lab values Flashcards
factors affecting lab values:
age, gender, race, pregnancy, and food digestion
urine studies are used to:
detect/diagnose & monitor renal & urinary disease, detect metabolic/systemic
urine studies types of specimens:
random, timed, culture & sensitivity, 1st morning, double-voided
UA (urinalysis) is a:
random specimen, mid-stream voided, straight cath or foley tubing
UA screening test:
infection, renal function, acid-base balance
UA desired result:
appearance: clear
color: yellow - amber
ketones: none
WBC’s: none
protein: usually none
timed urine specimen is for:
substances irregularly excreted over time & effects hydration, metabolism, & position
types of timed urine specimen:
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
24 hr urine:
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
sources of error for 24 hr urine:
contaminants in urine, failure to collect all urine in time period, including 1st voided urine, improper storage/preservation of specimen
CrCl (creatinine clearance) evaluates:
rate and efficiency of kidney filtration - clear creatinine and other waste
CrCl detects and diagnose:
kidney dysfunction and/or decreased blood flow to kidneys
-if creatinine clearance decreases, then you have a poorly functioning kidney
CrCl requires ___ hr urine and ___ blood specimen
24 hr; 1
if your kidneys are _____ in function, then your creatinine levels will _____
decreasing; increase
osmolality - urine measure:
dissolved particles in urine
osmolality - urine, determine:
kidneys concentrating ability and fluid/electrolyte abnormalities
osmolality is more exact measurement than specific gravity: true or false
true
normal urine osmolality:
300-900 mOsm/L
compare with blood osmolality:
urine : blood ratio = 1:3
blood tests - osmolality (serum) - normal serum osmolality:
280 - 300 mOsm/L
critical values: below 265 (diluted fluid) or more than 320 (lots of particles in fluid - concentrated)
osmolality (serum) rough estimate:
Na level x 2 (135-145 normal Na level)
osmolality (serum) measure:
amount of concentration of particles in blood
altered osmolality (serum) you will have increased levels of:
dehydration, Na or glucose, Hyperglycemic Hyperosmolar Nonketotic (type 2) or Diabetic ketoacidosis (type 1 diabetes), diuretic therapy
altered osmolality (serum) you will have a decreased levels of:
over hydration, SIADH (Syndrome of inappropriate antidiuretic hormone ADH release), CA- breast, colon, lung
prealbumin (transthyretin) used to monitor:
nutrition status & effects of treatments, liver function
prealbumin you will have an increased in ______ and _____
Hodgkin’s disease, pregnancy
prealbumin you will have decreased:
malnutrition, liver disease, inflammation, prealbumin inversely related to mortality (<11)
culture & sensitivity can be done from:
urine, blood, wound drainage, tissue & devices
what will you obtain prior to abx therapy?
culture & sensitivity
final report for S&S:
72 hrs
preliminary report for C&S is done in ___ hrs
24
“no growth in ___ or ___ hrs” - usually means _____
24 or 48 hrs; no infections
S&S culture for fungus may take:
6 weeks
sensitivity part of S&S tells doctor what?
abx therapy to use, from safest/most effective and least expensive tx
_____ may be done _____ to assess if further treatment needed
culture; abx therapy
gram stain: gram positive is ___ staining organism
blue
gram stain: gram negative is ___ staining organism
red
results for a gram stain in ____ minutes
10
gram stains are typically done if a ____ infection is detected and commonly on ___
bacterial; sputum
TDM (therapeutic drug monitoring) determines:
effective dose and prevent toxicity
peak:
drug highest level in blood but below toxic level
trough:
drug lowest level in blood but in therapeutic range; hold dose until lab results known
PT (prothrombin time):
assess coagulation
INR (international normalizing ratio):
assess warfarin therapy
____ & ____ effect natural clotting times and effectiveness of Coumadin treatment
diet & drugs
___ ____ for reversal of warfarin
vitamin K
PTT (partial thromboplastin time): assess what?
increased levels:
decreased levels:
assess coagulation or heparin therapy
increased levels: clotting factor deficiency, cirrhosis, Heparin
decreased levels: ovary. pancreas, colon CA
reversal of heparin is what?
protamine sulfate
PT/INR monitors:
evaluation:
assessment:
-of warfarin
-for vitamin K deficiency or severe malnutrition
-assessment of liver failure
PTT monitor:
assessment:
-monitoring (but not initiation) of heparin
-assessment of clotting factor function in hemophilia and von willebrand disease
Both PT/INR and PTT^10
-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
hematopoiesis:
process by which all formed elements of the blood are produced
_____ occurs in the _____ _____, where cells mature from a primitive stem cell
production; bone marrow
RBC’s life cycle:
platelets:
120 days life cycle; 7-9 days
granulocytes:
basophils, eosinophils, and neutrophils
CBC (complete blood count) used to diagnose:
anemias, bleeding disorders, infections, and blood cell changes
CBC has:
white blood cells (leukocytes, and lymphocytes), RBC, hematocrit (HCT), hemoglobin (HGB), and platelet count
WBC (white blood cell) is part of the body’s ____
defense system, respond to foreign invaders
WBC- assessment of:
infection, neoplasm, allergy, immunosuppression
drugs for leukopenia:
ampilicillin, vancomycin, chemotherapy, antihistamines
WBC’s > 10,000= leukocytosis
anemias, viral infections, ETOH, RA, trauma, physical or emotional stress
drugs for WBC- leukocytosis:
ASA, epinephrine, steroids, heparin
WBC’s < 4,000 = leukopenia
acute infection, MI, cirrhosis, burns, dietary deficiencies
WBC with differential:
granulocytes (polymorphonuclear)
- neutrophils (50-70%)
-eosinophils (1%-3%)
-basophils (<1%)
nongranulocytes (mononuclear)
-monocytes (2%-9%)
-lymphocytes (20%-30%)
polymorphonuclear:
having a lobed nucleus. commonly referred to as “polys”
granulocytes:
having granules in their cytoplasm
WBC- neutrophils
phagocytosis, bacterial infection, trauma
WBC- eosinophils
allergic reactions, parasitic conditions
WBC - basophils
mast cells, increase during healing process
WBC- monocytes
2nd line of defense against bacteria and foreign substances, stronger than neutrophils, can ingest larger particles, respond late during acute phase
WBC- lymphocytes
increased during chronic bacterial and viral infections, B lymphocytes, T lymphocytes
neutrophil cell: lifespan in blood and function
7 hours; immune defense
eosinophil: lifespan in blood and function
8 - 12 days; defense against parasites
basophil: lifespan in blood and function
a few hours to few days; inflammatory response
monocyte: lifespan in blood and function
3 days; immune surveillance
B-lymphocyte: lifespan in blood and function
memory cells may live for years; antibody production
T-lymphocyte: lifespan in blood and function
memory cells may live for years; cellular immune response
RRB (red blood cells) are formed:
transport:
assess:
reference values:
in blood marrow; transport oxygen; assess for anemia’s; male: 4.7 - 6.1
female: 4.2 - 5.4
RBC increased levels in:
drug effects:
-erythrocytosis- severe dehydration, COPD, polycythemia vera
-gentamicin, methyldopa
RBC decreased levels in:
drug effects:
etythropenia- anemia, hemorrhage, bone marrow failure, cirrhosis, renal disease, lymphoma, leukemia
drug effects: chloramphenicol, phenhtoin
HCT (hematocrit) is:
assess:
reference values:
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%
plasma is made up of:
water, proteins, nutrients, hormones
anemia you will have a ____ hematocrit %
depressed
polycythemia you will have an ____ hematocrit %
elevated
HCT increased levels of:
drugs:
-dehydration, diuretics, burns, high altitudes, hypoxemia, COPD
-drugs: erythropoeitin, glucocorticosteroids
HCT decreased levels:
drugs:
-decrease with age, s/s of anemia’s, blood loss, over hydration, extremely elevated WBC’s
-drugs: antieoplastic/radioactive agents, PCN
hgb (hemoglobin) is:
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
HGB: tourniquet on for >1 minute =
hemolysis
HGB is highest around what time and lowest around when?
0800 and lowest around 2000
HGB increased levels:
drugs:
dehydration, CHF, lung disease, heavy smokers
drugs: gentamicin, aldomet
if a physician is trying to determine if a patient has a viral infection vs a bacterial infection, they want a:
they want a complete blood count with differentials
HGB decreased levels:
drugs:
anemias, hemorrhage, hodgkins disease, kidney disease
drugs: antibiotics, ASA, MAOI, increase vitamin A
thalassemia:
a genetic group of blood disorders that result in the defective production of hemoglobin
spherocytosis:
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
hemolytic anemia:
breakdown of RBC’s in the blood vessels
platelets promote:
coagulation, vascular integrity
-produced in bone marrow
-thrombocytes
platelets increased levels:
drugs:
thrombocytosis: >400,000
-malignancy, polycythemia, vera, splenectomy, RA
drugs: epinephrine, estrogens, oral contraceptives
decreased levels- platelets
drugs:
thrombocytopenia (<100,000)
-hemorrhage, leukemia, aplastic anemia, cancers
drugs: streptomycin, ASA, thiazide diuretics
thrombocythemia:
vascular thrombosis with tissue or organ infarction is the major complication of thrombocythemia
CMP (complete metabolic panel): cmp
-measure electrolyte balance, kidney & liver function, glucose levels, acid/base balance, & blood proteins
BMP: basic metabolic panel
measure status of kidneys, blood sugar, electrolyte, and acid/balance
values on BMP and CMP reports:
glucose, sodium, potassium, chloride, CO2, BUN, creatinine, calcium, magnesium, total protein, albumin, total bilirubin, AST, ALT, ALP
glucose:
evaluation of blood glucose levels (assess for diabetes - random, FBS, PPGB)
fasting BG levels (FBS)
after 8-10 hr fast <99 mg/dL
post prandial BG levels (PPBG)
glucose in blood after meal (2hrs) <140 mg/dL
glucose levels increase:
drugs:
-DM, IV fluids, trauma, surgery, infection, MI
-antidepressants, beta blockers, steroids, diuretics
glucose decreased levels:
drugs:
insulin overdose, hypothyroidism, liver disease
drugs: tylenol, ETOH, insulin, MAO inhibitors
in general, anytime of day, most adults would be between
70-110 mg/dL
if a patient is less than ___ mg/dL or greater than ____ mg/dL are critical values
50; 400
sodium monitor:
reference values:
critical values:
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
increased levels of sodium is ___
hypernatremia
decreased sodium levels:
hyponatremia
potassium plays a role in:
reference value
heart and renal function, skeletal/smooth muscle contraction, acid-base balance
increased levels of potassium is:
hyperkalemia
decreased levels of potassium:
hypokalemia
chloride regulates the amount of ___ in the body and maintain the ___-___ balance, and absorbed from the ____. Excreted by the ____
fluid; acid-base; intestines; kidneys
reference values for chloride:
98-108 mEq/L
increased level of chloride:
s/s
hyperchloremia
s/s: lethargy, weakness, deep respirations
decreased chloride:
s/s:
hypochloremia
s/s: hyperexcitability of NS and muscles, shallow breathing, hypotension, tetany
CO2 measures amount of:
CO2 in the blood, mostly in form of bicarbonate (HCO3-), screen for electrolyte or acid-base imbalance
increased levels of CO2
metabolic acidosis, kidney disease, DKA, chronic diarrhea, addison’s disease
decreased levels of CO2
metabolic alkalosis, lung diseases, cushing’s disease
BUN (blood, urea, nitrogen)
measure liver metabolic & kidney excretory function, protein breakdown -> urea (waste product), urea made in liver, excreted in urine
increased BUN
dehydration, heart failure, renal injury, nausea
decreased BUN
diet low in protein, malnutrition, liver damage, over hydration, pregnancy
levels > 100 mg indicate serious _____ _____
renal impairment
creatinine is:
measures:
not influenced by:
more specific to:
-waste product in blood and urine
-measures kidney function
-not influenced by diet or fluid intake
-renal disease than BUN
creatinine clearance is a test used to measure:
the GFR of the kidney and is collected in a 24 hr urine
calcium- evaluate:
parathyroid function, calcium metabolism and excretion
____ and ____ can bind with calcium and decreased ionized calcium levels
protein and albumin
you may see ___ if you leave the tourniquet on too long
hypercalcemia
increased level of calcium:
hypercalcemia
decreased levels of calcium:
hypocalcemia
magnesium is needed for _____ ____ and useful in ___ & ____ metabolism
neuromuscular activity; carbohydrate and protein
when magnesium is low, so is ___ and ____
calcium and potassium
most accurate results for magnesium are obtained when ____ is not used
tourniquet
patients with ____ often present with confusion and psychosis
hypomagnesemia
watch for s/s of ____ with Mg
diarrhea
about ___ % of calcium is flowing through body and plays a roll in our ___ mechanism
50%; clotting
total protein is made up of ____, ____, and _____
prealbumin, albumin, and globulins
total protein: maintain ___ pressure within vascular space
osmotic
albumin:
protein formed in the liver; 60% of total protein
patient should not eat ___ ____ diet 24 hrs before CMP
high fat
____ levels will increase after a high protein diet
creatinine
albumin aids in ____ growth and healing
tissue
for albumin, maintain ____ ____ pressure
collodial osmotic
most common sign of low calcium level is:
muscle spasm/cramps
_____ is the most plentiful protein found in plasma
albumin
total bilirubin:
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
bilirubin:
produced by the breakdown of old RBC and HGB
albumin transports ___, ___, and _____
blood, hormones, and enzymes
____ can lower ____ levels
caffeine; bilirubin
what foods will increase your bilirubin levels?
carrots and yams
AST (aspartate aminotramferase)
converts amino acids to amino acid residue and is essential to energy production in the Krebs cycle
frequent ___ injections will increase AST levels
IM
ALT (alaine aminotransferase): specifically looking for
liver damage or disease
patients should avoid what before ALT test
strenuous exercise
ALT levels will rise several days before ____ is seen
juandice
ALP (alkaline phosphatase)
present in biliary ducts of liver, bone, and placental tissue
pancreas function and other tests NOT on a CMP
amylase, lipase, glycosylated hemoglobin A1c
amylase:
helpful in evaluation of abdominal pain, detect & monitor pancreatitis
lipase:
enzyme secreted by pancreas into small intestines, helps break down triglycerides into fatty acids
glycosylated hemoglobin A1c
used to monitor diabetes and effectiveness of treatment of diabetes
-average blood glucose level for past 3 months
