Question

Clifford Allen is a 64-year-old male who has been married to his wife, Pam, for 40 years. They live with their 24-year-old son, Gary, who was born with Down syndrome. Mr. Allen is a middle manager for a small manufacturing company where he has worked for the last 20 years. Overall, Mr. Allen is in good health, although he has been undergoing treatment recently for BPH. He has a history of depression for which he does not seek treatment because he fears the social stigma connected to the diagnosis. Mr. Allen has been considering retiring within the next few years so he and his wife can travel, but mostly to escape his stressful work environment. He enjoys bowling and is involved in activities at church. He and his wife walk each evening after supper. One evening while bowling, he notices that his bladder feels somewhat full. Mr. Allen calls to make an appointment to see his urologist for a follow up examination. He has been taking finasteride (Proscar) for the last 6 months but does not believe it has been particularly effective. He still has trouble urinating and believes that his symptoms are worse than before he started taking the drug. When he sees the urologist 2 weeks later, he reports that he often feels his bladder is full after voiding, he has difficulty starting his stream, and his stream is weak once started. He gets up frequently at night to void. His score on the American Urological Association Symptom Index is 28, up from 18 six months ago. The urologist confirms that the medication has not been effective and schedules further tests, including a uroflowmetry test, a postvoid residual test, a PSA blood test, and a urinalysis. Results from the uroflowmetry and postvoid residual test show a significant obstruction of urinary flow. The PSA is negative, and the urinalysis is consistent with bladder inflammation. A TURP is recommended in the upcoming weeks.

1. To determine Mr. Allen’s understanding of the procedure, what will the nurse want to ask him upon admission to the surgical center?

Answer 1

To determine Mr. Allen’s understanding of the procedure, the nurse can ask him upon admission to the surgical center the following:

1) Mr. Allen's general understanding of the TURP(Transurethral resection of the prostate)

• Do you know why and how is the procedure been done?
• Do you know the complications associated?
• Are you aware of the hospital stay after the procedure?

2) Do you expect and accept the following:

• A catheter will may remain in your bladder to drain your urine. An irrigant solution may be
connected to your catheter to keep the urine clear.
• Your urine may have some blood. Drink plenty of fluids to keep your urine clear
(10-12 cups of water/day).
• Your catheter will remain until the bleeding subsides and your surgeon deems it appropriate to be
removed, usually 1-2 days, but possibly longer depending on your situation.
• You may bladder discomfort or a sensation of fullness. This usually indicates bladder spasms.
Your nurse will make sure your bladder is draining properly, and may provide you with medications
to help with these symptoms.
• When the catheter is removed you may experience burning with urination. Medicines can
prescribed to help with these symptoms.
• Notify your nurse or surgeon if you are experiencing excessive bleeding, temperature above 101,
severe pain or the inability to void.
• Your nurse will provide you with follow-up instructions.Take at least three deep breaths and cough every two hours for the next few days.
• You may perform limited/non-strenuous activities as tolerated until released by your physician.So no work till 2 weeks. Do not lift anything heavier than 10 pounds.You wont be able to take care of your son atleast for a month. No bowling and recreational activities.You may attend mild church activities.

3)Are you aware that after discharge:
• You may go home with prescriptions for pain, burning, stool softener, antibiotics.
• You may resume your normal diet, high in fiber (fruits and vegetables).
• Drink 10 glasses of water daily.
• Walk 4 times daily.
• Continue foot pumping exercises while sitting.
• No heavy lifting over 10 lbs. for 4 weeks.
• No driving for at least 24 hours and not taking narcotic pain medication.
• Call the clinic for any fever over 101 F, increased pain, nausea/vomiting, increasing voiding
difficulties, increasing blood or clots in the urine, or other concerns.