DIAGNOSTIC AND LABORATORY EXAMINATIONS

A. ACTUAL

COMPLETE BLOOD COUNT

Date Basic Test Rationale Result Clinical Significance Nursing Interventions
Ordered with Normal
Values
October Hemoglobin To measure the 115.0 Increased Decreased PRETEST:
29, 2014 135-175 g/L amount of LOW -Identify the patient, and check the
 Polycythemia  Recent
hemoglobin in the requisition form with the patient’s
vera bleeding
blood, which identification bracelet
Acute  Fluid
reflects its oxygen -Explain the purpose for the
thermal retention
carrying capacity laboratory and diagnostic test to the
and to measure the
injury  Hemolysis patient and significant others
severity of anemia  Dehydration of red blood cells -Inform patient that the test requires
and the response to  Hemoconcent  Pregnancy blood sample taken with the use of
therapy. It also ration  Hemorrhage the syringe
monitors blood loss  COPD  Anemia -Obtain health history of the
and response to  Cirrhosis of patient’s complaints, including a list
 the liver of known allergies
 Hyperthyroi -Obtains a list of medications the
blood loss
dism patient is taking including herbs and
replacement
Hematocrit To measure the 0.41  Addison’s  Recent nutritional supplements
0.40-0.52 number of RBCs NORMAL disease hemorrhage -Note any recent procedure that
and the size of  Polycythemia  Anemia could interfere with test results such
RBCs. It gives a vera  Fluid overload as pretest fasting to follow the
percentage of RBCs  Acute  Fluid retention correct period of time
found in the whole thermal  Cirrhosis -Inform the significant others that
blood. This also test injury the specimen collection takes
 Hemolytic anemia
for the presence of  Extreme approximately 5-10 minutes
 Hemodilution
anemia., leukemia, physical -Check vital signs of the patient
 Leukemia
diet decency, or exertion -Inform the patient who will
 Lymphoma
other medical  Hemoconcent perform the venipuncture and when
condition ration and note that transient discomfort
 Dehydration may be felt from the needle
 COPD puncture and pressure of the
RBC Count To measure the 4.20  Cigarette  Bleeding tourniquet
4.20-6.10 number of RBCs NORMAL Smoking  Anemia -The patient may be seated or in the
X10^6/uL and to help  Dehydration  Fluid overload supine position. The patient’s arm is
 diagnose different  Hypoxia  Malnutrition in extension, with easy access to the
kinds of anemia and  Polycytemia  Cirrhosis antecubital fossa
other condition vera
affecting red blood  COPD DURING THE TEST:
cells. -Ensure that the blood is not taken
WBC Count To assess for 7.44  Bacterial  Typhoid fever from the hand or arm that has
5.0-10.0 presence of NORMAL infection  Viral infections intravenous line. Hemodilution with
X10^6/uL infection and  Lymphoma (influenza, intravenous fluids causes a false
inflammation, the  Leukemia rubella, hepatitis) decrease in the values of some test
need for further test  Chronic  Dengue fever -Inspect the antecubital fossae of
such as WBC infection  Malaria both arms to select the best vein for
differential bone  Mumps  Pernicious anemia the venipuncture
biopsy. It monitors
 Cancer (liver,  Aplastic anemia -Ask the patient to open and close
response to
intestines)  Radiation hand a few times to help make the
chemotherapy and
 Tissue  Antineoplastic veins more visible
radiation therapy
necrosis drugs -Cleanse the skin with 70% alcohol,
(burns,  Toxic ingestion of and allow it to air-dry
gangrene, heavy metals or -Provide support to the family
myocardial chemical poisons during the test
infarction)  Systemic lupus
  Varicella erythematosus POSTTEST:
-Instruct the patient to continue
Neutrophil To monitor 78  Acute  Aplastic anemia compression of the puncture site for
55-75 % hyponatremia or HIGH Infection  Chemotherapy 2 to 5 minutes or until bleeding
hypernatremia  Acute stress  Influenza stops
indicating fluid  Eclampsia  Radiation therapy -Assess the patient’s arm to ensure
excess or deficit.  Gout  Viral infection that subdermal bleeding has ceased.
An important  Myelocytic Apply an adhesive bandage as
 Widespread
indicator of leukemia severe bacterial needed
infection -If a hematoma develops at the site,
 Rheumatoid infection
arthritis apply warm compress
 Rheumatic -If a hematoma is large, monitor
fever pulses distal to the site

 Thyroiditis -Monitor patients intake and output

 Trauma and vital signs after the tests

Lymphocytes To assess levels of 19%  Infectious  Right-sided heart -Evaluate test results in relation to
20-35% lymphocyte LOW hepatitis failure patient’s symptoms and other test
production. This  Cytomegalov  Hodgkin’s performed
test differentiates irus infection diseases -Determine if the test was correctly
WBC count.  Tuberculosis  Systemic lupus performed according to appropriate
 Important to verify  Syphilis erythematosus procedure
bacterial or viral Lymphocytic  Aplastic anemia -Check other signs of on infection
infection leukemia  HIV infection and inflammation such as redness,
 Infectious  Military swelling, heat, and pain in the
momonucleo tuberculosis infected site
sis  Renal failure -Inform physician for any

Terminal cancer unusualities in vital signs or the

 Thoracic duct patient’s condition

drainage -Listen to the patient and significant
Monocytes To assess levels of 3  Acute  Hairy cell others’ expressed anxiety and fear
2-10 monocytes. Major NORMAL infection leukemia concerning the test
caution in the cell. (bacterial,  Bone marrow -Clarify or answer additional
It regulates viral) failure questions of patient and significant
osmolarity of acid-  Tuberculosis  Aplastic anemia others
base balance. They  Syphilis  Stress response to -Tell patient to report any
increase in chronic  Ulcerative colon trauma unusualities or changes observed
infection colitis  Shock after the procedure

 Myeloprolife  Burns
rative disease  Surgery
 Multiple
 myeloma  Mental distress
 Hodgkin’s  Cushing’s
disease syndrome

Platelet To assess levels of 313  Myeloprolife  Autoimmune

Count thrombocytes NORMAL rative disease disease
150-400 which are blood  Polycythemia  Chemotherapy
X10^3/uL cells that are vera  Thrombocytopeni
involved in cellular  Myelofibrosi a
mechanisms of s
primary  Iron
homeostasis that deficiency
leads to formation anemia
of blood clots  Acute or
chronic
infection
 Inflammation
diseases
 Chronic renal
disease
Mean Calculates the 27.5  Heditary  Iron deficiency
Corpuscular weight of the NORMAL spherocytosis anemia
Hemoglobin hemoglobin in the
25.7-32.20 average
pg erythrocytes.
Mean Measures the 33.4  Heditary  Iron deficiency
Corpuscular average NORMAL spherocytosis anemia
Hemoglobin concentration or
Concentratio percentage of
n (MCHC) hemoglobin in the
32.30-36.50 average erythrocyte
g/dl
URINE ANALYSIS
Date Basic Test Rationale Result Clinical Nursing Interventions
Ordered with Normal Significance
Values
October Appearance Some medications and chemicals are Clear NORMAL  Explain that this test aids
29, 2014 responsible causes of urine colour changes. in the diagnosis of urinary
Any change in clarity indicates a distinct result. tract disease and helps
Color Urine ranges from pale yellow to amber Dark NORMAL
evaluate overall renal
because the pigment urochrome (product of Yellow
function.
bilirubin metabolism). The colour indicates
 Inform patient that he need
concentration of the urine and varies with
not to restrict any food or
specific gravity
fluid intake.
Specific It is the measurement of the ability of the 1.03 NORMAL
Gravity kidneys to concentrate and excrete the urine.  Explain the procedure for

(1.005-1.03) Measurement of the concentration of particles a clean catch midstream

(including wastes and electrolytes) in the urine. urine collection.

Protein Presence of albumin is an indicator of Trace
 glomerular disease. Sensitive indicator of  Instruct to collect a sample
kidney function. preferably on arising in the
pH A high urine pH may be due to kidney failure, 6.0 NORMAL
morning.
4.6-8 UTI, and vomiting. A low urine pH may be due
to diabetic ketoacidosis, diarrhea, too much
acid in the body fluids and starvation
Glucose It is an indicator of significant hyperglycemia Negative NORMAL
and diabetes mellitus.
RBC Normally, a few RBCs are present in urine 8.0 NORMAL
0-11 u/L sediment, inflammation, injury, or disease in
the kidneys or elsewhere in the urinary tract,
for example, in the bladder or urethra, can
cause RBCs to leak out of the blood vessels
into the urine. RBCs can also be a contaminant
due to an improper sample collection and blood
from hemorrhoids or menstruation
WBC The number of WBCs in urine sediment is 18 HIGH
6-11 u/L normally low. When the number is high, it
indicates an infection or inflammation
somewhere in the urinary tract. WBCs can also
be a contaminant, such as those from vaginal
 secretions.
Epithelial cell Normally in men and women, a few epithelial 7.0 NORMAL
0-11u/L cells from the bladder (transitional epithelial
cells) or from the external urethra (squamous
epithelial cells) can be found in the urine
sediment. Cells from the kidney are less
common. In urinary tract conditions such as
infections, inflammation, and malignancies,
more epithelial cells are present.
Cast These are cylindrical particles sometimes found NONE NORMAL
0-1u/L in urine that are formed from coagulated
protein secreted by kidney cells. Different
types of casts are associated with
different kidney diseases, and the type of casts
found in the urine may give clues as to which
disorder is affecting the kidney. 
Bacteria The urinary tract is sterile; there will be 2 u/L NORMAL
0-111u/L no microorganisms seen in the urine
sediment. Bacteria from the surrounding skin
can enter the urinary tract at the urethra and
move up to the bladder, causing a UTI. If the
 infection is not treated, it can eventually move
to the kidneys and cause pyelonephritis. Less
frequently, bacteria from a blood infection may
move into the urinary tract.

BLOOD CHEMISTRY
Date Basic Tests Rationale Result Clinical Significance Nursing Interventions
ordered With Normal
 Values
October Creatinine The most common 33.52 Increased Decreased Pretest:
29, 53.00- laboratory test LOW  Myelofibrosis Low blood levels of  Obtain a history of patient’s
2014 115.00 used to evaluate  Iron deficiency creatinine are not complaints, including a list of
umol/L renal function and anemia common, but they known allergies.
to estimate the  kidneys aren't are also not usually  Obtain a history of the patient’s
effectiveness of working well a cause for concern. cardiovascular, gastrointestinal,
glomerular  dehydrated They can be seen genitourinary, hepatobiliary and
filtration. It is an  low blood volume with conditions that musculoskeletal systems, as well
amino acid and result in decreased as the results of previously
 eat a large amount
waste product of muscle mass. performed tests and procedures.
of meat
protein  Obtain a list of medications the
 take certain
metabolism. patient is taking, including herbs,
medications.
Calcium Measures the total 2.40  Consumed too  Malabsorption of nutritional supplements and
1.75-2.39 amount of calcium HIGH much calcium or nutrients nutraceuticals. the requesting
mmol/L in the blood. vitamin D  Hypoparathyroidi health care practitioner and
 HIV/AIDS sm laboratory should be advised if
 Hyperpathyroidis  Low blood level the patient is regularly using
m of albumin these products so that their
 Metastatic bone  Vitamin D effects can be taken into
 tumor deficiency consideration when reviewing
 Steomalacia  Magnesium results.
 Paget’s Disease deficiency  There are no food, fluid, or
 Kidney failure medication restrictions unless by
 Liver disease medical direction.
Potassium Monitor renal 4.40  Addison’s disease  Myelofibrosis  Instruct the patient to refrain
3.4-5.4 function, acid-base NORMAL  Crushed tissue  Iron deficiency from excessive exercise for 8
mmol/L balance, glucose injury anemia hours before the test.
metabolism. To  Kidney failure  Chronic diarrhea  Review the procedure with the
evaluate  Metabolic or  Use of diuretics patient. Explain that the patient
neuromuscular and respiratory  Hyperaldosteronis may have slight discomfort with
endocrine acidosis m the needle puncture and the
disorders and to  Too much  Not tourniquet.
enogh
determine the potassium on diet potassium on diet  Inform the patient that the
origin of
 Red blood cell  Vomiting specimen collection
arrhythmias.
destruction approximately takes 5 to 10
Serum Magnesium is one 1.09  Kidney failure  Low dietary minutes.
Magnesium of the major HIGH  Hypothyroidism intake
0.74-1.03 intracellular Intratest:
 Hyperparathyroidi  Gastrointestinal
mmol/L cations of the  Direct the patient to breathe
 body. It is sm disorders normally and to avoid
measured to  Dehydration  Uncontrolled unnecessary movement.
evaluate  Use of diabetes  Observe standard
electrolyte magnesium  Long term precautions when obtaining
disorders, containing diuretic use blood.
hypocalcemia, antacids or  Prolonged
hypokalemia, and laxatives diarrhea Posttest:
acid-base  Severe burns  Observe venipuncture site
imbalance. for bleeding or hematoma
Sodium To detect changes 138  Adrenal glan  Addisons disease
formation. Apply pressure
135-145 in water balance NORMAL problems like  Dehydration,
bandage.
mmol/L rather than sodium cushing syndrome vomiting, diarrhea
 Evaluate test results in
balance. To  Diabetes insipidus  Ketonuria
relation to the patient’s
determine  Increased fluid  Use of diuretics, symptoms and other tests
electrolytes, acid- loss morphine and performed.
base balance,  Too much salt or SSRI
water balance, sodium antidepressants
water intoxication, bicarbonate in diet
and dehydration.  Use of
corticosteroids,
 laxative, lithium,
and NSAIDS

B. POSSIBLE

Serology Blood Test Rationale Nursing Intervention

Anti-SM Anti-Sm is an antibody directed against Sm, a specific protein Pretest:
found in the cell nucleus. The protein is found in up to 30% of  Obtain a history of patient’s complaints,
people with lupus. It's rarely found in people without lupus. So including a list of known allergies.
a positive test can help confirm a lupus diagnosis.  There are no food, fluid, or medication
Antiphospholipid APLs are a type of antibody directed against phospholipids.
restrictions unless by medical direction.
Antibodies (APLs) APLs are present in up to 60% of people with lupus. Their
 Instruct the patient to refrain from excessive
presence can help confirm a diagnosis. A positive test is also
exercise for 8 hours before the test.
used to help identify women with lupus that have certain risks
 Review the procedure with the patient.
that require preventive treatment and monitoring. Those risks
Explain that the patient may have slight
include blood clots, miscarriage, or preterm birth. APLs may
discomfort with the needle puncture and the
also occur in people without lupus. Their presence alone is not
tourniquet.
enough for a lupus diagnosis.
Anti-Ro (SSA) and Anti-Ro(SSA) and Anti-La(SSB) are two antibodies that are  Inform the patient that the specimen

Anti-La(SSB) commonly found together. They are specific against ribonucleic collection approximately takes 5 to 10
 acid (RNA) proteins. Anti-Ro is found in anywhere from 24% minutes.
to 60% of lupus patients. It's also found in 70% of people with
another autoimmune disorder called Sjögren's syndrome. Anti- Intratest:
La is found in 35% of people with Sjögren's syndrome. For this  Direct the patient to breathe normally
reason, their presence may be useful in diagnosing one of these and to avoid unnecessary movement.
disorders. Both antibodies are associated with neonatal lupus, a  Observe standard precautions when
rare but potentially serious problem in newborns. obtaining blood.
In pregnant women, a positive Anti-Ro (SSA) or Anti-La(SSB)
warns doctors of the need to monitor the unborn baby. Posttest:
C-Reactive Protein CRP is a protein in the body that can be a marker of
 Observe venipuncture site for bleeding
(CRP) inflammation. The test looks for inflammation, which could
or hematoma formation. Apply pressure
indicate active lupus. In some cases, the test could be used to
bandage.
monitor inflammation. Results of the test could indicate
Evaluate test results in relation to the patient’s
changes in disease activity or in response to treatment. Because
symptoms and other tests performed
there are many causes for an elevated result, including
infection, the test is not diagnostic for lupus. Nor can it
distinguish a lupus flare from an infection. Also, the level of
CRP doesn't directly correlate with lupus disease activity. So it
isn't necessarily useful for monitoring disease activity.
Complement Complement proteins are involved in inflammation. The test
 can look for levels of specific complement proteins or for total
complement. Complement levels are often low in patients with
active disease, especially kidney disease. So doctors may use
the test to gauge or monitor disease activity. Like other tests,
complement must be taken in the context of clinical findings
and other test results. A low complement in itself is not
diagnostic of lupus.
Erythrocyte ESR measures the speed of red blood cells moving toward the
Sedimentation Rate bottom of a test tube. When inflammation is present, blood
(ESR) proteins stick together and fall and collect more quickly as
sediment. The more quickly the blood cells fall, the greater the
inflammation. ESR is used as a marker of inflammation.
Inflammation could indicate lupus activity. This test could be
used to monitor inflammation, which could indicate changes in
disease activity or response to treatment.
 Test Rationale
Tissue A biopsy procedure involves removal of a small bit of
Biopsies tissue that the doctor then examines under a
microscope. Almost any tissue can be biopsied.
 The skin and kidney are the most common sites
biopsied in someone who may have lupus.
 The results of the biopsy can show the amount of
inflammation and any damage being done to the
tissue.
 Further tests on the tissue sample can detect
autoimmune antibodies and determine whether
Nursing Intervention
 Observe standard precautions when obtaining blood
 Advise patient to tell the doctor if you are pregnant or if
you have any drug allergies or bleeding problems.
 Make sure the health care team knows what medications
you are taking.
 Instruct patient to avoid foods or fluids before the test.
 Tell that the amount of pain during and after the
procedure depends on the patient. Because a local
anesthetic is used, discomfort during the procedure is
usually minimal. The anesthetic may burn or sting when
 lupus or another factor such as infection or
medication is responsible.
Chest X- An image of your chest may reveal abnormal shadows
ray that suggest fluid or inflammation in your lungs.
first injected. After the procedure, the area may feel
tender or sore for a few days.
 Explain the procedure to the patient
 Remove jewelleries prior to test
 Provide privacy