KIDNEY INJURY NURSING MANAGEMENT
Trauma to abdomen, flank and back may produce renal injury.
Etiology and Pathophysiology
1. Blunt trauma (falls, sporting accidents, motor vehicle accidents) can suddenly move the kidney out of position and in contact with a rib or lumbar verte transverse process, resulting in injury.
2. Penetrating trauma (gunshot and stab wounds) can injure the kidney if it lies the path of the wound.
3. Renal trauma is classified according to severity of injury.
a. Minor injuries contusion, minor lacerations, hematomas.
b. Major injuries major lacerations and rupture of kidney capsule [ expanding hematomas)].
c. Critical injuries multiple and severe lacerations and renal pedicle injury (renal artery and vein are torn away from the kidney).
4. 80% of patients with renal trauma will have injuries to other organ system also necessitating Treatment.
Clinical Manifestation
1. Haematuria
2. Flank pain; perirenal hematoma.
3. Nausea, vomiting, abdominal rigidity from ileus [(seen when there retroperitoneal bleeding.
4. Shock- from severe / multiple injuries,
Diagnostic evaluation
1. History of injury [determine if injury was caused by blunt or penetration trauma].
2. IVP with nephrotomograms [to define extent of injury to involved kidney and the functioning of contra lateral kidney]
3. CT scan- [differentiates between major and minor injuries]
4. Arteriography if necessary to evaluate the renal artery.
Medical Management
1. contusions and minor lacerations are managed conservatively with bed rest, I fluids and monitoring of serial urines for clearing of haematuria.
2. Major lacerations are surgically repaired.
3. Ruptures are surgically repaired, usually by partis nephrectomy.
4. Renal pedicle injury - this haemorrhagic emergency requires immediate surgical repair and possible, nephrectomy.
Nursing interventions
1. Assess vital signs frequently to monitor for haemorrhage and impending shock.
2 Assess abdomen and back for local tenderness and palpable mass, swelling and ecchymosis, indicating haemorrhages or urine extravasations.
3. Establish IV access for support of Bp with fluids [er vasopressors], replacement of blood, a perfusion of kidneys.
4. Monitor serial haematocrit determinations to be certain that continued bleeding is not occurring.
5. Save, inspect and compare each urine specimen to follow the course and degree of haematuria.
6. Monitor Intake/Output carefully.
7. Give antibiotics as directed.
8. Monitor for paralytic ileus (lack of bowel sounds) caused by retroperitoneal bleeding.
a. Keep patient NPO until bowel sounds return.
b. Administer IV Fluid to maintain urine output.
9. Administer Analgesics as prescribed.
10. Encourage bed rest and positioning of comfort until haematuria clear to facilitate healing of minor injuries.
11. Expect low grade fever with retroperitoneal hematomas absorption of the clot occurs; administer antipyretics as ordered for comfort.
12. Instruct patient not to engage in strenuous activity for at least 1 month after blunt trauma to minimize incidence of delayed or secondary bleeding.
13. Teach patient s/s of late complication (i.e.) infection and nephrolithiasis.
Complications
1. Shock & cardiovascular collapse
2. Hematoma formation, abscess formation
3. Hypertension
4. Pyelonephritis
5. Nephrolithiasis
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