lab values

true or false: it is ALWAYS important to match lab value findings to the client's response

true

______ lab value responses MUST be reported to the MD because these are unexpected and can be harmful to the client - life threatening & requires emergent attention

Critical

true or false: abnormal values are considered critical values

false

the ________ ________ _______ measures 8 different substances that naturally occur in the blood, requires fasting, and is usually done on the fluid (plasma) part of the blood located at the top of the tube

basic metabolic panel (BMP)

basic metabolic panel (BMP) tests what things?

- electrolytes (Na, K, CO2, Cl-)

- acid/base balance

- blood sugar + thyroid (endocrine functioning)

- kidney/renal status (BUN & creatinine)

the average person has _____ L of blood circulating throughout the system

5.5

_____ makes up 55% of total blood volume and is mostly comprised of water which makes it the top layer in the blood collection tube

Plasma

in a blood collection tube, the top layer is plasma, the middle layer is referred to as the "buffy coat" containing ______ blood cells, and the bottom layer contains the most solid component which are ______ blood cells

white; red

a _______ _______ _______ measures the different parts of blood → the kinds of cells and the number of cells within the sample of blood

complete blood count (CBC)

what is measured in a complete blood count (CBC) test:

- leukocytes/WBC

- erythrocytes/RBC

- PLT (thrombocytes)

________ refers to the percentage of RBC within the blood

Hematocrit

low hemoglobin (Hgb) = low ________ = increased fatigue

oxygen

a _________ ________ / ________ _______ is a blood test that measures the enzymes, proteins, and other substances made by the liver

liver function / hepatic panel

the liver function / hepatic panel checks hepatocytes' enzyme levels in the blood and the liver's effectiveness in clearing _______, total _______, and ______

bilirubin; protein; albumin

_________ are liver enzymes important for maintaining liver homeostasis

Hepatocytes

the _______ panel detects serum albumin, serum pre-albumin, serum bilirubin, and ammonia

hepatic

what does the serum pre-albumin test show?

tells what happened with the protein levels in last 3 months (determines if it's an acute vs chronic problem)

why is it bad if the hepatic panel is high?

because it means liver is not functioning as it should

__________ ________ are used to find out if there is a problem with any clotting factors that may cause too little (excessive bleeding) or too much blood clotting

coagulation profiles

True or false: coagulation profiles look at how fast or slow the body can form a clot

true

lipid panel and d-dimer assay are used to rule out ______

clots

an anti factor Xa assay is designed to measure ______

plasma heparin levels

INR/PT measures how long it takes for a clot to form when blood escapes a vessel; specifically looks at the ________ pathway of coagulation

Extrinsic

aPPT/PPT measures how long it takes for a clot to form within a blood vessel; specifically looks at the ______ pathway of coagulation

intrinsic

high INR = ____ blood and low = ____

thin; clots

true or false: CK MB is only used if troponin levels are not attainable

true

increased numbers of BNP in those with ____ & _____

ACS; MI

BNP levels for HF: normal vs compensated vs uncompensated

- normal: 0-100

- compensated 100-700

- uncompensated >700

creatine kinase → CK-MM is in presence of __________

rhabdomyolysis

____________ is a condition that is characterized by muscle necrosis and the release of CK into circulation; can be caused by traumatic injuries and metabolic etiologies such as drugs, toxins, and myopathies

Rhabdomyolysis

in patients with rhabdomyolysis, avoid overexertion and use a symptom-based approach to treatment; prioritize preserving _______

ROM

true or false:lab values vary based on the procedure, gender, age, race, and ethnicity

true

true or false:low/high values due to underlying disease can be acceptable

true

WBC values: _________ (H) and _________ (L)

leukocytosis; leukopenia

________ are the most common type of WBC tested in immunocompromised individuals

Neutrophils

<________ is the absolute neutrophil count/ANC and is the critical level = serious infection

500

Neutropenic precautions: (___ by neutrophils and ___ for WBC)

<1k; <4k

neutropenic precautions are used when a client has a _____ number of neutrophils in their immune system, making them immunocompromised (AIDS, on immunosuppressants, active cancer treatment)

low

true or false: neutropenic precautions are comparable to contact precautions + mask for in/out of area (may involve room isolation, diet, germ, skin, rest, fever)

true

red blood cells carry _________ from the lungs to the rest of the body and also carry _______ ________ back to the lungs so it can be exhaled

oxygen; carbon dioxide

low RBC count = ________; the body may not be getting the oxygen it needs

anemia

high RBC count = _______; there is a chance that the RBC will clump together and block tiny vessels (capillaries); hard for your RBC to carry oxygen because they are sticky

polycythemia

there will be an increased concentration of RBC if someone is ______

dehydrated

true or false: hemoglobin and hematocrit (H/H) reflect the number of RBC and typically trend together

true

(low/high) hemoglobin and hematocrit (H/H) value = weakness, fatigue, SOBOE, palpitations, tachycardia

Low

(low/high) hemoglobin and hematocrit (H/H) value = HA, risk for thrombosis

High

________ = % of the total blood volume made up of RBC

Hematocrit

_______ = RBC protein responsible for the delivery of oxygen

Hemoglobin

(low/high) hematocrit = tobacco use, severe lung disease, heart defects, polycythemia

high

(low/high) hematocrit = anemia, acute or chronic blood loss

Low

(low/high) hemoglobin = chronic hypoxemia, polycythemia

High

(low/high) hemoglobin = anemia, cancer, blood loss

Low

for _______ hemoglobin values, use a symptoms-based approach and for ______ hemoglobin values, modify treatment to decrease/increase vital signs

high; low

true or false: for both high & low hematocrit values, use a symptoms-based approach for treatment

true

_________ are the smallest part of RBC that function to form clots and prevent bleeding

Platelets

a high platelet count = ________; iron deficiency, inflammation, splenectomy/surgical reaction

thrombocytosis

a low platelet count = __________; bone marrow destruction, medications, easier bleeding including bruises & prolonged bleeding throughout the body

thrombocytopenia

in someone with thrombocytopenia you should screen for ____

falls

_______ is important in nerve conduction, function of muscles and is the primary determinant in extracellular fluid

Sodium

high sodium levels = __________ (dehydration)

hypernatremia

low sodium levels = _________ (too much water in the system)

hyponatremia

treatment for low/high sodium levels is based on

symptoms, comorbidities, and lifestyle modifications

________ impacts neuromuscular function and is a very sensitive lab value

Potassium

high potassium levels = __________

hyperkalemia

low potassium levels = ___________

hypokalemia

for abnormal potassium levels, use a symptom-based treatment approach but consider cramping for _____ values and potential ECG changes for _____ values

low; high

abnormal levels of ______ ______ is dependent on all the lab values and the ability of the body to compensate or not

carbon dioxide

pH levels and electrolyte status is important for _______ ______ levels

carbon dioxide

blood urea nitrogen (BUN) is associated with the ________ and excreted in urine

liver

there are no treatment implications for BUN values; however, very ______ levels may cause cognitive dysfunction

high

creatinine (Cr) is regulated by the _______ and has a narrow window

kidney

abnormal values of _________ implicate the kidney and the client may have fluid restrictions

creatinine

________ (blood sugar/BS) has a range of normal and is affected by many factors including food, medications, anxiety, and DM

Glucose

true or false: symptoms for low and high blood sugar look different

false - similar (when in doubt treat as low BS)

normal glucose level

70-100 mg/dL

high blood sugar = __________; risk of ketoacidosis but can treat and maybe help decrease BS

hyperglycemia

hyperglycemia = > ________

250

low blood sugar = _________; low activity tolerance

hypoglycemia

hypoglycemia = < ____

70

if someone has low BS they have [high/low] activity tolerance

low (because exercise uses glucose)

in a coagulation profile, ________ ________ measures the effectiveness of oral anticoagulants (such as warfarin)

prothrombin time / PT

in a coagulation profile, ________ _______ _______ ________ measures the effectiveness of heparin therapy

activated partial prothrombin time (aPTT)

what is the normal value for INR?

1.0

what is the critical value for INR in which you need an order from a physician to treat the patient?

> 5

true or false: INR is a therapeutic range so there is not a specified high or low value and 2-3 is okay if there is a reason / condition requiring medication to elevate it

true

symptoms of anemia (low RBC) include

- dyspnea

- confusion

- fatigue

- weakness

- signs include hypotension and tachycardia as the heart tries to compensate for low oxygen

anemia requires close monitoring of vitals and _______ is a value used to predict tissue perfusion

SpO2

for an individual with anemia and a SpO2 <______%, exercise must be paused to let them rest OR exercise must be slowed down

88

a SpO2 decrease of ___% or more equates to desaturation and is clinically significant in individuals with anemia

4

patients with anemia may have tachycardia or __________ __________ if hemoglobin value is < 8 g/dL

orthostatic hypotension

the primary cause of polycythemia (increased RBC) is a disease of the ______ ________

bone marrow

secondary causes of polycythemia are due to decreased O2 supply and often include

high altitudes, nicotine, and chronic pulmonary or cardiac deficits

presentation of polycythemia

- fever, headache, dizziness

- blurred vision

- weakness & fatigue

- easy bruising or bleeding

- decreased mental acuity

- sensory disturbances in the hands and feet

factors affecting bleeding viscosity

- hematocrit

- RBC deformability (sickle cell)

- plasma viscosity

- RBC sedimentation / aggregation

- platelets

- enzymes

virchow's triad explains why a blood clot forms and includes

- changes in vessel wall

- changes in blood composition

- changes in blood flow

aPTT monitors a patient on _______

heparin

if someone is on heparin and aPTT is low then what do you do?

give more heparin

__________ is a protein produced by the liver for clotting of blood and is converted to thrombin during the clotting process

Prothrombin

prothrombin is reduced in patients with _______ disease

liver

the production of prothrombin depends on adequate vitamin ___ intake and absorption

K