Nursing Care Plan A Client with a Bladder Tumor

Nursing Care Plan A Client with a Bladder Tumor

1 Pages · 2003 · 41 KB · English

cytology, revealing gross hematuria and poorly differentiated abnormal cells. Cystoscopy and tissue biopsy confirm a stage C tumor involving the 

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CHAPTER 26 / Nursing Care of Clients with Urinary Tract Disorders 729 Ben Hussain is a 61yearold automobile salesman He is married and has five children, all of whom are grown and living away from home One week ago, Mr Hussain became alarmed when his urine became bright red Even though he had no other symptoms, he called his physician The physician ordered a urinalysis and urine cytology, revealing gross hematuria and poorly differentiated abnormal cells Cystoscopy and tissue biopsy confirm a stage C tumor involving the bladder trigone Mr Hussain is admitted for a radical cystectomy and continent urinary diversion ASSESSMENT Mr Hussain?s admission history, obtained by Tara Mills, RN, his primary nurse, indicates that he has lost 10 to 15 pounds over the last few months He smoked two to three packs of cigarettes per day for 40 years, but cut back to a pack a day about a year ago He says he could not quit smoking entirely He drinks five to six cups of coffee daily and consumes a moderate amount of al cohol, averaging three to four drinks a day Mr Hussain says that he is ?a little nervous about surgery and what they?re going to find? Ms Mills notes that he fidgets and talks rapidly through out their interview He also expresses concern about how he will handle the pain after surgery, because he has never been hos pitalized before his cystoscopy Physical assessment findings in clude T 982?F (367?C) PO, P 84, R 18, and BP 154/86 Examinations of the skin, neuromuscular, and cardiac systems are within normal limits Scattered expiratory crackles are noted on auscutlation of lung fields Bowel sounds are very active; Mr Hussain explains that he began taking his bowelpreparation laxative the day before admission Slight tenderness is noted in the suprapubic region Mr Hussain?s urine is clear and bright pink Complete blood count (CBC) and chemistry screening re sults are within normal limits Surgery is planned for 9:00 AM the following day DIAGNOSIS Ms Mills identifies the following nursing diagnoses ?Anxiety,related to undetermined extent of disease and fear of pain ?Deficient knowledge,related to care and management of conti nent urinary diversion ?Impaired urinary elimination,related to cystectomy and urinary diversion ?Risk for impaired gas exchange,related to smoking history and effects of anesthesia EXPECTED OUTCOMES The expected outcomes are that Mr Hussain will: ?Verbalize decreased feelings of anxiety ?Demonstrate appropriate postoperative pain relief through subjective reports of pain severity and objective findings ?Be able to care for urinary diversion and surrounding skin, prior to discharge ?Demonstrate selfcatheterization of stoma using appropriate technique prior to discharge?Maintain normal urine output with ac ceptable color and clarity and no signs of in fection ?Maintain adequate gas exchange as evidenced by good skin color, O 2saturation greater than 95%, and clear lung sounds upon auscultation PLANNING AND IMPLEMENTATION Ms Mills identifies the following nursing interventions ?Spend as much time as possible with Mr Hussain and his family preoperatively, answering questions fully and encouraging expression of fears ?Provide written and verbal explanations when feasible ?Administer analgesia on a regular basis for the first 48 to 72 hours Monitor for objective signs of unrelieved pain ?Explain all procedures related to stoma and diversion care as they are being performed ?Encourage Mr Hussain to look at stoma and touch it when ready ?Teach stoma and skin care, as well as selfcatheterization, em phasizing measures to prevent skin irritation and urinary tract infection ?Monitor urine output, color, clarity, and consistency every hour for first 24 hours, then every 4 hours for 24 hours, then every 8 hours Report output of less than 30 mL per hour, bright bleeding, excessively cloudy or malodorous urine ?Assist with use of incentive spirometer every hour while awake Ambulate as soon as possible Assess lung sounds every 4 hours, reporting increased crackles or diminished breath sounds ?Refer Mrand Mrs Hussain to local stoma group on discharge EVALUATION On discharge, Mr Hussain has performed selfcatheterization and stoma and skin care several times His wife also is able to catheterize the stoma and demonstrate skin care His urine is pale yellow

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