IV A.medical Management

IV.
MEDICAL MANAGEMENT
a. Medical Orders with Rationale
09/11/15
Doctors Order
Rationale
10:00 PM
Please admit
To properly monitor and provide medical attention

to the patient.
Secure consent to care
To have a proper consent in every medication and

procedure that needs to be done and for legal
purposes.
TPR q 4 hours
To properly monitor the patients condition.

To determine if there are any abnormalities with
the laboratory results.
Labs:
CBC
Bone Marrow Biopsy
Ultrasound
Chest X-Ray
9/12/2015
Confirm a blood cancer diagnosis or a bone

marrow disorder
To detect abnormalities inside the body
To evaluate lungs for any problem
Secure 1 unit pack red

blood cells with patients
blood type screened
crossmatched as stand by
Use to increase RBC count
Repeat CBC
To determine if there is a change in the

hematologic status especially the RBC
For Intrathecal
Chemotherapy with
methotrexate
Used to treat or to prevent cancer in the

CSF. IT chemotherapy may be administered,
as part of a chemotherapy regimen or on an
as needed basis.
Oxygen as needed
Necessary for promotion of normal O2 levels
Continue on meds
Constant monitoring by hospital staff
IVF: D5LNM1L @
20gtts/min
For fluid and electrolyte maintenance. Use for

medication ailment of compatible blood.
Refer accordingly
For further care & management
10
9/13/15
9:45 am
9/14/15
8:45 pm
9/15/2015
12:02 pm
9/17/15
9/21/15
9:00 AM
2:45 PM
Start blood transfusion of 1

unit PRBC with patients
blood type screened and
crossmatch
To increase RBC count
Repeat CBC
To determine any changes of the RBC (to

determine if there is increase in the RBC count)
Blood transfusion of 1 unit

PRBC crossmatch and
screened
Repeat RBC
To determine any changes in the RBC count

PRBC crossmatch and
screened
Repeat CBC
To determine any changes in the hematologic

status especially the RBC count

PRBC crossmatch and
screened
Repeat CBC
To determine any changes in the hematologic

status especially the RBC
For Intrathecal
Chemotherapy with
methotrexate
Used to treat or to prevent cancer in the CSF. IT

chemotherapy may be administered, as part of a
chemotherapy regimen or on an as needed basis.
Oxygen as needed
Necessary for promotion of normal O2 levels
Continue on meds
Constant monitoring by hospital staff
IVF: D5LNM1L @
20gtts/min
For fluid and electrolyte maintenance. Use for

medication ailment of compatible blood.
Refer accordingly
Repeat CBC
Determines hematologic status of the patient
May go home
Please relay CBC results
at discharge
For evaluation
Clinic ff. with CBC on Sept.

30, 2015
11
B. Laboratory Results
Name: K.M
Time Requested: 2015-09-11 10:00 PM
Age/Sex: 22/M
Time Released: 2015-09-12 8:35 AM
Physician: Dr. Floirendo

HEMATOLOGY REPORT
Test
Result
Unit
Expected
Values
5,000 10,000
Rationale/Interpretation
WBC
H 3.5
x10^
3/uL
RBC
L 4.0
Hgb
L 6.0
x10^
6/uL
g/dL
4.20 5.40
(million)
12.0 16.0
gm/dL
Hct
L 32
37.0 47.0 %
MCV
84.60
fL
82.0 98.0
Within normal range
MCH
29.50
pg
27.0 31.0
Within normal range
MCHC
34.90
g/dL
31.5 35.0
Within normal range
RDW
12.30
12.0 17.0
Within normal range
PDW
10.90
fL
9.0 16.0
Within normal range
MPV
9.80
fL
8.0 12.0
Within normal range
Increased WBC indicates increased production of WBC to

fight an infection. And a disease of bone marrow, causing
abnormally high production of white blood cells
Give an indirect estimate of the Hgb levels in the blood.
The most useful laboratory method for separating and
measuring normal and some abnormal Hgb. And Decreased
Hgb indicates anemia
Measures percentage by volume of PRBC in a whole blood
sample. Also it can be reduced due to shock, hemorrhage,
dehydration or excessive IV fluid administration
DIFFERENTIAL COUNT
Neutrophils
L 27.5
43.4 76.2%
Lymphocytes
L 3.80
17.4 48.2 %
Decreased due to bone marrow depression such as radiation

or cytotoxic drugs.
Decreased due to defective lymphatic circulation
Monocytes
5.70
4.5 10.5%
Within normal range
Eosinophil
L 0.05
1.0 - 3.0
Basophil
0.09
0.0 2.0
Within normal range
Bands/Stabs
%
Platelet
count
0.00
0 - 10
Within normal range
0.08 x 105
/ mL
x10^
3/uL
150 400
Within normal range
Decreased due to stress response such as trauma, shock,

burn, surgery mental distress and Cushings syndrome
12
Name: K.M
Age/Sex: 22/M

HEMATOLOGY REPORT
Test
Resul
t
Unit
fL
Expected
Values
5,000
10,000
4.20 5.40
(million)
12.0 16.0
gm/dL
37.0 47.0
%
82.0 98.0
WBC
6 .3
RBC
4.8
Hgb
15
x10^
3/uL
x10^
6/uL
g/dL
Hct
45
MCV
85.70
MCH
28.60
pg
27.0 31.0
Within normal range
MCHC
32.90
g/dL
31.5 35.0
Within normal range
RDW
14.30
12.0 17.0
Within normal range
PDW
14.20
fL
9.0 16.0
Within normal range
MPV
10.20
fL
8.0 12.0
Within normal range
Within normal range

Within normal range
Within normal range
Within normal range
Within normal range
DIFFERENTIAL COUNT
Neutrophils
60.5
Lymphocytes
30.8
0
Monocytes
6.70
Eosinophil
2.05
Basophil
Bands/Stabs
%
Platelet
count
Within normal range
43.4
76.2%
17.4 48.2
%
4.5
10.5%
1.0 - 3.0
0.09
0.0 2.0
Within normal range
0.00
0 - 10
Within normal range
0.20
x 105
/ mL
x10^
3/uL
150 400
Within normal range
Within normal range

Within normal range
Within normal range
Name: K.M
Age/Sex: 22/M
Time Released: 2015-09-14 6:00 PM
13

HEMATOLOGY REPORT
Test
Result
Unit
Expected
Values
5,000
10,000
WBC
H
13.4
x10^3/u
L
RBC
L 3.5
Hgb
L 9.0
x10^6/u
L
g/dL
4.20 5.40
(million)
12.0 16.0
gm/dL
Hct
L
35.0
37.0 47.0
%
MCV
91.60
fL
82.0 98.0
Within normal range
MCH
30.10
pg
27.0 31.0
Within normal range
MCHC
33.40
g/dL
31.5 35.0
Within normal range
RDW
14.30
12.0 17.0
Within normal range
PDW
14.20
fL
9.0 16.0
Within normal range
MPV
10.20
fL
8.0 12.0
Within normal range
Increased WBC indicates increased production of WBC to fight an

infection. And a disease of bone marrow, causing abnormally high
production of white blood cells
The most useful laboratory method for separating and measuring
normal and some abnormal Hgb. And Decreased Hgb indicates
anemia
Measures percentage by volume of PRBC in a whole blood sample.
Also it can be reduced due to shock, hemorrhage, dehydration or
excessive IV fluid administration
DIFFERENTIAL COUNT
L
40.62
L
13.80
43.4 76.2%
Decreased due to bone marrow depression such as radiation or

cytotoxic drugs.
Monocytes
6.70
17.4 48.2
%
4.5 10.5%
Eosinophil
L
0.08
1.00
1.0 - 3.0
Decreased due to stress response such as trauma, shock, burn,

surgery mental distress and Cushings syndrome
0.0 2.0
Within normal range
0.00
0 - 10
Within normal range
0.25 x
105 /
mL
x10^3/u
L
150 400
Within normal range
Neutrophils
Lymphocytes
Basophil
Bands/Stabs
%
Platelet
count
Within normal range
Name: K.M
Age/Sex: 22/M
14
HEMATOLOGY REPORT
Test
Result
Unit
WBC
H 15.6
x10^3/
uL
RBC
L 4.1
x10^6/
uL
Hgb
L
10.80
g/dL
Hct
L 32.0
MCV
84.60
fL
MCH
29.50
pg
MCHC
34.90
g/dL
RDW
12.30
PDW
10.90
MPV
9.80
Expected
Values
5,000
10,000
4.20
5.40
(million)
12.0
16.0
gm/dL
37.0
47.0 %

normal and some abnormal Hgb. And Decreased Hgb indicates
anemia
Within normal range
fL
82.0
98.0
27.0
31.0
31.5
35.0
12.0
17.0
9.0 16.0
fL
8.0 12.0
Within normal range

cytotoxic drugs.
Within normal range

Within normal range
Within normal range
Within normal range
DIFFERENTIAL COUNT
Neutrophils
L 40.7
Lymphocytes
L 15.4
Monocytes
5.70
Eosinophil
L 0.6
43.4
76.2%
17.4
48.2 %
4.5
10.5%
1.0 - 3.0
Basophil
0.09
0.0 2.0
Within normal range
Bands/Stabs
%
Platelet
count
0.00
0 - 10
Within normal range
0.35 x
105 /
mL
x10^3/
uL
150 400
Within normal range
Name: K.M
Within normal range

15
Age/Sex: 22/M

HEMATOLOGY REPORT
Test
Result
Unit
WBC
H
12.9
x10^3/
uL
RBC
L 3.9
Hgb
L
11.6
L
35.7
x10^6/
uL
g/dL
Hct
Expected
Values
5,000
10,000
4.20 5.40
(million)
12.0 16.0
gm/dL
37.0 47.0
%

normal and some abnormal Hgb. And Decreased Hgb indicates anemia
MCV
84.60
fL
82.0 98.0
Within normal range
MCH
29.50
pg
27.0 31.0
Within normal range
MCHC
34.90
g/dL
31.5 35.0
Within normal range
RDW
12.30
12.0 17.0
Within normal range
PDW
10.90
fL
9.0 16.0
Within normal range
MPV
9.80
fL
8.0 12.0
Within normal range

cytotoxic drugs.
DIFFERENTIAL COUNT
Neutrophils
L
39.7
Lymphocytes
L 16.5
Monocytes
5.70
Eosinophil
L
0.04
0.09
43.4
76.2%
17.4 48.2
%
4.5
10.5%
1.0 - 3.0
0.0 2.0
Within normal range
0.00
0 - 10
Within normal range
0.34 x
105 /
mL
x10^3/
uL
150 400
Within normal range
Basophil
Bands/Stabs
%
Platelet
count
Within normal range

Name: K.M
Date of Birth: 5/19/93 Age 22
Gender: Male
Procedure: Ultrasound
16
Procedure Date: 9/16/15
Referring Physician: Flor I, Fredegelbert
Patient Class: Inpatient
Report Text
Relative increase in liver parenchyma echogenicity w/c may relate to normal variance (40 %) or early
non-specific medical blood disease (60%). With uric acid oxalate, xanthine or metric) crystals along the
calyceal walls, both kidneys, seen obstructed at present. No enlarge lymph nodes seen. With enlarge
prostate gland, approximately 34.57 grams +.
IMPRESSION:
Mild Splenomegaly
Interpretation:
Infection and diseases can contribute to an enlarged spleen. Such as leukemia and lymphoma. The
spleen acts by filtering out and destroys old damaged blood cells and plays a key role in preventing
infection by producing WBC called lymphocytes and acting as a first line of defense against invading
pathogens.
17
Name: K.M
Date of Birth: 5/19/93 Age 22
Gender: Male
Procedure: CXR-AP
Procedure Date: 9/16/15
Referring Physician: Flor I, Fredegelbert
Patient Class: Inpatient
CHEST X-RAY
IMPRESSION:
Left pleurodiaphragmatic adherences. Arteriosclerosis of the thoracic aorta
SUMMARY OF BLOD TRANFUSION:
Blood Transfusion
Date
Time
Type of blood
9-13-15
9:45 am
1 u PRBC
9-14-15
8:45 am
1 u PRBC
9-15-15
12:02 pm
1 u PRBC
9-17-15
12:42 pm
1 u PRBC
18

IV A.medical Management

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IV.

To properly monitor and provide medical attention

Secure consent to care

To have a proper consent in every medication and

To properly monitor the patients condition.

Confirm a blood cancer diagnosis or a bone

Secure 1 unit pack red

Use to increase RBC count

To determine if there is a change in the

Used to treat or to prevent cancer in the

Necessary for promotion of normal O2 levels

Constant monitoring by hospital staff

For fluid and electrolyte maintenance. Use for

Start blood transfusion of 1

To increase RBC count

To determine any changes of the RBC (to

Blood transfusion of 1 unit

To increase RBC count

To determine any changes in the RBC count

Blood transfusion of 1 unit

To increase RBC count

To determine any changes in the hematologic

Blood transfusion of 1 unit

To increase RBC count

To determine any changes in the hematologic

Used to treat or to prevent cancer in the CSF. IT

Necessary for promotion of normal O2 levels

Constant monitoring by hospital staff

For fluid and electrolyte maintenance. Use for

For further care & management

Determines hematologic status of the patient

Clinic ff. with CBC on Sept.

For further care & management

Time Requested: 2015-09-11 10:00 PM

Time Released: 2015-09-12 8:35 AM

Physician: Dr. Floirendo

Within normal range

Within normal range

Within normal range

Within normal range

Within normal range

Within normal range

Increased WBC indicates increased production of WBC to

Decreased due to bone marrow depression such as radiation

Within normal range

Within normal range

Within normal range

Within normal range

Decreased due to stress response such as trauma, shock,

Time Requested: 2015-09-13 1:00 PM

Time Released: 2015-09-13 8:35 AM

Physician: Dr. Floirendo

Within normal range

Within normal range

Within normal range

Within normal range

Within normal range

Within normal range

Within normal range

Within normal range

Within normal range

Within normal range

Within normal range