Nursing care plan prostatectomy

I. Indications
a. Benign prostatic hyperplasia (BPH)-related complications
i. Urinary retention
ii. Frequent urinary tract infections
iii. Bladder stones
iv. Recurrent gross hematuria
v. Kidney damage from long-standing blockage
vi. Failure to respond to medical or minimally invasive
treatments
b. Prostate cancer is the second leading cause of cancer death
in the United States.

II. Procedures
a. Minimally invasive prostatectomy
i. Transurethral therapy using microwave
ii. Transurethral needle ablation (TUNA) using low-level
frequency thermal energy
iii. Laser ablation
iv. Cryotherapy—freezing of cancerous cells
v. Electrovaporization
vi. Transurethral resection of the prostate (TURP)
1. Most common procedure for the long-term treatment
of BPH
2. Obstructive prostatic tissue of the medial lobe surrounding
the urethra is removed by means of a cystoscope
introduced through the urethra.
b. Open surgical approaches performed when the prostate is
overly enlarged (greater than 75 g), the bladder has been damaged,
or when there are complicating factors, such as cancer.
i. Robot assisted—nerve sparing, uses a laparoscope, and
several incisions are made in the abdomen
ii. Suprapubic prostatectomy
1. Obstructing prostatic tissue is removed through a low
midline incision made through the bladder.
2. Preferred approach if bladder stones are present
iii. Retropubic prostatectomy
1. Hypertrophied prostatic tissue mass located high in
the pelvic region is removed through a low
abdominal incision without opening the bladder.
iv. Perineal prostatectomy
1. Laparoscopy removal of larger tumors or in presence
of cancerous lymph nodes or nerve invasion
2. Large prostatic masses low in the pelvic area are
removed through an incision between the scrotum and
the rectum.

III. Statistics
a. Morbidity: In 2005, 155,000 prostatectomy procedures
were performed in short-stay hospitals in the United States
(Centers for Disease Control and Prevention [CDC], 2007);
in 2007, 50,000 procedures were robotic assisted.
b. Mortality: Prostatectomy is a relatively low-risk procedure
(Guilli et al, n.d.).
c. Cost: In 2004, hospital costs for treatment of prostate cancer
totaled $657 million; most commonly performed procedures
are prostatectomy and TURP (Milenkovic et al, 2007).

Care Setting
Client is treated in inpatient acute surgical unit.

Related Concerns
Benign prostatic hyperplasia (BPH),
Cancer,
Psychosocial aspects of care,
Surgical intervention,

Nursing Priorities
1. Maintain homeostasis and hemodynamic stability.
2. Promote comfort.
3. Prevent complications.
4. Provide information about surgical procedure, prognosis,
treatment, and rehabilitation needs.

Discharge Goals
1. Urinary flow restored or enhanced.
2. Pain relieved or controlled.
3. Complications prevented or minimized.
4. Procedure, prognosis, therapeutic regimen, and rehabilitation
needs understood.
5. Plan in place to meet needs after discharge.

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