Bladder Cancer Nursing Diagnosis and Nursing Care Plan

Bladder Cancer Nursing Care Plans Diagnosis and Interventions

Bladder Cancer NCLEX Review and Nursing Care Plans

Bladder cancer is a type of cancer that typically begins in the urothelial cells. Urothelial cells can also be found in the kidneys and the tubes that connect the kidneys to the bladder (ureters). Urothelial cancer can also occur in the kidneys and ureters, but it is far more prevalent in the bladder.

Most bladder cancers are usually diagnosed during the early stage when they are easily treatable. However, even early-stage bladder cancers can recur after effective treatments.

As a result, patients with bladder cancer typically require follow-up examinations for several years after treatment to look for recurrent bladder cancer.

Types of Bladder Cancer

Transitional cell (urothelial) bladder cancer. Transitional cell carcinoma is a cancer that develops in cells in the bladder’s innermost epithelial layer. These cells can dilate when the bladder is full and contract when it is empty. The transitional cells are where the majority of bladder cancers start.

  • Low-grade transitional cell carcinoma. This condition frequently resurfaces after therapies, but it rarely propagates into the bladder’s muscular layer or to other parts of the body.
  • High-grade transitional cell carcinoma. This condition frequently recurs after treatment and spreads into the bladder’s muscle layer, other parts of the body, and lymph nodes. Almost all bladder cancer deaths are caused by progressive disease.

Squamous cell carcinoma. Squamous cell carcinoma is a type of bladder cancer that starts in the squamous cells (thin, flat cells lining the inside of the bladder). This type of bladder cancer can develop as a result of a long-term infectious disease or irritation.

Adenocarcinoma. Adenocarcinoma is a type of bladder cancer that begins in glandular cells found in the bladder lining. Mucus is produced by glandular cells in the bladder. Adenocarcinoma is a rare type of bladder cancer.

Signs and Symptoms of Bladder Cancer

The bladder is a hollow organ found in the lower abdomen. It has a flexible, smooth muscular wall that can retain urine and squeeze it out of the body. The primary function of the bladder is to store urine. Therefore, patients with bladder cancer have symptoms that are related to urinary elimination. The common signs and symptoms of bladder cancer are:

  • urine with blood or blood clots
  • During urination, the patient may experience pain or a tingling sensation.
  • frequent urination than usual
  • having frequent urges to urinate throughout the night
  • feeling the need to urinate but being unable to do so
  • lower back pain on one side of the body

Causes of Bladder Cancer

According to several researchers, most bladder cancers are caused by unknown factors. However, they have discovered some risk factors and are beginning to understand how they cause bladder cells to become cancerous.

Changes in the DNA of normal bladder cells can cause them to grow out of control and form cancer. DNA is a chemical found in our cells that makes up our genes, which manage how our cells work. We usually resemble our parents because they are the source of our DNA, but DNA influences more than just our appearance.

Risks Factors to Bladder Cancer

  • Tobacco consumption. Tobacco smoking is the most common risk factor for bladder cancer. Individuals who smoke are four to seven times more likely than nonsmokers to develop bladder cancer.
  • Age. The likelihood of being diagnosed with bladder cancer rises with age. More than 70% of bladder cancer patients are over 65.
  • Gender. Men are four times more likely than women to develop bladder cancer, but women are four times more likely to die from it. In addition, women may have a delayed prognosis of bladder cancer.
  • Race. White people are approximately twice as likely as black people to be diagnosed with bladder cancer, but black people are twice as likely to die due to the condition.
  • Chemicals. Chemical compounds used in the fabric, plastic, leather, dye, varnish, and print businesses, as well as some naturally occurring chemicals and aromatic amines, can all raise the risk of developing bladder cancer.
  • Previous pelvic radiation therapy. People who have had pelvic radiation therapy for cancer may be at a higher risk of developing bladder cancer.
  • Personal medical history. Individuals who have previously had bladder cancer are more inclined to develop it again.
  • Frequent and extreme arsenic exposure. Arsenic is a naturally occurring element that, if ingested in large quantities, can lead to health issues. Arsenic has been linked to a higher risk of bladder cancer when found in drinkable water. The severity of arsenic exposure varies depending on where an individual lives and whether the water comes from a well or from a source that meets appropriate arsenic levels.

Complications of Bladder Cancer

If detected early, bladder cancer can be cured and prevented from spreading to other organs. However, comprehensive treatment becomes complicated because bladder cancer is typically diagnosed at a later stage. The following are some of the complications that can arise as a result of bladder cancer:

  • Male and female infertility. Surgery for reproductive organ and pelvic cancers (such as bladder, colon, prostate, and rectal cancer) can harm these organ systems or surrounding nerves or lymph nodes in the pelvis, resulting in infertility.
  • Early menopause. Early menopause occurs in women with bladder cancer if the malignancy has spread to the ovaries and must be removed surgically.
  • Decreased libido. Both male and female bladder cancer patients may notice reduced sexual arousal. This situation can happen due to the physiological symptoms of cancer or its treatment, but it can also be because of emotional changes, such as decreased energy levels, stress, depressed mood, and anxiety.
  • Anemia. Anemia is a common complication experienced by bladder cancer patients. Anemia occurs due to cancer-induced inflammation, which reduces red blood cell production.

Diagnosis of Bladder Cancer

The following diagnostic tests are beneficial in diagnosing bladder cancer:

  • Diagnostic Tests or Procedures
    • Urine tests. The doctor may suggest urine cytology if the patient discovers any amount of blood in the urine. Urine cytology frequently employs a random urine sample from normal urination to determine whether the urine contains malignant cells.
    • Cystoscopy. Cystoscopy is the primary method of diagnosing bladder cancer. This test enables the doctor to see inside the body using a cystoscope, a thin, lighted, flexible tube. This quick procedure can identify bladder growths and determine whether a biopsy or surgery is required.
    • Biopsy/Transurethral resection of bladder tumor (TURBT). The doctor will perform a biopsy if they discover abnormal tissue during a cystoscopy. A biopsy involves the removal of a small portion of the tissue for microscopic examination.
    • Genetic counseling. Since some people may have genetic factors that elevate their risk of developing bladder cancer, consultation with a genetic counselor and developing a comprehensive family medical history can help determine the potential risk of cancer and the risk of people in the family, including extended family.
    • Tumor biomarker analysis. The doctor may advise running scientific tests on a cancer cell sample to identify genetic factors, proteins, and other tumor-specific factors. This procedure is also known as tumor molecular testing. The outcomes of these tests can help the doctor decide on a treatment plan, significantly if cancer has metastasized.
  • Imaging Tests.
    • CT scan (computed tomography). The doctor may suggest the patient undergo CT Scan to determine the tumor’s size and identify enlarged lymph nodes, which may imply that the cancer has advanced. A special dye known as a contrast medium is sometimes administered before the scan to improve image detail.
    • Magnetic resonance imaging (MRI). An MRI produces detailed images of the human body using magnetic fields rather than x-rays. MRI can be used to determine the size of a tumor and identify enlarged lymph nodes, which may demonstrate that cancer has progressed.
    • Bone scan. A bone scan examines the inside of the bones using a radioactive tracer. The tracer contains far too little radiation to be harmful.
    • PET (positron emission tomography) or PET-CT scan. A PET scan is a technique for images of tissues and organs inside the body. A small amount of radioactive substance is injected into the patient’s body. A scanner detects the substance, which produces images of the inside of the body.
    • Ultrasound. An ultrasound creates a picture of the internal organs by using sound waves. This test can determine whether the kidneys or ureters are blocked. There is no need for a contrast medium for this test.

Treatment for Bladder Cancer

  • Bladder Cancer Surgery
    • Transurethral bladder tumor resection (TURBT). During TURBT, a surgeon inserts an electric wire loop into the bladder via a cystoscope. The wire’s electric current or high-energy laser is used to cut or destroy cancer cells.
    • Cystectomy. Cystectomy is a surgical procedure that removes all or part of the bladder.
    • Neobladder reconstruction. Neobladder reconstruction is one option for urinary diversion. This procedure aims to allow bladder cancer patients to urinate normally.
    • Ileal conduit. The surgeon will use a piece of the intestine to create an ileal conduit for this type of urinary diversion.
    • Continent urinary reservoir. The surgeon will use a section of the intestine to construct a small pouch (reservoir) to retain urine inside the body during this type of urinary diversion procedure.
  • Chemotherapy. Chemotherapy employs the use of drugs to kill cancerous cells. Most cases of bladder cancer are treated with two or more chemotherapy drugs.
    • Chemotherapy through a vein (intravenously).
    • Chemotherapy directly into the bladder (intravesical therapy).
  • Radiation treatment. Radiation therapy destroys cancer cells by delivering powerful energy beams such as X-rays and protons.
  • Immunotherapy. Immunotherapy is a cancer-fighting drug that boosts the immune system of the patient.
  • Targeted therapy. Targeted therapy drugs specifically target areas of weakness in cancerous cells. This therapy aims to kill cancer cells.
  • Bladder preservation. In some cases, patients with muscle-invasive bladder cancer who do not want to endure bladder removal surgery may consider a combination of therapies. This approach, known as trimodality therapy, combines TURBT, chemotherapy, and radiation therapy.

Nursing Diagnosis for Bladder Cancer

Nursing Care Plan for Bladder Cancer 1

Impaired Urinary Elimination

Nursing Diagnosis: Impaired Urinary Elimination related to blockage of the bladder outlet, poor tone of the bladder muscles, diminished bladder capacity, reduced bladder cues, and disturbance in bladder innervation secondary to bladder cancer as evidenced by bladder distention, urinary incontinence, increased urination frequency and urgency, and dysuria.

Desired Outcomes:

  • The patient will demonstrate behaviors and techniques for preventing urinary retention and infection, and bladder cancer.
  • The patient will determine the source of his or her urinary incontinence.
  • The patient will verbalize his or her understanding of bladder cancer.
Bladder Cancer Nursing InterventionsRationale
Examine the patient’s voiding pattern, including the frequency and amount of urine. Compare the patient’s urine output and fluid intake and take note of specific gravity as well.  This intervention identifies bladder function characteristics, bladder emptying effectiveness, kidney function, and fluid balance. Remind the patient that urinary complications are possible symptoms of bladder cancer.
Keep track of the patient’s BUN, creatinine, and white blood cell (WBC) count. Encourage the patient to undergo urine tests as well.  This intervention aims to monitor renal function and detect complications. In addition to renal disorders, problems with urine elimination may indicate bladder cancer.
Take note of the patient’s reports of urinary urgency, frequency, pain while urinating, incontinence, nocturia, and urinary stream size or force. After voiding, palpate the bladder.  This intervention provides relevant information on the extent of obstruction to elimination and may imply bladder cancer. Fullness over the bladder after voiding indicates insufficient emptying or retention and necessitates treatment.
Thoroughly observe the patient’s urine. Examine if the urine is cloudy or has blood and foul odor.  Urine color, odor, and the presence of blood may indicate a urinary tract or kidney infection or, in the worst-case scenario, bladder cancer.
As needed, advise the patient to consult a urinary continence specialist.  Consultation with specialists is beneficial in developing an individual plan of care to meet the specific needs of the patient using the most up-to-date techniques. Simple problems with urine elimination could indicate bladder cancer, so it is best to see a doctor immediately.

Nursing Care Plan for Bladder Cancer 2

Anticipatory Grieving

Nursing Diagnosis: Anticipatory Grieving related to anticipated bodily changes, anxiety, hopelessness secondary to the new diagnosis of bladder cancer as evidenced by alterations in eating habits, sleeping habits, activity levels, libido, and patterns of communication.

Desired Outcomes:

  • The patient will recognize and express his or her emotions appropriately.
  • The patient will go about daily life, looking ahead or planning for the future one day at a time.
  • The patient will communicate their comprehension of the process of death and their feelings of being supported in their grieving process work.
Bladder Cancer Nursing InterventionsRationale
Expect initial shock and disbelief from the patient following a bladder cancer diagnosis and potentially traumatic procedures.Not all bladder cancer patients are entirely prepared for the realities of what can happen.
Encourage the patient to express their feelings or concerns about bladder cancer and recognize expressions of grief, frustration, and rejection. Recognize that these feelings are normal.  The understanding that deep and often conflicting emotions are normal and experienced by other bladder cancer patients in this challenging situation may help the patient feel supported in expressing feelings.  
Be highly cautious of the patient’s possibility of having severe depression. Inquire directly about the patient’s mental state.  According to studies, many bladder cancer patients are suicidal. They are especially vulnerable if recently diagnosed and released from the hospital.  
Discuss how the patient and significant other can plan for the future together.  Most cancer patients get tired of planning for their future because they anticipate death. Thus, encourage the patient to set goals.
Determine the patient’s and significant other’s current stage of grief. Educate the patient on what he or she needs to know about bladder cancer.  Awareness and knowledge about bladder cancer and the grieving process strengthen the normalcy of emotions and responses and help patients deal with them more effectively.    

Nursing Care Plan for Bladder Cancer 3

Acute Pain

Nursing Diagnosis: Acute Pain related to nerve tissue compression or damage, infiltration of nerves or their vascular supply, blockage of a nerve pathway, inflammatory processes, and side effects of various cancer treatment agents secondary to bladder cancer as evidenced by discomfort reports, changes in muscle tone, pain masking on the face, distraction or guarding behaviors, autonomic responses, and anxiousness.

Desired Outcomes:

  • The patient will report top pain management or control with minimal interference with daily activities (ADLs).
  • The patient will adhere to the pharmacological treatment plan prescribed.
Bladder Cancer Nursing InterventionsRationale
Assess and know the painful side effects of specific therapies for bladder cancer, such as surgery, chemoradiation, and immunotherapy.  Depending on the procedure and agent used, a wide range of discomforts (incisional pain, burning skin, low back pain, headaches) is typical. Invasive procedures to diagnose or treat bladder cancer are also associated with pain.  
Encourage the patient to use relaxation exercises, visualization, mental imagery, neurofeedback, laughter, music, aromatherapy, and therapeutic touch as stress management skills or alternative therapy.  Allows patients to engage in nonpharmacological pain management and increases their sense of control. Pain causes stress, which, combined with muscle contractions and internal stressors, increases the patient’s focus on self, increasing the pain level.  
Discuss the use of additional alternative or complementary therapies such as acupuncture and acupressure with the patient  This intervention may provide therapeutic benefit. This approach also prevents pain from bladder cancer complications without the use of prescription medications.
Determine the patient’s pain history (pain location, recurrence, intensity, and frequency using a numeric rating system (0-10 scale) or a spoken rating scale (“no pain” to “excruciating pain”), as well as the relief measures used. Believe the patient’s pain report, especially in the pelvic area.  This data provides a baseline for assessing the efficacy of intervention strategies. Pelvic pain lasting more than six months is considered chronic, which may influence treatment options. Recurrent acute pelvic pain episodes can occur within chronic pain, necessitating a higher level of intervention.  
Educate the patient and significant other about the anticipated therapeutic outcomes and explain how to manage the side effects of bladder cancer treatments.This information assists in establishing realistic expectations and confidence in one’s ability to handle whatever happens.

Nursing Care Plan for Bladder Cancer 4

Risk for Infection

Nursing Diagnosis: Risk for Infection related to malnutrition, chronic disease process, insufficient secondary defenses and immunosuppression, dose-limiting side effects of chemotherapy and radiation, and invasive procedures secondary to bladder cancer.

Desired Outcomes:

  • The patient will remain afebrile and heal as soon as possible.
  • The patient will acknowledge and partake in interventions to prevent or reduce the risk of infection.
Bladder Cancer Nursing InterventionsRationale
Encourage the healthcare staff and visitors to observe proper hand washing techniques. Thoroughly screen the visitors who may be infected. As directed, place in reverse isolation.  This intervention aims to protect bladder cancer patients from infection sources such as visitors and healthcare staff.  
Emphasize the importance of personal hygiene to bladder cancer patients.  This method reduces the number of potential sources of infection and secondary overgrowth.  
If the patient has a urinary tract infection, give antibiotics.  UTI is common in bladder cancer patients. Thus, antibiotics may treat an identified infection or as a preventative measure in immunocompromised patients.  
Regularly check the patient’s overall systems (skin, respiratory, reproductive) for signs and symptoms of infection. Most importantly, determine whether the patient has a urinary tract infection.  Early detection and treatment may prevent bladder cancer progression to a more complex situation or complications.  
Keep track of the patient’s temperature.    Various factors, including chemotherapy side effects, disease progression, or infection, can cause temperature elevation. Early detection of an infectious process allows for the initiation of successful treatment.

Nursing Care Plan for Bladder Cancer 5

Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to chemotherapy side effects such as anorexia, gastric irritation, taste imbalances, vomiting, mental anguish, fatigue, and poorly controlled pain secondary to bladder cancer as evidenced by insufficient food intake, altered taste sensations, loss of appetite, and decreased subcutaneous fat or muscle mass.

Desired Outcome: The patient will have stable or gradual weight gain toward the goal, normalized laboratory values, and no signs of malnutrition.

Bladder Cancer Nursing InterventionsRationale
Check the patient’s daily calorie intake and have the patient keep a food diary as directed.  This intervention aims to identify nutritional strengths and inadequacies in bladder cancer patients.  
Look for pallor, delayed wound healing, and enlarged parotid glands on the patient’s skin and mucous membranes.  Malnutrition is common in bladder cancer patients who are undergoing chemotherapy. As a result, this method aids in detecting protein-calorie malnutrition, mainly when weight is lower than average.  
Encourage the use of bladder cancer-fighting supplements.  Supplements can help the patient maintain a sufficient daily calorie and protein intake.  
Create a pleasant dining environment for the patient. Encourage the patient to eat with family and friends.  This method makes mealtime more enjoyable, which may increase patient consumption.  
Before meals, encourage the patient to use relaxation exercises, image processing, mental imagery, and moderate exercise.  This intervention may prevent or lessen the severity of nausea, reduce anorexia caused by chemotherapy, and allow the patient to increase oral intake.  

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Nursing Stat Facts
Nursing Stat Facts

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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