A nurse is instructing coworkers about how to minimize lower back pain and avoid repeated episodes of back pain.

Which of the following strategies should the nurse include? (Select all that apply.)

Choice A rationale

An elevated Hct (normal ≈ 36%-50%), elevated BUN (normal 8-20 mg/dL), and high urine specific gravity (normal 1.005-1.030) are all indicative of volume depletion or dehydration. Monitoring intake and output precisely quantifies the fluid balance, which is crucial for determining the degree of deficit and evaluating the effectiveness of rehydration therapy.

Choice B rationale

The client's confusion and weakness are potential symptoms of dehydration, as reduced intravascular volume can impair cerebral perfusion and electrolyte imbalances can disrupt nerve and muscle function. Regularly checking orientation provides an essential ongoing assessment of the client's neurological status and the effectiveness of fluid replacement.

Choice C rationale

The client's lab values and symptoms strongly suggest dehydration, which requires increased fluid intake, not restriction. Fluid restriction would exacerbate the existing hypovolemia, further worsening the elevated Hct, BUN, and specific gravity, potentially leading to renal compromise and worsening confusion.

Choice D rationale

Dehydration often leads to orthostatic hypotension due to reduced circulating blood volume. Instructing the client to sit briefly before standing allows time for baroreceptor reflexes to compensate for the positional change, preventing a sudden drop in blood pressure and minimizing the risk of a fall.

Choice E rationale

Daily weights provide a highly sensitive and objective measure of fluid status changes. A rapid change in body weight, especially in the context of dehydration and hypovolemia, directly reflects the magnitude of fluid loss or gain, making it a critical parameter for monitoring the effectiveness of interventions.

Choice A rationale

Offering oral fluids increases the overall fluid load, which is generally helpful for increasing urinary output and flushing the urinary tract; however, the client is currently experiencing zero urinary output with continuous bladder irrigation (CBI). Before adding more fluid, the immediate priority is to ensure the outflow tract is clear; otherwise, the fluid will back up into the bladder, causing distention and pain.

Choice B rationale

Notifying the provider is a necessary step if the immediate measures to restore patency fail. A period of anuria post-TURP with CBI suggests a possible clot obstruction that could lead to severe bladder distention, pain, and potential bladder rupture. However, the nurse must first independently assess and attempt to correct the most common cause (occlusion) before escalation.

Choice C rationale

Administering an analgesic may temporarily alleviate pain associated with bladder spasms or distention caused by an occluded catheter. However, addressing the underlying mechanical problem (lack of output/obstruction) is the primary concern, as pain is a symptom of the blockage, not the cause. Restoring patency prevents complications and is the immediate priority.

Choice D rationale

The absence of urinary output with continuous bladder irrigation (CBI) strongly suggests the 3-way catheter is occluded, most likely by a blood clot or tissue fragments following the TURP. The first action is to determine patency by checking for kinks and attempting to gently manually irrigate the catheter using an aseptic technique and 30-50 mL of sterile normal saline solution per protocol to dislodge the obstruction.