Case Study 13-4
Lori L. Lindsey-Clarkston
Lakeview College of Nursing
RN 309 Nursing of the Gerontological Client
January 30, 2011

1.	 The risk factors for bladder cancer are smoking, workplace exposures such as chemicals used in the dye industry, makers of rubber, leather, textiles, and paint products.  Other industry exposures include printers, hairdressers, machinist, and diesel truck driver (ACS, 2011).  Risk factors also include age, gender, more prevalent in men, chronic bladder irritation, and smoking (Mauk, 2010).  Other risk factors according to the American Cancer Society are race, personal history of bladder cancer, bladder birth defects, genetics, chemo/radiation therapy, arsenic and low fluid consumption (2011).  Dr. Johnson is man, had been a smoker for over thirty years, and he has had spots of blood in his urine which could indicate bladder irritation these are all risk for bladder cancer that he has been attributing to past problems with prostate for “sometime.”  Ignoring or not knowing these signs have put the doctor at risk for bladder cancer.  
2.	The primary sign that the doctor exhibited is painless hematuria (Mauk, 2010).  
3.	Treatment option for Dr Johnson is transurethral resection where superficial lesions are removed for biopsy (ACS, 2011) or burned through a scope (Mauk, 2010).  Depending on the extent of the cancer and biopsy results other treatments are available such as radiation therapy, immunotherapy, or chemotherapy (Mauk, 2010).  
4.	For invasive cancer a cystectomy total or partial, this is removal of all or part of the bladder and nearby lymph nodes (ACS, 2011) along with chemotherapy or radiation may also be used to eradicate the cancer in the body (Mauk, 2010).  
5.	When a cystectomy is performed a urostomy is created.  A urostomy creates a tube made from a part of the intestines creating a tube from the kidneys to the outside of the body creating a stoma (ACS, 2011).  Urine drains into a collection that has to be drained often that is on the outside of the body (Mauk, 2010).  Nurses must educate patients and family on care of the stoma, emptying/changing the urine collection bag (Mauk, 2010).  Return demonstration by patient and family will ensure proper care for the stoma and emptying/changing of the bag.  The patient must be taught the hazard of allowing the bag to become “to full” and breaking or leaking which could cause embarrassment or anxiety that could lead to social isolation, excellent education with questions and concerns covered will prevent this. Another area to educate on is possible sexual affects, in a radical cystectomy the prostate gland is also removed which will likely cause erectile dysfunction or the man will be unable to get or maintain an erection (ACS, 2011).  This implication must be discussed as it will affect the intimate relationship between two people.  Education regarding options or prognosis for sexual activity must be discussed.  There is a chance in younger men that the ability to achieve and maintain an erection will return (ACS, 2011).  
6.	The procedure should be explained to the family in easy to understand but frank terms.  I would say the bladder will be completely/partially removed through an incision in the abdomen.  After the bladder is removed, a tube will be made with a section of the intestine that we will wash and turn inside out and attach to the kidneys. With the end of the tube we will create what is called a stoma which is another name meaning opening.  This will allow for urine to drain out of the body, he will always have a bag attached with adhesive to his skin over the stoma to collect the urine, it will need to be changed or emptied many times daily depending on what he takes in.  When he comes out of surgery the stoma will appear red and puffy, over time it will become not as puffy, be pink, and will always be a little moist, if it is any other color besides red or pink or becomes dry that  not normal and he needs to see a doctor immediately.  It is not life threatening it does mean that the tube we created is not getting blood supply and will stop working properly.  

References
Mauk, K.L. (2010).  Gerontological nursing competencies for care (2nd ed.). Sudbury, MA: Jones and Bartlett.
American Cancer Society (2011).  Bladder cancer.  Retrieved from http://www.cancer.org/Cancer/BladderCancer/DetailedGuide/bladder-cancer-treating-surgery