Urinary Disorders Q 56

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The client with BPH undergoes a transurethral resection of the prostate. Postoperatively, the client is receiving continuous bladder irrigations. The nurse assesses the client for signs of transurethral resection syndrome. Which of the following assessment data would indicate the onset of this syndrome?

  

    A. Bradycardia and confusion

    B. Tachycardia and diarrhea

    C. Decreased urinary output and bladder spasms

    D. Increased urinary output and anemia

    

    

Correct Answer: A. Bradycardia and confusion

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Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

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Option B: The clinical spectrum ranges from asymptomatic hyponatremia to electrocardiographic changes, nausea, vomiting, convulsions, coma, alterations of vision, pulmonary edema, cardiovascular compromise, and death. Transurethral resection syndrome (“TUR syndrome”) is caused by absorption of electrolyte-free irrigating fluid and consists of symptoms from the circulatory and nervous systems. The clinical picture is inconsistent and the syndrome is easily confused with other acute disorders.

Option C: The severity of our patient’s clinical picture, in contrast with moderate hyponatremia, could be explained by multiple factors: age, rapid decrease of sodium concentration, hyperkalemia, and probably hyperglycinemia. The pathophysiology is complex but includes four mechanisms: circulatory distress from the rapid absorption of electrolyte-free irrigating fluid, adverse effects of glycine, dilution of the protein and electrolyte concentrations of the body fluids, and disturbance of renal function.

Option D: The treatment of the TUR syndrome consists of general life support and in specific treatment directed towards hypotension, hyponatremia, and anuria. Methods to lower the uptake of irrigating fluid are widely used and probably reduce the incidence of the TUR syndrome.

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