Nursing 211

N211: Health Differences Across the Lifespan I Homium laser causes less bleeding, fewer complications and a shorter hospital stay. Nursing Interventions Include monitor vital signs closely for 24 hours and observe for signs of hemorrhage. Monitor for drainage on dressings. If the client has a urinary catheter following surgery, the surgeon may apply traction against the prostatic fossa to prevent bleeding. The balloon at the tip of the catheter exerts pressure to prevent hemorrhage. A client who has a large indwelling catheter may feel the urge to void, which results in stimulation of the micturition center. Explain the client that this is a normal sensation and to try to void or strain will increase the risk of bleeding and aggravate the pain. The client will have continuous bladder irrigation to prevent formation of clots. Titrate flow of irrigating solution to maintain outflow of light pink) early) or pale yellow (later) in color with no visible clots. Calculate intake and output from urinary catheter to determine true urine output. Monitor for signs of hemorrhage, bladder spasms and frank bloody output may indicate bleeding. Monitor for signs of hyponatremia and bradycardia, nausea and vomiting due to fluid shifts and dilutional hyponatremia. Medicate as needed for surgical pain with opioids and use suppositories such as belladonna and opium to relieve sudden severe pain caused by bladder spasms. Prepare client for external beam radiation of the prostate and pelvic region. Side effects are cystitis or proctitis, dysuria, frequency, Suprapubic discomfort, fatigue and loss of appetite. Instruct client in cleansing perineal skin with a mild cleanser and lukewarm water. Proton beam radiotherapy combines imaging and charged protons to target more specifically prostate cancer cells while limiting damage to the overlying skin or adjacent structures including the bladder and rectum. Brachytherapy is the implantation of radioactive iodine-125 or palladium-103 seeds directly into the prostate, which emit highly localized radiation energy to kill localized cancer cells without excessive harm to nearby healthy cells. Seed implantation will cause inflammation of the prostate and may cause voiding frequency, difficulty in initiating a stream, semen may have a brownish color over the next 1 to 2 months and intercourse should be avoided during this period. Monitor stool for passage of large volumes of bright red blood. Teach client and partner the principles of radiation safety. Client should refrain from having children or adults sit in their lap for prolonged periods of time during the first two months following therapy. Teach client about the impact of surgery on sexual function, there will be temporary or permanent impotence and permanent infertility after a radical prostatectomy. Assess patient’s tolerance of activities and plan frequent rest periods. Allow client to express feelings regarding diagnosis. 3.16 Testicular Cancer

©2012

Page 102

of 148

Achieve