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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
Hematology Examination
Date: November 02, 2011 (due at 2 pm)
LABORATORYEXAMINATION NORMALVALUES RESULTS ANALYSIS NURSING INTERVENTION
Hemoglobin 120-180gm/l
89 gm/l Decrease inhaemoglobin results in
blood loss from thecellular injury which
disrupts blood flow fromentering the cells andtissues of the body.
Administer IV fluids asordered to improve tissueoxygenation.
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.
Proper positioning toprevent any complication.
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
Date: November 03, 2011
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
Date: November 03, 2011
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
Monitor vital signs.
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.
Monitor vital signs.
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
Hematology Examination
Date: November 08, 2011
LABORATORYEXAMINATION
NORMALVALUES
RESULTS FINDINGS NURSING INTERVENTION
Hemoglobin 120-180gm/l
80 Decrease in hemoglobinis a reflection of the
post-op blood loss afterthe surgery and a
inflammatory responseto inflammation caused
by the injury.
Administer IV fluids asordered to improve tissueoxygenation.
Monitor vital signs andpulse oximeter readingsclosely.
Promoting rest andcomfort to decrease oxygendemand.
Proper positioning toprevent any complication.
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
FINDINGS ANALYSIS NURSING INTERVENTION
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
Hematology Examination
Date: December 03, 2011LABORATOR
YEXAMINATI
ON
NORMALVALUES
RESULTS ANALYSIS NURSING INTERVENTION
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.
Monitor vital signs.
Document findings.MCH (MeanCorpuscularHemoglobin)
27 31 g/L 29 g/L NORMAL Observe for anychanges in anylaboratory values.
Monitor vital signs.
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.
Monitor vital signs.
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.
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Monocytes 0 9% 4.3% NORMAL Observe for anychanges in anylaboratory values.
Monitor vital signs.
Document findings.Eosinophils 1 3% 2.2% NORMAL Observe for any
changes in anylaboratory values.
Monitor vital signs.
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)
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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
RESULTS ANALYSIS NURSING INTERVENTION
Creatinine 45 104mol/L 77.67mol/L NORMAL
Observe for anychanges in anylaboratory values.
Monitor vital signs.
Document findings.Sodium 135 143
mmol/L138.2
mmol/LNORMAL Observe for any
changes in anylaboratory values.
Monitor vital signs.
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Document findings.Potassium 3.41 4.82
mmol/L3.63 mmol/L NORMAL Observe for any
changes in anylaboratory values.
Monitor vital signs. Document findings.
Arterial Blood Gas
Date: December 03, 2011
LABORATORY
EXAMINATION
NORMALVALUES
RESULTS ANALYSIS NURSING INTERVENTION
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
Date: December 03, 2011
DIAGNOSTIC
PROCEDURE
FINDINGS ANALYSIS NURSING INTERVENTION
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
Date: December 04, 2011
LABORATORY
EXAMINATION
NORMALVALUES
RESULTS ANALYSIS NURSING INTERVENTION
Color Light yellowto amber
Amber NORMAL Observe for anychanges in anylaboratory values.
Monitor vital signs.
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.
changes in anylaboratory values.
Monitor vital signs.
Document findings.
PH 5 - 6 6 NORMAL Observe for anychanges in anylaboratory values.
Monitor vital signs.
Document findings.SpecificGravity
1.010 1.025 1.025 NORMAL Observe for anychanges in anylaboratory values.
Monitor vital signs.
Document findings.Chemical
(sugar,protein,bilirubin,
nitrite etc.)
(-) (-) NORMAL Observe for anychanges in anylaboratory values.
Monitor vital signs.
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.
Monitor vital signs.
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.
Monitor vital signs.
Document findings.Epithelial
CellsNone None NORMAL Observe for any
changes in anylaboratory values.
Monitor vital signs.
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.
Monitor vital signs.
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Document findings.
Hematology Examination
Date: December 05, 2011
LABORATORY
EXAMINATION
NORMALVALUES
RESULTS ANALYSIS NURSING INTERVENTION
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.
Monitor vital signs.
Document findings.
Urinalysis
Date: December 13, 2011
LABORATORY
EXAMINATION
NORMALVALUES
RESULTS ANALYSIS NURSING INTERVENTION
Color Light yellowto amber
Light Yellow NORMAL Observe for anychanges in anylaboratory values.
Monitor vital signs.
Document findings.Appearance Clear Clear NORMAL Observe for any
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changes in anylaboratory values.
Monitor vital signs.
Document findings.
PH 5 6 6 NORMAL Observe for anychanges in anylaboratory values.
Monitor vital signs.
Document findings.SpecificGravity
1.010 1.025 1.015 NORMAL Observe for anychanges in anylaboratory values.
Monitor vital signs.
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
Date: December 14, 2011
LABORATOR
Y
EXAMINATI
NORMAL
VALUES
RESULTS ANALYSIS NURSING INTERVENTION
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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
changes in anylaboratory values.
Monitor vital signs. Document findings.
Albumin 35 52 g/L 41.74 g/l NORMAL Observe for anychanges in anylaboratory values.
Monitor vital signs.
Document findings.Globulin 11 - 33 31 NORMAL Observe for any
changes in anylaboratory values.
Monitor vital signs.
Document findings.Albumin /
Globulin Ratio1.5 3.0 1.5 NORMAL Observe for any
changes in anylaboratory values.
Monitor vital signs.
Document findings.
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