Question

Care Plan- Acute Renal Failure You are working in the ICU of an acute care hospital and assume the care of Edith Bunker, a 78 year-old woman who is 3 days post inferior wall MI. Mrs. Bunker had been healthy before admission except for a longstanding history of arthritis treated with rofecoxib (Vioxx) 50mgm daily and longstanding hypertension treated with atenolol (Tenormin) On admission to the emergency room the patent had a blood pressure of 210/122 mm Hg, therefore thrombolytics were contraindicated. An IV was started with D5/ W at keep open rate and was taken directly to the cardiac catheterization lab for acute PTCA Her angioplasty was successful, and she has been pain free since her PTCA. You are reviewing her lab work and note the following values: 142 4.6 100 26 60 Creatinine 3.8 Glucose158 Cl CO2 BUN 1. Define thrombolytics and why this medication may not have been used for this patient. 2. Define PTCA . Describe how you would have prepared the patient for this procedure 4. Identify the abnormalities in Mrs. Bunker's lab work as well as what the normal values should have been 5. State the possible causes for the abnormalities in the laboratory studies. 6. List the causes of acute urinary retention You are given the results of Mrs. Bunker's lab work from today. The results are: 140 5.0 104 24 68 Creatinine 4.0 104 CI CO2 BUN Glucose You have also noted that her urine output for the past 8 hours is 160 ml 7. Explain the lab values that have changed over the past 24 hours. 8. State the significance of the urine output. 9. State what your next nursing action is going to be 10. Define anuria and oliguria and identify which of the two the patient currently has In reviewing Mrs. Bunker's vital signs you cannot identify any episodes of hypotension since her admission.

Answer 1

Q. No 1. Answer :

ThrombolyticsThrombolytics are the drugs which are used to break down or dissolve the blood clots in the blood vessels and improves the blood flow to the tissues and organs and there by prevents the damage of those tissues and organs.

* thrombolytic therapy is contraindication for the patients who have blood pressure more than 185/ 110 mm of hg. In this case the patient is having 210/112 mm of hg.

* This high blood pressure may delay or decreases the thrombolysis therapy so that still more disease rate increases, so thrombolytic therapy is contraindication here.

Q. No 2. Answer :

PTCA : Percutaneous Transluminal Caronory Angioplasty :

It is defined as it is a one of the mild invasive procedure it is used to open the blocked coronary arteries and increases the blood circulation to the heart with out obstruction by using diagnostic catheter introduced in to the blood vessels through guiding wire.

Q. No 3. Answer :

Preparation of client for PTCA:

* Explain procedure to the client

* Take consent.

* Keep Nil by mouth from before midnight.

* Avoid giving medications like diabetic drugs, because patient is already in NBM which may leads to hypoglycemia.

* Give cardiac medicines as advised by physicians like nitroglycerin ect with sips of water.

* Keep ready all lab values like APTT, PTINR, CT, BT, creatinine, and X-ray ect, 2d Echo reports ect.

* provide psychological and emotional support to the clients like it is a small procedure, will be finish soon.

* like this we need to prepare the client.

Q. No 4. Answer :

Abnormal lab values are

* Creatinine 4.0 mg per dl, it is high, approximately normal value is

0.5 -1.1 mg per dl.

* BUN level 68 mg per dl, it is also high, Approximately normal value is 7 - 20 mg per dl.

* potassium (k) 5.0 , it is k but near to hyperkalemia Normal value is 3.5 - 5.0 meq per liter.