Lab Values

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bpayton
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245479
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Lab Values
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2013-11-06 17:52:52
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  1. What are the 3 phases of lab testing?
    • 1. Preanalytical
    • 2. analytical
    • 3. post analytical
  2. What part is considered the preanalytical phase.
    • Patient idenification
    • collection
    • processing
  3. What part is considered the analytical phase?
    • maintenance of the machine
    • quality control
    • calibration
    • testing
    • review results
  4. What part is considered post analytical?
    • TAT's
    • critical results
    • advising patients of results
  5. Where do most errors occur with lab testing?
    Preanalytical (what the nurse has to do)
  6. What labs are looked at in a complete blood count (CBC)?
    • WBC
    • RBC
    • HGB
    • HCT
    • MCV
    • MCH
    • MCHC
    • Platelets
  7. What color EDTA Anticoagulant top are the CBC collected in?
    Purple top
  8. What else is also included in a CBC result?
    automated differentials of the different types of WBC and classifying them as a percentage of the total white blood count.
  9. Why is the CBC ran in an EDTA anticoagulant tube?
    Prevents the clotting factors from being used up.
  10. After the tube is spun in the centrifuge, what is the results of the blood?
    Liquid part at the top is plasma and full of clotting factors and the remaining is whole blood.
  11. Which age group has the highest values during their lifetime, except for their platelet count which remains the same throughout life.
    INFANTS
  12. Which gender has a higher RBC, HgB, and Hct count?
    Men
  13. What is the normal range for WBC?
    4-11 thousand
  14. What is the normal range for RBC?
    4-6 million
  15. What is the normal range for HGB?
    12-17 gm
  16. What is the normal range for HCT?
    36-55 %
  17. What is the normal range for platelets?
    150-400 thousand
  18. If a patient has a WBC count of 2 thousand what could be the cause of this?
    • viral infection
    • radiation
    • chemotherapy
  19. If a patient has a WBC count of 13 thousand what could be the cause?
    • bacterial infection
    • Leukemia
    • a chronic condition
  20. If a patient has a RBC count of 1 million what could be the cause?
    • Anemia
    • Internal bleeding
    • Chronic illness
  21. If a patient has a RBC count of 8 million what could be the cause?
    • Polycythemia
    • Neonate, high altitude
    • Dehydration
  22. If a patient has a HGB count of 19 gm what could be the cause?
    • Patient is an infant and more likely a male
    • Dehydration
  23. If a patient has a HGB count of 10 gm what could be the cause?
    • Iron deficiency
    • Thalessemia
  24. If a patient has a HCT count of 28% what could be the cause?
    • Anemia
    • -iron deficency
    • -thalessemia
    • Leukemia
  25. If a patient has a PLT count of 120 thousand what could be the cause?
    • DIC
    • ITP (idiopathic Thromocytopenia)
    • Alcoholism
    • Liver disease
  26. If a patient has a PLT count of 500 thousand what could be the cause?
    • Splenectomy
    • CGL
    • Polycythemia vera
  27. What is the rule of three for CBC to follow?
    • RBC x 3 = HGB
    • HGB x 3 = HCT/MCHC
  28. What does MCV evaluate?
    average size of RBC (micro/macrocytic)
  29. What does MCH evaluate?
    average amount of hemoglobin
  30. What is the normal range for Neutrophil?
    40-60%
  31. What is the normal range for Lymphocyte?
    30-50%
  32. What is the normal range for Monocyte?
    3-7%
  33. What is the normal range for Eosinophil?
    1-3%
  34. What is the normal range for Basophil?
    0-1%
  35. What could be the cause of a neutrophil level being 80%?
    • acute bacterial infection
    • trauma
  36. What are bands of neutrophils?
    Immature neutrophils released into circulation when neutrophil production is significantly stimulated.
  37. What could be the reason for a lymphocyte level being 60%?
    • chronic bacterial infection
    • acute viral infection
  38. What could be the cause for monocytes level being 10%?
    chronic inflammatory disorder
  39. What could be the cause for eosinophils level being5%?
    • allergic reaction
    • parasitic infection
  40. What could be the cause for basophils level being 3%?
    • no real understanding
    • leukemia
  41. Which labs consist of a Basic Metabolic Panel?
    • Glucose
    • BUN
    • Creatinine
    • Calcium
    • Electrolytes (Sodium, Potassium, Chloride, CO2)
  42. Which color top is the BMP collected in and what is in the tube?
    Green top/ has heparin anticoagulant because the heparin doesn't interfere with the test and so the blood doesn't clot.
  43. What are the normal ranges for Glucose?
    70-110 mg/dl
  44. What are the normal ranges for BUN?
    7-17 mg/dl
  45. What are the normal ranges for Creatinine?
    0.5-1.2 mg/dl
  46. What are the normal ranges for calcium?
    8.5-10.0 mg/dl
  47. What are the normal ranges for Sodium?
    135-150 mEq/L
  48. What are the normal ranges for Potassium?
    3.5-5.0 mEq/L
  49. What are the normal ranges for chloride?
    95-105 mEq/L
  50. What are the normal ranges for Co2?
    22-32 mEq/L
  51. If a patient has a glucose level of 60 what could be the reason?
    • Endocrine disorder
    • Too much insulin intake
    • Hypoglycemia
  52. If a patient has a glucose level of 185 what could be the reason?
    • Diabetes
    • DKA
    • Stress
  53. If a patient has a BUN level of 5 mg/dl what could be the reason?
    • Severe liver disease
    • Severe vomiting & diarrhea
  54. If a patient has a BUN level of 26 mg/dl what could be the reason?
    • Kidney disease
    • High protein diet
    • Dehydrated
  55. If a patient has a CREAT level of 0.2 mg/dl what could be the reason?
    Severe vomiting & diarrhea
  56. If a patient has a CREAT level of 2.4 mg/dl what could be the reason?
    • Kidney disease esp. at the glomerlus
    • Renal impairment
  57. If a patient has a calcium level of 6.5 mg/dl what could be the reason?
    • Renal disease
    • Hypoparathyroidism
  58. If a patient has a calcium level of 13.0 mg/dl what could be the reason?
    • Hyperparathyroidism
    • Hyperthyroidism
    • Bone disease
  59. If a patient has a Sodium level of 127 mEq/L what could be the reason?
    • Kidney, Liver, or Heart disease
    • Vomiting
    • DKA
    • Adrenal insufficiency
    • Hyponatermia
  60. If a patient has a sodium level of 162 mEq/L what could be the reason?
    • Excess water loss (dehydrated)
    • Diabetes insipidus
    • Sweating
    • Hypernatermia
  61. If a patient has a potassium level of 2.8 mEq/L what could be the reason?
    • vomiting/diarrhea
    • malabsorption
    • thiazide and loop diuretics
    • Cushing's disease
    • Alkalosis
    • hypokalemia
  62. If a patient has a potassium level of 8 mEq/L what could be the reason?
    • Kidneys disease
    • Addison's disease
    • Dehydration
    • Hemolysis
    • Acidosis
    • Hyperkalemia
  63. If a patient has a chloride level of 85 mEq/L what could be the reason?
    • Same as Sodium because it follows sodium passively
    • Kidney, Liver, or Heart disease
    • Vomiting
    • DKA
    • Adrenal insufficiency
  64. If a patient has a chloride level of 115 mEq/L what could be the reason?
    • Loss of bicarbonate ions
    • Same as sodium
    • Excess water loss (dehydrated)
    • Diabetes insipidus
    • Sweating
  65. If a patient has a 20 mEq/L level of HCO3 what could be the reason?
    • Metabolic acidosis
    • Hyperventilation
  66. If a patient has a 37 mEq/L level of HCO3 what could be the reason?
    • Lung disease
    • Pneumonia
    • Metabolic alkalosis
  67. Which electrolyte is the major extracellular cation?
    Sodium and Chloride
  68. Which electrolyte is the major intracellular cation?
    Potassium
  69. What is CO2 and how is it usually obtained?
    CO2 is a gas and when dissolved in H2O it is HCO3 and that is what the lab test and it is obtained by the ABG.
  70. Which drugs have to be monitored for therapeutic range?
    • Vancomycin
    • Amikacin
    • Gentamicin
    • Tobramycin
    • Carbamazepine
    • Digoxin
    • Phenytoin
    • Valproic acid
    • lithium
    • phenobarbital
  71. When are the trough levels of a drug drawn?
    Just before the next dose is given
  72. When are the peak levels drawn for a drug?
    1 hour after the dose is given
  73. Why is knowing the peak level important?
    Peak level needs to be within therapeutic range because if its not if its above level it can become toxic and if its below its not therapeutic.
  74. Which labs are looked at for coagulation studies?
    • PT-Coumadin drug
    • PTT- heparin drug
    • Fibrinogen
    • D-dimer
    • Special coagualtions
    • -factor assays
    • -lupus antiocagulant
    • -protein C & S
    • -Factor Xa
  75. Which color top is used for collection of coagulants and what is significant about the way you collect?
    Blue top/ must allow the vacuum to fill completely in order to get the 1/9 ratio of anticoagulant to blood for accurate results.
  76. What are the normal results for PT (prothrombin time)?
    11-13 seconds
  77. What are the normal results for aPTT (activated partial thromboplastin time)?
    23-33 seconds
  78. What are the normal results for fibrinogen?
    200-400 mg/dl
  79. What are the normal results for d-dimer?
    <0.5 ug/ml
  80. Which labs are ordered when testing Coumadin therapy?
    PT/INR
  81. Which labs are ordered when testing heparin therapy?
    aPTT/PTT
  82. What is fibrinogen evaluating?
    Quantitative amount of protein
  83. What is d-Dimer evaluating?
    The fragment of the fibrin clot after it is broken down. Diagnose pulmonary emboli and DVT.
  84. Using d-dimer how do you asses for a positive or negative result?
    • If the test is negative the client DOES NOT have a PE or DVT. If the test is positive the client MAY OR MAY NOT have a PE or DVT.
    • IT HAS A NEGATIVE PREDICTIVE VALUE MEANING ONLY A FOR SURE ANSWER IS WHEN THE RESULTS OR NEGATIVE.
  85. What is the normal value of INR?
    2-3.5
  86. What is does the INR tell you and why is it important?
    INR is used for patients on Coumadin and its a calculation of their PT test. Its important because it allows a doctor to make a decision about a patients Coumadin dose no matter where the patient is getting their blood tested.
  87. What is the microbiology testing for?
    • Culture & Sensitivity
    • looking for any pathogen based on the source. the source/specimen should be obtained before antibiotics given.
    • Growth may indicate normal flora
  88. How is a C&S report read?
    • S=sensitive (antibiotic kills it)
    • I=intermediate sensitivity (antibiotic kills it a little)
    • R=resistant (antibiotic wont work)
  89. What things are we looking at in a liver function test?
    • Total Bilirubin=indirect & direct
    • Total protein
    • Albumin
    • ALT
    • AST
    • Alkaline phosphate
    • GGT
    • Amylase
  90. What is the best test that will tell you more specific for liver dysfunction?
    ALT
  91. What lab test is most specific for pancreas function?
    Amylase
  92. Which renal function test is affected by amount of protein a client eats?
    BUN
  93. Which test is best for kidney function?
    • elevated BUN/CREAT
    • GFR

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