Lab Analysis Nursing Assignment

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Lab Analysis Nursing Assignment

Lab Analysis Nursing Assignment

please use the attachment for the question

RNNUR235CaseStudyAdultIILabandDiagAnalysisAPAPaper.doc

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Nursing 235: Adult Health II

Laboratory Analysis Case Scenario

Patient Initials: KH Age: 60

Height: 65 in

Weight: 67.13 kg

HPI

KH presented to the ED with c/o bug bite on L thigh that occurred about 10 days ago that has turned into an abscess “as big as a personal sized watermelon.” Patient also reported urinary burning, frequency, and urgency. The ED, WBC 37,000, glucose 317, bicarbonate 13, anion gap 25, large amount of acetone, HgbA1C 10.3. Patient was admitted to the hospital for evaluation and management of DKA, DVT, abscess, and UTI. Lab Analysis Nursing Assignment

Past Medical/Surgical History:

· Type 2 Diabetes Mellitus

· Previous tobacco use (1/2 pack per day)

· MVA 7/13/20: pain in pelvis and knees since accident

Significant Clinical Events:

8/23/20

· Wound culture: staph aureus, methicillin sensitive

· Blood culture: no growth after 5 days (determined on 8/28/10) Lab Analysis Nursing Assignment

· Urine analysis indicates infection and DKA

· Insulin drip for DKA

· IV antibiotics for UTI, multiple abscesses

· IV antifungals for multiple abscesses & topical antifungal for yeast infection

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

8/24/20

· Deep muscle abscess extends to femur (visualized via CT)

· I&D done in OR discovered diffuse myositis & muscle necrosis

· S/p insulin drip for DKA treatment

· Wound nurse consult

· Infectious disease consult

8/26/20

· I&D done in OR on L thigh, R groin abscess

· Patient experience bleeding post-op

· SCD and TED hose prescribed for DVT

8/28/20

· d/c Coumadin due to post procedure bleeding, switched to Lovenox

8/29/20

· bleeding from wound, changed lovenox to heparin

· anemia due to blood loss s/p I&D, received 2 units packed RBC

· Constipation for 1 wk, senna, colace, lactulose

8/30/20

· blood glucose 340-360 mg/dL all day

· patient complains of recent onset visual disturbances (since hospitalization on 8/23/10)

· notify MD, increase levemir to 32 units daily

· MD d/c IV antibiotic and heparin, change to PO antibiotics and coumadin

Test/Result Admit 

8/23/20

 Sun 

8/29/20

 Mon 

8/30/20
Hemoglobin (g/dL) 13.8 7.4L 9.1L
Hematocrit (%) 42.2 21.1L 25.8L
RBC (M/uL) 4.35 2.28L 2.82L
WBC (K/Ul) 37.2H 11.4H 14.2H
MCV (FL) 97.1H 92.5 91.7
MCH (PG) 31.7 32.3 32.3
MCHC (g/dL) 32.7 35 35.2
RDW (%) 15.1H 15.8H 15.5H
PLT (K/uL) 461H 408 428H
MPV (FL) 7.5 6.6 6.3
PT (Sec.) n/a 9.7 10.0
INR n/a 0.93 0.96
PTT (Sec.) n/a 29.4 @ 0600 

30.3 @ 1400

 24.6 @ 0600 

48.1 @ 1400
guaiac negative
BUN (mg/dL) 15 7L 6L
Creatinine–mg/dl 0.96 0.29L 0.36L
GFR AF 54 n/a >60
BNP 277H
AGAP 25.0H 8.0 9.0
Chlroide (mmol/L) 92L 102 98
CO2 (mmol/L) 13L 24 25
Potassium (mmol/L) 4.8 4.1 4.0
Sodium (mmol/L) 130L 134L 132L
Glucose (U/L) 397H 266H 368H
HgbA1C 

 

 10.3H
Urinalysis 

Color

Yellow

 yellow
Appearance 

Clear

 Hazy
Spec. Gravity 

1.002-1.030

 1.025
PH 

4.5-8.0

 5.5
Protein 

Negative

 200mg/dL
GLU 

Normal

 1000mg/dL
Ketones 

Negative

 >150
Blood 

Negative

 300
Urobilinogen 

Normal

 2mg/dL
Leuk Ester 

Negative

 500

Dx. Tests Date and Client Results

Gram Stain 

 

 8/23/10 & 8/25/10 wound culture: gram positive cocci staph like
Cultures/ 

Sensitivities

 

 8/23/10 blood culture: no growth after 5 days (8/28/10) 

8/23/10 wound culture of groin abscess: staph aureus, sensitive to methicillin, clindamycin, erythromycin, oxacillin, naficillin, amoxicillin, clavulanic acid, ampicillin, sulbactam, SXT, most parenteral and oral cephalosporins

8/23/10 urine culture: >100,000 CFU/mL staph aureus sensitive methicillin, nitrofurantoin, oxacillin, SXT

8/25/10 culture abscess L bottom: staph aureus (see above wound culture for sensitivities)
Therapeutic 

Drug Levels

 PT (9-11.5 sec) and INR (2.0-3.0) evaluate therapeutic drug levels of coumadin, PTT (60-70 sec) evaluate therapeutic levels of heparin.

Dx. Tests Date and Client Results

CXR 

 

 8/23/10 CXR: cardiac mediastinal silhouettes normal, lungs are clear. No pleural effusion or indication of CHF.
CT/US/ 

Nuc Med/ Spec Proc

 

 8/26/10 CT abdomen & pelvis without contrast: inflammatory mass-like density with subcutaneous of R groin containing central air bubbles presumably secondary to recent drainage/intervention. No well-organized fluid collection in region. Body wall and intra-abdominal edema. Few non-specific bubbles of air within lower anterior abdominal wall. Abscess in proximal L thigh and L buttock not imaged. Lab Analysis Nursing Assignment 

8/26/10 CT pelvis with IV contrast: superficial L medial buttock abscess 5-6cm diameter extending inferiorly and connected to large deep muscle abscess, extends to femur measures 8x10cm

 
Cardiac monitoring 

 

 Measure and compare with report: 

PR interval:

QRS:

QT interval:

P-P interval regular:

R-R interval regular:
Medications
Cefazolin (Ancef) 

2g/D5W 110mL IVPB q 8hrs infuse over 30 min

 
Clindamycin (Cleocin) 

900mg IVPB infuse over 30 min
Fluconazole (Diflucan) 

100mg PO Q 24hrs
Heparin 

100 units/mL standard infusion

 

 
Warfarin (Coumadin) 

 

 
Nystatin 

Topical
Insulin Aspart 

0-14 units SQ 4 times daily ac/hs
Insulin Detemir (Levemir) 

32 units SQ daily
Polyethylene glycol (Golytely) 

400mL PO one time
Acetaminophen (Tylenol) 

650mg PO q 4 hrs prn

 

 
Oxycodone (Oxycontin) 

5 mg PO Q 4 hrs prn
Morphine (Duramorph) 

4mg IV Q 3hrs prn
Hydromorphone (Dilaudid) 

1mg IV Q 3hrs prn
Calcium Carbonate (Tums) chewable 

500mg PO 3x daily prn
Promethazine (Phenergan) 

6.25mg IV q 4hrs prn
Sennosides/ docusate sodium 

8.6mg/50mg 1 tablet PO BID prn

 

 
Trazadone (Desyrel) 

25mg PO hs prn

 

 

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  • attachment 

    RNNUR235LabandDiagAnalysisRubricFall2020.doc

    Lab Analysis: Grading Rubric

    TOTAL 50 Points

    Content  

     

    		  

     

    		  

     

    		 Points
    Analysis of data All of these criteria apply: 

    · Explanation unclear

    · Interpretation inaccurate

    · Some labs not addressed = 0 points

    		 2 of these criteria apply: 

    · Explanation partially clear

    · Interpretation partially inaccurate

    · Some labs not addressed = 7.5 points

    		 Explanation clear as to how altered lab values fit or don’t fit with patient’s current clinical status; all labs addressed; interpretation accurate = 

    15 points

     
    Diagnostic Statement All of these criteria apply: 

    · PCs/NANDAs are not based on lab results.

    · Diagnostic statements are not in correct format = 0 point

    		 1 of these criteria apply: 

    · PCs/NANDAs are not based on lab results.

    · Diagnostic statements are not in correct format = 5 points

    ·

    		 Identification of PCs/ NANDAs 

    based on lab results. Diagnostic statements are in correct format. = 10 points
    Desired Outcome All of these criteria apply: 

    · Desired outcomes are not measurable and achievable.

    · Outcomes are not relevant to PCs/ NANDAs = 0 point

    		 1 of these criteria apply: 

    · Desired outcomes are not measurable and achievable.

    · Outcomes are not relevant to PCs/ NANDAs = 2.5 points

    ·

    		 Desired outcomes are measurable and achievable and are relevant to the PCs/ NANDAs = 5 points
    Interventions All of these criteria apply: 

    · No specific intervention identified

    · Interventions not relevant to NANDAs or PCs

    · Rrationale do not support selected interventions. = 0 points

    		 2 of these criteria apply: 

    · Nursing/collaborative interventions are not consistent with NANDAs and PCs;

    · Are not relevant to address/correct altered lab values

    · Rationale do not support the selected interventions. = 7.5 points. Lab Analysis Nursing Assignment

    ·

    		 Nursing/collaborative interventions are consistent with 

    NANDAs and PCs; relevant to address/

    correct altered lab values. Rationale support selection of interventions. = 15 points
    Evaluation Inaccurate or no identification of effects of nursing interventions on patient’s status = 

    0 points

    		 Partial identification of effects of nursing interventions on patient’s status = 2.5 points Identification of effects of nursing interventions on patient’s status = 

    5 points
    Format Many spelling or grammar errors; or, no citing of references = deduct 

    4 points

    		 Some spelling or grammar errors; or, incorrect citing of references; or, references page not in APA format = deduct 2 point Free of spelling and grammar errors; correct citation of references; reference page contains references in APA format = 0 point 

     

     
    TOTAL POINTS
  • attachment 

    RNNUR235LaboratoryandDiagAnalysisGuidelineFall2020.doc

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    LABORATORY ANALYSIS ASSIGNMENT GUIDELINES

    PURPOSE OF ASSIGNMENT

    Integration of health alterations (medical and nursing diagnoses), presenting signs and symptoms, treatments, medications, and their effects on diagnostic laboratory results for a specific client.

    DATA COLLECTION

    The case scenario used for this Laboratory Analysis Assignment is similar to clients that you would have been assigned to in clinical.

    FORMAT

    · Introduction

    · Description of health alterations

    · Define medical diagnoses

    · Explain the pathophysiology for each diagnosis

    · Discuss how diagnoses are interrelated

    · Signs and Symptoms

    · Provide rationale for the client’s S&S in relation to the pathophysiology of his/her health alterations

    · Complete Laboratory Analysis Table

    · Analyze lab data for abnormal, pertinent normal, and therapeutic results, in relation to health alterations, client’s presenting S&S, and treatments (including medications). Explain how the lab results are a reflection of the pathologic process, client responsive or unresponsive to treatment, sign of a side effect or complication of treatment, and what S&S the client might exhibit from the lab results. Lab Analysis Nursing Assignment

    · Identify client problem—nursing diagnosis (NANDA) and/or collaborative problem based on the lab data.

    · Identify NOC and write desired outcome for the client problem. Must be achievable and measurable.

    · List NIC and nursing/collaborative interventions that address/correct the altered lab results. Include rationale for the interventions, with citations for the reference used (use APA format).

    · Evaluate the expected effects of the interventions on the client’s status. Include evaluation of the effectiveness of the interventions, degree that desired outcomes have been achieved, and if the client problem was resolved. Lab Analysis Nursing Assignment

    · Use a separate Diagnostic Analysis table for each client problem. Related laboratory data can be included on the same table. For example:

    · Health alteration: Glomerulonephritis

    · Nursing diagnosis: Excess fluid volume related to inflammation of the glomeruli, decreasing filtration, as evidenced by weight gain, edema, I>O, hypertension, decreased total protein/ablumin, increased BUN/Cr, proteinuria.

    · Lab Data: BUN, Creatinine, albumin, total protein, urinalysis

    · Conclusion

    · References (Use APA format)