MedSurg Exam2 Flashcards
Xerosis
dry skin (common in older pts)
Urticaria
hives
Contamination
presence of organisms w/out infx
Infection
organisms grow/spread, Ø control by body’s immune sys.
Hirsutism
excessive growth of body hair or in ab. areas
Acute paronychia
inflammation of skin around nail
Lichenification
thick skin (caused by scratching r/t dry skin)
Diagnosing Skin (5)
C&S - reveals fungal, bacterial, viral
Wood’s light - colors show infx, lighter pts
Tzank Smear - reveals viral
Potassium Hydroxide (KOH) - reveals fungal (threads)
Biopsy
4 Biopsies and 2 reqs?
Punch = 2 - 6 mm plug Shave = raised area only w/ razor Excisional = deep specimen, reqs. sutures Incisional = cross-section through center lesion. reqs. sutures
Biopsies req. consent and local anesthesia
Assessment of Darker pts
Pallor = ashe gray on mucous membranes Cyanosis = lips, mouth, tongue for blue Inflammation = palpation Jaundice = hard palate Bleeding = compare affected to unaffected. Also petechiae!
3 Phases of wound healing
Inflammatory
Proliferative
Maturation
Inflammatory Phase (3)
3 - 5 days when injury starts
WBC/macrophages migrate -> wound
S/S = edema, pain, erthyema, warmth
Proliferative/Fibroblastic (2)
2 - 4 weeks past 4th day
Epithelialization (tissue repair) takes place
Maturation Phase (3)
3 weeks after injury -> 1 year?
Collagen
Scar tissue becomes thinner/paler
Process of Wound Healing (3)
Depends for each wound.
1st - edges brought together
2nd - granulation/contraction
3rd - delayed closure, ↑% infx and scarring
Skin Risk Factors labs (3)
Albumin < 3.5 mg/dL
Prealbumin < 19.5 mg/dL
Lymphtocye < 1800/mm3
Skin Assessment Factors (7)
PCSE-CSL
Presense of foreign bodies Condition of surrounding tissue Spreading Extent of Tissue involvement Color Size Location
Skin S/S Infx Present (5)
Fever Exudate WBC > 10k ↑ CRP ↑ ESR
Cellulitis
Deep skin infx 2ndary to infx in open wound
MRSA
Mild folliculitis -> Extensive Furuncles
↑% incidence in communal environments
Herpes 1 and 2
1 - recurring sores last for 3 - 10 days
contagious first 3 - 5 days, tingling/burning lip!
2 - genital, lol.
Autoinoculation
transfer from 1 viral type to another part of body
Herpetic Whitlow
Occurs on fingertips of medical personnel
Herpes Zoster (shingles) (3)
Follows a dermatome (Cervial Nerve Ending)
Dormant active
Ø midline
Fungal Infx (2)
Dermatophyte - tinea, direct contact
Candida Albicans - vagina/mouth. In mouth, swish/swallow mystatin
Parasitic Infx (3)
Pediculosis - lice. S/S pruritis. c/w sprays, creams, changing bedding.
Scabies - S/S curved/linear ridges. Common w/ poor hygiene/living. Tx scabicides/laundry
Bedbugs - blood suckers. Tx topical antihistamines
Skin Lesion Configurations (9)
ACCCC - U DSL!
annular - ringlike, raised borders circinate - circular circumscribed - well defined sharp borders clustered coalesced - merge w/ one another diffuse - widespread linear serpiginous - wavy borders universal - all body fx'ed.
Primary Lesions (7)
MP N/T VPTW
Macule - color▲, Ø palpable Papule - circumscribed < 1 cm Nodule/Tumor - circumscribed, firm 2 cm Vesicle - serous fluid filled, < 1 cm Pustule - pus-filled Tumor - solid mass > 2 cm Wheal - irregular border
Secondary Lesions (5)
C-FUSE
Erosion - Lost epidermis, moist, Ø bleeding
Crust - dried blood
Scale - skin flakes
Fissue - linear crack
Ulcer - Lost epidermis AND dermis w/ bleeding
Skin Color ▲’s (4)
JPEC
Pallor - anemia/Ø blood flow
Cyanosis - hypoxia, thrombocytopenia, bruising
Jaundice - liver/RBC d/fx
Ertthema - inflammation/vasodilation
Abnormal Skin ABC’s
A - asymmetry B - Border irregularity C - color D - diameter E - Evolving
Benign Tumors (4)
SKNC
Cysts - dent upon palpation
Seborrheic Keratoses - scaly patches
Keloids - scar overgrowth
Nevi - moles
Actinic Keratosis are…?
Pre-malignant
Basal vs. Squamous cell carcinomas
Basal - mostly by UV and outter skin.
Squamous - cancer in epidermis/can be metastatic.
On ear, lip, and external genitalia.
Melanomas !!!’s (2)
> 6mm have doc check
Highly metastatic
Advanced Surgical Skin Managment
Crosurgery Electrodesiccation Excision Moh's for Basal Cell Carcinomas Wide Excisions
Dystrophic Nails reason
Clubbing b/c impaired gas exchange
Alopecia reasons (3)
Endocrine dz, ↓nutrition, male pattern baldness
Psoriasis
Autoimmune dz, 7x growth rate.
Psoriasis Big r/fs (4)
Infections - strep throat, candida, upper resp. infx
Seasons - warm weather
Hormones - puberty/menopause
Medications - Lithium, BBlockers, Anti-malarials, Indocin
3 Types Psoriasis
Vulgaris - silvery white scaly
Exfoliative - red severe inflammatory
Palmoplantar - browned hyperkaratotic
Psoriasis Big 4 Medications
Topical Corticosteroids
Topical Epidermopoiesis Suppresive Meds
Tar Preparations
Cytotoxic Meds
Topical Corticosteroid EFP
example, fx, precaution
Triamocinolone Acetonid (Kenalog)
↓ inflammatory response
Ø face skin, asses for thinning/hypopigmentation
Topical Epidermopoiesis Suppresive Meds EFP
Calcipotriene (Dovenex)
Mild - Moderate Psoriasis, ↓ epidermal development
TERATOGENIC and r/in hypercalcemia
Tar Preperations EFP
Anthralin (Drithocreme, Lasan)
ModeratePsoriasis, ↓ cell division/itching
STOP Creams, STARTs Cancer, stains and smells!
Cytotoxic Meds EFP
Methotraxate (Trexal)
Severe Psoriasis, ↓ epidermal turnover
TERATOGENIC, also r/in sore throat, fever, bleeding, fatigue
Photochemotherapy and Ultraviolet Light (PUVA)
Methoxsalen (Uvadex)
↓ cell proliferation
Report any extreme redness, swelling, long term aging fx.
Seborrheic Dermatitis
What? R/in 2? Tx 2? Report if 2?
Inflammation of areas w/ sebaceous glands.
R/in papulopustules (oily) and flakes (dry)
Topical Corticosteroids/Antiseborrheic Shampoos.
Exacerbations/remissions
Pruritis 4 Tx
Cool environment
Hygiene
Antihistamines
Topical Steroids
Braden Scale 7 Factors
SPAMMNF
Sensory Perception Moisture Activity Mobility Nutrition Friction/Sheer
Pressure Ulcer 5 Stages
1 - Intact, unblanchable redness 2- Non-intact w/ partial skin abrasian/blister 3 - full skin loss, subq visible 4 - full skin loss, bone/muscle visible 5 - eschar/slough
UlCcer Assessment (like skin) PCSE - CSL
Presence foreign body
Condition surrounding tissue
…
NonSurgical Ulcer Tx’s (4)
Dressing
Whirlpool
Drug
Nutrition
Future is Now Ulcer Tx (5)
Electrical Vaccum Assisted Hyperbaric O2 (HBO) Topical Growth Skin Substitutes
Surgical Ulcer (2)
Debridement
Skin Grafting
S/S Organ Rejection
Tachycardia, fever, pain
AST/ALT values ↓ (liver)
Pigmentation/Diaphoresis
Hyper-Acute Transplant Rejeciton
Remove STAT
HLA Ø recognize object
Acute Transplant Rejection
1 - 3 months post-transplant
Tx immunosuppresants
Chronic Rejection
Scarring impedes organ fx
S/S Appendicitis
Pain epigastric/umbilical area that migrates to Mc.Burney’s Point (R). Rebound tenderness.
Appendectomy req.
Paracentesis, Colonoscopy, and Thoracentesis Procedure.
Paracentesis - trocar catheter removes fluid (r/t liver cirrhosis)
Colonoscopy - camera up butt!
Thoracentesis - aspiration of fluid in pleural space
Key findings of Abdomen Organ Trauma (3)
CMM
Cullens - bruising around umbulicus (GI bleed)
McBurney’s - tenderness LQ (appendicitis)
Murphy’s - R side pain, increases w/ inspiration (Choli/gallblader)
Acute vs. Chronic Cholesystitis
Acute - Flatulence
Blumberg’s rebound tenderness
Steatorrhea fatty stools
R/in calculous (kidney stones)
Chronic - Pancreatitis
Jaundice & Icterus - yellow eyes
Pruritis - b/c bile salts in skin
R/in ↓motility, absorption
GERD CM
Cause, 2K M
Relaxed lower esosphincter and backward flow of stomach content (reflux esophagitis)
Dyspepsia (heartburn)
Waterbrash (hypersalivation)
GERD NonSurgical Management (4)
Diet Therapy
Education
Lifestyle changes (sleep head up, don’t strain, smoke)
Drug Therapy
GERD Drug Therapies (4) and EFPs
Antacids - Tums, Maalox, Mylanta. neutralize Ph > 3. Fx is Short!
H2 Antagonists - Pepcid, Zantac, Tagamet. ↓ acid secretion.
PPI - Prevacid, Prilosec. long acting ↓ acid secretion. ↓Ca and Protein absorption
Prokinetics - Reglan. ↑ gastric emptying. Tardive dykensia
Gastritis Cause and Tx
Inflammation gastric mucosa (Acute/Chronic) b/c H. Pylori in Serum, Breath, and Stool Triple Therapy (H2, PPI, Antibiotics)
Cholecystitis
How to Dx and different lab S/S comparative (6)
S/S p eating fatty foods
Lab changes
↑ WBC, AST, ALT, serum albumin, amylase and lipase (if pancreas involved)
Cirrhosis C3, labs S3 , assess S3
Extensive scarring of liver b/c inflammation
Laennec - alcohol
Postnecrotic - Viral Hep C or drugs
Biliary - biliary obstrx
↑ Labs ALT, AST, LDH
Ascites
↑ portal pressure
Hepatic encephalopathy
Transjugular Intraheptatic Portosystemic Shunt Fx
Controsl long term ascites to ↓ variceal bleeding
NonSurgical Tx for Excessive Volume Cirrhosis (3)
Drug Therapy - BBlocker (propranolol)
↓ bleeding
Gastric intubation - detect bleeding
Esophagogastric ballon tamponade - controls bleeding by putting pressure on wound. Protects airway!
NO Liver Transplant is you have…? (5)
♥ Dz Alcohol abuse/dependence Metastatic Cancer Respiratory Issues Refusal to follow up with Drug Therapy
Labs associated w/ Liver d/fx
↑ ALT, AST, LDH, alkaline phosphates, serum bilirubin, urobilinogen ↓ serum protein, albumin, Hgb, Hct, WBCs Thrombocytopenia ↑ Creat. level = death close ↑ ammonia
Peptic Ulcers C2, S0, T5
H.Pylori infx r/in lesion in stomach/duodenum
Pain relief
H. Pylori eradications
Ulcer Healing
Recurrence prevention
Education to avoid bedtime snacks, alcohol, and smoking
Ulcer Complications (4)
Hemorrhage (vomiting blood)
Perforation <- life threatening!!!
Pyloric Obstructx r/in vomitting
Intractable dz - pt Ø manages and recurrence
GI Bleed High vs. Low
Melena
Frank Hematochezia
Labs for GI Bleeds (8)
CBC BUN Electrolytes PT/PTT ABGs Liver Enzymes (AST, ALT, ammonia) Blood Glucose H & H
Dx for GI Bleeds
Type and Cross
Endoscopy
Hiatal Hernia C1, Types2, Education?
Protrusion of stomach through hiatus in diaphragm
Sliding = most common
Rolling = intestinal torsion, reqs. surgical intervention
Regular GI stuff… head elevated, no eating late, smoking, alcohol, etc.
Ulcerative Colitis C1, S4, T4 with EFØP
Inflammation of rectum/sigmoid colon
15 - 20 watery stools w/ blood/pus
LLQ pain
Pseudopolyps
B12 Ø absorption (pernicious anemia)
Drug Therapy Salicylate compounds (5ASAs) Sulfasalzine ↓ inflammation Corticosteroids Prednisone ↓ exacerbations Immunosuppresants Humira ↓ immune response Antidiarrheal drug Lomotil, Imodium S/S tx
ONLY TRUE CURE FOR UC (& 3 types)
Colectomy
Total permanent
Total continent
Total w/ stripping/ileoanal pouch
Crohn’s Dz C1, S5, TØ
Inflammation/ulceration GI tract
Fistulas 5 watery stools w/ pus/musucs RLQ paint Steatorrhea - fatty stool Req. B12 injection
Labs betwwen UC and Crohns
5↓ 6↑
↓ HH, Albumin, K, Mg, Ca
↑ ESR, WBC, Cprotein, Platelets,
↑pANCA (UC only)
↑ Antiglycan antibodies (Crohns only)
Diverticulitis C, S3, T
↑ pressure in intestinal lumen (usually asymptomatic)
Pain LLQ, ab. distension, low fever
Ø seeds n stuff
Pancreatis Fx on 2 labs
serum amylase and lipase ↑
Esophageal Varices C, S2, TØ (relation to exercise)
Distended esophageal veins r/in ↑ pressure
straining exercise ↑%
Bleeding (hemetemesis or melena) !!!
LIFE THREATENING EMERGENCY
Bariatric/Cholecystectomy Precautions (4 ea)
Bariatric Notify if displacement Monitor for leak Ambulate asap 6 small meals
Cholcystectomy Report ↑ drainage Monitor drainage Empty q8h Clamp q1-2h tp assess food tolerance
Labs r/t Enteral 3 and Parenteral 2 nutrition
Enteral - ↓Na, ↑K, and fluid overload
Parenteral - ↑Blood glucose, all electrolytes (Na/K imba common), ↑Ca
7 Labs r/t Nutrition HH Albumin Squad C TL
Hgb - anemia, hemorrhage, hemodilution/concentration
Hct - ↑ditto
Serum albumin (3.5 - 4.0 mg/dL) - reflects previous weeks.
Prealbumin (15 - 36 mg/dL) - most sensitive b/c 2 day HL (MOST ACCURATE)
Transferrin - iron-transport protein. ↑ sensitivity to protein status. HL 8 - 10 days
Cholesterol (160 - 220 mg/dL)) - ↓w/ malabsorption or malnutrition
Total Lymphocyte Count - TLC < 1500/mm3 = malnourishment which = ↓immune fx
Nursing Interventions r/t restoral oral HP (3)
Hygiene q2h soft toothbrush
Ø toothetes/foam brushes b/c Ø bacteria control
Ø commerical mouthwash b/c alcohol and acidity
Stomatitis C1, Types2, Tx2
Inflammation oral cavity
Primary - most common. includes cakers, herpes, and ulcers
Secondary - b/c opportunistic fungi, bacteria
Rinse mouth q2-3hours w/ baking soda/saline solution
SLS toothpaste
Hep ABCDE
A - fecal self limiting. GI S/S.
B - blood sex and needles. Whitlows! Nausea, fatigue.
C - Continuation of B. Carrier! Asymptomatic for decades.
D - Must have B. Needle sharers.
E - waterborne, self limiting.
Labs fx’ed by ALL Hepatitis
AST/ALT
R/f for ↑% Cancer 4
Antigens of importance?!
↑Alpha-fetoprotein
HepB and C
Esophageal tumors
Cancer of Liver (most common in the WOOOORLD!)
Oncofetal antigens.
Diarrhea Organism Cause and Diagnostics 2
C. Diff
Stool culture and C.Diff test (enzyme-linked immunosorbent assay ‘ELISA’ results w/in 2-6 hrs
Jaundice main lab and r/t which organs 3.
↑Bilirubin b/c liver Ø excreting
Liver d/fx, cancer gall bladder, panceratiis
Peritonitis and Perforation
Cause/Symptoms
Peritonitis - acute inflammation of peritoneum ab. pain and fetal position. ↓ GI Perforation - ulcers sudden sharp pain that spreads ↑ GI SURGICAL EMERGENCY!!!
4 Hernias S/S for 1st two.
2 Dx and 1 Tx?
Sliding - eso up ♥burn,dysphagia, belching Rolling - stomach up Fullness, worse when recumbent Inguinal (Femora) and Umbilical
Barium swallow, Endoscopy.
Nissen Fundoplication to prevent respiratory complication
Cirrhosis Early2, Late2r, Other3 Assessment
↑ wieght, pain
Jaundice & liver issues
Neuro changes, fetor hepaticus (fruity/musty breath), asterixis (tremors in wrists, hands, fingers)
Cirrhosis Lab changes ↑↓
7↑ 3↓ 1 Prolonged
↑ AST, ALT, ALP, LDH, bilirubin, ammonia, creatinine
↓ albumin, platelet, HH
Prolonged PT/INR
Types Pancreatitis 3
Chronic - progressive destruction w/ remissions/exacerbations
Acute - life threatening by premature activation of enzymes (autodigestion)
Necrotizing Hemorrhagic - bleeding! r/in high fever
Pancreatitis Assessment 5 and how to Dx
CT LABs
Cullens - perumbilical bluish grey Turners - Ecchymoses on flanks LUQ pain Ø bowel sounds Ascites
CatScan with Contrast
Pancreatis Labs
↑ amylase/lipase
↑ glucose
↑ liver enzymes
↓ calcium
Pancreatitis Pt education (4)
PAIN
PERT
Antiemetics
Insulin therapy
NPO early
Pancreatic Enzyme Replacement Therapy (PERT)
Administering enzymes w/ meals/glass of H2O.
Wipe lips after consuming.
Lungs place in pH defense.
Response to Respiratory Acidosis/Respiratory Alkalosis
2nd behind chemical buffers
RAcid - ↑ RR/depth to ↓ CO2 and pH
RAlk - ↓RR/depth to ↑ CO2 and pH
Smoking Calculations
(#years smoked) x (pks/day) = PACK years
Early/Late findings in declining Respiratory status
Early - tachy, restlessness, pallor
Late - brady, confusion/stupor, cyanosis
O2 Delivery Systems 7 (rates and key notes)
Nasal Cannula : 1 - 6 L. Fitting/Nasal patency
Simple Facemask : 5 - 8 L. Moisture r/in breakdown
Partial RBreather : 6 - 11 L. Deflation = ↓O2
Non RBreather : 80 - 95%. Suffocation if kinks.For unstable pts.
Venti Mask : 4 - 10 L. For chronic lung dz.
Tent/Collar : > 10L. For high humidity b/c thick secretions
T- Piece : > 10L. For tracheostomy and other procedures.
COPD
2 R/F, 3 Labs, 3 ABG fx
Primarily smoking, Alpha 1 antitrypsin (AAT) deficiency (genetic)
↑Hct, sputum for infx, electrolytes
Hypoxemia for PaCO2 < 80mm
Hypercarbia for PaCO2 > 45mm during attack
Respiratory Acidosis
COPD Dx 3 and 2 Medications
Chest X-Ray for hyperinflation (late)
PulseOx
AAT
Bronchodialtors and Anti-inflammatory
Cystic Fibrosis C1, SØ, Dx2
Genetic dz b/c error in chloride transport in lungs.
Dx with sweat chloride analysis and genetic testing
Cystic Fibrosis Interventions 4
Postural drainage
Ø mechanical ventilation
Heliox (50/50 oxy.helium
Avoid direct contact b/c Burkholderia Cepacia (IGGY)
Emphysema and Chronic Bronchitis
Emphysema - loss in elasticity and hyperinflation. R/in dysnpea and ↑RR. Stretches alveoli and bullae.
Chronic Bronchitis - inflammation r/t tobacco smoke. ONLY airways, not alveoli. Thick mucus and congestion
Sinusitis CST2 and Pharnygitis CSDx2
Frontal/Maxillary swelling b/c bacteroides. S/S similar to colds. Tx antibiotics, also Functional Endoscopic Sinus Surgery (FESS)
Sore throat b/c Strep. Dysphagia.
Rapid Antigen Test (RAT), results in 15 minutes.
C&S
Upper Airway Infx
Retropharyngeal Abscess
Tonsilar Infx
Cause by Staph/MRSA
Kids < 2 yrs old
Usually unilateral
3 Types of Pneumonia
Bacterial
Viral - most common
Atypical - look @ labs CRP and CBC
Bronchoiolitis
Viral induced lower respiratory for kids
Aspiration pneumonitis
Older folks and (Myconeum) babies
Pneumonia Labs 5 and Dx 2
Sputum C&S CBC ABG Blood Culture Electrolytes
Chest X-Ray
PulseIOx
Pneumonia Tx 3
Antibiotics
Bronchodialators
Anti-inflammatories
Myobacterium Tuberculosis (TB) Vector? Level communicable? 3 S/S Best Dx? Other Dx?
Similar infx?
Airborne
High
Persistent cough, night sweats, heoptysis (spitting up blood)
Nucleic Acid Amplicification Test (NAAT) 2 hrs
QuantiFeron GOLD (blood test)
Acid-Fast Bacilli Smear/Culture
Miliary TB blood Dz
TB Interventions
PIE!!!
Combined Drug Therapy
Pyrazinamide
Isonazids
Ethambutol
Pulmonary Empyema
Collection of pus in pleural space
Asthma
Is it like COPD?
Reason for S/S?
Age? Cause?
Reversible airflow obstruction (contrary to COPD)
Airway hyperresponsiveness
None, Unknown
Asthma Classifications 4
Mild intermittent - < 2x a week
Mild persistent - > 2x a week but Ødaily
Moderate persistent - daily w/ exacerbations 2x a week
Severe persistent - continuous w/ exacerbations FML
Bronchospams
…and Meds that trigger?
Narrowing of bronchial tubes b/c smooth muscle constriction in response to pollutants/viruses.
Airway hyperresponsiveness.
Triggered by Aspriin and NSAIDS b/c leukotrine
Asthma 1 Lab 3 Fx and other lab
PaCO2
Hypoxemia - ↓ PaCO2 < 80mm
Hypocarbia - ↓ PaCO2 < 35mm early in attack
Hypercarbia - ↑ PaCO2 > 45mm later in attack (Administer 1L O2)
Eosinophils and IgE for allergic
Asthma Dx 2
Pulmonary Function Test (Ø smoking 4 - 6 hrs before test)
Chest XRay
Asthma Tx 3
Bronchodialators
Short/Long acting B2 Agonist
Cholinergic Agonists
Peak Flow Meter
X used per day, X number times each use
Green, Yellow, Red Zones?
2x a day/3 times per use
Green = good control, 80% personal best
Yellow = Caution. Have rescue med.
Red = Med. Alert. Instruct to take med/seek med. attention
3 Pulmonary Fx Tests
Forced Vital Capacity (FVC) - full in/exhalation
Forced Expiratory Volume in the 1st second (FEV1) - volume air blown out forcefully 1st second exhalation
Peak Expiratory Flow Rate (PEFR) - fastest airflow rate during exhalation
15 - 20% < expected value is seen in asthmatics
This % increases 12% when given bronchodialators
Status Asthmaticus
Life threatening acute episode of asthma
Inhaler Education 3
Inhale drug as long as possible
Spacer helps
Full inhalers sink to bottom
Trach Education 2
Too large r/in hypoxia
Fenestrated vs. Non Fenestrated - fenestrated allows pt to speak
Trach Interventions 5
Confirm breath sounds q2hrs
Assess site qShift
Keep pressure 14 - 20 mm
Equipment left @ bedside for first 72 hours
Suctioning Complications 5 and follow-ups if(true)
Hypoxia, trauma, infx, vaginal stimulation, cardiac dysrhythmia (b/c hypoxia)
ANY? STOP IMMEDIATELY and 100% O2
Chest Tube Nursing Focus and 3 Chamber of Secrets
Ensure Integrity of System
1 - collects fluid. tube must Ø touch liquid
2 - water seal prevents air from entering pt pleural space. 2 cm H2O. Add sterile H2O as needed.
3 - Suction control.
Chest Tube Assessment 3
Drainage, Leaks, Crepitus (SubQ emphysema)
Ranges:
BUN
Creatinine
Blood Glucose
Urine Specific Gravity
10 - 20
0.5 - 1.5
70 - 120
1.00 - 1.03
Ranges:
Na K Ca Mg P Cl
135 - 145 3.5 - 5 9 - 10.5 1.3 - 2.1 3.0 - 4.5 98 - 106
Ranges:
T3
T4
HDL
LDL
70 - 205
4 - 12
> 50
< 190
Ranges:
WBC
RBC
HH
Platelets
4k - 10k
4.6 - 5.5
13.4 - 15.5 / 39 - 49
140 -400
Ranges:
AST ALt ALP Amylase Bilirubin Albumin Ammonia
5 - 40 8 - 20 30 - 120 56 - 90 0.1 - 1.0 3.5 - 5.0 15 - 110
