護理師照護一位經尿道攝護腺切除術後行連續膀胱沖洗的病人，哪些發現需要立即介入？（選所有適合的）
A nurse is caring for a client with a continuous bladder irrigation (CBI) following a transurethral resection of the prostate (TURP). Which findings require immediate intervention? (Select all that apply.)
- ABright red, viscous drainage with clots✓ 正解鮮紅色且黏稠並帶有血塊的引流液
- BThe client reports a feeling of bladder fullness✓ 正解病人主訴有膀胱脹滿感
- CThe color of the drainage is light pink引流液的顏色呈淡粉紅色
- DThe intake of the irrigation fluid is 500 mL and output is 100 mL✓ 正解沖洗液輸入量為 500 mL，輸出量為 100 mL
- EThe client reports mild suprapubic discomfort病人主訴輕微的恥骨上區不適
經尿道攝護腺切除術（TURP）術後行連續膀胱沖洗（CBI）的主要目的是預防血塊堵塞尿管。護理師需嚴格監測引流液顏色與量。若引流液變為鮮紅且黏稠（Indicating arterial bleeding），或引流量遠小於輸入量（Indicating obstruction），均顯示病人有術後出血或急性尿滯留風險，若不立即處理，血塊堆積會導致膀胱痙攣、穿孔，甚至造成低血容積休克。
Immediate intervention is required for bright red, viscous drainage with clots or a significant discrepancy between irrigation input and output, as these indicate arterial hemorrhage or catheter obstruction. A feeling of bladder fullness also suggests acute urinary retention due to blockage, which must be addressed promptly to prevent bladder damage or shock.
在美國臨床，TURP 術後 CBI 的監測權責極重，護理師需頻繁評估並依據 protocol 調節沖洗速度。台灣臨床亦然，但美國更強調護理師在發現阻塞時應具備「立即手動沖洗（Manual irrigation）」的技術，且若處理無效需即刻通知醫師。