Question

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 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 DS/ Wat 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 26 BUN 60 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 140 You are given the results of Mrs. Bunker's lab work from today. The results are: Na K 5.0 CI 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 7. Explain the lab values that have changed over the past 24 hours. 8. State the significance of the urine output.

Answer 1

1. Thrombolytics word refers to thromb/o =a blood clot or thrombus and lytic= breaking down.Hence breaking down of the blood clots is referred to has thrombolytics.

The thrombolytics cannot be prescribed if the systolic blood pressure is above 180mmHg and diastolic blood pressure above 110mmHg because it can cause intracranial hemorrhage.

2.PTCA stands for Percutaneous Transluminal Coronary Angioplasty. Here the blocked arteries is relieved by applying pressure with the help of a balloon. (This ballon is inflated by placing it in the narrowed pathway of the artery because of plaque formation and widening the blood vessels to enhance blood flow.

3.The patient can be prepared in the following ways

• Monitor the vital signs, intake out put ,IVF, medication as per order
• Get informed consent for the procedure
• Explain the procedure to the patient completely
• General pre op preparation like skin preparation, etc.,

4.The abnormal values are

• Elevated blood urea nitrogen (normal 7 to 20 mmol/L)
• Elevated creatinine level (normal 0.5 to 1.5 mg/dl)
• Elevated glucose (normal random 80_ 140 mg/dl)