Date Performed:

HEMATOLOGY

Laboratory test for hamatologic condidtions are done to diagnose anemias such as
microcytic (iron deficiency) and macrocytic (aplastic, hemolytic, pernicious) bleeding disorder,
and blood cell changes.

TEST RESULT NORMAL CLINICAL SIGNIFICANCE

RANGE
Hemoglobin 126 135-175 According to Oliveira et. al, from the
It serves as a vehicle for oxygen journal entitled Anemia in
and carbon dioxide transport hospitalized patients with pulmonary
tuberculosis there was a high
proportions of pulmonary
tuberculosis patients were clasified as
underweight and malnourished and a
high prevalence of Anemia.
Hematocrit 38 0.40-0.50 Low levels of hematocrit and low
Hematocrit (PCV) is the measure level of haemoglobin indicates that
of the ratio of the volume occupied the patient may be have anemia.
by the red blood cells to the
volume of whole blood.
WBC 3.01 5.0-10.0 A low white blood cell count you
It combats foreign organisms indicates that the patients is
which enters our body. WBC are immunosuppressed, which means that
nucleated cels and do not contain you are more vulnerable to
hemoglobin also known as potentially serious infections.
leukocytes
MCV 150 150-400 Within norml range

MCH 85.70 79.0-92.2 Within normal range

MCHC 31.80 25.7-32.2 Wihin normal range

Platelet Count 119 150-390 A low platelets counts indicates that

Plateletes count or thrombocytes the patient is at higher risk for
are the smallest formed elements bleeding
in blood. They promote
coagulation and formation of
hemostatic plug in vascular injury.
DIFFERENTIAL COUNT
 Segmenters 25 55-75 Low levels of your neutrophils could
The body's first line of defense be seen in patients with viral
during an acute bacterial infection infection, autoimmune diseases, some
medications and malignancy.
Lymphocytes 58 20-35 An increased in lymphocyte count
These cells play an important role usually represents an acute infection
in our immune system response. especially viral infections, leukemia,
The t-lymphocytes produce
antibodies
Monocytes 0.09 0.08-0.14 Within normal range
These cells leave the bloodstream
to become macrophage, these cells
are phagocytic and defend the
body against viruses and bacteria
Eosinophils 7 1.0-8.0 Within normal range
Eosinophils probably kill parasites
by releasing chemical mediators
into extracellular fluid
Basophils 1.0 0-0.01 Within normal range
Contains histamines integral part
of hypersensitivity reactions

X-RAY

A chest x-ray is one of the diagnostic test most often ordered by the health care provider

primarily for screening purposes and then followed by other diagnostic test.

INTERPRETATION

IMPRESSION:
  REGRESSING BILATERAL UPPER LOBE PNEUMONIA. KOCHS ETIOLOGY

CONSIDERED, SPUTUM AFB CORRELATION SUGGESTED

 PULMONARY NODULE, RIGHT -UNCHANGED

NURSING RESPONSIBILITIES

 Describe the x-ray procedure to the patient

 Inform the client that the x-ray test usually take 5-10 minutes

 Inform the client that there may be several x-rays taken, one or two chest films. The

client may be asked to remain in the waiting room after x-rays are taken to be sure the

films are readable

 Encourage the client to as questions or to express his or her concern to the nurse,

ohysician, and the technician. Also, if the client does not understand the directions, he or

she should ask to have them repeated.

DSM5

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used
by health care professionals in the United States and much of the world as the authoritative guide
to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for
diagnosing mental disorders. It provides a common language for clinicians to communicate
about their patients and establishes consistent and reliable diagnoses that can be used in the
research of mental disorders.

For a diagnosis of bipolar I disorder, it is necessary to meet thefollowing criteria for a manic
episode. The manic episode may have been preceded by and may be followed by hypomanic or
major depressive episodes.

Manic Episode

CRITERIA MANIFESTED BY THE PATIENT

A. A distinct period of abnormally and persistently
elevated, expansive, or irritable mood and
 abnormally and persistently increased goal-
directed activity or energy, lasting at least 1
week and present most of the day, nearly
everyday
B. During the period of mood disturbances and
increased energy or activity, three or more of the
following symptoms, four if the mood is only
irritable are present to a significant degree and
represented a noticeable change from usual
behavior:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep When Patient R was living in her parents’
residence it was mentioned that she does not have a
proper sleeping schedule due to the excessive use of
electronic gadgets such as cellular phones. “Na
ma’am dili na halos matulog kay mag sige rana’g
gamit og cellphone, mag bukot rana siya matulog”. As
claimed by Mr. B.

3. More talkative than usual or pressure to keep Patient R has overabundance of ideas. Patient R talks
talking spontaneously in a rapid manner and due to the speed of
her speech sometimes she will stutter and produce
incomprehensible words.
4. Flight of ideas or subjective experience that Patient R has overabundance of ideas. Though her
thoughts are racing answers to the questions were relevant, circumstantiality
was observed. One example is when the patient was
asked about how many siblings does she has, she replied
“Ang akong papa 14 sila nga mag-igsoon, ang akong
mama siya ra isa, kami 6 mi ka mag-igsoon, ug naa koy
blannk ka pag-umangkon”. Flight of ideas was noted by
jumping from one topic to another during the
interaction.

5. Disctractibility as reported or observed During the interview, the patient can’t sit still without
moving his feet up and down the chair and she’s
performing hand gestures whenever she explains

6. Increase in goal directed activity either
socially at work or school or sexually or siya og borikat tungod daghan na kaayo lalaki ang
psychomotor agitation.
something. She is easily distracted with environmental
factors such as people passing by in front of her.
Mrs. A verbalized “Usahay ingnon na jud na
nadala niya sa balay og kung dili na siya makainom og
tambal, mawala nadayon ang iyang kaulaw og
mahimong baga og nawong. Manghagit na siya og laki
og kung naa ganiy lalaki iyang makit-an kay ang iyang
attensyon mawala dayon og didto mag focus sa lalaki
kung naay sab magtipok nga laki kay mo duol siya ug
kung naa siyay maganahan mangregards dayon na
siya”.

Also according to Mrs. A when Patient R got

married her husband wanted them to live at Tagum but
Patient R did not want to stay at Tagum for a long
period of time because she had another boyfriend living
in living there as well, as claimed “Wala na siya
nisugot mu puyo sa Tagum kay naa man pud diay siyay
uyab didto nga wa pa niya gibuwagan.”.

7. Excessive involvement in activities that have

a high potential for painful consequences
(e.g. engaging in uinrestrained buying
sprees)
C. The mood disturbance if sufficiently severe to
cause marked impairment in social or Ms. F also claimed that Patient R would always
occupational functioning or to necessitated get into arguments and fights among their siblings and
hospitalization to prevent harm to self or others claimed “Hilig man jud na siya mamalikas og kung
sumpongon na kay lahi na manubag og kailangan jud
namo siya sabton. Tao raman sab mi moabot jud ang
time sauna nga dili nami ka pugong sa among kasuko
magaway-away mi”.
It was mentioned that Patient R would always
have arguments with her siblings Ms. F verbalized
“Dili malikayan nga magaway-away ni kay dili man
siya siya magpasulti og dali ra siya mangluod og mag-
tantrums kung storyahan siya og dili matuman ang iyang
gusto”.

At the age of 16 years old, around the year 2006.

She started manifesting symptoms of bipolar disorder.
Patient R’s mother received a call from the guidance
counselor of the college that her daughter was attending
and the landlady of the dormitory and claimed
“Nagsugod ang tanan adto’g ni tung-tung na siyag
college sa Holy Cross, ang course niya adto kay
accountancy. Ang nahitabo man jud adto kay naay
nikalit og tawag sa amo og iya diay tung guidance
councilor og landlady sa iyang dorm. Sa school, gitawag
na siya tungod sa pag puli na niya sa maestro niya og
siya ang magtudlo-tudlo sa iyang classmates. Ang
nahitabo sab sa dorm kay nagaway-away na sila sa mga
ka dormate niya kay iyaha dawng kauban kay mga
damak. Limpyada man jud na siya nga bata”.

In the next year around 2011, the patient was

admitted for three weeks at the Institute of Psychiatric
and Behavioral Medicine, Southern Philippines Medical
Center. According to Mrs. A, the patient’s family can
no longer tolerate the patients attitude and verbalized
 “Niabot gid sa punto nga dili lang laag-laag og takas sa
among balay, pasexy-sexy og mag make-up nga mga
simptomas ni Patient R, niabot siya nga magpisikal na
siya. Iya nang iduk-duk iyang ulo sa ding-ding og
musyagit og gusto na siya mamatay. Iya sab gitutukan
og kutsilyo ang iyang kaugalingon kay gikuha man sa
iyang ate ang cellphone tungod dili na siya matulog og
sige lang og text-text sa mga lalaki niya. Iya sab
pangbuk-on ang mga samin sa ilang aparador og
panggub-on ang mga butang sa balay”.
Patient R was admitted for the sixth time because her
manic episodes her manic episodes have worsened to
the point where she puts herself and others in harms
way. Which resulted into her parents taking extra safety
precautions such as restraining Patient R and hiding any
sharp objects around their house “Kadtong isa ka
higayon ma’am na nisumpong na siya, Nakuratan jud
me kay iyang ipakug iyang kaugalingon sa ding-ding
kay sakit kuno iyang ulo unya iyang gipang buak ang
mga bintana na bildo diri sa balay, apil among kabinet
iyang gipang buak, ang mga pultahan, maong tungod
adto amo siyang gigapos kay manakit naman siya og tao
D. The epsidoes is not attributable to the
physiological effects of a substance (e.g.
Note: Criteria A-D constitute for a manic episode. At least one lifetime manic episode is required
for the diagnosis of bipolar I disorder.

The doctor have diagnosed patient R with Bipolar I manic phase with psychotic features based
on the symptoms menifested by patient R, based on the assessment and history taking of the
patient, the patient has met the criteria on dsm 5.