Abnormal Labs?

  1. Hi

    My instructor did not give out lab sheets until late in our clinical so I did not get a chance to question my RN about my patient's abnormal labs. Instructor gave me labs at 1945 and I had a 2000 medpass and postconference at 2020.

    Patient is elderly woman, 2nd day post OP left hip replacement.

    Medical Hx: DM 2, HTN, Silent MI, A-fib, GERD, osteoarthritis.

    Allergic to morphine and latex.

    patient is currently on lovenox, senokot, zantac, celebrex, atenolol and chlorthalizone.

    Her fluid intake was limited to ~100 cc's water my shift. Output was 125 cc's.


    Abnormal labs are as follows:

    Na+ 130, K+ 3.1, Chloride 95, Ca 7.9, Magnesium 1.6, WBC 11.7, RBC 3.78, HCT 35, RDW 14.1

    Also on another page, I have a reading that says "Postitive Antibody screen, Anti-K and Anti-E were previously identified in the patient's specimen. Current reaction strengths have not increased since previous testing and antibody identification studies were not performed."

    Patient had a 240 cc blood loss during surgery.

    Thank you for your help
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  2. 16 Comments

  3. by   Daytonite
    I'm sorry. I don't understand. What is your question?
  4. by   RN BSN 2009
    Quote from Daytonite
    I'm sorry. I don't understand. What is your question?
    Hi, sorry.

    We have to account for each abnormal lab and explain why they are abnormal.

    There were a couple labs that I was able to explain, but these ones that I have listed are troubling me.
  5. by   Daytonite
    Magnesium 1.6 - this is a normal level

    RDW 14.1 - the normal RDW (red blood cell distribution width) is 11% to 14.5% so this would be a normal value. The RDW only indicates that the patient has RBCs that have some abnormal size. This value is elevated when the patient has one of the many types of anemia.

    Does this patient have a renal problem? That might account for some of the decreased electrolytes and the low calcium. I am curious as to why the patient is on a fluid restriction. The RBC, HCT and RCW would indicate some kind of anemia. Anemias are common in patients with renal problems.

    I have no information on the positive anitbody readings. There might have been some information in the doctor's progress notes on these results.
  6. by   danh3190
    What's the patient's osmolality? With the fluid restriction and low Na and K it sounds a bit like when my mother had SIADH. I'm just a student though so don't really know...
  7. by   danh3190
    What's the osmolality? With the low Na and K and the fact that they're restricting the patient's fluid intake, it reminds me of my mothers SIADH.

    I'm just a student though so I don't really know much about labs yet...
  8. by   RN BSN 2009
    Hi. Thanks for your responses.

    I searched her chart all over and there is no indication of renal problems, BUT she has been a type 2 diabetic for many years, some of those years uncontrolled. Could that account for the F/E imbalance?

    She is not on fluid restrictions, she is on a clear liquid diet. The post-ops on our floor have adequate intake but the output is low for the first couple post-op days so she may have hemedilution which may explain the RBC Hct etc

    Thanks!
  9. by   TruDivaRN
    Is she on lasix, that would account for the fluid and electrolyte imbalance. Also, check BUN and creat for renal failure/insuff, this could also case some imbalances. Do you have a lab book to refer to?
  10. by   TruDivaRN
    Also if she has renal insuff. it can lead to decreased RBC's and hct, because erythropoetin is produced in the kidneys. I hope this
  11. by   RN BSN 2009
    I am thinking she has some renal insuifficiency because she is a 20 year diabetic and she is elderly

    her renal labs were on the borderline low
  12. by   deeDawntee
    Na+ 130, K+ 3.1, Chloride 95, Ca 7.9, Magnesium 1.6, WBC 11.7, RBC 3.78, HCT 35, RDW 14.1

    The clinical picture you provide here is very sketchy. Was this an elective hip replacement or did the patient fall? Is she a nursing home patient?

    If the lab values being off were due to hemodilution, you would not see the WBC's elevated (unless they are truly MUCH higher).

    What I see here is a patient with poor nutrition. All of her lytes are depleted. She needs everything replaced. Is she being monitored via telemetry? I would bet she is throwing a lot of PVC's. Does she abuse alcohol? What is her mental status? When the sodium goes low, the confusion goes up.

    Why is she on Lovenox? Is she currently in a fib? What IS her heart rhythm? Does she ordinarily take Coumadin?

    How long did you take care of her with a urine output of only 125 ccs? What were her blood pressures?

    The elevated WBC's could be due to surgery. Did they do a UA?

    There are sooo many possible variables here.
  13. by   Daytonite
    Keep in mind that some of the complications of diabetes are:
    • cardiovascular disease
    • peripheral vascular disease
    • nephropathy
    • impaired resistance to infection
    There may be an impending condition that the doctor has not yet diagnosed. If this is a case study you would want to discuss the potential complications of diabetes in relation to some of these elevated lab values. Mention that they "could" be indicative of a possible condition although it has not been diagnosed.
  14. by   RN BSN 2009
    Quote from deeDawntee
    Na+ 130, K+ 3.1, Chloride 95, Ca 7.9, Magnesium 1.6, WBC 11.7, RBC 3.78, HCT 35, RDW 14.1

    The clinical picture you provide here is very sketchy. Was this an elective hip replacement or did the patient fall? Is she a nursing home patient?

    If the lab values being off were due to hemodilution, you would not see the WBC's elevated (unless they are truly MUCH higher).

    What I see here is a patient with poor nutrition. All of her lytes are depleted. She needs everything replaced. Is she being monitored via telemetry? I would bet she is throwing a lot of PVC's. Does she abuse alcohol? What is her mental status? When the sodium goes low, the confusion goes up.

    Why is she on Lovenox? Is she currently in a fib? What IS her heart rhythm? Does she ordinarily take Coumadin?

    How long did you take care of her with a urine output of only 125 ccs? What were her blood pressures?

    The elevated WBC's could be due to surgery. Did they do a UA?

    There are sooo many possible variables here.
    Hi

    Yes it was an elective hip replacement. She is not being monitored on telemetry.

    This is an orthopedics floor. Her chemstick was 148 but she is on SS insulin so if her chemstick is 200 or over she will get insulin. She is A&Ox3, not confused or distressed. 125 cc urine output in an entire shift (1500-2300), but, I know from being on this floor that is not an unusual output for post-op patients. She does not abuse alcohol, nor did she have an EtOH history. Her blood pressure was 85/54, but she is normally hypertensive and in the 160/100 range. Her chart started that she has medical history of a-fib but I dont believe she was currently in a-fib. Her pulse (aplical) was 83, and regular. I am guessing the WBC's were high due to the surgery, she is only 2nd day post-op. Lovenox and Coumadin are thrown around this floor like candy for DVT prophylaxis. Although I don't understand where the Coumadin came in, because her MAR said she was going to be D/C'ed with daily lovenox injections x 14 days, but that could always change on D/C. From what I know, correct me if I'm wrong, but doesn't coumadin take a couple days before it becomes effective? Maybe she was going to take coumadin for a couple more days, INR drawn and then she would be D/C'ed on coumdain, so that is a possibility as well.

    Thanks for your help!

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