Question

Case Study, Chapter 59, Assessment and Management of Problems Related to Male Reproductive Processes 1. Joe Smith, a 55-year-old patient, is admitted to the surgical unit after robotic-assisted laparoscopic radical prostatectomy with nerve sparring for early stage cancerous tumor confined to the prostate. The client has six small incisions in the abdomen with small 4x4 dressings with clear dressing dry and intact. The client has a JP drain in place with clear, red-colored drainage with 50 mL present and an indwelling urinary catheter draining clear, red-colored urine. The surgeon ordered ketorolac (Toradol) for pain management and belladonna and opiate (B&0) suppository every 8 hours, as needed, for bladder spasms. (Learning Objective #5 ) a. What nursing care should be provided to the patient in the immediate postoperative period? b. For what potential complications should the nurse observe, and what actions should the nurse take if the complication develops? c. The surgeon removes the JP drain the next day and discharges the patient with the indwelling urinary catheter to a leg bag. What discharge instructions should the nurse provide the patient? What follow-up care is anticipated for him?

Answer 1

a.The immediate post operative care which should be provided are

• Pain management with analgesics to control pain effectively
• Antibiotics to prevent infection postoperatively
• Place the patient in nil by mouth till further order until the bowel sounds or bowel movements occurs
• Administer intravenous fluid to prevent fluid loss and homeostasis
• Monitor vital signs every 4 hourly if patient is stable for first 24 hours
• Assesses GCS until patient receives consciousness
• Maintain intake and output to avoid fluid overload and bleeding,pain, change in the quantity of urine,color etc., to rule out infection ,JP drain monitoring and recording.
• Keep the dressing dry and intact and observe for redness, tenderness, inflammation, bleeding at the site of catheter
• Hang the catcher below hip level or below the bed level to ensure drainage
• Provide psychological support and diversional therapy

b.The expected complications are

• Infection
  • Meticulous hand washing
  • Administer antibiotics
  • Observe for signs of infection
• Bleeding
  • Due to blood thinners in perioperative period
  • Ruture
  • Monitor vitals
  • Stop blood thinners
• Incontinence
  • Clamp and release the catheter before removing catheter to assess the contractions and relaxation of the muscles(detrusor)
  • Ensure patient has full of bladder upon clamping when the bladder is full
• Compartment syndrome
  • Proper positioning

c.The following discharge advice to be given are

• Drink adequate amount of water to ensure clear passage of urine ,avoid irritation,infection
• Empty the urine bag when full and as per the need
• It can be cleansed by instilling distil water or normal saline once a day
• Keep the surgical site dry
• Avoid heavy lifting, driving, swimming, extreme hot showers or tub bath
• Take medication as per advice
• Encourage to take q bland diet followed by full diet as tolerated
• Report immediately in case of any side effects like bleeding ,pain in lower abdomen,fever,constipation, hypotension, etc.
• Teach patient about clamping and releasing to assess sensation.
• The follow up is usually planned at the second week of surgery