Lab Tests and Values Flashcards
Diagnostic test that detects viruses genetic material?
Molecular test
Diagnostic test that detects specific proteins found on the surface of the virus (also known as the rapid diagnostic test)
Antigen test
Diagnostic test that tests for antibodies made by immune cells (lymphocytes) in response to a threat (specific virus)
(Also called serological test, blood test)
Antibody test
Lab values can help a PT with…
- Provide supplemental info
- Develop best POC
- Utilize most appropriate interventions
- Treating the patient safely
Abnormal lab values represent physiologic deviations that may require what from a PT?
- Modification of treatment/interventions
2. Contraindicated intervention
Reference values/range -
- Normal values/range established by testing large number of healthy individuals
- May vary across age, gender, geo location, ethnicity, cultural, economic characteristics
Reference range of and what do they tell us? Hemoglobin = Hematocrit = Platelets = WBC =
Hemoglobin = 14-18 Hematocrit = 38-52 -> Both tell us O2 carrying capacity Platelets = 150,000 - 450,000 -> Bleeding Risk WBC = 4,000 - 11,000 -> Infection
T/F Values within 3 SDs of mean or typically considered normal
False, 2 SDs
T/F All individuals with values outside of the reference range are ill
False, some may not be
T/F Some individuals who are ill may fall within the reference range
True
T/F Screening is not diagnostic
TRUE
Screening -
Effort to identify individuals who are at risk for certain diseases
What should be the next step for individuals identified at risk?
Diagnostic testing
What are some values that should be monitored in patients?
- Hemoglobin A1c (glucose levels in diabetic patients)
2. Liver function/enzymes
Examples of lab tests are sufficiently sensitive and specific (diagnostic for a pathology)
True, BRCA1/2 = breast/ovarian cancer
Example of lab test that only piece of diagnostic puzzle
CRP - proinflammatory marker of liver used in combo for cardiac issues
Examples of lab values that are suggestive of less physiological demanding exercises
- Hg/HCT
2. Platelets - risk of bleeding if fall
Normal levels of blood glucose
fasting =
2 hrs after meal =
fasting = 70-99
2 hrs after meal = <140
What does presence of ketosis reflect?
Increased reliance on fatty acids for energy provision (ATP)
When should physical activity be avoided (at what glucose levels)?
Fasting glucose levels of:
- > 250 with ketosis present
- > 300
When should a diabetic ingest added carbs (what glucose level)?
glucose levels <100
Na levels and Na excretion at the level of the kidney are a critical determinant of what?
Blood volume
Elevated plasma [ ] can suggest what about water?
Depressed plasma [ ] can suggest what about water?
Water loss (dehydration) Water retention
Hypernatremia -
Elevated Na [ ]
What can cause Hypernatremia? (5 things)
- Increased fluid loss (sweating)
- Adrenal gland dysfunction (increased aldosterone favors Na retention in kidney = water reabsorption)
- Limited H2O intake (geriatric population)
- Diuretics/ACE inhibitors/ARBS (favor water loss)
- Excessive dietary intake
Hyponatremia
Depressed sodium [ ]
What can cause Hyponatremia? (5 things)
- Excessive H2O intake (hypervolemia)
- Inadequate Na intake
- CHF, kidney failure, liver disease (hypervolemia)
- Severe vomiting and diarrhea (Na loss exceeds water loss)
- Adrenal gland dysfunction (Addison’s disease) - (Reduced aldosterone synthesis - increase Na loss in kidney)
Why if potassium important?
Normal function of excitability of cells (abnormal levels = change in resting potential of cells)
Potassium levels can provide insight into what two functions?
- Renal
2. Adrenal
Hyperkalemia effect on AP-
brings membrane potential closer to threshold needed for the generation of AP
Hyperkalemia results in (3 things)
- Arrhythmias
- respiratory arrest
- Neurologic consequences
Hyperkalemia can be caused by (4 things)
- Kidney failure
- Hypoaldosteronism (addison’s disease - disease of adrenal gland)
- Dietary intake
- NSAIDs, ARBs, diuretics (favor water loss)
Hypokalemia effect on AP-
Makes membrane potential more negative and more difficult to stimulate (hyperpolarization)
Hypokalemia results in (5 things)
- Palpitations
- Fatigue, leg cramps, muscle weakness
- Flaccid paralysis
- NandV
- Constipation
Hypokalemia can be caused by (5 things)
- Diarrhea
- N&V
- Diuretics
- Kidney dialysis
- Low dietary intake
Hypocalcemia can result from -
- Renal disease
2. Diuretics (water loss)
Short term/long term hypocalcemia -
Short term - numbness/tingling, muscle cramps/tetany, lethargy, convulsions (neuromuscular instability), negative chronotropic effect and ionic effect
Long term - osteopenia, osteoporosis
Hypercalcemia results from -
Hyperparathyroidism caused by excessive release of parathyroid hormone -> stimulates osteoclast activity to degrade bone and make available in circulation
Hypercalcemia results in (4 things)
- Kidney stones
- Bone pain
- Abdominal pain/N7V
- Tachycardia
Glucose tolerance test (GTT)
Patient fasts -> blood sample -> consume high CHO drink -> blood sampled 60 and 120 min later
Impaired glucose tolerance (IGT) -
- Glucose value between 140-200 2 hours after drinking glucose solution
- Individual is at risk of developing diabetes (Type I) over time
If glucose value >200 after 2 hours of drinking glucose solution, what is the diagnoses?
Diagnostic Type I DM
Hemoglobin A1C -
Good control =
Fair control =
Poor control =
Test for glycemic control
Good control = 2.5-5.9%
Fair control = 6%-7%
Poor control = >7%
Long term health in both T1 and T2 DM is directly related to what?
Glycemic control
When H A1C is >7%, patient at risk for what symptoms
Hyperglycemia - vision loss, cardiac dysfunction, peripheral neuropathy
S/S of hypoglycemia?
- Headache
- Nervousness
- Irritability
- Decreased coordination
- Shaking
- Tachycardia
- Weakness
Severe diabetic hypoglycemia leads to what?
Diabetic comma
T/F Exercise should occur after eating not after insulin administration
True
Type 1 DM -
Cause -
Treatment -
- Loss of insulin production
- Cause: damage to pancreas, genetics
- Treatment: diet/exercise, insulin
Type 2 DM -
Cause -
Treatment -
- Inability of cells to respond to insulin (decreased sensitivity to insulin)
- Cause: diet/lifestyle (obesity)
- Treatment: diet/exercise, metformin
Symptoms of chronic hyperglycemia -
- Polyphagia - frequent hunger
- Polydipsia - frequent thirst
- polyuria - increased volume of urine production
- Blurred vision
- Fatigue
- Weight loss
- Poor wound healing
- Cardiac dysrhythmias
Ketoacidosis
Develops when use of glucose is severely limited resulting in increased break down of fats resulting in high levels of ketone bodies of ketosis
Ketone bodies (increase/decrease) blood pH
Decrease
S/S ketoacidosis - (7)
- Breath smells like juicy fruit
- Tachycardia
- Hypotension
- Acidosis
- High blood sugar
- Hyperkalemia
- Polyuria
What does a patient with ketoacidosis need? (3 things)
- Hydration
- Insulin
- Electrolyte replacement
Creatine -
- Released from striated muscle and excreted by the kidney in constant amounts so should be constant ratio if kidneys functionally normally
If the kidney fails, what effect on creatine levels?
Can not excrete creatinine so creatine levels go up in the blood
Describe differences in creatinine levels -
- Clearance changes with age, physiological state, and medical conditions
- Clearance changes with pharmacokinetic properties of drugs
- Levels larger in males than females
Blood urea nitrogen (BUN) -
Measures amount of urea nitrogen - a waste product of liver catabolism of amino acids present in serum
DECREASED RENAL FUNCTION and decreased renal clearance causes BUN levels to -
rise
Elevated BUN associated with (6 things)
- Heart failure (not being cleared)
- Gastrointestinal bleeding
- Hypovolemia (dehydration - not being cleared)
- Kidney disease/failure (not being cleared)
- Shock (not cleared)
- Urinary tract obstruction (cleared but backs up into blood)
Bilirubin -
- Reddish-yellow substance formed when hemoglobin is broken down by macrophages -> processed by
liver -> excreted in bile - Used to assess liver function
Liver damage/disease effect on bilirubin -
Reduces amount of bilirubin it modifies and removes from the blood resulting in the accumulation in the blood
T/F Small amounts of bilirubin are processed in the kidney
True, creates yellow color of urine
T/F Degradation of bilirubin responsible for brown color of feces
True
Describe cause of jaundice -
Signs -
Blood accumulation of bilirubin that leads to yellow discoloration of skin Signs: 1. Yellow skin/eyes 2. Lightening of feces 3. Bruising
Causes of elevated serum bilirubin (6)
- Reduced ability of liver to process
- Cirrhosis (scarring of liver)
- Hepatitis
- Alcoholic liver disease
- Increased RBC destruction (sickle cell anemia, transfusion reaction)
- Anatomic obstruction (biliary stricture, gallstones)
Albumin -
Protein synthesized in the liver that transports small charged molecules through the blood
Major role of albumin -
keeps fluid in the blood from leaking into the tissues (defines oncotic pressure)
Low levels of albumin can be caused by (2)
- Liver disease (inability to synthesize normal amounts)
2. Malnutrition
Glomerulonephritis -
Kidney disease that allows albumin to enter kidney tubules and be excreted
Albuminuria -
too much albumin in urine
Microalbuminuria -
- modest increase of albumin in urine
- associated with increase risk for developing diabetes
What can cause decreased RBC?
- Anemia
- Blood loss
- Dietary insufficiency of iron and vitamins essential to production
- Chemo
What can cause increased RBC?
- Dehydration
- Severe diarrhea
- Poisoning
- Pulmonary fibrosis
- High altitude
- Chronic heart disease
Neutropenia is a risk factor for -
Developing an infection (hand hygiene important!)
Blasts -
immature WBC indicative of blood pathologies
Absolute neutrophil count (ANC) -
What does is reflect?
- Number of neutrophils in blood
- Reflects body’s ability to fight infection
What is the most common cause of decreased ANC?
Chemo
Platelets -
Initiate clotting sequence to plug damaged blood vessels
As platelets count decreases, risk of bleeding
increases
Platelets count may be decreased as a result of
- Bone marrow suppression
- Bleeding disorders
- Other diseases
Prothrombin time (PT) and activated partial thromboplastin time (aPTT) -
- Tests used to determine coagulability either diagnostically or to monitor anticoagulant therapy of heparin and warfarin
- Is run pre surgery and when anticoagulant therapy is given
International normalized ratio (INR) -
- Determines clotting time and bleeding risk
- Effects of oral anticoagulant (warfaring) on blood clotting
INR can be prolonged in (4)
- Presence of anticoagulants
- Liver dysfunction
- Vit K deficiency
- Coagulation factors deficiency
T/F Almost all substances in urine are also found in blood
True
The color of urine -
- Reflects [ ]
2. Pale yellow = normal
What does increased urine color mean?
Increased color suggest concentrated urine (dehydration and increased water reabsorption)
Specific gravity of urine -
- Density of substance (urine)/density of ref substance (water)
- Reflects [ ] of excreted molecules in urine
- Measure of kidney function
When there are more molecules excreted, the specific gravity will (decrease/increase)
Increase
Increased specific gravity suggests -
- Increased [ ] of solutes in urine
- Dehydration, diarrhea, emesis, excessive sweating, decreased blood flow to kidney, excess ADH secretion
Decreased specific gravity suggests -
- Decreased [ ] of solutes in urine
- Renal failure, excessive fluid intake or specific kidney disease
Higher pH can be causes by - (alkaline)
Severe vomiting
Kidney disease
Urinary tract infections
Asthma
Low pH can be caused by - (acidic)
Severe lung disease Uncontrolled diabetes Aspirin overdose Severe diarrhea Dehydration Starvation ALcohol Drinking antifreeze
