Comprehensive Nursing Study Guide: Laboratory Reference Ranges, Fundamentals of Nursing & Assessment Standards

Laboratory Reference Ranges: Complete Blood Count & Hematology

• General Laboratory Variance: Precision and methods in laboratory testing have evolved continuously. Reference ranges vary across individual clinical laboratories based on specific analytical methodologies. When managing client care, always verify findings against the specific reference ranges supplied by the reporting laboratory.

• Hematocrit [Hct] (Measured in $\%$):

  • $2$\text{ weeks to }$2$\text{ months}: $39\,\%$ to $59\,\%$
  • $2$\text{ months to }$6$\text{ months}: $35\,\%$ to $50\,\%$
  • $6$\text{ months to }$1$\text{ year}: $29\,\%$ to $43\,\%$
  • $1$\text{ year to }$6$\text{ years}: $30\,\%$ to $40\,\%$
  • $6$\text{ years to }$18$\text{ years}: $32\,\%$ to $44\,\%$
  • Greater than $18$\text{ years} (Female): $37\,\%$ to $47\,\%$
  • Greater than $18$\text{ years} (Male): $42\,\%$ to $52\,\%$
  • Pregnant female: greater than $33\,\%$
  • CRITICAL VALUE: less than $21\,\%$ or greater than $65\,\%$

• Hemoglobin [Hgb] (Measured in $\text{g/dL}$):

  • $2$\text{ months to }$6$\text{ months}: $10\,\text{g/dL}$ to $17\,\text{g/dL}$
  • $6$\text{ months to }$6$\text{ years}: $9.5\,\text{g/dL}$ to $14\,\text{g/dL}$
  • $6$\text{ years to }$18$\text{ years}: $10\,\text{g/dL}$ to $15.5\,\text{g/dL}$
  • Greater than $18$\text{ years} (Female): $12\,\text{g/dL}$ to $16\,\text{g/dL}$
  • Greater than $18$\text{ years} (Male): $14\,\text{g/dL}$ to $18\,\text{g/dL}$
  • CRITICAL VALUE: less than $7\,\text{g/dL}$ or greater than $21\,\text{g/dL}$

• Platelet Count (Measured in $/\text{mm}^3$):

  • Infant: $200,000/\text{mm}^3$ to $475,000/\text{mm}^3$
  • Child and Adult: $150,000/\text{mm}^3$ to $400,000/\text{mm}^3$
  • CRITICAL VALUE: less than $20,000/\text{mm}^3$ or greater than $1,000,000/\text{mm}^3$

• Mean Platelet Volume (MPV): $7.4\,\text{fL}$ to $10.4\,\text{fL}$ (femtoliters)

• Red Blood Cell Count [RBC] (Measured in $\times 10^6/\mu\text{L}$):

  • $2$\text{ weeks to }$2$\text{ months}: $3.5 \times 10^6/\mu\text{L}$ to $5.5 \times 10^6/\mu\text{L}$
  • $2$\text{ months to }$6$\text{ months}: $3.5 \times 10^6/\mu\text{L}$ to $5.5 \times 10^6/\mu\text{L}$
  • $6$\text{ months to }$1$\text{ year}: $3.5 \times 10^6/\mu\text{L}$ to $5.2 \times 10^6/\mu\text{L}$
  • $1$\text{ year to }$18$\text{ years}: $4 \times 10^6/\mu\text{L}$ to $5.5 \times 10^6/\mu\text{L}$
  • Greater than $18$\text{ years} (Female): $4.2 \times 10^6/\mu\text{L}$ to $5.4 \times 10^6/\mu\text{L}$
  • Greater than $18$\text{ years} (Male): $4.7 \times 10^6/\mu\text{L}$ to $6.1 \times 10^6/\mu\text{L}$

• Red Blood Cell Indices:

  • Mean Corpuscular Volume [MCV] (Measured in $\text{fL}$):
    • Newborn: $96\,\text{fL}$ to $108\,\text{fL}$
    • Child / Adult / Older adult: $80\,\text{fL}$ to $95\,\text{fL}$
  • Mean Corpuscular Hemoglobin [MCH] (Measured in $\text{pg}$):
    • Newborn: $32\,\text{pg}$ to $34\,\text{pg}$
    • Child / Adult / Older adult: $27\,\text{pg}$ to $31\,\text{pg}$
  • Mean Corpuscular Hemoglobin Concentration [MCHC] (Measured in $\text{g/dL}$):
    • Newborn: $32\,\text{g/dL}$ to $33\,\text{g/dL}$
    • Child / Adult / Older adult: $32\,\text{g/dL}$ to $36\,\text{g/dL}$
  • Red Blood Cell Distribution Width [RDW] (Measured in $\%$):
    • Adult: variation of $11\,\%$ to $45\,\%$

• White Blood Cell Count [WBC] [Total] (Measured in $/\text{mm}^3$):

  • $1$\text{ month to }$24$\text{ months}: $6,200/\text{mm}^3$ to $17,000/\text{mm}^3$
  • Child and Adult: $5,000/\text{mm}^3$ to $10,000/\text{mm}^3$
  • CRITICAL VALUE: less than $2,000/\text{mm}^3$ or greater than $40,000/\text{mm}^3$

• WBC Differential:

  • Neutrophil: Percentage: $55\,\%$ to $70\,\%$; Absolute Count: $2,500/\text{mm}^3$ to $8,000/\text{mm}^3$
  • Lymphocytes: Percentage: $20\,\%$ to $40\,\%$; Absolute Count: $1,000/\text{mm}^3$ to $4,000/\text{mm}^3$
  • Monocytes: Percentage: $2\,\%$ to $8\,\%$; Absolute Count: $100/\text{mm}^3$ to $700/\text{mm}^3$
  • Eosinophils: Percentage: $1\,\%$ to $4\,\%$; Absolute Count: $50/\text{mm}^3$ to $500/\text{mm}^3$
  • Basophils: Percentage: $0.5\,\%$ to $1\,\%$; Absolute Count: $25/\text{mm}^3$ to $100/\text{mm}^3$

Laboratory Reference Ranges: Comprehensive Metabolic Profile

• Alanine Aminotransferase [ALT]: Child / Adult: $4\,\text{international units/L}$ to $36\,\text{international units/L}$

• Albumin and Total Protein:

  • Albumin: $3.5\,\text{g/dL}$ to $5\,\text{g/dL}$
  • Total Protein: $6.4\,\text{g/dL}$ to $8.3\,\text{g/dL}$

• Alkaline Phosphatase [ALP] (Measured in $\text{units/L}$):

  • Birth to $2$\text{ years}: $85\,\text{units/L}$ to $235\,\text{units/L}$
  • $2$\text{ to }$8$\text{ years}: $65\,\text{units/L}$ to $210\,\text{units/L}$
  • $9$\text{ to }$15$\text{ years}: $60\,\text{units/L}$ to $300\,\text{units/L}$
  • $16$\text{ to }$21$\text{ years}: $30\,\text{units/L}$ to $200\,\text{units/L}$
  • Adults: $30\,\text{units/L}$ to $120\,\text{units/L}$

• Aspartate Aminotransferase [AST] (Measured in $\text{units/L}$):

  • $0$\text{ to }$5$\text{ days}: $35\,\text{units/L}$ to $140\,\text{units/L}$
  • Less than $3$\text{ years}: $15\,\text{units/L}$ to $60\,\text{units/L}$
  • $3$\text{ to }$6$\text{ years}: $15\,\text{units/L}$ to $50\,\text{units/L}$
  • $6$\text{ to }$12$\text{ years}: $10\,\text{units/L}$ to $50\,\text{units/L}$
  • $12$\text{ to }$18$\text{ years}: $10\,\text{units/L}$ to $40\,\text{units/L}$
  • Adults: $0\,\text{units/L}$ to $35\,\text{units/L}$

• Bicarbonate [HCO3-] / Carbon Dioxide Content (Measured in $\text{mEq/L}$):

  • Newborn: $13\,\text{mEq/L}$ to $22\,\text{mEq/L}$
  • Infant: $20\,\text{mEq/L}$ to $28\,\text{mEq/L}$
  • Child: $20\,\text{mEq/L}$ to $28\,\text{mEq/L}$
  • Adult: $23\,\text{mEq/L}$ to $30\,\text{mEq/L}$

• Bilirubin (Measured in $\text{mg/dL}$):

  • Total Bilirubin: Newborn: $1\,\text{mg/dL}$ to $12\,\text{mg/dL}$; Child / Adult: $0.3\,\text{mg/dL}$ to $1\,\text{mg/dL}$
  • Direct Bilirubin: Child / Adult: $0.1\,\text{mg/dL}$ to $0.3\,\text{mg/dL}$
  • Indirect Bilirubin: Child / Adult: $0.2\,\text{mg/dL}$ to $0.8\,\text{mg/dL}$

• Blood Urea Nitrogen [BUN] (Measured in $\text{mg/dL}$):

  • Infant: $5\,\text{mg/dL}$ to $18\,\text{mg/dL}$
  • Child: $5\,\text{mg/dL}$ to $18\,\text{mg/dL}$
  • Adult: $10\,\text{mg/dL}$ to $20\,\text{mg/dL}$
  • CRITICAL VALUE: greater than $100\,\text{mg/dL}$

• Calcium (Total) (Measured in $\text{mg/dL}$):

  • Less than $10$\text{ days}: $7.6\,\text{mg/dL}$ to $10.4\,\text{mg/dL}$
  • $10$\text{ days to }$2$\text{ years}: $9.0\,\text{mg/dL}$ to $10.6\,\text{mg/dL}$
  • Child: $8.8\,\text{mg/dL}$ to $10.8\,\text{mg/dL}$
  • Adult: $9.0\,\text{mg/dL}$ to $10.5\,\text{mg/dL}$
  • CRITICAL VALUE: less than $6\,\text{mg/dL}$ or greater than $13\,\text{mg/dL}$

• Chloride [Cl] (Measured in $\text{mEq/L}$):

  • Infant: $96\,\text{mEq/L}$ to $106\,\text{mEq/L}$
  • Child: $90\,\text{mEq/L}$ to $110\,\text{mEq/L}$
  • Adult: $98\,\text{mEq/L}$ to $106\,\text{mEq/L}$

• Creatinine (Measured in $\text{mg/dL}$):

  • Less than $2$\text{ years of age}: $0.1\,\text{mg/dL}$ to $0.4\,\text{mg/dL}$
  • $2$\text{ years to less than }$6$\text{ years}: $0.2\,\text{mg/dL}$ to $0.5\,\text{mg/dL}$
  • $6$\text{ years to less than }$10$\text{ years}: $0.3\,\text{mg/dL}$ to $0.6\,\text{mg/dL}$
  • $10$\text{ years to less than }$18$\text{ years}: $0.4\,\text{mg/dL}$ to $1\,\text{mg/dL}$
  • $18$\text{ years to less than }$41$\text{ years}: Female: $0.5\,\text{mg/dL}$ to $1\,\text{mg/dL}$; Male: $0.6\,\text{mg/dL}$ to $1.2\,\text{mg/dL}$
  • $41$\text{ years to less than }$61$\text{ years}: Female: $0.5\,\text{mg/dL}$ to $1.1\,\text{mg/dL}$; Male: $0.6\,\text{mg/dL}$ to $1.3\,\text{mg/dL}$
  • $60$\text{ years and older}: Female: $0.5\,\text{mg/dL}$ to $1.2\,\text{mg/dL}$; Male: $0.7\,\text{mg/dL}$ to $1.3\,\text{mg/dL}$
  • CRITICAL VALUE: greater than $4\,\text{mg/dL}$

• Glucose (Measured in $\text{mg/dL}$):

  • Infant: $40\,\text{mg/dL}$ to $90\,\text{mg/dL}$ (CRITICAL VALUE: less than $40\,\text{mg/dL}$)
  • $13$\text{ months to }$2$\text{ years}: $60\,\text{mg/dL}$ to $100\,\text{mg/dL}$
  • Child greater than $2$\text{ years}: $70\,\text{mg/dL}$ to $110\,\text{mg/dL}$
  • Adult: $74\,\text{mg/dL}$ to $106\,\text{mg/dL}$
  • CRITICAL VALUE: Male: less than $50\,\text{mg/dL}$ or greater than $450\,\text{mg/dL}$; Female: less than $40\,\text{mg/dL}$ or greater than $450\,\text{mg/dL}$

• Magnesium [Mg] (Measured in $\text{mEq/L}$):

  • Newborn: $1.4\,\text{mEq/L}$ to $2\,\text{mEq/L}$
  • Child: $1.4\,\text{mEq/L}$ to $1.7\,\text{mEq/L}$
  • Adult: $1.3\,\text{mEq/L}$ to $2.1\,\text{mEq/L}$
  • CRITICAL VALUE: less than $0.5\,\text{mEq/L}$ or greater than $3\,\text{mEq/L}$

• Potassium [K] (Measured in $\text{mEq/L}$):

  • Infant: $4.1\,\text{mEq/L}$ to $5.3\,\text{mEq/L}$
  • Child: $3.4\,\text{mEq/L}$ to $4.7\,\text{mEq/L}$
  • Adult: $3.5\,\text{mEq/L}$ to $5\,\text{mEq/L}$
  • CRITICAL VALUE: less than $3\,\text{mEq/L}$ or greater than $8\,\text{mEq/L}$

• Sodium [Na] (Measured in $\text{mEq/L}$):

  • Infant: $134\,\text{mEq/L}$ to $150\,\text{mEq/L}$
  • Child: $136\,\text{mEq/L}$ to $145\,\text{mEq/L}$
  • Adult: $136\,\text{mEq/L}$ to $145\,\text{mEq/L}$
  • CRITICAL VALUE: less than $120\,\text{mEq/L}$ or greater than $160\,\text{mEq/L}$

Laboratory Reference Ranges: Arterial Blood Gases (ABGs)

• pH:

  • Newborn: $7.32$ to $7.49$
  • $2$\text{ months to }$24$\text{ months}: $7.34$ to $7.46$
  • Child / Adult: $7.35$ to $7.45$
  • Venous: $7.31$ to $7.41$
  • CRITICAL VALUE: less than $7.25$ or greater than $7.6$

• $PCO_2$ (Measured in $\text{mm Hg}$):

  • Child under $24$\text{ months}: $26\,\text{mm Hg}$ to $41\,\text{mm Hg}$
  • Child / Adult: $35\,\text{mm Hg}$ to $45\,\text{mm Hg}$
  • CRITICAL VALUE: less than $20\,\text{mm Hg}$ or greater than $60\,\text{mm Hg}$

• $HCO_3$ (Measured in $\text{mEq/L}$):

  • Newborn / Infant: $16\,\text{mEq/L}$ to $24\,\text{mEq/L}$
  • Child / Adult: $22\,\text{mEq/L}$ to $26\,\text{mEq/L}$
  • CRITICAL VALUE: less than $10\,\text{mEq/L}$ or greater than $40\,\text{mEq/L}$

• $PO_2$ (Measured in $\text{mm Hg}$):

  • Newborn: $60\,\text{mm Hg}$ to $70\,\text{mm Hg}$
  • Child / Adult: $80\,\text{mm Hg}$ to $100\,\text{mm Hg}$
  • Venous: $40\,\text{mm Hg}$ to $50\,\text{mm Hg}$
  • CRITICAL VALUE: less than $40\,\text{mm Hg}$

• $O_2$ Saturation (Measured in $\%$):

  • Newborn: $40\,\%$ to $90\,\%$
  • Child / Adult: $95\,\%$ to $100\,\%$
  • Older Adult: $95\,\%$
  • CRITICAL VALUE: $75\,\%$ or less

• $O_2$ Content (Volume $\%$):

  • Arterial: $15\,\%$ to $22\,\%$
  • Venous: $11\,\%$ to $16\,\%$

• Base Excess (Measured in $\text{mEq/L}$):

  • Normal: $0 \pm 2\,\text{mEq/L}$
  • CRITICAL VALUE: $\pm 3\,\text{mEq/L}$

• Alveolar to Arterial $O_2$ Difference: Less than $10\,\text{mm Hg}$

Laboratory Reference Ranges: Coagulation, Cardiac & Lipid Parameters

• Activated Partial Thromboplastin Time (aPTT): $30$ to $40$\text{ seconds}; CRITICAL VALUE: greater than $70$\text{ seconds}

• Partial Thromboplastin Time (PTT): $60$ to $70$\text{ seconds}; CRITICAL VALUE: greater than $100$\text{ seconds}

• Brain Natriuretic Peptides [BNP]: less than $100\,\text{ng/L}$; CRITICAL VALUE: greater than $400\,\text{ng/L}$

• C-Reactive Protein [CRP] (Measured in $\text{mg/dL}$):

  • Standard Range: less than $1\,\text{mg/dL}$
  • Cardiac Risk Categories:
    • Low Risk: less than $1\,\text{mg/dL}$
    • Average Risk: $1\,\text{mg/dL}$ to $3\,\text{mg/dL}$
    • High Risk: greater than $3\,\text{mg/dL}$

• Glycosylated Hemoglobin [HbA1c] (Measured in $\%$):

  • Clients without diabetes: $4\,\%$ to $5.9\,\%$
  • Clients with diabetes:
    • Good control: less than $7\,\%$
    • Fair control: $8\,\%$ to $9\,\%$
    • Poor control: greater than $9\,\%$

• High Density Lipoprotein [HDL] (Measured in $\text{mg/dL}$):

  • Standard Baseline: Female: greater than $55\,\text{mg/dL}$; Male: greater than $45\,\text{mg/dL}$
  • Cardiac Risk Categories:
    • Low Risk: Female: $70\,\text{mg/dL}$; Male: $60\,\text{mg/dL}$
    • Moderate Risk: Female: $55\,\text{mg/dL}$; Male: $45\,\text{mg/dL}$
    • High Risk: Female: $35\,\text{mg/dL}$; Male: $25\,\text{mg/dL}$

• Low Density Lipoprotein [LDL] (Measured in $\text{mg/dL}$):

  • Children: less than $110\,\text{mg/dL}$
  • Adults: less than $130\,\text{mg/dL}$

• Very Low Density Lipoprotein [VLDL]: $7\,\text{mg/dL}$ to $32\,\text{mg/dL}$

• Prothrombin Time [PT]:

  • Standard Baseline: $11$ to $12.5$\text{ seconds}
  • Full Anticoagulant Therapy: greater than $1.5$ to $2$\text{ times the control value}
  • CRITICAL VALUE: greater than $20$\text{ seconds}

• International Normalized Ratio [INR]:

  • Standard Range: $0.8$ to $1.1$
  • CRITICAL VALUE: greater than $5$

Laboratory Reference Ranges: Urinalysis Findings

• Physical Parameters:

  • Appearance: Clear
  • Color: Amber Yellow
  • Odor: Aromatic
  • pH: $4.6$ to $8$
  • Specific Gravity: $1.005$ to $1.03$

• Chemical Analysis:

  • Protein: $0\,\text{mg/dL}$ to $8\,\text{mg/dL}$; $50\,\text{mg/24 hr}$ to $80\,\text{mg/24 hr}$ (at rest); less than $250\,\text{mg/24 hr}$ (during exercise)
  • Leukocyte Esterase: Negative
  • Nitrites: None
  • Ketones: None
  • Bilirubin: None
  • Urobilinogen: $0.01\,\text{Ehrlich unit/mL}$ to $1\,\text{Ehrlich unit/mL}$
  • Glucose: Fresh specimen: None; $24$\text{ hr specimen}: $50\,\text{mg/24 hr}$ to $300\,\text{mg/24 hr}$

• Microscopic Findings:

  • Crystals: None
  • Casts: None
  • White Blood Cells [WBC]: $0$ to $4$\text{ per low-power field} (WBC casts: None)
  • Red Blood Cells [RBC]: $\le 2$\text{ per low-power field} (RBC casts: None)

Therapeutic Medication Monitoring

• Acetaminophen: Therapeutic Level: Depends on use | Toxic Level: greater than $25\,\mu\text{g/mL}$

• Amikacin: Therapeutic Level: $15\,\mu\text{g/mL}$ to $25\,\mu\text{g/mL}$ | Toxic Level: greater than $250\,\mu\text{g/mL}$

• Aminophylline: Therapeutic Level: $10\,\mu\text{g/mL}$ to $20\,\mu\text{g/mL}$ | Toxic Level: greater than $20\,\mu\text{g/mL}$

• Amitriptyline: Therapeutic Level: $120\,\text{ng/mL}$ to $150\,\text{ng/mL}$ | Toxic Level: greater than $500\,\text{ng/mL}$

• Carbamazepine: Therapeutic Level: $5\,\mu\text{g/mL}$ to $12\,\mu\text{g/mL}$ | Toxic Level: greater than $12\,\mu\text{g/mL}$

• Cyclosporine: Therapeutic Level: $100\,\text{ng/mL}$ to $400\,\text{ng/mL}$ | Toxic Level: greater than $400\,\text{ng/mL}$

• Chloramphenicol: Therapeutic Level: $10\,\mu\text{g/mL}$ to $20\,\mu\text{g/mL}$ | Toxic Level: greater than $25\,\mu\text{g/mL}$

• Desipramine: Therapeutic Level: $150\,\text{ng/mL}$ to $300\,\text{ng/mL}$ | Toxic Level: greater than $500\,\text{ng/mL}$

• Digitoxin: Therapeutic Level: $15\,\text{ng/mL}$ to $25\,\text{ng/mL}$ | Toxic Level: greater than $25\,\text{ng/mL}$

• Digoxin: Therapeutic Level: $0.8\,\text{ng/mL}$ to $2\,\text{ng/mL}$ | Toxic Level: greater than $2.4\,\text{ng/mL}$ | Peak Concentration Time: $30\,\text{min}$ to $90\,\text{min}$

• Disopyramide: Therapeutic Level: $2\,\mu\text{g/mL}$ to $5\,\mu\text{g/mL}$ | Toxic Level: greater than $5\,\mu\text{g/mL}$

• Ethosuximide: Therapeutic Level: $40\,\mu\text{g/mL}$ to $100\,\mu\text{g/mL}$ | Toxic Level: greater than $100\,\mu\text{g/mL}$

• Gentamicin: Therapeutic Level: $5\,\mu\text{g/mL}$ to $10\,\mu\text{g/mL}$ | Toxic Level: greater than $12\,\mu\text{g/mL}$ | Peak Concentration Time: $30\,\text{min}$

• Imipramine: Therapeutic Level: $150\,\text{ng/mL}$ to $300\,\text{ng/mL}$ | Toxic Level: greater than $500\,\text{ng/mL}$

• Kanamycin: Therapeutic Level: $20\,\mu\text{g/mL}$ to $25\,\mu\text{g/mL}$ | Toxic Level: greater than $35\,\mu\text{g/mL}$

• Lidocaine: Therapeutic Level: $1.5\,\mu\text{g/mL}$ to $5\,\mu\text{g/mL}$ | Toxic Level: greater than $5\,\mu\text{g/mL}$ | Peak Concentration Time: $2\,\text{hr}$

• Lithium:

  • Acute Mania: $0.8\,\text{mEq/L}$ to $1.2\,\text{mEq/L}$
  • Maintenance: $0.5\,\text{mEq/L}$ to less than $1.5\,\text{mEq/L}$
  • Toxic Level: $1.5\,\text{mEq/L}$
  • Peak Concentration Time: $1\,\text{hr}$ to $3\,\text{hr}$

• Methotrexate: Therapeutic Level: greater than $0.01\,\mu\text{mol}$ | Toxic Level: greater than $10\,\mu\text{mol/24 hr}$

• Nortriptyline: Therapeutic Level: $50\,\text{ng/mL}$ to $150\,\text{ng/mL}$ | Toxic Level: greater than $500\,\text{ng/mL}$

• Phenobarbital: Therapeutic Level: $10\,\mu\text{g/mL}$ to $30\,\mu\text{g/mL}$ | Toxic Level: greater than $40\,\mu\text{g/mL}$ | Peak Concentration Time: $12\,\text{hr}$

• Phenytoin: Therapeutic Level: $10\,\mu\text{g/mL}$ to $20\,\mu\text{g/mL}$ | Toxic Level: greater than $30\,\mu\text{g/mL}$ | Peak Concentration Time: $4\,\text{hr}$ to $8\,\text{hr}$

• Primidone: Therapeutic Level: $5\,\mu\text{g/mL}$ to $12\,\mu\text{g/mL}$ | Toxic Level: greater than $15\,\mu\text{g/mL}$

• Procainamide: Therapeutic Level: $4\,\mu\text{g/mL}$ to $10\,\mu\text{g/mL}$ | Toxic Level: greater than $16\,\mu\text{g/mL}$ | Peak Concentration Time: $1\,\text{hr}$ to $2\,\text{hr}$

• Propranolol: Therapeutic Level: $50\,\text{ng/mL}$ to $100\,\text{ng/mL}$ | Toxic Level: greater than $150\,\text{ng/mL}$

• Quinidine: Therapeutic Level: $2\,\mu\text{g/mL}$ to $5\,\mu\text{g/mL}$ | Toxic Level: greater than $10\,\mu\text{g/mL}$ | Peak Concentration Time: $2\,\text{hr}$

• Salicylate: Therapeutic Level: $100\,\mu\text{g/mL}$ to $250\,\mu\text{g/mL}$ | Toxic Level: greater than $300\,\mu\text{g/mL}$

• Sirolimus: Therapeutic Level: $3\,\text{ng/mL}$ to $20\,\text{ng/mL}$ | Toxic Level: greater than $20\,\text{ng/mL}$

• Tacrolimus: Therapeutic Level: $5\,\text{ng/mL}$ to $15\,\text{ng/mL}$ | Toxic Level: greater than $20\,\text{ng/mL}$

• Theophylline: Therapeutic Level: $10\,\mu\text{g/mL}$ to $20\,\mu\text{g/mL}$ | Toxic Level: greater than $20\,\mu\text{g/mL}$ | Peak Concentration Time: $2\,\text{hr}$ to $3\,\text{hr}$

• Tobramycin: Therapeutic Level: $5\,\mu\text{g/mL}$ to $10\,\mu\text{g/mL}$ | Toxic Level: greater than $12\,\mu\text{g/mL}$

• Valproic Acid: Therapeutic Level: $50\,\mu\text{g/mL}$ to $100\,\mu\text{g/mL}$ | Toxic Level: greater than $100\,\mu\text{g/mL}$

• Source Reference: Laboratory values adapted from Pagana, K. D., Pagana, T. J., & Pagana, T. N. (2022). Mosby's manual of diagnostic and laboratory tests (7th ed.). Elsevier.

Fundamentals of Nursing Process & Prioritization Frameworks

• The Nursing Process (ADPIE):

  • A - Assessment: Systemic collection of diagnostic and patient care data.
    • Subjective Data: Client self-reported statements (e.g., what the client says).
    • Objective Data: Directly observable, measurable findings obtained through inspection, vital signs, and physical exams.
  • D - Diagnosis: Formulating clinical nursing diagnosis statements comprising three essential components:
    1. Problem: What you are actively helping the client with.
    2. Cause: The underlying reason, etiology, or risk factors.
    3. Signs / Symptoms: The supportive clinical objective/subjective data.
    • Risk Nursing Diagnosis: Potential clinical problem based on existing risk factors.
    • Actual Nursing Diagnosis: Complete diagnostic statement based on present signs/symptoms.
  • P - Planning: Development of client-centered outcomes and goals.
    • SMART Goal Criteria:
      • S: Specific
      • M: Measurable
      • A: Achievable
      • R: Relevant
      • T: Timely
  • I - Implementation: Execution of planned nursing interventions.
  • E - Evaluation: Assessment of client progress toward goal attainment and outcome effectiveness.

• Maslow's Hierarchy of Needs (Ordered from lowest base priority to highest level):

  1. Physiological Needs: Baseline survival requirements including food, water ($H_2O$), oxygen, and shelter/clothing.
  2. Safety Needs: Securing a safe, risk-free environment.
  3. Love and Belonging Needs: Interpersonal giving and receiving of affection and social connection.
  4. Esteem Needs: Positive self-image, respect, and self-worth.
  5. Self-Actualization: Personal achievement, growth, and mastery of capabilities.

• ABCDE Clinical Prioritization Framework:

  • A - Airway: Assess airway patency. Check if client can speak clearly. Observe for laryngospasm, choking, wheezing, cyanosis, or an ineffective cough.
  • B - Breathing: Evaluate oxygenation ($SpO_2$), extra work of breathing/retractions, and nasal flaring.
  • C - Circulation: Monitor blood pressure, skin color/temperature, active bleeding, and hourly urine output.
  • D - Disability: Evaluate neurological level of consciousness (alert, verbal response, pain responsive, or unresponsive).
  • E - Exposure: Fully visualize client body/skin surface while taking measures to maintain thermoregulation (body temperature).

• Clinical Categorization Concepts:

  • Acute vs. Chronic: Acute conditions are newly developed; Chronic conditions are continuous/long-standing.
  • Urgent vs. Nonurgent: Urgent conditions require priority immediate intervention; Nonurgent conditions can wait.
  • Unstable vs. Stable: Unstable clients have impending life threats/imminent risk of death; Stable clients can safely wait.
  • Triage Color Coding: Red ($1^{\text{st}}$ priority / immediate), Yellow ($2^{\text{nd}}$ priority / delayed), Green ($3^{\text{rd}}$ priority / minimal).

• Risk Factor Classification:

  • Modifiable Risk Factors: Behaviors or attributes that can be altered or changed (e.g., smoking cessation, seatbelt use).
  • Nonmodifiable Risk Factors: Innate biological parameters that cannot be changed (e.g., age, gender).

• Levels of Disease Prevention:

  • Primary Prevention: Strategies designed to prevent initial disease occurrence before it happens (e.g., administration of vaccines).
  • Secondary Prevention: Early disease detection and intervention activities (e.g., routine health screenings).
  • Tertiary Prevention: Rehabilitation and treatment of existing disease to maximize functional recovery (e.g., physical therapy).
  • Quaternary Prevention: Medical actions taken to protect clients from unnecessary, excessive medical interventions that cause more harm than good (e.g., withholding antibiotics for a viral cold).

Health Assessment, Vital Signs & Pain Management

• General Survey & Health History Guidelines:

  • Client Environment & Interaction: Ensure client physical comfort and privacy. Execute the least invasive task, question, or diagnostic technique first. Carefully observe nonverbal cues. Avoid complex medical jargon. Engage a certified medical interpreter as needed (prn).
  • Eight Essential Health History Components:
    1. Chief complaint (CC)
    2. Demographic information
    3. Health history
    4. Current illness details
    5. Family history
    6. Source of history (evaluating reliability)
    7. Psychosocial history
    8. Health promotion behaviors

• Physical Assessment Sequential Order:

  1. Inspection: Visual, olfactory (smell), and auditory (hearing) observation.
  2. Palpation: Using touch/hands to evaluate tissue texture and organs.
  3. Percussion: Tapping body surfaces with fingers or instruments to elicit diagnostic sound waves.
  4. Auscultation: Listening to vascular and organ sounds using a stethoscope.

• Vital Signs Normal Ranges & Clinical Pathophysiology:

  • Pulse / Heart Rate:
    • Normal Range: $60\,\text{bpm}$ to $100\,\text{bpm}$
    • Anatomical Palpation Sites: Temporal, carotid, apical, brachial, radial, femoral, popliteal, posterior tibial, pedal.
    • Bradycardia: Pulse < $60\,\text{bpm}$; clinical manifestations include dizziness, low blood pressure, chest pain, and syncope.
    • Tachycardia: Pulse > $100\,\text{bpm}$; clinical manifestations include dizziness and dehydration.
  • Body Temperature:
    • Normal Range: $36^\circ\text{C}$ to $38^\circ\text{C}$ ($96.8^\circ\text{F}$ to $100.4^\circ\text{F}$)
    • Hyperthermia Threshold: $40^\circ\text{C}$ ($104^\circ\text{F}$)
    • Hypothermia Threshold: $35^\circ\text{C}$ ($95^\circ\text{F}$)
    • Measurement Routes: Rectal, tympanic, skin, oral (mouth), axillary. Wait $30\,\text{minutes}$ after food/liquid consumption before taking an oral temperature.
  • Respirations:
    • Normal Range: $12\,\text{breaths/min}$ to $20\,\text{breaths/min}$
    • Tachypnea: Respiratory rate > $20\,\text{breaths/min}$
    • Bradypnea: Respiratory rate < $12\,\text{breaths/min}$
    • Apnea: Complete absence of breathing.
    • Dyspnea: Difficult or labored breathing.
    • Medication Safety Precaution: Opioids suppress the central respiratory drive; never administer opioids if respiratory rate is less than $12\,\text{breaths/min}$.
  • Oxygen Saturation ($SpO_2$):
    • Normal Range: $95\,\%$ to $100\,\%$
    • Pathophysiological Note: Low hemoglobin causes compensatory tachypnea to deliver sufficient cellular oxygenation.
  • Blood Pressure (BP):
    • Normal Range: $90/60\,\text{mm Hg}$ to $120/80\,\text{mm Hg}$
    • Elevated Blood Pressure: Systolic $120\,\text{mm Hg}$ to $129\,\text{mm Hg}$ and diastolic < $80\,\text{mm Hg}$
    • Stage 1 Hypertension: Systolic $130\,\text{mm Hg}$ to $139\,\text{mm Hg}$ or diastolic $80\,\text{mm Hg}$ to $89\,\text{mm Hg}$
    • Stage 2 Hypertension: Systolic $\ge 140\,\text{mm Hg}$ or diastolic $\ge 90\,\text{mm Hg}$
    • Stage 3 Hypertensive Crisis: Systolic > $180\,\text{mm Hg}$ or diastolic > $120\,\text{mm Hg}$
    • Hypertension Signs: Red/flushed skin, sweating, headache.
    • Hypotension (< $90/60\,\text{mm Hg}$) Signs: Chest pain, dizziness.
    • Orthostatic Changes: A decrease in blood pressure by $20\,\text{mm Hg}$ or an increase in heart rate by $20\,\text{bpm}$ upon standing.

• Pain Concepts & Clinical Scales:

  • Pain Threshold: The exact point at which a stimulus is physiologically perceived as pain.
  • Pain Tolerance: The degree or duration of pain intensity a client is willing to endure.
  • Nociceptive Pain: Pain stemming from physical tissue damage.
  • Neuropathic Pain: Pain originating from damage or dysfunction of nerve tissue.
  • PQRST Pain Assessment Method:
    • P: Provoked (what triggers or relieves the pain)
    • Q: Quality (description of pain sensation)
    • R: Region (location and radiation)
    • S: Severity (intensity scale rating)
    • T: Timing (onset, duration, frequency)
  • FLACC Pain Scale (Pediatric / Non-verbal behavioral evaluation):
    • F: Face
    • L: Legs
    • A: Activity
    • C: Cry
    • C: Consolability
    • Scoring: Each of the 5 categories is scored from $0$ to $2$ (Total score range $0$ to $10$).

Professional Nursing Values, Ethics & Legal Frameworks

• Benner's Novice to Expert Model (Five Stages of Clinical Competence):

  1. Novice
  2. Advanced Beginner
  3. Competent
  4. Proficient
  5. Expert

• Core Professional Nursing Values:

  • Autonomy: Respecting client self-determination and personal choices over their own body.
  • Beneficence: Acting in the absolute best interest of the client.
  • Nonmaleficence: Minimizing harm while achieving the best possible client outcome.
  • Veracity: Dedication to complete truthfulness.
  • Fidelity: Keeping commitments and honoring promises made to clients.
  • Justice: Ensuring equal, fair, and equitable treatment for every individual.
  • Altruism: Demonstrating unselfish actions that directly benefit others.
  • Integrity: Practicing with personal honesty and ethical standards.
  • Social Justice: Upholding the universal right of all people to equal healthcare access.
  • Human Dignity: Treating every individual with respect based on inherent human worth.

• Ethical Decision-Making Process (11 Steps):

  1. Define the ethical issue and assess potential risks.
  2. Identify key stakeholders.
  3. Gather relevant information.
  4. Reflect on personal biases.
  5. Identify core principles and standards.
  6. Consult available institutional resources.
  7. Develop action options.
  8. Critically evaluate each option.
  9. Select the best course of action.
  10. Implement the selected action.
  11. Evaluate the overall outcome.

• Legal & Regulatory Standards:

  • EMTALA (Emergency Medical Treatment and Active Labor Act): Federal law mandating that emergency medical care be provided to everyone regardless of financial status.
  • HIPAA (Health Insurance Portability and Accountability Act): Federal legislation protecting client health information privacy.
  • Criminal Law vs. Civil Law:
    • Criminal Law: Prosecutes offenses against society (e.g., stealing medication).
    • Civil Law: Resolves disputes between individuals (e.g., failing to monitor a client properly).
  • Tort Law: Civil wrongs or omissions resulting in client harm.
  • Whistleblowing: Reporting illegal, unsafe, or unethical practice within an institution.
  • Sentinel Event: Unexpected occurrence resulting in death, permanent disability, or severe temporary injury.
  • Just Culture: System framework encouraging open error reporting ("see something, say something") to improve healthcare delivery systems rather than assigning immediate personal punishment.

• The Five Rights of Delegation (Transferring clinical task responsibility):

  1. Right Task
  2. Right Circumstance
  3. Right Person
  4. Right Direction and Communication
  5. Right Supervision and Evaluation

• Swanson's Theory of Caring (Six Essential Concepts):

  1. Maintaining Belief: Holding a positive, hopeful orientation toward the client.
  2. Knowing: Striving to understand the clinical event as it has meaning for the client.
  3. Being With: Being emotionally present and supportive.
  4. Doing For: Assisting with physical tasks, comfort measures, and nursing care.
  5. Enabling: Empowering the client to perform care tasks independently.
  6. Client Well-Being: Proactively checking in with the client ("What else can I do for you?").

Healthcare Communication, Documentation & Evidence-Based Practice

• Interpersonal Communication Styles:

  • Aggressive: Controlling, dominant behavior.
  • Passive: Conflict-avoidant, acting as a "door mat."
  • Assertive: Direct, honest, and respectful communication.
  • Passive-Aggressive: Indirect hostility, hidden anger, and sarcasm.

• Clinical Healthcare Communication Tools:

  • Closed-Loop Communication: Verbal re-confirmation verifying the exact order received.
  • ISBAR Framework (Provider interprofessional reporting):
    • I: Introduction
    • S: Situation
    • B: Background
    • A: Assessment
    • R: Recommendation
  • Bedside Shift Report: Patient-centered clinical handover conducted at the bedside involving the client.
  • Handoff Report: Concise verbal summary of client status passed between healthcare team members.
  • TigerConnect: Secure, encrypted digital messaging application used in healthcare facilities.
  • Care Transitions: Formal processes informing the healthcare team of modifications in client status or care setting.

• Clinical Documentation Formats & Standards:

  • Source-Oriented Medical Record: Traditional documentation structure divided into distinct discipline sections.
  • Problem-Oriented Medical Record: Comprehensive, organized record centered around client problem lists.
  • SOAP Notes: Subjective data, Objective data, Assessment, Plan.
  • PIE Notes: Problem, Intervention, Evaluation.
  • Focus Charting: Structured around specific health conditions and acute client changes.
  • Charting by Exception (CBE): Systems charting where only unexpected or abnormal findings are documented.
  • FACT Documentation Guidelines:
    • F: Factual
    • A: Accurate
    • C: Complete
    • T: Timely

• Evidence-Based Practice (EBP) & Research:

  • Six Steps of Evidence-Based Practice:
    1. Identify the clinical problem.
    2. Search for credible sources of evidence.
    3. Evaluate research findings critically.
    4. Implement recommendations into clinical practice.
    5. Review outcome effectiveness.
    6. Share results with professional colleagues.
  • PICOT Research Question Framework:
    • P: Population
    • I: Intervention
    • C: Comparison
    • O: Outcome
    • T: Timeframe

Approved Standard Medical Abbreviations

• abd: abdomen
• ac: before meal (ante cibum)
• Ad lib.: at liberty (client can move freely)
• BID: twice daily
• BK: below knee
• BP: blood pressure
• Cath: catheter
• CBC: complete blood count
• c/o: complains of
• CPR: cardiopulmonary resuscitation
• C&S: culture and sensitivity
• DNR: do not resuscitate
• Dx: diagnosis
• FBS: fasting blood sugar
• GI: gastrointestinal
• gtt: drops
• H&H: hemoglobin and hematocrit
• HOB: head of bed
• hr: hour
• HR: heart rate
• Hx: history
• ICU: intensive care unit
• I&O: intake and output
• IV: intravenous
• LLE: left lower extremity
• LMP: last menstrual period
• LOC: level / loss of consciousness
• LUE: left upper extremity
• MI: myocardial infarction
• MRSA: methicillin-resistant Staphylococcus aureus
• NG: nasogastric
• NKA: no known allergies
• NKDA: no known drug allergies
• NPO: nothing by mouth (nil per os)
• N/V or N&V: nausea and vomiting
• $O_2$: oxygen
• OOB: out of bed
• per: through / by
• PO: by mouth (per os)
• PRN: as needed
• q: every
• R/O: rule out
• Rx: prescription
• STAT: immediately
• TID: three times daily
• QID: four times daily