Lab Values

Question 1

K

Answer 1

3.5-5.0

INVERSE relationship w/ Na

Question 2

HYPOkalemia S/Sx

5 L’s

Answer 2

Lethargic
Limp muscles (weakness)
Lethal dysrhythmias (↑↓ HR, U-wave)
Low, shallow respiration
Less stool (constipation, ↓ GI motility)

Question 3

HYPOkalemia Causes

DAANG Cushion

Answer 3

Diuretics
↑ Aldosterone
Alkalosis 
NG suction (lots K+ in stomach)
GI loss (V/D)
Cushing's syndrome

Question 4

HYPOkalemia Interventions

Answer 4

PO or IV Potassium (NEVER IV push, Assess UO)
Use Spironolactone (K+ sparing)

FOODS: raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery
NO digoxin (↑ risk Dig Tox)

Question 5

HYPERkalemia S/Sx

MURDER

Answer 5

Muscle twitching (1st) → muscle weakness → flaccid paralysis

Urine - Oliguria, Anuria
Respiratory distress
Decreased HR
EKG changes (peaked T, small P waves, PVCs, VFib)
Reflexes - hyper/hypo

Question 6

HYPERkalemia Causes

MARCH

Answer 6

Meds (ACE I, Steroids, Beta Blockers)
Acidosis
Renal failure (excreted by kidneys)
Cellular destruction (burns, crushing injuries, trauma)
Hypoaldosteronism - Addison's (↓ adrenal hormones)

Question 7

HYPERkalemia Interventions

DDICK

Answer 7

Dialysis (impaired kidney)
Diuretics
Insulin + Dextrose (shifts K INTO cells ∴ √ hypokalemia, hypoglycemia)
Ca Gluconate (tx arrythmias)
Kayexalate (↑ excretion, causes diarrhea)

Question 8

Na

Answer 8

135-145

Question 9

HYPOnatremia S/Sx

NIMO “Nimo lives in the water”

Answer 9

N
ICP ↑ - confusion, muscle twitching, *seizures
Muscle cramps
Output ↑, USG ↓ (conc of urine)

Question 10

HYPOnatremia Causes

Answer 10

V/D
DIuretics
Diaphoresis
Excess IV dextrose + water

Question 11

HYPOnatremia Interventions

Answer 11

IV LR or NS
FOODS: beef broth, tomato juice
↓ Water intake (safest)
I&O, daily WT

Question 12

HYPERnatremia S/Sx

THUNDER

Answer 12

Temperature (fever)
HTN, ↑ HR
Urine output (↓), USG (↑)
Need water (Thirst, dry tongue)
Delusions, hallucinations
Edema
Restless

Question 13

HYPERnatremia Causes

Answer 13

D
diabetes insipidous
hyperventilation
hypertonic tube feedings w/o water

Question 14

HYPERnatremia Intervention

Answer 14

IV hypotonic solutions - 0.3%, 0.45% NaCl, or D5W

Kayexalate (causes diarrhea, ↑ excretion)

Question 15

Ca

Action
Regulated by

Answer 15

8.6-10

Action: blood clotting, skeletal muscle contraction
Regulation: PARATHYROID hormone + VITA D

Question 16

HYPOcalcemia S/Sx

Answer 16

EXCITABLE CNS

tetany (muscle spasms)
Trousseau’s sign - carpal spasm w/ BP cuff
Chvostek’s sign - contract facial muscle w/ light tap to facial nerve

↑ DTR, ↓ HR, ↓ BP 
seizures
confusion
paresthesia (tingling/ prickling d/t dmg to peripheral nerve)
irritability

Question 17

HYPOcalcemia Causes

Answer 17

hypoparathyroidism, post-thyroid surgery
pancreatitis
renal failure
steroids
loop diuretics

Question 18

HYPOcalcemia Interventions

Answer 18

Ca Gluconate 
PO CaCl, Vita D
Al Hydroxide - ↓ P to ↑ Ca 
NO digoxin 
Admin Ca supplement, Vita D

Question 19

HYPERcalcemia S/Sx

Answer 19

SEDATED CNS

↓ DTR, ↑ HR, ↑ BP
muscle weakness
lack coordination
C, abd distention
confusion

Question 20

HYPERcalcemia Causes

Answer 20

hyperparathyroidism

immobility

Question 21

HYPERcalcemia Interventions

Answer 21

IV NS
↑ Fluids
Furosemide 
Calcitonin - ↓ Ca levels
mobility, ambulation

Question 22

Mg

Action

Answer 22

1.3-2.3

Mg acts as DEPRESSANT
DIRECT relationship w/ Ca

Question 23

HYPOmagnesium S/Sx

Answer 23

Low Mg = EXCITABLE CNS

↑ neuromuscular irritability
tremors, tetany, seizures
depression, confusion
dysphagia - assess swallowing

Question 24

HYPOmagnesium Causes

Answer 24

D
diuretic or laxative abuse
alcoholism
GI suction

Question 25

HYPOmagnesium Interventions

Answer 25

IV MgSO4 | FOODS: green veggies, nuts, bananas, oranges, peanut butter, chocolate

Question 26

HYPERmagnesium S/Sx

Answer 26

``` *DEPRESSES CNS* ↓ BP, ↓ DTR, paralysis flushed face muscle weakness shallow respirations ```

Question 27

HYPERmagnesium Causes

Answer 27

``` renal failure Mg hydroxide (antacid) ```

Question 28

HYPERmagnesium Interventions

Answer 28

``` EMERGENCY!! D/C PO and IV MgSO4 support ventilation IV Ca gluconate monitor DTR ```

Question 29

RBC

Answer 29

4.2 - 6.2 million/mm3

Question 30

WBC

Answer 30

5,000 - 10,000

Question 31

Hgb

Answer 31

13 - 18

Question 32

Bleeding time

Answer 32

1.5 - 9.5 minutes

Question 33

PTT (partial thromboplastin time) | Action

Answer 33

Monitors effectiveness of HEPARIN therapy 25-35 seconds

Question 34

PT (prothrombin time) | Action

Answer 34

Monitors effectiveness of COUMADIN (Warfarin) therapy 9 - 12 seconds

Question 35

INR | Action

Answer 35

Monitors effectiveness of ANTICOAGULATION therapy 1.0 2 - 3 = Afib, DVT, PE therapy 2.5 - 3.5 = prosthetic heart valves therapy

Question 36

ESR (erythrocyte sedimentation rate) | Action

Answer 36

Indicated inflammation 0 - 20

Question 37

Hct

Answer 37

40 - 50% Increase 4+% in 2wks -- HTN, SEIZURES (even if still within norm/low)

Question 38

PLT

Answer 38

150,000 - 450,000

Question 39

LDL | NC

Question 40

HDL

Answer 40

60+

Question 41

Creatinine | BUN

Answer 41

Creatinine: 0.6 - 1.2 BUN: 7 - 18 Tests renal func

Question 42

Albumin | Action

Answer 42

Detects protein malnutrition 3.5 - 5.5

Question 43

ALT/ AST

Answer 43

10 - 40 units Tests hepatic func

Question 44

PaCO2

Answer 44

35 - 45 Resp Acidosis = 45+ Resp Alkalosis = 35-

Question 45

HCO3

Answer 45

22 - 26 Metabolic Acidosis = 22- Metabolic Alkalosis = 26+

Question 46

Urine Specific Gravity (USG)

Answer 46

1.01 - 1.03

Question 47

CVP (Central Cenous Pressure)

Answer 47

3-12 cm of water pressure 2-6 mmHg Monitors fluid load and effectiveness of fluid replacement therapy - 12+ cm or 6+mm = HYPERvolemia - 3-cm or 2-mm = HYPOvolemia