Trying to figure out labs

[DChristine]

i think if i had more sleep this would not be so hard, but looking at labs and trying to make sence of abnormals, such as the ua lk esterase.

my pt is 2years old and has cystic fibrosis, i am trying to figure the order of nursing dx. as well. was going to group all my oxygen needs into dx(1) and then nutrition less than as dx (2). he is in for iv antibiotics. i was looking at his labs and trying to determine if i should have infection higher up.

1. ineffective airway, breathing, gas exchange r/t excess mucous secretions

(maslow's physiological need for oxygen; breathing)

2. imbalance nutrition

(maslow's physiological need for food and water)

3. risk for fluid volume imbalance r/t inadequate intake, iv fluids and tube feedings

(maslow's physiological need for fluid)

4.risk for decreased cardiac output r/t electrolyte imbalance

(maslow's physiological need for circulation)

5. risk for infection r/t decrease in ciliary action and increased pulmonary secretions (maslow's physiological need for physical body regulation)

10/06/08

test result reference

ua pediatric dipstick

color: yellow yellow

clarity: cloudy( ) clear

spec gravity 1.019 1.007-1.030

ph 6.0 5.0-8.0

glucose negative negative

reduce subst negative negative

bilirubin negative negative

ketone negative negative

blood negative negative

protein negative negative

urobilinogen normal

nitrate negative negative

lk esterase trace (high) negative

microscopic

rbc rare 0-2 / hpf

wbc 0-2 0-5 / hpf

squam cells rare variable/hpf

caox crystal few /hpf

ua amorphous light /hpf

10/13/2008

test result reference

ua pediatric dipstick

color: yellow yellow

clarity: clear clear

spec gravity 1.009 1.007-1.030

ph 7.5 5.0-8.0

glucose negative negative

reduce subst negative negative

bilirubin negative negative

ketone negative negative

blood negative negative

protein negative negative

urobilinogen negative negative

nitrate negative negative

lk esterase negative negative

microscopic

rbc 5-10 (high) 0-2 / hpf

wbc 0-2 0-5 / hpf

squam cells 0-2 variable/hpf

10/06/08

test result reference

cbc

wbc 20.0 6.0-17.0k/ mm3f

rbc 4.47 3.90-5.20 m/mm3

hgb 13.0 9.8 - 14.5 g/dl

hct 38.7 32.0- 43.0 %

mcv 86.5 70.0 - 86.0 fl

mch 29.1 23.0 - 29.0 pg

mchc 33.7 30.0 - 36.0 g/dl

rdw 13.6 11-15 %

plt 465 150-400 k/ mm3

mpv 7.5 7.4 - 10.4 fl

gran % 37,5 15.0 - 35.0 %

lymph % 50.5 40.0 - 75.0 %

mono % 7.2 2.0- 14.0 %

eos % 4.2 0- 6.0%

baso % 0.6 0-2.0 %

absolute count abs diff

gran # 7.5 0.9-6.0 k/mm3

lymph # 10.1 2.4 - 12.8 k/mm3

mono # 1.4 0.1 - 2.4 k/mm3

eos # 0.8 0 - 1.0 k/mm3

baso # 0.1 0 - 0.3 k/mm3

10/06/08

test result reference

pt 11.6 9.5-11.0 seconds

inr 1.2 0.9 - 1.2 ratio

10/06/08

test result

gram stain final test not performed

cystic fibrosis resp culture normal oral flora (heavy growth)

10/07/08

test result

rad chest 1 view ap/pa evaluation of picc placement l arm

1) portable supine view of chest at 1221 compared to ap supine view dated 5/5/08

2) interval advancement / replacement of the centrally located left approach early picc line. the tip overlies the superior atriocaval junction. redemonstrated are mediastinal vascular clips.

3) the lungs are clear of focal opacification, effusion, or pneumothorax

4) redemonstrated is mild indentation of the right trachea suggestive of a right -sided aortic arch. remaining cardiomediastinal structures are stable

5) osseous structures and overlying soft tissues are unremarkable.

10/07/08

test result

adenovirus direct fa negative for adenovirus

hmetapneumovirus direct fa negative for hmetapneumovirus

influenza a direct fa negative for influenza a virus

parainfluenza pool direct fa negative for parainfluenza virus pool 1,2 and 3

rsv direct fa negative for respiratory syncitial virus (rsv)

10/07/08

test result

nasal culture

organism 1 streptococcus, alpha- hemolytic

(light growth)

organism 2 rothia species

(scant growth)

test result reference

ige 32 0-49 units/ml

10/07/08

test result reference

tobra trough

10/13/08

test result reference

bmp

na 137 134 - 144 meq/l

k 4.9 3.5 - 5.1 meq/l

cl 105 96 - 108 meq/l

co2 22 22 - 20 meq/ l

anion gap 10 4-14

bun 10 7 - 18 mg/dl

creatinine 0.3 0.2 - 0.4 mg / dl

glu 96 65- 110 mg/ dl

calcium 9.4 9.0 - 11.0 mg / dl

other lab or diagnostic not found but essential

not sure if has had flu shot

10/14/08

test result

renal function panel (rfp) results not back yet

tobra trough results not back yet

[Daytonite, BSN, RN]

your order of nursing diagnoses per maslow's hierarchy of needs should be:

1. ineffective airway, breathing, gas exchange r/t excess mucous secretions (maslow's physiological need for oxygen; breathing)
   • i would just use impaired gas exchange r/t ventilation-perfusion imbalance and ineffective airway clearance r/t increased production of thick mucous. each diagnosis represents a different problem.

[*]imbalance nutrition

[*]risk for decreased cardiac output r/t electrolyte imbalance (maslow's physiological need for oxygen)

• i don't see electrolyte imbalances causing a problem with the cardiac output. cardiac output consists of blood volume, heart rate and the force of the heart contraction. one of those 3 factors has to be altered to end up with a decreased cardiac output.

[*]risk for fluid volume imbalance r/t inadequate intake, iv fluids and tube feedings (maslow's physiological need for fluid)

• correct title is risk for imbalanced fluid volume

[*]risk for infection r/t decrease in ciliary action and increased pulmonary secretions (maslow's physiological need for physical body regulation)

do you have a lab reference book? it would tell you the significance of abnormal (increased or decreased) lab results. i think your sequencing is fine except for the risk for decreased cardiac output which is a need for oxygen to the heart tissue and should be sequenced before the risk for imbalanced fluid volume. cf patients are always at a risk for infection, but i would not make it a priority diagnosis.

[DChristine]

I do have a nursing lab book, but could not find anything on two interventions for LK Esterase with trace instead of having the normal negative for results. It does not even say what it is. I think it has to do with WBCs? I am suppose to have 1 intervention for every normal value and 2 interventions for every abnormal value. It is really hard to write intervention, when you are unsure of what you are looking at.

[Daytonite, BSN, RN]

lk esterase (leukocyte esterase) is a substance produced by wbcs. its presence indicates that there are wbcs present. my copy of mosby's diagnostic and laboratory test reference says that if this is positive on a urinalysis it indicates a uti. it is measured by dipstick and some labs will not do a microscopic exam of the urine unless this test is positive--saves them the money of doing the microscopic exam, i guess. conditions where lk esterase is elevated in the urine are

• bacterial, fungal or parasitic infections (especially uti)
  
• calculus formation
  
• glomerulonephritis
  
• interstitial nephritis
  
• tumors

http://en.wikipedia.org/wiki/leukocyte_esterase