Tiêu đề NCM 114 RLE SEMI FI ✅

NCM 113 RLE Semi Fi BY TONS and MADS to move fluid from pleural space to the peritoneal space. 7. Nursing Management a) Implementing medical regimen, prepares & positions patient for thoracentesis, offers support, making sure thoracentesis fluid amount is recorded and sent for laboratory b) If chest tube drainage and water-seal system used, nurse monitor system’s function and recording amount of drainage at prescribed intervals. c) Care is specific to underlying condition. d) If chest tube inserted for talc instillation, pain management is priority; help patient assume positions that are least painful. e) Frequent turning and movement to facilitate adequate spreading of talc on pleural surface. CARE OF CLIENTS WITH URINARY BLADDER MALIGNANCY From 112 Lec Semis A. Cancer of the Bladder 1. More common in>55 years of age; affects more men (4:1) more common in Caucasians than African Americans. 2. Combined with prostatic cancer, is the most common urologic malignancy, 90% of all tumors seen. 3. Cancers arising from the prostate, colon, and rectum in males and from lower gynecologic tract in females may metastasize to the bladder. 4. Tobacco use continues to be a leading risk factor for all urinary tract cancers. People who smoke develop bladder cancer twice as often 5. Risk Factors a) Cigarette smoking: risk proportional to pack-years of smoking b) Exposure to environmental carcinogens: dyes, rubber, leather, ink, or paint c) Recurrent or chronic bacterial infection of urinary tract d) Bladder stones e) High urinary pH f) High cholesterol intake g) Pelvic radiation therapy h) Cancers arising from the prostate, colon, and rectum in males 6. Clinical Manifestations a) Bladder tumors usually arise at the base of bladder and involve ureteral orifices and bladder neck. b) Visible, painless hematuria - most common c) UTIs - common complication, producing frequency and urgency. d) Any alteration in voiding or change in the urine may indicate cancer of the bladder. e) Pelvic or back pain may occur with metastasis. 7. Assessment and Diagnostic Findings a) Cystoscopy (mainstay of diagnosis), excretory urography, CT, ultrasonography, and bimanual examination with patient anesthetized. b) Biopsies of tumor and adjacent mucosa definitive diagnostic procedures. c) Cytologic examination of fresh urine and saline bladder washings provide information about the prognosis and staging, d) Bladder tumor antigens, nuclear matrix proteins, adhesion molecules, cytoskeletal proteins, and growth factors 8. Medical Management: Depends on grade of tumor (degree of cellular differentiation), stage of tumor growth ( degree of local invasion and presence or absence of metastasis), and multicentricity (having many centers),age and physical, mental, emotional status 9. Surgical Management a) Transurethral resection or fulguration (cauterization) for simple papillomas (benign epithelial tumors); eradicatetumors through surgical incision or electrical current b) Bladder-sparing surgery, intravesical administration of BCG (attenuated live strain of Mycobacterium bovis, causative agent in TB; to produce local inflammatory) c) The entire lining of urinary tract, or urothelium, is at risk because carcinomatous changes can occur in the mucosa of bladder, renal pelvis, ureter, and urethra. d) Simple cystectomy or radical cystectomy for invasive or multifocal bladder cancer. e) Trimodality therapy—transurethral resection of bladder tumor, radiation, and chemotherapy—in an effort to spare the need for cystectomy. 10. Pharmacologic Therapy a) Chemotherapy w/ combination of methotrexate (Rheumatrex), 5-fluorouracil (5-FU), vinblastine (Velban), doxorubicin (Adriamycin), and cisplatin (Platinol) has been effective in producing partial remission of transitional cell carcinoma of bladder in some patients. b) IV chemotherapy may be accompanied by radiation therapy. T c) Topical chemotherapy is considered when there is a high risk of recurrence, when cancer in situ is present, or when tumor resection has been incomplete; delivers high concentration of medication to tumor to promote tumor destruction. d) Direct infusion of cytotoxic agent through bladder’s arterial blood supply e) BCG - most effective intravesical agent for recurrent bladder cancer, especially superficial transitional cell carcinoma, because it is an immunotherapeutic agent that enhances body’s immune response to cancer; BCG has been shown to decrease risk of tumor progression f) The optimal course of BCG: 6-week course of weekly instillations, followed by a 3-week course at 3 months for tumors that do not respond. 2