LABORATORY VALUES

Urinalysis

Date: January 17, 2011

Laboratory Results Normal Analysis Nursing considerations

test values
Physical Examination 1. Explain the procedure and
Color yellow Amber- specific method of urine
yellow collection.
transparency hazy Clear Caused by pyuria, 2. Give the proper specimen
bacteriuria, or jars and cleaning agents if
phosphates in the necessary.
urine. 3. If possible, obtain first void
Ref: “Saunder’s of the day because it’s
Nursing Guide Lab more concentrated than the
& Diagnostics others.
(p.652) 4. Cover and refrigerate
PH 5.5 4.8 – 7.8 immediately if the
Specific 1.015 1.015 – specimen will not be tested
gravity 1.025 right away because the PH
Chemical Examination of a covered specimen will
Albumin Positive + Negative, Glomerulus dilates become alkaline because
normally not and impairs because the co2 will diffuse into the
present of decreased oxygen air. (diagnostic testing and
Sugar Positive ++ Negative reuptake which nursing implications, 3rd
+ causes passage of edition P223-224)
Blood Negative Negative big particles such as
Keytones Positive ++ Negative albumin, sugar, and  Albumin, sugar, blood:
+ blood into the urine. recommend diet low in
Nitrite Negative Negative (diagnostic testing protein. (diagnostic testing
Bilirubin Positive ++ Negative and nursing and nursing implications,
+ implications, 3rd 3rd edition P221)
Urobilinogen Negative Negative edition P221)
Leucocytes Trace Negative Keytones can
increase if presence
of starvation or
abnormal
carbohydrate
metabolism
Ref: “Saunder’s
Nursing Guide Lab
& Diagnostics
(p.653)
Microscopic Examination
Epithelial 4.20 /ul 0 - 11
cells
 LABORATORY VALUES

WBC 41.10 /ul 0 - 11 Elevation in WBC in

the urine indicates
urinary tract
infection, pyuria.
Ref: “Saunder’s
Nursing Guide Lab
& Diagnostics
(p.654)
RBC 7.90 /ul 0-11

Clinical Chemistry
Date: January 17, 2011
Laboratory Results Normal Analysis Nursing
test values considerations
Bilirubin Serum Pretest:
Total bilirubin 78.68 6.80 – 27.00 The hepatic  Instruct patient to
umol/L classification refers fast for 8-12 hours
Direct Bilirubin 72.33 1.70 – 8.20 to problems within over night.
umol/L the liver, due to
Indirect 6.35 umol/L 1.70 – 17.10 injury of the liver Post test:
Bilirubin cells or blockage  Ensure that the
SGOT (AST) 224.00 u/L 16.00 – within the vial of blood or
40.00 intrahepatic bile the microcapillary
ducts. tube is covered
and sent to the
Ref: “Saunder’s laboratory without
Nursing Guide Lab delay.
& Diagnostics Ref: “Saunder’s
(p.121) Nursing Guide Lab &
Chemical Examination Diagnostics (p.123-
Creatine 73.40 7.1 – 15.5 Decreased filtration 124)
mmol/day by the glomeruli and
Sodium 133.00 53.00 – renal tube
umol/L 115.00 absorption.
Potassium 9.20 umol /L 3.50 – 5.30 Nursing Guide Lab
SGPT (ALT) 263.00 U/L 8 – 53.00 & Diagnostics
(p.248,293,297)

Hematology (CBC)
Date: January 17, 2011
Laboratory test Results Normal values Analysis Nursing
considerations
 LABORATORY VALUES

Complete Blood Count

WBC 6.8 5.0 – 10.0 1. Explain
RBC 3.6 4.2 – 5.4 Caused by procedure to the
excessive loss of patient.
cells. 2. Obtain the
Nursing Guide specimen and
Lab & immediately
Diagnostics transfer the
(p.223) blood to the
Hemoglobin 11.7 g/dl 12.5 – 16.0 Due to decreased appropriate
RBC count. container.
Nursing Guide 3. Apply pressure
Lab & to the vein
Diagnostics puncture site.
(p.223) Assess site for
Hematocrit .35 .37 - .98 Caused by the bleeding.
excess loss of (diagnostic
RBC. testing and
Mean cell 96Fl 78 – 100 nursing
volume implications, 3rd
Corpuscular hbg 32 pg 27 – 31 Increased weight edition P374)
of hbg.
Corpuscular hc 34 ml  Hemoglobin,
Differential count hematocrit,
Segmenters .77 0.50 – 0 .70 Because of
Lymphocytes .09 0.20 – 0.44 infection
Monocytes 0.11 0.02 – 0.09 lymphocytes and
monocytes will
increase triggered
by the immuno-
response.
(laboratory and
diagnostic tests,
saunders, page
680)
PTT TEST
Date: January 18, 2011
PTT Result Unit Coagulation Normal Ranges
Pt. Control 37.7 seconds 28 – 44 seconds
Prothrombin time
Control 11.8 seconds
Pt. 11.8 seconds
Activity 79.7 70 – 130
INR 0.99 Equal to or less than 1.4

Ultrasound of the Hepatobillary Tree

 LABORATORY VALUES

Date January 18, 2011

Liver is normal size. Parenchyma is homogenous. Increase echogenicity. An anechoic focus with
enhanced through – transmission measuring 0.82 x 0.83 cm is seen in the left hepatic lobe.
The gallbladder is normal in size with thickened walls (.5 cm). A few mobile echonergic foci
with posterior shadowing measuring .66 cm - .83 cm are seen within the lumen. Positive mobile
medium level echoes are also seen layering in its dependent wall. Positive sonographic murphy’s
sign is elicited. Intrahepatic and common ducts are not dilated. Common duct measures .5cm.

IMPRESSION:
Hepatic steatosis
Hepatic cyst – left.
Calculus cholecystitis with biliary sludge

Endoscopic Retrograde Cholangioancreatography Report

Date: January 19, 2011
Findings
esophagus and stomach Normal
Duodenum Normal
Ampulla Potulous amnulla genenous sphirictorotomy dore
Pancreatic duct Not visualized
Common bile duct The CBD was selectively cannulated using sphinecterotomy guide wire
system. CBD was not dilated with filling defects seen at mid- CBD.
Sweepingusing dormia basket yielded few yellowish bile sludges after
which the balloon cholangiogram was done and able to extract one light
yellowish stone and plenty of sludges.
Gallbladder and cystic Multiple filling defect noted
ducts
Intrahepatic duct and No filling defects seen
helium
IMPRESSION:
Cholecystolithiasis, choledocholithiasis, bile sludges