F&E, Lab values Flashcards
S&S of fluid deficit
increased respirations and HR, decreased CV, weight loss, poor skin turgor, dry mucous membranes, decreased UO, increased specific gravity, increased hematocrit and altered LOC
Normal CVP value
4-11 cm H2O
Foods high in K+
avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, tomatoes
Causes of metabolic alkalosis
hypovolemia, loss of gastric fluid, excessive bicarbonate intake, massive transfusion of whole blood, hyperaldosteronism; loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid.
S&S of metabolic alkalosis
hypoventilation and tachycardia
Causes of metabolic acidosis
loss of buffer bases, retention of too many acids; in conditions such as renal failure, diabetic ketoacidosis; from production of lactic acid; from ingestion of toxins such as aspirin; manutrition; or severe diarrhea; intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes or ileostomy.
hyperpnea
respirations that are labored and increased in depth and rate
Kussmaul’s respirations
abnormally deep, regular, and increased in rate.
S&S of respiratory alkalosis
headache, tachypnea, paresthesias, tetany, vertigo, convulsions, hypokalemia, and hypocalcemia, lethargy, lightheadedness, tachycardia, dysrhythmias related to hypokalemia
Normal PT
9.6-11.8 seconds (m) or 9.5-11.3 seconds (f). therapeutic PT level is 1.5-2 times higher than normal level
Therpeutic range for digoxin
0.5-2.0 ng/mL
Normal BUN according to saunders
8-25 mg/dL
Troonin
a regulatory protein found in striated muscle; troponins function together in the contractile apparatus for striated muscle in skeletal muscle and in the yocardium; increased amounts of tropoinins are released into bloodstream when an MI causes damage to the myocardium
Troponin values that indicate MI
Troponin T:higher than 0.1 to 0.2 ng/ML; Troponin I: lower than 0.6 ng/mL
Normal aPTT, and therapeutic with heparin
normal: 20-36 seconds; therapeutic doese of heparin for DVT is between 1.5-2.5 times normal. so a client’s value should be between 30-90 seconds.
Normal serum protein level
6-8 g/dL; pt with cirrhosis has low protein d/t inadequate nutrition; excess protein isn’t helpful because the liver is needed to metabolie protein
Glycosylated hemoglobin
7% or less = good control, 7-8% = fair control, 8% or more = poor control; measures the amount of glucose that has become permanently bound to RBCs from sicrulating glucose
Normal WBC
4500-1100/mm3
Normal serum amylase level
25-151 units/L; chronic cases of pancreatitis, the rise in amylase levels usually doesn’t exceed 3x the normal value; in acute pancreatitis, the value may exceed 5x the normal value.
Normal Ca+ serum levels
8.6-10 mg/dL
Normal Mg+ serum levels
1.6-2.6
Normal phosphorus serum levels
2.7-4.5 mg/dL
normal neutrophil level
18000-7800/mm2
normal serum creatinine levels
0.6-1.3 mg/dL
S&S of respiratory acidosis
respiratory rate and depth increase in an attempt to compensate; headache; restlessness; mental status changes, such as drowsiness and confusion; visual distrubances; diaphoresis; cyanosis as ypoxia becomes more acute; hyperkalemia; rapid, irregular pulse; and dysrhythmias d/t hyperkalemia.
S&S of dehydration
lethargy, headaches, weight loss, sunken eyes, poor skin turgor, flat neck and peripheral veins, tachycardia, low BP.
Urine specific gravity levels
Normal: 1.010-1.030. dehydration = > 1.030.
Normal ratio of BUN/creatinine
10:1 - 15:1. values < 10:1 indicate diminished urea concentration; values > 15:1 indicate inadequate renal function
Why refrigerate urine?
b/s if specimen stands at room temp, bacteria nd WBCs decompose; also urea breaks down to ammonia and becomes more alkaline, increaseing the pH.
Proceedure for 24- hour urine test
start test with empty bladder; collectetd urine should be refrigerated or placed on ice; fifteen minutes before endo fo collection, pt should void and this specimen is added to collection.
Clean-catch urine specimen for culture and sensitivity testing
Pt will cleanse labia using cleansing towels, void into toilet and then void into sterile specimen container
best test to evaluate kidney’s ability to regulate fluid balance:
Specific gravity; it also evaluates the hydration status
S&S of glomerulonephritis
gross hematuria and proteinuria; small urine ouptut, dark or smoky urine from hematuria, foamy urine from proteinuria; sureum studies reveal elevated levels of BUN, creatinine, C-reactive protein and antistreptolysin Otiter.
Indication of Antibody to surface antigen (anti-HBs)
marker for the response to the vaccine and indicates immunity to hepatitis B.
Indication of Hepatitis B surface antigen (GBsAg)
chronic carrier
Indication of Hepatitis B virus DNA
viral replication
complications from viral hepatitis
bleeding tendencies, increasing prothrombin time values and abnormalitites of liver function; encephalopathy possibly.
asterixis
a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings. This motor disorder is characterized by an inability to actively maintain a position, which is demonstrated by jerking movements of the outstretched hands when bent upward at the wrist. The tremor is caused by abnormal function of the diencephalic motor centers in the brain, which regulate the muscles involved in maintaining position. Asterixis is associated with various encephalopathies due especially to faulty metabolism.
AEs of carbamazepine
blood dyscrasias including apastic anemia, agranulocytosis, thrombocytopenia, and leukopenia; cardiovascular distrubances; thrmbophlebitis; dysrhythmias; and dermatological effects
carbamazepine *Tegretol, Equetro)
an anticonvulsant and mood-stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder, as well as trigeminal neuralgia.
Trigeminal neuralgia
facial pain due to pressure on the trigeminal nerve.
normal serum ammonia level
10-80 mcg/dL, depending on the lab running the test
Creatinine kinase (CK) levels and significance
cellular enzyme that can be fractionated into 3 isoenzymes: MM band reflects CK from skeletal muscle (elevated in skeletal muscke disease); MB band reflects CK from myocardial muscle; BB band reflects CK from the brain.
Normal serum creatinine levels
Males: 0.6-1.3; females: 0.5-1.0 mg/dL
therapeutic range for serum phynytoin
10-20 mcg/mL
Therapeutic range for serum theophylline (or aminophylline)
10-20 mcg/mL
Theophylline
a methylxanthine drug used in therapy for respiratory diseases such as COPD and asthma under a variety of brand names. As a member of the xanthine family, it bears structural and pharmacological similarity to theobromine and caffeine.
Normal serum protein level
6-8 g/dL
Normal serum lipase level
10-140 units/L
Normal range for urine specific gravity
1.016-1.022
Normal total cholesterol
under 200 mg/dL
Normal fibrinogen level
180-240 mg/dL (M) and 190-420 mg/dL (F); in Dissimeminated intravascular coagulopathy (DIC), fibrinogen is low b/s fibrinogen is used in the clotting precess.
Disseminated intravascular coagulopathy (DIC)
a pathological process characterized by the widespread activation of the clotting cascade that results in the formation of blood clots in the small blood vessels throughout the body. This leads to compromise of tissue blood flow and can ultimately lead to multiple organ damage. In addition, as the coagulation process consumes clotting factors and platelets, normal clotting is disrupted and severe bleeding can occur from various sites.
Different classifications of hypermagnesemia
Mild: 3-5; moderate 6-7; severe 10-11; emergency 12-15; neurological depression begins in moderate cases (6-7), manifested by drowsiness, sedation, lethargy, respiratory depression, muscle weakness and areflexia.
Schilling test
used to determine cause of vitamin B12 deficiency, which leads to pernicious anemia; uses a small oral dose of radioactive B12 followed by large nonradioactive IM dose. 24 hr urine collection is performed to measure amount of radioactivity in urine.
Indirect Coombs’ test
detects circulating antibodies against RBCs; used in addition to the ABO typing to determine blood type when pt is receiving blood donation.
Granulocytes
Blood cells that destroy bacteria; less than 10,000 equals risk of infectin
Causes of increased RBCs
decreased cardiac output, impaired pulmonary gas exchange, chorticosteroid therapy, polycythemia vera, severe diarrhea, and dehydration.
Causes of decreased RBCs
B6 & B12 deficiencies, iron deficiency, chronic infection, bone marrow depression, mltiple myeloma, leukemia, hymolytic anemia, and pericious anemia; also in older age.
Increased hematocrit indicates:
dehydration, pernicious anemia, or polycythemia
Decreased hematocrit indicates:
leukemia, acute hemorrhage, iron deficiency anemia or hemolytic anemia
conditions inwhich decreased platelet aggregation is found
infectious mononucleosis, idopathic thrombocytopenia purpura, acute leukemia or von Willenbrand’s disease.
normal specific gravity level
1.016-1.022 g/mL
Allen test
Taken before a radial artery puncture for an ABG analysis; determines adequate ulnar circulation. Done to prevent ischemic injury ifdamage is done to the radial artery.
Homans sign
Calf pain on the dorsiflexion of the foot, indicating presence of DVT
Use of erythrocyte sedimentation rate (ESR)
to donfirm inflammation or infection anywhere in the body; useful for connective tissue disease because value directly correlates with the degree of inflammation and later with the severity of the disease.
Significance of ESR values
Mild inflammation: 30-40 mm/hr; moderate: 40-70 mm/hr; severe 70-150 mm/hr
Therapeutic level for solicylate serum levels in rheumatoid arthritis pt
10-20 mg/dL
Normal range of serum phosphate
2.7-4.5 mg/dL
Conditions that cause hypernatremia
congestive heart failure, Cushing’s disease, dehydration, diabetes insipidus, diaphoresis, diarrhea and hypovolemia.
Diseases that cause hyperkalemia
Addison’s disease, adrenocortical insufficiency, anemia, burns, and ketoacidosis.
Normal prothrombin time (PT)
female: 9.5-11.3; male: 9.6-11.8
Conditions in which decreased PT is found
arterial occlusion, deep vein thrombosis, edema, myocardial infarction, peripheral vascular disease and PEs
Normal albumin level
3.4-5 g/dL
Condistions with decreased albumin
acute infection, ascites, alcoholism, burns, and cirrhosis
Stimuli for ADH release
increased serum osmolality, decreased fluid volume, hypotension, pain, nausea and vomitting, stress, and a cool environment.
Triamterene (Dyrenium)
Potassium-sparing diuretic that increases excretion of sodium and water, which results in the retention of potassium.
The percentage of oxygen in room air
21%
Normal reference values for oral glucose tolerance test
< 140 mg/dL at 120 minutes; < 200 mg/dL at 30, 60 and 90 minutes; and < 115 mg/dL in the fasting state; so a client taking the test does not have DM if it is less than 140 after 2 hours.
Therapeutic serum lithium level
1.0-1.5 mEq/L during acute mania and levels of 0.6-1.4 mEq/L for mainenance treatment. At toxic levels, seizures may occur (3.5 and higher).
Indication of a left shift in the differential WBC count
an increased number of immature neutrophils, or an increased number of bands, signaling the presence of an acute infections process.
Indication of a right shift in the differential WBC count
an increased number of mature neutrophils
Clinical manifestations of metabolic acidosis
hypernea with Kussmaul’s respirations; headache; nausea, vomiting and diarrhea; fruity-smelling breath from improper fat metabolism; central nervous system depression including mental dullness, drowsiness, stupor and coma; twitching,; confvusions. Also hyperkalemia.
Clinical manifestions of respiratory acidosis
Respiratory rate and depth increase in an attempt to compensate; headache, restlessness, drowsiness and confusion visual disturbances, diaphoresis, cyanosis (as hypoxia becomes acute), hyperkalemia, rapid irregular pulse, and dysrhythmias.
People at risk of third-spacing
liver or kidney disease, major trauma, burns, sepsis, wound healing or major surgery, malignancy, gastrointestinal malabsorption, malnutrition, and alcoholic or loder adult clients.
Guillain-Barr syndrome
a rapid-onset weakness of the limbs as a result of an acute polyneuropathy, a disorder affecting the peripheral nervous system. The disease is usually triggered by an infection, which provokes immune-mediated nerve dysfunction. Many experience changes in sensation or develop pain, followed by muscle weakness beginning in the feet and hands that develops rapidly ; leads to rspiratory issues and associated with respiratory acidosis.
EKG in hypomagnesemia
Tall T waves, depressed ST segment.
Ekg in hypermagnesemia
Prolonged PR interval and widened QRS complexes
