Term
|
Definition
135-145mEq/L
(extracellular)
-Hyponatremia <120mEq/L (CHF, hepatic failure, metabolic acidosis, adrenal insufficiency)
S&S: confusion, irritability, N/V, LossOC
INTERVENTIONS:maintain airway, nomitor convulsions, fluid restriction (saline replacement requires close attnetion to serum & urine osmolality), hourly neuro checks
-Hypernatremia>160 (burns, dehydration, dieabetes)
S&S: restlessmess, intense thirst, weakness, swollen tongue, seizures, coma
INTERVENTIONS: tx. underlying causes fo H2O loss or Na+ excess (Na+ restriction + administer diuretics w/IV solutions of 5%dextrose in water(D5W) |
|
|
Term
|
Definition
8.2-10.2 mg/dL
(98-99% in teeth & bone)
-Calcium & phosphorous levels are inversely proportional
hypocalcemia: < 7mg/dL (hypoalbuminemia,alkalosis, chronic renal failure, Vit.D deficiency)
S&S: convulsions, arrhythmias, EKG changes (prolonged ST segment and QT interval), facial spasms (+ Chvostek’s sign), tetany, muscle cramps, numbness in extremities, tingling, and muscle twitching (+ Trousseau’s sign)
Interventions: seizure precautions, EKG monitoring, administration of calcium or magnesium.
hypercalcemia: >12mg/dL (some pts. can tolerate higher concentrations)(hyperparathyroidism & cancer, acidosis)
S&S: polyuria, constipation, EKG changes (shortened ST segment), lethargy, muscle weakness, apathy, anorexia, headache, nausea, and may result in coma.
Interventions: administration of normal saline and diuretics to speed up excretion or administration of calcitonin or steroids to force the circulating calcium into cells. |
|
|
Term
|
Definition
3.5-5.0 mEq/L
Abnormal K+ levels caused by: altered renal excretion, altered dietary intake, altered cellular metabolism
(most abundant intracellular cation)
<2.5 mEq/L (Alkalosis, CHF, HTN)
S&S: malaise, thirst, polyuria, anorexia, weak pulse, low BP, vomiting, decreased reflexes, and EKG changes (depressed T waves and ventricular ectopy
>6.5 mEq/L (acidosis, burns, dehydration, DKA)
S&S: irritability, diarrhea, cramps, oliguria, difficulty speaking, cardiac arrhythmias (peaked T waves and ventricular fibrillation)
Interventions: administration of sodium bicarbonate or calcium chloride – if pt. is receiving IV supplement, verify that pt. is voiding
-kayexalate w/sobitol to eliminate K by stool |
|
|
Term
|
Definition
1.6-2.6 mg/dL
(needed for transmission of nerve impulses and muscle relaxation)
<1.2mg/dL
S&S: tetany, weakness, dizziness, tremors, hyperactivity, N/V, convulsions, EKG changes (prolonged PR and QT intervals, broad flat T waves, and ventricular tachycardia)
Interventions: Administration of magnesium salts, monitor for respiratory depression
>4.9 mg/dL (Addison's, dehydration)
S&S: respiratory paralysis, decreased reflexes, cardiac arrest, EKG changes (prolonged PR and QT intervals, bradycardia).
Interventions: toxic levels may be reversed with administration of calcium, dialysis treatments, and removal of the source of excessive intake. |
|
|
Term
|
Definition
8-21 mg/dL
(BUN reflects the balance between production and excretion of urea)
Normal BUN:Cr is 10:1-20:1
>100 mg/dL (nondialysis patients) (acute renal failure, CHF, hypovolemia, shock)
S&S: academia, agitation, confusion, fatigue, N/V, and coma.
Interventions: tx. of the cause, administration of IV bicarbonate, a low-protein diet, hemodialysis, and caution when prescribing nephrotoxic medications.
causes a dec.:Inadequate dietary protein, Low-protein/high-carb diet, Malabsorption syndromes, Pregnancy, Sever liver disease |
|
|
Term
|
Definition
Male: 0.6-1.2mg/dL
Female: 0.5-1.1 mg/dL
(Ideal for determining renal clearance because a fairly constant quantity is produced w/in the body)
Accurately reflects the glomerular filtration rate
>7.4 mg/dL (nondialysis patients)
(acute & chronic renal failure, CHF, hypovolemia, shock)
Chronic renal insufficiency is identified by Cr levels bet. 1.5-3.0mg/dL; chronic renal failure is present at levels >3.0mg/dL
Interventions: renal or peritoneal dialysis, and organ transplant
causes a dec.:Inadequate dietary protein, Low-protein/high-carb diet, muscle dystrophy, Pregnancy, Sever liver disease |
|
|
Term
|
Definition
Normal Fasting:
65-99mg/dL
Prediabetes or impaired fasting blood glucose:
100-125mg/dL
2-hr postprandial: <105mg/dL
Diabetes diagnosis:
Glucose level >200mg/dL 2hr post glucose challenge w/ 75mg load
Fasting blood glucose >126mg/dL after a minimum of an 8-hr fast
<40 mg/dL (excess insulin, starvation)
S&S: headache, confusion, hunger, irritability, nervousness, restlessness, sweating, weakness.
Interventions: oral or IV glucose, IV or IM injection of glucagon, and continuous glucose monitoring.
>400 mg/dL (diebetes, MI, severe liver & renal disease)
S&S: abdominal pain, fatigue, muscle cramps, N/V, polyuria, thirst.
Interventions: SC or IV injection of insulin w/ continuous glucose monitoring. |
|
|
Term
|
Definition
0.3-1.2 mg/dL
Increased bilirubin = jaundice of skin & sclera. Assists in evaluation of liver and biliary disease.
Produced in liver, spleen, and bone marrow
>15mg/dL
causes:
-Prehepatic Jaundice: Hematoma, Hemolytic anemias, Pernicious anemia,
Post-blood transfusion period
-Hepatic Jaundice:Alcoholism, Cholecystitis, Cirrhosis, Hepatitis,
Mononucleosis, Hepatocellular damage
-PostHepatic Jaundice:Tumors of the liver, Biliary obstruction
Other: anorexia, starvation, hypothyroidism, premature or breastfed infants.
Sustained hyperbilirubinemia can result in brain damage. |
|
|
Term
|
Definition
30-110 U/L
-Sensitive indicator of pancreatic acinar cell damage & pancreatic obstruction.
-Circulating amylase is derived from the parotid glands & pancreas.
-Assists in early detection of acute pancreatitis
-Detection of blunt trauma or inadvertent surgical trauma to pancreas.
causes of dec.:
-Advanced cystic fibrosis
-Severe hepatic disease
-Pancreatectomy
-Pancreatic insufficiency
causes of inc.:
-Abdominal trauma
-Alcoholism
-Common bile duct obstruction
-Diabetic ketoacidosis
-Duodenal obstruction
-Gastric resection
-Pancreatic cyst
-viral infection |
|
|
Term
|
Definition
Total CK:
Male:38-174 U/L
Female:26-140 U/L
Isoenzymes:
CK-BB (brain):
Absent
CK-MB (heart):
<4-6%
CK-MM (skeletal muscle):
94-96%
-When injury to tissue occurs, these enzymes are released into the bloodstream.
-Measuring serum levels can help determine extent & timing of the damage.
-The specific isoenzyme determines the location of tissue damage
-Assist in diagnosis of acute MI & evaluate cardiac ischemia à CK-MB
-CK-MB appears in 1st 6-24 hours and is usually gone in 24 hrs (post MI)
-CK is released w/in 48 hrs. & values return to normal in 3 days.
-Recurrent elevation of CK suggests reinfarction or extension of ischemic damage.
-MI assessment: CK-MB w/ cardiac Troponin T, myoglobin, & serial EKGs. |
|
|
Term
|
Definition
< 0.35 ng/mL
-Cardiac muscle-specific
-Assists in establishing a diagnosis of MI
-Evaluate myocardial cell damage
-Cardiac Troponin I begins to rise 2-6 hours post MI
-Troponin I is thought to be a more specific marker of cardiac damage than Troponin T.
-Both proteins return to the reference range 7 days post MI |
|
|
Term
|
Definition
<0.20 µg/L
-Cardiac Troponin T levels rise 2-6 hours post MI and remain elevated
-Returns to reference range 7 days post MI |
|
|
Term
|
Definition
4.5-11.0 x 103/mm3
-Assists in confirming bone marrow depression
-Assists in determining cause of increased WBC (infection, inflammation)
(Leukopenia) <2.5 x 103/mm3
Pathologic:
Alcoholism, Anemias, Bone marrow depression, Malaria, Malnutrition, Radiation, Rheumatoid arthritis
Lupus, Toxic & antineoplastic drugs
Viral infections
(Leukocytosis)>30.0 x 103/mm3(30,000/mm3)
Normal Physiologic Conditions:
Early infancy, Emotional stress
Exposure to cold, Menstruation
Increased epinephrine, Pregnancy & labor, UV light, Strenuous exercise
Pathologic Conditions:
Acute hemolysis, Anemias, Appendicitis
Cushing’s, Inflammatory disorders
Leukemias and other malignancies
Parasitic infections, Polycythemia vera |
|
|
Term
| ANC (Absolute neutrophil count) |
|
Definition
1.8-7.7 (59%)
-Neutrophils: predominant WBC type in circulating blood
-Body’s 1st line of defense through the process of phagocytosis |
|
|
Term
|
Definition
Males: 4.71-5.14 x 106 cells/mm3
Females:4.20-4.87 x 106 cells/mm3
Presence of abnormal cells – e.g. sickle cells
Low RBC counts leads to anemia. Anemia can be caused by blood loss:
Menstrual excess or frequency
GI bleed
Inflammatory bowel disease
Hematuria
Anemia d/t decreased cell production:
Folic acid deficiency
Vit B12 deficiency
Iron deficiency
Chronic disease
Increased blood cell destruction:
Hemolytic rxn
Chemical rxn
Medication rxn
Sickle cell disease
Hemodilution:
CHF, renal failure, polydipsia, overhydration.
S&S: anxiety, dyspnea, edema, HTN, hypotension, hypoxia, JVD, fatigue, pallor, rales, restlessness, weakness.
TX: depends on cause
High RBC count leads to polycythemia – caused by dehydration, decreased O2 levels in body, overproduction of RBCs by bone marrow.
S&S: decreased pulse pressure & volume, loss of skin turgor, dry mucous membranes, headaches, hepatomegaly, low CVP, orthostatic hypotension, pruritis, splenomegaly, tachycardia, thirst, vertigo, weakness.
TX: depends on cause. May include IV fluids and d/c diuretics, if polycythemia vera: therapeutic phlebotomy and IV fluids. |
|
|
Term
|
Definition
Male: 43-49%
Female:38-44%
-Packed red blood cell volume
Polycythemia=abnormal increase in Hgb, Hct, and RBC
-Anemia=abnormal decrease in Hgb, Hct, and RBC
< 18%
> 54%
*See RBC |
|
|
Term
|
Definition
Male: 13.2-17.3 g/dL
Female:11.7-15.5 g/dL
< 6.0 g/dL
> 18.0g/dL
*See RBC |
|
|
Term
|
Definition
150-450 x 10^3/µL
150,000-400,000/mm^3
-Essential function in coagulation, hemostasis, and blood thrombus formation
< 50,000 (Thrombocytopenia<140x10^3/µL)
>1,000,000/mm3 (Thrombocytosis)
Possible interventions for decreased platelet count include transfusion of platelets. |
|
|
Term
|
Definition
9-11 seconds
1.5-2.5 x normal mean (for pts. on coumadin therapy)
-Evaluate response to anticoagulant therapy w/ coumadin
-Identify pts. who may be prone to bleeding during surgical, dental, or invasive procedures
-Monitor for effects of liver disease, protein deficiency, fat malabsorption on hemostasis
-Prothrombin is a vitamin K-dependent protein produced by the liver; measurement is reported as time in seconds or percentage of normal activity
> 20 secs (in pts. NOT on anticoag. Therapy)
3 x normal control (in pts. on anticoag. Therapy)
S&S: prolonged bleeding from cuts or gums, hematoma at puncture site, hemorrhage, blood in the stool, persistent epistaxis, heavy or prolonged menstrual flow, shock. Monitor VS, unusual ecchymoses, occult blood, severe headache, unusual dizziness, and neurologic changes until PT is w/in normal range.
TX: IM injection of Vitamin K (an anticoagulant reversal agent) |
|
|
Term
|
Definition
<2.0 (for pts. not receiving anticoag therapy)
2.0-4.0 (for pts. receiving tx. for venous thrombosis, pulmonary embolism, and valvular heart disease)
(International normalized ratio – standard used to assist in making decisions regarding oral anticoagulation therapy)
>4 secs (in pts. on anticoagulant therapy) |
|
|
Term
PTT (APTT)
(partial thromboplastin time) |
|
Definition
25-39 secs.
(reference ranges vary with equipment)
*Therapeutic Range: 1.5-2.5 x normal mean (~45-80)
-evaluate response to anticoagulant therapy w/ HEPARIN or coumadin.
> 70 secs
If APTT is <53 seconds in a pt. receiving heparin therapy, low value indicates therapy is providing inadequate anticoagulation.
S&S/Monitoring: SEE PT
TX: Administration of protamine sulfate may be indicated (heparin reversal) |
|
|
Term
|
Definition
Therapeutic Dose:
0.5-2.0ng/mL
Recommended collection time: 12-24 h after dose (trough)
>20 mcg/mL
S&S of toxicity: double vision, nystagmus, lethargy, ataxia, confusion, nausea, slurred speech, dizziness, CNS depression, and possible coma.
Interventions: airway support, EKG monitoring, administration of charcoal, gastric lavage w/ warm saline or tap water, administration of saline or sorbitol cathartic, and d/c medication. |
|
|
Term
Dilantin Level
(Phenytoin) |
|
Definition
Therapeutic Blood Levels:
10-20 mcg/mL
(in pts. with normal serum albumin and renal function)
>20 mcg/mL
S&S of toxicity: double vision, nystagmus, lethargy, ataxia, confusion, nausea, slurred speech, dizziness, CNS depression, and possible coma.
Interventions: airway support, EKG monitoring, administration of charcoal, gastric lavage w/ warm saline or tap water, administration of saline or sorbitol cathartic, and d/c medication. |
|
|
Term
|
Definition
Normal
pH: 7.35-7.45
pCO2: 35-45 mmHg
pO2: 80-95 mm Hg
HCO3-: 22-26mEq/L
O2 Sat: 95-100%
Abnormal
pH < 7.20 pH >7.60
HCO3- <10 HCO3- >40
pCO2 < 20mm Hg > 67mm Hg
pO2 < 45 mm Hg |
|
|
