What are the main Med-Surg lab values?
- ABG's*PH (acid)
- *HCO3 (bicarb)
- *PaCo2 (carbon dioxide)
- *Sodium and chloride
- Renal Function
- *Blood urea nitrogen
- *Serum creatinine
- *Glomerular Filtration Rate
- CBC (Complete blood count)
- Cardiac enzymes
Normal BUN/CR=10-15: 1
- Blood urea nitrogen (10-20)
- *Byproduct of protein break down into nitrogen.
- Why would the level be high?
- *Body’s inability to eliminate nitrogen through nephrons
- Serum creatinine (0.6-1.2)
- *Best indicator for kidney function
- *lower is better
- Bun's high and dry
- Bun's low = wet
- Glomural Filtration Rate (GFR)
- *90-120 mL/min
Complete blood count (CBC)
- WBC (white blood cell) range (4,800-10,800)
- WBC < or = 500, neutropenia
- Function: kill organisms considered none self (foreign).
- Mnemonic-Never let monkey eats banana
Neutrophil-elevation (left shift) suggested acute bacterial infection
Lymphocytes- fight infection (B-cells and T cells)
- Monocyte- elevation suggested of viral
- infection or parasite infection
Eosinophil-elevation suggested of allergy
nBasophil-elevation suggested of allergy
Red blood cell
- RBC-produce in the bone marrow with the aid of erythropoietin (produce in the kidney)
- *male 4.7-6.1 mm^3
- *female 4.2-5.4 mm^3
- *Erythrocyte Sed Rate < 20 mm/hr
- **Elevated = presence of inflammation
- Hemoglobin (Hgb)-range male 14-18 and female 12-16...how many rbc
- if < or =7...blood transfusion
Hematocrit-normal range – 3x hemoglobin...how red is the blood: Males 42-52%/Female 37-47%
Example Hgb is 9 and Hct is 27
What is the significant of not maintain 1:3 ratio?
- : if Hgb is 10 and Hct is 27 ..ratio<3 =Hemodilution (too much fluid).
- if Hgb is 10 and Hct is 35...ratio >3 =dehydration
Every unit RBC= increase Hgb by 1gm
- Normal range 150,000-450,000
- *Aide in clotting
- *Fix damage blood vessels or endothelia
- What is the significant of having higher platelets?
- *Clots formation (DVT etc)
- What is the significant of having lower platelets?
- *Bruising or bleeding
- *Know as thrombocytopenia
- INR 0.9-1.2 (for anticoagulation 2-3)
- PT 11-14 sec (anticoagulation therapy = 1.5 to 2X) coumadine
- PTT 16-40 sec (anticoagulant therapy = 1.5 to 2.5x) heprin
- CK-creatinine kinase
- *Byproduct of muscle breakdown.
- *Elevation signifies muscle injury
- *Peak 4-6 hours post injury/insult
- *Specific to cardiac and brain injury if value is elevated
- *Sensitive lab value.
- *Elevation signifies cardiac muscles injury.
- *Peak 6 hours post injury
- *measure the stretch of the ventricle.
- *The higher the values, the more
- stretch the ventricle is undergoing.
- *Use to determine CHF (high value)
- Operating System of the PC is Marginal
- Osmolarity = 270-300
- Sodium NA ECF = 135-145 Meq/L
- Potasium K ICF = 3.5 -5 Meq/L
- Calcium ECF = 8.5-10 Meq/L
- Magnesium ICF = 1.8-3 Meq/L
- Phosphorus = 2.5-4.5 mg/dl
- Glucose (fasting) =70-110 mg/dl
- *Glycosylated hemoglobin (HbA1c 5%, 7% for diabetics)
Na level greater than (>145
significant: cause fluid shift from intracellular to intravascular and causes cellular dehydration
Causes: by dehydration, excessive sodium intake or DI (diabetic insipidus)-lack of ADH.
S/S: confusion or seizure
- Treatments: what would you do if your blood is too salty?
- *Administer hypotonic solution
- *Increase po (water) intake
- *Give ADH (decrease urine
- production) and absorbed more water.
Potassium is more intracellular than extracellular
Normal values- 3.5-5.0
- *Aide with cardiac muscle contractility. Less potassium will cause irritability of the cell and causes arrhythmias.
- * loss of acid and gain in base
- *vomiting, diarrhea, Nasogastric lavage,
- excessive insulin usage.
- *Potassium po/iv
- *How fast can you give IV= 10Meq/hr
- *PO < or = 40 Meq/time
- *for every 10 Meq Kcl, K^0.1 to 0.2
- Diet high in potassium? What is
- diet high in potassium?
- *Albumin (3.8-5 g/dL)
- *SGOT/SGPT (13-40 units/L, 10-40unit/L)
- *bilirubin (0-1.5 mg/dl)
- *amonia (35-65 mcg/dl)
- *total protein (6-8 gm/dl)
- *Ck (36-204 units/L)
- *Ck-mb (Less than 4–6%)
- *Troponin (detectable a few hours to 7 days after the onset of symptoms of myocardial damage. <0.2 ng/dl
- **Troponin I Less than 0.35 ng/mL
- **Troponin T Less than 0.20 mcg/L
- *BNP (Less than 50 pg/m)
CBC (Complete blood count)
- *WBC (4800–10800 WBC/mm^3)
- *HGB (12-18 g/dL)
- *HCT (37-52 or 3x HGB)
- *Platelets (150,000–450,000/mm^3)
- *ESR (< 20mm/hr)
- *Blood urea nitrogen (10–20 mg/dL)
- *Serum creatinine (0.5–1.2 mg/dL)
- *GFR (90-120 mL/min)
Caused changes in electrical charge on the cell membrane and make the cell membrane more irritable
- *A gain in acid and a loss of base
- (Renal failure (absorb more hydrogen ion in the kidney)
- *Excessive blood glucose (diabetic
- *Excessive potassium supplement
- intake without diuretic
- Treatments to eliminate potassium?
- *Give kayexalate-bind with potassium and eliminate through feces.
- *Give insulin with D50 (dextrose)- insulin acts by binding with glucose and potassium and all three go into the cell- leaving less potassium in the blood stream.
- *Give sodium bicarbonate-acts by
- increasing blood pH.
- **As pH goes up, Potassium will
- come down.
- **Watch for s/s of volume overload
- and CHF
- *NaHCO3 (sodium bicarb)...binds to K
- PH acid 7.4 alk +/- 0.05
- HCo3 acid 24 alk +/-2
- PaCo2 Alk 40 acid +/- 5
- PaO2 (aterial) 80-100
- SaO2 (O2 sat) > 91
- RO=Resp opposite
- ME= metobolic equal
- If Ph is in romal range= Com
- if HCO3 & PaCo2 point same dir = comp
Blood Lipid Values...total cholesterol
Blood Lipid Values
- LDL<100 mg/dL
- HDL>40 mg/dL
- Triglycerides < 150 mg/dL (<100 if medicated)
Blood lipid level...low density lipid