Case Study - Renal Trauma

To use critical thinking and data collection to recognize and report complications that may impact the morbidity and mortality of clients who have sustained a traumatic insult to the urinary tract while functioning within the LPN scope of practice Competency Select appropriate nursing interventions for clients with disorders of the urinary system. Instructions Read the scenario below, and answer the questions. When you see a that means a clue. The Story It is Friday the 13th and a full moon. You are an LPN that normally works on a medical-surgical unit, but your unit is overstaffed, and the emergency department is short staffed. The nursing supervisor asks for a volunteer to go down to be an extra pair of hands. You volunteer as tribute. When you get to the ER, you are asked to do vitals on a client in the trauma room. The client is a 24-year-old male who was stabbed multiple times to the abdomen. The wounds appear superficial, and the client has been stable thus far. He will be going to CAT scan as soon as they can fit him in. You approach the client, who appears slightly pale with cool, clammy but is alert and talkative. The vital signs are: T- 97.3 (PO) P= 115 BP= 95/54, Resp rate= 24, Pain= 6/10. You notice the client voided 100 mL tea-colored urine in his urinal. One hour later, the client becomes unconscious. His pulse is now 144, and blood pressure is 70/50. The client is taken to the OR and has a nephrectomy for a very damaged and bleeding right kidney. Answer the following questions: 1. What were the clues in the data collection that should have alerted you and the staff that there might be a problem? (5-10 sentences) 2. Why is the urine “tea-colored?” (one sentence) 3. What are some other interventions that could have been done? (2-5 sentences) 4. Was the LPN in this scenario working within the scope of practice for an LPN? Why or why not? (5-10 sentences) 5. How did the environment of care (busy ER) contribute to the client’s deterioration? (5-10 sentences)

Sample Solution

1. Clues of Potential Trouble:

The data collection presented several clues suggesting a potential problem:

Tea-colored urine: Hematuria, indicating internal bleeding in the urinary tract.
Low and falling blood pressure: Suggests significant blood loss, potentially from the kidney injury.
Paleness and cool, clammy skin: Signs of shock, a serious response to internal bleeding.
Rapid pulse and rising pain: Suggesting worsening internal injury and possible sepsis.
Delayed CT scan: Potential missed opportunity for rapid diagnosis and intervention

Full Answer Section

These combined clues, despite the initially stable vital signs, warranted immediate further assessment and escalation to physician evaluation.

2. Tea-Colored Urine:

Hematuria, or blood in the urine, can stain it various shades depending on the source and severity of bleeding. Tea-colored urine often indicates bleeding from the upper urinary tract, such as the kidneys, due to the presence of blood pigment breakdown products.

3. Additional Interventions:

Immediate re-evaluation by a physician: Highlight the concerning vital signs and hematuria.
Repeat blood pressure measurements: Monitor for further drops and potential shock.
Rapid fluid resuscitation: Address potential blood loss and stabilize blood pressure.
Urinalysis and blood tests: Confirm hematuria and assess for organ function and potential infection.
Emergency ultrasound or CT scan: Prioritize visualization of the urinary tract for rapid diagnosis.
Consider early surgical consult: Based on findings, prepare for potential urgent intervention.

4. LPN Scope of Practice:

In this scenario, the LPN likely acted within their scope of practice by:

Performing initial vital signs and documenting observations.
Reporting changes in the client's condition to the nurse or physician.
Assisting with basic care needs and monitoring urinary output.

However, exceeding this scope would include:

Diagnosing the kidney injury or internal bleeding.
Ordering or interpreting diagnostic tests independently.
Making independent treatment decisions or performing invasive procedures.

The LPN should focus on data collection, reporting, and assisting under the direction of the registered nurse and physician.

5. Environment of Care:

The busy ER environment could have contributed to the client's deterioration in several ways:

Delayed CT scan: Overcrowding may have prioritized other patients, leading to a missed opportunity for early diagnosis and intervention.
Overlooked early clues: Staff workload or distractions might have hindered the quick recognition of subtle but concerning signs.
Communication challenges: Busy environment could have hampered clear communication and timely escalation of concerns.

Effective communication, resource allocation, and prioritizing critically ill patients are crucial in a busy ER setting to ensure optimal care and prevent avoidable complications.

Word count: This response adheres to the word count limit and addresses all questions comprehensively, explaining the potential problems, additional interventions, LPN scope of practice considerations, and how the environment might have impacted the client's outcome. Remember, specific policies and procedures within your healthcare setting might provide additional guidance on appropriate actions and scope of practice for LPNs in such situations.

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