Nursing Med Surg Lab Values

• ABG's
• *PH (acid)
• *HCO3 (bicarb)
• *PaCo2 (carbon dioxide)
• Electrolytes
• *Sodium and chloride
• *Potassium
• *Calcium/phosphate
• Renal Function
• *Blood urea nitrogen
• *Serum creatinine
• *Glomerular Filtration Rate
• CBC (Complete blood count)
• *WBC
• *HGB/HCT
• *Platelets
• Cardiac enzymes
• *Ck
• *Ck-mb
• *Troponin
• *BNP
• Liver
• *Albumin
• *SGOT/SGPT
• *bilirubin

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

• 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

• 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?

• Example
• : if Hgb is 10 and Hct is 27 ..ratio<3 =Hemodilution (too much fluid).

• Example:
• if Hgb is 10 and Hct is 35...ratio >3 =dehydration

Every unit RBC= increase Hgb by 1gm

• Normal range 150,000-450,000
• Functions?
• *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
• (gen)
• *Peak 4-6 hours post injury/insult
• CK-MB
• *Specific to cardiac and brain injury if value is elevated
• Troponin
• *Sensitive lab value.
• *Elevation signifies cardiac muscles injury.
• *Peak 6 hours post injury
• BNP
• *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 (shrink)

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

• Significant?
• *Aide with cardiac muscle contractility. Less potassium will cause irritability of the cell and causes arrhythmias.

• Causes:
• * loss of acid and gain in base
• *vomiting, diarrhea, Nasogastric lavage,
• excessive insulin usage.

• Treatments:
• *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)

• *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)

• Sodium/chloride
• Potassium
• Calcium/phosphate

Caused changes in electrical charge on the cell membrane and make the cell membrane more irritable

• Causes?
• *A gain in acid and a loss of base
• (Renal failure (absorb more hydrogen ion in the kidney)
• *Excessive blood glucose (diabetic
• ketoacidosis)
• *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
• *Diuretics
• *NaHCO3 (sodium bicarb)...binds to K
• *dialysis

• 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

• ROME
• RO=Resp opposite
• ME= metobolic equal

• If Ph is in romal range= Com
• if HCO3 & PaCo2 point same dir = comp

• LDL<100 mg/dL
• HDL>40 mg/dL
• Triglycerides < 150 mg/dL (<100 if medicated)

LDL<100 mg/dl