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Complex Health > Labs > Flashcards

Labs Flashcards

1
Q

CBC includes (4)

A

Hemoglobin
Hematocrit
WBC
Platelets

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2
Q

Hemoglobin

A 
Male = 13.5-18  gm/dl 
Female = 12-16 gm/dl
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3
Q

Hematocrit

A 
Male = 40-54%
Female = 38-47%
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4
Q

WBC

A

4,000-11,000

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5
Q

Platelets

A

150,000-400,000

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6
Q

Causes of Increased WBC (2)

A

Infection, Inflammation

ie. surgery, MI trauma, allergies, leukemia, use of steroids (prednisone)

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7
Q

Causes of Decreased WBC (5)

A

Bone marrow suppression, Chronic illness, Chemo, Aplastic anemia, Meds (Bactrim, AZT, steroids)

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8
Q

Implication for increased WBC?

A

Risk for Sepsis

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9
Q

Implication for decreased WBC?

A

Risk for infection (opportunistic)

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10
Q

Causes of increased Hgb/Hct (5)

A 
Polycythemia
Chronic hypoxia
living in high altitude
Hemoconcentration
Dehydration (falsely elevated)
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11
Q

Implications for increased Hgb/Hct (2)

A

Risk for Clotting, DVT

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12
Q

Causes of decreased Hgb/Hct

1) A___/H____
2) GI ____/ H____
3) Long term __/__ use
4) Bone marrow _____
5) Chronic ___/____
6) C____/R____
7) Meds (2)
8) P____
9) L____/L____
10) ____ failure
11) _____ disease
12) ____ surgery
13) P_____
14) C____/C____/G____
15) Meno____

A

1) Anemia /Hemodilution
2) GI bleed/ Hemorrhage
3) Long term PPI/H2 blocker use ( >1y makes stomach alkalkine, needs to be acidic to absorb iron/VB12)
4) Suppression
5) Infection/Inflammation
6) Chemo/Radiation
7) Cephalosporin, Retrovir (anbx, antiviral)
8) Poisoning (Arsenic)
9) Leukemia/Lymphoma
10) Kidney failure (no erythropoietin)
11) Celiac
12) Bariatric ( lower SA -> decreased absorption of VB12)
13) Pregnancy
14) Chrons, Colitis, Gastritis
15) Menorrhagia

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13
Q

Implications for decreased Hgb/Hct

1) Diminished _____?
2) Actively _____?
3) When to transfuse?
4) Is the patient going to the OR?
5) _____ of blood loss

A

1) perfusion
2) bleeding?
3) Hgb <7, Hct <21
5) source -call for GI consult

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14
Q

Causes for increased Platelets

1) I______
2) _____ disorders
3) __spenia
4) Reactive ______ (2)

A

1) Inflammation
2) Malignant
3) Asplenia (bc the spleen usually controls (limits) growth of platelets)
4) Thrombocytosis (Allergic reaction, Trauma)

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15
Q

Implications for increased Platelets (2)

A

Risk for clotting, DVT

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16
Q

Causes for decreased Platelets

1) _ _ _ (4)
2) A____ A____
3) Cancer, L_____, Ch____
4) Pes_____, Ars____, Ben____
5) _____ abuse
6) Meds (4)
7) P_____
8) Cirr_____
9) Splen_____
10) S____/In_____

A

1) HIT (Heparin induced thrombocytopenia), DIC, Immune thrombocytopenic purpura (ITP), Thrombotic thrombocytopenic purpura (TTP)
2) aplastic anemia
3) cancer, leukemia, chemo
4) pesticides, arsenic, benzene
5) alcohol abuse
6) Meds: sulfa, dilantin, vanco, rifampin
7) pregnancy
8) cirrhosis
9) splenomegaly
10) sepsis/infection (depresses immune response)

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17
Q

Implications for decreased Platelets (5)

1) Risk for _____* , stop ____?
2) Actively ____?
3) When to ____?
4) Is the pt going to the OR? when to stop?
5) ____ of blood loss?

A

1) Bleeding, Heparin
2) Bleeding
3) Transfuse
4) < 100,000 = no OR
5) Source

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18
Q

Shift to Left =

A

increase in greater than 10% of “bands” (neutrophils, immature wbc) signifies acute infection

Normally < 8%

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19
Q

Normal Prothrombin Time (PT) range =

Measures clotting factors (5)

A

11-16 seconds

I, II, V, VI, X (1, 2, 5, 6, 10)

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20
Q

Normal Activated Partial Thromboplastin Time (APT) time =

Measures clotting factors (5)

A

25-35 seconds

I, II, V, VIII, XII (1, 2, 5, 8, 12)

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21
Q

Normal INR =

A

0.6 - 1.7

22
Q

What is INR (International Normalized Ratio)?

A

The INR is a standardized system of reporting PT based on reference calibration model. Calculated by comparing the patient’s PT with a control value.

23
Q

INR for patients on Coumadin for Atrial Fibrillation/DVT?

A

2-3

24
Q

INR for patients on Coumadin for mechanical heart valves/P.E

A

2.5-3.5

25
Q

For patients on Coumadin for Pulmonary Embolism

A

2.5-3.5

26
Q

Causes of Increased (“Prolonged”) PT/INR, PTT

1) _____ Failure/C_____
2) Vitamin K _______
3) Clotting factors (5) _______
4) C____ disease (factor __ deficiency)
5) ______ (DIC)
6) “Too much _______”

A

1) Liver Failure(produces thrombin) /Cirrhosis
2) Vitamin K deficiency
3) Clotting factors I, II, V, VI, X deficiency (too much coumadin), Clotting factors I, II, V, VIII, XII deficiency (too much heparin)
4) Christmas disease (factor IX deficiency)
5) Disseminated Intravascular Coagulation (DIC)
6) Too much Coumadin/Heparin

27
Q

Indications for prolonged PT/INR/PTT

1) Risk for ______
2) Stop ___/___?
3) When to transfuse ____?
4 Is the patient going to the ___?
If the INR is > ___-___ = No OR

A

1) Bleeding
2) Heparin/Coumadin
3) plasma
4) OR
>1.2-1.5

28
Q

Nursing Implications for prolonged PT/INR/PTT

1) What will you see on the skin? (4)
2) need to be careful with that ____ and ____
3) Stool = , Urine = , ____ changes, ___ and ___ pains, a____ symptoms?
4) Antidotes (2)
5) Going to the ___? _____ transfusion?

A

1) Petechiae, purpura, Ecchymosis, hematoma
2) needle, razor
3) Melena, Hematuria, Neuro changes, bone and joint pains, abdominal symptoms
4) Vitamin K for coumadin , Protamine Sulfate for heparin
5) OR
6) Plasma

29
Q

Metabolic Profile (___ tube)

Chem (7)

A 
Na = 135-145 
K = 3.5-5.0 
Cl = 95-105 
CO2 (arterial) = 22-26 
BUN = 10-30 
Cr = 0.6-1.5 
Glucose = 70-110
30
Q

Metabolic Profile

Magnesium =
Ca (Ionized) =
PO4 (phosphate) =
Total Serum Ca =

A

Mg = 1.5-2.5
Ca (Ionized) = 4.5-5.6
PO4 (phosphate) = 4.5 - 5.6
Total Serum Ca = 8.5-11

31
Q

Albumin =

Check what?

Indication?

Low albumin indicates ->

A
  1. 5-5.0
    - Check Ca bc it is protein bound (If its high in the blood = low albumin)
    - Risk for drug toxicity for protein bound drugs such as coumadin, ca channel blockers

indicates immunosupression bc immunoglobulins need to bind to protein (albumin)

32
Q

Renal Profile

GFR =

CrCL Formula (Cockcroft and Gault formula) =

A

GFR = 85-135 (ave 125)

CrCl formula = (140-age) x weight in kg/ 72 x serum creatinine
- females (x 0.85)

33
Q

What is the significance of measuring creatinine clearance or GFR?

A

To determine or adjust dose of nephrotoxic meds, given to patients with renal failure.

34
Q

BUN: Creatinine Ratio

1) Normal Ratio = 
   Note: 
2) What does the ratio measure? 
3) Wide Ratio = 
    Indication: 
4) Narrow Ratio = 
    Indication:
A

1) 10:1 - 15:1
Assess pt as to what is the cause of renal failure, don’t get caught up in numbers
2) Type of renal failure
3) > 20:1
: pre-renal causes of kidney failure
4) < 20:1
: intra-renal cause of kidney failure (contrast dye, GN, DM, nephrotoxic meds)

35
Q

Pre-Renal Failure =

Could be due to?
Referred to as?

Note: all end stage renal disease (ESRD) ends up in intra-renal BUN: Creatinine pattern

A

= when kidney parenchymal cells are still able to remove creatinine from the body (still some circulation) but BUN accumulates d/t decreased perfusion or increased protein catabolism (Wide Ratio)

  • Dehydration -> hydrate!
  • Pre-Renal Azotemia
36
Q

Intra-Renal Failure =

Why is the ratio narrow?

A

= damage to parenchymal cells itself (glomerular, vascular, interstitial, tubular) (Narow Ratio)

  • Bc almost all of creatinine is excreted by the kidney. So an increase in Cr w/out significant increase in BUN will make it narrow
37
Q

Sodium in Renal Failure

A

135-145

1) Usually normal until late stages of kidney failure
2) Avoid using NS in IVPB medications
3 Monitor pt’s mental status dt hyponatremia = AMS
4) Monitor renal pt’s for CHF
5) Fluid restirction (1-1.5 L/day)

38
Q

Potassium in Renal Failure

A

3.5-5.0

1) Kidneys usually excrete majority K+
2) K+ is the FIRST to become abnormally HIGH in renal failure
3) Lvls > 6 can lead to muscle wasting, arrhythmias

39
Q

Tx for Hyperkalemia Meds

1)
2)
3)

A

1) Kayexalate (sodium polysterene sulfate)
=> a cation exchange resin that exchanges Na for K in the bowels, osmotic diarrhea is an expected outcome
2) IV Glucose (D50) and IV Insulin
- K+ follows glucose (dextrose) into cells
- Glucose to compensate for the insulin
3) 10% Calcium Gluconate
- to stabilize cardiac cell membrane potential and provent vtach/vfib by antagonizing K+ action

40
Q

Tx for Hyperkalemia (nonpharmacological)

1) Avoid what types of food? (3)
2) Use what cautiously? (4)
3) Use what med cautiously? (1)
4) Monitor K for pts ___-____

A

1) K+ rich foods -> OJ, melons, dried figs
2) Herbal remedies bc increase K -> Noni juice, Nettle, Horstail, Dandelions
3) Aldactone (potassium sparing diuretic)
4) Ace-Inhibitors (prils)
- bc increases K+ retention, usually aldosterone secretes K+

41
Q

CO2 (think ____!) in Renal Failure

Is part of the ____ reserve of the body -> indicates amount of ____ available to combine with __ ions.

CO2 + H20  \_\_\_\_  H+ + HCO3- 
Low CO2 ( < \_\_\_\_ ) = 
High CO2 ( > \_\_\_\_ ) =
A

20-30

alkali, bicarb, cations

H2CO3
< 20 = low alkali -> metabolic acidosis, the CO2 is being used to create bicarb or the patient is compensating for respiratory alkalosis
>30 = high alkali -> metabolic alkalosis -> pt may be compensating for respiratory/metabolic acidosis

42
Q

Magnesium in Renal Failure

A

1.5 - 2.5

  • Direct relationship with K+ (MaGic Kingdom)
  • Avoid giving Mg containing drugs such as Maalox
  • Diuretics (Lasix) enhances Mg excretion
43
Q

Glucose in Renal Failure

A

70-110

DM can cause intra-renal failure
Therefore, nurses should monitor blood sugar

44
Q

Phosphorus in Renal Failure

1) What happens to phosphorus lvls in renal failure? Kidney is the primary ___ organ
2) Inversely related to ____
3) Meds to decrease phosphorus (2), how to take the second med?
4) How does secondary hyperparathyroidism effect phosphorus?

A

2.4-4.5

1) Elevates, excretory
2) Ca
3) Phoslo (Calcium Acetate)
Renal (Sevelamer) is a phosphate binder
- take w meals! do not crush!
4) Increase PTH levels serve to increase phosphorus excretion (bc inversely related)

45
Q

Total Serum Ca in Renal Failure

1) Is the main mineral in _____, Aids in (3)
2) What happens to Ca in renal disease? Leads to (2)
3) Therefore, renal patients complain of (2)
4) Total serum ca measures =
5) If albumin is low, how does that effect TSCa?
6) Total Serum Ca is more what (2)

A

9-11

1) Bone
- Muscle Contraction, Neurotransmission, Clotting
2) Low absorption of Ca dt Vit D deficiency (produced by normal kidney)
- Leads to Hypocalcemia, Osteodystrophy
3) Cramps, Muscle Twitching
4) Bound Ca to protein
5) Low albumin -> low Ca, however Ionized Ca may be normal = asymptomatic
6) Total Serum is more physiologically active/homeostatically regulated

46
Q

Ionized Ca =

A

Free Ca not bound to albumin

47
Q

Uric Acid in Renal Failure

M =
F =

1) Uric acid = product of ->
- Normally excreted in the _____
2) In pts w Gout what happens to uric acid -> which then causes what? What should you do?

A 
M = 4.5-6.5 
F = 2.5 -5.5

1) purine metabolism
- normally excreted in urine
2) can form uric acid stones -> obstruction in urinary tract, increase fluid intake!

48
Q

Brain Natriuretic Peptide
= a ___ released from ____ cells in response to ____ filling _____.

  • Plasma measurements of BNP have been shown to reflect ___ status, to predict ___ at ___ and ___, and to serve as a ___ ____ in a variety of clinical settings
A

= neurohormone, ventricular, cardiac filling pressures

  • volume, risk at admission and discharge, treatment guide
49
Q

BNP Levels

  • Normal Levels =
  • Clinical Suspicion of CHF or past history of CHF (HF ___% probable) =
  • CHF is ___% probable =
  • Values > ____ = proved accurate in supporting?
A
  • < 100 (CHF Improbable)
  • 100-400 (75%)
  • 95%, >400
  • > 500 -> diagnosis of ADHF

Note: >100 CHF suspected so think of kidney -> pre renal failure/BNP should decrease if diuretics, inotropic meds are working

50
Q

BNP Consider this:

1) BNP lvls can augment clinical judgment regarding the presence of =
2) (2) independently increase BNP lvls, while ___ decreases BNP lvls, why?
3) Daily BNP measurements should not be used to guide ___ therapy in HF in patients
4) Admission and discharge BNP lvls can predict a___ o___, but is unclear how to act upon these data

A

1) HF in dyspneic pts
2) A-Fib, CKD - Obesity decreases bc less circulating lvls of BNP, possibly dt extra fat distribution in body that prevents more BNP from being produced
3) Diuretic
4) adverse outcomes

51
Q

Lactic Acid
Normal = ___ -____ mmol/L

Values ____ indicates _____
Consider (5)

A

0.7-2.2 mmol/L

> 4 = diagnostic for severe sepsis

  • Lactic Acidosis
  • Shock
  • HF
  • Hypoxia
  • Pharmacologic causes

Complex Health (4 decks)

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