Published
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?
If this were a "real" case, and they had a g-tube already.....then, I guess I'd hook that g-tube up to suction.
So, that means they were probably chronic with something else when they got the acute CVA. I think the hemmorhages in the kidneys are the clue....a hemmorhagic CVA doesn't come with hemmorhages in the kidneys.
I'd work him up for a brain and kidney transplant.
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?
1. AIRWAY, did they aspirate? check residuals, suction back of throat is there dye there or in mouth, check spo2
2. If not possibly septic, I would do comprehensive neuro exam diaphoresis and borderline htn, may be neuro, along with a neurogenic bladder along with the chang in resperatory rate
3. check basic metabolic profile... what is the BUN/creat? what are the last two days I&O? What is the hourly urine output ? The urine sounds amber which is not necessarily blood, if the urine shows blood you have two diagnosis going on.
4. If aspiration and sepsis is not an issue (seems likely, unless thrombolytics were given, why would the kidney's be taking a hit?) seems septic, do not need a temp to have this.
5. How long since BM? is there an obstruction? Consider holding feeds.
6. Accuchecks are high due to tube feeds and stress of illness, I'd change to choice DM or start insulin drip, not a priority.
jevans
224 Posts
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