Infection or Inflammation? The Quick & Dirty on CBCs

Even when I went up there, it is a Shannon say Shannon said it and I missed it. Totally my bad hemoglobin. Perfect. Yeah. H and H. Cool. Yeah. These are the things that are going to be affected by it. So let's go on to the next one. [inaudible] perfect. Like we talked about is you're going to be a little bit different. So a lot of people will say, I like your irons a little quote unquote. Especially if you're ever giving blood and this is what they're looking at. They're looking at that hemoglobin. Um, so what we want to do is we noticed that we know that red blood cells are typically higher, a little bit higher in men. So your hemoglobin concentration is going to be a little bit higher and men rather than women. And is it really going to change during pregnancy? Uh, I haven't gotten into pregnancy labs. We can probably do a session on those. Then I should be kind of cool and then have Miriam Dude. But we can talk about that and see how like pregnancy essentially total blood volume and that kind of stuff. Speaking of total blood volume matter grant, I drew a picture yesterday. Um, and it's also in the lesson and it's also in a cheat sheet. It's going to be coming out pretty soon. It talks about different or why a hematocrit is important and why it is it percentage. So who can tell me why Hermatocrit is a percentage
or do you, I'm gonna draw a picture and because I found out I can do colors on this, I'm going to do colors. Cool. So the reason that, uh,
see the reason that Hermatocrit is that percentage is because it's a Princeton edge or the actual total blood volume. All right. That known a second. No, I'll show you why yellow. So I can four again. Cool. All right. Area, which my little guy, oh my goodness. I'll ask my cursor. There we go. Okay, cool. So we look at this. This is plasma and these are red blood cells. And what we're looking at with the, this is something called the total blood volume. Oh my goodness. I can't, right, right over here. Total blood volume. Total blood volume is 100% of the volume of blood. So this is five mills, a blend. We expect this percentage, which is about that 40 to kind of a good rule of thumb is about 45% um, 45% his red blood cells. And uh, the, uh, the other 55% is plasma.
Okay. So we're looking at the total blood volume in terms of uh, as a percentage. So the reason you want to look at this is because he knew a little bit of sometimes difficult to remember and the h and h kind of go hand in hand and you'll say, okay, well my patients a Hematocrit is 20% I don't exactly remember what his hemoglobin is. Hemoglobin supposed to be like in the teens. Maybe his Metacritic is 20% and hemoglobin is, I'm pulling an arbitrary number. Southern Point for match should probably be less. Let's say it's 5.4. That's probably more right. So I would suspect that this patient has what condition?
Who can tell me [inaudible] hemoglobin is 5.4. Damien. Cool. What do you expect that would do for this patient? These values are that low. What am I, what do you think that I'm going to do? What is going to be my next, your blood guilt? Possibly try to identify, um, what, what the causes. So like if, let's say this and I'll give you an example. So I had a patient, um, he had had a, uh, colon cystectomy. So, um, gallbladder Brian we would very unlikely Brian says, uh, we'd give iron. We would much w the likelihood that we'd actually get an iron would be very, very low. Uh, because the, the need for iron does it. Um, does it surpass the need for actual hemoglobin? Cause remember hemoglobin has a direct correlation to the oxygenation. So what we want to do is we're probably going to have a patient who's going to have some oxygenation issues. So go back to the patient I was talking about. So he had had a colon cystectomy, it has gallbladder taken out, and then all of a sudden I noticed his blood pressure. I'd go to turn in the blood pressure. He's sitting like one, 10 or 80, but all of a sudden he goes, he whales out in pain and then blood pressure goes to this somewhere in there.
Remember he, he had had the coolest cystectomy. So what do you think that I'm thinking for this patient? Blood pressure drops. I'd turn him, his heart rate goes up. I think you went into like the one thirties. Yeah. This dude had had um, yeah, he has an internal bleed. So my first response is yes I can I or the surgeon involved, I gave him, I think I ended up giving him like a couple of boluses of, uh, I think I'd given him like a leader of LRS, a Bolus. Um, but my first concern is, okay this blood pressure was low so I get the blood pressure, blood pressure corrected. Cause we got 'em to him. We got to intravascular volume. But the other thing we needed to do is we need to get them to stat o r to find where this bleeds. Uh, I took them to Omar. I think they opened him. Um, cause he had a lap coli. So they did the internal, um, we did the internal, uh, the laparoscopic cholecystectomy where they take the scope and go in, take out the gallbladder
and that's what they did originally. But in the process they'd had a, um, he'd had a little bit of a bleed and so he's bleeding internally and the suction amount got him all fixed up, came back. Obviously you had some pain issues, but for the most part, all of this date, all right, I think they end up moving to the floor the next day. But these are the things you are going to think about. Okay, well, Hey, American snow, what's going to be the next step? Obviously transfusion is going to be somewhere in here, but the thing that you also want to figure out is what's going on. You can't automatically say, hey, he needs blood. Because if he's internally bleeding, it's not gonna matter. If he's going to continue to bleed and you continue to give blood, he's going to continue to bleed into like his abdomen and now you have increased intra abdominal pressures and all sorts of stuff.
So do the things you want to be mindful of. This is also why we said don't treat the know, treat the number, treat the patient. Yes, this is a concern. But the other thing we want to look at is what's going on with their patient. Let's go to the next one. Cool platelets there. Sometimes a little bit of controversy with this, but this is why I always say pay attention to your facility policy. Um, or what the lab says because what's going to happen is they could say, Hey, oh one 25 to 400 isn't a one wall, a 90 to three 75 as normal. Um, one 50 to 400 is normal, but these are all the things I want to think about also of these numbers, the a hundred of the four 50, which 1:00 AM I most concerned with?
Right? And the reason that we're concerned with is why are we concerned with it being a hundred or less? Oh, two oh two I'm looking for more specific. Aaron is, Danny says, not Connie. We worry about some specific bleeding. So Brian Talks about OT. So if we were in platelets, platelets are also known as thrombo sites. We break this word down cause I also did the medical terminology course. Thrombo refers to clot. And so, so this is a clotting type sell. Its responsibility is to go to sites of active bleeding and stop bleeding. So they run a risk. They actually have a risk of bleeding. So we want to make sure that anytime this number is less than a hundred, we want to try to figure out why and and also avoid things that are going to cause bleeding. Uh, so excessive venipunctures, that kind of stuff. But we also need to take a look at maybe he needs some, uh, actually this patient needs some platelets. So, uh, this is why it's also really important when I look at when I'm talking about this number is hey, what's going on with the patient and what does my facility say is normal? Also, what does a provider say that's normal? Because you have a patient that maybe has, um, uh, it's called I t. P.
Yeah.
Um, does anybody know ITP stands
for? It's going, it's going to be a little bit tricky and no searching Google either cheaters. I'm just kidding. IDP stands for immune
median
Rambo Cytopenia Purpura. Basically it's an immune mediated process where the homicides are a low, so this patient could be on some sort of steroids or an immunosuppressant. Ah, so Brian asked, is there bleeding from everywhere? No. So what happens is for us, what happens is, is that there's, um, I can't rent this room. So on the platelet like this, this is your plan then, and let's say your Bonnie recognizes, um, maybe an antibody on it and it recognizes it as born. So what happens is the body comes in as a response. The immune system comes in and says, Hey, I'm going to send this macrofossils come over and eats it. Okay. So now you start to see all these antibodies that are being produced in the, the white blood cells come and, uh, destroy it. So what you do is your patients are going to be on an immunosuppressant cause we want to suppress the immune system because the immune system is essentially attacking its own platelets.
So that's what ITP does. Um, in a nutshell. And it's, it's a lot more complicated than that, but it's not that they are bleeding from everywhere. It's just that when you have low platelets, they are at a higher risk of bleeding from everywhere, from lots of their places. They can actually go into like dic, they can have all of these other complications associated with it. So it's really important that when you see these things that you say, hey, my patients, the most important takeaway from this slide is that we need to look at our patient's platelets and make sure that they are not low. If they are low, we need to figure out why. And, uh, is there a need or a reason to correct it? Like let's say it's 90 k and my patient has ITP, they just started therapy two weeks ago. They're on steroids in some other immunosuppressive drugs. Well 90 is probably acceptable for that provider. They may say that their parameters, they want them 80 to 200. They may, that may be their, their, uh, their parameters for that patient. So it's always important to pay attention to the facility and the lab and also the provider. Does that make sense?
Cool.
All right, let's go to the next one. Okay. Differentials here, we gamma. This is probably the reason you guys showed up right now. It's about ancient and some platelets left the differentials. This is why meat and potatoes, right? Oh my goodness. They're finally circling. Sorry, my talents give me some trouble. So neutrophils, the differential, now these numbers are not always going to add up. Mothers should be close to a hundred but they vary. Like if I look and say this is 40 and this is 40 and this is maybe eight, and then you get one on one. They usually a a a similar to a hundred but neutrophils, what I want you to look at when you're looking at the differential, so the differential is the way that the white blood cells are broken up into. There's several different wetland cells. So you've got neutrophils, you've got lymphocytes, monocytes, eosinophils, and basophils.
So your neutrals, the reason you're going to have the majority of your white blood cells is that they are responsible for inflammation. We're going to cover this in just a second, a little bit more in depth, but it should be the majority right here should be in here. Um, and then your lymphocytes are going to be next. Monocytes, you're gonna need more Esinophilic, some basic fields that you should rarely see these. Um, so we'll pay it. We'll take a look at some actual cbcs on, uh, on patients here in a second. But these are, I want you to look at is you should look at this snapshot on a differential note that the majority is neutrophilic Nexis, lymphocytes and monocytes eosinophils and basophils usually are far less. So, um, cut off. I don't know if I can make this bigger. All right. Um, if you can't see one, two, three.
Okay, cool. Um, if you can't see the bottom of my screen, I'll, I'll, I'm gonna kind of write in this area, but at differential we're looking at these new tools. This is an inflammatory response. If you get a patient that comes in and let's say their neutrophils are 80%, you know, look at the reason your patient's there because they may be having, um, they may be having a neutrophilic response. So let's say their white count is, let's say it's 16, which is high, but 80% are neutrophilic. That means that there's an inflammatory process going on somewhere. That does not mean that they have an infection. And this is kind of the, the big deal, and I want you to take away from this session today, is that with these, it's so important to figure out what's going on in terms of the differential and figure out what's going on with my patient.
So now let's go back to, you know, let me race cause I can already, so let's say my patient's white blood cells are let's say 20, and let's say left. His white count is, um, let's say it's 60%. I would say this is 40, and that's pretty normal. But look at this. That's a pretty high, pretty high a lymphocytic count. So we're going to inspect and suspect infection. Now you're looking at antibody production, antigen production, T and B lymphocytes. It this place into like a HIV patients. And then, um, uh, natural killer cells. Sorry, it took me a second. Um, so these are all responsible for infection. When there's an infection, these are going to be the guys that go to that sign, the infection to try to kill off the infection. Now you also have monocytes, which also play an important part of infection because of macrophages. Do what?
Yeah.
Well good. Tell me what macrophages do they eat and eating of honing. Alright, so right, they're going to go to the site and they're actually going to end goal. Whatever bacteria is there, um, and or whatever pathogen is there and they're going to go and, and Gulf them and break them down. Now, the important thing that I want you to figure out between eosinophils, invasive cells, they are both responsible. They're an inflammatory response. So don't be surprised if, uh, when you, let's say you have a patient that comes in, they have an anaphylaxis reaction. This, you're going to see an increase in SFS. You may see an increase in your basophils, but you're also gonna see an increase in all that.
You're also going to see this increase in this neutrophilic response so that you can have an increase in these, an increase in your eosinophils and also in your basophils. But one thing that's really important that I want you to look at is this guy right here. Actually highlight, um, and you guys are more than welcome to like, uh, take notes and write stuff down kind of as I'm writing it down. That way you can figure out another, uh, whatever other helpful way. Um, and I'm also thinking of some ideas in terms of, uh, things that, uh, maybe some links that we can provide me at the beginning of the session. Uh, cause I know that you, if some of you guys have asked for that, um, so that you can actually be like, oh, hey, is there a way I can, you know, take notes and go along with you.
But you're always more than welcome to, you know, if you were a, uh, a kinesthetic learner, like I am, like I always have to be actively learning and writing stuff down in order to remember it, which is why this always looks like this. But parasites are going to be a tantamount to eosinophilic response. So if you have some sort of like, uh, here's it. Here's an example, a neurosystem neuro sister, so I can't say it, oh my goodness. Neuro system, sorry. Poses is a, um, it's basically a, a pathogen in pork. If it's under cooked and he goes into the brain, um, this is the brain on an MRI and here's your corporate clothes, then there's going to be these little holes all in the brain tissue and it comes from this pathogen. Well, inside of it, you're also going to see this nus in the field of response on the CBC.
Like you'll get this huge bounce of neutrophils. It is huge bouts of eosinophils. So you get this on a CT scan, your patient's got some neuro changes, hey, then there's a highly suspicious, uh, cause for some sort of parasitic granted. Okay. Those are the kind of the big takeaways from that. So let's look at a patient. Cool. You got a patient, he's a 35 year old male admitted for abdominal surgery. He's, Oh, I'm going to, I'll walk through this, uh, through this documentation so that you guys can maybe pick up on some of these, uh, these abbreviations that are really commonly used. So let's go and highlight. Cool. 35 year old Wyo. Has your old male admitted for abdominal surgery, two days. Set Status Post. Who has heard of staffs post
[inaudible].
Um, any one of you who has heard of status post care to explain it? What does status post mean? And I'll give you a second to type it because I want to make sure that like, I think there's some great value in having, um, right Christians is after something. So I think there's great value in, uh, having, uh, people who are learning things also teach them. So you want to do one teach one, right? So after surgery, so two days status post means explorer. So this two days, status post to explore for laparotomy means the, the exploratory laparotomy happened two days ago for an SB. Oh, anybody know what an SBO is? Small, small funding. Donald Surgery.
Yeah. Small Bowel instruction currently in the ICU. So let's look at his current complaints. So he's got fatigue, he has pallor. Here are his vital signs. Heart rate is 110. Blood pressure's 90, over 49. Uh, temperature is 37. This is in a Celsius and which is normal. And An spo two is 94. Okay. What are the first things that I want you guys to identify in your patient that, uh, should give you some sort of, maybe some significant, uh, indication as to what's going on in his bundle signs? Let's look at the vital signs first. Jackie techie. What? Danny [inaudible] is he to Kip? Nick, is he tech a Kartik. All right. Yeah. So one thing that I also want you guys to do is get in the habit of being very specific. This was something I learned early on, um, as a nurse, as a new nurse, was I can go talk to my, my provider and say, hey, he's tacky.
Well, what does that mean? Well, he's tacky, slightly tacky in 110. So just be very specific. Yeah, there you go, Danny. So I want you to, um, for the sake of these tutoring sessions, like it's okay. Like you don't have to be the first response or if other people do it. I want you to, I would rather have someone, uh, any tutoring sessions be very clear and concise so that we always know what we're talking about and that we're giving the best information all the time because, uh, if my provider gets mad, like I worked in a public hospital, so my providers were, um, very respectful. But that doesn't always happen in private hospitals. So if you walk up to your provider and say, oh, he's tacky, well, what does it mean? And they may be a jerk. So, I don't want to say that happens in every facility, but I want you guys to, I want to equip you with the absolute best tools in terms of communication because I think it is a shortcoming in, uh, in most nursing education programs is that they teach you all these concepts, but they don't teach you how to actually communicate.
So when you're talking about it, hey, his heart rate is 110, slightly tacky. Okay? That's not terribly crazy. Okay? He's got fatigue, she's got paddler, blood pressure. Um, who can tell me, would you would by show of hands, who would be a little bit nervous about this blood pressure? I can grab my calculator and you can say it that way. Joel bowls with the hand on. Let me see something. I want to do some quick man. Okay. Um, anybody ever heard of the map mean arterial pressure? So Danny asked what was the baseline B. Okay, cool. Um, I'm [inaudible], I'm going to kind of circle that. And the reason I say that, who can tell me what the minimum math should be for kidney perfusion?
Okay.
Brian says 60 does anybody know what this guys map is and you're ready to do that calculation? I had to do it cause I can't do that math in my head. I got him at 61 so I'm okay with this. I still should be doing something for this patient. I should not let this ride but he's slightly TigerCard his blood pressure is trending. Probably trending downward is this, Kyoto is 94 I don't know about if he's on a oxygen supplementation, but for now we're going to say that I'm okay. Cause minimum is usually about 92% but the map you always a rule of thumb is 60 because we're worried about kidney perfusion and this guy's at like 61 point something. For those of you who are curious. The way I got this, it's, it's basically, it's just all one plus two times diastolic blood pressure divided by three so it'd be 90 plus 49 plus 49 [inaudible] rent a room divided by three and that gives you 61 and change.
So I'm not worried about this guys. Like there's nothing that saying, Hey, I need the bullets. This guy right now. Well, the thing I want you to look at is here we get to the CBC check this guy out 1.8 million, 6.5 and the boogaloo and Mount of grits in 19.5. Those are all a, I suspect, just like we talked about with that other guy that that was actually my patient. I would say by suspect that this guy maybe has an internal bleed somewhere. But the other thing I want to do is I want to offer squirt therapy. So maybe I'll give him a fluid Bolus depending on if he needs to go to [inaudible]. Maybe he needs a CT abdomen, maybe he needs, so this is one of those things where I say, okay, look it surgery necessary. Let's talk to the provider. Um, are there things that I can do in the meantime? Maybe he just, uh, he went a little fluid deficit while he was in surgery two days ago and never recovered. Maybe he's, um, maybe he has a slow bleed somewhere. So maybe we need to do CT and see if there's something that can be done there. If there's an active bleed somewhere, maybe we'll give him a blood transfusion. Right? So I'm not jumping at this patient, but I am being considered of everything that's involved with them. Does that make sense?
Cool. I don't like you. I don't like, this is why I like to give a kind of a, a whole holistic picture of the patient because I don't, this is why I want you to say, hey, look, heart rate slow. He's an email junior to get blood. Well, what does a patient doing? Oh, this is okay. This is not terrible. If I get the fluid bullets, this should improve it. Improve the intravascular volume a little bit. I don't know what is is. Uh, ins and outs are, there's a lot more information than I need. But in terms of, uh, from a clinical standpoint, I think this is a good starting point to say, look, let's give a fluid Bolus. Let's see what you believe. Bring his blood pressure up, see if we can maybe chill his heart rate down a little bit. Um, let's investigate the blood, uh, the blood situation a little bit more. Who can tell me what that kind of the standard hemoglobin before we actually give blood is like, what's the number of, what are we going to say? We're in here. We're going to need a transfusion. Salmon. Yeah, it's about seven. So the other information, what other information do you think would be helpful to know from this patient? Just start seeing things that would be really beneficial to, to figure out does, where do we need to go for this next? For our next step?
You can
tell me
just anything, whatever comes to mind. What, what previous history would do you think would be really helpful for this patient to know about it? So any meds they're on. Sure. Some Drake, some drugs cause um, some drugs cause, uh, issues with, um, uh, red blood cell production. OK. Uh, maybe his kidney status, cardiac issues. So let's see. Guy's kidney status for a second, right? So kidneys produce something called Earth replete. [inaudible] eating. Um, Brian. So does he have any allergies? Um, when we're looking at, uh, earth or Permian EPO, EPO actually stimulates red blood cell production. Maybe the patient has a history of severe kidney disease and his, um, EPO production is low and so he's automatically gonna is automatically going to predispose him to having, uh, anemia. So now we know that this guy's already behind the eight ball. Now he's had surgery, maybe he's deficient. Maybe that fluid Bolus is a bad idea. Maybe we need to do a blood transfusion. Maybe we need a CT. So there's lots of things that we need to take into consideration when we're thinking about our patients. All right, let's move to the next one I've got, I think we've got two more cool. 18 year old female wines a fall from balcony radiograph confirms broken and distal Femur. Current complaint, pain in leg.
Alright,
vital signs, heart rate of one 15. Blood pressure is one 44 92 a spo two is [inaudible]. Cool. Let's get my little trusty handy. Dandy notebook. No, not notebook. Oh, Brian is on it. Brian says she's in pain. Brian. And why do you think she's in pain? Yeah. What's B o Oh, broken leg. Obviously she's in pain. She says she's in pain. But what of this stuff? And either either her vital signs or her blood work says that she's, that she's in pain. Yup. BP Art Mate on 15, those of men. Yeah, that's gotta be pretty tricky depending on where she lives. Um, I know patients that had been like, they live in like the 50 sixties and all sudden they start hurting or their heart rate goes up to, you know, one 10 at rest yet that heart rate and that blood pressure telling me she's a pain. Cool. So we do her BMP, we do our magnifies. Uh, we do her h and h, um, or we do the CVC. Cool. Okay. Alright. So what on here, what, looking at this CVC and a differential. Who can tell me what we're seeing on the CBC? Joel [inaudible] get me to neutrophils. Usually your, the high indicating inflammation. Yep. I didn't, the other thing that I would be concerned with, so she fell from a balcony and she's got this broken distal femur. What other values on the CBC, what I want to look at automatically as like a general response
or or a general nursing response. Hey, I didn't got a distal femur break. What am I looking at on a CBC? Yup. Joel says, I'm going to look at that RBC. I'm also going to look at the h and h team because that distal femur fracture,
is it going to pose a significant risk
for bleeding? What am I going to be looking at for the patient? We are going to a little bit of medsurge musculoskeletal stuff right now. What am I looking for on the patient? Like physically on a patient?
Let me, let me rephrase my question. What am I going to assess for?
Yeah,
there it is. Mary is on it. Compartment Syndrome. You Bet. First thing I'm going to do is check the patient's shoe. I get, hey she 18 year olds, she fell. She going to just a femur fracture. She's a heart rate and I'm checking this. I've got to make sure that the, I know I'm not quit lines and the CBC checked. The ribose has a cool, uh, she's slightly high, not a big deal in neutrophils, a little bit high and great. I'm checking a patient's like for Carbon Compartment Syndrome, I'm going to make sure that the compartments,
for those of you who may not know what compartment syndrome is, basically there's bleeding into a finite space. So, and the uh, the femur on the femur breaks on, there's going to be, um, the blood that's in the bone actually bleeds out into all the interstitial space and the leg knee comes really hard. Um, it becomes a very, a very firm and a non pliable in any sense. Um, and what happens is all of the, uh, all of that pressure inside the leg goes up and it, uh, basically, uh, restricts all the blood flow throughout the entire muscle, um, the musculature of the length and she caused, uh, tissue damage and necrosis. And, uh, we don't want that. So as soon as we have to do like fasciotomy is to relieve pressure, but for compartment syndrome, that's what we're looking at. Hey distal femur fracture. She always kind of just be your general. Uh, I want that in the back of my mind. Thinking about compartment syndrome. Good job guys. Next one.
Cool. It is. It's your own [inaudible]. Meanwhile comes in, she's 86. She complains of a scrape leg on the bushes. The leg is now a and a dentist. Compare. The current complaint is they're a pain in the leg. The vital signs are 114. Blood pressure's one in 10 or 62. A temp is 38.6. Where's my heaven? Her parents has infection. Do you have any other thoughts? Hi Tim. Cool. What else? What else am I looking at? Brian says infection. Brian, why would you say infection? Okay, so Brian says the white counts are elevated. Yeah. And the differential. What am I looking at? Joel says loved sites, right? So love to center up just a little bit. Cool. Um, can we explain this? So didn't to the heart rate of one 15. Um,
good.
Can we explain why that's up? Cut. Danny says fever. Anything else? I don't want this one on pin Mac. Cool. Oh, Shim any Christmas. Come on colors. Here we go. Cool. 36. What else? There's something else in your sixth grade filling in the bushes. It's red. Dematis there is Jolson pain for me. Mom, scripture leg. This isn't eminence. This makes me think of this cellulitis. I'm thinking, Eh, she may, she may have some anxiety. Um, who here has heard of something? A philosophical concept called outcomes raiser.
Okay.
You can say no if you haven't because I want to make sure that nope, no, no, not me. Cool. So it's a political philosophical concept called Hakim's razor. And Brian's on it. The simplest thing first, what is the most plausible answer? Um, if there's something that's old, if, if I get in my, if I walk out to my car and there is blue paint on my car, my car when I bought it was not, um, was not blue and it was gray. And I see some painters painting the wall blue. The most likely reason that it's going to, uh, be blue is that somebody smelled blue paint on it. Not that, um, some magical, uh, pixies from the forest came and wished my car to be blue. It's that the most, the simplest answer is the most plausible cause. So for this, the most likely cause from what we know about the bunny is that heart rate goes up for several reasons.
It's a compensatory mechanism. It's a response to fever or it's a response to pain. We know that this, she's in pain and she has a fever. These two compounding factors, muscle, I explain it. Does she have some sort of a heart issue? Maybe, but we know that we can try to correct your pain with a pain meds. Oh my goodness. I can't type. We can try with pain meds and we can also try maybe some, um, some, uh, anti-pyretics so stuff for fever, maybe she needs some antibiotics. See you. What happens with this response? This is not terribly high. This is not a dangerous lethal heart rate that we need to be worried about. Sure we can get an EKG. It's not gonna hurt anything, but these two reasons are probably the most likely reason that it's up. So just something to be aware of. What this, this idea of Occam's razor will also get you in the idea of simplifying, uh, answers to questions. What's the most likely thing? What's the thing we can rule out the easiest and first if we could do that, then we're gonna [inaudible] I gotta look it up I think, cause I always spell it wrong.
Spoke for you.
Yeah. And it's fine. Cool. We'll CC ADM.
Hey.
Okay.
Yeah, it's a super cool concept. If you can take that and just kind of put that in the back of your mind anytime you're dealing with a patient. Um, what's the easiest, most simplest and also kind of glean this idea of this higher level thinking. Guys, you did excellent today. What questions do you have about CVC?
Yeah,
I told you it was gonna be a little bit more involved cause they're a cvcs are not easy to do. Um, there are some other like, um,
[inaudible]
yeah, let me turn this off. I quit screen sharing. We can go back. Uh,
everybody see me? The thing about, um,
what was I talking about? Oh, a CBC. There's another thing, a MCH MCHC and RDW MCH has mean corpuscular hemoglobin. MCHC is main corpuscular hemoglobin concentration and RDW is with red cell. This British and with um, all of those things are really important for like hematologists and oncologists. For you. You don't necessarily, uh, it's not a high level thing. It's not good. You're not going to get a lot more information from it. If the RDW is high, I thought are you going to be as low if the MCHC is not a, typically you're going to see those changes with those red but because the red cells impact you more importantly with different disease processes like a sickle cell, um, uh, anemia, different types of pernicious anemia, um, any sort of bleed, there's kind of thing. So anybody have any questions I can answer for you because if you don't, hopefully I've done my job today and that you learned a lot.
Um, these are always fun to do. Uh, so yeah, for sure. No question. Perfect. Excellent. Um, oh back around two central time cause we're going to do a liver functions, so, all right guys. Oh wait, wait, wait, wait. Christian has a question, they Matika is three times a year. [inaudible] yeah. Uh, typically as a general rule of thumb about, yeah, it should be somewhere in there. Um, yeah, that's right. Cause 15 times three is 45. Yeah. That's another good rule of thumb. Krisha brought that up where their hemoglobin is three times the hemoglobin. So if you, uh, if your patients, you know, hemoglobin is, you know, 18 expecting hemoglobin to be, is there a reason why a Christian, I would have to look that up. It's not that it's too deep. It just may be that, uh, the physics of plasma and of like total blood volume and all of these things that are, that just go into like the, um, the pathophysiology and the physiology of blood itself, uh, is just that that general rule applies.
Um, there, I would have to look it up. So if you're really interested in, I can do some more digging. Um, but you can email us@contactatnrsng.com and just say, hey, this is Christian. I was in the CBC tutoring session and wanting to know if there was a good reason why the Hermatocrit was three times a hemoglobin and um, they'll send it to me and I'll give them, I'll give support. So that's who you're emailing and I can give support and answer for you. Yeah. I've never really looked into it because I don't know if it, that when I'm looking at that stuff, the thing is what information can I Glean from it that will help me provide better care for my patient? And if there's not much, then it just becomes a cool fact. Um, it, the, the the rule of thumb. Yeah. It's not, I have a very strong confidence that it would not be on the NCLEX.
That the reason that the hemoglobin is, uh, um, a third of the a doesn't matter. Credit is not going to be something that's on their, what they're gonna want to know is that you can identify, Oh, Christian's one week out. Yeah, I would, I would not concern myself with that. What I would be concerned, fit, concern with is what are the symptoms of my patient? What's their history and what is their current value and what am I going to do about it when I'm personally prioritizing care? Cause that's what the inclax wants to do is make sure that they certify you, that you're going to go out on the floor and you're gonna be a safe nurse. That's what they want to do. They want to make sure that they're not saying, sure, Christian's going to go out and he's going to potentially hurt somebody.
So yeah, I wouldn't worry too much about that, especially at this point. If you didn't come back later after getting clicks in and take a look at it, then that's great. Um, I think that's a cool thing. You know, we're always learning here. Um, it's always great to know as much things, as many things as you can. Uh, but basically, you know, for the, for the sake of what you're doing, you shouldn't need to worry about that right now. Yeah, for sure. All right guys. Um, we'll be back at two central time, so it's several hours. Go happy nursing as always, I guess. See y'all later.