CONFIRMING DIAGNOSIS Confirming a hemolytic transfusion reaction requires proof of blood incompatibility and evidence of hemolysis, such as hemoglobinuria, anti-A or anti-B antibodies in the serum, low serum Hb levels, and elevated bilirubin levels.
If you suspect such a reaction, have the patient’s blood retyped and crossmatched with the donor’s blood. After a hemolytic transfusion reaction, laboratory tests will show increased indirect bilirubin levels, decreased haptoglobin levels, increased serum Hb levels, and Hb in the urine. As the reaction progresses, tests may show signs of DIC (thrombocytopenia, increased prothrombin time, and decreased fibrinogen level) and acute tubular necrosis (increased blood urea nitrogen and serum creatinine levels).
A blood culture to isolate the causative organism should be done when bacterial contamination is suspected.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Chronic lymphocytic leukemia:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Typically, CLL is an incidental finding during a routine blood test that reveals numerous abnormal lymphocytes. In early stages, white blood cell (WBC) count is mildly but persistently elevated. Granulocytopenia is the rule, but the WBC count climbs as the disease progresses. Blood studies also show hemoglobin levels under 11 g, hypogammaglobulinemia, and depressed serum globulins. Other common developments include neutropenia (neutrophils less than 1,500/µl), lymphocytosis (lymphocytes more than 10,000/µl), and thrombocytopenia (platelets less than 150,000/µl). Bone marrow aspiration and biopsy show lymphocytic invasion.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Blood pressure increase [Hypertension]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you detect sharply elevated blood pressure, quickly rule out possible life-threatening causes. (See Managing elevated blood pressure.)
After ruling out life-threatening causes, complete a more leisurely history and physical examination. Determine if the patient has a history of cardiovascular or cerebrovascular disease, diabetes, or renal disease. Ask about a family history of high blood pressure—a likely finding in patients with essential hypertension, pheochromocytoma, or polycystic kidney disease. Then ask about its onset. Did high blood pressure appear abruptly? Ask the patient’s age. Sudden onset of high blood pressure in middle-aged or elderly patients suggests renovascular stenosis. Although essential hypertension may begin in childhood, it typically isn’t diagnosed until near age 35. Pheochromocytoma and primary aldosteronism usually occur between ages 40 and 60. If you suspect either, check for orthostatic hypotension. Take the patient’s blood pressure with him supine, sitting, and then standing. Normally, systolic pressure falls and diastolic pressure rises on standing; in orthostatic hypotension, both pressures fall.
Note headache, palpitations, blurred vision, and sweating. Ask about wine-colored urine and decreased urine output; these signs suggest glomerulonephritis, which can cause elevated blood pressure.
Obtain a drug history, including past and present prescription and over-the-counter drugs (especially decongestants) as well as herbal preparations. If the patient is already taking an antihypertensive, determine how well he complies with the regimen. Ask about his perception of elevated blood pressure. How serious does he believe it is? Does he expect drug therapy to help? Explore psychosocial or environmental factors that may impact blood pressure control.
Follow up the history with a thorough physical examination. Using a funduscope, check for intraocular hemorrhage, exudate, and papilledema, which characterize severe hypertension. Perform a thorough cardiovascular assessment. Check for carotid bruits and jugular vein distention. Assess skin color, temperature, and turgor. Palpate peripheral pulses. Auscultate for abnormal heart sounds (gallops, louder second sound, murmurs), rate (bradycardia, tachycardia), or rhythm. Then auscultate for abnormal breath sounds (crackles, wheezing), rate (bradypnea, tachypnea), or rhythm.
Palpate the abdomen for tenderness, masses, or liver enlargement. Auscultate for abdominal bruits. Renal artery stenosis produces bruits over the upper abdomen or in the costovertebral angles. Easily palpable, enlarged kidneys and a large, tender liver suggest polycystic kidney disease. Obtain a urine specimen to check for microscopic hematuria.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Blood pressure decrease [Hypotension]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is conscious, ask him about associated symptoms. For example, does he feel unusually weak or fatigued? Has he had nausea, vomiting, or dark or bloody stools? Is his vision blurred? Gait unsteady? Does he have palpitations, chest or abdominal pain, or difficulty breathing? Has he had episodes of dizziness or fainting? Do these episodes occur when he stands up suddenly? If so, take the patient’s blood pressure while he’s lying down, sitting, and then standing and compare readings. A drop in systolic or diastolic pressure of 10 mm Hg or more and an increase in heart rate of more than 15 beats/minute between position changes suggest orthostatic hypotension. (See Ensuring accurate blood pressure measurement, page 104.)
Next, continue with a physical examination. Inspect the skin for pallor, sweating, and clamminess. Palpate peripheral pulses. Note a paradoxical pulse—an accentuated fall in systolic pressure during inspiration—which suggests pericardial tamponade. Then auscultate for abnormal heart sounds (gallops, murmurs), rate (bradycardia, tachycardia), or rhythm. Auscultate the lungs for abnormal breath sounds (diminished sounds, crackles, wheezing), rate (bradypnea, tachypnea), or rhythm (agonal or Cheyne-Stokes respirations). Look for signs of hemorrhage, including visible bleeding, palpable masses, bruising, and tenderness. Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds. Also, carefully assess the patient for possible sources of infection such as open wounds.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Leukemia, acute:
Diagnosis
(Handbook of Diseases)
Typical signs and symptoms and bone marrow aspirate showing a proliferation of immature WBCs confirm acute leukemia. An aspirate that’s dry or free from leukemic cells in a patient with typical signs and symptoms requires a bone marrow biopsy, usually of the posterior superior iliac spine.
Blood counts show thrombocytopenia and neutropenia. A differential leukocyte count determines cell type. Lumbar puncture detects meningeal involvement.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Leukemia, chronic lymphocytic:
Diagnosis
(Handbook of Diseases)
Typically, chronic lymphocytic leukemia is an incidental finding during a routine blood test that reveals numerous abnormal lymphocytes. In early stages, the white blood cell (WBC) count is mildly but persistently elevated. Granulocytopenia is the rule, but the WBC count climbs as the disease progresses.
Blood studies also show a hemoglobin level below 11 g, hypogammaglobulinemia, and depressed serum globulin levels. Other common findings include neutropenia (less than 1,500/µl), lymphocytosis (more than 10,000/µl), and thrombocytopenia (less than 150,000/µl). Bone marrow aspiration and biopsy show lymphocytic invasion.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Leukemia, chronic granulocytic:
Diagnosis
(Handbook of Diseases)
In patients with typical signs and symptoms, chromosomal analysis of peripheral blood or bone marrow showing Ph1 and low leukocyte alkaline phosphatase levels confirms CGL. Other relevant laboratory results include:
❑ white blood cell abnormalities: leukocytosis (leukocyte count ranging from 50,000/µl to 250,000/µl), occasional leukopenia (leukocyte count less than 5,000/µl), neutropenia (neutrophil count less than 1,500/µl) despite a high leukocyte count, and increased circulating myeloblasts
❑ hemoglobin level: commonly below 10 g/dl
❑ hematocrit: low (less than 30%)
❑ platelet count: thrombocytosis (more than 1 million/µl) common
❑ serum uric acid level: possibly more than 8 mg/dl
❑ bone marrow aspirate or biopsy: hypercellular, characteristically shows bone marrow infiltration by significantly increased number of myeloid elements (a biopsy is done only if aspirate is dry); in the acute phase, myeloblasts predominate
❑ computed tomography scan: may identify the organs affected by leukemia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Blood pressure decrease:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Obtain the patient’s history from the patient or his family, paying particular attention to associated symptoms, such as weakness, fatigue, dizziness, fainting, blurred vision, nausea or vomiting, blood in stool, unsteady gait, palpitations, chest or abdominal pain, difficulty breathing, or generalized pain. Determine if symptoms appear when the patient changes positions suddenly.
Physical examination
Obtain blood pressure measurements with the patient lying down, sitting, and then standing, and compare readings. A drop in systolic or diastolic pressure of 10 mm Hg or more and an increase in heart rate of more than 15 beats/minute between position changes suggest orthostatic hypotension. (See Ensuring accurate blood pressure measurement.)
Obtain the patient’s other vital signs. Inspect the skin for pallor, sweating, and clamminess. Palpate peripheral pulses. Note paradoxical pulse — an accentuated fall in systolic pressure during inspiration — which suggests pericardial tamponade. Then auscultate for abnormal heart sounds (gallops, murmurs), rate (bradycardia, tachycardia), or rhythm. Auscultate the lungs for abnormal breath sounds (diminished sounds, crackles, wheezing), rate (bradypnea, tachypnea), or rhythm (agonal or Cheyne-Stokes respirations). Look for signs of hemorrhage, including visible bleeding and palpable masses, bruising, tenderness, or a positive stool occult blood test. Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds. Also, carefully assess the patient for possible sources of infection such as open wounds.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Blood pressure increase:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Determine if the patient has a history of cardiovascular or cerebrovascular disease, diabetes, or renal disease. Ask about a family history of high blood pressure — a likely finding with essential hypertension, pheochromocytoma, or polycystic kidney disease. If hypertension was a pre-existing disease, determine its onset, age at onset, medical treatment regimen, and associated symptoms. Pheochromocytoma and primary aldosteronism usually occur between ages 40 and 60. If you suspect either, check for orthostatic hypotension.
Note headache, palpitations, blurred vision, and sweating. Ask about wine-colored urine and decreased urine output; these signs suggest glomerulonephritis, which can cause elevated blood pressure.
Obtain a medication history, including past and present prescriptions, herbal preparations, and over-the-counter (OTC) drugs (especially decongestants). Determine if the patient takes prescribed antihypertensives as recommended.
ALERT: A sudden onset of high blood pressure in middle-age or elderly patients suggests renovascular stenosis. Although essential hypertension may begin in childhood, it typically isn’t diagnosed until around age 35.
Hypertension has been reported to be two to three times more common in women taking hormonal contraceptives than those not taking them. Women age 35 and older who smoke cigarettes should be strongly encouraged to stop; if they continue to smoke, they should be discouraged from using hormonal contraceptives.
Physical examination
Take the patient’s blood pressure with him lying down, sitting, and then standing. Normally, systolic pressure falls and diastolic pressure rises on standing. With orthostatic hypotension, both pressures fall.
Using a funduscope, check for intraocular hemorrhage, exudate, and papilledema, which characterize severe hypertension. Perform a thorough cardiovascular assessment. Check for carotid bruits and jugular vein distention. (See Preventing false bruits.) Assess skin color, temperature, and turgor. Palpate peripheral pulses. Auscultate for abnormal heart sounds (gallops, louder second sound, murmurs), rate (bradycardia, tachycardia), or rhythm. Then auscultate for abnormal breath sounds (crackles, wheezing), rate (bradypnea, tachypnea), or rhythm.
Palpate the abdomen for tenderness, masses, or liver enlargement. Auscultate for abdominal bruits. Renal artery stenosis produces bruits over the upper abdomen or in the costovertebral angles (CVAs). Easily palpable, enlarged kidneys and a large, tender liver suggest polycystic kidney disease. Obtain a urine sample to check for microscopic hematuria.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Blood pressure decrease:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient is conscious, ask him about associated symptoms. For example, does he feel unusually weak or fatigued? Has he had nausea, vomiting, or dark or bloody stools? Is his vision blurred? Gait unsteady? Does he have palpitations? Does he have chest or abdominal pain or difficulty breathing? Has he had episodes of dizziness or fainting? Do these episodes occur when he stands up suddenly? If so, take the patient’s blood pressure while he’s lying down, sitting, and then standing; compare readings. A drop in systolic or diastolic pressure of 10 to 20 mm Hg or more and an increase in heart rate of more than 15 beats/minute between position changes suggest orthostatic hypotension. (See Ensuring accurate blood pressure measurement.)
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Blood pressure increase:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
After ruling out life-threatening causes, complete a more leisurely patient history. Determine if the patient has a history of cardiovascular or cerebrovascular disease, diabetes, or renal disease. Ask about a family history of high blood pressure — a likely finding with essential hypertension, pheochromocytoma, or polycystic kidney disease. Then ask about its onset. Did high blood pressure appear abruptly? Ask the patient’s age. Sudden onset of high blood pressure in middle-aged or elderly patients suggests renovascular stenosis. Although essential hypertension may begin in childhood, it typically isn’t diagnosed until near age 35. Pheochromocytoma and primary aldosteronism usually occur between ages 40 and 60. If you suspect either, check for orthostatic hypotension. Take the patient’s blood pressure with him lying down, sitting, and then standing. Normally, systolic pressure falls and diastolic pressure rises on standing. With orthostatic hypotension, both pressures fall.
Note headache, palpitations, blurred vision, and sweating. Ask about wine-colored urine and decreased urine output; these signs suggest glomerulonephritis, which can cause elevated blood pressure.
Obtain a drug history, including past and present prescriptions, herbal preparations, and over-the-counter drugs (especially decongestants). If the patient is taking an antihypertensive, determine how well he complies with the regimen. Ask about his perception of elevated blood pressure. How serious does he believe it is? Does he expect drug therapy to help? Explore psychosocial or environmental factors that may impact blood pressure control.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Blood pressure, decreased [Hypotension]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient is conscious, ask him about associated symptoms. For example, does he feel unusually weak or fatigued? Has he had nausea, vomiting, or dark or bloody stools? Is his vision blurred? Is his gait unsteady? Does he have palpitations? Does he have chest or abdominal pain or difficulty breathing? Has he had episodes of dizziness or fainting? Do these episodes occur when he stands up suddenly? If so, take the patient's blood pressure while he's lying down, sitting, and then standing; compare readings. (See Ensuring accurate blood pressure measurement.)
A drop in systolic or diastolic pressure of 10 to 20 mm Hg or more and an increase in heart rate of more than 15 beats/minute between position changes suggest orthostatic hypotension.
Next, continue with a physical examination. Inspect the skin for pallor, sweating, and clamminess. Palpate peripheral pulses. Note paradoxical pulse—an accentuated fall in systolic pressure during inspiration—which suggests pericardial tamponade. Then auscultate for abnormal heart sounds (gallops, murmurs), rate (bradycardia, tachycardia), or rhythm. Auscultate the lungs for abnormal breath sounds (diminished sounds, crackles, wheezing), rate (bradypnea, tachypnea), or rhythm (agonal or Cheyne-Stokes respirations). Look for signs of hemorrhage, including visible bleeding and palpable masses, bruising, and tenderness. Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds. Carefully assess the patient for possible sources of infection such as open wounds.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Blood pressure, increased [Hypertension]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If you detect sharply elevated blood pressure, quickly rule out possible life-threatening causes. (See Managing elevated blood pressure, page 84.)
After ruling out life-threatening causes, complete a history and physical examination. Determine if the patient has a history of cardiovascular or cerebrovascular disease, diabetes, or renal disease. Ask about a family history of high blood pressure—a likely finding with essential hypertension, pheochromocytoma, or polycystic kidney disease. Then ask about its onset. Did high blood pressure appear abruptly? Ask the patient's age. The sudden onset of high blood pressure in middle-aged or elderly patients suggests renovascular stenosis. Although essential hypertension may begin in childhood, it typically isn't diagnosed until near age 35. Pheochromocytoma and primary aldosteronism usually occur between ages 40 and 60. If you suspect either, check for orthostatic hypotension. Take the patient's blood pressure with him lying down, sitting, and then standing. Normally, systolic pressure falls and diastolic pressure rises on standing. With orthostatic hypotension, both pressures fall.
Note headache, palpitations, blurred vision, and sweating. Ask about wine-colored urine and decreased urine output; these signs suggest glomerulonephritis, which can cause elevated blood pressure.
Obtain a drug history, including past and present prescriptions, herbal medicines, and over-the-counter drugs (especially decongestants). If the patient is already taking an antihypertensive, determine how well he complies with the regimen. Ask about his perception of elevated blood pressure. How serious does he believe it is? Does he expect drug therapy to help? Explore psychosocial or environmental factors that may impact blood pressure control.
Follow up the history with a thorough physical examination. Using a funduscope, check for intraocular hemorrhage, exudate, and papilledema, which characterize severe hypertension. Perform a thorough cardiovascular assessment. Check for carotid bruits and jugular vein distention. Assess skin color, temperature, and turgor. Palpate peripheral pulses. Auscultate for abnormal heart sounds (such as gallops, louder second sound, or murmurs), rate (for example, bradycardia or tachycardia), or rhythm. Then auscultate for abnormal breath sounds (such as crackles or wheezing), rate (for example, bradypnea or tachypnea), or rhythm.
Palpate the abdomen for tenderness, masses, or liver enlargement. Auscultate for abdominal bruits. Renal artery stenosis produces bruits over the upper abdomen or in the costovertebral angles. Easily palpable, enlarged kidneys and a large, tender liver suggest polycystic kidney disease. Obtain a urine sample to check for microscopic hematuria.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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