Dispel misconceptions, and explain all diagnostic procedures. Patients with early-stage disease need support while they make decisions about treatment options. Encourage the patient and his partner to verbalize their feelings and fears. Clarify the differences between the various treatment options and reinforce the treatment goals. Provide written materials, such as Facts on Prostate Cancer published by the American Cancer Society or What You Need to Know about Prostate Cancer published by the National Cancer Institute. Suggest that the patient write down questions that arise so they are not forgotten during visits with the physician.

Ask about pain regularly, and assess pain systematically. Believe the patient and family in their reports of pain. Inform the patient and family of options for pain relief as proposed by the

780 Prostate Cancer

National Cancer Institute (pharmacologic, physical, psychosocial, and cognitive-behavioral interventions), and involve the patient and family in determining pain relief measures.

Implement postoperative strategies to decrease complications. Patients are usually able to ambulate on the first day after surgery. Help the patient to get out of bed and walk in the halls to his tolerance level, usually three or four times a day. Once nausea has passed, bowel sounds are present, and fluids are allowed, encourage a fluid intake of 2500 to 3000 mL/day to maintain good urine output. Adequate fluid intake, and thus output, minimizes the formation of blood clots in the urinary bladder that can obstruct the Foley catheter.

Be alert for behavior indicating denial, grief, hostility, or depression. Inform the physician of any ineffective coping behaviors and the patient's need for more information or a referral for counseling. Postoperative incontinence and impotence may be difficult for patients to discuss. Inform patients of exercises, medications and products that can assist with incontinence. Suggest alternative sexual behaviors, such as touching and caressing. Patients who are undergoing orchiectomy need extensive emotional support. Establish a therapeutic relationship to promote the expression of feelings. Be sensitive to the patient's fear of his loss of masculinity. Reinforce that having the testes removed in adulthood does not affect the ability to have an erection and orgasm.

Stress to patients who are hospitalized for insertion of a radioactive implant that, while the temporary implant is in place, interactions with nurses and other individuals occur only during brief time periods. Attempt to relieve feelings of abandonment and isolation by communicating with the patient via the hospital intercom system. Once the temporary implant has been removed or the permanent radioactive substance has decayed, remind the patient that he is no longer a danger to others.

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