Nursing interventions for clients with disorders of the urinary system.

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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 to Potential Problems:

Several clues should have alerted the staff to a potential problem with the client, despite his initial stability:

  • Tea-colored urine: Though superficial wounds were observed, this suggests internal bleeding, likely involving the urinary tract.
  • Slight pallor and cool, clammy skin: These suggest internal blood loss affecting circulation.
  • Pain level of 6/10: While not alarmingly high, ongoing pain may indicate internal damage.
  • Decreased blood pressure: While initially within normal range, a one-hour drop from 95/54 to 70/50 signifies significant blood loss.
  • Elevated pulse (144): Tachycardia is a compensatory mechanism for blood loss, suggesting worsening internal bleeding.
  • Loss of consciousness: This is a critical red flag indicating potential hemorrhagic shock or other complications.

2. Tea-colored Urine:

The tea-colored appearance of the urine suggests the presence of blood (hematuria). This blood, likely from the injured kidney, is coloring the urine and indicates internal bleeding within the urinary tract.

3. Additional Interventions:

Besides taking vitals and noting the tea-colored urine, additional interventions could have included:

  • Frequent re-assessment of vital signs and mental status: This would provide early warning of deterioration.
  • Palpation of the abdomen for tenderness or rigidity: This could pinpoint localized injury.
  • Immediate catheterization: This would provide a clearer picture of internal bleeding and facilitate urine drainage.
  • Blood tests: Complete blood count and coagulation studies would evaluate blood loss and clotting ability.
  • Type and cross-matching of blood for potential transfusion: This would prepare for possible blood replacement.

4. LPN Scope of Practice:

In this scenario, the LPN functioned within the scope of practice for several reasons:

  • Performed delegated activities: Taking vitals and observing clinical signs are within an LPN’s scope under RN supervision.
  • Communicated observations: Reporting the tea-colored urine and other clues alerted the RN and physician to potential problems.
  • Did not initiate independent actions: The LPN did not diagnose, prescribe, or perform independent interventions beyond their authorized tasks.

However, some aspects could be debatable:

  • Catheterization: Some states allow LPNs to perform catheterization with proper training and supervision, while others require RNs.
  • Blood draw: Similar to catheterization, the ability for LPNs to draw blood depends on state regulations and facility policies.

5. Impact of Busy Environment:

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

  • Delayed assessment and intervention: Overburdened staff might miss subtle signs or delay crucial interventions.
  • Communication breakdowns: Information regarding the tea-colored urine or vital sign changes might not reach the right people immediately.
  • Resource limitations: Access to diagnostic tools, blood products, or surgical services might be delayed in a crowded ER.

While the LPN acted within their scope, optimized care may have required a more vigilant and resource-sufficient environment, highlighting the importance of adequate staffing and communication in critical situations.

Further Considerations:

This scenario offers a complex learning opportunity for nursing professionals. It underscores the importance of:

  • Critical thinking and vigilance: Nurses of all levels must analyze data, prioritize observations, and communicate concerns swiftly.
  • Interprofessional collaboration: Seamless communication and efficient teamwork between LPNs, RNs, and physicians are crucial for optimal patient care.
  • Adaptability and resourcefulness: Nurses must be able to adjust their approach and advocate for patient needs even in stressful environments.

By reflecting on this challenging case, nurses can refine their critical skills, advocate for effective communication, and strive for optimal patient care even in demanding circumstances.

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