"No Stupid Questions" scenario

jevans · Sep 17, 2002

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

prn nurse · Sep 17, 2002

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

LasVegasRN · Sep 17, 2002

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

prn nurse · Sep 17, 2002

Woops! Forgot the NGT to Low Intermittent Wall Suction.

And a nurse from Allnurses ATC !

Sleepyeyes · Sep 17, 2002

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.

Sleepyeyes · Sep 17, 2002

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... :lol2:

wanna make sure i don't overlook anything

jevans · Sep 17, 2002

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

Sleepyeyes · Sep 17, 2002

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

prn nurse · Sep 17, 2002

Old CVA vs acute? Two entirely different approaches.

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

We do it often at work.

kittyw · Sep 17, 2002

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

UA?

CR/BUN levels?

What are her daily weights?

Edema?

Sleepyeyes · Sep 17, 2002

acute cva

no edema, lungs dim/clear

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

ex., would you expect high BUN/CR ?