Lab Values Flashcards
1
Q
what to consider when looking at lab values
A
- do not rely on a single lab value, look at trends across multiple samples
- consider time of day specimen was drawn, drug interactions, recent meals, intravenous infusions
2
Q
PT considerations (risks/benefits)
A
- prior to intervention, anticipate physiological changes to occur if the lab is not in a typical range for pt
- risk level increases if lab values is in critical ranges
- must collaborate with members of team for risk/benefit of PT
- may require a conditional order to be placed to ensure communication and approval by medical staff if to proceed
3
Q
require more conservative approach due to pt’s ability to compensate in a short period of time
A
acute lab values
4
Q
examples of acute changes in lab values
A
blood loss, trauma
5
Q
allow the pt time to compensate, may still have capability to respond to exercise/mobility demands
A
chronic lab values
6
Q
examples of chronic changes in lab values
A
patients with CFH/COPD, cancer
7
Q
lab values may have referenced ranges for
A
age and sex (assigned at birth)
8
Q
is pt is on hormone replacement therapy, use ______ to determine reference ranges/values
A
transitioned gender
9
Q
if the pt is not on hormone replacement therapy, use _____ to determine reference ranges/values
A
biological sex
10
Q
can lead to differences in reactivity of DNA, proteins, cells and antibodies use in many lab tests
A
genetic heterogeneity
11
Q
african americans have increased what compared to Caucasians
A
muscle mass and skeletal structure
12
Q
what to african americans have increased levels of
A
higher serum total protein levels, higher serums levels of alpha/beta/gamma globulins
13
Q
african americans tend to have lower what
A
levels of hemoglobin
14
Q
what lab values may be altered in pts with sickle hemoglobin
A
HgbA1c (A1C)
15
Q
evaluates RBS, WBC, and platelets
A
complete blood count (CBC)
16
Q
where is CBC drawn from
A
peripheral vein
17
Q
looks more closely at components of the cell (provide examples)
A
CBC with differentials (CBC with diff)
- mean corpuscular hemoglobin (Hb) concentration (MCH), mean corpuscular volume (MCV)
- WBC: neutrophils, eosinophils, basophils, lymphocytes and monocytes
18
Q
where are stem cells created
A
bone marrow
19
Q
formation of stems cells into RBC, WBC or platelets (PLT)
A
hematopoesis
20
Q
deliver oxygen to tissues
A
RBC/erythrocyte
21
Q
is the measurement of percentage of whole blood occupied by cells
A
hematocrit
22
Q
RBCs contain _____ which is the iron containing protein
A
hemoglobin (Hb)
23
Q
primary goal is to fight infection
A
WBC
24
Q
list WBC granulocytes
A
neutrophils
eosinophils
basophils
25
kill bacteria via phagocytosis; make up 58% of WBC
neutrophils
26
kill parasites, role in allergic disorders; make up 2% of WBC
eosinophils
27
role in allergies, release histamine and heparin; 1% of WBC
basophils
28
list WBC agranulocytes
monocytes
lymphocytes
29
differentiate into macrophages and ingest bacteria; 4% of WBC
monocytes
30
list the different types of lympocytes
t lymphocytes
helper t
memory t
suppressor t
b lymphocytes
31
cell-mediated immunity
t lymphocytes
32
orchestrate immune response, stimulate B cells to form antibodies, stimulate cytotoxic T cells and activate macrophages
helper T
33
preserve memory of previous antigens
memory T
34
modulate intensity of immune response
suppressor T
35
produce antibodies; 33% of WBC
b lymphocytes
36
the real number of WBC that are neutrophils
absolute neutrophil count (ANC)
37
how to measure absolute neutrophil count (ANC)
- not measured directly
- derived by multiplying the WBC count times the percent of neutrophils in the differential WBC count
- % of neutrophils consists of segmented (fully mature neutrophils) + the bands (almost mature neutrophils)
38
what is the normal range of ANC
1.5 - 8.0 (1500-8000/mm3)
39
an ANC level of _____ is considered low --> activity restrictions/infection precautions in place (masks, gown, gloves to protect pt)
< 500
40
reference values for WBC
5.0-10.0 10^9/L
41
trending upward WBC lab value
leukocytosis >11.0 10^9/L
42
causes/presention/clinical implications of leukocytosis (trending upward WBC)
- infection, leukemia, neoplasm, trauma, surgery, sickle-cell disease, stress/pain, medication-induced, smoking, obesity, congenital, chronic inflammation, connective tissue disease
- fever, malaise, lethargy, dizziness, bleeding, bruising, unintentional weight loss, lymphadenpathy, painful inflamed joints
-
43
trending downards WBC lab values
- leukopenia <4.0 10^9/L
- neutropenia <1.5 10^9/L (moderate 0.5-1; severe < 0.5)
44
causes/presentation/clinical implications of neutropenia (trending downward WBC)
- stem cell disorder, bacterial infection, viral infection, radiation
- low grade fever, skin abscesses, sore mouth, sx of pnemonia
45
causes/presentation/clinical implications of leukopenia (trending downward WBC)
- viral infections, chemotherapy, aplastic anemia, autoimmune disease, hepatitis
- anemia, weakness, fatigue, fever, headache, SOB
-
46
essential component of hemostasis/clotting mechanism
platelets
47
adhere to disruptions of endothelial lining of a wound, then to each other to form a plug; also promote aggregation and activation of more platelets and increase the size of plug
platelets
48
normal PLT values
140 - 400 k/uL
49
trending upward lab values for platelets
thrombocytosis > 450 uk/L
50
trending downward lab values for platelets
thrombocytopenia <150 uk/L
51
causes/presentation/clinical implications of thrombocytosis (trending upward PLTs)
- splenectomy, inflammation, neoplasm/cancer, stress, iron deficiency, infection, hemorrhage, hemolysis, high altitudes, strenuous exercise, trauma
- weakness, headache, dizziness, chest pain, tingling in hands/feet
- sx based approach for activities, monitor sx, collaborate with team; elevated levels can lead to venous thromboembolism
52
causes/presentation/clinical implications of thrombocytopenia (trending downward PLTs)
- viral infection, nutrition deficiency, leukemia, radiation, chemotherapy, malignant cancer, liver disease, aplastic anemia, premenstrual and postpatum
- petechiae, ecchymosis, fatigue, jaundice, splenomegaly, risk for bleeding
- severe thrombocytopenia (<20 k/uL): sx based approach for activity; collaborate regarding possible need for/timing of transfusion prior to mobilization; fall risk awareness (risk for spontaneous hemorrhage)
53
protein in RBC that carries oxygen to our organs and tissues and transports CO2 from organs/tissue to lungs
hemoglobin
54
hemoglobin trending upward
polycythemia
55
hemoglobin trending downward
anemia
56
normal hemoglobin values for M and F
M: 14 - 18 g/dl
F: 12 - 16 g/dl
57
causes/presentation/clinical implications of polycythemia (trending upward hemoglobin)
- congenital heart disease, severe dehydration, chronic obstructive pulmonary disease (COPD), CHF, severe burns, high altitude
- orthostasis, presyncope, dizziness, arrhythmias, CHF onset/exacerbation, sx of transient ischemic attack (TIA), sx of MI, angina
- sx based approach, monitor sx, collaborate
58
what are low critical values of hemoglobin and what can it lead to
<5-7 g/dL
heart failure or death
59
what are high critical values of hemoglobin and what can it lead to
> 20 gd/L
clogging of capillaries as a result of hemoconcentration
60
do hemoglobin levels slightly increase or decrease with age
slightly decrease
61
causes/presentation/clinical implications for anemia (trending downward hemoglobin)
- hemorrhage, nutritional deficiency, neoplasia, lymphoma, systemic lupus, sarcoidosis, renal disease, spenomegaly, sickle cell anemia, stress to bone marrow, RBC destruction
- decreased endurance, decreased activity tolerance, pallor, tachycardia
- monitor vitals and SpO2 to predict tissue perfusion (may present with tachycardia or orthostatic hypotension); may be monitoring pre-existing cerebrovascular/cardiac/renal conditions for ineffective tissue perfusion; , 8g/dL sx based approach, may need transfusion depending on institution
62
what is the level of hemoglobin that may require transfusion and require stop of activity
8 g/dL
63
blood test that measures the percentage of RBCs in blood
hematocrit
64
what protein do RBC contain that help to pick up O2 from your lungs and transport it t/o your body
hemaglobin
65
hematocrit trending upward
polycythemia
66
hematocrit trending downward
anemia
67
what are the reference values for hematocrit (M and F)
M: 42-52%
F: 37-47%
multiple hemoglobin levels by 3 to find
68
causes of polycythemia
burns, eclampsia, severe dehydration, erythrocytosis, tends to be elevated in people living in high altitudes, hypoxia due to chronic pulmonary conditions (COPD, CHF)
69
presentation of hematocrit polycythemia
fever, HA, dizzy, weakness, fatigue, easy bruising/bleeding
70
low critical value of hematocit and what can it lead to
<25% - cardiac failure or death
71
high critical value of hematocrit and what can it lead to
>60% - spontaneous blood clotting
72
causes of anemia hematocrit
leukemia, bone marrow failure, multiple myeloma, dietary deficiency, pregnancy, hyperthyroidism, cirrhosis, rheumatoid arthritis, hemorrhage, high altitude
73
presentation of anemia hematocrit
pale skin, HA, dizziness, cold hands/feet, chest pain, arrhythmia, SOB
74
clinical implications of hematocrit anemia
- pt may have impaired endurance --> progress activity slowly
- monitor SpO2 for tissue perfusion, may have tachycardia and/or orthostatic hypotension
- medical team may monitor pre-existing cerebrovascular, cardiac, or renal conditions for ineffective tissue perfusion related to decreased hematocrit
75
describe the importance of sodium
Primary determinant of extracellular fluid volume
Allows for conduction of N impulses
Plays a role in muscle contractions
The kidneys maintain an appropriate amount of sodium in the body by adjusting the amount excreted in urine
Sources of Sodium: food/drinks
Lost: by sweat/urine
Older individuals can have difficulty maintaining appropriate sodium concentrations secondary to dehydration, medications, decreased fluid volume and changes in the kidneys
Part of electrolyte panel
76
normal range of sodium
134-142
77
hypernatremia
upward trending sodium
78
describe hypernatremia
>145
Causes: Increased sodium intake, Severe vomiting, CHF, Renal insufficiency, Cushing’s syndrome, Diabetes
Presentation: Irritability, agitation, seizure, coma, hypotension, tachycardia, decreased urinary output
Clinical Implications: Impaired cognitive status, seizure precautions
79
hyponatremia
downward trending sodium
80
describe hyponatremia
< 130
Causes: Dietetic use, gastrointestinal impairment, burns/wounds, hypotonic IV use, cirrhosis
Presentation: HA, lethargic, decreased reflexes, N/V, diarrhea, seizure, coma, orthostatic hypotension, pitting edema
Clinical: Impaired cognitive status
Monitor vitals secondary to risk for orthostatic hypotension
81
describe potassium
Important function of excitable cells (N, muscles, and heart)
Plays important role in cardiac function!!
Works with sodium to maintain appropriate fluid balance in body
Supports normal blood pressure
Both high and low potassium levels can lead to cardiac arrest
Sources: food and electrolyte drinks
Lost: urine
Part of electrolyte panel
82
normal range potassium
3.7-5.1
83
describe hyperkalemia
> 5.5
Causes: Renal failure, diabetic ketoacidosis (DKA), addison’s disease, excess potassium supplements, blood transfusion
Presentation: Muscle weakness/paralysis, paresthesia, cardiac arrest, bradycardia, heart block, ventricular fibrillation
Clinical: Pt at risk for cardiac issues if > 5: sx based approach, Might exhibit muscle weakness during interventions
84
hypokalemia
downward trending potassium
85
hyperkalemia
upward trending potassium
86
describe hypokalemia
Causes: Diarrhea/vomiting, gastrointestinal impairment, diuretics, cushing’s syndrome, malnutrition, restrictive diet, ETOH abuse
Presentation: Extremity muscle weakness, decreased reflexes, paresthesia, leg cramps, EKG changes, cardiac arrest, hypotension, constipation
Clinical: Sx-based approach
Severe hypokalemia <2.5 → collaborate with interprofessional team
87
describe calcium
Important for bone/tooth formation, cell division and growth, blood coagulation, mm cx, normal heart function, and release of neurotransmitters
About 99% of calcium is stored in bones
Calcium moved from bone to blood as needed → too much moved can cause bones to become weak
Regulated by 2 Hormones: parathyroid hormone and calcitonin
Part of electrolyte panel
88
normal range of calcium
8.6-10.3
89
hypercalcemia
upward trending calcium
90
describe hypercalcemia
Causes: Excessive calcium/antacids, bone destruction (tumor), immobilization, fx, excessive vitamin D, cancer, renal failure
presentation: Ventricular dysrhythmias, heart block, asystole, coma, lethargy, mm weakness, decreased reflexes, constipation, N/V
Clinical implications: sx-based
91
hypocalcemia
downward trending calcium
92
describe hypocalcemia
Causes: ETOH abuse, poor dietary intake, limited GI absorption, pancreatitis, laxative use
presentation: Anxiety, confusion, agitation, seizure, EKG changes, fatigue, numbness/tingling, increased reflexes, muscle cramps
clinical: Might have impaired cognitive abilities
Sx-based approach
93
describe chloride
Important for fluid/acid-base balance
Helps maintain blood pressure
Plays a role in digestion of food → stimulates secretion of hydrochloric acid in stomach
Plays a role in mm contraction and movement of N impulses
Mainly found in table salt
Excreted through urine
Part of electrolyte panel
94
normal range chloride
98-108
95
hyperchloremia
upward trending chloride
96
describe hyperchloremia
causes: High salt/low water diet, hypertonic IV, metabolic acidosis, renal failure
presentation: Lethargy, decreased levels of consciousness, weakness, edema, tachypnea, HTN, tachycardia
clinical: Determine if appropriate for tx is exhibiting decreased levels of consciousness
97
hypochloremia
downward trending chloride
98
describe hypochloremia
causes: Low salt diet, water intoxication, diuresis, excessive vomiting/diarrhea
presentation: Agitation, irritability, hypertonicity, increased reflexes, cramping, twitching
clinical: Monitor level of consciousness and motor function
99
describe phosphate
Necessary for: bone formation, acid-base balance, storage and transfer of energy (ATP)
Kidneys are the primary excretion of phosphorus
Imbalance may result due to: dietary intake, GI disorders, excretion by the kidneys
Sources: seafood, lentils, dairy, poultry
100
normal range phosphate
2.3-4.1
101
hyperphosphatemia
upward trending phosphate
102
describe hyperphosphatemia
causes: Bone destruction (tumor), immobilization, fx, excessive vitamin D, cancer, renal failure
presentation: Ventricular dysrthmia, heart block, asystole, coma, lethargy, mm weakness, decreased reflexes, constipation, N/V
clinical: sx-based
103
hypophosphatemia
downward trending phosphate
104
describe hypophosphatemia
causes: ETOH abuse, poor dietary intake, limited GI absorption, pancreatitis, laxative use
presentation: Anxiety, confusion, agitation, seizure, EKG changes, fatigue, N/T, increased reflexes, mm cramps
clinical implications: impaired cognition, sx-based
105
describe magnesium
Concentrated in bone and muscle
Involved in: ATP metabolism, cx and relaxation of mm, proper neurological functioning, neurotransmitter release
Regulated by kidneys
Sources: pumpkin seeds, chia seeds, spinach, black beans
106
normal range magnesium
1.2-1.9
107
hypermagnesium
upward trending magnesium
108
describe hypermagnesium
causes: Increased intake antacids/magnesium citrate, renal failure, leukemia, dehydration
presentation: Diaphoresis, N/V, drowsiness, lethargy, weakness/flaccidity, decreased reflexes, hypotension, heart block
clinical implications: sx-based
109
hypomagnesium and describe it
downward trending magnesium
causes: ETOH abuse, eating disorders, diuresis, DKA, medications
present: Increased reflexes, tremors, spasticity, seizures, nystagmus, EKG changs (premature ventricular contraction PVC → v-tach → v-fib), emotional lability
clinical: sx-based
