lab values Flashcards
1
Q
factors affecting lab values:
A
age, gender, race, pregnancy, and food digestion
2
Q
urine studies are used to:
A
detect/diagnose & monitor renal & urinary disease, detect metabolic/systemic
3
Q
urine studies types of specimens:
A
random, timed, culture & sensitivity, 1st morning, double-voided
4
Q
UA (urinalysis) is a:
A
random specimen, mid-stream voided, straight cath or foley tubing
5
Q
UA screening test:
A
infection, renal function, acid-base balance
6
Q
UA desired result:
A
appearance: clear
color: yellow - amber
ketones: none
WBC’s: none
protein: usually none
7
Q
timed urine specimen is for:
A
substances irregularly excreted over time & effects hydration, metabolism, & position
8
Q
types of timed urine specimen:
A
specific predetermined time of day: pregnancy, urobiligen, nitrates (ex: cortisol)
over a specified time period: -2 (hr) urine - postprandial glucose. pt doesn’t need to void during that 2 hrs
-24 (hr) urine- hormones, protein, creatinine
9
Q
24 hr urine:
A
pt to void (discard the 1st voiding) then start time for 24 hr. ALL urine saved in container for 24 hr (keep cool), pt voids at end of 24 hrs (end of test) – - mainly for hormones and protein
10
Q
sources of error for 24 hr urine:
A
contaminants in urine, failure to collect all urine in time period, including 1st voided urine, improper storage/preservation of specimen
11
Q
CrCl (creatinine clearance) evaluates:
A
rate and efficiency of kidney filtration - clear creatinine and other waste
12
Q
CrCl detects and diagnose:
A
kidney dysfunction and/or decreased blood flow to kidneys
-if creatinine clearance decreases, then you have a poorly functioning kidney
13
Q
CrCl requires ___ hr urine and ___ blood specimen
A
24 hr; 1
14
Q
if your kidneys are _____ in function, then your creatinine levels will _____
A
decreasing; increase
15
Q
osmolality - urine measure:
A
dissolved particles in urine
16
Q
osmolality - urine, determine:
A
kidneys concentrating ability and fluid/electrolyte abnormalities
17
Q
osmolality is more exact measurement than specific gravity: true or false
A
true
18
Q
normal urine osmolality:
A
300-900 mOsm/L
19
Q
compare with blood osmolality:
A
urine : blood ratio = 1:3
20
Q
blood tests - osmolality (serum) - normal serum osmolality:
A
280 - 300 mOsm/L
critical values: below 265 (diluted fluid) or more than 320 (lots of particles in fluid - concentrated)
21
Q
osmolality (serum) rough estimate:
A
Na level x 2 (135-145 normal Na level)
22
Q
osmolality (serum) measure:
A
amount of concentration of particles in blood
23
Q
altered osmolality (serum) you will have increased levels of:
A
dehydration, Na or glucose, Hyperglycemic Hyperosmolar Nonketotic (type 2) or Diabetic ketoacidosis (type 1 diabetes), diuretic therapy
24
Q
altered osmolality (serum) you will have a decreased levels of:
A
over hydration, SIADH (Syndrome of inappropriate antidiuretic hormone ADH release), CA- breast, colon, lung
25
prealbumin (transthyretin) used to monitor:
nutrition status & effects of treatments, liver function
26
prealbumin you will have an increased in ______ and _____
Hodgkin's disease, pregnancy
27
prealbumin you will have decreased:
malnutrition, liver disease, inflammation, prealbumin inversely related to mortality (<11)
28
culture & sensitivity can be done from:
urine, blood, wound drainage, tissue & devices
29
what will you obtain prior to abx therapy?
culture & sensitivity
30
final report for S&S:
72 hrs
31
preliminary report for C&S is done in ___ hrs
24
32
"no growth in ___ or ___ hrs" - usually means _____
24 or 48 hrs; no infections
33
S&S culture for fungus may take:
6 weeks
34
sensitivity part of S&S tells doctor what?
abx therapy to use, from safest/most effective and least expensive tx
35
_____ may be done _____ to assess if further treatment needed
culture; abx therapy
36
gram stain: gram positive is ___ staining organism
blue
37
gram stain: gram negative is ___ staining organism
red
38
results for a gram stain in ____ minutes
10
39
gram stains are typically done if a ____ infection is detected and commonly on ___
bacterial; sputum
40
TDM (therapeutic drug monitoring) determines:
effective dose and prevent toxicity
41
peak:
drug highest level in blood but below toxic level
42
trough:
drug lowest level in blood but in therapeutic range; hold dose until lab results known
43
PT (prothrombin time):
assess coagulation
44
INR (international normalizing ratio):
assess warfarin therapy
45
____ & ____ effect natural clotting times and effectiveness of Coumadin treatment
diet & drugs
46
___ ____ for reversal of warfarin
vitamin K
47
PTT (partial thromboplastin time): assess what?
increased levels:
decreased levels:
assess coagulation or heparin therapy
increased levels: clotting factor deficiency, cirrhosis, Heparin
decreased levels: ovary. pancreas, colon CA
48
reversal of heparin is what?
protamine sulfate
49
PT/INR monitors:
evaluation:
assessment:
-of warfarin
-for vitamin K deficiency or severe malnutrition
-assessment of liver failure
50
PTT monitor:
assessment:
-monitoring (but not initiation) of heparin
-assessment of clotting factor function in hemophilia and von willebrand disease
51
Both PT/INR and PTT^10
-active bleeding without obvious cause
-evidence of abnormal bleeding on physical examination
-hx of abnormal, excessive, or spontaneous bleeding
-suspected or confirmed disseminated intravascular coagulation
-high-risk pt in whom a clinical history is unavailable
52
hematopoiesis:
process by which all formed elements of the blood are produced
53
_____ occurs in the _____ _____, where cells mature from a primitive stem cell
production; bone marrow
54
RBC's life cycle:
platelets:
120 days life cycle; 7-9 days
55
granulocytes:
basophils, eosinophils, and neutrophils
56
CBC (complete blood count) used to diagnose:
anemias, bleeding disorders, infections, and blood cell changes
57
CBC has:
white blood cells (leukocytes, and lymphocytes), RBC, hematocrit (HCT), hemoglobin (HGB), and platelet count
58
WBC (white blood cell) is part of the body's ____
defense system, respond to foreign invaders
59
WBC- assessment of:
infection, neoplasm, allergy, immunosuppression
60
drugs for leukopenia:
ampilicillin, vancomycin, chemotherapy, antihistamines
60
WBC's > 10,000= leukocytosis
anemias, viral infections, ETOH, RA, trauma, physical or emotional stress
60
drugs for WBC- leukocytosis:
ASA, epinephrine, steroids, heparin
60
WBC's < 4,000 = leukopenia
acute infection, MI, cirrhosis, burns, dietary deficiencies
61
WBC with differential:
granulocytes (polymorphonuclear)
- neutrophils (50-70%)
-eosinophils (1%-3%)
-basophils (<1%)
nongranulocytes (mononuclear)
-monocytes (2%-9%)
-lymphocytes (20%-30%)
62
polymorphonuclear:
having a lobed nucleus. commonly referred to as "polys"
63
granulocytes:
having granules in their cytoplasm
64
WBC- neutrophils
phagocytosis, bacterial infection, trauma
65
WBC- eosinophils
allergic reactions, parasitic conditions
66
WBC - basophils
mast cells, increase during healing process
67
WBC- monocytes
2nd line of defense against bacteria and foreign substances, stronger than neutrophils, can ingest larger particles, respond late during acute phase
68
WBC- lymphocytes
increased during chronic bacterial and viral infections, B lymphocytes, T lymphocytes
69
neutrophil cell: lifespan in blood and function
7 hours; immune defense
70
eosinophil: lifespan in blood and function
8 - 12 days; defense against parasites
71
basophil: lifespan in blood and function
a few hours to few days; inflammatory response
72
monocyte: lifespan in blood and function
3 days; immune surveillance
73
B-lymphocyte: lifespan in blood and function
memory cells may live for years; antibody production
74
T-lymphocyte: lifespan in blood and function
memory cells may live for years; cellular immune response
75
RRB (red blood cells) are formed:
transport:
assess:
reference values:
in blood marrow; transport oxygen; assess for anemia's; male: 4.7 - 6.1
female: 4.2 - 5.4
76
RBC increased levels in:
drug effects:
-erythrocytosis- severe dehydration, COPD, polycythemia vera
-gentamicin, methyldopa
77
RBC decreased levels in:
drug effects:
etythropenia- anemia, hemorrhage, bone marrow failure, cirrhosis, renal disease, lymphoma, leukemia
drug effects: chloramphenicol, phenhtoin
78
HCT (hematocrit) is:
assess:
reference values:
rapid measurement of RBC count
assess: hydration status, anemia, oxygen transport
reference values: male 42%-52%; female: 37% to 47%, critical values: <15% or >60%
79
plasma is made up of:
water, proteins, nutrients, hormones
80
anemia you will have a ____ hematocrit %
depressed
81
polycythemia you will have an ____ hematocrit %
elevated
82
HCT increased levels of:
drugs:
-dehydration, diuretics, burns, high altitudes, hypoxemia, COPD
-drugs: erythropoeitin, glucocorticosteroids
83
HCT decreased levels:
drugs:
-decrease with age, s/s of anemia's, blood loss, over hydration, extremely elevated WBC's
-drugs: antieoplastic/radioactive agents, PCN
84
hgb (hemoglobin) is:
the protein molecule in RBC that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs
85
HGB: tourniquet on for >1 minute =
hemolysis
86
HGB is highest around what time and lowest around when?
0800 and lowest around 2000
87
HGB increased levels:
drugs:
dehydration, CHF, lung disease, heavy smokers
drugs: gentamicin, aldomet
88
if a physician is trying to determine if a patient has a viral infection vs a bacterial infection, they want a:
they want a complete blood count with differentials
89
HGB decreased levels:
drugs:
anemias, hemorrhage, hodgkins disease, kidney disease
drugs: antibiotics, ASA, MAOI, increase vitamin A
90
thalassemia:
a genetic group of blood disorders that result in the defective production of hemoglobin
91
spherocytosis:
a genetic disease that causes a defect in the RBC's cytoskeleton, causing RBC to be small, sphere-shaped, and fragile instead of donut-shaped and flexible
92
hemolytic anemia:
breakdown of RBC's in the blood vessels
93
platelets promote:
coagulation, vascular integrity
-produced in bone marrow
-thrombocytes
94
platelets increased levels:
drugs:
thrombocytosis: >400,000
-malignancy, polycythemia, vera, splenectomy, RA
drugs: epinephrine, estrogens, oral contraceptives
95
decreased levels- platelets
drugs:
thrombocytopenia (<100,000)
-hemorrhage, leukemia, aplastic anemia, cancers
drugs: streptomycin, ASA, thiazide diuretics
96
thrombocythemia:
vascular thrombosis with tissue or organ infarction is the major complication of thrombocythemia
97
CMP (complete metabolic panel): cmp
-measure electrolyte balance, kidney & liver function, glucose levels, acid/base balance, & blood proteins
98
BMP: basic metabolic panel
measure status of kidneys, blood sugar, electrolyte, and acid/balance
99
values on BMP and CMP reports:
glucose, sodium, potassium, chloride, CO2, BUN, creatinine, calcium, magnesium, total protein, albumin, total bilirubin, AST, ALT, ALP
100
glucose:
evaluation of blood glucose levels (assess for diabetes - random, FBS, PPGB)
101
fasting BG levels (FBS)
after 8-10 hr fast <99 mg/dL
102
post prandial BG levels (PPBG)
glucose in blood after meal (2hrs) <140 mg/dL
103
glucose levels increase:
drugs:
-DM, IV fluids, trauma, surgery, infection, MI
-antidepressants, beta blockers, steroids, diuretics
104
glucose decreased levels:
drugs:
insulin overdose, hypothyroidism, liver disease
drugs: tylenol, ETOH, insulin, MAO inhibitors
105
in general, anytime of day, most adults would be between
70-110 mg/dL
106
if a patient is less than ___ mg/dL or greater than ____ mg/dL are critical values
50; 400
107
sodium monitor:
reference values:
critical values:
fluid/electrolyte/acid-base balance
-balance between dietary Na intake and renal excretion
reference: 135-145 mEq/L
critical: < 120 mEq/L or >160 mEq/L
108
increased levels of sodium is ___
hypernatremia
109
decreased sodium levels:
hyponatremia
110
potassium plays a role in:
reference value
heart and renal function, skeletal/smooth muscle contraction, acid-base balance
111
increased levels of potassium is:
hyperkalemia
112
decreased levels of potassium:
hypokalemia
113
chloride regulates the amount of ___ in the body and maintain the ___-___ balance, and absorbed from the ____. Excreted by the ____
fluid; acid-base; intestines; kidneys
114
reference values for chloride:
98-108 mEq/L
115
increased level of chloride:
s/s
hyperchloremia
s/s: lethargy, weakness, deep respirations
116
decreased chloride:
s/s:
hypochloremia
s/s: hyperexcitability of NS and muscles, shallow breathing, hypotension, tetany
117
CO2 measures amount of:
CO2 in the blood, mostly in form of bicarbonate (HCO3-), screen for electrolyte or acid-base imbalance
118
increased levels of CO2
metabolic acidosis, kidney disease, DKA, chronic diarrhea, addison's disease
119
decreased levels of CO2
metabolic alkalosis, lung diseases, cushing's disease
120
BUN (blood, urea, nitrogen)
measure liver metabolic & kidney excretory function, protein breakdown -> urea (waste product), urea made in liver, excreted in urine
121
increased BUN
dehydration, heart failure, renal injury, nausea
122
decreased BUN
diet low in protein, malnutrition, liver damage, over hydration, pregnancy
123
levels > 100 mg indicate serious _____ _____
renal impairment
124
creatinine is:
measures:
not influenced by:
more specific to:
-waste product in blood and urine
-measures kidney function
-not influenced by diet or fluid intake
-renal disease than BUN
125
creatinine clearance is a test used to measure:
the GFR of the kidney and is collected in a 24 hr urine
126
calcium- evaluate:
parathyroid function, calcium metabolism and excretion
127
____ and ____ can bind with calcium and decreased ionized calcium levels
protein and albumin
128
you may see ___ if you leave the tourniquet on too long
hypercalcemia
129
increased level of calcium:
hypercalcemia
130
decreased levels of calcium:
hypocalcemia
131
magnesium is needed for _____ ____ and useful in ___ & ____ metabolism
neuromuscular activity; carbohydrate and protein
132
when magnesium is low, so is ___ and ____
calcium and potassium
133
most accurate results for magnesium are obtained when ____ is not used
tourniquet
134
patients with ____ often present with confusion and psychosis
hypomagnesemia
135
watch for s/s of ____ with Mg
diarrhea
136
about ___ % of calcium is flowing through body and plays a roll in our ___ mechanism
50%; clotting
137
total protein is made up of ____, ____, and _____
prealbumin, albumin, and globulins
138
total protein: maintain ___ pressure within vascular space
osmotic
139
albumin:
protein formed in the liver; 60% of total protein
140
patient should not eat ___ ____ diet 24 hrs before CMP
high fat
141
____ levels will increase after a high protein diet
creatinine
142
albumin aids in ____ growth and healing
tissue
143
for albumin, maintain ____ ____ pressure
collodial osmotic
144
most common sign of low calcium level is:
muscle spasm/cramps
145
_____ is the most plentiful protein found in plasma
albumin
146
total bilirubin:
is a measurement of both direct and indirect but if the total bilirubin is within reference values, the breakdown of direct vs indirect is unnecessary
147
bilirubin:
produced by the breakdown of old RBC and HGB
148
albumin transports ___, ___, and _____
blood, hormones, and enzymes
149
____ can lower ____ levels
caffeine; bilirubin
150
what foods will increase your bilirubin levels?
carrots and yams
151
AST (aspartate aminotramferase)
converts amino acids to amino acid residue and is essential to energy production in the Krebs cycle
152
frequent ___ injections will increase AST levels
IM
153
ALT (alaine aminotransferase): specifically looking for
liver damage or disease
154
patients should avoid what before ALT test
strenuous exercise
155
ALT levels will rise several days before ____ is seen
juandice
156
ALP (alkaline phosphatase)
present in biliary ducts of liver, bone, and placental tissue
157
pancreas function and other tests NOT on a CMP
amylase, lipase, glycosylated hemoglobin A1c
158
amylase:
helpful in evaluation of abdominal pain, detect & monitor pancreatitis
159
lipase:
enzyme secreted by pancreas into small intestines, helps break down triglycerides into fatty acids
160
glycosylated hemoglobin A1c
used to monitor diabetes and effectiveness of treatment of diabetes
-average blood glucose level for past 3 months
