Nursing Med Surg Lab Values

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alta_refugee
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54735
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Nursing Med Surg Lab Values
Updated:
2012-06-09 00:10:29
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med surg nursing nurse lab values labaratory
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Nursing lab values for med-surg
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  1. What are the main 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
    • *Glomerular Filtration Rate
    • CBC (Complete blood count)
    • *WBC
    • *HGB/HCT
    • *Platelets
    • Cardiac enzymes
    • *Ck
    • *Ck-mb
    • *Troponin
    • *BNP
    • Liver
    • *Albumin
    • *SGOT/SGPT
    • *bilirubin
  2. BUN/CR
    Normal 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 (0.6-1.2)
    • *Best indicator for kidney function
    • *lower is better
    • Bun's high and dry
    • Bun's low = wet
    • Glomural Filtration Rate (GFR)
    • *90-120 mL/min
  3. Complete blood count (CBC)
    • WBC (white blood cell) range (4,800-10,800)
    • 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 allergy
  4. Red blood cell
    • RBC-produce in the bone marrow with the aid of erythropoietin (produce in the kidney)
    • *male 4.7-6.1 mm^3
    • *female 4.2-5.4 mm^3
    • *Erythrocyte Sed Rate < 20 mm/hr
    • **Elevated = presence of inflammation

    • Hemoglobin (Hgb)-range male 14-18 and female 12-16...how many rbc
    • if < or =7...blood transfusion

    Hematocrit-normal range – 3x hemoglobin...how red is the blood: Males 42-52%/Female 37-47%

    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 1gm
  5. Platelets
    • 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
    • INR 0.9-1.2 (for anticoagulation 2-3)
    • PT 11-14 sec (anticoagulation therapy = 1.5 to 2X) coumadine
    • PTT 16-40 sec (anticoagulant therapy = 1.5 to 2.5x) heprin
  6. 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)
  7. 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 = 1.8-3 Meq/L
    • Phosphorus = 2.5-4.5 mg/dl
    • Glucose (fasting) =70-110 mg/dl
    • *Glycosylated hemoglobin (HbA1c 5%, 7% for diabetics)
  8. hypernatremia
    Na 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.
  9. hypokalemia
    Potassium 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?
  10. Liver enzymes
    • *Albumin (3.8-5 g/dL)
    • *SGOT/SGPT (13-40 units/L, 10-40unit/L)
    • *bilirubin (0-1.5 mg/dl)
    • *amonia (35-65 mcg/dl)
    • *total protein (6-8 gm/dl)
  11. 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. <0.2 ng/dl
    • **Troponin I Less than 0.35 ng/mL
    • **Troponin T Less than 0.20 mcg/L
    • *BNP (Less than 50 pg/m)
  12. CBC (Complete blood count)
    • *WBC (4800–10800 WBC/mm^3)
    • *HGB (12-18 g/dL)
    • *HCT (37-52 or 3x HGB)
    • *Platelets (150,000–450,000/mm^3)
    • *ESR (< 20mm/hr)
  13. Renal Function
    • *Blood urea nitrogen (10–20 mg/dL)
    • *Serum creatinine (0.5–1.2 mg/dL)
    • *GFR (90-120 mL/min)
  14. Electrolytes
    • Sodium/chloride
    • Potassium
    • Calcium/phosphate
  15. hyperkalemia
    Caused 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
  16. ABG's
    • PH acid 7.4 alk +/- 0.05
    • HCo3 acid 24 alk +/-2
    • PaCo2 Alk 40 acid +/- 5

    • PaO2 (aterial) 80-100
    • SaO2 (O2 sat) > 91

    • ROME
    • RO=Resp opposite
    • ME= metobolic equal

    • If Ph is in romal range= Com
    • if HCO3 & PaCo2 point same dir = comp
  17. Blood Lipid Values...total cholesterol
  18. Blood Lipid Values
    *LDL
    *HDL
    *Triglycerides
    • LDL<100 mg/dL
    • HDL>40 mg/dL
    • Triglycerides < 150 mg/dL (<100 if medicated)
  19. Blood lipid level...low density lipid
    LDL<100 mg/dl
  20. Urinalysis Values

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