Nursing care plan for prostatectomy

Daytonite, BSN, RN · Feb 6, 2009

i don't want to sound mean, but you went about this backwards. a case study is a care plan in a essay form. it needs to be organized using the nursing process (assessment, problem identification, planning, implementation, evaluation). the nursing process begins with assessment. assessment consists of:

reviewing the pathophysiology, signs and symptoms and complications of their medical condition
reviewing the signs, symptoms and side effects of the medications they are taking
assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)

next you move on to identifying the nursing problems. the nursing problems, aka nursing diagnoses, are based upon the abnormal data that is revealed from all that assessment data that is found above. the related factors (etiologies) and aebs (evidence/signs and symptoms) for those nursing diagnoses you already came up with will be found in that information you should have looked up first. the idea is to base the nursing diagnoses on that information, not to make the information fit your diagnoses.

the nursing interventions you will need all target that abnormal data that support the various nursing diagnoses. in fact, the foundation of the entire case study is based on the assessment.

use the weblinks on this thread to look for information about this patient's medical diseases, conditions and medical treatments: https://allnurses.com/nursing-student-assistance/medical-disease-information-258109.html - medical disease information/treatment/procedures/test reference websites

there are several examples of how the nursing process is tied in with care planning on this thread and by looking up any of the care plan threads i have answered: https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans

asims08 · Feb 6, 2009

I asked for any help, I don't think that was being mean. It is just hard for me this quarter because we are on a med. surg floor and this patient that I have to do a case study on I only had him for a couple of hours and then he went home. So I knew this one would be hard, but we only have 2 days a week at the hospital and with these types of surgeries that we are dealing with most of the time we do not have the same patient for two days.

Home Health Columnist / Guide · Feb 6, 2009

What are some signs and symptoms, Treatments, and predisposing factors and causes

What PROBLEMS did the patient have that sent him to surgeon = signs and symptoms = chief complaint "cc" physicians write at the top on their History and physical (H+P) form; nursing assessment may have similar chief complaint statement phrased as "patients understanding reason for admission" and check off of problems reported on systems review.

signs= whats observable

symptoms = whats reported by patient

workup includes tests and procedures done to pinpoint problems

predisposing factors + causes: family history, workplace/home exposure to hazzards/chemicals, inhereted genetic problems

Treaments= heat/cold modalities ie ice, whirpool, friction body massage; physical therapy manipulations; medications, surgery; need for Oxygen

removal from source occupational/home hazzard: radon gas, silica dust

The information written in physian H+P, nursing assessment,and med lists along with patient interview will get you 90% info. So they are they areas to focus on for your care planning. Add in lab/radiology/imaging tests and OR report will round out info gathering for case study.

Chief complaint common for patients with urological problems include blood in urine, difficulty/pain on urination, low back ache and for men: decrease in urine flow, 'can't pass my water", dribbling, erectile dysfunction.

So which of these was listed on assessments?

Any family history of Prostate CA or BPH

Put on your critical sleuthing hat when entering a chart/reviewing doc and nursing assessments along with just tallking to the patient "If you dont mind, tell me what brought you to the hospital" and you'll find a treasure trove of info to explore and organize THEN can flesh out detail for case study by reviewing testbook/articles for detail info on a specific desease process ---match your patients complaints/problems to common ones for condition; document common complaints patient did not have along with other problems not typical for diagnosis; list the treatment plan, nursing considerations THEN formalize iinfo into case study outline.

Daytonite, BSN, RN · Feb 6, 2009

i asked for any help, i don't think that was being mean. it is just hard for me this quarter because we are on a med. surg floor and this patient that i have to do a case study on i only had him for a couple of hours and then he went home. so i knew this one would be hard, but we only have 2 days a week at the hospital and with these types of surgeries that we are dealing with most of the time we do not have the same patient for two days.

for you, as a student, a case study is not about developing a care plan for the nursing staff to follow. it is about learning and for you to demonstrate several things to your instructors:

you know the nursing process and how to think critically
you can develop a plan of care (identify nursing problems and strategies to solve them) based on one small piece of information
you know how to independently research and look for more information to build upon your foundation of knowledge and incorporate it into this case study
you show problem solving ability, initiative, and leadership in this paper--that's what professional nurses do on a daily basis. (do you know how many times the only information we got about a patient was, "john smith. admitted with chf"? we couldn't sit around and wait for more to come our way. we had to start doing things for the patient--now.)
you have a good command of the english language

the prostatectomy was a surgical treatment (intervention) by the doctors. interventions are solutions hoping to have some kind of positive effect on a problem. so, what was this patient's medical problem (medical diagnosis). you need to distinguish what that was first [example: john smith is a 60 year old man admitted on xx/xx/xx with cancer of the prostate gland that was first diagnosed in june of xxxx.]. that information would have been in the chart and on the surgical report. in this case study you will be identifying his nursing problems (nursing diagnoses). and, as a nurse you will develop nursing interventions that you will want to perform. here is the general outline for your paper:

assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
- a physical assessment of the patient
- assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
- data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
- knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
  - use: https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html - medical disease information/treatment/procedures/test reference websites

[*]determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use). it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.

your instructors might have given it to you.
you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
- http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/
- http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm
[*]always sequence actual nursing problems before potential (risk for) or anticipated problems
- use maslow's hierarchy of needs to sequence the diagnoses in order of priority of importance
  - http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs - maslow's hierarchy of needs

[*]planning (write measurable goals/outcomes and nursing interventions)

goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
- improve the problem or remedy/cure it
- stabilize it
- support its deterioration
[*]how to write goal statements: see post #157 on thread https://allnurses.com/general-nursing-student/careplans-help-please-121128.html
[*]interventions are of four types
- assess/monitor/evaluate/observe (to evaluate the patient's condition)
  - note: be clear that this is assessment as an intervention and not assessment done as part of the initial data collection during step 1.
  [*]care/perform/provide/assist (performing actual patient care)
  [*]teach/educate/instruct/supervise (educating patient or caregiver)
  [*]manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

[*]implementation (initiate the care plan)

[*]evaluation (determine if goals/outcomes have been met)

asims08 · Feb 6, 2009

Well I guess one thing that I did wrong was trying to use the treatment for the diagnoses. He had a regular check up and they found that he had prostate cancer. So I guess I would use that to start with????

Daytonite, BSN, RN · Feb 7, 2009

Well I guess one thing that I did wrong was trying to use the treatment for the diagnoses. He had a regular check up and they found that he had prostate cancer. So I guess I would use that to start with????

For a case study, yes.

Nursey103, ADN, RN · Feb 8, 2009

I worked urology for 5 years and you just dont go to the MD and find out you have prostate cancer! You either have an elevated PSA, BPH symptoms, family history, prostate nodule felt on a digital rectal exam - any of those risk factors will lead the MD to do a prostate ultrasound/biopsy - that is the only way prostate cancer is diagnosed.

As far as treatment - obviously he chose to have a prostatectomy but there are other treatment options such as watchful waiting, radiation, etc.

Patient will need his PSA checked every 6 months - 1 year to make sure the cancer does not recur. Usually after a prostatectomy - patients have problems with erectile dysfunction & incontinence...

Hope that somewhat helps...

asims08 · Feb 8, 2009

I know he had a PSA of 5.5 and then he passed out during the initial exam so they sent him to OR in November after he passed out during the exam. It was there that he had a transrectal ultrasound. I have his history report and it says nothing about BPH symptoms, I wish it did tell me something about that, it might make it a little easier to do this case study. And as far as family history, his brother in law had it. I had him 2 weeks ago after his prostatectomy, that is why I am having such a hard time. I had him on the day he went home. So it is kind of tough for me to do a case study on someone I only had for one day. When he went home he was only on three meds, and they had already done the patient teaching on the catheter, and the IV's he was on was already stopped due to the fact that he was leaving to go home. Thanks for your help.

Nursey103, ADN, RN · Feb 8, 2009

It doesnt make sense to me that he would pass out during the exam and then he would be taken straight to the OR to have a prlostate u/s & bx. Unless he had something else going on and was take to the hospital and then the MD decided to just do a prostate u/s & bx while he was there.....?!

Plus they don't do prostate bx's in the OR - I dunno......I have a feeling you're missing a bunch of things.

I think if you go one at a time with your assessment, findings, etc. - you could start somewhere!

Daytonite, BSN, RN · Feb 8, 2009

what i think you are having trouble with is putting together this case study. there used to be a website where we could send students to so they could look at examples of nursing case studies, but it was taken off the internet. what you need to do is assemble all the information you copied down about this patient because it sounds like you have that. i posted that 5-step nursing process as a way for you to organize your paper. it usually begins by describing a little history of the patient and his disease process from discovery to the current situation. then you do a discussion of the pathophysiology of prostate cancer, how it is detected and treated. then you go into your nursing assessment, plan (nursing diagnoses) and goals and interventions, implementation and evaluation.