Enhancing Patient Outcomes: Counseling Patients Undergoing TURP

Patient Care for Transurethral Resection of the Prostate (TURP)

1Running head: NURSING
Name of student:
Name of university:
Author note:

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The patient in the present case study analysis is Alan Jones, a 60-year-old man, who
has been admitted to the healthcare unit for urinary symptoms after being diagnosed with
being prostatic hyperplasia (BPH). The patient has a history of type 2 diabetes and obesity.
The patient is a regular drinker of alcohol and lives alone. He had been taken to the hospital
for surgery and underwent a transurethral resection of the prostate (TURP) with spinal
anaesthesia. After remaining in the post-anaesthetic recovery room (PARU) he had been
transferred to the ward where continuous bladder irrigation was done with the hep of the
three-lumen urethral catheter. Blood clots are present in his urine. The present essay is
divided into three main sections. First, the aetiology and pathophysiology of the patient’s
presenting conditions have been described. The next section focuses on the underlying
pathophysiology of the post-operative deterioration. A nursing management plan is
prioritised and outlined accordingly. Lastly, a discussion is done on the inclusion of three
members of the interdisciplinary healthcare team who would be involved in the care plan for
Alan.
Benign prostatic hyperplasia (BPH) is the medical condition leading the patient to
suffer an increase in the prostate size. This increment is non-cancerous and involves
hyperplasia of epithelial and stromal cells of the prostate. The result is that the transition zone
of the prostate suffers emergence of large and discreet nodules. The increase in the cell
number is the distinct feature of this clinical condition (Chughtai et al., 2016).
The aetiology of the clinical condition can be conferred to three main factors;
hormones, diet and degeneration. Experts point out that androgens and testosterone play a
primitive role in the development of BPH. BPH is the result of a failure in the spermatic
venous drainage system, giving rise to the hydrostatic pressure increase. It is to be noted that
such failure occurs in men above the age of 50 years (Parnham & Haq, 2013). Studies
indicate that diet of an individual has a significant role in the progress of the clinical

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condition. A negative association with alcohol intake is prominent. Individuals who consume
alcohol on a daily basis are at higher risk of developing the condition. Epidemiological data
also indicate the relationship between diabetes and obesity, and BPH. BPH can be attributed
to being an age-related disease (Parsons et al., 2013).
When muscular tissues of the prostate are weak due to age and fibrosis occurs in the
tissues, BPH is common. The reason is that muscle tissues play a significant role in carrying
out thee main functions of the prostate as it is responsible for providing the force for fluid
excretion coming from the prostatic glands. With increasing age, myofibres suffer dilations
and as they are injured and broken. Regeneration of these myofibres are in a low rate, and
thus collagen fibres are used up for the replacement of broken myofibres. Any misrepair
makes the tissues weaker, and the functioning is hampered, impairing fluid secretion
(Scattoni & Maccagnano, 2017). Accumulation of the fluid is the cause of increased
resistance of muscular tissue at the time of dilations and contractions. Muscular tissue fibrosis
and fluid accumulation become the primary cause of prostate expansion (Vahlensieck et al.,
2015). In the present case, the age of the patient is 60 years, enhancing the chances of
elevated testosterone. Further, the patient is an alcohol consumer and suffers from diabetes
and obesity.
The patient in the present case has undergone a transurethral resection of the prostate
(TURP) with spinal anaesthesia given to him. After undergoing recovery in the post-
anaesthetic recovery room (PARU) for 2 hours, he has been shifted to his ward. His urine
contains large clots of blood, and a three-lumen urethral catheter is being used for continuous
bladder irrigation. His observations include BP 160/90mmHg and Pulse 128bpm which are
abnormal vital signs. While the normal reference range for BP is 120/80 mmHg, the normal
reference range for pulse is 60-100 bpm (Butcher et al., 2013). According to Bachmann et al.,
(2014) TURP might lead to blood clots in the urine of the patient due to the healing of the

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wound suffered at the time of the surgery. If the bladder is irrigated with the help of a
catheter, chances are high that urine becomes red due to blood cot and debris that is stopped
once irrigation is stopped. A blood clot is a major issue since this might lead to obstruction of
the urethra. A wide range of cardiopulmonary and neurologic symptoms suffered by the
patient is due to intravascular absorption of hypotonic bladder-irrigating fluids at the time of
transurethral resection of the prostate. Since the body absorbs an increased amount of fluid,
blood pressure and pulse rate increases. Hypertension is the result of hypervolemia. In
patients undergoing this surgery, reflex bradycardia is the response to the increased blood
pressure. These two conditions can be noted as Transurethral resection (TUR) syndrome (Teo
et al., 2017).
The role of the nurse in the management of patient conditions after TURP holds much
value as continual care is to be ensured in such cases. Comprehensive care is to be delivered
as per the needs of the patient on an individual basis. The first nursing priority would be
impaired urinary elimination. This is in relation to blood clots and irritation of catheter use.
At the time of bladder irrigation, assessment of drainage system and urine output is essential.
The rationale is that retention chances are high due to blood clots and spasms in the bladder
(Madersbacher, 2017). The patient is to be seated in a normal position for proper passage of
urine. Incision and dressing are to be checked on a regular basis as the promotion of wound
healing are important. The patient is to be encouraged to void when an urge is felt since
voiding with urge is a preventive measure for urinary retention. The second priority would be
encouraging the patient to increase fluid intake as tolerated. This is effective in renal
perfusion nd adequate hydration (Butcher et al., 2013).
Monitoring vital signs is imperative as there is a need of prompt intervention if
dehydration is suffered. If the patient is in a state of confusion or restlessness appropriate
guidance is to be provided by the nurse. Anchoring catheter needs special mention as pulling

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or movement that is improper causes bleeding. Bleeding is to be observed as active bleeding
is a concern. The catheter system is to be kept sterile for avoiding sepsis nd infection.
Dressings are to be changed regularly for the same reason. Wet dressings are the prime cause
of skin irritation as media is gained for bacterial growth (Suskind et al., 2016).
Health care delivery is comprehensive and of optimal standard when an
interdisciplinary team comes forward for planning the care of the patient that is person-
centred. Apart from the nursing and medical team, three members of the interdisciplinary
healthcare team who are to be involved in the care of Alan are a dietician, physiotherapist and
counsellor (Collins & Terris, 2016). The patient Alan has been suffering from obesity and
diabetes, implying that a proper diet is essential for the patient to recover fast from his
present condition. A dietician would aid in this regard. A one-to-one nutrition management
would be imperative for the patient. The physiotherapist would be responsible for changing
physical movement practices of the patient. A counsellor would help the patient to overcome
the depression and anxiety arising due to the operation and its consequences on the emotional
front (DiCenso et al., 2014).
The dietician would be responsible for carrying out an assessment of the requirement
of Alan and investigate the treatment options for him after a brief consultation. Research
indicates that dietary patterns influence the chronic disease such as diabetes. Patients are to
follow a diet chart outlined by the dietician on a strict basis. A collaboration of the dietician
with the physician is important since diet chart has a key relationship with the medical
treatment process outlined for the patient (Frede & Rassweiler, 2017). A physiotherapist
would be the exercise therapist who would promote body movement of alan for optimal
energy expenditure required by the patient to stay fit. Physical therapy would go hand in hand
with proper food intake. The activity that would be outlined for Alan would consider his BMI
and mobility needs. The physiotherapist would also aid in educating Alan about the

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implications of obesity, as indicated by its medical complications. The patient would be
encouraged not to adhere to a sedentary lifestyle (Potter et al., 2016). Counselling is a
primitive part of patient care undergoing prostate surgery as negative influence occurs on the
individual's emotions and thoughts. The purpose of counselling is to resolve any doubts
arising in the mind of the patient regarding his medical condition. A patient is to be given
adequate information regarding the treatment procedure for enabling the patient to be well
aware of the consequences they hold. The two main issues arising due to the surgery are
decreased sexual function and pelvic floor impairment. Alan needs to be informed about
these two concerns of sexual functioning and inconsistent urinary output for better self-
management (Bowen et al., 2015).
The above essay described the nursing procedure and underlying medical principles
guiding a patient care for transurethral resection of the prostate (TURP). The main causes of
the pathophysiology of Bening prostatic hyperplasia are diet, age and hormones. The
presenting condition might be complex, owing to a number of changes in the patient’s body.
Nursing management for such patients need to focus on impaired urinary elimination,
increased risk of volume deficiency, infection prevention and monitoring of vital signs.
Comprehensive care for the patient demands the inclusion of other healthcare professionals,
namely a dietitian, physiotherapist and counsellor. With the care plan outlined above, it is to
be expected that the patient would achieve desired outcomes within the stipulated time frame
prior to his discharge.

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