Important nursing management following transurethral resection of prostrate (TURP) is?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Medical & Surgical Nursing

Hard

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Explanation

The primary and most immediate risk after TURP is hemorrhage and the formation of blood clots.
A three-way Foley catheter with continuous bladder irrigation (CBI) is used specifically to prevent clots from obstructing urinary outflow.
Maintaining the patency of this system is the highest priority as an obstruction can lead to acute urinary retention, bladder distention, increased bleeding, and potential bladder rupture.
This intervention directly prevents a life-threatening complication, making it more critical than routine postoperative monitoring or comfort measures.

Option A: TURP is performed through the urethra, so there is no external surgical site to assess for infection. This option is factually incorrect for this procedure.
Option B: While vital signs are crucial for monitoring for shock from hemorrhage, the priority is the intervention that prevents the hemorrhage from becoming uncontrolled. Ensuring catheter patency prevents clot retention, which can worsen bleeding.
Option D: Pain management is important for comfort, but it is secondary to preventing a life-threatening physiological complication. Furthermore, sudden, severe pain can be a key indicator of catheter obstruction, which requires immediate assessment of patency, not just analgesia.

Clinical Relevance

Nursing practice connection: Knowing Postoperative management for Transurethral Resection of the Prostate (TURP) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing responsibility is to titrate the CBI flow rate. If the drainage is bright red (arterial bleeding), increase the rate. If it's clear, the rate may be decreased per protocol. The target is a light pink/rosé color.
Nurses must accurately calculate true urine output by subtracting the total amount of irrigant instilled from the total volume in the drainage bag. A significant drop in output indicates a potential obstruction.
What if? If the patient complains of sudden, severe lower abdominal pain and the drainage from the catheter stops, the nurse's first action should be to check the tubing for kinks or clots. If that doesn't resolve it, the nurse should stop the CBI and perform manual irrigation with a syringe and sterile saline as per protocol to dislodge the clot.

How to Approach the Question

First, identify the question type. This is a priority-setting question asking for the 'important' or 'most critical' nursing action.
Recall the specific procedure: Transurethral Resection of the Prostate (TURP). What are the most common and life-threatening complications?
The primary complication of TURP is bleeding and clot formation in the bladder.
Analyze each option based on how it addresses this primary complication.
Option A is incorrect as there's no external incision.
Options B and D are general postoperative care. Option C directly addresses the specific, high-risk complication of TURP.

Concept Tested & Keywords

Concept Tested: Postoperative management for Transurethral Resection of the Prostate (TURP)
Stem keywords: nursing management, transurethral resection of prostrate, TURP
Lead-in keywords: Important

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