lab values Flashcards
What are the vital signs?
Temperature, HR, RR,BP, O2,Pain
Can the UAP take vitals?
Yes, but the RN is responsible in documenting and reporting abnormal values to provider
When are vitals measured?
- Initial contact with the patient
- Before and after invasive procedure or surgery
- Before, after and during medications affecting heart, respiration and temperature
- Before, after and during blood transfusion
- When the patient state changes and they verbally say they are feeling off
- Before and after intervention (ambulation)
- When fever or infection is present (2-4 hours)
- During physical assessment
What is normal body temperature?
Convert F to C
Convert C to F
F: 97.5-99.5
C: 36.4-37.5
(F-32)x5/9
(Cx9/5)+32
Common measurement sites for temeprature?
Oral, head, axillary, rectal, ear
What is the difference between oral and rectal temperature?
rectal temperature is always 1 degreed F higher
What is the difference between oral, ear and axillary temperature?
axillary and ear are always 1 degrees F lower
Temperature and consideration
Temp is low in the morning and normal high at afternoon (increase metabolism)
Temp is high after exercise
High if infection
High-normal consistently during pregnancy
High during stress
Low before ovulation and high during menstruation
Why is it a red flag if your unable to get a temperature?
Indicative of hypothermia, especially in infants and elderly
Consideration for Oral temperature?
Has not smoked, drank coffee, or something hot/cold within 15-30 mins
Consideration for Oral temperature?
Rectal is taken when patient has jaw surgery, nasal congestion, nasal or mouth surgery
Thermometer is lubricated and inserted 1.5 inches in adult and .5 in infants
When is temperature not taken rectally?
Make sure patient does not have rectal surgery, hemmorhoids, fecal impaction, rectal bleeding or diarrhea, if patient is a cardiac patient (the probe can stimulate the vagus nerve in the rectum and cause dysryhtmia)
What is the least accurate measurement to take temp?
axillary
Client is told to hold the probe tightly and rest the arm on the chest
Consideration for tympanic temp?
Do not take if ear discharge, inflammation, infection or object in the ear
Ear wax and infection can change the temperature
If patient is sweating during temporal temp check what to do?
Use the neck behind the ear to check the temp
What is the pulse an indicator of?
The circulatory status, the pulse is assessing the status of the heart
Pulse=HR
HR and changes
Slows with age
increases stress, exercise, pain
Hemorrhage and low bp increases the HR
What do you assess when taking the pulse?
strength, rhythm, equality, rate
What are the pulse points?
- Temporal - anterior or front of the ear
- Carotid- groove in between the trachea and sternocleidomastoid muscle
- Brachial- above the elbow,in between the bicep and tricep, towards the pinky side, on the antecubital fossa
- Radial - towards the thumb side
- Ulnar- towards the pinky
- Femoral- below the inguinal ligament, in between the pubis symphysis and anterior superior illiac spine
- Popliteal- behind the knee
- Dorsalis pedal- anterior of the foot; in line with the groove between the extensor tendonds of the big and first toes
- Posterior tibial; behind and below the medial malleolus
- Apical- left midclaviular, 5th intercostal muscle
When is the apical pulse checked for one whole minute?
Before administration of beta blockers, digoxin and on children under 2
What is pulse deficit?
When the radial pulse is lower than the apical pulse. This means that there is inadequate perfusion and the heart is not contracting right.
Check apical and then radial right away, or have one check radial and one apical at the same time
Report to he provider right away
What causes decrease respiration?
Head injury, increased intracranial pressure and opioids
When should you assess respiration?
After checking the radial pulse but have the hand on the pulse
the RR can be counted for 30 sec and then multiplied
what is bp?
Force on the arterial wall from pulsating blood from the pressure of the heart
what is pulse pressure?
the difference between systolic and diastolic pressure
how to obtain orthostatic vital signs?
check bp when supine, sitting and then standing (1-3 mins)
Factors affecting BP?
increases as you age increases due to stress lowest in the early morning, increases during the day and peaks in the afternoon or evening males have higher bp after puberty woman have higher bp after menopause
what medications cause decrease in BP
Antihypertensive and opioids
BP and extremity to use?
Do not use on arm with mastectomy, axillary surgery, IV fluids, disease or trauma, fistula or shunt
Ensure that the client has not smoked or exercised 30 mins before the BP reading
If cuff too big then reading will be lower and vice versa
Whats pulse ox?
Oxygen saturation of hemoglobin Sa02
What do you do if pulse ox reading is low?
Instruct patient to take deep breaths and recheck and alert the provider
What effects the light transmission of the pulse ox?
nail polish, anemia, hypotension, vascular disorders, sensor movement
Where can you place the pulse ox ?
finger, nose, ear, forehead, toe
The types of pain
Acute/Transient Chronic/non cancer Chronic episodic Cancer Idiopathic
What is idiopathic pain
True chronic pain that does not have an identifiable physical or psychological cause
What are the types of conventional non pharmacological pain management?
1.Cutaneous stimulation -
( massage, heat, cold pressure, vibration, therapeutic touch
2.TENS- transcutaneous or percutaneous nerve stimulation
battery. operated device that delivers low electrical current to the skin and underlying tissue to block pain
Binders/slings/supportive devices such as pillows -
Elevation of the affected body part can reduce swelling
3.Heat and cold application - cold reduces swelling
In some conditions these treatments may require approval from the provider
Ice or heat applications should be applied with a barrier such as a towel only for 15-30 mins; if patient has loss of sensation or discomfort then stop
CAM
Used alongside pharmacological intervention ; some herbal treatments are considered pharmacological so may require provider approval
What are pharmacological pain interventions?
NSAID and aspirin (non-opioids), opioids, acetaminophen
What do you have to know about NSAID and aspirin?
Contraindicated in individuals with gastric irritation or ulcer or bleeding disorder.These medication can increase the risk of bleeding or amplify anticoagulant effects. Advice to take with snack or milk.
What type of medication is ibuprofen?
NSAID
What do you have to know about ibuprofen?
Can result in hypoglycemia if patient is also taking anti diabetic medications; can cause toxicity if taken the calcium channel blocker
What is the antidote for acetaminophen?
Acetylcysteine
What do you have to know about acetaminophen ( Tylenol)?
Contraindicated in people with renal, hepatic disease alcoholism and hypersensitivity.
Get history of hepatic function and labs prior to administration. Patient should not self medicate more than 10 days, children 5 days.
Assess for hepatic damage ( n,v,d,abdominal pain )
what is the major concern with Tylenol or acetaminophen?
hepatotoxicity
What is the antagonist for opioid?
nalaxone
What is an opioid?
Suppresses pain, respiration, and cough by acting on the medulla of the brainstem
Consideration of opioid?
Patient with renal or hepatic problem may tolerate low dose.
If patients RR,HR,BP drops stop the medication and contact PCP
administer safety parameter
advice not to engage in activity that requires alertness
Take with milk or snack
Monitor level on consciousness
How many hours before an activity should opioid be given?
30-60 mins
What are other side effects of opioid?
constipation and urine retention so monitor O&I
What should you encourage the patient to do who is on opioids?
deep breath, spirometer, turning to prevent lung collapse or pneumonia
What to know about codeine sulfate?
used for cough suppression, causes constipation
hydrocodone and oxycodone
what to know about hydromorphone?
Biggest concern is RD, causes drowsiness, dizzy and orthostatic hypotension
monitor vital signs closely
What is morphine used for?
acute pain from myocardial infraction or cancer; dyspnea from pulmonary edema and preoperative purposes
Side effects of morphine?
Can cause RD, constipation, urine retention, orthostatic hypotension, pupil constriction, nausea and vomiting
Indication of morphine overdose?
pinpoint pupils
What is aPTT (activated partial thromboplastin time) taken for?
It evaluates how well the intrinsic coagulation system is clotting by measuring the time in seconds it takes for recalcified citrated plasma to clot.
It also evaluates the effectiveness of heparin therapy.
It detects deficiency in all clotting factors except for factor 7 and 13 (know roman numerals).Screens for coagulation disorders.
If patient is on intermittent heparin therapy when should you draw the PTT?
an hour before the next dose of heparin
normal range for ptt
30-40 seconds
call the provider if the ptt is higher than 100 seconds, initiate bleeding precaution
What is the ptt when client is receiving heparin therapy?
It is 1.5-2.5 times the normal
When is ptt elevated?
Heparin therapy, liver disease, hemophilia, deficiency of factor 1,2,5,8-12
liver is not making clotting factors adequately
What is PT (prothrombin time)?
Prothrombin is a glycoprotein produced by the liver with vitamin K intake. its used for fibrin clot formation. Pt evaluates the effectiveness of warfarin therapy and how long it takes in seconds for clot formation and detects any problems in the extrinsic clotting factors due to liver disease, DIC, or vitamin K deficiency
What is the normal range for PT?
11-12.5 seconds
if longer than 25 initiate bleeding precaution
What is INR used for?
used to asses the effects of some anticoagulants therapy
When does PT time increase?
When does it increase for both INR and PT?
PT- when warfarin and heparin is taken at the same time
PT can increase 1.5-2.5 higher than normal on anticoagulant therapy
PT & INR- vitamin K deficiency, liver disease, deficiency of factor 1,2,57,10, warfarin therapy
what is normal range for INR?
.8-1.2 seconds
if longer than 3 initiate bleeding precaution
What are the functions of platelet?
Plug formation, clot retraction and coagulation factor formation
Platelet are fragments of cells and are less than 1% total blood
Where are platelets prouced?
bone marrow
range for platelet
150,000-400,000
When are there elevated values of platelet?
acute infection, chronic leukemia, chronic pancreatitis, cirrhosis, high altitude, cold weather, collagen issues, polycythemia ( increase amount of RBC, which causes the blood to get thicker and leads to many problems such as blood clots), postphelenctomy
When are platelets low?
acute leukemia, chemotherapy, hemorrhage, infection, DIC, thrombocytopenia purpura, lupus
What to do with patient with thrombocytopenia?
monitor venipuncture site
What is the relationship between chemotherapy and platelets?
chemo causes thrombocytopenia
any clients who will go under a invasive procedure should have coagulation studies done
What is hemoglobin?
Main component of RBC that transports oxygen and CO2
Is fasting required for hemoglobin test?
no
When is hemoglobin high?
polycythemia, high altitude, copd
When is hemoglobin low?
anemia or hemorrhage
What is hematocrit?
the amount of rbc in total blood
when is hematocrit high
dehydration, high altitude and polycythemia
when is hematocrit low
anemia, hemorrhage, over hydration, bone marrow problem and leukemia
What are lipids?
cholesterol, phospholipid (hdl and ldl) and triglycerides
What are the functions of the lipids?
cholesterol is present in all body tissues and is major component of LDL, brain cells, nerve cells, gallbladder stone and cell brane
LDL carry cholesterol from liver to tissue
triglycerides are produced in the liver from protein, glucose and fatty acid
what does cholesterol, LDL and tri cause?
coronary artery disease
HDL protects from CAD
How should client prepare for the lipid test?
no food or fluid 12-14 hours, and alcohol for 24 hours water allowed
How should client prepare for the lipid test?
no food or fluid 12-14 hours, and alcohol for 24 hours water allowed
avoid consuming high cholesterol food with evening meal before the test
Why are lipids high
why are low
go over in the book pg 315
what is hemoglobin A1C?
blood glucose bound to hemoglobin
evaluates glucose level from 3-4months
is fasting required for hemoglobin A1C?
no
what is normal level of hemoglobin A1C?
less than 6%
why is hemoglobin A1C high ?
hyperglycemia in non-diabetic patients and uncontrolled diabetes in patients whoa re diabetic
why is hemoglobin A1C low ?
blood loss, chronic kidney disease, pregnancy, sickle ell anemia
What does creatinine measure?
creatinine measures the gfr rate and the functions of the kidney
increased creatinine is low gfr rate
why would creatinine be high?
low kidney functions
why would creatinine be low?
disease with decrease in muscle mass such as myasthenia gravis and muscular dystrophy
what is BUN?
formed in liver with protein breakdown; it is excreted with urine
what is the normal bun/creatinine ratio
10/20
consideration for creatinine test
avoid red meat 24 hours prior and excessive excercise 8 hours
normal range for creatinine
male: .6-1.2
female: .5-1.1
when is bun high?
burn, dehydration, protein catabolism excessive (fever or stress) renal disease shock uti
when is bun low?
fluid overload, malnutrition, severe liver damage, siadh
what does the WBC differential provide?
information about WBC types
what does a shift to the left in the differential indicate?
increased number of immature neutrophils
normal wbc range
5,000-10,000
when are wbc high?
leukemia, infection inflammation
when are wbc low?
aplastic anemia, chemo, autoimmune disease,
chemo and wbc?
can lead to neutropenia placing the client at infection
a low total wbc with shift to the left?
recovery from bone marrow depression or an infection that demands for neutrophils int he tissue higher than the capacity of the bone marrow to produce them
a high total wbc with shift to the left?
increase release of neutrophils from bone marrow overwhelming infection or inflammation
