Lab Values Flashcards
what to consider when looking at lab values
- do not rely on a single lab value, look at trends across multiple samples
- consider time of day specimen was drawn, drug interactions, recent meals, intravenous infusions
PT considerations (risks/benefits)
- prior to intervention, anticipate physiological changes to occur if the lab is not in a typical range for pt
- risk level increases if lab values is in critical ranges
- must collaborate with members of team for risk/benefit of PT
- may require a conditional order to be placed to ensure communication and approval by medical staff if to proceed
require more conservative approach due to pt’s ability to compensate in a short period of time
acute lab values
examples of acute changes in lab values
blood loss, trauma
allow the pt time to compensate, may still have capability to respond to exercise/mobility demands
chronic lab values
examples of chronic changes in lab values
patients with CFH/COPD, cancer
lab values may have referenced ranges for
age and sex (assigned at birth)
is pt is on hormone replacement therapy, use ______ to determine reference ranges/values
transitioned gender
if the pt is not on hormone replacement therapy, use _____ to determine reference ranges/values
biological sex
can lead to differences in reactivity of DNA, proteins, cells and antibodies use in many lab tests
genetic heterogeneity
african americans have increased what compared to Caucasians
muscle mass and skeletal structure
what to african americans have increased levels of
higher serum total protein levels, higher serums levels of alpha/beta/gamma globulins
african americans tend to have lower what
levels of hemoglobin
what lab values may be altered in pts with sickle hemoglobin
HgbA1c (A1C)
evaluates RBS, WBC, and platelets
complete blood count (CBC)
where is CBC drawn from
peripheral vein
looks more closely at components of the cell (provide examples)
CBC with differentials (CBC with diff)
- mean corpuscular hemoglobin (Hb) concentration (MCH), mean corpuscular volume (MCV)
- WBC: neutrophils, eosinophils, basophils, lymphocytes and monocytes
where are stem cells created
bone marrow
formation of stems cells into RBC, WBC or platelets (PLT)
hematopoesis
deliver oxygen to tissues
RBC/erythrocyte
is the measurement of percentage of whole blood occupied by cells
hematocrit
RBCs contain _____ which is the iron containing protein
hemoglobin (Hb)
primary goal is to fight infection
WBC
list WBC granulocytes
neutrophils
eosinophils
basophils
kill bacteria via phagocytosis; make up 58% of WBC
neutrophils
kill parasites, role in allergic disorders; make up 2% of WBC
eosinophils
role in allergies, release histamine and heparin; 1% of WBC
basophils
list WBC agranulocytes
monocytes
lymphocytes
differentiate into macrophages and ingest bacteria; 4% of WBC
monocytes
list the different types of lympocytes
t lymphocytes
helper t
memory t
suppressor t
b lymphocytes
cell-mediated immunity
t lymphocytes
orchestrate immune response, stimulate B cells to form antibodies, stimulate cytotoxic T cells and activate macrophages
helper T
preserve memory of previous antigens
memory T
modulate intensity of immune response
suppressor T
produce antibodies; 33% of WBC
b lymphocytes
the real number of WBC that are neutrophils
absolute neutrophil count (ANC)
how to measure absolute neutrophil count (ANC)
- not measured directly
- derived by multiplying the WBC count times the percent of neutrophils in the differential WBC count
- % of neutrophils consists of segmented (fully mature neutrophils) + the bands (almost mature neutrophils)
what is the normal range of ANC
1.5 - 8.0 (1500-8000/mm3)
an ANC level of _____ is considered low –> activity restrictions/infection precautions in place (masks, gown, gloves to protect pt)
< 500
reference values for WBC
5.0-10.0 10^9/L
trending upward WBC lab value
leukocytosis >11.0 10^9/L
causes/presention/clinical implications of leukocytosis (trending upward WBC)
- infection, leukemia, neoplasm, trauma, surgery, sickle-cell disease, stress/pain, medication-induced, smoking, obesity, congenital, chronic inflammation, connective tissue disease
- ## fever, malaise, lethargy, dizziness, bleeding, bruising, unintentional weight loss, lymphadenpathy, painful inflamed joints
trending downards WBC lab values
- leukopenia <4.0 10^9/L
- neutropenia <1.5 10^9/L (moderate 0.5-1; severe < 0.5)
causes/presentation/clinical implications of neutropenia (trending downward WBC)
- stem cell disorder, bacterial infection, viral infection, radiation
- low grade fever, skin abscesses, sore mouth, sx of pnemonia
causes/presentation/clinical implications of leukopenia (trending downward WBC)
- viral infections, chemotherapy, aplastic anemia, autoimmune disease, hepatitis
- ## anemia, weakness, fatigue, fever, headache, SOB
essential component of hemostasis/clotting mechanism
platelets
adhere to disruptions of endothelial lining of a wound, then to each other to form a plug; also promote aggregation and activation of more platelets and increase the size of plug
platelets
normal PLT values
140 - 400 k/uL
trending upward lab values for platelets
thrombocytosis > 450 uk/L
trending downward lab values for platelets
thrombocytopenia <150 uk/L
causes/presentation/clinical implications of thrombocytosis (trending upward PLTs)
- splenectomy, inflammation, neoplasm/cancer, stress, iron deficiency, infection, hemorrhage, hemolysis, high altitudes, strenuous exercise, trauma
- weakness, headache, dizziness, chest pain, tingling in hands/feet
- sx based approach for activities, monitor sx, collaborate with team; elevated levels can lead to venous thromboembolism
causes/presentation/clinical implications of thrombocytopenia (trending downward PLTs)
- viral infection, nutrition deficiency, leukemia, radiation, chemotherapy, malignant cancer, liver disease, aplastic anemia, premenstrual and postpatum
- petechiae, ecchymosis, fatigue, jaundice, splenomegaly, risk for bleeding
- severe thrombocytopenia (<20 k/uL): sx based approach for activity; collaborate regarding possible need for/timing of transfusion prior to mobilization; fall risk awareness (risk for spontaneous hemorrhage)
protein in RBC that carries oxygen to our organs and tissues and transports CO2 from organs/tissue to lungs
hemoglobin
hemoglobin trending upward
polycythemia
hemoglobin trending downward
anemia
normal hemoglobin values for M and F
M: 14 - 18 g/dl
F: 12 - 16 g/dl
causes/presentation/clinical implications of polycythemia (trending upward hemoglobin)
- congenital heart disease, severe dehydration, chronic obstructive pulmonary disease (COPD), CHF, severe burns, high altitude
- orthostasis, presyncope, dizziness, arrhythmias, CHF onset/exacerbation, sx of transient ischemic attack (TIA), sx of MI, angina
- sx based approach, monitor sx, collaborate
what are low critical values of hemoglobin and what can it lead to
<5-7 g/dL
heart failure or death
what are high critical values of hemoglobin and what can it lead to
> 20 gd/L
clogging of capillaries as a result of hemoconcentration
do hemoglobin levels slightly increase or decrease with age
slightly decrease
causes/presentation/clinical implications for anemia (trending downward hemoglobin)
- hemorrhage, nutritional deficiency, neoplasia, lymphoma, systemic lupus, sarcoidosis, renal disease, spenomegaly, sickle cell anemia, stress to bone marrow, RBC destruction
- decreased endurance, decreased activity tolerance, pallor, tachycardia
- monitor vitals and SpO2 to predict tissue perfusion (may present with tachycardia or orthostatic hypotension); may be monitoring pre-existing cerebrovascular/cardiac/renal conditions for ineffective tissue perfusion; , 8g/dL sx based approach, may need transfusion depending on institution
what is the level of hemoglobin that may require transfusion and require stop of activity
8 g/dL
blood test that measures the percentage of RBCs in blood
hematocrit
what protein do RBC contain that help to pick up O2 from your lungs and transport it t/o your body
hemaglobin
hematocrit trending upward
polycythemia
hematocrit trending downward
anemia
what are the reference values for hematocrit (M and F)
M: 42-52%
F: 37-47%
multiple hemoglobin levels by 3 to find
causes of polycythemia
burns, eclampsia, severe dehydration, erythrocytosis, tends to be elevated in people living in high altitudes, hypoxia due to chronic pulmonary conditions (COPD, CHF)
presentation of hematocrit polycythemia
fever, HA, dizzy, weakness, fatigue, easy bruising/bleeding
low critical value of hematocit and what can it lead to
<25% - cardiac failure or death
high critical value of hematocrit and what can it lead to
> 60% - spontaneous blood clotting
causes of anemia hematocrit
leukemia, bone marrow failure, multiple myeloma, dietary deficiency, pregnancy, hyperthyroidism, cirrhosis, rheumatoid arthritis, hemorrhage, high altitude
presentation of anemia hematocrit
pale skin, HA, dizziness, cold hands/feet, chest pain, arrhythmia, SOB
clinical implications of hematocrit anemia
- pt may have impaired endurance –> progress activity slowly
- monitor SpO2 for tissue perfusion, may have tachycardia and/or orthostatic hypotension
- medical team may monitor pre-existing cerebrovascular, cardiac, or renal conditions for ineffective tissue perfusion related to decreased hematocrit
describe the importance of sodium
Primary determinant of extracellular fluid volume
Allows for conduction of N impulses
Plays a role in muscle contractions
The kidneys maintain an appropriate amount of sodium in the body by adjusting the amount excreted in urine
Sources of Sodium: food/drinks
Lost: by sweat/urine
Older individuals can have difficulty maintaining appropriate sodium concentrations secondary to dehydration, medications, decreased fluid volume and changes in the kidneys
Part of electrolyte panel
normal range of sodium
134-142
hypernatremia
upward trending sodium
describe hypernatremia
> 145
Causes: Increased sodium intake, Severe vomiting, CHF, Renal insufficiency, Cushing’s syndrome, Diabetes
Presentation: Irritability, agitation, seizure, coma, hypotension, tachycardia, decreased urinary output
Clinical Implications: Impaired cognitive status, seizure precautions
hyponatremia
downward trending sodium
describe hyponatremia
< 130
Causes: Dietetic use, gastrointestinal impairment, burns/wounds, hypotonic IV use, cirrhosis
Presentation: HA, lethargic, decreased reflexes, N/V, diarrhea, seizure, coma, orthostatic hypotension, pitting edema
Clinical: Impaired cognitive status
Monitor vitals secondary to risk for orthostatic hypotension
describe potassium
Important function of excitable cells (N, muscles, and heart)
Plays important role in cardiac function!!
Works with sodium to maintain appropriate fluid balance in body
Supports normal blood pressure
Both high and low potassium levels can lead to cardiac arrest
Sources: food and electrolyte drinks
Lost: urine
Part of electrolyte panel
normal range potassium
3.7-5.1
describe hyperkalemia
> 5.5
Causes: Renal failure, diabetic ketoacidosis (DKA), addison’s disease, excess potassium supplements, blood transfusion
Presentation: Muscle weakness/paralysis, paresthesia, cardiac arrest, bradycardia, heart block, ventricular fibrillation
Clinical: Pt at risk for cardiac issues if > 5: sx based approach, Might exhibit muscle weakness during interventions
hypokalemia
downward trending potassium
hyperkalemia
upward trending potassium
describe hypokalemia
Causes: Diarrhea/vomiting, gastrointestinal impairment, diuretics, cushing’s syndrome, malnutrition, restrictive diet, ETOH abuse
Presentation: Extremity muscle weakness, decreased reflexes, paresthesia, leg cramps, EKG changes, cardiac arrest, hypotension, constipation
Clinical: Sx-based approach
Severe hypokalemia <2.5 → collaborate with interprofessional team
describe calcium
Important for bone/tooth formation, cell division and growth, blood coagulation, mm cx, normal heart function, and release of neurotransmitters
About 99% of calcium is stored in bones
Calcium moved from bone to blood as needed → too much moved can cause bones to become weak
Regulated by 2 Hormones: parathyroid hormone and calcitonin
Part of electrolyte panel
normal range of calcium
8.6-10.3
hypercalcemia
upward trending calcium
describe hypercalcemia
Causes: Excessive calcium/antacids, bone destruction (tumor), immobilization, fx, excessive vitamin D, cancer, renal failure
presentation: Ventricular dysrhythmias, heart block, asystole, coma, lethargy, mm weakness, decreased reflexes, constipation, N/V
Clinical implications: sx-based
hypocalcemia
downward trending calcium
describe hypocalcemia
Causes: ETOH abuse, poor dietary intake, limited GI absorption, pancreatitis, laxative use
presentation: Anxiety, confusion, agitation, seizure, EKG changes, fatigue, numbness/tingling, increased reflexes, muscle cramps
clinical: Might have impaired cognitive abilities
Sx-based approach
describe chloride
Important for fluid/acid-base balance
Helps maintain blood pressure
Plays a role in digestion of food → stimulates secretion of hydrochloric acid in stomach
Plays a role in mm contraction and movement of N impulses
Mainly found in table salt
Excreted through urine
Part of electrolyte panel
normal range chloride
98-108
hyperchloremia
upward trending chloride
describe hyperchloremia
causes: High salt/low water diet, hypertonic IV, metabolic acidosis, renal failure
presentation: Lethargy, decreased levels of consciousness, weakness, edema, tachypnea, HTN, tachycardia
clinical: Determine if appropriate for tx is exhibiting decreased levels of consciousness
hypochloremia
downward trending chloride
describe hypochloremia
causes: Low salt diet, water intoxication, diuresis, excessive vomiting/diarrhea
presentation: Agitation, irritability, hypertonicity, increased reflexes, cramping, twitching
clinical: Monitor level of consciousness and motor function
describe phosphate
Necessary for: bone formation, acid-base balance, storage and transfer of energy (ATP)
Kidneys are the primary excretion of phosphorus
Imbalance may result due to: dietary intake, GI disorders, excretion by the kidneys
Sources: seafood, lentils, dairy, poultry
normal range phosphate
2.3-4.1
hyperphosphatemia
upward trending phosphate
describe hyperphosphatemia
causes: Bone destruction (tumor), immobilization, fx, excessive vitamin D, cancer, renal failure
presentation: Ventricular dysrthmia, heart block, asystole, coma, lethargy, mm weakness, decreased reflexes, constipation, N/V
clinical: sx-based
hypophosphatemia
downward trending phosphate
describe hypophosphatemia
causes: ETOH abuse, poor dietary intake, limited GI absorption, pancreatitis, laxative use
presentation: Anxiety, confusion, agitation, seizure, EKG changes, fatigue, N/T, increased reflexes, mm cramps
clinical implications: impaired cognition, sx-based
describe magnesium
Concentrated in bone and muscle
Involved in: ATP metabolism, cx and relaxation of mm, proper neurological functioning, neurotransmitter release
Regulated by kidneys
Sources: pumpkin seeds, chia seeds, spinach, black beans
normal range magnesium
1.2-1.9
hypermagnesium
upward trending magnesium
describe hypermagnesium
causes: Increased intake antacids/magnesium citrate, renal failure, leukemia, dehydration
presentation: Diaphoresis, N/V, drowsiness, lethargy, weakness/flaccidity, decreased reflexes, hypotension, heart block
clinical implications: sx-based
hypomagnesium and describe it
downward trending magnesium
causes: ETOH abuse, eating disorders, diuresis, DKA, medications
present: Increased reflexes, tremors, spasticity, seizures, nystagmus, EKG changs (premature ventricular contraction PVC → v-tach → v-fib), emotional lability
clinical: sx-based
