Geriatric Trauma Book: Urologic Trauma
Minimal research has been done on urologic injuries in the geriatric trauma population. A number of preexisting conditions may be seen and should be considered in the care of the older adult patient with urologic trauma. With aging, there is a loss of functional glomeruli and tubules as well as a reduction in blood flow, due to the decrease in mass of the kidney . This impacts the ability of the kidneys to excrete medications that rely on renal clearance, therefore increasing the risk of adverse drug reactions . Decreased functional reserve in the older adult also increases the risk of renal failure . Nursing care must include a thorough physical assessment that incorporates the location of pain, assessment for patterns of bruising or lacerations, as well as consideration for associated injury . Hematuria, flank pain/bruising, and abdominal pain have all been associated with assessment of renal injury . There should be a high suspicion of renal injury with rib fractures or spinal process fractures . Hemodynamic stabilization of the patient and treatment of concomitant injuries are critical components of immediate nursing care . Many older adults are currently taking anticoagulants, which can profoundly impact the care of older adult patient with a renal injury. It is critical to complete a thorough review of medications and preexisting comorbidities on admission.
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