Principles of Hospital Medicine

1. Joe Smith, a 55-year-old patient, is admitted to the surgical unit after robotic-assisted laparoscopic radical prostatectomy with nerve sparring for early stage cancerous tumor confined to the prostate. The client has six small incisions in the abdomen with small 4×4 dressings with clear dressing dry and intact. The client has a JP drain in place with clear, red-colored drainage with 50 mL present and an indwelling urinary catheter draining clear, red-colored urine. The surgeon ordered ketorolac (Toradol) for pain management and belladonna and opiate (B&O) suppository every 8 hours, as needed, for bladder spasms. (Learning Objective #5)

1. What nursing care should be provided to the patient in the immediate postoperative period?
2. For what potential complications should the nurse observe, and what actions should the nurse take if the complication develops?
3. The surgeon removes the JP drain the next day and discharges the patient with the indwelling urinary catheter to a leg bag. What discharge instructions should the nurse provide the patient? What follow-up care is anticipated for him?

2. Joe Smith, a 67-year-old man, is admitted with the diagnosis of adenocarcinoma of the penis. He presents with painless wartlike growth on the skin of the glans of the penis. (Learning Objective #7)

1. Explain the pathophysiology of cancer of the penis.
2. What are the early and late manifestations of cancer of the penis?
3. What are the management goals for cancer of the penis?