Medical Surgical Nursing

Urinary tract infections and epididymitis are possible complications after
prostatectomy. The patient is assessed for their occurrence; if they occur, the nurse
administers antibiotics as prescribed.
Because the risk for infection continues after discharge from the hospital, the patient
and family need to be instructed to monitor for signs and symptoms of infection
(fever, chills, sweating, myalgia, dysuria, urinary frequency, and urgency). The
patient and family are instructed to contact the urologist if these symptoms occur.
Deep Vein Thrombosis
Because patients undergoing prostatectomy have a high incidence of DVT and
pulmonary embolism, the physician may prescribe prophylactic (preventive) low-dose
heparin therapy. The nurse assesses the patient frequently after surgery for
manifestations of DVT and applies elastic compression stockings to reduce the risk
for DVT and pulmonary embolism. Nursing and medical management of DVT and
pulmonary embolism are described in Chapters 31 and 23, respectively. The patient
who is receiving heparin must be closely monitored for excessive bleeding.
Obstructed Catheter
After a TUR, the catheter must drain well; an obstructed catheter produces distention
of the prostatic capsule and resultant hemorrhage. Furosemide (Lasix) may be
prescribed to promote urination and initiate postoperative diuresis, thereby helping to
keep the catheter patent.
The nurse observes the lower abdomen to ensure that the catheter has not become
blocked. An overdistended bladder manifests a distinct, rounded swelling above the
pubis.
The drainage bag, dressings, and incisional site are examined for bleeding. The color
of the urine is noted and documented; a change in color from pink to amber indicates
reduced bleeding. Blood pressure, pulse, and respirations are monitored and compared
with baseline preoperative vital signs to detect hypotension. The nurse also observes
the patient for restlessness, diaphoresis, pallor, any drop in blood pressure, and an
increasing pulse rate.
Drainage of the bladder may be accomplished by gravity through a closed sterile
drainage system. A three-way drainage system is useful in irrigating the bladder and
preventing clot formation (Fig. 49-5). Continuous irrigation may be used with TUR.
Some urologists leave an indwelling catheter attached to a dependent drainage system.
Gentle irrigation of the catheter may be prescribed to remove any obstructing clots.
If the patient complains of pain, the tubing is examined. The drainage system is
irrigated, if indicated and prescribed, to clear any obstruction. Usually, the catheter is
irrigated with 50 mL of irrigating fluid at a time. The amount of fluid recovered in the
drainage bag must equal the amount of fluid injected. Overdistention of the bladder is
avoided, because it can induce secondary hemorrhage by stretching the coagulated
blood vessels in the prostatic capsule.
To prevent traction on the bladder, the drainage tube (not the catheter) is taped to the
shaved inner thigh. If a cystostomy catheter is in place, it is taped to the abdomen.
The nurse explains the purpose of the catheter to the patient and assures him that the
urge to void results from the presence of the catheter and from bladder spasms. He is
cautioned not to pull on the catheter, because this causes bleeding and subsequent
catheter blockage, which leads to urinary retention.
Complications With Catheter Removal
After the catheter is removed (usually when the urine appears clear), urine may leak
around the wound for several days in the patient who has undergone perineal,
suprapubic, or retropubic surgery. The cystostomy tube may be removed before or
after the urethral catheter is removed. Some urinary incontinence may occur after