Question

Matthew Sanders is a 69-year-old male who is one day post-op following open radical prostatectomy for treatment of prostate cancer. PMH: presented to PCP two weeks ago with dysuria, hematuria and urinary hesitancy accompanied by back and pelvic discomfort that began six months ago. PSA level was 7.8 ng/mL and DRE showed enlarged prostate: asymmetric, hard and nontender. Biopsy confirmed prostate cancer Stage II, Gleason Score 8, classified as high-risk cancer. Osteoarthritis, Type 2 DM and history of peptic ulcer disease. 0700 Assessment • 130/90 98.8°F- 86-20 pulse oximetry 98% on room air 4/10 incisional pain • HRR, no edema, +2 peripheral pulses, capillary refill < 3 sec, elastic skin turgor, LR infusing at 125 mL/h via right forearm IPID • Abdomen soft, hypoactive bowel sounds x 4 quadrants, 500 mL green liquid emesis – ondansetron given at 2030 with relief of n/v, PO intake ice chips only, abdominal incision dry and intact • CBI infusing – pale pink color with occasional tiny clot, 600 mL urinary output for 11-7 shift, morphine given for bladder spasms at 0415 – pain score 7/10 to 4/10 d.

On first rounds, you discover urine is leaking around the foley catheter tubing. What will you do?

Later in the day, drainage in the foley bag has changed from pale pink to red with multiple clots. What are your next steps?

At the end of your shift, the PCA tells you that Mr. Sanders reports increased cramping and pain in his lower abdomen. What actions will you take?

Answer 1

1.Check for and remove any kinks in the catheter or the drainage bag tubing.Urine leakage around the catheter also indicates that your catheter is blocked.The force generated by bladder spasms also causes leakage around the catheter by overwhelming the drainage capacity of the catheter. Management of leakage around the catheter is managing underlying cause.If it is due to blockage ,flush the catheter and if it is due to bladder spasm,antispasmodics can bring effective.

2.It is normal for the urine yo drain from catheter to have some blood clots.This is very common after prostatectomy.Drinking a plenty of fluids May help to flush out blood or blood clots out of bladder.

3.Typical pain after prostate surgery lasts for around 1 to 2 weeks as the incision May sore in that period.The patient would has bladder cramps or spasms while the catheter is in bladder.Nursinf pain management includes number of ways like providing comfortable position,assessing pain and deciding whether to administer analgesics and choosing route of administration. Identification of patients with high risk for severe postoperative pain and giving them special attention would be desirable.Patients with good analgesia are More comfortable and recover soon.If the pain is Not controlled in your hands,consult the responsible surgeon as soon as possible.