Question

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 4×4 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 prescribed ketorolac (Toradol) for pain management and belladonna and opiate (B&O) 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. In the immediate postoperative period, the nurse should assist the patient to minimize patients’ negative experiences. The immediate nursing activities includes urinary catheter care, infection prevention, and the provision of appropriate nutrition and hydration; postoperative activities, such as hygiene and surgical wound care; monitoring of medication administration; and education in the signs and symptoms of postoperative complications, pelvic-floor muscle exercises, and pain control.

assess for any frequency, urgency, hesitancy, dysuria, incontinence, retention

During bladder irrigation, assess urine output and drainage system.

Assist the patient to walk and to go to bathroom.

Encourage fluid intake up to 3 liters.

Maintain continuous bladder irrigation.

Keep monitoring vital signs.

Maintain intake output chart.

provide medications as prescribed.

Maintain iv infusion.

Keep the patient warm

Assess the surgical site for any oozing or leaking.

Administer pain control medications as prescribed.

b. Hemorrhage and bleeding. this can occur due to the trocar placement during the surgery. The nurse should notify the surgeon as soon as possible and support the patient. if cannot be controlled by initial management, the patient should be prepared for a open surgery to stop bleeding.

Rectal injuries: should notify the surgeon and immediate closure of the rectum with simultaneous colostomy construction is necessary.

ureteral injury. this can be managed by  ureteroneocystostomy

The patient may also go to hypovolemic shock. so fluid intake should be monitored and an intake output chart should be maintained.

c. Regarding emptying the bag:

Empty the leg bag when it is half filled.

Always clean the genitalia before applying the catheter.

Keep the catheter always clean

Always wash your hands before and after emptying the bag.

Assess for any leakage .

Unclamp the tube and let the bag drain.

Dont touch the tip of the tube or do not let it to touch the floor.

After emptying, clean the tube and clamp. use alcohol swabs to clean the tube.

skin care: clean the skin and nearby area always with soap and alcohol swabs. You can take shower with the catheter in place.

followup as prescribed by the healthcare provider or if there is any fever or chills, any catheter leakage, increased bladder spasms, mild spasms are normal. cloudy or blood color in the urine, foul smelling drains, backache, headache etc.