collecting bottle; irrigate catheter as ordered.

Increased bleeding - expect and report frank bleeding (if venous bleeding, increase traction on catheter); if bright red drainage, and clots (arterial bleeding), may need surgical control; cool, clammy, pale skin and increased pulse rate indicate shock.

Goal: assist in rehabilitation. Emotional support: fears of incontinence, loss of male identity, impotence.
Goal: health teaching.
1. Expectations: mild incontinence, dribbling for a while (several months) after surgery; need to void as soon as urge is felt; push fluids.
2. Exercises: perineal (Kegel) 1-2 days after surgery - buttocks are tightened for a count of ten, 20-50 times daily.
3. Avoid:
  1. Long auto trips, vigorous exercise, heavy lifting (anything heavier than 10 lb), and sexual intercourse for about 3 wk or until medical permission, because they may increase tendency to bleed.
  2. Alcoholic beverages for 1 mo, because this may cause burning on urination; caffeine, because it causes diuresis.
  3. Tub baths, because they increase chance of infection.
4. Medications: stool softeners or mild cathartics to decrease straining.

Evaluation/outcome criteria:
1. Relief of symptoms.
2. No complications (e.g., hemorrhage, impotence).

Urinary diversion. Incontinent - ileal conduit: anastomosis of ureters to a small portion of the ileum; stoma is called urostomy; urine flow is constant; requires external collection device. Continent - Kock pouch, Indiana pouch: segment of small bowel or colon is used to create a pouch; holds urine without leakage; requires self-catheterization.
1. Indications:
  1. Congenital anomalies of bladder.
  2. Neurogenic bladder.
  3. Mechanical obstruction to urine flow (e.g., bladder cancer).
  4. Chronic progressive pyelonephritis.
  5. Trauma to lower urinary tract.
2. Analysis/nursing diagnosis:
  1. Altered urinary elimination related to surgical diversion.
  2. Risk for impaired skin integrity related to leakage of urine.
  3. Risk for infection related to contamination of stoma.
  4. Constipation related to absence of peristalsis.
  5. Body image disturbance related to stoma.
3. Nursing care plan/implementation:
  1. Preoperative: optimal bowel and stoma site preparation.
    1. Diet: low-residue 2 days followed by clear liquids for 24 hr.
    2. Medications:
      1. Neomycin (for bowel sterilization).
      2. Cathartics (GoLYTELY), enemas.
    3. Site selection: appliance faceplate (incontinent diversion) must bond securely; avoid areas of pressure from clothing (waistline); usual site is right or left lower abdominal quadrant.
  2. Postoperative:
    1. Goal: prevent complications and promote comfort.
      1. Observe for signs of:
        
        Paralytic ileus (common complication) - keep NG tube patent.
        
        Stoma necrosis - dusky or cyanotic color (emergency situation).
      2. Skin care: check for leakage around ostomy bag.
      3. Urinary drainage - stents or catheter in stoma; blood in urine in immediate postoperative period; mucus normal.
    2. Goal: health teaching.
      1. Self-care activities:
        
        Peristomal skin care - prevent irritation, breakdown; proper cleansing - soap and water; adhesive remover, if needed.
        
        Appliance application and emptying; pouch opening 2-3 mm larger than stoma; do not remove each day; change appliance every 3-5 days or when leaking.
        
        Odor control - dilute urine, acid®||ash diet, hygiene; avoid asparagus, tomatoes.
        
        Use of night drainage system if necessary for uninterrupted sleep.
      2. Signs of complications: change in urine color, clarity, quantity, smell; stomal color change (normal is bright pink or red).
4. Evaluation/outcome criteria:
  1. Acceptance of new body image.
  2. Regains independence.
  3. Demonstrates confidence in management of self-care activities.