Exam 1: Interpreting Clinical Lab Results Flashcards
(142 cards)
1
Q
What are vital signs (4+2)
A
Temperature, BP, HR, RR, O2 Sat, Pain
2
Q
What is included in chem-7?
A
Na, Cl, BUN, K, HCO3, Cr, Glucose
3
Q
What are some hematology tests?
A
WBC, platelets, Hgb, HCT
4
Q
Temperature: reference range
A
97-100.3 F or 36.1-37.9 C
5
Q
BP: Reference range
A
100-140 mmHg / 70-90 mmHg
6
Q
HR: Reference range
A
60-100 bpm
7
Q
RR: Reference range
A
14-18 breaths/min
8
Q
O2 Sat: Reference range
A
92-100% on room air
9
Q
Pain: Reference range
A
0-10
10
Q
Sodium: Reference Range
A
135-146 mEq/L
11
Q
Potassium: Reference Range
A
3.4-5.2 mEq/L
12
Q
Chloride: Reference Range
A
98-110 mEq/L
13
Q
Bicarbonate: Reference range
A
24-32 mEq/L
14
Q
BUN: Reference range
A
7-23 mg/dL
15
Q
Cr: Reference range
A
0.5-1.1 mg/dL
16
Q
Glucose: Reference range
A
70-100 mg/dL
17
Q
Calcium: reference range
A
8.4-10.4 mg/dL
18
Q
Magnesium: Reference range
A
1.6-2.6 mg/dL
19
Q
Phosphorus: Reference range
A
2.4-4.4 mg/dL
20
Q
AST/ALT: Reference range
A
0-35 IU/L
21
Q
Alkaline Phosphaase: Reference Range
A
30-120 U/L
22
Q
Amylase: Reference Range
A
0-130 IU/L
23
Q
Lipase: Reference range
A
0-160 IU/L
24
Q
LDH: Reference range
A
50-150 U/L
25
Total Bilirubin: Reference range
0.1-1mg/dL
26
Direct Bilirubin: Reference range
0-0.2 mg/dL
27
Albumin: Reference Range
3.5-5 g/dL
28
INR: Reference Range
0.8-1.2
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WBC: Reference Range
3.2-9.8 x10^3 cells/mm^3
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Platelets: Reference Range
140-440 x10^3 /mL
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Hgb: Reference range
14-18 g/dL for males
| 12-16 g/dL for females
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HTC: Reference range
39-49% for males
| 33-43% for females
33
HR: What is considered bradycardia?
<60 bpm
34
HR: What is considered tachycardia?
>100 bpm
35
Weight: ABW formula
Actual body weight: (wt in lbs) / 2.2 = wt in kg
36
Weight: IBW formula
Men: 50 + 2.3(# inches over 5ft)
Women: 45.5 + 2.3(# inches over 5ft)
37
Sodium: Where is it predominately found?
Extracellular fluid
38
Sodium: Why do sodium abnormalities usually occur?
Usually a result of changes in water homeostasis -- volume overload (heart/liver failure) or volume depletion (vomiting/blood loss)
39
Sodium: HYPOnatremia: Na Loss examples
Excess sweating, N/V, medications (diuretics), shifting from extra to intracellular spaces
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Sodium: HYPOnatremia: water gain examples
Increased intake, SIADH (syndrome of inappropriate ADH > increases water retention)
41
Sodium: HYPOnatremia: Symptoms
Fatigue, confusion, muscle weakness/spasms, and coma in serious cases
42
Sodium: HYPERnatremia: Causes
Secondary to intake of high Na containing products (ex. 0.9% NaCl, some antibiotics (oxacilin)
43
Sodium: HYPERnatremia: Symptoms
Asymptomatic but muscle spasms may occur
44
Potassium: Where is it found?
Predominately an INTRAcellular cation (all but 2% is located within cells)
45
Potassium: Importance
Required for various enzymatic processes (Na/K ATPase, Krebs cycle)
Plays important role in sk. and sm. muscle contraction
46
Potassium: HYPOkalemia
Typically caused by fluid loss (bleeding, diarrhea, diuresis, vomiting)
Stool can contian 40-60mEq/L of K
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Stool can contain ____ of K
40-60mEq/L
48
Potassium: HYPERkalemia
Typically caused by renal dysfunction (decreased clearance) -- may be drug induced (ACEI/ARB, K-sparing diuretics)
49
Potassium: HYPO/HYPERkalemia s/sx
Muscle weakness - results from either LOW or HIGH levels of K
Dysrhythmias can be induced
50
Chloride: Where is it found?
Accounts for approximately 1/3 of all serum in EXTRAcellular fluid
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___ accounts for approximately 1/3 of all serum in ___cellular fluid
Chloride, extracellular
52
Chloride: how is it filtered
Actively filtered via the kidneys (along with Na)
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Chloride: Abnormalities causes
Reasons similar to those causing hypo+hypernatremia - diuretic use, vomiting
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Chloride: HYPOchloremia s/sx
muscle excitability + tremors
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Chloride: HYPERchloremia s/sx
weakness + lethargy
56
Bicarbonate: What does it measure
Levels of CO2 (Acid/base balance)
57
Bicarbonate: HYPObicarbonatremia
ACIDIC process
| Metabolic, diabetic, ketoacidosis, or an overdose of ethylene, methanol, salicilates
58
Bicarbonate: HYPERbicarbonatremia
ALKOLOTIC process or long term COPD (CO2 retention)
59
BUN: Def
Waste product from production of ammonia by the liver
60
BUN: How is it filtered?
Healthy kidneys can filter and remove urea via urine
61
BUN: Low BUN
LIVER disease/damage, malnutrition
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BUN: High BUN
RENAL disease/damage, dehydration, or high protein intake
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SCr: Def
Chemical waste product produced primarily by muscle metabolism, filtered via kidneys, similarly to BUN
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SCr: Low Scr
Lack of nutrition/muscle mass
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SCr: High SCr
RENAL disease/damage, excess muscle mass
66
What 2 Chem-7 lab results may indicate renal disease/damage?
High BUN and SCr -- if kidney is not properly filtering out, high BUN/SCr = renal disease/damage
67
Glu: Def
Source of energy for most cells
| Carbohydrates to glucose (regulated by insulin and glucagon)
68
Glu: LOW Glu: s/sx
Induce somnolence and coma
69
Glu: HIGH Glu: s/sx
Indicate impairment --> diagnosis of DIABETES?
70
Ca: Importance
Involved in muscle contraction and bone formation
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Ca: Storage
99% in skeleton and teeth
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Ca: How is it regulated
Vit D and parathyroid hormone
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Ca: Breakdown % of albumin bound, free, salt bound
40% albumin
45% free
15% salt
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Ca: HYPOcalcemia: causes
Poor Ca intake or vit D deficiency (~500mg of Ca removed from bones/day)
HYPOparathyroidism (part of feedback loop that regulates reabsorption of Ca from bones)
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Ca: HYPOCalcemia: s/sx
Paraesthesia
Tetany
QTc prolongation/arrhythmias
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Ca: HYPERcalcemia: Causes
Malignancy due to bone metastases
HYPERparathyroidism
Renal insufficiency
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Ca: HYPERcalcemia: s/sx
Bones, stones, groans, psychic moans
```
Lytic lesions
Urinary calculi
Malaise
N/V
Mental status changes (confusion and depression)
```
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Ca: Ionized calcium only changes with changes in ____
Vit D or parathyroid hormones
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Ca: Ionized Ca: Ref Ranges Children/Adults
Children: 4.4-6 mg/dL
Adults: 4.4-5.3 mg/dL
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Corrected calcium calculation equation
Observed serum Ca + 0.8(4 - serum Alb)
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Phosphate: Where is it found
Major INTRAcellular anion
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Phosphate: Importance
```
Important role in:
Bone mineralization
Storage and transfer of energy
Muscle contraction
Metabolism of glu and lipids
Maintenance of acid/base balance
```
83
Phosphate: HYPOphosphatemia: Levels
Moderate: 1-2.5mg/dL
Severe: <1mg/dL
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Phosphate: HYPOphosphatemia: Causes
Inadequate dietary intake
Hyperparathyroidism (increased excretion)
DKA (diabetic ketoacidosis)
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Phosphate: HYPOphosphatemia: s/sx
Muscle weakness/dysfunction and mental status changes
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Phosphate: HYPERphosphatemia: Causes
Common cause: renal failure
87
Calcium-Phosphate Product > 55 in CKD then ____
precipitation occurs and lytic lesions form
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Magnesium: Where is it found?
2nd most abundant INTRAcellular cation
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Magnesium: Importance
Required for utilization of ATP for energy
| Important for regulating energy, protein synthesis, neuromuscular transmission, CV tone
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Magnesium: Storage
Bone and muscle tissues
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Magnesium: HYPOmagnesemia: Causes
Vomiting, diarrhea, diuretics
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Magnesium: HYPOmagnesemia: Often coincides with ___
HYPOkalemia
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Magnesium: HYPOmagnesemia: s/sx
N/V, EKG changes
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Magnesium: HYPERmagnesemia: causes
Excessive Mg intake or renal failure
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Magnesium: HYPERmagnesemia: s/sx
Sedation, N/V, decreased reflexes, EKG changes
96
Cockcroft-Gault Formula: CrCl equation
CrCl = (140-age)(IBW) / (72*SCr) * 0.85(if female)
97
T/F: Cockcroft -Gault equation is the only validated method of renal fxn for drug dosing
True
98
Cockcroft-Gault equation: Issues
- unstable kidney fxn (change in Scr by >50% in 24hours): CrCl over estimated
- Elderly (> 65): some institutions will round Scr to 1 if <1
99
AST/ALT: What are they?
Enzymes found within liver that aid in metabolism of proteins and AA
100
Increase in AST/ALT indicates ____
```
hepatocellular injury (hepatitis or cirrhosis)
can see increase AST in other types of cell injury (post MI) but ALT is more specific for liver
```
Drug induced: statins, TZDs, EtOH
101
Which drugs can increase AST/ALT
Statins, TZDs, and EtOH
102
ALP: What is it?
Enzyme that aids in producing proteins within body
103
ALP: Where is it located and secreted?
Located in liver and bone
| Secreted in bile
104
Increases in ALP indicates ___
obstruction (liver/biliary) or bone disease/breakdown (Paget's disease)
105
Someone with Paget's disease may see an increase of ___ (enzyme)
ALP
106
LDH: What is it?
LD is necessary for citric acid cycle to produce NADH and pyruvate -- becomes energy
107
LDH: Where is it located?
Present in most tissues (making it non-specific for liver)
108
Increases in LDH may indicate ____
Some type of liver dysfunction
| Almost always increases post MI within 10-12 hours
109
___ almost always increases post MI within 10-12 hours
LDH
110
Bilirubin: What is it?
Metabolic byproduct of the lysis of erythrocytes by reticuloendothelial system
111
Bilirubin: HYPERbilirubinemia
Prehepatic - hemolysis
Hepatic - defective removal of bilirubin from blood or conjugation
Posthepatic or cholestatic - obstruction
If total bilirubin > 2mg/dL - jaundice can develop
112
Albumin: What is it
Most abundant protein in body
| Synthesized in liver --> marker of true hepatic function
113
Albumin: 3 Major functions
1. controlling oncotic pressure in plasma
2. transporting AA synthesized in liver to other tissues
3. transporting poorly soluble ligands
114
Amylase+Lipase: What are they?
Enzymes secreted by pancreas to breakdown carbs, proteins, and fats
115
___ increases after onset of acute pancreatitis in most patients
Amylase and lipase
116
INR: What is it
Measures clotting tendency or coagulation properties of blood
117
INR is prolonged in those ___
receiving warfarin and those with liver damage
118
Erythrocytes: Produced in ___
Bone marrow
119
Erythrocytes: Released into ___ and circulate for ___H
Released into peripheral blood
| Circulate for 120 days (60 days for those w CKD)
120
What is the difference between Hgb and HCT?
Hgb: O2 carrying compound in RBCs
HCT: % of RBC in volume of whole blood
121
Platelets: What are they
Maintain integrity of blood vessels, play key role in hemostasis + blood clotting
122
Platelets: lifespan
8-12 ays
123
Leukocytes (WBC): Neutrophils: % of total WBC
~60%
124
Leukocytes (WBC): Neutrophils: Increases in ___
infections, tissue destruction, inflammatory disease, stress, steroids
125
Leukocytes (WBC): Neutrophils: Decreases in ___
Cancer, post-chemotherapy, side effects of drugs
126
Absolute Neutrophil count equation
ANC = (WBC)(% neutrophils)
127
What is neutropenia?
ANC < 500/mm^3 --> increased risk of infection
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Leukocytes (WBC): Bands: % of WBC
~5%
129
Leukocytes (WBC): Bands: What are they?
Immature neutrophils
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Leukocytes (WBC): Bands: Increase in ___
response to acute infection (left shift = bands > 5%)
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Leukocytes (WBC): Lymphocytes: % of WBC
~30%
132
Leukocytes (WBC): Lymphocytes: What do they do?
Recognize foreign substances and initiate immune response
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Leukocytes (WBC): Lymphocytes: 2 types
T-lymphocytes: cell mediated immunity
| B-lymphocytes: antibody mediated immunity
134
Leukocytes (WBC): Monocytes: % of WBC
~7%
135
Leukocytes (WBC): Monocytes: Where are they formed
In bone marrow, migrate to tissue and mature into macrophages
136
Leukocytes (WBC): Monocytes: Increase in ___
Subacute bacterial endocarditis, malaria, tuberculosis, recovery phase from infections, initial recovery from chemotherapy
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Leukocytes (WBC): Eosinophils: % of WBC
~3%
138
Leukocytes (WBC): Eosinophils: What are they
Surface receptor of IgG and IgE
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Leukocytes (WBC): Eosinophils: What do they do?
Involved in hypersensitivity response or allergic disorder
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Leukocytes (WBC): Basophils: % of WBC
~<1%
141
Leukocytes (WBC): Basophils: What do they doinfla
Probably involved in immediate hypersensitivity reactions and delayed allergic reactions
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Leukocytes (WBC): Basophils: May increased due to ___
Inflammation and leukemia
