Page 422 - Critical Care Nursing Demystified

Chapter 9 CARE OF THE PATIENT WITH CRITICAL HEMATOLOGIC NEEDS 407

Percussion

Percussion of the liver and spleen can be done to determine enlargement. Nor-
mally the liver can be palpated under the right lower rib cage when the patient
takes a deep breath. The spleen is located under the left costal margin and is
only palpable when it is greatly enlarged.

Auscultation
Listen to the patient’s heart sounds. Are they regular; do you hear any extra or
skipped beats? Next, take the BP on both arms; a lower BP and hypotension
can be caused by extreme blood loss. Listen to the abdomen for bowel sounds.
Remember to do inspection and auscultation of the abdomen before percussion
and palpation. Patients with high-pitched, loud bowel sounds can have an intes-
tinal obstruction caused by lymphomas.

Collaborative Diagnostic and Laboratory Tools

Laboratory Tests

4 The tests in Table 9–1 are frequently monitored in a patient with a hematologic 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.
problem.

TABLE 9–1 Analyzing Test Values for RBCs and Platelets
Laboratory Tool Normal Value Meaning of Abnormal Values
RBC 5 million × 10.6 cells/mm 3 Decreased in anemias
(erythrocyte count) Increased in polycythemia
vera

Hemoglobin 12–18 g/dL Decreased in anemia
Decreased with active
bleeding
Increased in polycythemia
Hematocrit 35%–50% Decreased in anemia
Decreased in fluid volume
excess
Platelets 150,000–400,000/μL A drop can indicate DIC, a
reaction to heparin, extra-
corporeal blood circulation,
and disorders that decrease
platelet formation