Management of Pain and Complications in Post-Operative Bladder Irrigation

This case study discusses the management of pain and complications in post-operative bladder irrigation after transurethral prostate resection surgery. It covers the importance of stopping continuous bladder irrigation, the procedure of continuous irrigation, potential complications, assessment of blood clot formation, abnormal blood counts, and education for patients. The study provides valuable insights for healthcare professionals and patients.

Running head: CASE STUDY
CASE STUDY
Name of Student:
Name of University:
Author’s Note:

1CASE STUDY
Answer no 1.
Mr Brady who is 68 years old man was admitted to the hospital for transurethral prostate
resection surgery. Post-operation his pain was manageable was his health condition was in
control. However, as it was noted he was suffering from extreme bladder irrigation running with
pink tinged drainage. On evaluation, he compliant of 8/10 pain in the pelvic region which has got
increased over the time. The pain was making the patient discomfort and he was extreme
distress. Therefore, the priority action by the nurse would be to stopping the continuous bladder
irrigation and contacting the doctor (Sampson et al., 2019).
Answer no 2.
Transurethral resection of the prostate is the type of surgery which is used to treat and
remove the parts of grown prostate gland (Worthington et al., 2019). During the surgery, a
special instrument known as resectoscope used to remove any extra tissue blockage. In such
operation continuous bladder irrigation is used as the mean to manage the hemorrhage and
formation of clot after prostrate surgeries (Imlay et al., 2019). The patient has continuous balder
irrigation after the surgery. There is slight high probability in patient that he might develop clot
or may have problem of hemorrhage after the surgery. In order to avoid arising of such problems,
the patient was in continuous bladder irrigation. According to the Agrawal et al. (2018) the
patient who have undergone TRUP also experience interrupted drainage of urine and blood from
the lower urinary tract till the patient is in non-hemostasis state. Yoshida et al. (2019) said that
this causes continuous blockage of the catheter which is a great concern for the patient as well
the nurse. Hall and Rodgerson (2019) said that drainage of bladder post operation is mainly
effected through urethra, bladder and perineum. Thus, use of continuous irrigation of bladder

2CASE STUDY
with saline will help to remove any sort of blood blockage and will assist in attaining hemostasis
(Onishi et al., 2017). Continuous bladder irrigation given after the surgery is known to show
effectiveness which include preservation of the patency of the drainage catheter lumen, help to
prevent clot formation and its retention, helps in flushing of the clot when it becomes large in
size and helps to controlling bleeding.
Answer no 3.
The steps take would be taken as an intervention for management of pain:
 The nature of pain will be examined by determining the pain score.
 Nurse recognize those factors that might affect the patients’ expression of pain.
 Nurse on evaluation will determine the time to give pharmacological intervention to
manage the pain. If the pain is extreme, nurse would immediately administer analgesic in
consultation with the surgeon or health care professional (Chou et al., 2016).
 The dose of analgesic given should be calculated by the nurse to avoid any side effect of
the medicine.
 Nurse then evaluate the effectiveness of the analgesic (Kisely et al., 2015).
 Nurse will check the blockage of catheter time to time.
 Nurse will change the catheter after recognition of any blockage.
Answer no 4
Post-operative bladder irrigation is often regarded as the mean of preventing clot
formation and maintaining hemorrhage in patient who have undergone transurethral resection of
prostate. However, such method is connected with various complication which can lead to severe

3CASE STUDY
consequence of the patients. Three major complication of continuous bladder irrigation are as
follows:
Catheter blockage: Blockage of the catheter is the one of the major complication of the
continuous bladder irrigation. With continuous irrigation, there is flush of the clot which might
get formed after the operation. Those clot is responsible to cause blockage which does not allow
passage of urine from the bladder or caused retention of urine. The catheter blockage is evident
with the suprapubic distention which is associated with the discomfort in the lower abdomen.
The complication will cause no passage of urine which causes vaso-vagal symptoms like
sweating, hypotension, tachycardia and urgency (Avallone et al., 2017). If such complication
occurred then irrigation should be halted immediately in order to prevent filling of bladder and
discomfort in the patients. Manual bladder irrigation is the ultimate step to catheter is not able to
get unblock. More serious complication is retention of urine are organ damage and death
(Dungerwalla et al., 2015)
Discomfort during the procedure- Another complication linked with the continuous bladder
irrigation is connected with its procedure. During the process both male and female experience
uneasy with urinary catheter (Do et al., 2018).
Urinary tract infection: The tract infection is the other complication of the continuous bladder
irrigation which has led to increase in rate of morbidity, mortality and length of stay. Infection is
the most with the methods because catheters is known to inoculate the harmful organism into the
bladder. Such situation causes colonization of the bacteria or fungus as it provide a surface for its
growth causing mucosal irritation (Ding et al., 2016). It is known that urine is the house of
various germs and bacteria, with its continuous passage causes the risk of its growth and cause
urinary tract infection. Those bacteria quickly grows in colony making biofilms which has

4CASE STUDY
various collection of micro-organism which might get transferred to the body and causes severe
infection (Hill et al., 2015).
Answer no 5
Education and teaching is the important mean of communication to spread awareness
about the health issue of the patients (Leeming et al., 2018). The nurse is the responsible body to
provide valuable information about the risk associated with the disease and recommendation to
cope with the disease. To Mr Brady who has undergone TRUP need to get education about its
related consequence and ways to overcome with it. With the help of presentation and virtual
demonstration about the risk, nurse can give education to Mr Brady. All the related information
will be narrated with effective communication and linguistic.
The three most important teaching given to Mr Brady is as follows:
Teaching points Rationale
Bladder irrigation and its uses
Patient will be education about the bladder
irrigation and its related phenomenon.
Teaching will be given about what bladder
irrigation is and what are its use. The patient
will be explained that it is used to prevent
formation of blood clot after surgery
otherwise it would create pain and discomfort
(Pietropaolo et al., 2018).
A normal person do not have idea about the
bladder irrigation. They undergo such
procedure without any idea about its causes
and risk. Hence, for lay patient it is important
to provide a clear idea about the bladder
irrigation so that they can be able to assess it
accurately.

5CASE STUDY
Procedure of continuous irrigation
Nurse will briefly explain about what happen
during the continuous bladder irrigation
(Wilhelm et al., 2018).
Most of the patient do not have knowledge
about how continuous irrigation is given and
due to lack of such idea, they fear and does
not will to uses it.
Effect of continuous irrigation
Patient will educated that he might feel
discomfort in initial period of time and he will
be instructed to call for help when bladder
irrigation gets stopped (Kim et al., 2016).
Patient are anxious about the procedure and
its effects, hence it is important to make them
aware about the effects and in which situation
they need to call for help.
Answer no 6
The most importance concern in the assessment of Mr Brady is occurrence of clot in the
drainage bag with size ranging from 1cm to 3cm in diameter. The drainage in the catheter bag
has turn red. The major reason for such incidence might be blockage of continuous irrigation of
bladder where it was unable to flushing the blood clot. Such situation of Mr Brady can lead to
organ damage and in worse can cause death of the patient.
The most immediate action by the nurse is to discontinue the continuous irrigation of
bladder to prevent further filling and discomfort in the patient (Koraş et al., 2018). To solve the
situation and unblock the catheter, manual bladder irrigation is the next action the nurse need to
be taken. This process is used to clear the bladder and catheter of blood clots and restore catheter
patency (Madabhavi et al., 2018). It involves manually flushing of the bladder in three-way with

6CASE STUDY
the catheter syringe with sodium chloride in order to release all the clots. This step is followed by
continuous irrigation to prevent further clot formation.
Answer no 7
In the assessment of case study of Mr Brady, he is having normal range of WBC count,
number of platelets and hematocrit. The most concern factor in the assessment is less number of
RBC and very high value of hemoglobin. Normal range of RBC count is 4.2-5.9 million/mm3 and
hemoglobin accounts to 8.1-11.2mmol/L (Hubert & VanMeter, 2018). Mr Brady is having RBC
and hemoglobin in the abnormal range of 3.8 ×1012 /L and 128mmol/L respectively. The major
reason for low RBC can be loss of excessive blood due to surgery of the patient. The rationale
behind the fact is that with loss of blood, the cells also get lost. High value of hemoglobin is
attributed by high amount of iron in the blood and high level of vitamin B12. When a person
takes high amount of iron diet their hemoglobin level increase tremendously. Test of hemoglobin
is done to assess the amount of blood in the body and diagnosis of anemia and other related
disease. The test of abnormal RBC count and hemoglobin is significant because it provide all
the information connected with the circulation of blood and oxygen level. The test will help
doctor to provide effective treatment. It will help the doctor to evaluate the various disorder like
anemia, infection or even leukemia (Raghunath & Blocki, 2017).

7CASE STUDY
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