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Here is a great tutorial, and it might be useful in helping you to understand this problem.
http://www.ccmtutorials.com/renal/oliguria/
Check out this page also, as it gives some scenarios and solutions
Lasix would not make sense in chronic renal failure unless they are trying to use it as a venodilator to allow the large veins to store more fluid and take the workload of the heart. But nitro is much better at that. If the pt is in oliguric acute renal failure then lasix can help to jump start the kidneys. The difference is that CRF is irreversible damage to the kidneys.
The pulmonary and arterial pressures don't help determine much with this patient unless you also look at the filling pressures (CVP & PCWP or wedge), cardiac ouput, SVO2, and SVR. In order to determine why your pulmonary and systemic pressures are so high you have know whether the problem is with preload or afterload. Preload is represented by the filling pressures and they help to determine if this pt is fluid overloaded which is very possible in this pt.
My guess from the info you provided is that the pt is fluid overloaded and may need dialysis soon. In the meantime, nipride and/or esmolol would help control his BP and decrease the chances of any surgical bleeding from occuring.
Ditto all of the above. Isolated Pa/ and art line readings shouldn't replace how the patient presents clinically. First off I would never take the PACU readings as law because you aren't sure where the transducer was and if they were balanced and calibrated. So first step I'd get my own readings.
More than likely his AAA probably contributed to his renal failure long before surgery.
I think the ICU nurse didn't really think about what she/he was asking. Most all know that CRF=CRF=CRF and lasix isn't helpful and dialysis is optimal. Are you sure that the patient didn't have Chronic renal insufficiency? The treatment options might be more open in that case. Also, without wedge pressure it's a crap shoot. The patient may have underlying pulmonary htn so there are a lot of other factors that need to be considered.
Agree with everyone's input! Triple A's are notorious for sky high BP postop and we frequently use Nipride...and probably fluid overload was also a culprit (frequent problem in renals during surgery) CVP better represents that.
Our surgeons are getting smarter now with our renals and getting renal consults prior to surgery and some specific guidelines for the patient. ...so they don't have to answer to the nephrologists when they're called in emergently...LOL!
This patient probably needed Primacor to lower his SVR and PA pressures. He has what seems to be pulmonary hypertension. When we recover these AAA patients, they almost always are on Primacor to decrease the SVR and PA pressures. They want these patients vasodialated.
However, this patient is a chronic renal failure patient. He probably needed dialysis. Did this patient pee on his own at all. Was he oliguric BEFORE the surgery? If he wasn't then Lasix may have helped.
Most of all open-heart patients experience some ATN or slight renal failure from being on the bypass machine. If this guy had a preexisting renal condition than the surgery could hav emade it worse. Hope this helps!!!!
Thanks you guys(gals)!!!! You all have really contributed alot to help me here. The patient was a chronic oliguric, Dialysis patient(had dialysis just prior to surgery). I believe that the CHF is not new as well. The guy was a wreck already. I'm surprised he survived. Of course he waz being ventellated in PACU. His ABG's were the most normal numbers! The ICU nurses frequently ask us these types of thing to "show us up". To make sure we know we are "only" PACU nurses, not ICU nurses. (Of course we stabilize the ICU surgical patients for them and recover them!).
Thanks again :)
sharann, BSN, RN
1,758 Posts
Hi,
I have a question for anyone who would care to help me understand. Had a patient in our recovery room, has chronic renal failure, pre-existing CHF. Just underwent a AAA (Aortic aneurism) Repair. His PA readings and Art line BP's were off the wall high. PA ranges of 60/30- 75/40. Also is oliguric. The ICU nurse asked the recovery nurse why the doc didn't order Lasix. My understanding is Lasix is no ggod for renal oliguria. He obviously has high SVR(systemic vascualr resistance). What do you do for this? Is Lasix helpful? I just don't completely understand the phisiology behind this. help???