NURSING DIAGNOSIS: Knowledge deficit, Ineffective management of therapeutic regimen, or Altered health maintenance*

*The nurse should select the diagnostic label that is most appropriate for the client's discharge teaching needs.

Desired Outcome
The client will demonstrate the ability to perform care related to the urinary catheter and drainage system.
Nursing Actions and Selected Purposes/Rationales
  1. Instruct client in care related to the urinary catheter and drainage system including:
    1. washing the urinary meatus with soap and water at least twice a day
    2. anchoring the catheter tubing securely to abdomen or thigh
    3. keeping catheter and urine collection bag tubing free of kinks
    4. keeping urine collection bag below the level of the bladder
    5. changing from the leg bag to bedside collection bag when lying down for more than a few hours
    6. emptying the leg bag and the bedside collection bag
    7. measuring and recording the amount of urine output if necessary.
  2. Allow time for questions, clarification, practice, and return demonstration.
Desired Outcome
The client will identify ways to manage urinary incontinence if it occurs following catheter removal.
Nursing Actions and Selected Purposes/Rationales
  1. Provide information about ways to reduce the risk of urinary incontinence following removal of the urinary catheter (incontinence can occur as a result of trauma to urinary sphincters during surgery and/or irritation from the urinary catheter, damage to pelvic nerves during surgery, and/or a temporary decrease in bladder capacity because of the continued decompression of the bladder while the catheter was in place):
    1. try to urinate every 2-3 hours and when the urge is felt
    2. urinate in a standing or sitting position to facilitate complete bladder emptying
    3. avoid drinking large quantities of liquid over a short period
    4. limit intake of alcohol and caffeine-containing beverages (alcohol and caffeine have a mild diuretic effect and act as irritants to the bladder; these factors may make urinary control more difficult)
    5. stop drinking liquids a few hours before bedtime (reduces risk of nighttime incontinence)
    6. avoid activities that make it difficult to empty bladder as soon as the urge is felt (e.g. long car rides, lengthy meetings).
  2. Reinforce the importance of performing perineal exercises (e.g. stopping and starting stream during voiding; squeezing buttocks together, then relaxing the muscles) regularly when allowed in order to improve urinary control.
  3. Inform client that if urinary incontinence occurs following catheter removal, he should:
    1. wash and dry perineal area after each episode of incontinence
    2. wear disposable underwear liners or absorbent undergarments such as Attends if needed
    3. consult physician about treatment options (e.g. biofeedback, insertion of an artificial urinary sphincter) if the problem persists.
Desired Outcome
The client will identify ways to manage bowel incontinence if present.
Nursing Actions and Selected Purposes/Rationales
  1. If client is experiencing bowel incontinence, instruct him to:
    1. adhere to a routine bowel care program
    2. perform perineal exercises (e.g. stopping and starting stream during voiding; squeezing buttocks together, then relaxing the muscles) regularly when allowed in order to improve bowel control
    3. wash and dry perineal area after each episode of incontinence
    4. wear disposable underwear liners or absorbent undergarments such as Attends if needed.
Desired Outcome
The client will state signs and symptoms to report to the health care provider.
Nursing Actions and Selected Purposes/Rationales
  1. Refer to Standardized Postoperative Care Plan, Diagnosis 22, for signs and symptoms to report to the health care provider.
  2. Instruct client to also report:
    1. urinary or bowel incontinence that persists longer than expected, worsens, or interferes with daily life
    2. persistent, unexpected impotence
    3. difficulty coping with the diagnosis of cancer and/or the effects of the radical prostatectomy on body functioning.
Desired Outcome
The client will verbalize an understanding of and a plan for adhering to recommended follow-up care including future appointments with health care provider, medications prescribed, activity level, wound care, and plans for subsequent treatment.
Nursing Actions and Selected Purposes/Rationales
  1. Refer to Standardized Postoperative Care Plan, Diagnosis 22, for routine postoperative instructions and measures to improve client compliance.
  2. Reinforce physician's explanations and instructions regarding subsequent treatment (e.g. external radiation therapy) if planned.