| Serum Creatinine Normal Values Posted: 17 Dec 2010 06:47 PM PST 
Serum Creatinine 
- It is a by product of in the breakdown of muscle creatinine phosphate resulting from energy metabolism.
- It is produced at a constant rate depending on the muscle mass of the person and is removed from the body by the kidneys.
- Production of creatinine is constant as long as muscle mass remains constant.
- A disorder in kidney function reduces excretion of creatinine, resulting in increased blood creatinine levels. Thus, serum creatinine levels give an approximation of the glomerular filtration rate.
- It diagnoses impaired renal function. It is a more specific and sensitive indicator of kidney disease than BUN.
Normal Values: Young Children (0 – 3 years old): 0.3 – 0.7 mg/dL Children (3 – 18 years old): 0.5 – 0.10 mg/dL Adults Men: 0.9 – 1.3 mg/dL Adults Women: 0.6 – 1.1 mg/dL Procedure: - This is done by obtaining 5 mL of venous blood serum sample.
- Assess diet for meat and protein intake.
Clinical Implications: - impaired renal function
- chronic nephritis
- obstruction of urinary tract
- muscle disease such as gigantism, acromegaly
- congestive heart failure
- shock
- dehydration
- rhabdomyolysis
- hyperthyroidism
- small stature
- decreased muscle mass
- advanced and severe liver disease
- inadequate dietary protein
- pregnancy
Interfering Factors: - High levels of ascorbic acid and cephalosphorin antibiotics can cause a false increased creatinine level.
- Drugs that influence kidney function plus other medications can cause a change in the blood creatinine level.
- A diet high in meat can elevate serum creatinine levels.
- Creatinine is falsely decreased by by bilirubin, glucose, histidine and quinidine compounds.
- Ketoacidosis may increase serum creatinine substantially.
Nursing Considerations:
- Correlate the elevated createnine levels to clinical problems. Low levels indicates small muscle mass which is mostly found in amputees and in clients with muscle disease.
- As ordered by the physician, hold all medications for 24 hours before the test as some medications may affect the result.
- Check the urine output in 24 hours. Renal insufficiency may happen when urine output is less than 600ml for 24 hours.
- If BUN and createnine are increased, most likely there is kidney disease.
Photo credits: www.health.allrefer.com Related posts: - Serum Creatinine
- Serum Sodium Normal Values
- Serum Albumin
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| Serum Sodium Normal Values Posted: 17 Dec 2010 06:31 PM PST 
Definition: - Sodium is the most abundant cation and the chief base of the blood.
- Its primary functions in the body are to maintain osmotic pressure and acid-base balance chemically and to transmit nerve impulses.
- Mechanisms for maintaining a constant sodium level in the plasma and extracellular fluid include renal blood flow, carbonic anhydrase enzyme activity, aldosterone, and action of other steroids.
- Determinations of serum sodium balance detect changes in water balance rather than sodium balance.
- Sodium levels are used to determine electrolytes, acid-base balance, water balance, water intoxication and dehydration.
Normal Values: Infants: 133 – 142 mEq/L Children (1 – 16 years old): 136 – 145 mEq/L Adults: 136 – 145 mEq/L Procedure: - This is done by obtaining 5 mL of venous blood serum sample.
- Heparinized blood can be used.
- Avoid hemolysis.
Clinical Implications: - Increased sodium / hypernatremia:
- dehydration and insufficient water intake
- Conn’s syndrome
- primary aldosteronism
- coma
- Cushing’s disease
- diabetes insipidus
- tracheobronchitis
- Decreased sodium / hyponatremia:
- severe burns
- congestive heart failure
- excessive fluid loss such as severe diarrhea, vomiting
- excessive IV induction of nonelectrolyte fluids such as glucose
- Addison’s disease
- severe nephritis
- pyloric obstruction
- malabsorption syndrome
- diabetic acidosis
- drugs such as diuretics
- edema
- large amounts of water per orem
- hypothyroidism
- excessive ADH production
Interfering Factors: - Anabolic steroids, corticosteroids, calcium, fluorides, and iron can increase sodium levels.
- Heparin, laxatives, sulfates and diuretics can cause decreases in sodium levels.
- High triglycerides or low protein can cause artificially low sodium values.
Decreased serum sodium:
- Assess for signs and symptoms of hyponatremia. (apprehension, anxiety, muscular, twitching, muscular weakness, headaches, tachycardia and hypotension)
- Be knowledgeable that hyponatremia after surgery is the result of SIADH. There is an increased reabsorption from the kidney and sodium dilution between one to two days before the surgery.
- Take vital signs to determine cardiac status during hyponatremia.
Increased serum sodium: - Check for signs and symptoms of hypernatremia. (restlessness, thirst, flushed skin, sticky mucous membrane, a rough dry tongue and tachycardia)
- Keep an accurate record of input and output of fluids.
- Observe for signs of edema and overhydration resulting from an elevated serum sodium level.
Photo credits: www.wellsphere.com Related posts: - Serum Creatinine Normal Values
- Fluid and Electrolyte Imbalance: Hyponatremia
- Serum Albumin
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| Vacuum Assisted Closure Pressure Therapy Assistance Posted: 17 Dec 2010 06:27 PM PST 
Definition - Also known as negative pressure wound therapy
- Is used to enhance delayed or impaired wound healing
- The device applies local sub-atmospheric pressure to draw the edges of the wound toward the center.
- A special dressing is placed in the wound or over a graft or flap, which removes fluid from the wound and stimulates growth of healthy granulation tissue.
- The procedure is used for acute and traumatic wounds and pressure ulcers or chronic open wounds, such as diabetic ulcers, meshed grafts, and skin flaps.
Contraindications - Fistulas that involve organs or body cavities
- Necrotic tissue with eschar
- Untreated osteomyelitis
- Malignant wounds
- Use cautiously in patients with active bleeding, patients undergoing anticoagulant therapy, and with patients with history of difficult wound hemostasis.
Equipment - Water proof trash bag
- Goggles
- Gown
- Emesis basin
- Normal saline solution
- Clean gloves
- Sterile gloves
- Sterile scissors or scalpel
- Linen-saver pad
- 35 ml piston syringe with 19G catheter
- Reticulated foam
- Fenestrated tubing
- Evacuation tubing
- Evacuation canister
- Vacuum unit
Preparation of equipment - Assemble the VAC device at the bedside
- Negative pressure is set according to the physician's order
Procedure - Check the physician's order for the dressing change and for any pre-procedure analgesics to be administered.
- Verify the patient's identity using two patient identifiers, such as the patient's name and identification number.
- Reinforce the explanation of the procedure, provide privacy, and wash your hands.
- Put on gown and goggles to protect yourself from wound drainage and contamination.
- Place a linen saver pad under the patient to catch spills
- Position the patient to allow maximum wound exposure, and place the emesis basin under the wound to collect drainage.
- Put on clean gloves; remove the soiled dressing and discard.
- The physician or wound specialist will:
- Attach the 19G catheter to the 35 ml piston syringe and irrigate the wound thoroughly using normal saline solution.
- Clean the area around the wound with normal saline solution
- Remove and discard soiled gloves and put on sterile gloves
- Cut the foam to the shape and measurement of the wound using sterile scissors or a scalpel
- Carefully place the foam in the wound
- Place the transparent occlusive air-permeable drape over the foam, enclosing the foam and tubing together.
- Remove and discard the soiled gloves
- Connect the free end of the fenestrated tubing to the tubing that's connected to the evacuation canister
- Turn on the vacuum unit and ensure that the dressing is occlusive.
- When the procedure is finished, make sure the patient is comfortable.
- Dispose all soiled equipment.
Nursing Interventions - The dressing is changed every 48 hours; try to coordinate the dressing change with the physician's visit so he can inspect the wound.
- Measure the amount of drainage every shift.
- Audible and visual alarms alert you if the unit is tipped greater than 45 degrees, the canister is full, the dressing has an air leak, or the canister becomes dislodged.
- Reinforce the explanation of the procedure to the patient and answer questions.
- The patient may need to maintain bed rest during vacuum therapy.
- Provide support to the patient as needed.
Related posts: - CHECKLIST FOR CHANGE OF DRESSING
- PROVIDING TRACHEOSTOMY CARE
- Urinary Catheter Irrigation
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| Urinary Catheter Irrigation Posted: 17 Dec 2010 06:22 PM PST 
To avoid introducing microorganisms into the bladder, urinary catheter irrigation is only done to remove obstruction such as a blood clot that develops after bladder, kidney, or prostate surgery. Contraindications - Use caution if the patient has recently had prostate, bladder, ureteral, or kidney surgery.
Equipment - Ordered irrigating solution such as normal saline
- Sterile graduated receptacle or emesis basin
- Sterile bulb syringe or 60 ml catheter tip syringe
- Two alcohol pads
- Sterile gloves
- Linen-saver pad
- Intake-output sheet
- Basin of warm water
Preparation of Equipment - Check the expiration date on the irrigating solution and warm the solution to room temperature to prevent vesical spasms during instillation.
- Place the container basin of warm water
- Wash your hands and assemble the equipment at the bedside.
Procedure - Check the physician's order for the dressing change and for any pre-procedure analgesics to be administered.
- Verify the patient's identity using two patient identifiers, such as the patient's name and identification number.
- Place the patient in dorsal recumbent position
- Place a linen-saver pad under the patient's buttocks to protect bed linens
- Create a sterile field at the patient's bedside by opening the sterile equipment tray or commercial kit.
- Clean the lip of the solution bottle by pouring a small amount into a sink or waste receptacle, using sterile technique.
- Pour the prescribed amount of solution into the graduated receptacle or emesis basin.
- Place the tip of the syringe into the solution
- Squeeze the bulb or pull back the plunger and fill the syringe with appropriate amount of solution.
- Open the package of alcohol pads and put on sterile gloves
- Clean the juncture of the catheter and drainage tube with an alcohol pad to remove as many bacterial contaminants as possible.
- Disconnect the catheter and drainage tube by twisting them in opposite directions and carefully pulling them apart without creating tension on the catheter.
- Don't let go of the catheter-hold it in your non-dominant hand.
- Place the end of the drainage tube on the sterile field.
- Keep the end of the drainage tube sterile by placing sterile gauze over it.
- Twist the bulb syringe or catheter tip syringe into the catheter's distal end.
- Squeeze the bulb or slowly push the plunger of the syringe to instill the irrigating solution through the catheter.
- Refill the syringe and repeat this step until you've instilled the prescribed amount of irrigating solution.
- Remove the syringe and direct the return flow from the catheter into a graduated receptacle or emesis basin.
- Wipe the end of the drainage tube and catheter with the remaining alcohol pad.
- Wait a few seconds until the alcohol evaporates, then reattach the drainage tubing to the catheter.
- Dispose all used supplies properly.
Nursing Interventions - Catheter irrigation requires strict sterile technique to prevent bacteria from entering the bladder.
- The end of the catheter and drainage tube and tip of the syringe must be kept sterile throughout the procedure.
- The physician may order a continuous irrigation system, which decreases the risk of infection by eliminating the need to disconnect the catheter and drainage tube repeatedly.
- Encourage the patient not on restricted fluid intake to increase intake to 3,000 ml per day to help flush the urinary system and reduce the sediment formation.
- To keep the patient's urine acidic and help prevent calculus formation, tell him to eat foods containing ascorbic acid, including citrus fruits and juices, cranberry juice, and dark green and deep yellow vegetables.
- Reinforce that the patient remains as still as possible and should report any discomfort during procedure.
Complications - Introduction of bacteria into the urinary tract can produce a urinary tract infection.
Related posts: - ADMINISTERING AN EAR IRRIGATION
- ADMINISTERING AN EYE IRRIGATION
- IRRIGATING A NASOGASTRIC TUBE CONNECTED TO SUCTION
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| Salmonella Typhosa Posted: 17 Dec 2010 06:06 PM PST 
Salmonella typhosa Common Name: Typhus abdominalis General Characteristics - gram negative, non sporeforming rods with variable length
- motile with peritrichous flagella
- grow readily on simple media containing glucose and ammonium salts over a pH range of 6 to 8 and at a temperature range between 15 and 41C with 37C as the optimum temperature
- non-lactose fermenter but forms acid and sometimes gas
- produce hydrogen sulfide gas
- aerobic but facultatively anaerobic
- produce endotoxin responsible for the fever and body weakness of the patient
- produce cytotoxin that appears to be associated with the outer bacterial membrane and plays a part in cellular invasion and destruction
- on bismuth sulfite medium, produce colonies which are colored jet black in contrast to the colorless colonies of E. coli
- on EMB agar plate and Salmonella-Shigella (SS agar), colonies are small and colorless
- remain alive in cultures for months or even years as long as moisture is supplied
- survive freezing for long periods
- destroyed in milk by pasteurization, in water by chlorination
- inhabit intestinal tract of man
- cause typhoid fever
Three main species: a. Salmonella typhi (one serotype) b. Salmonella cholerasuis (one serotype) c. Salmonella enteritidis (more than 1500 serotypes) Typhoid Fever - a systemic, granulomatous, active infectious disease with incubation period of 10-14 days
- characteristized by continuous fever, malaise, headache, constipation, bradycardia and myalgia
- rose spots – characteristic sign
Mode of Transmission - ingestion of contaminated foods such as shellfish, dried or frozen eggs, meat and meat products
- drinking contaminated water, milk and dairy products
- use of recreational drugs and animal dyes
- playing with household pets
- via convalescent or healthy permanent carriers who continue to harbor organisms in their tissues for variable lengths of time
Laboratory Diagnosis Treatment - chloramphenicol – drug of choice
- ampicillin – alternative drug
- if with resistance to both, trimethoprim-sulfamethoxazole
Prevention and Control - Sanitary measures must be taken to prevent contamination of foods and water by rodents or other animals that excrete salmonella.
- Infected poultry, meats and eggs must be thoroughly cooked.
- Carriers must not be allowed to work as food handlers and should observe strict hygienic precautions.
- Cholecystectomy or ampicillin may eliminate the carrier state.
- Oral typhoid vaccine confers 3 years protection.
- Injectable typhoid vaccine confers only 6 months protection.
Photo credits: www.dartmouth-hitchcock.org Related posts: - Nursing Care Plan – Typhoid Fever
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