6/11/13
NUR202

Answer the following three questions (3.30 points)

The purpose of the procedure
2 nursing priorities
1 complication 1. What is a TURP?
A TURP, other wise known as a transurethral resection of the prostate, is type of prostate surgery done to relieve moderate to severe urinary retention symptoms caused by an enlarged/swollen prostate. The physician essentially trims away part of the prostate to relieve the blocked urine flow. In layman’s terms (however it doesn’t sound so appealing) one could think of this as a “rotorouter” which corrects the block! RN diagnoses would be:

1. Acute pain r/t procedure aeb the patient stating he is in pain 2. Risk for TURP syndrome related to invasive procedure 3. Risk for hemorrhage related to invasive procedure

Two RN priorities would include monitoring the patient for pain and preventing and monitoring for hemorrhage and TURP syndrome, which is the most serious complication of a TURP. Abnormal vascular absorption of irrigation fluid during surgery causes severe hyponatremia and hypervolemia. So the RN must assess for: dramatic increase in BP, bounding pulses, bradycardia, tachypnea, and altered mental status. The RN must also monitor for bleeding related to the invasive procedure since hemorrhage is the most common complication. To monitor for hemorrhage the RN can assess vital signs (mostly pulse, bp) every four hours, assess urinary output for color, consistency, and amount, and remind the patient to lay flat.

2. What is Hemodialysis?

Hemodialysis is the most common way to treat end stage renal failure. During hemodialysis a machine filters wastes, salts and fluid from your blood (through a “fistula” which is usually located in your arm – referred to as an AV fistula, or ateriovenous) when your kidneys are no longer healthy enough to do this work adequately. Hemodialysis is the most common way to treat advanced kidney failure. Hemodialysis consists of an extremely strict schedule accounting for about 3 or 4 days a week out of 7. The hemodialysis machine does several things; it pumps blood and monitors the flow for safety, clean wastes from blood, and monitors blood pressure and the rate of fluid removal from the body. RN diagnoses would be: 1. Risk for fluid volume excess r/t rapid fluid volume intake 2. Risk for hypotension

During hemodialysis the RN must monitor the patients blood pressure, SpO2, and pulse, lung sounds, I/O, and edema. The RN must also monitor the fistula site to ensure patency and to ensure there is no infiltration during the dialysis. One complication of hemodialysis is hemolysis. Hemolysis may result from a number of biochemical and toxic insults during the dialysis procedure. The half-life of red blood cells in renal failure patients is less than healthy patients and the cells are more susceptible to injury.

What is Peritoneal Dialysis?

Peritoneal dialysis is another way to remove waste products from your blood when your kidneys can no longer do the job efficiently. During peritoneal dialysis, blood vessels in the abdominal lining, peritoneum fill in for the kidneys, via a fluid (dialysate) that flows into and out of the peritoneal space.
With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling. Patients may are able to use fewer medications and eat a less restrictive diet than with hemodialysis. However, not everyone is a candidate for peritoneal dialysis. RN diagnosis would be:

1. Ready for enhanced learning related to catheter care and peritoneal dialysis 2. Risk for fluid volume overload related to excess fluid in the body 3. Altered body image related to catheter in abdomen

Since peritoneal dialysis is done mostly at home, it is important for RNs to educate patients about the responsibility related to peritoneal dialysis and it’s potential complications such as discomfort, poor drainage, catheter displacement, leaks, dehydration, fluid volume overload. RNs need to ensure that the patients understand how peritoneal dialysis works and how to take care of the catheter. A common complication of peritoneal dialysis is peritonitis, an infection of the peritoneum, usually caused by bacteria entering through the catheter. This can happen when patients touch the open ends of the connections between the bag of dialysis fluid and the catheter. Sometimes, even though everything is kept clean, an infection can get into the abdomen anyways. The chances of getting peritonitis are greatly reduced by following correct dialysis exchange procedures. Another complication of peritoneal dialysis is leaking catheters – these can be fixed by replacing the catheter but the patient must be aware of the condition of his or her catheter at all times.

Reference Page

Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.