Friday, April 16, 2010

Gout also known as gouty arthritis is a metabolic disease marked by monosodium urate deposits that cause red, swollen, and acutely painful joints. Gout can affect any joint but mostly affects those in the feet, especially the great toe, ankle, and midfoot. Gout is a medical condition that usually presents with recurrent attacks of acute inflammatory arthritis (red, tender, hot, swollen joint). It is caused by elevated levels of uric acid in the blood. The uric acid crystallizes and deposits in joints, tendons, and surrounding tissues. Gout affects 1% of Western populations at some point in their lives. Gout is caused by an increased level of uric acid in the blood, salts of which are deposited in the joints. It mostly occurs in middle-aged men and almost always involves pain at the base of the great toe. Gout may result from a primary metabolic disturbance or may be a secondary effect of another disease, as of the kidneys.Gout is treated with drugs to suppress formation of uric acid or to increase elimination of uric acid. Patients who receive treatment for gout have a good prognosis. 
The final, unremitting stage of the disease (also known as tophaceous gout) is marked by persistent painful polyarthritis. An increased concentration of uric acid leads to urate deposits in cartilage, synovial membranes, tendons, and soft tissue, called Tophi/tophus . Tophi/tophus form in the fingers, hands, knees, feet, ulnar sides of the forearms, pinna of the ear, Achilles tendon and, rarely, in such internal organs as the kidneys and myocardium. Renal involvement may adversely affect renal function. 

Causes for Gout/Gouty Arthritis 
Hyperuricemia is the underlying problem of gout, Although the underlying cause of primary gout is unknown, it appears to be linked to a genetic defect in purine metabolism that causes overproduction of uric acid (Hyperuricemia), retention of uric acid, or both. 
Secondary gout develops during the course of another disease, such as obesity, diabetes mellitus, hypertension, polycythemia, leukemia, myeloma, sickle cell anemia, and renal disease. Secondary gout can also follow treatment with such drugs as hydrochlorothiazide or pyrazinamide. 

Complications for Gout/Gouty Arthritis 
Potential complications include: Renal disorders such as renal calculi Circulatory problems, such as atherosclerotic disease, cardiovascular lesions, stroke, coronary thrombosis, and hypertension Infection that develops when occur tophi ruptures and nerve entrapment. 

Treatment for Gout/Gouty Arthritis 
Gout/Gouty Arthritis management has three goals: Stop the acute attack. Treat hyperuricemia to reduce urine uric acid levels. Prevent recurrent gout and renal calculi. 
Treatment for an acute attack: 
Bed rest; immobilization and protection of the inflamed, painful joints; and local application of cold. Analgesics, such as acetaminophen, relieve the pain associated with mild attacks. Acute inflammation requires nonsteroidal anti-inflammatory drugs or intramuscular corticotropin. 
Treatment for chronic gout involves 
Decreasing the serum uric acid level. Adjunctive therapy emphasizes avoidance of alcohol and sparing use of purine-rich foods. Weight reduction program decreases uric acid levels and eases stress on painful joints. In some cases, surgery may be necessary excised and drained tophi to improve joint function or correct deformities. 

Nursing Assessment 
Patient history Reveal that the patient has a sedentary lifestyle and a history of hypertension or renal calculi. report waking with pain in toe or another location in the foot.He may complain that initially moderate pain has grown and He may report accompanying chills and a mild fever. 
Inspection a swollen, dusky red or purple joint with limited movement. Maybe found tophi, especially in the outer ears, hands, and feet, In chronic stage of gout, the skin over the tophi may ulcerate and release a chalky white exudate or pus. 
Palpation may reveal warmth over the joint and extreme tenderness. The vital signs assessment may disclose fever and hypertension. If the patient has a fever, possible occult infection must be investigated. 

Diagnostic tests for Gout/Gouty Arthritis 
Needle aspiration of synovial fluid (arthrocentesis) or tophaceous material Serum uric acid X-rays 

Nursing Diagnosis
Common nursing diagnosis found in Nursing care plans for Gout/Gouty Arthritis Acute pain Activity intolerance Anxiety Deficient knowledge (diagnosis and treatment) Disturbed sleep pattern Impaired physical mobility Ineffective coping Risk for injury

Tuesday, April 13, 2010

Nursing Care Plans for Prostate Cancer. Prostate cancer is the most common neoplasm in males older than age 50; it’s a leading cause of male cancer death. Adenocarcinoma is the most common form; only seldom does prostate cancer occur as a sarcoma. Most prostate cancers originate in the posterior prostate gland, with the rest growing near the urethra. Malignant prostatic tumors seldom result from the benign hyperplastic enlargement that commonly develops around the prostatic urethra in older males. 
Slow-growing prostate cancer seldom produces signs and symptoms until it’s well advanced. Typically, when primary prostatic lesions spread beyond the prostate gland, they invade the prostatic capsule and then spread along the ejaculatory ducts in the space between the seminal vesicles or perivesicular fascia. When prostate cancer is fatal, death usually results from widespread bone metastases. 

Stage of Prostate Cancer 

  1. Stage A or I: Prostate cancer that is only found by elevated PSA and biopsy, or at surgery for obstruction. It is not palpable on DRE. It is usually found accidentally during surgery for other reasons, such as BPH, usually curable, especially if it is a relatively low Gleason grade. 
  2. Stage B or II: can be felt on rectal examination and is click to enlargelimited to the prostate. Other tests, such as bone scans or CT/MRI scans, may be needed to determine this stage, especially if the PSA Blood tests is significantly elevated or the Gleason grade is 7 or greater 
  3. Stage C or III: Cancer has already spread beyond the capsule of the prostate into localclick to enlarge organs or tissues, but has not yet metastasized or jumped to other sites 
  4. Stage D or IV: Cancer has already spread, first site usually pelvic and perivesicular lymph nodes and bones of the pelvis, sacrum, and lumbar spine 

Stage of Prostate Cancer

Causes for Prostate Cancer 
Risk factors for prostate cancer include age (the cancer seldom develops in males younger than age 40) and infection. Endocrine factors may also have a role, leading researchers to suspect that androgens speed tumor growth. 
Complications for Prostate Cancer 
Progressive disease can lead to spinal cord compression, deep vein thrombosis, pulmonary emboli, and myelophthisis. 

Nursing Assessment 
The patient’s history may reveal urinary problems, such as dysuria, frequency, retention, back or hip pain, and hematuria. The patient with these complaints may have advanced disease, with back or hip pain signaling bone metastasis. The patient usually has no signs or symptoms in early disease. Inspection may reveal edema of the scrotum or leg in advanced disease. During digital rectal examination (DRE), prostatic palpation may detect a nonraised, firm, nodular mass with a sharp edge (in early disease) or a hard lump (in advanced disease). 

Diagnostic tests for Prostate Cancer 
The American Cancer Society advises a DRE and a blood test to detect prostate-specific antigen (PSA) yearly for males age 50 and older with a life expectancy of at least 10 years. These screenings may be done for males at high risk of the disease beginning at age 40 to 45, depending on their risk factors. Blood tests may show elevated levels of PSA. Although most males with metastasized prostate cancer have an elevated PSA level, the finding also occurs with other prostatic disease, so the PSA level should be assessed in light of DRE findings. Transrectal prostatic ultrasonography may be used for patients with abnormal DRE and PSA test findings. Bone scan and excretory urography are used to determine the disease’s extent. Magnetic resonance imaging and computed tomography scanning can help define the tumor’s extent. 

Treatment for Prostate Cancer 
Therapy varies by cancer stage and may include radiation, prostatectomy, orchiectomy (removal of the testes) to reduce androgen production, and hormonal therapy with synthetic estrogen (diethylstilbestrol). Radical prostatectomy is usually effective for localized lesions without metastasis. A transurethral resection of the prostate may be performed to relieve an obstruction. Radiation therapy may cure locally invasive lesions in early disease and may relieve bone pain from metastatic skeletal involvement. It may also be used prophylactically for patients with tumors in regional lymph nodes. Alternatively, internal beam radiation may be recommended because it permits increased radiation to reach the prostate but minimizes the surrounding tissues’ exposure to radiation. If hormonal therapy, surgery, and radiation therapy aren’t feasible or successful, chemotherapy may be tried. Chemotherapy for prostate cancer (combinations of cyclophosphamide, doxorubicin, fluorouracil, cisplatin, etoposide, and vindesine) offers limited benefits. Researchers continue to seek the most effective chemotherapeutic regimen. 

Nursing Diagnosis 
Common nursing diagnosis found in Nursing Care Plans Prostate Cancer: 

  • Acute pain 
  • Anxiety 
  • Fear 
  • Impaired urinary elimination 
  • Ineffective coping 
  • Risk for infection Sexual dysfunction 

Nursing Key Outcomes 
The patient will voice increased comfort. The patient will report that he feels less anxious. The patient will verbalize concerns and fears related to his diagnosis. The patient will maintain an adequate urine output. The patient will demonstrate positive coping mechanisms. The patient will remain free from signs and symptoms of infection. The patient will acknowledge a problem in sexual function. 

Nursing interventions  
Provide encourage the patient to express his fears and concerns, including those about changes in his sexual identity, owing to surgery. Offer reassurance when possible. Give analgesics as necessary Administer ordered. Provide comfort measures to reduce pain. Encourage the patient to identify care measures that promote his comfort and relaxation. 

After prostatectomy 
Regularly check the dressing, incision, and drainage systems for excessive blood. Also watch for signs of bleeding (pallor, restlessness, decreasing blood pressure, and increasing pulse rate). Be alert for signs of infection (fever, chills, inflamed incisional area). Maintain adequate fluid intake (at least 2,000 ml daily). Give antispasmodics, as ordered, to control postoperative bladder spasms. Also provide analgesics as needed. Because urinary incontinence commonly follows prostatectomy, keep the patient’s skin clean and dry. 

After suprapubic prostatectomy 
Keep the skin around the suprapubic drain dry and free from drainage and urine leakage. Encourage the patient to begin perineal exercises between 24 and 48 hours after surgery. Allow the patient’s family to assist in his care and encourage them to provide psychological support. Give meticulous catheter care. After prostatectomy, a patient usually has a three-way catheter with a continuous irrigation system. Check the tubing for kinks, mucus plugs, and clots, especially if the patient complains of pain. Warn the patient not to pull on the tubes or the catheter. 

After transurethral resection 
Watch for signs of urethral stricture (dysuria, decreased force and caliber of urine stream, and straining to urinate). Also observe for abdominal distention (a result of urethral stricture or catheter blockage by a blood clot). Irrigate the catheter, as ordered. 

After perineal prostatectomy 
Avoid taking the patient’s temperature rectally or inserting enema or other rectal tubes. Provide pads to absorb draining urine. Assist the patient with frequent sitz baths to relieve pain and inflammation. 

After perineal or retropubic prostatectomy 
Give reassurance that urine leakage after catheter removal is normal and subsides in time. 

After radiation therapy 
Watch for the common adverse effects of radiation to the prostate. These include proctitis, diarrhea, bladder spasms, and urinary frequency. Internal radiation of the prostate almost always results in cystitis in the first 2 to 3 weeks of therapy. Encourage the patient to drink at least 2,000 ml of fluid daily. Administer analgesics and antispasmodics to increase comfort. 

After hormonal therapy 
When a patient receives hormonal therapy with diethylstilbestrol, watch for adverse effects (gynecomastia, fluid retention, nausea, and vomiting). Be alert for thrombophlebitis (pain, tenderness, swelling, warmth, and redness in calf). 

Patient teaching and home health guide 
Before surgery, discuss the expected results. Explain that radical surgery always produces impotence. Up to 7% of patients experience urinary incontinence. To help minimize incontinence, teach the patient how to do perineal exercises while he sits or stands. To develop his perineal muscles, tell him to squeeze his buttocks together and hold this position for a few seconds; then relax. He should repeat this exercise as frequently as ordered by the physician. Prepare the patient for postoperative procedures, such as dressing changes and intubation. If appropriate, discuss the adverse effects of radiation therapy. All patients who receive pelvic radiation therapy will develop such symptoms as diarrhea, urinary frequency, nocturia, bladder spasms, rectal irritation, and tenesmus. Encourage the patient to maintain a lifestyle that’s as nearly normal as possible during recovery. When appropriate, refer the patient to the social service department, local home health care agencies, hospices, and other support organizations.

Monday, April 12, 2010

Kidney Anatomy
Nursing Care Plans for Kidney Cancer, kidney cancer is rare, kidney cancer also called nephrocarcinoma; renal carcinoma, hypernephroma, and Grawitz’s tumor originate in the kidneys. Others are metastases from various primary-site carcinomas. Kidney cancers are classified by cell type. The three most commonly seen in the adult are renal cell carcinoma, transitional cell carcinoma, and sarcoma. 
Most kidney tumors are large, firm, nodular, encapsulated, unilateral, and solitary. They may affect either kidney; occasionally they’re bilateral or multifocal. Kidney cancer is twice as common in males as in females; it typically strikes after age 40. Kidney cancer can be separated histologically into clear cell, granular cell, and spindle cell types. Sometimes the prognosis is considered better for the clear cell type than for the other types; in general, however, the prognosis depends more on the cancer’s stage than on its type. 

Causes for Kidney Cancer
Although the cause of kidney cancer is unknown, some studies implicate several factors seem to predispose a person to kidney cancer. Smokers increase their risk to develop kidney cancer by 40%. A link also exists between kidney cancer and occupational exposure to cadmium (found in batteries), asbestos, some herbicides, benzene, and organic solvents, particularly trichloroethylene. Patients who receive regular hemodialysis may also be at increased risk. kidney cancer stage 

Complications for Kidney Cancer Related to metastasize to other sites

  • Respiratory problems from metastasis to the lungs, 
  • neurologic problems from brain metastasis 
  • GI problems from liver metastasis. 

Nursing Assessment Nursing Care Plans for Kidney Cancer
The patient may complain of hematuria and often a dull, aching flank pain. He may also report weight loss, although this is uncommon. Rarely, his temperature may be elevated. Palpation may reveal a smooth, firm, nontender abdominal mass. 

Diagnostic tests for Kidney Cancer

  • Renal ultrasonography 
  • Computed tomography scan 
  • Renal angiography 
  • Urography 
  • Nephrotomography
  • Kidney-ureter-bladder radiography. Additional relevant tests include liver function studies 

Treatment for Kidney Cancer

  • Radical nephrectomy. 
  • Radiation treatment is used only when the cancer has spread into the perinephric region or the lymph nodes or when the primary tumor or metastatic sites can’t be completely excised 
  • Chemotherapy 
  • Biotherapy with lymphokine (causes many adverse reactions) 
  • Hormone therapy, such as medroxyprogesterone and testosterone 

Nursing diagnosis 
Primary nursing diagnosis Nursing Care Plans for Kidney Cancer is altered urinary elimination related to renal tissue destruction, common nursing diagnosis found on Nursing Care Plans for Kidney Cancer: 

  • Acute pain 
  • Anxiety 
  • Fear 
  • Impaired physical mobility 
  • Ineffective breathing pattern 
  • Ineffective tissue perfusion: Renal 
  • Readiness for enhanced management of therapeutic regimen 
  • Risk for imbalanced fluid volume 

Nursing outcomes for nursing care plans for Kidney Cancer, Patient will:

  • Maintain urine specific agents within normal range 
  • Report increased comfort. 
  • Identify strategies to reduce anxiety. 
  • Express fears and concerns relating to his condition and prognosis. 
  • Maintain joint mobility and range of motion. 
  • Maintain ventilation. 
  • Communicate understanding of medical regimen, medications, diet, and activity restrictions. 
  • Maintain fluid balance. 

Nursing interventions for Kidney Cancer
Before surgery, assure the patient that the body will adequately adapt to the loss of a kidney. Administer prescribed analgesics as necessary. Provide comfort measures, such as positioning and distractions, to help the patient cope with discomfort. After surgery, encourage diaphragmatic breathing and coughing. Assist the patient with leg exercises, and turn him every 2 hours to reduce the risk of phlebitis. Check dressings often for excessive bleeding. Watch for signs of internal bleeding, such as restlessness, sweating, and increased pulse rate. Position the patient on the operative side to allow the pressure of adjacent organs to fill the dead space at the operative site, improving dependent drainage. If possible, assist the patient with walking within 24 hours of surgery. Provide adequate fluid intake, and monitor intake and output. Monitor laboratory test results for anemia, polycythemia, and abnormal blood chemistry values that may point to bone or hepatic involvement or may result from radiation therapy or chemotherapy Provide symptomatic treatment for adverse effects of chemotherapeutic drugs. Encourage the patient to express his anxieties and fears, and remain with him during periods of severe stress and anxiety. 

Patient Teaching And Home Healthcare Guide for Kidney Cancer
Tell the patient what to expect from surgery and other treatments. Before surgery, teach diaphragmatic breathing and effective coughing techniques, such as how to splint the incision Be sure the patient understands what medications are to be taken at home, their effects, and dosages. Explain follow-up information, such as when the physician would like to see the patient. Provide and arrange for a home visit from nurses if appropriate. Refer the patient and family to hospital and community services such as support groups Reinforce any postoperative restrictions. Explain when normal activity can be resumed. Make sure the patient understands the need to have ongoing monitoring of the disease. Annual chest x-rays and routine IVPs are recommended to check for other tumors. Emphasize and give understanding of the lifestyle choices that can aid in recovery e.g. Quit smoking, limit alcohol, eat more fruits, vegetables, and whole grains and less animal fat; exercise once you are able. Explain the possible adverse effects of radiation and drug therapy. Advise the patient how to prevent and minimize these problems. When preparing the patient for discharge, stress the importance of compliance with prescribed outpatient treatment.

Sunday, April 11, 2010

The choice of therapy depends on the type of hernia. For a reducible hernia, temporary relief may result from moving the protruding organ back into place. Afterward, a truss may be applied to keep the abdominal contents from protruding through the hernial sac. Although a truss doesn’t cure a hernia, the device is especially helpful for an elderly or a debilitated patient, for whom any surgery is potentially hazardous. 

Herniorrhaphy is the preferred surgical treatment for infants, adults, and otherwise-healthy elderly patients. This procedure replaces hernial sac contents into the abdominal cavity and seals the opening. Another effective procedure is hernioplasty, which involves reinforcing the weakened area with steel mesh, fascia, or wire. Strangulated or necrotic hernia requires bowel resection. Rarely, an extensive resection may require a temporary colostomy
Inguinal Hernia
Hernia is a protrusion or projection of an organ or organ part through an abnormal opening in the containing wall of its cavity, a hernia results. An inguinal hernia occurs when the omentum, the large or small intestine, or the bladder protrudes into the inguinal canal. In an indirect inguinal hernia, the sac protrudes through the internal inguinal ring into the inguinal canal and, in males, may descend into the scrotum. In a direct inguinal hernia, the hernial sac projects through a weakness in the abdominal wall in the area of the rectus abdominal muscle and inguinal ligament. 

Hernia is classified into three types: 

  • Reducible, Hernias can be reducible if the hernia can be easily manipulated back into place 
  • Irreducible or incarcerated, this cannot usually be reduced manually because adhesions form in the hernia sac. 
  • Strangulated, if part of the herniated intestine becomes twisted or edematous and causing serious complications, possibly resulting in intestinal obstruction and necrosis. 

Inguinal hernias can be direct which is herniation through an area of muscle weakness, in the inguinal canal, and inguinal hernias indirect herniation through the inguinal ring. Indirect hernias, the more common form, can develop at any age but are especially prevalent in infants younger than age 1. This form is three times more common in males. 

Causes for Inguinal Hernia
An inguinal hernia is the result of either a congenital weakening of the abdominal wall, traumatic injury, aging, weakened abdominal muscles because of pregnancy, or from increased intra-abdominal pressure (due to heavy lifting, exertion, obesity, excessive coughing, or straining with defecation). Inguinal hernia is a common congenital malformation that may occur in males during the seventh month of gestation. Normally, at this time, the testicle descends into the scrotum, preceded by the peritoneal sac. If the sac closes improperly, it leaves an opening through which the intestine can slip, causing a hernia. 

Complications for Inguinal Hernia
Inguinal hernia may lead to incarceration or strangulation. That can interfere with normal blood flow and peristalsis, and leading to intestinal obstruction and necrosis. 

Diagnostic tests
Commonly No specific laboratory tests are useful for the diagnosis of an inguinal hernia. Diagnosis is made on the basis of a physical examination. Although assessment findings are the cornerstone of diagnosis, suspected bowel obstruction requires X-rays and a white blood cell count, which may be elevated. 

Treatment for Inguinal Hernia
The choice of therapy depends on the type of hernia. For a reducible hernia, temporary relief may result from moving the protruding organ back into place. Afterward, a truss may be applied to keep the abdominal contents from protruding through the hernial sac. Although a truss doesn't cure a hernia, the device is especially helpful for an elderly or a debilitated patient, for whom any surgery is potentially hazardous. 
Herniorrhaphy is the preferred surgical treatment for infants, adults, and otherwise-healthy elderly patients. This procedure replaces hernial sac contents into the abdominal cavity and seals the opening. Another effective procedure is hernioplasty, which involves reinforcing the weakened area with steel mesh, fascia, or wire. Strangulated or necrotic hernia requires bowel resection. Rarely, an extensive resection may require a temporary colostomy 

Nursing Assessment Nursing care plan for Inguinal Hernia
Patient History, an infant or a child may be relatively free from symptom until she or he cries, coughs, or strains to defecate, at which time the parents note painless swelling in the inguinal area. On adult patient may occurs of pain or note bruising in the area after a period of exercise. More commonly, the patient complains of a slight bulge along the inguinal area, which is especially apparent when the patient coughs or strains. The swelling may subside on its own when the patient assumes a recumbent position or if slight manual pressure is applied externally to the area. Some patients describe a steady, aching pain, which worsens with tension and improves with hernia reduction 
Physical Examination, If the patient has a large hernia, inspection may reveal an obvious swelling in the inguinal area. If he has a small hernia, the affected area may simply appear full. As part of your inspection, have the patient lie down. If the hernia disappears, it's reducible. Also ask him to perform Valsalva's maneuver; while he does so, inspect the inguinal area for characteristic bulging. 
Auscultation should reveal bowel sounds. The absence of bowel sounds may indicate incarceration or strangulation. Palpation helps to determine the size of an obvious hernia. It also can disclose the presence of a hernia in a male patient. Primary Nursing Diagnosis: Pain related to swelling and pressure Primary nursing Outcomes: Pain, disruptive effects; pain level Primary nursing Interventions: Analgesic administration; pain management 

Nursing Diagnosis
Common Nursing diagnoses found on Nursing care plan for Inguinal Hernia

  • Activity intolerance 
  • Acute pain 
  • Ineffective tissue perfusion: Gastro Intestinal 
  • Risk for infection 
  • Risk for injury 

Nursing outcomes nursing care plans for Inguinal Hernia

  • The patient will perform activities of daily living within the confines of the disease process. 
  • The patient will express feelings of comfort. 
  • The patient's bowel function will return to normal. 
  • The patient will remain free from signs or symptoms of infection. 
  • The patient will avoid complications. 

Nursing interventions Nursing care plan for Inguinal Hernia

  • Apply a truss only after a hernia has been reduced. For best results, apply it in the morning before the patient gets out of bed. 
  • Assess the skin daily and apply powder for protection because the truss may be irritating. 
  • Watch for and immediately report signs of incarceration and strangulation. 
  • Closely monitor vital signs and provide routine preoperative preparation. If necessary, When surgery is scheduled 
  • Administer I.V. fluids and analgesics for pain as ordered.
  • Control fever with acetaminophen or tepid sponge baths as ordered.
  • Place the patient in Trendelenburg's position to reduce pressure on the hernia site. After surgery,
  • Provide routine postoperative care.
  • Don't allow the patient to cough, but do encourage deep breathing and frequent turning.
  • Apply ice bags to the scrotum to reduce swelling and relieve pain; elevating the scrotum on rolled towels also reduces swelling. 
  • Administer analgesics as necessary. 
  • In males, a jock strap or suspensory bandage may be used to provide support. 

Patient teaching home health guide

  • Explain what an inguinal hernia is and how it's usually treated.
  • Explain that elective surgery is the treatment of choice and is safer than waiting until hernia complications develop, necessitating emergency surgery. 
  • Warn the patient that a strangulated hernia can require extensive bowel resection, involving a protracted hospital stay and, possibly, a colostomy.
  • Tell the patient that immediate surgery is needed if complications occur.
  • If the patient uses a truss, instruct him to bathe daily and apply liberal amounts of cornstarch or baby powder to prevent skin irritation.
  • Warn against applying the truss over clothing, which reduces its effectiveness and may cause slippage. Point out that wearing a truss doesn't cure a hernia and may be uncomfortable. 
  • Tell the postoperative patient that he'll probably be able to return to work or school and resume all normal activities within 2 to 4 weeks. 
  • Explain that he or she can resume normal activities 2 to 4 weeks after surgery.
  • Remind him to obtain his physician's permission before returning to work or completely resuming his normal activities. 
  • Before discharge, Instruct him to watch for signs of infection (oozing, tenderness, warmth, redness) at the incision site. Tell him to keep the incision clean and covered until the sutures are removed. 
  • Inform the postoperative patient that the risk of recurrence depends on the success of the surgery, his general health, and his lifestyle. 
  • Teach the patient signs and symptoms of infection: poor wound healing, wound drainage, continued incision pain, incision swelling and redness, cough, fever, and mucus production. 
  • Explain the importance of completion of all antibiotics. Explain the mechanism of action, side effects, and dosage recommendations of all analgesics. 
  • Caution the patient against lifting and straining.