Laboratory Test Complete Blood Count The CBC is used as a broad screening test to check for such disorders

as anemia, infection, and many other diseases. It is actually a panel to tests that examines different parts of the blood and includes the following: Hemoglobin a complex protein-iron compound that is the main component of red blood cells. Its function is to carry oxygen from the lungs to the tissue and transport carbon dioxide, the product of metabolism, back to the lungs. It is often ordered as part of complete blood count. Red blood cells are complete with hemoglobin. Hematocrit - percent of whole blood that is comprised of red blood cells. It is compound measures how much space in the blood is occupied by red blood cells. It is useful when evaluating a person with anemia. Red Blood Cells - percent of whole blood that is comprised of red blood cells. It is compound measures how much space in the blood is occupied by red blood cells. It is useful when evaluating a person with anemia. White Blood Cells - blood cells that do not contain hemoglobin. White blood cells are made by bone marrow and help body fight infections and other diseases as part of immune system. Platelet - part of cytoplasm that are involved in the coagulation process. Platelet attach or adhere to the walls of injures blood vessels, where they clump together or aggregate to form platelet plugs necessary for coagulation. It is produced by bone marrow and processed and removed by the spleen when they are damaged or old. Platelet count blood test that is performed to monitor the course of the disease for thrombocytopenia or bone marrow failure. Differential count - measures the percentage of each type of leukocytes. An increased in percentage of one type of leukocyte, maybe a decreased in percentage of the other type. Segmenters/ Neutropils circulating white blood cells essentially for phagocytosis. A neutrophil of <500 is life-threatening. Lymphocytes - class of leukocytes produced in a variety of lymphoid organs throughout the body and is responsible for cellular and normal immune responses. They are so-called the surveillance system of the body that is vigilant for progressing threats to immunity. Monocytes. It is the largest cell of a normal blood that transforms into macrophages and become responsible for phagocytosis of unwanted particular matter.

NURSING RESPONSIBILITIES Before the Procedure Explain the slight discomfort may be felt when skin is punctured Avoid stress if possible because altered physiologic status influence and changes normal hemogram values.

Fasting is not necessary. Dehydration or over hydration can dramatically alter values for example, large volumes of IV fluids dilute the blood values will appear as low count. During the Procedure Assist the medical technologist and significant others in holding the client to provide safety to the client. Disinfect the site, inform the patient to avoid using and opening the hand after tourniquet is applied. Apply manual pressure and dressings to the puncture site on removal of the needle. Monitor the puncture site for oozing of hematoma formation. Maintain pressure dressings on the side if necessary. Resume normal activities and diet. Bruising at the puncture site is not uncommon.

After the Procedure

Signs of inflammation are unusual and should be reported if the inflamed area appears larger, if red streaks develop or if drainage occurs. Hematology (January 9, 2012) Hematology RESULT NORMAL FINDINGS HEMOGLOBIN HEMATOCRIT RBC WBC PLATELET DIFFERENTIAL COUNT SEGMENTERS 0.45 0.55-0.71 DECREASED 93 0.29 3.09 11.7 ADEQUATE 120-160g/L 0.37-0.37 4.0-5.4 x 10^12/L 5.0 - 10.0 x 10^9/L 150-400 x 10^9/L DECREASED DECREASED DECREASED INCREASED Normal ANALYSIS

LYMPHOCYTES MONOCYTES EOSINOPHILS

0.43 0.08 0.06

0.25-0.40 0.02-0.08 0.01-0.06

INCREASED Normal Normal

Analysis: CBC showed low hemoglobin, hematocrit, RBC levels and increase in initial WBC level. Increased WBC suggests infection. Total Protein Albumin Globulin (TPAG) Total protein measurements can reflect nutritional status and may be used to screen for and help diagnose kidney disease, liver disease, and many other conditions. Sometimes conditions are first detected with routine testing before symptoms have begun to appear. If total protein is abnormal, further tests must be performed to identify which specific protein is abnormally low or high so that a specific diagnosis can be made. Proteins are the most abundant compounds in your serum (the rest of your blood when you remove all the cells). Amino acids are the building blocks of all proteins. In turn proteins are the building blocks of all cells and body tissues. They are the basic components of enzymes, many hormones, antibodies and clotting agents. Proteins act as transport substances for hormones, vitamins, minerals, lipids and other materials. In addition, proteins help balance the osmotic pressure of the blood and tissue. Osmotic pressure is part of what keeps water inside a particular compartment of your body. Proteins play a major role in maintaining the delicate acid-alkaline balance of your blood. Finally, serum proteins serve as a reserve source of energy for your tissues and muscle when you are not ingesting an adequate amount. The major measured serum proteins are divided into two groups, albumin and globulins. There are four major types of globulins, each with specific properties and actions. A typical blood panel will provide four different measurements - the total protein, albumin, globulins, and the albumin globulin ratio. Total Protein Because the total protein represents the sum of albumin and globulins, it is more important to know which protein fraction is high or low than what is the total protein. Total protein may be elevated due to: Chronic infection (including tuberculosis) Adrenal cortical hypofunction Liver dysfunction Collagen Vascular Disease (Rheumatoid Arthritis, Systemic Lupus, Scleroderma) Hypersensitivity States

Sarcoidosis Dehydration (diabetic acidosis, chronic diarrhea, etc.) Respiratory distress Hemolysis Cryoglobulinemia Alcoholism Leukemia Malnutrition and malabsorption (insufficient intake and/or digestion of proteins) Liver disease (insufficient production of proteins) Diarrhea (loss of protein through the GI tract) Severe burns (loss of protein through the skin) Hormone Imbalances that favor breakdown of tissue Loss through the urine in severe kidney disease (proteinuria) Low albumin Low globulins Pregnancy (dilution of protein due to extra fluid held in the vascular system.

Total protein may be decreased due to:

Albumin Albumin is synthesized by the liver using dietary protein. Its presence in the plasma creates an osmotic force that maintains fluid volume within the vascular space. A very strong predictor of health; low albumin is a sign of poor health and a predictor of a bad outcome. Albumin levels may be elevated in: Dehydration - actual Congestive heart failure Poor protein utilization Glucocorticoid excess (can result from taking medications with cortisone effect, the adrenal gland overproducing cortisol, or a tumor that produces extra cortisol like compounds) Congenital Dehydration Hypothyroidism Chronic debilitating diseases (ex: RA) Malnutrition - Protein deficiency

Albumin levels may be decreased in:

Dilution by excess H2O (drinking too much water, which is termed polydipsia, or excess administration of IV fluids) Kidney losses (Nephrotic Syndrome) Protein losing-enteropathy (protein is lost from the gastrointestinal tract during diarrhea) Skin losses (burns, exfoliative dermatitis) Liver dysfunction (the body is not synthesizing enough albumin and indicates very poor liver function) Insufficient anabolic hormones such as Growth Hormone, DHEA, testosterone, etc.

GLOBULINS, Total serum Globulins are proteins that include gamma globulins (antibodies) and a variety of enzymes and carrier/transport proteins. The specific profile of the globulins is determined by protein electrophoresis (SPEP), which separates the proteins according to size and charge. There are four major groups that can be identified: gamma globulins, beta globulins, alpha-2 globulins, and alpha-1 globulins. Once the abnormal group has been identified, further studies can determine the specific protein excess or deficit. Since the gamma fraction usually makes up the largest portion of the globulins, antibody deficiency should always come to mind when the globulin level is low. Antibodies are produced by mature B lymphocytes called plasma cells, while most of the other proteins in the alpha and beta fractions are made in the liver. The globulin level may be elevated in: Chronic infections (parasites, some cases of viral and bacterial infection) Liver disease (biliary cirrhosis, obstructive jaundice) Carcinoid syndrome Rheumatoid arthritis Ulcerative colitis Multiple myelomas, leukemias, Waldenstrom's macroglobulinemia Autoimmunity (Systemic lupus, collagen diseases Kidney dysfunction (Nephrosis) Nephrosis (A Condition in which the kidney does not filter the protein from the blood and it leaks into the urine) Alpha-1 Antitrypsin Deficiency (Emphysema) Acute hemolytic anemia Liver dysfunction Hypogammaglobulinemia/Agammaglobulinemia

The serum globulin level may be decreased in:

BLOOD CHEMISTRY

TEST

UNIT CONVENTIONAL

SI UNIT

ANALYSIS

RESULT REFERENCE RESULT REFERENCE Total Protein 6.95 g/dl 6.4 - 8.3 69.50 g/L Albumin L 3.01 g/dl 3.20 - 5.00 30.08 g/L Globulin H 3.94 g/dl 1.20 - 3.20 39.42 g/L Analysis: Test is done to determine the nutritional status of the patient which is affected by her condition. Albumin level is slightly low and may indicate other problem. Urinalysis A routine analysis tests for urinary and systemic disorders. This test evaluates physical characteristics (color, odor, turbidity, and opacity) of urine, determines specific gravity and pH detects measure protein, glucose, ketone bodies and examines sedimentary for blood cells, casts and crystals. PURPOSE: To screen the patients urine for renal and urinary disease. To help detect metabolic disorders or systemic disease unrelated to renal disorders Explain to the patient that the routine urinalysis aids in the diagnosis of renal or urinary tract disease and helps evaluate over all body function. Inform the patient that he need not restrict foods and fluids. Notify the laboratory and physician of medications of the patient is taking that may affect laboratory results; they may need to be restricted Assist the patients caregiver urine collection. Collect the urine in midstream portion Collect a random specimen atleast 15ml. 12 - 32 INCREASED 32 - 50 DECREASED 64 - 83 Normal

Before the Procedure

During the procedure

After the Procedure

Obtain a first voided morning specimen if possible. Inform the patient that he may resume his usual diet and medications as ordered. Make sure that specimen must be free of fecal contamination. Check the amount of the urine sample. Make sure that the urine sample is sealed to avoid contamination Indicate the patients name immediately right after the urine collection. Carefully pour the urine sample to an unfolded 4x4 inches gauze pad or fine mesh sieve place over the specimen container. Send urine specimen to the laboratory. Refrigerate the specimen if analysis will be delayed longer than one hour. Urinalysis MACROSCOPIC MICROSCOPIC RBC: PUS CELLS: EPITHELIAL CELLS: 7.5 MUCUS THREAD: BACTERIA: +1 Negative +1 Normal Normal Negative CRYSTALS: CASTS: FINE GRANULAR: None None RENAL CELLS: OTHERS: None Loaded None 0.3 0-3/HPF Few

Precautions:

COLOR: TRANSPARENCY: SPECIFIC GRAVITY: REACTION: CHEMICAL TEST PROTEIN: SUGAR: KETONE: UROBILLINOGEN: BILIRUBIN: NITRITE:

Yellow Turbid 1.005

ERYTHROCYTES:

+1

COARSE GRANULAR

None

LEUKOCYTES:

Negative

HYALINE:

None

Analysis: Urine specimen of the patient showed that it was loaded with bacteria that may suggest infection. Chest X-Ray (CXR) The chest x-ray is the most commonly preferred diagnostic x-ray examintaion. A chest x-ray make images of the heart, lungs, airway, blood vessels and the bones of the spine and chest. The chest x-ray is performed to evaluate the lungs, heart and chest wall. A chest x-ray is typically the first imaging test used to help diagnose symptoms such as: shortness of breath. a bad or persistent cough. chest pain or injury. fever.

Physicians use the examination to help diagnose or monitor treatment for conditions such as: pneumonia. heart failure and other heart problems. emphysema. lung cancer. line and tube placement. other medical conditions

Nursing Responsibility: A chest x-ray requires no special preparation. You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the xray images. Results:

Chest X-ray Report Prominence of the pulmonary vascular markings is seen. Consolidation is noted in the right lower lobe. Heart is enlarged. Aorta is tortous and calcified. Bilateral pleural effusion is seen.

Impression: Consider pulmonary congestion Pneumonia right lower lobe Cardiomegaly Atheromatuos Aorta Bilateral Pleural Effusion