A client involved in a motor vehicle collision reports severe pelvic and right heel pain. While waiting for imaging, the nurse assesses the client. Which finding should the nurse report to the health care provider immediately?

Question

Quizplus · Accepted Answer

Motor vehicle collisions and motorcycle crashes, followed by falls, are the most common mechanisms for pelvic fractures. The pelvis contains several large vascular structures (eg, internal and external iliac veins and arteries) and abdominal and pelvic organs (eg, small bowel, sigmoid colon, bladder, urethra, uterus, prostate). Therefore, when caring for a client with a fractured pelvis, in addition to pain, the nurse should assess for internal hemorrhage (eg, abdominal distension, vital signs, hematocrit, hemoglobin), paralytic ileus (eg, bowel sounds), neurovascular deficits (eg, extremity circulation, sensation, movement), and abdominal and genitourinary organ injuries (eg, hematuria, urine output <0.5 mL/kg/hr). Abdominal distension could be due to serious intra-abdominal bleeding or injury to the bowel or urinary structures. Absent bowel sounds can indicate the presence of a paralytic ileus related to the trauma and/or a retroperitoneal hematoma; these should be reported to the health care provider (HCP) (Option A). (Options B and D) Tenderness, bruising, and ecchymosis over the injured bones are expected and do not need to be reported to the HCP. However, it would be important to communicate ecchymosis over the suprapubic area to the HCP as this could indicate organ damage and internal hemorrhage. (Option C) Hemoglobin of 11.5 g/dL (115 g/L) and hematocrit of 34% (0.34) are slightly lower than normal and may be from the bleeding. During the acute hemorrhage, hemoglobin and hematocrit can be normal and will take some time to reduce to significant levels. This is a second priority over actual bleeding findings. Educational objective: The pelvis contains vascular structures and pelvic organs. Significant internal hemorrhage is common with pelvic fractures and can manifest as abdominal distension and paralytic ileus.

A Client Involved in a Motor Vehicle Collision Reports Severe