Case Studies

Case Study I: Interpretation of Lab values

Case Study II: Diabetes

Case Study I:Evaluating Laboratory Results

Which of the laboratory findings are not within normal limits?

The metabolic picture of Mr. Jones shows slight deviation from normal values; however the medicines and his diseased condition may account for most of the deviations. The unaccounted for deviations include the lab findings of Blood urea creatinine (BUN), serum creatinine and serum albumin.

Are there any deviations in the results that are consistent with normal aging? If so, which ones and why?

There is an alteration in complete blood picture with aging process. Mr. Jones blood count portrays a general decrease in all the values. The values can be attributed to normal aging process (Cubota et al, 1991). The kidney function deteriorates with age. The deviated values of albumin, creatinine, and BUN may be due to the loss in kidney function. Electrolytes are also excreted through kidney. The alteration in kidney functions causes electrolyte imbalance.

Are there any deviations in laboratory results that would be expected in persons with prolonged chronic illness, like Mr. Jones? If so, what are they and why are they expected?

Mr. Jones is suffering from an assortment of illnesses; therefore his lab values may vary from the standard values. The decreased values of Red Blood Cells, Hemoglobin and Hematocrit are due to his chronic anemia. The hypoalbuminemia can be a symptomatic finding of heart disease (http://chemocare.com) or an indicative of increased excretion due to furosemide. The decreased albumin in Mr. Jones' serum can also be due to malnutrition syndrome.

Which of the above deviations from normal are potentially the most dangerous for Mr. Jones at this time? If so, why?

The potassium levels are slightly elevated but they have a narrow therapeutic index. The serum electrolytes are to be controlled within a narrow physiological range. The muscle twitching augments the laboratory finding of increased potassium levels. The prolonged hyperkalemia may be damaging to Mr. Jones' heart. The nurse should immediately report the lab result to Mr. Jones' primary care provider as he is already a heart patient.

Could any of the abnormal blood tests be related to his medications?

The medications have a tendency to affect the lab values. It is important to keep the factors in mind while interpreting lab values of people taking medications. Mr. Jones has been taking insulin to control his diabetes. The insulin dose is 12 units but the result shows that the dose has caused slight hypoglycemia to Mr. Jones. Lisinopril is an ACE inhibitor class of drug. The drug has a tendency to cause hyperkalemia (Frewin et al, 1992). Mr. Jones has been taking potassium supplements and the hyperkalmeia caused by lisinopril can cause accumulated potassium levels in his blood.

Are there any results that need prompt referral to Mr. Jones' primary care provider? If so, which one(s)?

Mr. Jones has a known history of heart disease. The muscle twitching and the increased potassium levels in lab values are suggestive of potassium accumulation in his serum. The condition should be immediately referred to his ...