Nursing Case Analysis-AVF
Nursing Case Analysis-AVF
Nursing Case Analysis-AVF
I. Assessment
I. Demographic Profile Clients Initials: SVE Age: 56 y/o Address:Purok 2 Barangay Mercedes,Camarines norte Religion: Roman Catholic Civil Status: Widowed Nationality: Filipino Date of Birth: July 4,1955 Place of Birth: Daet, Camarines Sur
History
Family History: (+) Hypertension- Mother (+) Allergy to sea foods siblings (-) DM,CVD,Asthma,Cancer,Thyroid Disease Medical History: 1 month PTA patient complained of non-radiating epigastric pain relieved by food intake.. Admitted for 3 days at a local hospital. 2 weeks PTA- (+) vomiting for 5 hours of previously ingested food. Was admitted for 3 days UTZ- cholelithiasis. Was advised surgery. Opted for a second opinion in our institution,was advised surgery. Hence,admission.
III.Pathophysiology
Steal Syndrome-Clinical conditon caused by arterial insufficiency distal to a hemodialysis AV fistula or graft due to the diversion of blood into the fistula or graft.
Creation of arterio-venous fistula Backflow of blood from artery to vein due to low flow resistance of vein
Arterial insufficiency
IV. OR Procedure
AVF Ligation- An arterio-venous fistula is a
connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm. Ligation of AVF is performed to stop the blood flow through the fistula.
Procedure
-The patient was brought to the operating room and placed on the operating room table in supine position . -The whole body was draped with only the left arm exposed. The arm was then prepared by Glutacept spray to the entire forearm -The area overlying the proximal portion of the fistula was infiltrated with 2% lidocaine.
-A transverse incision was then made overlying the fistula. Following this,the proximal outflow tract of the fistula was encircled. This was then ligated with Silk 4.0 ties. -The flow in the fistula was thus stopped. Hemostasis was inspected and found obtained. The wound was closed in two layers with Silk 4.0 sutures.
V. Drug analysis
Generic name Brand name Action Rationale Nursing Intervention
Amlodipine
Norvasc
acts by relaxing the smooth muscle in the arterial wall, decreasing tota l peripheral resistance and hence reducing blood pressure; in angina it increases blood flow to the heart muscle.
Generic name
Brand name
Action
Rationale
Nursing Intervention
Saxagliptin
Onglyza
slows down the breakdown of incretin hormones, including increasing insulin production in response to meals and decreasing the amount of glucose that the liver produces.
Instruct patient to take saxagliptin as directed. Take missed doses as soon as remembered, unless it is almost time for next dose; do not double doses.
Generic name
Brand name
Action
Rationale
Nursing Intervention
Atovorstatin
Lipitor
used to lower cholester ol levels by inhibiting the enzyme HMGCoA reductase, which plays a central role in the production of cholesterol in the liver.
Administer drug without regard to food but at the same time each day
Monitor for concurrent alcohol use. (Alcohol may affect liver function.)
Generic name
Brand name
Action
Rationale
Nursing Intervention
Isosorbide mononitrate
Imdur
Generic name
Brand name
Action
Rationale
Nursing Intervention
Pregabalin
Lyrica
binds to calcium channels on nerves and may modify the release of neurotransmitt ers .Reducing communication between nerves may contribute to its effect on pain and seizures.
Pregabalin therapy should be stopped gradually over at least 1 week to decrease risk of seizure activity and avoid unpleasant symptoms such as diarrhea, headache, insomnia, and nausea.
Generic name
Brand name
Action
Rationale
Nursing Intervention
Celecoxib
Celebrex
Assess patient for allergy to sulfonamides, aspirin, or NSAIDS. Patients with these allergies should not receive celecoxib.
May be administered without regard to meals.
Generic name
Brand name
Action
Rationale
Nursing Intervention
Advise patient to notify health care professional promptly if signs or symptoms of GI toxicity (abdominal pain, black stools), skin rash, unexplained weight gain, edema occurs.
Generic name
Brand name
Action
Rationale
Nursing Intervention
Co-amoxiclav
Augmentin
destroys Prophylactic bacteria by antibiotic disrupting their ability to form cell walls.
If the patient develops a rash, wheezing, itching, fever or swelling in the joints, this could indicate an allergy and should be reported. - Patients must ensure they take the full course of the medicine. - The medicine must be taken
Generic name
Brand name
Action
Rationale
Nursing Intervention
- The medicine must be taken in equal doses around the clock to maintain level in the blood.
Report diarrhoea, cramping and blood in stools as pseudomembr anous colitis may occur.