Understanding key Lab Values

Lab Value Cheat Sheet

Vital Signs

• Normal systolic blood pressure: 120 mmHg
• Normal diastolic blood pressure: 80 mmHg
• Normal heart rate: 60-100 BPM
• Normal respiration rate: 12-20 breaths per minute
• Normal oxygen saturation: 95%-100%
• Normal temperature: 97.8°F - 99°F

Basal Metabolic Panel (BMP)

• Normal sodium: 135-145 mEq/L
• Normal potassium: 3.5-5.0 mEq/L
• Normal chloride: 95-105 mEq/L
• Normal calcium: 9-11 mg/dL
• Normal BUN: 7-20 mg/dL
• Normal creatinine: 0.6-1.2 mg/dL
• Normal albumin: 3.4-5.4 g/dL
• Normal total protein: 6.2-8.2 g/dL

Liver Function Test (LFT)

• Normal ALT: 7-56 U/L
• Normal AST: 5-40 U/L
• Normal ALP: 40-120 U/L
• Normal bilirubin: 0.1-1.2 mg/dL

Lipid Panel

• Normal total cholesterol: less than 200 mg/dL
• Normal triglycerides: less than 150 mg/dL
• Normal LDL (bad cholesterol): less than 100 mg/dL
• Normal HDL (happy cholesterol): greater than 60 mg/dL

Renal

• Normal calcium: 9-11 mg/dL
• Normal magnesium: 1.5-2.5 mg/dL
• Normal phosphorus: 2.5-4.5 mg/dL
• Normal specific gravity: 1.010-1.030
• Normal GFR: 90-120 mL/min/1.73 m²
• Normal BUN: 7-20 mg/dL
• Normal creatinine: 0.6-1.2 mg/dL

ABG's

• Normal pH: 7.35-7.45
• Normal PaCO2: 35-45 mmHg
• Normal PaO2: 80-100 mmHg
• Normal HCO3: 22-26 mEq/L
• Remember ROME: Respiratory Opposite Metabolic Equal

Pancreas

• Normal amylase: 30-110 U/L
• Normal lipase: 0-150 U/L

HbA1c

• Normal non-diabetic HbA1c: 4-5.6%
• Normal pre-diabetic HbA1c: 5.7-6.4%
• Normal diabetic HbA1c: greater than 6.5% (goal for diabetic: less than 6.5%)

Complete Blood Count (CBC)

• Normal WBC: 4,500-11,000
• Normal RBC's: 4.5-5.5
• Normal PLT: 150,000-450,000
• Normal hemoglobin (Hg) for females:12-16 g/dL
• Normal hemoglobin (Hg) for males: 13-18 g/dL
• Normal hematocrit (HCT) for females: 36%-48%
• Normal hematocrit (HCT) for males: 39%-54%

Coags

• Normal PT: 10-13 sec
• Normal PTT: 25-35 sec
• Normal aPTT: 30-40 sec (heparin)
• INR not on Warfarin: less than 1 second
• INR on Warfarin: 2-3 seconds
• Heparin therapeutic range (aPTT): 1.5-2.0 x normal "control" value, antidote is Protamine Sulfate
• Warfarin therapeutic range (PT/INR): 1.5-2.0 x normal "control" value, antidote is Vitamin K
• Higher numbers may indicate a higher chance of bleeding

Other

• Normal MAP: 70-100 mmHg
• Normal ICP (intracranial pressure): 5-15 mmHg
• Normal BMI: 18.5-24.9
• Glasgow Coma Scale: Best = 15, Mild: 13-15, Moderate: 9-12, Severe: 3-8

Lab Value Memory Tricks

Electrolytes

• Sodium normal range: 135-145
• Commit to memory!
• Potassium normal range: 3.5-5
• Bananas: there are about 3-5 in every bunch & you want them half ripe (1/2) so, think 3.5-5.0
• Phosphorus normal range: 2.5-4.5
• PHOR: 4, US: 2 (me + you = 2)
• Calcium normal range: 9-11
• Call 911
• Magnesium normal range: 1.5-2.5
• MAGnifying glass you see 1.5-2.5 bigger than normal
• Chloride normal range: 95-105
• Think of a chlorinated pool that you want to go in when it's SUPER HOT: 95-105 °F

Basal Metabolic Panel (BMP)

• BUN normal range: 7-20 mg/dL
• Think hamburger BUNs... Hamburgers can cost anywhere from $7-$20 dollars
• Creatinine normal range: 0.6 – 1.2 mg/dL
• This is the same value as LITHIUM's therapeutic range (0.6 - 1.2 mmol/L)
• Lithium is excreted almost solely by the kidneys... And creatinine is a value that tests how well your kidneys filter

Complete Blood Count (CBC)

• Hemoglobin (Hgb) for females: 12-16 g/dL
• Hemoglobin (Hgb) for males: 13-18 g/dL
• Hematocrit (HCT) for females: 36%-48%
• Hematocrit (HCT) for males: 39%-54%
• To remember HCT, multiply hgb by 3

Blood Types

Blood Types

• Antigens are proteins that elicit an immune response and identify the cell
• Plasma antibodies protect the body from "invaders"(think ANTI) and are opposite of the antigen that is found on the RBC

Blood Type A

• Antigen: A
• Antibodies: B
• Recipient: A, O
• Donor: A, AB

Blood Type B

• Antigen: B
• Antibodies: A
• Recipient: B, O
• Donor: B, AB

Blood Type AB

• Antigen: A & B
• Antibodies: None
• Recipient: ALL
• Donor: AB
• Universal recipient

Blood Type O

• Antigen: None
• Antibodies: A & B
• Recipient: O
• Donor: ALL
• Universal donor

Rh Factor

• Has Rh on surface: Can receive +
• Does not have Rh on surface: Can receive -

Sodium Imbalance

Key Information About Sodium

• Sodium is a major electrolyte found in ECF
• Essential for acid-base, fluid balance, active & passive transport mechanism, irritability & condition of nerve-muscle tissue

Hypernatremia

• Greater than 145 mEq/L
• "Big & bloated"
• Signs and symptoms: flushed skin, restless, anxious, confused, irritable, increased BP & fluid retention, edema (pitting), decreased urine output, skin flushed & dry, agitation, low-grade fever, thirst (dry mucous membranes)
• Risk factors: increased sodium intake, loss of fluids, decreased sodium exertion
• Management: if due to fluid loss: administer IV infusions, if the cause is inadequate renal excretion of sodium: give diuretics that promote sodium loss, restrict sodium & fluid intake as prescribed

Hyponatremia

• Less than 135 mEq/L

Hypovolemic hyponatremia

• Decreased fluid & sodium
• Signs and symptoms: stupor/coma, anorexia (nausea/vomiting), lethargy (weakness/fatigue), tachycardia (thready pulse)

Hypervolemic hyponatremia

• Increased body water that is greater than Na+
• Signs and symptoms: limp muscles (muscle weakness), orthostatic hypotension, seizures/headache, stomach cramping (hyperactive bowels)

Hyponatremia Risk Factors

• Increased sodium excretion
• Inadequate sodium intake
• Kidney disease
• Heart failure

Hyponatremia Management

• ADMINISTER IV sodium chloride infusions (only if due to hypovolemia)
• DIURETICS (if due to hypervolemia): Hyponatremia → high fluids & low salt = hemodilution
• DAILY WEIGHTS: Where sodium goes, water FLOWS
• SAFETY (othostatic hypotension AKA risk for falls)
• AIRWAY PROTECTION (NPO): Don't give food to a lethargic, confused client (INCREASED RISK FOR ASPIRATION)
• LIMIT WATER INTAKE: Hypervolemic hyponatremia (high fluid & low salt)
• TEACH to avoid a diet high in salt (canned food, packaged/processed meats, etc.)

Potassium Imbalance

• Potassium imbalance plays a vital role in cell metabolism, transition of nerve impulses, the functioning of cardiac, lung, muscle tissues, & acid-base balance
• Potassium normal range: 3.5-5 mEq/L

Hyperkalemia

• Greater than 5 mEq/L
• "Tight & contracted"
• Signs and symptoms: muscle cramps & weakness, urine abnormalities, respiratory distress, decreased cardiac contractility, ECG changes, reflexes
• ECG changes may include: tall peaked T waves, flat P waves, widened QRS complexes, prolonged PR intervals
• Nursing considerations: monitor EKG, discontinue IV & PO potassium, initiate a potassium-restricted diet, potassium-excreting diuretics, prepare the client for dialysis, IV calcium gluconate & IV sodium bicarb, avoid the use of salt substitutes or other potassium-containing substances

Hypokalemia

• Less than 3.5 mEq/L
• Signs and symptoms: thready, weak, irregular pulse, orthostatic hypotension, shallow respirations, anxiety, lethargy, confusion, coma, paresthesias, hyporeflexia, hypoactive bowel sounds (constipation), nausea, vomiting, abdominal distention, ECG changes
• ECG changes: ST depression, shallow or inverted T wave, prominent U wave
• Actual total body potassium loss, inadequate potassium intake or movement of potassium from the extracellular fluid to the intracellular fluid
• Oral potassium supplements, liquid potassium chloride, potassium-retaining diuretic
• Potassium is NEVER administered by IV push, IM, or subcut routes; IV potassium is always diluted & administered using an infusion device!
• Potassium & Sodium = Opposites example: ↑ NA = ↓ K+

Magnesium Imbalance

• Majority of magnesium is found in the bones
• Regulates BP, blood sugar, muscle contraction & nerve function
• Normal magnesium: 1.5-2.5 mg/dL

Hypermagnesemia

• Greater than 2.5 mg/dL
• Low everything AKA sedated
• Signs and symptoms: low energy, low HR, low BP, low RR, decreased respirations, decreased bowel sounds, decreased DTR's

Hypomagnesemia

• Less than 1.5 mg/dL
• High everything AKA not sedated
• Signs and symptoms: high HR, high BP, increased deep tendon reflex, shallow respirations, twitches, paresthesias, tetany & seizures, irritability & confusion
• Positive Trousseau's: Carpal spasm caused by inflating a blood pressure cuff
• Chvostek's Signs: Contraction of fascial musciles w/ light tap over thje facial nerve

Risk Factors

• Increased magnesium intake
• Renal insufficiency
• Insufficient magnesium intake
• Increased magnesium excretion
• Intracellular movement

Magnesium Management & Nursing Considerations

• Diurectics
• IV adm. calcium chloride or calcium gluconate
• Restrict dietary intake of Mg containg foods
• Avoid the use of laxatives & antacids containing magnesium
• Hemo dialysis
• Magnesium Sulfate IV or PO
• Seizure precautions
• Instruct the clieht to increase magnesium-containg foods
• Magnesium & Calclium: SAME Example: ↑ MG = ↑ CA+

IV Therapy: Types of IV Solutions

Types of IV Solutions

• Fluid in our body is found in 2 places: intracellular & extracellular
• Intracellular (ICF) is fluid inside the cell
• Extracellular (ECF) is fluid outside the cell
• Interstitial (IF) is fluid that surrounds the cell
• Intravascular ((IV) is plasma in the blood vessel

Hypertonic Solutions

• "Enter the vessel from the cells"
• More concentrated & ↑ osmolality
• 5% dextrose in 0.9% saline (D5NS), 5% dextrose in 0.45% saline, 5% dextrose in LR
• Uses: cerebral edema, low levels of sodium, metabolic alkalosis, maintenance fluid, hypovolemia

Isotonic Solutions

• "Stays where I put it"
• Same osmolality as body fluids (ISO means Equal)
• 0.9% saline (NS), Lactated Ringers (LR), 5% dextrose (D5W)
• Expands intravascular fluids volume
• Replaces the fluid loss associated with burns, hemorrhage, surgery, dehydration, vomiting & diarrhea
• Also used for fluid maintenance

Hypotonic Solutions

• "Go Out of the vessel & into the cell"
• More diluted & ↓ osmolality
• 0.45% NS, 2.5% Dextrose, 0.33% NS
• Intracellular dehydration such as DKA
• Never give to clinic with burns or ICP
• Helps kidney's excrete excess fluids

IV Therapy: Complications

Air Embolism

• Air enters the vein through IV tubing
• Symptoms: tachycardia, chest pain, hypotension, decreased LOC, cyanosis
• Treatment: clamp tubing, turn client on the left side & and place in Trendelenburg position, notify PCP

Infiltration

• IV fluid leaks intro surrounding tissues
• Symptoms: pain, swelling, coolness, numbness, or no blood return
• Treatment: remove IV, elevate extremity, apply warm or cool compress, do not rub the area

Infection

• Entry of microorganism into the body via IV
• Symptoms: tachycardia, redness, swelling, chills & fever, malaise and nausea & vomiting
• Treatment: remove the IV, obtain blood cultures and possible antibiotics administration

Circulatory overload

• Administration of fluids too rapidly
• Fluid volume overload
• Symptoms: hypertension, distended neck veins, dyspnea and wet cough & crackles
• Treatment: decrease flow rate and keep vein open, elevate the head of bed and keep the client warm and notify PCP

Phlebitis

• Inflammation of the vein canlead to a clot (thrombophelbitis)
• Symptoms: heat and redness with tenderness, decreased flow of IV
• Treatment: remove the IV, notify the PCP and restart a IV on the opposite side.

Hematoma

• Collection of blood in the tissues
• Symptoms: ecchymosis, at the site with blood, hard and painful lump
• Treatment: Elevate and apply pressure & ice

Blood Transfusions

Administration of the Transfusion

• Insert IV line using an 18- or 19-gauge IV needle
• Run it with normal saline (keep-vein-open-rate)
• Use the largest catheter port available
• Begin the transfusion slowly
• The first 15 minutes most critical monitor the client for sign and symptoms of possible transfusion reaction
• Vital signs are monitored every 30 minutes - hour
• After 15 minutes the flow can be increased
• Document the client's tolerance to the administration of blood product

Facts About Blood Transfusion

• Administered by the RN
• Only Normal Saline (NS) can be used in conjunction with blood
• Type & screen and a cross match are good for 72 hours
• 30 minutes - from the time you received if from the blood bank to the time you infuse
• 4 hours - All blood must be infused
• STOP the transfusion if you suspect a transfusion reaction

Transfusion Reactions

• A transfusion reaction is an adverse reaction that happens as a result of receiving blood transfusions

Immediate Transfusion Reaction Signs And Symptoms

• Chills, diaphoresis, aches, chest pain, rash, hives, itching, swelling, dyspnea, cough, wheezing, or rapid, thready pulse

Circulatory Overload Signs And Symptoms

• Infusion of blood too rapid for the client to tolerate
• Cough, dyspnea, chest pain, headache, hypertension, tachycardia and bounding pulse, dinstended neck vein, and wheezing

Septicemia Signs And Symptoms

• Blood that is contaminated with microoganisms
• Rapid onset of chills, high fever, vomiting, diarrhea, hypotension & shock

Iron Overload

• Complication that occurs in client's who receive multiple blood transfusions
• Vominting, diarrhea, hypotension & altered hematologic values

Signs Of Transfusion Reactions

• Fast heart rate and itching uticaria skin rash and wheezing/ dyspnea/tachynea
• Anxiety and flushing/fever and back pain

Nursing Actions To Transfusion Reaction

• STOP the transfusion
• Change IV tubing down to IV site
• Keep Iv open and with Normal Saline
• Notify the HCP & blood bank
• Do not leave clients alone and monitor the client's vital signs continue assess the client

Pressure Injuries (Ulcers)

Pressure Injuries

• What is a pressure ulcer? The break down of skin integrity due to unrelieved pressure
• Braden Scale: Assess your client's skin every shift for pressure injuries using Braden scale
• Low risk: 22-23, Less risk: 19-21, High risk: &18

Risk Factors For A Pressure Injury

• Aging Skin
• Vascular Disorders
• Obesity
• Immobility & Incontinence
• Diabetes
• Skin Friction
• Poor Nutrtion
• Reduced RBC's (Anemia)
• Edema
• Sensory Deficits
• Sedation

Prevention Of Pressure Injuries

• Relieve Pressure:
• Apply pressure relieving devices (overlays, speciality beds, air cushions, foam-padded seat cushions, etc.)
• Do not use donut-type devices or synthetic sheepskins!
• Proper Nutrition
• Elevate protien Intake
• Adequte hydration
• Possible enteral nutrition
• Skin Hygene:
• Clean skin with mild soap
• Clean incontinent clients

Pressure Injury Types

• Type 1 Pressure Injury: - Skin is intact (unbroken), Nonblanchable redness, Swollen tissue, Darker skin → may appear blue / purple
• Type 2 Pressure Injury: Partial thickness, Epidermis & the dermis, No fatty tissue is visible, Superficial ulcer, Abrasion or ulcer
• Type 3 Pressure Injury: Full thickness SKIN loss, Damage to or necrosis of subcut tissue, nNo exposed musice or bone, Ulcer extend down to the underlying fascia & but not through it, Deep crater with or without tunneling
• Type 4 Pressure Injury: Full thickness TISSUE loss, Destruction of tissue, Damage to muscle & bone & Deep pockets of infection & tunneling
• Unstageable Pressure Injury: When the stage cannot be determined due to ESCHAR or SLOUGH covering the visibility of the wound making the depth unknown.

Hyovolemia vs Hyvervolemia

Hypovolemia

• "Low" & volume
• Dehydration & Fluid Volume Deficit
• Hypovolemic Shock

Causes Of Hypovolemia

• Loss of fluid from ANYWHERE & Thoracentesis
• Paracentesis & Hemorrhage
• NG tube & Trauma
• Gl losses & Vomitting
• Diarrhea & Third Spacing
• Burns & Ascites
• Polyuria & Diabetes
• Diurectics & Diabetes Insipidus

Signs And Symptoms Of Hypovolemia

• Flat neck veins & increased HR
• Weak & Thready & Increase respirations

Hyvervolemia

• "High" Volume
• Over-hydration
• Fluid Volume Excesses
• Heat Faliure & Kidney Dysfunction
• can't filter blood= backup of fluids
• Sir rhosis and increase Socium take
• where socium goes & water flows

Signs and Symptoms and Labs related to Hypo and Hypervolemia

• Weight decrease & skin intergrity decrees
• Urine Output decrease & dry miscos Membranes
• Urine Specific Gravity increased &Serum socium increase

Hypervolemia

• Distened neck veins and Increase HP increase BP and Increase weight
• Increate CVP and Edema with wet long sounds
• polyuna and kidney

Key nursing consideration/treatment

• Fluid Replacment
• Fluids/PO or IV
• Moniter Fluid Volume
• With fluid Administation
• high Fowlers

Scope of Pratice

• A breakdown of basic needs for RN, LPN/LVN, and UAP and what there role entails.