Lab Values

Question 1

Normal RBC values for male and female

Answer 1

male - 4.7-6.1 x 10^6

female - 4.2-5.4 x 10^6

Question 2

Normal HgB values for male and female. What is cutoff value for working w/ patient?

Answer 2

male - 14-17 Gm/dl
female - 12-16 Gm/dl

< 8 Gm/dl - hold PT
male - <9g/dl
female - <7g/dl

Question 3

Normal HCT values for male and female. What is cut off value for working w/ patient?

Answer 3

male - 43-49%
femaile - 38-44%

<25% - hold PT
Pt may have SOB, tachycardia, fatigue, muscle cramping

Question 4

Normal WBC values. What is cutoff value for working w/ patient?

Answer 4

4,500 - 10,000 x 10^6 ul

<5,000 w/ fever - hold PT

Question 5

Normal Platelets. What is cutoff value for working w/patient?

Answer 5

150,000 - 350,000 x 10^6

< 10,000 and/or temp > 100.5 degrees

Question 6

What is leukocytosis? What does it mean?

Answer 6

> 11,000/mm^3

- indicates infection

Question 7

What is leukopenia? What does it mean?

Answer 7

<4,000/mm^3

• infection and immunocompromised state
• patient at high risk for additional infection

Question 8

neutropenia levels

Answer 8

<1500/m^3

Question 9

What does elevated Hg or Hct mean? Decreased?

Answer 9

elevated - thicker blood/increased risk for clots

decreased - low O2/low activity tolerance

Question 10

What are implications of ANC 1000-500 ul?

Answer 10

pt needs mask and MD approval to ambulate in hall

- should stay in their room

Question 11

What are implications of ANC <500 ul?

Answer 11

isolation to room

Question 12

Implications of platelets 150k-50k

Answer 12

limited resistive exercises, encourage ambulation, ADLs, aerobic exercise equipment

Question 13

Implications of platelets <50k

Answer 13

No MMT, no resistive exercise, AROM

Question 14

Implications of platelets > 20k-35k

Answer 14

light exercise, no bicycle, treadmill, ADLs Nustep, UE ergometer, ambulate as tolerated
- No AROM - any pressure could cause bleeding/bruising

Question 15

Implications of platelets < 20k

Answer 15

Guarded therapy intervention. High risk for bleeding into extracellular space

• watch bleeding times
• AAROM and sitting/standing as tolerated

Question 16

What has a more narrow reference range for clotting time?

Answer 16

aPTT over PTT

Question 17

What does aPTT assess?

Answer 17

clotting risk

Question 18

What does high INR mean? Low? cutoff for PT?

Answer 18

high INR - risk for bleed
low INR - risk for clot
> 6 PT contraindicated

Question 19

INR for Afib/DVT/PE

Answer 19

2-3

Question 20

INR for valve replacement

Answer 20

2.5-3.5

Question 21

Coumadin INR to mobilize

Answer 21

< 2 no mobility
2-5 to mobilize
> 5 check w/ MD

Question 22

NOAC (novel oral anticoagulants) time since admin

Answer 22

< 2 h no mobile
2-3 check w/ MD
> 3 hours to mobilize

Question 23

UFC (unfractionated heparin) time since admin

Answer 23

< 24 h no mobility
24-48 h check w/ MD
>48 h mobility

Question 24

Fondaparinux time since admin

Answer 24

< 2 h - no mobility
2-3 h check w/ MD
> 3 h to mobilize

Question 25

LMWH time since admin. What should you do if new DVT despite preventive dosage?

Answer 25

< 3 h no mobility
3-5 h check w/ MD
> 5 to mobilize

• wait for higher dose to be given

Question 26

Cna you mobilize a patient with an IVC filter?

Answer 26

yes

Question 27

High vs low sodium meaning

Answer 27

low - cramps, weakness, confusion

high - fluid retention, swelling, hypertension

Question 28

high vs low potassium meaning

Answer 28

low - flattened T waves, arrhythmias, muscle weakness

high - peaked T waves, shortened Q-T wave interval, chest pain

Question 29

high vs low calcium meaning

Answer 29

low - parathesis, muscle spasms and seizure, and QT interval prolongations
high - bradycardia, AV block, and short QT interval, coma

Question 30

high vs low magnesium

Answer 30

low - prolonged PR or QT intervals, T wave flattening or inversion, SVT, ventricular arrhythmias
high - weakness, respiratory failure, coma, paralysis

Question 31

high vs low chloride

Answer 31

low - metabolic alkalosis - increased pH

high - metabolic acidosis - decreased pH

Question 32

When is creatine kinase (CK) levels high? What activity can be done?

Answer 32

CK elevated after MI, muscle injury, strenuous exercise

- activity should be limited or held when CK trend is rising (clears 48-72 hours)

Question 33

what troponin levels indicates myocardial damage?

Answer 33

> 0.2 mcg/L

• hold activity until 24 hour after troponin peak and it begins trending down
• peaks 12-16 hours after MI and returns to normal after 1 wk

Question 34

Respiratory alkalosis

Answer 34

Hyperventilation - lowers arterial CO2 and increased pH

Associated with nervousness, anxiety, pain, pregnancy, PE

Question 35

Respiratory acidosis

Answer 35

Hypoventilation

Associated with COPD, pneumonia, sleep apnea, head trauma

Question 36

Metabolic alkalosis

Answer 36

Associated with severe vomiting, excess use of antacids, diuretics, hypokalemia

Question 37

Metabolic acidosis

Answer 37

Associated with chronic diarrhea, shock/sepsis, trauma, diabetic ketoacidosis, renal failure/uremia, hypoxia

Question 38

elevated BUN meaning

Answer 38

renal disease, high protein diet, decreasing volume, CHF

Question 39

normal glucose range

Answer 39

70-100 mg/dl

Question 40

What should be done if patient glucose is < 70 mg/dl?

Answer 40

give carbs before activity

Question 41

What should be done if patient glucose is > 240 mg/dl?

Answer 41

hold activity until patient receives insulin

Question 42

What is albumin used to measure? What is the difference between albumin and pre-albumin and which is more accurate?

Answer 42

• used to measure nutritional status - important for wound healing
• difference between albumin and pre-albumin is ½ life – pre-albumin is more accurate (2 days vs 21 days)