Bladder Trauma: Etiology, Pathophysiology, and Management

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11/21/2024
Dr: Nagwa M., Ahmed
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BLADDER
TRAUMA
 
11/21/2024
Dr: Nagwa M., Ahmed
Learning Objectives:
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Identify  Bladder trauma condition
 Understand key elements of Bladder trauma (etiology, pathophysiology and clinical
presentation)
Identify diagnostic evaluation and management
Identify nursing diagnosis for
 Bladder trauma
11/21/2024
Dr: Nagwa M., Ahmed
11/21/2024
Dr: Nagwa M., Ahmed
Bladder trauma
Injuries to the bladder commonly occur along with pelvic trauma or may be due to
surgical interventions.
Injuries of the urinary bladder are caused by blunt or penetrating trauma.
11/21/2024
Dr: Nagwa M., Ahmed
ETIOLOGY
Injuries to the bladder is commonly associated with
pelvic fractures and multiple trauma.
Certain surgical procedures (endoscopic urologic
procedures, gynecologic surgery, caesarian section,
surgery of the lower colon and rectum) also carry a
risk of trauma to the bladder.
11/21/2024
Dr: Nagwa M., Ahmed
PATOPHYSIOLOGY
Bladder injuries are classified as follows:
    a. Contusion of bladder
    b. Intraperitoneal rupture.
    c. Extra peritoneal rupture.
    d. Combination   intraperitoneal and extraperitoneal bladder
rupture
11/21/2024
Dr: Nagwa M., Ahmed
Intraperitoneal bladder Rupture
rupture occurs   when the bladder is full of urine and
the lower  abdomen sustains blunt trauma. The
bladder ruptures as its weakest point, the dome.
Urine and blood extravasates in to the peritoneal
cavity.
Extraperitoneal bladder Rupture
rupture occurs when the lower bladder is perforated by
a bony fragment during pelvic fracture / with a sharp
instrument during surgery. Urine and blood
extravasate in to the pelvic cavity.
11/21/2024
Dr: Nagwa M., Ahmed
CLINICAL MANIFESTATIONS
 Inability to void
 Hematuria; presence of blood at urinary meatus
 Suprapubic pain and tenderness
 Rigid abdomen – indicates intraperitoneal rupture.
11/21/2024
Dr: Nagwa M., Ahmed
DIAGNOSTIC EVALUATION
 
Cystogram 
– to detect and localize perforation / rupture of
bladder
 
Plain film of abdomen 
– may show associated pelvic fracture
11/21/2024
Dr: Nagwa M., Ahmed
MANAGEMENT
 
Treatment instituted for shock and hemorrhage.
 Surgical intervention carried out for intraperitoneal bladder
rupture. Extravasated blood and urine will first be drained and
urine diverted with suprapubic cystostomy / indwelling
catheter.
Small extraperitoneal bladder ruptures will heal spontaneously
with indwelling suprapubic / urethral catheter drainage.
Large extraperitoneal bladder ruptures are repaired surgically  
11/21/2024
Dr: Nagwa M., Ahmed
NURSING DIAGNOSES
 Risk for Deficient Fluid Volume related to trauma and resulting
hemorrhage.
 Impaired Urinary Elimination related to disruption of intact lower
urinary tract.
 Acute pain related to traumatic injury.
 Fear related to traumatic injury and uncertain prognosis.
11/21/2024
Dr: Nagwa M., Ahmed
NURSING INTERVENTIONS
Stabilizing Circulatory Volume
1.
Monitor vital signs and CVP frequently as
indicated by condition.
2.
 Establish IV access, and replace blood and fluids
as ordered.
11/21/2024
Dr: Nagwa M., Ahmed
Facilitating Urinary Elimination
1. Obtain urine specimen, if possible, and assess for degree of
hematuria and presence of  infection.
2. Prepare patient for surgical repair by assisting with
preoperative workup and describing postoperative
experiences.
3. Postoperatively, maintain patency and flow of indwelling
urinary catheters.
4. Inspect suprapubic incision and drains from perivesical
areas for bleeding, extravasation of urine, or signs of
infection.
11/21/2024
Dr: Nagwa M., Ahmed
Controlling Pain
1.
Administer analgesics as ordered (when pt’s vital signs are
stable).
2.
 Assess pt’s response to pain control medications.
3.
 Position for comfort (usually semi – fowler’s position) if
not contraindicated by other injuries, and prevent pulling of
catheter tubing.
11/21/2024
Dr: Nagwa M., Ahmed
Relieving Fear
1.
Provide information to the conscious pt throughout the
stabilization and evaluation phase; prepare for surgery if
impending.
2.
 Keep pt’s family / significant others informed of condition
and progress.
3.
 Provide information on long term outcome of  treatment.
11/21/2024
Dr: Nagwa M., Ahmed
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Bladder trauma commonly occurs due to pelvic trauma or surgical interventions, leading to injuries like contusion, intraperitoneal rupture, and extraperitoneal rupture. Dr. Nagwa M. Ahmed presents key elements of bladder trauma, including its etiology, pathophysiology, clinical presentation, diagnostic evaluation, and nursing diagnosis. Learn to identify and manage bladder trauma conditions effectively.


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  1. BLADDER TRAUMA C ritical C are N ursing L evel 8 , A cademic Y ear (A Y ) 2 01 7 C ritical C are N ursing L evel 8 , A cademic Y ear (A Y ) 2 01 7 - -2 01 8 2 01 8 11/21/2024 Dr: Nagwa M., Ahmed

  2. BLADDER TRAUMA 11/21/2024 Dr: Nagwa M., Ahmed

  3. Learning Objectives: At the end of this lecture the students will be able to : Identify Bladder trauma condition Understand key elements of Bladder trauma (etiology, pathophysiology and clinical presentation) Identify diagnostic evaluation and management Identify nursing diagnosis for Bladder trauma 11/21/2024 Dr: Nagwa M., Ahmed

  4. 11/21/2024 Dr: Nagwa M., Ahmed

  5. Bladder trauma Injuries to the bladder commonly occur along with pelvic trauma or may be due to surgical interventions. Injuries of the urinary bladder are caused by blunt or penetrating trauma. 11/21/2024 Dr: Nagwa M., Ahmed

  6. ETIOLOGY ETIOLOGY Injuries to the bladder is commonly associated with pelvic fractures and multiple trauma. Certain surgical procedures (endoscopic urologic procedures, gynecologic surgery, caesarian section, surgery of the lower colon and rectum) also carry a risk of trauma to the bladder. 11/21/2024 Dr: Nagwa M., Ahmed

  7. PATOPHYSIOLOGY PATOPHYSIOLOGY Bladder injuries are classified as follows: Bladder injuries are classified as follows: a. Contusion of bladder b. Intraperitoneal rupture. c. Extra peritoneal rupture. d. Combination intraperitoneal and extraperitoneal bladder rupture 11/21/2024 Dr: Nagwa M., Ahmed

  8. Intraperitoneal bladder Rupture Intraperitoneal bladder Rupture rupture occurs when the bladder is full of urine and the lower abdomen sustains blunt trauma. The bladder ruptures as its weakest point, the dome. Urine and blood extravasates in to the peritoneal cavity. Extraperitoneal Extraperitoneal bladder bladder Rupture Rupture rupture occurs when the lower bladder is perforated by a bony fragment during pelvic fracture / with a sharp instrument during surgery. Urine and blood extravasate in to the pelvic cavity. 11/21/2024 Dr: Nagwa M., Ahmed

  9. CLINICAL MANIFESTATIONS CLINICAL MANIFESTATIONS Inability to void Hematuria; presence of blood at urinary meatus Suprapubic pain and tenderness Rigid abdomen indicates intraperitoneal rupture. 11/21/2024 Dr: Nagwa M., Ahmed

  10. DIAGNOSTIC EVALUATION DIAGNOSTIC EVALUATION Cystogram Cystogram to detect and localize perforation / rupture of bladder Plain film of abdomen Plain film of abdomen may show associated pelvic fracture 11/21/2024 Dr: Nagwa M., Ahmed

  11. MANAGEMENT MANAGEMENT Treatment instituted for shock and hemorrhage. Surgical intervention carried out for intraperitoneal bladder rupture. Extravasated blood and urine will first be drained and urine diverted with suprapubic cystostomy / indwelling catheter. Small extraperitoneal bladder ruptures will heal spontaneously with indwelling suprapubic / urethral catheter drainage. Large extraperitoneal bladder ruptures are repaired surgically 11/21/2024 Dr: Nagwa M., Ahmed

  12. NURSING DIAGNOSES Risk for Deficient Fluid Volume related to trauma and resulting hemorrhage. Impaired Urinary Elimination related to disruption of intact lower urinary tract. Acute pain related to traumatic injury. Fear related to traumatic injury and uncertain prognosis. 11/21/2024 Dr: Nagwa M., Ahmed

  13. NURSING INTERVENTIONS Stabilizing Stabilizing Circulatory Circulatory Volume Volume 1. Monitor vital signs and CVP frequently as indicated by condition. 2. Establish IV access, and replace blood and fluids as ordered. 11/21/2024 Dr: Nagwa M., Ahmed

  14. Facilitating Facilitating Urinary Elimination Urinary Elimination 1. Obtain urine specimen, if possible, and assess for degree of hematuria and presence of infection. 2. Prepare patient for surgical repair by assisting with preoperative workup and describing postoperative experiences. 3. Postoperatively, maintain patency and flow of indwelling urinary catheters. 4. Inspect suprapubic incision and drains from perivesical areas for bleeding, extravasation of urine, or signs of infection. 11/21/2024 Dr: Nagwa M., Ahmed

  15. Controlling Controlling Pain 1. Administer analgesics as ordered (when pt s vital signs are stable). 2. Assess pt s response to pain control medications. 3. Position for comfort (usually semi fowler s position) if not contraindicated by other injuries, and prevent pulling of catheter tubing. Pain 11/21/2024 Dr: Nagwa M., Ahmed

  16. Relieving Relieving Fear 1. Provide information to the conscious pt throughout the stabilization and evaluation phase; prepare for surgery if impending. 2. Keep pt s family / significant others informed of condition and progress. 3. Provide information on long term outcome of treatment. Fear 11/21/2024 Dr: Nagwa M., Ahmed

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