Need-To-Know lab Flashcards
Important nursing information
Importance of sodium in the body
Most abundant cation in extracellular fluid; maintains osmotic pressure of extracellular fluid; regulates renal retention and excretion of water; responsible for stimulation of neuromuscular reactions & maintains SBP
Hyponatremia values
serum below 135; critical less than 120
Hyponatremia causes
excess sodium loss through N/V/D, skin and kidneys; excess diuretic dosage; liver failure; CHF; increased hypotonic IV fluids
Hyponatremia treatments
sodium containing fluids; isotonic ringers; NS 0.9% or 3%
Hyponatremia-Nursing considerations
THINK VOLUME..monitor electrolytes, vital signs, neurological responses, mental status, headaches, fluids, I&O overload, weight, cardiac overload (CHF), cramps, weakness, tremors
Hypernatremia values
Serum above 145…critical above 160
Hypernatremia causes
Dehydration-fluid loss through N/V/D (water loss in excess of salt loss) or excessive sweating; diabetes-DKA; Fever
Hypernatremia treatments
Replace fluids (D5W); diuretics-excrete excess volume
Hypernatremia-Nursing considerations
THINK VOLUME..monitor electrolytes, vital signs, mental status, weight, I&O, monitor for seizures
Importance of potassium in the body
most abundant intracellular cation and is essential for transmission of electrical impulses in cardiac and skeletal muscle; helps maintain acid-base balance and has inverse relationship to metabolic pH..decrease of pH of 0.1 (acidosis) increases K+ by 0.6; 80-90% K+ filtered through the kidneys
Hypokalemia values
serum below 3.5…critical below 2.5
Hypokalemia causes
inadequate intake of K+; ETOH abuse; CHF/HTN; GI Loss-V&D; Renal loss; Diuretics-loop (Lasix/Bumex)
Hypokalemia treatments
Oral or parenteral potassium; diet high in potassium; balanced electrolyte solutions; Pedialyte; Sports drinks
Hypokalemia-Nursing considerations
THINK ELECTRICITY..Monitor electrolytes, vital signs (low BP), cardiac responses; irregular heart rate and rhythm for increased ectopy-PVC’s/VT
Hyperkalemia values
serum above 5.0…critical above 6
Hyperkalemia causes
metabolic acidosis; dehydration; excess potassium intake; potassium sparring diuretics; tissue damage *Burns (K+ goes out of cell); renal failure
Hyperkalemia treatments
insulin-Moves K+ into the cell; D50-Prevents hypoglycemia caused by the infusion of insulin; IV calcium gluconate=ER measure to counteract cardiac effects of potassium; Sodium Bicarbonate-treats acidosis caused when K+ moves into the cell and pushes hydrogen ion into the serum
Hyperkalemia-Nursing considerations
THINK ELECTRICITY..monitor electrolytes, cardiac responses, musculoskeletal cramps/weakness/parathesias; Peaked T wave/wide QRS; Monitor neurological responses, mental status, headache; Irregular heart rate and rhythm for increased ectopy-PVC’s/VT
Importance of magnesium in the body
second most abundant intracellular cation; required for transmission of nerve impulses and muscle relaxation; controls absorption of sodium, potassium, calcium and phosphorus; magnesium, potassium and calcium all go low or high together!
Hypomagnesemia values
Serum below 1.8..critical below 1.2
Hypomagnesemia causes
chronic alcoholism; GI loss-V&D; impaired absorption; renal disease; pancreatitis
Hypomagnesemia treatments
Treat underlying causes; GI loss; Give magnesium replacement
Hypomagnesemia-Nursing considerations
THINK NEUROMUSCULAR TRANSMISSION//THINK CARDIAC RESPONSE..Monitor electrolytes and vital signs; tachycardia; increased PVC’s; VTach; Hypertension; Tremors, tetany, paresthesias; Muscle weakness
Hypermagnesemia values
serum above 2.6…critical above 6.1
Hypermagnesemia causes
dehydration; severe metabolic acidosis; renal failure; tissue trauma
Hypermagnesemia treatments
treat underlying cause; renal patients treat with dialysis; monitor cardiac effects of magnesium-increased PVC’s/VT; give calcium gluconate
Hypermagnesemia-Nursing considerations
THINK NEUROMUSCULAR TRANSMISSION//THINK CARDIAC RESPONSE…monitor electrolytes/VS; bradycardia; hypotension; muscle weakness
Importance of calcium in the body
Most abundant cation in body and necessary for almost all vital processes; half of total body calcium circulates as free ions that participate in coagulation, neuromuscular conduction, intracellular regulation, control of skeletal and cardiac muscle contractility; 98-99% calcium reserves stored in teeth and skeleton
Hypocalcemia values
serum below 8.5..critical below 7
Hypocalcemia causes
ETOH abuse; pancreatitis; chronic renal failure-inadequate intake; decreased Vitamin D (sunshine); lack of weight bearing; loop diuretics; hypomagnesemia
Hypocalcemia treatments
Oral calcium carbonate/gluconate; calcium chloride (more irritating to the vein); watch for extravastation into subcutaneous tissue
Hypocalcemia-Nursing considerations
THINK MUSCLE RESPONSE…monitor vital signs/electrolytes; cardiac output decreases; hypotension; dysrhythmias; monitor neuromuscular responses-seizures, tetany, paresthesias, muscle spasms
Hypercalcemia values
serum above 10.5..critical above 12
Hypercalcemia causes
Prolonged immobilization; dehydration; cancer; excess antacid intake
Hypercalcemia treatments
Eliminate calcium through kidneys through IV fluids; Loop diuretic to promote elimination of calcium
Hypercalcemia-Nursing considerations
THINK MUSCLE RESPONSE…monitor electrolytes; monitor VS-hypertension; Monitor GI: N/V, anorexia; Dysrhythmias
Creatinine patho
End product of creatine metabolism which is performed in skeletal muscle; Small amount of creatine is converted to creatinine which is then secreted by the kidneys; Amount of creatinine generated proportional to mass of skeletal muscle
Creatinine values
0.5-1.3; Gold standard for kidney function because creatinine is produced in consistent quantity and rate of clearance reflects glomerular filtration
Decrease in creatinine caused by
decreased skeletal muscle; inadequate protein intake
Increase in creatinine caused by
CHF; dehydration; Acute/Chronic renal failure; Shock
Creatinine treatments
Correct underlying problems; fluid resuscitation to keep SBP > 90; Dialysis
Creatinine-Nursing Considerations
THINK FLUID BALANCE…Assess I&O closely; Fluid restriction; Assess for signs of fluid retention/edema
BUN patho
urea represents end product of protein metabolism performed in the liver; urea diffuses freely in intra/extracellular fluid and then excreted by kidneys; BUN reflects balance between production and excretion of urea; Ratio to creatinine is 15-24:1; Is indirect measurement of renal function but does not reflect glomerular filtration
BUN values
10-20…critical >100
BUN decrease causes
poor protein intake/malnutrition; liver disease; malabsorption syndromes
BUN increase causes
acute renal failure; CHF; hypovolemia-dehydration; pyelonephritis; hyperalimentation/TPN
BUN treatments
fluid resuscitation-HIGH; dialysis-HIGH; improve nutritional intake/Failure to thrive-LOW
BUN-Nursing considerations
THINK FLUID BALANCE…assess I&O closely; fluid restriction; assess for signs of fluid retention/edema; assess for agitation, confusion, fatigue; N&V (HIGH); Assess liver profile labs for correlating liver damage
Hemoglobin patho
Primary protein of erythrocytes that is composed of heme (iron) and globin (protein); carries oxygen to cells and carbon dioxide back to lungs; parallels hematocrit which is the % of RBC in proportion to total plasma volume; GOLD standard for evaluating blood/RBC adequacy (anemia, blood loss)
Hemoglobin values
Adult: 13-17…critical below 6 or above 18
Mild Anemia value/symptoms
10-12; asymptomatic
Moderate Anemia value/symptoms
6-10; weakness, fatigue, palpitations, SOB, decreased tol to activity (orthostatic hypotension)
Severe Anemia value/symptoms
below 6; Hypoxia, confusion, SOB, skin pallor MM/nail-beds, dizziness, weakness, tachycardia
Hemoglobin testing purpose
detect blood loss; anemia and response to treatment; detect any possible blood disorder
Decrease in hemoglobin caused by
anemia; cancer; fluid retention/overload; hemorrhage
Increase in hemoglobin caused by
COPD; CHF; Dehydration; Polycythemia
Hemoglobin treatments
correct underlying problem; blood transfusions if symptomatic
Hemoglobin-Nursing considerations
THINK BLOOD LOSS/ANEMIA…identify early signs of blood loss: tachycardia, then hypotension; Transfuse as needed-assess closely in first 30 minutes for transfusion reactions; Assess for signs of tissue hypoxia
White Blood Cell Count (WBC) patho
WBC represent primary defense against invading infection; this is a total count of all 5 leukocytes: neutrophils, basophils, monocytes, lymphocytes, eosinophils; Indicates overall degree of body’s response to pathology, but must be evaluated and correlated through differential count; physiologic stress or steroids will increase WBC
WBC values
4,500-11,000…critical below 2,500 or above 15,000
Decrease in WBC caused by
ETOH abuse; anemia; bone marrow depression; viral infections
Increase in WBC caused by
infection; anemia; inflammatory disorders; steroid use (acute or chronic)
WBC treatments
identify infectious process; confirm bone marrow depression in chemo/radiation therapy
WBC-Nursing considerations
THINK INFECTION…low or elevated WBC can represent sepsis; assess closely for hypotension with known infection (septic shock); assess closely for any change in temperature trend–hypothermia or febrile can both represent sepsis especially in elderly
Neutrophils patho
most predominant differential WBC–comprise 50-70% of all WBC’s; First line of defense against bacterial infection through phagocytosis (think pacman); BANDS–if present on differential–correlate with overwhelming sepsis. Immature neutrophils body is kicking into circulation before they are ready because of the severity of infection/sepsis.
Neutrophils values
50-70% of differential…critical or clinical concern over 80%
Increase in neutrophils caused by
infection; acute hemorrhage; physical stress; tissue necrosis/injury
Decrease in neutrophils caused by
Bone marrow depression (chemo/radiation therapy); Viral infection (due to increased lymphocytes)
Neutrophils treatments
Identify infectious process; Confirm bone marrow depression in chemo/radiation therapy
Neutrophils-Nursing considerations
THINK INFECTION…low or elevated WBC can represent sepsis; assess closely for hypotension with known infection (septic shock); assess closely for any change in temperature trend–hypothermia or febrile can both represent sepsis especially in elderly
Troponin patho
Contractile protein found in cardiac muscle that will be released into systemic circulation with cardiac ischemia or acute MI; Levels will rise 2-6 hours after injury-peak 16-24 hours and then remain elevated for several days; if acute onset CP to r/o MI they will be done every 6 hours x3 to determine pattern of abnormal elevation
Troponin values
<0.05 this may be depending on each hospital lab; if elevated this establishes diagnosis of acute MI; if positive MI, the degree of elevation provides general barometer of degree of heart muscle damage
Troponin increase is caused by
Acute MI; Unstable angina; Minor myocardial damage after CABG or PTCA/stent placement
Troponin treatments
Standards of cardiac care include continuous telemetry, b-blockers to decrease cardiac workload, heparin or nitroglycerin gtts; definitive treatment of MI includes PTCA/stent or CABG
Troponin-Nursing considerations
THINK CARDIAC–MI…assess closely for recurrent or new onset of chest pain; assess cardiac rhythm for any changes such as PVC’s, VT or atrial fibrillation; assess HR and SBP carefully to promote decreased cardiac workload (maintain heart rate <80 and SBP <140); assess tolerance to activity closely
Brain Natriuretic Peptide (BNP) patho
hormone that is stored in the ventricle of the heart; when left ventricle is distended and stretched due to CHF exacerbation, BNP is released into circulation; inhibits the release of renin by kidneys which promotes water and sodium loss as well as increases in glomerular filtration rate (Body’s own ACE inhibitor)
BNP values
Normal: <100; 100-500 abnormal but not critical for ventricular strain (mild); above 500 critical for positive correlation of CHF exacerbation
BNP causes
CHF exacerbation; ventricular hypertrophy (cardiomyopathy); severe hypertension
BNP treatments
Aggressive diuresis for fluid overload; may be on NTG gtts or PO Nitrates to decrease preload which decreases workload of heart
BNP-Nursing considerations
THINK CARDIAC–CHF…assess respiratory status for tachypnea and breath sounds closely for basilar or scattered crackles; assess HR and SBP carefully to promote decreased cardiac workload (HR <80, SBP <140); assess tolerance to activity closely; assess I&O closely; Assess K+ closely with loop diuretics
