F.

DIAGNOSTIC AND LABORATORY PROCEDURES

DATE
ORDERED
DIAGNOSTIC AND INDICATIONS OR
RESULTS ANALYSIS AND INTERPRETATION
PROCEDURE DATE PURPOSES
RESULTS
IN

2D Date Echocardiogram is a test in
Echocardiogram Ordered: which ultrasound is used to
with Doppler 11-27-09 examine the heart and
Date capable of cross-sectional
Results In: "slice" of the beating heart,
11-27-09 including the chambers,
valves and the major blood
vessels that exit from the left
and right ventricle In the case
of the patient who had
undergone Echocardiogram,
it was used to show the
structure and movement of
the heart as well as blood
flowing through blood
vessels.
1. Dilated left ventricular size with
thinned out akinetic entire
interventricular septum from mid to
apex, severe hypokinesia of all left
ventricular segments except the
basal anterior interventricular septum
and anterior left ventricular free wall
which shows some contractility; left
ventricular systolic function is
severely depressed with calculated
ejection fraction of 34% by cube
method and 25 +/- 25% by visual
estimated method; there is
spontaneous echocontrast noted but
without definite thrombus formation.
Hypokinesia or decrease movement
of left ventricular segments is due to
heart attack and decreased blood
flow from blockage in an artery.
Blood pools to the left ventricle
causing left ventricle dilatation. Blood
pooling will trigger the left ventricle to
pump harder but as the heart tires,
the left ventricle’s capacity to pump is
decreased. This is supported by the
depression of left ventricular systolic
function with an ejection fraction of
34%.

2. Dilated right ventricular size with

mild hypokinetic free wall; prominent
moderate band.

3. Diatrial dilatation without visible

thrombus.

4. Thickened aortic cusps without

restriction of motion.

28
 5. Thickened mitral valve leaflets
without flow configuration without
restriction of motion.

6. Structurally normal tricuspid and

pulmonic valves.

7. normal main pulmonary artery.

8. normal aortic root and visualized

portion by proximal ascending aorta.

9. No pericardial effusion on Doppler:

tricuspid regurgitation-moderate;
mitral regurgitation- moderate.
Pulmonic regurgitation- mild. Mild-
moderate pulmonary hypertension
with estimated pulmonary artery
pressure of 56% by tricuspid
regurgitation jet area
method restrictive mitral inflow
pattern.

Conclusion:
Dilated left ventricle with
segmental wall motion
abnormalities, CAD etiology can’t
be ruled out; Severely depressed
left ventricular systolic function
with at least grade 3 left
ventricular diastolic dysfunction.
No visible thrombus noted. Biatrial
dilatation without visible thrombus
specimen.

29
 Nursing Implication for 2D Echocardiogram

 BEFORE:

1. Check the Doctor’s order.

2. Consent must be signed by the patient.
3. Instruct the patient that lubricating jelly would be applied on his chest.

 DURING:

1. Inform the patient to lie still during the procedure.

 AFTER:

1. Wipe off the gel that was applied to the skin

2. Document the results that were performed.
3. Attach the result on the chart of the patient as soon as it is available

ELECTRO Date ECG was indicated to the 11-25-09 ST segment depression signifies a
CARDIOGRAM Ordered: patient to confirm the (9:00pm) partially blocked artery. Impaired
11-25-09 presence of chest pain and to The patient ECG shows a marked heart perfusion due to coronary
(ECG) 11-26-09 check for any electro ST segment depression occlusion will lead to myocardial cell
physiologic changes. 11-25-09 death; the heart’s muscle will then be
Results in: (9:30pm) irritated. As a result, the heart tries to
11-25-09 The patient ECG shows atrial compensate by pumping faster but
(9:00pm) fibrillation in rapid ventricular this pumping action is not effective
11-25-09 response. This type of resulting to irregular heartbeats. Clot
(9:30pm) arrhythmias is common among formation may arise as a result of
11-26-09 patient with acute injury to the blood pooling due to irregular
(8:00am) myocardium heartbeat.
11-26-09
(8:00am)
The patient’s ECG shows a normal
sinus rhythm, this is probably
because of the effect of the lidocaine

30
 drip given to the patient.
Nursing Implication for Electrocardiogram

 BEFORE:

1. Check the Doctor’s order.

2. Inform the patient about the procedure that would be done.
3. Instruct the patient that lubricating jelly would be applied on his chest.

 DURING:

1. Inform the patient to lie still during the procedure.

 AFTER:

1. Wipe off the gel that was applied to the skin

2. Document the results of the ECG.
3. Attach the result on the chart of the patient as soon as it is available

Chest X-Ray (PA) Date Chest X-ray PA view gives a
Ordered: good assessment of the
11-25-09 cardiac size. In the case of
Date the patient, it was also used
Results In: to detect presence of
11-25-09 pulmonary congestion or
edema, which would be more
likely in patients with NSTEMI
involving a significant
proportion of the left ventricle
or in those with known left
ventricular dysfunction.
11-25-09
Examination of the chest
radiograph reveals fuzziness of
the lung markings in both lungs.
Future cardiac size cannot be
ascertained.
Aorta is dilated.
Other chest structures are
unremarkable.
leading to the backflow of this blood to
Impression:
1. Consider mild pulmonary
congestion.
2. True cardiac size not
ascertained.
Fuzziness in chest x- ray denotes a
fluid accumulation in the lungs. The
fluid accumulation in the lungs in
brought by the pooling of the blood in
the left ventricle due to decreased
function of the heart until in some
period of time, the ventricle will not be
able to accommodate the increasing
volume of blood in the ventricle
the lungs.

31
 3. Atherosclerotic aorta.
Nursing Implication for Chest X- ray

 BEFORE:

1. Explain the procedure to the patient/patient’s SO.

2. Assure the patient that the procedure will be pain free
3. Inform the patient that no jewelries or any accessories should be worn
4. Ask the patient to remove shirt and wear X-ray gown
5. Provide privacy to the client.

 DURING:

1. Inform the patient to lie still during the procedure.

2. Assist the patient in during the procedure.
3. Assist the radiologist when doing the procedure.

 AFTER:

1. Attach result to the chart as soon as it is available.

2. Refer for any unusual findings
DATE
LABORATORY ORDERED INDICATIONS OR NORMAL ANALYSIS AND
RESULTS
PROCEDURES AND DATE PURPOSES VALUES INTERPRETATION
RESULTS IN

CK-MB Date Ordered: Creatine kinase (CK)
11-26-09 Date and its isoenzyme CK-
Results In: MB are the most
11-26-09 specific enzymes
analyzed in acute MI,
and they are the first
enzyme levels to
increase. Since the
patient is experiencing
47.4 mg/dl 0.00 – 10.40 mg/ml The appearance of
elevated CK–MB levels in
serum is highly specific
and sensitive for
myocardial cell wall injury.
In the case of the patient
who is known to
experience chest pain,
CK-MB was tested to

32
 chest pain, enzyme detect myocardial cellular
levels should be tested necrosis or damage as
in relation to the time of this enzyme are
onset of chest significantly elevated in
discomfort or other events of myocardial
symptoms to suspect hypoperfusion. The CK-
myocardial infarction. MB level is significantly
elevated therefore
confirming the occurrence
of MI. CK-MB starts to
reach its peak level within
3-6 hours after the onset
of chest pain and remains
elevated for 12-36 hours.
With this finding, Imdur
was administered for the
patient to relieve angina
attacks.
Troponin T- plasma Date Ordered: 0.00 – 0.05
(heparinized) 11-25-09 Troponin T is a protein ng/ml Troponin T result is within
Date Results In: found only in cardiac the normal range of less
11-25-09 muscle. Troponin test than 0.05 mg/ml which
is primarily ordered for indicates that there has
the patient, since he <0.05 ng/ml not been a heart damage.
was known to Troponin T is known to
experience chest pain reach is peak level within
from the day he was 12-48 hours after the
admitted. onset of chest pain.
It was also ordered to
detect if he have had
heart attack or other
damage to the heart.

Nursing Implication for Blood Chemistry

 BEFORE:

1. Check the doctor’s order

33
2. Explain the procedure
3. Explain the purpose and what to expect
4. No food or fluid restrictions

 DURING:

1. Do not take the blood sample from hand or arm with receiving IVF
2. The tourniquet should be less on a minute
3. Do not squeeze the punctured site rightly
4. Wipe away the first drop of blood
5. Collect recommended amount of blood.

 AFTER:

1. Observed and record vital signs.

2. Check injection sites for bleeding, infection, tenderness or thrombosis.
3. Report untoward reaction to the physician.
4. Apply warm compress to ease discomfort, as ordered.
5. Apply pressure to the puncture site until the bleeding stops to reduce bruising.
6. Encourage relaxation by allowing client to discuss experiences and verbalize feelings.
7. Interpret results and provide counsel appropriately.

COMPLETE BLOOD Date Ordered: This test evaluates the 124 g/dl 140- 175 g/dl The patient’s Hgb is
COUNT 11-25-09 hemoglobin and test below the normal which
the iron status and indicates that there is an
Hemoglobin (Hgb) Date Results In: oxygen carrying inadequate oxygen
11-25-09 capacity of carrying capacity of the
erythrocytes since the blood due to the viscosity
patient has DM, the of the blood as a result of
possibility of having a patient’s DM.
low hemoglobin count
can be suspected due
to the viscosity of the
blood.

34
Hematocrit (Hct) Date Ordered: To detect abnormally 0.39
11-25-09 low levels of hematocrit
Date Results In: due to blood viscosity
11-25-09 as a result of patient’s
DM.
To aid diagnosis of
abnormal states of
hydration, since the
patient was at risk to
develop dehydration
due to an increased
urine output and
diaphoresis, this test
was ordered to check
for fluid deficit.
041- 0.50 g/dl The result is decreased
because of
hemoconcentration
resulting from increased
blood glucose level AEB
HGT of 159 mg/dl.
Low hematocrit levels
also suggest that there is
decreased circulating
blood volume to the
patient, since he was at
risk to develop fluid deficit
and so, the patient was
kept hydrated with D5W.

WBC Date Ordered: The WBC count is 6.9 4.5-11 x 109/L The patient’s WBC is
11-25-09 used to determine the within normal range which
Date Results In: presence of an indicates that the patient
11-25-09 infection. The test was has no infection.
performed to the
patient to find out if
elevated WBCs would
mean the presence of
an infection since the
patient had DM, the
viscosity of the blood
would impair blood flow
and the hemoglobin
release of oxygen and
that would cause an
infection.

35
Neutrophils Date Ordered: To detect presence of 0.65 0.18-0.70 The result indicates a
11-25-09 bacterial infection or an normal amount of
Date Results In: inflammatory disease neutrophils within the
11-25-09 due to impaired blood circulation and that it is
flowing within the not near borderlines of
patient’s body as a the normal range value in
result of DM. which there is no bacterial
infection. Since the
patient may have an
infection as a result of
DM.

Lymphocytes Date Ordered: To detect presence of 0.30 0.10-0.48 Patient’s lymphocytes

11-25-09 viral infection due to reveal a result of 0.30
Date Results In: impaired blood flowing which is within the normal
11-25-09 within the patient’s range of 0.10-
body as a result of DM. 0.48.wherein there is
absence of a viral
infection. Since the
patient may have an
infection as a result of
DM.

Eosinophils Date Ordered: To detect presence of 0.01 0.00-0.03 The result of 0.01, is
11-25-09 allergic disease or normal, with the given
Date Results In: parasitic infection due range of 0.00 – 0.03.
11-25-09 to impaired blood Since the patient may
flowing within the have an infection as a
patient’s body as a result of DM.
result of DM.

36
 Monocytes Date Ordered: To detect presence of 0.04 0.00-0.04 The patient’s monocytes
11-25-09 inflammation due to result is within the upper
Date Results In: impaired blood flowing borderline of the normal
11-25-09 within the patient’s range, but may indicate
body as a result of DM. as well that the client had
an inflammation due to
the absence of Neutrophil
elevation. This has been
tested since the patient
may have an infection as
a result of DM.

Platelet count Date Ordered: Platelet count is 218,000/µL 150-400 x 109/L The result indicates that
11-25-09 determined to establish the platelet count is within
Date Results In: baseline data the normal range; wherein
11-25-09 regarding the number in the case of the patient
of platelet circulating in it was checked prior to
the body of the patient administration of Heparin
prior to administration to note for abnormally low
of antithrombotic drugs platelet count since,
such as Heparin and Heparin is a drug that can
Aspirin. lower platelet count.

Nursing Implications for CBC Test:

 BEFORE:

1. Inform the patient that the test is used to evaluate numerous conditions inflammation, infection, and response to
chemotherapy.
2. Obtain a history of the patient’s complaints (such as allergies and sensitivity to latex.
3. Obtain a history of the patient’s gastrointestinal, hematopoietic, immune, and respiratory systems, as well as
results of previously performed laboratory tests, surgical procedures, and other diagnostic procedures.
4. Obtain a list of medications the patient is taking, including herbs, nutritional supplements, and nutraceuticals.
37
5. Review the procedure with the patient. Explain the duration of the procedure and inform the client that there may
be some discomforts during the procedure.
6. Consider the patient’s cultural beliefs and practices and it is important to provide psychological support before,
during, and after the procedure.

 DURING:

1. Avoid using equipment containing latex if the patient has allergy to it.
2. Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid
unnecessary movement.
3. Observe Standard precautions.
4. Remove the needle, and apply a pressure dressing over the puncture site.
5. Promptly transport the specimen to the laboratory for processing and analysis.

 AFTER:

1. Observe venipuncture site for bleeding or hematoma formation. Apply paper tape or other adhesive to hold
pressure bandage in place.
2. Instruct the patient to limit salt intake, alcohol intake and cut down smoking.
3. Reinforce information regarding the test results and address any concerns voiced by the patient or family

Prothrombin Time Date Ordered: Prothrombin Time 13.7 s 10-14 s The patient’s PT level is
11-25-09 measures the ability of within the normal range
Date Results In: the blood to clot and in which indicates that the
11-25-09 the case of the patient clotting factors that are
who is taking being produced in the
anticoagulant drugs liver are still being
which are Aspirin and synthesized well in the
Heparin; they should liver AEB no presence of
be checked prior to bleeding or bruises noted.

38
 administration.
International Normalized Date Ordered: INR value was used to 1.14
Ratio (INR) 11-25-09 monitor prior to the
administration of anti-
Date Results In: coagulant drugs such
11-25-09 as Heparin and Aspirin.
Activated partial Date Ordered: Along with the PT test, 34.8 s
thromboplastin time 11-25-09 the aPTT was used to
(aPTT) Date Results In: investigate the cause
11-25-09 of a bleeding or
thrombotic (blood clot)
episode of the patient.
It is also used as a
baseline data prior to
the administration of
anticoagulant drugs,
which are Heparin and
Aspirin.
Anticoagulant drugs such
as Heparin and Aspirin
were given to inhibit
formation of blood clots.
0.8- 1.2 The INR value of 1.14 is
within the normal range
which indicates that the
patient has normal
clotting function AEB no
bleeding and bruises
noted. Anticoagulant
drugs such as Heparin
and Aspirin were given to
inhibit formation of blood
clots.
31.88- 43.68 s aPTT result of the patient
is within the normal
range; which reflects that
the patient has normal
clotting function AEB no
bleeding and bruises
noted. Anticoagulant
drugs such as Heparin
and Aspirin were given to
inhibit formation of blood
clots.
39
Nursing Implications for CBC Test:

 BEFORE:

1. Inform the patient that the test is used to evaluate numerous conditions inflammation, infection, and response to
chemotherapy.
2. Obtain a history of the patient’s complaints (such as allergies and sensitivity to latex.
3. Obtain a history of the patient’s gastrointestinal, hematopoietic, immune, and respiratory systems, as well as
results of previously performed laboratory tests, surgical procedures, and other diagnostic procedures.
4. Obtain a list of medications the patient is taking, including herbs, nutritional supplements, and nutraceuticals.
5. Review the procedure with the patient. Explain the duration of the procedure and inform the client that there may
be some discomforts during the procedure.
6. Consider the patient’s cultural beliefs and practices and it is important to provide psychological support before,
during, and after the procedure.

 DURING:

1. Avoid using equipment containing latex if the patient has allergy to it.
2. Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid
unnecessary movement.
3. Observe Standard precautions.
4. Remove the needle, and apply a pressure dressing over the puncture site.
5. Promptly transport the specimen to the laboratory for processing and analysis.

 AFTER:

1. Observe venipuncture site for bleeding or hematoma formation. Apply paper tape or other adhesive to hold
pressure bandage in place.
2. Instruct the patient to limit salt intake, alcohol intake and cut down smoking.

40
3. Reinforce information regarding the test results and address any concerns voiced by the patient or family.

FBS Date Ordered: It is a test that was 192.91
11-26-09 done to the patient with
Date Results In: possible cardiovascular
11-26-09 disorders to determine
blood glucose levels. It
is also used to
determine an elevated
blood glucose levels as
a result of patient’s DM.
76.36-116.36 mg/dl An increase in glucose
levels specifies that there
is a large amount of
glucose found in the
circulatory system. Since
the patient has Diabetes
Mellitus, there is an
elevation in glucose levels
in the blood resulting to
blood viscosity. And so,
Mixtard was given to the
patient to decrease blood
glucose level.

HBAIc Date Ordered: Glycosylated 10.9% 4.40-6.40% The result shows the
(Whole Blood) 11-25-09 hemoglobin (HBAic) is average blood glucose
Date Results In: monitored to the patient level measured over the
11-25-09 with DM. It reflects the previous 2-3 months.
blood glucose levels 10.9% would mean that
over 2 to 3 months. the patient has large
amounts of glucose
attached in the blood
since; the patient has
Diabetes Mellitus, which is
characterized by elevation
of blood glucose levels.

41
Nursing Implication for FBS, Blood:

 BEFORE:

1. Inform the patient that the test is used to assist in the evaluation of fasting hypoglycemia
2. Obtain a history of the patient’s complaints, including a list of known allergens such as allergy to latex.
3. Obtain a history of the patient’s endocrine system and results of previously performed laboratory tests, surgical
procedures, and other diagnostic procedures.
4. Note any procedures that can interfere with the test results.
5. Obtain a list of medications patient is taking, including herbs, and nutritional supplements.

 DURING:

1. Ensure that the patient has complied with dietary or medication restrictions and other pretesting preparations.
2. Instruct the patient to cooperate fully and to follow directions. Direct patient to breathe normally and to avoid
unnecessary movement.
3. If the patient has a history of severe allergic reaction to latex, care should be taken and to avoid the use of
equipment containing latex.
4. Observe Standard precautions.
5. After obtaining the specimen, promptly transport to the laboratory for processing and analysis.

 AFTER:

1. Observe venipuncture site for bleeding or hematoma formation.

2. Instruct the patient to report signs and symptoms of hypoglycemia or hyperglycemia.
3. Emphasize that good glycemic control delays the onset of and slows the progression of diabetic retinopathy,
nephropathy, and neuropathy.
4. Reinforce information regarding the test results and address concerns voiced by the family or the patient

42
 SERUM
ELCTROLYTES

Sodium Date Ordered: Used to measure serum 139.3 mEq/L 135 – 150 mEq/L The patient’s sodium level
11-25-09 levels of sodium in is within the normal range
Date Results In: relation to the amount which indicates that there
11-25-09 of water in the body. In is no change within the
the case of the patient plasma water
who has DM, it was concentration or alteration
checked to detect of either sudden increase
presence of fluid or decrease of serum
volume deficit due to sodium in the plasma
increased urine output water since the patient has
and diaphoresis. no signs of fluid deficit.

Nursing Implication for Sodium Test in the Blood:

 BEFORE:

1. Inform the patient that the test is used to evaluate electrolyte balance.
2. Obtain a history of the patient’s endocrine and genitourinary systems, as well as previously performed laboratory
tests, surgical procedure, and other diagnostic procedures.
3. Assess patient for allergy, including list of unknown allergens (especially allergies or sensitivities to latex).
4. Obtain a list of medications the patient is taking, including herbs, and nutritional supplements.
5. Review the procedure with the patient. Inform the patient about the duration of the procedure and explain to the
patient that there may be some discomforts during the venipuncture.

 DURING:

1. Instruct the patient to cooperate fully and to follow directions.

2. Observe Standard Precautions.
3. Remove the needle, and apply pressure dressing over the puncture site.

43
4. Promptly transport the specimen to the laboratory for processing and analysis.

 AFTER:

1. Observe the venipuncture site for bleeding or hematoma formation. Apply paper tape or other adhesive to hold
pressure bandage in place.
2. Evaluate patient for signs and symptoms of dehydration, decreased skin turgor, dry mouth, and multiple
longitudinal furrows in the tongue are symptoms of dehydration
3. Educate the patients with low sodium levels that the major source of dietary sodium is found in table salt.
4. Reinforce information given by the patient’s health care provider regarding the test results. Answer any questions
or address any concerns voiced by the patient or family

Potassium Date Ordered: It was checked in order to 11-25-09 3.50 – 5.50 mEq/L The initial result indicates
11-26-09 assess for possible 3. 83 mEq/L that the serum potassium
Date Results In: electrolyte imbalance due maintains its normal level.
11-26-09 to an increased urine 11-26-09
output as a result of DM. 4.25 mEq/L
And as a baseline data
prior to administration of
diuretics like Aldazide, 11-28-09
since high potassium 4.1mEq/L
levels may further
increased if given with
potassium-sparing
diuretic. In addition to
that, patient was given
Lasix that would cause
renal excretion of
potassium and so this
was tested to detect if the
patient is experiencing
hypokalemia.

44
Nursing Implication for Potassium Test in the blood:

 Before
1. Check the doctor’s order
2. Explain the procedure
3. Explain the purpose and what to expect
4. No food or fluid restrictions

 During
1. Do not take the blood sample from hand or arm with receiving IVF
2. The tourniquet should be less on a minute
3. Do not squeeze the punctured site rightly
4. Wipe away the first drop of blood
5. Collect 2ml venous blood in a lavender top tube

 After
1. Observed and record vital signs.
2. Check injection sites for bleeding, infection, tenderness or thrombosis.
3. Report untoward reaction to the physician.
4. Apply warm compress to ease discomfort, as ordered.
5. Encourage relaxation by allowing client to discuss experiences and verbalize feelings.
6. Interpret results and provide counsel appropriate

BLOOD CHEMISTRY

Creatinine Date Ordered: Determination of 1.39 mg/dl 0.79- 1.56 mg/dl The result of creatinine
11-25-09 creatinine level is done level is within normal
Date Results In: to determine kidney range.
11-25-09 function. Since in the
case of the patient with
DM, chronic elevations
of blood glucose levels

45
 will have a complication
to the kidney function
because it may damage
the capillaries that
supply the glomeruli of
the kidney.

Magnesium Date Ordered: Test for magnesium 0.65 mg/dl 0.73-1.06 Decreased magnesium
11-25-09 levels is done to the levels is probably caused
Date Results In: patient to rule out the by the damage in the
11-25-09 cause of dysrhythmias myocardium as
and also muscle magnesium will be used to
weakness. dilate blood vessels,
Prevent spasm in the heart
muscle and blood vessel
walls,
Counteract the action of
calcium,
Help dissolve blood clots,
Dramatically lessen the
site of injury and prevent
arrhythmia.

Calcium (ionized) Date Ordered: Calcium is checked to 4.35 mg/dl 4.56- 5.32 mg/dl In the case of the patient,
11-25-09 the patient to who has
Date Results In: investigate the cause of Decreased calcium levels,
11-25-09 dysrrhythmias. As it ECG tracing revealed
slow down myocardial dysrhythmia and so
contractility. Lidocaine was given to
reduce the contractility of
the heart. Along with low
Ca levels, a low Mg levels
can also be seen with this
findings.

46
Nursing Implication for Creatinine and Magnesium test, blood,

 BEFORE
5. Check the doctor’s order
6. Explain the procedure
7. Explain the purpose and what to expect
8. No food or fluid restrictions

 DURING
6. Do not take the blood sample from hand or arm with receiving IVF
7. The tourniquet should be less on a minute
8. Do not squeeze the punctured site rightly
9. Wipe away the first drop of blood
10. Collect 2ml venous blood in a lavender top tube

 AFTER
7. Observed and record vital signs.
8. Check injection sites for bleeding, infection, tenderness or thrombosis.
9. Report untoward reaction to the physician.
10. Apply warm compress to ease discomfort, as ordered.
11. Encourage relaxation by allowing client to discuss experiences and verbalize feelings.
12. Interpret results and provide counsel appropriately
LIPID PROFILE

HDL Date Ordered: This is a blood test that 77.52mg/dl 30.23-70.54 mg/dl The result shows that
11-26-09 measures HDL there is a high level of
Date Results In: cholesterol or “good” HDL cholesterol as a
11-26-09 cholesterol in the body. result of taking
It was checked to antilipidemic drug, which is
determine the level of Simvastatin, it acts by
HDL since the patient increasing HDL cholesterol
was known to have since it has a protective

47
 dyslipidemia. action in the blood.

CHOLESTEROL Date Ordered: Used to determine the 133.33 mg/dl <220.33 mg/dl The result indicates that
11-26-09 level of cholesterol in the patient’s cholesterol
Date Results In: the blood since the level is within the normal
11-26-09 patient was known to range, which is below
have dyslipidemia 220.33mg/dl thus
indicating normal lipid
metabolism.

LDL Date Ordered: It is used to determine 46.51mg/dl 81.40-189.92 mg/dl LDL levels of the patient
11-26-09 LDL levels in the blood are low, which indicates
Date Results In: since the patient was that the effect of
11-26-09 known to have Simvastatin and
dyslipidemia. Atorvastatin works
effectively by decreasing
LDL cholesterol synthesis
since the patient has been
taking his maintenance
drug.

Triglycerides Date Ordered: It provides quantitative 46.90mg/dl 151.33 mg/dl The result indicates that
11-26-09 analysis of triglycerides triglycerides are below
Date Results In: its purpose is to screen normal and thus, it
11-26-09 for dyslipidemia as the indicates that antilipidemic
patient is known to have drugs which are
this condition. Simvastatin and
Atorvastatin works
effectively decreasing
Triglycerides level.

Nursing Implication for Total Cholesterol Test:

48
 BEFORE:

1. Inform the patient that the test is used to assess and monitor risk for coronary artery disease.
2. Obtain history of the patient’s past health history and previously performed laboratory tests, surgical procedures,
and other diagnostic procedures.
3. Instruct the patient to withhold drugs and alcohol known to alter cholesterol levels for 12 to 24 hours before
specimen collection.
4. Fasting 6 to 12 hours before specimen collection is required if triglyceride measurements are included; it is
recommended if cholesterol levels alone are measured for screening.

 DURING:

1. Ensure that the patient has complied with the dietary restrictions and pre testing precautions.
2. If the patient has a history of severe allergic reaction to latex, care should be taken to avoid the use of equipment
containing latex.
3. Instruct the client to cooperate fully and to follow directions.
4. Observe Standard Precautions.
5. Remove the needle and apply pressure dressing over the puncture site.
6. Immediately transport the specimen to the laboratory for processing and analysis.

 AFTER:

1. Observe venipuncture site for bleeding or hematoma formation.

2. Instruct the patient to reduce intake of foods high in saturated fats and cholesterol and triglyceride levels. (E.g. red
meats, eggs, and dairy products are major sources of saturated fats and cholesterol.
3. Consider social and cultural beliefs and practices of the client.
4. Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle.
5. Provide teaching and information regarding the clinical indications of the test results.

49
HGT Date Ordered: The test is used to 11-25-09 (9:45pm) 80-120 mg/dl The results show that
11-25-09 determine blood 301 mg/dl there is large amount of
Date Results In: glucose levels of the hemoglobin bound to
11-25-09 up to patient with DM. 11-25-09 glucose. In the case of the
11-27-09 159 mg/dl patient who has diabetes,
there is an elevation in the
11-26-09 (6am) amount of glucose in the
179 mg/dl blood as seen in the initial
result of 301 mg/dl,
11-26-09 (12nn) Mixtard was given which is
148 mg/dl an antidiabetic agent to
decrease the blood
11-26-09 (6pm) glucose levels of the
156 mg/dl patient.

11-27-09 (12mn) As the patient’s glucose

153 mg/dl levels decreases by the
time that Mixtard was
11-27-09 (6am) given, the last result of the
148 mg/dl test is 71 mg/dl which
indicates that
11-27-09 Hypoglycemia may also
(12nn) occur as a result of
75 mg/dl Mixtard Insulin therapy.

11-27-09 (6pm)
71 mg/dl

11-28-09
(12mn)
153mg/dl

(6am)
140mg/dl

(12nn)
75mg/dl

50
 (6pm)
112mg/dl

11-29-09
(12mn)
160mg/dl

(6am)
155mg/dl

(12nn)
80mg/dl

(6pm)
120mg/dl

11-30-09
(6am)
148mg/dl

(6pm)
98mg/dl

12-01-09
(6am)
120mg/dl

(6pm)
93mg/dl

12-02-09
(6am)
120mg/dl

(6pm)
130mg/dl

51
 Nursing Implication for HGT:

 BEFORE:

1. Check the doctor’s order

2. Identify the right client
3. Explain the procedure to the patient and the significant others
4. Explain the purpose of the procedure
5. Inform the patient and the significant others the duration of the procedure
6. Inform the patient the she will feel some discomfort from the needle puncture and the tourniquet

 DURING:

1. Select a vein for venipuncture

2. Apply a tourniquet several inches above the intended puncture site
3. Clean the venipuncture site with cotton soak with alcohol
4. Perform venipuncture by entering the skin with needle approximately 15 degree angle to the skin
5. If using vacutainer, ease the tube in holder once in the vein and collect the desired amount of blood. If using a
syringe, pull back the plunger slowly as blood fills the syringe
6. Release the tourniquet when blood begins to flow
7. After blood is drawn, place a cotton ball over the site and apply a slight pressure to stop bleeding
8. If hematoma is formed, apply a warm compress to relieve the clot

 AFTER:

1. Record the date and time of blood collection

2. Properly disposed contaminated materials
3. Fill-up laboratory form and send the sample to the laboratory for testing

52