Question

A patient was brought into the ICU for internal bleeding. The patient presented with hematemesis and tarry stool. Upon admission, the patient's RBC was 1.8, Hgb of 4.2, Hct of 13% The patient received 10 units of PRBC, 8 units of FFP, 3 units of platelets, and 2 units of cryoprecipitate. Interpret the  High or Low & Cause of Abnormal Values. Discuss the Trend (worse or improving)? What was or is the expected treatment/nursing actions needed to improve abnormal value.

Lab Test w/ Normal Values	Admitted	Day 2	Day 3	Interpretation: High or Low & Cause of Abnormal Values. Discuss the Trend (worse or improving)? What was or is the expected treatment/nursing actions needed to improve abnormal value
Plt 142-424	21K	37K	55K
PT 1.9-14.7 sec	21.8 sec	28.5 sec	28.3 sec
INR 0.8-1.1 unless on meds: 2-3 for venous clot prophylaxis 2.5-3.5 for arterial clot prophylaxis	1.88	2.67	3.64
PTT 23.3-35.3 sec Therapeutic 60-80 sec	24.9 sec	95.5 sec	Not taken
Ca 8.9-10.3	10.5	8.4	7.7
K+ 3.6-5.1	3.5	2.8	3.4
Cl 98-107	101	105	103
BUN 8-20	67	44	51
Creat 0.6-1.3	2.60	2.03	3.10

Answer 1

Lab Test w/ Normal Values	Admitted	Day 1	Day 2	Interpretation: 1. High or Low & Cause of Abnormal Values. 2. Trend (worse or improving). 3. Expected treatment/nursing actions needed to improve the abnormal value
Plt 142-424	21K	37K	55K	1. Low: This could be due to some underlying hematology condition; bleeding/clotting disorder, as evident from hematemesis, internal bleeding, and the given values. 2. Trend: Improving. 3. More units of platelets should be given. Lab tests should be ordered to find the cause.
PT 1.9-14.7 sec	21.8 sec	28.5 sec	28.3 sec	1. High: The blood takes longer time to clot due to blood thinners, vitamin K deficiency, some underlying hematology condition; bleeding/clotting disorder, as evident from hematemesis, internal bleeding, and the given values. 2. Trend: Worse 3. Further lab tests should be ordered to find the cause. Consider giving medications like vitamin K etc., based on the values. Discontinuing any blood-thinning medications taken by the patient.
INR 0.8-1.1 unless on meds: 2-3 for venous clot prophylaxis 2.5-3.5 for arterial clot prophylaxis	1.88	2.67	3.64	1. High: The blood takes longer time to clot due to blood thinners, vitamin K deficiency, some underlying hematology condition; bleeding/clotting disorder, as evident from hematemesis, internal bleeding, and the given values. 2. Trend: Worse 3. Further lab tests should be ordered to find the cause. Discontinuing any blood-thinning medications taken by the patient.
PTT 23.3-35.3 sec Therapeutic 60-80 sec	24.9 sec	95.5 sec	not taken	1. High: On admission, the patient's PTT value is normal. Day-1 value is higher therapeutically as well as non-therapeutically. This could be due to blood thinners, some underlying hematology condition; bleeding disorder, as evident from hematemesis, internal bleeding, and the given values. 2. Trend: Worse 3. Further lab tests should be ordered to find the cause. Discontinuing any blood-thinning medications taken by the patient.
Ca 8.9-10.3	10.5	8.4	7.7	1. On admission, the value is slightly higher than the high-normal. On day 1, the value is slightly lower than the low-normal, which shows a further decrease on day 2. This could be due to calcium deficiency caused due to diet or any medication. 2. Trend: Worse 3. Discontinuing any blood-thinning medications taken by the patient. Increase the calcium intake of the patient.
K+ 3.6-5.1	3.5	2.8	3.4	1. Normal. 2. Trend: Improving 3. No treatment/nursing actions needed.
Cl 98-107	101	105	103	1. Normal. 2. Trend: Improving 3. No treatment/nursing actions needed.
BUN 8-20	67	44	51	1. High: High on admission, decreased on day 1, slightly increased on day 2. Due to gastrointestinal bleeding. 2.Trend: Improving. 3. The above-given measures to check/control the bleeding disorder.
Creat 0.6-1.3	2.60	2.03	3.10	1. High: This could be due to some underlying condition or medication. 2. Trend: Worse 3. Order tests. Any medication causing an increase in creatinine should be stopped.