Lab Analysis

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NurseFaith
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258042
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Lab Analysis
Updated:
2014-01-26 14:35:57
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Lab Analysis
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304 Laboratory Analysis
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  1. Factors that Affect Labs:
    Fasting vs. Nonfasting

    Age (the older a person is the less quickly they will be able to excrete a medication from their body)

    • Source:
    •  1. Arterial- femoral, brachial (put on ice!)
    •  2. Venous- venipuncture (most common)
    •  3. Capillary- glucose

    Gender (hemoglobin/hematocrit...men produce more erythropoietin than women)

    Effect of Diet

    Effect of Medications

    "Margin of Error" (the more lab tests done at one time, the higher the chance for abnormal results)

    Variance in Normal Ranges

    • *some lab results will be off if pt has been exercising before hand
    • *always draw up labs BELOW IV 

    *Position of Patient- the longer a pt is supine, the higher the plasma volume

    • COMPARE!!! TRENDS, TRENDS, TRENDS!!!!
    • (compare to admission labs/vitals)
  2. Proper methods to obtain accurate lab results:
    *Do NOT leave a tourniquet on longer than 1 minute (prevent hemoconcentration...also occurs with dehydration)

    *Always draw blood below the IV site (prevent hemodilution)

    *Place specimen being sent (especially from an artery) on ice

    *Handle carefully (prevent hemolysis...also occurs with too small of a needle) 

    *Correct Tube- each tube has different color/additive depending on the test

    *Adequate filling of the tube- "to the line"

    *Proper mixing of the sample and additive- gently rotate upside down, back and forth 7-10x

    *Transport RIGHT AWAY

    *Label correctly- at pt. bedside with name, MRN, date, time, what test, and initials of the person that drew the blood
  3. Discuss the significance of color-coding the blood collection tubes and centrifugation in the processing of laboratory tests
    Each tube is a different color depending on the additive inside...Color signifies the presence and type of additive to either cause or prevent the clotting of a specimen

    • Centrifugation is when whole blood is spun in a centrifuge separating the solid portions of the blood, such as red and white blood cells and other solid particles, from the plasma (liquid portion).  The plasma is thick
    • and rich with dissolved chemicals and other substances such as proteins and
    • other chemicals
  4. Elevated Cell Count
    • Cytois
    • (ex: leukocytosis, thrombocytosis)
  5. Decreased Cell Count
    • Penia
    • (ex: thrombocytopenia, erythropenia)
  6. Decrease in ALL TYPES of cell count
    Pancytopenia
  7. "In the Blood"
    - emia
  8. "Excessive potassium in the blood"
    Hyperkalemia
  9. "Decreased sodium in the blood"
    Hyponatremia
  10. Function of WBC (leukocytes)
    • Fight Infection
    • Phagocytosis
    • Antibodies
  11. Normal Values for WBC
    4.5-10 cell/mm3
  12. Critical Values for WBC
    • <2 or >30
    • (<.5 is often fatal)
  13. Increase in WBC
    • Leukocytosis
    • (Infection, Tissue injury or necrosis (heart attack or stroke, phagocytosis occurs to get rid of that dead tissue), steroids (trying
    • to enhance the immune system), Leukemia, Polycythemia vera
  14. Decrease in WBC
    • Leukopenia
    • (Bone marrow depression (Immunosuppression – cancer/chemo), HIV,  viral infections, Pernicious and Aplastic anemias (no WBC being produced)
  15. WBC differential: Granulocytes
    Neutrophils, Eosinophils, Basophils
  16. WBC differential: Agranulocytes
    Lymphocytes, Monocytes
  17. Neutrophils
    • 50% of Granulocytes
    • Primary defense against infection!
    • Bacterial Infections

    Neutropenia - <1.8 CRITICAL (put patient on reverse isolation to prevent ANY infection)
  18. Eosinophils
    • Allergies and Parasitic Infection
    • (contains histamine)
  19. Basophils
    • Parasitic Infections and some Allergies
    • *Chronic Inflammation
  20. Lymphocytes
    Viral Infections
  21. Monocytes
    • Second line of defense
    • Severe infection and phagocytosis
  22. Agranulocytosis
    MARKED neutropenia and leukopenia
  23. Function of RBC
    • Transport Oxygen and CO2
    • (measured to evaluate anemia or polycythemia vera)
  24. Normal Value of RBC
    • MEN: 5.2- 5.8
    • Women: 3.9-5.1
  25. Increase in RBC
    • Erythrocytosis
    • (Polycythemia vera (abnormal condition
    • where your body produces more RBC, unknown reasons…) high altitudedehydration (hemoconcentration), pulmonary disease (lower oxygen levels
    • and retention of CO2, stimulating them to breathe….body tries to compensate by
    • producing more RBC)
  26. Decrease in RBC:
    • Erythropenia
    • Anemia, hemodilution, renal failure

    • –Decreased production
    • (problem with bone marrow)
    • Blood loss
    • (Car accident? Amputation? GI bleeding? Surgery? Etc…)
    • -Cell Destruction
    • (hemolysis)
  27. Function of Hemoglobin (Hgb)
    O2 and CO2 carrying vehicles on RBC
  28. Normal values of Hgb
    • Men: 13.2-17.3
    • Women: 11.7-15.5
  29. Critical Values of Hgb
    <6 and >18
  30. Increase in Hgb
    Polycythemia vera, CHF, COPD; hemoconcentration (dehydration)
  31. Decrease in Hgb
    Iron, B12, Folic acid deficiencies; hemorrhage; hemolysis; chronic disease; hemodilution (volume excess)
  32. Function of Hematocrit
    Measures the percentage of RBC in whole blood
  33. Normal Hct levels
    • Men: 38-51%
    • Women: 33-45%
  34. Critical levels for Hct
    <20 and >60
  35. Interventions for RBC, Hb, and Hct
    •Assess for S&S of bleeding (tachycardia, hypotension, pallor, dyspnea, hematuria)

    •Assess dietary intake of Fe, Folic acid, B12.

    •Give Fe and MVI supplements as ordered

    •Monitor O2 sat.  Administer O2 prn to keep sat > 92%

    •Teach pts re: foods high in Fe, folic acid, B12.
  36. Function of Platelets
    necessary for clotting
  37. Normal values for Platelets
    150-400k
  38. Critical Value for Platelets
    • <20K could lead to spontaneous bleeding
    • *Monitor Closely if <100K
  39. Increase in Platelets: Thrombocytosis
    • >400K
    • Primary myeloproliferative disease, malignancy, rapid bld regeneration after hemorrhage
  40. Decrease in Platelets: Thrombocytopenia
    • <150K
    • ITP; Drugs (Heparin, Histamine-2 blockers, Aspirin, Plavix); hemodilution (CHF); pernicious, aplastic, & hemolytic anemias; chemotherapy & radiation
  41. Interventions for Platelets:
    -Monitor for Signs/Symptoms of Thrombocytopenia (excessive bleeding, bruising, and petichiae)

    • -Teach to use soft toothbrush, electric razor, fall precautions, report any bleeding
    • or bruising.

    -Hold ASA/Plavix for Plt < 100K
  42. Comprehensive Metabolic Profiles consist of:
    • Basic Metabolic Profile (BMP): 
    • –Na, K, Cl, CO2, BUN, Cr, Glucose
    • –Most facilities:  Ca, GFR

    • Liver Function Tests (LFTs):
    • –AST (Aspartate Transaminase), ALT (Alanine Aminotransferase), Alkaline Phosphatase

    • Other: 
    • –Total Protein,
    • Albumin, Globulin, Total Bilirubin, Mg
  43. Function of Sodium:
    Cation in ECF that maintains water balance and stimulates neuromuscular reactions
  44. Normal Sodium Values
    135-145
  45. Hypernatremia
    • >145
    • -from Dehydration:
    • (N&V, burns, uncontrolled diabetes, sweating, fever)
    • -from Cushing’s
    • -from hyperaldosteronism
    • -from excessive IV fluids with sodium
  46. Hyponatremia:
    • <135
    • -from Volume excess (CHF, excess ADH)
    • -from diuretics
    • -from Addison’s (low aldosterone)
    • -from nephrotic syndrome (poor reabsorption)
  47. Function of Venous Carbon Dioxide
    Total CO2 is the majority of CO2 in the body and is measured mainly in the form of bicarbonate which is regulated by the kidneys to maintain acid-base balance
  48. Arterial CO2
    Gas regulated by the lungs
  49. Normal Value of venous carbon dioxide (CO2)
    23-29
  50. Cardiac Enzymes
    Troponin, CK, CKMB
  51. CK/CKMB
    Indicates there has been muscle damage

    Isoenzymes:  CK-MB (0-3 ng/ml) – indicates there has been myocardial damage

    –Elevates in 4-6 hrs, peaks in 24 hrs, returns to normal in 48-72 hrs
  52. Normal Range for CK/CKMB
    0-3
  53. Troponin
    Indicates there has been myocardial damage

    Normal:  < 0.35 ng/ml

    Elevate in 2 hrs, peaks 15-24 hrs, returns to normal in 7-10 days
  54. Normal Range for Troponin
    <.35
  55. Lipid Profile Consists of:
    • Total Cholesterol
    • Desirable < 200 mg/dL
    • Borderline 200-239 mg/dL

    • Triglycerides
    • < 150 mg/dL

    • HDL (High Density Lipoprotein)
    • Desired > 60, acceptable 40-60mg/dL, low < 40

    • LDL (Low Density Lipoprotein)
    • Desired < 100 mg/dL; CAD/DM < 80 mg/dL
  56. Normal Level of Cholesterol
    • <200
    • (Borderline = 200-239)
  57. Normal level of Triglycerides
    <150
  58. Normal Level of HDL
    • Desired: >60
    • Acceptable: 40-60
    • Low: <40
  59. Normal Level of LDL
    • Desired: <100
    • CAD/DM: <80
  60. Function of Lactic Acid
    Produced as byproduct of anaerobic metabolism which occurs with poor tissue perfusion or in septic shock when tissues cannot extract oxygen from blood to use in metabolism
  61. Normal Ranges of Lactic Acid
    0.3-2.6 mmol/L
  62. Increased Lactic Acid usually occurs:
    Shock (cardiogenic, hypovolemic), sepsis, liver damage, diabetic ketoacidosis, strenuous exercise
  63. Coagulation Studies:
    • Prothrombin Time (PT)
    • International Normalized Ratio (INR)
    • Activated Partial Thromboplastin Time (APTT)
  64. Purpose of INR Coagulation Studies
    Evaluates extrinsic pathway of clotting sequence; used to monitor dosing of Coumadin
  65. Normal INR (patients not on coumadin)
    <2
  66. Therapeutic Range for Patient's on Coumadin
    • INR 2-3
    • (INR 2.5-3.5 for mechanical heart valves)
  67. Purpose of APTT Coagulation Study
    Evaluates intrinsic  common pathways of coagulation sequence; used in dosing of Heparin
  68. Normal Range of APTT (not on Heparin)
    25-39 sec (not on Heparin)
  69. Therapeutic APTT Range (on Heparin)
    2-2.5 X normal value on  IV Heparin

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