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Lab Values and Electrolytes Flashcards

1
Q

BMP Basic Metabolic panel

A

Na
CL
K
CO2
Cr
BUN
Glucose

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2
Q

Sodium

A

Sodium 135-145

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3
Q

Hyponatremia

A

Sodium level lower than 135
usually associated with Fluid Volume Imbalances could be fluid volume overload or fluid volume deficit

Causes: Increased sodium excretion
Excess diaphoresis
Diuretics
Vomiting
Diarrhea
Decreased secretion of aldosterone

Signs and symptoms
Shallow decreased resp due to muscle weakness
Muscle weakness
Diminished tendon reflex
Headache
Confusion
Seizures
Increased urinary output
Dry mucus membranes

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4
Q

Hypernatremia

A

Sodium level above 145
Causes: Decreased sodium excretion
Corticosteridos
Cushings syndrome
Kidney disease
Hyperaldosteronism ‘

Signs and symptoms:
HR and BP respond to fluid volume status
Pulmonary edema if hypovolemia is present
Muscle twitches
Diminished reflex
Altered LOC
Extreme thirst
Decreased uriinary output
Presence of edema

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5
Q

Potassium

A

3.5-5.0
Priority = pumps the heart

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6
Q

Hypokalemia

A

Potassium level less than 3.5
Life threatening because every body system is effected

Signs and Symptoms:
Weak threads pulse
Orthostatic hypotension
Dysrhythmias
Shallow ineffective respirations
Diminished breath sounds
Anxiety, lethargy, confusion
Muscle weakness
decreased deep tendon reflex
Hypoactive bowel sounds
Nausea vomting, constipation

ST depression
Inverted T wave
Prominent U wave

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7
Q

Hyperkalemia

A

Potassium over 5.0

Signs and symptoms
slow and irregular HR
Decreased BP
Dysrhythmias
Weakness of resp muscles leading to resp failure
Muscle twitches Early
Profound weakness late
Hyperactive bowel sounds
Diarrhea

Tall peaked T waves
Flat P waves
Widened QRS complex
Prolonged PR interval

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8
Q

Potassium IV

A

First action heart monitor
Never push = death
Only 10-20meq max per hour (IV pump)
Slow infusion if arm burns

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9
Q

Potassium ECG changes

A

Peaked T waves: 6-7mEq/L
ST elevation 7-8 mEq/L
Wide QRS complex: Over 8

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10
Q

Client with kidney disease is weak, lethargic and bradycardic

A

K+ 8.5 is lab value to be expected

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11
Q

Treatment for Hyperkalemia

A
  1. IV calcium gluconate = dysrthmias
  2. IV 50% dextrose + regular insulin
  3. kayexalate (polystryene sultfanate)
  4. Dialysis

If dysthrmias is not int he question progress to option 2

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12
Q

Patient with chronic kidney disease missed 3 dialysis sessions… potassium level of 8.1.. wide QrD complex’s, heart rate of 48 and lethargy. Which order should the nurse implement first?

A

Iv calcium gluconate

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13
Q

End stage renal disease potassium 7.2, BUN 35, creatinine of 3.8 and urine output of 300ml in 24 hours. Which order is priority?

A

IV regular Insulin and 50% dextrose

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14
Q

Calcium

A

9.0-10.5
Calcium contracts the muscles

Low calcium
Diarrhea
trousseau’s: twerking arm when BP cuff on
Chvosteks: cheek smile when stroking face

High Calcium
Stones, moans and grains
Kidney stones
Costipation

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15
Q

Hypocalcemia

A

Calcium level lower than 9.0
Decreased HR
Hypotension
Diminished peripheral pulses
Anxiety
Twitches, Seizures
Hyperactive deep tendon reflex
Positive Trousseaus and Chvostek signs
Hyperactive bowels - diarrhea

Prolonged ST intervals, Prolonged QT intervals

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16
Q

Hypercalcemia

A

Calcium level that exceeds 10.5
Increased HR in early phase, bradycardia in the late phase
Increased Blood pressure
Bounding pulse
Ineffective respirations
Lethargy, Cooma
Profound muscle weakness
Diminished or absent deep tendon reflex
Nausea, anorexia, abdominal distention, constipation

Short ST segments, Wide T wave, heart block

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17
Q

Magnesium

A

1.8 - 2.6
Magnesium mellows the muscles
Low magnesium
Hyper-excitability
Torsades de pointes and V fib
Hyperreflexia
Increases DTR

High Magnesium
Decreased DTR
Hyporeflexia

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18
Q

Hypomagnesium

A

magnesium level less than 1.8
Causes:
Vomitting/diarrhea
Celiac disease
Crohns disease

signs and symptoms:
Tachycardia
Hypertension
Shallow resp
Hyperrefleia
Positive trousseaus and chvostek
Confusion
Tall T waves
Depressed ST segments

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19
Q

Hypermagnesemia

A

Magnesium level that exceeds 2.6
Bradycardia, dysrhythmias
Hypotension
Respiratory insufficiency
Diminished tendon reflex
Muscle weakness
Drowsiness and lethargy
Prolonged Pr inerval
Widened QRS

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20
Q

Phosphorus

A

Normal level 3.0-4.5

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21
Q

Hypophosphatemia

A

phosphorus level lower than 3.0
accompanied by an increased serum calcium level

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22
Q

Hyperphosphatemia

A

Phosphate level that exceeds 4.5
Most body systems tolerate elevated phosphorus

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23
Q

CBC complete blood count

A

WBC
HGH
HCT
PLT

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24
Q

Hemoglobin

A

Carries oxygen
Normal 12-18
Risky: 8-11 report to HCP and surgeon if before surgery
Bleeding and anemia, malnutrition and cancer

Below 7 = heaven or blood transfusion
Pale skin: pallor, dusky skin tones
Cool clammy skin
Fatigue, weakness

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25
Client with a hemoglobin of 10.8 is most likely caused by which condition
Iron deficiency anemia
26
The nurse determines that the hemoglobin level is normal if which value is noted on the laboratory report
14g/dl
27
Hematocrit
Ratio of red blood cells and oral blood volume Normal: 36-54% Elevated HCT = dehydration Decreased HCT = fluid volume overload Bleeding, anemia and malnutrition
28
Client with diagnosis of fluid volume overload...the nurse would expect to note which finding about the hematocrit level?
Decrease HTC
29
Client with gastrointestinal (GI) bleeding...laboratory results hematocrit level of 30% which action should the nurse take?
report the abnormal low level
30
H/H ratio
1:3 ratio multiply hemoglobin by 3 to get the hematocrit
31
RBC red blood cell count
4-6 million Low = anemia, renal failure iron (fe+) Erythropoietin High = Dehydration High labs = dry body
32
White Blood cells
5000-10000 Higher = leukocytosis infection (sepsis) Steroids (prednisone) Low = leukopenia Chemotherapy Radiation immunosuppressant drugs lupus - autoimmune diseaase Neutropenic precautions: Low grade fever = priority Private room No fresh fruits/flowers Avoid crowds and sick people No drinking water pitcher or sitting out CD4 count Over 200 below = aids (active form of HIV)
33
Which blood laboratory test result should the nurse report to the HCP
White blood cells 2000 Hemoglobin 6 Potassium 6.5 Sodium 150 platlets 45,000
34
Coagulation Panel
Platelets: 150lk-400k PTT: 30-50 INR: 0.9-1.2
35
Platelets
150,000-400,000 Notify the HCP if less than 150k Less than 50k very risky Drugs that decrease platelets: apron, clopidogrel, enoxaparin, heparin
36
PTT
30-40 seconds PTT for Heparin: 46-70 Higher = horrible Should never be 3 times their range
37
INR
0.9 - 1.2 Warfarin 2-3 Higher = horrible Should never be 3 times their range
38
Client on warfarin with an INR of 4.5 Client on heparin PTT of 100
Stop or hold drug Assess bleeding Prep antidote Report to HCP
39
Cardiac Labs
Troponin Over 0.5 = trauma to heart muscles
40
CHF (congestive Heart failure) labs
BNP under 100 Big stretched out ventricles
41
Natriuretic Peptide
Hormones secreted by cells that lie in the heat chambers when there is damage presented 2 Types ANP: Atrial natriuretic peptides - in the atria upstairs of the heart BNP: Brain natriuretic peptides - in the ventricles downstairs of the heart
42
BNP
Brain natriuretic peptides Over 100pg/ml = Heart failure causes of elevation High sodium diet Sedentary lifestyle High cholesterol diet
43
ANP
Atrial natriuretic peptides Kills aldoerstone Increased ANP = acute heart failure, supervantricular tachycardia Hyperthyroidism small cell lung cancer Decreased ANP Chronic heart failure: ANP gives sup in the battle Hypothyrdoism Put on antihypertensive drugs
44
Diabtes Labs
Normal: 70-115 (3.6-5.5) Normal fasting = under 100 Normal HgBA1C = under 5.7 Hypoglycemia is most deadly because it causes brain death
45
HgBA1C
test to see how well patients have been controlling their BG over a few months
46
Hyperglycemia
Over 115 Polyuria polydyispa Polyphagia Causes: Sepsis (infection) Stress (surgery or hospital stay) Skip insulin Steroids (prednisone) Treat with insulin Increase insulin during stress
47
Hypoglycemia
Below 70 most deadly Cool pale Sweaty, diaphoretic, clammy Nervous -anxious, tumbling Headache Treatment: Give sugar Juice, soda, crackers low fat milk Not high fat milk or peanut butter Cause: Exercise: Give extra glucose Alcohol: lowers sugar Insulin peak times: most at risk for low sugar - give plate of food
48
A client with type 1 diabetes is only responsive to painful stimuli with a blood sugar of 42, what is the first action taken by the nurse
Give dextrose IV push and reassess in 15min
49
Which medication could cause risk for hyperglycaemia
Prednisone
50
The non diabetic client is admitted for a kidney infection that has now turned septic. The blood sugars have increased from 150 to 225, what is the best answer to give a family member who is asking why insulin is used?
High sugar is common during infection and stress to the body, the insulin will help lower the sugar until the infection resolves
51
Renal Labs
Hydrogen Ions Urea Creatinine
52
Hydrogen Ions
Very acidic = metabolic acidosis
53
Clients most at risk for metabolic acidosis
Renal failure Pyelonephritis Patient waiting for hemodialysis Child with diarrhea x2 days
54
BUN
10-20 MAX Trash the body needs to toss out Starts as ammonia broken brown to urea and excreted through kidneys Elevated: dehydration - body is dry
55
Creatinine
Over 1.3 = Bad kidney Waste product produced by the muscles Higher creatinine = higher kidney impairment (failure) Critical kidney lab value
56
Urine Output
30ml/hr or less = Kidney Distress
57
Client with an infected toe due to diabetes is scheduled for cardiac catheterization with contrast, which lab value should the nurse report to the provider
Creatine 1.9 (contact kills the kidneys)
58
Urine Analysis
Colour: light means hydrated and dark means dehydrated unless Diabetes insidious = light urine, dry body SIADH: dark urine and fluid filled body RBC: blood hematuria WBC: leukocytes = bladder infection oor UTI Nitrites = kidney infection Protein = nephrotic syndrome Glucose = diabetes *urine culture and sensitivity test Over 10,000 organisms/ml = UTI
59
Specific Gravity
1.003-1.030 Light urine = low specific urine Dark urine = high specific urine (dry body)
60
Client with history if diabetes which does the nurse suspect Specific gravity = 1.030 Protein = none Glucose = high Red blood cells = none Leukocytes: medium
Dehydration (low fluid intake) and possible UTI
61
Procedure for collecting a sterile urine specimen from a foley bag
1. Clamp drainage tube below port 2. Wait 15-30 minutes 3. Scrub the port using an antiseptic swab 4. Attach a sterile, needless access device to aspirate a specimen via the port
62
Liver Failure Labs
Ammonia High = hepatic encephalopathy Albumin Low (under 3.5) = calcium low, low platelets Bilrubin High Coagulation panel: High PT, PTT, INR Elevated ALT and AST
63
Which blood lab values are expected to be elevated in a client with worsening liver cirrhosis?
Ammonia Bilirubin PT
64
Highest Priority = Safety
A&B: Airway, breathing = oxygenation Low PaO2 norm = 80-100 High Co2 Over 45 mental changes, restless, agitation Skin: pale dusky, cool and clammy C: Circulation Bleeding: High PTT/INR Shock: severe low BP Chest pain (any kind) Hypertension crisis (over 180 sys) Infection: Priority = less than 5000 WBC “leukopenia” Kidney Labs: Creatinine over 1.3 = Bad kidney Pain: Loose life or limb? Chest pain = priority Compartment syndrome - cast/broken limb pain = unrelieved with pain meds
65
Airway and breathing Priority ABGs
PaO2: normal: 80-100 60 or less = hypoxemic respiratory failure, low O2 PaCO2: Normal 35-45 50 or more hypercapnia respiratory failure, high CO2 Hyper cap = give BIpap Intubate and ventilate
66
Circulation - Bleeding
INR over 4 aPTT over 100 1. Stop/hold drug 2. Assess bleeding 3. Prep antidote Warfarin - vitamin K Heparin - Protamine sulfate 4. Report to HCP
67
An emergency room nurse is presented with four clients at the same time. Which of the following clients should the nurse see FIRST?
A client with abdominal and chest pain following a large, spicy meal
68

Nclex Study Cards (38 decks)

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