Lab Values Flashcards
note
for priority questions: MANS
- Maslow: basic needs take priority over higher needs (air, water, food, safety)
- ABCs: keep them breathing, look for things that could affect airway, breathing or circulation, these take priority
- Nursing process: remember ADPIE (assessment, diagnosis, planning, implementation, evaluation), always assess before you intervene, answers aren’t typically to delegate to CNA
another note
these cards are not the same as the ppt. these are only what she mentioned is important. there is more on the ppt.
what are lab values for?
- screening (to check if anything abnormal pops up)
- diagnosis (have symptoms and we’re looking to see what is wrong)
- monitoring (have been diagnosed so just checking lab value to see how treatment is going)
factors affecting lab values
- age
- gender (female lab values generally lower than males)
- race
- pregnancy
- food ingestion
^CBC (complete blood count)
- RBC: # of red cells per mL/blood
- Hgb: O2 carrying protein
- Hct: packed volume of RBCs, % of total volume
- MCV: cell size (normocytic, macro and micro)
- MCH: amount of Hgb per cell
- MCHC: Hgb/Hct per 100mL/RBCs
- RDW: red cell distribution width
- platelet: # of plt. per cc/blood
- WBC: # of white cells per mL/blood
(1 vial, 1 order,
cellular components of blood,
infection, weakness, anemia, bleeding and fluid status)
erythrocyte count (RBC)
- if have ongoing bleeding issue, may use erythrocyte count to monitor it
- normally low in pregnancy
- when decreased by more than 10% of normal range, that is considered anemia
hemoglobin (Hgb or Hb)
- for in depth evaluation of anemic patients
- if low hemoglobin, low oxygen transport, there is going to be strain on cardiopulmonary system
hematocrit (Hct)
- if hematocrit less than 15% or above 60%, it is a critical situation
- normal level can vary by gender and age, so women normally have lower hematocrit, and advanced age have lower hematocrit
anemia
- greater than 10% decrease in erythrocytes (RBCs) is considered anemia
- decrease in number of RBCs (erythrocytes)
– impaired RBC production
– blood loss
– RBC destruction
– combination of all 3
platelet count (thrombocytes)
- platelets form the clot that stops the bleeding
– if too low, could bleed out, bc no clot to stop bleeding
– if too high, could form clots when don’t need to - anything under 80,000: cause for concern
- anything under 50,000: significant bleeding
- hold enoxaparin or levinox (injectable med to prevent blood clots, decreases platelets) if platelet count is less than 80,000
(if pt has chronically low platelets, may be an order to still give it if platelets above 50 or 40,000) - teaching: for low platelets, tell us if have bleeding gums when brushing teeth, be careful, maybe put on fall risk bc simple things could cause problems and bleeding for them
total WBCs (leukocytes)
- bacterial infections typically alter white count as opposed to viral
WBC definitions
- leukocytosis: abnormally large # of leukocytes, 10,000 or greater cells/mL3
- left shift: tells us where inflammation is found in the body, where inflammation is coming from
basic metabolic panel (BMP)
- kidney function
- blood glucose
- acid/base balance
- electrolyte imbalance
includes: - blood urea nitrogen
- creatinine
- glucose
- carbon dioxide content
- calcium
- chloride
- potassium
- sodium
comprehensive metabolic panel (CMP)
BMP plus:
- blood proteins
- liver function
includes BMP plus:
- albumin
- total protein
- alkaline phosphatase (ALP)
- aspartate aminotransferase (AST)
- alanine aminotransferase (ALT)
- bilirubin
glucose
- normal range: 70-110 mg/dL
- dependent on when and what I last ate
- normal fasting glucose: pt hasn’t eaten in last few hours
- expect number to be higher than this if they’ve recently eaten
- can check with accudata
glycosylated hemoglobin A1c
- avg blood glucose for last 3 months
- not dependent on what or when they’ve eaten
- non-diabetic normal person: 4 - 5.9%
- good diabetic control: less than 7%
- fair diabetic control: 8-9%
- poor: greater than 9%
- if A1c is 9.5, do a glucose check
- may not want to do a sliding scale insulin
sodium (Na+)
beginning of electrolytes
- ingested via diet or drinking and excreted via kidneys
- body wants to maintain homeostasis and maintain blood level
potassium (K+)
- abnormalities with potassium can cause arrhythmias, heart attacks or even death
- low: renal failure issue, may have been given a blood transfusion with hemolyzed blood in it, GI disorders, diuretics, surgery, burns, trauma
chloride (Cl-)
- if sodium is high, chloride prob going to high
- high: common in dehydration, kidney dysfunction
- low: overhydration, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), CHF, vomiting, diuretic therapy
bicarbonate (HCO3-)
- regulated by kidneys
- critical value: less than 6
- high: severe vomiting, lots of gastric suction
- low: chronic diarrhea (stored in gut so lost a lot with diarrhea)
calcium
- helps evaluate parathyroid
- monitor patients with renal failure, renal transplant and thyroid issues
phosphorus
- assists in interpretation of thyroid and calcium abnormalities
magnesium (Mg-)
- important in calcium metabolism, tied to calcium levels
- anytime giving magnesium, monitor with EKG
- generally electrolytes: if eaten a lot, is high
- end of electrolytes
total protein
- helps evaluate cancer, intestinal/renal protein wasting states, immune disorders, liver dysfunction, impaired nutrition
albumin
- good look at hepatic (liver) function and nutritional state
- low: malnutrition, pregnancy, liver issues
alkaline phosphatase (ALP)
- helps detect and monitor diseases of liver and bone
- high with liver things: primary cirrhosis, intrahepatic/extrahepatic biliary obstruction, primary or metastatic liver tumor, metastatic tumor to the bone
alanine aminotransferase (ALT)
- primarily found in liver
- any issue in liver is going to cause release of ALT in bloodstream, ALT up in labs
aspartate aminotransferase (AST)
- found in very high concentrations within highly metabolic tissues (liver muscle cells, heart muscle cells, skeletal muscle cells)
- injury to these causes release of AST into bloodstream
- people who work out a lot and cause damage to one of those areas like skeletal muscle trauma means high
bilirubin
(liver function)
- eval of newborns with jaundice
- jaundice = above 2.5 = yellow skin, yellow eyes
- conjugated (direct) and unconjugated (indirect)
blood urea nitrogen (BUN)
- kidney and liver function
- produced in liver, excreted in kidneys
- high:
– indicates problems before kidneys in the body (pre-renal), kidneys, and after kidneys in the body (post-renal)
creatinine
- renal function
- excreted entirely by kidneys
- critical value = more than 4
- best lab to assess kidney function
- high: kidney issues, CHF and dehydration affect kidneys
amylase
- pancreatic test helpful in evaluation of abdominal pain (abdominal pain with no other cause, would do this test to test pancreas)
- low: pancreas not producing enough of it
lipase
- secreted by pancreas into small intestines
- highly specific for pancreatic diseases
- high: acute pancreatitis, early pancreatic cancer, perforated ulcer
- low: acute severe pancreatitis
urinalysis (UA)
- generally if something in body gets too high, it goes to urine to get out
- tells color and appearance of urine
- tells positive/negative for glucose and ketones (should be none)
- tells positive/negative for blood and bilirubin (should be none)
- specific gravity: looks at hydration
- protein: kidney, diabetic issue, pre-eclampsia, fever, infection, chronic UTI
- bacteria: UTI
- nitrates: significant bacteria
24 hour urine
- normal UA only good for 1 hr so send it/ take it down to the lab promptly
- 24 hr urine: start at 11 AM, flush first one, all urine is collected and kept refrigerated or on ice, go to bathroom 1 last time at 11:00
- can be done at home like pregnant women
- room temp urine only good for 1 hr
urinary protein
- very good kidney function monitor
- if protein shows with dipstick, going to do 24 hr urine
clotting factors
to assess normal bleeding and taking coumadin (warfarin):
- PT critical value: more than 20 seconds
- INR critical value: more than 5.5 seconds
- tells us how long it takes the blood to clot
- critical means very high risk for bleeding here
to assess heparin therapy:
- PTT
- if results are high, it means their blood is too thin, doesn’t clot fast enough, so they should be careful
peak and trough drug monitoring
- monitor drug levels in the blood to maintain therapeutic range
- test on 3rd dose, 30 minutes before 3rd dose get blood sample and test for trough, if its too low, not in therapeutic level, pharmacist will increase dosage
- 1.5 hrs after med is finished going in on 3rd dose, do venipuncture to get blood to see peak, if value comes back above therapeutic level, pharmacist will decrease dosage
culture and sensitivity
- used to monitor for infection
- can run this test on urine, blood, wound drainage, tissue from body or devices
- obtain specimen before starting antibiotics
- if nothing has grown in 24 hrs, typically not going to grow, but some bugs do grow then and can see at 72 hrs
- culture going to be positive for organism, sensitivity sees what antibiotics kill the organism
blood cultures
- obtain 2 vials from one site, 2 vials from another site
- new stick preferred over CVAD
- doesn’t matter which vial first
- not sterile procedure, just wearing exam gloves and using sterile specimen
stool testing
- fecal occult blood test (FOBT): looks to see if blood is in the stool
- FOBT can be early indicator for colon cancer
bedside glucose
- performed anywhere
- gives an instant reading of the patient’s current blood sugar
- sliding scale insulin is ordered for admitting diabetic patients
- SSI sometimes used at home for DM
