Acute Care- Lab Values Skills Check

red blood cells, hemoglobin, hematocrit, white blood cells, platelets

what lab values are included in the complete blood count

red blood cells, hemoglobin, hematocrit

what lab values measure oxygen transport

anemia, blood loss, bone marrow suppression

hemoglobin assesses

14 -17.4g/dL

what are the norms for hemoglobin in males

12-16 g/dL

what are the norms for hemoglobin in females

polycythemia

an uptrend in hemoglobin may indicate

>20 g/dL

what value of hemoglobin may indicate polycthemia

orthostasis, presyncope, dizziness, arrhythmias, CHF onset/exacerbation, seizure, symptoms of transient ischemic attack, symptoms of MI, angina

patients with an uptrend in hemoglobin (polycythemia) may present with

<5-7 g/dL

critically low values of hemoglobin are

heart failure or death

critically low values of hemoglobin of <5-7 g/dL can lead to

>20 g/dL

critically high values of hemoglobin are

clogging of capillaries as a result of hemoconcentration

critically high values of hemoglobin >20 g/dL can lead to

anemia

a downtrend in hemoglobin may indicate

decreased endurance, decreased activity tolerance, pallor, tachycardia

patients with a downtrend in hemoglobin (anemia) may present with

symptom based approach, monitor vitals including SPO2; be aware of tachycardia or orthostatic hypotension, collaborate with the interprofessional team

what are clinical implications of high or low hemoglobin values

blood loss and fluid balance

hematocrit assesses

42%-52%

what are the normal levels of hematocrit for males

37%-47%

what are the normal levels of hematocrit for females

polycythemia

an uptrend in hematocrit may indicate

fever, headache, dizziness, weakness, fatigue, easy bruising or bleeding

those with an uptrend in hematocrit (polycthemia) may present with

anemia

a downtrend in hematorcit may indicate

pale skin, headache, dizziness, cold hands/feet, chest pain, arrhythmia, shortness of breath

those with a downtrend in hematocrit (anemia) may present with

<15-20%

what are critically low values of hematocrit

cardiac failure or death

critically low values of hematocrit of <15-20% may indicate

>60%

what are critically high values of hematocrit

spontaneous blood clotting

critically high values of hematocrit of >60% may lead to

symptoms based approach when determining appropriateness for activity, collaborate with interprofessional team

what are clinical implications for patients who have high hematocrit

patients might have impaired endurance- progress slowly with activity; monitor vitals including SPO2- might present with orthostatic hypotension and/or tachycardia

what are clinical implications for patients who have low hematocrit

<25%

at what level of hematocrit might you want to consider a symptoms based approach when determining appropriateness for activity; collaborate with interprofessional team

white blood cells

what lab values measure immune response (inflammation/infection)

infection, inflammation, allergens

white blood cells are routine tests to identify the presence of

5.0-10.0 x 10^9/L

what is the normal value for white blood cells

leukocytosis

an upward trend of white blood >11.0 x 10^9 cells indicates

>11.0 x 10^9/L

what value of white blood cells indicates leukocytosis

fever, malaise, lethargy, dizziness, bleeding, bruising, weight loss, lymphadenopathy, painful inflamed joints

a patient with high white blood cells (leukocytosis) may present with

symptom based approach when determining appropriateness for activity, especially in the presence of fever; consider timing of therapy session (early=low, late afternoon=high)

clinical implications for patients who have high white blood cells

leukopenia

a downtrend in white blood cells of <4.0 x 10^9/L indicates

<4.0 x 10^9/L

what value of white blood cells indicated leukopenia

anemia, weakness, fatigue, fever, headache, shortness of breath

a patient with white blood cells of <4.0 x 10^9/L (leukopenia) may present with

systems based approach when determining the appropriateness for activity especially in the presence of fever

clinical implications for patients who have low white blood cells (<4.0 x 10^9/L leukopenia)

neutropenia

a downtrend in white blood cells of <1.5 x 10^9 indicates

<1.5 x 10^9/L

what value of white blood cells indicates neutropenia

low grade fever, skin abscess, sore mouth, symptoms of pneumonia

a patient who has white blood cells of <1.5 x 10^9 (neutropenia) may present with

neutropenic precautions; symptoms based approach when determining appropriateness for activity, especially in the presence of fever

clinical implications for patients who have low white blood cells (<1.5 x 10^9/L neutropenia)

platelets

what lab values measure clotting/immune function?

140-400 k/uL

what are the normal values for platelets

thrombocytosis

an uptrend in platelets may indicate

>450 k/uL

what value of platelets may indicate thrombodytosis

weakness, headache, dizziness, chest pain, tingling in hands/feet

patients with high values of platelets (thrombocytosis) may present with

symptoms based approach, collaborate with interprofessional team, monitor for signs and symptoms of VTE

what are clinical implications if a patient has high platelet count

venous thromboembolism

elevated levels of platelets can lead to

thrombocytopenia

a downtrend in platelets may indicate

<150 k/uL

what value of platelets may indicate thrombocytopenia

petechiae, ecchymosis, fatigue, jaundice, splenomegaly, risk of bleeding

patients with low values of platelets (thrombocytopenia) may present with

symptom based approach when determining the appropriateness for activity, collaborate with the interprofessional team (regarding possible need for/timing of transfusion prior to mobilization); fall risk awareness

what are clinical implications for patients with low platelets (thrombocytopenia)

<20 k/uL

what platelet count would indicate severe thrombocytopenia

international normalized ratio

used to determine the coagulation profile when the patient is on a vitamin K agonist (coumadin)

0.8-1.2

what is the normal range for INR

>4-5

what value of INR places the patient at a greater risk for spontaneous bleeding

>6

what is the critical INR value

extreme caution, avoid resistive exercises; light exercise only or hold mobility depending on fall risk; consult with team

what are the clinical implications that should be taken if the patient has an INR of > 4-5

activated partial thromboplastin time (aPTT)

used to determine the coagulation profile when the patient is on a unfractionated heparin

anti Xa assay

used to determine the coagulation profile when the patient is on low molecular weight heparin

clotting

for all coagulation profiles, if the patient is subtherapeutic (below their level of A/C therapy) what are they at a risk of

bleeding

for all coagulation profiles, if the patient is supratherapeutic (above their level of A/C therapy) what are they at a risk of

d-dimer

protein fragment that the body makes when breaking down a blood clot

low likelihood of DVT

if a D-dimer is negative there is a

less helpful and further testing is still needed

if a D-dimer is positive it is

ultrasound

if a patient has a positive D-dimer, what should be used in conjunction

DVT, PE, throbosis associated with malignancy

higher levels of D-dimer are seen in

high sensitivity and low specificity

D-dimer has a

medical interventions being implemented, meds- how long, are they in therapeutic range, IVC filter- are they hemodynamically stable

what are clinical implications to consider with the D-dimer

troponin

biomarker that are sensitive, specific indicators to the myocardium of the heart; they are released when cardiac injury occurs (6 hours after insult to 3 days), and they serve as the greatest use for diagnosing a myocardial infarction

normal function

low levels of troponin indicate

myocardial infarction, rhabdomyolysis with cardiac damage, renal failure, inflammatory disease (myocarditis, endocarditis), hypertrophic cardiomyopathy, drug toxicity, critical illness, congestive heart failure, cardiac surgery, defibrillation, cardioversion, large surface area burns, aortic valve disease, aortic dissection, PE, pulmonary HTN, COPD, blunt thoracic damage, acute neurologic disease

high values of troponin may indicate

vigilantly monitor for cardiac symptoms, and alter the PT session accordingly

what are PT implications when observing troponin levels

BNP (B-type natriuretic peptide)

the strongest independent predictor of congestive heart failure

more severe limitations and symptoms of cardiac disease

higher levels of BNP indicate

females, african american or hispanic, anemia, atrial fibrillation

patients who might have higher values of BNP include

obesity

what is associated with lower BNP levels

symptoms based approach when determining appropriateness for activity

what are the PT implications when monitoring the BNP

creatinine kinase (CK)

an isoenzyme that is released into the blood when skeletal, brain, or cardiac muscle is injured

CK2-MB

commonly elevated in myocardial infarction within 3-6 hours of cardiac injury and then returns to normal within 2-3 days (peaks 18-24 hours). useful for diagnosing re-infarction

myocardial infarction, carbon monoxide poisoning, pulmonary embolism, hypothyroidism, crush injuries, muscular dystrophy

elevated levels of CK2-MB may be present in

HgbA1C

shows the average level of blood glucose control over the previous 3 months

diabetes mellitus

an increase in HgbA1C is caused by

<5.7%

what are normal values for HgbA1C

5.7-6.4%

what HgbA1C levels indicate pre-diabetes mellitus

>6.5%

what HgbA1C levels indicate pre-diabetes mellitus

eye disease, heart disease, kidney disease, nerve damage, stroke, gum disease, non0traumatic amputations

patients with high HgbA1c may present with

monitor vitals if poorly controlled diabetes, educate importance of exercise for blood sugar control, consider wound care management

what are clinical implications when observing patients with high HgbA1C

hyperthyroidism

an increased T3 and/or T4 is caused by

hypothyroidism

a decreased T3 and/or T4 is caused by

tremors, nervousness, weakness, increased reflexes, fatigue, tachycardia, arrhythmias, hypotension, chronic periarthritis, proximal weakness, also affects integumentary, GI, GU

patients with increased T3 and/or T4 (hyperthyroidism) may present with

decreased exercise tolerance (both strength and capacity), monitor HR and BP, patient at risk for dysrhythmias during exercise, patient in hypermetabolic state will deplete nutrients quickly with exercise

clinical implications for patients with increased T3 and/or T4 (hyperthyroidism)

hypothyroidism frequently accompanied by myalgia and CK elevation, more prone to skin tears, activity intolerance- should improve with treatment of hypothyroidism, rhabdomyolysis, although rare, can appear in the presence of heavy exercise, alcohol, or medications, monitor HR for bradycardia

clinical implications for patients with decreased T3 and/or T4 (hypothyroidism)

slow speech/hoarseness, slow mental function, ataxia, oriximal muscle weakness, carpal tunnel syndrome, prolonged reflexes, paresthesia, muscular/joint edema, back pain, bradycardia, CHF, poor peripheral circulation, hyperlipidemia, HTN, also affects integumentary, GI, GU

patients with decreased T3 and/or T4 (hypothyroidism) may present with

glucose

measures blood glucose at the time sample obtained

70-100 mg/dL

what is the normal value for blood glucose

hyperglycemia

what happens if there is an uptrend in glucose (>200 mg/dL)