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Lab values

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Napa Valley College  Associate Degree Program in Nursing

Lab Values & Diagnostic Test Results Signifigence/Trend of Lab Test

Nursing Actions

Name Nam e of Test Test Norm Normal al Ra Rang nge e

Na

134-144 mmol

K

3.6-5.3 mmol

Cl

98-107 mmol

CO2

22-30 mmol

Na is a major cation of ECF and has a water  retaining effect. It is part of the NA/K pump. Its functions are to maintain body fluid, conduction of  neuromuscular impulses, and enzyme activity K is a major ICF cation. It is part of the NA/K pump. The ECF/ICF ECF/ICF ratio of K is the major factor  in resting membrane potential of nerve and muscle cells and effects neuromuscular and cardiac function K has a narrow range and 80-

Observe S/S Hyperkalemia: Bradycardia, abd cramps, oliguria, anuria, tingling, twitching, numbness Renal function: UOP should be 25ml/hr or 600 ml/day; less may cause hyperkalemia hyperkalemia

90% is excreted in the urnine, so it needs to monitored closely. When there is tissue breakdown K leaves the cells and enters the ECF, in there is adequat reanal fucntion it is excreted if  not levels rise. High: Acute renal failure, metabolic acidosis, oliguria, anuria High/Drugs: Diuretics (K sparing), antibiotics,

Report: >5.0; restriction may be needed, and Kayexelate may be needed. If administering Kayexelate;; Observe S/S Hypokalemia Kayexelate > 7.0 may cause cardiac arrest

Cl is and ECF anion anion important in ma mainatining inatining body water balance and acid base balance. CO2 determines metabolic acid-base abnormalites. If CO2 is low HCO3 is lost resulting in metabolic acidosis. If CO2 is high HCO3 is retained resulting in metabolic alkalosis.

 

Ca functions to transmit nerve impulses, myocardial contraction, blood clotting, formation of teeth and bones, and muscle contraction. It has a reciprocal realtionship to phosphorus and both are regulated by PTH. Low: Malabsorption,, lack of intake, hypopara Malabsorption hypoparathyroidism, thyroidism, chronic renal failure/phoph failure/phophate ate retention, laxative abuse, chronic infections, burns, pacreatitis, alchoholism, diarrhea, pegnancy

Ca Mg

2.13-2.55 mmol 1.51.5-2. 2.5 5 meq meq

Low: Observe for S/S of teteny/hypocalcemia: muscular twitching, tremors, sasms of larynx, paresthesia, facial spasmss, saspmodic contractions Observe for positive Chvosteks's and Trousseau's signs Observe when client is recieving citrated blood, may prevent ionization Digoxin: Hypercalcemia enhances Dig toxicity: N/V, anorexia, bradycaardia  Administer IV Ca gluconate slowlly with D5W not NS, sodium promotes Ca loss. Ca should not be given with solution containing

Ab Abor orbe bed d in sm smal alll in inte test stin ine ea and nd ex excr cret eted ed by the the Low: Check serum K, Na, Ca, and Mg. If  kidneys. Magnesium influences use of k, Ca, and hypokalemia is present K supplementation supplementation will protein.With hypomanesemia there will usually be fully correct until Mg levels are corrected. a k and Ca defecit. Mg is needed for  neuromuscular activity. Mg activates many enzymes needed for carbohydrate and protein metabolism. Low: Protein malnutrition, malabsorption, chirrosis of  liver, alchoholism, hypoparathryoi hypoparathryoidism, dism, hyperaldosteronism, hyperaldo steronism, hypokalemia, IV soultions without Mg, chronic diarrhea, bowel resection complications, dehydra dehydration. tion.

Observe for S/S Hypomagnesemia: Teteny; Twitching, tremors, carpopedal spasm, generalized generalize d spacticity. Restlessness, confusion, dyrythmias Digoxin: Hypomagnesemia enhances Dig toxicity: N/V, anorexia, bradycardia Renal: Mg is excreted by kidneys, Assess when giving MG supplementation supplementation EKG: A flat or inverted inverted T wave may indicate hypomagnesemia or hypokalemia IV slowly to prevent flushed Mg: IV CaAdminister gluconatae should be available to feeling. prevent hypermagnesemia. Ca antagonizes the sedative effect of Mg. High: Monitor: UOP, effective UOP >750 ml/day

Phos

1.7-2. 1.7-2.6 6m meq/ eq/L L

P is the princi principal pal ICF ani anion on an and d iis s impor importan tantt in in enzyme activity for energy transfer. It has a recriprocal realtionship to calcium. Both are regulated by PTH. Low: Starvation, malabsorption,

Low: Check serum levels of phospphorus, calcium, and magnesium. Elevated calcum can decrease phophorus. Observe S/S Hypophosphatemia: Anorexia, pain in muscle and bone

hyperparathyroidism, hypercalcemia, hyperparathyroidism, hypomagnesemia, hypomagn esemia, chronic alcholholism, Vit D dec=ficiency, diabetic acidosis, cont. glucose IV, NG suctioning, vomiting.

Teach: Foods rich in phosphorus: meats, milk, whole grain cereal, almonds Do not take: Antacids with aluminum hydroxide, bin binds ds with with ho hos s ho horus rus..

 

Gluc BUN

70-110 mg/dl 55-25 25 mg/d mg/dll

Cr

0.5-1. 0.5-1.50 50 m mg/d g/dll

GFR

90-120

Hgb

F: 12-15 g/dl M: 13.5-18 g/dl

Hct

F: 36-46% M: 40-54%

Glucose is stored as glycogen is liver or skeltsl muscle. Insulin is needed to transport glucose into cells. Glucagon is neede to convert glycogen to glucose. BU BUN N iis s an an end end pr prod oduc uctt o off p pro rote tein in meta metabo boli lism sm.. It It is is High: Compare with Cr; In renal disease both monitored to detect renal disorder or dehydration. BUN and Cr will be elevated VS High: Dehydrat Dehydration, ion, high protein intake, renal and UOP: Q8 hours S/S failure, kidney disease, GI bleed, sepsis, AMI, Dehydration: Poor turgor, Increased P and RR, DM, licorice dry MM, decrease UOP<25 ml/h S/S methyldopa, a, High/Drugs: Diuretics, antibiotics, methyldop Overhydration: Renal disorder; Dyspnea, JVD, sulfonamides, propranolol, morphine, lithium, peripheral edema, puffy eyelids, weight gain salicylates I &O's Cr is is a by pro produc ductt of of mu muscl scle e ca catab taboli olism. sm. It is is excreted by the kidneys and is a more specific indicator of renal function than BUN. It is not influenced by diet or fluid intake.

High: Acute/chronic renal failure, shcok, diabetic neuropathy, CHF, AMI, diet High/Drugs: Antibiotics, ascorbic acid, methyldopa,, lithium methyldopa Estimates how much blood passes throught the filters in the kidneys k idneys each minute. Oler people will have lower GFR rate because is decreases with age. Low: >60 for 3 months or more indicated chronic renal faillure Hgb is the iron protein of RBC that is the 02 carrier. Low: Anemia, kidney disease, excess IV fluids Low/Drugs: Antibiotics, ASA, sulfonamides Hct measures concentration of RBC in blood. Low: Acute blood loss, anemias, chronic renal failure, chirosis of liver, malnutrition, vitamin B/C defficiencies Low/Drugs: PCN, chloramphenicol .

High: Compare to BUN; BUN; In renal disease disease both BUN and Cr will be elevated High diet: Limit beef/poultry

Encourage nutrition. Promote energy conservation and safety. Observe S/S Anemia: Dizziness, weakness, tachycardia, dyspnea at rest. Compare with Hct. Encourage nutrition. Promote energy conservation and safety. Observe S/S Anemia: Dizziness, weakness, tachycardia, dyspnea at rest. Observe S/S Shock: Vs changes;tachycardia, changes;tachycardia, tachypnea, tachypne a, decreased BP. Compare with Hgb.

 

Plt

150,000-400,00ul

Montior platelet count with bleeding episodes. Plts are the blood component that promotes Observe S/S Bleeding: Purpura, petechiae, coagulation. Low levels are associated with hematemesis, reactal bleeding bleeding. High levels are associated with clotting. Teach: Clent to avoid injury Low: Idiopathic thrombocytopenic purpura, aplastic anemia, liver disease, kidney disease, uremia

Low/Drugs: ASA, Heparin, sulfonamides, diuretics. Alb

3.5-5.0 g/dl

Low assess: Peripheral ascites/edema  Alb is a plasma protein protein synthe synthesized sized by tthe he liver. It Teach: Foods rich in protein is important in maintaining vascular fluid levels in the vessels by oncotic pressure. Decreases with cause fluid shifts and edema. Low: Chirrhosis of liver, acute liver failure, severe burns, sever malnutriton , malnutriton , reanal disorders, ulcerative colitis, prolonged immobilization , immobilization , proetein-losing enteropathies, malabsorption Low/Drugs: PCN, sulfonamides, ASA, ascorbic acid Client is elderly, has ALZ, and had a ruptured bladder  and rectal hematoma. Most Most likely due to poor  nutrition and blood loss. Also very likey long immobilization too. Enzyme found in heart muscle, liver, skeletal muscle, kidneys, pancreas. High levels are found after MI and in liver disease. Often compared with  ALT. Low: Pregnancy, diabetic ketoacidosis, Vit B6 defficiency(berib defficiency(beriberi), eri), Malabsorption,, malnutrition, poor diet, diet low in Malabsorption foods with nitrogen, Fever, Severe diarrhea

Ast

8-38

ALT

10-35

Enzyme in liver cells. Used to detect hepatocellularr destruction hepatocellula defficiency(beriberi), Malabsorption, Low: Vit B6 defficiency(beriberi), malnutrition, poor diet, diet low in foods with nitrogen, Fever, Severe diarrhea

Alk Phos

42-136

Enzyme pr produced ma mainly iin n lliiver a an nd bo bone, a allso iin n intestine, kidney and placenta. Used to measure liver or bone disorder.

 

Tbili

0.10.1-1. 1.2 2 mg mg/d /dll

WBC

4.3-10.8

RBC

F: 4.0-5.0

Prod Produc uctt of b bre reakd akdow own n of H Hgb gb c car arri ried ed tto o li live verr and and excreted in bile. Used to m onitor biliruben levels assocaited with jaundice and to measure liver  disorder. W BC BC's ar are part of tth he body's de defense mechanism an respond to infection. High: Acute infection High/Drugs:  Asa, antibiotics, gold gold compounds, procainamide, triamerene, allopurinol, potassium iodide, hydantoin hydanto in derivatives, sulfonamides, heparin, difitalis, epinepherine, lithium Monitors RBC count. Low: Hemorrhage, anemia, chronic infection, chronic renal failure, Overhydratio Overhydration n

High assess: VS, S/S infection: Fever, increased pulse, RR, leukocytoiss Teach: Some medications can cause cause agranulocytoiss agranulocytoiss or  leukopenia Leukopenia: Avoid contacts with contagious persons due to reduced resistance to colds or infections

Low assess: Blood loss, renal insufficiency, chronic infection Assess S/S Iron deficiency Anemia: Fatigue, pallor, dyspnea dyspnea on exertion, tachcardia, tachcardia, HA Chronic S/S: Cracked corners of mouth, smooth tounge, dyphagia, numbness/tinbling extremeties Teach: Client to eat foods rich in iron: Liver, red meats, freen vegetables, iron-fortified breads Iron supplements: Teach client stools may be dark. Take with meals. Milk/antacids interfere with absorption.

M: 4.6-6.0

PT

10-13 sec

INR

2.0-3.0

PTT

60-70 sec

Fibrinogen

200-400 mg/dl

Pt is a precusor to clotting process. Measures clotting ability. Increase/Prolonged: Liver disease, factor  deficiencies, leukemias, CHF Increase/Prolonged/Drugs: Anticoagulants, antibiotics, ASA, sulfonamides, pheytoin, pheytoin, chlorpromazine, chlordiazepoxide, methyldopa, methyldopa, mithramycin, resperine

Monitor anticoagulation anticoagulation therapies. Hold per MD Observe S/S Bleeding : Purpura, petechiae, hematemesis, reactal bleeding. Record and report Vitamin K per MD; when PT is>40 Teach: No self medicate, many OTC drugs may effect anticogulants anticogulants

 

Alb

BNP

Troponin I

3.5-5.0 g/dl

<100 <100 pg pg/m /mll

0.1-0.5 ng/ml

Low assess: Peripheral ascites/edema  Alb is a plasma protein protein synthe synthesized sized by tthe he liver. It Teach: Foods rich in protein is important in maintaining vascular fluid levels in the vessels by oncotic pressure. Decreases with cause fluid shifts and edema. Low: Chirrhosis of liver, acute liver failure, severe burns, sever malnutriton , malnutriton , reanal disorders, ulcerative colitis, prolonged immobilization , immobilization , proetein-losing enteropathies, malabsorption Low/Drugs: PCN, sulfonamides, ASA, ascorbic acid Client is elderly, has ALZ, and had a ruptured bladder  and rectal hematoma. Most Most likely due to poor  nutrition and blood loss. Also very likey long immobilization too. Neur Neuroh ohor ormo mone ne in ca card rdia iac cv ven entr tric icle les s inc incre reas ases es in High assess S/S HF: Dyspnea, cough, edema response to volume exapnsion and pressure Teach: Report increased SOB, edema, cough. overload. Used to diagnose HF Follow up with MD. Take medications as High: HF, L ventricular hypertrophy hypertrophy,, myocarditis, prescribed. Early rejection of transplants, Acute MI, renal failure Protein enzymes in heart and skeletal muscle Within normal limits-Continue to monitor  released to blood stream 1-3 hours after onset of  MI symptoms. More specific to acardiac injury that CPK-MB

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