TURP stands for Transurethral Resection of the Prostate, which is the surgical removal of the Prostate
Working in a Urology ward means that you will get a lot of patients with problems in their prostate. The two most common issues are Benign Prostatic Hyperplasia and Prostatic Cancer, and they are both typically treated with TURP.
There are several ways to remove the prostate, but the TURP surgery provides a lot of advantages:
It can be done through endoscopy, so the patient avoids an abdominal incision, making it safer for patients with surgical risks.
Shorter hospital stay
Lower morbidity rate
Decreased post-operative pain
Minimal risk of erectile dysfunction
Pre-Operative Nursing Care for TURP
Pre-Operative Nursing Assessment for TURP
Start by having a chat with your patient to establish a safe and therapeutic relationship. While having the conversation, make sure to ask specific questions that will explain your patient’s situation. So, ask him:
What he understands about the diagnosis and the surgery
If his activity level has changed since the problem started
His presenting symptoms (Nocturia/ urgency/ retention etc.)
Erectile dysfunction or sex-related issues
Related pain or discomfort
How he feels about the diagnosis
Whether he needs any psychological or emotional support
If he has a relative or friend who can support him
During the nursing assessment, you should also obtain a full medical and family history of your patient.
Pre- Operative Nursing Diagnosis for TURP
Having finished the conversation, you can now build your nursing diagnosis, and you’ll most likely find the following:
Lack of knowledge about the surgery
Fear and anxiety about the operation and outcomes
Acute pain related to bladder distention
Pre-operative Nursing Interventions for TURP
1. Education about TURP
As a nurse, you play a significant role in effectively educating your patient and addressing any questions. With the help of diagrams, you should highlight which structures are being affected, and what their job is in the urinary and reproductive system.
After that, you can give your patient an overview of how the surgery works, and what he can expect after it is done. Mainly that he will have a urinary catheter inserted, and possibly also an irrigation system. Lastly, reassure your patient that the post-operative pain will be addressed through analgesia and supportive measures.
2. Managing Anxiety & Fear
Pre-operative anxiety and fear can arise from many factors. Particularly in a TURP, patients often feel scared about how the surgery will affect their body in terms of reproduction, sexual function. They might also have a false idea that their current issue is related to their sexual practice.
Research has indicated that men tend to suppress their feelings and hide their fears, so encourage your patient to verbalise any concerns that he might have and answer accordingly. Moreover, you should give your patient a contact number so that he can get in touch if he has any other questions. Lastly, reassure your patient that once he is fully recovered, he will be able to function normally and go on with his daily life.
3. Managing Discomfort
If your patient is in pain during the pre-op stage, he will most likely get analgesia and bedrest prescribed. In some cases, the patient may be hospitalised before the surgery, so you should take note of:
His voiding patterns
An indwelling catheter may be indicated if your patient has reoccurring urinary retention, or Azotemia (build-up of nitrogenous waste in the blood). In that case, you should pay close attention to your patient’s blood pressure and kidney function as they might fluctuate after inserting the catheter.
4. Preparation on the Day of Surgery
The final step is to make sure that your patient is ready for surgery from the medical perspective. Your patient should be starved for at least 6 hours before the surgery, and make sure that he is kept hydrated through adequate IVI infusions.
Make sure that your patient has the following:
Allergy Bracelet (if applicable)
Changed into a hospital gown and removed his underwear
Removed all jewellery/ foreign teeth/ hearing aid/ contact-lenses/ glasses/ make-up
Before going down to the Operating Theatre, your patient’s file should have:
All medical notes and treatment charts
A signed consent form
Pre-operative medical assessment
An ECG done in the last 2weeks
Blood results, and Blood type from the past 3 days (often found online)
Post-Operative Nursing Care for TURP
Post TURP Nursing Assessment
Start by having a quick chat with your patient to determine his consciousness level. While having the conversation, ask her if she is in pain or feeling nauseous as these are expected after surgery. And you will also be assessing her airway and breathing patterns.
The next thing to do is to check:
Circulation in his hands and feet
Check if the penis is bleeding around the catheter
Take note of the urine volume and colour
Before leaving his side, ensure that the environment is safe; Place the bed rails up and give the nurse call bell to the patient. Check that all IV lines are secure, and that catheter is not kinked. Lastly, ask the patient if he wants a relative or a friend to be by his side.
Post TURP Nursing Diagnosis
The nursing assessment is likely to highlight the following nursing diagnoses:
Acute pain from bladder spasms
Discomfort from the catheter
Post TURP Nursing Interventions
1. Relieving Pain and Discomfort
When your patient complains of pain, ask him to identify which part of his body is painful. Pain in the flank area can be from kidney problems or radiating from bladder spasms, while pain in the penis is likely from the catheter.
Bladder spasms post TURP are a common occurrence and can be very painful; typically, these can be resolved with smooth muscle relaxant medication and a warm compress on the pubis.
Moreover, because the bladder will be irritated, it may form blood clots that can block the catheter and cause urine retention. So, pay close attention to the drainage tubing and irrigate the system as prescribed to relieve any obstruction.
Lastly, advise your patient not to sit for long periods as this increases the intra-abdominal pressure, and can worsen the pain.
2. Maintaining a Good Fluid Balance
Since the patient will most likely have continuous irrigation into the bladder, he will be at risk of fluid imbalance. The irrigating solution might be absorbed through incisions in the bladder instead of appropriately excreted, and this can lead to fluid retention, electrolyte imbalance and water intoxication.
So, with this in mind, make sure to chart your patient’s intake and output frequently, and record any discrepancies. You should also look out for high blood pressure, confusion, respiratory distress, or electrolyte imbalance as they are all symptoms of fluid imbalance.
Post TURP Complications
Having a Hysterectomy might put patients at risk of:
Deep Vein Thrombosis
Post TURP Discharge Planning
Before sending your patient home, make sure that she has:
Anxiety under control
Minimal pain and discomfort
Fluid and Electrolytes within range
Normal urine output
Is continent of urine, or knows what exercises to do to regain continence
Did you find this helpful? If so then you should have a look at the rest of the Study Guides Here.
If reading is not for you, Don’t Worry! Take a look at my YouTube Channel were I explain the Pre-Operative Phase in Detail
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