Management of Patient with Altered Urinary Function - PDF

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					   Care of the Patient With
 Renal and Urinary Disorders -
       Nursing IV - Medical Surgical

       Classroom Objectives
• Discuss the pathophysiology and clinical
  manifestations of renal failure
• Interpret the results of laboratory data &
  diagnostic tests associated with renal
• Discuss three treatment modalities used
  in the collaborative management of
  chronic renal failure.

   Classroom Objectives Cont.
• Describe the kidney donor selection
• Discuss the drug therapy used to prevent
  transplant rejection.
• Use Maslow’s hierarchy to prioritize
  assessments in the patient with CRF
  undergoing various treatment modalities.
• State four nursing diagnoses
  (NANDA)commonly associated with a
  patient in end-stage renal disease.

   Classroom Objectives Cont.
• List four corresponding nursing outcomes
  (NOC) associated with the diagnoses
  generated for the patient in end-stage
  renal disease.
• Discuss appropriate NIC based nursing
  interventions for the patient undergoing
  dialysis or renal transplant.

• Discuss the nursing management of the
  end-stage renal patient at home and the
  use of community resources
Anatomic Location of the Organs
  of the Renal/Urinary System

                                  Slide 72.1

Bisection of the Kidney Showing
 Major Structures of the Kidney

                                  Slide 72.4

  Anatomy of the Nephron
 Sodium and Water Reabsorbtion by the Tubules of
              a Cortical Nephron

             Renal Function
• Excretory function- urine
• Regulatory functions -
  acid base balance
• Renal related endocrine
       Excretory Function/urine
• Glomerular filtration
• Tubular Reabsorption - proximal
  convoluted tubule
• Tubular secretion
• Active and passive reabsorption

        Regulatory Functions*
• Partial control of acid-base balance
• Renal regulation of water
• Renal regulation of electrolytes- Na+ & K+

      Renal Related Endocrine
•   Renin
•   Erythropoietin
•   Prostaglandins
•   Vitamin D/Calcium
•   Insulin
  The Juxtaglomerular Complex-

                                                                            Slide 72.10

    Renal Hormone Production and
     Hormones Influencing Renal
Hormones influencing                  • Makes DCT and CD
Renal function                          permeable to water to
• Antidiuretic hormone                  maximize
  (ADH)                                 reabsorption and
                                        produce a
                 • Released from
• Aldosterone                           concentrated urine
                   posterior pituitary
                                      • Promotes sodium
                                        reabsorption and
                 • Released from        potassium secretion
                   adrenal cortex       in DCT and CD;
                                        water and chloride
                                        follow sodium
                   DCT = distal convoluted tubule; CD = collecting ducts.
                                                                             Slide 72.3
   Renal Hormone Production and
    Hormones Influencing Renal
             Function Stimulates make red
                       marrow to

                   • Renal               blood cells
Renal hormone        parenchyma        • Promotes absorption
                                         of calcium in the
• Erythropoietin
                    • Renal              gastrointestinal tract
• Activated vitamin D parenchyma       • Raises blood
                                         pressure as result
• Renin             • Juxtaglomerular    of angiotensin
                      cells of           (vasoconstriction)
                      the afferent and   and aldosterone
                      efferent           (volume expansion)
• Prostaglandins
                      arterioles         secretion
                                       • Regulate intrarenal
                    • Renal tissues      blood flow by vaso
                                         dilation or constriction
                                                              Slide 72.2

     Assessment of Renal/urinary
 • Secondary Prevention: Early
 • history
 • physical signs & symptoms
 • renal system lab tests

       Interview Your New Patient
     Very ill new admission - Suspect
    CRF, 7 lb weight gain in 3 wks, Hx
              diabetes and HTN
• What questions should you ask regarding
• What risk factors for development of CRF
  does the new admission have?
• What cardiac and respiratory
  manifestations might you find on physical

      History/diseases RT. Renal
• HTN, D.M., SLE
•  Infectious diseases - Strep. UTI
• Drugs
• Congenital abnormalities, ie polycystic
  kidney disease
• Diet - ca++, higher mineral
• Immobility

     Commonly Used Renal and
         Urinary Terms*
    • Oliguria — decreased urinary output; Total
      urinary output between 100 and 400 ml in 24
    • Polyuria — increased urinary output; Total
      urinary output usually greater than 2000 ml in
      24 hr.
    • Azotemia — increased BUN and serum
      creatinine levels- suggestive of renal impair.
      but without outward symp.of renal failure.
    • Uremia — full-blown signs and symptoms of
      renal failure; Sometimes referred to as the
      uremic syndrome, especially if cause
      unknown.                                     Slide 72.6
    Physical Signs & Symptoms of
           Renal Disease*
•   Fatigue
•   Change in mentation
•   Headache
•   HTN
•   Change in body weight
•   Pain –sharp or dull, localized or diffuse

    Clinical Manifestations of CRF*
• Cardiovascular             •   Integumentary
• Respiratory-sleep apnea,   •   Nutritional
  jittery                    •   Electrolyte Imbalances
• Hematologic                •   Metabolic
• Genitourinary
• Reproductive
• Gastrointestinal
• Musculoskeletal- renal
  osteodystrophy – 90%
• Neurological

           Blood Chemistries*
• BUN -greater than 20mg/dl - renal
  normal =10-20mg/dl. Elderly sl. Higher
• Creatinine - 0.8 - 1.5 mg/dl
• Creatinine clearance - best indication of
  overall renal function- ave. 108- 120ml/min
• BUN/ Creatinine ratio: 10:1 to 20:1
        Acute Renal Failure
• Prerenal causes
• Renal causes
• Postrenal causes

  Medical Management During
• Dialysis
• Manage secondary infections &
• Careful fluid replacement
• Electrolyte replacement
• High calorie, low protein diet
• Symptomatic relief - seizures, anemia,
  bleeding tendencies

      Chronic Renal Failure*
• Progressive reduction of functioning renal
  tissue. Remaining kidney can no longer
  maintain body environment.
• Insidiously or after ARF.
• HTN and diabetes - most common causes.
  Progression Toward Chronic
         Renal Failure
• Stage I

• Stage II

• Stage III

                                                   Slide 75.6

Stage I: Diminished Renal Reserve.*

• Renal function is reduced, but no
  accumulation of metabolic wastes occurs.
• The healthier kidney compensates for the
  diseased kidney.
• Ability to concentrate urine is decreased,
  resulting in nocturia and polyuria.
• A 24-hour urine for creatinine clearance is
  necessary to detect that renal reserve is less
  than normal.

    Stage II: renal insufficiency.*

• Metabolic wastes begin to accumulate in the
  blood because the unaffected nephrons can
  no longer compensate.
• Responsiveness to diuretics is decreased =
  oliguria and edema.
• The degree of insufficiency is determined by
  decreasing GFR (glomerular filtration rate)
  and is classified as mild, moderate, or severe.
• Treatment is medical.
    Stage III: Renal Failure - end-stage renal

• Excessive amounts of metabolic wastes
  such as urea and creatinine accumulate in
  the blood.
• The kidneys are unable to maintain
• Treatment is by dialysis or other renal
  replacement therapy.

Stage IV End Stage Renal Failure -
•   Anuria
•   Marked azotemia
•   Severe electrolyte imbalances
•   Pul edema , uremic lung
•   Uremic frost,pruritus
•   Anemia
•   Proteinuria
•   CHF

    GFR = Calculation of Age, Serum
         Creatinine, Race, Sex
• Stage 1 90 mL/min or more - Healthy kidneys
  or Kidney damage with normal or high GFR
• Stage 2 60 to 89 mL/min -Kidney damage and
  mild decrease in GFR
• Stage 3 30 to 59 mL/min - Moderate decrease
  in GFR
• Stage 4 15 to 29 mL/min Severe decrease in
• Stage 5 Less than 15 mL/min or on dialysis -
  Kidney failure
    Clinical Manifestations of CRF*
• Cardiovascular             •   Integumentary
• Respiratory-sleep apnea,   •   Nutritional
  jittery                    •   Electrolyte Imbalances
• Hematologic                •   Metabolic
• Genitourinary
• Reproductive
• Gastrointestinal
• Musculoskeletal- renal
  osteodystrophy – 90%
• Neurological

        Clinical Manifestations

     Key Features of Uremia- Excessive
      amounts of Urea & Nitrogenous
           Wastes ( Azotemia)*
•   Metallic taste
•   Anorexia
•   Nausea
•   Vomiting
•   Muscle Cramps
•   Itching
       Key Features of Uremia
•   Fatigue & Lethargy
•   Hiccups
•   Edema
•   Dyspnea
•   Muscle Cramps
•   Parenthesis

     Electrolyte Imbalances*N.B!
•   K+ increases
•   Phosphate increases
•   Sodium - normal or decreased
•   Magnesium increases
•   Calcium decreases
•   Metabolic acidosis

     The Effects of Renal Failure on
    Phosphate and Calcium Balance

                                       Slide 75.1
Focused Assessment for Care Clients
with Chronic Renal Failure (Acute Care Too)*
   Assess renal status, including

   • Amount, frequency, and appearance of
     urine (anuric clients)
   • Presence of bone pain

   • Presence of hyperglycemia secondary to

                                               Slide 75.19

 Focused Assessment for Care Clients
     with Chronic Renal Failure*
Assess cardiovascular and respiratory
 status, including
• Vital signs, with special attention to blood
• Presence of S3 and/or pericardial friction
• Presence of chest pain

                                               Slide 75.18

      Assessment Continued*
• Presence of edema (periorbital, pretibial,
• Jugular vein distension
• Presence of dyspnea
• Presence of crackles, beginning at the
  bases, and extending upward

Assess hematologic status, including
• Presence of petechiae, purpura,
• Presence of fatigue or shortness of breath
Assess gastrointestinal status, including
• Presence of stomatitis
• Presence of melena

       Assessment Continued*
Assess integumentary status, including
• Skin integrity
• Presence of pruritis
• Presence of skin discoloration

    Review - Focused Assessment for
    Clients with Chronic Renal Failure
Assess NEUROLOGIC status, including
•   Changes in mental status
•   Presence of seizure activity
•   Presence of sensory changes
•   Presence of lower extremity weakness
  Assess NUTRITIONAL status,

• Weight gain or loss
• Presence of anorexia, nausea, or vomiting

   Case Study-End Stage Renal

     Nursing Diagnoses for CRF
• Fluid Vol. deficit of      • Risk for Impaired Skin
  Fluid Vol Excess rt.         Integrity
  impaired Renal             • Knowledge Deficit rt.
  function                     disease process &
• Altered Nutrition less       treatment
  than Body                  • Risk for Ineffective
  Requirements rt              Management of
  anorexia, nausea             Therapeutic Regime
• Fatigue rt. anemia &       • Risk for Ineffective
  altered metabolic            Family Coping-
  state                        Financial - *80% fed.

     Nsg. Diagnoses Continued*
• Activity Intolerance rt.   • Fatigue rt. Altered
  Effects of Anemia            Body Chemistry
• Impaired Comfort :         • Risk for Injury rt. bone
  puritis                      changes, muscle
• Chronic Sorrow rt.           weakness
  Chronic Illness            • Decreased Cardiac
                               Output rt. elevated K+

         Medical Goals of CRF
•   Preservation of Renal Function
•   Delay of need for Dialysis or transplant
•   Improvement of Body Chemistry
•   Alleviation of Extrarenal effects
•   Provide optimal quality of life
        Dietary Restrictions*
• Fluid
• Protein –on dialysis – high quality protein
  – not limited on hemodialysis
• Potassium 60-70 mEg./day
• Sodium
• Phosphorus

       Medications for CRF*
• Diuretics
• Vitamins and Minerals
• Sodium bicarbonate
• Erythropoietin
• Calcium Preparations & Phosphorus
• Antihypertensives

    NIC Label: Nutrition Therapy

• Nursing Diagnosis:
• Imbalanced Nutrition, less than body
    NOC Label: Nutritional Status
            1= extremely compromised
           3= moderately compromised
• Demonstrates improved nutritional status
• Consumes adequate nutrition
• Identifies nutritional requirements

           NIC Interventions
• Collaborate with dietician
• Teach family and client about prescribed
• Monitor and calculate food intake

     NOC Label: Fluid Balance
          1= extremely compromised
             to 5=not compromised
•    Remains free of edema, anasarca.
•    Maintains clear lungs.
•    Remains free of restlessness, anxiety, or
•    Explains measures to prevent & treat
     excess fluid
 NIC Label: Fluid Management
• Nursing Diagnosis:
• Excess Fluid Volume

          NIC Interventions
• Monitor location of edema
• Monitor daily weight
• Monitor vitals: decreased. BP, tachycardia,
  tachypnea. Monitors gallop rhythm
• Teach patient & family about sx. of both
  excess and deficient fluid volume.

          Goals for Dialysis
• removal of end products of protein
  metabolism from blood- urea, creatinine
• maintenance of safe concentration of
  serum electrolytes
• correction of acidosis, replenishment of
  bicarbonate buffer system
• removal of excess fluid from blood
    Hemodialysis vs. Peritoneal -
       Finding the Best Fit*
• Hemodialysis - a quick      • Peritoneal - slower, less
  fix                           aggressive
• Not appropriate when        • Not appropriate for those
  hemodynamically               with impaired respiratory
  unstable                      excursion
• Not appropriate when        • Not appropriate in sepsis,
  trained personnel &           peritonitis, abdominal
  vascular access not           adhesions, abdominal
  available                     adhesions or abdominal
• Not appropriate for those     trauma
  unable to tolerate

       Key concepts of Dialysis*
•   Diffusion
•   Filtration/Ultrafiltration
•   Concentration gradient
•   Osmosis

           Vascular Access for
• Subclavian / internal jugular double lumen
• AV fistula/AV graft
A Surgically Created Venous

                              Slide 75.7

 An Arteriovenous Shunt of
        the Forearm

                              Slide 75.9
Examples of Multilumen caths

     A Hemodialysis Circuit

                               Slide 75.5
   Nursing Care of A-V Fistula*
• Initially assess hemorrhage, infection,
  edema. elevate arm
• No B/P, venipunctures, I.V.s in access arm
• assess function of fistula - bruit & thrill
• assess distal pulse circulation
• Allen’s test
• no carrying heavy objects etc.

   A Surgically Created Venous

                                                       Slide 75.7

 Native Arteriovenous (AV) Fistula
• the preferred type of vascular access for
  patients with end stage renal disease.

• AV fistulae result in significantly lower rates of
  complication (such as infection and clotting),
  longer patency, fewer hospitalizations, lower
  patient morbidity, and significantly lower costs
  compared to other accesses
      Dialysis - Nursing Care*
• Prior to Dialysis
• During Dialysis

       KB – Dialysis at 10AM
• Meds: Atacand, Lasix, Regular insullin,
  Digoxin, Tums – What do you give?
• Other Nsg. Duties?
• Nausea, hypertensive,

       The Client Undergoing
   • Weigh the client before and after
   • Know the client's dry weight.
   • Decide whether any of the client's meds
     should be withheld until after dialysis.
   • Be aware of events that occurred during
     the dialysis treatment.
   • Measure blood pressure, pulse rate,
     respirations, and temperature..

                                                Slide 75.17
• Assess for symptoms of orthostatic hypotension.
• Assess the vascular access site.
• Observe for bleeding.
• Assess the client's level of consciousness and
  assess for headache, nausea, and vomiting.

           Post- Dialysis Nsg.
• Disequilibrium syndrome
• Monitor for bleeding, hematoma & patency
• Neuro assessment, LOC

          Peritoneal Dialysis*

•   Osmosis
•   Diffusion
•   Dialysate Concentrations
•   Dwell time
 Manual Peritoneal Dialysis Via Implanted
 Abdominal Catheter (Tenckhoff Catheter)

                                        Slide 75.13

     Nursing Management of
       Peritoneal Dialysis*
• installations and dwell periods
• dialysate
• outflow times
    Peritoneal Dialysis - types
• Continuous Ambulatory Peritoneal Dialysis
• Automated Peritoneal Dialysis (ADP) can
  be run at different time intervals -
• Two forms of ADP
  1. (CCPD) continuous cyclic with 3 cycles
  at noc and one 8 hr. in morning -
  2.(IPD)intermittent 10-14 hrs/ 3-4 x wk.,
  NPD nightly peritoneal dialysis 8-12 hrs at

            The used Dialysis Bags are 'Clinical Waste'. The Renal
            Unit will contact the local authority for you and arrange
               for free yellow coloured clinical waste bags to be
             delivered to your home (usually four a week. You will
                need only two bags but they need to be double
              wrapped). They will also arrange for a free weekly
                            collection of the full bags.

            Flatten your cardboard boxes (see diagram on the box)
                 and put out for your regular rubbish collection.

               Please click on the links below for further CAPD info.
               Weight & Fluid Balance | Clean Procedures : Infection |
                                     General Info

   Complications of Peritoneal
• Peritonitis- meticulous aseptic technique.
  Check fever, rebound tenderness, nausea,
  WBCs, malaise
• Hyperglycemic & hyperosmolar states
  Esp. with high glucose dialysate
• Cath. Displacement
• Abd. Discomfort
• Lack of compliance when self dialysing
                Assess laboratory data,
                • BUN & Creatinine
                • Creatinine clearance
                • CBC
                • Electrolyte
                Assess psychosocial
                 status, including
                • Presence of anxiety
                • Presence of maladaptive
                                                           Slide 75.20

     Nsg. Management of ESRD at
                Community Resources

              Kidney Transplant*
•   Living Related
•   Living Unrelated
•   Cadaver
•   United Network for Organ Sharing, Richmond Va.
•   National kidney transplant waiting list - 38,760
•   First successful transplant -1954 - Dr. Jos. Murray,
    Brigham & Women’s Hospital Boston MA.
              Kidney Donor

              Selection Process

    Hand-assisted Laproscopic Donor
•   3-5 incisions in donor abdomen
•   Full recovery in up to 6 weeks

     Placement of a Transplanted
    Kidney to the Right Iliac Fossa

                                      Slide 75.16
     Nursing Responsibilities

             Post Transplant

          Renal Transplant
• Graft rejection -
  hyperacute, acute, or chronic
• Other complications: infection, disease
  recurrence, complications of drug therapy,
  ulcers, HTN, steroid-induced diabetes etc.

      Hyperacute Rejection*
              Hyperacute Rejection
           • Within 48 hr after surgery

           Clinical Manifestations
           • Increased temperature
           • Increased blood pressure
           • Pain at transplant site
           • Immediate removal of the transplanted
                                BUN = blood urea nitrogen.
                                                                       Slide 75.21

                   Acute Rejection*

                    Acute Rejection
• 1 wk to 2 yr postoperatively (most common
  in first 2 wk)
Clinical Manifestations
•   Oliguria or anuria
•   Temperature over 37.8° C (100° F)
•   Increased blood pressure
•   Enlarged, tender kidney
•   Lethargy
•   Elevated serum creatinine, Blood Urea Nitrogen, potassium levels
•   Fluid retention

• Increased doses of immunosuppressive drugs
                                BUN = blood urea nitrogen.
                                            .                          Slide 75.22
           Chronic Rejection*

            Chronic Rejection
   • Occurs gradually during a period of
     months to years
     Clinical Manifestations
   • Gradual increase in Blood Urea Nitrogen and
     serum creatinine levels
   • Fluid retention
   • Changes in serum electrolyte level
   • Fatigue

   • Conservative management until dialysis is
                                                   Slide 75.23

  Immunosuppressive therapy
    after Renal Transplant*
• Corticosteroids -     • FK-506 - 100 X more
  Prednisone or           potent than
  methylprednisone        cyclosporin
  (Solu-medrol)         • OKT-3 - monoclonal
• Azathioprine (Imuran,   antibody
  CellCept,             • Antilymphocyte
• Cyclosporine - used     globulin - Atgam
  with steroids           (ALG)
  (Sandimmune or
          Nursing Problems rt.
•   increased risk of infection
•   bone marrow suppression
•   incidence of malignancy- lymphoma
•   c/o with steroids - gastritis & peptic ulcer
    disease, bone weakness, GI bleeding,
    steroid induced DM, F&E imbalance

        Common Types and
     Locations of Renal Trauma
                   Minor Trauma

                                                   Slide 74.7

        Common Types and
     Locations of Renal Trauma
                   Pedicle Injury

                                                   Slide 74.8
   Common Types and
Locations of Renal Trauma
        Major Trauma

                             Slide 74.9

   Common Types and
Locations of Renal Trauma

                            Slide 74.11

     The Patient with Bladder
• Primary prevention: Stop Smoking – doubles the
• Secondary prevention: Hematuria?
• Men 3X more likely
• Chemicals in the workplace – dye, leather,
• Whites more likely
• Age – late 60’s
• 53,000 new cases in 2000
• 94% survival rate

Blood in the urine (slightly rusty to deep red
  in colour).
Pain during urination.
Frequent urination, or feeling the need to
  urinate without results.
Bladder Cancer

Bladder Tumors
       Treatment Modalities*
• Chemotherapy
• Radiation
• Surgery: Partial Cystectomy
            Total Cystectomy

       Treatment Continued

 Total Cystectomy with Urinary
• Ileal Conduit
• Continent Internal Ileal Reservoir (Kock
• Cutaneous Ureterostomy
• Vesicostomy
Urinary Diversion Procedures Used
in the Treatment of Bladder Cancer

                                      Slide 73.9

Urinary Diversion Procedures Used
in the Treatment of Bladder Cancer

                                     Slide 73.10

Urinary Diversion Procedures Used
in the Treatment of Bladder Cancer

                                     Slide 73.11
    Urinary Diversion Procedures Used
    in the Treatment of Bladder Cancer

                                         Slide 73.12

•                    •
       Sure-Fit Natura

  Face Plate –Cut to Fit Skin

Karaya 5 Lo-Profile Urostomy
    Nursing Management of
   Patients Requiring Urinary
                     • Psychological Needs
                     • Immediate Post-op

   Postoperative Nursing Care of
   Patient with Urinary Diversion*
• Immediate Post-op: Hypovolemia,
  hematuria, stoma checks
• 48 hrs. or more: peritonitis
• Stoma care

             Case Study

       Patient with Ileal Conduit
 Nsg. Dx & Outcomes rt. Pt with
         Ileal Conduit*
• Knowledge Deficit rt     • Demonstrates how to
  Stoma Care                 perform pouch
                             change & ostomy
• Social Isolation rt
                             care 1=no knowledge 5=
  Fear of Accidental         extensive knowledge
  leakage                  • Participates in activities
                             to level of ability &
• Risk for Imapired Skin     desire 1= no social
  Integrity                  involvement;5= extensive
                           • Regains integrity of
• Disturbed Body             skin surface.

 Client Education of the Patient
     with a Urinary Diversion
      Developing a Teaching Care Plan

      Cancer of the Prostate*

         Function of Prostate Gland-
        Prevention of Prostate Cancer
                and Detection

The Prostate Gland with Cancer and
   Benign Prostatic Hyperplasia

                                       Slide 79.12

 Diagnostic Tests and Physical
• PSA assay
• Rectal exam
• Transrectal /Transperineal and
  Percutaneous needle aspiration and
• Other diagnostic tests
       Treatment Modalities and
       Management of Prostate
•   Hormone therapy
•   Chemotherapy
•   Radiation
•   Surgery

      Pharmacology - Hormone
• Androgen supressing
  agents – ex.
  finasteride (Proscar)
  flutamide (Eulexin) - a
  new androgen
• leuprolide (Lupron) -
  a gonadotropin

    Leuprolide (Lupron) s.c. - Side
•   Dizziness, HA
•   N&V, Anorexia, Constipation
•   Peripheral edema, Cardiac Arrhythmias
•   Hot flashes, sweats
   Chemotherapy or Radiation



    Types Prostate Surgery*
• Laser
• Cryosurgery
• Robotic Prostatectomy –

 Radical Open Prostatectomy*

• Suprapubic approach
• Retropubic approach
• Perineal approach
Suprapubic, or Transvesical,

                               Slide 79.6

Retropubic, or Retrovesical,

                               Slide 79.7

Three Way Foley Catheter
      Perineal Prostatectomy

                                              Slide 79.8

      Nursing Care Following
        Prostate Surgery*
• Hematuria
• Bladder spasms
• Hemorrhage
• Retropubic - care of the low ABD incision
  & Suprapubic catheter
• Discharge teaching

         Effects of Surgery*
• Client is STERILE
• Erective Dysfunction – (if pudental nerve
  fx. Spared – 3-6 mos of ED ( impotence)
• Urinary Incontinence – if internal &
  external urinary sphincters involved.
       Care Immediately after Radical
• Encourage the client to use patient-controlled
  analgesia (PCA) as needed.
  The PCA device may be used through the second
  postoperative day.
• Keep the client on bed rest on the day of surgery. Help
  the client to get out of bed and ambulate for a short
  distance by the first postoperative day.
• Keep the client on NPO status as ordered, usually until
  the first or second postoperative day.

                                                     Slide 79.11

          Care after Radical
       Prostatectomy Continued
• Maintain the sequential compression device until the
  client begins to ambulate.
  Apply antiembolic stockings until discharge.
• Monitor the client for deep vein thrombosis and
  pulmonary embolus.
• Keep an accurate record of intake and output,
  including Jackson-Pratt or other drainage device

                                                     Slide 79.11

      Teaching Following Radical
           You are developing a handout for
            patients following radical open
             prostatectomy . What are the
          Pt. Teaching following Radical
• Keep the urinary meatus clean using soap and water.
• Avoid rectal procedures or treatments.
• Teach the client how to care for the urinary catheter
  because he will be discharged with the catheter in
• Teach the client how to use a leg bag.
• Emphasize the importance of not straining during
  bowel movement. Advice the client to avoid
  suppositories or enemas.
• Remind the client about the importance of follow-up
  appointments with the physician to monitor progress.
                                                     Slide 79.11

                     Leg Bag

    Discharge Teaching following
       Radical Prostatectomy
  • Remind client about importance of follow-
    up appointments with M.D.
  • Exercises for Urinary Incontinence :tighten
    perineal muscles, biofeedback
  • Function – ED alternatives:prostheses,
    vaccum devices, viagra.
Nsg. Diagnoses Associated with
    Radical Prostatectomy*
• Knowledge Deficit rt Self Care & Home
• Acute Pain rt. Bladder Spasm
• Risk for Urinary Incontinence
• Risk for Sexual Dysfunction – NOC
  Outcomes: expresses comfort with sexual
  expression 1-= never demonstrated; 5 = consistently

       Potential Complications
• Sexual dysfunction with radical perineal
• Urinary incontinence with radical

                   The End

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