Labs Flashcards
CBC includes (4)
Hemoglobin
Hematocrit
WBC
Platelets
Hemoglobin
Male = 13.5-18 gm/dl Female = 12-16 gm/dl
Hematocrit
Male = 40-54% Female = 38-47%
WBC
4,000-11,000
Platelets
150,000-400,000
Causes of Increased WBC (2)
Infection, Inflammation
ie. surgery, MI trauma, allergies, leukemia, use of steroids (prednisone)
Causes of Decreased WBC (5)
Bone marrow suppression, Chronic illness, Chemo, Aplastic anemia, Meds (Bactrim, AZT, steroids)
Implication for increased WBC?
Risk for Sepsis
Implication for decreased WBC?
Risk for infection (opportunistic)
Causes of increased Hgb/Hct (5)
Polycythemia Chronic hypoxia living in high altitude Hemoconcentration Dehydration (falsely elevated)
Implications for increased Hgb/Hct (2)
Risk for Clotting, DVT
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____
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
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
1) perfusion
2) bleeding?
3) Hgb <7, Hct <21
5) source -call for GI consult
Causes for increased Platelets
1) I______
2) _____ disorders
3) __spenia
4) Reactive ______ (2)
1) Inflammation
2) Malignant
3) Asplenia (bc the spleen usually controls (limits) growth of platelets)
4) Thrombocytosis (Allergic reaction, Trauma)
Implications for increased Platelets (2)
Risk for clotting, DVT
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_____
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)
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?
1) Bleeding, Heparin
2) Bleeding
3) Transfuse
4) < 100,000 = no OR
5) Source
Shift to Left =
increase in greater than 10% of “bands” (neutrophils, immature wbc) signifies acute infection
Normally < 8%
Normal Prothrombin Time (PT) range =
Measures clotting factors (5)
11-16 seconds
I, II, V, VI, X (1, 2, 5, 6, 10)
Normal Activated Partial Thromboplastin Time (APT) time =
Measures clotting factors (5)
25-35 seconds
I, II, V, VIII, XII (1, 2, 5, 8, 12)
Normal INR =
0.6 - 1.7
What is INR (International Normalized Ratio)?
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.
INR for patients on Coumadin for Atrial Fibrillation/DVT?
2-3
INR for patients on Coumadin for mechanical heart valves/P.E
2.5-3.5
For patients on Coumadin for Pulmonary Embolism
2.5-3.5
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 _______”
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
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
1) Bleeding
2) Heparin/Coumadin
3) plasma
4) OR
>1.2-1.5
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?
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
Metabolic Profile (___ tube)
Chem (7)
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
Metabolic Profile
Magnesium =
Ca (Ionized) =
PO4 (phosphate) =
Total Serum Ca =
Mg = 1.5-2.5
Ca (Ionized) = 4.5-5.6
PO4 (phosphate) = 4.5 - 5.6
Total Serum Ca = 8.5-11
Albumin =
Check what?
Indication?
Low albumin indicates ->
- 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)
Renal Profile
GFR =
CrCL Formula (Cockcroft and Gault formula) =
GFR = 85-135 (ave 125)
CrCl formula = (140-age) x weight in kg/ 72 x serum creatinine
- females (x 0.85)
What is the significance of measuring creatinine clearance or GFR?
To determine or adjust dose of nephrotoxic meds, given to patients with renal failure.
BUN: Creatinine Ratio
1) Normal Ratio =
Note:
2) What does the ratio measure?
3) Wide Ratio =
Indication:
4) Narrow Ratio =
Indication:
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)
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
= 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
Intra-Renal Failure =
Why is the ratio narrow?
= 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
Sodium in Renal Failure
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)
Potassium in Renal Failure
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
Tx for Hyperkalemia Meds
1)
2)
3)
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
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 ___-____
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+
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 ( > \_\_\_\_ ) =
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
Magnesium in Renal Failure
1.5 - 2.5
- Direct relationship with K+ (MaGic Kingdom)
- Avoid giving Mg containing drugs such as Maalox
- Diuretics (Lasix) enhances Mg excretion
Glucose in Renal Failure
70-110
DM can cause intra-renal failure
Therefore, nurses should monitor blood sugar
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?
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)
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)
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
Ionized Ca =
Free Ca not bound to albumin
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?
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!
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
= neurohormone, ventricular, cardiac filling pressures
- volume, risk at admission and discharge, treatment guide
BNP Levels
- Normal Levels =
- Clinical Suspicion of CHF or past history of CHF (HF ___% probable) =
- CHF is ___% probable =
- Values > ____ = proved accurate in supporting?
- < 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
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
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
Lactic Acid
Normal = ___ -____ mmol/L
Values ____ indicates _____
Consider (5)
0.7-2.2 mmol/L
> 4 = diagnostic for severe sepsis
- Lactic Acidosis
- Shock
- HF
- Hypoxia
- Pharmacologic causes
