Lab Values Flashcards
RNs are responsible for what in regards to labs?
Know normal ranges of labs
interpret results to a degree
Always check the pts baseline
Lab values often direct our care
Certain medications need corresponding bloodwork
Genreal principles for responding to lab values
Always trespond to a “critical finding”
- Unless it’s already known OR improving with current therapy
Make sense of your result
- Correlate the with pertinent pt assessment findings BF reporting to physicina
Always compare current results to previous results (EVEN previous hospitalizations if necessary)
CBC includes
Hemoglobin
RBC index
Reticulocyte count
Hematocrit
Platelet count
WBC
What is hemoglobin a measure of
O2 carrying capacity
What is hemoglibn
iron-rich protein found in RBCs that binds to oxygen transporting oxygen from the lungs throughout the body
Normal
F 115-155g/L
M 125-170 g/L
Low =
Low hemoglobin
F Less than 115g/L
M Less tham 125g/
Caused by Blood loss, nutritoin def, renal failure
SS: Fatigue, dizzy, SOB, pale skin, blue lips
High hemoglobin caused by
F Aboce 155
M Above 170
smoking, high altitutide, dehydration, lung/heart conditions (I.e. COPD)
When are PRBC (Packed RBC trasfusion) transfusions done related to low hgb
70-80
Acdvocate for diagnsotics to help find out WHY
Meatocrit
Measure of volume RBC in whole blood compared to plasma and other blood components
M: 41%-50%
F 36%-44%
High Hematocrit cause
Dehyderatdion hypoxia, smoking, polysythemiavera (Too many RBCs0, tumors, lung dx
Low Hematocrit cause
Overhydration, nutrtional def, blood loss, bone marrow suppression, leukemia, lead poisionings, hodgkins lymohoma
Platlets
Number of platlets integral to clotting
Normal range
150000-400,000/microleter
Concernerd when platlets drop beneath 50,000 (SS start to occur)
Low platlet count may indicate
Viral infections, lupus, leukemia, chemo, pernicious anemia (Vit B12 def)
High platlet count may indicate
Leukemia, myeloproliferative disorders (which cause blood cells to grow abnormally in bone marrow), inflammatory conditions, acute infections, iron deficiency
WBC Blood count
Exist in blood, lymph and tissues
When pts are on antibioitics, WBC should drop withihn 24 hr
5 types of WBC
Neutro
WHen neutrophils drop below ___ they are at extreme risk of developing infection
0.1 x10 tothe9
Neutropenia
Reverse isolations
5 types of WBC measured in count
Neutrophils
Lymphocytes- increase with viral infection
Basophils- often increase with allergic reactions
Eosinophils- increase with allergic reactions decreased seen in acute
Monocytes- often increased in chronic infections, autoimmune diseases.
Blast cells
Immature WBCs
large number indicates release frombone marrow prematuring indicating that pt is fighting an infeciotn
Normal sodium range
136-146 mmol/L
Causes of low Na
Low Na from diuretics, overhydration, excessive sweating, kidney failure, heart failure (Dillutional hypoNa)
SS
Nausea vomiting, headache, confusion, fatigure, cramps, seizures,
High Na causes
High Na intake (not common)
SS
CNS impairment (Confusion, NM excitabilitym, hyperrefelxes), seizures, coma
Patients <___mmol/L are at significant risk for _______. Regular Neuro and consider advocating for ______. For patients who are 120-125mmol/L, regular Neuro checks.
120
cerebral edema
hypertonic saline
Hyperchloridism
Cause: prolonged dehydration
high level of blood Na
Diabetes insipidus
NV, dry mouth swollen tongue, confusion
Tx: Tx underlying cuase + PO/IV Fluid
Hypocholridism
Cause: Vomiting, diarrhea, CHF, Chronic lung dx, chemo
SS, NVD, seating, fever
Tx: IV NS
K+ range
3.5-5.1mmol/L
Critical numbers and intervention for K+
Patients with K+ <3.0mmol/L or >6.0-6.5mmol/L should be on a cardiac monitor or at minimum, have an ECG done with rapid correction attempted. The more abnormal the finding, the greater the risk for dysrhythmias. Correct AND prevent.
Total Ca vs ionized
Total ca binded to albumin and Ca that is free and active.
Ionized = free and active Ca
- More accurate for determining if the Ca is too high or low
HyperCa indicates
Tuberculosis, fungal and mycobacterial infections, HIV/AIDS, hyperparathyroidism, metastatic bone tumor, multiple myeloma, hyperthyroidism
HypoCa indicates
Malnutrition, vitamin D deficiency, hypoparathyroidism, low blood level of albumin, kidney failure, magnesium deficiency, liver disease, pancreatitis
Hypermagnesia Cause, SS, Tx
Ingestion of antacids containing Mg
Decreased kidney ability to excrete Mg
Muscles relaxed, decreased Deep Tendon reflex
Resp Arrest
Tx: IV Ca, Diuretics, Dialysis
HypoMg
Cause: Malnutrition, malabsorption
SS: Muscle excitinment, increased DTR, seizure, tachy cardia
Tx: IV Mg
Phosphate and Ca have what relationship
Inverse
Hyperphophate CMI
CKD, hypoparathyroidis,. metabolic or resp acidosis
M: SS of hypoCa (Trousseaus sign and chvostek sign), weak bones
tx: IV NS with diurtetic to increase urinartu Ph excretion, I and O monitor, dialysis
HypoPh CMI
Acohol use dx, burns, starvation, diuretic use
M: Constipation, Kidnye stones, muscle weakness, decreased HR and RR
I: IV Ph, monitor SS of low CO
Liver funciton tests
Altered synthesis
- albumin (Drops in chronic Liver disease)
- Clotting factors (measure by PT)
Primary liver damage
-ALT (Unique to liver)
-AST
ALtered biliary funciton
- Total bilirubin
Alkaline phosphatase (ALP)
GGT
Non hepatic causes for increaseed PT
intake of anticoagulants, bleeding disorder, vit K def
Normal INR
0.9-1.1
Prothrombin Time
Measure of how quickly blood clots
What to check before administering Warfarin
INR
D-Dimer
A protein released when blood clot breaks down, can indicate presence of clot develpment
When being taken to rule-in or out a DVT/ PE, results >600 ng/mL should warrant a CT angiography.
Beware of FALSE POSITIVES. Pts who have just had surgery or interventional procedures with symptoms will have elevated results. With clinical suspicion, advocate for CTA right away.
Lactate Dehydrogenase
(LD or LDH) is anenzymeinvolved in energy production that is found in almost all of the body’s cells, with the highest levels found in the cells of the heart, liver, muscles, kidneys, lungs, and in blood cells;bacteriaalso produce LD. This test measures the level of LD in the blood or sometimes other body fluids.
More of a blood test for trending tissue damage than it is diagnostic for any one condition.
BUN
Blood Urea nitrogen
Waste product formed in liver from protein breaksedoown and kidneys filter it out of blood
Builds up if kidneys not functioning
Creatininie
Chemical waste product from muscel metabolism, removed by kidneys
Issue with kidnyes will result in a higher Creatinine
Normal findings regarding leukocytes, nitrites, ketones, and proteins?
SHould have none of these
What causes urine to change colour
Amber/dark = dehdration
Pink/reddish= Blood in urine, beet intake, UTI, prostate problem
Protein in urine indicates
Kidney function problem
1st type of protein comound excreted in urine in event of kidney problem
Albumin
HF, DM, CKD can produce this
Nitrites occur because
Bacteria in urinary tract convert nitrates into nitritrites
What is a lot vs a little bit of ketones in urine
5mg/dL is a little
160mg/dL is a. lot
Troponin
Group of protiens found in cardiac and skseltal fibres regulating musculara contraction
Helps ID pts with heart damage
Can be elevated in stable angina
Indicates increased risk for future heart events
Levels can be elevated withihin 3-4 hours following injury
Can nurses order labs?
No, doctors can
What to have when u call the doctor
MAR, diagnosis, current labs, past labs, VS
Metabolic syndrome
Agroup of conditions that include High blood glucose, cholesterol, abdom fat, HTN, lpiids
Tx of hepatic encephalopy
Lactulose
