Question

Course Project Case Study: Mr. Lopez is an 85 year-old Hispanic man who was admitted to the hospital with complaints of fatigue, decreased appetite, and a 25 pound weight loss over the past six months. He also reports change in his short term memory. He used to be active with his local retired friends and walked 1.5 miles a day but now spends most of his time in his recliner watching television. He has a medical history of coronary artery disease and hypertension.

rders include:

Regular diet, calorie count

Ensure shakes TID daily

Ambulate TID daily, stand by assist

Daily weights

Warfarin 2 mg PO daily

Digoxin 125 mcg PO daily

Atorvastatin 20 mg PO daily

Escitalopram 10 mg PO daily

Metoprolol 50 mg PO BID

Do not resuscitate

Choose five labs or diagnostic tests that might be ordered for your case study client and explain why. Note normal results, expected abnormal values, and what that would signify for your client.

Answer 1

1.Haemoglobin: Normal values Male: 13-18 grams per deciliter (g/dL) Female: 12-16g/dl

The rationale to check for anemia secondary to blood loss malignancy, nutritional deficiencies, etc

2.Complete Blood Count

normal values

RBC In men: 4.32-5.72 million cells/mcL

In women: 3.90-5.03 million cells/mcL

hematocrit In men: 38.8-50.0 percent

In women: 34.9-44.5 percent

white blood cell count 3,500 to 10,500 cells/mcL

platelet count 150,000 to 450,000/mcL

the rationale to find out if there is any infection, features of malignancy, decrease in platelet (induced by warfarin), etc

3.Lipid Profile

S cholesterol <200 mg/ml

LDL cholesterol Below 70 mg/dL

HDL cholesterol> 40mg/.dl

The rationale to check for the control of dyslipidemia, which can cause dementia, stroke coronary artery disease etc

4.Coagulation profile

aPTT Activated partial thromboplastin time test, prothrombin time (PT),International Normalized Ratio (INR),

The reference range of the aPTT is 30-40 seconds.

prothrombin time (PT) 11 to 13.5 seconds.

INR of 0.8 to 1.1.

The rationale as the patient is already on warfarin optimization of the coagulation profile is mandatory

5. Serum electrolytes

Sodium 136-146 mEq/L (136-146 mmol/L)

Chloride 96-106 mmol/L

Potassium 3.5-4.5 mEq/L (3.5-4.5 mmol/L)

Bicarbonate 22-29 mEq/L (23-29 mmol/L)

Rationale, when the patient is on digoxin its mandatory to check Serum electrolytes as ELECTROLYTE IMBALANCE like hypokalemia, will worsen digoxin toxicity