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ROLE OF ALBUMIN IN HYPOPROTEINEMIA IN HEAD INJURY PATIENTS AND ITS NURSING IMPLICATIONS
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ROLE OF ALBUMIN IN HYPOPROTEINEMIA IN HEAD INJURY PATIENTS AND ITS NURSING IMPLICATIONS

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ROLE OF ALBUMIN IN HYPOPROTEINEMIA IN HEAD INJURY PATIENTS AND ITS NURSING IMPLICATIONS ROLE OF ALBUMIN IN HYPOPROTEINEMIA IN HEAD INJURY PATIENTS AND ITS NURSING IMPLICATIONS Presentation Transcript

  • BY MS BINCY JOHN,Dr Deepak Agarwal
  •  HYPOPROTEINEMIA OCCURS COMMONLY IN THE SEVERE HEAD INJURY PATIENTS DUE TO DECREASED SYNTHENSIS BY THE LIVER OR INCREASED LOSSES EITHER INTERNALLY OR EXTERNALLY.ADMINISTRATION OF ALBUMIN SOLUTIONS TO CORRECT HYPOPROTEINEMIA IN SEVERE HEAD INJURY PATIENTS IS VERY COMMON
  •  HOWEVER ITS USE IS DEBATEABLE. MOREOVER ALBUMIN, ADMINISTRATION MAY ALSO HAVE DELETERIOUS EFFECTS INCLUDING ALTERED COAGULATION,ALTERED RENAL FUNCTION,DECREASED MYOCARDIAL CONTRACTILITY,IMMUNOSUPPRESSION AND WORSENED EDEMA.
  •  IT IS A PROSPECTIVE STUDY WHICH WAS CONDUCTED IN A NEUROSURGERY WARD OF TRAUMA CENTRE, IN SEVERE HEAD INJURY PATIENTS FROM THE MONTH OF JANUARY 2013.  THE DATA WAS COLLECTED THROUGH THE RECORDS AVAILABLE IN THE NEUROSURGERY WARD AND ALSO THROUGH ELECTRONIC HEALTH RECORD OF EACH PATIENT MAINTAINED
  •  A TOTAL OF 13 PATIENTS WITH SEVERE HEAD INJURY ( I.E HISTORY OF TRAUMA,EVIDENCE OF HEAD TRAUMA IN CT SCAN AND A SCORE OF 3-8 ON THE GLASGOW COMA SCALE) WERE INCLUDED IN THE STUDY.
  •  TOTAL OF 13 PATIENTS RECEIVED ALBUMIN FROM THE MONTH OF JANUARY 2013. OUT OF THIS TOTAL NUMBER 92% WERE MALES AND 8% WERE FEMALES. SCALE FOR AGE GROUP AGE GROUP DENOTES 10 TO 30 1 31 TO 50 2 51 TO 70 3 71 AND ABOVE 4
  • AGE FREQUENCY PERCENT CUM 1 3 23.08 23.03 2 8 61.54 84.62 3 1 7.69 92.31 4 1 7.69 100 TOTAL 13 100
  •  AGE IN CORRESPONDENCE TO SURVIVAL /DEATH FREQUENCY TABLE  SCALE SURVIVAL 00 DEATH 01
  • AGE 00 01 TOTAL 1 1 2 3 33.33 66.67 100 2 4 4 8 50.00 50.00 100.00 3 1 0 1 100.00 0.00 100.00 4 0 1 1 0.00 100.00 100.00 TOTAL 6 7 13 46.15 53.85 100.00
  •  THIS SHOWS THAT A MAJOR GROUP OF PATIENT WHO RECEIVED ALBUMIN WERE MALES SPECIFIC TO THE AGE GROUP OF 31 TO 50 YEARS.
  •  PRE AND POST ALBUMIN LEVEL CHART N 13 13 MEAN 2.12 2.87 SD .53 .87 P50 2.1 3.1 MIN 1.1 1.3 MAX 2.9 4.1 PROB > |Z| = 0.0535
  •  PRIOR TO ALBUMIN ADMINISRATION THE INITIAL ALBUMIN LEVELS WAS 2.1 .AND POST ADMINISTRATION THE AVERAGE INCREASE WAS OF 2.9 WITH THE |Z| = 0.0535 ,MAKING IT STATISTICALLY INSIGNIFICANT.  ON A WHOLE ONLY A NET DIFFERENCE OF 0.8 WAS SEEN AMONG THESE PATIENTS
  •  OUTCOME CHART OUTCOME FREQ PERCENT CUM 00 6 46.15 46.15 01 7 53.85 100 TOTAL 13 100
  •  OUTCOME CHART WITH PRE AND POST ALBUMIN LEVELS  SURVIVAL N 6 6 MEAN 2.4 3.7 SD .39 .60 P50 2.5 3.15 MIN 1.8 2.6 MAX 2.9 4.1 PROB > |Z| = 0.0273
  • DEATH N 7 7 MEAN 1.8 2.4 SD .52 .89 P50 1.8 2.2 MIN 1.1 1.3 MAX 2.8 4 PROB > |Z| = 0.0178
  •  TOTAL COST CHART ACCORDING TO OUTCOME OUTC OME N MEAN SD P50 MIN MAX 00 6 15000 0 15000 15000 15000 01 7 25000 14142.1 4 15000 15000 45000 TOTA L 13 20384. 68 11266.0 1 15000 15000 45000 ON AN AVERAGE EACH PATIENT RECEIVED ALBUMIN FOR 4 DAYS ( MIN 3 DAYS MAX 9 DAYS)MOUNTING TO AN EXPENSE OF RS 20,000 EACH.
  •  NUMBER OF DAYS POST ADMISSION ALBUMIN STARTED CHART BY OUTCOME 0UTCO ME N MEAN SD P50 MIN MAX 00 6 18.33 11.86 13.5 8 37 01 7 18.71 17.71 14 2 51 TOTAL 13 18.53 14.63 14 2 51 POST ADMISSION ON AN AVERAGE OF 19 DAYS ALBUMIN WAS INITIATED IN THE PATIENTS FOR BOTH SURVIVED AND DEAD PATIENTS
  •  PRIOR  OBTAIN THE ALBUMIN LEVELS.NORMAL RANGE 3.3 TO 5 G/DL IN ADULTS.  ENSURE PRE INFUSION OBSERVATIONS.  ENSURE GOOD VENOUS ACCESS  PROTECT MEDICINE FROM DIRECT SUNLIGHT AND PRESERVE AT A TEMPREATURE OF NOT ABOVE 25 DEGREE C.  SHOULD NOT BE MIXED WITH OTHER MEDICINES ,PACKED CELLS OR WHOLE BLOOD.
  •  GENERAL  CHECK PRODUCT LABEL AND PRESCRIPTION. CONNECT ALBUMIN ACCORDING TO RELEVANT INTRAVENOUS THERAPY GUIDELINES USING AN ASEPSIS  SET INFUSION RATE ACCORDING TO PRESCRIPTION BUT ENSURE INFUSION IS COMPLETED WITHIN THREE HOURS  THE INTRAVENOUS SOLUTION ADMINISTRATION SET MAY NEED FLUSHING WITH 0.9% SODIUM CHLORIDE TO ENSURE THE TOTAL AMOUNT OF ALBUMIN PRESCRIBED IS INFUSED
  •  RECORD THE FOLLOWING TRANSFUSION CHART:  THE BATCH OF THE ALBUMIN  DATE AND TIME OF STARTING INFUSION  SIGN THAT YOU ARE RESPONSIBLE FOR ITS ADMINISTRATION
  •  CHECK PERIPHERAL INFUSION ACCESS SITE  REDNESS  SWELLING/INFLAMMATION  PALLOR  LEAKAGE/OOZING  SKIN TEMPERATURE CHANGE  TENDERNESS .
  •  OBSERVE FOR MINOR REACTIONS  MOTTLED APPEARANCE  DIZZINESS  RASH  REDNESS ON CHEST  FLUSHING  FEVER  TACHYCARDIA  NAUSEA  CHILLS  SALIVATION
  •  OBSERVE FOR MAJOR REACTIONS  RIGOR  LABOURED BREATHING/WHEEZING  CHEST PAIN  BACK OR LOIN PAIN/DARKENED URINE  LOSS OF CONSCIOUSNESS  SUDDEN COLLAPSE
  •  VOLUME OVERLOAD CAN OCCUR IF THE DOSAGE AND RATE OF INFUSION ARE TOO HIGH .CLINICAL SIGNS AND SYMPTOMS INCLUDE:  HEADACHE  DYSPNOEA  JUGULAR VEIN CONGESTION  INCREASED BLOOD PRESSURE  RAISED CENTRAL VENOUS PRESSURE  PULMONARY OEDEMA  MEDICAL ASSISTANCE SHOULD BE SOUGHT IF ANY OF THESE SYMPTOMS OCCUR.
  •  STOP INFUSION.  INFUSE 0.9% SODIUM CHLORIDE FOR INFUSION USING NEW INTRAVENOUS SOLUTION ADMINISTRATION SET  OBTAIN MEDICAL ASSISTANCE AND RECORD INCIDENT
  •  USE OF ALBUMIN IN SEVERE HEAD PATIENTS IS ASSOCIATED WITH INCREASED MORTALITY RATES HENCE MAKING ITS USE CONTROVERSIAL.  ALBUMIN ADMINISTRATION IN THE CRITICALLY ILL HAS BEEN DEBATED INTENSIVELY  ALBUMIN IS STOPPED AT MANY ICUS EVEN THOUGH A NEW STUDIES COULD NOT CONFIRM ANY ADVERSE EFFECT OF ALBUMIN ON MORTALITY.