Nursing 211

N211: Health Differences Across the Lifespan I of 148 compressing the gland and allows increased urinary flow. A heated probe is inserted into the urethra, causing inflammatory reaction that result in reduction of prostatic tissue. N rsing Interventions Include preoperative teaching pain from bladder spasms that occur postoperatively. Maintain patent urinary drainage system (large three-way indwelling catheter with a 30ml balloon) to decrease the spasms. Provide pain relief with analgesics, narcotics and antispasmodics. Minimize catheter manipulation by taping catheter to or leg. Maintain gentle traction on urinary catheter. Check urinary drainage system for clots. Irrigate bladder as prescribed (may be continuous or rarely intermittent). If continuous, keep Foley bag emptied to avoid retrograde pressure. Observe the color and content of urinary output. Normal drainage after prostate surgery is reddish pink, clearing to light pink within 24 hours after surgery. Some small to medium sized blood clots may be present. Monitor for bright red bleeding with large clots. Monitor vital signs frequently for indication of circulatory collapse. Monitor hemoglobin (Hgb) and hematocrit (Hct) for pattern of decreasing values that indicates bleeding. After catheter is removed, monitor amount and number of times client’s voids. Have the client use urine cups to provide a specimen with each voiding. Observe for hematuria after each voiding (urine should progress to clear yellow color by the fourth day). Inform client that burning on urination and frequency are usually experienced during the first postoperative week. Generally, the client is not impotent after surgery, but sterility may occur. Instruct client to report frank bleeding immediately. Instruct client to increase fluid intake to 3000ml/day. Prepare client for discharge with instructions to drink 12 to 14 glasses of water a day; avoid constipation and straining; avoid strenuous activity. TURP involves an endoscope being inserted into the prostate through the urethra. The prostate is removed in small pieces with an electrical cutting loop. This approach is less invasive and requires shorter hospital stays. Immediate postoperative care involves maintenance of continuous bladder irrigation which facilitates flow of urine and prevents clot formation. A three-way Foley catheter is inserted in surgery. One lumen is for irrigation solution of normal saline, the second is for urine flow, and the third is for balloon inflation. Strict intake and output are required. Use only sterile saline for bladder irrigation after TURP because the irrigation must be isotonic to prevent fluid and electrolyte imbalance. Prostatectomy involved surgical removal of the prostate gland. Complications range from increased risk of infection, bleeding, and permanent nerve damage resulting in impotence or urinary incontinence. Pain management is required for these clients. 3.11 Skin Cancer Basal cell carcinoma is abnormal cell overgrowth of the basal layer of epidermal skin cells that do not mature properly into keratinocytes; neoplastic growth occurs, and surrounding skin is also destroyed. ©2012 Achieve Page 93

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