mfayLABORATORY TESTS RESULTS AND DIAGNOSTIC EXAMINATIONS

Gat Andres Bonifacio Memorial Medical Center Hematology Examination Date: November 02, 2011 LABORATORY NORMAL RESULTS ANALYSIS EXAMINATION VALUES Hemoglobin 120-180 114 gm/l Decrease in hemoglobin gm/l results in blood loss from the cellular injury which disrupts blood flow from entering the cells and tissues of the body thus decrease in tissue perfusion from decrease blood volume or reduced circulating erythrocytes. Hematocrit 0.370-0.540 0.339 Due to acute massive blood loss causing disruption of blood from entering the cells and tissues of the body.

NURSING INTERVENTION Administer IV fluids as ordered to improve tissue oxygenation. Prepare for Blood transfusion if massive blood loss occurs to increase blood volume. Monitor vital signs and pulse oximeter readings closely. Assess for signs and symptoms of hypovolemic shock. Promoting rest and comfort to decrease oxygen demand. Proper positioning to prevent any complication. Provide O2 therapy as ordered to increase oxygen in the blood. Observe and report signs of infection.

Segmenters

0.60-0.70

0.48

Decrease in segmenters is due to blood loss cause by the response to

cellular injury. Lymphocytes 0.20-0.40 0.52 High lymphocytes count indicates the response to cellular changes by release of chemical mediators as an inflammatory response.

Platelet count 150-450 x 109/L 332 x 109/L NORMAL

Blood type

N/A

Type A Rh positive

N/A

Assess temperature. Note and report laboratory values (e.g., white blood cell count and differential, serum protein, serum albumin, and cultures). Encourage a balanced diet, emphasizing proteins to feed the immune system. Encourage fluid intake and adequate rest to bolster the immune system. Administer antibiotics, as ordered. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. N/A

Hematology Examination Date: November 02, 2011 (due at 2 pm) LABORATORY NORMAL RESULTS EXAMINATION VALUES Hemoglobin 120-180 89 gm/l gm/l

ANALYSIS Decrease in haemoglobin results in blood loss from the cellular injury which disrupts blood flow from entering the cells and tissues of the body.

NURSING INTERVENTION Administer IV fluids as ordered to improve tissue oxygenation. Prepare for Blood transfusion if massive blood loss occurs to increase

Hematocrit

0.370-0.540

0.250

Due to acute massive blood loss causing disruption of blood from entering the cells and tissues of the body

blood volume. Monitor vital signs and pulse oximeter readings closely. Assess for signs and symptoms of hypovolemic shock. Promoting rest and comfort to decrease oxygen demand. Proper positioning to prevent any complication. Provide O2 therapy as ordered to increase oxygen in the blood.

ECG Date: November 03, 2011 DIAGNOSTIC FINDINGS PROCEDURE ECG A tall R wave (greater than 25 mm 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 V6 and ST depression. Left axis deviation is present. QRS is slightly prolonged.

ANALYSIS Left ventricular hypertrophy

NURSING INTERVENTION Provide positioning with the head of bed the elevated (Fowler's position). Give adequate oxygen supply. Monitor vital signs regularly and before medications if

indicated. Identify early signs or worsening signs of CHF, such as reduced oxygen saturations, pedal edema, heart irregularities, heart rate, increased work of breathing, rapid weight changes, etc. and notify the physician if changed from baseline. Monitor intake and output.

Plain Cervical CT- Scan Date: November 03, 2011 DIAGNOSTI FINDINGS C PROCEDURE Plain Cervical Thickened nasopharynx CT-Scan likely inflammatory in nature.

ANALYSIS The thickened nasopharynx is probably due to the inflammatory process caused by the trauma made to the

NURSING INTERVENTION Monitor vital signs. Cleanse the wound of the patient. Assist in exploration of the wound of the patient to

right neck. The inflammatory process reaches to the adjacent areas to localized the inflammation. Collapsed right pyriform sinus. The right pyriforms sinus collapsed is due to the surgery done on the right side of the neck causing collapse to the right pyriform sinus. The edema of the thyroid gland is caused by too much force outside the capillaries causing it to leak into the surrounding tissues. This excess fluid causes the tissues to swell. In this case, the force is the trauma taken by the capillaries in the zone 2 on the left side of the neck. Subcutaneous emphysema can result from a puncture of a part of the respiratory system. Particularly in the neck, air may

Engorged thyroid gland which may relate to edema.

examine for foreign bodies or injuries underneath the skin. Administer intravenous fluids, as ordered. Assist in laceration repair for stabbed wound. Administer antiinflammatory medications for pain. Administer antibiotics to prevent infections.

For Normal Findings: Observe for any changes in any laboratory values. Monitor vital signs. Document findings.

Subcutaneous emphysema left side of the neck.

Parotid and submandibular

glands are non remarkable. Soft tissue densities are noted in both carotid canal, jugular, anterior and posterior triangle of the neck.

become trapped as a result of penetrating trauma. trauma such as stabbed wound. NORMAL Soft tissue density is due to trapped air as a result of injury to a part of the airway. Carotid, jugular and the posterior triangle of the neck is affected because it is positioned in the zone 2 of the neck. The sternoclaidomastoid muscle is thickened because of the inflammatory process caused by trauma. The irregular shape is cause by the tissue injury. NORMAL

The sternocleidomastoid muscles are thickened and irregular.

The proximal common carotid arteries until the thyroid are grossly normal. The bifurcation internal, external carotid and jugular veins are obscured by hematoma or collapsed / injured.

Due to the tissue injury, blood vessels in the tissue are affected

Doppler studies may be of help for further evaluation and the rest are non remarkable.

causing it to leak outside the blood vessels. This blood is usually collected in liquid form within the tissue. NORMAL

Hematology Examination Date: November 08, 2011 LABORATORY NORMAL EXAMINATION VALUES Hemoglobin 120-180 gm/l

RESULTS 80

FINDINGS Decrease in hemoglobin is a reflection of the post-op blood loss after the surgery and a inflammatory response to inflammation caused by the injury. Decrease in hematocrit is a reflection of the post-op blood loss after the surgery and a inflammatory response to inflammation caused by the injury.

NURSING INTERVENTION Administer IV fluids as ordered to improve tissue oxygenation. Monitor vital signs and pulse oximeter readings closely. Promoting rest and comfort to decrease oxygen demand. Proper positioning to prevent any complication. Provide O2 therapy as ordered to increase oxygen in the blood. Provide nutritional support to increase blood cells.

Hematocrit

0.370-0.540

0.233

Neck Ultrasound

Date: November 23, 2011 DIAGNOSTI FINDINGS C PROCEDUR E Neck Mass is cystic with its Ultrasound superficial wall more thick. It measures 2.8x2.3x1.7cm. It exhibits pulsations and is adjacent a vein (internal jugular?)

ANALYSIS

NURSING INTERVENTION

Right neck mass is caused by post traumatic venous aneurysm as a result of prior exploratory laparotomy procedure on bilateral neck.

Monitor increased ICP due to neck mass. Position patient on semi fowlers. Instruct patient to avoid neck flexion, hyperextension and rotation. Nurses should take measures to prevent patients from coughing, vomiting, shivering, tremoring, posturing, and straining for bowel movements.

Jose Reyes Memorial Medical Center Hematology Examination Date: December 03, 2011 LABORATOR NORMAL RESULTS Y VALUES EXAMINATI ON Hemoglobin 135-180 g/dL 116 g/dl

ANALYSIS

NURSING INTERVENTION

A decrease in the haemoglobin content in the blood is due to the decrease in the red blood cell. The red

Elevate head of bed especially at night. Instruct to avoid strenuous activity.

Hematocrit

0.40-0.54

0.36

blood cell contains the haemoglobin. Hemoglobin is directly proportional with the red blood cell therefore a decrease in the red blood cell is also a decrease in the haemoglobin and vice versa. A decrease in the hematocrit of the blood is due to the decrease in the red blood cell. The hematocrit, also determines the percentage of red blood cells in the plasma. Hematocrit is directly proportional with the red blood cell therefore a decrease in the red blood cell is also a decrease in the hematocrit and vice versa.

Instruct patient to eat food rich in iron. Promote adequate bed rest. Encourage quiet and restful atmosphere. Assess for his/her ability to tolerate physical activity. Assess the extent of the patient's weakness and fatigue on exertion when planning physical care activities. Encourage the patient to eat foods that are high in protein and iron, such as liver, egg yolk, beef, and dried fruits such as prunes and apricots. Instruct the client to take iron supplements, as ordered. Give health teaching on when to take iron supplements and what substances

Red Blood Cells

4.6-6.2 x 10^12/L

3.99 x 10^12/L

The decrease in the amount of red blood cells in the blood is due to the accumulation of the cell in the injured site as a part of the inflammatory process.

MCV (Mean corpuscular Volume) 80 96 fL 91 fL NORMAL

MCH (Mean Corpuscular Hemoglobin)

27 31 g/L

29 g/L

NORMAL

MCHC (Mean Corpuscular Hemoglobin Concentration )

33-36 g/dL

32 g/dL

The decrease in the mean corpuscular haemoglobin concentration is due to the decrease of haemoglobin in the body. The MCHC is directly proportional to the amount of haemoglobin the person has. If the haemoglobin increase, the

interfere with iron absorption. Administer IV fluids as ordered. Monitor vital signs and pulse oximeter readings closely. Promote rest and comfort. Provide O2 therapy, as ordered. Provide nutritional support. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Elevate head of bed especially at night. Instruct to avoid strenuous activity. Instruct patient to eat food rich in iron. Promote adequate bed rest.

RDW CV (Red Blood Cell Distribution Width) White Blood Cell Count

11.0 16.0%

14.2%

MCHC also increases vice versa. NORMAL

5 10 x 10^9/L

9.03 x 10^9/L

NORMAL

Neutrophils

54-62%

74.5%

The increase in the neutrophils is one of the bodys first inflammatory response due to ischemic damage. Neutrophils accumulate at the site of ischemic damage producing neutrophil extracellular trap in order to engulf any offending organism and to remove cellular debris as well. The immunologic response signals the bone marrow to produce more neutrophils to provide the body with greater ability to fight infection hence the increase of neutrophils in the blood.

Encourage quiet and restful atmosphere. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe and report signs of infection. Assess temperature. Note and report laboratory values (e.g., white blood cell count and differential, serum protein, serum albumin, and cultures). Encourage a balanced diet, emphasizing proteins to feed the immune system. Encourage fluid intake and adequate

Lymphocytes

25-30%

18.9%

Basophils

0.4-1%

0.1%

The decrease in lymphocytes is the inflammatory response of the body due to ischemic damage. Killer T cells search the body for cells infected by antigens. When a killer T cell recognizes an antigen (ischemic clot) attached to a cell of the body, it attaches itself to the surface of the infected cell. It then secretes toxic chemicals into the cell, killing both the antigen and the infected cell. The decrease lymphocyte is due to the accumulation or walling of on the damage area to prevent the spread of infection. The decrease in basophils is the inflammatory response due to ischemic damage. They are the one who is responsible for secreting histamine which cause the EARLY changes in vasodilation and vascular permeability. The basophils is present at the time of development of inflammation causing it to become lower when the inflammation process is through.

rest to bolster the immune system. Before and after giving care to client use proper hand washing techniques. Use goggles, gloves, and gowns when appropriate. Use sterile technique in catheterization. Use careful technique when changing and emptying urinary catheter bags; avoid cross contamination. Use careful sterile technique wherever there is a loss of skin integrity. Ensure client's appropriate hygienic care with hand washing; bathing; and hair, nail, and perineal care. Administer antibiotics, as ordered.

Monocytes

0 9%

4.3%

NORMAL

Eosinophils

1 3%

2.2%

NORMAL

Platelet Count

150-450 x 10^9/L

129 x 10^9/L

The decrease in platelets is due to the accumulation of platelet cells at the site of tissue injury. The platelet in the body goes to the site of the injury probably produce by the ischemic clot leaving the blood volume with a decrease in platelet cells.

Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Instruct client to avoid activities that might result in injury. Instruct client to use an electric razor for shaving. Instruct client to brush with a softbristle toothbrush. Instruct client to avoid other medications that may weaken platelets. These include: - Acetylsalicylicacid and products that contain acetylsalicylicacid - Ibuprofen and other non

Mean Platelet Volume (MPV)

7.5 11.5 fL

8.9 fL

NORMAL

Clinical Chemistry Date: December 3, 2011 LABORATOR NORMAL Y VALUES EXAMINATI ON Creatinine 45 104 mol/L

steroidal antiinflammatory medications (NSAIDs) - Warfarin Avoid rectal suppositories or enemas for constipation and do not use a rectal thermometer. Observe for any changes in any laboratory values. Monitor vital signs. Document findings.

RESULTS

ANALYSIS

NURSING INTERVENTION

77.67 mol/L

NORMAL

Sodium

135 143 mmol/L

138.2 mmol/L

NORMAL

Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs.

Potassium

3.41 4.82 mmol/L

3.63 mmol/L

NORMAL

Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings.

Arterial Blood Gas Date: December 03, 2011 LABORATO NORMAL RY VALUES EXAMINATI ON pH 7.350- 7.450

RESULTS

ANALYSIS

NURSING INTERVENTION

7.402

PO2 PCO2 SO2 HCO3

80.0- 100.0 35.0- 45.0 75.9- 99.0 22- 26

195.5 (+)mmHg 25.5mmHg (-) 99.6 % (+) 15.5 mmHg

In order to compensate for the respiratory alkalosis, pH level should adjust to the borderline of alkalinity. Increased when inspired higher oxygen levels. PCO2 is decreased in Respiratory Alkalosis. Breathing oxygenenriched air will increase SO2 level. HCO3 is decreased in Respiratory Alkalosis.

Encourage patient to breathe slowly and deeply. Speak in a low, calm tone of voice; provide safe environment. Demonstrate appropriate breathing patterns, if appropriate. Provide comfort measures. Promotes relaxation and reduces stress. Control and reduction of fever reduces potential for seizures and helps reduce respiration rate.

Plain Cranial CT-Scan Date: December 03, 2011 DIAGNOSTI FINDINGS C PROCEDUR E Plain cranial There is an area of CT-Scan hypodensity involving the right frontotemporo- parietal lobes with effacement of the adjacent cortical sulci and follows the right territorial distribution of the right middle cerebral artery.

ANALYSIS

NURSING INTERVENTION

Cerebrovascular Accident can produce hypodense areas in region that is cut off from blood flow.

Teach the patient to identify risk factors and necessary life-style modifications, such as diet, stress reduction, and smoking cessation. Maintain a patent airway to promote adequate oxygenation. Maintain bed rest to minimize metabolic requirements. Begin bedside range-of-motion exercise to preserve mobility and prevent deformities.

Urinalysis Date: December 04, 2011 LABORATOR NORMAL Y VALUES EXAMINATI ON Color Light yellow to amber

RESULTS

ANALYSIS

NURSING INTERVENTION

Amber

NORMAL

Appearance

Clear

Turbid

The turbid appearance of

Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any

the urine is probably due to the RBC, WBC ketones and bacteria present in the urine making it cloudy / turbid. PH 5-6 6 NORMAL

changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Assess the client. Advise the client to increase carbohydrate and lessen fat and protein in his diet. Continuously monitor any changes in laboratory results. Report if there are certain changes, as necessary.

Specific Gravity

1.010 1.025

1.025

NORMAL

Chemical (sugar, protein, bilirubin, nitrite etc.) Ketones

(-)

(-)

NORMAL

(-)

(+)

Ketonuria occurs in starvation states, low or no carbohydrate diet and high fat and protein in diet. In absence of glucose, cells metabolize fats for energy. Ketone bodies accumulate in plasma and are excreted in urine.

RBC

0 2 hpf

1 hpf

NORMAL

WBC

0 - 5 hpf

3 hpf

NORMAL

Crystals (Amorphous Urates)

None

None

NORMAL

Epithelial Cells

None

None

NORMAL

Bacteria

None

Few

Bacteria in urine sediment reflect GUT or contamination of external genitalia.

Casts

None

None

Normal

Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Advise client to regularly clean genitalia to prevent contamination. Give medications, as ordered to fight bacterial infection Observe for any changes in any laboratory values. Monitor vital signs.

 Hematology Examination Date: December 05, 2011 LABORATOR NORMAL Y VALUES EXAMINATI ON Prothrombin 11.3 15.3 Time sec PT Control PT INR PT % Activity 70 100 % APTT APTT Control 28 -37 sec

Document findings.

RESULTS

ANALYSIS

NURSING INTERVENTION

13.8 sec 12.8 sec 1.10 sec 96.0 % 33.9 sec 33.9 sec

NORMAL

NORMAL NORMAL

Observe for any changes in any laboratory values. Monitor vital signs. Document findings.

Urinalysis Date: December 13, 2011 LABORATOR NORMAL Y VALUES EXAMINATI ON Color Light yellow to amber

RESULTS

ANALYSIS

NURSING INTERVENTION

Light Yellow

NORMAL

Appearance

Clear

Clear

NORMAL

Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any

 PH 56 6 NORMAL

changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Practice clean technique in collecting urine to minimize amorphous urates in the urine. Use an intermittent catheter if available to provide the sterility of the urine.

Specific Gravity

1.010 1.025

1.015

NORMAL

Crystals (Amorphous Urates)

None

Few

The amorphous urates in the urine depict how clean the technique is. It signifies the dirt present in the urine once it is collected. There is no internal significance.

Clinical Chemistry Date: December 14, 2011 LABORATOR Y EXAMINATI NORMAL VALUES RESULTS ANALYSIS NURSING INTERVENTION

ON Fasting Blood Sugar

4.1 5.09 mmol/L

4.02 mmol/L

There is a minimal decrease in the blood sugar probably due to the fasting required to gain the laboratory result. The body increases its metabolism to compensate for the fasting needed in the FBS leading to a minimal decrease. NORMAL

Total Protein

66 - 83

72.73

Advice the client to go back to the usual routine of eating. Monitor for baseline data as soon as the client goes back to the usual routine of eating. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Document findings.

Albumin

35 52 g/L

41.74 g/l

NORMAL

Globulin

11 - 33

31

NORMAL

Albumin / Globulin Ratio

1.5 3.0

1.5

NORMAL