F. DIAGNOSTIC AND LABORATORY PROCEDURES DIAGNOSTIC PROCEDURE DATE ORDERED AND DATE RESULTS IN INDICATIONS OR PURPOSES RESULTS ANALYSIS AND INTERPRETATION 2D Echocardiogra m with Doppler Date Ordered: 11-27-09 Date Results In: 11-27-09 Echocardiogram is a test in which ultrasound is used to examine the heart and capable of cross- sectional "slice" of the beating heart, including the chambers, valves and the major blood vessels that exit from the left and right ventricle In the case of the patient who had undergone Echocardiogram, it was used to show the structure and movement of the heart as well as blood flowing through blood vessels. 1. Dilated left ventricular size with thinned out akinetic entire interventricular septum from mid to apex, severe hypokinesia of all left ventricular segments except the basal anterior interventricular septum and anterior left ventricular free wall which shows some contractility; left ventricular systolic function is severely depressed with calculated ejection fraction of 34% by cube method and 25 +/- 25% by visual estimated method; there is spontaneous echocontrast noted but without definite thrombus Hypokinesia or decrease movement of left ventricular segments is due to heart attack and decreased blood flow from blockage in an artery. Blood pools to the left ventricle causing left ventricle dilatation. Blood pooling will trigger the left ventricle to pump harder but as the heart tires, the left ventricle’s capacity to pump is decreased. This is supported by the depression of left ventricular systolic function with an ejection fraction of 34%. 28
Transcript
F. DIAGNOSTIC AND LABORATORY PROCEDURES
DIAGNOSTIC PROCEDURE
DATE ORDERED
AND DATE
RESULTS IN
INDICATIONS OR PURPOSES
RESULTS ANALYSIS AND INTERPRETATION
2D Echocardiogram
with Doppler
Date Ordered:11-27-09
Date Results In:11-27-09
Echocardiogram is a test in which ultrasound is used to
examine the heart and capable of cross-sectional "slice" of the beating heart,
including the chambers, valves and the major blood
vessels that exit from the left and right ventricle In the case
of the patient who had undergone Echocardiogram,
it was used to show the structure and movement of the heart as well as blood
flowing through blood vessels.
1. Dilated left ventricular size with thinned out akinetic entire
interventricular septum from mid to apex, severe hypokinesia of all left
ventricular segments except the basal anterior interventricular septum and anterior left ventricular free wall which shows some contractility; left
ventricular systolic function is severely depressed with calculated
ejection fraction of 34% by cube method and 25 +/- 25% by visual
estimated method; there is spontaneous echocontrast noted but without definite thrombus formation.
2. Dilated right ventricular size with mild hypokinetic free wall; prominent
moderate band.
3. Diatrial dilatation without visible thrombus.
4. Thickened aortic cusps without restriction of motion.
Hypokinesia or decrease movement of left ventricular segments is due to
heart attack and decreased blood flow from blockage in an artery. Blood pools to the left ventricle
causing left ventricle dilatation. Blood pooling will trigger the left ventricle to pump harder but as the heart tires,
the left ventricle’s capacity to pump is decreased. This is supported by the depression of left ventricular systolic function with an ejection fraction of
34%.
28
5. Thickened mitral valve leaflets without flow configuration without
restriction of motion.
6. Structurally normal tricuspid and pulmonic valves.
7. normal main pulmonary artery.
8. normal aortic root and visualized portion by proximal ascending aorta.
9. No pericardial effusion on Doppler: tricuspid regurgitation-moderate; mitral regurgitation- moderate.
pressure of 56% by tricuspid regurgitation jet area
method restrictive mitral inflow pattern.
Conclusion:Dilated left ventricle with segmental wall motion
abnormalities, CAD etiology can’t be ruled out; Severely depressed left ventricular systolic function
with at least grade 3 left ventricular diastolic dysfunction.
No visible thrombus noted. Biatrial dilatation without visible thrombus
specimen.
29
Nursing Implication for 2D Echocardiogram
BEFORE:
1. Check the Doctor’s order.2. Consent must be signed by the patient.3. Instruct the patient that lubricating jelly would be applied on his chest.
DURING:
1. Inform the patient to lie still during the procedure.
AFTER:
1. Wipe off the gel that was applied to the skin2. Document the results that were performed.3. Attach the result on the chart of the patient as soon as it is available
presence of chest pain and to check for any electro physiologic changes.
11-25-09(9:00pm)
The patient ECG shows a marked ST segment depression
11-25-09(9:30pm)
The patient ECG shows atrial fibrillation in rapid ventricular
response. This type of arrhythmias is common among patient with acute injury to the
myocardium11-26-09(8:00am)
The patient’s ECG shows a normal sinus rhythm, this is probably
because of the effect of the lidocaine drip given to the patient.
ST segment depression signifies a partially blocked artery. Impaired heart perfusion due to coronary
occlusion will lead to myocardial cell death; the heart’s muscle will then be irritated. As a result, the heart tries to compensate by pumping faster but this pumping action is not effective
resulting to irregular heartbeats. Clot formation may arise as a result of
blood pooling due to irregular heartbeat.
30
Nursing Implication for Electrocardiogram
BEFORE:
1. Check the Doctor’s order.2. Inform the patient about the procedure that would be done.3. Instruct the patient that lubricating jelly would be applied on his chest.
DURING:
1. Inform the patient to lie still during the procedure.
AFTER:
1. Wipe off the gel that was applied to the skin2. Document the results of the ECG.3. Attach the result on the chart of the patient as soon as it is available
Chest X-Ray (PA) Date Ordered:11-25-09
Date Results In:11-25-09
Chest X-ray PA view gives a good assessment of the
cardiac size. In the case of the patient, it was also used
to detect presence of pulmonary congestion or
edema, which would be more likely in patients with NSTEMI
involving a significant proportion of the left ventricle
or in those with known left ventricular dysfunction.
11-25-09Examination of the chest
radiograph reveals fuzziness of the lung markings in both lungs.
Future cardiac size cannot be ascertained.
Aorta is dilated.Other chest structures are
unremarkable.
Impression:1. Consider mild pulmonary
congestion.2. True cardiac size not
ascertained.3. Atherosclerotic aorta.
Fuzziness in chest x- ray denotes a fluid accumulation in the lungs. The
fluid accumulation in the lungs in brought by the pooling of the blood in
the left ventricle due to decreased function of the heart until in some
period of time, the ventricle will not be able to accommodate the increasing
volume of blood in the ventricle leading to the backflow of this blood to
the lungs.
31
Nursing Implication for Chest X- ray
BEFORE:
1. Explain the procedure to the patient/patient’s SO.2. Assure the patient that the procedure will be pain free3. Inform the patient that no jewelries or any accessories should be worn 4. Ask the patient to remove shirt and wear X-ray gown5. Provide privacy to the client.
DURING:
1. Inform the patient to lie still during the procedure.2. Assist the patient in during the procedure.3. Assist the radiologist when doing the procedure.
AFTER:
1. Attach result to the chart as soon as it is available.2. Refer for any unusual findings
LABORATORY PROCEDURES
DATE ORDERED AND DATE
RESULTS IN
INDICATIONS OR PURPOSES
RESULTSNORMAL VALUES
ANALYSIS AND INTERPRETATION
CK-MB Date Ordered:11-26-09 Date
Results In:11-26-09
Creatine kinase (CK) and its isoenzyme CK-
MB are the most specific enzymes
analyzed in acute MI, and they are the first
enzyme levels to increase. Since the
patient is experiencing chest pain, enzyme
47.4 mg/dl 0.00 – 10.40 mg/ml
The appearance of elevated CK–MB levels
in serum is highly specific and sensitive for
myocardial cell wall injury. In the case of the patient who is known to experience chest pain, CK-MB was tested to
detect myocardial cellular
32
levels should be tested in relation to the time
of onset of chest discomfort or other
symptoms to suspect myocardial infarction.
necrosis or damage as this enzyme are
significantly elevated in events of myocardial
hypoperfusion. The CK-MB level is significantly
elevated therefore confirming the
occurrence of MI. CK-MB starts to reach its peak level within 3-6 hours
after the onset of chest pain and remains
elevated for 12-36 hours. With this finding, Imdur
was administered for the patient to relieve angina
attacks.Troponin T- plasma
(heparinized)Date Ordered:
11-25-09Date Results
In:11-25-09
Troponin T is a protein found only in cardiac muscle. Troponin test is primarily ordered for the patient, since he
was known to experience chest pain from the day he was
admitted.It was also ordered to detect if he have had heart attack or other damage to the heart.
<0.05 ng/ml
0.00 – 0.05ng/ml Troponin T result is
within the normal range of less than 0.05 mg/ml
which indicates that there has not been a heart
damage. Troponin T is known to reach is peak level within 12-48 hours after the onset of chest
pain.
Nursing Implication for Blood Chemistry
BEFORE:
1. Check the doctor’s order
33
2. Explain the procedure3. Explain the purpose and what to expect4. No food or fluid restrictions
DURING:
1. Do not take the blood sample from hand or arm with receiving IVF2. The tourniquet should be less on a minute3. Do not squeeze the punctured site rightly4. Wipe away the first drop of blood5. Collect recommended amount of blood.
AFTER:
1. Observed and record vital signs.2. Check injection sites for bleeding, infection, tenderness or thrombosis.3. Report untoward reaction to the physician.4. Apply warm compress to ease discomfort, as ordered.5. Apply pressure to the puncture site until the bleeding stops to reduce bruising.6. Encourage relaxation by allowing client to discuss experiences and verbalize feelings.7. Interpret results and provide counsel appropriately.
COMPLETE BLOOD COUNT
Hemoglobin (Hgb)
Date Ordered:11-25-09
Date Results In:
11-25-09
This test evaluates the hemoglobin and test the iron status and
oxygen carrying capacity of
erythrocytes since the patient has DM, the
possibility of having a low hemoglobin count can be suspected due to the viscosity of the
blood.
124 g/dl 140- 175 g/dl The patient’s Hgb is below the normal which indicates that there is an
inadequate oxygen carrying capacity of the
blood due to the viscosity of the blood as a result of
patient’s DM.
34
Hematocrit (Hct) Date Ordered:11-25-09
Date Results In:
11-25-09
To detect abnormally low levels of
hematocrit due to blood viscosity as a
result of patient’s DM.To aid diagnosis of abnormal states of hydration, since the patient was at risk to develop dehydration due to an increased
urine output and diaphoresis, this test was ordered to check
for fluid deficit.
0.39 041- 0.50 g/dl The result is decreased because of
hemoconcentration resulting from increased blood glucose level AEB
HGT of 159 mg/dl.Low hematocrit levels
also suggest that there is decreased circulating blood volume to the
patient, since he was at risk to develop fluid
deficit and so, the patient was kept hydrated with
D5W.
WBC Date Ordered:11-25-09
Date Results In:
11-25-09
The WBC count is used to determine the
presence of an infection. The test was
performed to the patient to find out if
elevated WBCs would mean the presence of an infection since the patient had DM, the viscosity of the blood would impair blood
flow and the hemoglobin release of oxygen and that would
cause an infection.
6.9 4.5-11 x 109/L The patient’s WBC is within normal range
which indicates that the patient has no infection.
35
Neutrophils Date Ordered:11-25-09
Date Results In:
11-25-09
To detect presence of bacterial infection or
an inflammatory disease due to
impaired blood flowing within the patient’s body as a result of
DM.
0.65 0.18-0.70 The result indicates a normal amount of
neutrophils within the circulation and that it is not near borderlines of
the normal range value in which there is no
bacterial infection. Since the patient may have an infection as a result of
DM.
Lymphocytes Date Ordered:11-25-09
Date Results In:
11-25-09
To detect presence of viral infection due to
impaired blood flowing within the patient’s body as a result of
DM.
0.30 0.10-0.48 Patient’s lymphocytes reveal a result of 0.30
which is within the normal range of 0.10-0.48.wherein there is
absence of a viral infection. Since the patient may have an
infection as a result of DM.
Eosinophils Date Ordered:11-25-09
Date Results In:
11-25-09
To detect presence of allergic disease or
parasitic infection due to impaired blood flowing within the
patient’s body as a result of DM.
0.01 0.00-0.03 The result of 0.01, is normal, with the given range of 0.00 – 0.03. Since the patient may have an infection as a
result of DM.
36
Monocytes Date Ordered:11-25-09
Date Results In:
11-25-09
To detect presence of inflammation due to
impaired blood flowing within the patient’s body as a result of
DM.
0.04 0.00-0.04 The patient’s monocytes result is within the upper borderline of the normal range, but may indicate
as well that the client had an inflammation due to
the absence of Neutrophil elevation. This
has been tested since the patient may have an infection as a result of
DM.
Platelet count Date Ordered:11-25-09
Date Results In:
11-25-09
Platelet count is determined to
establish baseline data regarding the number
of platelet circulating in the body of the patient prior to administration of antithrombotic drugs such as Heparin and
Aspirin.
218,000/µL 150-400 x 109/L The result indicates that the platelet count is
within the normal range; wherein in the case of
the patient it was checked prior to
administration of Heparin to note for abnormally
low platelet count since, Heparin is a drug that
can lower platelet count.
Nursing Implications for CBC Test:
BEFORE:
1. Inform the patient that the test is used to evaluate numerous conditions inflammation, infection, and response to chemotherapy.
2. Obtain a history of the patient’s complaints (such as allergies and sensitivity to latex.3. Obtain a history of the patient’s gastrointestinal, hematopoietic, immune, and respiratory systems, as well as
results of previously performed laboratory tests, surgical procedures, and other diagnostic procedures.
37
4. Obtain a list of medications the patient is taking, including herbs, nutritional supplements, and nutraceuticals.5. Review the procedure with the patient. Explain the duration of the procedure and inform the client that there may
be some discomforts during the procedure.6. Consider the patient’s cultural beliefs and practices and it is important to provide psychological support before,
during, and after the procedure.
DURING:
1. Avoid using equipment containing latex if the patient has allergy to it.2. Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid
unnecessary movement.3. Observe Standard precautions.4. Remove the needle, and apply a pressure dressing over the puncture site.5. Promptly transport the specimen to the laboratory for processing and analysis.
AFTER:
1. Observe venipuncture site for bleeding or hematoma formation. Apply paper tape or other adhesive to hold pressure bandage in place.
2. Instruct the patient to limit salt intake, alcohol intake and cut down smoking.3. Reinforce information regarding the test results and address any concerns voiced by the patient or family
Prothrombin Time Date Ordered:11-25-09
Date Results In:
11-25-09
Prothrombin Time measures the ability of the blood to clot and in the case of the patient
who is taking anticoagulant drugs
which are Aspirin and Heparin; they should
13.7 s 10-14 s The patient’s PT level is within the normal range which indicates that the clotting factors that are being produced in the
liver are still being synthesized well in the
liver AEB no presence of
38
be checked prior to administration.
bleeding or bruises noted. Anticoagulant
drugs such as Heparin and Aspirin were given to inhibit formation of blood
clots.
International Normalized Ratio (INR)
Date Ordered:11-25-09
Date Results In:
11-25-09
INR value was used to monitor prior to the
administration of anti-coagulant drugs such
as Heparin and Aspirin.
1.14 0.8- 1.2 The INR value of 1.14 is within the normal range which indicates that the
patient has normal clotting function AEB no
bleeding and bruises noted. Anticoagulant
drugs such as Heparin and Aspirin were given to inhibit formation of blood
clots.
Activated partial thromboplastin time
(aPTT)
Date Ordered:11-25-09
Date Results In:
11-25-09
Along with the PT test, the aPTT was used to investigate the cause
of a bleeding or thrombotic (blood clot) episode of the patient.
It is also used as a baseline data prior to the administration of anticoagulant drugs,
which are Heparin and Aspirin.
34.8 s 31.88- 43.68 s aPTT result of the patient is within the normal
range; which reflects that the patient has normal
clotting function AEB no bleeding and bruises noted. Anticoagulant
drugs such as Heparin and Aspirin were given to inhibit formation of blood
clots.
39
Nursing Implications for CBC Test:
BEFORE:
1. Inform the patient that the test is used to evaluate numerous conditions inflammation, infection, and response to chemotherapy.
2. Obtain a history of the patient’s complaints (such as allergies and sensitivity to latex.3. Obtain a history of the patient’s gastrointestinal, hematopoietic, immune, and respiratory systems, as well as
results of previously performed laboratory tests, surgical procedures, and other diagnostic procedures.4. Obtain a list of medications the patient is taking, including herbs, nutritional supplements, and nutraceuticals.5. Review the procedure with the patient. Explain the duration of the procedure and inform the client that there may
be some discomforts during the procedure.6. Consider the patient’s cultural beliefs and practices and it is important to provide psychological support before,
during, and after the procedure.
DURING:
1. Avoid using equipment containing latex if the patient has allergy to it.2. Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid
unnecessary movement.3. Observe Standard precautions.4. Remove the needle, and apply a pressure dressing over the puncture site.5. Promptly transport the specimen to the laboratory for processing and analysis.
AFTER:
1. Observe venipuncture site for bleeding or hematoma formation. Apply paper tape or other adhesive to hold pressure bandage in place.
2. Instruct the patient to limit salt intake, alcohol intake and cut down smoking.
40
3. Reinforce information regarding the test results and address any concerns voiced by the patient or family.
FBS Date Ordered:11-26-09
Date Results In:11-26-09
It is a test that was done to the patient with possible cardiovascular disorders to determine blood glucose levels. It
is also used to determine an elevated blood glucose levels as a result of patient’s DM.
192.91 76.36-116.36 mg/dl An increase in glucose levels specifies that there
is a large amount of glucose found in the
circulatory system. Since the patient has Diabetes
Mellitus, there is an elevation in glucose levels
in the blood resulting to blood viscosity. And so, Mixtard was given to the patient to decrease blood
glucose level.
HBAIc(Whole Blood)
Date Ordered:11-25-09
Date Results In:11-25-09
Glycosylated hemoglobin (HBAic) is
monitored to the patient with DM. It reflects the blood glucose levels over 2 to 3 months.
10.9% 4.40-6.40% The result shows the average blood glucose
level measured over the previous 2-3 months.
10.9% would mean that the patient has large amounts of glucose
attached in the blood since; the patient has
Diabetes Mellitus, which is characterized by
elevation of blood glucose levels.
41
Nursing Implication for FBS, Blood:
BEFORE:
1. Inform the patient that the test is used to assist in the evaluation of fasting hypoglycemia2. Obtain a history of the patient’s complaints, including a list of known allergens such as allergy to latex.3. Obtain a history of the patient’s endocrine system and results of previously performed laboratory tests, surgical
procedures, and other diagnostic procedures.4. Note any procedures that can interfere with the test results.5. Obtain a list of medications patient is taking, including herbs, and nutritional supplements.
DURING:
1. Ensure that the patient has complied with dietary or medication restrictions and other pretesting preparations.2. Instruct the patient to cooperate fully and to follow directions. Direct patient to breathe normally and to avoid
unnecessary movement.3. If the patient has a history of severe allergic reaction to latex, care should be taken and to avoid the use of
equipment containing latex.4. Observe Standard precautions.5. After obtaining the specimen, promptly transport to the laboratory for processing and analysis.
AFTER:
1. Observe venipuncture site for bleeding or hematoma formation. 2. Instruct the patient to report signs and symptoms of hypoglycemia or hyperglycemia.3. Emphasize that good glycemic control delays the onset of and slows the progression of diabetic retinopathy,
nephropathy, and neuropathy.4. Reinforce information regarding the test results and address concerns voiced by the family or the patient
42
SERUM ELCTROLYTES
Sodium Date Ordered:11-25-09
Date Results In:11-25-09
Used to measure serum levels of sodium
in relation to the amount of water in the body. In the case of the patient who has DM, it was checked to detect
presence of fluid volume deficit due to
increased urine output and diaphoresis.
139.3 mEq/L 135 – 150 mEq/L The patient’s sodium level is within the normal range which indicates that there
is no change within the plasma water
concentration or alteration of either sudden increase
or decrease of serum sodium in the plasma water since the patient
has no signs of fluid deficit.
Nursing Implication for Sodium Test in the Blood:
BEFORE:
1. Inform the patient that the test is used to evaluate electrolyte balance.2. Obtain a history of the patient’s endocrine and genitourinary systems, as well as previously performed laboratory
tests, surgical procedure, and other diagnostic procedures.3. Assess patient for allergy, including list of unknown allergens (especially allergies or sensitivities to latex).4. Obtain a list of medications the patient is taking, including herbs, and nutritional supplements.5. Review the procedure with the patient. Inform the patient about the duration of the procedure and explain to the
patient that there may be some discomforts during the venipuncture.
DURING:
1. Instruct the patient to cooperate fully and to follow directions.2. Observe Standard Precautions.
43
3. Remove the needle, and apply pressure dressing over the puncture site.4. Promptly transport the specimen to the laboratory for processing and analysis.
AFTER:
1. Observe the venipuncture site for bleeding or hematoma formation. Apply paper tape or other adhesive to hold pressure bandage in place.
2. Evaluate patient for signs and symptoms of dehydration, decreased skin turgor, dry mouth, and multiple longitudinal furrows in the tongue are symptoms of dehydration
3. Educate the patients with low sodium levels that the major source of dietary sodium is found in table salt.4. Reinforce information given by the patient’s health care provider regarding the test results. Answer any questions
or address any concerns voiced by the patient or family
Potassium Date Ordered:11-26-09
Date Results In:11-26-09
It was checked in order to assess for possible electrolyte imbalance
due to an increased urine output as a result of DM. And as a baseline data
prior to administration of diuretics like Aldazide, since high potassium
levels may further increased if given with
potassium-sparing diuretic. In addition to that, patient was given Lasix that would cause
renal excretion of potassium and so this was tested to detect if
the patient is experiencing hypokalemia.
11-25-093. 83 mEq/L
11-26-094.25 mEq/L
11-28-094.1mEq/L
3.50 – 5.50 mEq/L The initial result indicates that the serum potassium maintains its normal level.
44
Nursing Implication for Potassium Test in the blood:
Before
1. Check the doctor’s order2. Explain the procedure3. Explain the purpose and what to expect4. No food or fluid restrictions
During
1. Do not take the blood sample from hand or arm with receiving IVF2. The tourniquet should be less on a minute3. Do not squeeze the punctured site rightly4. Wipe away the first drop of blood5. Collect 2ml venous blood in a lavender top tube
After
1. Observed and record vital signs.2. Check injection sites for bleeding, infection, tenderness or thrombosis.3. Report untoward reaction to the physician.4. Apply warm compress to ease discomfort, as ordered.5. Encourage relaxation by allowing client to discuss experiences and verbalize feelings.6. Interpret results and provide counsel appropriate
BLOOD CHEMISTRY
Creatinine Date Ordered:11-25-09
Date Results In:11-25-09
Determination of creatinine level is done
to determine kidney function. Since in the
case of the patient with
1.39 mg/dl 0.79- 1.56 mg/dl The result of creatinine level is within normal
range.
45
DM, chronic elevations of blood glucose levels will have a complication to the kidney function
because it may damage the capillaries
that supply the glomeruli of the kidney.
Magnesium Date Ordered:11-25-09
Date Results In:11-25-09
Test for magnesium levels is done to the patient to rule out the
cause of dysrhythmias and also muscle
weakness.
0.65 mg/dl 0.73-1.06 Decreased magnesium levels is probably caused
by the damage in the myocardium as
magnesium will be used to
dilate blood vessels,Prevent spasm in the
heart muscle and blood vessel walls,
Counteract the action of calcium,
Help dissolve blood clots,Dramatically lessen the site of injury and prevent
arrhythmia.
Calcium (ionized) Date Ordered:11-25-09
Date Results In:11-25-09
Calcium is checked to the patient to
investigate the cause of dysrrhythmias. As it
slow down myocardial contractility.
4.35 mg/dl 4.56- 5.32 mg/dl In the case of the patient, who has
Decreased calcium levels, ECG tracing revealed dysrhythmia and so
Lidocaine was given to reduce the contractility of the heart. Along with low
Ca levels, a low Mg levels can also be seen with this
findings.
46
Nursing Implication for Creatinine and Magnesium test, blood,
BEFORE
5. Check the doctor’s order6. Explain the procedure7. Explain the purpose and what to expect8. No food or fluid restrictions
DURING
6. Do not take the blood sample from hand or arm with receiving IVF7. The tourniquet should be less on a minute8. Do not squeeze the punctured site rightly9. Wipe away the first drop of blood10.Collect 2ml venous blood in a lavender top tube
AFTER
7. Observed and record vital signs.8. Check injection sites for bleeding, infection, tenderness or thrombosis.9. Report untoward reaction to the physician.10.Apply warm compress to ease discomfort, as ordered.11.Encourage relaxation by allowing client to discuss experiences and verbalize feelings.12. Interpret results and provide counsel appropriately
LIPID PROFILE
HDL Date Ordered:11-26-09
Date Results In:11-26-09
This is a blood test that measures HDL
cholesterol or “good” cholesterol in the body.
It was checked to determine the level of HDL since the patient
77.52mg/dl 30.23-70.54 mg/dl The result shows that there is a high level of HDL cholesterol as a
result of taking antilipidemic drug, which is Simvastatin, it acts by
increasing HDL
47
was known to have dyslipidemia.
cholesterol since it has a protective action in the
blood.
CHOLESTEROL Date Ordered:11-26-09
Date Results In:11-26-09
Used to determine the level of cholesterol in the blood since the
patient was known to have dyslipidemia
133.33 mg/dl <220.33 mg/dl The result indicates that the patient’s cholesterol level is within the normal
range, which is below 220.33mg/dl thus
indicating normal lipid metabolism.
LDL Date Ordered:11-26-09
Date Results In:11-26-09
It is used to determine LDL levels in the blood since the patient was
known to have dyslipidemia.
46.51mg/dl 81.40-189.92 mg/dl LDL levels of the patient are low, which indicates
that the effect of Simvastatin and
Atorvastatin works effectively by decreasing LDL cholesterol synthesis since the patient has been
taking his maintenance drug.
Triglycerides Date Ordered:11-26-09
Date Results In:11-26-09
It provides quantitative analysis of triglycerides its purpose is to screen for dyslipidemia as the
patient is known to have this condition.
46.90mg/dl 151.33 mg/dl The result indicates that triglycerides are below
normal and thus, it indicates that antilipidemic
drugs which are Simvastatin and
Atorvastatin works effectively decreasing
Triglycerides level.
48
Nursing Implication for Total Cholesterol Test:
BEFORE:
1. Inform the patient that the test is used to assess and monitor risk for coronary artery disease.2. Obtain history of the patient’s past health history and previously performed laboratory tests, surgical procedures,
and other diagnostic procedures.3. Instruct the patient to withhold drugs and alcohol known to alter cholesterol levels for 12 to 24 hours before
specimen collection.4. Fasting 6 to 12 hours before specimen collection is required if triglyceride measurements are included; it is
recommended if cholesterol levels alone are measured for screening.
DURING:
1. Ensure that the patient has complied with the dietary restrictions and pre testing precautions.2. If the patient has a history of severe allergic reaction to latex, care should be taken to avoid the use of equipment
containing latex.3. Instruct the client to cooperate fully and to follow directions.4. Observe Standard Precautions.5. Remove the needle and apply pressure dressing over the puncture site.6. Immediately transport the specimen to the laboratory for processing and analysis.
AFTER:
1. Observe venipuncture site for bleeding or hematoma formation.2. Instruct the patient to reduce intake of foods high in saturated fats and cholesterol and triglyceride levels. (E.g. red
meats, eggs, and dairy products are major sources of saturated fats and cholesterol.3. Consider social and cultural beliefs and practices of the client.4. Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. 5. Provide teaching and information regarding the clinical indications of the test results.
49
HGT Date Ordered:11-25-09
Date Results In:11-25-09 up to
11-27-09
The test is used to determine blood
glucose levels of the patient with DM.
11-25-09 (9:45pm)301 mg/dl
11-25-09159 mg/dl
11-26-09 (6am)179 mg/dl
11-26-09 (12nn)148 mg/dl
11-26-09 (6pm)156 mg/dl
11-27-09 (12mn)153 mg/dl
11-27-09 (6am)148 mg/dl
11-27-09(12nn)
75 mg/dl
11-27-09 (6pm)71 mg/dl
11-28-09(12mn)
153mg/dl
(6am)140mg/dl
(12nn)75mg/dl
80-120 mg/dl The results show that there is large amount of
hemoglobin bound to glucose. In the case of the patient who has diabetes, there is an elevation in the amount of glucose in the
blood as seen in the initial result of 301 mg/dl,
Mixtard was given which is an antidiabetic agent to
decrease the blood glucose levels of the
patient.
As the patient’s glucose levels decreases by the time that Mixtard was
given, the last result of the test is 71 mg/dl which
indicates that Hypoglycemia may also
occur as a result of Mixtard Insulin therapy.
50
(6pm)112mg/dl
11-29-09(12mn)
160mg/dl
(6am)155mg/dl
(12nn)80mg/dl
(6pm)120mg/dl
11-30-09(6am)
148mg/dl
(6pm)98mg/dl
12-01-09(6am)
120mg/dl
(6pm)93mg/dl
12-02-09(6am)
120mg/dl
(6pm)130mg/dl
51
Nursing Implication for HGT:
BEFORE:
1. Check the doctor’s order2. Identify the right client3. Explain the procedure to the patient and the significant others4. Explain the purpose of the procedure5. Inform the patient and the significant others the duration of the procedure6. Inform the patient the she will feel some discomfort from the needle puncture and the tourniquet
DURING:
1. Select a vein for venipuncture2. Apply a tourniquet several inches above the intended puncture site3. Clean the venipuncture site with cotton soak with alcohol4. Perform venipuncture by entering the skin with needle approximately 15 degree angle to the skin5. If using vacutainer, ease the tube in holder once in the vein and collect the desired amount of blood. If using a
syringe, pull back the plunger slowly as blood fills the syringe6. Release the tourniquet when blood begins to flow7. After blood is drawn, place a cotton ball over the site and apply a slight pressure to stop bleeding8. If hematoma is formed, apply a warm compress to relieve the clot
AFTER:
1. Record the date and time of blood collection2. Properly disposed contaminated materials3. Fill-up laboratory form and send the sample to the laboratory for testing
