The client is admitted to the ER following a MVA. The client was wearing a lap seat belt when the accident occurred. The client has hematuria and lower abdominal pain. To determine further whether the pain is due to bladder trauma, the nurse asks the client if the pain is referred to which of the following areas?
A. Shoulder
B. Umbilicus
C. Costovertebral angle
D. Hip
Correct Answer: A. Shoulder
Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, CV angle, or hip. Aside from iatrogenic injuries, patients with signs and symptoms of bladder injury will likely relay a history typical for pelvic trauma.
Option B: Most patients with bladder rupture complain of suprapubic or abdominal pain but many can still void. The ability to urinate does not exclude bladder injury or perforation, however.
Option C: An abdominal examination may reveal distention, guarding, or rebound tenderness. Absent bowel sounds and signs of peritoneal irritation indicate possible intraperitoneal bladder rupture.
Option D: Bladder injury pain does not radiate to the hip. If the prostate is “high riding” or elevated, proximal urethral disruption should be suspected. In the setting of motor vehicle collision or crush injury, bilateral palpation of the bony pelvis may reveal abnormal laxity or mobility, indicating an open-book fracture or disruption of the pelvic girdle.
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