John Wong is an 80 year old male of Chinese origin medical history includes hypothyroidism and osteoporosis and he smokes 10 cigarettes per day

John Wong is an 80 year old male of Chinese origin. John’s medical history includes hypothyroidism and osteoporosis and he smokes 10 cigarettes per day. His gait has recently been increasingly unstable and he has difficulty with simple tasks, such as getting up his house stairs and getting up from chairs.

In the last 4 weeks, he has noticed that he has been having difficulty passing urine and some abdominal discomfort. His GP referred him to a urologist and a prostate biopsy was taken. This showed BPH (benign prostate hyperplasia) and it was recommended that he undergo a Transurethral Resection of the Prostate (TURP).

While conducting John’s pre-admission assessment it is noted that John is slightly hypertensive and is fidgeting and moving around the waiting room. After some education John states that he is pleased to have the surgery as he hopes it will relieve some of the discomfort he has been experiencing. John tells the nurse that he currently lives alone.
John’s surgery is uneventful during the intra-operative stage. On arrival to PACU John is placed in a supine position. He is drowsy and restless and oxygenated through a facemask on 02 at 5l/min. A wheeze and non-productive cough is noted. John has an IDC insitu with continuous bladder irrigation with output noted to be a reddish pink.

A number of blankets are placed on top of him as he is shivering. His observations are T 36.5c, HR 90, RR 30, BP 150/90 and SpO2 91%. John is transferred to the surgical ward after a 65 minute stay in PACU. John remains drowsy but easily rousable. He is oxygenated via intra-nasal cannulae at 2l/min and he states his pain is 3/10. He has 0.9% sodium chloride infusion running at 125ml/hr. Postoperative orders include IVF, analgesia (PRN Endone, 5mg 6hrly and Paracetamol, 1g 4-6hourly), strict FBC and continuous bladder irrigation for 24 hours, with an aim of rose
urine output.
Four hours after John’s return to the ward he is observed to be in pain and distressed. He is diaphoretic and restless and states that his bladder feels full and he feels the urgent help

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