1. 1 BLADDER TRAUMA Injuries to the bladder commonly occur along with pelvic trauma or may be due to surgical interventions.

2. 2 PATOPHYSIOLOGY AND ETIOLOGY 1. Bladder injuries are classified as follows: a. Contusion of bladder b. Intraperitoneal rupture. c. Extra peritoneal rupture. d. Combination intraperitoneal and extraperitoneal bladder rupture.

3. 3 2. Injuries to the bladder is commonly associated with pelvic fractures and multiple trauma. 3. Certain surgical procedures (endoscopic urologic procedures, gynecologic surgery, surgery of the lower colon and rectum) also carry a risk of trauma to the bladder.

4. 4 4.Intraperitoneal bladder 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. 5. Extraperitoneal bladder 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.

5. 5 CLINICAL MANIFESTATIONS Inability to void Hematuria; presence of blood at urinary meatus Suprapubic pain and tenderness Rigid abdomen – indicates intraperitoneal rupture.

6. 6 DIAGNOSTIC EVALUATION Cystogram – to detect and localize perforation / rupture of bladder Plain film of abdomen – may show associated pelvic fracture

7. 7 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

8. 8 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.

9. 9 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.

10. 10 Facilitating Urinary Elimination 1. Obtain urine specimen, if possible, and assess for degree of hematuria and presence of infection. 2. Prepare pt 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. 11 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.

12. 12 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.