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Lab Values
Lab Values
48
Health Care
10/22/2007

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Cards

Term
                            RBC
Definition
Normal
4.6 - 6.0 million/mm3 men
4.0 - 5.0 million/mm3 women

Critical Value - 10% decrease is anemia

Sig. of decreased : Anemia, dilutional, overhydration, cirrhosis, hemorrhase, renal disease
Sig. of increased Value: dehydration, COPD, Congenital heart disease

HGB & HCT also looked at
RBC count of the number of circulating RBCs in 1 mm of peripheral venous blood, life of one RBC 120days
 
Term
             Hgb - Hemoglobin
Definition

Normal: 
13.5 - 17.0 g/dl men
12 -15 g/dl women
Critical Values - below 5.0 or 20 g/dl
Decreased Values: Anemia, dilutional overhydration, cirrhosis, hemorrhage, renal disease
Increased Value - dehydration, COPD, congenital heart disease

Hct is 3X Hgb
Hemoglobin - transports 02 & C02 in the blood, test determines the 02 carrying capacity of the blood, important to the acid-base buffer system
Term
Nursing interventions for Abnormal HGB Values
Definition
Decreased Value
Blood transfusion Hbg<8g/dl, or Hct<24
Monitor patient for fatigue, paleness, tachycardia & bleeding

Increased Value
With dehydration, Rehydrate with IV fluids
Check S&S of Dehydration - thirst, poor skin turgor, dry mucous membranes, tachycardia, hypotension, low urinary output
Term
Hct - Hematocrit
Definition
Normal Values    40% - 54%  men
                      36% - 46% women
Critical Values <15% or >60%

>60% = blood clot formation danger

Decreased Values: Anemia, dilutional overhydration, cirrhosis, hemorrhage, renal disease
Increased Value - dehydration, COPD, congenital heart disease
Hematocrit - indirect measure of RBC number & volume, measure of the percentage of total blood volume that is made up of RBCs, Hight of RBC is compaired to the ratio height of the total blood volume, closely reflects the Hgb & RBC values, Hct is 3 times the Hgb
Term
           Plt. Platelets
Definition
N: 150,000 - 400,000/mm3
CV: <50,000 or > 1 million/mm3
Decreased Values - <100/mm3 have thrombocytopenia,
         < 20,000 have spontaneous bleeding, hemorrhage, leukemia, DIC, infection, post chemotherapy, ESLD
Increased Values: untreated cancer - leukemia, colon cancer, & lymphoma; polycythemia vera=high plt. & high RBC

DIC=diseminated intravascular coagulation FYI

Platelets -part of the hemostatic mechanism is platelet aggregation (clumping), platelets initiate coagulation, life of a platelet 7-9 days, essential for blood clotting
Term
Red Blood Cells
Definition
Count of the number of circulation RBC's in 1 mm of peripheral venous blood, part of the complete blood count, produced by erythroid elements in the bone marrow, life of RBC 120 days.
Term
Nursing Interventions for Abnormal Platelet Values
Definition
  • Decreased Values
    At risk for bleeding
    Apply pressure to venipuncture sites for at least 5 mins.
    No IM injections, only use and elctric razor
    Check body orifices for bleeding, guaic stool

    Increased Values:
    For the Doctor to treat the disease process.
Term
   MCV - Mean Corpuscular  Vol
            Anemias
Definition
  • Normal:  80 - 98/um3 (cubic micro meters) Size of RBC
    Decreased Value
    Small RBC = microcytic Anemia
    Conditions - Fe deficiency anemia
    Thalassemia, genetic in meditranian area

    Increased Value
    Larger RBC = Macrocytic Anemia
    Conditions - pernicious anemia, folic acid anemia, ETOH, liver disease

    *ETOH from lack of B1

Term
MCH
Definition
  • Normal: 27 - 31 pg  (picamole) weight of RBC
    Decreased Value
    Microcytic Anemia, Hypochromic Anemia
    Increased Value
    Macrocytic Anemia
    Treatment: Treat the cause of the anemia. B1, Fe, Folic Acid
Term
MCHC - Mean Corpuscular Hgb Concentration
% of Hemoglobin in 1 RBC
Definition
  • Normal  32% - 36%
    Decreased Value - Hypochromic Anemia, Fe Deficiency Anemia, Thalassemia

    Increased Value - Spherocytosis(cell count error), Intravascular Hemolysis, Cold Agglutins (antigen antibody reaction in RBC)
Term
RDW - Red Blood Cell
Distribution Width


Size/Witdth differencial of RBC
Definition
  • Normal: 11.5% - 14%
    No Decreased Value

    Increased Value - Anemias (Fe,B12) Folic Acid Deficiency Anemia, Sickle Cell Anemia, Hemolytic Anemia, increased variation in RBC
Term
General Interventions for
Anemias
Definition
Assess patient for fatigue, pallor, dyspnea on exertion, tachycardia, HA-head ache

For Fe Deficiency Anemia - High Fe diet & Fe supplement tablets
Term
WBC Diff
Neutrophil
Definition
Normal:  50 - 70%
FXN: Phagocytosis kill & digest bacteria

Decreased Values - aplastic anemia, overwhelming bacterial infection, viral infection, post chemotherapy or radiation therapy

Increased Values - acute bacterial infection, leukemia, stress, trauma, inflammatory disease, acute MI
Term
WBC Diff
Lymphocytes
Definition
Normal: 25 - 35% of WBC count
FXN: Tcells = killer cells/supressor cells & Bcells+antibody production

Decreased VAlues - leukemia, cancer, post radiation or chemotherapy, sepsis, immunodeficiency disease HIV AIDS
Increased Values - chronic bacterial infection, viral infection, leukemia, Hodgkin's disease, mononucleosis, hepatitis
Term
WBC Diff

Monocytes
Definition
Normal:  4 - 6% of WBC count
FXN: Phagocytic, produce interferon, kill bacteria,

Decreased Values - prednisone drug therapy, lymphocytic leukemia, aplastic anemia

Increased Values - chronic inflammatory disease (ulcerative colitis), viral infection, cancer, TB, parasites (malaria) Parasitic infection
Term

WBC diff
Eosinophils

Definition

Normal 1 - 3% of WBC count
FXn: Phagocytic Antigen/Antibody responce, alergic responce Asthma-alergic reaction

Decreased Values - burns, shock, increased adrenosteroid production

Increased Values - parasitic infections GI, autoimmune diseases, allergic reaction, asthma, leukemia, renal failure

Term
WBC Diff
Basophils
Definition

Normal: 0.4% - 1.0%
FXN: Phagocytic antigen/antibody responce-Alergic responce Asthma. Same as Eosinophils

Decreased Values - allergic reaction, hyperthyroidism, stress

Increased Values - Myeloproliferative diseases (cancer), leukemia, inflammatory process, healaing process, post surgery, asthma, cold.

Term
Interventions for Abnormalities in
WBC & WBC Diff.
Definition

1.Treat infections - antibacterials, antifungals, etc.
2. Take temperature q4hrs 101or 101.5 Doc may give Tylenol
3. Monitor patient for S&S of infection - increased temp. & pulse,   redness, swelling, drainage, tenderness
4. Check patient for S&S of allergies
5. For patients with decreased WBC &/or neutrophils, protect them from infection. they should avoid sick people & crowds

Term
BUN
Blood Urea Nitrogen
(# of Urea Nitrogen in the blood)
Definition
  • NV: 5 - 25 mg/dl
    CV: 100mg/dl serious renal disease - Dialysis necessary
    DV: Liver failure, overhydration, low protein diet, early pregnancy
    IV: Renal disease (infection, failure); hypovolemia, shock, burns, CHF, MI, High protein diet, starvation
Term
BUN Blood Urea Nitrogen
Interventions for Increased Value
Definition

1. Check pt. for dehydration - tachycardia,   hypotension, low UO, dry skin
2. Give IV fluids to the dehydrated pt.
3. Check UO for pt. with renal failure
4. Check dietary protein intake

Term
Cr - Creatinine
Definition
Breakdown of Creatine Phosphate
NV: 0.5 - 1.5 mg/dl
CV: >4.0mg/dl Serious renal disease, 2.5 mg/dl indicates renal impairment,
DV: debilitation, decreased muscle mass (muscular dystrophy) eclampsia, elderly
IV: renal disease, cancer, acute MI acromegaly, high meat diet, shock, lupus, drugs toxicity-Gentamycin, Vancomycin, Cephalosporins - peak & trough dosing
Term
Cr - Creatinine
Treatment for Elevated Values
Definition
  • Low protein diet
    Treat renal disease
    Decrease the dose or discontinue renal toxic meds
    Check UO
    Elevate BUN & Cr levels qd
Term
NA - Sodium
Hyponatremia
Specifications
Definition
  • NV: 135 - 145 Meq/L
    CV: <120 
    DV: Hyponatremia
    Signs & Symptoms
    <125  WEAKNESS
    <115 CONFUSION, LETHARGY THAT PROGRESSES TO STUPOR & COMA
Term
Causes of
Hyponatremia
Definition
Causes of Hyponatremia

Low Na intake in foods or IV fluids

Increased NA losses - Addison's disease, diarrhea vomiting paralytic ileus, diuretics

Increased free water - excessive po fluid intake or IV fluid w/o Na, CHF, ascites, edema
Term
NA - Sodium
Hyponatremia
Interventions for
Definition
  • Interventions for Hyponatremia, low Na - Sodium levels in the blood

    1. Check for S&S - anxiety, muscle twitching or weakness, HA head ache, tachycardia, hypotension
    2. Na replacement in IV fluids or Na tablets with meals
Term
NA - Sodium
Hypernatremia

Specifications
Definition
  • NV: 135 - 145 Meq/l
    CV: > 160 meq/l
    Increased Value is Hypernatremia
    Signs & Symptoms - dry mucous mmembranes, thirst, restlessness, hyperreflexia, mania, convulsions/seizures, urine specific gravity >1.030
Term
NA - Sodium
Hypernatremia
Interventions for
Definition
  • Monitor for S&S
    IV fluid replacement without NA
    Seizure Precautions
    Strict I & O
Term
K – Potassium
Hyperkalemia
Definition
NV:3.5 - 5.3 Meq/l
 Increased Value – Hyperkalemia
>6.5meq/l

1. S&S – EKG – peaked t waves, widen QRS, Depressed ST segment; irritability, nausea, vomiting, intestinal colic, bradycardia, decreased UO, numbness, tingling

2. Causes – excessive dietary or IV intake, renal failure, Addison's disease, taking a K sparing diuretic – Aldactone, hemolysis of RBCs, blood transfusion with hemolyzed blood, infection, acidosis, dehydration

3. Treatment – Low K diet, Kayexalate po or enemas, Lasix , Check I&O, IV infusion of glucose & insulin solution to move K back into the cells
Term
K – Potassium
Hypokalemia
Definition
NV: 3.5 - 5.3 meq/l
Critical Values - < 2.5 or > 6.5 meq/l

Decreased Values – Hypokalemia  >6.5meq/l

1. S&S – cardiac dysrhythmias, flattened T waves, prominent U waves, weakness, paralysis, dizziness, hyporeflexia, ileus, decreased bowel sounds and deep tendon reflexes, confusion

2. Causes – decreased dietary intake, IV fluid deficit, burns, diarrhea, vomiting, diuretics, hyperaldosteronism, renal disease, ascites

3. Treatment – Potassium replacement po or in IV fluid bag, check patient for S&S of overhydration, monitor K level for patients taking diuretics, increase dietary intake of high K foods – bananas, tea, dried fruits, meat, nuts

Term
ALT - Alanine Aminotransferase
Definition
NV: 4 - 36 Iu/l International
Decreased
Values - due to exercise effect or ASA

Increased Values

1. Significantly increased - hepatitis, liver necrosis or ischemia

2. Moderately increased – cirrhosis, hepatic tumor, drug toxicity, obstructive jaundice, severe burns

3. Mildly increased – myositis, pancreatitis, MI, CHF, shock, mononucleosis

C. Interventions - monitor liver enzyme lab values & for jaundice, check patient’s medication profile for liver toxic medications



Term
LDH – Lactic Dehydrogenase
Definition
NV: 70 - 250 u/l
No Decreased Value
Increased Total LDH – MI, pulmonary disease, hepatic disease, cirrhosis, skeletal muscle disease & trauma


Liver enzyme
C. Increased LDH –5 –
hepatitis, cirrhosis, liver cancer

D. Treatment – treat the disease process

Term

AST –Aspartate Aminotransferase

Liver & Heart Enzyme
Definition

NV: 8 - 38 u/l
Decreased Values – acute renal disease, beriberi, DM, ketoacidosis, pregnancy

Increased Values – MI, post cardiac surgery, liver disease ( hepatitis, cirrhosis, cancer, tumor); skeletal muscle disease, pancreatitis

Interventions for Increased Values – check patient’s medication list for liver toxic drugs, IM injections cause false high values, assess patient for S&S of liver disease & MI

Term
ALP – Alkaline Phosphatase
Definition
NV: 42 - 136 u/l    -Kupfer cells & Biliruben, monitor liver & bone disease
Decreased Values – hypophosphatemia, malnutrition, pernicious anemia, scurvy, hypothyroidism

Increased Values

1. Large increase – cirrhosis, extra hepatic and intrahepatic obstructive biliary disease

2. Smaller increase – hepatic tumor, hepatotoxic drugs, hepatitis, bone tumor, new bone growth, rheumatoid arthritis, Piaget’s disease, MI

C. Interventions for a Patient with an Elevated Value – check for S&S of liver or bone disease, check patient’s medication list for liver toxic medications, IV Albumin can increase the value by 5 – 10 times normal

Term
Bilirubin
Definition

NV: 0.1 - 1.2 mg/dl
Critical Values – Adult > 12 mg/dl

Newborn > 15 mg/dl

Increased Level of Conjugated (Direct Bilirubin) – gallstones, extra hepatic duct obstruction, extensive liver metastases

Increased Level of Unconjugated (Indirect) Bilirubin – hepatitis, cirrhosis, neonatal hyperbilirubinemia, transfusion reaction

Treatment – low protein diet for patients with liver disease, check skin & sclera for jaundice

Term
Albumin
Definition
 NV: 3.5 - 5 g/dl
A. Decreased Valuesliver disease, 3rd spacing (ascites, burns); malnutrition, overdehydration, preeclampsia

Interventions for Decreased Valueshigh protein diet if not in liver failure, assess patient for ascites & peripheral edema, transfuse with albumin as orderedIncreased

Valuesdehydration

Intervention for Increased Value – Rehydrate the patient with oral or IV fluids

Term
Blood Glucose
Definition

NV: 70 - 110 mg/dl
Critical Values < 40 or > 400 mg/dl

Decreased Values – insulinoma, hypothyroidism, liver disease, insulin overdose, starvation

1. Treatment – give a concentrated glucose source & a long acting CH2O, do not skip meals, check for S&S of hypoglycemia nervous, weak, confusion, cold, clammy skin, tachycardia

Increased Values – diabetes mellitus (DM), acute stress response, Cushing’s disease, acute pancreatitis, drug therapy with diuretics or corticosteroids

1. Treatment – for DM give regular or aspart insulin

Term
Urinalysis UA
Normal Results
Definition
Appearance - Clear
Color - Light Straw to Dark Amber
Odor - Aromatic
pH - 4.5 -8.0
Protein - 2-8 mg/dl usual

Specific Gravity - 1.005-1.030
Leukococyte esterase, Nitrites, Ketones & Glucose ALL NEGATIVE
Crystals - 0
Casts - occasional hyaline
WBC 3-4 per low-power field
WBC casts -0
RBC <=2 per low field power
RBC casts -0
Term
Interpretation of Urinalysis Abnormalities
Definition
1. Appearance – cloudy = infection

2. Color – straw color = overhydration

deep amber = fever, dehydration

dark red = bleeding from kidney

bright red = lower urinary tract bleeding

Odor – strong, sweet odor = DM

foul odor = UTI

fecal odor = enterovesicle fistula

Term

Interpretation of Urinalysis Abnormalities Cont.

Definition
 
4. pH –
a. Elevated – alkalemia, UTI, vomiting,
diet high in fruits & vegetables
b. Decreasedacidemia, DM, starvation, COPD, diet high in protein
5.Specific Gravity –
a. Elevated – dehydration, decreased renal blood flow, glycosuria, proteinuria, vomiting, diarrhea
b. Decreased – overhydration, diabetes insipidus, renal failure, diuretics
6.Leukocyte Esterasepositive in UTI
Term
Interpretation of Urinalysis Abnormalities Cont.
Definition
 
7. Nitrates – positive in UTI
8. Ketones – positive in DM out of control, ETOH, fasting, starvation, high protein diet, severe stress
9.9.Castsmany in renal disease
10.10.WBC– increased in UTI
11.11.WBC Castsincreased in kidney infection
12.12.RBCsincreased in renal disease, bladder or renal tumor, trauma, anticoagulant use, menstruation
 13. RBC Casts - incrased in glomerulonephritis, renal infarction, lupus, vasculitis, malignant hypertension
14. Glucose - present with DM, renal disease
Term
Radiological Exams
Definition

1. GI Tests – iodine contrast dyes should be scheduled before barium studies

2. GI Tests – NPO 8 hours before the test

3. Studies Using Iodine –

   a. ask the patient if (s)he is allergic to shellfish or iodine

   b. the patient should be well-hydrated before & after the exam

Term
CBC
All test involved +
Normal Values
Definition
RBC - 4.6 - 6.0 million/mm3 men
         4.0 - 5.0 million/mm3 women

Hgb - 13.5 - 17.0 g/dl men
         12 - 15 g/dl women
Hct  - 40% - 54% men
         36% - 46% women
Plt 150,000 - 400,000/mm3
MCV 80 -98/um3
MCH  27 - 31 pg
MCHC 32% - 36%
RDW 11.5% - 14.5%
WBC 4,500 - 10,000/mm3
Term
RBC Indices
(Anemia Test)
Definition
*  Called the RBC Indices - part of a routine CBC, help determine type of anema

1. Mean Corpuscular Volume (MVC) -Measure average volume or size of a single RBC

2. Mean Corpuscular Hemoglobin (MCH) - average amount (weight of Hgb in a RBC

3. Mean Corpuscular Hemoglobin Concentration (MCHC) - average concentration or percentage of Hbg in a single RBC

4. RBC Distribution Width (RDW) - RBC size variation or width differences of RBC's



Term

ELECTROLYTES TESTS

Definition

1.Serum Sodium Na - major cation in extracellular space, major determinant of extracellular osmolarity

2.  Serum Potassium K - Major cation in the cell, need for protein synthesis, maintenance of oncotic (fluid) pressure, cellular electrical neutrality, membrane electrical potential, & acid-base balance.
Term
Liver Function Tests
Definition
1. Alanine Aminotransferase (ALT) - used to diagnose & monitor liver disease, hepatocellular enzyme, mainly found in the liver also found in kidney, heart, & skeletal muscle
2. Lactic Dehydrogenase (LDH) - intracellular enzyme found in many body tissues - liver, heart, RBCs brain, skeletal muscle, & lungs, 5 separate enzymes make up LDH. LDH-5 -isoenzyme in the liver
3. Asparate Aminotransferase (AST) - enzyme found in highly metabolized tissue especially the liver & heart, when liver cells lyse, AST is released.
4. Alkaline Phosphatase (ALP) - found in the liver's Kupffer cells in the biliary system, increases pH, use to monitor liver & bone disease.
5. Bilirubin - evaluates liver fxn, breakdown of RBCs in reticuloendothelial system (Heme--->Bilirubin).
   Indirect (Unconjugated) Bilirubin - assesses hepatocellular fxn, increased destruction of RBCs hemolysis
   Direct (conjugated) Bilirubin - obstruction of extrahepatic fxn (gallstones, bile duct blockage or intrahepatic; conjugated bilirubin cannot escape in the bile into the small intestine
Term
Definition
Term
White Blood Cell Count
WBC count & WBC Diff.
Definition
Total Number of WBC's (leukocytes) in 1 mm of blood

WBC Differential Count:
Percent of each type of cell in 1mm of blood, increase one type of WBC results in a decrease in another type of WBC, total percent of each type of cell equals 100%
Neutrophils 50-70%
Lymphocytes 25-35%
Monocytes 4-6%
Eosinophils  1-3%
Basophils 0.4-1.0%
Never Let Monkeys Eat Bananas
Term
Renal Function Tests
Definition
Blood Urea Nitrogen - A measure of renal function, glomerular filtration, & liver function, Urea is formed in the liver as an end product of protein metabolism & digestion, the kidney excretes ura

Creatinine-used to diagnose impaired renal function, is a breakdown product of creatine phosphate, excreted by the kidney, when the creatinine level doubles then glomerular filtration is 50% of normal