6 Prostatectomy Nursing Care Plans

Impaired Urinary Elimination

Prostatectomy involves the removal of part or all of the prostate gland, which can lead to impaired urinary elimination due to the disruption of the normal urinary tract anatomy and the possible damage or irritation to the surrounding tissues during surgery. This can result in difficulty with starting or stopping the flow of urine, urinary urgency or frequency, and other urinary problems.

Nursing Diagnosis

• Impaired 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

• The patient will void normal amounts without retention.
• The patient will demonstrate behaviors to regain bladder/urinary control.

Nursing Assessment and Rationale

1. During bladder irrigation, assess urine output and drainage system.
Retention can occur because of edema of the surgical area, blood clots, and bladder spasms.

Nursing Interventions and Rationales

1. Assist patient to assume normal position when voiding. Instruct to stand, and walk to the bathroom at frequent intervals after catheter is removed.
Promotes sense of normality and encourages passage of urine.

2. Regularly check the dressing, incision, and drainage for excessive bleeding. Watch out for signs of bleeding and infection.
Reopening of sutures can occur.

3. Record time, amount of voiding, and size of stream after catheter is removed. Note reports of bladder fullness, inability to void, and 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.

4. 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.

5. Measure residual volumes via suprapubic catheter, if present, or with Doppler ultrasound.
Monitors effectiveness of bladder emptying. Residuals of more than 50 mL suggest need for continuation of catheter until bladder tone improves.

6. 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.

7. 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.

8. 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.

9. 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.