Case Study Assignment: Preston Schmidt '

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Case Study Assignment
For: Mindy Colburn
From: Catherine Aragona
NRSG 10032
Mohawk College

Case Scenario Seven: Preston Schmidt

Preston Schmidt is a 22-year-old male who is diagnosed with cancer of the lest testicle. Preston is scheduled for a unilateral orchiectomy. Preston has had history of an anaphylactic allergy to latex and severe depression. Preston’s age, the type of surgery and his history of depression are taken into consideration to develop a plan of care so he may have a successful recovery. I would remind all staff of his allergy during our briefing and time out in the operating room.
Procedure: Unilateral Orchiectomy
Major Anatomy
The scrotum is a sac located between the penis and anus. It is dual-chambered,
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For benign conditions, the incision is made into the scrotum.
2. The skin incision continues into the next layer of fascia to expose the testicle.
3. Retractors are placed for visualization, and bleeding vessels are clamped and severed.
4. The spermatic cord is divided into 2 or 3 vascular bundles. Each bundle gets clamped, cut and ligated. A 0 absorbable suture is used along with a 0 absorbable tie.
5. The surgeon then removes the testicle.
Inguinal Approach
1. The inguinal incision is made on the side of the patient that the orchiectomy is being performed on. In Preston’s case, it is the left side.
2. The inguinal canal is exposed and the spermatic cord is identified and cross-clamped.
3. Gentle forward traction is applied to the cord, which is dissected from its bed. I have seen a Penrose drain soaked in antibiotic solution used for this part of the procedure.
4. The testicle is then removed the inguinal incision.
5. Bleeding is controlled with the ESU. A small drain may be placed in the empty scrotum if the surgeon requests it.
6. The fascia is sutured with a 2-0 suture.
7. The next layer of tissue and fascia is closed with 4-0 absorbable sutures.
8. The skin is closed with surgical staples or 4-0 sutures.

Special
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The patient also has a history of severe depression and has an anaphylactic allergy to latex.
Nursing Diagnosis Expected Outcomes Nursing Interventions/ Strategies
A) High risk for chronic low self-esteem related to patient history of depression and altered body image as evidenced by surgical removal of testicle. The patient will implement new coping patterns and verbalize and demonstrate acceptance of appearance, demonstrate a willingness and ability to resume self-care and the patient will initiate new or reestablish with existing support systems (Carpenito, 1995). 1. Assist the individual in identifying and expressing feelings by being empathetic and nonjudgmental, listen and do not discourage expressions of anger or crying (Carpenito, 1995).
2. Assist in identifying positive self-evaluations by discussing coping skills, examine and reinforce positive abilities and traits, help the patient accept both positive and negative feelings and encourage patient to join a support group (Carpenito, 1995).
3. Assess current support system by asking patient if he lives alone, are friends and relatives available, is religion a support for him, and ask patient if he has used community resources (Carpenito,

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