CYSTECTOMY
PREOPERATIVE CARE
•Assess knowledge of the proposed surgery and its long-term
implications, clarifying misunderstandings and discussing
concerns.
Clients having surgery for cancer of the urinary tract
are trying to cope with diagnosis of cancer and may not fully un-
derstand the surgery and its potential effects. Open discussion
can fa
cilitate postoperative recovery and adjustment.
•Begin teaching about postoperative tubes and drains, self-
care of stoma, and control of drainage and odor.
Postoperativephysiologic and psychologic stressors may interfere with learn-
ing. A basic understanding of what to expect in the way of tubes,
drains, and procedures reduces stress in the immediate postoper-
ative period. Preoperative teaching can enhance recall and post-
operative learning.
•Assist in identifying stoma site, avoiding folds of skin, bones,
scar tissue, and the waistline or belt area. Be sure to consider
the client’s occupation and style of clothing. The site should
be visible to the client and accessible for manipulation.
Stomaplacement is a vital component of adjustment and self-care. Care
is taken to place the stoma away from areas of constant irritation
by clothing
or movement. It should be located so that the client
can cover and
disguise the collecting device, maintain the seal to
prevent leakage, and effectively cleanse and maintain the site.
•Perform bowel-preparation activities as ordered.
Bowel prepa-
ration
is done to prevent fecal contamination of the peritoneal
cavity and to
decompress the bowel during surgery.
POSTOPERATIVE CARE
•Provide
routine postoperative care (See ch. 7).
•Monitor intake
and output carefully, assessing urine output
every hour for the first 24 hours, then every 4 hours or as or-
dered. Call the physician if urine output is less than 30 mL per
hour.
Tissue edema and bleeding may interfere with urinary out-
put from stoma, catheters, or drains. Maintenance of urine out-
flow is vital to prevent hydronephrosis and possible renal damage.
A urine output of at least 30 mL per hour is necessary for effective
renal function.
•Assess color and consistency of urine. Expect pink or bright red
urine fading to pink and then clearing by the third postopera-
tive day. Urine may be cloudy due to mucus production by
bowel mucosa.
Bright red blood in the urine from a urinary diver-
sion may indicate hemorrhage, necessitating further surgery.
Excessive cloudiness or malodorous urine may indicate infection.
•Assess size, color, and condition of the stoma and surrounding
skin every 2 hours for the first 24 hours, then every 4 hours for
48 to 72 hours. Expect the stoma to appear bright red and
slightly edematous initially. Slight bleeding during cleansing is
normal.
Comprom
ised circulation causes the stoma to appear
pale, gray, or cyanotic or blanch when touched. Other complica-
tions, such as infection or impaired healing may be evidenced by a
change in the appearance of the stoma or incision.
•Irrigate the ileal diversion catheter with 30 to 60 mL of normal
saline every 4 hours or as ordered.
Mucus produced by the bowel
wa
ll may accumulate in the newly devised reservoir or obstruct
cat
heters.
•Monitor seru
m electrolyte values, acid-base balance, and renal
function tests such as BUN and serum creatinine.
Reabsorption
of electrolytes from reservoirs created by portions of bowel may re-
sult in electrolyte imbalance and metabolic acidosis. Optimal renal
function is necessary to maintain a normal state of homeostasis.
•Tea
ch the client and family about stoma and urinary diversion
care, including odor management, skin care, increased fluid
intake, pouch application and leakage prevention, self-
catheterization for clients with continent reservoirs, and signs
of infection and other complications.
The ability to provide
self-care is a significant factor in the adjustment to a changed
body image. Teaching family members facilitates acceptance
and adjustment. The family also needs this knowledge in case ill-
ness or disability interferes with the self-care capacity
NURSINGCAREOFPATIENTWITH
PERCUTANEOUSNEPHROSTOMYTUBES
P
URPOSE
o
To maintain a patent catheter providing
drainage
of urine from the kidney when the flow of urine
through a
ureter
is not possible or desirable and
to prevent infection
o
Inserted into the renal pelvis to allow drainage
and relieve pressure –
hydronephrosis
Indications
•
Urinary tract obstruction
•
Urinary diversion (e.g. ureteric
injury; urine
leak)
•
Access for percutaneous
procedures (e.g.
stone treatment; ureteric stenting)
•
Diagnostic testing (e.g.
antegrade
pyelography
)
P
RE
-
PROCEDURE
MANAGEMENT
¢
Written patient consent must be obtained prior to
insertion or
change of tube
¢
Nil by mouth (as per hospital policy)
¢
Confirm with team the administration or withholding of
anti-
coagulants and other medication (as per team
instructions)
¢
Bloods –
coag
, U&E
¢
X/Ray procedure check-list (CUH) – if in patient
¢
Hospital gown
P
OST
-
PROCEDURE
MANAGEMENT
¢
Administer analgesia as prescribed
¢
Nephrostomy
tube must be connected to a sterile closed
drainage system and drainage bag should be below level
of
kidney at all times
¢
Post-procedure vital signs
¢
Monitor urine - out-put, colour, sediment
NOTE: normal for blood to be present in the urine
immediately after
nephrostomy
insertion but it should
decrease within 48 hours
P
OST
-
PROCEDURE
MANAGEMENT
–
CONT
’
D
¢
Encourage patient to drink at least 2litres of water per
day
(unless contraindicated)
¢
Observe dressing and tubing for leakage
¢
Inspect
nephrostomy
to ensure it is secure and no kinking
has occurred
¢
Common complications:
-
Infection
-
Pain
-
Dislodgement
O
NGOING
C
ARE
Dressing Changes
:
•
Secured in place with Drain-Fix dressing
•
Available in two sizes
P
ATIENT
D
ISCHARGE
¢
Provide individualised education to the patient/carers,
significant others
¢
Refer patient to public health nurse/community nursing
service to maintain continuity of care
¢
Provide patient with extra bags and
drainfix
dressings
prior to discharge
¢
Ensure patient booking for change of tube is requested
or
alternative plan in place (same communicated via
discharge letter to community)
