1. Care of the Urology Patient

2. Care of the Urology Patient
Why review care?
Patients: Patient quality of care and safety are foremost. We want to insure that every patient receives the best care every time.
Employees: Provide nursing employees the opportunity to learn about the care of this unique group of patients. Provide an opportunity for employees to ask questions and share knowledge.

3. Care of the Urology Patient
What is BPH (Benign prostatic hyperplasia)?
Symptoms
Pathophysiology
Management
Surgical Treatment

4. Care of the TURP Patient
What is TURP (transurethral resection of the prostate)?

5. Nursing Care of the TURP Patient
Continuous bladder irrigation with warmed solutions from the top shelf of the blanket/solution warmer. Follow the directions on the front of the warmer regarding labeling and rotating the solutions. Observe for signs of urinary compromise. Expect red-tinged urine that fades to pink within 24 hours.
Observe for signs of vascular compromise: rapid pulse and decreasing blood pressure.
Weights: daily including upon arrival to the unit
I&O: Accurate. Check every 1-2 hours. Track the amount of irrigation fluid that is instilled on the white board and subtract this volume from the amount that is measured from the catheter bag to obtain urine output.
If blood clots impede adequate catheter drainage, gentle irrigation is performed with saline solution after completing bladder scan for residual.
Dressings: May place a gauze dressing loosely over the end of the penis to absorb bloody discharge. A large amount of bleeding or urine leakage may indicate obstruction of the catheter.

6. Nursing Care of the TURP Patient
Activity: Dangle on the day of surgery. Starting post-op day one, walk at least 4 times a day and patient should be out of bed in chair. Document distance, assist level, assistive devices and tolerance in the record.
First post-op day: Release the traction from the catheter early in the morning when collecting I&O. Exception: Order to leave traction intact until physician rounds. Apply a catheter strap to decrease meatal irritation caused by catheter movement.
Second post-op day: Discontinue the catheter early in the morning when collecting I&O. Exception: Physician instruction to leave in place. The balloon holds ml of solution. Remove using a 10 – 20 ml syringe. Orders: Add Signed/Held column to your patient list. Use your worklist. Communicate orders during report.
Pain: Discomfort is often associated with bladder distention and irrigation/urine retention, irritation from the catheter or bladder spasm. Use belladona and opium (B&O) suppository for bladder spasms. Always check for retention before beginning irrigation. No retention indicates no hand irrigation necessary. Give B&O plus IV pain meds to treat spasm.

7. Nursing Care of the TURP Patient
Documentation: Document on the LDA. Remove LDAs when complete.
Turn, cough, deep breath, IS. Again document.
Oxygen: Try maneuvers to get saturation up. Do not start oxygen without an order. Think of oxygen as a medication.
Education: Remember to document all education completed. Add special instructions to the AVS.
Care Plans: Complete care plans. Appropriate Nursing Diagnoses include - Impaired Urinary Elimination, Risk for Deficient Fluid Volume, Risk for Infection, Acute Pain, Risk for Sexual Dysfunction and Knowledge Deficit.
Diet: Diet per physician order. Encourage increased fluid intake to ml of fluids daily to relieve initial dysuria and resolve hematuria.

8. Complications of TURP Intra-operative and during hospitalization:
Hemorrhage
TURP syndrome
Bacteremia
Urinary Catheter Obstruction
Later complication:
Fibrotic scarring

9. Discharge Planning for TURP patient
Post Transurethral Urethral Surgery Instruction Sheet
Despite the fact that no skin incision were used the area of the prostate is raw and covered with scabs. Precautions outlined under activity on the instruction sheet are needed to insure that theses scabs are not disturbed over the next 2-4 weeks while the healing proceeds.
Diet: Return to normal diet. Avoid alcohol, spicy foods, acidic foods and drinks with caffeine as they may cause irritation and frequency. Drink plenty of fluids during the day (8-10 glasses). Tip: Avoid cranberry juice as it is very acidic!
Activity: Physical activity is restricted until first post-operative visit. Use the following guidelines during recovery
NO liting heay objects (anything greater than 10 pounds)
NO long car rides
NO strenuous exercise
NO sexual intercourse until approved by doctor
NO severe strainin during bowel movements – use stool softener as recommended

10. Discharge Planning for TURP patient
Wound: The inside of the urethra will be irritated after surgery. The patient may experience frequency and/or urgency (a stronger desire to urinat) of urination. This should resolve over 4-6 weeks. The patient may see some blood in the urine over the first few weeks after surgery and should get off his feet and drink lots of fluids unil the urine clears.
Medication: Pre-surgery medication should be resumed. In addition, the patient may also be given an antibiotic to prevent infection and a stool softener. The antibiotic should be taken according to directions and the entire prescription should be completed. Milk of Magnesia or Colace are recommended after surgery to avoid constipation. The patient should not strain to move bowels as this can cause beleding.
When to notify the physician:
Fevers over Fahrenheit
Heavy bleeding or clots (pink in the urine is okay, dark red is not okay)
Inability to urinate
Drug reactions (hives, rash, nausea, vomiting, diarrhea)

11. Discharge Planning for TURP patient
Follow-Up: Follow-up appointment 2-3 weeks after surgery.
Perineal hygiene
Medications: resuming anticoagulants, usual medications, pain meds
Constipation
Exercise
Sexual activity

12. Urology cart is located on PCU in the ICU desk area
Urology cart is located on PCU in the ICU desk area. The nurse caring for the patient is responsible for restocking the cart using the supply list located on the side of the cart. It is imperative that the department is recorded on the sheet to insure that items are charged appropriately.