NR 324 Adult Health ROK 2

1. Describe the purpose, normal range, significance of results, and nursing responsibilities for these hematological diagnostic and clotting studies: (hemoglobin, Hematocrit, WBC, Total RBC, Platelet count, activated clotting time (ACT), PT, and INR, Lipid profile (cholesterol, LDL, HDL), BUN and Creatine (How abnormal values relate to HTN and Heart failure), Troponin, BNP. Specific Tests Normal Ranges Significance of Results Nursing Responsibilities Hemoglobin 12.0-16.0gm/dL Oxygen carrying capacity. Low Hgb = low RBC’s =anemia; High Hgb blood disorder, smoking, dehydration Anemia Type and cross Hematocrit 36-46% Low hematocrit: recent blood loss, anemia, blood disorders (leukemia), Vitamin or mineral deficiencies High hematocrit: Dehydration, A disorder, such as polycythemia vera, that causes your body to produce too many red blood cells Lung or heart disease Anemia Type and cross WBC 4.5-11.0K/uL Increased WBC’s body is fighting infection Decreased WBC’s body is not able to fight infection Infection Total RBC 4.2-5.4M/uL Low RBC’s = anemia High RBC’s= polycythemia vera O2 Carrying capacity Bleeding Platelet Count 150,000-400,000 mm3 thrombocytopenia Bleeding Use electric razor Soft toothbrush Activated Clotting Time (ACT) 70 to 120 seconds is the usual amount of time for blood to clot without heparin. 70 to 120 seconds is the usual amount of time for blood to clot without heparin. 180 to 240 seconds is the usual amount of time for blood to clot with heparin. This is called the therapeutic range. Heparin PT 11-12.5 seconds With out blood thinning medication Blood clotting factor INR 0.7-1.8 Therapeutic 1-2 Therapeutic range for people taking warfarin for disorders such as atrial fibrillation or a blood clot in the leg or lung. Blood clotting factor Liver Profile LDL 130 mg/dL Good cholesterol Teach about good eating habits DASH diet Cholesterol values HDL F- 35-80 mg/dL M- 35-65 mg/dL Bad cholesterol Eating poorly Genetic Teach about good eating habits DASH diet Cholesterol values BUN 7-20 mg/dL Renal insufficiency Kidneys Creatine 0.3-1.7 mg/dL Renal insufficiency Kidneys 2. Define anemia, general common clinical manifestations and priority nursing care for this disorder. Define: Anemia is a deficiency in the number of erythrocytes (red blood cells [RBCs]), the quantity or quality of hemoglobin, and/or the volume of packed RBCs (hematocrit) Manifestations: The clinical manifestations of anemia are caused by the body's response to tissue hypoxia. Decreased RBC’s (deficient nutrients folic acid, iron, erythropietin), Blood loss (acute trauma, ruptured aortic aneurysm, GI bleed), increased RBC destruction (sickle cell disease, incompatible blood, trauma) Priority nursing care: 3. Identify the etiologies, clinical manifestations, and collaborative management for the following anemias. (Iron-deficiency, Thalassemia, Pernicious, and Folic Acid Deficiency). ANEMIAS Etiologies Clinical Manifestations Collaborative Management Iron-deficiency result of inadequate dietary intake, malabsorption, blood loss, or hemolysis Assessment Lethargy, pallor, tachycardia, tachypnea, dizziness, clubbing (Hypoxemia) Pallor, glossitis (inflammation of the tongue) Cheilitis (inflammation of the lips). H/A, Paresthesias, burning sensation of the tongue, Jaundice, bone pain, weight loss, Identification and treatment of underlying cause. Ferrous sulfate or ferrous gluconate Iron dextran, sodium ferrous gluconate, iron sucrose IM or IV. Nutritional and diet therapy Transfusion of packed RBCs (symptomatic patient only) Nutrition, medications, nutrient and fluid replacement, blood transfusion