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7/29/2019 Compiled Lab Values
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LAB NORMALVALUE
PURPOSE ABNORMAL
SERUMAMYLASE
25 TO 151SOMOGYIUNITS =
53 TO 123
PANCREASFXN
HIGH
HGB FEMALE 12 TO 15 O2 CARRYING LOW
HGB MALE 14 to 18 INCRESAED are dehydrationand polycythemia,
DECREASED overhydrationand anemia.
HEMATOCRIT FE 36 TO 48 INCRESAED are dehydrationand polycythemia,
DECREASED overhydrationand anemia.
HEMATOCRITMA
42 TO 52 VALUES DEPEND ON SOURCE
PLATELETS 150,000 TO400,000
SODIUM 135 TO 145
POTASSIUM 3.5 TO 5 Notify physician if level greater than 5.5 mEq/L, and prepare totreat hyperkalemia.
CALCIUM 8.6 TO 10MAGNESIUM 1.6 TO 2.6
PHOSPHORUS 2.7 TO 4.5
CREATININEMALECREATININEFEMALE
0.6 TO 1.3
0.5 TO 1.0;
0.7 to 1.4
RENALFUNCTION,betterdeterminant ofkidney functionbecause it doesnot vary withprotein intake
and metabolicstate
Serum creatinine increases withdecreased kidney function.
BUN 10 TO 20 End product of metabolism ofproteins frommuscles anddietary intake
BUN level varies with urineoutput.
Increased BUN decreasedrenal function, GI bleeding,dehydration, increased proteinintake, fever, sepsis
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Decreased BUN END stageliver failure, low protein diet,starvation, pregnancy
URINE SPECIFIC
GRAVITY
1.016 TO
1.022
KIDNEYS
ABILITY TOREGULATEFLUIDBALANCEINDIRECTMEASURE OFTHE AMOUNTOF PROTEIN INTHE URINE
ELEVEATED
PROTEIN IN URINE
BUN/CREATININE
RATIO
10/1 TO15/1
RENALDISEASE
KIDNEYFUNCTION
< 10/1 LOW UREACONCENTRATION
>15/1 KIDNEY DYSFUNCTION
SERUMAMMONIA
10 TO 80 LIVERFUNCTION
SERUM
PROTEIN NOTALBUMIN
6 TO 8
SERUM LIPASE 10 TO 140
NORMALRANDOMFASTING
GLUCOSE
70 TO 110
ORAL GLUCOSETOLERANCETEST
NORMALVALUES
120 MIN
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DrugsPregnancy
or prehypertension
BNP < 100 Heart damagedue to stretchingof myocardium
Determinant ofCHF
100 to 300 mild CHF300 to 600 moderate CHF> 600 severe CHF
TOTALCHOLESTEROL
> HIGH CAD
10% decrease in total cholesterolresults in 30% decrease for risk of
CAD
LDLs
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HDLS > 40 MEN> 50WOMEN
When it comesto HDLcholesterol goodcholesterol
the higher thenumber, thelower your risk.
60 and above High;
Optimal cardioprotective +
associated with lower risk
Goal
Men > 45; Women > 55
Less than 40 in men and less
than 50 in women Low;
considered a risk factor for
heart disease
Weight reduction and exercise
can increase HDLsTRIGLYCERIDES 100
1. Abdominal obesityMen 40 inches or more
Women 35 inches or more
2. hypertriglyceridemia
3. low HDLs
4. High blood pressure
5. high fasting blood
glucose
6. elevated CRPGLUCOSE
FASTING
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6 Greater than 200=
HGB A1C < 5.0 6.5%
Diabetes
HEMOGLOBINA1C > 8INDICATESVERYPOOR/NOCONROL OVERTHEIR BLOODGLUCOSE &DIABETES
PREDIABETES= VALUES 5.7TO 6.4
Criteria for DiagnosisSymptomatic patient with one
Fasting plasma glucose >= 7.0
mmol/LFasting plasma glucose >= 7.0mmol/LRandom plasma glucose >=
11.1 mmol/LIf there are no symptoms then
you need two separatereadings on different days
CRP < 1 > 3 high risk
1.0 to 3.0moderate risk
High CRP is associated with heartdisease, systemic inflammationassociated with atheriosclerosis
WBCS 4500 TO11,000
CARBAMAZEPINE CANDEPRESS WBC COUNTS
NEUTROPHILS 1800 TO
7800AST LIVER
FUNCTIONVIRAL HEPATITIS LOWERED
VANCOMYCINTITERS 30 TO 40
MCG/ML
PEAK SERUMMEASURED 1.5HOURS TO 2.5HOURS AFTERTHECOMPLETED IVINFUSION
NEPHROTOXICITY ANDOTOTOXICITY
DILANTIN
THERAPUETICSERUM
10 TO 20
MCG/ML
< 10 RISK FOR SEIZURE
> 20 TOXICITY
THEOPHYLLINETHERAPUETIC
10 TO 20MCG/ML
< 10 EXCERBATERESPIRATORY DISORDER
DIGOXINTHERAPUETIC
0.5 TO 2.0
BLOOD pH 7.35 to 7.45
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paCO2 35 to 45 ELEVATED CO2 LEVELS
OCCURS WITH LOWER pHrespiratory acidosis
HCO3 22 TO 26 ELEVATED HCO3 OCCURSWITH HIGHER pH metabolic
alkalosisLOW HCO3 Metabolic acidosis
FIBRINOGENFEMALES
190 TO 420 TENDENCY TO BLEED, DIC
FIBRINOGENMALES
180 TO 340 TENDENCY TO BLEED, DIC
SCHILLING TEST DETERMINEPERNICIOUS
ANEMIA
INCREASED
RBC COUNT
DECREASED
CARDIACOUTPUTIMPAIREDPULMONARYGASEXCHANGECORTICOSTEROID THERAPYPOLYCYTHEMI
A VERA,SEVERE
DIARRHEA,DEHYDRATION
INCREASEDPLATELET
AGGREGATION
NORMAL
LESSTHAN 5MINUTES
INCREASEDPLATELET
AGGREGATIONOCCURS
AFTERSURGERY,
ACUTEILLNESS,VENOUS
THROMBOSIS DVT,PULMONARYEMBOLISM
ESRERYTHROCYTESEDIMENTATION RATE
< 30NORMAL30 TO 40MILD
AUTOIMMUNE
DISEASEDEGREE OFINFLAMMATIO
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INFLAMM40 TO 70MODERATE INFLAMM70 TO 150
SEVEREINFLAMM
N,CONNECTIVETISSUEINFLAMM;RHEUMATOID
ARTHRITIS
PTPROTHROMBINTIME
FEM 9.5 TO11.3MALE 9.6TO 11.8
ASPIRINTHERAPYBLEED TIME
DECREASED PT VALUEARTERIAL OCCLUSION,DVT, EDEMA, MI, PERIPHERALVASCULAR DISEASE,PULMONARY EMBOLISM
Right Sided HFback up in SVCand IVC
COPD,emphysema
Liver and kidneyfailure
dependent edema
jugular distension
englarged liver
anorexia/nausea
distended abdomen, ascites portal hypertension
abdominal pulsesmeasureable
swollen arms,hands
nocturia, polyuria
weight gain
high or low blood pressure
elevated BUN and creatinine
kidney failure
ATRIAL FIBRILLATIONLeft Sided HF
Ejection fraction
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obtained andrecorded. A 1-kgweight gain isequal to 1000 mLof retained fluid.
risk Orthnopia trifold position
Paroxysmal nocturnal dyspnea(PND)
ATRIAL FIBRILLATION
Ventricular tachycardia
Angina Decreased LOC
Respiratory acidosis
JC core measuresfor pneumonia
Dropletprecautions
Gown, mask,eye shield,gloves
Communityacquired < 48hours afteradmission
Hospitalacquired/ventilator aquired > 48hours afteradmission
Bacterial moreserious than
viral
Get ABGs inaddition to O2
saturation more accurate
2. blood culture before antibiotic3. antibiotic within 4-6 hrs4. documentation of smoking
cessation teaching to patient5. patient given pneumococcal
vaccine + influenza vaccine6. arranged appointment for
follow up
Admission:
Fever > 100.4
Altered LOC, esp 70 yrs orolder
New onset or worseningcough
Prurulent sputum, change insputum
Dyspnea or tachypnea
Rales or bronchial breathsounds
02 sat
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day for at least6 months, or 3to 6 monthsafter negativesputum
True diagnostic for TB QFTgold blood test results within 2 hrs
airborne isolation n95
exposed ppl prophylaxis ofINH for 6 months
abnormal Xray orimmunosuppressed/HIV prophylaxis of INH for 12months
COPD ChronicBronchitis
If perfusion 3months
Eventual lungchanges result
in brochectasisand emphysema
Hypoxia, hypercapnia, respiratoryacidosis, digital clubbing,
cardiomeagly, cor pulmonaleright sided heart failure LATE indisease , increased risk forrespiratory infectionBLUE BLOATER
COPDEmphysema
If perfusion
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absorbed when taken with food.Other statins such as Prvacholand Zocor can be taken withoutregard to food intake. However,all the statin drugs can cause
adverse GI effects such ascramps, diarrhea, constipation,flatus and heartburn, andgenerally taken with evening mealor bedtime.
Liver damage check LFTs
Muscle pain/damageRhabdomyolysis can causesevere muscle pain, liver damage,kidney failure and death
24 HOUR URINE COLLECTION SPECIMEN PLACE IN THE REFRIDGERATOROR THE BACTERIA AND WBCS IN THE URINE WILL DECOMPOSE AND UNABLETO MEASURE, PRESERVES THE ELEMENTS OF THE URINE, IF LEFTUNREFRIDGERATED THE URINE BREAKS DOWN TO AMMONIA AND BECOMESMORE ALKALINE
24 HOUR URINE COLLECTION IS TIMED, QUANTITATIVE MEASUREESSENTIOAL TO START TEST WITH AN EMPTY BLADDER
AT START TIME ASK PATIENT TO VOID, DISCARD THE SPECIMEN = BLADDER
NOW EMPTY, AND NOTE THE START TIME. COLLECTION STARTS AFTER THISVOID AND TIME. IN BETWEEN COLLECTIONS PLACE THE URINE SPECIMEN ONICE OR REFRIDGERATE IT, AND AT THE END OF COLLECTION (24 HOURS) HAVEPATIENT VOID ADDING THIS TO THE COLLECTION.FIFTEEM MINUTES BEFORE THE END OF COLLECTION TIME THE PATIENTSHOULD BE ASKED TO VOID AND ADD THIS SPECIMENT TO THE COLLECTION
CLEAN CATCH SPECIMEN HAVE PATIENT CLEANSE LABIA/PENIS USINGTOWELS THEN HAVE THEM VOID INTO THE STERILE SPECIMENT CONTAINER
GROSS HEMATURIA AND PROTEINURIA CLASSIC SIGNS OF
GLOMERULONEPHRITIS
THROAT CULTURE MUST BE REFRIDGERATED IF CANNOT BE ANALYZEDWITHIN 1 HOUR
CHRONIC CARRIER STATE OF HEPATITIS POSITIVE FOR HEPATITIS B
SURFACE ANTIGEN (HBsAG) CHRONIC CARRIERS
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Anti-HBs ANTIBODY TO SURFACE ANTIGEN MARKER FOR RESPONSE TOTHE VACCINE AND INDICATES IMMUNITY TO HEPATITIS B
Labs for bleeding and clotting timesLets look at the three tests used to determine bleeding or clotting times:
1. Prothrombin Time (PT) this blood test measures how long ittakes blood to clot and can be used to check for bleeding problems.
An abnormal PT/INR can be caused by liver disease; injury; lack of
vitamin K; or treatment with blood thinners.QUIZ YOURSELF: Which blood thinner are we talking about here?(answer below).
2. International Normalized Ratio (INR) is a standardized wayto report results of bleeding time. It is used in place of PT; in fact, some
labs will only report INR.
3. Activated Partial Thromboplastin Time (APTT)* this blood
test also measure the time it takes your blood to clot and to helpdiagnose bleeding problems.
An abnormal APTT can be caused by bleeding disorders (such as
hemophila); liver or kidney disease; or treatment with bloodthinners.QUIZ YOURSELF: Which blood thinner are we talking about here?(answer below)
Therapeutic Lab ValuesLets look at these same lab tests once again.
PT & INR If you answered warfarin (Coumadin) to the first question
above, you were correct! How much warfarin the person is prescribeddepends on the prothrombin time (or INR). The therapeutic value ofPT is about 1.5 to 2.5 times the normal value; the therapeutic valueof INR is 2 to 3 times the normal value.
Test Normal lab value Therapeutic lab value
Prothrombin time (PT) 11 13 seconds 15.5 35 seconds
International normalized ratio
(INR)
0.8 1.1 2 3
APTT If you answered heparin for this test, you were correct! As
with the PT/INR test, the heparin dose is changed so that the APTT
result is about 1.5 to 2.5 times the normal value.How can you remember if APTT is used for heparin or warfarin? I always
remember APTT has 2 sticks (the Ts), and there are 2 sticks in the H in
HEPARIN its stuck with me all these years.
Test Normal lab value Therapeutic labvalue
Activated Partial thromboplastin 30 40 seconds 45 100 seconds
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time (aPTT)
Applying this informationSo, lets say you are caring for a client taking warfarin (for example,
following total hip replacement surgery). This means that when you look at
the labs for this client, you want to see longer bleeding times or, essentially
abnormal values. The idea here is to prevent blood clots from forming.
For heparin therapy, you are caring for a client who is on IV heparin
(admission diagnosis is deep vein thrombosis). When you look at the labs for
this client, you also want to see longer bleeding times.
Keep in mind that if the number is too high for either client, you should start
watching for signs of spontaneous bleeding and the dosage should be
decreased. Another key point to remember, these tests should be done atthe same time of day every day while the client is hospitalized.QUIZ YOURSELF: What are the antidotes for reversing the effects ofheparin? And for warfarin?(Watch for the answer below.)**
Now its your turnAre there any other topics you would like me to discuss in an upcoming blog?
*Are you wondering if it's PTT or APTT? PTT was first used in the early 1950s
and was replaced by APTT in the 1970s.
** The antidote for reversing the effects of heparin is... protamine
sulfate. The antidote for reversing the effects of warfarin is... vitamin K. Did
you come up with the correct response without looking?The risk of bleeding increases significantly when the INR is 3or greater.
DASH dietLow saturated fats, low cholesterol, low total fat, LOW SODIUM
Stage 1 HTN < 2400 mg of sodium
Stage 2 HTN < 1500 mg sodiumCan increase K+ in diet though