Urinary Disorders Q 59

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The client is admitted to the hospital with BPH, and a transurethral resection of the prostate is performed. Four hours after surgery the nurse takes the client’s VS and empties the urinary drainage bag. Which of the following assessment findings would indicate the need to notify the physician?

  

    A. Red bloody urine

    B. Urinary output of 200 ml greater than intake

    C. Blood pressure of 100/50 and pulse 130.

    D. Pain related to bladder spasms.

    

    

Correct Answer: C. Blood pressure of 100/50 and pulse 130.

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A rapid pulse with low blood pressure is a potential sign of excessive blood loss. The physician should be notified. Class III of hemorrhagic shock includes a volume loss from 30% to 40% of total blood volume, from 1500 mL to 2000 mL. A significant drop in blood pressure and changes in mental status occurs. Heart rate and respiratory rate are significantly elevated (more than 120 BPM). Urine output declines. Capillary refill is delayed.

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Option A: Frank bleeding (arterial or venous) may occur during the first few days after surgery. In the first two days after surgery, your urine might have blood or clumps of blood in it – particularly following TURP. It is important to drink a lot of water in the first few days in order to rinse the bladder and speed up the healing process. Mild bleeding may occur later too, for example when scabs break away and are flushed out.

Option B: Some hematuria is usual for several days after surgery. Urinary output of 200 ml of greater than intake is adequate. It can take a few months for everything to return to normal. During this time you may have urinary problems, such as an urge to urinate or temporary loss of bladder control. Your organs need some time to adjust to the changes in the operated area and to start working normally again, so it’s important to be patient.

Options D: Bladder spasms are expected to occur after surgery. To prevent the healing wound from coming into contact with urine, a urinary catheter is needed for a few days after surgery. A catheter is a thin plastic tube that drains the bladder through the urethra. The tube is held in place by a small water-filled balloon in the bladder. This can lead to painful bladder spasms, mainly in the first few hours and days. Antibiotics are sometimes used to prevent infections.

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