Mrs. Thompson, who was recently diagnosed with high-grade urothelial carcinoma, is experiencing hydronephrosis due to a ureteral obstruction. As part of her nursing care, what is the most appropriate nursing action to address her current renal complications?

B) Monitor urine output and assess for signs of worsening renal function, such as increased serum creatinine.

A) Encourage increased fluid intake to promote urine flow and relieve obstruction.

B) Monitor urine output and assess for signs of worsening renal function, such as increased serum creatinine.

C) Educate the patient on the importance of avoiding nephrotoxic medications and substances.

D) Prepare the patient for immediate surgical intervention to remove the obstructing tumor.

A nurse is caring for Mrs. Thompson, who has been diagnosed with high-grade urothelial carcinoma with muscular invasion and is now experiencing hydronephrosis due to ureteral obstruction. Which nursing intervention is most critical to prioritize given her current complications?

B) Monitor serum creatinine levels and urine output closely.

A) Educate the patient on the side effects of chemotherapy.

B) Monitor serum creatinine levels and urine output closely.

C) Encourage increased fluid intake to flush the kidneys.

D) Assist with pre-operative preparation for TURBT.

Mrs. Thompson has developed symptoms suggestive of an infection following her ureteral stent placement. As the nurse, what is the most appropriate action to prioritize in her care plan?

D) Administer the ordered empirical antibiotics and monitor for any adverse reactions.

A) Monitor Mrs. Thompson's temperature every 4 hours and administer antipyretics as needed.

B) Ensure Mrs. Thompson's fluid intake is increased to flush out the urinary tract.

C) Educate Mrs. Thompson on the signs and symptoms of worsening infection and when to notify the healthcare provider.

D) Administer the ordered empirical antibiotics and monitor for any adverse reactions.

Mrs. Thompson, who recently had a ureteral stent placed, is now showing signs of a urinary tract infection. Which nursing intervention is the priority to address her current condition?

B) Administer prescribed antibiotics and monitor for therapeutic effects.

A) Increase fluid intake to promote urine dilution and flush out bacteria.

B) Administer prescribed antibiotics and monitor for therapeutic effects.

C) Educate the patient on proper hygiene practices to prevent further infections.

D) Prepare the patient for an immediate TURBT procedure to address the underlying tumor.

Mrs. Thompson, a patient who had a ureteral stent placed and is currently on empirical antibiotic therapy, presents with increased abdominal bloating and a sensation of incomplete bladder emptying. A repeat ultrasound shows mild hydronephrosis, suggesting possible stent obstruction. Which nursing intervention is most appropriate to address her current symptoms and prevent further complications?

C) Contact the urology team immediately to discuss potential stent revision or replacement.

A) Encourage increased fluid intake to enhance urine flow and potentially dislodge any obstruction.

B) Administer analgesics as ordered to manage abdominal discomfort and reassess the patient's condition in 48 hours.

C) Contact the urology team immediately to discuss potential stent revision or replacement.

D) Monitor vital signs and continue the current antibiotic regimen without changes until further notice.

A nurse is caring for Mrs. Thompson, who is experiencing new symptoms of abdominal bloating and a sensation of incomplete bladder emptying after the initiation of empirical antibiotic therapy. Imaging shows mild hydronephrosis, suggesting obstructed urine flow due to possible stent migration or encrustation. What is the nurse's priority intervention to address Mrs. Thompson's symptoms and potential complications?

C) Prepare Mrs. Thompson for possible stent revision or replacement as advised by the urology team.

A) Encourage Mrs. Thompson to increase her fluid intake to facilitate urine flow.

B) Monitor Mrs. Thompson's vital signs and report any further changes to the healthcare provider.

C) Prepare Mrs. Thompson for possible stent revision or replacement as advised by the urology team.

D) Educate Mrs. Thompson about the potential complications of ureteral stents and signs to report immediately.

After Mrs. Thompson's cystoscopy and stent replacement procedure, which nursing intervention is most important to prioritize in her post-procedure care plan to ensure optimal recovery and prevent complications?

B) Monitor for signs of infection such as fever and increased pain.

A) Encourage increased fluid intake to promote urine flow.

B) Monitor for signs of infection such as fever and increased pain.

C) Educate Mrs. Thompson on how to perform Kegel exercises to strengthen pelvic floor muscles.

D) Instruct Mrs. Thompson to avoid heavy lifting to prevent stent displacement.

Following Mrs. Thompson's cystoscopy and stent replacement, which nursing intervention is most critical to address her ongoing mild hematuria and elevated white blood cell count?

A) Encourage increased fluid intake to help flush out the urinary tract.

B) Apply warm compresses to the lower abdomen for pain relief.

C) Educate the patient on signs of infection and when to seek medical attention.

D) Monitor vital signs every 4 hours to detect early signs of systemic infection.

A nurse is caring for Mrs. Thompson, who has recently undergone a stent placement and is now showing signs of a urinary tract infection. Based on this clinical scenario, which nursing intervention is most appropriate to prioritize in preventing further complications?

A) Encourage increased fluid intake to promote renal perfusion

B) Administer analgesics as needed to manage flank pain

C) Educate the patient on avoiding high-potassium foods

D) Limit physical activity to reduce stress on renal function

Mrs. Thompson is experiencing flank pain, low-grade fever, and persistent hematuria following her recent stent placement. The clinical team suspects a urinary tract infection and adjusted her antibiotic regimen based on culture sensitivities. As a nurse caring for Mrs. Thompson, what is the most appropriate action to take to support her recovery and prevent complications?

B) Monitor Mrs. Thompson's vital signs and report any significant changes to the healthcare provider.

A) Encourage Mrs. Thompson to limit fluid intake to prevent overhydration.

B) Monitor Mrs. Thompson's vital signs and report any significant changes to the healthcare provider.

C) Advise Mrs. Thompson to avoid all physical activity to prevent further kidney strain.

D) Suggest Mrs. Thompson self-discontinue the antibiotics once symptoms improve.

bladder cancer - Nursing Case Study

Pathophysiology

• Primary mechanism: The majority of bladder cancers are urothelial carcinomas, originating from the epithelial cells lining the bladder. Carcinogens, such as those from tobacco smoke or industrial chemicals, lead to DNA mutations in these cells, promoting uncontrolled cell division and tumor formation.

• Secondary mechanism: Chronic inflammation or irritation, often due to recurrent urinary tract infections or prolonged catheter use, can contribute to cellular changes in the bladder lining. This persistent irritation may promote a pro-carcinogenic environment, increasing the risk of malignant transformation.

• Key complication: As the tumor grows, it can invade the bladder wall and spread to nearby tissues or distant sites (metastasis), leading to potential complications such as urinary obstruction, renal impairment, and systemic disease spread, which significantly impact patient prognosis and treatment strategies.

Patient Profile

Demographics:

67-year-old female, retired school teacher

History:

• Key past medical history: Hypertension, Type 2 Diabetes, history of smoking (quit 10 years ago)

• Current medications: Metformin, Lisinopril, Atorvastatin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Blood in urine and increased urinary frequency

• Key symptoms: Hematuria, dysuria, lower abdominal pain, fatigue

• Vital signs: Blood pressure 145/90 mmHg, heart rate 95 bpm, respiratory rate 18 breaths per minute, temperature 99.1°F

Section 1

New Complications:

Following the initial diagnosis of bladder cancer, the patient, Mrs. Thompson, underwent further imaging and cystoscopy to assess the extent of the tumor. The results revealed a high-grade urothelial carcinoma with evidence of invasion into the muscularis propria of the bladder wall. Given the tumor invasion, Mrs. Thompson's care team planned a transurethral resection of the bladder tumor (TURBT) as an initial treatment step. However, during pre-operative evaluation, a new complication arose: Mrs. Thompson began experiencing worsening flank pain and a decrease in urine output, prompting concerns for potential urinary obstruction or renal involvement.

In response to these developments, additional diagnostic tests, including a renal ultrasound and CT scan, were conducted. The imaging revealed hydronephrosis in the left kidney, suggestive of obstruction at the ureterovesical junction, likely due to tumor compression. This complication necessitated the urgent placement of a ureteral stent to relieve the obstruction and prevent further renal impairment. Mrs. Thompson's blood work also showed an increase in serum creatinine levels, indicating a decline in renal function, which required close monitoring and potential adjustments to her current medications, particularly those affecting renal excretion.

These findings underscore the importance of addressing the obstructive and renal complications promptly to optimize Mrs. Thompson's overall management plan. The clinical team must now weigh the risks and benefits of proceeding with the TURBT versus exploring alternative therapeutic strategies, such as neoadjuvant chemotherapy, to shrink the tumor pre-operatively. This decision will involve careful consideration of Mrs. Thompson’s renal function, her overall health status, and the potential for metastasis, guiding the next steps in her treatment journey.

Section 2

Following the placement of the ureteral stent, Mrs. Thompson initially experienced relief from her flank pain, and her urine output improved. However, a few days post-intervention, she began exhibiting new symptoms, including generalized abdominal discomfort and intermittent fever. Her vital signs revealed a low-grade fever of 38.1°C (100.6°F), a slightly elevated heart rate of 102 beats per minute, and blood pressure readings of 138/86 mmHg. Concerned about the possibility of an infection or another complication, the clinical team decided to conduct a thorough re-evaluation.

Laboratory results indicated a mild leukocytosis, with a white blood cell count of 12,500/mm³, suggesting an inflammatory response. Her serum creatinine, although slightly improved post-stent placement, remained elevated at 1.8 mg/dL, necessitating ongoing renal function monitoring. Urinalysis revealed hematuria, moderate leukocyte esterase, and the presence of nitrites, raising suspicion for a urinary tract infection potentially linked to the recent stent placement. Blood cultures and urine cultures were ordered to identify the causative organism and guide antibiotic therapy.

In light of these findings, the clinical team initiated empirical antibiotic therapy to address the suspected infection. They also emphasized the need for close monitoring of Mrs. Thompson's renal function and fluid balance, given her compromised kidney status. The team discussed the potential implications of this infection on her upcoming TURBT procedure, considering whether it might be prudent to delay the surgery until the infection is fully resolved. This decision would require balancing the urgency of tumor resection against the risks associated with operating in the presence of an active infection, highlighting the importance of coordinated care and comprehensive assessment in guiding Mrs. Thompson's treatment plan.

Section 3

In the days following the initiation of empirical antibiotic therapy, Mrs. Thompson's condition showed signs of partial improvement. Her fever subsided slightly, with her body temperature stabilizing around 37.8°C (100°F), and her heart rate decreased to 98 beats per minute. However, her blood pressure remained relatively unchanged at 136/84 mmHg. Despite these improvements, Mrs. Thompson began experiencing new symptoms, including increased abdominal bloating and a sensation of incomplete bladder emptying. These developments prompted the clinical team to reassess her condition and consider potential complications linked to the ureteral stent.

A repeat abdominal ultrasound was conducted to evaluate the position and function of the stent. The imaging revealed mild hydronephrosis, suggesting obstructed urine flow, possibly due to stent migration or encrustation. This finding raised concerns about the effectiveness of the stent in maintaining adequate drainage and highlighted the need for further investigation to prevent worsening renal function. Additionally, repeat laboratory tests showed persistent hematuria, and her white blood cell count remained elevated at 13,000/mm³, indicating ongoing inflammation or infection.

The clinical team faced the challenge of determining the most appropriate course of action. They considered the possibility of stent revision or replacement to address the suspected obstruction while also weighing the risks of further invasive procedures in the context of her current infection. The team decided to consult with urology to explore these options and ensure a multidisciplinary approach to Mrs. Thompson's care. This decision underscored the importance of comprehensive assessment and timely intervention to prevent further complications and optimize her treatment outcomes.

Section 4

Following the consultation with the urology team, it was decided to proceed with a cystoscopy to directly visualize the ureteral stent and assess the degree of obstruction or migration. During the procedure, it was observed that the stent had indeed migrated slightly, with signs of encrustation contributing to the partial obstruction. The urologist carefully removed the stent, cleaned the encrustations, and replaced it with a new one to ensure proper urine flow. This intervention was critical in addressing the underlying issue contributing to Mrs. Thompson's symptoms of bloating and incomplete bladder emptying.

Post-procedure, Mrs. Thompson was monitored closely for changes in her condition. Her abdominal bloating began to decrease, and her sensation of incomplete bladder emptying improved significantly. Vital signs remained stable, with her temperature further normalizing to 37.5°C (99.5°F) and her heart rate slightly decreasing to 92 beats per minute. However, her blood pressure was noted to have dropped slightly to 128/82 mmHg, which was interpreted as a positive response to the relief of obstruction and subsequent reduction in systemic stress.

Despite these improvements, her laboratory tests continued to show mild hematuria and an elevated white blood cell count of 12,500/mm³, albeit slightly reduced from previous values. These findings suggested ongoing inflammation, prompting the clinical team to maintain antibiotic therapy while exploring additional supportive measures to aid her recovery. The team also emphasized the importance of regular follow-up imaging to monitor the position and function of the new stent, aiming to prevent future complications. This phase of Mrs. Thompson's care highlighted the need for vigilant monitoring and timely intervention to manage her bladder cancer-related complications effectively.

Section 5

In the days following the procedure, Mrs. Thompson's initial improvement plateaued, and new symptoms emerged that warranted further investigation. She began experiencing intermittent episodes of flank pain and low-grade fever, with her temperature creeping back up to 38.0°C (100.4°F). These developments, combined with the persistent mild hematuria and elevated white blood cell count, prompted the clinical team to consider a possible urinary tract infection or pyelonephritis as complications related to the stent placement.

A repeat urinalysis and blood cultures were performed to identify any infectious agents contributing to her symptoms. The urinalysis revealed persistent leukocyturia and bacteriuria, and the cultures eventually confirmed the presence of Escherichia coli, indicating a urinary tract infection. Given her recent stent replacement and the risk of ascending infection, this finding was significant and required prompt intervention to prevent further complications such as sepsis or impaired renal function.

The clinical team adjusted her antibiotic regimen based on the culture sensitivities, opting for a more targeted approach to eradicate the infection effectively. Additionally, they emphasized the importance of hydration and regular monitoring of her renal function through serum creatinine levels and estimated glomerular filtration rate (eGFR), which remained stable at 55 mL/min/1.73 m². These steps were essential to ensure that Mrs. Thompson's renal function was not compromised further and to support her recovery from this new complication. The team's proactive management underscored the complexity of caring for patients with bladder cancer and the importance of continual reassessment and adaptation of the treatment plan.