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NUR Th II > Lecture 03 Lab values > Flashcards

Lecture 03 Lab values Flashcards

1
Q

Normal Values for

Hematocrit

What’s the sig when it’s

decreased?

increased?

A

Normal value:

Male: 42%~ 52%

Female: 37~47%

Decreased: Anemia/active bleeding

Increased: chronic hypoxia, or polycythemia vera

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2
Q

Normal Values for

Hemoglobin

What’s the sig when it’s

decreased?

increased?

A

Male: 14~18 g/dl

Female 12~16 g/dl

Decreased: anemia / active bleeding

Increased: chronic hypoxia/polycythemia vera

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3
Q

Normal Values for

RBC count

What’s the sig when it’s

decreased?

increased?

A

Male: 4.7 ~6.1 u/L

Female: 4.2~5.4 u/L

Decreased: Anemia, active bleeding

Increased:: Chronic hypoxia or polycythemia vera

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4
Q

Normal Values for

Reticulocyte count

What’s the sig when it’s

decreased?

increased?

A

1~2% of RBCs

Increase: May indicate chronic blood loss (being released from the bone marrow before they mature)

Decreased: possible inadequate RBC func

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5
Q

How does hydration status affect Hgb and Hct?

A

Dehydration can show falsely high levels and hemodilution (over hydration) can show a disease.

HCT is calculated as the percentage of RBCs in total blood volume

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6
Q

What are reticulocytes and what is it’s role?

A

It’s an immature RBC and normal levels are necessary to stimulate the bone marrow to produce RBCs in the kidney.

If they are low levels, look at the level of hormone erythropoietin.

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7
Q

What is MCV and what does it indicate?

A

MCV: Mean Corpuscular Volume is the size of RBC

Too big: indication of megaloblastic anemia

Too small: iron deficiency anemia

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8
Q

What is MCHC and what does it indicate?

A

MCHC: Mean corpuscular hemoglobin concentration, the level is an indication of a variety of anemia

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9
Q

Types of Anemia

What are normocytic/normochromic?

what causes it?

A

The cell size and Hgb content is normal with low Hct

Causes: Early iron deficiency, chronic illness, sepsis, tumor processes, acute blood loss, renal disease d/t loss of erythropoietin

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10
Q

Types of Anemia

What is Macrocytic normochromic?

What causes it?

A

Large cell size and normal Hgb content

Causes are: B12 deficient, folic acid deficiency, chemotherpay

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11
Q

Types of Anemia

What are microcytic hypochromic cells like?

What is it caused by?

A

They are small size and low hgb

Causes: Late iron deficiency anemia, lead poisoning

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12
Q

Types of anemia

What are microcytic like?

causes?

A

small RBC and normal Hgb

Causes: Chronic illness (any type), aging process

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13
Q

White Blood Cells

What is the typical count?

A

5000 to 10000 ul

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14
Q

White Blood Cells

Neutrophil

What are the percentages?

What causes it to rise?

A

Overall percentage is 55% to 75%

Increase in bacterial infection causes it to rise

Segmented neutrophils: phagocytosis in response to bacterial infection

Bands: immature neutrophils increased production in response to increased neutrophil use

Left shift: greater percentage increase in band neutrophils than segmented neutrophils; normal and ongoing response to bacterial infection

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15
Q

White Blood Cells

Monocytes

What are the percentages?

What causes it to rise?

A

2~8%

Phagocytic or myelodysplastic disorders causes it rise.

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16
Q

White Blood Cells

Lymphocytes

What are the percentages?

What causes it to rise?

A

20~40%

Cause to rise: Humoral and cellular immunity, viral infection.

B cell response (humoral immunity) formation of antibody to antigen

T cell response (cellular immunity) cytotoxic, memory T, helper T, and suppressor T cell immune

response

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17
Q

White Blood Cells

Eosinophils

What are the percentages?

What causes it to rise?

A

1~4%

Increase in alelrgic reaction/parasite infection, anaphalytic response

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18
Q

White Blood Cells

Basophils

What are the percentages?

What causes it to rise?

A

0.5%~1~

Increase in allergic reaction

: (mast cells which contain histamine, potent endogenous vasodilator) increased in allergic responses

Eosinophils and basophils do not increase in viral or bacterial infections

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19
Q

What are neutrophils bands?

What percentage do they account for?

A

0~5%

Immature neutrophils and an indication of an infection

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20
Q

What does a Left shift mean?

What is it in a presence of?

A

Left shift is: greater percentage increase in band neutrophils than segmented neutrophils; normal and ongoing response to bacterial infection

In presence of infection (likely bacteria) the number of immature bands will increase and this is known as left shift.

Pay atten to Segs vs bands ratio

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21
Q

what are normal neutrophil counts?

What’s it derived from?

A

normal > 2000

Derived from WBC

Normal value for ANC is based on the patient’s WBC and percentage of neutrophils and bands.

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22
Q

what are clinical implications when

critical absolute neutrophil count is <1000?

A

Pt is at high risk for infection and have little immunity to fight infection

Neutropenic precautions must be taken: remove fresh fruits, cut flowers, flowers with dirt and use hand hygiene

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23
Q

What are normal platelet counts?

What are critical values?

A

normal count is 150,000 to 400,000 mm^3

Crtical values < 50,000

x> 1 million

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24
Q

what is thrombocytopenia?

Causes of it?

A

It’s a decrease in platelets

Causes: bone marrow suppression, hemorrhagic disorders, coagulation disorders (liver), occasionally r/t heparin or mechanical heart devices

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25
Q

What is thrombocytosis and what causes it?

A

Increase in platelets

Causes: Polycythemia vera, malignancy

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26
Q

When does platelet count decrease?

A

Platelet count decreased in patients with liver disease, medications such as heparin, febrile illness,

Decreased in patients with prosthetic metal and ball heart valves (not porcine or bovine valves) and ventricular assist devices used for heart failure and bridge to heart transplant

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27
Q

What happens to the WBC in viral infections?

A

WBC remains normal/slightly decreased

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28
Q

What happens to WBC in bacterial & fungal infection?

A

WBC is increased

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29
Q

What happens to WBCs during a myelodysplastic disorder?

A

Look at lymph/monocyte counts for lymphomas, may have extreme increase in WBC/increased blasts for differentiation of leukemias

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30
Q

What do you look at for clotting abnormalities?

A

Look at platelet count

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31
Q

Blood Urea Nitrogen

Normal values?

Sig of Increase?

Sig of decrease?

A

Normal values 10~20 mg/dl

Indication of renal func

Increased: dehydration, GI bleeding

Decreased: over hydration, malnutrition and severe hepatic damage

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32
Q

Creatine

Normal values?

Sig of Increase?

Sig of decrease?

A

Female 0.5 ~1.1 mg/dl

Male .5 ~ 1.2 mg/dl

More accurate than BUN in the indication of renal func

Increased: kidney impairment

Decreased: decreased muscle mass

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33
Q

Sodium

Normal values?

Sig of Increase?

Sig of decrease?

A

Normal 136~ 145 mEq/L

Increased: dehydration, kidney disease, hypercortisolism

Decreased: fluid overload, liver disease, adrenal insufficiency

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34
Q

Potassium

Normal values?

Sig of Increase?

Sig of decrease?

A

3.5~5 mEq/L

Increased: dehydration, kidney disease, acidosis, adrenal insufficiency, and crush injuries

Decreased: fluid overload, diuretic therapy, alkalosis, insulin admin, hyperaldosteronism

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35
Q

Chloride

Normal values?

Sig of Increase?

Sig of decrease?

A

98~106 mEq/L

Increased: metabolic acidosis, respiratory alkalosis, hypercortisolism

Decreased: fluid overload, excessive comiting/diarrhea, adrenal insufficiency, diuretic therapy

36
Q

CO2/HCO3

Normal values?

Sig of Increase?

Sig of decrease?

A

35~45 mEq/L

21~28 mEq/L

Implications are related to blood gas interpretation

37
Q

Magensium

Normal values?

Sig of Increase?

Sig of decrease?

A

1.3~2.1 mEq/L

Increased: kidney disease, hypothyroidism, adrenal insufficiency

Decreased: malnutrition, alcoholism, ketoacidosis

38
Q

Calcium

Normal values?

Sig of Increase?

Sig of decrease?

A

9~10.5 mg/dL

Increased: hyperthyroidism, hyperparathyrodism

Decreased: Vitamin D defiency, hypothyroidism, hypoparathyroidism, kidney disease, excessive intake of phosphorus containing food

39
Q

Phosphorus

Normal values?

Sig of Increase?

Sig of decrease?

A

3~4.5 mg/dl

increased: kidney disease, hypoparathyoidism, hypocalcemia
decreased: chronic acid intake, hyperparathyroidism, hypercalcemia, vitamin d deficiency, alcoholism, malnutrition

40
Q

Why is Creatine more accurate than BUN?

A

It’s more accurate because it’s a constant metabolic end product of muscle metabolisma nd reflects the GFR

41
Q

What relationship does P and C

A

They’re in a reciprocal relationship

42
Q

What are two conditions that may occur if there’s a decrease in Ca and an increase in P?

A
  1. Chvostek’s sign: sign of tetany tap trigeminal nerve
  2. Trousseau’s sign: carpal spasm induced by mechanism of occluding arm vessels with BP cuff for 3 min (10 mm above SBP). place the blood pressure cuff around the upper arm, inflate the cuff to greater than the patient’s systolic pressure and the cuff inflated for 1-4 minutes- positive sign occurs when the hand and the fingers go into spasm in palmer flexion
43
Q

What are assessment considerations for decrease/increased potassium?

A

Cardiac symptoms are the biggest concern

44
Q

What assessment considerations do you take if there’s a a decrease in Sodium? (2)

A
  1. Change in level of consciousness and mental status
  2. Muscle weakness
45
Q

What lab values would you look at for renal func? (2)

A

BUN, creatine

46
Q

What lab values would you look at for cellular func? (6)

A

Na, K, Cl, Ca, Mg, P

47
Q

What lab values would you look at for enzymatic func? (2)

A

Mg, P

48
Q

What lab values would you look at for glucose metabolism? (2)

A

Fasting glucose and random glucose

49
Q

What lab values would you look at for baseline info. (2)

A

PCP, electronic info

50
Q

What is Hgb A1C?

A

It’s the value of hemoglobing A1C, and would be the average glucose over 120 days.

It’s a good indication of glucose metabolism steady state.

51
Q

How does interpretation of Hgb A1C work?

what’s consider non diabetic and diabetic values?

A

Interpretation: baseline info about no diabetes or if diabetic following a lab test to determine how effective the meds uare (In managing Type I or Type II diabetes. Can test if patient adheres or don’t adheres to therapeutic regime)

Non diabetic value: 3.9%~5.2%

Diabetic: Good 6.9 ~ 8%

Fair: 8~9%

52
Q

What compareison of the Hemoglobin A1C test have with fasting glucose?

A

Fasting glucose is only a spot check at a given moment of time

53
Q

What are uncontrolled values of Hemoglobin A1C typically associated with?

A

Uncontrolled diabetes mellitus; individual is at risk for long term complications associated with diabetes mellitus.

There may be changes in wound healing, eyes, kidneys.

54
Q

TSH and T4 are used to monitor what? (2)

A
  1. Thyroid replacement
  2. Suppression therapy
55
Q

Secondary hypothyroidism invovles what?

A

Decreased activity of the thyroid caused by failure of the pituitary gland.

56
Q

TSH
Normal Values?

Increase leads to
Decrease leads to

A

helps differentiate between thryoid disorder (primary hypothyroidism) and secondary (pituitary disorder)

Values: 2~10 ml

Increased : hypothyroidism

Decreased: hyperthyroidism

57
Q

T3
Normal Values?

Increase leads to
Decrease leads to

A

72~205 ng/dl (20~50 years old)

40~180 ng/dl (>50 years old

Increased: hyperthyroidism

Decreased: Hypothyroidism

58
Q

T4
Normal Values?

Increase leads to
Decrease leads to

A

Male: 4~12 mcg/dl

female 5~12 mcg/dl

Increase: hyperthryoidism (Graves)
Decreased: Hypothyroidism (Myxedema)

59
Q

Free T4
Normal Values?

Increase leads to
Decrease leads to

A

.8 ~2.8 ng/dl

Increased: hyperthryoidism

Decreased: hypothyroidism

60
Q

Signs & Symptoms

Hypothyroidism
Increased TSH/Decreasead T3 and T4 (7)

A
  1. Fatigue
  2. Delayed reflexes
  3. irregular menstrual cycle
  4. cold intolerance
  5. hair loss
  6. chf
  7. hypothermia
61
Q

Hyperthyroidism

Decreased TSH/Incresaed T3 and T4 (5)

A
  1. Hyperthermia
  2. Heat intolerance
  3. Acute, involuntary weight loss
  4. exopthalmus
  5. CHF
62
Q

Total Protein

Normal Value:

Significance?

A

Normal values 6.4~8.3 g/dl

Sig: Contribute to maintaining osmotic pressure in the vascular space, thereby keeping fluid in the vascular space.

Albumin+ Gamma Globulin: Total Protein

Proteins: contribute to maintaining osmotic pressure in the vascular space thereby keeping fluid in the vascular space

63
Q

Albumin

Normal Value:

Significance?

A

3.5~5 g/dl

Decreased albumin indicates: acute/chronic infection, tissue necrosis, surgery, stress response, liver cirrhois

Albumin is produced in the liver and its main function is to maintain colloidal osmotic pressure, transporter or medications, hormones, and enzymes

Considerations for analysis include evaluating nutritional status vs liver disease

64
Q

Gamma Globulin is:

Normal value:

Sig?

A

Gamma globulin: immunoglobulins (antibodies); decreased in multiple myeloma, decreased or absent in agammaglobulinemia (inherited disorder)

Normal values: 2.3~3.4 g/dl

Decreased indicates: muptiple myeloma, decreased or absent (inheritated disorder)

65
Q

Pre Albumin

Normal Values

Sig:

A

Sig:

Prealbumin: Used to monitor a patient’s nutritional status and component of liver functional status. It’s use as a monitor and assessment of nutritional status bases on short half life and consumed quickly in acute stress response in illness, also decreases with inflammation, malignancy, and protein wasting diseases of intestines and kidneys. Used as indicator for effectiveness of repletion nutritional stores in patients receiving total parenteral nutrition.

Normal Values: 15~36 mg/dl

66
Q

Total Bilirubin

Normal Values

Sig

A

Normal .3~1mg/ dl

Total Bilirubin= Indirect +direect bilirubin

67
Q

Direct Bilirubin

Normal Values

Sig of Increase

A

Normal value: 0.1 ~0.3 mg/dl

Increased: gallstones, biliary obstruction, trauma, liver Ca or Liver mets

68
Q

Indirect Bilirubin

Normal values

Sig of Increase

A

0.1 ~1.0 mg/dl

Increased indication: hepatoma, newborn jaundice, hepatitis, cirrhosis

69
Q

What is LDH 5?

Normal values:

A

It’s an isoenzyme that will be elevated with liver disease

100~190 U/L

70
Q

What does the liver function test do?

A

It monitors for pt’s response to life style modification, cholesterol, and reducing meds

71
Q

Cholesterol

When is it increased?

When is it decreased?

A

Increased:: HTN, uncontrolled diabetes, high cholesterol diet, biliary cirrhosis

Decreased: malabsorption, malnutrition, cholesterol reducing meds

72
Q

Triglycerides:

When is it increased?

When is it decreased?

A

Increased: hyperlipidemias, HTN, alcohol induced liver disease, high carb diet

Decreased: malabsorption, manutrition

73
Q

LDL Cholesterol

When is it increased?

When is it decreased?

A

Increased: familiar LDL lipoproteinemia, nephrotic syndrome, chronic liver disease

Decreased: hypoproteinemia such as malabsorption, malnutrition, severe trauma, burns

74
Q

HDL Cholesterol

When is it increased?

When is it decreased?

A

Increased: Excessive exercise, familial HDL, lipoproteinemia

Decreased: hepatitis, cirrhosis

75
Q

Cholesterol

Normal Values

Sig of Increase, decrease?

A

Normal <200 mg/dl

Increased: HTN, uncontrolled DM, biliary cirrhosis

Decreased: Malabsorption, malnutrtion

76
Q

Triglcyerides

Normal values in Females? Males?

Increased values indicate

A

Female: 35~135 mg/dl

Male: 40~160 mg/dl

Increased levels increases risk of CAD, may be an indication of alcohol induced liver disease or high carb diet

77
Q

LDH

Normal Values
Increased sig?

Decreased sig?

A

Normal Values: 60~180 mg/dl

Increased: In pt with familial LDL lopoprotein, chronic liver disease

Decreased: malabsorption, malnutrition, severe trauma, burns

78
Q

HDL

Normal Values with male? Females?

Sig of increase and decrease?

A

Malse >45 mg/dl

Female>55mg/dl

Increased: excessive exercise, familial HDL

Decreased: Hepatitis, Cirrhosis

79
Q

Partial Thromboplastin Time (PTT)

What does it do?

Normal?

A

evalutes intrinsic pathway of clotting system

Normal is 60 to 70 seconds

80
Q

Activated Partial Thromboplastin Time (APTT)

What’s the normal?

Seen in?

What’s the antidote?

A

Normal 30 to 40 seconds

Seen in clotting factor deficiencies, liver cirrhosis, DIC, Vit K deficiency

Used to monitor effects of IV heparin therapy

Antidote for Heparin overdose is Protamine Sulfate

81
Q

Prothrombin Time (PT)

Evalutes what?

What’s normal?

Prolonged in what disease?

Guided by what?

What’s the antidote for coumadin?

A

PT and INR evalute the extrinsic and final common pathway of clotting cascade

PT and INR are used to regulate dosing.

Normal 11 ~12.5 seconds

PT is prolonged in liver disease, obstructive biliary disease, Vit K def, DIC.

PTT used with INR to regulate Coumadin dosing

When pt is being weaned off heparin infusion t Coumadin, PT is initially used to guide coumadin therapy; coumadin dosing long term is monitored and guided by INR

Antidote for Coumadin overdose: Vit K

82
Q

What are acceptable ranges based on idications for therpay (Coumadin)?

Guided by INR, International Normalized Ratio

A

§Acceptable Ranges Based on indications for therapy (Coumadin)

  1. §Standard therapy < 2.5 INR
    § - minimize risk of bleeding during procedures
  2. §2.0 INR (range 1.6 to 2.5)
    §stroke prevention in persons with atrial fibrillation over 75 years of ag
  3. §2.5 INR (range 2.0 to 3.0)
    §for stroke prevention in persons with atrial fibrillation up to 75 years of age
  4. §2.0 to 3.0 INR
    §management of DVT, prevention of systemic embolism, prosthetic valve prophylaxis
  5. §2.5 to 3.5 INR (high intensity therapy)
    §recurrent systemic embolism, prophylaxis in high risk surgery
83
Q

Urine Analysis

How is pH affected?

A

Diet

Meds

Acid base distrubances

renal tubuular func

84
Q

Urine Analysis

What does presence of ketones mean?

A

associated with poorly managed diabetes

85
Q

Urine Analysis

Protein indicates

A

Sensitive indicator of glomerular and renal tubular func

NUR Th II (17 decks)

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