Nursing of Urinary System

about :

“Answer Case Study”

Lecturer :

Hema Malini, S.Kp, MN, PhD

By :

Dwi Yani Adinda (1511314006)

UNDERGRADUATED STUDENT

NURSING FACULTY

UNIVERSITAS ANDALAS

PADANG

2017/2018
1. Discuss about the important thing of TUR (Transurethral Resection)
Trans Urethral Resection (TUR) of the bladder is a surgical procedure that is used
both to diagnose bladder cancer and to remove cancerous tissue from the bladder.
This procedure is also called a TURBT (transurethral resection for bladder
tumour). General anesthesia or spinal anesthesia is often used. During TUR surgery,
acystoscope is passed into the bladder through the urethra. A tool called a
resectoscope is used to remove the cancer for biopsy and to burn away any remaining
cancer cells.
In man, TUR can be called Trans Urethral Resection of Prostate (TURP).
Transurethral resection of the prostate is the operation carried out primarily to relieve
obstruction of urine passing from the bladder through the urethra. This operation is
also known as a "Rebore". The operation is performed by passing a telescopic
instrument in through the penis along the urethra and into the area where the prostate
gland is obstructing. A special electrode is used to cut away the prostate tissue. At the
end of the procedure, a catheter is placed and usually kept in place from between one
to three days after surgery. While the catheter is in place irrigating fluid flows in and
out of the bladder through the catheter. The purpose of this fluid is to keep the
operated area and the bladder clean and free of clots.
2. As a nurse, What should we do in Pre-Operation and Post-Operation ?
 Pre-Operation
 Collect data
 General Assessment :
 Assest Client Identity, such as Client’s Name, Age, and Client’s Parent
Name to make sure we give the right procedure with the right client.
 Give Informed Consent to client and Client’s Family. This information
include : What Surgery the client would get, the procedure of surgery,
Advantage and Risk of the surgery, What condition that our client will
get if the surgery success.
 Medical History / Information :
 Assest client medical History, such as :
1. Past medical History / Chronic Illness.
2. Did the client get any surgery before this / TUR ?
3. Previous medicine therapy.
 Assest client Allergy, with food or fluid or maybe with some medicine.
  Assest client lifestyle behaviour, such as Smoke, Alcoholism, etc.
 Client Psychosocial and spiritual
 Assest client Anxiety Level
 Physical Examination
 Check client vital sign.
 Assest client Consciousness with GCS (Glasgow Coma Scale).
 Assest client fluid balance and electrolyte.
 Develop Plan of Care

No Nursing Diagnosis NOC Nursing Intervention

Anxiety related to the Desired Outcome  Provide psychosocial support.
surgical experience : Reducing  Be a good listener, be empathetic, and
(anesthesia, pain) and Anxiety Level provide information that helps alleviate
the outcome of surgery concerns.
 During preliminary contacts, give the
patient opportunities to ask questions
and to become acquainted with those
who might be providing care during
and after surgery.
 Acknowledge patient concerns or
1 worries about impending surgery by
listening and communicating
therapeutically.
 Explore any fears with patient, and
arrange for the assistance of other
health professionals if required.
 Teach patient cognitive strategies that
may be useful for relieving tension,
overcoming anxiety, and achieving
relaxation, including imagery,
distraction, or optimistic affirmations.
Deficient Desired Outcome  Teach each patient as an individual,
2 Knowledge related to : Client would with consideration for any unique
the surgical process understand about concerns or learning needs.
his / her surgical  Begin teaching as soon as possible,
process starting in the physician’s office and
continuing during the pre admission
visit, when diagnostic tests are being
performed, through arrival in
the operating room.
 Space instruction over a period of time
to allow patient to assimilate
information and ask questions.
 Combine teaching sessions with
various preparation proce-dures to
allow for an easy flow of information.
Include descriptions of the procedures
and explanations of the sensations the
patient will experience.
 During the preadmission visit, arrange
for the patient to meet and ask
questions of the perianesthesia nurse,
view audiovisuals, and review written
materials. Provide a telephone number
for patient to call if questions arise
closer to the date of surgery.
 Reinforce information about the
possible need for a ventilator and the
presence of drainage tubes or other
types of equipment to help the patient
adjust during the postoperative period.
 Inform the patient when family and
friends will be able to visit after
surgery and that a spiritual advisor will
be available if desired.
  P.S :
1. Apply therapeuthic Communication everytime we had interaction with
client.
2. Make sure the client didn’t consume food nor water 6 hours before
surgery.
3. Teach client deep breathing technique to reduce the anxiety.
4.
 Post-Operation
 General Assessment
1. Assess air exchange status and note patient’s skin color
2. Verify patient identity. The nurse must also know the type of operative
procedure performed and the name of the surgeon responsible for the
operation.
3. Assess Client Vital Sign and Urine color regularly.
4. Neurologic status assessment. Level of consciousness (LOC) assessment
and Glasgow Coma Scale (GCS) are helpful in determining the neurologic
status of the patient.
5. Operative site examination.
6. It is important to remain our client on bedrest until the next morning.
Reducing activity allows client body to recover from the anaesthetic and
reduces the possibility of bleeding.
7. Ask the client if he ‘ she feel pain on site of surgery.
 Physical Exercise (to prevent complication) :
1. Breathing exercises : take five long and slow deep breaths. Each breath
should be deeper than the previous breath. Think about getting the air to
the very bottom of the lungs.
2. Circulation exercises: firmly move client ankles up and down to stretch
and contract client calf muscles.
 REFFERENCE

1. Herdman, T. H & Kamitsuru, S. (Eds). (2014). NANDA International Nursing

Diagnosed: Definition & Classification, 2015-2017. Oxford: Wiley Blackwell.
2. Staff of Mater Hospital Brisbane, Raymond Terrace, South Brisbane Q 4101 © 2010
Mater Misericordiae Ltd. ACN 096 708 922.

3. https://www.healthlinkbc.ca/health-topics/uh1456
4. Vera , Matt. 2012. Pre-operation phase. Nurselabs