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?

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.

Understanding the Rationale

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].