Stuff in CBC I've never seen before

Nursing Students Student Assist

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In my pt's CBC:

:up: WBC (13.8)

:up: BAND (12)

:down: MONO (0)

Nucleated RBC (1)

Ovaloctyes (1+)

Anisocytosis (1+)

Poikilocytosis (1+)

Polychromasia (1+)

Atypical Lymphocytes (3)

Pt admitted for gastroenteritis and dehydration but is it just my imagination or is there something really wrong with her that I am NOT seeing anywhere in the chart except in her unusual lab data? Not trying to "play Dr" but something's off.

Also noteworthy: Pt's temp on chart today ran 96's (tympanic) all day until about 1507 when it was charted at 94.2. Excuse me but what the heck?!? BP at that time charted as 64/22. Previous BP at 1400 was 58/33. Am I crazy or does this raise cause for alarm?

Thanks for any insight.

Specializes in HCA, Physch, WC, Management.

I had suspected renal failure as soon as I read her chart. Her Dr was there on Wed and marked in his progress notes that her temps that day were "normal". Her temps ranged from 94 to 92.6. Excuse me, NORMAL? He ordered a CT which I never got to see the results of. Social worker noted that family was not interested in Hospice and I witnessed them several times in her room arguing over her bed about what to do with her. The Dr was supposed to speak to the family about whether they wanted to treat her aggressively with antibiotics, etc and diagnostic testing or continue to attempt to provide comfort measures and just wait things out. They never came to a definitive decision while I was there. My instructor ended up taking me off the board and moving me down to CCU to observe some things because the arguing was getting too heated and she didn't want me in the middle of the situation, particularly since there was not much I could do for her besides reposition her every hour and attempt to get her to drink or let me wet her mouth with a toothette.

If she wasn't in renal failure when I was up there, she probably was after I left. Her urine output was basically down to next to nothing. Waaaay below the 30mL/hour it's "supposed" to be.

I am still 100% convinced that this woman had something more going on like some kind of anemia or bone marrow production issue but I'll likely never know now. It was a really rough week.

Thanks for all the help and advice.

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