Page 122 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 107

Red Blood Cells (RBCs)
The red cell or erythrocyte count determines the number of red blood cells
found in each cubic centimeter of whole blood. The primary function of RBCs
is to carry hemoglobin, which provides oxygen to all cellular and tissue areas of
the body. Oxygen combines chemically with the hemoglobin to perform these
functions. Normal red blood cell results are as follows: males, 4.5 to 6 million
and females, 4.5 to 5 million. Red blood cells are further broken down into
hemoglobin or Hgb with 14 to 18 g/dL being the normal range for males and
12 to 16 g/dL being the normal female range. The hematocrit describes the
volume percentage of RBCs in whole blood. The normal range for males is 40%
to 54%. The normal female range is 38% to 48%.
A decrease in the serum level of total red blood cells will demonstrate a
decrease in the Hgb and Hct levels. A condition such as anemia, where less
oxygen is delivered to the cells and body tissues due to a reduction in the num-
ber of red blood cells, can increase cardiac workload and lead to heart failure.
Increases in RBC formation, known as polycythemia, results in higher Hgb and
Hct levels and can be a response to tissue hypoxia.

Erythrocyte Sedimentation Rate (ESR) Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
The ESR measures how quickly RBCs separate from plasma within a 1-hour
period of time. With specific injuries such as endocarditis or pericarditis, or a
myocardial infarction, the ESR will increase due to the faster precipitation of
globulin and fibrinogen levels in the bloodstream. The ESR is a nonspecific test
that can indicate a pathologic condition, but it does NOT identify the source
of inflammation, infection, or tissue injury. In the adult male, a normal range
would be 0 to 17 mm/hr and 1 to 25 mm/hr in the female.

NURSING ALERT

Heart failure will decrease the ESR due to decreased levels of serum fibrinogen found
in the bloodstream.

White Blood Cells (WBCs)
WBCs are the absolute total number of leukocytes circulating in a cubic mil-
limeter of blood. WBCs defend against invading organisms through the process
of phagocytosis. They also provide antibodies to help fight infections and main-
tain immunity against diseases.
A normal white cell count is 5 to 10,000 mm . A rise in the white cell count
3
generally indicates the presence of disease, infection, or inflammation such as myo-
cardial infarction (MI), rheumatic fever, and endocarditis, to name a few. Necrotic