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Common Med-Surg Lab Values ABG's *PH (acid) *HCO3 (bicarb) *PaCo2 (carbon dioxide) Electrolytes *Sodium and chloride *Potassium *Calcium/phosphate Renal Function *Blood urea nitrogen *Serum creatinine CBC (Complete blood count) *WBC *HGB/HCT *Platelets Cardiac enzymes *Ck *Ck-mb *Troponin *BNP Liver *Albumin *SGOT/SGPT *bilirubin
BUN/CRNormal BUN/CR=10-15: 1
Blood urea nitrogen (10-20) *Byproduct of protein break down into nitrogen. Why would the level be high? *Body’s inability to eliminate nitrogen through nephrons Serum creatinine (0.8-1.2) *Best indicator for kidney function *lower is better Bun's high and dry Bun's low = wet
Complete blood count (CBC)WBC (white blood cell) range (4,000-11,00) WBC < or = 500, neutropenia Function: kill organisms considered none self (foreign). Mnemonic-Never let monkey eats banana Neutrophil-elevation (left shift) suggested acute bacterial infection
Lymphocytes- fight infection (B-cells and T cells)
Monocyte- elevation suggested of viral infection or parasite infection
Eosinophil-elevation suggested of allergy
nBasophil-elevation suggested of allergyRed blood cellRBC-produce in the bone marrow with the aid of erythropoietin (produce in the kidney)
Hemoglobin (Hgb)-range male 14-16 and female 12-14...how many rbc if < or =7...blood transfusion
Hematocrit-normal range – 3x hemoglobin...how red is the blood
Example Hgb is 9 and Hct is 27
What is the significant of not maintain 1:3 ratio?
Example : if Hgb is 10 and Hct is 27 ..ratio<3 =Hemodilution (too much fluid).
Example: if Hgb is 10 and Hct is 35...ratio >3 =dehydration
Every unit RBC= increase Hgb by 1gmPlatelets
Normal range 150,000-450,000 Functions? *Aide in clotting *Fix damage blood vessels or endothelia What is the significant of having higher platelets? *Clots formation (DVT etc) What is the significant of having lower platelets? *Bruising or bleeding *Know as thrombocytopenia
Cardiac enzymes CK-creatinine kinase
*Byproduct of muscle breakdown. *Elevation signifies muscle injury (gen) *Peak 4-6 hours post injury/insult CK-MB *Specific to cardiac and brain injury if value is elevated Troponin *Sensitive lab value. *Elevation signifies cardiac muscles injury. *Peak 6 hours post injury BNP *measure the stretch of the ventricle. *The higher the values, the more stretch the ventricle is undergoing. *Use to determine CHF (high value)
prime electrolytes Operating System of the PC is Marginal Osmolarity = 270-300 Sodium NA ECF = 135-145 Meq/L Potasium K ICF = 3.5 -5 Meq/L Calcium ECF = 8.5-10 Meq/L Magnesium ICF = 1.2-2.1 Meq/L
hypernatremiaNa level greater than (>145)
significant: cause fluid shift from intracellular to intravascular and causes cellular dehydration (shrink)
Causes: by dehydration, excessive sodium intake or DI (diabetic insipidus)-lack of ADH.
S/S: confusion or seizure
Treatments: what would you do if your blood is too salty? *Administer hypotonic solution *Increase po (water) intake *Give ADH (decrease urine production) and absorbed more water.hypokalemiaPotassium is more intracellular than extracellular
Normal values- 3.5-5.0
Significant? *Aide with cardiac muscle contractility. Less potassium will cause irritability of the cell
and causes arrhythmias.
Causes: * loss of acid and gain in base *vomiting, diarrhea, Nasogastric lavage, excessive insulin usage.
Treatments: *Potassium po/iv *How fast can you give IV= 10Meq/hr *PO < or = 40 Meq/time *for every 10 Meq Kcl, K^0.1 to 0.2
Diet high in potassium? What is diet high in potassium?
Liver enzymes *Albumin (3.4-4.8 g/dL) *SGOT/SGPT (13-40 units/L, 10-40unit/L) *bilirubin (0.3-1.2 mg/dl)
Cardiac enzymes *Ck (36-204 units/L) *Ck-mb (Less than 4–6%) *Troponin (detectable a few hours to 7 days after the onset of symptoms of myocardial damage. **Troponin I Less than 0.35 ng/mL **Troponin T Less than 0.20 mcg/L *BNP (Less than 100 pg/m)
CBC (Complete blood count) *WBC (4500–11000 WBC/mm^3) *HGB (11.4-17.0 g/dL) *HCT (38-49 or 3x HGB) *Platelets (150,000–450,000/mm^3)
Renal Function *Blood urea nitrogen (10–31 mg/dL) *Serum creatinine (0.6–1.2 mg/dL)
Electrolytes Sodium/chloride Potassium Calcium/phosphate
hyperkalemiaCaused changes in electrical charge on the cell membrane and make the cell membrane more irritable
Causes? *A gain in acid and a loss of base (Renal failure (absorb more hydrogen ion in the kidney) *Excessive blood glucose (diabetic ketoacidosis) *Excessive potassium supplement intake without diuretic
Treatments to eliminate potassium? *Give kayexalate-bind with potassium and eliminate through feces. *Give insulin with D50 (dextrose)- insulin acts by binding with glucose and potassium and all three go into the cell- leaving less potassium in the blood stream. *Give sodium bicarbonate-acts by increasing blood pH. **As pH goes up, Potassium will come down. **Watch for s/s of volume overload and CHF *Diuretics *NaHCO3 (sodium bicarb)...binds to K *dialysis
ABG'sPH acid 7.4 alk +/- 0.05 HCo3 acid 24 alk +/-2 PaCo2 Alk 40 acid +/- 5
PaO2 (arterial) 60-100 SaO2 (O2 sat) > 91
ROME RO=Resp opposite ME= metabolic equal
If Ph is in normal range= Com if HCO3 & PaCo2 point same dir = comp