A.

) INITIAL BLOOD GAS REPORT (ABL 800) JANUARY 28, 2013 @ 10:30 PM PURPOSE: Blood gas measurements are used to evaluate your oxygenation and acid/base status. They are typically ordered if you have worsening symptoms of an acid/base imbalance, difficulty breathing, or shortness of breath. Blood gases may be ordered along with other tests, such as electrolytes to determine if an electrolyte imbalance is present, glucose to evaluate blood sugar concentrations, and BUN and creatinine tests to evaluate kidney function. If continuing supplemental oxygen therapy, blood gases may be used to monitor the effectiveness of that treatment. Blood gas tests are ordered when you have symptoms of an oxygen/carbon dioxide or pH imbalance, such as difficulty breathing, shortness of breath, nausea or vomiting. Blood gas measurements may be ordered when you are known to have a respiratory, metabolic, or kidney disease and are experiencing respiratory distress. When on a "on oxygen" (ventilation), you may have your blood gases measured at intervals to monitor the effectiveness of treatment. Blood gases may also be ordered when you have head or neck trauma, injuries that may affect breathing. When you are undergoing prolonged anesthesia particularly for cardiac bypass surgery or brain surgery you may have your blood gases monitored during and for a period after the procedure. TEMPERATURE: 36.0 C PARAMETER pH PCO2 PO2 HC03 TCO2 ABE SAT.O2 IMPLICATIONS: partly compensated metabolic acidosis HEMOGLOBIN: 7.8 g/dL (NORMAL VALUE: 13.5 17.5) NORMAL RANGE 7.35 7.45 32 48 mmHg 83 108 mmHg 20 -24 mmol/L 21 25 mmol/L -3.3 (+) 1.2 mmol/L 95 -99 % RESULT 7.283 27.1 mmHg 126 mmHg 14.3 mmol/L 12.4 mmol/L -12.8 mmol/L 98.9 %

Decreased PCO2 and HCO3 may indicate metabolic acidosis by lowering the PCO2 to compensate. Increase ABE may indicate metabolic alkalosis.
Hughey (2001), in patients with chronic renal disease there is impaired excretion of Hydrogen ions and reabsorption of HCO3 in which impairing the normal process of regulating pH in. Hydrogen ions cause binding to HCO3 that leads to production of carbonic acid and decrease reabsorption of HCO3 which is basic that leads to impaired lowering of acid levels. As a normal compensatory mechanism, metabolic acidosis leads to alveolar hyperventilation with a fall in PaCO2. Reddy (2009)

B.) Blood Chemistry JANUARY 29, 2013 PURPOSE: Blood chemistry Tests to assess a wide range of conditions and the function of organs. Often, blood tests check electrolytes, the minerals that help keep the body's fluid levels in balance, and are necessary to help the muscles, heart, and other organs work properly. To assess kidney function and blood sugar, blood tests measure other substances. Creatinine test indicates the function capacity of the kidneys by measuring how much creatinine is in your blood. The SGPT (alanine aminotransferase) blood test is typically used to detect liver injury. The Amylase test is done to help diagnose and monitor acute or chronicpancreatitis and other disorders that may involve the pancreas LIVER FUNCTION TEST Purpose: Liver Function Test helps to detect inflammation and damage to the liver. They can also check how well the liver is working. Liver function testing includes ALT, AST, alkaline phosphatase, PT, INR, albumin, and bilirubin. Potassium and Sodium test Measures the amount of potassium in the blood. Potassium (K+) helps nerves and muscles communicate. This test is routinely done as part of a basic or comprehensive metabolic panel. This test is to diagnose or monitor kidney disease. The most common cause of high potassium levels is kidney disease. Because potassium is important to heart function, your doctor may order this test if you have signs of high blood pressure or heart problems. While sodium testing is used to detect abnormal concentrations of sodium, termed hyponatremia (low sodium) and hypernatremia (high sodium). It helps identify an electrolyte imbalance. It may be ordered to determine if a disease or condition involving the brain, lungs, liver, heart, kidney, thyroid, or adrenal glands is causing or being exacerbated by a sodium deficiency or excess, Urine sodium testing is also used to see if a person with high blood pressure is eating too much salt. JANUARY 29, 2013 BLOOD CHEMISTRY PHOSPHORUS RESULT 5.16 mg/dL REFERENCE RANGE 2.70 4.50 136 142 mmol/L

SODIUM 136 mmol/L JANUARY 30, 2013

BLOOD CHEMISTRY CREATININE UREA/BUN

RESULT 13.1 mg/dL 86 mg/dL

REFERENCE RANGE 0.6 1.5 7 - 18

LIVER FUNCTION TEST ALBUMIN 2.45 g/dL CLINICAL CHEMISTRY TEST POTASSIUM 5.3 mmol/L FEBRUARY 2, 2013 @ 5:45 AM BLOOD CHEMISTRY CREATININE CLINICAL CHEMISTRY POTASSIUM IMPLICATIONS: RESULT 7.0 mg/dL RESULT 4.7 mmol/L

3.80 5.10

4.0 5.6

REFERENCE RANGE 0.6 1.5 REFERENCE RANGE 4.0 5.6

The kidneys help control the amount of phosphate in the blood. Extra phosphate is filtered by the kidneys and passes out of the body in the urine. A high level of phosphate in the blood is usually caused by a kidney problem and there will be increased phosphate retention. American Association for Clinical Chemistry (2001). Sodium level is within normal range. An increase in BUN can mean the kidneys are impaired. It can also indicate problems in other body systems such as heart problems, dehydration or severe burns. Increased creatinine levels suggest that the kidneys are damaged or infected. BUN concentrations may be elevated when there is excessive protein breakdown (catabolism), significantly increased protein in the diet, or gastrointestinal bleeding (because of the proteins present in the blood). Patients on dialysis have higher BUN levels, usually 40-60 mg/dL. Nelson(2012) Albumin, produced only in the liver, is the major plasma protein that circulates in the bloodstream. A low serum albumin may indicate poor liver function. Decreased serum albumin levels are not seen in acute liver failure because it takes several weeks of impaired albumin production before the serum albumin level drops. The

most common reason for a low albumin is chronic liver failure. In advanced liver disease, the serum albumin level may be less than 3.5 g/dl. Albumin levels can be low in conditions other than liver disease, such as severe malnutrition and some kidney diseases that cause extensive protein wasting. The RnCeus (2010). Potassium level is within normal range

C.) ULTRASOUND
JANUARY 29, 2013 PURPOSE: X-ray beams are passed through the abdomen, producing images of the kidneys, ureters, and bladder on a special type of film. KUB radiography is often used as a first step in diagnosing problems of the urinary system, to determine the size, shape, and position of the kidneys and bladder to detect obvious abnormalities of the urinary system, such as kidney stones to help differentiate between urologic and gastrointestinal diseases, which both produce abdominal pain to locate a foreign object (e.g., that has been swallowed), to detect air or fluid in the space surrounding the abdominal organs (peritoneal space). EXAMINATION: K.U.B and P.G ULTRASOUND SONOGRAPHIC FINDINGS: Right kidney measures 7.1 x 3.3 cm

Cortical thickness 1.4 cm Left kidney measures 8.3 x 4.8 cm Cortical thickness 2.0 cm Examination reveals increased ethnogenicity of the renal cortices (Grade II) There is no evidence of a stone, mass or hydronephrosis The ureters are unremarkable The urinary bladder is normal The prostate gland is normal in size with a volume of 21.1 cc, smooth in outline There are no masses noted CONCLUSION: IMPLICATIONS: Intrinsic Renal Parenchymal disease BILATERAL

In patients with CKD/renal parenchymal diseases, the renal cortical echogenicity increases at ultrasound. In addition, the renal cortex often becomes thinner. Often this finding occurs with a normal bipolar renal length and an increase in the relative amount of central sinus fat. Beland (2010)

Complete Blood Count JANUARY 30, 2013 Purpose: This test helps in determining certain blood disorders, inflammation and infection. It evaluates the three main types of blood cells: the RBCS, WBCS, and platelet. It is frequently ordered to provide information about the hematologic system and other systems. It consists of a series of tests that determine the number, variety, percentage, concentrations, and quality of blood cells. It is also used in monitoring routine physical exam and diagnosis of a wide range of conditions and diseases. COMPONENT WBC NEU LYM MONO EOS BASO RBC HGB HCT MCV MCH RESULTS 12.0 K/uL 6.97 2.81 L .943 M 1.18 58.3 % N 23.5 % 7.89 % 9.86 % E NORMAL VALUE 4.10 10.9 2.50 7.50 1.00 4.00 .100 1.20 0.00 5.00 0.00 - .100 4.50 5.90 13.5 17.5 41.0 53.0 80.0 100 26.0 34.0 47.0 80.0 % N 13.0 40.0 % L 2.00 11.0 % M 0.00 5.00 % E 0.00 2.00 % B

.058 .482 % B 3.01 M/uL 8.15 g/dL 23.6 % 78.4 fL 27.1 pg

MCHC RDW PLT MPV IMPLICATIONS:

34.5 g/dL 17.2 % 364 K/uL 6.34 fL

31.0 36.0 11.6 18.0 140 440 0.00 99.9

High WBC count usually means there is increase in production of these cells to fight a possible infection. It may also means it is a reaction to a drug that helps in improving the WBC production. Bone marrow diseases may also cause high white blood cells count. Or it may also be due to an immune system disorder that leads to increase in white blood cell production. Increased eosinophils can be idiopathic (primary) or, more commonly, secondary to another disease. Allergic diseases are the most common causes, especially those of the respiratory or integumentary systems and parasitic infection can cause eosinophilia. Baxamusa (2010) The means of discerning the hematocrit levels in the body are Mean Corpuscular Volume (MCV) and the Red Cell Distribution Width (RDW), and these help doctors determine if a person is suffering from low hemoglobin and hematocrit levels in the body. The MCV determines the actual size of the blood cells, and the RDW determines the differences in size between all the red blood cells. Decreased results of this test may indicate red blood cell production is disrupted or there could be blood lost or bleeding happening. Thadani (2010)

D.) RESCREENING TEST RESULT

JANUARY 30, 2013 PURPOSE:

NVBSP20130010408/65848636 GROUP A RH (+)

Anti- HCV MEIA detects the presence of antibodies to the hepatitis c, indicating exposure to HCV. This test cannot distinguish between someone with an active or a previous HCV infection. Usually, the test is reported as "positive" or "negative." There is some evidence that if the test is "weakly positive," it may be a false positive. The Centers for Disease Control and Prevention (CDC) suggests that weakly positive tests be confirmed with the HCV RIBA test before being reported. Anti-HIV ECLIA HIV antibody test looks for HIV antibodies in a persons blood, urine, or fluids from the mouth. When a person has a positive result from an HIV antibody test, a second and dierent type of antibody test is done to confirm that the person is indeed infected with HIV (western blot).

HBsAG. ECLIA test the presence of protein that is present on the surface of the virus; will be present in the blood with acute and chronic HBV infections. Often used to screen for and detect HBV infections; earliest indicator of acute hepatitis B and frequently identifies infected people before symptoms appear; undetectable in the blood during the recovery period; it is the primary way of identifying those with chronic infections. TEST Anti-HCV MEIA Anti-HIV ECLIA HBsAG. ECLIA 0.19 0.37 0.64 RESULT CUT OFF 1.00 1.00 1.00 INTERPRETATIO N Non reactive Non reactive Non - reactive

REMARKS: RPR: Non reactive Malarial smear not done due to limitations of the procedure

IMPLICATIONS:

Anti HCV nonreactive means that px was never exposed to hepatitis C. American Association for Clinical Chemistry (2010) HBsAg nonreactive means no active or prior infection; not immune or is possibly still in the incubation stage or Infection is already resolved (recovery); and must
do other test to confirm results like Anti-HBS, Ant-HBC IGM-IGG, HBEAG, Anti-HBE . American Association for Clinical Chemistry (2010)

Anti HIV eclia nonreactive means no antibodies were found which could take the rate of reaction during test to HIV anti bodies. American Association for Clinical
Chemistry (2010)

Reddy P, Mooradian AD. (2009). Clinical utility of anion gap in deciphering acid-base disorders. Retrieved from: http://emedicine.medscape.com/article/242975-overview Hughey, M.J(2001). ABG (Arterial Blood Gas). Retrieved from: http://www.brooksidepress.org/Products/OperationalMedicine/DATA/operationalmed/Lab/ABG_ArterialBloodGas.htm

American Association for Clinical Chemistry,(2001). Phosphorus. Retrieved from: http://labtestsonline.org/understanding/analytes/phosphorus/tab/test

Nelson, M (2012). What Do Elevated BUN & Creatinine Levels Mean?. Retrieved from: http://www.ehow.com/facts_6005342_do-bun-creatinine-levels-mean_.html#ixzz2Jw5uHlqP The RnCeus, (2010). Liver Function And Albumin. Retrieved from: http://www.rnceus.com/lf/lfalb.html

Beland, M. (2010) Renal Cortical Thickness Measured at Ultrasound: Is It Better Than Renal Length as an Indicator of Renal Function in Chronic Kidney Disease? Retrieved from http://www.ajronline.org/content/195/2/W146.full.pdf

Baxamusa, B. (2010). High White Blood Cell Count - What Does it Mean. Retrieved from: http://www.buzzle.com/articles/high-white-blood-cell-count-what-does-it-mean.html Thadani, R. (2010). Low Hemoglobin and Hematocrit. Retrieved from: http://www.buzzle.com/articles/low-hemoglobin-and-hematocrit.html American Association for Clinical Chemistry,(2001). Hepatitis C Retrieved from: http://labtestsonline.org/understanding/analytes/hepatitis-c/tab/test American Association for Clinical Chemistry,(2001). Hepatitis B. Retrieved from: http://labtestsonline.org/understanding/analytes/hepatitis-b/tab/test

American Association for Clinical Chemistry,(2001). HIV Antibody. Retrieved from: http://labtestsonline.org/understanding/analytes/hiv-antibody/tab/test