Labs

Question 1

Normal Hemoglobin Values

Answer 1

12-18 g/dL

Question 2

Low Hemoglobin value

Answer 2

Anemia: hemoglobin <12g/dL
hgb <7g/dL requires blood transfusion

Question 3

Anemia Signs and Symptoms

Answer 3

dizziness; lightheadedness; fall risk

Question 4

Polycythemia

Answer 4

High Hemoglobin (>18g/dL)

Question 5

Signs and Symptoms of Polycythemia

Answer 5

fatigue, weakness, shortness of breath, visual disturbances, nose bleeds, bleeding gums.

Question 6

Hematocrit

Answer 6

Directly related to hemoglobin; the ratio of RBC to total blood volume
Normal is 37 - 57%

Question 7

Normal RBC Count

Answer 7

4.5 - 5.5 million

Question 8

Normal WBC Count

Answer 8

5,000 - 10,000

Question 9

Leukopenia

Answer 9

Low WBC count (>5,000); immunocompromised
Causes: Cancer, immunosuppression, autoimmune disease, IV Abx.

Question 10

Leukocytosis

Answer 10

High WBC count (>10,000); caused by infection and surgery

Question 11

Normal Platelet Count

Answer 11

4.5 - 5.4 million

Question 12

Thrombocythemia

Answer 12

high platelet count (>5.4 million); clot risk

Question 13

Thrombocytopenia

Answer 13

low platelet count (<4.5 million); increased risk for bleeding.

Question 14

Normal Sodium Level

Answer 14

135 - 145 mEql/L

Question 15

Hyponatremia

Answer 15

<135 mEq/L

Question 16

Euvolemic Hyponatremia

Answer 16

water in the body decreases, but the sodium level remains the same. Caused by SIADH, polydypsia, adrenal insufficiency, excessive hypotonic IV fluids, and low dietary sodium.
Signs and symptoms: weak pulse, tachycardia, hypotension, dizziness.
Treatment: water restriction, osmotic diuresis, and increased PO sodium.

Question 17

Hypervolemic Hyponatremia

Answer 17

water in the body increases to the point of hypervolemia, which dilutes the amount of sodium in the serum, causing dilution or relative hyponatremia.
Causes: CHF, RF, liver failure, and water intoxication.
Signs and Symptoms: bounding pulse, hypertension.
Treatment: water restriction, increased osmotic diuresis, increased sodium intake.

Question 18

Hypovolemic Hyponatremia

Answer 18

loss of sodium and water.
Causes: vomiting, diarrhea, diuretics (furosemide), burns, and excessive sweating.
Signs and Symptoms: seizure, confusion, lethargy, cerebral edema, increased ICP, cramps, weakness, shallow resps, muscle spasms, OH, loss of appetite, hyperactive bowel sounds.
Treatment: 0.9% NaCl; if severe, 3% NaCl

Question 19

Foods High in Sodium

Answer 19

canned or processed foods, frozen foods, lunch meats, cheeses, bacon, table salt, etc.

Question 20

Normal Potassium Levels

Answer 20

3.5 - 5.0 mEq/L

Question 21

Hyperkalemia

Answer 21

high serum potassium; caused by too much potassium shifting out of cells such as with burns, tissue damage, DKA; or too much potassium as a result of renal failure and excessive potassium uptake; or with taking potassium sparing diuretics or ACE inhibitors.

Question 22

Hypokalemia

Answer 22

low potassium (<3.5); caused by drugs such as laxatives, diuretics, or corticosteroids, too much water intake, or heavy fluid loss such as with NG suction, vomiting, diarrhea, wound drainage, sweating, alkalosis, and hypertension; inadequate potassium intake such as with NPO, anorexia, bulimia, alcoholism, Cushing’s syndrome, retention of sodium and water, excessive cortisol, or excessive secretion of potassium.

Question 23

Hypokalemia Treatment

Answer 23

Treatment: hold digoxin; hold potassium-wasting drugs; give potassium, IV or PO (NEVER PUSH); give tomatoes, oranges, avocados, bananas, etc.

Question 24

ECG Changes caused by Hypokalemia

Answer 24

ECG Changes: U-Wave appearance after peaked T-wave followed by abnormal T-wave.

Question 25

Signs and Symptoms of Hypokalemia

Answer 25

Signs and Symptoms: decreased reflexes; weakness; faccidity; shallow respirations; decreased bowel sounds; constipation; abdominal distension; OH; weak pulses; cardiac dysrhythmias; and increased urinary output.

Question 26

Hyperkalemia Treatment

Answer 26

Treatment: dependent on severity - monitor cardiac ECG - DC potassium supplements - potassium-restricted diet - IV calcium gluconate or chloride - D5W with regular insulin to drive potassium back into cells - albuterol, bicarbonate - kayexalate to remove K+ from feces - Diuretics such as hydrochlorothiazide or furosemide - dialysis if unresponsive to treatment.

Question 27

Signs and Symptoms of Hyperkalemia

Answer 27

Signs and Symptoms: muscle weakness, decreases reflexes, numbness, shallow respirations, cramping, hyperactive bowel sounds, diarrhea, impaired contractility, decreased CO, weak pulses, hypotension, urine abnormalities, and ECG changes (wide, flat p-waves with widened QRS, depressed ST, and tall, peaked T-waves.

Question 28

Normal Chloride Levels

Answer 28

98 - 106 mEq/L

Question 29

Hypochloremia

Answer 29

decreased chloride levels (<98mEq/L) Causes: Fluid overload (CHF, water intoxication), salt loss (burns, sweating, vomiting, diarrhea, cystic fibrosis, acidosis, Addison's disease).

Question 30

Signs and Symptoms of Hypochloremia

Answer 30

seizure risk; weakness; fatigue; SOB; diarrhea/vomiting; signs of dehydration.

Question 31

Treatment for Hypochoremia

Answer 31

monitor electrolytes; treat the cause with 0.9% NaCl

Question 32

Osmolarity of urine

Answer 32

300 - 900 mOsm/Kg H20

Question 33

Serum Osmolarity

Answer 33

285 - 295 mOsm/Kg H20

Question 34

Urine Specific Gravity

Answer 34

the ratio of the density of a substance to the density of a standard, usually water. Normal is 1.005 - 1.030 increased USG = dehydration decreased USG = needs electrolytes

Question 35

Normal Calcium Levels

Answer 35

9 - 10.5 mEq/L

Question 36

Normal Magnesium Levels

Answer 36

1.5 - 2.5

Question 37

Normal Phosphorus Levels

Answer 37

2.5 - 4.5

Question 38

Normal Glucose Levels

Answer 38

70 - 110 g/dL

Question 39

Normal BUN

Answer 39

10 - 20

Question 40

Normal Creatinine

Answer 40

0.6 - 1.2

Question 41

Normal GFR

Answer 41

>90

Question 42

Normal Total Protein

Answer 42

6.4 - 8.3

Question 43

Normal Albumin Levels

Answer 43

3.5 - 5

Question 44

Normal Bilirubin

Answer 44

<1

Question 45

Normal Ammonia Levels

Answer 45

15 - 110

Question 46

Normal Liver Enzymes

Answer 46

AST: 0 - 35 ALT: 4 - 36 ALP: 30 - 120

Question 47

GFR indicating kidney damage

Answer 47

<30

Question 48

GFR indicating kidney failure

Answer 48

<15

Question 49

Considerations for CT

Answer 49

Computed tomography scans may be performed with or without contrast. This procedure uses radiation and is commonly indicated for abdominal pain, stroke, and spinal cord injuries. If contrast is administered, a baseline creatinine and eGFR should be obtained. The client should be instructed to increase their fluid intake following a contrast procedure to facilitate its passing. Before IV contrast administration, prescreening must include questioning the patient regarding prior reactions to contrast dye or allergies to medications/substances. Any allergy (not specifically shellfish) may increase the risk of having an IV contrast dye reaction. If there is a history of severe allergies or prior reaction to contrast dye, such patients may be premedicated with diphenhydramine and steroids. Shellfish allergy is not a contraindication. Patent vascular access of at least a 20-gauge catheter is necessary before the infusion of intravenous contrast. Extravasation of contrast media can be severe, and treatment involves stopping the infusion, removing the catheter, and elevating the extremity above the heart. This can be avoided by establishing IV patency before the infusion of contrast. Warm or cold compresses may also be helpful.

Question 50

CT

Answer 50

uses many x-rays to generate 3D anatomical images donut shaped scanner may or may not use contrast each set of scans takes 5-10 mins best way to see detail of bony structures check renal function first If contrast is used, increase PO fluid intake, monitor output, hold meftormin for 24 hrs and up to 48 hrs after to avoid risk of lactic acidosis

Question 51

MRI Considerations

Answer 51

Nitroglycerin transdermal patches should be temporarily removed during the procedure because they may burn the client. The transdermal patch may contain aluminum which is contraindicated for an MRI. An MRI questionnaire is always completed before this exam to ensure client safety. MRI units can produce sounds up to 120 decibels, resulting in hearing damage. MRIs do not use radiation; this imaging exam uses magnets to create 3D cross-sectional images of the body. Uses magnetic fields & radio waves to generate 3D anatomical images (no radiation) * Lasts 15 - 60 minutes * May show soft tissue/organ changes * Great for brain, spinal cord, & nerves * May or may not use contrast * Ensure client has no metal obiects in/on them * Assess for claustrophobia * Check if client has pacemaker (old machines may deactivate pacemakers) * Contraindications: agitation, old tattoos An MRI is a unique imaging exam that uses magnets (not radiation) to assist clinicians in diagnostic imaging. MRI is most suited to image soft tissue structures in the body with a high water content to utilize the protons in water molecules. The brain and spinal cord are often evaluated using MRI. MRI can differentiate between gray and white matter and blood vessels. Nursing care for a client scheduled for an MRI includes - Completing a comprehensive MRI screening form that is submitted before the exam. MRIs are safe during pregnancy because it does not use radiation. MRIs may be ordered with contrast. The contrast agent of choice is gadolinium-based. The MRI may become unsafe for a pregnant client if this contrast is necessary. MRI safety includes having the client wear ear protective device(s) as this test is extremely loud.

Question 52

Which labs would be expected after a client receives an angiogram with contrast?

Answer 52

In order to yield valuable, quality results from an angiogram, the use of contrast media is essential. Like all medications and substances, risks are present even when utilizing the minimum amount required. Two documented risks of contrast media are contrast-associated acute kidney injury (CA-AKI) and contrast-induced nephropathy (CIN), as contrast media is metabolized in the kidneys. To assess for kidney damage, kidney function tests are performed one day after the client receives contrast media to evaluate renal function and compare the result to the pre-procedure testing result. Adequate hydration before and after contrast agent administration is regarded as the most important preventive strategy for circumventing kidney injuries.