1. PATHOPHYSIOLOGY: Closed surgical procedure in which rectoscope through the urethra and the enlarged protion of the prostate gland is resected in small pieces.
3. Impaired Urinary Elimination
   1. S/SX
      1. Three way urinary catheter
      2. Continuous Bladder Irrigation (CBI)
      3. Small blood clots and tissue debris present in urinary bag
   2. NIC
      1. Best Practices after transurethral resection of the prostate.
         1. Monitor for signs of infection.
            1. Older men undergoing prostate surgery often also have underlying chronic diseases (cardiovascular disease, chronic lung disease, diabetes).
         2. Assist with mobility promote out of the bed to the chair as soon as permitted to prevent complications of immobility.
            1. Older men may need assistance because of underlying changes in the musculoskeletal system, risk for falls.
         3. Assess the patient's pain every 2 to 4 hours
         4. Use normal saline solution for the bladder irrigant unless otherwise prescribed
         5. Monitor the color, consistency, and amount of urine output.
         6. Check the drainage tubing frequently for external obstructions and internal obstructions .
         7. Assess the patient for severe bladder spasms with decreased urinary output, can indicate obstruction.
            1. If urinary catheter is obstructed irrigate the catheter per agency or surgeon protocol
         8. Notify the physician immediately if the obstruction does not resolve by hand irrigation or if the urinary return becomes ketchup-like.
      2. Adjust CBI rate to maintain a colorless or light pink drainage return
      3. Monitor for postoperative bleeding.
      4. Monitor vital signs every 4 hours.
      5. Monitor urine output every 2 hours.
      6. Monitor lab values
4. ACUTE PAIN
   1. S/Sx
      1. Physical Symptoms
         1. Increased B/P, Pulse, Respirations
         2. Dilated pupils
         3. Sweating
         4. Withdrawal, restlessness, irritability
         5. Refuses PT, mobility exercises
         6. Guarding behavior
         7. Facial grimaces
         8. Complaint of pain
      2. Behavioral Symptoms
         1. restlessness
         2. inability to concentrate
         3. apprehension
         4. overall distress
   2. NIC
      1. Assess Pain
         1. Document using a standard behavioral pain assessment scale
         2. Precipitating factors
         3. Aggravating factors
         4. Localization of pain
         5. Character and quality of pain
            1. Use descriptions such as “ache,” “sore,” and “hurt,” rather than the word “pain.
         6. Duration of pain
      2. Assess patients prior experiences with pain and pain control
      3. Provide pain meds/re-evaluate
         1. Consider around-the-clock dosing of analgesics
         2. Beware of adverse effects of acetaminophen and NSAIDs
      4. Best Practices for Postop Pain Management Nonpharm Interventions
         1. Control or remove noxious stimuli
         2. Cushion and elevate painful areas; avoid tension or pressure on those areas
         3. Provide adequate rest to increase pain tolerance
         4. Encourage the patient's participation in diversional activities
            1. Relaxation
            2. Guided imagery
            3. Provide opportunities for meditation
            4. Instruct the patient in relaxation techniques; use audiotapes or CDs and breathing exercises
         5. Use ice to reduce and prevent swelling, as indicated
         6. Assist patient to find position of comfort
         7. Encourage patient to stimulate the area contralateral (opposite) to the painful area