Help with Clinical homework: about trauma patients

  1. Hi, we have a homework for our clinicals, and our instructor gave us this scenario and asked us to answer several questions: If there is a trauma patient who has not voided for almost 6-8 hours what would you do? What kind of medical emergency is this? what is this medical emergency called? some nursing interventions? Please help, i would really appreciate it. thanks you so much..
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  2. 14 Comments

  3. by   ERnurse:)
    Is that all of the information that you get?
    My first thoughts would be to that his blood volume is in his boots. Aside from all of the attention he should be getting for that, specific to the urine issue...insert a foley to measure output while giving him fluids. That being said, if he is really critical there are a lot of other things you need to tend to.

    hope that helps
    ernurse
  4. by   Tweety
    You're asking too many questions. It is not the job of Allnurses to do your assignment for you.

    What specific parts of this assignment are you having trouble with. Maybe we can help guide you. But to post your whole assignment and expect answers is asking a bit too much in my opinion.

    Good luck.
  5. by   augigi
    I agree, you need to do some of the critical thinking yourself

    Have a think about what you would think most trauma patients would come in with (eg. traumatic injuries) and think about what would most likely be their biggest problem initially. The answers are easy once you establish this.
  6. by   rn/writer
    Quote from Leng27
    Hi, we have a homework for our clinicals, and our instructor gave us this scenario and asked us to answer several questions: If there is a trauma patient who has not voided for almost 6-8 hours what would you do? What kind of medical emergency is this? what is this medical emergency called? some nursing interventions? Please help, i would really appreciate it. thanks you so much..
    Why don't you do some "thinking out loud" with these questions. Tell us what ideas come to mind and we'll let you know if you're on the right track. Working through the answers is what will give you a solid understanding of the pathophysiology at work. It will also sharpen your critical thinking skills.

    What would be your first reaction upon hearing in report that you were being given a trauma patient who had not voided in 6-8 hours? What kinds of evaluations might you think about doing? What kinds of information might you want to look up?
  7. by   Daytonite
    Hi, Leng27! Do you still have your anatomy and physiology book? Or, a good medical dictionary? Look up urine. Normal urine output should be 1000 to 1500 mL per 24 hours. In your nursing textbook(s) in the section under postoperative complications you should find something telling you that if a patient hasn't voided after about 8 hours you need to be concerned. The reason for that is due to the effects of drugs given during surgery. However, in the scenario you've been given the patient has had some trauma, or injury. What kind of injury is not given. So, when a patient hasn't voided and the clock is ticking you start thinking about why the urine isn't coming out of this patient. Is the pathway for the urine to come out blocked in some way? Are the patient's kidneys even making urine?

    Look up the definitions to these conditions: ischuria, oliguria

    http://kidney.niddk.nih.gov/kudiseas...s/yoururinary/ - Your urinary system and how it works
    http://www.nlm.nih.gov/medlineplus/e...cle/000507.htm - obstructive uropathy

    Just how do you get urine out of a bladder? You will find some independent (does not require a doctor's order) and collaborative (requiring a doctor's order) nursing interventions here. (Let me warn you that not all the nursing interventions listed on these sites are appropriate for the situation you've described, so you have to chose the ones that are.):
    http://www1.us.elsevierhealth.com/ME...ex.cfm?plan=57
    http://www1.us.elsevierhealth.com/Ev...replan_074.php

    Here are links to the catheterization procedure for males and females.
    http://teach.lanecc.edu/nursingskill...cathFemale.htm
    http://teach.lanecc.edu/nursingskills/cath/cathMale.htm
  8. by   Leng27RN,BSN
    Hi, I know what you guys are talking about. sorry if i posted those questions as if i want all of you to answer the question for me. I am doing some research already last week and i just want to know what your opinions are and know that i am going the right track. Thank you again. I'll post here my the final answer i found and i hope to hear your opinion if it is okay with you guys. Thanks again i really appreciate it.I apologize again for posting my questions in a wrong way.
  9. by   Daytonite
    there is no need for you to apologize. i always try to determine what a student is asking. if i think that the content is hard for them to grasp and just a nudge is needed then that is what i give. other times i can tell that the student doesn't have a clue as to which way to turn. i draw from my own learning experiences many years ago in deciding this. if i feel someone is truly looking for a nurse to do their homework for them i just don't respond to the thread. i try to do as my nursing instructors so many years ago did. that is, at the very least, point you toward the road you should be traveling down with maybe a few tidbits to chew on along the way. good luck with your assignment. see you here on the forums!
  10. by   Leng27RN,BSN
    Hi guys, the injury is spinal injury. Anyways, here is the answer I found. Please let me know if it is okay.When a person has spinal cord injury or trauma, the first response of the nervous system is spinal shock . During Spinal shock the person experiences flaccid paralysis below the level of injury and the somatic reflex can be either absent or depressed. The autonomic activity is also depressed and the person experiences urinary retention and also constipation. On this case, the urinary bladder must be drained with indwelling urethral catheter. I just want to know if i am on the right track thanx for all your help.
  11. by   Daytonite
    By, george! I think you've got it! Good work! You would also want to do a physical assessment of the person. If they are having a problem with urinary retention their bladder is going to start getting very full depending on whether there is any injury to the urinary track or how much fluid they had consumed in the day prior to the injury. They may not be able to tell that they have to pee--badly!--if there is neurological damage.
  12. by   Leng27RN,BSN
    There is one more thing, my classmates are thinking it is autonomic dysreflexia, because our intsructor is asking about a medical emergency that needs to be treated immediately? What do you guys think? Thanks.
  13. by   jax
    It's my understanding that autonomic dysreflexia becomes a possibility only after spinal shock has worn off, and some reflexes start to return, and usually only for a pt. with a T6 injury or above. However, this is from memory and I wouldn't take my word for it. Good luck
  14. by   NYNewGrad
    Quote from jax
    It's my understanding that autonomic dysreflexia becomes a possibility only after spinal shock has worn off, and some reflexes start to return, and usually only for a pt. with a T6 injury or above. However, this is from memory and I wouldn't take my word for it. Good luck

    Thats my understanding too. AD only occurs after the phase of spinal shock, in which reflexes return.
    Do you have any more background info on this pt? Vitals? How much time s/p injury? Other s/s?

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