Med Surg Chapter 43 pg 1008-1014 & 1018-1021/BPH, Vasectomy, & ED #2
An asymptomatic pt is admitted with gastric bleeding. For which of the following signs should the nurse monitor?
*Diaphoresis and hypotension* are common signs of hypovolemic shock. *LOC* is an indication of altered oxygenation, which accompanies shock.
The nurse completes a nursing Hx on a Pt admitted for TURP. Which symptoms of BPH does the nurse expect to find?
A feeling of incomplete bladder emptying; Difficulty urinating; Nocturia
A pt returns from surgery following a TURP with a 3way Foley catheter and continuous bladder irrigation. Postop orders include Demerol, belladonna & opium suppository, and strict I&O. The Pt reports bladder spasms and the nurse observes blood tinged urine. What action should the nurse take first?
Administer the B&O suppository to relieve the bladder spasms
A Pt is admitted with chronic gastritis Type B. Which of the following S&S is the nurse likely to find on assessment?
Anorexia
A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. Which are the signs/symptoms of transurethral resection (TUR) syndrome?
Bradycardia and confusion
A client has undergone esophagogastroduodenoscopy (EGD). The nurse places highest priority on which action as part of the client's care plan?
Checking for return of a gag reflex
A Pt with a duodenal peptic ulcer and is taking Tagamet. Which of the following side effects should be included in the teaching plan?
Confusion, especially in older adults
Urge Urinary Incontinence r/t poor sphincter control as evidenced by inability to control urination
Expected Outcome: Pt will be able to prevent incontinence Interventions: Teach Kegel exercises Discuss use of condom catheter or penile pads; Instruct Pt to drink 2000-4000 mL of noncaffeinated drinks Encourage Pt to discuss long-term incontinence with his PCP; Refer Pt to National Incontinence support group
Anxiety r/t concerns over loss of sexual functioning
Expected Outcome: Pt will verbalize that sexual changes are normal after prostate surgery and identify support systems Interventions: Teach about retrograde ejaculation; Teach Pt to meet with urologist if erection problems occur
Deficient knowledge r/t lack of experience with postop restrictions and care
Expected outcome: Pt will avoid activities that increase intra-abdominal pressure resulting in bleeding Interventions: Teach Pts not to lift objects more than 10 lbs, no stair climbing, driving or strenuous activities, straining during BM, constipation or sex until approved by PCP; Instruct proper catheter care if discharged with catheter; Teach to report bleeding that does not stop with rest; fever, swelling or difficulty urinating
Risk for bleeding r/t surgical intervention
Expected outcome: Pts bleeding will be minimal as evidenced by Pts urine becoming more clear; Interventions: Closely monitor urinary output; Explain to the Pt that bloody urine is expected after TURP; Encourage intake of 2500 mL a day Teach Pt to avoid constipation; Advise Pt to lie down if urine becomes bright red or has large clots; Teach Pt to avoid aspirin and NSAIDs until bleeding is over
Acute Pain r/t bladder spasms, obstruction, or surgical process as evidenced by pt pain rating
Expected outcome: Pts pain will be controlled Interventions: Monitor pain on an appropriate scale every 2-4 hrs for first 48 hrs within 30 mins after medication; Monitor for S&S of pain such as bladder spasms; Administer medications and monitor response; Irrigate catheter as ordered; Educate Pt on nonpharmacological methods to control pain such as relaxation and deep breathing
A Pt is admitted who was involved in a motor vehicle accident resulting in trauma to the abdomen and back. The Pt has a ruptured spleen and kidney trauma. Which of the following changes in the Pts urine should the nurse observe?
Hematuria
Perineal prostatectomy involves making an incision between the scrotum and anus to remove the gland
However this approach is rarely done b/c of the increased risk of contamination of the incision (close to the rectum) and risk of urinary incontinence, erectile dysfunction, or injury to the rectum
A Pt is having an acute episode of gastric bleeding. The HCP orders an IV of 100 mL of 0.9% saline, a CBC, an NG tube to low wall suction and oxygen by nasal cannula. Which of these orders should the nurse do first?
Start the OXYGEN first
Open Prostatectomy
Suprapubic approach is done through an incision made through the lower abdomen into the bladder; the gland is removed and then the urethra is reattached to the bladder.
A Post TURP Pt experiences dribbling following removal of his catheter. Which action should the nurse take?
Teach him to perform Kegel exercises 10-20 times an hour
A Pt just had a TURP procedure and asks the nurse why he needs to have bladder irrigation? Which is her best response?
The irrigation is needed to keep the catheter from becoming occluded by the blood clots.
A Pt tells a nurse that he has delayed TURP b/c he is afraid that it will affect his sexual performance. Which response by the nurse is most appropriate?
This type of surgery rarely affects the ability to have an erection or ejaculation.
A Pt with right side flank pain, fever and generalized weakness is admitted to the hospital. He has a hx of recurrent urinary tract infections and renal calculi are suspected. On the 2nd day hospitalized, he develops distention and pain in the suprapubic area as well as a drop in his urine to 300 mL/24 hrs. What does the nurse suspect is the most likely cause?
Urinary Tract Obstruction
Retropubic approach
gland is removed but there is no incision into the bladder
An open prostatectomy means a longer
hospital stay with the presence of a suprapubic catheter and care for an abdominal incision as well as increased risk for complications; follow up home care is important
Radical Prostatectomy
removal of the entire prostate gland when the gland is very large and causing an obstruction or in the case of cancer;