Procedure date 8/3/20118/4/2011 Complete Blood Count

Indication The complete blood cell count (CBC) identifies the total number of white and red blood cells, the platelet count, and the hemoglobin and hematocrit. The CBC is carefully monitored in patients with CVD. White blood cell counts are monitored in immunocompromised patients and in situations where there is concern for infection (eg, after invasive procedures or surgery). The red blood cells carry haemoglobin, which transports oxygen to the cells. The hematocrit is a measure of the relative proportion of red blood cells and plasma. Low haemoglobin and hematocrit levels have serious consequences for patients with CAD, such as more frequent angina episodes. Platelets are the first line of protection

Normal value/ Findings

Nursing Responsibilities/Implication Preprocedure 1. Explain test procedure. Explain that slight discomfort may be felt when skin is punctured. Refer to venipuncture procedure for additional information. 2. Avoid stress if possible because altered physiologic status influences and changes normal hemogram values. 3. Select hemogram components ordered at regular intervals (eg, daily, every other day). These should be drawn consistently at the same time of day for reasons of accurate comparison; natural body rhythms cause fluctuations in laboratory values at certain times of the day. 4. Dehydration or overhydration can dramatically alter values; for example, large volumes of IV fluids can dilute the blood, and values will appear as lower counts. The presence of either of these states should be communicated to the laboratory. 5. Fasting is not necessary. However, fat-laden meals may alter some test results as a result of lipidemia. Postprocedure 1. Apply manual pressure and dressings to the puncture site on removal of the needle. 2. Monitor the puncture site for oozing or hematoma formation. Maintain pressure dressings on the site if necessary. Notify physician of unusual problems with bleeding.

Test

Normal Actual Actual Significance Findings Findings Findings 8/3/2011 8/4/2011

4.5-5x10 3 ^12 mm 5-10x10 3 ^9 mm 0.400.54% 0.40-0.75 0.25-0.40 4.76 20.8 0.46 0.89 0.11 4.59 16.1 0.42 0.96 0.12 Increase in the number of WBC, Segmenters and Lymphocytes is a sign infection.

RBC WBC Hematocrit Segmenters Lymphocytes

against bleeding. Once activated by blood vessel wall injury or rupture of atherosclerotic plaque, platelets undergo chemical changes that form a thrombus.

3. Resume normal activities and diet. 4. Bruising at the puncture site is not uncommon. Signs of inflammation are unusual and should be reported if the inflamed area appears larger, if red streaks develop, or if drainage occurs. NEVER apply a total circumferential dressing and wrap because this may compromise circulation and nerve function if constriction, from whatever cause, occurs

8/3/2011 FBS

To determine if there is abnormal function of glucagons and insulin or if diabetes is present. Glucose is formed from carbohydrate digestion and conversion of glycogen to glucose by the liver. Fasting blood plasma glucose is a vital component of diabetes management.

Test FBS

Normal Findings 71-105

Actual Findings 114

Significance In type 2 Diabetes Mellitus fasting states, the insulin levels are decreased and the other hormones like glucagons take over. The counter regulatory hormones and the insulin resistance allow the glycogen in the liver and the muscle to be used as a fuel. Thats why even they had a fasting; their blood sugar levels are still increased compare to people who are not diabetic. The patient is in hyperglycaemic state because his blood glucose is not used as an energy or fuel for his ADLs since the patient is in the comatose state. If the glucose is not burned as a

Preprocedure 1. Explain test purpose and blooddrawing procedure. 2. Tell patient that the test requires at least an overnight fast; water is permitted. Instruct the patient to defer insulin or oral hypoglycemic until after blood is drawn, unless specifically instructed to do otherwise. 3. Note the last time the patient ate in the record and on the laboratory requisition. Procedure 4. Draw a 5-mL venous blood sample from a fasting person. Observe standard precautions. Serum is acceptable if separated from red cells within an hour. A gray-topped tube, which contains sodium chloride, is acceptable for 24 hours without separation. Postprocedure 5. Tell the patient that he or she may eat and drink after blood is drawn. 6. Interpret test results and monitor appropriately for hyperglycemia and hypoglycemia. Counsel regarding necessary lifestyle changes (eg, diet, exercise, glucose monitoring, medication). 7. Persons with glucose levels >200 mg/dL (>11.1 mmol/L) should be placed on a strict intake and output program.

8/3/2011 Lipid Profile

Lipoprotein measurements are diagnostic indicators for hyperlipidemia and hypolipidemia. Lipids are fatty substances made up of cholesterol, cholesterol esters, triglycerides, nonesterized fatty acids and phospholipids. Lipoproteins are unique plasma proteins that transport otherwise insoluble lipids such as LDL, HDL, and VLDL. Cholesterol This test evaluates the risk for arthrosclerosis, myocardial occlusion, and coronary arterial occlusion. Cholesterol relate to Coronary Heart Disease (CHD) and an important screening test for heart disease., LDL bad cholesterol is closely associated with CHD and atherosclerosis.

Test Cholesterol Triglycerides HDL LDL VLDL

Normal Findings 71-105 200 mg/dL and below 40-160 mg/dL 30-75 mg/dL 66-178 mg/dL 40 mg/dL and below

Actual Findings 230 127.8 64.4 140.2 25. 4

Significance Hypercholesterolaemia is due to the diet (High saturated fats) the patient had before. It also predisposes CVA. Also as the effect of DM, there is an altered metabolism of glucose, the metabolism of triglycerides fatty acids are altered also. Instead of lipogenesis( formation of fats for storage of energy) lipolysis (breakdown of fats) happen thats why cholesterol levels are high.

Preprocedure 1. Explain test purpose and procedure. A 9-12 hour fast is recommended. The patient should abstain from alcohol for 24 48 hours before testing. Prolonged fasting with ketosis increases values. 2. Document drugs the patient is taking. If possible, withhold all medication for at least 24 hours before testing. Check with physician. 3. Encourage the patient to relax. Procedure: 1. Obtain a 5-mL venous blood sample. Fasting is necessary. Serum is use. 2. Observe standard precaution. Place specimen in a biohazard bag. Postprocedure 1. Interpret test results and counsel appropriately. 2. Some lifestyle changes may be necessary to reduce elevated cholesterol level. 3. Low HDL levels can be raised by diet management, weight loss, exercise and smoking cessation. 4. Perform a comprehensive lipoprotein analysis if cholesterol levels are not lowered within 6 months after start of therapy.

8/3/2011 Creatinine

Triglycerides this test evaluates suspected atherosclerosis and measures the bodys ability to metabolize fats. The serum creatinine test is performed to measure the level of the waste product creatinine in a person's blood. The test also helps to assess the functioning of the kidneys. Creatine is formed during the metabolism of proteins. This creatine is further broken down into creatinine. The kidneys filter the blood and throw creatinine out of the body through urine. If the kidneys fail to do so effectively due to some kidney disease, the creatinine level in the urine decreases and that in the blood increases. This test is usually performed to check

Reference: A Manual of laboratory and Diagnoostic Tests 7th edition by Frances Fischbach

Test Creatinine

Normal Findings 0.5-1.7 mg/dL

Actual Findings 1.2

Significance Normal- This indicates that the patient has normal kidney function.

Pre test 1. Explain to the patient about the purpose and procedure of the test. 2. Asses diet for meat and protein intake Procedure 1. Obtain a 5 ml venous blood sample. Serum is preferred, but heparinized blood can be used. Place the specimen in biohazard bag 2. Observe standard precautions 3. Send the sample to the laboratory Post test 1. Interpret results and monitor as appropriate for impaired renal function Reference: A Manual of laboratory and Diagnoostic Tests 7th edition by Frances Fischbach

whether the kidneys are functioning normally

8/3/20118/4/2011 Electrolytes

Test

Normal Findings 135-145 3.5-5.3 96-107

Sodium Potassium Chloride

Actual Findings 8/3/2011 140 3.6 100.8

Actual Significance Findings 8/4/2011 136.8 Normal 4.1 100.8

Pre test 1. Explain the purpose and procedure. Encourage relaxation 2. Be aware that the tourniquet application should be as brief as possible when drawing blood from the patient Procedure 1. Obtain a 5 ml venous blood sample; this will provide sufficient serum for this test 2. Observe standard/ universal precautions. 3. Observe standards precautions Post test 1. Resume normal activities and diet 2. Interpret test results and monitor appropriately 3. If an electrolyte disorder is suspected, daily weight and accurate fluid intake and output should be recorded Reference: A Manual of laboratory and Diagnoostic Tests 7th edition by Frances Fischbach

8/2/20118/12/2011 Random Blood Sugar

Test

Normal Findings

Actual Findings

Significance

RBS 8/2/2011 63-183 mg/dL 202

8/3/2011 2pm 8pm 8/4/2011 2am 8am 2pm 8pm 8/5/2011 2am 8am 2pm 8pm 8/6/2011 8am 2pm 8pm 8/7/2011 2pm 8pm 8/8/2011

140 143

141 140 137 140

180 127 140 156 152 124 133

141 137

A high level of RBS is the most common clinical manifestation of type 2 DM which the patient has. In type 2 DM, there is an Insulin resistance which act like a block in the uptake of glucose in the muscle and fat cells thus, it increases the glucose in the bloodstream, which increases the resistance to insulin and worsens the hyperglycemia. The patient is in hyperglycaemic state because his blood glucose is not used as an energy or fuel for his ADLs since the patient is in the comatose state. If the glucose is not burned as a fuel of the body, the glucose in the blood will increase resulting to hyperglycemia

Pre test 1. Explain the purpose and procedure. Encourage relaxation 2. Make sure that the hands of the patient are clean, dry and warm Procedure 1. Prick the finger with lancet 2. Squeeze out a drop of capillary blood 3. Drop the blood onto the test strip 4. Wait for the test strip to develop 5. Apply pressure on the pricked finger using cotton balls Post test 1. Compare the test strip to the chart or insert it in the meter 2. Safely dispose of your lancet in approved sharps container 3. Record blood glucose results with date and time Reference: A Manual of laboratory and Diagnoostic Tests 7th edition by Frances Fischbach

2am 8am 2pm 8/9/2011 8am 8/10/2011 8am 2pm

152 141 155

results upon testing.

161

143 150

8/11/2011 2am 8pm 2pm 8am 8/12/2011 2am

202 183 220 190

206

Procedure date 8/2/2011 8/10/2011 CT Scan

Indication

Normal value/ Findings

Actual Findings 8/2/2011 CT Normal Hyperdense scan frequency collection withi signals n the basal and cisterns, evoked sfylvian responses fissures, presented interhemisphere as a fissures and colored cortical sulci map of with some electrical expansion into brain both lateral activity ventricles. Midline structures are displaced. Gray white matter interphased is distinct. Posterior fossa structures and petromastoids are unremarkable.

Test

Normal Findings

Actual Findings 8/10/2011 There is a less amount of hyperdense collection within the basal cisterns, interhemispheric fissures, cortical sulci and ventricular system. An area of hypodensity is seen at the paramedian portion of the left frontal lobe suggestive infarct. Midline structures are displaced. Gray white matter interphased is distinct Posterior fossa structures and petromastoids are unremarkable. Cranial vault is intact

Significance

Anterior subarachnoid haemorrhage with intraventricular extension

Nursing Responsibilities/Implication Preprocedure 1. Explain the purpose and procedure. There are no known risks. Emphasize the fact that the electrical impulses pass from the patient to the machine and not opposite 2. Tell the patient that food and fluids can be taken before testing. However no coffee, tea or caffeinated drinks should be ingested for at least 8 hours before tests 3. Ensure that the hair has been recently washed 4. Ensure that the tranquilizers are not taken before testing (check with the physician). Other prescribed medications such as antihypertensive and insulin can be taken Procedure 1. Ensure that he patient is rested and awake for the test so that no sleep signals appear as individual indicators of beta wave activity 2. After the skin of the scalp is cleansed with an abrasive solution, place 42 electrodes at designated areas of the scalp and hold in plac with an adhesive or paste formulated for this purpose 3. Place the client in recumbent position and instruct to keep eyes closed and refrain from any movement 4. Postprocedure 1. Remove the conduction gel and

encourage the patient to ash his or her hair. Provide supplies if available 2. Interpret results and monitor for seizure activity and other neurologic manifestations

Reference: A Manual of laboratory and Diagnoostic Tests 7th edition by Frances Fischbach