Bladder Cancer (Prep U)

A client diagnosed with bladder cancer wants to avoid surgery. For which intravesical treatment will the nurse prepare teaching for this client?

Bacillus Calmette Guerin (BCG) Live BCG Live is now considered the most predominant and conservative intravesical agent for recurrent bladder cancer, especially superficial transitional cell carcinoma, because it is an immunotherapeutic agent that enhances the body's immune response to cancer. The optimal course of BCG Live appears to be a 6-week course of weekly instillations, followed by a 3-week course at 3 months for tumors that do not respond. In high-risk cancers, maintenance BCG Live given in a 3-week course at 6, 12, 18, and 24 months may limit recurrence and prevent progression. Radiation may be used preoperatively to reduce micro-extension of the neoplasm and reduce recurrence and metastasis. It may also be used in combination with surgery to control inoperable tumors. Other options for managing transitional cell bladder cancer mandate lifelong surveillance with periodic cystoscopy. Infusion of a cytotoxic agent is through the bladder's arterial blood; however, this is not an intravesical procedure.

A female client who is diagnosed with a malignant tumor in her bladder is advised to undergo cystectomy followed by a urinary diversion procedure. Which of the following would be most important for the nurse to assess preoperatively?

Client's manual dexterity and vision It is essential to assess manual dexterity, vision, and level of understanding of a client who undergoes a urinary diversion procedure, because this information will determine the client's ability to manage stoma care and self-catheterization following the urinary diversion procedure. The client's history of allergy to iodine and seafood, dietary habits related to high cholesterol intake, and menstrual history are not important factors for this situation.

The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of:

Disturbed body image The client is exhibiting defining characteristics of disturbed body image.

Resection of a client's bladder tumor has been incomplete and the client is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the client, the nurse should emphasize the need to do which of the following?

Hold the solution in the bladder for 2 hours before voiding. The client is allowed to eat and drink before the instillation procedure. Once the bladder is full, the client must retain the intravesical solution for 2 hours before voiding. The solution is instilled through the meatus; it is not consumed orally. There is no need to avoid acidic foods and beverages during treatment.

A client is recovering from the creation of an ileal conduit with stents. Which action(s) will the nurse take if the conduit and stents stop draining urine? Select all that apply. Change the collection bag. Insert a catheter through the stoma. Apply external pressure around the stoma. Remove the skin barrier around the stoma. Irrigate the stents with 5 to 10 mL sterile normal saline.

Insert a catheter through the stoma. Irrigate the stents with 5 to 10 mL sterile normal saline. If urine output drops below 0.5 mL/kg/hr, the client may be experiencing dehydration or an obstruction in the ileal conduit. A catheter can be inserted through the stoma to monitor for possible stasis or residual urine from a constricted stoma. If the ureteral stents are not draining, careful irrigation with 5 to 10 mL of sterile normal saline may be performed. Changing the collection bag will not improve the urine flow. Pressure should not be applied around the stoma. Removing the skin barrier around the stoma will not improve the urine flow.

The nurse has tested the pH of urine from a client's newly created ileal conduit and obtained a result of 6.8. What is the nurse's best response to this assessment finding?

Obtain an order to increase the client's dose of ascorbic acid. Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine pH is kept below 6.5 by administration of ascorbic acid by mouth. An increased pH may suggest a need to increase ascorbic acid dosing. This is not treated by administering bicarbonate or citric acid, or by increasing fluid intake.

Which finding is an early indicator of bladder cancer?

Painless hematuria Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection.

The nurse is preparing to assess a client's new stoma. Which finding would the nurse include in the documentation of a healthy stoma?

Pink color Characteristics of a healthy stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. A black, purple, or brown color may indicate that the vascular supply may be compromised, which may require surgical intervention.

The nurse is assessing a client's new stoma and observes that the stoma color is now dark purple. The appropriate nursing intervention is to

contact the physician. The appropriate nursing intervention when a newly created stoma is dark purple is to notify the physician. The physician or wound, ostomy, and continence (WOC) nurse will assess the stoma to determine whether it has superficial ischemia or is necrotic.

A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to:

help the client cope with the anxiety associated with changes in body image. Many clients who undergo surgery for creation of an ileal conduit experience anxiety associated with changes in body image. The mental health practitioner can help the client cope with these feelings of anxiety. Mental health practitioners don't evaluate whether the client is a surgical candidate. None of the evidence suggests that urinary diversion surgery, such as creation of an ileal conduit, places the client at risk for suicide. Although evaluating the need for mental health intervention is always important, this client displays no behavioral changes that suggest intervention is necessary at this time.