Lab Values Flashcards by Tabitha Unknown

What are the 6 reasons for obtaining blood studies?

establish a diagnosis
Rule out a clinical problem
To Monitor therapy
To establish a prognosis
To screen for a disease
To determine effectiveness drug dose & prevent toxicity

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What are the 4 divisions of the clinical lab?

Hematology:
- CBC, CBC with diff
Chemistry:
- BMP, CMP, Adds ons
Microbiology:
- Sputum gram stain, sputum culture & sensitivity, pleural fluid culture & sensitivity
Blood bank:
- Blood typing & storage

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What are included in Hematology?

CBC (complete blood count)
- RBC
- WBC*
- Hemoglobin (Hgb)*
- Platelets*
- Neutrophils*
- Hematocrit

(* = RELEVANT for every patients!!)

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What are included in Chemistry?

BMP (Basic Metabolic Panel):
- Sodium*
- Potassium*
- Glucose*
- Creatinine*
- BUN
- Total CO2
- Chloride
CMP (Complete Metabolic Panel):
- Sodium*
- Potassium*
- Glucose*
- Creatinine*
- BUN
- Total CO2
- Chloride
AND PLUS LIVER ENZYMES…
- Calcium
- Total protein
- Albumin
- Bilirubin
- ALP
- AST
- ALT
THESE 7 ARE LIVER ENZYMES!!!!!!
Ads On
- Phosphorus
- Magnesium
- Amylase –> PANCREATIC ENZYME!!
- Lipase –> PANCREATIC ENZYME!!

(* = RELEVANT for every patients!!)

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What are included in Microbiology clinical lab?

Microbiology:
- Sputum gram stain
- Sputum culture & sensitivity
- Pleural fluid culture & sensitivity

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What are included in Blood bank?

Blood Bank:
- Blood typing & storage

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What is another name for White Blood Cells????

Leukocytes!!!

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What are important things we need to know regarding white blood cells - Leukocytes??

They’re the body’s primary defense against foreign invaders
It’s correlated btwn the presence of inflammation/infection in the body
Originate in BONE MARROW
Life span: 13-20 days
Fight infection through phagocytosis (engulfment of bacteria)
Two Measurements: WBC total count & Differential
- WBC total count –> Gives the count of TOTAL white blood cells in the blood
- Differential –> the % of EACH type of leukocytes in the blood

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What are the 5 types of Leukocytes (white blood cells) AND the normal values for DIFFERENTIAL?

Granulocytes
- Neutrophils (55-70%)
- Bands (3-5%)
- Eosinophils (1-4%)
- Basophils (0.5-1%)

Agranulocytes
- Lymphocytes (20-40%)
- Monocytes (2-8%)

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What do you need to know about Neutrophils??

First RESPONDERS!!
Present in band & segmented forms
Immature Neutrophils are called “Bands” !!!
“Left Shift” is seen as an increase in the number of bands & is common w/ acute infection!!!!!
Bands make up <5% of circulating neutrophils!
Main function is to Locate, Ingest, & Kill bacterias and invaders

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What are the terms for High and Low WBC? And what are the causes for both???

High = Leukocytosis OR Neutrophilia
- Causes:
– Excessive physical activities
– Stress
– Smoker
– Very late in pregnancy
– Labor
– Traumatic event
– Major tissue necrosis (death)
– Infections

Low = Leukopenia OR Neutropenic
- Causes:
– Drug toxicity
– Bone Marrow failure
– Overwhelming infection that has been ignored
– Dietary deficiencies
– Autoimmune diseases like CANCER (ppl on chemotherapy)
– Congenital infections like bone marrow infection
– Viral infections like common cold & flu

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How do we interpret the CBC?

What is the total white cell count?
Marked leukocytosis usually due to neutrophils or lymphocytes
If the neutrophils are causing the leukocytosis, compare the neutrophils % (from differential) to total WBC
If the % of neutrophils is high, it’s going to indicate the severity of the infection. The total WBC reflects the QUALITY of the immune system.

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What is the nursing implications if somebody has a high WBC??

Evaluate what medications patient is taking
Is patient pregnant?
Is patient stressed? a smoker? (look at the factors of leukocytosis)
Note and report s/s of infection or inflammation if HIGH
Initiate NEUTROPENIC PRECAUTIONS if LOW!!
Notify HCP if WBC count is too low or high

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If someone has a LOW (leukopenia!) WBC, what would you put them on?? What are some of the things you should do?

Put them on NEUTROPENIC PRECAUTIONS!!! (protecting Immunocompromised patient from infections we may give them)
1. Meticulous HAND WASHING
2. NO fresh flowers
3. NO fresh fruits/veggies
4. NO standing water (they need to get new water anytime they need to drink)
5. Nurse wears PPE

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What is another name for Red blood cells???

Erythrocytes!!!!

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What produce RBC?? What removes old & damaged RBC??

Liver & Red bone marrow PRODUCE RBC!
Spleen REMOVES old & damaged RBC!

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What are the terms for Increased and Decreased RBC Count?? What causes that???

Increased RBC count = Polycythemia (Viscous, Thick blood)
- Causes: living @ high altitude, chronic lung disease w/ hypoxia like COPD, some drugs
- May lead to false elevations: Dehydration, excessive exercise, anxiety, pain
- Treatment: pull blood out to remove excess
Decreased RBC count = Anemia
- Causes: pregnancy, decreased bone marrow production, over hydration, renal diseases blood lost/hemolysis, some drugs

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What is Hematocrit??

The percentage (%) or proportion of Red blood cell TO plasma volume

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When looking at the Hematocrit, if you see that the red blood cells are lower than the plasma, what does that mean??

Decreased RBC = Which means that they are anemic!
It could be somebody who got over hydrated (ex: getting bunch of IV fluids), so then all of the sudden, their plasma amount has gone up and make it seem like their RBC are lower than they truly are (false elevation); OR it could be because they have a true decreased in # of RBC

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When looking at the Hematocrit, if you see that the red blood cells are higher than the plasma, what does that mean??

Shows increased in RBC = polycythemia!
Causes: living @ high altitude, chronic lung disease w/ hypoxia like COPD, some drugs
- False elevations: Dehydration, excessive exercise, anxiety, pain

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Any decreased in volume of plasma in hematocrit causes what in hematocrit number?

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Any DECREASED in volume of plasma in hematocrit cause an INCREASE in hematocrit number!

(because remember that hematocrit is the proportion OF red blood cells to plasma volume)

What is the rule of Three for?

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Used to detect lab error in measuring the Hbg (Hemoglobin), HCT (hematocrit), and RBC count!!
- 3 times the RBC count should = Hbg
- 3 times the Hbg should = Hct

EX:
- IF someone has a RBCs of 5 million, the hemoglobin would be 5(3) = 15, and Hematocrit would be 15(3) = 45%

What is the nursing implications for people who have high/low RBC count?

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Assess color, peripheral pulses, cap refill (shouldn’t take longer than 3 secs), vital signs, fatigue
Type of anemia
Dietary needs –> are they eating enough iron to produce hemoglobin
Good oral health –> pale gums = low RBC count
Need iron supplements
Need blood transfusion –> if hemoglobin level is low
Procrit/Epogen –> see if they’re taking these. usually ppl take these if they have a renal disease. These are gonna help treat low RBC & you’d see an increase after using

What are important informations to know regarding to platelet counts??

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Formed in BONE MARROW
Spleen remove them when they’re old & damaged
Protect intact blood vessels & initiate repair thru the formation of platelet (form clots to stop bleeding!!!)
It’s relevant all the time AND for when there’s a concern of anemia (blood lost) or if patient is on HEPARIN bc if they have an adverse rxn, platelet count DROPS and they get HIT (heparin induced thrombocytopenia!)
THEY’RE THE FIRST RESPONDER TO BLEEDING!!!
Lifespan: 10 days !!

What does a Low & High platelet counts called?? What are the causes of each?? What 2 things do you look for in low platelet counts??

1. Low platelet counts = Thrombocytopenia!! Causes: - Common with the use of heparin (HIT) - When someone's using Heparin, an adverse reaction that's common w/ the use of heparin is HIT or HEPARIN INDUCED THROMBOCYTOPENIA. This just means platelet count has dropped lower than it should. You would stop them from Heparin - DIC or Disseminated Intravascular Coagulation - where ur bleeding and clotting @ the same time - Bone marrow disease, Liver failure and sepsis, bleeding TO LOOK FOR: - Look for PETECHIA = red pinpoint/ round spots on the skin - Look for ECCHYMOSIS = bruising!! 2. High Platelet counts = Thrombocytosis/Thrombocythemia Causes: - Polycythemia vera, iron deficiency anemia, and rheumatoid arthritis

Someone with Thrombocytopenia, WHAT ARE THE TWO THINGS YOU LOOK FOR??!!!

1. Look for Petechia --> red pinpoint/round spots on skin 2. Look for Ecchymosis = bruising!!

What are the 2 clotting pathways??? What's included in each of them? (what drug you use, labs, antagonist)

1. Intrinsic pathway - CONTACT ACTIVATION = the plasma comes in contact w/ the damaged vessel surface; they might have some issue fixing it by clotting. (from inside the blood vessels) - USE: Heparin (prevents clot from happening) - Labs: PTT and APTT - antagonist : protamine sulfate 2. Extrinsic pathway - TISSUE FACTORS = damaged to the lining of the layers of the blood vessels/cells. External trauma which causes blood to escape into circulation - USE: Coumadin (warfarin) - Labs: PT & INR - antagonist: Vit. K

What should you know about Prothrombin (PT) test (this is the test u use with coumadin)?

- Normal findings depend on reagents used - measures clotting ability of factors 1, 2, 5, 7, 10 - EXTRINSIC pathway - Normal: 11-12.5 seconds!! - antagonist: vit. K

For the INR test (this is the test u use with coumadin), what is it used for? What are the values of it?

- Measures the time it takes for blood to clot - Normal : <1.1 - People on anticoagulants: 2-3 - People w/ mechanical heart valves: 3.5-4.5

What are normal findings of APTT FOR normal people and people on anticoagulant? is it intrinsic or extrinsic?

- INSTRINSIC SYSTEM - Normal findings: 30-40 secs - Patient on anticoagulant: 1.5-2.5 time the control value in secs

What are the nursing implications for PT/INR or coagulant issue?

1. Evaluate what meds/herbs they take (NO "G" herbs allowed: ginkgo biloba, ginger, & garlic) 2. Monitor bleeding 3. Hold pressure longer if needed 4. Soft toothbrush 5. Electric razor 6. Venipuncture technique 7. Monitor labs

What are the 8 Chemistry profiles (values)??

ELECTROLYTES 1. Sodium*: 135-145 mEq/L 2. Potassium*: 3.5-5 mEq/L 3. Chloride: 98 - 106 4. Calcium: 9 - 10.5 5. Phosphorus: 2.7 - 4.6 6. Magnesium: 1.3 - 2.1 RENAL FUNCTION 1. BUN: 10-20 2. Creatinine (serum)*: 0.5-1.1/1.5 PANCREATIC FUNCTION 1. Albumin: 3.5-5 2. Amylase: 60-120 3. Lipase: 0-120 (* means relevant labs for ALL patients!!)

What are the 2 test values for diabetes control?

1. Blood sugar (glucose): 70-110 2. Hemoglobin A1C: 4-5.9%

What are the always Relevant labs??

CBC - WBC* - Hemoglobin* - Platelets* - Neutrophils* BMP - Potassium* - Sodium* - Glucose* - Creatinine*

What are the LIVER enzymes in CMP (complete metabolic panel)?

1. Calcium 2. TOtal protein 3. Albumin 4. Bilirubin 5. ALP 6. AST 7. ALT

What are the electrolyte adds on in the chemistry division of clinical lab??? Which two of them are PANCREATIC ENZYMES??

1. Phosphorus 2. Magnesium 3. Amylase 4. Lipase Amylase & Lipase are PANCREATIC enzymes!!!

What is the primary defense against foreign invaders??? And Which type of it is the primary defense against invaders??

WBC or leukocytes. and Neutrophils!!

Where do WBC originate? What is their life span? What is its function? What are the two measurements?

- Bone marrow!! - Lifespan: 13-20 days - Fight infection through phagocytosis (engulfment of bacteria). - Two measurements: WBC total count & Differential - WBC total count --> Gives the count of TOTAL white blood cells in the blood - Differential --> the % of EACH type of leukocytes in the blood

What are bands?? Left shift means what??

- Bands are immature neutrophils!! If you have a AN ACUTE infection & the body is unable to keep up w/ it, the body will start to throw out more bands or more immature neutrophils. - Left shift is an increase in the number of bands and is common with ACUTE infection!!

What is the most common granulocytes that's produced?

Neutrophils

Is neutrophils relevant for every patients??

Yes it is!!

What is Neutrophils function?? What are immature neutrophils called? And how many percentages do they make up ? An increase of bands is called what and is common with what??? Neutrophils are present in what 2 forms?

- They are first responders!! Main function is to locate, Ingest, and Kill foreign invader!! - Immature neutrophils are called BANDS - Bands make up <5% of neutrophils - "Left shift" is seen as an increase in the number of brands AND is common with ACUTE infection - Bands are present in band & segmented forms...

What is another name for HIGH WBC? How about LOW WBC?

High: - Leukocytosis and Neutrophilia Low: - Leukopenia and Neutropenic

What are the 7 factors for Leukocytosis/ Neutrophilia??

1. Excessive physical activities 2. Stress 3. Smoker 4. Pregnancy/labor 5. Traumatic event 6. Major tissue necrosis (death) 7. Infections

What are the 7 factors for Leukopenia/ Neutropenic??

1. Drug toxicity 2. Bone marrow failure 3. Overwhelming infection that has been ignored/untreated 4. Dietary deficiencies 5. Autoimmune diseases like cancer (people on chemotherapy) 6. Congenital, like bone marrow, infections 7. Viral infections like common cold & flu

Increased RBC count is called? Decreased?

Increased RBC = polycythemia Decreased RBC = anemia

Where is platelets produced? What are they removed by? What is the function of Platelets?? What is the LIFE SPAN?

- Platelets are formed in bone marrow - Spleen remove them - They are The first responder for bleeding!! Essential for blood clotting (form clots to stop bleeding)! - Life span: 10 days!!

What is the first responder for bleeding??

Platelets!!

A high platelets is called? How about a low?

High = Thrombocytosis/thrombocythemia Low = Thrombocytopenia

Ecchymosis means what??????

BRUISING!!!

Lab Values Flashcards

(50 cards)