Heparin therapy value: 2x normal value (50-70) sec
Over: 100 seconds too high.
PTT: therapeutic range is 40-90 if it's within a therapeutic range, medication may be held.
Lab values for Warfarin? What should you know about warfarin?
PT (prothrombin time): Normal value without therapy: 10-13 sec
Warfarin therapy value: 1.5x normal value (15-19.5) sec
INR used to monitor Warfarin (coumadin)
Normal value without therapy: <2 sec
Pt. with venous thrombosis (DVT), PE, Valvular heart: anticoagulant therapy: 2.0-3.0 is ideal
Mechanical heart valve replacement: 2.5-3.5 is ideal.
H/H for Men and Women
Hematocrit and hemoglobin
Hematocrit panic value less than 15% or greater than 60%. RBC per 100ml
Hct should be 3 times the HgB
Mean Corpuscular Volume=RBC size
Most useful lab for diagnosing anemias.
Measures average volume of RBC(80-98 um^3)
Low value indicates iron deficiency anemia. (chronic blood loss, cancers of GI)
High value indicates B12 deficiency anemia ( pernicious/ folic acid)
4,500-10,000 uL (mm^3)
Normal 50-150 mcg/dl
150,000-400,000 uL0.15-0.4 x 10^12/L (SI units)
A decrease in circulating platelets of less than 50% of normal value will cause bleeding: if the decrease is severe (<50,000 uL) hemorrhaging might occur.
RBC count for men and women
Men: 4.6 million/uL-6.0 million/ul
Women: 4.0-5.0 million/u
Associated with bacterial infections
2,500-7,000 uL (mm^3)
act against infestation of parasitic larvae and increased in allergic reactions
think: Drug allergies
1-3% 100-300 uL (mm^3)
contains granules with chemical that act upon blood vessels (◦Heparin, histamine, serotonin, kinins, & leukotrienes)-
manifestation of inflammation.
0.4-1.0% 40-100 uL (mm^3)
Increased number associated with viral infections and lymphoid leukemia.
25-35% 1,700-3,500 uL (mm^3)
Phagocytes-bacteria and debris
4-6% 40-100 uL (mm^3)
0.5-1.5% of all RBCs
Indicator for bone marrow activity
Decreased number of WBC
Neutropenia: decreased # of neutrophils which can lead to life threatening sepsis
Absolute granulocyte count=Neutrophils + Bands=Less than 1000 needs neutropenic percautions
PaCO2 value=respiratory low value is basic, high value is acidic
Normal value: 40
<35 is alkalosis
HCO3=metabolic low value is acidic, high value is basic
Kidney regulation of PH indicated by Bicarbonate.
HCO3- main base for regulation of PH
PH panic values?
Death<6.8 or >7.8
RR for Pediatrics?
1 year: 20-40
3 year: 20-30
6 year: 16-22
10 year: 16-20
Uncomp. Met. Alkalosis
Uncomp. Resp. acidosis
Fully Comp. Resp. Acidosis
CBG normal values?
Adult brain requires: 60-100
bond between RBC and hemoglobin for lifespan of RBC (120Days)
uncontrolled diabetic >8%
Glucose tolerance test (GTT)
CBG checked every 30mins for 2 hours.
12 hours fast followed by a 300ml high carb drink.
Less than 140mg/dl is a normal glucose test
140-199 is prediabetes
>200mg/dl is DIABETES
Saves water-Makes the kidney tubules more permeable.
Leads to concentrated urine.
synthesized by hypothalamus
secreted by posterior pituitary
Controlled by osmoreceptors in hypothalamus
Other factors which stimulate ADH- hypovolemia, stress, nausea, nicotine and morphine
Released by kidneys due to decrease in pressure or sodium. Converts angiotensinogen to angiotensin 1 which then gets converted by ACE to angiotensin 2 which has vasoconstrictive effects and increases blood flow to kidneys.
angiotensin 2 stimulates release of aldosterone from adrenal glands which act on the kidneys to reabsorb and conserve sodium and also increasing water reabsorption.
Aldosterone also stimulates ADH.
Nursing process for test questions, depending on the question you must answer the question in order of the nursing process.
Analyze your assessment
Planning based on your analysis
Implement your plan
Evaluate effectiveness of implemented plan
Impending renal failure
urine output less than 30cc/hr indicates potential renal failure
Urine specific gravity<1.010
indicates dilute urine.
Can be caused by too little ADH
Fluid gain and loss equivalents
1 cup= 8oz
<280 mOsm/l- sodium determines this less than 280=FVE
Necessary for transmission of nerve impulses, blood clotting, strengthens capillary membranes.
Adult: 4.5-5.5mEq/L, 9-11mg/dL.
Child: 4.5-5.8 mEq/L, 9-11.5mg/dL.
maintaining homeostasis, osmolality of body fluids, Ph balance
Adult: 95-105 mEq/L
Child: 98-105 mEq/L
Neuromuscular activity, influences use of potassium, calcium and protein. responsible for transport of sodium and potassium across cell membrane.
Adult: 1.5-2.5 mEq/L, 1.8-3.0mg/dL
Child: 1.6-2.6 mEq/L
Indicator of hydration status, helpful in diagnosing fluid and electrolyte imbalances. Sodium contributes 85-90% of serum osmolality.
Adult: 280-300 mOsm/kg
Child: 270-290 mOsm/kg
Panic values: <240 or >300 mOsm/kg
High value indicates: hemoconcentration due to dehydration
Low value indicates: hemodilution due to overhydration.
Principal intracellular anion; exists in blood as phosphate. functions include metabolism of carbohydrates, fats, ph balance, use of B vitamins, promotion of nerve transmission. Requires vitamin D for absorption from gastrointestinal tract-stored with calcium in bones/teeth.
Adult: 1.7-2.6 mEq/L or 2.5-4.5mg/dL
Child: 4.5-5.5 mg/dL
Most abundant intracellular fluids, Narrow range (2.5 mEq/L-7.0 mEq/L)-can lead to cardiac arrest. 90% of potassium excreted by kidneys. *Rhabdomyolysis can lead to hyperkalemia.
Adult: 3.5-5.3 mEq/L
Child: 3.5-4.8 mEq/L
Protein Total (Serum)
Composed mostly of albumin and globulins-important in fluid and electrolyte balance.
Adult: 6.0-8.0 g/dL
Child: 6.2-8.0 g/dL
Major cation in extracellular fluid, retains water,Maintains body fluids, neuromuscular impulses via sodium pump (Na+ shifts into cells as K+ shifts out for cellular activity) Enzyme activity, regulates PH balance by combining with chloride or bicarbonate ions.
Adult: 135-145 mEq/L
Panic: < 115 mEq/L
Hypo or Hyper-natremia
Panic values: <115 mEq/L and >150 mEqL
CNS most easily affected by this.
<115 mEq/L leads to cerebral edema. Water/fluids from ECF goes into the ICF causing swelling.
Opposite is said for >150 mEq/L-Crenation takes place or shrinkage.
Hypo or hyper-kalemia
Panic value: <2.5 mEq/L and >7.0 mEq/L
Mainly found in ICF, with hypo there is an increase in ICF distribution leading to abnormal amounts.
Leads to Cardiac arrest and respiratory insufficiency. Respiratory failure #1 cause of death in Hypokalemia.
Never give potassium supplement if urine output less than 0.5ml/kg/hr. Kidneys main regulator for K+.
Most common cause of Hyperkalemia is Renal failure
Maximum infusion rate: K+ 5-10 mEq/hr never exceed 20 an hour.
Hypo or Hyper-calcemia
Panic Value: <7mg/dL and >13mg/dl ; <4.5 mEq/L and > 5.5 mEq/L
Low value causes tetany any lower leads to arrhythmias or death. Common cause: is renal failure, hypomagnesemia, hypoparathryoidism, diuretics, malabsorption, hypoalbuminemia, hyperphophatemia (reciprocal relationship).hyperexcitability of cells, (think twitchy) cells are easily depolarized due to increased permeability of membranes
High value causes (Think floppy), decreased neuromuscular excitability, bradyarrhythmias, decreased LOC, confusion, hypophophatemia. Common causes: Renal failure, hyperparathyroidism, vitamin D intoxication,
fluids are pulled from the cells and interstitial spaces and into the intravascular space
Rarely used, very dangerous.water pulled from cells causing crenation 3-5% saline bags for dangerously low sodium levels
fluids are forced into cells and interstitial spaces
Dilutes ECF, restores ICF balance-flushes kidneys and excretes electrolytes.
D5-10W-2/3 enters cells, 1/3 stays in ECF
used to replace ECF due to illness. expands circulating volume. has same osmolality as plasma
Ringers-Balanced electrolyte solution resembling normal plasma
Lactated Ringers-Converted into bicarbonate by the liver.
TSH levels are high but T3 & T4 levels are low?Anticipation of administering?
Administer: Thyroid replacement-levothyroxine
Mild tingling or numbness around the mouth or in hands/feet
Severe muscle cramps
Causes a decrease in serum calcium due to lack of PTH
Adrenal Hypofunction S&S?
Loss of Aldosterone
K, Na, water imbalance
hypovolemia: decrease in BP
Hyperkalemia: Metabolic acidosis and dysrhythmias
Diabetes insipidus due to too little ADH?
dilute urine <1.005
dry mucous membranes
rapid heart rate
unintended weight loss
can be caused by cushings, adrenal adenoma and pregnancy
Na+ and water rentention
BP increase and weight gain, edema
Hypokalemia: Metabolic alkalosis
Serum lab values thyroid disorders
TSH: Thyroid Stimulating Hormone-released by anterior pituitary gland
T3: Triiodothronine Both of these are created by the thyroid and synthesized from iodine and tryosine(amino acid)
ADH puts water into urine which effects?
Urine osmolality or specific gravity.
Too little ADH: Urine is dilute
Too much ADH: Urine is concentrated.
Thyroid stimulating hormone (TSH)
0.35-5.5 ulU (microinternational unit/ml), Less than 3ng/mlsecreted by anterior pituitary gland, in response to thyroid releasing hormone from hypothalamus. Stimulates release of thyroxine (T4). Dependent on the negative feed back system
Thyroxine (T4) serum
4.5-11.5 mcg/dLMain hormone secreted by thyroid and is at least 25 times more concentrated than triiodothyronine (T3).
Triiodothyronine (T3) serum
80-200ng/dl more short acting and more potent than thyroxine.
BUN Serum Range
Blood urea nitrogen level
Adult: 8-21 mg/dL
Approximately two thirds of renal function must be lost before a significant rise in the BUN level occurs.
High level: dehydration, prerenal failure or renal failure, GI bleeding. They will usually check a serum creatinine level to determine if the high BUN is renal or due to dehydration. Also indicative of BPH
Low level: overhydration (hypervolemia), severe liver damage, low protein diet, malnutrition
10:1 -20:1 (BUN:creatinine)Average is 15:1High value indicative of renal disease, inadequate renal perfusion, shock, dehydration.Low value indicative of liver disease, malnutrition, low protein diet, overhydration
Creatinine serum range?
Adult: Male: 0.6-1.2
Female: 0.5-1.1 mg/dL, 45-132.3 umol/L. Creatinine value of 10mg/dl: 90% of kidney function has been lost
Females may have a slightly lower value due to less muscle mass. Creatinine, a by product of muscle catabolism (creatine phosphate). Considered a more sensitive test for renal failure. It's not as easily influenced by diet or fluid intake.
High value: acute and chronic renal failure, shock, systemic lupus erythematosus, cancers, HF. Drug influence: amphotericin (antifungal), cephalosporins(cefazolin), aminoglycosides (gentamicin), lithium, ketone bodies.
Low value: pregnancy, eclampsia.
Color: light straw to dark amber
PH: 4.5-8.0 average 6
Specific gravity: 1.005-1.030
protein: (2-8 mg/dL negative reagent strip test)
RBC: 0-2 per High power field
WBC: M: 0-3, F: 0-5 HPF
Casts: occasional hyaline
Early indicator of widespread inflammatory reaction due to infection or autoimmune disordersUsually normal in OA
Lab values for muscle
CK-Creatine Kinase for skeletal and cardiac muscle
CPK-MM-Creatine phosphokinase for skeletal muscle 10 to 120 micrograms per liter (mcg/L)
CK-MB (My beat)-is an enzyme found in the myocardium. NR: 5-25IU/L or 3 to 5%
LDH- Lactic acid dehydrogenase 140-280
HS-CRP (high sensitivity C-reactive protein)
1.0 to 3.0 mg
AST (liver, kidney, heart, skeletal muscles)
Liver Lab tests
ALT-Most specific to liver
alanine aminotransferase: enzyme released from hepatocytes when the liver is injured.
AST: Aspartate aminotransferase found in hepatocytes and cardiac cells may increase more than 10 times normal, and stay elevated, less specific than ALT
ALP: Alkaline phosphatase Primarily found in liver and bone, may be markedly elevated
GGT: Gamma-glutamyltransferase: elevated with liver, heart and kidney injury.
Serum ammonia: increases with liver issues Due to the liver being unable to convert ammonia to urea
Serum albumin: decreases with liver issues due to liver being unable to create albumin
PT: Will increase due to liver being unable to synthesize clotting factors.
Bilirubin may increase and can lead to anemia due to bleeding/malnutrition due to vitamin deficiencies.
HDL: 40-59 is healthy too low is bad too high is good.
LDL: 100-190 too high is bad too low is good
LPN can only care for what type of conditioned patients?
The RN will always see the patient first that is in the ?
Least stable condition
Pay particular attention to the wording of the question, what is it asking you to do?
There will be assessment, analysis, planning, implementing and evaluating questions....the answer will include wordings from the question. Don't fall for "distractors"
For LPN questions the length of the answer may increase the probability of it being more correct....true or false
True :) This does not work for the NCLEX RN
Integrated process of the NCLEX-RN.....Besides the nursing process
Caring: for people not about working with high tech equipment.
Communication and documentation: you may be asked to identify appropriate documentation of a client of behavior or nursing action.
Teaching and learning principles: Questions may be about teaching a client about their diet or medications
Culture and spirituality: be sensitive and respond to unique needs of each client.
Levels of questions on the NCLEX RN
Recall/recognition-understanding-application---analysis(these are the most abundant on the NCLEX.)
For select all that apply questions you must eliminate the answers that are only "kinda right" example:
Nurse caring for a patient with a Right sided CVA with dysphagia, which actions by the nurse reflects appropriate care for the client? select all that apply....
1: the nurse assesses the client's ability to swallow
2: the nurse positions the client at a 45 degree angle
3: the nurse ofers the client scrambled eggs
4: the nurse instructs the client to place food on the left side of the mouth
5: the nurse turns off the television.
Correct: 1, 3, 5
2 is a distractor since the patient should be sitting up right in a full fowlers position.
Majority of the questions on the NCLEX will be multiple choice.
Pay particular attention to the Stem of the questions
Stem of the question is the situation that describes the client, his or her problems or healthcare needs and other relevant information.
Example of rewording the stem of a question:
a client is being treated for heart failure with diuretic therapy. which of the following assessments BEST indicates to the nurse that the clients condition is improving?
1: The clients weight has remained stable since admission.
2: the clients systolic blood pressure has decreased.
3: there are fewer crackles heard when auscultating the clients lungs.
4: the clients urinary output is 1,500ml per day.
Stem: Heart failure, treatment is diuretic therapy and how do you know the clients condition is improving?
Correct answer is3
Steps to correctly answer an NCLEX -RN exam question
Step 1: reach each question carefully from first word to last word. Do not SKIM
Step 2: Look for hints in the wording of the question stem. Adjectives ( Most, First, Best, primary, initial) all indicate that you must establish a priorities. The phrase further teaching is necessary indicates that the answer will contain incorrect information. The phrase client understands the teaching indicates the answer will be correct info.
Step 3: Reword the question stem in your own words so that it can be answered with a yes or a no, or with a specific bit of information.
Step 4: check the answer choices for clues to the question.