NADN 180 Clinical: Labs & Diagnostic Tests
Test name: CBC
Date(s) & results:
9/15
WBC 15.64
RBC 5.75
Hgb. 16.9
HCT 52.2
MPV. 11.4
Normal values/results:
WBC 5,000-10,000
RBC 4.2-5.4
Hgb 12-16
HCT 37-47
MPV 7.4-10.4
What the results and trends indicate: Patient diagnosed with Diabetic ketoacidosis.
Elevated WBC is likely caused from stress and dehydration from the diarrhea she’s
had for the last few days. Patients with DKA may present with leukocytosis relating
to the blood ketone body concentrations.
Normal values/results:
Na 136-145
HCO 3. 23-29
Glucose. 70-100
BUN 6-20
Create 0.5-1.1
Anion gap <12
Chloride 98-106
eGFR >60
What the results and trends indicate: These labs indicate diabetic ketoacidosis. This
indicates that the patient needs to continue insulin drip and replacement fluids.
How I am using this information to plan and provide nursing care: IV fluids,
electrolyte replenish, find underlying cause for vomiting and diarrhea resulting in
dehydration (DKA). Encourage fluids, monitor intake and output.
9/16
WBC 13.77
MPV. 12.6
Test name: CMP
Date(s) & results:
9/15
Na 133
HCO 3. 14
Glucose 275
BUN 23
Creat 1.56
Anion Gap 23
Chloride 96
eGFR 36
How I am using this information to plan and provide nursing care: Assessing breath
sounds, daily weights, and evidence of hypovolemia. Continue Endotool, adjusting
titration of insulin drip and checking BG levels as instructed. Educate patient on
heart healthy diet and ways to prevent DKA. Verify they are using proper insulin
administration at home.
9/16
HCO 3. 18
Glucose 165
Na 135
Test name: UA
Date(s) & results:
9/15
Glucose. >500
Ketones. 80
protein. 30
Normal values/results:
glucose. <130
Ketones. None
Protein. <150
What the results and trends indicate: Confirms diagnosis of DKA
How I am using this information to plan and provide nursing care:
Closely monitoring blood glucose levels, insulin dosing, meal intake and assessing
for s/s of hyperglycemia
Test name: ABG
Date(s) & results:
9/15
PH. 7.28
Normal values/results:
PH. 7.31-7.41
PCO 2. 40-50
What the results and trends indicate: Respiratory acidosis increasing Ph indicates
a return to homeostasis
PCO 2. 36.7
bicarb 16.9
base excess. -8.9
02 57.6
9/16
PH. 7.3.
PCO 2. 36.9
Bicarb 17.9
base access. 7.7.
02 85.2
Bicarb 21-28
base access. 0+2
02
How I am using this information to plan and provide nursing care:
Addressing metabolic deficiency. Assessing for hypovolemia and hypervolemia
with daily weights, monitoring I&O, lung sounds, checking for edema.
Test name: Chest X-ray
Date(s) & results:
9/15
Mild Vascular Congestion
Normal values/results:
What the results and trends indicate: Pulmonary arterial hypertension
Normal lungs and
surrounding structures
How I am using this information to plan and provide nursing care: Checking B/P and
HR frequently, but most importantly before administration of medications. She is
prescribed Atorvastatin for HTN. Recommended educating patient on a DASH diet
to help lower LDL and mild exercise.
Test name: Blood Glucose
Date(s) & results:
9/15 275 (Lab draw)
9/16
0600- 165 (Lab draw)
9/16 (Q 1-2hrs as indicated
POC)
0816- 141
0916- 155
1016- 164
(Was off unit)
1230- 124
1350- 164
Normal values/results:
Fasting 70-110
Casual < 200
What the results and trends indicate: Uncontrolled DM
How I am using this information to plan and provide nursing care: Patient is
receiving regular insulin via Endotool. POC BS is ordered Q2hr and to follow
hospital protocol utilizing the Endotool Smart Pump. Monitoring amount of
carbohydrates consumed during meals and adjusting dosing as indicated. Frequent
checks of BS before meals and after. Encouraging a carb controlled diabetic diet.
Educate on diet and encourage exercise. Educate patient and family on s/s of
hyperglycemia, hypoglycemia and when BS should be checked. Educate on s/s of
DKA and when to seek help from HCP or return to ED.