Lab Values and Electrolytes Flashcards
BMP Basic Metabolic panel
Na
CL
K
CO2
Cr
BUN
Glucose
Sodium
Sodium 135-145
Hyponatremia
Sodium level lower than 135
usually associated with Fluid Volume Imbalances could be fluid volume overload or fluid volume deficit
Causes: Increased sodium excretion
Excess diaphoresis
Diuretics
Vomiting
Diarrhea
Decreased secretion of aldosterone
Signs and symptoms
Shallow decreased resp due to muscle weakness
Muscle weakness
Diminished tendon reflex
Headache
Confusion
Seizures
Increased urinary output
Dry mucus membranes
Hypernatremia
Sodium level above 145
Causes: Decreased sodium excretion
Corticosteridos
Cushings syndrome
Kidney disease
Hyperaldosteronism ‘
Signs and symptoms:
HR and BP respond to fluid volume status
Pulmonary edema if hypovolemia is present
Muscle twitches
Diminished reflex
Altered LOC
Extreme thirst
Decreased uriinary output
Presence of edema
Potassium
3.5-5.0
Priority = pumps the heart
Hypokalemia
Potassium level less than 3.5
Life threatening because every body system is effected
Signs and Symptoms:
Weak threads pulse
Orthostatic hypotension
Dysrhythmias
Shallow ineffective respirations
Diminished breath sounds
Anxiety, lethargy, confusion
Muscle weakness
decreased deep tendon reflex
Hypoactive bowel sounds
Nausea vomting, constipation
ST depression
Inverted T wave
Prominent U wave
Hyperkalemia
Potassium over 5.0
Signs and symptoms
slow and irregular HR
Decreased BP
Dysrhythmias
Weakness of resp muscles leading to resp failure
Muscle twitches Early
Profound weakness late
Hyperactive bowel sounds
Diarrhea
Tall peaked T waves
Flat P waves
Widened QRS complex
Prolonged PR interval
Potassium IV
First action heart monitor
Never push = death
Only 10-20meq max per hour (IV pump)
Slow infusion if arm burns
Potassium ECG changes
Peaked T waves: 6-7mEq/L
ST elevation 7-8 mEq/L
Wide QRS complex: Over 8
Client with kidney disease is weak, lethargic and bradycardic
K+ 8.5 is lab value to be expected
Treatment for Hyperkalemia
- IV calcium gluconate = dysrthmias
- IV 50% dextrose + regular insulin
- kayexalate (polystryene sultfanate)
- Dialysis
If dysthrmias is not int he question progress to option 2
Patient with chronic kidney disease missed 3 dialysis sessions… potassium level of 8.1.. wide QrD complex’s, heart rate of 48 and lethargy. Which order should the nurse implement first?
Iv calcium gluconate
End stage renal disease potassium 7.2, BUN 35, creatinine of 3.8 and urine output of 300ml in 24 hours. Which order is priority?
IV regular Insulin and 50% dextrose
Calcium
9.0-10.5
Calcium contracts the muscles
Low calcium
Diarrhea
trousseau’s: twerking arm when BP cuff on
Chvosteks: cheek smile when stroking face
High Calcium
Stones, moans and grains
Kidney stones
Costipation
Hypocalcemia
Calcium level lower than 9.0
Decreased HR
Hypotension
Diminished peripheral pulses
Anxiety
Twitches, Seizures
Hyperactive deep tendon reflex
Positive Trousseaus and Chvostek signs
Hyperactive bowels - diarrhea
Prolonged ST intervals, Prolonged QT intervals
Hypercalcemia
Calcium level that exceeds 10.5
Increased HR in early phase, bradycardia in the late phase
Increased Blood pressure
Bounding pulse
Ineffective respirations
Lethargy, Cooma
Profound muscle weakness
Diminished or absent deep tendon reflex
Nausea, anorexia, abdominal distention, constipation
Short ST segments, Wide T wave, heart block
Magnesium
1.8 - 2.6
Magnesium mellows the muscles
Low magnesium
Hyper-excitability
Torsades de pointes and V fib
Hyperreflexia
Increases DTR
High Magnesium
Decreased DTR
Hyporeflexia
Hypomagnesium
magnesium level less than 1.8
Causes:
Vomitting/diarrhea
Celiac disease
Crohns disease
signs and symptoms:
Tachycardia
Hypertension
Shallow resp
Hyperrefleia
Positive trousseaus and chvostek
Confusion
Tall T waves
Depressed ST segments
Hypermagnesemia
Magnesium level that exceeds 2.6
Bradycardia, dysrhythmias
Hypotension
Respiratory insufficiency
Diminished tendon reflex
Muscle weakness
Drowsiness and lethargy
Prolonged Pr inerval
Widened QRS
Phosphorus
Normal level 3.0-4.5
Hypophosphatemia
phosphorus level lower than 3.0
accompanied by an increased serum calcium level
Hyperphosphatemia
Phosphate level that exceeds 4.5
Most body systems tolerate elevated phosphorus
CBC complete blood count
WBC
HGH
HCT
PLT
Hemoglobin
Carries oxygen
Normal 12-18
Risky: 8-11 report to HCP and surgeon if before surgery
Bleeding and anemia, malnutrition and cancer
Below 7 = heaven or blood transfusion
Pale skin: pallor, dusky skin tones
Cool clammy skin
Fatigue, weakness
Client with a hemoglobin of 10.8 is most likely caused by which condition
Iron deficiency anemia
The nurse determines that the hemoglobin level is normal if which value is noted on the laboratory report
14g/dl
Hematocrit
Ratio of red blood cells and oral blood volume
Normal: 36-54%
Elevated HCT = dehydration
Decreased HCT = fluid volume overload
Bleeding, anemia and malnutrition
Client with diagnosis of fluid volume overload…the nurse would expect to note which finding about the hematocrit level?
Decrease HTC
Client with gastrointestinal (GI) bleeding…laboratory results hematocrit level of 30% which action should the nurse take?
report the abnormal low level
H/H ratio
1:3 ratio
multiply hemoglobin by 3 to get the hematocrit
RBC red blood cell count
4-6 million
Low = anemia, renal failure
iron (fe+)
Erythropoietin
High = Dehydration
High labs = dry body
White Blood cells
5000-10000
Higher = leukocytosis
infection (sepsis)
Steroids (prednisone)
Low = leukopenia
Chemotherapy
Radiation
immunosuppressant drugs
lupus - autoimmune diseaase
Neutropenic precautions: Low grade fever = priority
Private room
No fresh fruits/flowers
Avoid crowds and sick people
No drinking water pitcher or sitting out
CD4 count
Over 200
below = aids (active form of HIV)
Which blood laboratory test result should the nurse report to the HCP
White blood cells 2000
Hemoglobin 6
Potassium 6.5
Sodium 150
platlets 45,000
Coagulation Panel
Platelets: 150lk-400k
PTT: 30-50
INR: 0.9-1.2
Platelets
150,000-400,000
Notify the HCP if less than 150k
Less than 50k very risky
Drugs that decrease platelets: apron, clopidogrel, enoxaparin, heparin
PTT
30-40 seconds
PTT for Heparin: 46-70
Higher = horrible
Should never be 3 times their range
INR
0.9 - 1.2
Warfarin 2-3
Higher = horrible
Should never be 3 times their range
Client on warfarin with an INR of 4.5
Client on heparin PTT of 100
Stop or hold drug
Assess bleeding
Prep antidote
Report to HCP
Cardiac Labs
Troponin Over 0.5 = trauma to heart muscles
CHF (congestive Heart failure) labs
BNP under 100
Big stretched out ventricles
Natriuretic Peptide
Hormones secreted by cells that lie in the heat chambers when there is damage presented
2 Types
ANP: Atrial natriuretic peptides - in the atria upstairs of the heart
BNP: Brain natriuretic peptides - in the ventricles downstairs of the heart
BNP
Brain natriuretic peptides
Over 100pg/ml = Heart failure
causes of elevation
High sodium diet
Sedentary lifestyle
High cholesterol diet
ANP
Atrial natriuretic peptides
Kills aldoerstone
Increased ANP = acute heart failure, supervantricular tachycardia
Hyperthyroidism
small cell lung cancer
Decreased ANP
Chronic heart failure: ANP gives sup in the battle
Hypothyrdoism
Put on antihypertensive drugs
Diabtes Labs
Normal: 70-115 (3.6-5.5)
Normal fasting = under 100
Normal HgBA1C = under 5.7
Hypoglycemia is most deadly because it causes brain death
HgBA1C
test to see how well patients have been controlling their BG over a few months
Hyperglycemia
Over 115
Polyuria
polydyispa
Polyphagia
Causes:
Sepsis (infection)
Stress (surgery or hospital stay)
Skip insulin
Steroids (prednisone)
Treat with insulin
Increase insulin during stress
Hypoglycemia
Below 70
most deadly
Cool
pale
Sweaty, diaphoretic, clammy
Nervous -anxious, tumbling
Headache
Treatment: Give sugar
Juice, soda, crackers low fat milk
Not high fat milk or peanut butter
Cause:
Exercise: Give extra glucose
Alcohol: lowers sugar
Insulin peak times: most at risk for low sugar - give plate of food
A client with type 1 diabetes is only responsive to painful stimuli with a blood sugar of 42, what is the first action taken by the nurse
Give dextrose IV push and reassess in 15min
Which medication could cause risk for hyperglycaemia
Prednisone
The non diabetic client is admitted for a kidney infection that has now turned septic. The blood sugars have increased from 150 to 225, what is the best answer to give a family member who is asking why insulin is used?
High sugar is common during infection and stress to the body, the insulin will help lower the sugar until the infection resolves
Renal Labs
Hydrogen Ions
Urea
Creatinine
Hydrogen Ions
Very acidic = metabolic acidosis
Clients most at risk for metabolic acidosis
Renal failure
Pyelonephritis
Patient waiting for hemodialysis
Child with diarrhea x2 days
BUN
10-20 MAX
Trash the body needs to toss out
Starts as ammonia broken brown to urea and excreted through kidneys
Elevated:
dehydration - body is dry
Creatinine
Over 1.3 = Bad kidney
Waste product produced by the muscles
Higher creatinine = higher kidney impairment (failure)
Critical kidney lab value
Urine Output
30ml/hr or less = Kidney Distress
Client with an infected toe due to diabetes is scheduled for cardiac catheterization with contrast, which lab value should the nurse report to the provider
Creatine 1.9 (contact kills the kidneys)
Urine Analysis
Colour: light means hydrated and dark means dehydrated
unless Diabetes insidious = light urine, dry body
SIADH: dark urine and fluid filled body
RBC: blood hematuria
WBC: leukocytes = bladder infection oor UTI
Nitrites = kidney infection
Protein = nephrotic syndrome
Glucose = diabetes
*urine culture and sensitivity test
Over 10,000 organisms/ml = UTI
Specific Gravity
1.003-1.030
Light urine = low specific urine
Dark urine = high specific urine (dry body)
Client with history if diabetes which does the nurse suspect
Specific gravity = 1.030
Protein = none
Glucose = high
Red blood cells = none
Leukocytes: medium
Dehydration (low fluid intake) and possible UTI
Procedure for collecting a sterile urine specimen from a foley bag
- Clamp drainage tube below port
- Wait 15-30 minutes
- Scrub the port using an antiseptic swab
- Attach a sterile, needless access device to aspirate a specimen via the port
Liver Failure Labs
Ammonia High = hepatic encephalopathy
Albumin Low (under 3.5) = calcium low, low platelets
Bilrubin High
Coagulation panel: High PT, PTT, INR
Elevated ALT and AST
Which blood lab values are expected to be elevated in a client with worsening liver cirrhosis?
Ammonia
Bilirubin
PT
Highest Priority = Safety
A&B: Airway, breathing = oxygenation
Low PaO2 norm = 80-100
High Co2 Over 45
mental changes, restless, agitation
Skin: pale dusky, cool and clammy
C: Circulation
Bleeding: High PTT/INR
Shock: severe low BP
Chest pain (any kind)
Hypertension crisis (over 180 sys)
Infection:
Priority = less than 5000 WBC “leukopenia”
Kidney Labs:
Creatinine over 1.3 = Bad kidney
Pain: Loose life or limb?
Chest pain = priority
Compartment syndrome - cast/broken limb pain = unrelieved with pain meds
Airway and breathing Priority ABGs
PaO2:
normal: 80-100
60 or less = hypoxemic respiratory failure, low O2
PaCO2:
Normal 35-45
50 or more hypercapnia respiratory failure, high CO2
Hyper cap = give BIpap
Intubate and ventilate
Circulation - Bleeding
INR over 4
aPTT over 100
1. Stop/hold drug
2. Assess bleeding
3. Prep antidote
Warfarin - vitamin K
Heparin - Protamine sulfate
4. Report to HCP
An emergency room nurse is presented with four clients at the same time. Which of the following clients should the nurse see FIRST?
A client with abdominal and chest pain following a large, spicy meal
