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...
 HOWEVER ITS USE IS DEBATEABLE. MOREOVER
ALBUMIN, ADMINISTRATION MAY ALSO HAVE
DELETERIOUS EFFECTS INCLUDING ALTERED
COAG...
 IT IS A PROSPECTIVE STUDY WHICH WAS
CONDUCTED IN A NEUROSURGERY WARD OF
TRAUMA CENTRE, IN SEVERE HEAD INJURY
PATIENTS FR...
 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...
 TOTAL OF 13 PATIENTS RECEIVED ALBUMIN
FROM THE MONTH OF JANUARY 2013. OUT
OF THIS TOTAL NUMBER 92% WERE MALES
AND 8% WER...
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
T...
 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| = 0.05...
 PRIOR TO ALBUMIN ADMINISRATION THE
INITIAL ALBUMIN LEVELS WAS 2.1 .AND POST
ADMINISTRATION THE AVERAGE INCREASE WAS
OF 2...
 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...
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...
 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...
 PRIOR
 OBTAIN THE ALBUMIN LEVELS.NORMAL RANGE
3.3 TO 5 G/DL IN ADULTS.
 ENSURE PRE INFUSION OBSERVATIONS.
 ENSURE GOO...
 GENERAL
 CHECK PRODUCT LABEL AND PRESCRIPTION.
CONNECT ALBUMIN ACCORDING TO RELEVANT
INTRAVENOUS THERAPY GUIDELINES USI...
 RECORD THE FOLLOWING TRANSFUSION
CHART:
 THE BATCH OF THE ALBUMIN
 DATE AND TIME OF STARTING INFUSION
 SIGN THAT YOU ...
 CHECK PERIPHERAL INFUSION ACCESS SITE
 REDNESS
 SWELLING/INFLAMMATION
 PALLOR
 LEAKAGE/OOZING
 SKIN TEMPERATURE CHA...
 OBSERVE FOR MINOR REACTIONS
 MOTTLED APPEARANCE
 DIZZINESS
 RASH
 REDNESS ON CHEST
 FLUSHING
 FEVER
 TACHYCARDIA
...
 OBSERVE FOR MAJOR REACTIONS
 RIGOR
 LABOURED BREATHING/WHEEZING
 CHEST PAIN
 BACK OR LOIN PAIN/DARKENED URINE
 LOSS...
 VOLUME OVERLOAD CAN OCCUR IF THE DOSAGE
AND RATE OF INFUSION ARE TOO HIGH
.CLINICAL SIGNS AND SYMPTOMS INCLUDE:
 HEADAC...
 STOP INFUSION.
 INFUSE 0.9% SODIUM CHLORIDE FOR INFUSION
USING NEW INTRAVENOUS SOLUTION
ADMINISTRATION SET
 OBTAIN MED...
 USE OF ALBUMIN IN SEVERE HEAD PATIENTS IS
ASSOCIATED WITH INCREASED MORTALITY
RATES HENCE MAKING ITS USE CONTROVERSIAL.
...
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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Transcript of "ROLE OF ALBUMIN IN HYPOPROTEINEMIA IN HEAD INJURY PATIENTS AND ITS NURSING IMPLICATIONS"

  1. 1. BY MS BINCY JOHN,Dr Deepak Agarwal
  2. 2.  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
  3. 3.  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.
  4. 4.  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
  5. 5.  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.
  6. 6.  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
  7. 7. 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
  8. 8.  AGE IN CORRESPONDENCE TO SURVIVAL /DEATH FREQUENCY TABLE  SCALE SURVIVAL 00 DEATH 01
  9. 9. 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
  10. 10.  THIS SHOWS THAT A MAJOR GROUP OF PATIENT WHO RECEIVED ALBUMIN WERE MALES SPECIFIC TO THE AGE GROUP OF 31 TO 50 YEARS.
  11. 11.  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
  12. 12.  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
  13. 13.  OUTCOME CHART OUTCOME FREQ PERCENT CUM 00 6 46.15 46.15 01 7 53.85 100 TOTAL 13 100
  14. 14.  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
  15. 15. 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
  16. 16.  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.
  17. 17.  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
  18. 18.  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.
  19. 19.  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
  20. 20.  RECORD THE FOLLOWING TRANSFUSION CHART:  THE BATCH OF THE ALBUMIN  DATE AND TIME OF STARTING INFUSION  SIGN THAT YOU ARE RESPONSIBLE FOR ITS ADMINISTRATION
  21. 21.  CHECK PERIPHERAL INFUSION ACCESS SITE  REDNESS  SWELLING/INFLAMMATION  PALLOR  LEAKAGE/OOZING  SKIN TEMPERATURE CHANGE  TENDERNESS .
  22. 22.  OBSERVE FOR MINOR REACTIONS  MOTTLED APPEARANCE  DIZZINESS  RASH  REDNESS ON CHEST  FLUSHING  FEVER  TACHYCARDIA  NAUSEA  CHILLS  SALIVATION
  23. 23.  OBSERVE FOR MAJOR REACTIONS  RIGOR  LABOURED BREATHING/WHEEZING  CHEST PAIN  BACK OR LOIN PAIN/DARKENED URINE  LOSS OF CONSCIOUSNESS  SUDDEN COLLAPSE
  24. 24.  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.
  25. 25.  STOP INFUSION.  INFUSE 0.9% SODIUM CHLORIDE FOR INFUSION USING NEW INTRAVENOUS SOLUTION ADMINISTRATION SET  OBTAIN MEDICAL ASSISTANCE AND RECORD INCIDENT
  26. 26.  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.

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