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"No Stupid Questions" scenario

Nurses   (3,159 Views 23 Comments)
by Sleepyeyes Sleepyeyes (Member)

8,838 Profile Views; 1,244 Posts

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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223 Posts; 3,506 Profile Views

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

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208 Posts; 7,345 Profile Views

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

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835 Posts; 9,780 Profile Views

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

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208 Posts; 7,345 Profile Views

Woops! Forgot the NGT to Low Intermittent Wall Suction.

And a nurse from Allnurses ATC !

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1,244 Posts; 8,838 Profile Views

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.

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1,244 Posts; 8,838 Profile Views

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

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223 Posts; 3,506 Profile Views

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

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1,244 Posts; 8,838 Profile Views

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

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208 Posts; 7,345 Profile Views

Old CVA vs acute? Two entirely different approaches.

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

We do it often at work.

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312 Posts; 5,520 Profile Views

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

UA?

CR/BUN levels?

What are her daily weights?

Edema?

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1,244 Posts; 8,838 Profile Views

acute cva

no edema, lungs dim/clear

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

ex., would you expect high BUN/CR ?

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