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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. Proper positioning to prevent any complication. 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). Assess for signs and symptoms of hypovolemic shock. A deep S in V1 or V2. ANALYSIS Left ventricular hypertrophy NURSING INTERVENTION • Provide positioning with the head of bed the elevated (Fowler's position). ECG Date: November 03.370-0. Monitor vital signs and pulse oximeter readings closely.540 0. Inverted T waves in V5 or V6 and ST depression. Left axis deviation is present. Provide O2 therapy as ordered to increase oxygen in the blood. QRS is slightly prolonged. Promoting rest and comfort to decrease oxygen demand.250 Due to acute massive blood loss causing disruption of blood from entering the cells and tissues of the body • • • • • blood volume. • Give adequate oxygen supply. • Monitor vital signs regularly and before medications if .

Assist in exploration of the wound of the patient to . etc. heart irregularities.• • indicated. increased work of breathing. Identify early signs or worsening signs of CHF. heart rate. Cleanse the wound of the patient.Scan Date: November 03. such as reduced oxygen saturations. and notify the physician if changed from baseline. Monitor intake and output. Plain Cervical CT. 2011 DIAGNOSTI FINDINGS C PROCEDURE Plain Cervical Thickened nasopharynx CT-Scan likely inflammatory in nature. rapid weight changes. ANALYSIS The thickened nasopharynx is probably due to the inflammatory process caused by the trauma made to the NURSING INTERVENTION • • • Monitor vital signs. pedal edema.

• Monitor vital signs. In this case. The edema of the thyroid gland is caused by too much force outside the capillaries causing it to leak into the surrounding tissues. Particularly in the neck. For Normal Findings: • Observe for any changes in any laboratory values. examine for foreign bodies or injuries underneath the skin. This excess fluid causes the tissues to swell. The right pyriform’s sinus’ collapsed is due to the surgery done on the right side of the neck causing collapse to the right pyriform sinus. the force is the trauma taken by the capillaries in the zone 2 on the left side of the neck. Parotid and submandibular . • Document findings. Administer antibiotics to prevent infections. Administer antiinflammatory medications for pain. air may • • • • Engorged thyroid gland which may relate to edema. Subcutaneous emphysema can result from a puncture of a part of the respiratory system. Subcutaneous emphysema left side of the neck. as ordered. Collapsed right pyriform sinus.right neck. Assist in laceration repair for stabbed wound. The inflammatory process reaches to the adjacent areas to localized the inflammation. Administer intravenous fluids.

anterior and posterior triangle of the neck. jugular and the posterior triangle of the neck is affected because it is positioned in the zone 2 of the neck. The irregular shape is cause by the tissue injury.glands are non remarkable. The bifurcation internal. NORMAL Soft tissue density is due to trapped air as a result of injury to a part of the airway. trauma such as stabbed wound. blood vessels in the tissue are affected . Due to the tissue injury. The proximal common carotid arteries until the thyroid are grossly normal. The sternoclaidomastoid muscle is thickened because of the inflammatory process caused by trauma. external carotid and jugular veins are obscured by hematoma or collapsed / injured. Soft tissue densities are noted in both carotid canal. NORMAL The sternocleidomastoid muscles are thickened and irregular. jugular. Carotid. become trapped as a result of penetrating trauma.

NORMAL Hematology Examination Date: November 08.233 Neck Ultrasound . Proper positioning to prevent any complication. Promoting rest and comfort to decrease oxygen demand.370-0. causing it to leak outside the blood vessels. This blood is usually collected in liquid form within the tissue. Hematocrit 0. NURSING INTERVENTION • • • • • • Administer IV fluids as ordered to improve tissue oxygenation.Doppler studies may be of help for further evaluation and the rest are non remarkable. Provide O2 therapy as ordered to increase oxygen in the blood. 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.540 0. 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. Monitor vital signs and pulse oximeter readings closely. Provide nutritional support to increase blood cells.

Jose Reyes Memorial Medical Center Hematology Examination Date: December 03. • • • • Monitor increased ICP due to neck mass. Nurses should take measures to prevent patients from coughing.8x2. 2011 DIAGNOSTI FINDINGS C PROCEDUR E Neck Mass is cystic with its Ultrasound superficial wall more thick.Date: November 23. vomiting. posturing.3x1. Instruct patient to avoid neck flexion. It measures 2. The red • • Elevate head of bed especially at night. . Instruct to avoid strenuous activity.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. hyperextension and rotation. Position patient on semi fowlers. shivering. and straining for bowel movements. 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. tremoring.

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. Encourage quiet and restful atmosphere.36 blood cell contains the haemoglobin. Assess the extent of the patient's weakness and fatigue on exertion when planning physical care activities. A decrease in the hematocrit of the blood is due to the decrease in the red blood cell. • • • • Instruct patient to eat food rich in iron.Hematocrit 0. as ordered. Promote adequate bed rest. Instruct the client to take iron supplements. 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. such as liver. egg yolk. Give health teaching on when to take iron supplements and what substances • • • • . beef. The hematocrit.54 0. Encourage the patient to eat foods that are high in protein and iron. Assess for his/her ability to tolerate physical activity.40-0. and dried fruits such as prunes and apricots.

. Provide nutritional support.Red Blood Cells 4.2 x 10^12/L 3. Promote rest and comfort. Instruct to avoid strenuous activity. Provide O2 therapy. • • • • • 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. Instruct patient to eat food rich in iron. Monitor vital signs and pulse oximeter readings closely. Promote adequate bed rest. Elevate head of bed especially at night. as ordered. the interfere with iron absorption. Administer IV fluids as ordered.6-6. Monitor vital signs.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. Document findings. Observe for any changes in any laboratory values. Observe for any changes in any laboratory values. Document findings. Monitor vital signs. The MCHC is directly proportional to the amount of haemoglobin the person has. If the haemoglobin increase.

.5% The increase in the neutrophils is one of the body’s first inflammatory response due to ischemic damage.g. Monitor vital signs.2% MCHC also increases vice versa. emphasizing proteins to feed the immune system.RDW – CV (Red Blood Cell Distribution Width) White Blood Cell Count 11. Observe for any changes in any laboratory values. Note and report laboratory values (e. • • Encourage quiet and restful atmosphere.03 x 10^9/L NORMAL Neutrophils 54-62% 74. 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. Document findings. Monitor vital signs. and cultures). serum albumin. white blood cell count and differential.0% 14. Assess temperature. Observe for any changes in any laboratory values. Encourage fluid intake and adequate . Document findings. 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. serum protein.0 – 16. Encourage a balanced diet. NORMAL • • • • • • • • • • 5 – 10 x 10^9/L 9. Observe and report signs of infection.

Use sterile technique in catheterization. The decrease in basophils is the inflammatory response due to ischemic damage. and gowns when appropriate.1% The decrease in lymphocytes is the inflammatory response of the body due to ischemic damage. Use goggles. and hair. The decrease lymphocyte is due to the accumulation or walling of on the damage area to prevent the spread of infection. it attaches itself to the surface of the infected cell.9% Basophils 0. nail. It then secretes toxic chemicals into the cell. Ensure client's appropriate hygienic care with hand washing. When a killer T cell recognizes an antigen (ischemic clot) attached to a cell of the body. The basophils is present at the time of development of inflammation causing it to become lower when the inflammation process is through. and perineal care. Killer T cells search the body for cells infected by antigens. • • • • • • • rest to bolster the immune system. Before and after giving care to client use proper hand washing techniques. Use careful sterile technique wherever there is a loss of skin integrity.Lymphocytes 25-30% 18. . Administer antibiotics. as ordered. Use careful technique when changing and emptying urinary catheter bags. killing both the antigen and the infected cell. bathing. avoid cross contamination.4-1% 0. They are the one who is responsible for secreting histamine which cause the EARLY changes in vasodilation and vascular permeability. gloves.

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. Document findings.3% NORMAL • • • • • • • • • • Eosinophils 1 – 3% 2. Instruct client to avoid activities that might result in injury.Acetylsalicylicacid and products that contain acetylsalicylicacid . Document findings.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.Monocytes 0 – 9% 4. Observe for any changes in any laboratory values. Monitor vital signs.Ibuprofen and other non . These include: . Monitor vital signs. Observe for any changes in any laboratory values. 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.

Observe for any changes in any laboratory values. RESULTS ANALYSIS NURSING INTERVENTION 77.Warfarin Avoid rectal suppositories or enemas for constipation and do not use a rectal thermometer. 2011 LABORATOR NORMAL Y VALUES EXAMINATI ON Creatinine 45 – 104 μmol/L steroidal antiinflammatory medications (NSAIDs) . Document findings.2 mmol/L NORMAL • • • • Observe for any changes in any laboratory values.• Mean Platelet Volume (MPV) 7. Document findings.5 – 11.5 fL 8. . Monitor vital signs.9 fL NORMAL • • • Clinical Chemistry Date: December 3.67 μmol/L NORMAL • Sodium 135 – 143 mmol/L 138. Monitor vital signs. Monitor vital signs. Observe for any changes in any laboratory values.

6 % (+) 15. Provide comfort measures.99.45.0 22. • • • • Encourage patient to breathe slowly and deeply. Document findings.0 35. Control and reduction of fever reduces potential for seizures and helps reduce respiration rate.450 RESULTS ANALYSIS NURSING INTERVENTION 7. Observe for any changes in any laboratory values. 2011 LABORATO NORMAL RY VALUES EXAMINATI ON pH 7. if appropriate.5 (+)mmHg 25.41 – 4.0 75. Increased when inspired higher oxygen levels.5mmHg (-) 99. provide safe environment.82 mmol/L 3. Promotes relaxation and reduces stress. Arterial Blood Gas Date: December 03. Demonstrate appropriate breathing patterns. PCO2 is decreased in Respiratory Alkalosis. Breathing oxygenenriched air will increase SO2 level.350.402 PO2 PCO2 SO2 HCO3 80.0.100.63 mmol/L NORMAL • • • • Document findings.26 195. pH level should adjust to the borderline of alkalinity. Monitor vital signs.5 mmHg In order to compensate for the respiratory alkalosis. calm tone of voice. Speak in a low. .0.Potassium 3.9.7. HCO3 is decreased in Respiratory Alkalosis.

Maintain a patent airway to promote adequate oxygenation. Observe for any . such as diet. stress reduction. and smoking cessation. • • • • Teach the patient to identify risk factors and necessary life-style modifications.Plain Cranial CT-Scan Date: December 03. Monitor vital signs. 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. Document findings. Begin bedside range-of-motion exercise to preserve mobility and prevent deformities.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. 2011 DIAGNOSTI FINDINGS C PROCEDUR E Plain cranial There is an area of CT-Scan hypodensity involving the right frontotemporo. Urinalysis Date: December 04. Maintain bed rest to minimize metabolic requirements.

025 NORMAL Chemical (sugar.025 1. PH 5-6 6 NORMAL • • • • • • • • • • • • • changes in any laboratory values. Document findings. Advise the client to increase carbohydrate and lessen fat and protein in his diet. protein.) Ketones (-) (-) NORMAL (-) (+) Ketonuria occurs in starvation states. Monitor vital signs. • • . as necessary. bilirubin. Observe for any changes in any laboratory values. Document findings. low or no carbohydrate diet and high fat and protein in diet. WBC ketones and bacteria present in the urine making it cloudy / turbid. In absence of glucose. Document findings. Specific Gravity 1. Continuously monitor any changes in laboratory results. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Report if there are certain changes. cells metabolize fats for energy. Monitor vital signs. Assess the client.the urine is probably due to the RBC.010 – 1. Observe for any changes in any laboratory values. Monitor vital signs. nitrite etc. Ketone bodies accumulate in plasma and are excreted in urine.

Observe for any changes in any laboratory values. Monitor vital signs.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. .RBC 0 – 2 hpf 1 hpf NORMAL • • • WBC 0 . Document findings. Give medications. Monitor vital signs. Document findings. as ordered to fight bacterial infection Observe for any changes in any laboratory values. Observe for any changes in any laboratory values. Monitor vital signs. Document findings. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. Advise client to regularly clean genitalia to prevent contamination. Monitor vital signs.

8 sec 12.3 Time sec PT Control PT INR PT % Activity 70 – 100 % APTT APTT Control 28 -37 sec Document findings.9 sec NORMAL • • • NORMAL NORMAL Observe for any changes in any laboratory values.8 sec 1.0 % 33. 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. Document findings. Monitor vital signs.3 – 15. RESULTS ANALYSIS NURSING INTERVENTION 13.• Hematology Examination Date: December 05.10 sec 96.9 sec 33. Urinalysis Date: December 13. Observe for any . Monitor vital signs. Document findings. 2011 LABORATOR NORMAL Y VALUES EXAMINATI ON Prothrombin 11.

Monitor vital signs. Monitor vital signs.015 NORMAL Crystals (Amorphous Urates) None Few The amorphous urates in the urine depict how clean the technique is. Use an intermittent catheter if available to provide the sterility of the urine. Document findings.010 – 1.025 1. There is no internal significance. Specific Gravity 1. Document findings. Observe for any changes in any laboratory values. Monitor vital signs. It signifies the “dirt” present in the urine once it is collected. • Clinical Chemistry Date: December 14.• • PH 5–6 6 NORMAL • • • • • • • changes in any laboratory values. 2011 LABORATOR Y EXAMINATI NORMAL VALUES RESULTS ANALYSIS NURSING INTERVENTION . Observe for any changes in any laboratory values. Practice clean technique in collecting urine to minimize amorphous urates in the urine. Document findings.

Observe for any changes in any laboratory values. Document findings. Monitor vital signs. Document findings. Observe for any changes in any laboratory values. Monitor vital signs.5 – 3.1 – 5. 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. NORMAL • • Total Protein 66 . Albumin 35 – 52 g/L 41.83 72. Document findings.0 1. Document findings.02 mmol/L There is a minimal decrease in the blood sugar probably due to the fasting required to gain the laboratory result.33 31 NORMAL Albumin / Globulin Ratio 1.73 • • • • Advice the client to go back to the usual routine of eating.74 g/l NORMAL • • • • • • • Globulin 11 . The body increases its metabolism to compensate for the fasting needed in the FBS leading to a minimal decrease.09 mmol/L 4. Monitor vital signs.5 NORMAL • • .ON Fasting Blood Sugar 4. Observe for any changes in any laboratory values.