Laboratory and Diagnostic Exam

8/3/2019 Laboratory and Diagnostic Exam

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mfayLABORATORY TESTS RESULTS AND DIAGNOSTIC EXAMINATIONS

Gat Andres Bonifacio Memorial Medical Center

Hematology Examination

Date: November 02, 2011

LABORATORYEXAMINATION

NORMALVALUES

RESULTS ANALYSIS NURSING INTERVENTION

Hemoglobin 120-180gm/l

114 gm/l Decrease in hemoglobinresults in blood loss fromthe cellular injury whichdisrupts blood flow fromentering the cells and

tissues of the body thus

decrease in tissueperfusion from decreaseblood volume or reducedcirculating erythrocytes.

Administer IV fluids asordered to improve tissueoxygenation.

Prepare for Bloodtransfusion if massive bloodloss occurs to increase

blood volume. Monitor vital signs and

pulse oximeter readingsclosely.

Assess for signs andsymptoms of hypovolemicshock.

Promoting rest and comfortto decrease oxygendemand.

Proper positioning toprevent any complication.

Provide O2 therapy asordered to increase oxygenin the blood.

Hematocrit 0.370-0.540 0.339 Due to acute massiveblood loss causing

disruption of blood fromentering the cells andtissues of the body.

Segmenters 0.60-0.70 0.48 Decrease in segmentersis due to blood loss

cause by the response to

Observe and report signsof infection.


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cellular injury. Assess temperature. Note and report laboratory

values (e.g., white bloodcell count and differential,

serum protein, serumalbumin, and cultures). Encourage a balanced diet,

emphasizing proteins tofeed the immune system.

Encourage fluid intake andadequate rest to bolster theimmune system.

Administer antibiotics, asordered.

Lymphocytes 0.20-0.40 0.52 High lymphocytes countindicates the response

to cellular changes byrelease of chemical

mediators as aninflammatory response.

Platelet count 150-450 x109/L

332 x 109/L NORMAL Observe for any changes inany laboratory values.

Monitor vital signs.

Document findings.Blood type N/A Type A Rh

positiveN/A N/A


Date: November 02, 2011 (due at 2 pm)

LABORATORYEXAMINATION NORMALVALUES RESULTS ANALYSIS NURSING INTERVENTION


89 gm/l Decrease inhaemoglobin results in

blood loss from thecellular injury which

disrupts blood flow fromentering the cells andtissues of the body.


Prepare for Bloodtransfusion if massive bloodloss occurs to increase


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blood volume.

Monitor vital signs andpulse oximeter readingsclosely.

Assess for signs andsymptoms of hypovolemicshock.

Promoting rest and comfortto decrease oxygendemand.


Provide O2 therapy asordered to increase oxygen

in the blood.

Hematocrit 0.370-0.540 0.250 Due to acute massiveblood loss causing

disruption of blood from

entering the cells andtissues of the body

ECG


DIAGNOSTICPROCEDURE

FINDINGS ANALYSIS NURSINGINTERVENTION

ECG A tall R wave (greater than 25mm in V5 or V6) or R plus S

greater than 35 mm).

A deep S in V1 or V2.

Inverted T waves in V5 or V6and ST depression.

Left axis deviation is present.

QRS is slightly prolonged.

Left ventricular

hypertrophy

Providepositioning withthe head of bed

the elevated(Fowler'sposition).

Give adequateoxygen supply.

Monitor vitalsigns regularlyand beforemedications if


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indicated. Identify early

signs orworsening signs

of CHF, such asreduced oxygensaturations,pedal edema,heartirregularities,heart rate,increased workof breathing,rapid weight

changes, etc.and notify thephysician ifchanged frombaseline.

Monitor intakeand output.

Plain Cervical CT- Scan


DIAGNOSTIC

PROCEDURE

FINDINGS ANALYSIS NURSING INTERVENTION

Plain CervicalCT-Scan

Thickened nasopharynxlikely inflammatory in

nature.

The thickenednasopharynx is probablydue to the inflammatoryprocess caused by thetrauma made to the


Cleanse the wound of thepatient.

Assist in exploration of thewound of the patient to


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Collapsed right pyriformsinus.

Engorged thyroid glandwhich may relate to edema.

Subcutaneous emphysema

left side of the neck.

Parotid and submandibular

right neck. Theinflammatory process

reaches to the adjacentareas to localized the

inflammation.

The right pyriformssinus collapsed is dueto the surgery done on

the right side of theneck causing collapse tothe right pyriform sinus.

The edema of the

thyroid gland is causedby too much force

outside the capillariescausing it to leak into

the surrounding tissues.This excess fluid causes

the tissues to swell. Inthis case, the force is

the trauma taken by thecapillaries in the zone 2

on the left side of theneck.

Subcutaneousemphysema can resultfrom a puncture of a

part of the respiratorysystem. Particularly in

the neck, air may

examine for foreign bodiesor injuries underneath theskin.

Administer intravenous

fluids, as ordered. Assist in laceration repair

for stabbed wound.

Administer anti-inflammatory medicationsfor pain.

Administer antibiotics toprevent infections.

For Normal Findings:

Observe for any changes inany laboratory values.


Document findings.


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glands are non remarkable.

Soft tissue densities arenoted in both carotid canal,

jugular, anterior andposterior triangle of theneck.

The sternocleidomastoid

muscles are thickened andirregular.

The proximal commoncarotid arteries until the

thyroid are grossly normal.

The bifurcation internal,external carotid and jugular

veins are obscured byhematoma or collapsed /

injured.

become trapped as aresult ofpenetrating

trauma. trauma such asstabbed wound.

NORMAL

Soft tissue density is dueto trapped air as a resultof injury to a part of theairway. Carotid, jugular

and the posteriortriangle of the neck is

affected because it ispositioned in the zone 2of the neck.

The sternoclaidomastoidmuscle is thickened

because of theinflammatory process

caused by trauma. Theirregular shape is cause

by the tissue injury.

NORMAL

Due to the tissue injury,blood vessels in thetissue are affected
http://en.wikipedia.org/wiki/Penetrating_traumahttp://en.wikipedia.org/wiki/Penetrating_traumahttp://en.wikipedia.org/wiki/Penetrating_traumahttp://en.wikipedia.org/wiki/Penetrating_trauma


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Doppler studies may be ofhelp for further evaluation

and the rest are nonremarkable.

causing it to leak outsidethe blood vessels. This

blood is usually collectedin liquid form within the

tissue.

NORMAL



LABORATORYEXAMINATION

NORMALVALUES

RESULTS FINDINGS NURSING INTERVENTION


80 Decrease in hemoglobinis a reflection of the

post-op blood loss afterthe surgery and a

inflammatory responseto inflammation caused

by the injury.


Monitor vital signs andpulse oximeter readingsclosely.

Promoting rest andcomfort to decrease oxygendemand.


Provide O2 therapy asordered to increase oxygenin the blood.

Provide nutritional supportto increase blood cells.

Hematocrit 0.370-0.540 0.233 Decrease in hematocritis a reflection of the

post-op blood loss afterthe surgery and a

inflammatory responseto inflammation caused

by the injury.

Neck Ultrasound


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Date: November 23, 2011DIAGNOSTI

CPROCEDUR

E


NeckUltrasound

Mass is cystic with itssuperficial wall more thick. Itmeasures 2.8x2.3x1.7cm. It

exhibits pulsations and isadjacent a vein (internal

jugular?)

Right neck mass iscaused by post

traumatic venousaneurysm as a result of

prior exploratorylaparotomy procedure

on bilateral neck.

Monitor increased ICP dueto neck mass.

Position patient on semifowlers.

Instruct patient to avoidneck flexion,hyperextension androtation.

Nurses should take

measures to preventpatients from coughing,vomiting, shivering,tremoring, posturing, andstraining for bowelmovements.

Jose Reyes Memorial Medical Center


Date: December 03, 2011LABORATOR

YEXAMINATI

ON

NORMALVALUES


Hemoglobin 135-180 g/dL 116 g/dl A decrease in thehaemoglobin content in theblood is due to the decreasein the red blood cell. The red

Elevate head of bedespecially at night.

Instruct to avoidstrenuous activity.


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blood cell contains thehaemoglobin. Hemoglobin isdirectly proportional with the

red blood cell therefore a

decrease in the red blood cellis also a decrease in thehaemoglobin and vice versa.

Instruct patient to eatfood rich in iron.

Promote adequatebed rest.

Encourage quiet andrestful atmosphere.

Hematocrit 0.40-0.54 0.36 A decrease in the hematocritof the blood is due to thedecrease in the red bloodcell. The hematocrit, also

determines the percentage ofred blood cells in theplasma. Hematocrit is

directly proportional with thered blood cell therefore adecrease in the red blood cell

is also a decrease in thehematocrit and vice versa.

Assess for his/herability to toleratephysical activity.

Assess the extent ofthe patient'sweakness and fatigueon exertion when

planning physicalcare activities.

Encourage thepatient to eat foodsthat are high inprotein and iron, suchas liver, egg yolk,beef, and dried fruitssuch as prunes andapricots.

Instruct the client totake ironsupplements, asordered.

Give health teachingon when to take ironsupplements andwhat substances


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interfere with ironabsorption.

Red BloodCells

4.6-6.2 x10^12/L

3.99 x10^12/L

The decrease in the amountof red blood cells in the blood

is due to the accumulation ofthe cell in the injured site asa part of the inflammatory

process.

Administer IV fluidsas ordered.

Monitor vital signsand pulse oximeterreadings closely.

Promote rest andcomfort.

Provide O2 therapy,as ordered.

Provide nutritionalsupport.

MCV (Mean

corpuscularVolume)

80 96 fL 91 fL NORMAL Observe for any

changes in anylaboratory values.


Document findings.MCH (MeanCorpuscularHemoglobin)

27 31 g/L 29 g/L NORMAL Observe for anychanges in anylaboratory values.


Document findings.

MCHC (MeanCorpuscularHemoglobin

Concentration)

33-36 g/dL 32 g/dL The decrease in the meancorpuscular haemoglobin

concentration is due to thedecrease of haemoglobin in

the body. The MCHC isdirectly proportional to theamount of haemoglobin the

person has. If thehaemoglobin increase, the

Elevate head of bedespecially at night.

Instruct to avoidstrenuous activity.

Instruct patient to eatfood rich in iron.

Promote adequatebed rest.


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MCHC also increases viceversa.

Encourage quiet andrestful atmosphere.

RDW CV(Red Blood

CellDistributionWidth)

11.0 16.0% 14.2% NORMAL Observe for anychanges in any

laboratory values. Monitor vital signs.

Document findings.White BloodCell Count

5 10 x10^9/L

9.03 x10^9/L

NORMAL Observe for anychanges in anylaboratory values.


Document findings.Neutrophils 54-62% 74.5% The increase in the

neutrophils is one of thebodys first inflammatoryresponse due to ischemic

damage. Neutrophilsaccumulate at the site of

ischemic damage producingneutrophil extracellular trap

in order to engulf anyoffending organism and toremove cellular debris as

well. The immunologicresponse signals the bonemarrow to produce moreneutrophils to provide thebody with greater ability to

fight infection hence theincrease of neutrophils in the

blood.

Observe and reportsigns of infection.

Assess temperature. Note and report

laboratory values(e.g., white bloodcell count anddifferential, serumprotein, serumalbumin,and cultures).

Encourage abalanced diet,emphasizing proteinsto feed the immunesystem.

Encourage fluidintake and adequate


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rest to bolster theimmune system.

Before and aftergiving care to client

use proper handwashing techniques. Use goggles, gloves,

and gowns whenappropriate.

Use sterile techniquein catheterization.

Use careful techniquewhen changing andemptying urinary

catheter bags; avoidcross contamination. Use careful sterile

technique whereverthere is a loss of skinintegrity.

Ensure client'sappropriate hygieniccare with handwashing; bathing;

and hair, nail, andperineal care. Administer

antibiotics, asordered.

Lymphocytes 25-30% 18.9% The decrease in lymphocytesis the inflammatory responseof the body due to ischemicdamage. Killer T cells search

the body for cells infected byantigens. When a killerT cellrecognizes an antigen

(ischemic clot) attached to acell of the body, it attachesitself to the surface of the

infected cell. It then secretestoxic chemicals into the cell,killing both the antigen and

the infected cell. The

decrease lymphocyte is dueto the accumulation orwalling of on the damage

area to prevent the spread ofinfection.

Basophils 0.4-1% 0.1% The decrease in basophils isthe inflammatory responsedue to ischemic damage.They are the one who isresponsible for secreting

histamine which cause theEARLY changes in

vasodilation and vascularpermeability. The basophils is

present at the time ofdevelopment of inflammation

causing it to become lowerwhen the inflammationprocess is through.
http://www.wisegeek.com/what-is-a-t-cell.htmhttp://www.wisegeek.com/what-is-a-t-cell.htm


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Monocytes 0 9% 4.3% NORMAL Observe for anychanges in anylaboratory values.


Document findings.Eosinophils 1 3% 2.2% NORMAL Observe for any



Document findings.Platelet Count 150-450 x

10^9/L129 x 10^9/L The decrease in platelets is

due to the accumulation ofplatelet cells at the site of

tissue injury. The platelet in

the body goes to the site ofthe injury probably produceby the ischemic clot leaving

the blood volume with adecrease in platelet cells.

Instruct client toavoid activities thatmight result in injury.

Instruct client to usean electric razor forshaving.

Instruct client tobrush with a soft-bristle toothbrush.

Instruct client toavoid othermedications that mayweaken platelets.

These include:- Acetylsalicylic-

acid andproducts thatcontainacetylsalicylic-acid

- Ibuprofen andother non


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steroidal anti-inflammatorymedications(NSAIDs)

-

Warfarin Avoid rectal

suppositories orenemas forconstipation and donot use a rectalthermometer.

Mean PlateletVolume (MPV)

7.5 11.5 fL 8.9 fL NORMAL Observe for anychanges in anylaboratory values.

Monitor vital signs. Document findings.

Clinical Chemistry

Date: December 3, 2011

LABORATORY

EXAMINATION

NORMALVALUES


Creatinine 45 104mol/L 77.67mol/L NORMAL

Observe for anychanges in anylaboratory values.


Document findings.Sodium 135 143

mmol/L138.2

mmol/LNORMAL Observe for any




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Document findings.Potassium 3.41 4.82

mmol/L3.63 mmol/L NORMAL Observe for any



Arterial Blood Gas


LABORATORY

EXAMINATION

NORMALVALUES


pH 7.350- 7.450 7.402 In order to compensate forthe respiratory alkalosis, pH

level should adjust to theborderline of alkalinity.

Encourage patient tobreathe slowly anddeeply. Speak in alow, calm tone ofvoice; providesafe environment.

Demonstrateappropriate breathingpatterns,if appropriate.

Provide comfort

measures. Promotes relaxation

and reduces stress.Control and reductionof fever reducespotential for seizuresand helps reducerespiration rate.

PO2 80.0- 100.0 195.5(+)mmHg

Increased when inspiredhigher oxygen levels.

PCO2 35.0- 45.0 25.5mmHg (-) PCO2 is decreased inRespiratory Alkalosis.

SO2 75.9- 99.0 99.6 % (+) Breathing oxygen-enriched air will increase

SO2 level.

HCO3 22- 26 15.5 mmHg HCO3 is decreased inRespiratory Alkalosis.


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Plain Cranial CT-Scan


DIAGNOSTIC

PROCEDURE


Plain cranialCT-Scan

There is an area ofhypodensity involving

the right fronto-temporo- parietal

lobes witheffacement of the

adjacent cortical sulciand follows the right

territorial distributionof the right middlecerebral artery.

Cerebrovascular Accidentcan produce hypodense

areas in region that is cutoff from blood flow.

Teach the patient to identify riskfactors and necessary life-stylemodifications, such as diet, stressreduction, and smokingcessation.

Maintain a patent airway topromote adequate oxygenation.

Maintain bed rest to minimize

metabolic requirements. Begin bedside range-of-motion

exercise to preserve mobility andprevent deformities.

Urinalysis


LABORATORY

EXAMINATION

NORMALVALUES


Color Light yellowto amber

Amber NORMAL Observe for anychanges in anylaboratory values.


Document findings.Appearance Clear Turbid The turbid appearance of Observe for any


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the urine is probably due tothe RBC, WBC ketones and

bacteria present in the urinemaking it cloudy / turbid.



Document findings.

PH 5 - 6 6 NORMAL Observe for anychanges in anylaboratory values.


Document findings.SpecificGravity

1.010 1.025 1.025 NORMAL Observe for anychanges in anylaboratory values.


Document findings.Chemical

(sugar,protein,bilirubin,

nitrite etc.)

(-) (-) NORMAL Observe for anychanges in anylaboratory values.


Document findings.Ketones (-) (+) Ketonuria occurs in

starvation states, low or nocarbohydrate diet and high

fat and protein in diet. Inabsence of glucose, cells

metabolize fats for energy.Ketone bodies accumulate inplasma and are excreted in

urine.

Assess the client.

Advise the client toincrease carbohydrate

and lessen fat andprotein in his diet.

Continuously monitorany changes inlaboratory results.

Report if there arecertain changes, asnecessary.


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RBC 0 2 hpf 1 hpf NORMAL Observe for anychanges in anylaboratory values.


Document findings.WBC 0 - 5 hpf 3 hpf NORMAL Observe for anychanges in anylaboratory values.

Monitor vital signs.Document findings.

Crystals(Amorphous

Urates)

None None NORMAL Observe for anychanges in anylaboratory values.


Document findings.Epithelial

CellsNone None NORMAL Observe for any



Document findings.Bacteria None Few Bacteria in urine sediment

reflect GUT or contaminationof external genitalia.

Advise client toregularly cleangenitalia to prevent

contamination. Give medications, as

ordered to fightbacterial infection

Casts None None Normal Observe for anychanges in anylaboratory values.



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Document findings.



LABORATORY

EXAMINATION

NORMALVALUES


ProthrombinTime

PT ControlPT INRPT %

Activity

APTTAPTT

Control

11.3 15.3sec

70 100 %

28 -37 sec

13.8 sec12.8 sec1.10 sec

96.0 %

33.9 sec33.9 sec

NORMAL

NORMAL

NORMAL

Observe for anychanges in anylaboratory values.


Document findings.

Urinalysis


LABORATORY

EXAMINATION

NORMALVALUES


Color Light yellowto amber

Light Yellow NORMAL Observe for anychanges in anylaboratory values.


Document findings.Appearance Clear Clear NORMAL Observe for any


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Document findings.

PH 5 6 6 NORMAL Observe for anychanges in anylaboratory values.


Document findings.SpecificGravity

1.010 1.025 1.015 NORMAL Observe for anychanges in anylaboratory values.


Document findings.Crystals

(AmorphousUrates)

None Few The amorphous urates inthe urine depict how cleanthe technique is. It signifies

the dirt present in theurine once it is collected.

There is no internalsignificance.

Practice cleantechnique in collectingurine to minimizeamorphous urates inthe urine.

Use an intermittentcatheter if available toprovide the sterility of

the urine.

Clinical Chemistry


LABORATOR

Y

EXAMINATI

NORMAL

VALUES



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ONFasting Blood

Sugar4.1 5.09mmol/L

4.02 mmol/L There is a minimal decreasein the blood sugar probablydue to the fasting required

to gain the laboratory result.The body increases its

metabolism to compensatefor the fasting needed in the

FBS leading to a minimaldecrease.

Advice the client to goback to the usualroutine of eating.

Monitor for baselinedata as soon as theclient goes back to theusual routine ofeating.

Document findings.Total Protein 66 - 83 72.73 NORMAL Observe for any



Albumin 35 52 g/L 41.74 g/l NORMAL Observe for anychanges in anylaboratory values.


Document findings.Globulin 11 - 33 31 NORMAL Observe for any



Document findings.Albumin /

Globulin Ratio1.5 3.0 1.5 NORMAL Observe for any



Document findings.


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Laboratory and Diagnostic Exam