BPH and TURP on the NCLEX
CBI management, expected vs emergency bleeding, and TURP syndrome basics.
After a TURP, the nurse runs the bladder irrigation. Knowing normal from emergency is the whole exam topic.
BPH in one paragraph
The prostate enlarges and squeezes the urethra: weak stream, hesitancy, dribbling, nocturia, urgency, incomplete emptying, and eventually retention. Untreated retention backs up to the kidneys. Meds first: alpha-blockers (tamsulosin: orthostatic hypotension, rise slowly) relax the outlet; 5-alpha-reductase inhibitors (finasteride: takes months, handle-with-care for pregnant women) shrink the gland. Surgery when meds fail: TURP.
Running the CBI
TURP patients return with a three-way catheter and continuous bladder irrigation. The point of CBI: keep clots from plugging the catheter. Titrate the irrigation rate to keep the outflow light pink. True urine output = total output minus irrigant instilled. Chart both. If outflow stops: check for kinks, then follow orders for manual irrigation, and notify the provider if patency cannot be restored. A blocked catheter with a filling bladder causes pain, spasm, and bleeding.
Expected vs emergency
Expected: pink to light-red outflow in the first 24 hours, small clots, bladder spasms (treat with prescribed antispasmodics; do not remove the catheter), burning around the catheter. Emergency: bright-red, thick, ketchup-like outflow that does not clear with faster irrigation, a stream of clots, no outflow with a distending bladder, or falling BP with rising pulse. Increase the rate per protocol for arterial-looking blood and notify the provider.
TURP syndrome and discharge teaching
Irrigating fluid absorbed through open venous channels dilutes the serum: dilutional hyponatremia. Watch for confusion, nausea, bradycardia, and hypertension in the first hours: report immediately. Discharge: no heavy lifting or straining for 4-6 weeks, stool softeners, fluids, avoid caffeine and alcohol; expect dribbling and small amounts of blood in urine for a few weeks; Kegel exercises help continence. Fresh bright-red bleeding at home means call the provider.
Frequently asked
CBI outflow turns bright red. First action?
Increase the irrigation rate per protocol to keep the catheter clear, assess vitals, and notify the provider if it does not lighten.
Post-TURP patient becomes confused and nauseated. What is the concern?
TURP syndrome: dilutional hyponatremia from absorbed irrigant. Check sodium and notify the provider now.
Quick check
Loading a question…
How ready are you right now?
10 real NCLEX questions, free, in your browser. See how close you are to ready and which subjects are costing you.
Try 10 questions free