Pain at the lumbar area and straining in order to urinate, these are the symptoms of an enlarged prostate gland. Males especially those who are above 40 years old may have common complaints such as the stated above. Urologists may give medications in order to relieve the enlargement of the prostate. However, when symptoms worsen, surgical intervention may be needed.
Procedure
This surgical intervention is called the Trans-Urethral Resection of the prostate. The urologist in particular performs the surgery. He uses a resectoscope, a 12-inch long instrument that reaches the prostate precisely. This external-incision free procedure involves the removal of tissues of the prostate thus preventing its compression on the surroundings parts of the body. Most of the time, the procedure may last between 30 to 60 minutes.
The resectoscope is inserted into the penis of the patient. The tube includes valves and a wire loop wherein the scarped tissues are carried into the urinary bladder which is then excreted. Fragments of tissues can be washed away by introducing fluids. The procedure can be called a success if the fluid can turn into sanguineous into clear urine output.
Nursing Process in TURP
Assessment:
- Assess for signs and symptoms of benign prostatic hypertrophy such as urinary frequency, hesitancy, dribbling, and straining during urination.
- Check for the occurrence of chronic urinary tract infection or an episode of urinary tract infection.
- Monitor vital signs and note of any presence of pain and signs of bleeding.
- Refer to the physician for hypotension, tachycardia, and hemorrhage.
Possible Nursing Diagnoses
- Acute Urinary Infection related to obstruction secondary to TURP
- Acute Pain related to bladder spasms or incisions
- Risk for Excess Fluid Volume
- Stress Urinary incompetence related to poor sphincter control secondary to prolonged Foley catheter usage
Objectives
- The client will be able to prevent urinary retention.
- The client will be able to feel pain in minimal levels.
- The client will be able to excrete enough fluid from the body.
- The client will be able to have control over urination or voiding after proper bladder training.
Nursing Interventions
Post-Operative Interventions
- Monitor vital signs closely in order to observe any signs of shock.
- Note the color of the fluid being expelled from the three-way catheter.
- Monitor the fluid status of the patient as he gets into the 24-hour bladder irrigation.
- Assess for patient’s mental status as this is the first sign of water intoxication which can be possible because of 24-hour fluid irrigation.
- Note the client’s reaction regarding bladder training and eventually the removal of the catheter.
- Assess for urinary retention and feeling of bloating and fullness of the patient.
- Check for the dressing and the surrounding tissues for inflammation and infection.
- The assessment of urine and blood loss must be monitored every hour especially on the first 24 hours of the procedure. Normal findings may include red-tinged urine to pink within 24 hours.
TURP syndrome
As part of the pre-operative nursing intervention, monitoring the client’s response to urinary catheter insertion and fluid irrigation may also lead to an increase in fluid absorption. The tendency of the body is to absorb the fluid leading to unbalanced levels of sodium. A state of hyponatremia and hypervolemia.
Nursing Management
- Monitor the fluid intake and output during bladder irrigation.
- Palpate the bladder for its character and shape. The distended bladder may signal that the catheter is not patent or something is obstructing the flow of fluid.
- Use the normal saline solution for irrigation. Cold saline solution is used for the first 24 hours until the bleeding is controlled.
- Assess for the proper placement of the bladder irrigation. Ideally, the height of the irrigation bags can be between 2 to 3 feet above the bladder.
- Note the following signs of the TURP syndrome: hypertension, full and bounding pulses, confusion, agitation, temporary blindness.
