Discharge And Home Healthcare Guidelines

PATIENT TEACHING. Instruct patients about the need to maintain a high fluid intake (at least 2 L/day) to ensure adequate urine output. Teach the patient to monitor urinary output for 4 to 6 weeks after surgery to ensure adequacy in volume of elimination combined with a decrease in volume of retention.

MEDICATIONS. Provide instructions about all medications used to relax the smooth muscles of the bladder or to shrink the prostate gland. Provide instructions on the correct dosage, route, action, side effects, and potential drug interactions and when to notify these to the physician.

PREVENTION. Instruct the patient to report any difficulties with urination to the physician immediately. Explain that BPH can recur and that he should notify the physician if symptoms of urgency, frequency, difficulty initiating stream, retention, nocturia, or bladder distension recur.

POSTOPERATIVE. Encourage the patient to discuss any sexual concerns he or his partner may have after surgery with the appropriate counselors. Reassure the patient that a session can be set up by the nurse or physician whenever one is indicated. Usually, the physician recommends that the patient have no sexual intercourse or masturbation for several weeks after invasive procedures.

Bladder Cancer

DRG Category: 318

Mean LOS: 5.5 days

Description: MEDICAL: Kidney and Urinary Tract

Neoplasm with CC DRG Category: 303 Mean LOS: 9.7 days

Description: SURGICAL: Kidney, Ureter, and Major Bladder Procedures for Neoplasm

Cancer of the urinary bladder is the second most common genitourinary (GU) cancer after prostate cancer. It accounts for approximately 4% of all cancers and 2% of deaths from cancer in the United States. The American Cancer Society estimates that, in 2005, there will be over 63,000 new cases of bladder cancer diagnosed, and over 13,000 deaths in the United States. The majority of bladder tumors (>90%) are urothelial or transitional cell carcinomas arising in the epithelial layer of the bladder, although squamous cell (4%), adenocarcinoma (1% to 2%), and small cell (1%) may occur. Urothelial tumors are classified as invasive or noninvasive, and according to their shape, papillary or flat. Noninvasive urothelial cancer affects only the innemost layer of the bladder, whereas invasive urothelial cancer spreads from the urothelium to the deepest layers of the bladder. The deeper the invasion, the more serious the cancer. Papillary tumors have finger-like projections that grow into the hollow of the bladder. Flat urothelial tumors involve the layer of cells closest to the inside of the bladder.

Most bladder tumors are multifocal, because the environment of the bladder allows for the continuous bathing of the mucosa with urine that contains tumor cells that can implant in several locations. The ureters, bladder neck, and prostate urethra may become obstructed. Direct extension can occur to the sigmoid colon, rectum, and depending upon the sex of the patient, the prostate or uterus and vagina. Metastasis occasionally occurs to the bones, liver, and lungs.

Bladder cancer is staged based on the presence or absence of invasion and is graded (I to IV) based on the degree of differentiation of the cell, with grade I being the best differentiated and slowest growing. Both the stage and the grade of the tumor are considered when planning treatment.

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