Care plan questions

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Hi, everyone! I really need help with this for my care plan. I need to put in rationales for abnormal lab values and I'm not sure if what I have in mind is correct or not. Here are the details:

Obese (BMI:44) diagnosed with CP, hypoxemia, and pancreatitis. Complains of N/V, HA and abd pain, has SOB. Patient takes the following drugs and solution: D5NS 1000 mL at 125 mL/hr, morphine 2-4 mg Q2H PRN, ibuprofen 600 mg PRN, amlodipine 10 mg daily, Cymbalta 60 mg daily, Protonix 40 mg daily, Lovenox 40 mg daily, Lithium 900 mg daily, Remeron 45 mg daily, Zofran 4 mg Q6H PRN. Hx includes HTN, GERD, depression, bipolar disorder, and dyslipidemia. Pt was NPO, then switched to clear diet. Pt is also on NC 3L.

Here are my questions:

1. Pt's lab values show that the neutrophil level is elevated but slowly going back to normal level (89.3, then 84.4, then 70.2). This indicates inflammatory response, possibly due to pancreatitis, correct?

2. Next, the lymphocytes are low but are slowly coming back up (5.6, then 9.0, then 19.7 during clinical day). I'm not so sure why the lymphocytes are low in the first place, but could that be because of malnutrition from being on NPO then clear diet?

3. RBCs are trending down and decreasing (from 13.6 on admission, 12.3, then 11.7). I looked at the meds and the only one that had a side effect of anemia is ibuprofen. I know that D5NS is a hypertonic solution and could cause the RBCs to shrink, but I don't know if that means the RBC values going down.

4. Hgb and hct are also trending down (Hgb: 13.6, then 12.3, then 11.7; Hct: 38.1, 35.6, 34.8), which would indicate anemia. Would anemia be due to overhydration using D5NS, perhaps? Or is there something else I'm missing?

5. BUN is also trending down--it went from a normal value of 13, then decreased to 8, then 5. I'm thinking it's due to the decreased protein intake from the clear liquid diet, but does the D5NS have something to do with it too?

Also, can anyone point me to a site where I can get "drug" information about fluid infusions, like D5NS? I'm talking about typical dose, precautions, nursing considerations, side effects/adverse effects. I can't find it in any drug handbook and I need to cite a source for all information, so I can't just come up with the information myself.

If there are any values/information that I still need to put up, please tell me. I'd be grateful for any help!

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A male, with pancreatitis? Hmmmmm... Does he have a Hx of ETOH???

Any history of bleeding? Did you assess for melena (upper GI bleeds)? Did you assess for bright red blood? (lower GI bleeds)? Maybe the low trending HCT IS r/t the overhydration- a sort of dilutional effect? This goes for the BUN as well. With pancreatitis, I was taught hydration is crucial and often aggressive.

Can't wait to see what the experts say. :D

I'm just the local SN that loves to TRY and help.

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Pt is female (oops, did I not mention that? haha), and according to Pt, she hasn't drunk alcohol in about 30 years. I read in her history that she had a lady partsl bleed around 2004 (Pt is currently in her 60s); as for melena and bright red blood on stools, her last BM was prior to her admission (2 days before my clinical), and there wasn't anything on her charts to suggest bleeding, nor did the Pt say anything when I asked.

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Whoops, I just assumed patient was a male... ! My bad... Definitely.

Weird how our mind fills in the blanks... eh?

I've done 5+ care plans on pancreatitis, ALL males with ETOH; its also in my text that this is common.

Surely someone will show up later and have a lot better understanding.

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Think: All that blood in her gut. Is that protein?

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