Urinary Disorders Q 140 - Gyan Darpan : Learning Portal
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Monday 4 April 2022

Urinary Disorders Q 140

A client underwent a TURP, and a large three-way catheter was inserted into the bladder with continuous bladder irrigation. In which of the following circumstances would the nurse increase the flow rate of the continuous bladder irrigation?
    A. When the drainage is continuous but slow.
    B. When the drainage appears cloudy and dark yellow.
    C. When the drainage becomes bright red.
    D. When there is no drainage of urine and irrigating solution.

Correct Answer: C. When the drainage becomes bright red.

The decision made by the surgeon to insert a catheter after a TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so clots do not plug it.

Option A: CBI is started in the OR to allow for observation of the urine color. The CBI should be titrated to light pink. TUR syndrome is very concerning. This condition arises due to the irrigation fluid used during the resection being pushed intravascularly, causing hyponatremia and neurologic symptoms, such as confusion. The risk of this is low, as modern-day TURPs utilizing bipolar technology and saline as irrigation, as compared to a monopolar TURP.
Option B: There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Postoperative complications include transurethral resection syndrome (TUR syndrome), LUTS but these typically improve as the patient is further from surgery, but they may never completely resolve, retrograde ejaculation, infection including UTI and prostatitis, urethral stricture, bladder neck contracture, incontinence, urinary retention due to either obstruction or poorly functional bladder requiring CIC or catheter, and recurrence.
Option D: Increasing the flow would be contraindicated when there is no return of urine and irrigating solution. Patients are typically admitted one night. If the urine has remained clear, a voiding trial is performed the next morning. If a patient is unable to void, a foley will be placed, and follow-up with the patient will be conducted in about one week for a voiding trial in the clinic.

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