Lab Values Flashcards
Lab Values Used for:
-Screening for diseases
-Confirming diseases
-Preventative therapy
Acute changes
Associated with blood loss due to trauma or surgery, may require the therapist to select a more
conservative plan of care
~may not allow the pt to compensate quickly enough
Chronic changes
Associated with chronic conditions or longer-term medical interventions allow the
patient a period of time for their body to adapt or attempt to adapt to the changes in lab values
~May allow them to have more resources to deal with potential adverse events caused by increasing cardiorespiratory demand,
mobility, and exercise
Complete Blood Count Panel
Hemoglobin
Hematocrit
Platelets
White blood cells
CBC
Evaluate the different cellular components of blood
Simple blood draw from a peripheral vein
White Blood Cells (WBC)
Determines status of immune system; detects presence of infection/inflammation
Infection may increase O 2 demand, affecting occupational performance
WBC counts are age-related
Normal newborns/infants > adults
WBC Normal Values
Child > 2 years/adult: 5,000-10,000 mm3
5-10.0 x103 /uL
WBC Possible critical value
< 2,500 or > 30,000
Leukocytosis
High WBC
> 11.0 x 10 3 /uL
Leukocytosis Effects
Bacterial or viral infections
Inflammation/inflammatory condition (RA,
vasculitis, IBD)
Leukemia
Tissue necrosis (ex: trauma, burns, surgery, heart
attack)
Allergic response
Intense exercise
Severe emotional or physical stress
Pregnancy in final month and labor
Leukopenia
Low WBC
< 5.0 x 10 3 /uL
Leukopenia Effects
Bone marrow damage
Bone marrow disorders
Lymphoma
Autoimmune disorders (ex: lupus)
Sepsis
Immune system diseases (ex: HIV)
Neutropenia
Abnormally low levels of neutrophils (type of WBC) in the blood
< 1.8 x 10 3 /uL
Institutional guidelines determine neutropenic precautions
Why are neutrophils important?
Fighting infections
Hemoglobin (HB)
Measurement of blood’s oxygen
carrying capacity
Enables RBCs to bind to O 2 in the
lungs and carry it to tissues/organs
HB Normal Values
Adult Male:
14-18 g/dL
Adult Female:
12-16 g/dL
HB Possible Critical Values
< 5 or > 20
Anemia (Low HB)
Bleeding
Iron, vitamin B-12, or folate deficiency
CA (leukemia)
Kidney or liver disease
Hypothyroidism
Hemolytic anemia
Bone marrow damage or disorders
Chronic inflammatory conditions
Thalassemia (↓ Hb production) – inherited
Polycythemia (high HB)
Dehydration (artificial ↑)
Living @ high altitude
Heavy smoking
Burns
Excessive vomiting
Extreme physical exercise
Congenital heart disease
Lung disease
Kidney tumors (↑ erythropoietin production)
Genetic causes:
Polycythemia vera (↑ RBC production) – bone marrow disorder, gene defect
Critically low value of HB
< 5 g/dL
Can lead to heart failure or death
Critically high value of HB
> 20 g/dL
Increased blood viscosity, clogging of capillaries,
tissue ischemia
Hematocrit (HCT)
Measurement of RBC % in total blood volume
Low RBCs: similar to Hb
High RBCs: similar to Hb
HCT Normal Values
Adult Male:
42-52%
Adult Female:
37-47%
Critically low value of HCT
< 15%
May result in cardiac failure/death
High HCT
> 60%
Associated with spontaneous blood clotting
Platelets
Responsible for forming platelet plugs for blood clotting
May be used as a workup for:
Bleeding disorders
Bone marrow disease
Excessive clotting disorder
Platelets Signs and Symptoms of bleeding disorder
Unexplained/easy bruising
Prolonged bleeding from small cut
Numerous nosebleeds
GI bleeds
Petechiae
Purpura
Petechiae
small, flat, red, purple, or brown spots that appear on the skin or mucous membranes due to bleeding under the skin
Purpura
a condition that causes red or purple spots or patches to appear on the skin or in mucus membranes
Platelets Reference value
140-400 k/uL
Platelets - Trending upward (thrombocytosis)
: >450 k/uL
Symptoms-based approach when determining appropriateness for activity; monitor symptoms; collaborate with interprofessional
team
Elevated levels can lead to thromboembolism
Platelets - Trending downward (thrombocytopenia)
< 150 k/uL
In presence of severe thrombocytopenia (< 20 k/uL) use a symptoms-based approach when determining appropriateness for
activity; monitor symptoms; collaborate with interprofessional team
Fall-risk awareness (risk of spontaneous hemorrhage)
Platelets Possible Critical Values
< 50,000 or > 1 million
Basic Metabolic Panel
Sodium
Potassium
Chloride
Calcium
Magnesium
Blood Urea Nitrogen
Creatinine
Blood Glucose
Total Carbon Dioxide
Fluid Imbalances
-Total fluid is distributed between the intracellular and extracellular compartments
-Intracellular fluid
Contains ~2/3 of the body’s fluid
-Extracellular fluid
Interstitial and intravascular fluid
Blood and plasma
Loss of Fluid
Inadequate intake
Hemorrhage
Plasma loss (burns)
Vomiting/diarrhea
Fluid shift into the interstitial space
Ascites – liver failure
Pleural effusion – heart failure
Loss of fluid Signs and Symptoms
Decreased BP
Increased HR
Changes in mental status
Thirst
Dizziness
Poor skin turgor
Orthostatic hypotension
Excess of fluid
Increased intake of fluid
Excessive sodium intake
Kidney failure (acute and chronic)
Ventricular failure
Liver failure – loss of serum albumin
Fluid overload
Excess of fluid Signs and Symptoms
Weight gain
Pulmonary edema
Peripheral edema
Bounding pulse
Tachycardia
Hypotension
Electrolyte imbalance
The result of fluid imbalances
Vice versa
Cellular function is reliant on proper electrolyte balance
Neuromuscular excitability
Secretory activity
Membrane permeability
Electrolyte Balance - Sodium (Na+)
135-145 mmol/L or mEq/L
Vital to normal body processes:
Nerve function
Muscle function
Regulates amount of fluid in body
Primary determinant of ECF volume
Reason to test Sodium (Na+)
Usually done as part of electrolyte or basic
metabolic panel
In the presence of dehydration or edema
Monitor blood pressure
Possible critical value of Sodium (Na+)
: < 120 or > 160
Hypernatremia
High Na+
> 145 mEq/L
Causes of hypernatremia
Increased fluid loss (excessive sweating, diarrhea, use of
diuretics, or burns)
Inadequate fluid intake and dehydration
Too much salt or sodium bicarbonate in the diet
Renal insufficiency and failure
Adrenal gland problems (Cushing Syndrome or
hyperaldosteronism)
DM and Diabetes insipidus
Use of certain medicines
NSAIDs (ibuprofen or naproxen)
Antibiotics
Laxatives
Corticosteroids
Anabolic steroids
Hypernatremia S/S
Dry mucous membranes
Decreased urine output
Thirst
Agitation
Restlessness
Acting irrational
Coma
Convulsions
Hyponatremia
Low Na+
< 135 mEq/L
Causes of hyponatremia
Dehydration, vomiting, diarrhea
Increase in total body water (heart failure,
certain kidney diseases, or cirrhosis of the liver)
Too much water intake or retention
Adrenal insufficiency
Use of certain medications
Diuretics (water pills)
Morphine
SSRI antidepressants
Hyponatremia S/S
~Hypovolemia:
Poor skin turgor
Dry mucous membranes
Orthostatic hypotension/tachycardia/weak pulse
~Hypervolemia:
Hypertension
Tachycardia
Pitting edema
Potassium (K + )
3.5 - 5.0 mEq/L
Vital to normal body processes:
Muscle function
Heart function
Cell metabolism
Possible Critical Value of Potassium (K+)
< 2.5 or > 6.5
Reason to test K+
Part of a basic or comprehensive metabolic panel
Diagnose or monitor kidney disease
Signs of high blood pressure or heart problems
Suspect metabolic acidosis (uncontrolled diabetes)
Suspect alkalosis (excess vomiting)
May be done for person having an attack of paralysis
Hyperkalemia
High K+
> 5.0 mEq/L
Causes of hyperkalemia
Blood transfusion
Crushed tissue injury
Kidney failure
Metabolic or respiratory acidosis
RBC destruction
Certain medications (NSAIDs, ACEi)
Hyperkalemia S/S
Muscle weakness
Flaccid paralysis
Bradycardia, heart block, ventricular fibrillation
Cardiac arrest
Hypokalemia
Low K+
< 3.5 mEq/L
Causes of hypokalemia
Vomiting
Chronic diarrhea
Nasogastric suction
Diuretics
Not enough potassium in the diet
Malnutrition
Alcoholism
Hypokalemia S/S
Extremity weakness
Hyporeflexia
Paresthesia
Leg cramps
ECG changes (ST depression, T wave inversion),
dysrhythmias, cardiac arrest
Hypotension
Diminished bowel function, constipation,
abdominal distension, paralytic ileus
Chloride (Cl)
Reference value: 98-108 mEq/L
Trending upward (hyperchloremia):
high levels in blood
Determine if appropriate for treatment if exhibiting decreased level of consciousness
Hypertension, tachycardia
Trending downward (hypochloremia):
low levels in blood
Monitor level of consciousness and motor function
Creatinine
Creatine is a compound primarily made in liver and transported to muscles to be
used as energy
A waste product produced by muscles from breakdown of creatine is creatinine
Almost all creatinine is excreted by kidneys (except with kidney disease)
Reason to test Creatinine
To determine if kidneys are functioning normally
Monitor treatment for kidney disease
Often used as part of a comprehensive or basic metabolic panel
Creatinine Normal range
0.66-1.25 mg/dL
Higher than normal level of Creatinine may be due to:
Reduced renal blood flow (shock, dehydration, CHF, atherosclerosis, or complications with diabetes
Blocked urinary tract
Kidney damage, infection
Dehydration
Muscle problems, such as breakdown of muscle fibers (rhabdomyolysis)
Problems during pregnancy, such as seizures or high blood pressure caused by pregnancy
(preeclampsia)
Bacterial infection of kidneys (pyelonephritis)
Kidney - Blood Urea Nitrogen (BUN)
Urea nitrogen is what forms from protein breakdown
Reason to test BUN
To check protein balance (how much protein a person takes in)
Measures amount of urea the kidneys excrete (shows kidney function)
BUN Normal value
Normal value
9-20 mg/dL
Low levels of BUN indicate:
Kidney problems
Malnutrition (inadequate protein in diet)
High levels of BUN indicate:
Increased protein breakdown in the body
Too much protein intake
High levels of BUN due to:
Congestive heart failure
Heart attack
Excessive protein levels in the gastrointestinal tract
Hypovolemia (dehydration)
Kidney disease
Kidney failure
Shock
Urinary tract obstruction
Glucose Normal Range
70-100 mg / dL
Carbon Dioxide
Normal range
22 – 26 mEq/L
A bicarbonate (HCO 3-) test is part of an electrolyte panel or metabolic panel used to
identify or monitor an electrolyte imbalance or acid-base (pH) imbalance
This test measures the total amount of carbon dioxide (CO 2) in the blood, which
occurs mostly in the form of HCO 3-
Measuring HCO 3– as part of an electrolyte or metabolic panel may also help
diagnose acidosis or alkalosis
