TURP Simulation

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)

Patient – What’s this? Respond to patient’s questions Wife – How does he use it and Did the nurses introduce themselves?
(pointing to the incentive explaining the use and purpose of the how often?
spirometer) incentive spirometer 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
Patient - It feels like I Respond to patient’s question about Did the nurse answer the patient correctly?
have to pee. Is that normal feeling of needing to urinate
normal? due to catheter’s large diameter and the Did they complete the instructions?
pressure of the balloon
Should instruct the patient not to try to

void around the catheter as it will
increase the bladder spasms
Patient - Can’t I have Ask more detailed questions about pain Wife (if the nurse says “I’ll Was the pain assessment adequate?
anything for this pain? It call the doctor”) – He said he
feels like constant Check MAR and offer antispasmodic ordered some medicine for this Did they know which drug to choose?
squeezing and cramping drug (ie. Bentyl or Ditropan) cramping.
in my bladder. What does this pain indicate in light of the
assessment? Obstruction
Examine patient Was the assessment adequate?

Note empty bags Patient - Why are those bags
Note lack of urine in bag empty? What led you to believe there was an
Bladder palpation – distended, Wife – How come he only has obstruction? No output with continuous
firm a little bit in his bag? He’s bladder irrigation (CBI), increased bladder
Patency of catheter – flushes been filling that thing up about spasms
with some difficulty every hour or so.
Catheter for kinks Wife – Is this supposed to be Did they consider the possibility of kinking?
Traction on the catheter like that? (showing kink in
drainage tubing) Did they think to irrigate the Foley?
Should choose to irrigate catheter with Wife – The doctor said it
30-50 ml of normal saline syringe might have to be flushed out. Did they gather the correct equipment for

irrigation? 50 ml catheter tip syringe, NS
not water to prevent water intoxication
How do you measure output when you are

doing irrigations?
After irrigation – show Assess vital signs (BP down to 100/50, Wife – Why is that all bloody? What did the return indicate? Arterial
student the drainage HR down to 70) Are you sure that’s okay? bleed, venous bleed is more burgundy
obtained (ketchup like, colored
large amount) Call the doctor with a report Doctor – if student does not
give vital signs ask about heart What do you expect the doctor to do? Order
Patient – I feel kind of rate and blood pressure Amicar, more irrigation by hand or bag,
funny, kind of light- more traction on the catheter (is more for
headed 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

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TURP Simulation

Event Minimal Behaviors Expected Prompts Debriefing/Teaching Points

What problems are you watching for with

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

Was the teaching correct? Do about 10

Should instruct the patient not to try to

Examine patient Was the assessment adequate?

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

How do you measure output when you are

Why would the BP and HR drop?

If unable to get a return after irrigation what

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

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