Medical Surgical Nursing

after surgery but should clear as the prostate area heals.
While the prostatic fossa heals (6 to 8 weeks), the patient should avoid activities that
produce Valsalva effects (straining, heavy lifting), because this may increase venous
pressure and produce hematuria. He should avoid long motor trips and strenuous
exercise, which increase the tendency to bleed. He should also know that spicy foods,
alcohol, and coffee may cause bladder discomfort. The patient should be cautioned to
drink enough fluids to avoid dehydration, which increases the tendency for a blood
clot to form and obstruct the flow of urine. Signs of complications, such as bleeding,
passage of blood clots, a decrease in the urinary stream, urinary retention, or
symptoms of urinary tract infection symptoms, should be reported to the physician
(Chart 49-5).
Continuing Care
Referral for home care may be indicated if the patient is elderly or has other health
problems, if the patient and family cannot provide care in the home, or if the patient
lives alone without available supports. The home care nurse assesses the patient's
physical status (cardiovascular and respiratory status, fluid and nutritional status,
patency of the urinary drainage system, wound and nutritional status) and provides
catheter and wound care, if indicated. The nurse reinforces previous teaching and
assesses the ability of the patient and family to manage required care. The home care
nurse encourages the patient to ambulate and to carry out perineal exercises as
prescribed. The patient may need to be reminded that return of bladder control may
take time.
The patient is reminded about the importance of participating in routine health
screening and other health promotion activities. If the prostatectomy was performed to
treat prostate cancer, the patient and family are also instructed about the importance of
follow-up and monitoring with the physician.
Evaluation
Expected Preoperative Patient Outcomes
Expected preoperative patient outcomes may include the following:

 Demonstrates reduced anxiety

 States that pain and discomfort are decreased

 Relates understanding of the surgical procedure and postoperative course and

practices perineal muscle exercises and other techniques useful in facilitating

bladder contrlo

Expected Postoperative Patient Outcomes
Expected postoperative patient outcomes may include the following:

 Reports relief of discomfort

 Exhibits fluid and electrolyte balance

o Irrigation fluid and urinary output are within parameters determined by

surgeon

o Experiences no signs or symptoms of fluid retention

 Participates in self-care measures

o Increases activity and ambulation daily

o Produces urine output within normal ranges and consistent with intake

o Performs perineal exercises and interrupts urinary stream to promote

bladder control

o Avoids straining and lifting heavy objects

 Is free of complications