Acute Care Lab Values

Components of a CBC that PTs pay most attention to are

WBC, HgB, Hct, Plt

Where are electrolytes found in the lab results?

on the CMP or BMP

Creatinine, BUN, and GFR assess

renal function

AST, ALT, ALP, and bilirubin assess

liver function

INR, PT, and APTT assess

blood viscosity

Shorthand ABGs are written in what format?

pH/pCO2/pO2/HCO3

WBC normal range

5,000-10,000/mm3

High WBCs indicate

Leukocytosis

Leukocytosis value

> 11,000 /mm3

Low WBCs indicate

Leukopenia

Leukopenia value

< 4,000/mm3

Possible critical values for WBC count

<2500 or >30,000

Precautions to protect the patient from infection are required at a WBC count of

<2500

A WBC count of >30,000 likely indicates

the patient has a very high fever and has increased metabolic expenditure

Neutropenia value

<1,000/mm3

Neutropenic precautions place a patient in protective isolation and are required d/t severely immunocompromised status. At what ANC value would you expect this?

<1000

ANC critical value

<500/mm3

Neutropenic precautions require

mask for patients and caregivers due to SEVERE risk of infection

HgB normal range males

14-18 g/dL

HgB normal range females

12-16 g/dL

Low Hemoglobin is called

anemia

Anemia HgB value

6-8 g/dL

A patient's HgB comes back as a 6. What symptoms would you expect to see?

low BP, tachycardia, orthostasis, blood loss

If a pt tells you their hemoglobin normally runs around a 7 and do not exhibit any symptoms of anemia, is treatment contraindicated?

No!

HgB high critical

>20 g/dL

A high critical HgB poses major risk for _____ and ________

DVT; oxygen desaturation

HgB low critical value

<5 g/dL

If a patient has an HgB of 4, can you still treat them?

Probably yes, but it will be mainly bed mobility

Hematocrit (HCT) measures

the percentage of RBCs compared to total blood volume

HCT male normal range

42-52%

HCT female normal range

37-47%

Treating a pt with low HCT requires what kind of approach?

Systems-based. Light aerobics or anaerobic may be fine, but be sure to monitor their heart rhythm

HCT High critical value

>60%

HCT high critical value puts someone at major risk for

spontaneous blood clotting

HCT low critical value

<15%

Your patient recently had an HCT value of 13%. What are they at risk for?

heart failure and death

Are the following symptoms characteristic of high H&H or low H&H?

-weakness

-bruising

-bleeding

-fever

-fatigue

-headache

-dizziness

HIGH H&H

Are the following symptoms characteristic of high H&H or low H&H?

-pale skin

-DOE

-heart arrhythmias

-tachycardia

-decreased exercise tolerance

-headache

-dizziness

-diaphoresis

LOW H&H

Platelets (Plt) normal range

150,000-400,000

High platelets are called

thrombocytosis

Thrombocytosis value

>450,000

Thrombocytosis causes

iron deficiency anemia, cancer, splenectomy, inflammation, strenuous exss

Does thrombocytosis contraindicate therapy?

NO, since amb decreases DVT risk

Low platelets is called

thrombocytopenia

Thrombocytopenia value

<150,000

Thrombocytopenia may be due to

blood loss, damage to blood cells, various disease processes

Your patient recently had a plt count of 100,000. What are the 3 things you should be aware of and monitor during tx?

1. Bruising and minor trauma can cause MAJOR bleeding

2. They are a fall risk

3. Monitor fatigue!

Plt possible critical values

<50,000 or >1million

Severe thrombocytopenia

<20,000; likely requires transfusion and MUST decide if benefit outweighs risk

Which 4 ions are assessed in an electrolyte panel?

1. calcium

2. sodium

3. potassium

4. magnesium

Sodium normal value

136-145 mEq/L

Hypernatremia value

>145 mEq/L

Hypernatremia S/S

high HR, CONFUSION, altered mental status, hypotension, seizures, coma

Hyponatremia value

<130 mEq/L

Hyponatremia S/S

N/V/D, LETHARGY, Headache, orthostasis, decreased reflexes, seizures

True or False:

Hyponatremia AND hypernatremia can cause coma

true

Sodium possible critical values

<120 or >160

Potassium normal value

3.5-5.0 mEq/L

Hyperkalemia value

>5.5

Hyperkalemia S/S

EKG CHANGES (heart block, vfib, wide QRS complex, bradycardia), muscle weakness

True or false: hyperkalemia AND hypokalemia can cause cardiac arrest

true

Hypokalemia value

<3.5 mEq/L

Hypokalemia S/S

EKG changes, hypotension, weakness, decreased reflexes, paresthesia, CRAMPS, cardiac arrest

Potassium high critical

>6.5

A potassium level of >6.5 mEq/L may result in

loss of mm function

Potassium low critical

<2.5

A potassium level of <2.5 mEq/L may result in

arrhythmia or cardiac event

With altered sodium levels, you should expect

1. CONFUSION

2. Seizure precautions

3. BP fluctuations

With altered potassium levels, you should expect

MAJOR impacts on heart fxn

Calcium normal value

9-10.5 mg/dL

Hypercalcemia value

>10.5 mg/dL

Hypercalcemia causes

excess antacid use, fracture or immobilization, renal failure

Hypocalcemia value

< 8.5 mg/dL

Hypocalcemia causes

CKD, sepsis, malnutrition, excess laxatives, pancreatitis

Calcium critical values

<6 or >13

Magnesium normal range

1.3-2.1 mEq/L

Hypermagnasemia causes

antacids/miralax, dehydration, renal failure

Hypomagnesemia causes

alcohol abuse, diuresis, DKA, malnutrition

Glucose normal fasting value

70-110 mg/dL

Hyperglycemia value

>200 mg/dL

Treating a patient in active hyperglycemia requires a

systems based approach

Hyperglycemia s/s

dehydration, severe fatigue, frequent urination, thirst

Hypoglycemia value

<70 mg/dL

Your patient currently has a blood sugar of 64 mg/dL. They c/o headache, shakiness, cold sweats, and are highly irritable. Should you treat this patient?

No. Their low blood sugar needs to be corrected first

Hypoglycemia critical value

<50

Hyperglycemia critical value

>400

HgB A1C pre-diabetic range

5.7-6.4%

HgB A1C Diabetic value

>6.5%

What is the purpose of coagulation profiles?

1. Assess the ability to initiate a clotting sequence

2. Diagnose a clotting disorder

3. Monitor the effectiveness of anticoag therapy

Prothrombin time (PT) normal value

11-12.5 seconds

Partial Thromboplastin time (aPTT) normal value

30-40 seconds

International Normalized Ratio (INR) normal range

0.8-1.1 if not on warfarin

INR critical value

>5.5

What are the 2 biggest complications of immobility?

DVT and PE

Swelling, localized redness, and localized pain are s/s of

DVT

Increased HR, oxygen desat, and pain are s/s of

PE

What medication is a clot preventative via decreasing platelet count?

Aspirin

What medications inhibit synthesis and function of clotting factors to prevent and treat thromboembolism?

anticoagulants

Heparin and enoxaparin are medications used in the hospital for ______ ________________

acute anticoagulation

Warfarin/Coumadin INR therapeutic range general

2.-3.5