Developing a Continuing Education Program for Application to NJNSA
After surgery, there is need for a continuing educational program to be followed by the patient in order to prevent urological infections and to ensure that the patient takes good care of the catheter. Healing after conventional prostatectomy may take time; therefore, it is important to follow instructions during recovery at hospital and at home. Urethral catheter removes urine from the bladder and facilitates the healing of the bladder to the urethra. In most cases, it stays for 7 to 10 days, but it can take more days if the link between the urethra and the bladder needs more healing. The doctor will always determine the time to remove the catheter. It is important for the catheter to stay in place during the entire healing period.
The doctor will position a pelvic drain around the surgical area during surgery, and this always extends to the abdominal wall. It functions by draining excess fluid from the area. For most patients, the drain is removed one day after surgery, but in some cases in it may remain for more than a week, in which case the patent is given instructions on how to manage it at home. Post-surgical pain is managed by the use of PCA (Patient Controlled Analgesic device). This device administers pain medication via the IV. Patients can push a button, which then releases the prescribed dosage at preset intervals. This is stopped the next morning after surgery and the patient will use oral medication to manage pain. Self-inflating stockings are used during surgery and the night after surgery to avert blood clots around the legs by boosting blood circulation in the areas. After the patient starts walking the following day, they are removed.
Patients are normally discharged from hospital a day after surgery. They are discharged with a urinary catheter, which is known as Foley catheter and it held in position by a balloon in the bladder. It facilitates continuous discharge of the bladder into an external bag that is emptied as necessary. Patients are advised not to remove the catheter on their own; it must remain in position until it is no longer required. Patients are not cleared to drive; therefore, they will need someone to drive them home. They are also advised not to drive for a week after surgery. Additionally, patients should avoid demanding activities such as bicycling or running. Climbing stairs or sitting still for long in one position should also be avoided. Bathtubs, hot tubs, swimming pools or submerging oneself should be avoided when the catheter is still in place.
Soon after surgery, the abdomen will be bloated; therefore fitting into regular outfits may be a challenge. Loose fitting clothing is recommended especially those with an elastic waistband. Initially, the patient will have to wear loose clothing in order to accommodate the collection bag and the catheter. Patients may take a shower a day after being discharged from hospital. The collection bag can be removed when taking a shower. The patient pulls the colored catheter off the plastic tubing from the bag to allow the urine to drain onto the shower. After the shower, the patient can pad the sutures gently with a towel. Applying ointments to the incision areas is not advised. The suture used during surgery dissolve on their own; therefore, there is no need of removing them. Restricted redness around the incision areas and bloody or clear discharge from the wound is normal. Excessive drainage that can soak dressings and redness that is more than half an inch from the incision requires physician intervention.
Cleaning the urethral opening is important in order to prevent infections from the catheter and later scarring. Soap and water is used to clean urethral opening two times a day. It is recommended to use small amounts of bacitracin ointment in the meatus. If a reaction to the ointment is the form rash or irritation occurs, discontinue use of the ointment.
Caring for the Catheter
The catheter should stay in position as the anastamosis heals. Patients should not remove the catheter by themselves. In case it falls accidentally, they must contact their urologist for it to be replaced. It is important not to allow a nurse or a physician to replace the catheter, but the urologist alone because he/she placed it with regard to the patient's prostatectomy. Patients are provided with an antibiotic ointment that lubricates the outside catheter at the entry to the urethral meatus. This ointment lowers inflammation at the urethral meatus and discomfort. The stat-lock, which is a plastic clip that is glued to thigh to hold the catheters in position, is provided. It is removed one week after surgery.
Patients are provided with two urine collection bags. The smaller one is used during the day and can last up to four hours. The larger bag is used at night. Patient can remove, empty or change the bags as necessary. Moreover, they advised to contact their surgeon if the catheter is not functioning well and it has other serious problems.
Care for the Drainage Bag
The nurse aids with the initial set up of the urinary bag and the leg bag. It is advisable to place the buttons of the leg bag through the openings at the bottom and top of the bag with the buttons facing out to safeguard against pressure on the leg. The bag should be placed with the soft backing against the skin and the straps should be adjusted until they are comfortable. Long straps can be trimmed using scissors. When attaching the urine bag to the catheter, the open end of the tubing from the bag is inserted into the urethral catheter. Caution must be taken when connecting the leg bag into the catheter in order to keep it clean. It is also important to ensure that the outlet valve located at the bottom of the bag is closed. This is achieved by simply flipping the valve at the drainage port upward until it snaps firmly into position. Flipping the drainage port down ward drains the bag. Considering that the outlet tube is flexible, it can be directed to control urine flow. According to Medline plus, it is not necessary to disconnect the bag from the catheter when emptying since it can be emptied directly into the commode. After every disconnection, the connector must be washed with water and soap and covered using the grey cap. When not in use, the grey cap cab soaked in soapy water. It is recommended to rinse with warm water before placing it onto the connector.
When emptying the bag, it is important to wash hands with water and soap. The leg bag should be emptied when it is half-full. The urine can be emptied into a container or directly into the toilet. After emptying the bag, the clamp on the bag is closed and placed into position at the bottom of the bag. It is advisable to change the leg bag from one leg to the other especially after a shower. When going to sleep, change from the leg bag to the drainage bag. The leg bag should be rinsed out in a mixture of water and vinegar and soaked for twenty minutes. It is then rinsed with warm water and hanged to dry. In the morning, the patient should change from the drainage bag into the leg bag, and the drainage bag should be cleaned the same way. The leg bag should be cleaned on a daily basis and replaced under the recommendations of the doctor, which is usually a month. It is also advisable to keep the level of the drainage bag and the leg bag below the level the bladder in order to enhance drainage.
Infection of the urinary tract is common for individuals with an indwelling urinary catheter. Patients are advised to call a nurse or a physician if they experience infection signs such as pain or burning sensation in the pelvis or the liver; feeling achy, tired and having difficulties in focusing; pain in the lower back and sides; if the urine is of different color or bad odor; and chills or fever. Furthermore, patient are advised to call and nurse of a physician if they have problems cleaning, emptying or attaching the leg bag; if they have sores or rashes; if the bag is not filling at all or filling up faster; and if they have any questions regarding the catheter and drainage bags.
Scrotal swelling is common for up to one week after surgery. The swelling can be mitigated by wearing supportive underwear and supporting the scrotum when resting using a rolled towel. Bowel function recovers gradually after surgery. Patient must avoid bowel straining by taking plenty of water. They are also provided with medication that softens the stool such as colace. Laxatives are effective in managing constipation. Before the urethral catheter is removed, the patient may experience bladder spasms. They can be experienced as short rectal or pelvic pressure or urgency to urinate. The spasms can cause blood or urine squirting during bowel movement. It is advisable to contact a physician if the spasms become problematic. Medication is prescribed to ease spasms and associated pain. Medications such as detrol and ditropan must be stopped a day before the catheter is removed.
Regaining urinary control will take time after the removal of the catheter. Patients are advised to bring adult urinary pads during catheter removal. The pads are worn because urinary control may take time to regain. It is also important to maintain regular kegel exercises, which strengthen urinary control mechanisms. Mild incontinence may continue in some men for several years after surgery. This mitigated by wearing a small pad. If urinary control is unsatisfactory even after a year, additional techniques such as placement of artificial urinary sphincter can be explored.
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American Urological Association. Managing Bladder Dysfunction with Products and Devices.
Medline plus. Urine drainage bags.
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University of Michigan Health Systems (UMHS). Initial post-op care in the hospital.