Question

nursing skills online answer key

mo Concept Map - Renal Insufficiency 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 ML. 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 DS/ 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: NA 142 4.6 100 CO2 BUN 60 Creatinine 3.8 Glucose 158 K CI 26 1. Define thrombolytics and why this medication may not have been used for this pati 2. Define PTCA 3. Describe how you would have prepared the patient for this procedure 1. Identify the abnormalities in Mrs. Bunker's lab work as well as what the normal v should have been 1 11111

Answer 1

(A) Thrombolyties: - Thrombolytics are class of drugs used to dissolve clyse) blood clots (thrombi) which our in vascular bed like in cooonary, cerebral, pulmonary ressels. Mechanism of action. orged Thrombolytres Plasminogen I Thrombolytics are hosue plasminogen activator). Activates plasmin Streptok nare Urokinase Alteplase Fibrin - Fibrin degradahon I product lyris of clot. 2A) PTCA means "percutaneous trane dominal coronary angioplacty which is minimally invasive procedure to open up blocked coronary arteries , allowing the blood to circulate properly In this procedure a guide wire placed from femoral artery later introducer is placed & wine is removed a long narrow diagnostic catheter through which dye is passed tho is placed through introducer then the Catheter is placed in opening of one coronary arteries and takes x-ray to see the blockade E.

is inflated to widen the blocked Sometimes uaballoon arteries. > Asking the patient not to eat cord drink anything after midnight / on night before yanas procedure. - Explain the possible rieke and benefite of procedure > Before procedure should see that Ela, x-rays and blood tests (routine) were done. > Would administer dringe under superussion of the physivan * Previous allergie druge will be listed confirming Whether patient had any allergies to metal, x-ray due (or) iodine. should see that Sif pt had allergies & auti allergic medications is given to patient, > Before procedure see that patient empred bladder and die pt is calm and relaxed mood Absolute contraindications for fibriu alytice uso are Prior intracranial haemorrhage CICH), ischemic stroke. (within 3 months aortie diesochon, bleeding, since Bunicer is 3 days post inferior wall me pt a Hiph BP. 210),22 mmHg thrombolyties are contra sudicated (A)

labtest It ralue Normal Caures of abnormal values 135-145 Melit Z 2 100 Z 3.5-5 meqllt 96-106 meyllt 23 -9qmeglt. LOy 26 26 Z It is on BUN 60 USAID eter 3.8 Which Causes ARF on longusele Patient is lauded on renal insuffineay due to cardiac insuffinency aco) there is declare in glenal blood flow through kidneys . so filtration by Assement 158. 140-2 Glucose Recent Earhoer 142 140 JA Na 140 mild dreaneale in Not Mild increase in kt mild increase in un 100 at 104 Da bo 68 BUN in theme Mild denne in BUN mild increau in Sr.er 318 er 4. tory 158 I mild decrease in loy levels Glucose I glucose CO2 Urine out 24 lboml pt is have confirmed to renal foulure. put

6A) Cautes of acute erana urine retention in - Benign proctane obetrueboy - Dungs like & agoulets ß agonists, Te Ai, anda cholinergie, antipsychotice, benzodiazepine, NSAIDs CeBe. Diabetes mellite It was on rofecoxib - Constipation which might be Urethral chones, tumorsiralres cause. Urethral shricsune Vaginal vault prolapse. - Dysfunctional voidinga =4) Significance of urine output:- - urine out put is often a marker for enemal failure) acutekidney injury - Usine output is indirect measure for glomerular filtration rate of kidneys - Normal Urine output is 800-2000 ml per ay his (2.60 ml apps for q 8 hrs) - A decrease in urineput indicatei decreau in glove rular filtration due to dorreare in real blood flow which means gonal failure