Question

Ms. RG, 85 year old female

End-stage COPD Pressure Injury-Stage 3 PMH s/p right lobectomy x 1 year ago s/p trach placement

Vital Signs q 4 hours NPO Trach Care q shift and as needed Trach mask to 50% humidified O2 Wet to dry dressing to coccyx q shift Wound culture IV-D5 ½ NS @ 100mL/hour IV-Cefazolin 1g in 100 mL of D5W q 8 hours

CBC BMP PT, PTT Wound culture Diagnostic Test Na: 138mEQ/ L Cl: 90 mEQ/ L K: 4.0 mEQ/ L Cr: 1.2 mg/ dL Glucose: 200 mg/ dL BUN: 25 mg/ dL WBC: 6800/ mm/3 Hgb: 11.5 g/dL HCT: 34% PLT: 200000 PT- 18 aPTT: 25 seconds

Patient had restful shift; needs dressing change to pressure injury on coccyx. Planned transfer back to SNF tomorrow.

Lab Planning: Fill in this table, according to the prior table, to create a Plan of Care with 3 Priority Lab

Lab	Normal Value/Critical Value	Clinical Significance	Nursing Assessment/Interventions Required
Lab	Normal Value/Critical Value	Clinical Significance	Nursing Assessment/Interventions Required
Lab	Normal Value/Critical Value	Clinical Significance	Nursing Assessment/Interventions Required

Answer 1

Lab1:
Glucose
Normal value:
Below 140mg/dl..patient value 200mg/dl(increase)
clinical significance:
Patient blood glucose level increased due to many factors..We need to control the blood glucose level..
Interventions required:
- Stop the intra venous glucose immediately and inform to doctor..
-check blood glucose after 4th hourly
-Watch the patient for hyperglycemic symptoms
-Provide Antidiabetic medication as per doctor advice
Lab2:
BUN ( blood,urea,nitrogen)
Normal value:
7-18mg/dl..patient value 25mg/dl it is increased
clinical significance:
there is increased blood urea concentration..we need to decrease the urea level
Intervention:
-Monitor 24 hours urine output
- monitor BUN, creatinine and electrolytes
-check patient weight
-follow strict hygienic precautions
-provide wound care
Lab3:
PT(prothrombin time)
Normal value:
10-12,patient value 18.it is increased
clinical significance:
prothrombin time take more than normal period for blood clot for this patient, she will be potential for bleeding..
Intervention:
-Avoid patient with any other activity , encourage only bed side activities
- Avoid injections
-Watch patient for any bleeding symptoms
- Administer oral anticoagulant drugs as per doctor advice..