Scenario:

hemorrhagic CVA, on GT (with dye), tests indicate kidney infarcts. Accuchecks are on the high side, but not >350, with coverage. IVF of NS @50. Ab is distended, fairly firm with +4 hypo BS. Resps are occasionally rapid, in conjunction with diaphoresis but no fever.

Urine starts looking thick and brown-red (somewhat but not real "red" hematuric though) at about 3 am and continues throughout shift.

What's your plan?

Sleepyeyes Hon

I'm sorry I will have to ask some questions for clarity cos I'm across the pond

what are accuchecks and hypo BS

I'm afraid we use different systems but I am a stroke nurse so I will have to ask another pertinent question acute or rehab

j:imbar

I'll probably "flunk out", LOL, but here's my plan...

0. EKG

1. Check PT levels q 12 h for next 4 days

2. Check initial PTT level, cardiac enzymes

3. Check CBC, Renal function,liver function results

4. Hourly neuro checks

5. Hourly --at least-- v/s

6. Hourly urine outputs

7. Send UA each a.m

8. Elevate head of bed--don't lower for anything !

9. Transfer to ICU-- cardiac monitoring

10. Start meds to decrease cerebral edema at once !

11. O2 nasal cannula.... ABG's.. pulse oximetry

12. Start another Saline lock

13. Observe for respiratory depression

Okay, let me think.... OW! That hurt... :imbar ... Medic!!

Woops! Forgot the NGT to Low Intermittent Wall Suction.

And a nurse from Allnurses ATC !

Oh, sorry jevans--

accuchecks are fingerstick capillary blood glucose tests

Hypo BS are shorthand for Abdominal auscultation sounds: it means you hear bowel sounds, but they're less frequent and more subdued than normal--hypoactive to all four quadrants.

I learn a lot from discussing with more experienced nurses, which is why I posed the question....so there is no "pass" or "fail"==this is just a clinical type I see sometimes, so I'm just pickin' yer brains...

wanna make sure i don't overlook anything

OK lets be logical. This is hard as we use all senses when assessing pts.? When was the last time pt pu? what has been the last 24hr output? is the pt catheterised? has the oral intake been sufficient?

first a dipstick of urine what does that tell you ?

Is the pt compromised with vital signs or pain ie are we looking at infection or are we looking at renal shut down or simply inability to adequately hydrate

Certainly look at blood results, has there been an alteration in last few results. Get some bloods done

I work in rehab so medic cover not really there over night There is an oncall service but we would have to look at these issues first

hope this is of help

j

Thanks...i'm just collecting information and your answers have helped!

sooo....let's suppose hypothetically:

Foley cath

24h output is on the low side of normal

"dipstick"?== if it's what I think it is, let's say it'd be +hematuric

Pt is NPO and receiving IVF and GT feedings only

BP tends to run on the high side but not uncontrolled

Radiology indicates renal infarcts

Old CVA vs acute? Two entirely different approaches.

I like to toss out scenario's and learn too.

We do it often at work.

Does dipstick test positive for anything else? WBC, protein, etc?

UA?

CR/BUN levels?

What are her daily weights?

Edema?

acute cva

no edema, lungs dim/clear

---what would you expect to find on these tests?

ex., would you expect high BUN/CR ?

Sorry sleepyeyes-cross talking

Dipstick of urine investigates at ward level

albumin

Ph

glucose

protein

blood

ketones

nitrates

It amazes me the different abreviations. I'm sure we look at the same things

what is BUN/CR

Would you do daily weights for CVA

Eager learner

j