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

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• Small, intermittent blood clots are an expected finding in the initial 24–48 hours after a TURP procedure due to the nature of the surgery.
• The standard management is continuous or intermittent bladder irrigation, which helps flush out clots and prevent urinary catheter obstruction.
• This response correctly identifies the expected nature of the finding and the appropriate nursing management, providing reassurance to the patient.
• Continuous bladder irrigation (CBI) is recommended to prevent the introduction of pathogens into the bladder and maintain a closed system.

Why Other Options Were Wrong

• Option A: While small clots are a normal finding, stating that 'nothing to do for it' is incorrect and provides false reassurance. The nurse has an active role in monitoring the patient, managing the bladder irrigation, and assessing for complications.
• 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: The catheter should not be changed as a first-line response. Catheter replacement is only indicated if it is obstructed by clots and cannot be cleared with manual irrigation.

Related Visual

• Visual 1: Diagram: A three-way Foley catheter setup for Continuous Bladder Irrigation (CBI), clearly labeling the inflow port (from irrigation bag), outflow port (to drainage bag), and balloon inflation port. This helps visualize the equipment used.
• Visual 2: Chart: A urine color guide for post-TURP patients. This visual aid shows the expected progression from reddish-pink immediately post-op, to light pink, and finally to clear yellow, helping nurses and patients assess healing.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Postoperative nursing management of a patient after Transurethral Resection of the Prostate (TURP), specifically regarding hematuria and bladder irrigation to guide bedside assessment, documentation, and the next nursing action.
• A key nursing responsibility post-TURP is managing the CBI system to maintain catheter patency. Failure to do so can lead to acute urinary retention, bladder distention, and potential hemorrhage.
• Nurses must accurately calculate 'true urine output' by subtracting the amount of irrigant instilled from the total volume in the drainage bag. This is vital for assessing kidney function and detecting urinary retention or hemorrhage.
• What if? If the patient reported passing large, thick, 'ketchup-like' clots and the urinary drainage suddenly stopped, the nurse's priority would shift. The most appropriate initial response would be to attempt manual irrigation to clear the catheter, and if unsuccessful, then inform the doctor immediately as this indicates a significant obstruction or hemorrhage.

How to Approach the Question

• Identify the clinical scenario: A patient is in the early postoperative period after a TURP.
• Analyze the patient's reported symptom: 'small blood clots in his urine'.
• Recall the expected findings after a TURP. It is crucial to know that some bleeding (hematuria) and small clots are normal initially.
• Evaluate each option based on standard nursing practice for post-TURP care. The goal is to maintain catheter patency and monitor for complications.
• Option A is incorrect because nursing action (monitoring, irrigation) is required. Option B is an overreaction for an expected finding. Option D is not the initial action.
• Select the option that both acknowledges the finding as expected and describes the correct management strategy (bladder irrigation), which is the most therapeutic and accurate response.

Concept Tested & Keywords

• Concept Tested: Postoperative nursing management of a patient after Transurethral Resection of the Prostate (TURP), specifically regarding hematuria and bladder irrigation.
• Stem keywords: transurethral resection of the prostate (TURP), small blood clots, urine, postoperative
• Lead-in keywords: most appropriate response
• Clinical cues: recently underwent a TURP
• Clinical cues: small blood clots

Question ID

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