LABORATORY STUDY Hematology

Diagnostic Procedure WBC RBC HGB Actual Values 6.0 x 10^9/L 3.35 x10^12/L 102 g/L Normal Values 4-10 x 10^9/L 4.5 – 5.4 x10^12/L 115-155 g/L Interpretation Normal Decreased Decreased Significance Functions remain thesame Decreased RBC indicates anemia, fluid overload. Decreased HGB indicates hemodilution (Fluid Overload) and Anemia. It also indicates hypoxia because there is lack of oxygen supply to the circulation and patient has fluid overload as evidenced by edematous lower extremities. Decreased HCT indicates anemia and fluid overload. HCT is also decreased due to inability of the kidney to regulate RBC production by releasing erythropoietin to stimulate the bone marrow to produce RBC, as a result, the ratio of RBC to total blood volume is decreased. Increase PLT is refer red to as thrombocytosis and can be trigger spleen removal ,excessive anemia and chronic myelogenous anemia. Functions remain the same. Functions remain the same. Functions remain the same. Date: April 30, 2012 Nursing Responsibilities Patient Preparation:  Explain to the patient that this test is used to detect abnormalities in the blood like anemia, polycythemia, infections, dehydration, overhydration, hypoxia and many more. This is also to assess the response to treatment. Tell the patient that a blood sample will be taken. Explain who will perform the venipuncture and when. Explain to the patient that he may feel slight discomfort from the needle puncture and tourniquet. Inform the patient that he needs not to restrict him foods and fluids.

  

HCT

0.30

0.36-0.47

Decreased

PLT

359X 10^g/uL

100-300X10^g/uL

Increase

MCV MCH MCHC

89 fL 30 pg 340 g/L

86-100 fL 26-31 pg 310-370 g/L

Normal Normal Normal

Procedure and Posttest Care:  Perform a venipuncture and collect the sample in 3 to 5 ml with EDTA added  If hematoma develops at the venipuncture site, apply warm soaks. If hematoma is large, monitor pulses distal to the venipuncture site.  Ensure subdermal bleeding has stopped before removing pressure.

blood disorder and in Cancer. avoid excessive probing the venipuncture site and handle the sample gently. Functions remain the same Functions remain the same .6-13.7% Normal May indicate iron deficiency anemia  40% 40-70% Normal Functions remain the same   To prevent hemolysis. Assess for signs and symptoms of infection Promote adequate rest 41% Lymphocyte 19-42% Normal Functions remain the same.RDW Differential Count Neutrophil 12.6 % 11. Monocyte 15% 3-9% Increase 3% Eosinophils Basophils BT 0% “A“ 2-8% 0-5% Normal Normal May indicate chronic infections. in auto immune disorder.

.6 – 5. Functions remains the same Creatinine 61 umol/L 53 – 97 umol/L Increased Uric Acid Lipid Profile Cholesterol 235 umol/L 155 – 360 umol/L Normal 6. The amount of creatinine in the blood depends partly on the amount of muscle tissue you have.7 mmol/L Increase High level of of lipid profie cholesterol known to increase the risk for Coronary Heart Disease.1 mmol/L NORMAL VALUE 3. 2012 DIAGNOSTIC PROCEDURE Glucose (oxidase) ACTUAL VALUE 7. A high creatinine level may mean your kidneys are not working properly.8 mmol/L INTERPRETATION Increased SIGNIFICANCE High levels of glucose can indicate the presence of diabetes or another endocrine disorder or maybe caused by taking corticosteroids The blood creatinine level shows how well your kidneys are working.2 mmol/L 3. men generally have higher creatinine levels than women.BLOOD CHEMISTRY Date: April 30.9 – 5.

liver disease. When the liver is damaged. ALT levels in the blood are low.7 nkat/L 0 – 517 nkat/L Within Normal Range . seen in states of decreased synthesis (malnutrition. This makes ALT a useful test for detecting liver damage. Albumin 33 g/L 35 – 32 g / L Decreased SGPT/ ALT 266. such as jaundice. ALT is released into the blood stream. liver disease. much smaller amounts of it are also found in the heart and muscles. and other chronic diseases) (ALT) is an enzyme found mostly in the cells of the liver and kidney. In healthy individuals.Total Protein 70 g/L 64 – 83 g/L Normal Total protein measurements can reflect nutritional status and may be used to screen for and help diagnose kidney disease. malabsorption. usually before more obvious symptoms of liver damage occur.

hCG levels have a wide range of normal that often overlap for single and multiple pregnancies. CA stands for cancer antigen. high hCG levels alone are not considered a reliable indication of a multiple pregnancy.90 Increase .5 – 2. therefore. and the function of the CA 125 protein is not currently understood. such as twins or triplets.03 mic/ ml < o.IMMUNOLOGY DIAGNOSTIC PROCEDURE CA 12-5 ACTUAL VALUE O – 35 u/ml NORMAL VALUE INTERPRETATION SIGNIFICANCE CA 125 is a protein that is a socalled tumor marker or biomarker. Elevated hCG levels are usually present in a multiple pregnancy. CA 125 is present in greater concentration inovarian cancer cells than in other cells. which is a substance that is found in greater concentration in tumor cells than in other cells of the body. However. In particular. 14 u/ml Normal B HCG 38. It was first identified in the early 1980s.

g. facial grimacing. concurrent use of drugs that can cause extrapyramidal symptoms. prokinetic agent (GI stimulant). cisplatin dacarbazine) to facilitate intubation of small bowel. ANS agent. rigidity or tremirs > Monitor for possible hypernatremia and hypokalemia. involuntary movement. SKIN: urticarial or maculopapular ras BODY AS A WHOLE: glossal or periorbital edema CV: Hypertensive crisis > Remember the 10 R’s > Report immediately the onset of restlessness. diarrhea. especially if patient has CHF or cirrhosis. fatigue. history of breast cancer. allergy to sulfitting agents. dry mouth. antiemetic Management of diabetic gastric acid stasis (gastopharesis) to pevent nausea and vomiting associated with emetogetic cancer. agitation. insomnia. restlessness. symptomatic treatment of gastroesophageal reflux Potent central dopamine receptor antagonist. Exact mechanism of action not smooth muscle to effect of acethylcholine by direct action Sensitivity to intolerance to metochlopramid e. IM/IVTT 10mg over 12mins 1 amp prior to chemo CNS: mild sedation. altered drug absorption. direct acting cholinergic(par asympathomim etic). constipation. headache. history of seizure disorders. Safety during (category B) or lactation is not established.DRUG STUDY Generic Name Brand Name General Classification Indication Mode of Action Contraindication Usual Dose Actual Dose Adverse Reaction/s Nursing Responsibilities M E T O C H L O P R A M I D E H C L M A X E R A N Gastrointestina l agent. chemotherapy (e. . Structurally related to procanamide but has little antiarrythmic ir anesthetic activity. pheochromocyto ma. mechanical GI abstraction or perforation. extrapyramidal symptoms(acute dystonic type) GI: nausea. disorientation.

Hypersensitivity Active untreated infection Lactation Systemic fungal infection 10 mg 10 mg 1. Vision problems ( Dexamethaso ne may cause cataracts and increased intraocular pressure) 4.Generic Name Brand Name General Classification Indication Mode of Action Contraindication Usual Dose Actual Dose Adverse Reaction/s Nursing Responsibilities D E X A M E T H A S O N E D E X O N E Long. Swollen face. Black or tarry stool Remember the 10 R’s Monitor intake and output of patient. Skin rash prior to 2. Observe the patient for peripheral edema. steady weight gain. It prevents the release of substances in the body that causes inflammation. . rales or dyspnea. chemo legs or ankles (fluid retention) 3. Cold or infection that last for a long time 5. Instruct patient to avoid people with known infection and contagious illnesses ascorticosteroids cause s immunosuppression and may mask symptoms of infection. Notify the physician immediately if these clinical manifestations are noted. .acting corticosteroid >Management of cerebral edema >Diagnostic agent in adrenal disorders >Relieves inflammation >Allergic disorders >Asthma >Arthritis Suppresses inflammation and the normal immune response. Muscle weakness 6.

Assess patient for epigastric or abdominal pain and frank Nurse should know that it may cause false-positive results for urine protein. • Advise patient to report onset of black. druginduced hepatitis. Inform patient that it may cause drowsiness or dizziness. headache. nausea HEMAT: Agranulocyt osis. GI: Altered taste. constipation . neutropenia . Aplastic Anemia. test with sulfosalicylic acid. Inform patient that increased fluid and fiber intake may minimize constipation. . Crosssensitivity may occur. acid indigestion. diarrhea. resulting in inhibition of gastric acid secretion ContraIndication Hypersensitivit y. tarry stool. some oral liquids contain alcohol and should be avoided in patients with known intolerance.Generic Name R A N I T I D I N E Brand Name Z A N T A C General Classification Anti-ulcer agents Histamine H2 antagonists Indication Treatment and prevention of heartburn. Usual Dose 20 mg Actual Dose 1 tab prior to chemo Adverse Reaction/s CNS: drowsiness. and sour stomach. thrombocyt openia Nursing Responsibilities Remember the 10 R’s . black tongue. Mode of Action Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells. dark stools.

confusion. >Caution the fatigue. may cause vertigo. P A R K I N S O N I A N DRUG Antagonizes the effect of histamine at H1 receptor sites. urinary hesitancy or > Report onset of rash or fever frequency. d drowsiness. Adverse Reaction/s . does not bind or inactivate histamine 10 to 50 mg Cardiac IV disease or hypertension glaucoma gastric or duodenal ulcers Nursing Responsibilitie s > Remember CNS: the 10 R’s headache. blurred >Explain to the vision client that use • GI: dry of these drugs mouth. hazards or other activities failure that require •EENT: alertness. vom in warm weather may iting. difficulties or palpitations. constipation increase the likelihood of • GU: heatstroke. client that the anxiety. retention withdraw drugs. immediately to urine physician. creating •CV: tachycardia. nausea. medication tremors.Generic Name D I P H E N H Y D R A M I N E Brand Name B E N A D R Y L General Classification Indication Mode of Action Contraindication Usual Dose Actual Dose 1 amp slow IVTT 1 hour prior to Chemo A N T I Parkinsonism or druginduced extrapyramidal effects For active treatment of motion sickness.

nonof DNA. but small cell lung also leads to cancer. replication prostate.should be prepared for 100%) administration Nephrotoxicity only by (28-36%) professionals Ototoxicity. only inhibits ovary. complex not endometrium. head programmed & neck cell death squamous (called cell cancer. apoptosis). osteogenic sarcomas. transcription kidney.Generic Name C I S P L A T I N Brand Name P L A T I N O L General Classification A N T I N E O P L A S T I C A G E N T Mode of Action Cancers (OffCoordinates to DNA and label) that this Cancer of coordination cervix. Myelosuppres >Operations sion (25-30%) such as reconstitution. solution other platinum  1mg/mL compounds Powder for Severe myelosuppres injection  10mg sion. Anaphylaxis dilution and (1-20%) transfer to Alopecia syringes should be carried out only in the designated area. lactation Actual Dose Adverse Reaction/s Nausea (76100%) Nursing Responsibilities > Chemotherape utic agents Vomiting (76.  50mg hearing impairment Pregnancy. renal impairment. and esophagus. bone marrow transplants Indication Contraindicatio Usual n Dose Hypersensitivi Injectable ty to cisplatin. who have been especially in trained in the children safe use of the (31%) preparation. > The personnel carrying out .

. >Pregnant personnel are advised not to handle chemotherapeuti c agents . gloves and eye shield.these procedures should be adequately protected with clothing.

OOO “U” SQ 24 huors post chemo. Adverse Reaction/s Rash & urticaria. uncontrolled HTN. cancer. Usual Dose Starting dose: 50-100 IU/kg 3 times wkly by IV or SC Actual Dose 4.Generic Name R E N O G E N Brand Name General Classification Indication Mode of Action Contraindicatio n Hypersensitivi ty to mammalian cell-derived products & albumin (human). Treatment of anemia ass ociated w/ chronic renal failure w/ or w/o dialysis. HIV in fection & autologous blood transfusion. Nursing Responsibilitie s > Remember the 10 R’s problems .

8 oC. urine output of >30cc/hr. moist mucous membranes.NURSING DIAGNOSIS Imbalance nutrition less than body requirements r/t decrease in appetite ASSESSMENT S-“Wala ako gana kumain. > Discuss importance of eating a wellbalanced and as well as effects on health when failed to take nutritious foods. > Unpleasant odors or sights may have a negative effect on appetite. > This would provide client relevant ideas as significance of eating nutritious foods thus increasing their cooperation and compliance to treatment . > Determine psychological factors." > Patient has moist mucous membranes. as verbalized. Patient verbalized "Kailangan ko kumain kahit paunti-unti para lumakas ako kahit papano at para makalabas na ako dito. O> eat less > appears weak > dry and cracked lips noted CLIENT OUTCOME Within the shift. > Minimize unpleasant odors or sights. > Water is a vital element in our body to maintain homeostasis of fluids and electrolytes in the body. thus providing respect to their autonomy. NURSING INTERVENTIONS > Discuss eating habits and food preferences and intolerances to food. client will be able to verbalize understanding on the importance of proper nutrition and balanced diet. > This enhance intake of the client by using a distraction technique as well as a relaxation techniques. > Maintain fluid volume at a functional level as evidenced by adequate urine output. cultural. . T= 36. stable vs. RATIONALE > Necessary to appeal on client's likes and dislikes to food and allergies to food. EVALUATION > Goal met. or religious inferences. relaxing environment including socialization. > Promote adequate fluid intake. VS of BP=1110/80mmHg. CR= 98bpm. RR= 20bpm. >This would affect client's food choices. > To prevent injury from dryness. > Promote pleasant.

the patient still has body weakness. suggest use of relaxation techniques. > To enhance sense of wellbeing. > Assisted in Rom exercises. Therefore. as verbalized. client will able to tolerate some forms of activities. > To prevent contractures from occuring. > To prevent development of pressure ulcers. . O>body weakness noted >with difficulty in moving extremities and body CLIENT OUTCOME Within the shift. NURSING INTERVENTIONS > Assisted to a more comfortable position. thus he can't still tolerate some activities.”. RATIONALE > To enhance ability to participate in activities. the goal is not met.NURSING CARE PLAN NURSING DIAGNOSIS Activity intolerance r/t body weakness ASSESSMENT S-“Medyo nahihirapan ako gumalaw. EVALUATION > After 8 hours. > Encourage client to maintain positive attitude. > Assisted in moving from side to side.

. client will able to identify specific interventions to promote healthy oral mucosa. NURSING INTERVENTIONS >Encourage adequate fluid intake >Instruct patient in oral hygiene techniques and proper dental care. patient was able to identify specific interventions to promote health oral mucosa > Encourage early initiation og good oral health practices and timely interventions for treatable problems. O> dry lips noted >mucosal pallor noted CLIENT OUTCOME Within the shift. within the shift.NURSING CARE PLAN NURSING DIAGNOSIS Impaired Oral Mucous Membane r/t side effects of therapeutic regimen: chemotheraph y ASSESSMENT S> “masyadong tuyo ang labi ko. >Provide nutritional information  > To correct deficiencies and reduce irritation .as patient verbalized. RATIONALE > To prevent dehydration EVALUATION > Goal met. > To prevent or limit mucosal or gum irritation > Instruct patient to use soft-bristle brush to cleanse teeth.