Lab Values

What is normal BP

120/80 mmHg

What is normal HR

60-100 bpm

What is normal SpO2

95%-100%

What is normal RR

12-20 bpm

What does WBC count indicate

Leukocytes

what is the function of leukocytes

Helps the body fight infection

What is the normal reference range for WBC count

5,000-10,000 mm3

What is the possible critical value for WBC count

What is Leukocytosis

high WBC count

what does leukocytosis indicate

infection

what is leukopenia

low WBC count

what is neutropenia

low neutrophil count

What does leukopenia indicate?

a weakened immune system

what does neutropenia indicate

All neutrophils in circulation have gone to fight the infection and the bone marrow hasn't caught up

what are neutropenic precautions

- do not enter room if sick

- no fresh or dried plants in room

- clean hands before entering room

- patient wears mask to leave room

- wear mask to enter room

what is hemoglobin

Protein on RBC's that carries O2 and CO2

What is the normal reference range for hemoglobin in males

14-18 g/dL

What is the normal reference range for hemoglobin in females

12-16 g/dL

what is the possible critical value for hemoglobin

What is anemia

Anemia is a deficiency in red blood cells or hemoglobin.

what does a decrease in the amount of hemoglobin indicate

anemia

What is the below 7 rule for hemoglobin

if your hemoglobin decreases to 7 or below, they will have you get a blood transfusion because you are approaching critically low values

What are possible causes of anemia

- hemorrhage

- nutritional deficiency

- sickle cell anemia

- blood loss (surgery)

What vital signs do we want to monitor for patients with anemia

- Monitor SpO2 and watch for orthostatic hypotension

- Fatigue

what is Polycythemia

too much Hgb

what are causes of polycythemia

- High altitudes with low O2

- COPD

What is hematocrit

% of your blood that is made up of RBCs (when compared to plasma - liquid that contains hormones, proteins, etc)

what is the normal male hematocrit

42-52%

what is the normal female hematocrit

37-47%

what are the possible critical values for hematocrit

What does a downward trend in hematocrit indicate

anemia

In patients with low hematocrit, what do we want to monitor for

- Monitor SpO2 and watch for orthostatic hypotension

- Fatigue

What does an upward trend in hematocrit indicate

Polycythemia

In patients with high hematocrit, what do we want to monitor for

Screen for clots

why do we want to screen for clots in patients with high hematocrit

High HCT means lots of RBC making blood thick promoting clots

what is the purpose of measuring platelet levels

Assesses coagulation/coagulopathy

What is the normal reference range for platelet levels

150,000-400,000 mm3

What is Thrombocytopenia

low platelet count

what is the biggest risk with patients with Thrombocytopenia

Prevent falls!

what is thrombocytosis

too many platelets

what do we want to screen for in patients with thrombocytosis

screen for clots

why do we want to screen for clots in patients with thrombocytosis

too many platelets leads to increased coagulation of blood putting the patient at risk for clots

why do we measure Na

Fluid movement within the body

What is the normal reference range for Na

134-145 mEq/L

what are the possible critical values for Na

what is Hypernatremia

Blood sodium level is high

what does hypernatremia indicate

too little water (dehydration, vomiting)

what is hyponatremia

Blood sodium level is low

what does hyponatremia indicate

too much water (kidney disease, HF)

how do diuretics relate to hyponatremia?

diuretics can cause hyponatremia since it causes you to lose too much water and Na+

what are the main signs/symptoms you want to monitor for in patients with an imbalance of sodium

- Altered cognition

- seizure precautions

why is potassium important

- Important for functions of excitable cells

- Heart, muscles, neurons

what is the normal reference range for K+

3.5-5.0 mEq/L

what are the possible critical values for K+

what is hyperkalemia

too much potassium

what is the biggest risk associated with hyperkalemia

cardiac arrhythmias

what is hypokalemia

low potassium

what are the clinical manifestations associated with hypokalemia

- Extremity weakness

- decreased reflexes

- leg cramps

- paresthesia

what are key points about blood glucose tests

- A measure of the Body's primary energy source

- Assesses blood glucose at the time test is attained

what is the normal reference range for fasting blood glucose

70-110 mg/dL

what are the requirements for a fasting blood glucose test

no caloric intake for 8 hours

what is the normal reference range for a casual blood glucose test

< 200 mg/dL

what is hypoglycemia

low blood glucose

what are symptoms associated with hypoglycemia

- Lethargy

- irritability

- shaking

- extremity weakness

- LOC

what are the different classifications of hypoglycemia

- Level 1 < 70 mg/dL

- Level 2 =

what does level 1 hypoglycemia indicate

blood glucose < 70 mg/dL

what does level 2 hypoglycemia indicate

blood glucose < 54 mg/dL

what does level 3 hypoglycemia indicate

AMS

what is Hemoglobin A1C (HgbA1C)

- Average glucose over 3 months

- How much sugar is attached to Hgb

what is the normal reference range for Hemoglobin A1C (HgbA1C)

what is the normal reference range for Hemoglobin A1C (HgbA1C) in individuals with DM

>6.5%

what are key points about Hemoglobin A1C (HgbA1C)

- Used to diagnose DM

- Not frequently clinically reassessed

- High A1C makes it hard for wounds to heal

what are key points about Blood Urea Nitrogen (BUN) Serum Creatinine

- Evaluates kidney function

- If elevated - may decrease activity tolerance + renal failure

what is the normal reference range for Blood Urea Nitrogen (BUN) Serum Creatinine

6-25 mg/dL

what is the critical value range for Blood Urea Nitrogen (BUN) Serum Creatinine

>100 mg/dL

what is the risk of elevated Blood Urea Nitrogen (BUN) Serum Creatinine

may decrease activity tolerance + renal failure

why is chloride concentration important to know about

Fluid balance, usually works with Na+

why is calcium concentration important to know about

Important for bone health/growth, muscle contraction and release of neurotransmitters

why is magnesium concentration important to know about

Lives in bone and muscle and regulated by the kidneys

why is phosphate concentration important to know about

Important for bone formation and storage/transfer of energy

Patient is a 78 year old admitted with acute exacerbation of COPD. The patient wears 3L NC at home and monitors his own SpO2 with a portable pulse oximeter regularly. Their Current SpO2 is 90%. Further chart review reveals patient reports his oxygen levels usually run between 88-92% at home. What do you do next?

Yellow light, have a conversation with the multidisciplinary team or referring physician and monitor SpO2

Patient is a 62 year old arriving to your outpatient clinic with a PMH of Non-Hodgkin's Lymphoma for an evaluation. Reports he has been feeling "wiped out" and expresses concern about becoming a falls risk. You notice from his notes that he has chemotherapy-induced thrombocytopenia. Most recent lab value 3 days ago: 42,000 mm3. Note, his lowest has been 28,000 mm3. What do you do next?

Yellow Light, have a conversion with the medical team about safe PT options and fit him with an AD

Patient is a 78 year old female admitted with worsening dyspnea on exertion with known HFpEF and chronic anemia. PT consult to evaluate and treat. Their current Hgb is 6.8 g/dL. Further chart review reveals patient is a Jehovah's witness and has formally declined all blood transfusions. Hgb over the past year has trended between 6.5 and 7.5 g/dL. What do you do next?

Yellow light, have a conversation with the medical team. Exercise is good for increasing Hgb but we need to be careful not to overexert the patient.

Patient is a 45 year old male admitted with a GI bleed. You speak with the patient's nurse who reports a recent episode of melena. Current Hgb: 8.2 g/dL. Further chart review reveals Hgb levels have dropped significantly this morning. Lab values from yesterday say Hgb was at 16.5 g/dL. No new note from primary medical team in chart. What do you do next?

Red light, they are still actively bleeding so do not proceed

Patient is a 62 year old s/p TKA arriving to your outpatient clinic for her follow-up physical therapy appointment. PMH: DM2 (takes insulin), HLD, HTN. She reports she feels "a little shaky", nauseous and "almost like I might faint." What do you do next?

Yellow light, take vitals

What are key points about Arterial Blood Gas (ABG) testing

- Draws blood from an artery (Usually in the wrist)

- Measures O2, CO2 and pH of blood

What is the normal range for pH

7.35-7.45

What is the normal range for PaO2

80-100 mmHg

What is the normal range for PaCO2

35-45 mmHg

What is the normal range for HCO3

21-28 mEq/L

when talking about Respiratory Alkalosis and Acidosis, what lab value are we primarily talking about?

CO2

is CO2 an acid or a base

an acid

what lab values indicate respiratory acidosis

- pH < 7.25

- PaCO2 > 45

what are possible causes of respiratory acidosis

- Decreased ventilation

- depression of respiratory center (neuro)

- asthma/COPD

what are symptoms associated with respiratory acidosis

- Confusion

- fatigue

- lethargy

- SOB

what lab values indicate respiratory alkalosis

- pH > 7.45

- PaCO2

what are possible causes of respiratory alkalosis

Anxiety, pain → hyperventilation

what are symptoms associated with respiratory alkalosis

- Dizziness

- paresthesia

- chest pain

- seizure

when talking about metabolic Alkalosis and Acidosis, what lab value are we primarily talking about?

HCO3

is HCO3 an acid or a base

a base