Post-renal tx and CVP

shinynurse · May 6, 2008

Wow, good test question!

I don't work with transplants in our hospital. I can work with you from basically the same angle that you're working from, though.

When I see a CVP of 2, automatically we know the pt. is intravascularly dry. Why?? How about labs? Does the pt. have hypoalbuminia? Is the pt. 3rd shifting? What's the pts' Na level? Tons of pitting edema? You need to do one of two things. Either you're going to intravascularly rehydrate with fluids to get your CVP up because the pt. is truly dehydrated or you're going to have to figure out a way to get the pt. to shift back into intravascular and give "some" IV fluids without overhydrating the system, especially if the pt is shifting everything out. So, as an acute dialysis nurse this is what I'd do. Regardless of the pts. nutritional status (albumin level) I'd probably give Albumin 50 gms, raise my intravascular sodium level and give small amts. of fluid. Also if your CVP is 2 then your bp is probably going to be in the bucket and your heartrate is going to be elevated. Very slowly rehydrate and give time for your albumin to get to work. If 50gms doesn't do the job, give 75 or 100gms to bring that osmotic pressure up. I would consider this a pretty critical situation but just be careful you don't overload with IV fluids because you don't want to stress out that new kidney. You would definately work from the angle of doing a somewhat slower quick fix then work on the long term issues. What is the pts. output? Any other underlying issues? etc!! Also, post op, of course you want to be careful of the lungs and heart with your fluid status. We just want to get and keep that fluid in the right places.

Did this help? Would love to hear!

shinynurse · May 6, 2008

Oh my gosh, forgot to say something :bugeyes:

Back to the original question. Typically you'd like to see a CVP of 10, but very dependant on the pt and diagnosis. Also, remember that the CVP (aka RVEDP or R. ventricular end diastolic pressure) assesses th R. ventricular function and general fluid status. Soooo, as always, the very first thing you'd want to do with a value that low is to recalibrate your CVP line and make sure it's accurate. Also, take another look at the pts. meds. Any diuretics on board?

icunurse08 · Jun 10, 2008

Hello to hellooonurse,

I believe we may be applying to the same program in the Philadelphia, PA area! I too, just received an interview packet with the very same question.............as well as a few others.

Care to talk about your application process to CRNA programs????

hell000nurse · Jun 10, 2008

Hello to hellooonurse,
I believe we may be applying to the same program in the Philadelphia, PA area! I too, just received an interview packet with the very same question.............as well as a few others.
Care to talk about your application process to CRNA programs????

i only applied to/interviewed at one school, which was my #1 choice, and i got in. so i dont really have a lot of 'interview' stories to tell, just the one that i went to :)

so did you apply to jeff? for jan 2009? PM me

icunurse08 · Jun 11, 2008

i only applied to/interviewed at one school, which was my #1 choice, and i got in. so i dont really have a lot of 'interview' stories to tell, just the one that i went to :)
so did you apply to jeff? for jan 2009? PM me

Hi future classmate;) (have to think positive!)

Yes, I did apply to Jeff for 1/09. I have an interview in July. If you care to share, what was the interview like?? How much ICU experience did you have at the time of the interview? Also, how many are admitted to each class?

Thanks.

ICUNurse08

hell000nurse · Jun 11, 2008

Hi future classmate;) (have to think positive!)
Yes, I did apply to Jeff for 1/09. I have an interview in July. If you care to share, what was the interview like?? How much ICU experience did you have at the time of the interview? Also, how many are admitted to each class?
Thanks.
ICUNurse08

i believe they accept 25 people? the interview was nowhere near as bad as i thought after reading peoples experiences on this site!!! first its a powerpoint presentation, then you interview one on one with the director and then the assistant director. then you go to lunch. then you interview with 2 of the clinical coordinators. most important thing in my eyes is to be CALM, CONFIDENT. i was laid back, i made them laugh, i was calm (although i wasnt calm on the inside!!)

now i think they switch up the way they do the interviews, so dont go exactly by what i say. but know your pressors and how they act. they actually didnt ask me ANY of those prepared questions, but i know other people who DID get asked those questions. so prepare for them.

i am 25. ive been a nurse for about 4 years. i have 1.5 years of ICU experience....so by the rtime i start school i will have had a little over 2 years experience. i was very worried about my experience being a negative thing...especially since 3 of the people i was interviewing with had 7-10 years experience. they also went over my undergrad grades...they pay attention to your science grades mostly. thank god mine were good.

other than that, a lot of personal questions. why you wanna do this, why you think youll be good at it, they ask all about your current ICU and the kinds of things you see/kinds of patients you treat...so prepare yourself for that.

hope this helps!

icunurse08 · Jun 11, 2008

Hell000nurse,

Thanks for your tips, I will definitely follow your advice. I think calm and cool is a good way to go...sometimes easier said then done :)

ICUNurse08