer is one such intriguing method. It's crucial to remember that each treatment comes with its own unique set of side effects and care instructions. For patients undergoing such a procedure, noticing and reporting any changes in everyday bodily functions can be a crucial part of their journey towards recovery.

10 / 35

10. A patient suffering from bladder cancer is undergoing treatment via iridium seed implants. What important advice should the nurse emphasize in the discharge instructions for this client?

💡 Hint

Delving into the pharmacological world, one discovers an intriguing network of drug interactions and effects. Beta-adrenergics are a type of drug that modulates the body's communication pathways, specifically impacting how the nervous system interacts with the bladder. It's a marvelous journey understanding how these little molecules can have such profound impacts on our body's function. As you ponder over this, you might also consider how this knowledge plays a crucial role in managing conditions related to bladder control.

11 / 35

11. What is an accurate characterization of beta-adrenergics?

💡 Hint

Cancer types are as diverse as the constellations in the night sky, each with its unique characteristics. Transitional Cell Carcinoma (TCC) is one such 'constellation,' arising from a specific 'star system' within our body: the urothelial lining of the urinary tract. Understanding the origin of different cancer types is a step towards appreciating the vast complexity of oncology, a bit like mapping the starry sky of health and disease.

12 / 35

12. How is Transitional Cell Carcinoma (TCC) best described?

💡 Hint

Imagine a list of potential culprits behind a mysterious event - in this case, the development of cancer. Some might seem innocent, like a sweetener in your coffee, while others, such as radiation or inflammation, might sound more plausible. But can we completely exclude any of them from our suspect list?

13 / 35

13. The statement that artificial sweeteners, pelvic irradiation, and chronic cystitis cannot lead to cancer is:

💡 Hint

Navigating through the complex web of bodily functions can be like sailing through uncharted waters. It's important to remember the alpha and the beta of things. Think about it - when we want to slow a rushing current (like a full bladder), we might need to block something instead of opening more floodgates.

14 / 35

14. Which medication category is known to lessen the resistance of the bladder outlet?

💡 Hint

In garment fitting, a painful, red, and weeping skin area might suggest a poor fit - it's like wearing shoes that are too tight. Now, translate this concept to a more clinical context involving a stoma and a pouch.

15 / 35

15. A male patient suffering from bladder cancer has undergone a bladder removal and an ileal conduit has been created for urine diversion. Upon changing this patient's pouch, the nurse notes that the area surrounding the stoma is reddened, oozing, and causing the patient discomfort. What should Nurse Katrina infer from this observation?

💡 Hint

The work of certain chemotherapeutic drugs can be likened to a skilled hacker who manages to interrupt both the operating system and the backup system of a computer. In the context of thiotepa, this drug manages to disrupt two crucial processes in the cell's information processing system.

16 / 35

16. A male patient is undergoing a chemotherapy regimen to treat bladder cancer, which includes a weekly 60 mg dose of the cell cycle–nonspecific alkylating agent thiotepa (Thioplex) for four weeks via bladder installation. When he asks the nurse how the medication works, what would be the correct explanation for thiotepa's therapeutic effects?

💡 Hint

When we think about occupations and their associated health risks, we often picture jobs in high-risk environments like chemical factories or mining operations. However, even seemingly innocuous professions can be a source of concern, depending on the substances involved in the work. As an example, let's take a trip to the world of gastronomy. One might wonder if an occupation as delightful as pizza making, which involves dough, tomato sauce, cheese, and heat, could pose a serious health risk like bladder cancer. It's important to stay curious and informed about the health implications of different professions.

17 / 35

17. Is there evidence suggesting a correlation between exposure to the process of pizza making in one's occupation and the development of bladder cancer?

💡 Hint

Imagine the bladder as a serene lake. When something disrupts this tranquility, ripples can appear without causing a commotion (pain). In the case of bladder cancer, the equivalent of these ripples might be something you'd notice in the color of your urine.

18 / 35

18. What is the most common initial symptom associated with bladder cancer?

💡 Hint

Consider the grading system as if it were a staircase: the lower the step, the less daunting the climb. In terms of malignancy, which step do you suppose is the easiest to take on?

19 / 35

19. Which tumor grade signifies the least degree of malignancy?

💡 Hint

Consider the world of oncology as a battlefield, where medical professionals use an arsenal of therapies to combat cancer. One such weapon is radiation therapy. However, just like certain defenses work better against certain offenses, different tumor grades respond differently to various treatments. When it comes to radiation therapy, there's a particular grade that doesn't respond as well, akin to a fortress that's harder to breach. This variability in response underscores the complexity of cancer treatment and the need for tailored therapeutic approaches.

20 / 35

20. Which grade of tumor typically shows a poor response to radiation therapy?

💡 Hint

As a nurse, it's like being a detective in the world of health and wellness. Patients often present clues about their conditions through their symptoms. In this scenario, the sensation of voiding through an unexpected pathway can be a critical clue, pointing towards an abnormal connection that might have formed. Remember, understanding these clues and interpreting them correctly is essential to ensuring the patient gets the appropriate care and treatment.

21 / 35

21. A female patient undergoing radiation therapy for bladder cancer reports to the nurse that it feels as though she's urinating through the vagina. The nurse surmises that the patient could be experiencing:

💡 Hint

Let's delve a bit deeper into the intriguing world of chemistry and colors. Aniline, a fundamental ingredient in many dyes, is a fascinating compound derived from coal tar. Its applications are manifold, and indeed, it's what gives many of our clothes their vibrant hues. But, as with all things, there can be a shadowy side to this brightness. Health implications connected to aniline and its derivatives have been a topic of scientific investigation. In your journey of knowledge, it's crucial to balance the marvel of discovery with a keen awareness of potential hazards.

22 / 35

22. Is it accurate to assert that there's a connection between aniline dyes and the onset of cancer?

💡 Hint

The effect of certain drugs can be as unexpected as a plot twist in a thriller novel. Tricyclic antidepressants, while primarily known for treating depression, might have some side effects on the urinary system. Imagine them acting like a pause button, slowing things down and promoting storage rather than release.

23 / 35

23. How do tricyclic antidepressants impact the urinary system?

💡 Hint

In the world of pharmaceuticals, it's all about finding balance. Like a master architect, certain drugs can reinforce structures and increase resistance. In the context of alpha-adrenergics, imagine them as building up a dam, making it harder for the river (urine) to flow freely.

24 / 35

24. What defines alpha-adrenergic medications?

💡 Hint

Cholinergic drugs can be thought of as the green light at a busy intersection, signaling the detrusor muscle to go ahead and contract, thus facilitating the traffic flow of urine. They keep the journey of urine from the bladder smooth and unimpeded.

25 / 35

25. What is the primary action of cholinergic medications within the urinary system?

💡 Hint

Stepping into the world of medical procedures can sometimes feel like embarking on a well-organized expedition. Each step, be it preoperative or postoperative, has a vital role in the overall journey towards patient recovery. For invasive procedures like a cystectomy, preparing the body in specific ways, such as ensuring a clean gastrointestinal tract, can be crucial. These preparations might seem minute in the grand scheme of things, but they often play an essential role in the overall treatment journey.

26 / 35

26. A patient has been diagnosed with bladder cancer, and preparations are being made for a cystectomy and an ileal conduit. What is the appropriate preoperative plan that the nurse should arrange?

💡 Hint

The world of oncology has its own unique language, with classifications that might sound more like they belong to an educational grading system. The complexity and aggressiveness of a tumor can be categorized into different 'grades.' These grades give us clues about how a tumor might behave, including how it might react to treatments like radiation therapy. It's interesting to consider how this grading system can be a vital tool for medical professionals, helping guide their decisions to give the best possible care.

27 / 35

27. Which tumor grade is characterized by a complete non-responsiveness to radiation?

💡 Hint

The world of cancer epidemiology offers a deep insight into the prevalence of various types of cancers. Bladder cancer is one such type that affects the genitourinary tract. It's a bit like looking at a chart of the most popular music tracks; each cancer type holds a different rank based on how commonly it's diagnosed. Remember, understanding these ranks helps in recognizing the global impact of these diseases and can guide research and public health initiatives.

28 / 35

28. Where does bladder cancer rank in terms of the most frequently diagnosed genitourinary (GU) cancers in adults?

💡 Hint

In the vast world of substances, certain ones, such as aromatic amines, may not smell 'sweet' to our bodies. Think about it – what could prolonged exposure to such substances in a work setting possibly lead to?

29 / 35

29. The statement that occupational exposure to aromatic amines does not lead to cancer is:

💡 Hint

Choosing a treatment strategy in oncology often resembles selecting the right tool for a job, each therapy with its specific indications. Chemotherapy, a powerful tool in the cancer-fighting arsenal, is often deployed under specific circumstances. These can be thought of as 'triggers' that signal the need for this intervention. Remember, understanding these triggers can give us deeper insight into the complex decision-making process in cancer care.

30 / 35

30. What circumstance would signal the need to employ chemotherapy?

💡 Hint

In the treatment of diseases like bladder cancer, specific routes of drug administration are followed based on the need to target specific areas. Isn't it fascinating to consider how these unique methods of delivering medication can make a world of difference in patient outcomes? Understanding the prefixes and suffixes used in these terms can unlock a wealth of knowledge about these medical procedures.

31 / 35

31. When treating superficial bladder cancer, mitomycin (Mutamycin), an antineoplastic antibiotic, can be directly instilled. What is the name for this procedure?

💡 Hint

In the bustling city of our bodies, some drugs act like traffic lights, helping to manage the flow. Consider which category might signal a 'red light' to prevent the rush (contractility) and encourage a traffic build-up (urine storage).

32 / 35

32. Which category of drugs is known to suppress contractility and encourage the retention of urine?

💡 Hint

In the detective-like work of medical diagnostics, biopsies serve as critical clues, providing direct evidence from the 'crime scene'—the affected tissue. These clues can confirm the identity of our 'perpetrator'—the type, stage, and grade of a tumor. This helps in devising an effective 'strategy' or treatment plan. Remember, each piece of evidence plays a vital role in solving the 'mystery' of a patient's condition and guiding their treatment journey.

33 / 35

33. What is the primary purpose of conducting a random bladder biopsy?

💡 Hint

Communication in nursing often requires an empathetic and sensitive approach. Imagine you're stepping into a friend's shoes - if they were visibly anxious about an upcoming event, wouldn't you want to open a conversation about their feelings rather than brushing it off or leaving them alone?

34 / 35

34. Mr. Canelo, who has been diagnosed with bladder cancer, is due for a cystectomy along with the formation of an ileal conduit the following morning. He's noticed to be pacing the floor and anxiously wringing his hands as the nurse enters his room. What's the most appropriate response?

💡 Hint

Dealing with radioactive treatments is like handling a lit candle - it's best to keep it in a contained space to prevent any unintended spread of its effects. Therefore, think about how you'd want to manage the patient's environment in the nursing ward.

35 / 35

35. A male patient, post-radium implant for bladder cancer, is to be admitted to the nursing ward. What would be the most critical action for the head nurse to take in managing this patient's care?

Nursing Care Plan

Nursing Diagnosis:

Risk for infection related to inadequate defenses, secondary and immune system (the effect of chemotherapy / radiation), malnutrition, invasive procedures.

Goals:
  • Patients are able to identify and participate in infection prevention measures.
  • Showed no signs of infection and wound healing normally takes place.
Nursing Interventions :
  • Wash hands before taking action. Visitors are also encouraged to do the same.
  • Maintain a good personal hygine
  • Monitor the temperature
  • Examine all the systems to look for signs of infection
  • Avoid / limit invasive procedures and maintain aseptic procedures
  • Collaborative
  • Give antibiotics when indicated.

Nursing Diagnosis

Risk for Sexual Dysfunction related to deficit of knowledge / skills about alternative responses to health transition, decreased function / structure, the effects of treatment.

Goals:
  • Patients may express its understanding of the effects of cancer and treatment on sexuality.
  • Maintaining sexual activity within your limits
Nursing Interventions:
  • Discuss with patients and families about sexuality and the reactionprocess and its relationship with disease
  • Give advise on the effect of treatment on sexuality
  • Give privacy to the patient and her partner. Knock before entering.

Nursing Diagnosis:

Risk for Impaired Skin Integrity related to the effects of radiation and chemotherapy, immunologic deficits, decreased nutrient intake and anemia.

Goals:
  • Patients can identify interventions related to specific conditions
  • Participate in the prevention of complications and accelerated healing
Nursing Interventions:
  • Assess the integrity of the skin to see any side effects of cancer therapy, wound healing observed.
  • Instruct patient not to scratch the itch
  • Change the position of the patient on a regular basis
  • Give advise patients to avoid the use of skin creams, oils, powders without medical advice