Patient who recently underwent a transurethral resection of the prostate (TURP) reports noticing small blood clots in his urine. Which is the most appropriate response by the nurse?

1. A

   This is normal and nothing to do for it

2. B

   Inform to doctor immediately

3. C

   It will clear with bladder irrigation

4. D

   We will change the catheter

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)

Explanation

Listen in Hindi

• Small blood clots and reddish-pink urine are common and expected findings during the initial 24-48 hours after a TURP procedure due to the nature of the surgery.
• Bladder irrigation, often continuous (CBI) using a three-way catheter, is the standard of care to prevent these clots from obstructing the catheter.
• This response correctly identifies the routine management for an expected postoperative event, providing reassurance and accurate information to the patient.

Why Other Options Were Wrong

• Option A: This statement is partially correct in that the finding is normal, but it is incorrect to suggest doing nothing. Active management through monitoring and irrigation is required to prevent complications like clot retention.
• Option B: Informing the doctor immediately is not necessary for small, expected blood clots. This action constitutes an overreaction and can cause unnecessary alarm.
• Option D: Changing the catheter is not the first-line intervention for managing blood clots. The existing catheter is typically a large-gauge, three-way catheter specifically placed for irrigation.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Postoperative nursing management for a patient after Transurethral Resection of the Prostate (TURP) to guide bedside assessment, documentation, and the next nursing action.
• A key nursing responsibility post-TURP is to differentiate between expected venous bleeding (reddish-pink urine, small clots) and arterial hemorrhage (bright red urine, large clots, decreased blood pressure, increased heart rate).
• Nurses must meticulously monitor intake and output during CBI. To calculate true urine output, the total amount of irrigation fluid infused must be subtracted from the total volume in the drainage bag.
• What if? If the patient's urine suddenly turns bright red and the drainage tube is filled with large clots, the nurse's priority is to stop the irrigation (as it can increase intravesical pressure and worsen bleeding) and notify the surgeon immediately, as this is a sign of arterial hemorrhage, a medical emergency.

How to Approach the Question

• First, identify the clinical context: the patient is postoperative from a TURP.
• Next, analyze the specific finding presented: 'small blood clots in his urine'.
• Recall the common and expected postoperative course for a TURP. Bleeding is a known and anticipated issue.
• Evaluate each option against standard nursing protocol for post-TURP care. Is the finding normal? Is it an emergency? Or is it a common issue with a standard management procedure?
• Conclude that small clots are expected and that bladder irrigation is the standard procedure to manage them and prevent catheter obstruction.

Concept Tested & Keywords

• Concept Tested: Postoperative nursing management for a patient after Transurethral Resection of the Prostate (TURP).
• Stem keywords: transurethral resection of the prostate (TURP), postoperative, small blood clots, urine
• Lead-in keywords: most appropriate response
• Clinical cues: Recent TURP surgery is a key cue, as it sets the context for expected postoperative findings.

Question ID

QXytxrWFwQb2brXXHCLSm1

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 605-607

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 17-19