Proofreading Lab Values and Meanings

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Hello,

I would appreciate it if someone could look over my chart of lab values and interpretations to see if everything makes sense. Certain values are not making sense to me such as Cl, Ca, CO2, BUN, and creatinine.

Patient is female, 5/1 173 lbs. PMH of DM I, CHF (EF

Currently on these meds:

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[TD]Cefazolin (Ancef)[/TD]

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[TD]Chlorhexidine Gluconate sol. 4%[/TD]

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[TD]Metoclopramide (Reglan)[/TD]

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[TD]Insulin Aspart (Novolog)[/TD]

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[TD]Insulin Detemir (Levemir)[/TD]

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[TD]Ceftriaxone (Rocephin)[/TD]

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[TD]Duloxetine (Cymbalta)[/TD]

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[TD]Furosemide (Lasix) (diuretic)[/TD]

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[TD]Heparin drip[/TD]

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[TD]Hydrocortisone 1% (Cortef)[/TD]

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[TD]Ammonium lactate (lactate hydrin 12%)[/TD]

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[TD]Magnesium oxide (laxative)[/TD]

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[TD]Nysatin powder[/TD]

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[TD]Pregabalin (Lyrica)[/TD]

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[TD]NaCl 0.9% 5mL IV[/TD]

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[TD]Warfarin (reminder) (Coumadin)[/TD]

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[TD]*Hydromorphone (Dilaudid) *PRN[/TD]

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[TD]DIAGNOSTIC STUDIES-Pt. Values

*all taken 9/15 0417[/TD]

[TD]Normal[/TD]

[TD]Significance For This Pt.-

WHY was study or test done[/TD]

[TD]WHAT do the results mean?[/TD]

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[TD]RBC 2.86[/TD]

[TD]3.87-5.01[/TD]

[TD]Pt. was on heparin drip, but discontinued because it caused GI bleeding (RBC ↓ upon bleeding); pt. has a hx of iron deficiency anemia; also taking diuretics (Furosemide) which may cause dehydration (RBC count artificially rises)[/TD]

[TD]RBC is low which is an indicator of anemia, dehydration, and bleeding. GI bleeding caused RBC to decrease and pt. is anemic.[/TD]

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[TD]WBC 5.70[/TD]

[TD]3.9-9.5[/TD]

[TD]Pt. has cellulitis of legs. Count completed to determine immune function against infection.[/TD]

[TD]WBC is not elevated, infection under control-antibiotics (Cefazolin and Ceftriaxone) are working.[/TD]

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[TD]Hct 27.0[/TD]

[TD]34.5-43.07%[/TD]

[TD]To see if pt. has signs of anemia, diet deficiency.[/TD]

[TD]Pt. has anemia, and iron deficiency[/TD]

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[TD]Hgb 9.2[/TD]

[TD]11.7-15.1[/TD]

[TD]To ensure pt. is receiving adequate oxygenation throughout the body; important evaluation of anemic pts (pt has iron deficiency anemia)[/TD]

[TD]Pt. may not be receiving adequate oxygenation throughout the body, low count indicates anemia.[/TD]

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[TD]Platelets 318,000[/TD]

[TD]129,000- 366,000[/TD]

[TD]Pt. has hx of DVT. Was on heparin drip, but discontinued because it caused GI bleeding. To monitor for coagulation and risk of blood clots.[/TD]

[TD]Platelets might be a little high for someone with DVT. There is no immediate indication of excessive clotting, but pt. may need to be restarted on anticoagulation treatment soon.[/TD]

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[TD]Protime 13.7[/TD]

[TD]9.9-13.2 sec[/TD]

[TD]Hx of DVT; lab monitors the clotting ability of certain clotting factors and how well anticoagulant meds are working to prevent blood clots (pt was on heparin drip)[/TD]

[TD]Pt. is not currently on anticoagulation treatment and PT & INR correlate and are a little low for someone with DVT. For pts with DVT we want the PT to be higher and the INR to be w/in 2.0-3.0 because DVT causes blood clots, we want the blood to take longer to clot. Pt. may need to be restarted on anticoagulation treatment soon.[/TD]

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[TD]INR 1.2[/TD]

[TD]Normally 0.8-1.2;

2.0-3.0 (for pts with DVT)[/TD]

[TD]Hx of DVT; lab is a ratio for PT which monitors the clotting ability of certain clotting factors and how well anticoagulant meds are working to prevent blood clots (pt was on heparin drip)[/TD]

[TD]Pt. is not currently on anticoagulation treatment and PT & INR correlate and are a little low for someone with DVT. For pts with DVT we want the PT to be higher and the INR to be w/in 2.0-3.0 because DVT causes blood clots, we want the blood to take longer to clot. Pt. may need to be restarted on anticoagulation treatment soon.[/TD]

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[TD]K+ 3.6 mEq/L[/TD]

[TD]3.5-5.1[/TD]

[TD]On loop diuretic (Furosemide) which increases excretion of potassium; potassium is vital to cardiac function as it affects heart rate and contractility (pt. has CHF), low potassium may cause dysrhythmias[/TD]

[TD]Furosemide is working therapeutically and is not promoting excessive excretion of potassium. Potassium could be a little higher, but pt. is currently NPO for morning and has not eaten anything.[/TD]

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[TD]Na 140 mEq/L[/TD]

[TD]136-145[/TD]

[TD]On loop diuretic (Furosemide) which increases excretion of sodium and puts pt. at risk for dehydration; pt. also on 0.9% NaCl IV.[/TD]

[TD]Furosemide is working therapeutically and is not promoting excessive excretion of sodium which would lead to HA, nausea, confusion, or hallucinations. Sodium helps to regulate amount of water in body-important that we have enough, but not too much which can cause edema (pt. already has edema of legs)[/TD]

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[TD]Cl 102 mEq/L[/TD]

[TD]98-107[/TD]

[TD]On loop diuretic (Furosemide) which increases excretion of chloride; pt. also on 0.9% NaCl IV. Also to asses acid/base balance.[/TD]

[TD]Furosemide is working therapeutically and is not promoting excessive excretion of sodium which would lead to HA, nausea, confusion, or hallucinations. Controlled acid/base balance[/TD]

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[TD]Ca 7.8[/TD]

[TD]8.6-10.3[/TD]

[TD]On loop diuretic (Furosemide) which increases excretion of calcium. Ca is vital in muscle contractility, cardiac function (pt. has CHF), and blood clotting (pt. has DVT).[/TD]

[TD]Pt. may have some kind of renal impairment because Ca, BUN, and creatinine are on the low side.[/TD]

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[TD]BGM 144 mg/dL[/TD]

[TD]65-99[/TD]

[TD]Pt. has DM type 1. To monitor for hypoglycemia and hyperglycemia[/TD]

[TD]Blood glucose is high maybe because pt. has not been given any insulin as they are NPO for the morning and giving insulin might put them at risk for hypoglycemia before procedure.[/TD]

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[TD]CO2 35.2 mEq/L[/TD]

[TD]19-33[/TD]

[TD]To evaluate lung and kidney function and acid/base balance[/TD]

[TD]Slightly higher level may indicate dehydration[/TD]

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[TD]BUN 8 mg/dL[/TD]

[TD]7-25[/TD]

[TD]To evaluate kidney function. Urea is a nitrogen containing waste left from protein break down. Failing kidneys cause urea build up. Also caused by dehydration and excess bleeding[/TD]

[TD]BUN itself does not pose any immediate concerns, but BUN in addition to Ca and creatinine may indicate some renal impairment.[/TD]

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[TD]Creatinine 0.22 mg/dL[/TD]

[TD]0.6-1.2[/TD]

[TD]Used along with BUN test to assess kidney function. Levels too high = kidneys aren't excreting and filtering creatinine properly. Can also be raised by dehydration and muscle damage.[/TD]

[TD]Decreased cardiac output caused by CHF leads to less bloodflow to kidneys, kidneys cannot get creatinine out of body[/TD]

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Nice job. However, the CO2 level is primarily looking at acid/base balance, not necessarily lung and kidney function. The patient might have a mild alkalosis going on, but the rest of the labs look OK.

Have you considered why the patient is on both a heparin drip AND warfarin? Remember that heparin drips are titrated based on the patient's aPTT, not the PT/INR. If the patient is on a heparin drip, why haven't they drawn an aPTT level?

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