A nurse's client, who is in post-operative phase, during assessment obtains the information chills, high grade fever, significantly drop in blood pressure and rapid breathing. Patient may develop septicaemia. Based on the above assessment, which result is abnormal and should be reported to the physician?

Appeared in: NORCET -4 , 2023

Explanation

The patient's symptoms (fever, chills, hypotension) are classic signs of septicemia, a systemic infection.
The normal White Blood Cell (WBC) count is between 5,000 and 10,000/mm³.
A WBC count of 18,000/mm³ indicates leukocytosis, a significant elevation that is a hallmark of the body's response to a severe infection.
This finding directly correlates with the clinical suspicion of septicemia and is the most critical value to report for immediate medical intervention.

Option B: A glucose level of 78 mg/dl is within the normal fasting range of 70-110 mg/dl. It does not indicate an acute infectious process.
Option C: A hemoglobin level of 13.2 g/dl is within the normal range for adults (approx. 12-16 g/dl for females, 14-18 g/dl for males). It reflects oxygen-carrying capacity, not an acute infection.
Option D: A platelet count of 150,000/mm³ is at the lower limit of the normal range (150,000-450,000/mm³). While sepsis can lead to a drop in platelets (thrombocytopenia), this value is not yet critically abnormal.

Visual 1: Infographic: A chart showing the systemic effects of sepsis, including fever, hypotension, tachycardia, tachypnea, and the corresponding expected changes in lab values (leukocytosis or leukopenia).
Visual 2: Flowchart: A decision-making flowchart for nurses on recognizing and responding to suspected sepsis, starting with vital sign assessment and leading to lab draws and physician notification.

Clinical Relevance

Nursing practice connection: Use the key finding related to Interpretation of laboratory results in the context of a post-operative infection (septicemia) to guide bedside assessment, documentation, and the next nursing action.
Early recognition and escalation of care for sepsis are critical nursing responsibilities. Sepsis is a medical emergency, and delays in treatment significantly increase mortality.
Nurses must be proficient in interpreting basic lab results in the context of a patient's clinical presentation to identify life-threatening conditions.
What if? If the patient's WBC count was 2,000/mm³ (leukopenia) instead of 18,000/mm³, it would also be a critical finding. This could indicate an overwhelming infection where the bone marrow cannot keep up with production, or that the patient is immunocompromised. This is also a sign of severe sepsis and must be reported immediately.

How to Approach the Question

First, analyze the clinical scenario presented in the question stem. Identify the key signs and symptoms: chills, high fever, low blood pressure, and rapid breathing. Recognize these as classic indicators of sepsis or septicemia.
Next, review the question's specific ask: which lab result is abnormal and needs to be reported?
Evaluate each option by comparing the given lab value to its known normal range.
Option A (WBCs): 18,000/mm³ is significantly higher than the normal 5,000-10,000/mm³.
Option B (Glucose): 78 mg/dl is within the normal 70-110 mg/dl.
Option C (Haemoglobin): 13.2 g/dl is within the normal range for an adult.

Concept Tested & Keywords

Concept Tested: Interpretation of laboratory results in the context of a post-operative infection (septicemia).
Stem keywords: post-operative, chills, high grade fever, drop in blood pressure, rapid breathing, septicaemia
Lead-in keywords: abnormal, reported to the physician
Clinical cues: The combination of fever, hypotension, and tachypnea is a classic presentation of sepsis, a systemic inflammatory response to infection.

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Practise the full NORCET -4 , 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.