After TURP, what is a major nursing consideration to prevent TURP syndrome and irrigation-related complications?

• A. Maintain catheter patency with continuous bladder irrigation
• B. Monitor for fever only
• C. Increase irrigation flow rate to prevent clots
• D. Monitor for hyponatremia from irrigation fluid

Answer: (D)

Absorption of irrigation fluid during TURP can trigger TURP syndrome, so the major nursing focus is watching for hyponatremia caused by that absorbed irrigation. If a hypotonic irrigation solution enters the systemic circulation, it dilutes plasma sodium and can lead to neurologic symptoms such as confusion, agitation, headache, nausea, and, in severe cases, seizures or coma, along with signs of fluid overload like hypertension and tachycardia. Because of this, priorities include frequent assessment of mental status, monitoring of serum sodium and overall fluid balance, and vigilance for early signs of electrolyte disturbance. Adjusting irrigation as needed and communicating any neurologic changes promptly are critical. While keeping the catheter patent and avoiding clotting is important for urinary drainage, those actions do not address the systemic risk of hyponatremia from irrigation fluid, which is why this measure is the most important after TURP.