Basics

Question 0

The 8 specific levels that a BMP will test

Answer 0

Serum concentrations of sodium, potassium, chloride, calcium, blood urea nitrogen (BUN), creatinine, glucose, carbon dioxide.

Question 1

What are the most common lab tests referred to collectively?

Answer 1

Basic Metabolic Panel (BMP)
Comprehensive metabolic panel
Hepatic function panel

Question 2

Why is Potassium important?

Answer 2

Vitally important in the function of excitable cells (nerve, muscles, heart).

Heart most affected. Leads to arrhythmia or cardiac arrest.

Also causes muscle weakness or irritability.

Question 3

Respiratory Acidosis

Uncompensated
Compensated

Answer 3

Uncompensated. pH 45. HCO3 normal. Signs. HA, sweating, tachycardia, disorientation, agitation, cyanosis, lethargy, decreased DTRs

Compensated. pH normal. PCO3 >45 HCO3 >26

Question 4

Signs to look for with potassium imbalance

Answer 4

Dizziness, muscle cramping or weakness, numbness or tingling, and balance issues.

Question 5

Why is Chloride important?

Answer 5

Changes in chloride levels usually occur with changes in sodium and water.

HCO3- is a critical component in the pH of the blood.

Low HCO3 leads to metabolic acidosis.

Doctors can change the HCO3 levels by means of respiration or renal measures, but renal measures take several days to work.

Question 7

Why is Sodium important?

Answer 7

Critical determinant of fluid volume in the body.

Under normal circumstances:
Increased sodium = retention of water
Decreased sodium = loss of water

Can be decreased by: taking in excessive fluid or production of anti-diuretic hormone.
Can be increased by: profuse sweating or decreased anti-diuretic hormone.

Increased fluid volume can increase blood pressure and increases in cell volume. Neurons are especially vulnerable to this increase.

Question 8

Metabolic Acidosis

Uncompensated

Compensated

Answer 8

Uncompensated: pH < 7.35 PCo2 normal HCO3 <22

Signs. Increased respiratory rate.

Question 8

Metabolic Alkalosis

Uncompensated
Compensated

Answer 8

Uncompensated. pH >7.45. PCO3 normal. HCO3 > 26. Signs. N/V, diarrhea, confusion, irritability, agitation, muscle twitching, muscle cramping, muscle weakness, parenthesis, convulsions, slow breathing.

Compensated. pH normal PCO3 > 45 HCO3 > 26. Signs decreased respiratory rate.

Question 9

Average reference glucose levels

Answer 9

Adults 70-100 mg/dl

Question 10

What value is considered hypoglycemic and what action should be taken?

Answer 10

Below 70 and provide them with carbohydrate snack such as OJ, honey, hard candy

Question 11

Signs of a hypoglycemia

Answer 11

HA, weakness, irritability, lack of muscular coordination, apprehension, inability to respond to verbal commands, psychosis.

Question 12

Symptoms related to activation of sympathetic nervous system.

Answer 12

Due to a sudden drop in blood glucose levels that might not be below 70 but the sympathetic effects will mirror hypoglycemia.

HA, nervousness, irritability, decreased coordination, shaking, tachycardia, complaints of weakness, decreased responsiveness, psychosis.

Question 13

Effects on glucose by eating and exercising

Answer 13

Eating with increase glucose, exercise and insulin decrease it.

Be careful with people if they just ate or just had insulin.

Question 14

What lab values to look at for someone with kidney disease or failure?

Answer 14

BUN, Creatine

Question 15

Creatinine and kidney function

Answer 15

Normally the skeletal muscle produces a set level of creatinine and the kidneys are able to handle it. If the value goes up that indicates that the kidney function is in decline and/or there was a lot of skeletal muscle damage.

Question 16

Decreased renal function leads to what change in BUN?

Answer 16

BUN will increase because of decreased renal blood flow.

Could be elevated by protein catabolism or increases protein intake.

Question 17

What two organs will affect BUN levels

Answer 17

Kidney disease and liver disease

Kidney: increased BUN
Liver: decreased BUN

People that have both at the same time might be normal.

Question 18

Blood ammonia

Answer 18

By product of breaking down amino acids. Severe liver injury results in the inability to convert ammonia into urea.

Can lead to signs of confusion, lethargy, dementia, tremors, deterioration of speech and fine motor skills.

Question 19

Normal range for blood ammonia

Answer 19

< 75 mcg/dl

Question 20

Symptoms of hepatic disease

Answer 20

Altered behavior or mental status, fluctuating levels of consciousness, peripheral edema, right upper abdominal,pain, musculoskeletal pain. Ascities

Question 21

ALT and AST levels

Answer 21

Measure liver function.

Normal AST: 8-20
Normal ALT: 5-35

Can also be elevated by severe muscle injury. Serum creatine kinase CK-MM can differentiate.

Question 22

RBC count

Answer 22

Similar way of assessing the capacity of the blood to carry oxygen such as hemoglobin or hematocrit correlating with a person’s endurance and orthostatic tolerance.

Men: 4.5-5.3
Women: 4.1-5.1

Question 23

Leukocytes

Answer 23

White blood cells, to fight infection, and react against foreign bodies or tissues

Women’s and Men: 4500-11,000
Elevated, fighting infection or high level of inflammation

Depressed, on chemo, bone marrow transplant, or organ transplant. At risk for nosocomial infection.

Question 24

Explain HcT

Answer 24

Relative volume of RBCs in blood

Will be low in people with anemia, but people with anemia might have ok values.

36-49

Question 25

Hemoglobin

Answer 25

Hemoglobin is found within RBCs. People can have normal RBCs or HCT, but have low HgB

12-16

Question 26

Anemia

Answer 26

Decreased exercise tolerance with decreased aerobic capacity, decreased endurance, orthostatic intolerance. Needs lower intensity and more frequent breaks.

HCT less than 25%
HgB less than 8

Physically demanding exercise will not be beneficial.

People with chronic anemia could be able to handle more exercise than someone acutely anemic with the same values.

Question 27

Low platelets…three other things to consider before therapy

Answer 27

Fever, past history of bleeding, known infection.

Over fatigue can lead to a greater reduction in immune function.