maci case study 3 turp.docx

8/18/2019 MACI Case Study 3 TURP.docx

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1.a) Identify 5 relevant priorities of careb) with rationale for each priority identi ed.

•

2cute !ain may be related to #ladder irrita#ility and irri$ations-presence of a


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approaches and usually decrease%ithin B hours.

Monitor inta?e and output carefully. To evaluate 7uid #alance andprevent #ladder distention.

!ercuss #ladder or use #ladderscanner To chec? for distension to validateade uate emptyin$ of the #ladder

Maintain patency of catheter anddraina$e system. Leep tu#in$ freeof ?in?s and clots.

Maintainin$ a properly functionin$catheter and draina$e systemdecreases ris? of #ladder distentionand spasm. )nsurin$ a continuous7o% of urine from the #ladder andno clots #ecause these may causeo#struction of urine 7o%, resultin$ in#ladder spasms.

ncrease the continuous #ladderirri$ation rate if there is increasedhematuria postoperatively- irri$atemanually if occluded

To prevent clots and possi#leocclusion of catheter.

!romote inta?e of up to


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pium suppositories!ropantheline #romide (!ro=1anthine"

Relieves #ladder spasms #yanticholiner$ic action. suallydiscontinued to B hours #eforeanticipated removal of catheter to

promote normal #ladder contraction

ne ective Self=+ealth Mana$ement)/pected utcome: 'escri#es follo%=up care and activity restrictions

>ursin$ ntervention Rationalendependent

Revie% implications of procedureand future e/pectations.

!rovides ?no%led$e #ase from %hichclient can ma?e informed choices.

Stress necessity of $ood nutrition-encoura$e inclusion of fruits andincreased #er in diet.

!romotes healin$ and preventsconstipation, reducin$ ris? ofpostoperative #leedin$.

2dvise client to avoid or limit inta?eof ca eine, citrus &uices, car#onated#evera$es, and spicy foods for rstfe% %ee?s after sur$ery.

2cidic su#stances can lo%er urinep+, there#y a$$ravatin$ dysuria.

)ncoura$e continuation of perineale/ercises.

Hacilitates urinary control andalleviation of incontinence.

'iscuss initial activity restrictions,such as avoidance of heavy liftin$(not N .5?$", strainin$ durin$defecation, drivin$, prolon$edsittin$, lon$ car trips, clim#in$ N7i$hts of stairs at a time, and se/ualactivity until the sur$eon approves.

ncreased a#dominal pressure andstrainin$ places stress on the#ladder and prostate, potentiatin$ris? of #leedin$.

nstruct in urinary catheter care ifpresent. dentify source for suppliesand support.

!romotes independence andcompetent self=care. Catheter may#e in place only on day of sur$ery%hen laser procedure is done or fordays to %ee?s %ith otherprocedures .

nstruct client to avoid tu# #athsafter dischar$e.

'ecreases the possi#ility ofintroduction of #acteria or unduetension on incision.

Revie% s3s re uirin$ medical !rompt intervention may prevent


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evaluation: erythema, purulentdraina$e from %ound sites- ina#ilityto urinate, chan$es in character oramount of urine, presence ofur$ency or fre uency- and heavy

clots or #ri$ht red #leedin$, fever, orchills.

serious complications. >ote: rinemay appear cloudy for several%ee?s until postopera= tive healin$occurs and may appear cloudy afterintercourse #ecause of retro$rade

e&aculation.

!rovide %ritten information to clientand S re$ardin$ recoverye/pectations and homemana$ement, as indicated,re$ardin$ pain, incision care, andcatheter=related pro#lems and care.

2n/iety related to hospitaliKation-procedure performed- andassociated dia$nosis, fati$ue, andpostoperative pain often ma?es itdiOcult for client to a#sor#necessary self=care information.

Stress importance of follo%=up carePevaluation #y primary healthcareprovider, urolo$ist or oncolo$ist, and

la#oratory studies.

Monitorin$ and follo%=up can reduceincidence of unaddressedcomplications. !ersistent

incontinence and otherpostoperative issues %ill re uireadditional evaluation and treatment.

!rovide information on availa#lecommunity resources, such ashome=health services, medicale uipment supply company,house?eepin$, and support persons.

Can #e helpful in assistin$ client andS in copin$ %ith challen$es theyare faced %ith follo%in$prostatectomy , %hatever the reasonfor procedureP1!+, cancer,incontinence, and so forth.

r$e rinary ncontinence)/pected utcome: Reports decrease in urine lea?a$e #et%een voidin$s

dentify factors that contri#ute toincontinence episodes.

To plan appropriate interventions.

nstruct the patient to respondimmediately to the ur$e to void.

To prevent involuntary lea?a$e.

)/plain the etiolo$y of the pro#lemand the rationale for actions.

To help the patient plan appropriateinterventions.

8imit the in$estion of #ladderirritants (e.$., colas, co ee, tea,chocolate"

To decrease urinary ur$ency.

8imit 7uids for Q< hr #efore#edtime.

To avoid ni$httime ur$ency.

2dvise the patient a#out devices forshort=term mana$ement of dri##lin$(e.$., incontinence $arments orpads, a condom catheter, or penileclamp".

So the patient is a%are of variousdevices and can ma?e an informeddecision amon$ alternatives.


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Teach the patient Le$el e/ercises To stren$then sphincter tone.

Ris? for nfection)/pected utcome: )/perience no si$ns of infection and achieve timelyhealin$.

>ursin$ ntervention RationalendependentMaintain sterile catheter system-provide re$ular catheter and urinarymeatus care %ith soap and %ater,applyin$ anti#iotic ointment aroundcatheter site per protocol.

!revents introduction of #acteriaand resultant infection.

2m#ulate %ith draina$e #a$dependent.

2voids #ac?%ard re7u/ of urine,%hich may introduce #acteria intothe #ladder.

Monitor vital si$ns, notin$ lo%=$radefever, chills, rapid pulse andrespiration, restlessness, irrita#ility,and disorientation.

Client %ho has had cystoscopy or T R! is at increased ris? for sur$icaland septic shoc? related toinstrumentation.

#serve draina$e from %oundsaround suprapu#ic catheter.

!resence of drains and suprapu#icincision increases ris? of infection,as indicated #y erythema orpurulent draina$e.

Chan$e suprapu#ic3retropu#ic andperineal incision dressin$sfre uently, cleanin$ and dryin$ s?inthorou$hly each time.

0et dressin$s cause s?in irritationand provide medium for #acterial$ro%th, increasin$ ris? of %oundinfection.

se ostomy=type s?in #arriers. !rovides protection for surroundin$s?in, preventin$ e/coriation andreducin$ ris? of infection.

Colla#orative2dminister anti#iotics, as indicated.

May #e $iven prophylactically#ecause of increased ris? ofinfection %ith prostatectomy.

Ris? for Se/ual 'ysfunction)/pected utcome: Report understandin$ of se/ual function and alterationsthat may occur %ith sur$ery in individual situation. 'iscuss concerns a#outpossi#le chan$es in #ody ima$e and se/ual functionin$ %ith partner3S andcare$iver.'emonstrate pro#lem=solvin$ s?ills re$ardin$ solutions to pro#lemsthat occur.

>ursin$ ntervention Rationale


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ndependent!rovide openin$s for client and Sto tal? a#out concerns ofincontinence and se/ual functionin$.

May have an/ieties a#out the e ectsof sur$ery and may #e hesitanta#out as?in$ necessary uestions.2n/iety may have a ected a#ility toaccess information $iven previously.

'iscuss #asic anatomy. 1e honest inans%ers to clientFs uestions. The nerve ple/us that controlserection runs posteriorly to theprostate throu$h the capsule. nprocedures that do not involve theprostatic capsule, impotence andsterility are usually notconse uences. Sur$ical proceduremay not provide a permanent cure,and hypertrophy may recur.

Dive accurate information a#out

e/pectation of return of se/ualfunction.

!hysiolo$ical impotence occurs

%hen the perineal nerves are cutdurin$ radical procedures- %ithother approaches, se/ual activitycan usually #e resumed %ithin%ee?s. f erectile dysfunctionpersists after healin$ is complete ,client may %ant to pursue options torestore functionPuse of medicationssuch as sildena l citrate (4ia$ra".

'iscuss retro$rade e&aculation iftransurethral or suprapu#icapproach is used.

Seminal 7uid $oes into the #ladderand is e/creted %ith the urine. Thisdoes not interfere %ith se/ualfunctionin$, #ut %ill decreasefertility and cause urine to #ecloudy.

nstruct in perineal and pelvic 7oore/ercises and interruption of urinarystream e/ercises

Ti$htenin$ pelvic 7oor muscles priorto standin$, cou$hin$, and sneeKin$promotes re$ainin$ #ladder and,perhaps, erectile function.

Colla#orativeRefer to se/ual counselor asindicated.

!ersistent or unresolved pro#lemsmay re uire professionalintervention.

.a) Identify and develop detailed health promotion strategies to

meet patient needs in case scenario;b) provide clear rationale for selected strategies.


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Health Promotion Strategies RationaleRegular Prostate specific antigen (PSA)monitoring

Early prostate cancer screening may reduce themortality rate by as much as 35%

!ifestyle changes " decrease alcoholconsumption and scheduling bathroom #isits

$ngestion of alcohol increases prostaticsymptoms because of its diuretic effect he

buildup of urine increases bladder distentionScheduling regular bathroom #isits " oncee#ery & to 3 hours or upon feeling the urge "encourages return of normal patterns of urineelimination ('retraining') Prolonging mighto#erstretch the bladder muscle and causedamage

onitor fluid inta e and output o chec for ade*uate hydration $ncreasingfluid inta e at this moment +ill aid in flushingout any remaining blood or clots from the

bladder Ha#ing less fluid inta e +ill not help

the client but may +orsen the situation byma ing him dehydrated or prone to infections

!.a) Identify relevant teaching priorities to meet patient"s care

needs;b) develop a detailed teaching plan for patient and family to

manage patient"s condition.eaching Priorities Strategies o $mplement

emporarily a#oid acti#itiesthat increase intra"

abdominal pressure

• hese acti#ities include sitting upright and standing for prolonged periods, straining due to constipation, long

tra#el times, dri#ing, stair climbing, se-ual acti#ity, andhea#y lifting

• $nform client that his surgeon +ill appro#e theseacti#ities +hen bleeding from .RP is no longer a

possibility• E-plain the relationship bet+een increased abdominal

pressure and postoperati#e hemorrhage• Remind client of the date and time of his follo+"up

appointment as scheduled by his physician or surgeon• Stress the importance of coming bac to see his

physician or surgeon e#en after he feels better.rinary sphincter toning orretraining

• Pro#ide #ideos to +atch about ho+ the male urinarysystem functions

• E-plain the reason for urinary incontinence anddribbling

• /i#e step by step instructions on ho+ to do 0egele-ercises and encourage him to practice 12"&2 times in aday


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• Pro#ide a urinal for the client to use after instructinghim to practice starting and stopping the stream se#eraltimes during urination

• $nform client that it usually ta es se#eral +ee s toachie#e urinary continence

Se-ual acti#ity e-pectationsafter undergoing .RP

• Ac no+ledge client s concern about se-ual acti#itychanges 4lient #erbali ed '$ don t thin se- +ill e#er bethe same'

• Allo+ client to e-press his concerns and as *uestions• Pro#ide client +ith researched information about the

unli ely de#elopment of erectile dysfunction from.RP procedure

• Educate the client about retrograde e6aculation• $nform the patient that e6aculate may be decreased in

amount or totally absent but is not harmful•

Refer client and his partner to a se-ual counselor

5.a) Identify 2 relevant medications based on patient"s situation#

health condition;b) complete a thorough case study for the 2 medications$

a. the trade and generic name of the medication;b. mechanism of action;c. uses;d. route;

e. dosage;f. common side e%ects;g. adverse reactions;h. contraindications;i. precautions and interactions;

&. development 'lifespan) considerations;(. important health teaching for the patient and the family.

Trade >ame: 1 @ SuppositoriesDeneric >ame: 1elladonna al?aloids and opiumClassi cation: >arcotic anal$esic and anti=spasmodic com#ination

medicationMechanism: 1elladonna rela/es smooth muscles and stops muscle

spasms. pium is converted to morphine %hich is anopioid pain reliever. pioids can reduce $astrointestinalmotility, propulsion, secretions, and increase$astrointestinal muscle tone. pioids also stimulatereceptors on nerves in the #rain to increase the thresholdto pain (increasin$ the amount of stimulation it ta?es to


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feel pain" and reduce the perception of pain (theperceived importance of the pain". These e ects help incontrollin$ pain and relievin$ spasms, especially #ladderspasms. 1elladonna3opium is a controlled su#stance.

ses: Treat moderate to severe pain from spasm of the urinary

tract.Route: Rectal'osa$e: nsert * suppository rectally once or t%ice daily. >ot to

e/ceed N suppositories3day or as directed #y physician.Side e ects 'ro%siness, diKKiness, #lurred vision, dry mouth, urine

retention, nausea, vomitin$, constipation, itchin$, andhives.

2dverse) ects:

Slo% shallo% #reathin$- severe dro%siness or diKKiness.Can #e ha#it formin$ and has a#use potential #ecause ofits opium content.

Contraindications:

>ot recommended for children * years or youn$er

!recautionsandinteractions

• 2lvimopan ()ntere$" Qincreases #elladonna andopium levels in the #ody- opioid must #e stopped Adays prior to startin$ 2lvimopan.

• M2 inhi#itors li?e phenelKine (>ardil", sele$iline( elapar, )msam, )ldepryl", and isocar#o/aKid(Marplan" as %ell as lineKolid ( yvo/" anti#iotic Qmay lead to serious chan$es in #lood pressure,fever, sleepiness, a$itation, confusion and in severecases, death. Must #e stopped or separated #y *days #efore administerin$ 1@ .

• >altre/one (Revia" Qdecreases levels andtherapeutic e ects of 1@ , leadin$ to treatmentfailure.

• >arcotic anal$esics Qincreased ris?s of diKKiness,sedation, and respiratory depression.

• Cimetidine, 1utorphanol, >al#uphine, !otassiumta#lets, !ramlimtide, Rifampin


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+ealth Teachin$

• 'o not stop a#ruptly as it may cause %ithdra%alsymptoms.

• 'o not increase dose.• May cause addiction.• Store at room temperature a%ay from li$ht and

moisture.• 'o not refri$erate.• 'o not store in the #athroom.• Leep a%ay medications from children and pets.• 'o not 7ush medication in the toilet or pour them

into the drain unless instructed to do so.• !roperly discard product %hen it is e/pired or no

lon$er needed.• Consult your pharmacist or local %aste disposal for

safe disposal of product.'evelopment(lifespan"Consideration:

!R)D>2>C : There are no ade uate studies done on#elladonna3opium suppositories to determine safe ande ective use in pre$nant %omen. They should #e usedonly if clearly needed.

> RS >D M T+)RS: pium is converted to morphine.Morphine is e/creted in #reast mil?, ho%ever, the2merican 2cademy of !ediatrics committee states that itis safe to use %hile nursin$ .

Trade >ame: 'etrol, 'etrol 82Deneric >ame: tolterodine tartateClassi cation: choliner$ic (acetylcholine" receptor #loc?ersMechanism: The urinary #ladder is a muscular #a$. rine comin$

from the ?idneys lls the #ladder and causes it to stretchli?e a #alloon. 2s #ladder stretches, pressure in the#ladder increases and, %hen the #ladder reaches acertain level of stretch, a desire to urinate is felt. >ervesin the muscular %all of the #ladder release acetylcholine,a chemical that attaches to receptors on the muscle cellsand causes the cells to contract (ti$hten". This contri#utesfurther to the increase in pressure %ithin the #ladder andthe desire to urinate.

1y #loc?in$ the e ect of acetylcholine on the musclecells, tolterodine slo%s the #uild=up of pressure in the#ladder, reduces the sensation to urinate, and preventsuncontrolled urination.

ses: treat uncontrolla#le urination Eoveractive #ladder or ur$e

http://www.medicinenet.com/childrens_health/article.htmhttp://www.medicinenet.com/breastfeeding/article.htmhttp://www.medicinenet.com/breastfeeding/article.htmhttp://www.medicinenet.com/childrens_health/article.htm


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incontinenceG. Symptoms include the need to urinatefre uently, an ur$e to urinate immediately, and anina#ility to control the release of (urinary incontinence".

Route: 1y mouth'osa$e: Ta?en / daily. The startin$ dose is * or m$ / daily. The

startin$ dose %hen usin$ lon$=actin$ tolterodine is or m$ daily. The dose may need to #e reduced for patients%ho have impaired liver or ?idney function.

Side e ects 'ry mouth, dry eyes, headache, upset stomach, diKKiness,dro%Kiness, constipation, and may cause #lurred vision.

2dverse) ects:

vision chan$es, severe stomach pain, trou#le urinatin$,si$ns of ?idney infection, irre$ular heart#eat, severediKKiness, faintin$

Contraindications:

Contraindicated %ith people %ho3have heart pro#lems.Caution is recommended for patients %ith narro%=an$le$laucoma , o#struction to the 7o% of urine, or pooremptyin$ of the stomach since tolterodine may %orsenthese medical conditions.

!recautionsandinteractions

• Tolterodine is #ro?en do%n #y liver enKymes #eforeelimination from the #ody. 'ru$s that #loc? theseliver enKymes may slo% the elimination oftolterodine, raise tolterodine #lood levels, and leadto side e ects.

• interfere %ith the elimination of tolterodine includeserythromycin, clarithromycin (1ia/in", ?etoconaKole(>iKoral", itraconaKole ( Sporano/ ", cyclosporine,vin#lastine, and miconaKole (Monistat, Micatin". Thedose of tolterodine should #e reduced to * m$ t%icedaily if ta?en %ith any of these dru$s.

+ealth Teachin$

• Suc? hard candies or ice chips to relieve dry mouth• )at ade uae #er, drin? plenty of %ater and

e/ercise to prevent constipation.• 'o not drive or3 use machinery %hen ta?in$ this

dru$.• 8imit alcoholic #evera$es.• 'rin? lots of 7uids.

http://www.medicinenet.com/liver_anatomy_and_function/article.htmhttp://www.medicinenet.com/glaucoma/article.htmhttp://www.medicinenet.com/itraconazole/article.htmhttp://www.medicinenet.com/liver_anatomy_and_function/article.htmhttp://www.medicinenet.com/glaucoma/article.htmhttp://www.medicinenet.com/itraconazole/article.htm


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'evelopmental(lifespan"Considerations

!R)D>2>C : 2t doses much $reater than those used inhumans, tolterodine causes fetal a#normalities in animals,#ut there are no studies %ith tolterodine in pre$nant%omen. Therefore, tolterodine should only #e $iven topre$nant %omen if the #ene ts are felt to out%ei$h the

potential ris?s.

> RS >D M T+)RS: Tolterodine is secreted into #reastmil? in animals- ho%ever, it is not ?no%n if tolterodine issecreted into the #reast mil? of %omen. Therefore,nursin$ mothers should either not #reast feed ordiscontinue tolterodine.

Droup Mem#ers:2suncion, Drace

1autista, Julius1ernardo, 1ryan HloydCheon$, Caitlin MarieManimtim, Lristine

n$, Mary StephenieSoluta, Rochelle Marie
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maci case study 3 turp.docx

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