Medical Surgical Nursing

 Anxiety about surgery and its outcome

 Acute pain related to bladder distention

 Deficient knowledge about factors related to the disorder and the treatment

protocol

Postoperative Nursing Diagnoses

 Acute pain related to the surgical incision, catheter placement, and bladder

spasms

 Deficient knowledge about postoperative care and management

Collaborative Problems/Potential Complications
Based on the assessment data, the potential complications may include the following:

 Hemorrhage and shock

 Infection

 Deep vein thrombosis

 Catheter obstruction

 Sexual dysfunction

Planning and Goals
The major preoperative goals for the patient may include reduced anxiety and learning
about his prostate disorder and the perioperative experience. The major postoperative
goals may include maintenance of fluid volume balance, relief of pain and discomfort,
ability to perform self-care activities, and absence of complications.
Preoperative Nursing Interventions
Reducing Anxiety
The patient is frequently admitted to the hospital on the morning of surgery. Because
contact with the patient may be limited before surgery, the nurse must establish
communication with the patient to assess his understanding of the diagnosis and of the
planned surgical procedure. The nurse clarifies the nature of the surgery and expected
postoperative outcomes. In addition, the nurse familiarizes the patient with the
preoperative and postoperative routines and initiates measures to reduce anxiety.
Because the patient may be sensitive and embarrassed discussing problems related to
the genitalia and sexuality, the nurse provides privacy and establishes a trusting and
professional relationship. Guilt feelings often surface if the patient falsely assumes a
cause-and-effect relationship between sexual practices and his current problems. He is
encouraged to verbalize his feelings and concerns.
Relieving Discomfort
If the patient experiences discomfort before surgery, he is prescribed bed rest,
analgesic agents are administered, and measures are initiated to relieve anxiety. If he
is hospitalized, the nurse monitors his voiding patterns, watches for bladder
distention, and assists with catheterization if indicated. An indwelling catheter is
inserted if the patient has continuing urinary retention or if laboratory test results
indicate azotemia (accumulation of nitrogenous waste products in the blood). The
catheter can help decompress the bladder gradually over several days, especially if the
patient is elderly and hypertensive and has diminished renal function or urinary
retention that has existed for many weeks. For a few days after the bladder begins
draining, the blood pressure may fluctuate and renal function may decline. If the
patient cannot tolerate a urinary catheter, he is prepared for a cystostomy (see