NURSING DIAGNOSIS: Fear/Anxiety

related to:
  1. diagnosis of cancer, treatment plan, and prognosis;
  2. potential embarrassment or loss of dignity associated with body exposure during preoperative care, surgery, and postoperative assessments and treatments;
  3. anticipated loss of control associated with effects of anesthesia;
  4. lack of understanding of the surgical procedure and postoperative expectations and care;
  5. anticipated surgical findings, postoperative pain, and changes in body functioning;
  6. unfamiliar environment and separation from significant others;
  7. financial concerns associated with hospitalization.
Desired Outcome
The client will experience a reduction in fear and anxiety (see Standardized Preoperative Care Plan, Diagnosis 1, for outcome criteria).
Nursing Actions and Selected Purposes/Rationales
  1. Refer to Standardized Preoperative Care Plan, Diagnosis 1, for measures related to assessment and reduction of fear and anxiety.
  2. Implement additional measures to reduce fear and anxiety:
    1. allow time for verbalization of concerns regarding the effects of the radical prostatectomy on body functioning (e.g. sterility, possible impotence, possible urinary and/or bowel incontinence); reinforce physician's explanation that if incontinence occurs, it often resolves over time and that nerve-sparing surgical techniques have greatly reduced the incidence of impotence
    2. instruct client to expect the following postoperatively so that he is not overly concerned when they occur:
      1. presence of a urinary catheter (the catheter is usually removed about 2-3 weeks after surgery)
      2. frequent dressing changes and/or presence of wound drainage collection device for the first 2-4 days after surgery
      3. possible need for bladder irrigations to keep catheter patent
      4. presence of some blood in urine (can occur occasionally during the first 1-3 days after surgery)
    3. reinforce physician's explanation about the positive effects of surgery (when diagnosed and treated in early stages, prostatic cancer is a highly curable disease)
    4. assure client that privacy will be maintained during preoperative care and postoperative assessments and treatments
    5. assure client that he will receive thorough instructions about management of the urinary catheter prior to discharge.