Group 4
Members: CUNANAN, ENGELBERT ESPINA, JERALDINE
CATUBIG, PRINCESS EVE ESTOPO, SHANE
DANO, DANIELLE MAREE LIM, BERNIEDELLI RUZELLE
DELA TORRE, NICOLE
1. Complete Blood Count (CBC):
WBC: 18,500/µL (High)
Neutrophils: 88% (High)
Bands: 10% (Left shift)
→ Indicates a significant bacterial infection. The left shift suggests the body is producing more immature
white blood cells to fight infection, raising concern for sepsis.
2. Blood Cultures (x2):
Result: Positive for Staphylococcus aureus
Antibiotic Sensitivity: Responsive to vancomycin and Zosyn
→ Confirms Staph aureus bacteremia (bacteria in the blood), a serious condition. Fortunately, the
bacteria are sensitive to prescribed antibiotics.
3. Wound Culture & Sensitivity:
Result: Positive for MRSA
Resistant to: Bacitracin and neomycin
→ MRSA explains worsening wound infection despite using over-the-counter ointments like Neosporin.
More potent, targeted antibiotics are needed.
4. Serum Lactate:
Level: 3.8 mmol/L (Elevated)
→ High lactate is a key marker for sepsis, suggesting poor tissue oxygenation and systemic involvement
of the infection.
5. Basic Metabolic Panel (BMP)
● High glucose (280 mg/dL)
— means his blood sugar is very high, likely from uncontrolled diabetes and stress from infection.
● High BUN (30) and creatinine (1.8)
— shows his kidneys are not working well, probably due to sepsis.
● Low sodium (132)
— slightly low, possibly from fluids or the infection.
● Potassium (4.5)
— normal, but needs to be monitored.
6. C-Reactive Protein (CRP)
● Very high (145 mg/L)
— a sign of severe inflammation in the body, usually from a serious bacterial infection like sepsis.
7. Procalcitonin
● Very high (6.2 ng/mL)
— a marker that confirms a serious bacterial infection and sepsis. It helps monitor how bad the infection
is.
8. HbA1c
● High (8.6%)
— means his blood sugar has been poorly controlled over the past 2–3 months, making him more prone
to infections.
9. Urinalysis with Culture:
Result: Negative for infection
→ Since his urine is clear of infection, this tells us the source of infection is not his urinary system.
→ This narrows down the source of his infection to his infected wounds (abrasions on his hip and
shoulder), which are:
● Red, swollen, and draining pus
● Tested positive for MRSA (a dangerous skin bacteria)
10. Chest X-ray
Result: Clear lungs, no infiltrates or effusions
→ This finding supports the localized skin and soft tissue infection (due to MRSA) as the most likely
origin of his systemic symptoms, rather than pulmonary involvement.
11. Electrocardiogram (ECG)
Result: Normal sinus rhythm, HR: 98 bpm
→ The normal rhythm is reassuring and indicates no underlying cardiac arrhythmia, despite the patient
reporting palpitations — possibly due to fever, dehydration, or stress.
12. Arterial Blood Gas (ABG)
Result: pH: 7.31 (Acidotic)
HCO₃⁻: 17 mEq/L (Low)
PaCO₂: 30 mmHg (Low)
→ These results indicate metabolic acidosis with respiratory compensation, which is highly relevant in
this context:
○ The metabolic acidosis is likely due to lactic acid buildup from poor tissue perfusion and
infection, as supported by the elevated serum lactate (3.8 mmol/L).
○ Jordan delayed treatment for 5 days, during which the infection progressed and systemic
inflammation worsened — leading to sepsis and tissue hypoxia.
○ His compensatory respiratory alkalosis (low PaCO₂) shows the body’s attempt to maintain
pH by hyperventilating and "blowing off" CO₂.
13. Coagulation Panel (PT/INR, aPTT)
Result: INR: 1.4 (Normal: 0.8–1.2) aPTT: 47 sec (Normal: 25–35 sec)
Interpretation: Mr. Torres’ INR and aPTT are both elevated, which indicates impaired blood clotting. This
is concerning in the context of sepsis, as the infection can trigger systemic inflammation, leading to
coagulation abnormalities or even early disseminated intravascular coagulation (DIC).
14. Liver Function Tests (LFTs)
Result: AST: 65 U/L (↑) ALT: 72 U/L (↑) Bilirubin: 0.9 mg/dL (Normal)
Interpretation: Both AST and ALT are mildly elevated, showing liver stress or inflammation, which is
common in septic patients due to decreased perfusion or possible drug effects (e.g., antibiotics like
Zosyn). However, the bilirubin remains normal, suggesting no major liver dysfunction or cholestasis at
this point.
15. Glucose (Fingerstick or Serum)
Result: 280 mg/dL
Interpretation: Mr. Torres’s blood glucose is critically elevated, which can be caused by infection-related
stress, diabetes, or possibly medication effects. High glucose levels impair immune function and delay
wound healing, making infection harder to control. Although he is on Metformin, his current condition may
require insulin therapy to control his blood sugar during hospitalization.
Question & Answers
1. The nurse is caring for a client diagnosed with cervical dysplasia. The client asks for the meaning of
dysplasia. Which response by the nurse is best?
A. Replacement of a fully differentiated cell by another in tissues where the second type normally isn’t
found.
B. Presence of completely undifferentiated tumor cells that don’t resemble cells of their origin.
C. Alteration in the size, shape, and organization of differentiated cells.
D. Increase in the number of normal cells in a normal arrangement.
Answer: C. Alteration in the size, shape, and organization of differentiated cells. Rationale: Dysplasia
refers to an alteration in the size, shape, and organization of differentiated cells. dysplasia is not cancer,
but it may sometimes become one. It can be mild, moderate, or severe, depending on how abnormal the
cells look under the microscope and how much of the tissue or organ is affected.
2. The patient with cervical cancer has an implanted sealed internal radiation device. The nurse provides
which instruction to the patient?
A. "Your visitors need to limit their stay to 1 hour per day and remain 3 feet away from you at all times."
B. "Because the device is implanted close to the cancerous region, it has a limited, local effect."
C. "Please bear in mind that your body and bodily fluids are radioactive; take care to limit exposure to
others."
D. "Call me immediately if the implant becomes dislodged. I will pick it up with gloves and forceps and
place it in a sterile container until the radiation safety officer can collect it."
Answer: B Rationale: Oncology patients can be treated with implanted internal radiation devices which
are used to provide radiotherapy targeted to cancer cells either through direct implantation or some sort
of targeted delivery system. Sealed implants are implanted close to the tumor region and exert a limited,
local effect. Unsealed implants are systemic (i.e. radioactive iodine for hyperthyroidism). All patients with
implanted radiation devices require special safety practices, which attempt to limit radiation exposure to
other patients and to health care personnel. It is recommended that visitors remain 6 feet away from the
patient and limit their stay to 30 minutes per day. Patients with sealed implants should understand they
will be emitting radiation that may be harmful to others.
