Fundamental ATI question

[RLtinker, LPN]

Well I was doing my fundamental ATI questions this morning for atitutor when I came across a question about lab values of infection. Because of copyright issues I will paraphrase: Basically, it said you were going over labs of an older client and it gave you a list of values, and you had to identify which is a sign of infection. Here are the values;

Neutrophil count 50%

Lymphocyte count 30%

Basophil count 1.0%

WBC count 6,000 mm3

I must have spent five minutes looking at this question , as far as I could tell all the values are WNL. Well I took a random stab in the dark and got the question wrong. I am going to hold off saying what the answer is until I get some responses. I checked my med-surg book and it doesn't mention a change in lab values, but say there is a decrease in normal immune response. What am I missing?

[MendedHeart]

Humm...there has to be more to this question. I'm gonna go with the Neutrophil..but I'm not sure.

WBC is not always an indication of infection. Tough one.

[ClearBlueOctoberSky]

You look at the Neutrophil count. WBC can be low with a raging infection. All the WBC shows, is the count in the blood. It will be low if the body is using more WBC's at the site of infection than it is able to make.

ETA The number that you want, if you want to know if there is an infection is the Banded Neutrophil count. Anything high is a left shift, or the body is having to pump up the production of new Neutrophils.

[RLtinker, LPN]

Humm...there has to be more to this question. I'm gonna go with the Neutrophil..but I'm not sure.

WBC is not always an indication of infection. Tough one.

The exact wording was,

"A nurse is reviewing lab values of an older adult client. Which of the following findings should the nurse report to the charge nurse as a sign of infection?"

Yep, it was the Neutrophil. But my Lab and diagnostic manual has the count as 55-70% as being normal. Another book places them at 60% and this page places them at 36-66%.

Normal White Blood Cell Count - Brief and simplified information about White Blood Cells Count. - WBCCount.org

So what makes a value of 50% high, the question never said they were banded neutrophils which is considerably lower.

[MendedHeart]

I think it would make it on the lower end. I think in a severe infection, neutrophils are being used up faster than can be replaced in blood. I was thinking that if the infectionn was in a wound, would all the neurophils be at that site and not circulating? Not sure what stage the infection would be in though.

I read that CRP, ESR and Procalcitonin are more effective in ruling in infection.

[NicuGal, MSN, RN]

In sepsis, you are cranking out WBC's at a fast rate so there is a high count of immature cells....like the PP said, look at the bands, higher the bands the worse the infection. Also long or a high count of vaculated cells.

[MendedHeart]

True..but I dont think the OP was referring specifically to.sepsis, just infection in general.

I had a patient this week with WBCs up to 50,000 in the absence of infection..he had a lot going on but no infection.(surgical patient). Just one example of how WBC cannot truely solely rule in infection in suspicious cases.

[ClearBlueOctoberSky]

Remember, the WBC just refers to overall white blood cell count.

When you are looking at infection, remember that it is the NNEUTROPHILS main job to fight infection.

You need to remember which job which white blood cell does..

[ClearBlueOctoberSky]

Grr, my phone won't allow me to edit...

Anyway, when you talk about low neutrophil count, neutropenia, you need to investigate WHY there are no neutrophils.

It is usually from bone marrow failure to manufacture, most likely from suppression. Think chemo or anti-retovirals, not from infection.

That is where your banded neutrophils come into play. Bandeds are immature neutrophils. If you have severe infection, the body is going to attempt to increase the neutrophils to fight the infection by increasing production. A left shift, or a bigger number of immature cells to mature cells.

[RLtinker, LPN]

The question is clearly looking for signs of infection, which would mean an increase in WBC, neutrophils (usually acute) and/or Lymphocytes (usually chronic), but none of these values are high. They are all within normal range. The question doesn't mention banded neutrophils which happens when the neutrophils are being stimulated.I am curious to see the rational for this question, but that would mean answering all 60 questions again.

[ClearBlueOctoberSky]

The key to remember about ATI and NCLEX is that they are looking for the BEST answer. In your question, what they are looking for is "Which lab value is the (best) indicator of infection?" The answer is Neutrophils. Neutrophils is the best indicator that you would look for in infections.

[Anbo3882]

The key to remember about ATI and NCLEX is that they are looking for the BEST answer. In your question, what they are looking for is "Which lab value is the (best) indicator of infection?" The answer is Neutrophils. Neutrophils is the best indicator that you would look for in infections.

I agree with Clearblueoctobersky. In real life that Neutrophil count may not be something you would report. But you must always find the best (or most abnormal in this case) answer. So looking at all those values which was the closest to abnormal? The Neutrophil count or course. Also, In my experience ATI tends to be more conservative about WNL values whereas other sources (including most textbooks) are broader.