KING SAUD UNIVERSITY

COLLEGE OF NURSING
MEDICAL SURGICAL DEPARTMENT
2nd Semester 2016- 2017

NURS 317 – CLINICAL

ASSIGNMENT NO. 1
LABORATORY TEST ANALYSIS

Name of Student : Score: \ 5 Marks

Name of the teacher : __________ Date Submitted


Blood Tests Function
 
Carry oxygen throughout your body
Red Blood Cells and remove carbon dioxide
White Blood Cells Fight infection
 
Hemoglobin Oxygen-carrying protein
   
Hematocrit Percentage of red blood cells in your
blood
Platelets Platelets help your blood clot and
control bleeding
  Elevated or decreased in accordance
Mean Corpuscular Volume with average red cell size
)MCV(
  Estimate of the amount of
Mean Corpuscular hemoglobin in an average red blood
Hemoglobin Cell (MCH) cell. Hemoglobin is a substance in
  the blood that carries oxygen to the
cells in the body from the lungs
Mean Corpuscular A measure of the concentration
Hemoglobin Concentration of hemoglobin in a given volume of
(MCHC ) .packed red blood cell
CBC ( Complete Blood Count ) -1
Normal Value
Male: 4.7 to 6.1 million cells/mcL
)to 6.1 x 10^12/L 4.7(
Female: 4.2 to 5.4 million cells/mcL
)to 5.4 x 10^12/L 4.2 ( 
to 10,000 cells/mcL (4.5 to 11.0 4,500 Immune disorder
x10^9/L)
 Male: 13.8 to 17.2 gm/dL
)to 172 g/L 138(
Female: 12.1 to 15.1 gm/dL
)to 151 g/L  121( 
Male: 40.7% to 50.3% (0. 41 to 0.50)
Female: 36.1% to 44.3% (0.36 to
0.44)
to 450,000 /dL (150 to 450 x 150,000
10^9/L)
to 95 femtoliter 80
to 31 pg/cell 27
to 36 gm/dL (320 to 360 g/L) 32
Significance if Significance if Nursing Responsibility
decreased Increased
     
Anemia Polycythemia Monitor hemoglobin, hematocrit, RBC counts, and reticulocyte counts
.Provide supplemental oxygen therapy, as needed
  • Assess immunization status and history
Infection • Elevated temperature.
• Redness, swelling, increased
    • Check vital signs before and after narcotic medication
    • Instruct patient to report pain 
Anemia Polycythemia • Determine the patient’s health history for signs that can be
associated with a risk for bleeding such as liver disease
• Monitor patient’s vital signs
     .,Monitor vital signs, capillary refill  
Hydration Dehydration .Discuss strategies to stop vomiting and use of laxatives / diuretics •
.Identification of a plan to increase the optimal fluid balance •
.Assess the results of the test function electrolyte / kidney •
Thrombocytopenia Thrombocytosis Inform the pharmacist about a low \ high platelet count
 
Microcytic anemia Macrocytic Anemia Inform the physician
Too little vitamin Macrocytic Anemia Inform the physician
B12 or folic acid in
the body
Microcytic anemia Macrocytic Anemia Inform the physician
  
Serum Electrolytes (2 marks) -2
 

Serum Electrolytes  Function  Normal Value  Significance if decreased  Significance if Increased 

 Hyponatremia  Hypernatremia
Sodium Na =
Fluid and water regulation to 145 mEq/L 134  Water retention  Syndrome of inappropriate ADH
 Congestive heart failure  Kidney disease
Responsible for the functioning of excitable tissues such as     Hypokalemia
Potassium skeletal and cardiac muscle and nerves to 5.0 mmol/L 3.5  Kidney diseases Acute kidney failure
 Decreased oral intake
     
Magnesium Mg Another element that has a strong effect on muscle contractions to 0.95 mmol/L 0.70 Excessive urination (polyuria) Any damage in kidneys

Calcium Important element in the body as it helps to control nerve  to 2.55 mmol/L 2.20 Hypoalbuminemia Hyperparathyroidism
impulses, muscle contractions and has a role in clotting

       
 Phosphate Build and repair bones and teeth, help nerves function, and make to 1.3 mmol/L 0.8 Hyperparathyroidism Kidney problem
  muscles contract

  to 106 milliequivalents per 96    Hypochloremia  Hyperchloremia

Chloride  Help keep the proper balance of body fluids and maintain the liter (mEq/L) or 96 to 106  Certain kidney diseases
body's acid-base balance millimoles per liter (millimol/L)  Dehydration  Veractivity of the parathyroid glands
 
 
 
     
Bicarbonate  It keeps the pH of blood from becoming too acidic or too basic mmol/L 22-30 .Kidney  diseases, some lung diseases, and metabolic problems
 
Hypophosphatemia Hyperphosphatemia
Phosphorus It helps with bone growth, energy storage, and nerve and muscle to 4.5 mg/dL 2.5    
  production Liver disease and vitamin D deficiency  
 
 

Nursing Responsibility of Serum Electrolytes

 

• Check weight everyday to monitor the fluid volume status.

• Administer prescribed medication as order.
Sodium Na • Monitor laboratory serum sodium levels as order to determine the effectiveness of IV fluids.
 
• Monitor and observe for neuromuscular changes such as declining levels of consciousness, fatigue and muscular weakness.
• Monitor vital signs carefully and note respiratory rate and depth to indentify pulmonary edema.
• Educate the patient .
• Monitor the v/s

• Monitor abdomen for bowel sounds, distention, and pain

• Teach patient about medications and diets
Potassium K  • Monitor cardiac rhythm
• Educate the patient .
• Monitor the v/s
• Monitor V/S for Changes
• Monitor Cardiovascular status for changes in heart rhythm, pulse deficit
Magnesium Mg • Monitor intake and output
  • Educate the patient .
• Monitor vital signs for changes.
• Monitor cardiovascular status for irregularity of heart rhythm, pulse deficit.
Calcium • Monitor intake and output.
• Assess muscle strength
• Monitor vital signs for changes.
• Monitor cardiovascular status for irregularity of heart rhythm, pulse deficit.
Phosphate P • Monitor intake and output.
  • Assess muscle strength
 
• Monitor vital signs for changes.
• Monitor intake and output
Chloride • Educate the patient
•  
• Watch for signs of muscle weakness, tetany or decreased activity. Monitor vital signs frequently and record intake and output to evaluate respiratory, fluid and
Bicarbonate electrolyte status.
• Observe seizure precautions.
• Educate the patient
•  
• Monitor vital signs for changes.
• Monitor cardiovascular status for irregularity of heart rhythm, pulse deficit.
Phosphorus • Monitor intake and output.
• Educate the patient

Blood Coagulation Profile Normal Value
Prothrombin Time PT or 18.3 ) 15.3 – 11.7 (
sec Measure the time
Activated partial thromboplastic time (aPTT) .of blood to clot
or 69sec )22.7-35.6 (
  international normalized ratio (INR) 1.2 – 0.8
Blood Coagulation Profile -3
)marks 1(
Function Significance if decreased
At risk of hemorrhage Deep vein thrombosis
Significance if Nursing Responsibility
Increased
 Check and monitor any sign of bleeding
 Check any sign of complication
 Obtain lab orders to monitor APTT, PT and INR
 Educate the patient
 assessing the patient for signs of a hematoma formation
 Preventing bleeding episodes:
 Avoiding contact sports or other activities in which head injury
might occur
 Avoiding accidental cuts by using an electric razor and taking care
when using sharp tools or kitchen implements
 Avoiding intramuscular injections
 Brushing teeth with a soft toothbrush to decrease gum bleeding
 Recognizing bleeding symptoms:
 Headache or changes in neurological status can indicate
intracranial bleeding.
 Vomiting frank blood or coffee ground material
 A backache or flank pain may indicate internal bleeding
 Urine that appears dark or smoky looking may indicate bleeding in
the urinary tract

ARTERIAL BLOOD GASES FUNCTION
 
 cells use oxygen to break down
Partial pressure of oxygen sugar to produce ATP, or adenosine
(PO2) triphosphate. ATP is a molecule that
supplies cells with energy.
The cells in human body need certain
Partial pressure of carbon concentrations of co2 to help body to
dioxide (PCO2) release oxygen to the cells, dilate
capillary, thinning the blood and
restoring the blood circulation.
pH influences every physiologic
activity in body, including
metabolism, pain, and diseases. The
pH
speed of all biological and electrical
reactions is under pH control
Hco3
Keeps the pH of blood from
becoming too acidic or too basic
Arterial blood gases (1 marks ) -4
Normal Value Significance if Significance if NURSING RESPONSIBILITY
decreased Increased
  - Monitor v/s
- Monitor respiratory rate, depth, and effort, including use
of accessory muscles, nasal flaring, and abnormal breathing patterns. 
- Auscultate breath sounds presence of crackles and wheezes may alert
80 to 100 mm Hg Arterial hypoxemia Hyperoxia the nurse to an airway obstruction
  - Monitor oxygen saturation continuously
- Observe for cyanosis in skin; especially note color of tongue and oral
mucous membranes.
- Position client with head of bed elevated, in a semi-Fowler's or sitting
position
- Monitor v/s
- monitor respiratory rate, depth, and effort. Ascertain cause of
- Hyperventilating - Hypo ventilating hyperventilation if possible. Differentiate hyperventilation caused by
35 to 45 mm Hg - Respiratory alkalosis  - Respiratory anxiety, pain, or improper ventilator settings.
acidosis - Encourage patient to breathe slowly and deeply. Speak in a low, calm
tone of voice. Provide safe environment.
- Demonstrate appropriate breathing patterns, if appropriate, and assist
with respiratory aids or rebreathing mask/bag.
- Monitor the infusion rate to prevent damage and watch out for signs of
phlebitis.
7.35-7.45 Acidosis Alkalosis - Watch for signs of muscle weakness, tetany or decreased activity.
Monitor vital signs frequently and record intake and output to evaluate
respiratory, fluid and electrolyte status.
- Observe seizures precautions.
- Monitor v/s
- Monitor respiratory rate, depth, and effort, including use
of accessory muscles, nasal flaring, and abnormal breathing patterns. 
- Auscultate breath sounds presence of crackles and wheezes may alert
22-28 Medabolic acidosis Metabolic alkalosis the nurse to an airway obstruction
- Monitor oxygen saturation continuously
- Observe for cyanosis in skin; especially note color of tongue and oral
mucous membranes.
- Position client with head of bed elevated, in a semi-Fowler's or sitting
position
 Blood Chemistry (2 marks ) -5
BLOOD CHEMISTR Function Normal Value Significance if Significance if Increased Nursing Responsibility
  decreased
-It used as source of energy for brain and red - Monitor v/s.
blood cells - Assess blood glucose level before meals and at bedtime.
Glucose -Used as temperature regulator 80-120 mg/dL hypoglycemia Hyperglycemia - Assess the pattern of physical activity.
Diabetes  - Assess the patient’s current knowledge and understanding about the prescribed
diet.
- Monitor for signs of hypoglycemia or hyperglycemia.
- Check the skin and mucous membranes for hydration or dehydration.
Helps control blood pressure and regulates Hyponatremia - Encourage patient to take fluid orally if hypernatremia.
Sodium the function of muscles and nerves 135-147 mEq/L Dehydration Hypernatremia - Teach patient about foods high in sodium and low sodium food.
- Monitor v/s .
 
Important mineral for the proper function of - Monitor v/s .
all cells, tissues, and organs in the human - monitoring for patient safety.
body. - Monitor cardiovascular status for regularity of rhythm, rate, heart sounds, and
onducts electricity in the body, along with - Hyperkalemia peripheral pulses.
sodium, chloride, calcium, and magnesium 3.5-5.5 mEq/L Hypokalemia - Dehydration - Monitor abdomen for bowel sounds, distention, and pain.
Potassium Potassium is crucial to heart function and - Monitor intravenous site for redness, swelling, and pain.
plays a key role in skeletal and smooth - Teach patient about medications and diet.
muscle contraction
It’s important for digestion
 
Helps generate the osmotic pressure - Monitor v/s, laboratory results and level of consciousness frequently.
of body fluids. It is an important constituent
of stomach hydrochloric acid (HCl), the key - Hyperchloremia - Record intake and output accurately to monitor renal function.
Chloride digestive acid. 98-106 mEq/L Hypochloremia - Dehydration
needed to maintain the body's acid-base - Teach patient about medications and diet.
balance.  
 
  - Monitor v/s .
Male: - Inform the patient that he may resume his usual medications(if he use
0.8 to 1.2 mg/dl Impaired kidney function medication) that were discontinued before the test, as ordered.
Creatinine It used to supply energy mainly to muscles. Liver disease or kidney disease - Instruct the patient that he doesn’t need to restrict food and fluids.
Female: - Notify the laboratory and the practitioner of medications the patient is taking that
0.6 to 0.9 mg/dl may affect test results; they may need to be restricted.
- Assess the I&O
 
     - Monitor v/s
Blood urea nitrogen Nitrogen in the blood that comes from the waste product - Liver damage - Renal disease - Monitor cardiovascular status for regularity of rhythm, rate, heart sounds,
(BUN) urea. Urea is made when protein is broken down in your 7 to 20 mg/dL  - Malnutritio - Dehydration and peripheral pulses.
body. - Overhydration - Assess for kidney function.
- Assess for dehydration.
  If increased:
- Keep patient hydrated (decrease chance of renal stone formation)
- Keep patient safe from falls or injury
- Monitor cardiac, GI, renal, neuro status
- Assess for complaints of flank or abdominal pain & strain urine to look for
It keeps bones and teeth strong, thereby supporting stone formation
skeletal structure and function 9-11 mg/dL; 4.5- Hypocalcemia Hypercalcemia
And plays key roles in cell signaling, blood clotting, 5.5 mEq/L - Decrease calcium rich foods and intake of calcium-preserving drugs
Calcium muscle contraction and nerve function. like thiazides, supplements, Vitamin D
If decreased:
- Monitor v/s
- Encourage intake of foods high in calcium
- Safety (prevent falls because patient is at risk for bone fractures, seizures
precautions, and watch for laryngeal spasms)
- Administer IV calcium as ordered give slowly as ordered.
- Asses for cardiac dysrhythmias
helps break down proteins in the body and exists in - Monitor v/s
different forms, depending on where it originates. - Inform the physician
Alkaline Phosphatase 44 to 147 IU/L Malnutrition Damage liver - Monitor abdomen for distention, and pain
- Assess the skin for jaundice
- Assess urine color
- Instruct the patient to change his lifestyle
Needed growth and maintenance, it’s is the major - Monitor v/s.
Protein structural component of all cells in the body, especially 6.3-8.0 mg/dL Hypoproteinemia Hyperproteinemia - Asses for hydration and dehydration
muscle. - Inform the physician
The cells in human body need certain concentrations
- Kidney disease
Carbon dioxide of co2 to help body to release oxygen to the cells, 23 to 29 mEq/L  - Breathing disorders - Monitor v/s
dilate capillary, thinning the blood and restoring the - Monitor patient level of consciousness
blood circulation
- alkalosis - Acidosis - Inform the physician

- Hyperventilation

Cardiac Enzymes  Function
plays a major role in the
production of energy in the body,
Creatinine kinase making it necessary for the
proper functioning of most tissue
and organs
Plays role in the regulation
of cardiac muscle contraction, and
their clinical applications.
Troponin
Creatine kinase-mb
(ck mb) Is an important protein enzyme
catalyzing the reversible
phosphorylation reaction.
Cardiac Enzymes (1.5 marks ) -6
Normal Value Significance if decreased Significance if Increased Nursing Responsibility
- Acute Myocardial Infarction(MI) - Monitor v/s
25-200 U/L inflammation of cardiac muscle - Ischemia - Auscultate apical pulse, assess heart rate,
  - Muscular Dystrophy rhythm.
- Heart attack, skeletal muscle injury - Palpate peripheral pulses.
  - Inspect skin for pallor, cyanosis
- Monitor urine output, noting decreasing output
and concentrated urine.
- Inform physician
- Monitor v/s
- Heart attack - Weakening of the heart muscle - Auscultate apical pulse, assess heart rate,
0-0.4 ng/mL rhythm.
- coronary disease - Palpate peripheral pulses.
- Inflammation of the heart muscle - Inspect skin for pallor, cyanosis
- Monitor urine output, noting decreasing output
- heart failure, pulmonary embolism, and concentrated urine.
- Inform physician
- Monitor:Muscle damage
Range from 3 to Another muscle has been injured Heart attack or have other heart - Evaluate success of treatment
5% or 5 to 25 problems - Diagnose:
IU/L Acute Myocardial Infarction(MI)
Ischemia
Muscular Dystrophy
 Capillary blood glucose (0.5marks ) -7

CAPILLARY BLOOD Function Normal Value Significance if Significance if Nursing Responsibility

GLUCOSE decreased Increased
- Monitor v/s.
Non-diabetic while fasting
- It used as source of energy for brain (70 to 100 mg/dL) - Assess blood glucose level before meals and at
and red blood cells   bedtime.
- Used as temperature regulator Diabetic persons: Hypoglycemia - Hyperglycemia
Simple blood (90-130 mg/dL) before - Diabetes - Assess the pattern of physical activity.
suger level test meals, and less than  
(180 mg/dL) after meals - Assess the patient’s current knowledge and
understanding about the prescribed diet, and
teach patient to prevent hypoglycemia by
following
- Monitor for signs of hypoglycemia or
hyperglycemia

Fasting tests provide the most accurate

results and are easier to interpret than -  Complying with the prescribed treatment
Fasting blood random tests.  less than 100 mg/dL (5.6 Hypoglycemia - Hyperglycemia program
sugar level test mmol/L)  - Diabetes
- The nurse will demonstrate to the pt how to
check blood sugars and give insulin injections
properly and will ask the patient to
reciprocate.
- Monitor v/s.
- Assess the pattern of physical activity