Question

Care Plan- Acute Renal Failure You are working in the ICU of an scute care hospital and assume the care of Edics 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 arthrisis treated witih rofecoxib (Vioxx) 0mgm daily and longstanding hypertension treated with atenolol Tenormin) On admission to the emergency room the patent had a blood pressure of 210/122 mum Hg, therefore thrombolytics were contraindicated. An IV was started with DSW at keep open rate and was taken directly to the cardiac catheterization lab for scute PTCA Her angioplasty was successful, and she has been pain free since ber PTCA. You are reviewing her lab work and note the following values: 142 4.6 CL co2 26 60 Creatinine 3.8 Glucose 158 l. Define thrombolyrics and why this medication may not have been used for this patient 2. Define PTCA 3. Describe how you would have prepazed the patłent for this procedure 4. Iéentify the abnormalities in Mrs. Bunker's lab work as well as what the normal values should bave been 5 State the possible causes for the abaormalities 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: Na 140 5.0 104 24 Cl Co2 BUN Creatinine 4.0 Glucose 104 You have also noted that ber 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

1)The word thrombolytics indicates thrombo= thrombus or clot,lytic=break

It means lysis or breaking up of clot.It is not indicated for a patient posted for PTCA because it acts as a blood thinner and bleeding cannot be ceassed during procedure.

2)PTCA refers to percutaneous transluminal coronary angioplasty. It is a minimal invasive procedure of opening up the blocked artery of the heart.

3)The following preparation is necessary

• Through explanation of the procedure
• Getting informed consent
• Stopping thrombolytics
• Blood investigation like PT,PT INR,PTT, Sr.creatinine,CBC,Triple H test,RBS,FBS ,PPBS to be done
• NBM as per order

4) The patients BUN,Sr,creatinine and glucose are increased

Normal range

BUN :7-20mmol/L

Sr.Creatinine :0.5-1.5mg/dl

RBS:90_140mg/dl