Understanding Normal Lab Values

Vital Signs

• Systolic blood pressure normal range: 120 mmHg
• Diastolic blood pressure normal range: 80 mmHg
• Heart rate normal range: 60-100 BPM
• Respirations normal range: 12 - 20 breaths/min
• Oxygen saturation normal range: 95% - 100%
• Temperature normal range: 97.8°F - 99°F

Basal Metabolic Panel (BMP)

• Sodium normal range: 135 - 145 mEq/L
• Potassium normal range: 3.5 - 5.0 mEq/L
• Chloride normal range: 95 - 105 mEq/L
• Calcium normal range: 9 - 11 mg/dL
• BUN (Blood Urea Nitrogen) normal range: 7 - 20 mg/dL
• Creatinine normal range: 0.6 - 1.2 mg/dL
• Albumin normal range: 3.4 - 5.4 g/dL
• Total protein normal range: 6.2 - 8.2 g/dL

Lipid Panel

• Total cholesterol goal: <200 mg/dL
• Triglyceride goal: <150 mg/dL
• LDL (low-density lipoprotein, "bad" cholesterol) goal: <100 mg/dL
• HDL (high-density lipoprotein, "happy" cholesterol) goal: >60 mg/dL

HbA1c

• Non-diabetic HbA1c: 4 - 5.6%
• Pre-diabetic HbA1c: 5.7 - 6.4%
• Diabetic HbA1c: >6.5% (Goal for diabetics: <6.5%)

Liver Function Test (LFT)

• ALT (Alanine Aminotransferase) normal range: 7 - 56 U/L
• AST (Aspartate Aminotransferase) normal range: 5 - 40 U/L
• ALP (Alkaline Phosphatase) normal range: 40 - 120 U/L
• Bilirubin normal range: 0.1 - 1.2 mg/dL

Pancreas

• Amylase normal range: 30 - 110 U/L
• Lipase normal range: 0 - 150 U/L

Renal

• Calcium normal range: 9 - 11 mg/dL
• Magnesium normal range: 1.5 - 2.5 mg/dL
• Phosphorus normal range: 2.5 - 4.5 mg/dL
• Specific gravity normal range: 1.010 - 1.030
• GFR (glomerular filtration rate) normal range: 90 - 120 mL/min/1.73 m²
• BUN (Blood Urea Nitrogen) normal range: 7 - 20 mg/dL
• Creatinine normal range: 0.6 - 1.2 mg/dL

Arterial Blood Gases (ABGs)

• pH normal range: 7.35 - 7.45
• PaCO2 (partial pressure of carbon dioxide) normal range: 35 - 45 mmHg
• PaO2 (partial pressure of oxygen) normal range: 80 - 100 mmHg
• HCO3 (bicarbonate) normal range: 22 - 26 mEq/L
• ROME: Respiratory Opposite Metabolic Equal

Coagulation Studies (COAGs)

• PT (prothrombin time) normal range: 10 - 13 sec
• PTT (partial thromboplastin time) normal range: 25 - 35 sec
• aPTT (activated partial thromboplastin time) normal range: 30 - 40 sec (heparin)
• INR (international normalized ratio), not on warfarin: < 1 sec, on warfarin: 2 - 3 sec
• Heparin therapeutic range using aPTT: 1.5 - 2.0 x normal "control" value, antidote: protamine sulfate
• Warfarin therapeutic range using PT/INR: 1.5 - 2.0 x normal "control" value, antidote: vitamin K
• Higher numbers in PT, PTT, and aPTT indicate a higher chance of bleeding

Complete Blood Count (CBC)

• WBC (white blood cell count) normal range: 4,500 - 11,000
• RBC's (red blood cell count) normal range: Males: 4.5 - 5.5
• PLT (platelet count) normal range: 150,000 - 450,000
• Hemoglobin (Hg) normal range: Female: 12 - 16 g/dL, Male: 13 - 18 g/dL
• Hematocrit (HCT) normal range: Female: 36% - 48%, Male: 39% - 54%
• To estimate hematocrit, multiply hemoglobin by 3

Other Lab Values

• MAP (mean arterial pressure) normal range: 70 - 100 mmHg
• ICP (intracranial pressure) normal range: 5 - 15 mmHg
• BMI (body mass index) normal range: 18.5 - 24.9
• Glasgow Coma Scale: Best = 15. Mild: 13-15, Moderate: 9-12, Severe: 3-8

Electrolyte Mnemonics

• Sodium normal range: 135 - 145; “Commit to memory!”
• Potassium normal range: 3.5 - 5; Think bananas, about 3-5 in a bunch, want them half ripe.
• Phosphorus normal range: 2.5 - 4.5; Think Phor: 4 and 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 you want to go in when super hot

Anemia - Hemoglobin/Hematocrit

• Hemoglobin (Hgb), Female: 12-16 g/dL, Male: 13-18 g/dL
• Hematocrit (Hct), Female: 36%-48%, Male: 39%-54%

Basal Metabolic Panel

• BUN: 7 - 20 mg/dL; Think hamburger BUNs - Hamburgers can cost anywhere from $7 - $20 dollars
• Creatinine: 0.6 – 1.2 mg/dL; This is the same value as Lithium’s therapeutic range (0.6 - 1.2 mmol/L)

Blood Types

• Antigens: Proteins that elicit immune response, identifies the cell
• Plasma antibodies: Protects body from invaders
• Blood Type A: Has A antigens, B antibodies. Can receive A, O
• Blood Type B: Has B antigens, A antibodies. Can receive B, O
• Blood Type AB: Has A and B antigens, no antibodies. Can receive all. Universal recipient
• Blood Type O: Has no A and B antigens, A and B antibodies. Can receive O. Universal donor

Rh factor

• Positive: Has Rh factor on surface. Can receive positive and negative blood
• Negative: Does not have Rh factor on surface. Can receive negative blood

Sodium Imbalance

• Sodium normal range: 135-145 mEq/L
• Sodium is a major extracellular electrolyte, essential for acid-base balance, fluid balance, and nerve-muscle function
• Hypernatremia: >145 mEq/L; Causes cells to shrink
  • Signs/Symptoms: BIG & BLOATED; Flushed skin, restlessness, increased BP, edema, decreased urine output, agitation, low-grade fever, thirst
  • Risk Factors: Increased sodium intake, decreased sodium excretion, loss of fluids
  • Treatment: If due to fluid loss, administer IV infusions. If the cause is inadequate renal excretion of sodium, give diuretics to promote sodium loss and restrict sodium and fluid intake
• Hyponatremia: <135 mEq/L; Causes cells to swell
  • Hypovolemic Hyponatremia: Caused by a loss of fluid and sodium
    • Signs/Symptoms: Stupor, anorexia, lethargy, tachycardia
  • Hypervolemic Hyponatremia: More body water than sodium
    • Signs/Symptoms: Limp muscles, orthostatic hypotension, seizures, stomach cramping
  • Risk factors: Increased sodium excretion, inadequate sodium intake, kidney or heart failure
  • Treatment:
    • Administer IV sodium chloride infusions if due to hypovolemia
    • Diuretics if due to hypervolemia
    • Monitor daily weights
    • Safety precautions due to orthostatic hypotension
    • Airway protection due to risk for aspiration
    • Limit water intake
    • Teach patients to avoid a diet high in salt
    • 5 D's: diaphoresis, diuretics, diarrhea & vomiting, drains

Potassium Imbalance

• Potassium normal range: 3.5 - 5 mEq/L
• Hyperkalemia: > 5 mEq/L
  • Signs/Symptoms: TIGHT & CONTRACTED; Muscle cramps & weakness, urine abnormalities, respiratory distress, decreased cardiac contractility, ECG changes, increased reflexes
  • Risk Factors: Medications (potassium-sparing diuretics, ACE inhibitors, NSAIDs), excessive potassium intake, kidney disease, decreased potassium excretion, adrenal insufficiency, tissue damage, acidosis, hyperuricemia, hypercatabolism
  • Treatment: Monitor EKG, discontinue IV and PO potassium, initiate a potassium-restricted diet, potassium excreting diuretics, prepare the client for dialysis, administer IV calcium gluconate and IV sodium bicarb
• Hypokalemia: < 3.5 mEq/L
  • Signs/Symptoms: Thready, weak, irregular pulse, orthostatic hypotension, shallow respirations, anxiety, lethargy, confusion, paresthesias, hyporeflexia, hypoactive bowel sounds, nausea and vomiting, ECG changes
  • Risk Factors: Actual total body potassium loss, inadequate potassium intake, movement of potassium from extracellular fluid to intracellular fluid, excessive water intake
  • Treatment: Oral potassium supplements or liquid potassium chloride, potassium-retaining diuretic

Magnesium Imbalance

• Magnesium normal range: 1.5-2.5 mg/dL
• Hypermagnesemia: >2.5 mg/dL
  • Signs/Symptoms: LOW EVERYTHING AKA SEDATED; Low energy, low heart rate, low blood pressure, low respiratory rate, decreased bowel sounds, decreased deep tendon reflexes
  • Risk Factors: Increased magnesium intake, renal insufficiency, DKA (Diabetic Ketoacidosis)
  • Treatment: Diuretics, IV calcium chloride or calcium gluconate, restrict dietary intake of magnesium containing foods, avoid the use of laxatives and antacids containing magnesium, hemodialysis
• Hypomagnesemia: <1.5 mg/dL
  • Signs/Symptoms: HIGH EVERYTHING AKA NOT SEDATED; High heart rate, high blood pressure, increased deep tendon reflexes, shallow respirations, twitches, paresthesias, tetany & seizures, irritability & confusion
  • Risk Factors: Insufficient magnesium intake, increased magnesium excretion, intracellular movement
  • Treatment: Magnesium sulfate IV or PO, seizure precautions, instruct the client to increase magnesium-containing foods

Intravenous (IV) Therapy: Types of IV Solutions

• Isotonic: "Stays where I put it." Same osmolality as body fluids.
  • Examples: 0.9% saline (NS), Lactated Ringers (LR), 5% dextrose (D5W)
  • Uses: Expands intravascular fluid volume and replaces fluid loss
• Hypotonic: "Go out of the vessel" and into the cell. Fluids go out of the vessel into the cells.
  • Examples: 0.45% NS, 2.5% Dextrose, 0.33% NS
  • Uses: Intracellular dehydration and helps kidneys excrete excess fluids
• Hypertonic: "Enter the vessel from the cells."
  • Examples: 5% dextrose in 0.9% saline (D5NS), 5% dextrose in 0.45% saline, 5% dextrose in LR
  • Uses: Cerebral edema, low sodium levels, metabolic alkalosis, maintenance fluid, and hypovolemia

IV Therapy: Complications

• Air Embolism: Air enters the vein through the IV tubing
  • Symptoms: Tachycardia, chest pain, hypotension, decreased LOC, cyanosis
  • Treatment: Clamp the tubing, turn client on the left side and place in Trendelenburg position, notify the HCP
• Infiltration: IV fluid leaks into surrounding tissue
  • Symptoms: Pain, swelling, coolness, numbness, no blood return
  • Treatment: Remove the IV, elevate the extremity, apply warm or cool compress
• Infection: Entry of microorganism into the body via IV
  • Symptoms: Tachycardia, redness, swelling, chills and fever, malaise, nausea and vomiting
  • Treatment: Remove the IV, obtain cultures, possible antibiotics
• Circulatory Overload: Administration of fluids too rapidly
  • Symptoms: Increased blood pressure, distended neck veins, dyspnea, wet cough and crackles
  • Treatment: Decrease flow rate, elevate the head of the bed, keep the client warm, notify the HCP
• Phlebitis: Inflammation of the vein
  • Symptoms: Heat, redness, tenderness, decreased flow of IV at the site.
  • Treatment: Remove the IV, notify the HCP, restart the IV on the opposite side
• Hematoma: Collection of blood in the tissues
  • Symptoms: Ecchymosis, blood and a hard lump
  • Treatment: Elevate the extremity, apply pressure and ice

Blood Transfusions

• Administration:
  • Insert an IV line using an 18- or 19-gauge IV needle
  • Run it with normal saline only
  • Use the largest catheter port available Use a Y tubing
  • Begin the transfusion slowly
  • The first 15 min is the MOST CRITICAL to monitor the client for S/S of any transfusion reaction
  • Vital signs monitored q 15 min the first 30 min, the q hour
  • After 15 minutes the flow can be increased (unless a transfusion reaction has occurred)
  • Document the client's tolerance to the administration of the blood product
• Facts About:
  • Administered by the RN
  • Only Normal Saline can be used in conjunction with blood
  • Type & screen and a cross match are good for 72 hours
  • 30 minutes - from the time received it from the blood bank to when you infuse
  • All blood must be transfused in 4 hours
  • STOP the transfusion if you suspect a transfusion reaction
• Transfusion Reaction:
  • Signs of: Fast heart rate, itching/urticaria/skin rash, wheezing/dyspnea/tachypnea, anxiety, flushing / fever, back pain
  • Nursing Actions:
    • STOP the transfusion
    • Change the IV tubing down to the IV site
    • Keep the IV open with normal saline
    • Notify the HCP & blood bank, assess the client
• Immediate Transfusion Reaction:
  • Chills, diaphoresis, aches, chest pain, rash, hives, itching, swelling, dyspnea, cough, wheezing, thready pulse
• Circulatory Overload:
  • Infusion of blood too rapid for the client to tolerate
  • Cough, dyspnea, chest pain, headache, hypertension, tachycardia, bounding pulse, distended neck vein, wheezing
• Septicemia: Blood contaminated with microorganisms
  • Rapid onset of chills, high fever, vomiting, diarrhea, hypotension & shock
• Iron Overload: Occurs in clients who receive multiple blood transfusions
  • Vomiting, diarrhea, hypotension, altered hematological values

Pressure injuries (ulcers)

• Results from breakdown of skin integrity due to unrelieved pressure
• Risk factors: Advoids Pressure - Aging skin, vascular disorders, obesity, immobility & incontinence, diabetes, skin friction. poor nutrition, reduced RBCs, edema, sensory deficits, sedation
• Prevention: Relieve pressure, proper nutrition, skin hygiene, repositioning
• Braden Scale: Assesses risk (sensory perception, moisture, activity, mobility, nutrition, friction & shear)
• Stage 1: Skin intact, nonblanchable redness
• Stage 2: Partial thickness skin loss, epidermis and dermis
• Stage 3: Full thickness skin loss
• Stage 4: Full thickness tissue loss
• Unstageable: Cannot be determined due to eschar or slough

Hypovolemia vs. Hypervolemia

• Hypovolemia
  • LOW volume
  • Causes: Loss of fluid from anywhere, third spacing
  • Signs & Symptoms: Flat neck veins, ↑ HR/Respirations, ↓ Weight/BP
  • Labs: Concentrated: ↑ Urine-specific gravity
  • Nursing Considerations: Fluid Replacement, monitor, safety precautions
• Hypervolemia
  • HIGH volume
  • Causes: Heart Failure, Kidney Dysfunction, cirrhosis
  • Signs and Sypmtoms Distended neck, ↑ HR/BP/Weight
  • Labs: Diluted: ↓ Urine Specific Gravity, BUN
  • Nursing Considerations: Low sodium diet, I&O's Diuretics, position patient in High Fowler's

Scope of Practice

• Registered Nurse (RN)
  • Post-op assessment, initial client teaching, starting blood products, sterile procedures, IV's and IV medications, discharge education, clinical assessment.
• Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN)
  • Stable clients, monitor RN's findings and gather ata, specific assessments, reinforce teaching, routine procedures, administer injections and narcotics, tube potency and enteral feedings, sterile procedures, specific assessments; lung sounds, bowel and neruovasclar checks
• Unlicensed Assistive Personnel (UAP)
  • Routine, stable vital signs, documenting input and output, can get blood from the blood bank, activities of daily living (ADL's)
  • ADL's; feeding (not aspiration risk), positioning, ambulation, cleaning, linen change and hygiene

This lesson covers normal ranges for vital signs, basal metabolic panel (BMP), lipid panel, and HbA1c. It provides a quick reference for healthcare professionals and students to understand the standard values for these common health indicators.