{"id":10356,"date":"2020-11-20T20:31:53","date_gmt":"2020-11-20T20:31:53","guid":{"rendered":"http:\/\/onlineclassesguru.com\/?p=10356"},"modified":"2020-11-20T20:31:53","modified_gmt":"2020-11-20T20:31:53","slug":"1004-american-family-physician","status":"publish","type":"post","link":"https:\/\/onlineclassesguru.com\/index.php\/2020\/11\/20\/1004-american-family-physician\/","title":{"rendered":"1004 American Family Physician"},"content":{"rendered":"<style type=\"text\/css\"><\/style><p>1004 American Family Physician www.aafp.org\/afp Volume 92, Number 11 ? December 1, 2015<\/p>\n<p>An elevated white blood cell count has many potential etiologies, including malignant and nonmalignant causes. It is important to use age- and pregnancy-specific normal ranges for the white blood cell count. A repeat complete blood count with peripheral smear may provide helpful information, such as types and maturity of white blood cells, uniformity of white blood cells, and toxic granulations. The leukocyte differential may show eosinophilia in parasitic or allergic conditions, or it may reveal lymphocytosis in childhood viral illnesses. Leukocytosis is a common sign of infection, particularly bacterial, and should prompt physicians to identify other signs and symptoms of infection. The peripheral white blood cell count can double within hours after certain stimuli because of the large bone marrow stor- age and intravascularly marginated pools of neutrophils. Stressors capable of causing an acute leukocytosis include surgery, exercise, trauma, and emotional stress. Other nonmalignant etiologies of leukocytosis include certain medi- cations, asplenia, smoking, obesity, and chronic inflammatory conditions. Symptoms suggestive of a hematologic malignancy include fever, weight loss, bruising, or fatigue. If malignancy cannot be excluded or another more likely cause is not suspected, referral to a hematologist\/oncologist is indicated. (Am Fam Physician. 2015;92(11):1004-1011. Copyright \u00a9 2015 American Academy of Family Physicians.)<\/p>\n<p>Evaluation of Patients with Leukocytosis LYRAD K. RILEY, MD, and JEDDA RUPERT, MD, Eglin Air Force Base Family Medicine Residency, Eglin Air Force Base, Florida<\/p>\n<p>L eukocytosis, often defined as an ele- vated white blood cell (WBC) count greater than 11,000 per mm3 (11.0 \u00d7 109 per L) in nonpregnant adults,<\/p>\n<p>is a relatively common finding with a wide differential. It is important for clinicians to be able to distinguish malignant from non- malignant etiologies, and to differentiate between the most common nonmalignant causes of leukocytosis.<\/p>\n<p>Leukocytosis in the range of approxi- mately 50,000 to 100,000 per mm3 (50.0 to 100.0 \u00d7 109 per L) is sometimes referred to as a leukemoid reaction. This level of elevation can occur in some severe infections, such as Clostridium difficile infection, sepsis, organ rejection, or in patients with solid tumors.1 Leukocytosis greater than 100,000 per mm3 is almost always caused by leukemias or myeloproliferative disorders.2<\/p>\n<p>Normal Variation The normal range for WBC counts changes with age and pregnancy (Table 1).3 Healthy newborn infants may have a WBC count from 13,000 to 38,000 per mm3 (13.0 to 38.0 \u00d7 109 per L) at 12 hours of life (95% confidence interval). By two weeks of age, this decreases to approximately 5,000 to 20,000 per mm3 (5.0 to 20.0 \u00d7 109 per L), and gradually declines throughout childhood to reach adult levels of 4,500 to 11,000 per mm3<\/p>\n<p>(4.5 to 11.0 \u00d7 109 per L; 95% confidence interval) by about 21 years of age.3 There is also a shift from relative lymphocyte to neu- trophil predominance from early childhood to the teenage years and adulthood.4 During pregnancy, there is a gradual increase in the normal WBC count (third trimester 95% upper limit = 13,200 per mm3 [13.2 \u00d7 109 per L] and 99% upper limit = 15,900 per mm3 [15.9 \u00d7 109 per L]), and a slight shift toward an increased percentage of neutrophils.5 In one study of afebrile postpartum patients, the mean WBC count was 12,620 per mm3 (12.62 \u00d7 109 per L) for women after vaginal deliveries and 12,710 per mm3 (12.71 \u00d7 109 per L) after cesarean deliveries. Of note, pos- itive bacterial cultures were not associated with leukocytosis or neutrophilia, making leukocytosis an unreliable discriminator in deciding which postpartum patients require antibiotic therapy.6 Patients of black African descent tend to have a lower WBC count (by 1,000 per mm3 [1.0 \u00d7 109 per L]) and lower absolute neutrophil counts.7In this discussion, you will need to begin to explore your future role as a masters-prepared nurse and consider potential differential diagnoses for a child after reading a brief scenario.<\/p>\n<p>Please answer the following:<\/p>\n<p>1. What are the priority areas of concern for the masters-prepared nurse to consider in reviewing the individuals diagnostic test results?<\/p>\n<p>2. What are the usual treatment options for individuals suffering from his condition based on the potential differential diagnoses?<\/p>\n<p>Explain your rationale for your choices, citing resources from the literature.<\/p>\n<p>John, a four-year-old boy, is being admitted to your unit for further treatment, management, and confirmation of diagnostic test results. His most recent complete blood count revealed a total white blood count of 250,000\/\u00b5L. John has loss of appetite, is easily bruised, has gums that bleed frequently, and has marked fatigue. The physical exam reveals that he has splenomegaly, pale skin color, an oral temperature of 102\u00b0F, and some upper abdomen tenderness.<\/p>\n<p>3. What would you expect the patient to look like? What are the risks associated with the medical and nursing interventions? What are your plans to address these potential risk factors as a masters-prepared nurse?<\/p>\n<p><center><a href=\"http:\/\/onlineclassesguru.com\/orders\/ordernow\"><img decoding=\"async\" src=\"https:\/\/encrypted-tbn0.gstatic.com\/images?q=tbn:ANd9GcTyj99p60XCLyLk1htB7-1neRt8-2QdnenNlQ&usqp=CAU\"target=\"_http:\/\/onlineclassesguru.com\/orders\/ordernow\"\/><\/center><p>","protected":false},"excerpt":{"rendered":"<p>1004 American Family Physician www.aafp.org\/afp Volume 92, Number 11 ? December 1, 2015 An elevated white blood cell count has many potential etiologies, including malignant and nonmalignant causes. It is important to use age- and pregnancy-specific normal ranges for the white blood cell count. A repeat complete blood count with peripheral smear may provide helpful&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-10356","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>1004 American Family Physician - onlineclassesguru<\/title>\n<meta name=\"description\" content=\"American Family Physician\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/onlineclassesguru.com\/index.php\/2020\/11\/20\/1004-american-family-physician\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"1004 American Family Physician - 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