Case Study: Client with Red Blood Count (RBC) of 9.10 x 10[6]/mcL (Nursing)

00:01 Okay. Look at this question.

00:03 You see that this is our same friend, right? "Mr. Rosenstein has a health history of type II diabetes, COPD, and hypertension." And remember, he's got that nasty infection.

00:14 So, "He has an acute bacterial infection of the right leg.

00:18 The wound drainage is purulent.

00:19 His vital signs are blood pressure 142/88, pulse is 97, and respirations are 16.

00:26 His temp is 39.4°C or 102.9°F." Okay. Even though we just did this question, I want to walk through it again. We know what his history is: type II diabetes, COPD, hypertension, he's got a bad infection of his right leg.

00:44 Now, when I'm taking a test, anytime they're specific about things like that, right side, left side, I will literally take my hand and tap that side of my body.

00:51 It's just a way to focus your brain on what we're talking about.

00:56 Now in this particular question, it doesn't make a difference, but in some questions it makes a big difference.

01:02 So he's got an acute bacterial infection of the right leg.

01:06 The wound drainage is purulent.

01:08 That's not normal.

01:09 So we know for sure that's backing up that he has an infection.

01:13 His blood pressure is a little high, but we're okay with it.

01:16 His pulse is normal; little high, but still within normal.

01:20 Respiratory rate is 16, temp is high.

01:23 Okay, all that lines up with him having an infection.

01:27 Now, here's where this question gets a little different.

01:30 Because of his temperature, he's been drinking large amounts of fluid.

01:34 His lab work results included a red blood cell count of 9.1.

01:39 Which of the following is the most likely cause of this red blood cell count? Okay, now, his red blood cell count is high, low, or normal? Right. It's high.

01:52 So, we know he's been drinking a lot of fluid, his red cell count is high, so which of the following is the most likely cause of this red blood cell count? Okay, so you've written down A, B, C and D on your scratch paper.

02:09 Now, let's think about chronic COPD.

02:12 Is there any connection between chronic COPD and a high red blood cell count? Yes, there is. So people that have chronic COPD are always -- short of -- oxygen. So, over time, the body will compensate and make extra red blood cells.

02:30 We're going to leave that in.

02:32 Now, what about acute infection? Is there a connection between acute infection and elevated red blood cells? Now, in an acute infection, we have elevated white blood cells, so I can get rid of that.

02:47 Now what about an inflammatory response? Do I see an elevation in red blood cells? No. That's an elevation in white blood cells not red cells, so I can get rid of that.

02:59 Now, overhydration.

03:02 Will I see an elevation in red blood cells? Well, I know he's been drinking a lot of fluid and that was in the question, so it must be -- No, stop.

03:09 Don't let the distractions in the questions throw you off course.

03:13 Stick to what you know and what your focus is.

03:16 Overhydration -- will it cause an elevated red blood cell count? No. The answer is "no." So I think it's chronic COPD.

03:26 Now, I go back up to the question and say, "Does this make sense?" Yes. My rationale is still solid.

03:32 I know in chronic COPD, the body can respond by elevating the red cell count, trying to deal with that problem of not enough oxygen.

03:41 All right. There you have it.

03:43 I know it's going to feel really, really awkward at first, but the more you work on these rules, think through the stem of the question very carefully, with any number you see, ask yourself if it's high, low, or normal.

03:55 Any assessment you see, ask if it's normal or abnormal.

03:59 Any diagnosis you see, think through what the worst-case scenario is, and then you start working on your question and answers, making sure you eliminate each answer choice as you go.

04:10 Don't just gravitate to the right answer.

04:12 Eliminate the wrong answers and make yourself say why you're doing that.

04:17 I promise if you take these simple strategies and apply them, it will take you a little more time at first, but it's going to be a big payoff in the end.

04:26 Thanks for watching our video today and good luck on all your exams.