Lab Values Flashcards
(50 cards)
What are the 6 reasons for obtaining blood studies?
- establish a diagnosis
- Rule out a clinical problem
- To Monitor therapy
- To establish a prognosis
- To screen for a disease
- To determine effectiveness drug dose & prevent toxicity
What are the 4 divisions of the clinical lab?
- Hematology:
- CBC, CBC with diff - Chemistry:
- BMP, CMP, Adds ons - Microbiology:
- Sputum gram stain, sputum culture & sensitivity, pleural fluid culture & sensitivity - Blood bank:
- Blood typing & storage
What are included in Hematology?
CBC (complete blood count)
- RBC
- WBC*
- Hemoglobin (Hgb)*
- Platelets*
- Neutrophils*
- Hematocrit
(* = RELEVANT for every patients!!)
What are included in Chemistry?
- BMP (Basic Metabolic Panel):
- Sodium*
- Potassium*
- Glucose*
- Creatinine*
- BUN
- Total CO2
- Chloride - CMP (Complete Metabolic Panel):
- Sodium*
- Potassium*
- Glucose*
- Creatinine*
- BUN
- Total CO2
- Chloride
AND PLUS LIVER ENZYMES…
- Calcium
- Total protein
- Albumin
- Bilirubin
- ALP
- AST
- ALT
THESE 7 ARE LIVER ENZYMES!!!!!! - Ads On
- Phosphorus
- Magnesium
- Amylase –> PANCREATIC ENZYME!!
- Lipase –> PANCREATIC ENZYME!!
(* = RELEVANT for every patients!!)
What are included in Microbiology clinical lab?
Microbiology:
- Sputum gram stain
- Sputum culture & sensitivity
- Pleural fluid culture & sensitivity
What are included in Blood bank?
Blood Bank:
- Blood typing & storage
What is another name for White Blood Cells????
Leukocytes!!!
What are important things we need to know regarding white blood cells - Leukocytes??
- They’re the body’s primary defense against foreign invaders
- It’s correlated btwn the presence of inflammation/infection in the body
- Originate in BONE MARROW
- Life span: 13-20 days
- Fight infection through phagocytosis (engulfment of bacteria)
- Two Measurements: WBC total count & Differential
- WBC total count –> Gives the count of TOTAL white blood cells in the blood
- Differential –> the % of EACH type of leukocytes in the blood
What are the 5 types of Leukocytes (white blood cells) AND the normal values for DIFFERENTIAL?
Granulocytes
- Neutrophils (55-70%)
- Bands (3-5%)
- Eosinophils (1-4%)
- Basophils (0.5-1%)
Agranulocytes
- Lymphocytes (20-40%)
- Monocytes (2-8%)
What do you need to know about Neutrophils??
- First RESPONDERS!!
- Present in band & segmented forms
- Immature Neutrophils are called “Bands” !!!
- “Left Shift” is seen as an increase in the number of bands & is common w/ acute infection!!!!!
- Bands make up <5% of circulating neutrophils!
- Main function is to Locate, Ingest, & Kill bacterias and invaders
What are the terms for High and Low WBC? And what are the causes for both???
High = Leukocytosis OR Neutrophilia
- Causes:
– Excessive physical activities
– Stress
– Smoker
– Very late in pregnancy
– Labor
– Traumatic event
– Major tissue necrosis (death)
– Infections
Low = Leukopenia OR Neutropenic
- Causes:
– Drug toxicity
– Bone Marrow failure
– Overwhelming infection that has been ignored
– Dietary deficiencies
– Autoimmune diseases like CANCER (ppl on chemotherapy)
– Congenital infections like bone marrow infection
– Viral infections like common cold & flu
How do we interpret the CBC?
- What is the total white cell count?
- Marked leukocytosis usually due to neutrophils or lymphocytes
- If the neutrophils are causing the leukocytosis, compare the neutrophils % (from differential) to total WBC
- If the % of neutrophils is high, it’s going to indicate the severity of the infection. The total WBC reflects the QUALITY of the immune system.
What is the nursing implications if somebody has a high WBC??
- Evaluate what medications patient is taking
- Is patient pregnant?
- Is patient stressed? a smoker? (look at the factors of leukocytosis)
- Note and report s/s of infection or inflammation if HIGH
- Initiate NEUTROPENIC PRECAUTIONS if LOW!!
- Notify HCP if WBC count is too low or high
If someone has a LOW (leukopenia!) WBC, what would you put them on?? What are some of the things you should do?
Put them on NEUTROPENIC PRECAUTIONS!!! (protecting Immunocompromised patient from infections we may give them)
1. Meticulous HAND WASHING
2. NO fresh flowers
3. NO fresh fruits/veggies
4. NO standing water (they need to get new water anytime they need to drink)
5. Nurse wears PPE
What is another name for Red blood cells???
Erythrocytes!!!!
What produce RBC?? What removes old & damaged RBC??
- Liver & Red bone marrow PRODUCE RBC!
- Spleen REMOVES old & damaged RBC!
What are the terms for Increased and Decreased RBC Count?? What causes that???
- Increased RBC count = Polycythemia (Viscous, Thick blood)
- Causes: living @ high altitude, chronic lung disease w/ hypoxia like COPD, some drugs
- May lead to false elevations: Dehydration, excessive exercise, anxiety, pain
- Treatment: pull blood out to remove excess - Decreased RBC count = Anemia
- Causes: pregnancy, decreased bone marrow production, over hydration, renal diseases blood lost/hemolysis, some drugs
What is Hematocrit??
The percentage (%) or proportion of Red blood cell TO plasma volume
When looking at the Hematocrit, if you see that the red blood cells are lower than the plasma, what does that mean??
Decreased RBC = Which means that they are anemic!
It could be somebody who got over hydrated (ex: getting bunch of IV fluids), so then all of the sudden, their plasma amount has gone up and make it seem like their RBC are lower than they truly are (false elevation); OR it could be because they have a true decreased in # of RBC
When looking at the Hematocrit, if you see that the red blood cells are higher than the plasma, what does that mean??
Shows increased in RBC = polycythemia!
Causes: living @ high altitude, chronic lung disease w/ hypoxia like COPD, some drugs
- False elevations: Dehydration, excessive exercise, anxiety, pain
Any decreased in volume of plasma in hematocrit causes what in hematocrit number?
Any DECREASED in volume of plasma in hematocrit cause an INCREASE in hematocrit number!
(because remember that hematocrit is the proportion OF red blood cells to plasma volume)
What is the rule of Three for?
Used to detect lab error in measuring the Hbg (Hemoglobin), HCT (hematocrit), and RBC count!!
- 3 times the RBC count should = Hbg
- 3 times the Hbg should = Hct
EX:
- IF someone has a RBCs of 5 million, the hemoglobin would be 5(3) = 15, and Hematocrit would be 15(3) = 45%
What is the nursing implications for people who have high/low RBC count?
- Assess color, peripheral pulses, cap refill (shouldn’t take longer than 3 secs), vital signs, fatigue
- Type of anemia
- Dietary needs –> are they eating enough iron to produce hemoglobin
- Good oral health –> pale gums = low RBC count
- Need iron supplements
- Need blood transfusion –> if hemoglobin level is low
- Procrit/Epogen –> see if they’re taking these. usually ppl take these if they have a renal disease. These are gonna help treat low RBC & you’d see an increase after using
What are important informations to know regarding to platelet counts??
- Formed in BONE MARROW
- Spleen remove them when they’re old & damaged
- Protect intact blood vessels & initiate repair thru the formation of platelet (form clots to stop bleeding!!!)
- It’s relevant all the time AND for when there’s a concern of anemia (blood lost) or if patient is on HEPARIN bc if they have an adverse rxn, platelet count DROPS and they get HIT (heparin induced thrombocytopenia!)
- THEY’RE THE FIRST RESPONDER TO BLEEDING!!!
- Lifespan: 10 days !!
