Nclex review > Lab Values > Flashcards
Lab Values Flashcards
Red Blood Count
Male: 4.6-6.2 million/mm
Female: 4.2-5.4 million/mm
Child: 3.2-5.2 million/mm
White Blood Count
Adult: 5,000-10,000/mm
Child: 5,000-13,000/mm
Hemoglobin
Man: 13-18
Women: 12-16
Child: 11-12.5
Hematocrit
Man: 42-50%
Women: 40-48%
Child: 35-45%
PTT
25-35 seconds for healthy adult
2 1/2 times longer for a patient on blood thinners
INR
2.0-3.0
Platelet Count
100,000-400,000/mm
Glucose
70-100
BUN
8-20 mg
Positive TB test
Normal healthy person- 10m Induration
Immunocompromised- 5m Induration
Urine Output hourly/daily
30 mL an hour
1500 mL-2000 mL a day
Albumin
3.5-5.5
pH
7.35-7.45
PaO2
80-100 mm
SaO2
95-98%
PaCO2
35-45 mm
HCO3
22-26
Rapid Acting insulin
Lispro (humalog): onset- 5-15 min, Peak- 1 hour, Duration- 3 hours
Aspart (NovoLog): onset- 5-15 min Peak 40-50 min Duration- 4-6 hours
Patient should eat within 5-15 minutes after injection.
Short Acting Insulin
Regular (Humulin R, Novolin R, IIetin II Regular): Onset- 30-60 min, Peak- 2-3 hours, Duration- 4-6 hours
Clear solution; given 20-30 minutes before meal; can be alone or with other insulins
Intermediate Acting Insulin
Isophane (NPH) or Lente: Onset- 2-4 hours, Peak- 6-12 hours, Duration- 16-20 hours
White and cloudy solution; can be given after meals
Long Acting Insulin
Humulin V or Ultralente: Onset- 6-8 hours, Peak- 12-16 hours, Duration 20-30 hours
Used to control fasting blood glucose levels
Very Long Acting Insulin
Glargine (Lantus): Onset- 1 hours, Peak- it’s continuous (no peak), Duration- 24 hours
Maintains blood gluclose levels regardless of meals; cannot be mixed with other insulins; given at bedtime.
Complication of surgery- Hemorrhage
Decreased BP, increased pulse, cold, clammy skin
Replace blood volume and monitor vital signs
Complications of surgery- Shock
Decreased BP, increased pulse, cold clammy skin
Treat cause, oxygen, IV fluids
Complications of surgery- Atelectasis and pneumonia
Dsypnea, cyanosis, cough, tracycardia, elevated temperature, pain on affected side
Experienced second day postop, suctioning, postural drainage, antibiotics, cough and turn.
Complications of surgery- Deep Vein Thrombosis
Positive Homan’s sign
Experienced 6-14 days up to 1 year later, anticoagulant therapy
Complications of surgery- Embolism
Dyspnea, pain, hemopytsis, restlessness, ABG-low O2, high CO2
Experienced second day postop, oxygen, anticoagulants (heparin), IV fluids.
Complications of surgery- Paralytic ileus
Absent bowel sounds, no flatus or stool
Nasogastric suction, IV fluids, Decompression tubes
Complications of surgery- Infection of wound
Elevated WBC and temperature, Positive cultures
Experienced 3-5 days postop, antibiotics, aseptic technique, good nutrition
Complications of surgery- Dehiscence
Disruption of surgical incision or wound
Experienced 5-6 days postop, low flowler’s position, no coughing, NPO, notify physician
Complications of surgery- Evisceration
Protrusion of wound contents
Experienced 5-6 days postop, low fowler’s position, no coughing, NPO, cover viscera with sterile saline dressing or wax paper (if at home), notify physician
Complications of surgery- Urinary retention
Unable to void after surgery, bladder distension
Experienced 8-12 hours postop catheterize as needed.
Urinary infection
Foul smelling urine, Elevated WBC
Experienced 5-8 days postop, antibiotics, force fluids
Psychosis
Inappropriate affect
Therapeutic communication, medicaion
Volume Deficit
Symptoms: thirst (early signs), temperature increases, rapid and weak pulse, respirations increase, poor skin turgor-skin cool, moist, hypotension, emaciation, weight loss, dry eye sockets, mouth and mucous membranes, anxiety, aprehension, exhaustion, decreased urine output, increased hemoglobin, hematocrit, headache, confusion, weight loss.
Urine specific gravity > 1.030
Plan: florce fluids, provide isotonic IV fluids; lactated ringer’s or 0.9% NaCl, I and O hourly, daily weights, vital signs, check skin turgor, assess urine specific gravity.
Volume overload
Symptoms: No change in temperature, pulse increases slightly and is bounding, respirations increase, SOB, dyspnea, rales, peripheral edema- bloated, weight gain, hypertension, jugular vein distention, apprehension, increased venous pressure, decreased hematocrit BUN, hemoglobn.
Urine specific gravity s position of dyspneic.
Diabetes Insipidus (decreased ADH)
Assessment: Excessive urine output, chronic, severe dehydration, excessive thirst, anorexia, weight loss, weakness, constipation
Plan: record intake and output, monitor urine specific gravity, skin condition, weight, blood pressure, pulse, temperature
Administer Pitressin
SIADH- Syndrome of inappropriate antidiuretic hormone secretion (increased ADH)
Assessment: Anorexia, nausea, vomiting, lethargy, headaches, change in level of consciousness, decreased deep tendon reflexes, tachycardia, increased circulating blood volume, decreased urinary output.
Plan: Restrict water intake (500-600 mL/24h), administer diuretics to promote excretion of water, hypertonic saline (3% NaCl) IV, administer demeclocycline (Declomycin), weigh daily, I and O, monitor serum Na levels and assess LOC.
Hypokalemia
<3.5
Assessment: anorexia, nausea, and vomiting, muscle weakness, paresthesias, Dysrhythmias, increased sensitivity to digitalis.
Causes: vomiting, gastric suction, diarrhea, diuretics and steroids, inadequate intake.
Plan: Administration of oral potassium supplements- dilute in juice to avoid gastric irritation, increase dietary intake- raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery
IV supplements- 40 mEq/L usual concentraion; cannot give concentration greater than 40 into peripheral IV or without cardiac monitor
*increase risk of digoxin toxicity, protect from injury, assess renal function prior to administration.
Hyperkalemia
> 5.0
Assessment: EKG changes, dysrhythmias, cardiac arrest, Muscle weakness, paralysis, nausea, diarrhea
Causes: renal failure, use of potassium supplements, burns, crushing injuries
Plan: Restrict dietary potassium and potassium containing medications, Kayexalate-cation exhange resin (casuses diarrhea taking the extra K with it), rectally give in conjunction with sorbitol to avoid fecal impaction. In emergency siuation, calcium gluconate given IV, sodium bicarbonate given IV, regular insulin and dextrose, IV administration of regular insulin and dextrolse shifts potassium into the cells, peritoneal or hemodialysis, diuretics.
Hyponatremia
s or 0.9% NaCl, water restriction, I and O, daily weight.
Hypernatremia
> 145
Assessment: Elevated temperature, weakness, disorientation, delusion and hallucinations, thrist, dry swollen tongue, sticky mucous membranes, hypotension, tachycardia
Causes: Hypertonic tube feedings without water supplements, diarrhea, hyperventilation, diabetes insipidus, ingestion of OTC drugs such as alka-seltzer, inhaling large amounts of salt water (near drowning), inadequate water ingestion
Plan: IV administration of hypotonic solution- 0.3% NaCl or 0.45% NaCl; 5% dextrose in water offer fluids at regular intervals, decrease sodium in diet, daily weight.
