Lab Values

Question 1

Albumin/Pre-albumin

Answer 1

• Albumin: 3.5 to 5.0
• Albumin detects liver and kidney function
• low albumin can be the result of malnutrition and can impair wound healing
• high albumin can be the result of dehydration or severe diarrhea
• Pre-albumin: 16 to 30
• longer half life and is preferred to use to diagnosis chronic liver or kidney damage (high) or malnutrition (low)

Question 2

Electrolytes

Answer 2

• Sodium: 135 to 145
• hyponatremia: confusion, thirst, weakness
• hypernatremia: confusion, nausea, dizziness, and abdominal cramp
• Potassium: 3.5 to 5.0
• hypokalemia: irregular heart rate, muscle weakness, leg cramps, anorexia
  -hyperkalemia: vomiting, diarrhea, cardiac dysrhythmias, muscle weakness
• Calcium: 9.0 to 10.5
  -Hypocalcemia: paresthesia of fingers and lips, positive Chvostek’s sign (tap on facial nerve and there is facial twitching), positive Trousseau’s sign (hand/finger spasms with sustained blood pressure cuff inflation), hyperactive deep tendon reflexes, decreased HR and BP, hyperactive bowel sounds, diarrhea, cramping, seizure precautions necessary
  -Hypercalcemia: nausea, vomiting, muscle weakness or twitches, fatigue, bone pain
• Chloride: 95 to 105
  -hypochloremia: lack of emotion, anorexia, muscle cramps
  -hyperchloremia: vomiting
• Phosphorus: 2.5 to 4.5
  -hypophosphatemia: rare
  -hyperphosphatemia: numbness and tingling around mouth and extremeties, tetany
• Magnesium: 1.5 to 2.0
  -Hypomagnesemia: positive Chvostek’s and Trousseau’s signs, hypoactive bowel sounds, constipation, abdominal distention, paralytic ileus
  -Hypermagnesemia: weakness, nausea, dizziness, and confusion

Similar:
- Magnesium, sodium, potassium, and calcium usually rise and fall together
-sodium and phosphorus usually rise and fall together

Question 3

Vital Signs

Answer 3

• Temperature:
• Oral: 36.5 to 37.5 C (97.6 to 99.6 F)
• Rectal: 37 to 38 C (98.6 to 100.4 F)
• Axilla 36 to 37 C (96.6 to 98.6 F)
• Blood Pressure:
• Normal: <120/<80
• Elevated: 120s/<80
  -Stage 1: 130s/80s
  -Stage 2: >140/>90
  -Crisis: >180/>120
• Pulse:
• 60 to 100 BPM
• Strength: 0 absent, +1 weak, +2/3 normal, +4 bounding (fluid overload, anxiety)

-Respirations:
- 12 to 20 BPM

-SPO2:
- 92% to 100%

Glucose:
-Fasting: 70 to 120
-Nonfasting: <140
-HbA1c:
-<5.7% is normal
-5.7% to 6.4% is prediabetic
->6.5% is diabetic

Question 4

Fluid Volume Balance

Answer 4

Values:
- Hematocrit: 42 to 52% (men), 37 to 47% (women)
- Hemoglobin: 14 to 18 (men), 12 to 16 (women)
- BUN: 10 to 20 mg/dL
- Sodium: 135 to 145
- Serum Osmolarity: 275 to 295 (diluted blood vs concentrated blood)
- Urine Specific Gravity: 1.005 to 1.030 (low = overhydrated, high = dehydrated)

Fluid Volume Deficit:
- Hematocrit: increased
- BUN: increased
- Sodium: increased
- Serum osmolarity: increased

Fluid Volume Overload:
- hematocrit and hemoglobin: decreased
- serum osmolarity and urine osmolarity: decreased
- BUN: decreased
- chest Xray will show pulmonary congestion (white out)

Question 5

WBCs and Platelets

Answer 5

• WBC: 5,000 to 10,000
• Platelets: 150,000 to 400,000

Question 6

ABGs

Answer 6

Values:
- pH: 7.35 to 7.45
- PCO2: 35 to 45
-HCO3: 21 to 26
-PO2: 80 to 100

Respiratory (opposite arrows):
- Acidosis = low pH + high PCO2
- Alkalosis = high pH + low PCO2

Metabolic (same arrows):
- Acidosis = low pH, low HCO3
- Alkalosis = high pH, high HCO3

Question 7

Clotting times

Answer 7

PT (prothrombin time):
- tests for how long it takes for a person’s blood to generate fibrin and form a clot
- extrinsic clotting abilities of factors I, II, V, Vll, X)
-prolonged PT could mean vitamin K deficiency or liver disease
-Normal range: 11 - 12.5 seconds

aPTT (activated partial thromboplastin time):
- measures the time is takes for blood to clot
- intrinsic clotting abilities of VIII, IX, XI, and XII)
- aPTT = monitors heparin therapy
- Normal Range: 30 to 40 seconds (Therapeutic aPTT is 1.5 to 2 times normal value - while on heparin)

INR:
- is calculated from PT (INR = PT of patient / Average PT of normal person their age/sex)
- INR = monitors warfarin therapy
- Normal Range: 0.7 to 1.8 (therapeutic INR is 2 to 3 - while on warfarin)

Question 8

Medications

Answer 8

Digoxin:
- 0.5 to 2.0 ng/mL
- Toxicity: anorexia, nausea, vomiting, abdominal pain, confusion, halo vision

Lithium:
- 0.8 to 1.4 mg/dL
- Toxicity: nausea, vomiting, lethargy, hand tremors, fatigue, vision changes

Phenytoin (Dilantin):
- 10 to 20 mcg/mL
- Toxicity: ataxia (lack of coordination), slurred speech, vomiting, lethargy, coma, seizures (even though it treats seizures)

Theophylline:
- 10 to 20 mcg/mL
- Toxicity: Tachycardia, tachypnea, respiratory alkalosis, AFib, irritability, hypokalemia, hyperglycemia

Question 9

Cholesterol

Answer 9

• Cholesterol: < 200 mg/dL
• Triglycerides: 40 - 160 (males), 35 - 135 (females)
• HDL: >45 (male), >55 (females)
• LDL: <130