A patient recently underwent a transurethral resection of the prostate (TURP) and is now presenting with confusion, restlessness, elevated blood pressure, and low serum sodium levels. Which of the following nursing interventions is the priority to address this patient's current condition?

B) Implement seizure precautions due to the risk of hyponatremia-induced seizures.

A) Administer analgesics to address potential postoperative pain.

B) Implement seizure precautions due to the risk of hyponatremia-induced seizures.

C) Encourage oral fluid intake to increase urine output and prevent dehydration.

D) Educate the patient about postoperative care to reduce anxiety and confusion.

A patient who recently underwent a transurethral resection of the prostate (TURP) is exhibiting signs of confusion, restlessness, and hyponatremia with a serum sodium level of 126 mEq/L. The clinical team has started hypertonic saline therapy. What is the priority nursing intervention to monitor the effectiveness of the treatment?

B) Assess the patient's neurological status regularly.

A) Monitor the patient's urine output and color.

B) Assess the patient's neurological status regularly.

C) Check the patient's blood glucose levels hourly.

D) Measure the patient's abdominal girth daily.

A patient several hours post-TURP is exhibiting signs of worsening confusion, agitation, and ongoing hyponatremia. What is the most appropriate immediate nursing action to prioritize this patient's care?

B) Initiate seizure precautions and closely monitor neurological status.

A) Increase the rate of hypertonic saline infusion to rapidly correct hyponatremia.

B) Initiate seizure precautions and closely monitor neurological status.

C) Administer a diuretic to manage fluid overload and improve urine output.

D) Prepare the patient for immediate transfer to the intensive care unit for closer monitoring.

A patient in the recovery period post-TURP is experiencing worsening confusion, agitation, and new-onset headache with photophobia. The blood pressure is 170/110 mmHg, heart rate is 112 bpm, and serum sodium is 128 mEq/L. Which nursing intervention is the most appropriate to prioritize at this time?

C) Increase the rate of hypertonic saline infusion to correct hyponatremia.

A) Administer a rapid bolus of isotonic saline to address hypotension.

B) Prepare for administration of mannitol to manage potential cerebral edema.

C) Increase the rate of hypertonic saline infusion to correct hyponatremia.

D) Request an immediate neurological consult to assess for intracranial pressure changes.

A patient with TURP syndrome is being treated for mild cerebral edema and electrolyte imbalance. The healthcare team administers mannitol to reduce intracranial pressure. Given the patient's current status of elevated blood pressure, tachycardia, and low urine output, which nursing intervention should be prioritized to ensure safe administration of mannitol?

B) Assess for signs of fluid overload and pulmonary edema.

A) Monitor serum sodium levels closely to prevent hypernatremia.

B) Assess for signs of fluid overload and pulmonary edema.

C) Administer antihypertensive medication to control blood pressure.

D) Increase fluid intake to enhance urine output.

A patient post-TURP is being treated for cerebral edema with mannitol due to TURP syndrome. Which of the following clinical findings would indicate that the treatment with mannitol is effective?

D) Increased level of consciousness and reduced neurological symptoms

A) Decreased blood pressure to 140/90 mmHg

B) Improved urine output with a clear appearance

C) Reduced heart rate to 80 bpm

D) Increased level of consciousness and reduced neurological symptoms

A patient with hyponatremia and elevated BUN and creatinine levels is being treated with mannitol for cerebral edema. Considering the patient's condition and the recent changes in treatment, which nursing intervention is the most appropriate to prioritize at this time?

B) Monitor neurological status and report any changes immediately.

A) Increase oral fluid intake to promote renal clearance.

B) Monitor neurological status and report any changes immediately.

C) Administer a high-sodium diet to quickly correct hyponatremia.

D) Prepare the patient for dialysis to address potential renal failure.

A patient with hyponatremia and renal impairment is receiving mannitol as part of his treatment plan. Recent lab results show elevated BUN and creatinine levels. The healthcare team decides to adjust the patient's fluid management strategy. Which of the following nursing interventions is most appropriate in response to these findings?

B) Monitor serum electrolytes and renal function markers more frequently.

A) Increase the rate of mannitol infusion to further reduce cerebral edema.

B) Monitor serum electrolytes and renal function markers more frequently.

C) Administer a high-dose loop diuretic to enhance diuresis.

D) Decrease oral fluid intake to prevent fluid overload.

A patient in a medical unit develops sudden agitation and confusion along with hypotension and increased heart rate. Considering the recent lab results indicating increased BUN and creatinine levels, which nursing intervention should be prioritized to address the patient's condition?

B) Administer the prescribed low-dose norepinephrine infusion to stabilize blood pressure.

A) Increase the rate of intravenous fluid administration to improve renal perfusion.

B) Administer the prescribed low-dose norepinephrine infusion to stabilize blood pressure.

C) Restrict oral fluid intake to prevent fluid overload and further renal compromise.

D) Initiate seizure precautions due to the risk of neurological deterioration.

A patient develops confusion and hypotension with worsening renal function and decreased urine output. Which of the following nursing interventions is most appropriate to address the patient's current condition?

C) Initiate a low-dose norepinephrine infusion to stabilize blood pressure.

A) Administer a fluid bolus to improve renal perfusion.

B) Increase the rate of diuretics to manage possible fluid overload.

C) Initiate a low-dose norepinephrine infusion to stabilize blood pressure.

D) Encourage oral fluid intake to correct hyponatremia.

turp - Nursing Case Study

Pathophysiology

• Primary mechanism: Transurethral resection of the prostate (TURP) involves removing excess prostate tissue causing urinary obstruction due to benign prostatic hyperplasia (BPH). This relieves pressure on the urethra, improving urine flow.

• Secondary mechanism: During the procedure, irrigation fluids are used to clear the surgical area, which can lead to potential fluid absorption into the bloodstream, sometimes resulting in electrolyte imbalances like hyponatremia, known as TURP syndrome.

• Key complication: TURP syndrome can manifest with symptoms such as confusion, nausea, and hypertension, necessitating careful monitoring of fluid balance and electrolytes during and after the procedure.

Patient Profile

Demographics:

45-year-old male, construction worker

History:

• Key past medical history: Benign Prostatic Hyperplasia (BPH), hypertension

• Current medications: Tamsulosin 0.4 mg once daily, Lisinopril 20 mg once daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Difficulty urinating and lower abdominal pain

• Key symptoms: Increased urinary frequency, nocturia, incomplete bladder emptying, mild fever

• Vital signs: Blood pressure 150/95 mmHg, heart rate 96 bpm, respiratory rate 18 breaths per minute, temperature 100.4°F, oxygen saturation 98% on room air

Section 1

Shortly after the transurethral resection of the prostate (TURP) procedure, the patient is transferred to the recovery unit. The initial assessment reveals that the patient is experiencing increased confusion and restlessness. His blood pressure has risen to 160/100 mmHg, and his heart rate has increased to 104 bpm. Despite maintaining an oxygen saturation of 97% on room air, his temperature has climbed to 101.2°F. The nursing staff notes that his urine output is low, and the urine appears pinkish, indicative of postoperative bleeding, which is common but requires monitoring.

Laboratory results return, showing a significantly decreased serum sodium level of 126 mEq/L, suggestive of hyponatremia, a potential component of TURP syndrome. The patient's confusion and elevated blood pressure may be attributed to this electrolyte imbalance. The clinical team initiates a careful fluid management plan, including the administration of hypertonic saline to address the hyponatremia, while closely monitoring his fluid intake and output to prevent further complications.

As the patient’s status is closely observed, the healthcare team must remain vigilant for signs of worsening condition, such as seizures or significant changes in cardiovascular status, which could indicate an exacerbation of TURP syndrome. This situation requires ongoing assessment and prompt intervention, ensuring electrolyte corrections are effectively managed to stabilize the patient’s condition. The immediate goal is to restore normal sodium levels while monitoring for any additional complications that could arise during his recovery.

Section 2

Several hours into the recovery period, the patient’s status begins to change, warranting a reassessment of his condition. The nursing team notes that his confusion has worsened, with the patient becoming increasingly agitated and unresponsive to verbal cues. His blood pressure has escalated further to 170/110 mmHg, and his heart rate is now 112 bpm. Despite receiving hypertonic saline, his serum sodium remains low at 128 mEq/L, only marginally improved from the initial finding. The urine output continues to be scant, and the pinkish tinge persists, indicating ongoing bleeding. These signs raise concerns about the effectiveness of the current fluid management strategy and the possibility of an evolving TURP syndrome.

The clinical team decides to conduct an urgent re-evaluation of the patient to identify any new complications. A focused neurological assessment reveals brisk reflexes and the onset of mild tremors, suggesting that the hyponatremia is still impacting the patient's neurological status. Additionally, the patient reports a new-onset headache and demonstrates increased sensitivity to light, both of which suggest potential intracranial pressure changes. Recognizing the critical nature of these symptoms, the team orders a stat CT scan of the brain to rule out any cerebral edema or hemorrhage, which could complicate the clinical picture further.

In response to these developments, the healthcare team intensifies monitoring protocols, adjusting the fluid therapy to include a more aggressive correction of the electrolyte imbalance. The patient is placed on continuous cardiac monitoring to detect any arrhythmias and provided with supplemental oxygen to maintain optimal oxygenation levels. As the team awaits the results of the CT scan, they remain prepared to implement advanced interventions, including potential pharmacological management of intracranial pressure and further adjustments to the fluid regimen, prioritizing the stabilization of the patient's neurological and cardiovascular status.

Section 3

As the healthcare team closely monitors the patient, the results of the stat CT scan return, revealing mild cerebral edema without evidence of hemorrhage. This finding confirms that the patient's neurological symptoms are likely due to hyponatremia and fluid shifts associated with TURP syndrome. In light of these results, the team decides to adjust the treatment plan to better address the cerebral edema while continuing to correct the electrolyte imbalance. They initiate a cautious administration of mannitol, an osmotic diuretic, to help reduce intracranial pressure and closely observe the patient for any adverse reactions.

Meanwhile, the patient's cardiovascular status remains a concern. His blood pressure continues to be elevated at 168/108 mmHg, and his heart rate is slightly increased at 115 bpm. Despite supplemental oxygen, his oxygen saturation dips to 92%, prompting the team to increase the oxygen flow to support adequate tissue perfusion. The scant urine output persists, and the pinkish tinge in the urine suggests that the bleeding has not yet subsided. These challenges highlight the need for a delicate balance in fluid management to avoid exacerbating the electrolyte imbalance while preventing further complications.

Clinically, the patient shows subtle improvement in his level of consciousness, becoming slightly more responsive to verbal stimuli. However, his brisk reflexes and mild tremors persist, indicating ongoing neurological involvement. The team remains vigilant, continuously reassessing the patient's status and evaluating the effectiveness of the current interventions. They are prepared to escalate care if necessary, with the understanding that the patient's journey is still evolving and requires a coordinated, multidisciplinary approach to manage the complexities of TURP syndrome effectively.

Section 4

As the healthcare team continues to monitor the patient, new diagnostic results return, offering further insight into his condition. The latest serum electrolyte panel shows that the patient's sodium levels have improved slightly, now at 128 mmol/L, up from a critically low 122 mmol/L. This modest improvement suggests that the interventions to correct the hyponatremia are having an effect, but the levels are still below the normal range, necessitating ongoing careful management. In addition, the blood urea nitrogen (BUN) and creatinine levels are elevated, indicating a potential compromise in renal function, possibly exacerbated by the osmotic diuretic therapy with mannitol. This development raises concerns about the patient's renal status and the need to balance the diuretic's benefits with its potential impact on kidney function.

In response to these findings, the healthcare team decides to adjust the fluid management strategy. They plan to reduce the rate of mannitol infusion while increasing the monitoring of renal function markers more frequently. Additionally, they consider introducing a low-dose loop diuretic to facilitate diuresis without overloading the kidneys, aiming to promote urine output and help clear any excess fluid contributing to the cerebral edema. They also maintain a close watch on the patient's cardiovascular status, particularly his blood pressure and heart rate, to ensure that these remain within a manageable range.

Clinically, the patient's overall status appears to be stable but remains guarded. The slight improvement in his responsiveness is encouraging, yet the persistence of brisk reflexes and mild tremors indicates ongoing neurological involvement that will need further attention. The team remains committed to a multidisciplinary approach, coordinating with nephrology and neurology specialists to optimize care. As the patient progresses, the team prepares to reassess and refine the treatment plan, ready to address any new complications that may arise as the patient's journey unfolds.

Section 5

As the healthcare team continues to monitor the patient, a change in his status prompts immediate attention. Overnight, the patient develops increased agitation and confusion, which were not present before. Upon assessment, the nurse notes that the patient is disoriented to time and place, a significant change from his previous alert and oriented status. Vital signs reveal that the patient's heart rate has increased to 110 bpm, and his blood pressure has dropped to 90/60 mmHg. The patient's respiratory rate is slightly elevated at 22 breaths per minute, and his oxygen saturation remains stable at 95% on room air. These changes suggest a possible shift in the patient's fluid balance or a new neurological complication.

New laboratory results obtained in the morning show that the patient's sodium level has increased to 130 mmol/L, indicating gradual correction of hyponatremia. However, the BUN and creatinine levels have risen further, with the BUN at 30 mg/dL and creatinine at 2.2 mg/dL, raising concerns about worsening renal function. Additionally, the patient's urine output has decreased over the past 12 hours, further suggesting renal compromise. In light of these findings, the team reevaluates the current fluid and diuretic management strategy, considering the possible need for more aggressive renal protection while continuing to address the neurological symptoms.

The multidisciplinary team discusses the potential causes of the patient's confusion and hypotension, suspecting a combination of factors including fluid imbalance, medication effects, or a possible underlying infection. They decide to initiate a low-dose norepinephrine infusion to support the patient's blood pressure while carefully managing fluid intake to prevent further renal impairment. In collaboration with neurology, a decision is made to perform a CT scan to rule out any acute intracranial events that could explain the sudden neurological changes. The team remains vigilant, knowing that any intervention will need to be balanced delicately to prevent exacerbating the patient's condition further. As the patient’s journey continues, the healthcare team prepares for the next steps in diagnosis and management, ready to pivot their approach as new information emerges.