Acute Care - Skills Check 1 - Lab Values

hemoglobin

is the main component of RBCs and transports oxygen and carbon dioxide. Elevated values (> 20 g/dL) can lead to clogging of capillaries because of hemoconcentration. Iron deficiency anemia is the most common hematologic disorder and the most common cause of anemia among infants and children.

hemoglobin normal values

Males: 14-18 g/dL

Females: 12-16 g/dL

hemoglobin critical values

<5 or >20 g/dL

s/s of elevated hemoglobin, what could it mean?

s/s: fatigue, dizziness, HA, visual changes, TIA, dysrhythmias, bruising, bleeding

Indication: polycythemia, severe dehydration, high altitude, smoking, congenital heart disease, chronic pulmonary disorders

s/s of low hemoglobin, what could it mean?

s/s: pallor, tachy, OTH, dysrhythmias, impaired endurance & activity tolerance 

Indication: Anemia, hemorrhage, blood loss, bone marrow suppression, cancer, metabolic disorders

What are the precautions for PT & mobility in regards to abnormal hemoglobin levels?

High: monitor vitals, fall prevention education, pacing

Low: talk about transfusion needs with team, monitor vitals, fall prevention, OTH

hematocrit

percentage of RBCs in the total blood volume. Abnormal values may indicate blood loss or fluid imbalance.

Hematocrit normal range

Males: 42-52%

Females: 37-47%

hematocrit critical values

<15% or >60%

s/s of elevated hematocrit & what could it indicate?

s/s: fatigue, dizziness, HA, visual changes, TIA, dysrhythmias, bruising, bleeding (same as hemoglobin)

Indication: Severe dehydration, Congenital heart disease, Polycythemia vera, Erythrocytosis, Burns, Eclampsia, Living in high altitudes, Hypoxia due to chronic pulmonary conditions (COPD, heart failure)

s/s of low hematocrit, and what could it indicate?

s/s: Orthostatic hypotension, Dizziness, Headache, Pallor, Cold hands/feet, Angina, Dysrhythmia, Dyspnea

Indication: anemia, Hemorrhage, Leukemia, Bone marrow failure, Multiple myeloma, Dietary deficiency, Pregnancy, Hyperthyroidism, Cirrhosis, Rheumatoid arthritis, Hemolytic reaction, Hemoglobinopathy, Prosthetic valve, Renal disease, Lymphoma

What are the precautions for PT & mobility for abnormal hematocrit values?

High: screen for embolism

Low: monitor vitals, monitor for orthostatic hypotension

platelets

main clotting agent in blood

platelet normal range

150,000-400,000 mm3

s/s of elevated platelets, and what could it indicate?

s/s: HA, dizziness, weakness, chest pain, tingling in hands/feet

Indication: cancer, polycythemia vera, splenectomy, acute/chronic inflammation, strenuous exercise, iron deficiency anemia

s/s of low platelets, and what could it indicate?

s/s: petechiae, ecchymosis, oral bleeding, hematuria, epistaxis

Indication: hemorrhage/blood loss, damage to developing blood cells due to cancer, chemo, or radiation), various diseases

What are the precautions for PT & mobility with abnormal platelet levels?

High: screen for embolism, monitor s/s

Low: fall education, monitor fatigue (RPE scale)

white blood cells (leukocytes)

used for fighting infections

WBC normal values

5,000-10,000 mm3

WBC critical values

< 2,500 or > 30,000

platelet critical values

< 50,000 or > 1 million  

s/s elevated WBC and its possible indications?

s/s: fever, fatigue, bleeding, bruising, frequent infections

Indication: infection, inflammation, bone marrow disease, immune system disorder, severe stress/pain

s/s low WBC and its possible indications?

s/s: frequent infections, inflammation/ulcers in & around the mouth, headache, stiff neck, sore throat, fever, chills, night sweats 

Indication: chemo, radiation therapy, marrow infiltrative diseases, infections (viral/bacterial), dietary deficiency, autoimmune disease

What are the precautions for PT & mobility for abnormal WBC?

High: consider the time of PT- WBC is higher later in the day

Low: monitor s/s, watch/consider fatigue, use BORG RPE, fall prevention screening, notify the team about cancer patients with a high fever

troponin

this is an enzyme that is released when there is damage to the heart

s/s of elevated troponin and what it could indicate?

s/s: chest pain, difficulty breathing, heavy chest, nausea/vomiting, dizziness

Indication: myocardial disease, MI, heart failure, hypertension, hypotension, PE, renal failure and myocarditis

Low values s/s, what could it indicate for troponin? 

Nothing. We want a value of 0!

What are the precautions for PT & mobility for troponin?

Only initiate PT when the values are down or 0. Look at the trend in the chart.

Activated partial thromboplastin time (aPTT)

measures the time it takes plasma to clot when exposed to clotting factors of the intrinsic and common pathways. There is no standardization, and it varies by laboratory and reagent. It is used to monitor heparin therapy. A shortened time is rare and warrants further testing.

High Activated partial thromboplastin time (aPTT) s/s, what could it indicate?:

s/s: increased bleeding tendency, bruising, oozing from wounds, mucosal bleeding

Indication: inherited deficiency in clotting factor, liver disease, vitamin K deficiency

What are the precautions for PT & mobility for abnormal aPTT levels?

Watch for bleeding risk, assess for embolism

anti-factor Xa assay

provides a more consistent and reliable measure of anticoagulation monitoring of unfractionated heparin (UFH) and low molecular weight heparin

High heparin values s/s, what could it indicate?:

s/s: Increased bleeding tendency, Bruising, Oozing from wounds, Mucosal bleeding, Indication: heparin administration, Heparin resistance, Renal failure, Hemophilia, Lupus anticoagulant

What are the precautions for PT & mobility for anti-factor Xa assay

Fall risk screening & education, watch for bleeding, easy doing repetitive BP

International Normalized Ratio (INR)

international standard for the prothrombin time test.

INR normal values

0.8-1.1

INR critical values

>5.5

High INR values s/s, what could it indicate?: 

s/s: Increased bleeding tendency Bruising Oozing from wounds Mucosal bleeding

Indication: Alcohol, Anticoagulation therapy, Liver disease, Bile duct obstruction, Vitamin K deficiency, Hereditary factor deficiency

What are the precautions for PT & mobility for high INR?

Fall risk screening & education, watch for bleeding, easy doing repetitive BP

D-dimer

protein fragment as a result of a clot breakdown

what can high d-dimer values indicate

Indication: thromboembolism, inflammation (COVID-19, sepsis), malignancy, trauma, pregnancy, vascular disorders, kidney and liver disease. Additionally, older age, infections, burns, and heart failure

precautions for PT & mobility with abnormal D-dimer values

Screen for DVT, caution with bleeding

glucose

level of body's major energy source primarily obtained from the diet

glucose normal values

74-106 mg/dL

glucose critical values

<50 or >400 mg/dL

s/s of high glucose values and what they might indicate?

s/s: polyphagia (extreme, insatiable hunger), polyuria (excessive urination), polydipsia (excessive thirst), dry skin, blurred vision, delayed wound healing

Indication: hyperglycemia

s/s of low glucose values and what they might indicate?

s/s: (cold & clammy needs some candy): tachycardia, irritability, restless, polyphagia (excessive hunger), dizziness, pallor/clammy - use TIRED as an acronym to remember

Indication: hypoglycemia

precautions for PT and mobility with abnormal glucose values?

Monitor levels through care, be prepared to give snacks/drinks for sugar levels

Hemoglobin A1c (HbA1c)

average level of blood glucose control over the previous 120 days.

what are potential s/s for high HbA1c & what might it indicate

Types 1 and 2: 

Polyuria 

Polydipsia 

Blurred vision 

Weakness 

Fatigue 

Dizziness  

Type 1: 

Ketonuria 

Weight loss 

Excessive hunger 

Type 2 often asymptomatic detected through labs, non-healing wounds, or infection 

Diabetic Ketoacidosis: 

Nausea/vomiting 

Fruity breath 

Confusion 

Weak/rapid pulse 

Kussmaul respiration  

Chronic Hyperglycemia: 

Chronic kidney disease 

Peripheral neuropathy 

Retinopathy 

Cardiovascular disease (myocardial infarction, stroke)  

Peripheral vascular disease 

Non-traumatic amputations

Indication: hyperglycemia, Diabetes mellitus, Acute stress response, (general anesthesia, stroke, MI, strenuous exercise, burns), Cushing syndrome, Cystic fibrosis Chronic kidney, disease, IV fluids, Acute pancreatitis, Medications

possible s/s of low HbA1c and what it could indicate?

s/s: Perspiration, Weakness, Pallor, Nervousness, Seizure, Lethargy, Irritability, Tachycardia, Palpitation, Altered mental status, Hunger, Headache, Shaking, Blurred vision, Loss of consciousness

Indication: Excess insulin, Hypopituitarism, Hypothyroidism, Addison's disease, Malnutrition, Alcoholism

PT and mobility precautions for abnormal HbA1c values

Monitor glucose levels, watch for s/s of hypo/hyper, consult if levels are high

Electrolyte panel - Sodium (Na)

primarily a determinant of extracellular fluid volume and regulates blood pressure. Can also be related to nerve function.

s/s and possible indications of high Electrolyte panel - Sodium (Na) levels?

s/s: Thirst, Confusion, Irritability, Hyperreflexia, Seizure, Coma, Tachycardia, Hypotension, Oliguria, high BP

Indication: Hypovolemia (gastrointestinal and free body water loss), Sodium overload, Endocrine disorders

s/s and possible indications of low Electrolyte panel - Sodium (Na) levels?

s/s: Headache, Lethargy, Hyporeflexia, Seizure, Coma, Orthostatic hypotension, Pitting edema, Confusion, Weakness, Nausea, low BP

Indication: Hypervolemia and hypovolemia, Severe GI loss, Dehydration, Diuretics, Renal or hepatic disease, Gastrointestinal disorders, Hypotonic IV administration

precautions for PT and mobility for abnormal s/s and possible indications of low Electrolyte panel - Sodium (Na) levels?

Monitor for orthostatic hypotension, consider seizure precautions, fall prevention, monitor/assess for cognitive impairments

Electrolyte panel - Potassium (K)

important for the function of excitable cells including nerve, muscle, and cardiac tissues.

s/s and possible indications for high Electrolyte panel - Potassium (K) values?

s/s: Muscle weakness or paralysis, Muscle tenderness, Paresthesia, Dysrhythmia, Bradycardia

Indication: Excess K supplementation (IV, oral, dietary), Renal failure, Metabolic acidosis, Diabetic acidosis, Blood transfusion

s/s and possible indications for low Electrolyte panel - Potassium (K) values?

s/s: Extremity weakness, Hyporeflexia, Paresthesia, Leg cramps, Dysrhythmia, Hypotension

Indication: Fluid overload, Renal dysfunction, Gastrointestinal disorders, Diuretics, Alcoholism, Hormonal and endocrine disorders, Cystic fibrosis

PT and mobility precautions for abnormal Electrolyte panel - Potassium (K) values?

Assess for acute muscle strength loss, monitor heart rhythm, vitals and look for decreased activity tolerance

Electrolyte panel - Calcium (Ca)

levels of Ca, important for bone formation, cell division and growth, blood coagulation, neurotransmitter release, and muscle contraction.

s/s and possible indications for high Electrolyte panel - Calcium (Ca) values?

s/s: Hyporeflexia, Muscle weakness, Ventricular dysrhythmia, Lethargy, Constipation, Nausea/vomiting, Bone pain

Indication: Excessive release of calcium into the blood, Dehydration, Endocrine and hormonal disorders, Gastrointestinal disorders, Excessive vitamin D, Supplements/Antacids, Cancer, Immobilization

s/s and possible indications for low Electrolyte panel - Calcium (Ca) values?

s/s: Confusion, Muscle cramps, Hyperreflexia, Dysrhythmia, Paresthesia, Agitation, Seizure, Fatigue

Indication: Chronic kidney disease (CKD), Sepsis, Malnutrition, Malabsorption, Pancreatitis, Laxative use

PT & mobility precautions for abnormal Electrolyte panel - Calcium (Ca) values?

Monitor vitals, watch for symptoms of high/low, look for cognitive impairments, may be fall risk, seizure precautions.