DIAGNOSTIC TESTS

DIAGNOSTIC TESTS Complete Blood Count (07/28/13) NORMAL VALUES Red Blood Cell = 4-6x10.12/L Hematocrit = 0.37-0.47 Hemoglobin = 110-180 g/L WBC = 5-10x10 g/L Segmenters = 0.50-0.65 Lymphocytes = 0.25-0.35 Stabs = 0.05-0.10 Monocytes = 0.03-0.07 Eosinophils = 0.01-0.03 Basophils = 0.01 RESULT Red Blood Cell = 4.80 Hematocrit = 0.43 Hemoglobin = 145.0 WBC = 17.6 Segmenters = 0.80 Lymphocytes = 0.18 Stabs = 0 Monocytes = 0.02 Eosinophils = 0 Basophils = 0 INTERPRETATION WBC = An increase in WBC count could represent an ongoing infection Segmenters = High levels usually represent and ongoing infection, an inflammation, malignancy, cause by some drugs, etc. Lymphocytes= Low lymphocyte count is usually not significant. Stabs =Low stab count is usually not significant. Monocytes = Low levels of monocytes are usually none significant if other cells are normal. Eosinophils = Low levels are usually not significant. Basophils = Decreased in number suggests a stress reaction. NURSING CONSIDERATIONS Explain test procedure. Explain that slight discomfort may be felt when the skin is punctured. Encourage to avoid stress if possible because altered physiologic status influences and changes normal hematologic values. Explain that fasting is not necessary. However, fatty meals may alter some test results as a result of lipidemia. Apply manual pressure and dressings over puncture site on removal of dinner. Monitor the puncture site for oozing or hematoma formation. Instruct to resume normal activities and diet.

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Urinalysis (07/28/13)

Color: Pale yellow to amber Transparency: Clear to slightly hazy Specific Gravity: 1.015-1.025 PH Reaction: 4.5-8.0 Protein: Negative Sugar: Negative Acetone: Negative Blood Occult: Negative Microscopic WBC -/hpf: 2-5/hpf RBC -/hpf: less than 2/hpf Others NITRITE: Negative LEUKOCYTES: Negative

Color: Yellow Transparency: Cloudy Specific Gravity: 1.015 PH Reaction: 7.0 Protein: +1 Sugar: Negative Acetone: +1 Blood Occult: +2 Microscopic WBC -/hpf: INNUMERABLE RBC -/hpf: 4-6 Others NITRITE: POSITIVE LEUKOCYTES: POSITIVE

Transparency: Turbid (cloudy) urine may be caused by either normal or abnormal processes. Normal conditions giving rise to turbid urine include precipitation of crystals, mucus, or vaginal discharge. Abnormal causes of turbidity include the presence of blood cells, yeast, and bacteria. Protein: Presence of protein in urine indicates kidney damage. Acetone: Ketones are found in the urine in several other conditions, including fever; pregnancy; glycogen storage diseases; and weight loss produced by a carbohydraterestricted diet. Blood Occult: Presence of blood in urine may be caused by excessive red cell destruction, glomerular disease, kidney or urinary tract infection, malignancy, or urinary tract injury. Microscopic WBC -/hpf = A high number of WBCs indicates infection, inflammation, or contamination. RBC -/hpf = Indicates renal or urinary tract damage, infection or inflammation.

Instruct the patient to void directly into a clean, dry container. Sterile, disposable containers are recommended. Women should always have a clean-catch specimen if a microscopic examination is ordered. If a urine sample is obtained from an indwelling catheter, it may be necessary to clamp the catheter for about 15-30 minutes before obtaining the sample. Clean the specimen port with antiseptic before aspirating the urine sample with a needle and a syringe. Cover all specimens tightly, label properly and send immediately to the laboratory. If the specimen cannot be delivered to the laboratory or tested within an hour, it should be refrigerated or have an appropriate preservative added Inform the patient that specimen collection 29 | P a g e

HBSAG (QUALITATIVE) (07/28/13)

NONREACTIVE

NONREACTIVE

NITRITE: A positive test for nitrite indicates bacteruria, or the presence of bacteria in the urine. LEUKOCYTES: The presence of white blood cells in the urine usually signifies a urinary tract infection, such as cystitis, or renal disease, such as pyelonephritis or glomerulonephritis. A nonreactive test result means the person is not infected with Hepatitis B virus.

takes approximately 5 to 10 minutes.

Explain test procedure. Explain that slight discomfort may be felt when the skin is punctured. Encourage to avoid stress if possible because altered physiologic status influences and changes normal hematologic values. Explain that fasting is not necessary. However, fatty meals may alter some test results as a result of lipidemia. Apply manual pressure and dressings over puncture site on removal of dinner. Monitor the puncture site for oozing or hematoma formation. 30 | P a g e

 Pelvic Ultrasound (07/29/13) Fetal heart beat = 120 160 BPM Fetal weight = varies in AOG 20 weeks AOG = 10.58 oz and 300 grams No masses and other abnormalities found. Fetal heart beat = 180 BPM Fetal weight = 11 oz and 312 grams Approx EDC by LMP = December 15, 2013 Approx EDC by fetal measurement = December 19, 2013 The placenta is located ANTERIOR with Grade I placental maturity. The stomach and urinary bladder were noted suggesting patent orogastric tract and functional kidneys, respectively. The uterine cervix measures 4.09 cm in length and 2.7 cm in AP diameter. No masses. Impression: SINGLE LIVE, INTRAUTERINE FETUS, CEPHALIC, APPROX. 19 WEEKS and 4 DAYS OF GESTATION, BASED ON FETAL MEASUREMENTS. PLACENTA IS LOCATED ANTERIOR, GRADE I MATURITY NORMOHYDRAMNIOS, AFI = 12.5 CM An increase in fetal heart beat may indicate fetal distress.

Instruct to resume normal activities and diet. Inform the patient that this procedure can assist in assessing pelvic organ function. Instruct the patient to remove jewelry and other metallic objects from the area to be examined. Instruct the patient that a latex or sterile sheathcovered probe will be inserted into the vagina for the transvaginal approach. The patient should fast and restrict fluids for 8 hr prior to the procedure. Protocols may vary among facilities. Instruct the patient receiving transabdominal utz to drink three to five glasses of fluid 90 min before the examination and not to void, because the procedure requires a full bladder. Patients receiving transvaginal utz only do not need to have a full bladder. 31 | P a g e

Kidney, Ureter, Bladder (K.U.B.) Ultrasound (07/30/13)

Normal size and structure of kidneys, ureter and bladder.

NEGATIVE FOR ADNEXAL MASSES AND FLUID The kidneys are normal in size and location. The right kidney measures 11.54 x 4.89 x 4.43 cm with cortical thickness of 1.4 cm. The left kidney measures 10.32 x 4.6 x 4.95 cm with cortical thickness of 1.55 cm. The renal cortical parenchyma is normal in thickness and ethnogenecity. There is mild bilateral pelvoectasia, slightly greater in degree in the right. No focal mass seen. No calculus seen. The urinary bladder is well filled with urine. No intravesical echoes seen. The bladder mucosa is smooth. Impression: 1. Mild bilateral pelvoectasia, slightly greater degree in the right. This could be secondary to compression by the gravid uterus. However, an occult ureteral calculus in the right cannot be ruled out. 2. Normal ultrasound of the urinary bladder.

Bilateral pelviectasis = This is a condition in which there is dilatation of the renal pelvis, the kidney part that is in direct connection with the ureter. The ureter is in direct communication with urinary bladder. If urinary bladder infection occurs, transmission through the ureter to the renal pelvis may occur resulting a more serious infection known as pyelonephritis which was reported to be more common in children born with pelviectasis. Pyelonephritis can cause chronic renal damage. Pelviectasis is usually diagnosed in the prenatal period or shortly after in newborns and is thought to be a self limited that resolves later. Dilatation in the renal pelvis in adults occurs when obstruction below the kidney level occurs either in the ureter or in the bladder near the ureteric orifice (like stones, fibrosis). Back pressure will cause changes in the kidney usually in the form of renal pelvis dilatation and calcyeal dilatation.

Inform the patient that this procedure can assist in assessing pelvic organ function. Instruct the patient to remove jewelry and other metallic objects from the area to be examined. Instruct the patient that a latex or sterile sheathcovered probe will be inserted into the vagina for the transvaginal approach. The patient should fast and restrict fluids for 8 hr prior to the procedure. Protocols may vary among facilities. Instruct the patient receiving transabdominal utz to drink three to five glasses of fluid 90 min before the examination and not to void, because the procedure requires a full bladder. Patients receiving transvaginal utz only do not need to have a full bladder. 32 | P a g e