1- What is main lesson regarding CBC interpretation based on the article interpretation a Blood Count? Why do a CBC? Your response must include something from the article (interpretation a Blood Count).

2- What is the main lesson regarding blood glucose monitoring based on the article Blood Glucose Monitoring in Diabetes??? Your response must include from the article.

3- How is the question “when to rely on what the monitor tells you vs the patient “resolved in the article The Balance between Assessment and Monitoring”?? What conclusion is reached?

4- What is the main lesson regarding lab testing Based on the article Detecting  Hypo-Magnesemia? What did you take away from it? 

5- What do you learn from the patient teaching section of the article BUN/Creatinine that you can apply to your general nursing practice? In short if you made a template for patient teaching labs based on section what would it include and Why?

TheBa
Assessm
Monitoring

t%

When to rely on what the monitor tells you vs. the patient

s medical technology continues to

advance and assessment tools

become smaller, cheaper and more

practical for use in the field, we

are faced with the challenge of

determining where these tools fit within our

overall pafienf assessmenf.

In trying to emphasize the imporfance ot

a proper physical exam, it is often said that

paramedics must “treat the patient and not the

monitor.”This conventional wisdom is beginning

to change, with one exampie being STEMi bypass

programs that involve altering patient care based

largely on what is seen on the cardiac monitor.

Furthermore, the 2010 American Heart

Association guidelines recommend against

routine supplemental oxygen tor acute coronary

syndrome because ot the risks that are naw recog-

nized and likely result in part trom tree radical

formation. Specifically, supplemental oxygen is

not recommended tor patients who are not short

ot breath, have an oxygen saturation ot at least

94%, and are not showing signs ot heart tailure

ar shock.i

This increasing emphasis on these previously

downplayed assessment tindings requires a shift

in our thinking where we will need to. at times,

trust our monitor.

In a discussion with colleagues around this

shift in thinking, it was suggested the monitor is

a good tool, but you never want to be the para-

medic who withholds oxygen trom a patient wha is

cyanotic based on a high oxygen saturation levei.

Having heard so many times about treating

the patient and not the monitor, everyone seemed

to agree. It certainly sounded iike a nice idea,

but it is one that must be caretuiiy assessed. We

must tirst exclude trom the discussion any poten-

tial issues with the quality ot the reading being

obtained. For this, it is important that we examine

the plethysmograph or pieth waveform from the

oxygen saturation probe.

The most important component ot this

wavetorm tor our purposes is the a

tude, which would be low if there is pi

signal strength, Assuming there is

good wavetorm and the monitor i

tunctioning properly, what would

cause a patient to preserit with

centrai cyanosis but also a high

oxygen saturation? This ques-

tion is more difficult to answer,

but taking the time to work

through the possibilities is

an interesting exercise.

We should begin

by briefly reviewing

the normal physi-

ology and essen-

tial components

ot respiration and

oxygénation.

132

Eating Disorders, 18:132–139, 2010
Copyright © Taylor & Francis Group, LLC
ISSN: 1064-0266 print/1532-530X online
DOI: 10.1080/10640260903585540

UEDI1064-02661532-530XEating Disorders, Vol. 18, No. 2, jan 2010: pp. 0–0Eating Disorders

Interpreting the Complete Blood Count
in Anorexia Nervosa

Interpreting the Complete Blood Count in Anorexia NervosaB. S. Cleary et al.

BARBARA S. CLEARY, JENNIFER L. GAUDIANI, and
PHILIP S. MEHLER

Department of Internal Medicine, University of Colorado Health Sciences Center
and Denver Health Medical Center, Denver, Colorado, USA

Anemia, leukopenia and thrombocytopenia are frequent
complications of anorexia nervosa. The complete blood count
provides useful information to diagnose and characterize these
findings. Anemia tends to be normocytic and normochromic.
Leukopenia manifests as a deficiency of lymphocytes or neutro-
phils. Thrombocytopenia, if severe, may confer a bleeding risk.
A careful history and physical examination should be
performed to evaluate for other possible etiologies of cytopenias.
Cell line deficiencies related solely to anorexia nervosa often
resolve with nutritional rehabilitation. Knowledge of these
potential findings and their expected outcomes may help avoid
costly and potentially invasive procedures in patients with
anorexia nervosa.

INTRODUCTION

Anorexia Nervosa occurs in 0.9% of women and 0.3% of men in the United
States (Hudson, Hiripi, Pope & Kessler, 2007) and is associated with exten-
sive medical complications that can affect almost every organ system
(Mehler & Krantz, 2003). The bone marrow is frequently affected, and
patients with anorexia nervosa may present with anemia (low hemoglobin
and hematocrit), leukopenia (low white blood cell count) or thrombocy-
topenia (low platelet count) in a pattern involving one, two or all three cell
lines simultaneously (Hütter, Ganepola & Hofmann, 2009).

Address correspondence to Philip S. Mehler, M.D., Department of Internal Medicine,
University of Colorado Health Sciences Center/Denver Health Medical Center, 660 Bannock
Street, MC 0278, Denver, CO 80204, USA. E-mail: [email protected]

Interpreting the Complete Blood Count in Anorexia Nervosa 133

Along with a thorough history and physical examination, a complete
blood count (CBC) provides baseline diagnostic information about hemato-
logic medical issues encountered in the patient with anorexia nervosa. With
a basic understanding of the typical findings on the CBC in the patient with
anorexia nervosa, excessive worry and more invasive and costly tests such
as bone marrow biopsy may be avoided. Reference ranges for normal CBC
values are listed in Table 1.

ANEMIA

Red blood cells (RB

DETECTING

HYPO
MAGNESEIMIA

THE MOST OVERLOOKED ELECTROLYTE IMBALANCE
Long ignored as a cause of

potentially fatal arrhythmias,
hypomagnesemia is now

receiving carefui attention.
Find out what you need to

know to uncover this problem
in your patients.

AVID WALLACE, A 73-YEAR-OLD RETIRED CON-
struction worker, is admitted to your
coronary care unit (CCU) with a di-
agnosis of congestive heart failure
(CHF). Although he denies having
chest pain, he’s pale, diaphoretic, and
dyspneic. You auscultate moist crack-
les in his lungs and note that he’s pro-
ducing frothy, pink-tinged sputum.

His vital signs are: pulse, 110; blood
pressure, 100/64; respirations, 28; and
temperature, 97.6° F (36.4° C). Car-
diac monitoring shows sinus tachycar-
dia, with four to five ventricular ec-
topic beats per minute.

This is Mr. Wallace’s second episode

BY REBECCA P. YARNELL, RN, MSN
Nursing Instructor
Fort Sanders School of Nursing
Knoxville, Tennessee

MARTHA P. CRAIG, RN, MSN
Director of Department of Nursing
Maryville College
Knoxville, Tennessee

of CHF since he suffered a myocardial
infarction 4 years ago. He’s remained
otherwise healthy on a drug regimen
of digoxin (Lanoxin), furosemide (La-
six), and a potassium chloride supple-
ment (K-Lyte/Cl). Other than a bor-
derline low hematocrit of 39%, his lab
results are within normal limits.

So what’s gone wrong? The answer
isn’t immediately obvious because Mr.
Wallace is suffering from hypomag-
nesemia, an often overlooked and life-
threatening- electrolyte deficiency,
which affects many more patients than
you might suspect. Recent research
suggests doctors and nurses should be-
come more aware of this potential
problem.

This article will tell you what you
need to know — how to identify patients
at risk for hypomagnesemia, what
causes to consider, what signs and
symptoms to look for, and how to ad-

Nursing91, July 55

minister treatment. We’ll also take you
through Mr. Wallace’s therapy and
postdischarge planning.

Associated with hypokalemia
Studies show that 42% of hypokalemic
patients also have hypomagnesemia —
many of them experiencing ventricular
ectopy, one of Mr. Wallace’s symp-
toms. In these studies, ventricular ar-
rhythmias persisted after hypokalemia
was corrected and continued until hy-
pomagnesemia was eliminated. The
findings prove that magnesium is as
important as potassium in the etiology
and treatment of these cardiac prob-
lems.

That’s because a magnesium deficit
can lead to intracellular potassium loss
and sodium accumulation, altering
membrane excitability. This creates ab-
normal areas of automaticity, which
contribute to inefficient conduction in
the heart. Of course, any changes in
the normal sequence of conduction

usually result in symptomatic arrhyth-
mias.

Diagnosing Mr. Wal

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52 march 5 :: vol 28 no 27 :: 2014 © NURSING STANDARD / RCN PUBLISHING

CONTINUING
PROFESSIONAL
DEVELOPMENTCPD

Blood glucose monitoring in diabetes
NS733 Holt P (2014) Blood glucose monitoring in diabetes.
Nursing Standard. 28, 27, 52-58. Date of submission: December 4 2013; date of acceptance: December 18 2013.

Abstract
While the prevalence of all types of chronic conditions is increasing,
diabetes is one of the few long-term conditions that individuals can
successfully manage and control on a day-to-day basis, providing that they
have access to appropriate advice and support. Blood glucose monitoring
and patient education are essential in diabetes care and management,
and if used appropriately, can help to achieve maximum benefit for the
patient and diabetes care team. This article considers the link between
blood glucose levels and the incidence of diabetes-related complications.
It explores the different blood glucose monitoring strategies, particularly
self-monitoring of blood glucose in people with type 2 diabetes. The
frequency of blood glucose monitoring, and the identification of patterns
and trends in blood glucose control are highlighted and applied to practice.

Author
Paula Holt
Lecturer in diabetes care, School of Healthcare, University of Leeds.
Correspondence to: [email protected]

Keywords
Blood glucose levels, blood glucose monitoring, diabetes, glycated
haemoglobin, hyperglycaemia, hypoglycaemia, self-monitoring

Review
All articles are subject to external double-blind peer review and checked
for plagiarism using automated software.

Online
Guidelines on writing for publication are available at
www.nursing-standard.co.uk. For related articles visit the archive
and search using the keywords above.

 Page 60
Blood glucose multiple
choice questionnaire

 Page 61
Read Anita Skinner’s
practice profile on mental
health emergencies

 Page 62
Guidelines on
how to write a
practice profile

Aims and intended learning outcomes
This article aims to highlight the role of
blood glucose monitoring in the prevention
of diabetes-related complications, and to
provide information on the different methods
and approaches that can be used to monitor
diabetes control. After reading this article and
completing the time out activities you should
be able to:
Discuss the importance of effective blood
glucose monitoring in people with type 1 and
type 2 diabetes.
Identify recommended blood glucose levels
in both type 1 and type 2 diabetes.
Discuss the use of urinalysis, HbA1c
(glycated haemoglobin) and self-monitoring
of blood glucose in reducing the risk of
diabetes-related complications.
Recognise patterns and trends in patients’
blood glucose levels.