Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder...
-
Upload
willie-siddons -
Category
Documents
-
view
216 -
download
3
Transcript of Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder...
![Page 1: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/1.jpg)
Urostomy
Why?
Patricia Anderson BSN RN CWOCN
![Page 2: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/2.jpg)
The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are:
About 72,570 new cases of bladder cancer
About 15,210 deaths from bladder cancer
![Page 3: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/3.jpg)
More common among men than women.
More common among whites than blacks.
Man having this cancer during his lifetime is about 1 in 26.For women, it is about 1 in 90.
![Page 4: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/4.jpg)
Risk Factor
Cigarette smokingExposure to aniline dyeSchistosomiasis Chronic irritation of the bladder Patients treated with pelvic radiationPatients taking phenacetin
![Page 5: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/5.jpg)
Categorization of Cancers
Histologic type
Grade
Stage
![Page 6: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/6.jpg)
Histologic types
Transitional cell carcinoma: 95%
Adenocarcinoma
Squamous cell carcinoma
![Page 7: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/7.jpg)
Stage Tumor invasion
Nodes
Metastasis
This is the TNM system
![Page 8: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/8.jpg)
Tumor Stage
T 0 T carcinoma in situ T1
T2 T3 T4
Superficial disease Superficial disease Borderline
Invasion into the muscle
Invasion through muscle into the fat surrounding the bladder and lymph nodes.
![Page 9: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/9.jpg)
Superficial bladder cancers
Treated topically with chemotherapy instillation
Monitoring for recurrence
Only 10 to 15% of superficial cancers develop into aggressive cancer
![Page 10: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/10.jpg)
Radical Cystectomy and Urinary DiversionHigher grade tumor
Larger tumor
Multiple tumors
Carcinoma in situ in multiple sites in the bladder
![Page 11: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/11.jpg)
Preoperative Preparation
Educational visit with WOC nurse
Stoma marking
Discuss outcomes, including sexuality changes
Preoperative bowel preparation
Patient will see their primary care physician for surgical clearance
![Page 12: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/12.jpg)
Types of Cystectomies Partial cystectomy: removes part of the bladder
where tumor located. Simple cystectomy: removal of the bladder. Radical cystectomy: removal of the bladder, pelvic
lymph nodes, urethra Men: prostate, the seminal vesicles, and part of the
vas deferens. Women: the cervix, the uterus, the ovaries, the
fallopian tubes, and part or all of the vagina.
![Page 13: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/13.jpg)
Radical Cystectomy and Creation of Ileal Conduit Involves
Removal of the bladder
Lymph nodes in the pelvis are included in this removal
Conduit made from small bowel
![Page 14: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/14.jpg)
Ileal Conduit
![Page 15: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/15.jpg)
Mesentary stays connected
![Page 16: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/16.jpg)
Urethral stent
![Page 17: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/17.jpg)
Urostomy with stents
![Page 18: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/18.jpg)
Early Postoperative Complication
Bleeding Wound infection Pelvic abscess Bowel obstruction Prolonged ileus Urine leak Ureteral obstruction
![Page 19: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/19.jpg)
Postoperative Care Hospital stay generally 5 to 7 days
Mainly to return to normal bowel function and normal ambulation
Generally have nasogastric tube for 2 to 3 days
Urethral stents will be removed 5 to 14 days post op
Continue pouching and stoma education
![Page 20: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/20.jpg)
Postoperative complications
Stomal complications - stenosis, bowel necrosis, parastomal hernia, prolapse, retraction
Complications related to ureterointestinal anastomoses - leakage, stricture, pyelonephritis
80% of patients will have asymptomatic bacteriuria
Metabolic complications can occur
![Page 21: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/21.jpg)
Mortality post radical cystectomy
Reported to be 1 to 3%
![Page 22: Urostomy Why? Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649c7c5503460f949312c0/html5/thumbnails/22.jpg)
References http://www.wisegeek.org/what-is-aniline-dye.htm http://
medical-dictionary.thefreedictionary.com/phenacetin
http://www.webmd.com/cancer/bladder-cancer/cystectomy-for-bladder-cancer
https://www.google.com/search?q=ileal+conduit&hl=en&qscrl=1&rlz=1T4ADFA_enUS490US491&tbm=isch&tbo=u&source=univ&sa=X&ei=M5cNU_S-
Colwell, Goldberg, Carmel: Fecal and Urinary Diversions: Management Principles, Mosby 2009, pages 184 to 203.