Trin's Precautions Remediation

What are the normal lab values (M&F) for red blood cell count?
What is abnormally high called and its symptoms?
What is abnormally low called and its symptoms?

4.7-6.1 for males; 4.2-5.4 for females
High = erythrocytosis; weakness, fatigue, HA, dyspnea
Low = anemia; orthostatic hypotension, fatigue, pallor, chest pain

What is the normal lab value range for WBCs/leukocytes?
What is abnormally high called and its symptoms?
What is abnormally low called and its symptoms?

5k-10k
High = leukocytosis; fever, fatigue, bruising, frequent infections
Low = leukopenia; frequent infections, HA, ulcers around mouth

When is WBC count usually low? When does it peak?

Low in the morning, peaks in the late afternoon

What is the normal lab value range for platelets?
What is abnormally high called and its symptoms?
What is abnormally low called and its symptoms?

150k-400k
High = thrombocytosis; HA, dizzy, weak, chest pain, tingling in hands/feet
Low = thrombocytopenia; d/t blood loss, sx incl ecchymosis, oral bleeding, petechiae (cap rupture)

What are the normal lab values (M&F) for hemoglobin?
What is abnormally high called and its symptoms?
What is abnormally low called and its symptoms?

M: 14-28, F: 12-16
High = polycythemia; fatigue, HA, visual changes, TIA
Low = anemia; pallor, tachycardia, ortho hypotn, dysrhythmias

What is the normal lab values (M&F) for hematocrit?
What is abnormally high called and its symptoms?
What is abnormally low called and its symptoms?

Hematocrit is the percentage of RBCs in the total blood volume
M: 42-52%, F 37-47%
High = polycythemia; fatigue, HA, dizziness, TIA
Low = anemia: ortho hypotn, dizziness, HA, pallor

What is the normal lab value range for sodium/Na?
What is abnormally high called and its symptoms?
What is abnormally low called and its symptoms?

136-145; critical if <120 or >150
High = hypernatremia; thirst, confusion, hyperreflexia
Low = hyponatremia; HA, lethargy, hyporeflexia, seizure, coma

What is the normal lab value range for potassium/K?
What is abnormally high called and its symptoms?
What is abnormally low called and its symptoms?

3.5-5.0; critical if <2.5 or >6.5
High = hyperkalemia d/t renal failure or acidosis; sx incl musc weakness, tenderness, paresthesia, bradycardia
Low = hypokalemia; extremity weakness, hyporeflexia, paresthesia

What is the normal lab value range for BUN?
What is abnormally high called and its symptoms?
What is abnormally low called and its symptoms?

10-20; 100+ indicates serious renal impairment
High = edema, hypertn, fatigue, oliguria
Low = nausea/vomiting, HA< confusion

What is the normal lab value range for glucose?

74-106; critical if <50 or >400

What is A1C? What is the normal lab value?

Average level of blood glucose control. Norm is <5.7%, becomes DM at 6.5%+

What is plasma D-dimer? What is its normal lab value?

It is a clotting factor; normal is <250 ng/mL

What is anti-factor Xa?

Aka heparin; how well blood thinning works

What is INR? What are the normal lab values?

How well blood counts. Normal is 0.8-1.1, critical if >5.5

What are standard precautions?

Basic; wash hands, cover coughs, wipe down equipment.

What are airborne precautions? What are some diseases where they would be used?

Airborne precautions include the PT wearing an N95, the pt wearing a surgical mask, and limiting pt transport.
Examples are measles, varicella/chickenpox, TB, SARS

What are droplet precautions? What are some diseases where they would be used?

Don a mask, limit pt transport. OK if door is open, but physical separation from other patients.
Flu, meningitis, pneumonia, sepsis, pertussis, diphtheria, mumps, rubella, strep

What are contact precautions? What are some diseases where they would be used?

Don gloves and gown (no mask), do not share equipment, limit pt transport
GI infections, respiratory infections, skin or wound infections, stool incontinence d/t norovirus, rotavirus, or C diff, e coli, MRSA, herpes simplex, scabies, impetigo

Where is a PIV inserted? What does it do? Any contraindics?

Typically in the forearm; temporary delivery of meds, fluid, or blood. Does not draw blood. Contraindics is no BP on this extremity

Where is a PICC inserted? What does it do? Any contraindics?

Inserted in upper arm with access to SVC; it is for the long term delivery of meds and can be taken home. Contraindics include BP on that extremity, axillary crutches, and an x-ray is needed for successful placement before mobilizing

Where is an A-line inserted? What does it do? Any contraindics?

It can be placed in the brachial, radial, or femoral artery; it measures arterial BP, obtains bl samples, and delivers meds. It cannot be unplugged. If dislodged, immediately apply pressure and call for help. Can mobilize if in the UE, bedrest with hip fl limit of 60-80 degrees if femoral. Strict bedrest of 60-90 min after removal

Where is a PAC/Swan-Ganz inserted? What does it do? Any contraindics?

Through large vein into pulmonary artery. It measures pulmonary artery pressure, RA pressure, and cardiac output. Potentially on bedrest/protocols

Where is a CVL inserted? What does it do? Any contraindics?

Inserted into vein to SVC; more permanent access for drug administration and blood samples, monitors central venous pressure. Do not take BP on this side, limit cervical ROM

What is a Port-a-cath? What does it do? Any contraindics?

It is a surgically implanted management device mainly used for chemo tx, infusion therapy, or parenteral nutrition. No limitations once healed

What is a chest tube? What does it do? Any contraindics?

It is a device placed in the pleural or mediastinal space that drains excess fluids and/or maintains pulmonary inflation. Treats pneumo- and hemothorax. Radiograph is needed prior to mobilizing. Keep the system below the level of insertion and do not tip reservoir. If dislodged, sit the pt upright, monitor vitals, and cover opening with gauze

What is an ICP monitor? What does it do? Any contraindics?

Intracranial pressure monitor/intraventricular catheter; temporary monitoring with norms <20 mmHg. Transducer must stay aligned with external auditory meatus. Do not mobilize if draining, and check with nurse if not.