6 Prostatectomy Nursing Care Plans

March 8, 2014

Prostatectomy is the surgical removal of the prostate wherein the procedure could include all (radical) or part (simple). Prostatectomy is indicated in the treatment of benign prostatic hyperplasia while radical prostatectomy is indicated in the treatment of prostate cancer.

Transurethral resection of the prostate (TURP): Obstructive prostatic tissue of the medial lobe surrounding the urethra is removed by means of a cystoscope/resectoscope introduced through the urethra.
Suprapubic/open prostatectomy: Indicated for masses exceeding 60 g (2 oz). Obstructing prostatic tissue is removed through a low midline incision made through the bladder. This approach is preferred if bladder stones are present.
Retropubic prostatectomy: Hypertrophied prostatic tissue mass (located high in the pelvic region) is removed through a low abdominal incision without opening the bladder. This approach may be used if the tumor is limited.
Perineal prostatectomy: Large prostatic masses low in the pelvic area are removed through an incision between the scrotum and the rectum. This more radical procedure is done for larger tumors/presence of nerve invasion and may result in impotence.

Nursing Care Plans

Nursing care planning for patients who underwent prostatectomy includes: maintaining homeostasis and hemodynamic stability, promoting comfort, preventing complications, and providing information about the procedure, prognosis, and treatment.

Here are six (6) prostatectomy nursing care plans (NCP):

Impaired Urinary Elimination

Impaired Urinary Elimination: Disturbance in urinary elimination.

May be related to

Mechanical obstruction: blood clots, edema, trauma, surgical procedure
Pressure and irritation of catheter/balloon
Loss of bladder tone due to preoperative overdistension or continued decompression

Possibly evidenced by

Frequency, urgency, hesitancy, dysuria, incontinence, retention
Bladder fullness; suprapubic discomfort

Desired Outcomes

Void normal amounts without retention.
Demonstrate behaviors to regain bladder/urinary control.

Nursing Interventions	Rationale
During bladder irrigation, assess urine output and drainage system.	Retention can occur because of edema of the surgical area, blood clots, and bladder spasms.
Assist patient to assume normal position when voiding. Instruct to stand, walk to the bathroom at frequent intervals after catheter is removed.	Promotes sense of normality and encourages passage of urine.
Regularly check the dressing, incision and drainage for excessive bleeding. Watch out for signs of bleeding and infection.	Reopening of sutures can occur.
Record time, amount of voiding, and size of stream after catheter is removed. Note reports of bladder fullness, inability to void, urgency.	The catheter is usually removed 2–5 days after surgery, but voiding may continue to be a problem for some time because of urethral edema and loss of bladder tone.
Encourage patient to void when urge is noted but not more than every 2–4 hr per protocol.	Voiding with urge prevents urinary retention. Limiting voids to every 4 hr (if tolerated) increases bladder tone and aids in bladder retraining.
Measure residual volumes via suprapubic catheter, if present, or with Doppler ultrasound.	Monitors effectiveness of bladder emptying. Residuals more than 50 mL suggest need for continuation of catheter until bladder tone improves.
Encourage fluid intake to 3000 mL as tolerated. Limit fluids in the evening, once catheter is removed.	Maintains adequate hydration and renal perfusion for urinary flow. Reducing fluid intake at the right schedule decreases the need to void and interrupt sleep during the night.
Instruct patient to perform perineal exercises: tightening buttocks, stopping and starting urine stream.	Helps regain control of the bladder, sphincter, or urinary control and minimizes incontinence.
Advise patient that “dribbling” is to be expected after catheter is removed and should resolve as recuperation progresses.	Information helps patient deal with the problem. Normal functioning may return in 2–3 wk but can take up to 8 mo following perineal approach.
Maintain continuous bladder irrigation (CBI), as indicated, in early postoperative period.	Flushes bladder of blood clots and debris to maintain patency of the catheter and urine flow.