TURP Simulation

Objectives:
Thoroughly and appropriately perform a focused assessment on a post-operative TURP patient.
Promptly recognize and appropriately respond to assessment changes in a post-operative TURP patient.
Identify and discuss causes and treatments for possible complications in the post-operative TURP patient.

Roles/Students Needed
2 students (give phone to one student)
1 family member

Equipment/supplies needed
Room 131
Nursing Anne or Sim Man (must be male) with saline lock to right hand
2 empty irrigation bags on IV pole
200 ml pale pink urine in bag
3 way Foley catheter (should be pulled taut and taped to abdomen or thigh), kink in drainage tubing
2nd urine bag with ketchup (also add black cherry jello) clots throughout – 1500 ml (keep under the bed covered)
MAR with Bentyl or Ditropan as needed for bladder spasms, order to irrigate for decreased output, order to adjust rate of normal saline bladder
irrigation to keep output clear and free of clots
Incentive spirometer
1st vital signs – 80, 128/82
2nd vital signs – 70, 100/50

Report:
70 year old man (Jodi Haskell) returned 3 hours ago from a TURP. He received epidural anesthesia for the surgery. He is receiving continuous
bladder irrigation with normal saline. I hung 2000 ml of saline about an hour ago. At that time he had 1000 ml in and 1000 ml of pink urine out. He
had some clots in the bag when he first came back from surgery, but it has cleared considerably. His vital signs have been stable with a HR of 80 and
a blood pressure of 128/82. He’s not had any pain since he came back from the OR. His wife is with him. He’s a real sweet little guy.

Event Minimal Behaviors Expected Prompts Debriefing/Teaching Points

Report – see above Take notes Any concerns with the report? Did it all
Ask questions sound normal?

What problems are you watching for with

all TURPs?

Developed by Megan McClintock, RN, MS - McClintock Consulting LLC (www.mtmconsult.me)

 Event
Patient – What’s this?
(pointing to the incentive
spirometer)
Patient - It feels like I
have to pee. Is that
normal?
Patient - Can’t I have
anything for this pain? It
feels like constant
squeezing and cramping
in my bladder.
Developed by Megan McClintock, RN, MS - McClintock Consulting LLC (www.mtmconsult.me)
Minimal Behaviors Expected
Respond to patient’s questions
explaining the use and purpose of the
incentive spirometer
Respond to patient’s question about
normal feeling of needing to urinate
due to catheter’s large diameter and the
pressure of the balloon
Should instruct the patient not to try to
void around the catheter as it will
increase the bladder spasms
Ask more detailed questions about pain
Check MAR and offer antispasmodic
drug (ie. Bentyl or Ditropan)
Examine patient
Note empty bags
Note lack of urine in bag
Bladder palpation – distended,
firm
Patency of catheter – flushes
with some difficulty
Catheter for kinks
Traction on the catheter
Should choose to irrigate catheter with
30-50 ml of normal saline syringe
Prompts
Wife – How does he use it and
how often?
Wife (if the nurse says “I’ll
call the doctor”) – He said he
ordered some medicine for this
cramping.
Patient - Why are those bags
empty?
Wife – How come he only has
a little bit in his bag? He’s
been filling that thing up about
every hour or so.
Wife – Is this supposed to be
like that? (showing kink in
drainage tubing)
Wife – The doctor said it
might have to be flushed out.
Debriefing/Teaching Points
Did the nurses introduce themselves?
When should this teaching have been done?
Before surgery
Was the teaching correct? Do about 10
times every 1-2 hours while awake, prevents
pneumonia, take a deep breath in and hold it
as long as possible
Did the nurse answer the patient correctly?
Did they complete the instructions?
Was the pain assessment adequate?
Did they know which drug to choose?
What does this pain indicate in light of the
assessment? Obstruction
Was the assessment adequate?
What led you to believe there was an
obstruction? No output with continuous
bladder irrigation (CBI), increased bladder
spasms
Did they consider the possibility of kinking?
Did they think to irrigate the Foley?
Did they gather the correct equipment for
 Event
After irrigation – show
student the drainage
obtained (ketchup like,
large amount)
Patient – I feel kind of
funny, kind of light-
headed
Developed by Megan McClintock, RN, MS - McClintock Consulting LLC (www.mtmconsult.me)
Minimal Behaviors Expected
Assess vital signs (BP down to 100/50, Wife – Why is that all bloody?
HR down to 70)
Call the doctor with a report
Prompts
Are you sure that’s okay?
Doctor – if student does not
give vital signs ask about heart
rate and blood pressure
Debriefing/Teaching Points
irrigation? 50 ml catheter tip syringe, NS
not water to prevent water intoxication
How do you measure output when you are
doing irrigations?
What did the return indicate? Arterial
bleed, venous bleed is more burgundy
colored
What do you expect the doctor to do? Order
Amicar, more irrigation by hand or bag,
more traction on the catheter (is more for
venous bleeding), may have to go back to
OR
Why would the BP and HR drop?
Overstretched bladder could result in a
vasovagal response when pressure is
relieved
If unable to get a return after irrigation what
needs to be done? Call the surgeon, catheter
could need to be replaced increasing risk of
bleeding and infection