Question

in the ICU of an acute care hospital and assume the care of a care of Edith erior wall MI. Mrs. Bunker had been & history of arthritis treated with hypertension treated with atenolol except for a longstading hyperten ad a blood pressure of 210/122 An IV was started with DS/W at atheterization lab for acute PTCA. 60 Concept Map - Renal Insufficiency You are working in the ICU of an acu Bunker, a 78 year-old woman who is 3 days post inferior wall ML healthy before admission except for a longstanding history of arthrin rofecoxib (Vioxx) 50mom daily and longstanding hypertension trea (Tenormin) On admission to the emergency room the patent had a blood pressur mm Hg, therefore thrombolytics were contraindicated. An IV was started keep open rate and was taken directly to the cardiac catheterization lab for acus Her angioplasty was successful, and she has been pain free since her PTCA. reviewing her lab work and note the following values: NA 142 4.6 Cl 100 CO2 26 BUN Creatinine 3.8 Glucose 158 1. Define thrombolytics and why this medication may not have been used for this patient. 2. Define PTCA 3. 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 K 5.0 104 CO2 24 BUN 68 Creatinine 4.0 Glucose 104 You have also noted that her urine output for the past 8 hours is 160 ml Na СІ 7. Explain the lab values that have changed over the past 24 hours. 8. State the significance of the urine output. Revised 9/19

Answer 1

1) Myocardial infarction refers to heart attack occurs when the blood supply to the myocardial layers of the heart is hindered resulting in occlusion of coronary artery. MI contributes to myocardial damage and if left untreated end up with heart failure / cardiac arrest.Thrombolytic therapy ,first line treatment to re perfuse blocked coronary arteries. It is also termed as clot dissolvers helps in lysis or dissolving the clots that occluded in the major arteries or veins, improves blood flow and preserve major organs from damage. The most important contraindications of thrombolytic drug is high blood pressure, bleeding disorders, hemorrhagic stroke.In this scenario patient blood pressure is 210/120 indicating hypertensive crisis in this case administering thrombolytic drugs results in intracranial hemorrhage.

2) PTCA - Percutaneous transluminal coronary angioplasty refers to a minimally invasive procedure helps to remove the blocked or narrowed coronary vessels. PTCA also used as a diagnostic measures to identify the abnormality of heart valves, coronary artery and to identify congenital abnormalities of heart.

3) PTCA pre procedural care:

- Educate patient about the procedure and give necessary explanations on this doubts. Explain the benefits and risks of the procedure. Assess the history of allergy as usage of iodine based dye may cause anaphylactic reactions. Instruct patient not to eat or drink for 8 hours before the procedure. Maintain two Intravascular access to infuse intravenous fluid to reduce the risk of dehydration. Assess the rate and rhythm of pulses on the extremity.

4) The abnormal value identify is elevated blood urea nitrogen. The normal value ranges from 7- 21 mg/dl. Blood urea nitrogen an important factor to determine the kidney function. Urea nitrogen waste products removed by the kidneys. BUN is usually done for patients with renal diseases, family history of kidney diseases, abnormal blood pressure. BUN elevated due to dehydration,drug induces,high protein intake.

5) The reason for elevated Blood urea nitrogen in this scenario is secondary to contrast used in cardiac catheterization. Contrast induced nephropathy occurs as a result of inability of the kidneys to excrete the contrast dyes. Aging a common reason for decline in renal function. To facilitate the excretion of drugs adequate rehydration measures is to be taken in order to facilitate the drug excretion.