Ensinar ao paciente sobre a anatomia da próstata, a PR e a relação entre o procedimento cirúrgico e as complicações – IU e DS.(66. Brito-Brito PR, Oter-Quintana C, Martín-García A, Alcolea-Cosín MT, Martín-Iglesias S, Fernández-Gutiérrez DÁ. Case study: community nursing care plan for an elderly patient with urinary incontinence and social interaction problems after prostatectomy. Int J Nurs Knowl. 2014;25(1):62–5.,1717. Grondhuis Palacios LA, Krouwel EM, Duijn M, den Oudsten BL, den Ouden ME, Putter H, et al. Written information material and availability of sexual health care for men experiencing sexual dysfunction after prostate cancer treatment: an evaluation of Dutch urology and radiotherapy departments. Eur J Cancer Care (Engl). 2017;26(2):1–8.,2323. Santos DR, Lima CA, Saldanha EA, Cavalcanti MI, Medeiros AB, Lira AL. [Nursing prostatectomy patients]. Rev Enferm UERJ. 2015;23(4):513-9. Portuguese.,2828. Nicolaisen M, Müller S, Patel HR, Hanssen TA. Quality of life and satisfaction with information after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy: a long-term follow-up study. J Clin Nurs. 2014;23(23-24):3403–14.)
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Fornecer informações sobre o tratamento, que sejam adequadas para cada paciente, considerando o nível cultural de cada um e o quanto o paciente deseja ser informado.(55. Chambers SK, Occhipinti S, Schover L, Nielsen L, Zajdlewicz L, Clutton S, et al. A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology. 2015;24(7):748–56.,1212. Novick BJ, Angie M, Walker E, Kitay R, Monday K, Albert NM. The Effect of Intensive Education On Urinary Incontinence Following Radical Prostatectomy: A Randomized Control Trial. Urol Nurs. 2014;34(5):246–51.,1818. Derogar M, Dahlstrand H, Carlsson S, Bjartell A, Hugosson J, Axén E, Johansson E, Lagerkvist M, Nyberg T, Stranne J, Thorsteinsdottir T, Wallerstedt A, Haglind E, Wiklund P, Steineck G; LAPPRO steering committee. Preparedness for side effects and bother in symptomatic men after radical prostatectomy in a prospective, non-randomized trial, LAPPRO. Acta Oncológica. 2016;55(12):1467–76.,1919. Huang CY, Wang MJ, Lin YH, Chen CI. Depressive Symptoms and Health-Related Quality of Life Among Prostate Cancer Survivors. Cancer Nurs. 2018;41(1):E1–8.,2222. Allchorne P, Green J. Identifying Unmet Care Needs of Patients with Prostate Cancer To Assist with Their Success in Coping. Urol Nurs. 2016;36(5):224–32.)
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Promover e moderar grupos de apoio a pacientes prostatectomizados, a fim de compartilharem experiências e formas de gerenciamento do problema.(1111. Wang C, Song Z, Li S, Tai S. Extended nursing for the recovery of urinary functions and quality of life after robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial. Support Care Cancer. 2018;26(5):1553–60.,2626. O'Shaughnessy PK, Laws TA, Esterman AJ. The prostate cancer journey: results of an online survey of men and their partners. Cancer Nurs. 2015;38(1):E1–12.)
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Ensinar o paciente a realizar os exercícios para os músculos da pelve (EMAP). Explicá-lo que o exercício é realizado com os músculos anal e uretral e que as nádegas, coxas e abdômen devem estar relaxados. Ele deve visualizar a retração da base do pênis e elevação testicular. Instruí-lo a colocar dois dedos em seu períneo para sentir como este é contraído ao realizar os exercícios. 1a etapa: Realizar 10 contrações e relaxamentos rápidos, descansar por dois minutos e repetir. 2a etapa: Repetir os mesmos exercícios, porém realizar contração firme por cinco segundos e relaxar o mais lentamente possível, descansar por dois minutos e, repetir. Os exercícios devem ser realizados pela manhã e à tarde, nas posições: deitado com as pernas esticadas, deitado de joelhos dobrados, em pé com as pernas abertas, em pé com as pernas fechadas e enquanto caminha. Aconselhá-lo a contrair os músculos antes e durante atividades que causem vazamento de urina, como tossir e espirrar.(66. Brito-Brito PR, Oter-Quintana C, Martín-García A, Alcolea-Cosín MT, Martín-Iglesias S, Fernández-Gutiérrez DÁ. Case study: community nursing care plan for an elderly patient with urinary incontinence and social interaction problems after prostatectomy. Int J Nurs Knowl. 2014;25(1):62–5.,2121. Zhang AY, Fu AZ. Cost-effectiveness of a behavioral intervention for persistent urinary incontinence in prostate cancer patients. Psychooncology. 2016;25(4):421–7.,2424. Terzoni S, Montanari E, Mora C, Ricci C, Sansotera J, Micali M, et al. Electrical stimulation for post-prostatectomy urinary incontinence: is it useful when patients cannot learn muscular exercises? Int J Urol Nurs. 2015;9(1):29–35.,2525. Terzoni S, Montanari E, Mora C, Ricci C, Destrebecq A. Developing a rehabilitation programme for male urinary incontinence: detailed schemes and results on 122 patients. Int J Urol Nurs. 2015;9(3):149–55.,2727. Serdà BC, Marcos-Gragera R. Urinary incontinence and prostate cancer: a progressive rehabilitation program design. Rehabil Nurs. 2014;39(6):271–80.)
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Envolver e ensinar a família os EMAP para que possam incentivar o paciente em realizá-los.(1111. Wang C, Song Z, Li S, Tai S. Extended nursing for the recovery of urinary functions and quality of life after robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial. Support Care Cancer. 2018;26(5):1553–60.)
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II |
Entregar ao paciente material escrito com figuras e detalhes sobre a execução dos EMAP.(1111. Wang C, Song Z, Li S, Tai S. Extended nursing for the recovery of urinary functions and quality of life after robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial. Support Care Cancer. 2018;26(5):1553–60.,2525. Terzoni S, Montanari E, Mora C, Ricci C, Destrebecq A. Developing a rehabilitation programme for male urinary incontinence: detailed schemes and results on 122 patients. Int J Urol Nurs. 2015;9(3):149–55.,2626. O'Shaughnessy PK, Laws TA, Esterman AJ. The prostate cancer journey: results of an online survey of men and their partners. Cancer Nurs. 2015;38(1):E1–12.,2828. Nicolaisen M, Müller S, Patel HR, Hanssen TA. Quality of life and satisfaction with information after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy: a long-term follow-up study. J Clin Nurs. 2014;23(23-24):3403–14.)
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Fornecer Estimulação elétrica funcional para o paciente que apresentar dificuldades em realizar os EMAP.(2424. Terzoni S, Montanari E, Mora C, Ricci C, Sansotera J, Micali M, et al. Electrical stimulation for post-prostatectomy urinary incontinence: is it useful when patients cannot learn muscular exercises? Int J Urol Nurs. 2015;9(1):29–35.)
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Intervenções de Enfermagem para IU
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NE
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Explicar ao paciente sobre a transitoriedade da IU e que o alcance da continência urinária é um processo gradual.(77. Martín-Ruiz MJ, Escrivá-de-Romaní-Vereterra A. [Treatment in urology nursing consultation of the two most frequent side-effects in patients undergoing radical prostatectomy]. Enfuro. 2014;126(9):30–8. Spanish.,1111. Wang C, Song Z, Li S, Tai S. Extended nursing for the recovery of urinary functions and quality of life after robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial. Support Care Cancer. 2018;26(5):1553–60.)
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Apresentar ao paciente os tipos de protetores, absorventes e fraldas masculinas disponíveis no mercado.(66. Brito-Brito PR, Oter-Quintana C, Martín-García A, Alcolea-Cosín MT, Martín-Iglesias S, Fernández-Gutiérrez DÁ. Case study: community nursing care plan for an elderly patient with urinary incontinence and social interaction problems after prostatectomy. Int J Nurs Knowl. 2014;25(1):62–5.,77. Martín-Ruiz MJ, Escrivá-de-Romaní-Vereterra A. [Treatment in urology nursing consultation of the two most frequent side-effects in patients undergoing radical prostatectomy]. Enfuro. 2014;126(9):30–8. Spanish.,1212. Novick BJ, Angie M, Walker E, Kitay R, Monday K, Albert NM. The Effect of Intensive Education On Urinary Incontinence Following Radical Prostatectomy: A Randomized Control Trial. Urol Nurs. 2014;34(5):246–51.,2323. Santos DR, Lima CA, Saldanha EA, Cavalcanti MI, Medeiros AB, Lira AL. [Nursing prostatectomy patients]. Rev Enferm UERJ. 2015;23(4):513-9. Portuguese.)
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Apresentar ao paciente os sinais e sintomas da infecção urinária (febre, dor ao urinar, odor fétido da urina) e a necessidade de tratá-la.(88. Colley W. Incontinence following prostate cancer surgery. Nurs Times. 2014;110(9):16–8.)
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Conversar com paciente sobre a necessidade de maior cuidado higiênico com a pele perineal.(66. Brito-Brito PR, Oter-Quintana C, Martín-García A, Alcolea-Cosín MT, Martín-Iglesias S, Fernández-Gutiérrez DÁ. Case study: community nursing care plan for an elderly patient with urinary incontinence and social interaction problems after prostatectomy. Int J Nurs Knowl. 2014;25(1):62–5.,77. Martín-Ruiz MJ, Escrivá-de-Romaní-Vereterra A. [Treatment in urology nursing consultation of the two most frequent side-effects in patients undergoing radical prostatectomy]. Enfuro. 2014;126(9):30–8. Spanish.)
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Orientar sobre a importância de ingerir bastante líquido durante o dia (2500 a 3000 ml) para evitar infecção urinária e constipação intestinal.(88. Colley W. Incontinence following prostate cancer surgery. Nurs Times. 2014;110(9):16–8.)
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Aconselhar o paciente a reduzir ou parar o consumo de álcool e produtos com cafeína (chocolate, chá, refrigerante de cola).(66. Brito-Brito PR, Oter-Quintana C, Martín-García A, Alcolea-Cosín MT, Martín-Iglesias S, Fernández-Gutiérrez DÁ. Case study: community nursing care plan for an elderly patient with urinary incontinence and social interaction problems after prostatectomy. Int J Nurs Knowl. 2014;25(1):62–5.,88. Colley W. Incontinence following prostate cancer surgery. Nurs Times. 2014;110(9):16–8.,1212. Novick BJ, Angie M, Walker E, Kitay R, Monday K, Albert NM. The Effect of Intensive Education On Urinary Incontinence Following Radical Prostatectomy: A Randomized Control Trial. Urol Nurs. 2014;34(5):246–51.)
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Intervenções de Enfermagem para DS
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NE
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Educar o paciente e seu parceiro sexual nos temas CP e sexualidade.(55. Chambers SK, Occhipinti S, Schover L, Nielsen L, Zajdlewicz L, Clutton S, et al. A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology. 2015;24(7):748–56.)
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II |
Fornecer um material educativo ao paciente e se possível ao parceiro sexual, com tópicos separados, sobre a DS após PR.(1717. Grondhuis Palacios LA, Krouwel EM, Duijn M, den Oudsten BL, den Ouden ME, Putter H, et al. Written information material and availability of sexual health care for men experiencing sexual dysfunction after prostate cancer treatment: an evaluation of Dutch urology and radiotherapy departments. Eur J Cancer Care (Engl). 2017;26(2):1–8.)
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Explicar a etiologia da DS e suas consequências, tanto físicas quanto mentais.(1717. Grondhuis Palacios LA, Krouwel EM, Duijn M, den Oudsten BL, den Ouden ME, Putter H, et al. Written information material and availability of sexual health care for men experiencing sexual dysfunction after prostate cancer treatment: an evaluation of Dutch urology and radiotherapy departments. Eur J Cancer Care (Engl). 2017;26(2):1–8.,2020. Schantz Laursen B. Sexuality in men after prostate cancer surgery: a qualitative interview study. Scand J Caring Sci. 2017;31(1):120–7.)
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Explicar sobre o funcionamento da ereção.(2323. Santos DR, Lima CA, Saldanha EA, Cavalcanti MI, Medeiros AB, Lira AL. [Nursing prostatectomy patients]. Rev Enferm UERJ. 2015;23(4):513-9. Portuguese.)
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Informar ao paciente sobre o impacto da PR na ejaculação (diminuição ou ausência do liquido ejaculado, possibilidade de climactúria).(77. Martín-Ruiz MJ, Escrivá-de-Romaní-Vereterra A. [Treatment in urology nursing consultation of the two most frequent side-effects in patients undergoing radical prostatectomy]. Enfuro. 2014;126(9):30–8. Spanish.,1717. Grondhuis Palacios LA, Krouwel EM, Duijn M, den Oudsten BL, den Ouden ME, Putter H, et al. Written information material and availability of sexual health care for men experiencing sexual dysfunction after prostate cancer treatment: an evaluation of Dutch urology and radiotherapy departments. Eur J Cancer Care (Engl). 2017;26(2):1–8.)
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Apresentar as possibilidades de tratamento da DE (uso de inibidores da fosfodiesterase-5, supositório intrauretral, injeção peniana, dispositivo de ereção por vácuo e prótese peniana).(55. Chambers SK, Occhipinti S, Schover L, Nielsen L, Zajdlewicz L, Clutton S, et al. A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology. 2015;24(7):748–56.,1717. Grondhuis Palacios LA, Krouwel EM, Duijn M, den Oudsten BL, den Ouden ME, Putter H, et al. Written information material and availability of sexual health care for men experiencing sexual dysfunction after prostate cancer treatment: an evaluation of Dutch urology and radiotherapy departments. Eur J Cancer Care (Engl). 2017;26(2):1–8.,2222. Allchorne P, Green J. Identifying Unmet Care Needs of Patients with Prostate Cancer To Assist with Their Success in Coping. Urol Nurs. 2016;36(5):224–32.,2323. Santos DR, Lima CA, Saldanha EA, Cavalcanti MI, Medeiros AB, Lira AL. [Nursing prostatectomy patients]. Rev Enferm UERJ. 2015;23(4):513-9. Portuguese.)
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Ensinar o paciente sobre o uso correto das medicações prescritas pelo médico para tratamento da DE.(77. Martín-Ruiz MJ, Escrivá-de-Romaní-Vereterra A. [Treatment in urology nursing consultation of the two most frequent side-effects in patients undergoing radical prostatectomy]. Enfuro. 2014;126(9):30–8. Spanish.,2323. Santos DR, Lima CA, Saldanha EA, Cavalcanti MI, Medeiros AB, Lira AL. [Nursing prostatectomy patients]. Rev Enferm UERJ. 2015;23(4):513-9. Portuguese.)
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Ensinar o paciente a definição do termo sexualidade e estimula-lo a aumentar expressões de carinho e formas alternativas de sentir prazer, que não exijam penetração.(55. Chambers SK, Occhipinti S, Schover L, Nielsen L, Zajdlewicz L, Clutton S, et al. A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology. 2015;24(7):748–56.,2323. Santos DR, Lima CA, Saldanha EA, Cavalcanti MI, Medeiros AB, Lira AL. [Nursing prostatectomy patients]. Rev Enferm UERJ. 2015;23(4):513-9. Portuguese.)
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Conhecer a realidade e expectativas quanto à atividade sexual de cada paciente e propor soluções e tratamentos específicos para cada caso.(55. Chambers SK, Occhipinti S, Schover L, Nielsen L, Zajdlewicz L, Clutton S, et al. A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology. 2015;24(7):748–56.)
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Fornecer contatos de profissionais de saúde que possam ajudar o paciente a enfrentar a DS.(1717. Grondhuis Palacios LA, Krouwel EM, Duijn M, den Oudsten BL, den Ouden ME, Putter H, et al. Written information material and availability of sexual health care for men experiencing sexual dysfunction after prostate cancer treatment: an evaluation of Dutch urology and radiotherapy departments. Eur J Cancer Care (Engl). 2017;26(2):1–8.)
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Incentivar o paciente a expor suas dúvidas, medos e expectativas relacionadas à DS aos profissionais de saúde.(55. Chambers SK, Occhipinti S, Schover L, Nielsen L, Zajdlewicz L, Clutton S, et al. A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology. 2015;24(7):748–56.)
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Envolver o parceiro sexual no tratamento para DS, se aplicável.(55. Chambers SK, Occhipinti S, Schover L, Nielsen L, Zajdlewicz L, Clutton S, et al. A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology. 2015;24(7):748–56.,1717. Grondhuis Palacios LA, Krouwel EM, Duijn M, den Oudsten BL, den Ouden ME, Putter H, et al. Written information material and availability of sexual health care for men experiencing sexual dysfunction after prostate cancer treatment: an evaluation of Dutch urology and radiotherapy departments. Eur J Cancer Care (Engl). 2017;26(2):1–8.,2020. Schantz Laursen B. Sexuality in men after prostate cancer surgery: a qualitative interview study. Scand J Caring Sci. 2017;31(1):120–7.)
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II, VI |