LABORATORY STUDY Hematology

Diagnostic Procedure WBC RBC HGB Actual Values 6.0 x 10^9/L 3.35 x10^12/L 102 g/L Normal Values 4-10 x 10^9/L 4.5 5.4 x10^12/L 115-155 g/L Interpretation Normal Decreased Decreased Significance Functions remain thesame Decreased RBC indicates anemia, fluid overload. Decreased HGB indicates hemodilution (Fluid Overload) and Anemia. It also indicates hypoxia because there is lack of oxygen supply to the circulation and patient has fluid overload as evidenced by edematous lower extremities. Decreased HCT indicates anemia and fluid overload. HCT is also decreased due to inability of the kidney to regulate RBC production by releasing erythropoietin to stimulate the bone marrow to produce RBC, as a result, the ratio of RBC to total blood volume is decreased. Increase PLT is refer red to as thrombocytosis and can be trigger spleen removal ,excessive anemia and chronic myelogenous anemia. Functions remain the same. Functions remain the same. Functions remain the same. Date: April 30, 2012 Nursing Responsibilities Patient Preparation: Explain to the patient that this test is used to detect abnormalities in the blood like anemia, polycythemia, infections, dehydration, overhydration, hypoxia and many more. This is also to assess the response to treatment. Tell the patient that a blood sample will be taken. Explain who will perform the venipuncture and when. Explain to the patient that he may feel slight discomfort from the needle puncture and tourniquet. Inform the patient that he needs not to restrict him foods and fluids.

HCT

0.30

0.36-0.47

Decreased

PLT

359X 10^g/uL

100-300X10^g/uL

Increase

MCV MCH MCHC

89 fL 30 pg 340 g/L

86-100 fL 26-31 pg 310-370 g/L

Normal Normal Normal

Procedure and Posttest Care: Perform a venipuncture and collect the sample in 3 to 5 ml with EDTA added If hematoma develops at the venipuncture site, apply warm soaks. If hematoma is large, monitor pulses distal to the venipuncture site. Ensure subdermal bleeding has stopped before removing pressure.

RDW Differential Count Neutrophil

12.6 %

11.6-13.7%

Normal

May indicate iron deficiency anemia

40%

40-70%

Normal

Functions remain the same

To prevent hemolysis, avoid excessive probing the venipuncture site and handle the sample gently. Assess for signs and symptoms of infection Promote adequate rest

41% Lymphocyte

19-42%

Normal

Functions remain the same.

Monocyte

15%

3-9%

Increase

3% Eosinophils Basophils BT 0% A

2-8% 0-5%

Normal Normal

May indicate chronic infections, in auto immune disorder, blood disorder and in Cancer. Functions remain the same Functions remain the same

BLOOD CHEMISTRY
Date: April 30, 2012 DIAGNOSTIC PROCEDURE Glucose (oxidase) ACTUAL VALUE 7- 1 mmol/L NORMAL VALUE 3.9 5.8 mmol/L INTERPRETATION Increased SIGNIFICANCE High levels of glucose can indicate the presence of diabetes or another endocrine disorder or maybe caused by taking corticosteroids The blood creatinine level shows how well your kidneys are working. A high creatinine level may mean your kidneys are not working properly. The amount of creatinine in the blood depends partly on the amount of muscle tissue you have; men generally have higher creatinine levels than women. Functions remains the same

Creatinine

61 umol/L

53 97 umol/L

Increased

Uric Acid Lipid Profile Cholesterol

235 umol/L

155 360 umol/L

Normal

6.2 mmol/L

3.6 5.7 mmol/L

Increase

High level of of lipid profie cholesterol known to increase the risk for Coronary Heart Disease.

Total Protein

70 g/L

64 83 g/L

Normal

Total protein measurements can reflect nutritional status and may be used to screen for and help diagnose kidney disease, liver disease, seen in states of decreased synthesis (malnutrition, malabsorption, liver disease, and other chronic diseases) (ALT) is an enzyme found mostly in the cells of the liver and kidney; much smaller amounts of it are also found in the heart and muscles. In healthy individuals, ALT levels in the blood are low. When the liver is damaged, ALT is released into the blood stream, usually before more obvious symptoms of liver damage occur, such as jaundice. This makes ALT a useful test for detecting liver damage.

Albumin

33 g/L

35 32 g / L

Decreased

SGPT/ ALT

266.7 nkat/L

0 517 nkat/L

Within Normal Range

IMMUNOLOGY

DIAGNOSTIC PROCEDURE CA 12-5

ACTUAL VALUE O 35 u/ml

NORMAL VALUE

INTERPRETATION

SIGNIFICANCE CA 125 is a protein that is a socalled tumor marker or biomarker, which is a substance that is found in greater concentration in tumor cells than in other cells of the body. In particular, CA 125 is present in greater concentration inovarian cancer cells than in other cells. It was first identified in the early 1980s, and the function of the CA 125 protein is not currently understood. CA stands for cancer antigen. Elevated hCG levels are usually present in a multiple pregnancy, such as twins or triplets. However, hCG levels have a wide range of normal that often overlap for single and multiple pregnancies; therefore, high hCG levels alone are not considered a reliable indication of a multiple pregnancy.

14 u/ml

Normal

B HCG

38.03 mic/ ml

< o.5 2.90

Increase

DRUG STUDY

Generic Name

Brand Name

General Classification

Indication

Mode of Action

Contraindication

Usual Dose

Actual Dose

Adverse Reaction/s

Nursing Responsibilities

M E T O C H L O P R A M I D E H C L

M A X E R A N

Gastrointestina l agent; prokinetic agent (GI stimulant); ANS agent; direct acting cholinergic(par asympathomim etic); antiemetic

Management of diabetic gastric acid stasis (gastopharesis) to pevent nausea and vomiting associated with emetogetic cancer, chemotherapy (e.g. cisplatin dacarbazine) to facilitate intubation of small bowel; symptomatic treatment of gastroesophageal reflux

Potent central dopamine receptor antagonist. Structurally related to procanamide but has little antiarrythmic ir anesthetic activity. Exact mechanism of action not smooth muscle to effect of acethylcholine by direct action

Sensitivity to intolerance to metochlopramid e; allergy to sulfitting agents; history of seizure disorders; concurrent use of drugs that can cause extrapyramidal symptoms; pheochromocyto ma; mechanical GI abstraction or perforation; history of breast cancer. Safety during (category B) or lactation is not established.

IM/IVTT 10mg over 12mins

1 amp prior to chemo

CNS: mild sedation, fatigue, restlessness, agitation, headache, insomnia, disorientation, extrapyramidal symptoms(acute dystonic type) GI: nausea, constipation, diarrhea, dry mouth, altered drug absorption. SKIN: urticarial or maculopapular ras BODY AS A WHOLE: glossal or periorbital edema CV: Hypertensive crisis

> Remember the 10 Rs > Report immediately the onset of restlessness, involuntary movement, facial grimacing, rigidity or tremirs > Monitor for possible hypernatremia and hypokalemia; especially if patient has CHF or cirrhosis.

Generic Name

Brand Name

General Classification

Indication

Mode of Action

Contraindication

Usual Dose

Actual Dose

Adverse Reaction/s

Nursing Responsibilities

D E X A M E T H A S O N E

D E X O N E

Long- acting corticosteroid

>Management of cerebral edema >Diagnostic agent in adrenal disorders >Relieves inflammation >Allergic disorders >Asthma >Arthritis

Suppresses inflammation and the normal immune response. It prevents the release of substances in the body that causes inflammation.

Hypersensitivity Active untreated infection Lactation Systemic fungal infection

10 mg

10 mg 1. Skin rash prior to 2. Swollen face, chemo legs or ankles (fluid retention) 3. Vision problems ( Dexamethaso ne may cause cataracts and increased intraocular pressure) 4. Cold or infection that last for a long time 5. Muscle weakness 6. Black or tarry stool

Remember the 10 Rs Monitor intake and output of patient. Observe the patient for peripheral edema, steady weight gain, rales or dyspnea. Notify the physician immediately if these clinical manifestations are noted. Instruct patient to avoid people with known infection and contagious illnesses ascorticosteroids cause s immunosuppression and may mask symptoms of infection.

Generic Name R A N I T I D I N E

Brand Name Z A N T A C

General Classification Anti-ulcer agents Histamine H2 antagonists

Indication Treatment and prevention of heartburn, acid indigestion, and sour stomach.

Mode of Action Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion

ContraIndication Hypersensitivit y, Crosssensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance.

Usual Dose 20 mg

Actual Dose 1 tab prior to chemo

Adverse Reaction/s CNS: drowsiness, headache, GI: Altered taste, black tongue, constipation , dark stools, diarrhea, druginduced hepatitis, nausea HEMAT: Agranulocyt osis, Aplastic Anemia, neutropenia , thrombocyt openia

Nursing Responsibilities Remember the 10 Rs . Assess patient for epigastric or abdominal pain and frank Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stool.

Generic Name D I P H E N H Y D R A M I N E

Brand Name B E N A D R Y L

General Classification

Indication

Mode of Action

Contraindication

Usual Dose

Actual Dose 1 amp slow IVTT 1 hour prior to Chemo

A N T I

Parkinsonism or druginduced extrapyramidal effects

For active treatment of motion sickness.

P A R K I N S O N I A N DRUG

Antagonizes the effect of histamine at H1 receptor sites; does not bind or inactivate histamine

10 to 50 mg Cardiac IV disease or hypertension

glaucoma gastric or duodenal ulcers

Nursing Responsibilitie s > Remember CNS: the 10 Rs headache, >Caution the fatigue, client that the anxiety, medication tremors, may cause vertigo, confusion, d drowsiness, creating CV: tachycardia, difficulties or palpitations, hazards or other activities failure that require EENT: alertness. blurred >Explain to the vision client that use GI: dry of these drugs mouth, nausea, vom in warm weather may iting, constipation increase the likelihood of GU: heatstroke. urinary hesitancy or > Report onset of rash or fever frequency, immediately to urine physician; retention withdraw drugs.

Adverse Reaction/s

Generic Name C I S P L A T I N

Brand Name P L A T I N O L

General Classification A N T I

N E O P L A S T I C A G E N T

Mode of Action Cancers (OffCoordinates to DNA and label) that this Cancer of coordination cervix, complex not endometrium, only inhibits ovary, replication prostate, and esophagus, transcription kidney; nonof DNA, but small cell lung also leads to cancer; head programmed & neck cell death squamous (called cell cancer; apoptosis). osteogenic sarcomas; bone marrow transplants

Indication

Contraindicatio Usual n Dose Hypersensitivi Injectable ty to cisplatin, solution other platinum 1mg/mL compounds Powder for Severe myelosuppres injection 10mg sion, renal impairment, 50mg hearing impairment Pregnancy, lactation

Actual Dose

Adverse Reaction/s Nausea (76100%)

Nursing Responsibilities > Chemotherape utic agents Vomiting (76- should be prepared for 100%) administration Nephrotoxicity only by (28-36%) professionals Ototoxicity, who have been especially in trained in the children safe use of the (31%) preparation. Myelosuppres >Operations sion (25-30%) such as reconstitution, Anaphylaxis dilution and (1-20%) transfer to Alopecia syringes should be carried out only in the designated area. > The personnel carrying out

these procedures should be adequately protected with clothing, gloves and eye shield. >Pregnant personnel are advised not to handle chemotherapeuti c agents

Generic Name R E N O G E N

Brand Name

General Classification

Indication

Mode of Action

Contraindicatio n Hypersensitivi ty to mammalian cell-derived products & albumin (human); uncontrolled HTN.

Usual Dose Starting dose: 50-100 IU/kg 3 times wkly by IV or SC

Actual Dose 4,OOO U SQ 24 huors post chemo.

Adverse Reaction/s Rash & urticaria.

Treatment of anemia ass ociated w/ chronic renal failure w/ or w/o dialysis, cancer, HIV in fection & autologous blood transfusion.

Nursing Responsibilitie s > Remember the 10 Rs problems

NURSING DIAGNOSIS Imbalance nutrition less than body requirements r/t decrease in appetite

ASSESSMENT S-Wala ako gana kumain, as verbalized. O> eat less > appears weak > dry and cracked lips noted

CLIENT OUTCOME Within the shift, client will be able to verbalize understanding on the importance of proper nutrition and balanced diet. > Maintain fluid volume at a functional level as evidenced by adequate urine output, stable vs, moist mucous membranes.

NURSING INTERVENTIONS > Discuss eating habits and food preferences and intolerances to food. > Determine psychological factors, cultural, or religious inferences.

RATIONALE > Necessary to appeal on client's likes and dislikes to food and allergies to food. >This would affect client's food choices, thus providing respect to their autonomy. > This would provide client relevant ideas as significance of eating nutritious foods thus increasing their cooperation and compliance to treatment . > This enhance intake of the client by using a distraction technique as well as a relaxation techniques. > Unpleasant odors or sights may have a negative effect on appetite. > Water is a vital element in our body to maintain homeostasis of fluids and electrolytes in the body. > To prevent injury from dryness.

EVALUATION > Goal met. Patient verbalized "Kailangan ko kumain kahit paunti-unti para lumakas ako kahit papano at para makalabas na ako dito." > Patient has moist mucous membranes, urine output of >30cc/hr. VS of BP=1110/80mmHg, T= 36.8 oC, RR= 20bpm, CR= 98bpm.

> Discuss importance of eating a wellbalanced and as well as effects on health when failed to take nutritious foods. > Promote pleasant, relaxing environment including socialization. > Minimize unpleasant odors or sights. > Promote adequate fluid intake.

NURSING CARE PLAN

NURSING DIAGNOSIS Activity intolerance r/t body weakness ASSESSMENT S-Medyo nahihirapan ako gumalaw., as verbalized. O>body weakness noted >with difficulty in moving extremities and body CLIENT OUTCOME Within the shift, client will able to tolerate some forms of activities. NURSING INTERVENTIONS > Assisted to a more comfortable position. > Assisted in moving from side to side. > Assisted in Rom exercises. RATIONALE > To enhance ability to participate in activities. > To prevent development of pressure ulcers. > To prevent contractures from occuring. > To enhance sense of wellbeing. EVALUATION > After 8 hours, the patient still has body weakness, thus he can't still tolerate some activities. Therefore, the goal is not met.

> Encourage client to maintain positive attitude, suggest use of relaxation techniques.

NURSING CARE PLAN

NURSING DIAGNOSIS Impaired Oral Mucous Membane r/t side effects of therapeutic regimen: chemotheraph y ASSESSMENT S> masyadong tuyo ang labi ko,as patient verbalized. O> dry lips noted >mucosal pallor noted CLIENT OUTCOME Within the shift, client will able to identify specific interventions to promote healthy oral mucosa.. NURSING INTERVENTIONS >Encourage adequate fluid intake >Instruct patient in oral hygiene techniques and proper dental care. RATIONALE > To prevent dehydration EVALUATION > Goal met, within the shift, patient was able to identify specific interventions to promote health oral mucosa

> Encourage early initiation og good oral health practices and timely interventions for treatable problems. > To prevent or limit mucosal or gum irritation

> Instruct patient to use soft-bristle brush to cleanse teeth. >Provide nutritional information

> To correct deficiencies and reduce irritation