Date Diagnostic Procedure Rationale Normal values Result Impression
November 12, 2006
Arterial Blood Gas(ABG)- Arterial blood gas analysis is a test in which blood is taken from an artery in your wrist to evaluate how effective your lungs in bringing oxygen to the blood and
removing carbon dioxide from it
Blood gases are used to determine the acid-base balance and/or the respiratory or metabolic status of the client.
The pH is the measurement of the free hydrogen ion concentration in the blood.
pCO2 represents the partial pressure carbon dioxide exerts in the arterial blood.
pO2 represents the partial pressure of oxygen in the blood, identifies how well the lungs are oxygenating
Decreased base excess;
indicates non respi/meta disturbance or true base deficit
Normal
Partially Compensated Respiratory Alkalosis
November 21, 2006
that functions as an important buffer in the blood stream.
O2 sat is the amount of oxygen actually bound to the hemoglobin and available for transport
throughout the body.
pH 7.35-7.45 mmHg
pCO2 35-45 mmmHg
pO2 80-100mmHg
HCO3 22.0-27.0 mmol/L
BE(ecf) (-2)-(+2) mmol/L
O2sat 80-100%
pH 7.439 mmHg
pCO2 22.9 mmmHg
pO2 124.2 mmHg
HCO3 15.2 mmol/L
BE(ecf) -9.0 mmol/L
O2sat 98.6%
Normal
Decreased pCO2
Increased pO2
Decreased HCO3
Decreased base excess
Normal
Fully Compensated Respiratory Alkalosis
Date Diagnostic Procedure Rationale Normal values Result Impression November
12, 2006
November 17, 2006
Blood Chemistry Analysis of the physical, chemical, and
microbiological properties of blood, carried out to diagnose disease, monitor treatment, or detect the presence of specific substance.
RBS is used as a random screen for glucose level.
Creatinine is essential in the evaluation of renal function.
Sodium and Potassium
evaluates fluid and electrolyte balance as well as renal or adrenal disorders Chloride helps diagnose disorders of acid-base and water balance.
Increased; may indicate DM or stress
Increased; may indicate impaired renal function, essential hypertension, acute MI, severe CHF or urinary obstruction Normal
Normal
Increased; may indicate dehydration, cardiac
November 21, 2006
November 26, 2006
Responsible for maintaining water balance and cellular integrity through its influence on osmotic pressure.
Creatinine 53.0-115.0 mmol/L
Sodium 136.0-145.0 mmol/L
Potassium 3.5-5.5 mmol/L
Sodium 136.0-145.0 mmol/L
Potassium 3.5-5.5 mmol/L
127.80
140
4.4
141
4.0
Increased
Normal
Normal
Normal
Normal
Date Diagnostic Procedure Rationale Normal values Result Impression ability, anemia and response to
therapy. It is an important
component of red blood cell that carries oxygen and carbon dioxide to and from the tissues.
Evaluates blood loss, anemia, blood replacement
therapy and fluid balance and screens red blood cell status. It is the measure of red blood cells within the volume and also evaluates
Decreased; may be due to medication, blood clotting factor is decreased and so at high risk for
November blood cell indices.
Oxygen transport to the cells throughout the body depends upon sufficient numbers of red blood cells with adequate
alterations in the total WBC count including count may indicate parasitic or
Increased; may indicate infection, inflammation, tissue necrosis or stress Increased; may indicate bacterial infection, tissue necrosis or MI
Decreased; may indicate defective lymphatic circulation, renal failure or advanced tuberculosis Normal
Normal
November and viral infection, immune disease, leukemia and ulcerative colitis.
Elevated levels may indicate active viral infection and depressed level not understood as well as other white cell types; it is believed to be related to allergic
Basophil
Decreased; may be due to medication, blood clotting factor is decreased and so at high risk for
spontaneous bleeding
Normal
Normal
Normal
Decreased; may indicate bone marrow failure, overwhelming infection, dietary deficiency or drug toxicity
Normal
Decreased; may indicate defective lymphatic
Platelet
and anaphylactic responses.
Evaluates platelet production. It notes the platelet size and shape. Low levels predispose bleeding while high levels may increase the risk of thrombocytosis.
Monocytes 2-10
Eosinophil 1-5
Basophil 0-1 Platelet 150-400x10’3/uL
12
0
0
141
circulation, renal failure or advanced tuberculosis Increased; may indicate infection such as
tuberculosis and subacute bacterial endocarditis Decreased; may indicate stress response associated with trauma, shock or CHF
Normal
Decreased; may be due to medication, blood clotting factor is decreased and so at high risk for
spontaneous bleeding
Date Diagnostic
Procedure Rationale Normal Values Result Impression
November
12, 2006 Urinalysis- is the testing of the physical within the urinary system as well as for systemic problems that may manifest symptoms through the urinary tract.
Color- Pale-star colored to amber color Appearance- clear to slightly hazy
Normal Pus cells- 0-2 hpf
Result pus cells 3-4hpf
Normal
Hazy or cloudy urine may indicate the presence of RBC, WBC, bacteria, pus, phosphate, uric acid or spermatozoa
Normal Normal
Positive albumin may indicate nephritic syndrome, UTI, fever, trauma, CHF, acute infection, or kidney disease
Normal
Increased; may indicate renal problem
Increased; may indicate presence of infection or tuberculosis
Date: May 15, 2006
Diagnostic procedure:
Echocardiogram (2D Echo report) test evaluates the size, shape & motion of various structures within the heart, it is a noninvasive test.
Rationale:
This ultrasonic test diagnoses abnormalities in anatomy and valvular function within the heart. Sound waves are bounced off the heart using a transducer to image the heart in motion as well as its valves and vessels.
Normal findings:
Normal anatomical structure and position, normal and patent arteries and/or veins of the heart, normal valve structure, normal valve structure, normal blood flow within the heart, normal ventricular function, absence of thrombi or bacterial vegetations, absence of pericardial effusions
Result: Echo-Doppler findings
• Eccentric left ventricular hypertrophy with multisegmental wall motion abnormal with depressed systolic function
• Left ventricular ejection fraction of 23%
• Dilated left atrium
• Normal right atrium, main pulmonary artery & aortic root dimension
• Aortic sclerosis with aortic regurgitation of 2+
• Mitral sclerosis with mild mitral regurgitation
• Mild tricuspid regurgitation
• Structurally normal tricuspid valve & pulmonic valve
• No intra-cardiac thrombus or pericardial effusion noted
• Normal pulmonary artery pressure by tricuspid regurgitation jet
Date: November 23, 2006
Diagnostic procedure:
Chest x-ray is the most commonly performed diagnostic x-ray examination. A chest x-ray makes images of the lungs, airway, blood vessels and the bones of the spine and chest
Rationale:
Identify various abnormalities of the lungs and structures in the thorax, including the heart, great vessels, ribs or diaphragm. It may also be used as a general screening tool or for a specific diagnostic purpose, including identification of pulmonary diseases or orthopedic abnormalities. It is also used to evaluate the status of respiratory abnormalities or cardiac conditions.
Normal Findings:
Normal chest and surrounding structures, including bony thorax, soft tissues, mediastinum, lungs, pleura, heart, and great vessels
Result:
Study done in AP supine view. Haziness is noted in both lower lung fields. A thin band of opacity is noted in the right apex. The rest of the lungs are clear. Tracheal air column is at midline. The heart is enlarged with inferolateral displacement of the cardiac apex, fullness of the retro cardiac space and splaying of the carina. Both costophrenic sulci are blunted. The hemidiaphragms are obscured. The rest of the included structures are unremarkable.
Impression:
• Left sided cardiomegaly. Please correlate with ECG findings
• Bibasal pneumonia with underlying minimal pleural effusion
• Apico-pleural thickening, right
Diagnostic procedure:
Electrocardiogram (ECG) most common test of heart’s condition and is used to graphically record the electrical current generated by the beating heart
Rationale:
This electrophysiologic test is used primarily to screen for and diagnose a variety of cardiac conditions as well as to monitor the heart’s response to therapy. It is used to diagnose abnormal heart rhythms, conduction disturbances, hypertrophy of cardiac chambers, myocardial infarction and ischemia and pericarditis.
Normal findings:
Normal sinus rhythm, normal conduction patterns, absence of areas of infarct or ischemia
First result: Second result:
AF in MVR
Old inferior wall infarct Incomplete RBBB, Anterolateral wall infarct
Course AF in slow VR Infarction anterolateral wall LAD, PVW R wave program Incomplete RBBB
Date: November 12, 2006
Immunology:
Troponin – T qualitative is reliable markers of myocardial injury and is found in human serum within 4-6 hours following MI
Rationale:
Primarily ordered for people who have chest pain to see if they have had a heart attack or other damage to the heart. It is done 2-3 times in 12-16 hours period.
Result: POSITIVE
Implication:
• It indicates pulmonary embolism because of right ventricular dilatation and myocardial injury
Hematology:
PROTIME and APTT
Rationale (ProTime):
Screens for lack of coagulation factors necessary for blood clotting. Prothrombin time measures the time required for a fibrin clot to form in a citrated plasma sample after addition of calcium ions and tissue thromboplastin and compares this with fibrin clotting time in a control sample plasma.
Rationale (APTT):
Assess bleeding disorders or the effectiveness of heparin therapy by evaluating intrinsic coagulation factors necessary for blood clotting. The basis of the test is fibrin clot formation and it evaluates all the clotting factors of the intrinsic pathway except factors VII and VIII.
Normal Findings (ProTime): 11-14 seconds Normal Findings (APTT): 27-34 seconds
November 16, 2006 November 16, 2006 November 22, 2006
Result: 19.5 seconds
Increased protime may indicate deficiency of clotting factors or circulating anticoagulant products
Result: 40 seconds
Increased Activated Partial Thromboplastin Time (APTT), may indicate vitamin k deficiency or presence of circulating anticoagulants
Result: 16.3 seconds
Increased protime may indicate deficiency of clotting factors or circulating anticoagulant products