LABORATORYRESULTS

Includethosepertinenttonursingandmedicaldiagnoses.Includenormalvaluesandpatientresults.Includereason(s)forabnormalfindingsandnursinginterventionsfor
labpreparationandlabresultfollowup.
NAMEOFSTUDY

BUN/Creatinineratio

NORMAL
PARAMETERS

10:1to20:1

PATIENTS
RESULTS

RATIONALEFORRESULTS

HealthcareprovidersusetheBUN
andcreatinineclearanceteststo
assessrenalfunction.Apatient
experienceshealthproblemsif
renalfunctionfallsto25%or
below.Wastethatnormallyis
excretedbuildsupintheblood
causingatoxicresult.

25:24

NURSINGINTERVENTIONSFORTEST
PREPARATIONANDTESTFOLLOWUP
Explain:Whybloodsampleistaken;
Thatthehealthcareprovidermayaskthe
patienttorefrainfromtakingTagametor
tetracycline.Toavoidstrenuousexercise
for2dayspriortothetest,Ingesting
proteinfor1daypriortothetest,
Drinkingcoffeeandteaforthecreatinine
clearancetest,sincetheseincreaseurine
production

WBC

UricAcid

4.8-10.9 K/uL

3.4to7.0
mg/dL

18.8 K/uL

19.2mg/dL

Leukocytes normally increase when

infection is present. High WBC count may
also indicate inflammation, tissue damage,
stress, malnutrition, burns lupus, thyroid
gland problems.
Ahighlevelofuricacidmay
indicatekidneydiseaseorgout.
Uricacidisproducedwhenpurine
ismetabolized.Uricacidentersthe
bloodandisthenexcretedbythe
kidneysthroughtheurineanda
smallamountinstool.Theuric
acidtestmeasuresthelevelofuric
acidintheblood.

Observe and report signs of infection such as

redness, warmth, discharge, and increased body
temperature.

Assessthepatientforstarvation,
strenuousexercise,andahighprotein
diet,sincethesecanraisethelevelofuric
acid;Ifthepatientistakingaspirin,
theophylline,diuretics,niacin,caffeine,
vitaminC,ascorbicacid,epinephrine,
levodopa,warfarin,diazoxide,cisplatin,
cyclosporinenicotinicacid,
phenothiazines,tacrolimus,methyldopa,
orethambutol,whichcanaffectthetest
results;Ifthepatientispregnant,since

uricacidlevelcanincreaseduring
pregnancythatassiststhehealthcare
providerindiagnosingpreeclampsia;If
thepatienthaseatenliver,redmeats,
gamemeat,herring,sardines,scallops,or
beer;Uricacidlevelsarehigherinthe
morningandlowerintheevening,
thereforenotethetimewhenthetestis
administered.

K+

3.5to5.0
mEq/L

413
mEq/L

Potassium(K)isamineralstored
insidethecellthathasmultiple
functions,includingmuscle
contractions,neuraltransmission,
andfluidbalance.Potassiumis
excretedbythekidneys,regulated
byaldosteronehormone,and
releasedbytheadrenalglands.
Potassiumandsodiumhavean
inverserelationship.The
potassiumtestmeasuresthelevel
ofpotassiuminblood.Ahighlevel
ofK+mayindicatemyocardial
infarction,Ingestingoftoomany
potassiumsupplements,Intakeof
ACEinhibitors,Diabetic
ketoacidosis,orKidneydamage

AssessifthepatienthasTakenpotassium
supplements,Takenheparin,glucose,
nonsteroidalantiinflammatorydrugs
(NSAIDs),andantibioticsthatcontain
potassium,naturallicorice,
corticosteroids,angiotensinconverting
enzyme(ACE)inhibitors,orinsulin,
xperiencedseverevomiting,Improperly
usedlaxatives

Medication
Trade/Generic
Names
Na+

Hydromorphone
(Dilaudid)

Dosage
&
Frequenc
y

1mgIV
q3hPRN

Methodof
administrat
ion
136to145
mEq/L

IV

Indication
Whyisthepatient
takingthemedication
31mEq/L

Indication:Moderateto
severepain(aloneandin
combinationwith
nonopioidanalgesics);
extendedreleaseproduct
foropioidtolerant
patientsrequiringaround
theclockmanagementof
persistentpain.
Antitussive(lowerdoses).

Sideeffects
MostCommonfor
eachdrug

Sodium(Na)isamineralstored
Assessifthepatienthaselevated
Contraindicatedin:Hypersensitivity;Some
outsidethecellinbloodandlymph
proteinlevels,receivedIVfluid
productscontainbisulfitesandshouldbe
fluidthathasmultiplefunctions,
containingsodium,hightriglyceride
avoidedinpatientswithknown
includingmusclecontractions,
levels,heparin,birthcontrolpills,
hypersensitivity;Severerespiratory
neuraltransmission,andfluid
NSAIDs,antibiotics,tricyclic
depression(inabsenceofresuscitative
balance.Sodiumisexcretedbythe
antidepressants(TCAs),corticosteroids,
equipment);Paralyticileus(extendedrelease
kidneys,regulatedbyaldosterone
lithium,orestrogen
only);PriorGIsurgeryornarrowingofGI
hormone,andreleasedbythe
tract(extendedreleaseonly);Opioidnon
adrenalglands.Sodiumand
CNS:confusion,
tolerantpatients(extendedreleaseonly);
potassiumhaveaninverse
sedationdepression.
relationship.Thesodiumtest
CV:hypotensionGI:
measuresthelevelofsodiumin
constipation
NursingImplications:AssessBP,
blood.AlowNavaluemay

PatientsIndication:
ManagementofPain

IV

Contraindications
&
Nursingresponsibilities

Indication: Hydration and

provision of NaCl in deficiency
states. Maintenance of fluid and
electrolyte status in situations in
which losses may be excessive
(excess diuresis or severe salt
restriction)

Patients Indication:
CV: HF, PULMONARY
Replacement, Treatment of
EDEMA, edema. F and E:
metabolic alkalosis, A priming
hypernatremia,
1000 mLs
fluid for hemodialysis, To begin
hypervolemia, hypokalemia.
NaCl 0.9%
@75 mL/hr
PATHOPHYSIOLOGY
and end blood transfusions.
Local: IV extravasation,
Q30H20min
Small volumes of 0.9% NaCl
irritation at IV site.
Describe in as much detail as possible, the(preservative-free
pathophysiology,
or
with reference, underlying the
bacteriostatic)
usedlist
to repatients medical diagnoses and relate it to nursing
needsare(i.e.
five nursing interventions for
constitute or dilute other
diagnosis).
medications.

pulse,andrespirationsbeforeand
periodicallyduringadministration.If
respiratoryrateis<10/min,assess
levelofsedation.Dosemayneedto
bedecreasedby2550%.Initial
drowsinesswilldiminishwith
continueduse.

Contraindicated in: Hypertonic (3%, 5%) solutions

should not be used in patients with elevated, slightly
decreased, or normal serum sodium; Fluid retention or
hypernatremia.
Nursing Implications: Assess fluid balance (intake and
output, daily weight, edema, lung sounds) throughout
therapy.PRIORITIZED LIST OF NURSING

DIAGNOSES
LIST IN ORDER OF PRIORITY
(MINIMUM OF 3 NURSING DIAGNOSIS)

Goutisasyndromecausedbyaninflammatoryresponsetouricacidproductionor
excretionresultinginhighlevelsofuricacidintheblood(hyperuricemia)andin
otherbodyfluids,includingsynovialfluid.Althoughhyperuricemiaisessentialfor
thedevelopmentofgout,itisnottheonlyfactor.Otherfactorsincludeage(rare
before30years),geneticpredisposition(Xlinkedalterationofenzymehypoxan
thineguaninephosphoribosyltransferase[HGPRT]),excessivealcohol
consumption,obesity,certaindrugs(especiallythiazides),andleadtoxicity.When
theuricacidreachesacertainconcentrationinfluids,itcrystallizes,formingin
solubleprecipitatesthataredepositedinconnectivetissuesthroughoutthebody.
Crystallizationinsynovialfluidcausesacute,painfulinflammationofthejoint,a
conditionknownasgoutyarthritis.Withtime,crystaldepositioninsubcutaneous
tissuescausestheformationofsmall,whitenodules,ortophi,thatarevisible
throughtheskin.Crystalaggregatesdepositedinthekidneyscanformuraterenal
stonesandleadtorenalfailure.

(Pathophysiology, McCance, page 1602)

MMDSON
PLAN OF CARE

1. Acute pain r / t presence of

inflammation in the joints.
2. Impaired physical mobility r / t
presence of joint pain.
3. Knowledge Deficit: about
treatment and care at home.

DATE: 02-09-15
STUDENT NAME: Vanessa Sanchez
MEDICAL DIAGNOSIS: Sickle Cell Disease
PATTERN
MANIFESTATION

NURSING
DIAGNOSIS

Subjective: My arms and

feet hurt. I cannot walk

Impaired physical
mobility related to
pain

Objective:
Reluctance to
attempt
movement
Limited Range
of Motion
Decreased
Muscle Strength
V/S taken as
follows:
T: 100.1
P: 136
R: 18
BP: 104/75

MUTUAL
GOALS
Client will maintain or
increase strength and
function of affected
body parts before end
of shift.

PATIENTS INITIALS: A.M.

AGE/SEX: 53 M
NURSING
INTERVENTION

SCIENTIFIC RATIONALES
REFERENCES

EVALUATION
(MODIFICATION)

Evaluate or
continuously monitor
degree of joint
inflammation or pain

Level of activity or exercise depends

on progression and resolution of
inflammatory process

Patient was unable to move joints

of hands and feet before end of
shift. A modification to the goal
would be to extend it to 3 days and
also administer anti-inflammatory
drugs as prescribed to relieve pain
and swelling during acute attacks.

Maintain bed rest or

chair rest when
indicated. Schedule
activities providing
frequent rest periods
and uninterrupted
night time sleep
Encourage adequate
fluid intake
Assist with active or
passive range of
motion
Encourage patient to
maintain upright and
erect posture when
sitting, standing, or
walking.

Systemic rest during acute attacks

are important throughout all phases
of diseases to reduce fatigue and
improve strength
To assist with excretion of uric acid
and decrease likelihood of stone
formation
Maintains or improves joint function,
muscle strength, and general
stamina
Maximizes joint function, maintains
mobility

MMDSON
PLAN OF CARE
DATE: 02-02-15
STUDENT NAME: Vanessa Sanchez
MEDICAL DIAGNOSIS: Gout Intractable pain
PATTERN
MANIFESTATION

NURSING
DIAGNOSIS

Subjective:
Client States:
Life has not
been the same
since Ive lost
control over my
hands and feet

Body Image
disturbance r/t
decreased function
and deformities of
hands and feet

Objective:

Reluctant to
engage in ADLs
Change in
structure of
patients hand

MUTUAL
GOALS
1.

Patient
demonstrates
enhanced body
image and selfesteem as
evidenced by
ability to look at,
touch, talk about,
and care for
actual or
perceived altered
body part or
function within 4
hours of
implementing
nursing
intervention

PATIENTS: A.M
AGE/SEX: 53 M
NURSING
INTERVENTION
Acknowledge
normalcy of
emotional
response to
actual or
perceived change
in body structure
or function
Help patient
identify actual
changes
Encourage
evaluation of
positive or
negative feelings
about actual or
perceived change

SCIENTIFIC RATIONALES
REFERENCES

EVALUATION
(MODIFICATION)

Stages of grief over loss

of a body part or function
is normal, and typically
involves a period of
denial, the length of which
varies from individual to
individual.

Yes, patient has demonstrated

enhanced body image by end of shift.

Patients may perceive

changes that are not
present or real, or they
may be placing unrealistic
value on a body structure
or function.
It is worthwhile to
encourage the patient to
separate feelings about
changes in body structure
and/or function from
feelings about self-worth.

Date

Progress Notes

02-02-15

53 y/o male, admitted on the 17th of January for gout intractable pain. He is on a regular diet and has been given Dilaudid 1
mg IV PRN for pain. He has a past medical history of hypertension and alzheimers. He was received in bed alert and oriented
x4. Neuro: oriented to time, place, person and situation. PEERL at 4mm. Unable to follow commands with hand grips and
foot pushes due to excruciating pain. Pulm: states I do not feel short of breath. No dyspnea. Breath sounds clear.
Respirations are even and unlabored. Mucous membranes pink. Cardiac: denies chest pain. He has an IVF of NaCl 70 mL/hr
infusing to the (L) hand via a 20 gauge catheter. The site is clean, dry, and intact with absence of redness, drainage, edema,
or pain. Brisk capillary refill in fingers and toes. Abdomen : denies abdominal tenderness. Normoactive bowel sounds in all
four quadrants; Nontender abdomen. Integumentary: Skin edges well approximated. No redness or bony prominences. D/C
plan is to stabilize the patient (temperature and heart rate) before discharging to a SNF. V/S: 100.1 F (Temporal), 136 Pulse,

BP: 104/75, 18 RR, 98% O2, Pain: 8/10.

within reach.

Patient remains in bed with side rails up x2, bed low with break and call light