Neutrophils

1.     – most common wbc in blood

a.     Fx is phagocytosis

b.     Killing and digestion of bacterial microorganisms

Basophils and eosinophils-

a.     Involved in allergic reactionParasitic infestations also are capable of stimulating the production of these a.     DO NOT respond to bacterial or viral infections

1.     Lymphocytes-

                                                                                                     i.      T cells – cellular type immune reactions

                                                                                                   ii.      B cells – humoral immunity (antibody production)

Monocytes

a.     phagocytic cells capable of fighting bacteria

produced more rapidly  than neutrophils and can spend a longer time in the circulation

Platelet count 

                                               i.     Adult: 150,000-400,000/mm3

Blood glucose 

Value: 70-110 

casual < 200

MALE 4.7-6.1

FEMALE 4.2-5.4

MALE 14-18g/dl

FEMALE 12-16g/dl

male 42%-52%

female 37%-47%

Protein 

                                               i.     - Ingested proteins are a source of amino acids needed to synthesize the body's own proteins, which are essential for the growth of new tissue or the repair of damaged tissue. Excess protein in the diet results in increased nitrogen excretion in the urine.

Albumin

                                               i.     In the blood albumin acts as a carrier molecule and helps to maintain blood volume and blood pressure. In humans the principal function of albumin is to provide colloid osmotic pressure, preventing plasma loss from the capillaries. Albumin, like all the plasma proteins, can act as a source for rapid replacement of tissue proteins

Alanine aminotransferasc (23) ALT

                                               i.     An intracellular enzyme involved in amino acid and carbohydrate metabolism. It is present in high concentrations in muscle, liver, and brain. An increased level of this enzyme in the blood indicates necrosis or disease in these tissues. Its measurement is most commonly used as part of the differential diagnosis of liver disease.

Alkaline phosphatase (31) ALP

                                               i.     An enzyme whose optimal pH is about 9.8. It is present in the liver, kidneys, intestines, teeth, plasma, and developing bone. Alkaline phosphatase levels greater than 300% of normal usually signify cholestatic disorders like obstructive jaundice or intrahepatic biliary disease.

Creatinine

                                               i.     Normal Male: 0.6-1.1 mEq/dL Female: 0.5-1.1 mEq/dl

The decomposition product of the metabolism of phosphocreatine, a source of energy for muscle contraction. Increased quantities of it are found in advanced stages of renal disease. It is a normal, alkaline constituent of urine and blood.

Blood urea nitrogenBUN

Normal 10-20 mg/dl

BUN is directly related to the metabolic function of the liver and the excretory fx of the kidney.  Nitrogen in the blood in the form of urea, the metabolic product of the breakdown of amino acids used for energy production. The level of urea in the blood provides a rough estimate of kidney function. Blood urea nitrogen levels may be increased in the presence of dehydration, decreased renal function, upper gastrointestinal bleeding, or treatment with drugs such as steroids or tetracyclines. 

Potassium

Electrolyte testing

Normal 3.5-5.0 mEq/L

A mineral element that serves as both the principal cation in intracellular fluid and an important electrolyte in extracellular fluid.Participates in many functions, including cell membrane homeostasis, nerve impulse conduction, and muscle contraction.

Sodium (900) Na

Electrolyte testing

a.     Normal 136-145 mEq/L
The most abundant cation in extracellular fluids.
It is the main contributor to osmotic pressure and hydration; participates in many specialized pumps and receptors on cell membranes; and plays a fundamental part in the electrical activities of the body (e.g., nerve impulse transmission and muscular contraction).

Chloride (257) Cl

a.     Electrolyte testing

a.     Normal 98-106 mEq/L

is the major extracellular anion and contributes to many body functions including the maintenance of osmotic pressure, acid-base balance, muscular activity, and the movement of water between fluid compartments. It is associated with sodium in theblood and was the first electrolyte to be routinely measured in the blood. Chloride ion is secreted in the gastric juice as hydrochloric acid.

Prothrombin time pt 

a.     Electrolyte testing

a.     The time it takes for clotting to occur after thromboplastin and calcium are added to decalcified plasma. The test is used to assess levels of anticoagulation in patients taking warfarin, to determine the cause of unexplained bleeding (e.g., in patients with hemophilia), or to assess the ability of the liver to synthesize blood-clotting proteins. Ex: Coumadin therapy

Partial thromboplastin time (730) PTT-

a.     Electrolyte testing

a.     - The time needed for plasma to clot after the addition of partial thromboplastin; used to test for defects of the clotting system. Ex: Heparin therapy

Upper gastrointestinal series (UGI)

a.     Radiographical and fluoroscopic examinations of the stomach and duodenum after the ingestion of a contrast medium, such as barium sulfate or an iodinized glucose solution.

Myelogram

a.     A radiograph of the spinal cord and associated nerves. A differential count of bone marrow cells.

Esophagogastroduodenoscopy (Mosby’s 420) EGD - 

a.     Examination of the upper gastrointestinal tract with a flexible fiberoptic endoscope.
EGD is often performed to identify the cause of or to treat bleeding, pain, or swallowing disturbances.

Nuclear scan 

a.     with the administration of a radionuclide and subsequent measurement of the radiation of a particular organ, functional abnormalities of various body areas can be detected. (brain, heart, lung, bones). ONLY MINIMAL RADIATION EXPOSURE OCCURS.

Intravenous pyelography (Mosby’s 820) IVP

                                               i.     X-ray with contrast dye

                                             ii.     A pyelogram in which a radiopaque material is given intravenously. Multiple radiographs of the urinary tract taken while the material is excreted provide important information about the structure and function of the renal pelvis, kidney, ureter, and bladder. This examination may be used to detect kidney stones and other lesions that may block or irritate the urinary tract.

a.     Indicated for:

                                                                                                     i.     Pain compatible with urinary stones

                                                                                                   ii.     Blood in urine

                                                                                                  iii.     Proposed pelvic surgery to locate the ureters

                                                                                                  iv.     Trauma to the urinary system

                                                                                                    v.     Urinary outlet obstruction

                                                                                                  vi.     A suspected kidney tumor

Diagnostic ultrasound

Fluroscopy-  

-  is used in clinical medicine to provide real-time images of moving objects

Magnetic resonance imaging

MRI

A type of medical imaging that uses the characteristic behavior of protons when placed in powerful magnetic fields to make images of tissues and organs. This technique is valuable in providing soft-tissue images of the central nervous and musculoskeletal systems. Imaging techniques allow visualization of the vascular system without the use of contrast agents.  Magnetic resonance imaging is contraindicated in patients with cardiac pacemakers or ferromagnetic aneurysmal clips in place

Computed tomography

A computerized x-ray scanning system that produces a sectional anatomic image. It is achieved by digital processing of x-ray attenuation coefficients from a 360° wedge scan of ionizing radiation

Barium

a radiopaque contrast medium used in radiographic studies of the GI tract

NPO-

a.     Nothing by mouth

Electrocardiogram

a.     gives important information concerning the spread of electricity to the different parts of the heart and is used to diagnose rhythm and conduction disturbances, myocardial infarction or ischemia, chamber enlargement, and metabolic disorders, among others.

a.     Before any examination procedure:

1.     Explain the procedure and allay patient concerns or anxieties.

2.     Requirements such as fasting, obtaining baseline values, and performing bowel preparations.

                                             ii.     Explain procedure to pt

                                            iii.     Determine if NPO or not

                                            iv.     Obtain consent form

                                              v.     Explain discomfort

                                            vi.     During and after, observe pt for adverse effects

Identify information provided by a chest x-ray

a.     Tumors of the lung (primary and metastatic), heart (myxoma), chest wall (soft tissue sarcomas), and bony thorax (osteogenic sarcoma)

b.     Inflammation of the lung (pneumonia), pleura (pleuritis), and pericardium (pericarditis)

c.     Fluid accumulation in the pleura (pleural effusion), pericardium (pericardial effusion), and lung (pulmonary edema)

d.     Air accumulation in the lung (chronic obstructive pulmonary disease), and pleura (pneumothorax)

e.     Fractures of the bones of the thorax or vertebrae

f.      Diaphragmatic hernia

g.     Heart size, which may vary depending on cardiac function

h.     Calcification, which may indicate large vessel deterioration or old lung granulomas

i.      Location of centrally placed intravenous access devices

Describe rationale and significance of culture and sensitivity ordered on a urinalysis

a.     Urine cultures and sensitivities are obtained to determine the presence of pathogenic bacteria in patients with suspected UTI

b.     Most often uti’s are limited to the bladder; however kidneys, ureters, bladder, or urethra can be the source of infection.

c.     Culture needs to be done before antibiotic therapy is initiated otherwise the antibiotic may interrupt the growth of the organism in the laboratory.

d.     Most organisms require approx.. 24 hrs to grow in the laboratory, and a preliminary report can be given at that time. Usually 48 to 72 hours is required for growth and identification of the organism.

e.     An important part of any routine culture is to assess the sensitivity of any bacteria that are growing in the urine to various antibiotics. The physician can then more appropriately recommend the correct antibiotic therapy.

f.      Antibiotics that are the safest, least expensive, and most effective for the treatment of specific bacteria are prescribed.

List abnormal components of a urinalysis and their significance

                                               i.     color: orange/deep amber/red

1.     may be cloudy, have sediment

2.     DH, bleeding (decreased ptl), infection

3.     Odor: fowl odor (infection)

4.     pH:>normal (infection), <normal (starvation, diet high in meat)

5.     protein: + (liver/kidney issues)

6.     Specific Gravity: increase = concentration

a.     Low = diluted urine

7.     Leukocyte: + (UTI)

8.     Nitrites

a.     Normal urinalysis

                                               i.     Color: yellow/straw, amber

                                             ii.     Appearance: clear

                                            iii.     Odor: fresh (aromatic)

                                            iv.     pH:7.35 (4.6-8.0)

                                              v.     protein

                                            vi.     specific gravity

                                           vii.     leukocyte esterase: negative

                                         viii.     nitrites:negative

                                            ix.     ketones:negative

                                              x.     Crystals:negative

                                            xi.     Casts:none present

                                           xii.     Glucose:

1.     Fresh specimen:negative

2.     24hr. specimen: 50-300mg/day or 0.3-1.7mmol/day

                                         xiii.     WBCs: 0.4 per low-power field

                                          xiv.     WBC casts: negative

                                           xv.     RBCs: <2

                                          xvi.     RBC casts: none

1.     Rationale for laboratory and diagnostic studies

a.     Use of scientific/clinical methods to establish cause/nature of a person’s illness/injury and subsequent fx impairment caused by the pathology

b.     Forms basis of pt care

1.     Various levels in which nursing interfaces laboratory and diagnostic testing

a.     Interact with patient and communicate any teachings

b.     Maintain quality control = reliability (helps c cost)

c.     Health care economic demands that laboratory and diagnostic testing be performed accurately and in the least amount of time possible. (Mosby xi)

                                               i.     Nursing notifies lab to draw blood cultures prior to start of iv antibiotics

d.     Collaboration c other health care providers in interpreting findings as the relate to planning and implementing total pt care

e.     Communicate significant alteration in test to health care team

f.      Coordinate interdisciplinary efforts

Discuss the indications for a complete blood count 

a.     Series of test of the peripheral blood, they provide tremendous amt of info about the hematologic system and many other organ systems

                                               i.     Valuable dx info

b.     Inexpensive easily and rapidly performed as a screening test

                                               i.     Most often ordered test

                                             ii.     Purple top