"No Stupid Questions" scenario

  1. 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?
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  2. 22 Comments

  3. by   jevans
    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
  4. by   prn nurse
    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
  5. by   LasVegasRN
    Okay, let me think.... OW! That hurt... :imbar ... Medic!!
  6. by   prn nurse
    Woops! Forgot the NGT to Low Intermittent Wall Suction.

    And a nurse from Allnurses ATC !
  7. by   Sleepyeyes
    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.
  8. by   Sleepyeyes
    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
  9. by   jevans
    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
  10. by   Sleepyeyes
    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
  11. by   prn nurse
    Old CVA vs acute? Two entirely different approaches.
    I like to toss out scenario's and learn too.
    We do it often at work.
  12. by   kittyw
    Does dipstick test positive for anything else? WBC, protein, etc?
    UA?
    CR/BUN levels?
    What are her daily weights?
    Edema?
  13. by   Sleepyeyes
    acute cva

    no edema, lungs dim/clear

    ---what would you expect to find on these tests?
    ex., would you expect high BUN/CR ?
  14. by   jevans
    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

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