Labs for pneumonia and hypoxia?

Hi,

I'm working on a care plan for a theoretical pt who has pneumonia as demonstrated by low Spo2 less than 75% on room air. (They are on O2 by nasal cannula obviously =) So...I'm a little stuck on labs for this pt. Definetely want to assess WBC - as it will indicate infection. Hgb to assess O2 in the blood? What about BUN and Creatinine? BUN because of metabolic acidosis? As you can see...I'm a bit lost on this...Any help in getting me back on track would be greatly appreciated.

-Student

[CDeniseGo]

Anything dealing with impaired gas exchange or inadequate tissue perfusion: should find examples in nanda or noc books. All labs that affect O2 and circulatory symptoms

[hypocaffeinemia, BSN, RN]

Hi,

I'm working on a care plan for a theoretical pt who has pneumonia as demonstrated by low Spo2 less than 75% on room air. (They are on O2 by nasal cannula obviously =) So...I'm a little stuck on labs for this pt. Definetely want to assess WBC - as it will indicate infection. Hgb to assess O2 in the blood? What about BUN and Creatinine? BUN because of metabolic acidosis? As you can see...I'm a bit lost on this...Any help in getting me back on track would be greatly appreciated.

-Student

1) Why are you concerned about metabolic acidosis?

2) How does BUN correlate to metabolic acidosis?

3) How does the level of hemoglobin correlate to hemoglobin saturation?

Here's a hint: you can have 100% SpO2 with a hemoglobin of 5.

---

As for labs, you have bigger fish to fry than infection. Besides, they've already been medically diagnosed with pneumonia. You'd expect an elevated WBC (however, a normal WBC wouldn't mean they are suddenly without pneumonia).

You said they were SpO2 of 75% on room air. That's pretty crappy. What were they via nasal canula? I don't anticipate them to be much better. How can you best evaluate their oxygenation?

There's a certain lab here that is ideal for the potentially acute hypoxia your patient may have. What is it?

And what interpretation of it would you predict the patient to have before you even get the results? Why?

[loricatus]

Don't forget about an ABG & possibly blood cultures if antibiotics haven't been started.

[Sarah Hay]

I'm thinking arterial blood gasses, WBC to determine if there is an infection, try to culture sputum to determine if it's bacterial so it can be treated with antibiotics... uhm. I should know because we have a test on this in the morning...

A chest xRay may be done to determine consolidation. Pulse ox is measured along with ABGs... that's what my book says! [=

[MattiesMama]

hmm...haven't gotten to this point in school yet but my first instinct with a potentially hypoxic pt. would be to get all of their ABG's and their blood pH. Then use the ROME technique, (which I am not entirely familiar with so I'll leave it to someone else on here to explain)

Again, I'm new at this myself so I could be off base but I THINK that the ABG's are the way to go with this pt...

[hypocaffeinemia, BSN, RN]

An ABG is indeed what I was hinting at. The expected interpretation is respiratory acidosis from likely hypoventilation.

I'd also expect the pO2 to be somewhere south of good.

Depending on just how south of good the ABG is, the patient might require intubation or at the very least, some CPAPing.

[morte, LPN, LVN]

their baseline oxegenation level would be good to know. If they are a copder, this may not be so far from their norm. the last i knew a low po didnt dx pneumonia, it simply is lack of o2. pneumonia would be one cause, via hypoventilation..

[NewBeee]

Everyone, thank you for your help! I certainly feel like I'm on the right track now. I just started 2nd semester so we are now starting to learn more about labs. This semester I feel like I'm realizing everything I don't know! I find it all so interesting and I love learning about it, but I feel overwhelmed at times...probably like most nursing students =) I will look up each of the labs listed above in my text books. I hope to become a pro at labs by the end of this semester. I will continue to post now and again if I get stuck. Thanks again for taking the time to help me.

[Daytonite, BSN, RN]

these websites will always give you the doctor's prospective on treatment and diagnosis for most diseases:

• family practice notebook (use search box and input a disease) http://www.fpnotebook.com/index.htm
  
  • http://www.fpnotebook.com/lung/id/pnmn.htm - pneumonia - includes the labwork a doc would order
    

  [*]i would also check the articles on e-medicine (http://www.emedicine.com/)

my copy of nurse's 5-minute clinical consult: diseases says labs include:

• cbc
  
• blood cultures
  
• abgs
  
• fungal or acid-fast bacilli cultures
  
• assays for legionella soluable antigen in urine
  
• sputum culture, gram stain and smear
  
• also, cxr, pulse oximetry, and possible bronchoscopy
  

[silas2642]

Hi,

I'm working on a care plan for a theoretical pt who has pneumonia as demonstrated by low Spo2 less than 75% on room air. (They are on O2 by nasal cannula obviously =) So...I'm a little stuck on labs for this pt. Definetely want to assess WBC - as it will indicate infection. Hgb to assess O2 in the blood? What about BUN and Creatinine? BUN because of metabolic acidosis? As you can see...I'm a bit lost on this...Any help in getting me back on track would be greatly appreciated.

-Student

Just curious, did they tell you that the pt had pneumonia, or are you just assuming that the the pt has pneumonia because the the O2 sat is low? Because unless they told you that the pt had pneumonia, your approach to the clinical situation may be kind of different.

[NewBeee]

This is VERY helpful! :wink2: I especially appreciate the link to the family practice notebook. I am bookmarking this website for sure.

Thank you!