Complete Blood Count The complete blood count (CBC) is one of the most commonly ordered blood tests.

The complete blood count is the calculation of the cellular (formed elements) of blood. These calculations are generally determined by special machines that analyze the different components of blood in less than a minute. A major portion of the complete blood count is the measure of the concentration of white blood cells, red blood cells, and platelets in the blood. DAT E TESTS WITH NORMAL RANGE Hemoglobin (140-180 g/dl) CLINICAL SIGNIFICANCE

RATIONALE

RESULT

J U N E

Test determines the concentration of hemoglobin in whole blood.

144g/dl Normal

3 0 , 2 0 1 1

Erythrocytes (4.5 5.0 1012/L)

The test is used to evaluate anemia

4.76 1012/L Normal

MCH (27.0 33 pg)

The RBC indices provide information about the size (MCV), weight (MCH), and hemoglobin

30.2 pg normal

LOW: Hemorrhage, anemia, bone marrow failure, renal disease. HIGH: severe chronic obstructive pulmonary disease LOW: Anemia, hemorrhage, bone marrow failure, burns, parasitic infection HIGH: Severe dehydration, polycythemia vera, severe chronic obstructive pulmonary disease LOW: Microcytic anemia HIGH: Macrocytic anemia

NURSING INTERVENTION S BEFORE: -Explain the procedure to the patient. -Tell the patient that no fasting is required.

AFTER: -Apply pressure to the venipuncture site. -Observe the venipuncture site for bleeding.

MCV (85 - 96)

concentration (MCHC) of RBCs.

88 fL Normal

MCHC (32 36 g/dl)

34.5 g/dl Normal

Leukocyte (5 10 109/L)

Test help in the evaluation of the patient with infection, allergy and immunosuppressio n.

8.5 109/L Normal

Neutrophil (0.55 0.65 %)

0.07% Low

Lymphocyte (0.25 0.40 %)

0.26% Normal

Monocyte (0.02 0.06 %)

0.03% normal

LOW: Iron deficiency anemia HIGH: Liver disease LOW: Iron deficiency anemia HIGH: Intravascular hemolysis LOW: Bone marrow failure, autoimmune disease. HIGH: Infection, dehydration, steroid use LOW: Infection, aplastic anemia, neutropenia HIGH: Trauma, rheumatic fever and arthritis LOW: Sepsis, immunodeficienc y disease HIGH: Infectious hepatitis, viral infection LOW: Monocytopenia, infection, HIGH: Cirrhosis, leukemia, bacterial infection

Eosinophil (0.01 0.05 %)

Test is used to diagnose allergy, drug reactions, and Parasitic infections.

0.04% Normal

Basophil (0.000 0.005 %)

0.00% Normal

Hematocrit (0.37 0.45 ml/dl)

Test is used to evaluate anemia and Blood loss and indicate extracellular fluid excess. Measures a volume percentage of red blood cells in the plasma.

0.42ml/dl Normal

Thrombocytes (150.0 300.0 109/L)

Test is used to evaluate, diagnose, and follow up bleeding disorders.

434 109/L High

LOW: Increased adrenosteroid production, acute severe infection, AIDS HIGH: Parasitic infection, allergic reaction, autoimmune disease, burns, hypoxia, myocardial infarction LOW: Acute allergic reactions HIGH: Leukemia LOW: Anemia, cirrhosis, hemorrhage, bone marrow failure, severe burns, hemoglobinopat hies, rheumatic fever, over hydration HIGH: polycythemia vera, severe dehydration LOW: Hemorrhage, HELLP HIGH: Polycythemia vera

Serum Electrolyte It is used to screen for an electrolyte or acid-base imbalance and to monitor the effect of treatment on a known imbalance that is affecting bodily organ function. Since electrolyte and acidbase imbalances can be present with a wide variety of acute and chronic illnesses, the electrolyte panel is frequently ordered for hospitalized patients and those who come to the emergency room. Dat e Tests and Normal Findings J U N E Sodium, Substance Concentration (135-145 mmol/L) To determine Sodium a the sodium 133.4 level mmol/L balance low LOW: Hyponatremia, Dehydration, Congestive failure, Liver HIGH: Hypernatremia, diuretic use, -Apply pressure to the venipuncture site. y disease, -Observe the venipunct ure site for bleeding. AFTER: disease, Nephrotic syndrome -Tell the patient that no fasting is required. BEFORE: -Explain the procedure to heart the patient. Rationale Result s Clinical Significance Nursing Interventions

imbalance. represents between you

sodium and and the

water in the food and drinks consume amount in urine.

3 0 , 2 0 1 1 Potassium, Substance Concentration (3.5-5.1 mmol/L) Serum or plasma tests potassium patients serious levels when they for 4.45 are mmol/L are Also,

Addison's disease. High : Hyperkalemia, acute or chronic kidn ey failure, Addison's hypoaldosteronism, injury to tissue, Infection, Dehydration LOW: Hypokalemia, Dehydration, Vomiting,

routinely performed in most normal investigated for any type of illness. because potassium is so important to heart function, it is usually ordered (along with other electrolytes) during all complete routine evaluations, especially in those or who blood take diuretics or

pressure medications.

or

heart is

Diarrhea

Potassium

ordered when a doctor is diagnosing and evaluating high blood pressure and kidney (hypertension)

disease and when monitoring a patient receiving dialysis, diuretic therapy,

or intravenous therapy. Calcium, Substance Concentration (2.12-2.52 mmol/L) A blood calcium to and test is 2.33 for, mmol/L a normal Low: Hypocalcemia High: Hypercalcemia

ordered diagnose,

screen monitor

range of conditions relating to the bones, heart, nerves, kidneys, and teeth. Blood calcium levels do not directly tell how much calcium is in the bones, but rather, how much calcium is circulating in the blood.

Dat e

Tests and Normal Findings

Rationale

Result s

Clinical Significance

Nursing Interventions

J U L Y

Sodium, Substance Concentration (135-145 mmol/L)

To

determine Sodium a the

sodium 138 level mmol/L balance Normal

LOW: Hyponatremia, Dehydration, Congestive failure, Liver disease, Nephrotic syndrome

BEFORE: -Explain the procedure to heart the patient. -Tell the patient that no fasting is required.

imbalance. represents between

sodium and

water in the food and drinks you consume and the amount in urine.

2 , 2 0 1 1

HIGH: Hypernatremia, diuretic use, Addison's disease. AFTER: -Apply pressure to the venipuncture site. -Observe the venipuncture site for bleeding.

Liver Functions The test is used to screen a person for liver damage, especially someone who has a condition, or is taking a drug, that may affect the liver. Several biochemical tests are useful in the evaluation and management of patients with hepatic dysfunction. DAT E J U N E 30, 2011 BASIC TESTS AND NORMAL FINDINGS ALT (Alamine Amino Transferase (30-65u/L) RATIONALE RESULTS CLINICAL SIGNIFICANCE Very high levels of ALT (more than 10 times the highest normal level) are usually due to acute hepatitis, often due to a virus infection. NURSING INTERVENTION S BEFORE: -Explain the procedure to the patient. -Tell the patient that no fasting is required.

Used to detect normal functioning and damage of the liver

50 u/L normal

AFTER: -Apply pressure to the venipuncture site. -Observe the venipuncture site for bleeding.

Kidney Functions Kidney function tests are common lab tests used to evaluate how well the kidneys are working. DAT E J U N E 30, 2011 BASIC TESTS AND NORMAL FINDINGS Creatinine ( 53.0-115.0 umol/L) RATIONALE RESULTS CLINICAL SIGNIFICANCE LOW: Liver disease, pregnancy HIGH: Dehydration, hyperthyroidism, shock NURSING INTERVENTION S BEFORE: -Explain the procedure to the patient.

Renal function assessment (creatine level)

76 umol/L normal

AFTER: -Apply pressure to the venipuncture site. -Observe the venipuncture site for bleeding.

DAT E J U N E 30, 2011

BASIC TESTS AND NORMAL FINDINGS Glucose 40.-70. mg/dl

RATIONALE

RESULTS

CLINICAL SIGNIFICANCE LOW:Hypopituita rism, Hypothyroidism, Insulinoma (very rare), Too little food, Too much insulin or other diabetes medications HIGH: Glucagonoma, Impaired fasting glucose, Hyperthyroidism, Pancreatic cancer,

A blood glucose test measures the amount of a sugar, called glucose, in a sample of theblood.

66.mg/dl normal

NURSING INTERVENTION S BEFORE: -Explain the procedure to the patient.

AFTER: -Apply pressure to the venipuncture site. -Observe the venipuncture site for bleeding.

DAT E J U N E 30, 2011

BASIC TESTS AND NORMAL FINDINGS Total Protein (Less than 500 mg/L)

RATIONALE

RESULTS

CLINICAL SIGNIFICANCE HIGH: Chronic infection, HIV and hepatitis B or C, Multiple myeloma LOW: Bleeding, Glomerulonephri tis, Liver disease, Malabsorption, Malnutrition, Nephrotic syndrome

To test nutritional problems, kidney disease or liver disease and to measure all the proteins found in the blood.

886.03 High

NURSING INTERVENTION S BEFORE: -Explain the procedure to the patient.

AFTER: -Apply pressure to the venipuncture site. -Observe the venipuncture site for bleeding.

Blood Culture A blood culture is a test to find an infection in the blood. The blood does not normally have any bacteria or fungi in it. Date Test with Normal values Blood culture Rationale Result Clinical Significance If no bacteria or fungus grows, the blood culture is called negative. The type of bacteria or fungus that grows is checked with chemical tests and by looking at the culture under a microscope. Nursing Interventions 1. Wrap an elastic band around your upper arm to stop the flow of blood. 2. Clean the needle site with alcohol. 3. Remove the band from your arm when enough blood is collected. 4. Apply cotton ball over the needle site as the needle is removed. Apply pressure to the site.

J U L Y 1, 2011 & J U L Y 2, 1011

A blood culture can show what bacteria or fungi are in the blood.

No growth up to 24 hours of incuba tion

No growth after 48 hours of incuba tion

Arterial Blood Gas An arterial blood gas (ABG) test measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery. This test is used to check how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.

Date

Test

Rationale

Result

Significance

Nursing responsibilities

J U N E 30, 2011

Arterial Blood Gas

Measures the levels

the PH- 7.43 of PCO2- 37.7

Metabolic Acidosis Low pH, less HCO3, PaCo2 is -cardiac dysrhythmias CNS & dysfunction headache, normal or low if compensation occurring

Nursing Responsibilities -Monitor values respiratory and -Institute precautions necessary -Assess sources ABG and rate

acidity (pH) and oxygen carbon in the

and PO2-116.3 dioxide blood HCO3-24.7

from an artery. TCO2-25.7 This test is used to check how B.E- 25.9

pattern and as

well your lungs O2 sat- 1.1 diarrhea, tremors are able to O2 move oxygen Metabolic supplementationinto the blood Alkalosis and remove 98.4% carbon dioxide Normal from the blood. -cardiac dysrhythmias; tetany/seizures; confusion;

maintain seizure

of

anxiety

and

intervene to help reduce anxiety

muscle Encourage deep the

(Nassal Cannula twitching, agitation - high pH; more @ 1lmp) HCO3; normal slow,

PaCo2 or elevated if breathing; compensation occurs instruct patient to breathe into and out of a

Respiratory Acidosis -Dyspnea, wheezing, tachypnea arrhythmias; tachycardia -Somnolence decreased ventilation Respiratory Alkalosis High PaC02; compensation - nausea, vomiting, tingling of fingers, lightheadedness. pH; less HCO3 & Vasodilatation Cardiac

paper reverse

bag,

if to

necessary,

hyperventilation -Assist patient activities necessary the with as

normal or low due to

Hemoglucotest It is a test that measures the concentration of glycosylated hemoglobin in the blood. This is the amount of hemoglobin bound to glucose.

Date

Test with Normal values HGT ( 80- 120

Rationale

Result

Clinical Significance LOW:

Nursing Interventions BEFORE:

To determine the blood glucose level

182 mg/dl

U L Y 2, 2011

mg/dl)

at regular intervals, to diagnose hyperglycemia, hypoglycemia, the need for insulin, and also for comparison of progress in interventions altering blood sugar levels

Low sugar content in blood. HIGH: High sugar content in blood.

Disinfect the finger with the use of cotton balls with alcohol. Air dry. Milk it. Do not aspirate the syringe before injecting the insulin AFTER: Do not apply pressure to the venipuncture site. Assess for signs of bleeding.

Lumbar punctures (Gram Stain and India Ink) Medical personnel perform lumbar punctures and test the cerebrospinal fluid to detect or rule out suspected diseases or conditions. CSF testing looks for signs of possible infection by analyzing the white blood cell count, glucose levels, protein, and bacteria or abnormal cells that can help identify specific diseases in the central nervous system. Date Test with Rationale Normal values Gram Stain A Gram stain is a and India Ink laboratory procedure used to detect the presence (no organism) of microorganisms, especially bacteria, (No in a sample taken cryptococcus from the site of a identified) suspected infection. It gives relatively quick results as to the general type of Result Clinical Significance -A negative Gram stain is often reported as "no organism seen." This may mean that there is no bacterial infection present or that there were not enough microorganisms present in the sample to be Nursing Interventions - Observe strict asepsis. -See to it that the patient does not move during procedure. - To prevent the needle from breaking inside the spinal column. -Keep patient flat

J U L Y 2, 2011

Gram Stain= Pus cells few No organism seen

India Ink= Negative

bacteria that may be present.

seen with the stain under a microscope. -No cryptococcus identified

in bed without pillow for about 8 hours.

A diagnostic test used to detect the cryptococcal organism C. neoformans. A dye, called India ink, is added to a sample of CSF fluid, and if the fungi is present, they will become visible as the dye binds to the capsule surrounding the fungus.

Clinical Microscopy The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders.

Dat e J U N E 30, 201

Test with Normal values WBC (0-2/HPF)

Rationale

Result

Clinical Significance Excess may be indicative of cystitis or pyelonephritis There might be infection, obstruction, inflammation, trauma, tumors, renal calculi, and

Nursing Interventions 1. Explain that this test aids in the diagnosis renal or urinary tract diseases. 2. Inform the patient that he doesnt need to restrict food and fluids.

Its presence may indicate urinary tract inflammation

1 normal

RBC (0-2/HPF)

May indicate bleeding within genitourinary tract

5 High

hemorrhagic disorders Epithelial cells (0-2/HPF) May suggest renal degeneration 0 normal There might be heavy metal poisoning, and kidney transplant rejection May be due to inflammation, trauma, renal tubular damage, acute or chronic renal failure May indicate prostatovesiculiti s, urethritis,etc. Deep yellow presence of riboflavin; smokey presence of red blood cells; black presence of melanin LOW: Hydration HIGH: Dehydration, Diabetes Mellitus, liver failure, nephrosis Usually indicate diabetes mellitus, but may result from Cushings syndrome,

3. Notify the laboratory and practitioner of medications the patient is taking that may affect lab results. 4. Explain how to collect a cleancatch specimen. 5. Obtain first morning-voided morning specimen if possible.

Cast (0-3/HPF)

May indicate renal disease

0 normal

Bacteria (0-20/HPF)

This will reflect genitourinary infection The first part of a urinalysis is direct visual observation. Normal, fresh urine is pale to dark yellow or amber in color and clear.

1 normal

Color

Yellow

Clarity

Clear

Spec Gravity (1.007 to 1.010)

Measures urine density, or the ability of the kidney to concentrate or dilute the urine.

1.005 normal

Glucose

Measures glucose present in the urine

Negative

pheochromocyto ma, etc. CHON To determine presence of protein in the circulation. Negative HIGH: Pyelonephritis, gnephrotic syndrome, acute infection

CHEST X-RAY It can help find some problems with the organs and structures inside the chest. DATE J U N E 30, 2011 RATIONALE Help find the cause of common symptoms such as a cough, shortness of breath, or chest pain. Find lung conditions-such as pneumonia, lung cancer, chronic obstructive pulmonary disease (COPD), collapsed lung (pneumothorax), or cystic fibrosisand monitor treatment for these conditions. RESULT -Study done in AP projection -The lungs are clear with no evident of active infiltrates. -Tracheal air column is midline. -The heart is normal in size -Pulmonary vessels are unremarkable. -Diaphragm are clear y IMPRESSION Unremarkable Chest Findings NURSING INTERVENTIONS BEFORE: Remove all clothing and wear hospital gown. Remove jewelry, and any metal objects.

CT Scan A cranial computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.

DATE J U N E 30, 2011

RATIONALE A CT scan is done to study the skull, brain, jaw, sinuses, and facial bones. The scan will look for signs of injuries, tumors, or other disease.

RESULT -Multiple Plain and IV contrast enhanced axial CT images of the head were obtained. No adverse reaction noted. -There is focal leptomeningeal enhancement in the posterior cranial fossa and right temporal lobe. -No other abnormal density changes seen in the rest of the brain and brainstem parenchyma. -No evident intracranial bleed. -Midline structure are not displaced. -Cerebral sulci are effected. -The ventrivles are not dilated. -Sella, orbits, petromastoids and visualized paranasal sinuses are unremarkable. -Caluarium and visualized facial bones are intact. y

IMPRESSION Leptomeningeal enhancement. Underlying meningitis may be consider

NURSING INTERVENTIONS BEFORE: Remove all clothing and wear hospital gown. Remove jewelry, and any metal objects.

Typhidot Typhidot is a medical test consisting of a dot ELISA kit that detects IgM and IgG antibodies against the outer membrane protein (OMP) of the Salmonella typhi. The typhidot test becomes positive within 23 days of infection and separately identifies IgM and IgG antibodies. The test is based on the presence of specific IgM and IgG antibodies to a specific 50Kd OMP antigen, which is impregnated on nitrocellulose strips. DAT E J U N E 25, 2011 TESTS WITH NORMAL RANGE Typhidot RATIONALE RESULTS CLINICAL SIGNIFICANCE IgM positive only-Acute typhoid fever IgM & IgG posititve-Acute typhoid fever(in the middle stage of infection) IgG positiveImplications for the presence of IgG antibodies include relapse or reinfection of previous infection(in which case current fever may not be due to typhoid). NURSING INTERVENTIONS BEFORE: Explain the purpose of the procedure to the patient AFTER: Apply pressure to the venipuncture site. Observe the venipuncture site for bleeding.

This test is done to determine whether the patient is having a typhoid fever.

IgG negative & IgM negative

Blood Smear for Malaria Parasite Microscopic examination of thick and thin peripheral blood smears stained with Romanovsky dye. Thick smears are more difficult to interpret but greatly increase sensitivity. Thick smears require considerable experience with malaria. Recent techniques: DNA hybridization probes for detection of malarial parasites. DAT E J U N E 25, 2011 TESTS WITH NORMAL RANGE BSMP RATIONALE RESULTS CLINICAL SIGNIFICANCE Postivepresence of maarial parasite (Plasmodium vivax, P. falciparum, P. ovale, P. malariae) Negativeabsence of malarial parasite NURSING INTERVENTIONS BEFORE: Explain the purpose of the procedure to the patient AFTER: Apply pressure to the venipuncture site. Observe the venipuncture site for bleeding.

This test is done to diagnose malaria, parasitic infestation of blood; evaluate febrile disease of unknown origin.

No Malarial Parasite seen