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IM2 > lab values > Flashcards

lab values Flashcards

1
Q

factors affecting lab values:

A

age, gender, race, pregnancy, and food digestion

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2
Q

urine studies are used to:

A

detect/diagnose & monitor renal & urinary disease, detect metabolic/systemic

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3
Q

urine studies types of specimens:

A

random, timed, culture & sensitivity, 1st morning, double-voided

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4
Q

UA (urinalysis) is a:

A

random specimen, mid-stream voided, straight cath or foley tubing

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5
Q

UA screening test:

A

infection, renal function, acid-base balance

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6
Q

UA desired result:

A

appearance: clear
color: yellow - amber
ketones: none
WBC’s: none
protein: usually none

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7
Q

timed urine specimen is for:

A

substances irregularly excreted over time & effects hydration, metabolism, & position

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8
Q

types of timed urine specimen:

A

specific predetermined time of day: pregnancy, urobiligen, nitrates (ex: cortisol)

over a specified time period: -2 (hr) urine - postprandial glucose. pt doesn’t need to void during that 2 hrs
-24 (hr) urine- hormones, protein, creatinine

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9
Q

24 hr urine:

A

pt to void (discard the 1st voiding) then start time for 24 hr. ALL urine saved in container for 24 hr (keep cool), pt voids at end of 24 hrs (end of test) – - mainly for hormones and protein

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10
Q

sources of error for 24 hr urine:

A

contaminants in urine, failure to collect all urine in time period, including 1st voided urine, improper storage/preservation of specimen

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11
Q

CrCl (creatinine clearance) evaluates:

A

rate and efficiency of kidney filtration - clear creatinine and other waste

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12
Q

CrCl detects and diagnose:

A

kidney dysfunction and/or decreased blood flow to kidneys
-if creatinine clearance decreases, then you have a poorly functioning kidney

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13
Q

CrCl requires ___ hr urine and ___ blood specimen

A

24 hr; 1

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14
Q

if your kidneys are _____ in function, then your creatinine levels will _____

A

decreasing; increase

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15
Q

osmolality - urine measure:

A

dissolved particles in urine

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16
Q

osmolality - urine, determine:

A

kidneys concentrating ability and fluid/electrolyte abnormalities

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17
Q

osmolality is more exact measurement than specific gravity: true or false

A

true

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18
Q

normal urine osmolality:

A

300-900 mOsm/L

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19
Q

compare with blood osmolality:

A

urine : blood ratio = 1:3

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20
Q

blood tests - osmolality (serum) - normal serum osmolality:

A

280 - 300 mOsm/L
critical values: below 265 (diluted fluid) or more than 320 (lots of particles in fluid - concentrated)

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21
Q

osmolality (serum) rough estimate:

A

Na level x 2 (135-145 normal Na level)

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22
Q

osmolality (serum) measure:

A

amount of concentration of particles in blood

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23
Q

altered osmolality (serum) you will have increased levels of:

A

dehydration, Na or glucose, Hyperglycemic Hyperosmolar Nonketotic (type 2) or Diabetic ketoacidosis (type 1 diabetes), diuretic therapy

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24
Q

altered osmolality (serum) you will have a decreased levels of:

A

over hydration, SIADH (Syndrome of inappropriate antidiuretic hormone ADH release), CA- breast, colon, lung

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25
Q

prealbumin (transthyretin) used to monitor:

A

nutrition status & effects of treatments, liver function

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26
Q

prealbumin you will have an increased in ______ and _____

A

Hodgkin’s disease, pregnancy

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27
Q

prealbumin you will have decreased:

A

malnutrition, liver disease, inflammation, prealbumin inversely related to mortality (<11)

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28
Q

culture & sensitivity can be done from:

A

urine, blood, wound drainage, tissue & devices

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29
Q

what will you obtain prior to abx therapy?

A

culture & sensitivity

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30
Q

final report for S&S:

A

72 hrs

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31
Q

preliminary report for C&S is done in ___ hrs

A

24

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32
Q

“no growth in ___ or ___ hrs” - usually means _____

A

24 or 48 hrs; no infections

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33
Q

S&S culture for fungus may take:

A

6 weeks

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34
Q

sensitivity part of S&S tells doctor what?

A

abx therapy to use, from safest/most effective and least expensive tx

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35
Q

_____ may be done _____ to assess if further treatment needed

A

culture; abx therapy

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36
Q

gram stain: gram positive is ___ staining organism

A

blue

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37
Q

gram stain: gram negative is ___ staining organism

A

red

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38
Q

results for a gram stain in ____ minutes

A

10

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39
Q

gram stains are typically done if a ____ infection is detected and commonly on ___

A

bacterial; sputum

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40
Q

TDM (therapeutic drug monitoring) determines:

A

effective dose and prevent toxicity

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41
Q

peak:

A

drug highest level in blood but below toxic level

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42
Q

trough:

A

drug lowest level in blood but in therapeutic range; hold dose until lab results known

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43
Q

PT (prothrombin time):

A

assess coagulation

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44
Q

INR (international normalizing ratio):

A

assess warfarin therapy

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45
Q

____ & ____ effect natural clotting times and effectiveness of Coumadin treatment

A

diet & drugs

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46
Q

___ ____ for reversal of warfarin

A

vitamin K

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47
Q

PTT (partial thromboplastin time): assess what?
increased levels:
decreased levels:

A

assess coagulation or heparin therapy

increased levels: clotting factor deficiency, cirrhosis, Heparin

decreased levels: ovary. pancreas, colon CA

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48
Q

reversal of heparin is what?

A

protamine sulfate

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49
Q

PT/INR monitors:
evaluation:
assessment:

A

-of warfarin
-for vitamin K deficiency or severe malnutrition
-assessment of liver failure

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50
Q

PTT monitor:
assessment:

A

-monitoring (but not initiation) of heparin
-assessment of clotting factor function in hemophilia and von willebrand disease

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51
Q

Both PT/INR and PTT^10

A

-active bleeding without obvious cause
-evidence of abnormal bleeding on physical examination
-hx of abnormal, excessive, or spontaneous bleeding
-suspected or confirmed disseminated intravascular coagulation
-high-risk pt in whom a clinical history is unavailable

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52
Q

hematopoiesis:

A

process by which all formed elements of the blood are produced

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53
Q

_____ occurs in the _____ _____, where cells mature from a primitive stem cell

A

production; bone marrow

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54
Q

RBC’s life cycle:
platelets:

A

120 days life cycle; 7-9 days

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55
Q

granulocytes:

A

basophils, eosinophils, and neutrophils

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56
Q

CBC (complete blood count) used to diagnose:

A

anemias, bleeding disorders, infections, and blood cell changes

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57
Q

CBC has:

A

white blood cells (leukocytes, and lymphocytes), RBC, hematocrit (HCT), hemoglobin (HGB), and platelet count

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58
Q

WBC (white blood cell) is part of the body’s ____

A

defense system, respond to foreign invaders

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59
Q

WBC- assessment of:

A

infection, neoplasm, allergy, immunosuppression

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60
Q

drugs for leukopenia:

A

ampilicillin, vancomycin, chemotherapy, antihistamines

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60
Q

WBC’s > 10,000= leukocytosis

A

anemias, viral infections, ETOH, RA, trauma, physical or emotional stress

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60
Q

drugs for WBC- leukocytosis:

A

ASA, epinephrine, steroids, heparin

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60
Q

WBC’s < 4,000 = leukopenia

A

acute infection, MI, cirrhosis, burns, dietary deficiencies

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61
Q

WBC with differential:

A

granulocytes (polymorphonuclear)
- neutrophils (50-70%)
-eosinophils (1%-3%)
-basophils (<1%)

nongranulocytes (mononuclear)
-monocytes (2%-9%)
-lymphocytes (20%-30%)

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62
Q

polymorphonuclear:

A

having a lobed nucleus. commonly referred to as “polys”

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63
Q

granulocytes:

A

having granules in their cytoplasm

64
Q

WBC- neutrophils

A

phagocytosis, bacterial infection, trauma

65
Q

WBC- eosinophils

A

allergic reactions, parasitic conditions

66
Q

WBC - basophils

A

mast cells, increase during healing process

67
Q

WBC- monocytes

A

2nd line of defense against bacteria and foreign substances, stronger than neutrophils, can ingest larger particles, respond late during acute phase

68
Q

WBC- lymphocytes

A

increased during chronic bacterial and viral infections, B lymphocytes, T lymphocytes

69
Q

neutrophil cell: lifespan in blood and function

A

7 hours; immune defense

70
Q

eosinophil: lifespan in blood and function

A

8 - 12 days; defense against parasites

71
Q

basophil: lifespan in blood and function

A

a few hours to few days; inflammatory response

72
Q

monocyte: lifespan in blood and function

A

3 days; immune surveillance

73
Q

B-lymphocyte: lifespan in blood and function

A

memory cells may live for years; antibody production

74
Q

T-lymphocyte: lifespan in blood and function

A

memory cells may live for years; cellular immune response

75
Q

RRB (red blood cells) are formed:
transport:
assess:
reference values:

A

in blood marrow; transport oxygen; assess for anemia’s; male: 4.7 - 6.1
female: 4.2 - 5.4

76
Q

RBC increased levels in:
drug effects:

A

-erythrocytosis- severe dehydration, COPD, polycythemia vera
-gentamicin, methyldopa

77
Q

RBC decreased levels in:
drug effects:

A

etythropenia- anemia, hemorrhage, bone marrow failure, cirrhosis, renal disease, lymphoma, leukemia
drug effects: chloramphenicol, phenhtoin

78
Q

HCT (hematocrit) is:
assess:
reference values:

A

rapid measurement of RBC count
assess: hydration status, anemia, oxygen transport
reference values: male 42%-52%; female: 37% to 47%, critical values: <15% or >60%

79
Q

plasma is made up of:

A

water, proteins, nutrients, hormones

80
Q

anemia you will have a ____ hematocrit %

A

depressed

81
Q

polycythemia you will have an ____ hematocrit %

A

elevated

82
Q

HCT increased levels of:
drugs:

A

-dehydration, diuretics, burns, high altitudes, hypoxemia, COPD
-drugs: erythropoeitin, glucocorticosteroids

83
Q

HCT decreased levels:
drugs:

A

-decrease with age, s/s of anemia’s, blood loss, over hydration, extremely elevated WBC’s
-drugs: antieoplastic/radioactive agents, PCN

84
Q

hgb (hemoglobin) is:

A

the protein molecule in RBC that carries oxygen from the lungs to the body’s tissues and returns carbon dioxide from the tissues to the lungs

85
Q

HGB: tourniquet on for >1 minute =

A

hemolysis

86
Q

HGB is highest around what time and lowest around when?

A

0800 and lowest around 2000

87
Q

HGB increased levels:
drugs:

A

dehydration, CHF, lung disease, heavy smokers
drugs: gentamicin, aldomet

88
Q

if a physician is trying to determine if a patient has a viral infection vs a bacterial infection, they want a:

A

they want a complete blood count with differentials

89
Q

HGB decreased levels:
drugs:

A

anemias, hemorrhage, hodgkins disease, kidney disease
drugs: antibiotics, ASA, MAOI, increase vitamin A

90
Q

thalassemia:

A

a genetic group of blood disorders that result in the defective production of hemoglobin

91
Q

spherocytosis:

A

a genetic disease that causes a defect in the RBC’s cytoskeleton, causing RBC to be small, sphere-shaped, and fragile instead of donut-shaped and flexible

92
Q

hemolytic anemia:

A

breakdown of RBC’s in the blood vessels

93
Q

platelets promote:

A

coagulation, vascular integrity
-produced in bone marrow
-thrombocytes

94
Q

platelets increased levels:
drugs:

A

thrombocytosis: >400,000
-malignancy, polycythemia, vera, splenectomy, RA
drugs: epinephrine, estrogens, oral contraceptives

95
Q

decreased levels- platelets
drugs:

A

thrombocytopenia (<100,000)
-hemorrhage, leukemia, aplastic anemia, cancers
drugs: streptomycin, ASA, thiazide diuretics

96
Q

thrombocythemia:

A

vascular thrombosis with tissue or organ infarction is the major complication of thrombocythemia

97
Q

CMP (complete metabolic panel): cmp

A

-measure electrolyte balance, kidney & liver function, glucose levels, acid/base balance, & blood proteins

98
Q

BMP: basic metabolic panel

A

measure status of kidneys, blood sugar, electrolyte, and acid/balance

99
Q

values on BMP and CMP reports:

A

glucose, sodium, potassium, chloride, CO2, BUN, creatinine, calcium, magnesium, total protein, albumin, total bilirubin, AST, ALT, ALP

100
Q

glucose:

A

evaluation of blood glucose levels (assess for diabetes - random, FBS, PPGB)

101
Q

fasting BG levels (FBS)

A

after 8-10 hr fast <99 mg/dL

102
Q

post prandial BG levels (PPBG)

A

glucose in blood after meal (2hrs) <140 mg/dL

103
Q

glucose levels increase:
drugs:

A

-DM, IV fluids, trauma, surgery, infection, MI
-antidepressants, beta blockers, steroids, diuretics

104
Q

glucose decreased levels:
drugs:

A

insulin overdose, hypothyroidism, liver disease
drugs: tylenol, ETOH, insulin, MAO inhibitors

105
Q

in general, anytime of day, most adults would be between

A

70-110 mg/dL

106
Q

if a patient is less than ___ mg/dL or greater than ____ mg/dL are critical values

A

50; 400

107
Q

sodium monitor:
reference values:
critical values:

A

fluid/electrolyte/acid-base balance
-balance between dietary Na intake and renal excretion

reference: 135-145 mEq/L
critical: < 120 mEq/L or >160 mEq/L

108
Q

increased levels of sodium is ___

A

hypernatremia

109
Q

decreased sodium levels:

A

hyponatremia

110
Q

potassium plays a role in:
reference value

A

heart and renal function, skeletal/smooth muscle contraction, acid-base balance

111
Q

increased levels of potassium is:

A

hyperkalemia

112
Q

decreased levels of potassium:

A

hypokalemia

113
Q

chloride regulates the amount of ___ in the body and maintain the ___-___ balance, and absorbed from the ____. Excreted by the ____

A

fluid; acid-base; intestines; kidneys

114
Q

reference values for chloride:

A

98-108 mEq/L

115
Q

increased level of chloride:
s/s

A

hyperchloremia
s/s: lethargy, weakness, deep respirations

116
Q

decreased chloride:
s/s:

A

hypochloremia
s/s: hyperexcitability of NS and muscles, shallow breathing, hypotension, tetany

117
Q

CO2 measures amount of:

A

CO2 in the blood, mostly in form of bicarbonate (HCO3-), screen for electrolyte or acid-base imbalance

118
Q

increased levels of CO2

A

metabolic acidosis, kidney disease, DKA, chronic diarrhea, addison’s disease

119
Q

decreased levels of CO2

A

metabolic alkalosis, lung diseases, cushing’s disease

120
Q

BUN (blood, urea, nitrogen)

A

measure liver metabolic & kidney excretory function, protein breakdown -> urea (waste product), urea made in liver, excreted in urine

121
Q

increased BUN

A

dehydration, heart failure, renal injury, nausea

122
Q

decreased BUN

A

diet low in protein, malnutrition, liver damage, over hydration, pregnancy

123
Q

levels > 100 mg indicate serious _____ _____

A

renal impairment

124
Q

creatinine is:
measures:
not influenced by:
more specific to:

A

-waste product in blood and urine
-measures kidney function
-not influenced by diet or fluid intake
-renal disease than BUN

125
Q

creatinine clearance is a test used to measure:

A

the GFR of the kidney and is collected in a 24 hr urine

126
Q

calcium- evaluate:

A

parathyroid function, calcium metabolism and excretion

127
Q

____ and ____ can bind with calcium and decreased ionized calcium levels

A

protein and albumin

128
Q

you may see ___ if you leave the tourniquet on too long

A

hypercalcemia

129
Q

increased level of calcium:

A

hypercalcemia

130
Q

decreased levels of calcium:

A

hypocalcemia

131
Q

magnesium is needed for _____ ____ and useful in ___ & ____ metabolism

A

neuromuscular activity; carbohydrate and protein

132
Q

when magnesium is low, so is ___ and ____

A

calcium and potassium

133
Q

most accurate results for magnesium are obtained when ____ is not used

A

tourniquet

134
Q

patients with ____ often present with confusion and psychosis

A

hypomagnesemia

135
Q

watch for s/s of ____ with Mg

A

diarrhea

136
Q

about ___ % of calcium is flowing through body and plays a roll in our ___ mechanism

A

50%; clotting

137
Q

total protein is made up of ____, ____, and _____

A

prealbumin, albumin, and globulins

138
Q

total protein: maintain ___ pressure within vascular space

A

osmotic

139
Q

albumin:

A

protein formed in the liver; 60% of total protein

140
Q

patient should not eat ___ ____ diet 24 hrs before CMP

A

high fat

141
Q

____ levels will increase after a high protein diet

A

creatinine

142
Q

albumin aids in ____ growth and healing

A

tissue

143
Q

for albumin, maintain ____ ____ pressure

A

collodial osmotic

144
Q

most common sign of low calcium level is:

A

muscle spasm/cramps

145
Q

_____ is the most plentiful protein found in plasma

A

albumin

146
Q

total bilirubin:

A

is a measurement of both direct and indirect but if the total bilirubin is within reference values, the breakdown of direct vs indirect is unnecessary

147
Q

bilirubin:

A

produced by the breakdown of old RBC and HGB

148
Q

albumin transports ___, ___, and _____

A

blood, hormones, and enzymes

149
Q

____ can lower ____ levels

A

caffeine; bilirubin

150
Q

what foods will increase your bilirubin levels?

A

carrots and yams

151
Q

AST (aspartate aminotramferase)

A

converts amino acids to amino acid residue and is essential to energy production in the Krebs cycle

152
Q

frequent ___ injections will increase AST levels

A

IM

153
Q

ALT (alaine aminotransferase): specifically looking for

A

liver damage or disease

154
Q

patients should avoid what before ALT test

A

strenuous exercise

155
Q

ALT levels will rise several days before ____ is seen

A

juandice

156
Q

ALP (alkaline phosphatase)

A

present in biliary ducts of liver, bone, and placental tissue

157
Q

pancreas function and other tests NOT on a CMP

A

amylase, lipase, glycosylated hemoglobin A1c

158
Q

amylase:

A

helpful in evaluation of abdominal pain, detect & monitor pancreatitis

159
Q

lipase:

A

enzyme secreted by pancreas into small intestines, helps break down triglycerides into fatty acids

160
Q

glycosylated hemoglobin A1c

A

used to monitor diabetes and effectiveness of treatment of diabetes
-average blood glucose level for past 3 months

IM2 (14 decks)

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