Lab Values

Question 1

International Normalized Ration (INR)

Answer 1

Monitors Wardarin
Therapeutic 2-3
4 or > is high priority, hold, assess for bleeding, prepare vit k antidote), call HCP

Question 2

pH

Answer 2

7.35-7.45
PH in the 6s = DEADLY
Acidosis can kill them, assess vitals call HCP

Question 3

Potassium

Answer 3

3.5-5.3
5.0 - 5.9 = critical. hold all potassium, assess heart, prepare dex 5 and insulin, call HCP
6 or > = do something NOW

Question 4

HgB

Answer 4

<8 = critical, transfuse 7 or lower

Question 5

CO2

Answer 5

> 50 = do something (pursed lip breathing - blow out candle)

> 60 = do something NOW - assess lungs, pursed lip breathing, prepare to intubate + ventilate call resp therapy, call HCP

Question 6

Po2

Answer 6

low 70-77 = do something. assess lungs give oxygen

low <60’s = respiratory failure do something NOW. assess lungs, give oxygen, prepare intubate + ventilate, call resp therapy, call HCP

Question 7

O2 Sat

Answer 7

<93 do something. assess lungs give oxygen

Question 8

Sodium

Answer 8

135-145
high - look for dehydration
low - look for overload
change in LOC = C

Question 9

WBC’s

Answer 9

WBC 5,000-11,000 (inflammation, immunity, allergy) (<5000 = C)
ANC (bacterial infection) >500 (<500 = C)
CD4 (HIV) >200 (<200 = C)

Question 10

Leukopenia
Neutropenia
Agranulocytosis
Immunosuppression

Answer 10

Neutropenic precautions
strict handwashing, shower with antimicrobial soap, avoid crowds, private room, limit staff/visitors, low bacteria diet (no raw fruits veg meat)
vitals 4 hrly
Check wbc (ANC) daily
AVOID idc
Do not reuse cups, wash inbetween uses
use disposable plates, cups, cutlery
Dedicated stethiscope, bp cuff, thermometer, gloves

Question 11

Platelets

Answer 11

150,000-400,000 wide range
Thrombocytopenia (low platelet count)
<90,000 C - assess, call, bleeding precautions
<40,000 = D (assess, call, bleeding precautions, transfusion)

bleeding precautions
- no unnecessary venipuncture/injection/IV
- Electric razor
No toothbrush or flossing
- No aspirin
- Stool softener, no straining
- Notify MD of blood in urine/stool

Question 12

Know the 5 D’s

Answer 12

K+ 6 or higher
pH 6 or lower
CO2 60 or higher
pO2 60 or lower
Plt below 40,000

Question 13

When should you call the rapid response team?

Answer 13

SYMPTOMATIC D’s, no sx no problem