Chapter 8 Flashcards
what can cause alterations in lab values
- dehydration
- inadequate nutrition
- infections
- inflammation
bone marrow alterations with age
hematooietic tissue decreases by around 20%
normal red blood cell range
4.2-6.1
normal hemoglobin range
12-18
- main component or rbc
- used as an indicator for anemia
hemoglobin
critical hemoglobin value
<
hemoglobin value that indicates anemia
< 13 in men
< 12 in women
normal hematocrit range
37%-52%
percentage of rbc to plasma
hematocrit
elevations in hct and hgb usually early sign of…
hypovolemia
signs of hypovolemia
- malnutrition
- dehydration
- diarrhea
- volume depletion
lifespan of white blood cells
15-20 days
number of wbc’s is regulated by…
endocrine system
types of white blood cells
- neutrophil
- eosinophil
- basophil
- monocyte
- lymphocyte
normal wbc range
5000-10000
critical wbc values
30,000
neutrophil normal range
55%-70%
- wbc
- first responder
- phagocytes
neutrophils
increased neutrophils
neutrophilia
what can cause neutrophilia
- meds (corticosteroids)
- connective tissue disease
- arthritis
- malignancies
- trauma
- gout or uremia
- thyrotoxicosis
normal lymphocyte range
20%-40%
lymphocyte responsible for cell to cell combat
T cells
lymphocyte responsible for antibody production
b-cells
lymphocyte changes with age
decrease T cells, elevated B cells
normal monocyte range
2%-8%
- migrating wbc’s
- grow up to be macrophages
monocytes
normal eosinophils range
1%-4%
wbc that work against allergens and parasites
eosinophils
eosinophil aging effect
decreased mucosal immune response
normal basophils
0.6%-1%
transport histamine and histamine
basophils
younger adults s/s of infection
- elevated temp
- lymph node enlargement
- increase in total wbc count
older adult s/s of infection
- all may be absent until they are very ill or septic
2. immature neutrophils usually the first indicator of illness
rules for neutropenic pts
- ppe
- visitors ppe
- handwashing
- equipment hygiene
- pt wears mask
- no fresh vegetables or fruits
- no flowers
leukocytosis range
2,500-5,000
neutropenic range
below 2,500
normal platelet (thrombocytes) range
150,000-400,000
stimulate the clotting cascade
platelets (thrombocytes)
platelet related aging changes
- no change in number
2. increase in clotting factors
platelet count less than 100,000
thrombocytopenia
spontaneous hemorrhage may occur when platelet counts are less than…
20,000
common diagnostics for hematological testing
- erythrocyte sedimentation rate (esr)
- C-reactive protein (crp)
- iron studies
- b vitamins
- vitamin d
rate at which a rbc settles/falls to the bottom of a saline or plasma solution
erythrocyte sedimentation rate (esr)
problem with esr
- very nonspecific
2. can be used to measure status of treatment for inflammatory disorders
elevation in esr indicates
- common in healthy adults with chronic illness
- elevated serum proteins
- inflammation
produced by liver in acute phase of inflammation, surgery, injuries, or infection
C-reactive protein (crp)
crp test results indicate:
- evaluation of acute mi
2. risk for cad
heart risk of crp at <1
low risk
heart risk of crp at 1-3
average risk
heart risk with crp at >3
high risk
source of iron
- dark, green, leafy vegetables
- red meats
what is iron needed for?
- o2 transport
- energy production in the mitochondria
normal serum iron range
60-170 mcg/dL
normal TIBC range
250-450 mcg/dL
normal transferrin saturation
20%-50%
b vitamins needed for normal functioning of wbc and rbc and dna synthesis
-stored in liver
folic acid
b vitamin needed for normal development of rbc, neurologic function, dna synthesis
-need intrinsic factor for absorption
b12
thrombocytopenia precautions
- bleeding precautions
- fall precautions
what can cause low levels of b vitamins
- protein energy malnutrition
- liver and renal disease
- alcoholism
what can cause decreased vitamin d levels
- aging skin
- decreased uv light exposure
- decreased intrinsic factor
decreased vitamin d levels =
bone resorption
electrolytes
- sodium and chloride
- potassium
- calcium and phosphorus
- glucose
sodium and chloride are influenced by:
- renal filtration
- renal blood flow
- cardiac output
- glomerular filtration rate
- asymptomatic in beginning
- can cause seizures, coma, and death
- <135
hyponatremia
- > 145
- most often free water loss and dehydration
- mental status changes
hypernatremia
function of potassium
- cell osmolarity
- muscle function
- transmission of nerve impulses
- acid base balance
normal potassium range
3.5-4.5
decrease in lean muscle mass=
decreased potassium
s/s of hypokalemia
- generalized muscle weakness
- fatigue, muscle cramps
- constipation
- ileus
- flaccid paralysis
- hyporeflexia
- hypercapnia
- tetany
ecg changes with hypokalemia
- qt prolonged
- t wave flattened or depressed
- st segment depressed
s/s of hyperkalemia
- impaired muscle activity
- weakness
- muscle pain/cramps
- increased gi motilityy
- bradycardia
- cardiac arrest
ecg changes with hyperkalemia
- p wave flattened
- t wave large, peaked
- qrs broad
- biphasic qrs-t complex
diagnostic criteria for diagnosing diabetes
- one random plasma glucose of 200 when exhibiting symptoms
or - two of any on or combo of positive tests on different days
-fasting glucose 126
-oral glucose tolerance test 200 2 hours after glucose
-random plasma glucose 200 without symptoms
additional diagnostic test for diabetes
hgb a1c
general cut off for hgb a1c
<6.5%
normal creatinine kinase (ck) level
0-3 ng/mL
- indicator of acute mi
- also measures myocardial muscle damage, unstable angina, shock, malignant hyperthermia, myocarditis
- rises in 3-6 hours, peaks in 12-24 hours
creatinine kinase (ck)
what can cause false elevated ck?
- anticoagulants
- dexamethasone
- furosemide
- captoril
- cholchicine
- lovastatin
- propanolol
- morphine
- gold standard for diagnosing acute mi
- elevated within 6 hours and will stay elevated 7-14 days
troponin
normal troponin level
<0.03 ng/mL
normal total protein range
6.4-8.3
normal serum albumin range
3.5-4.8
- measures nutritional status
- most useful as indicator of severity of illness and risk of mortality
serum albumin
protein is needed for…
- energy
- drug and chemical transportation
- maintaining intravascular pressure
normal blood urea nitrogen (BUN) range
7-21
measurement of nitrogen portion of urea; used as gross measurement for renal functioning
BUN
normal creatinine range
0.5-1.4
measures breakdown of muscle creatinine phosphate
creatinine
normal/therapeutic digoxin level
0.8-2.0
breakthrough seizures can occur with dilantin levels below…
10
dilantin toxicity
above 20
most common disturbance seen in older adults
hypothyroidism
free thyroxine (T4 free) levels
0.8-1.5
tsh level
0.4-4.5
t4 total level
5.5-12.3
t3 level
60-181
normal specific gravity of urine
1005-1030
normal pH of urine
4.6-8
bilirubin level in urine
0.2-1.0
negative urine studies
protein, glucose, ketones, blood, nitrates, leukocytes
what to do to fix protein levels
colloid followed by diuretic
what can raise tsh levels
lithium
what can lower tsh levels
heparin and aspirin
what is key to promoting max health for older adults in the long term care setting (cmp, cbc, thyroid)
annual lab testing
most lab findings and their meanings are the same for…
older and younger adults
an indicator of cardiac events and inflammation
CRP
