A 72-year-old male with benign prostatic hyperplasia (BPH) is scheduled for a transurethral resection of the prostate (TURP). Which preoperative nursing intervention is most important to prevent postoperative complications?
1Administer prophylactic antibiotics as ordered
2Ensure adequate hydration and monitor electrolyte balance✓ 정답
3Teach deep breathing and coughing exercises
4Apply sequential compression devices to prevent thrombosis
해설
Ensuring adequate hydration and monitoring electrolyte balance preoperatively helps prevent TURP syndrome, a life-threatening complication. Other interventions are beneficial but less critical for preventing this specific complication.
The most important preoperative nursing intervention for a patient scheduled for a transurethral resection of the prostate (TURP) is to ensure adequate hydration and monitor electrolyte balance. This directly targets the prevention of a classic and life-threatening postoperative complication: transurethral resection (TUR) syndrome.
Pathophysiology of TUR Syndrome
During a monopolar TURP, the surgical field is irrigated with a non-conductive, hypotonic solution such as glycine or sorbitol. The prostatic venous sinuses are opened during resection, which allows for the systemic absorption of large volumes of this irrigating fluid. This rapid intravascular volume expansion leads to a specific cascade of problems:
- Dilutional Hyponatremia: The excess water dilutes the serum sodium concentration. A rapid drop in sodium is the hallmark of TUR syndrome.
- Fluid Overload: The sudden increase in intravascular volume can precipitate pulmonary edema and congestive heart failure, especially in an older adult with potentially compromised cardiac function.
- Cerebral Edema: The acute hyponatremia creates an osmotic gradient that shifts water into brain cells, leading to increased intracranial pressure. This manifests as restlessness, confusion, nausea, vomiting, visual disturbances, and can progress to seizures and coma.
A recent randomized clinical trial specifically investigated this risk, confirming that monopolar TURP carries a significant risk of TUR syndrome leading to hyponatremia and fluid overload [2]. The study evaluated the use of prophylactic furosemide to mitigate this risk, underscoring that fluid and electrolyte shifts are the primary physiological threats of the procedure [2].
Why This Is the Preoperative Priority
The preoperative assessment establishes the baseline for the patient. For a 72-year-old, the nurse’s focus must be on identifying pre-existing risk factors that could be exacerbated by TUR syndrome. These include:
- Baseline Hyponatremia: A patient starting with a low-normal sodium level is at extreme risk for a critical drop during surgery.
- Pre-existing Fluid Imbalance: Dehydration or recent fluid restrictions must be identified.
- Renal or Cardiac History: These conditions impair the body’s ability to handle a sudden fluid challenge.
By ensuring the patient is well-hydrated with isotonic fluids preoperatively and that their baseline serum electrolytes, particularly sodium, are documented, the nurse provides the surgical and anesthesia teams with critical data to guide intraoperative fluid management and monitoring. This proactive step is the most direct nursing action to prevent the onset of TUR syndrome.
Analysis of Other Options
- Option 1 (Administer prophylactic antibiotics): While preventing infection is a standard surgical precaution, it is not the most critical concern specific to the physiological mechanism of TURP. The provided evidence focuses on TUR syndrome as the significant complication [2], and other studies on TURP nursing care do not prioritize antibiotic administration as the primary outcome [3, 4].
- Option 3 (Teach deep breathing and coughing exercises): This is a universal postoperative intervention to prevent atelectasis and pneumonia. It is important but secondary to the immediate, life-threatening risk of TUR syndrome caused by massive fluid shifts.
- Option 4 (Apply sequential compression devices): This prevents deep vein thrombosis, a risk in any pelvic surgery. However, a recent randomized controlled trial on TURP nursing care identified external catheter fixation, not thrombosis prevention, as a key area of investigation for value-based care . This suggests thrombosis is not the most unique or highest-priority complication linked to the procedure itself, unlike the electrolyte and fluid disturbances of TUR syndrome [2].
References (research sources)
[2]
Prophylactic Intravenous Furosemide for Reducing Hyponatremia Risk in Monopolar Transurethral Prostate Surgery: A Randomized Clinical Trial.RCT/clinical trialGholipour F, Bahrami Samani H, Assadi A, Behnamfar A, Nazarpour M, Saberi N. (2025) · DOI: 10.30476/ijms.2025.105024.3860
Clinical Practice Guide: Preoperative Care for TURP
A 72-year-old male with BPH is scheduled for TURP. The priority nursing intervention is ensuring adequate hydration and monitoring electrolyte balance to prevent TUR syndrome.
Nursing Assessment
Obtain baseline vital signs, weight, and complete metabolic panel with specific attention to serum sodium and osmolality.
Assess cardiovascular and pulmonary status, noting any signs of pre-existing fluid overload (e.g., edema, crackles, JVD).
Evaluate baseline mental status to detect subtle changes postoperatively indicative of cerebral edema.
Review medication list for diuretics or antihypertensives that may influence fluid balance.
Key Interventions
Ensure the patient is well-hydrated preoperatively to optimize renal function and baseline electrolyte status.
Establish and document a precise baseline weight and electrolyte panel on the day of surgery for comparison.
Educate the patient and family about early signs of TUR syndrome to report: restlessness, confusion, nausea, or visual changes.
Collaborate with the surgical team to confirm the type of TURP (monopolar vs. bipolar) to anticipate risk level.
Postoperative Monitoring for TUR Syndrome
Monitor for cardiovascular signs: hypertension, bradycardia, and signs of pulmonary edema (dyspnea, crackles).
Monitor for neurological signs: acute confusion, agitation, seizure, or visual disturbances.
Closely track intake and output; a mismatch may indicate ongoing irrigant absorption.
Report any drop in serum sodium or onset of symptoms immediately; treatment may include fluid restriction and hypertonic saline.
Clinical Pearls
TUR syndrome typically manifests within the first 24 hours postoperatively when large volumes of hypotonic irrigant are absorbed.
Bipolar TURP uses normal saline for irrigation, drastically reducing the risk of dilutional hyponatremia.
Preoperative hydration is a modifiable risk factor; dehydration concentrates serum sodium, making a dilutional drop more dangerous.
TUR syndrome — A complication of monopolar TURP caused by systemic absorption of hypotonic irrigating fluid, leading to dilutional hyponatremia, fluid overload, and cerebral edema.
Dilutional hyponatremia — A decrease in serum sodium concentration resulting from an excess of water in the intravascular space, a hallmark of TUR syndrome.
Transurethral resection of the prostate (TURP) — A surgical procedure to remove prostate tissue through the urethra using a resectoscope, commonly performed for benign prostatic hyperplasia.
Monopolar TURP — A type of TURP using an electric current that requires a non-conductive, hypotonic irrigating fluid like glycine, which carries a higher risk of TUR syndrome.