LABORATORY RESULTS

HEMATOLOGY REPORT (11/01/2013)

TEST WHIITE BLOOD CELLS RED BLOOD CELLS HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW-CV PDW MPV DIFFERENTIAL COUNT LYMPHOCYTE (%) NEUTROPHIL (%) MONOCYTE (%) EOSINOPHIL (%) BASOPHIL (%) BANDS/STABS (%) PLATELET

RESULTS 16.27 4.74 13.8 42.5 89.7 29.1 32.5 12.9 10.0 9.4

UNIT x10^3/uL x10^6uL g/dL % fL pg g/dL % fL fL

REFERENCE 5.0-10.0 4.2-5.4 12.0-16.0 37.0-47.0 82.0-98.0 27.0-31.0 31.5-35.0 12.0-17.0 9.0-16.0 8.0-12.0

INTERPRETATION INDICATES INFECTION NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL

20.3 57.4 10.1 12.0 0.2

% % % % % % x10^3uL

17.4-48.2 43.4-76.2 4.5-10.5 1.0-3.0 0.0-2.0

NORMAL NORMAL NORMAL INDICATES INFECTION NORMAL

231

150-400

NORMAL

Electrolytes
RESULTS POTASSIUM SODIUM CHLORIDE REFERENCE VALUES 3.5-5.3 mmol/L 135-148 mmol/L 98-107 mmol/L INTERPRETATION

123.57

HEMATOLOGY REPORT (11/08/2013)

TEST WHIITE BLOOD CELLS RED BLOOD CELLS HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW-CV PDW MPV DIFFERENTIAL COUNT LYMPHOCYTE (%) NEUTROPHIL (%) MONOCYTE (%) EOSINOPHIL (%) BASOPHIL (%) BANDS/STABS (%) PLATELET

RESULTS 15.96 4.78 13.9 43.0 90.0 29.1 32.3 12.7 9.5 9.1

UNIT x10^3/uL x10^6/uL g/dL % fL pg g/dL % fL fL

REFERENCE 5.0-10.0 4.2-5.4 12.0-16.0 37.0-47.0 82.0-98.0 27.0-31.0 31.5-35.0 12.0-17.0 9.0-16.0 8.0-12.0

INTERPRETATION INDICATES INFECTION NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL

17.2 58.6 8.4 15.4 0.4

% % % % %

17.4-48.2 43.4-76.2 4.5-10.5 1.0-3.0 0.0-2.0

NORMAL NORMAL NORMAL INDICATES INFECTION NORMAL

259

x10^3/uL

150-400

NORMAL

Electrolytes
RESULTS POTASSIUM SODIUM CHLORIDE 3.44 REFERENCE VALUES 3.5-5.3mmol/L 135-148mmol/L 98-107mmol/L INTERPRETATION NORMAL

HEMATOLOGY REPORT (11/13/2013)

TEST WHITE BLOOD CELLS RED BLOOD CELLS HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW-CV PDW MPV DIFFERENTIAL COUNT LYMPHOCYTE (%) NEUTROPHIL (%) MONOCYTE (%) EOSINOPHIL (%) BASOPHIL (%) BANDS/STABS (%) PLATELET RESULTS 15.80 4.55 13.0 41.8 91.9 28.6 31.1 13.0 10.5 9.9 UNIT x10^3/uL x10^6/uL g/dL % fL pg g/dL % fL fL REFERENCE 5.0-10.0 4.2-5.4 12.0-16.0 37.0-47.0 82.0-98.0 27.0-31.0 31.5-35.0 12.0-17.0 9.0-16.0 8.0-12.0 INTERPRETATION INDICATES INFECTION NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL

18.2 58.9 7.9 14.7 0.3

% % % % %

17.4-48.2 43.4-76.2 4.5-10.5 1.0-3.0 0.0-2.0

NORMAL NORMAL NORMAL INDICATES INFECTION NORMAL

227

x10^3/uL

150-400

NORMAL

CHEST CT-SCAN PLAIN AND CONTRAST

IMPRESSION: 1. Large, solid, lobulated heterogeneously enhancing pulmonary mass, right middle lobe with mediastinal invasion associated with encasement and luminal narrowing of the superior vena cava, favoring malignancy. 2. Multiple heterogeneously enhancing smaller pulmonary and pleural base masses may relate to metastases. 3. Obstructive pneumonitis. 4. Pre- paratracheal, subcarinal, anterior pre-vascular, hilar, aortapulmonary window and supraclavilar adenopathy. 5. Bilateral pleural thickening/effusion. 6. Simple renal cortical cyts, bilateral. 7. Thoracic spondylosis.

DRUG STUDY
1. GENERIC NAME: decadrol BRAND NAME: Dexamethasone CLASSIFICATION: Long-acting corticosteroid DOSAGE: ROUTE: FREQUENCY: MECHANISM OF ACTION: Dexamethasone suppresses inflammation and the normal immune response. It prevents the release of substances in the body that causes inflammation. INDICATIONS: Management of cerebral edema, diagnostic agent in adrenal disorders, relieves inflammation, allergic disorders, asthma, and arthritis. CONTRAINDICATIONS: Hypersensitivity, active untreated infection, and systemic fungal infection. ADVERSE EFFECTS OF THE DRUGS: Skin rash, swollen face, legs or ankles (fluid retention), muscle weakness, vision problems, cold that last for a long time and black or tarry stool. NURSING RESPONSIBILITIES/PRECAUTIONS: Monitor intake and output of the patient. Observe the patient for peripheral edema, steady weight gain, rales or crackles or dyspnea. Notify the physician immediately if these clinical manifestations are noted. Guaiac test stools should be carried out. Guaiac positive stools should be reported to the physician immediately. Administer with meals to minimize GI irritation.

2. GENERIC NAME: azithromycin BRAND NAME: Zithromax CLASSIFICATION: Macrolide DOSAGE: ROUTE: FREQUENCY: MECHANISM OF ACTION: Azithromycin blocks transpeptidation by binding to 50s ribosomal submit of susceptible organisms and disrupting RNA- depend protein synthesis at the chain elongation step. INDICATIONS: Treatment of lower respiratory infections. Acute bacterial exacerbations of COPD due to Haemophilus influenza, Moraxella catarrhalis, Streptococcus pneumonia; community acquired pneumonia H. influenzae. CONTRAINDICATIONS: Contraindicated with hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic. ADVERSE EFFECTS OF THE DRUG: Mild modrerate nausea, vomiting, abdominal pain, dyspepsia, flatulence, diarrhea, cramping, angioedema, cholestatic jaundice; dizziness, headache, vertigo and somnolence. NURSING RESPONSIBILITIES/PRECAUTIONS: Take full course prescribed. Do not take with antacids. Tablets and oral suspension can be taken with or without food. You may experience these side effects: stomach cramping, discomfort, diarrhea; fatigue and headache. Report severe or watery diarrhea, severe nausea or vomiting, rash or itching and mouth sores.

3. GENERIC NAME: amlodipine besylate BRAND NAME: Norvasc CLASSIFICATION: Antihypertensive DOSAGE: ROUTE: FREQUENCY: MECHANISM OF ACTION: Inhibits the movement of calcium across the membrane of cardiac and arterial muscle cells; inhibits transmembrane calcium flow, which results in the depression of impulse formation in specialized cardiac pacemaker cells. INDICATIONS: Angina Pectoris due to coronary artery spasm (Prinzmetals variant angina) Chronic Stable angina, alone or in combination with other agents. CONTRAINDICATIONS: Contraindicated with allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block (second or third degree) Use cautiously with CHF. ADVERSE EFFECTS OF THE DRUG: Dizziness, light- headedness, headache, asthenia, fatigue, lethargy, peripheral edema, arrhythmias, flushing, rash, nausea, and abdominal discomfort NURSING RESPONSIBILITIES/PRECAUTIONS: Take with meals if upset stomach occurs.medication may be ordered You may experience these side effects: nausea, vomiting (eat frequent small meals); headache (adjust lighting, noise, and temperature; medication may be ordered). Report irregular heartbeat, shortness of breath, swelling of the hands and feet, pronounced dizziness and constipation.

4. GENERIC NAME: acetylcysteine BRAND NAME: Acetadote CLASSIFICATION: Miscellaneous respiratory tract drugs DOSAGE: ROUTE: FREQUENCY: MECHANISM OF ACTION: Mucolytic that reduces the viscosity of pulmonary secretions by splitting disulfide linkages between mucoprotein molecular complexes. Also, restores liver stores of glutathione to treat acetaminophen toxicity. INDICATIONS: Adjunct therapy for abdominal viscid or thickened mucous secretions in patients with pneumonia, bronchitis, bronchiectasis, primary amyloidosis of the lung, tuberculosis, cystic fibrosis, emphysema, atelectasis, pulmonary complications of thoracic surgery or CV surgery. CONTRAINDICATIONS: Contraindicated in patients hypersensitive to drug. Use cautiously in elderly or debilitated patients with severe respiratory insufficiency. ADVERSE EFFECTS OF THE DRUGS: Fever, drowsiness and gait disturbances, tachycardia, hypotension and hypertension, rhinorrhea, ear pain and eye pain, stomatitis, nausea and vomiting, rash, clamminess and urticaria. NURSING RESPONSIBLITIES/PRECAUTIONS: Use plastic, glass, stain less steel, or another non reactive metal when giving by nebulization. Hand-bulb nebulizers arent recommended because output is too small and particles size too large. Drug is physically or chemically incompatible with tetracyclines, erythromycin lactobionate, amphlericin B, and ampicillin sodium. If given by aerosol inhalation, nebulizer this drug.

5. GENERIC NAME: salbutamol BRAND NAME: Atrovent CLASSIFICATION: Bronchodilator DOSAGE: ROUTE: FREQUENCY: MECHANISM OF ACTION: Inhibits cholinergic receptor in bronchial smooth muscle resulting in decreased concentration. INDICATIONS: Bronchodilator in maintenance therapy of reversible airway obstruction due to asthma or COPD. CONTRAINDICATIONS: Avoid use during acute bronchospasm. ADVERSE EFFECTS OF THE DRUGS: Nervousness, dizziness, headache, blurred vision, sore throat, cough, bronchospasm, palpitations, hypotension, nausea, GI irritation and rash. NURSING RESPONSIBILITIES/PRECAUTION: Assess respiratory status (rate, breath sounds and dyspnea) Confirm with physician about alternative medication if severe bronchospasm is present.

6. GENERIC NAME: furosemide BRAND NAME: Lasix CLASSIFICATION: Loop diuretic DOSAGE: ROUTE: FREQUENCY: MECHANISM OF ACTION: Inhibits reabsorption of sodium and chloride from the proximal and distal tubules and ascending limb of the loop of Henle, leading to a sodium-rich diuresis. INDICATIONS: Edema associated with heart failure, cirrhosis and renal disease CONTRAINDICATIONS: Contraindicated with allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); anuria, severe renal failure and hepatic coma. ADVERSE EFFECTS OF THE DRUGS: Dizziness, vertigo, paresthesias, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss, orthostatic hypotension, rash, pruritus,urticaria and nocturia. NURSING RESPONSIBILITIES/PRECAUTIONS: Take with food or meals to prevent GI upset. Blood glucose levels may become temporarily elevated in patients with diabetes after starting this drug. Report loss or gain of more than 1.5 kg in 1 day, swelling in your ankles or fingers, unusual bleeding or bruising, dizziness, trembling, numbness, fatigue, muscle weakness or cramps.