Review on ABC

8/11/2019 Review on ABC

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Often occurs in the left ventricle

Severity depends on area of heart

involved

Healing process

1st24 hrs: inflammatory well established

4-10 days: necrotic zone well-defined10-14 days: formation of scar tissue

foundation


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Assessment

Severe, substernal and crushing pain

unrelieved by nitroglycerin

Dyspnea

n/v, digestion, pallor, decrease BP,

tachycardia, syncope

Dx

Cardiac isoenzymes: CPK & troponin

WBC

B-type natriuretic peptide


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Immediate Treatment of MI

MORPHINE

OXYGEN

NITROGLYCERIN

ASA


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Nursing Intervention

Decrease pain & increase myocardial oxygenati

Reclining w/ head elevated

Nitroglycerin SL

Morphine

ASA

Evaluate pain & overall response

CBR w/o TP

NPO initially

X valsalva; increase fiber


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Assessment

Left-sided HF

Blood backs up into left atrium &

pulmonary veins

Pulmonary congestionRight-sided HF

Blood backs up into systemic circulation

Precipitated by LHF


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ManifestationsBreathing pattern

problems

Paroxysmal

nocturnal dyspnea

Cough

Increase in PAP (

15-25/5-15 mmHg)

PAWP (4-12 mmHg)

Hepatomegaly

Pitting edema

Dependent edema

Ascites Inc. CVP (4-10 mm

of H2O)


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ManagementHigh Fowlers or semi-Fowlers

6-8 Lpm then intubate

Morphine SO4

Cardiac glycoside/digitalis prep

Digoxin, Cedilanid, Dislanoside

Diuretic

Low sodium

Fluid restrictions (5lbs=2L)


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Assessment Oliguric


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Manifestations Fixed specific gravity (intrarenal & postrenal);

high (prerenal)

Elevated BP

Azotemia

Uremic frost

M. acidosis

Kussmauls

Anemia

Hypocalcemia, hyperphosphatemia, hyperkalemia


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Management Low Na

antiHPN drugs

Skin care

NaHCO3

Epogen

AlMgOH

Na polystyrene sulfonate (Kayexalate)

Glucose & insulin

Dialysis


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Hemodialysis


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Prep

Check v/s

Weigh client

Withhold antiHPNCheck serum K+ det.


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Fistula

External AV shunt 6-12mos

Internal AV fistula -- 3yrs

Subclavian/femoral cannula


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Common cx

Steal syndrome

Vascular insufficiency w/ diminished P,pallor & pain distal from site

Patency

Check loud bruits, thrills & warmth

Disequilibrium syndrome

Rapid removal of urea from blood rather

than brain causing cerebral edema

HA, n/v, confusion convulsion


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The Dialysate

Warmed at 37.4

Primed w/ heparin

Position of comfort

3-4hrs 3-4x/wk

Observe cx Infxn

Pulmonary embolism (sudden severe chest

pain, tachypnea, dyspnea) d/c

Disequilibrium


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Post-Dialysis

Check v/s

Weigh

Call lab for extraction of serumK det. (if elevated, shift to PD)


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Peritoneal dialysis


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PrepPeritoneal cath immediately below umbilicus

Empty bladder

Cleansing enema

Prep equipment

Dialysate (37-38 deg C)

urea clearance & comforPD sheet

Drainage bag

Inflow clamp & outflow clamp

Semi-Fowlers


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Periods

Installation 5-10minsDwelling/equilibriation 30-45mins

Drainage 30-45mins

1exchange PD = 1H40mins

1 exchange HD = 3-4H


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Advantage

Doneanywhere

Cheaper

No specialmachine

Disadvantage

Slow tx


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CAPDCONTINUOUS AMBULATORY PERITONEAL DIALYSIS


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Installation

20-30mins

Open clamp (inflow)

May complain back pain

Will disappear in a few hrs


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Dwelling

4-8 H

Close clamp (inflow) osmosis & diffusion

Complications

Peritonitis

Boardlike abd, fever, pallor, v/s, diaphoresis

d/c

Add dialysate w/ antiB & glucose (osmotic

pressure for solid removal)


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Respiratory difficulty &/or respiratory

distress

Drain out drainage

Semi-Fowlers


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Drainage

4-8H

Open outflow clamp

Observe color & amount

1st2 exchanges blood-tinged

N color clear

Bright red hemorrhage

Dark drown bowel perforation

Cloudy infection

No drainage dislodged


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During the absence of drainage:

Reposition to semi-Fowlers

Press/massage abdomen w/ palms of hands & turn from

side to side

Kink cath

O>I


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Advantages

More independent

Diet is liberal

Alleviates sx

Time for dialysis


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If K+ is still , RENAL

TRANSPLANTYoung donor + functional kidney

Cx

Infection: steroids (Azathioprine, Prednisone)

Graft rejection

Hyperacute 1st48H postop

Acute 2-3wks

Chronic several mos to yrs

Sx: BUN & creat. & wt., absence of urine, tenderness o

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Review on ABC