Labs Flashcards
Components of ABG’s
pH
PaCo2 -partial pressure of carbon dioxide
PaO2- partial pressure of oxygen
SO2-oxygen saturation
HCO3- bicarbonate
BE- base excess
Normal range pH &
What does it mean
7.35-7.45
Normal range PaCO2 &
What does it mean
35-45 mm Hg
shows adequacy of gas exchange between alveoli and external environment (alveolar ventilation)
hypoventilation (damaged alveoli, as in COPD) PaCO2 is elevated causing respiratory acidosis
hyperventilation= PaCO2 is decreased, causing respiratory alkalosis
PaO2- Normal range
75-100 mmHg (partial pressure Oxegen)
indicates the amount of O2 present to bind with hemoglobin
SO2
Oxygen Saturation
94-100%
HCO3
Bicarbonate
22-26 mEq/L
Deficit indicates metabolic acidosis
Increased indicates metabolic alkalosis
Intracellular Electrolytes
Cations: K+, Na+, Mg2+
Anions: Cl- HCO3-, PO4 3-
What does Sodium do in the body?
Where sodium goes, fluid flows.
Major cation in the ECF
Maintains blood volume and Blood pressure
regulated by ADH (add da H20)
- aldosterone holds back salt to keep water
Works with K+
Hypernatremia, What is it? What causes it?
-high serum sodium
Caused by:
-inadequate water intake
-excess water loss
-(rarely) Sodium gain
-diarrhea, diabetes related
osmotic diuresis
- increased insensible water loss
fever, heatstroke,
hyperventilation
Sodium is main ECF osmolality, so hypernatremia can cause hyperosmolality
Clinical manifestation and Nursing management of hypernatremia
-water shifts out of cell into ECF due to high osmolarity of ECF
-causes dehydration and shrinking of cells, which can cause dehydration of brain cells, resulting in change in metal status,
Symptoms of decreased ECF volume:
-drowsiness, restlessness, confusion, seizures, coma
- diarrhea
-intense thirst, dry swollen tounge,
postural hypotension
- increased pulse, weakness muscle crams
Symptoms with Normal or increased ECF volume:
-agitations restlessness, twitching, siezures
-edema
-intense thirst
-weight gain, increased BP
Nursing Management:
-if primary water deficit: fluid replacement orally or IV with d5w
-If problem is sodium excess or intravascular depletion: IV fluids like .9% NS,
- or if sodium excess not from water loss, Na excretion through diuretics, and restrict dietary sodium intake
Hyponatremia, causes
low serum sodium
excess sodium loss:
- diarrhea
-vomiting
-primary adrenal insufficiency
-diuretics
-NG suctions
Inadequate sodium intake
- fasting diets
excess water gain:
-misuse of sodium free fluids, hypotonic fluids
water excess in relation to sodium
Signs/symptoms of Hyponatremia
Decreased EFC volume
- apprehension, irritability
-confusion
-cold clammy skin
-postural hypotnesion
-inreased pulse, thready pulse
With normal or increased ECF volume
- apathy headache
-confusion
-muscle spasms, seizures, coma
-nausea vomiting, diarrhea
-weight gain, increased BP
Hyperkalemia causes, Excessive potassium intake
-Excessive or rapid IV administration
-potassium containing drugs
-Renal Failure
-Low aldosterone
-potassium containing slat substitute
hyperkalemia causes, Shift of potassium out of cells
-acidosis
-intense exercise
-tissue catabolism (crush injuries, sepsis, burns, fever)
-tumor lysis syndrome
What does Potassium do?
King Potassium, king of action and contraction. 3.5-5.0
Especially in the heart, keeping cells polarized through Na K+ channel
hyperkalemia causes, failure to eliminate postassium
adrenal insufficiency
meds: Angiotensin II receptor blockers, ACE inhibitors, Heparin, Potassium sparing diuretics, NSAIDS
Renal disease
Hyperkalemia clinical manifestations
Heart:
ECG Tall T waves and ST Elevation
hypotension bradycardia
irregular pulse
GI:
cramping diarrhea, vomiting
Hyperactive bowel sounds
Neuromuscular
increased DTR
paralysis and paesthesia (tingling)
confusion
fatigue irritability
muscle weakness
Causes of hypokalemia
Below 3.0
Fluid/electrolyte loss
D’s
Diarrhea, Diuretics, Diet, DKA, alDosterone
Symptoms of Hypokalemia
Heart
- low and slow pump
- flat T waves, ST depression, presence of U wave
-
Neuromuscular
- Shallow respirations= most deadly!
- Decreased DTR
-cramps and paralysis
GI:
- constipation
- hypoactive bowel sounds
- paralytic illeus= priority because causes risk of small bowel obstruciton
Sodium imbalances values
Hypernatremia: > 145 mEq/L
Hyponatremia <136 mEq/L
hyperkalemia EKG changes
-loss of p waves
- prolong PR interval
ST segment depressions
-Widening QRS
-Tall, peaked T wave
- Vfib
Hypokalemia causes, potassium loss
Dialysis
diaphoresis
GI losses: diarrhea, Vomiting, fistulas, NG suction, ileostomy drainage
renal losses: diuretics, hyperaldosteronism, magnesium depletion
Hypokalemia Shift into cells
-alkalosis
increased epinephrine, up stress
increased insulin release
insulin therapy
hypokalemia from lack of potassium intake
diet low in K+
failure to include potassium in IV fluids if NPO
Starvation
hypokalemia, clinical manifestations
constipations, nasusea
fatigue, hyperglycemia
irregular, weak pulse
muscles soft, flabby
muscle weakness, leg vramps
decreased feflexes
shallow respirations
Hypokalemia, EKG changes
peaked P wave
prolonged QTS
ST segment depression
Flattened T wave
Presence of U wave
Ventricular dysrhythmias
1st and 2nd degree heart block
calcium imbalances lab values
hypercalcemia > 10.5
Hypocalcemia< 9.0
Normal range 9-10.5
hypercalcemia: causes
Causes:
-2/3 caused by hyperparathyroidism= high PTH
-cancers cause remaining 1/3
Excess calcium comes from pulling Ca out of bone
Hypercalcemia clinical manifestations
-Increased bone pain, fractures
-fatigue lethargy, ca acts like sedative
-severe muscle weakness
-depressed reflexes
-kidney stones
-polyuria and dehydration
Hypercalcemia EKG changes
- short ST segment
-Short QT intervla
-Ventricular dysrhythmias
hypercalcemia treatment
Mild: stop meds related to hypercalcemia, diet low in Ca, increase weight bearing activity, adequate hydration, drink 3000-4000 ml fluid daily.
Severe: IV isotonic saline, bisphosphonate, and calcitonin. But be careful of impaired renal function, as these pt’s cannot excrete excess fluid. Bisphosphonates- pamidronate, zoledronic acid, gold standard for treating hypercalcemia
Potassium Lab Range
3.5/5 mEq/L
Total Calcium Lab value range
9.0-10.5 mg/dL
Magnesium Lab value Ranges
1.3-2.1 mg/dL
What does Magnesium do in the body?
1.3-2.1 mg/dL
Magnum Magnesium keeps law and order in the body’s muscles- by protein synthesis, nerve function, and blood sugar control
Stimulates parathyroid hormone- which regulates calcium levels- Required for Calcium and Vit D absorption
Obtained in diet through spinach almonds and yogurt
What does Calcium do in the body?
9.0- 10.5 mEq/L
99% found in bones
3 strong B’s:
Strong Bones
strong blood- clotting factors
strong Beets
regulated by PTH (parathyroid hormone)- increases calcium in blood
Calcitonin Hormone- decreases blood calcium by putting in bone
Calcitrol- controls release of calcitonin
What does phosphate do in the body?
3.0-4.5 mEq/L
Enemies with calcium- always work inversely
obtained from meat, poultry, fish, nuts, beans, and dairy
Main function is to help bone and teeth formation and repair cell tissue
Regulated by all things that regulate Calcium, PTH- because they are inversely related
What does Chloride do in the body?
98-106
follows sodium around
absorbed with salt
helps sodium maintain BP and blood volume
Normal WBC range?
5,000-10,000/mm3
Hemoglobin men and women
Men 14-18 g/100L
Women 12-16 g/100 L
Hematocrit lab range
Men 42-52%
Women 36-44%
Platelet lab range
150,000-400,000/mm3
RBC’s lab range
Men 4.7-6.1 million/mm3
Women 4.2-5.4 million/mm3
PT INR normal and therapeutic range and which thinner is it used for?
Warfarin (war-K-IN) - measured with INR and Vit K is antidote
Normal INR- 0.7-1.8
Therapeutic INE 2-3
PTT normal and Therapeutic. What thinner does it check
Heparin (remember hePTT)
Normal- 30-40 sec
Therapeutic 1.5-2 times normal values
Digoxin labs
.5–2.0 mg/ml
