"No Stupid Questions" scenario

jevans · Sep 17, 2002

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

Sleepyeyes · Sep 17, 2002

BUN = blood urea nitrogen

CR = creatinine level of blood

hmmm....daily wts for CVA, I think, not, more for CHF--but if I'm wrong, please say so!! happy to learn

jevans · Sep 17, 2002

I* would also send urine for Benz jones protein due to the fact that BP elevated could have been undiagnosed reason for CVA

Sleepyeyes · Sep 17, 2002

AhhhhhhA!

very interesting!

jevans · Sep 17, 2002

I agree with you sleepyeyes no daily weights would not be done in UK unless confirmed renal failure

kittyw · Sep 17, 2002

In the ICU where I spent some time we always did daily weights... never knew when someone would code & we would really need those #'s.

prn nurse · Sep 18, 2002

If this were a "real" case, and they had a g-tube already.....then, I guess I'd hook that g-tube up to suction.

So, that means they were probably chronic with something else when they got the acute CVA. I think the hemmorhages in the kidneys are the clue....a hemmorhagic CVA doesn't come with hemmorhages in the kidneys.

I'd work him up for a brain and kidney transplant.

Rustyhammer · Sep 18, 2002

Is he alert? Verbal?

Any Abdominal pain upon palp?

sounds more like trauma than a CVA.

Sleepyeyes · Sep 18, 2002

OK....

IVF's DC'd

+bacteria (Large amt), +ketones, +bili, +blood to UA

output still ok

Liver tests being done

GT feed (diabetic) going, blood sugar is High 200's with coverage

LOC is aphasic but alert and rousable

Sleepyeyes · Sep 18, 2002

Anticoagulant was dc'd

nimbex, RN · Sep 19, 2002

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?

1. AIRWAY, did they aspirate? check residuals, suction back of throat is there dye there or in mouth, check spo2

2. If not possibly septic, I would do comprehensive neuro exam diaphoresis and borderline htn, may be neuro, along with a neurogenic bladder along with the chang in resperatory rate

3. check basic metabolic profile... what is the BUN/creat? what are the last two days I&O? What is the hourly urine output ? The urine sounds amber which is not necessarily blood, if the urine shows blood you have two diagnosis going on.

4. If aspiration and sepsis is not an issue (seems likely, unless thrombolytics were given, why would the kidney's be taking a hit?) seems septic, do not need a temp to have this.

5. How long since BM? is there an obstruction? Consider holding feeds.

6. Accuchecks are high due to tube feeds and stress of illness, I'd change to choice DM or start insulin drip, not a priority.