Lab Value Cheat Sheet - Vital Signs

LAB VALUE CHEAT SHEET VITAL SIGNS BASAL METABOLIC PANEL (BMP) • Blood pressure RENAL • Sodium: 135 – 145 mEq/L • Systolic: 120 mmHg • Potassium: 3.5 – 5.0 mEq/L • Diastolic: 80 mmHG • Chloride: 95 - 105 mEq/L • Heart Rate: 60 - 100 BPM • Calcium: 9 - 11 mg/dL • Respirations: 12 - 20 Breaths per min • BUN: 7 - 20 mg/dL • Oxygen: 95% - 100% • Creatinine: 0.6 – 1.2 mg/dL • Temperature: 97.8 °F - 99 °F • Albumin: 3.4 - 5.4 g/dL • Calcium: 9 - 11 mg/dL • Magnesium: 1.5 - 2.5 mg/dL • Phosphorus: 2.5 - 4.5 mg/dL • Specific gravity: 1.010 - 1.030 • GFR: 90 - 120 mL/min/1.73 m2 • BUN: 7 - 20 mg/dL • Creatinine: 0.6 – 1.2 mg/dL • Total protein: 6.2 - 8.2 g/dL LIVER FUNCTION TEST (LFT) LIPID PANEL ABG’S • ALT: 7 - 56 U/L • Total cholesterol: <200 mg/dL • AST: 5 - 40 U/L • Triglyceride: <150 mg/dL • ALP: 40 - 120 U/L • LDL: <100 mg/dL → Bad cholesterol • Bilirubin: 0.1 - 1.2 mg/dL • HDL: >60/dL → Happy cholesterol • PH: 7.35 - 7.45 • PaCO2: 35 - 45 mmHg • PaO2: 80 - 100 mmHg • HCO3: 22 - 26 mEq/L HbA1c REMEMBER • Non-diabetic: 4 - 5.6% PANCREAS ROME • Pre-diabetic: 5.7 - 6.4% Opposite Metabolic Equal • Diabetic: > 6.5% (GOAL for diabetic: < 6.5%) • Amylase: 30 - 110 U/L Respiratory • Lipase: 0 - 150 U/L COMPLETE BLOOD COUNT ( CBC ) COAGs • WBC: 4,500 - 11,000 • RBC’s: 4.5 - 5.5 • PT: 10 - 13 sec • PLT: 150,000 - 450,000 • PTT: 25 - 35 sec • Hemoglobin (Hgb) Female: 12 - 16 g/dL Male: 13 - 18 g/dL • Hematocrit (HCT) Female: 36% - 48% Male: 39% - 54% • aPTT: 30 - 40 sec (heparin) • INR - NOT ON Warfarin < 1 sec - ON Warfarin 2 - 3 sec OTHER Measured with Therapeutic Range Antidote HEPARIN aPTT 1.5 - 2.0 x normal “control” value Protamine Sulfate WARFARIN PT/INR 1.5 - 2.0 x normal “control” value Vitamin K *The higher these numbers = higher chance of bleeding © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. • MAP: 70 - 100 mmHg • ICP (intracranial pressure): 5 - 15 mmHg • BMI: 18.5 - 24.9 • Glascow coma scale: Best = 15 Mild: 13-15 Moderate: 9-12 Severe: 3-8 18 ELECTROLYTES LAB VALUE MEMORY TRICKS SODIUM: 135 - 145 POTASSIUM: 3.5 - 5 *Commit to memory! BANANAS: There are about 3-5 in every bunch & you want them half ripe (½) PHOR: 4 US: 2 (me + you = 2) *don’t forget the .5 So, think 3.5 - 5.0 CALCIUM: 9 - 11 CALL 911 COMPLETE BLOOD COUNT (CBC) PHOSPHORUS: 2.5 - 4.5 MAGNESIUM: 1.5 - 2.5 MAGnifying glass you see 1.5 - 2.5 bigger than normal CHLORIDE: 95 -105 Think of a chlorinated pool that you want to go in when it’s SUPER HOT: 95 - 105 °F • Hemoglobin (Hgb) Female: 12 - 16 g/dL Male: 13 - 18 g/dL • Hematocrit (HCT) To remember HCT, multiply Hgb by 3 Female: 36% - 48% Male: 39% - 54% 12 X 3 = 36 16 X 3 = 48 13 X 3 = 39 BASAL METABOLIC PANEL (BMP) 18 X 3 = 54 BUN: 7 - 20 mg/dL Think hamburger BUNs... Hamburgers can cost anywhere from $7 - $20 dollars (Female) (Male) CREATININE: 0.6 – 1.2 mg/dL This is the same value as LITHIUM’s therapeutic range (0.6 - 1.2 mmol/L) Lithium is excreted almost solely by the kidneys... And creatinine is a value that tests how well your kidneys filter © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 19 BLOOD TYPES ANTIGENS: Proteins that elicit immune response → → → Plasma WBC’s RBC’s A Identifies the cell PLASMA ANTIBODIES Protects body from “invaders” (think ANTI) Opposite of the type of antigen that is found on the RBC B rsal Unive ENT RECIPI AB rsal Unive R DONO Antigen: A Antigen: B Antigen: Antibodies: B Antibodies: A Antibodies: NONE Recipient: Donor: A, O A, AB Recipient: Donor: B, O B, AB A&B Recipient: Donor: ALL AB O Antigen: NONE Antibodies: A&B Recipient: Donor: O ALL Rh FACTOR Has Rh on surface Can receive Does not have Rh on surface Can receive © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 20 POTASSIUM IMBALANCE 3.5 - 5 mEq/L Potassium imbalance plays a vital role in cell METABOLISM, and TRANSITION of nerve impulses, the functioning of cardiac, lung, muscle tissues, & acid-base balance. HYPERKALEMIA SIGNS & SYMPTOMS ✹ > 5 mEq/L TIGHT & CONTRACTED ✹ Orthostatic hypotension uscle cramps & weakness D E R ecreased cardiac contractility (↓HR, ↓BP) ✹ Shallow respirations rine abnormalities ✹ Anxiety, lethargy, confusion, coma ✹ Paresthesias espiratory distress eflexes (↑ DTR ) • Tall peaked T waves • Flat P waves • Widened QRS complexes • Prolonged PR intervals RISK FACTORS ✹ Medication ➥ Potassium-sparing diuretics (Spironolactone) ➥ Ace inhibitors ➥ NSAIDs ✹ Excessive potassium intake (Example: rapid infusion of potassium-containing IV solutions) ✹ Kidney disease or those on Dialysis ➥ Decreased potassium excretion ✹ Adrenal insufficiency (Addison’s disease) ✹ Tissue damage ✹ Acidosis ✹ Hyperuricemia ✹ Hypercatabolism MANAGEMENT < 3.5 mEq/L ✹ Thready, weak, irregular pulse M U R CG changes HYPOKALEMIA ✹ Hyporeflexia ✹ Hypoactive bowel sounds (constipation) ✹ Nausea, vomiting, abdominal distention ✹ ECG changes • ST depression • Shallow or inverted T wave • Prominent U wave ✹ Actual total body potassium loss ✹ Inadequate potassium intake ➥ Fasting, NPO ✹ Movement of potassium from the extracellular fluid to the intracellular fluid ➥ Alkalosis ➥ Hyperinsulinism ✹ Dilution of serum potassium ➥ Water intoxication ➥ IV therapy with potassium-deficient solutions Potassium imbalance can cause cardiac dysrhythmias that can be life-threatening! ✹ Monitor EKG ✹ Oral potassium supplements ✹ Initiate a potassium-restricted diet ✹ Potassium-retaining diuretic ✹ Discontinue IV & PO potassium ✹ Potassium-excreting diuretics ✹ Prepare the client for dialysis ✹ Prepare for administration: ➥ IV calcium gluconate & IV sodium bicarb ✹ Liquid potassium chloride ✹ Potassium is NEVER administered by IV push, IM, or subcut routes. ➥ IV potassium is always diluted & administered using an infusion device! ✹ Avoid the use of salt substitutes or other potassium-containing substances Potassium & sodium = opposites © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Example: ↑ Na = ↓ K+ 21 CALCIUM IMBALANCE Calcium is found in the body’s cells, bones, and teeth. Needed for proper 9 - 11 mg/dL functioning of the CARDIOVASCULAR, NEUROMUSCULAR, ENDOCRINE systems, blood clotting & teeth formation SIGNS & SYMPTOMS HYPERCALCEMIA B A HYPOCALCEMIA > 11 mg/dL one pain rrhythmias C ardiac arrest (bounding pulses) K idney stones M uscle weakness ↓ (DTR) E xcessive urination C A onvulsions T S etany < 9 mg/dL rrhythmias (dimished pulses) pasms & stridor GO NUMB ness in the fingers, face, & limbs POSITIVE TROUSSEAU’S: Carpal spasm caused by inflating a blood pressure cuff CHVOSTEK’S SIGNS: Contraction of facial muscles w/ light tap over the facial nerve. Think “C” for Cheesy smile MANAGEMENT RISK FACTORS ✹ Increased calcium absorption ✹ Decreased calcium excretion ✹ Kidney disease ✹ Thiazide diuretics ✹ Increased bone resorption of calcium ➥ Hyperparathyroidism / Hyperthyroidism ➥ Malignancy (bone destruction from metastatic tumors) ✹ Hemoconcentration ✹ D/C IV or PO calcium ✹ D/C Thiazide diuretics ✹ Administer phosphorus, calcitonin, bisphosphonates, & prostaglandin synthesis inhibitors (NSAIDs) ✹ Avoid foods high in calcium ✹ Inhibition of calcium absorption from the GI tract ✹ Increased calcium excretion ➥ Kidney disease, diuretic phase ➥ Diarrhea & steatorrhea ➥ Wound drainage ✹ Conditions that decrease the ionized fraction of calcium ✹ Adm. calcium PO or IV ➥ For IV, warm before & adm. slowly ✹ Adm. aluminum hydroxide & Vit D ✹ Initiate seizure precautions ✹ 10% calcium (acute calcium deficit) ✹ Consume foods high in calcium A client with a calcium imbalance is at risk for a pathological fracture. Move the client carefully and slowly Calcium & phosphate = Inverse © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Example: ↑ Ca+ = ↓ Po4 22 MAGNESIUM IMBALANCE Most of the magnesium found in the body is found in the bones. Regulates BP, blood sugar, muscle contraction & nerve function. HYPERMAGNESEMIA > 2.5 mg/dL MEMORY TRICK: SIGNS & SYMPTOMS ✹ LOW 1.5 - 2.5 mg/dL HYPOMAGNESEMIA < 1.5 mg/dL MAGNESIUM IS A SEDATIVE! EVERYTHING AKA SEDATED ✹ HIGH EVERYTHING AKA NOT SEDATED ✹ Low energy (drowsiness / coma) ✹ High HR (tachycardia) ✹ Low BP (hypotension) ✹ Increased deep tendon reflex (hyperreflexia) ✹ Low HR (bradycardia) ✹ Low RR (bradypnea) ✹ ↓ Respirations (shallow) ✹ ↓ Bowel sounds ✹ ↓ DTR’s (deep tendon reflex) ✹ High BP (hypertension) REMEMB ER: Als ✹ Shallow respirations ✹ Twitches, paresthesias ✹ Tetany & seizures ✹ Irritability & confusion hypoca o seen lcemia Mg rise POSITIVE TROUSSEAU’S: in . Ca & and fall togeth er! Carpal spasm caused by inflating a blood pressure cuff CHVOSTEK’S SIGNS: RISK FACTORS Contraction of facial muscles w/ light tap over the facial nerve ✹ Increased magnesium intake ➥ Magnesium-containing antacids (TUMS) & laxatives ➥ Excessive adm. of magnesium IV ✹ Renal insufficiency ➥ ↓ renal excretion of Mg = ↑ Mg in the blood ✹ DKA (Diabetic Ketoacidosis) ✹ Insufficient magnesium intake ➥ Malnutrition/vomiting/diarrhea ➥ Malabsorption syndrome ➥ Celiac & Chron’s disease ✹ Increased magnesium excretion ➥ Diuretics or chronic alcoholism ✹ Intracellular movement of magnesium ➥ Hyperglycemia & Insulin adm. MANAGEMENT ➥ Sepsis ✹ Diuretics ✹ IV adm. calcium chloride or calcium gluconate ✹ Magnesium sulfate IV or PO ✹ Avoid the use of laxatives & antacids containing magnesium ✹ Instruct the client to increase magnesium-containing foods ✹ Restrict dietary intake of Mg containing foods ✹ Hemodialysis Magnesium & Calcium = SAME © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. ✹ Seizure precautions Example: ↑ Mg = ↑ Ca+ 23 SODIUM IMBALANCE Sodium is a major ELECTROLYTE found in ECF. Essential for acid-base, fluid balance, active & passive transport mechanism, irritability & CONDUCTION of nerve-muscle tissue HYPERNATREMIA RISK FACTORS SIGNS & SYMPTOMS ✹ > 145 mEq/L F R I lushed skin E D dema (pitting) S kin flushed & dry A L T gitation ↓ of fluid & sodium estless, anxious, confused, irritable ncreased BP & fluid retention ecreased urine output < 135 mEq/L HYPERVOLEMIC HYPONATREMIA: ↑ body water that is greater than Na+ S A tupor/coma L imp muscles (muscle weakness) norexia (nausea/vomitting) rthostatic hypotension L ethargy (weakness/fatigue) T achycardia (thready pulse) 0 S S eizures/headache tomach cramping (hyperactive bowels) ✹ Increased sodium excretion ➥ Diaphoresis (ex: high fever) ➥ Diuretics ➥ Diarrhea & vomiting ➥ Drains (NGT suction) ➥ Diuretics (Thiazides & loop diuretics) ow-grade fever hirst (dry mucous membranes) 5 d’s ✹ SIADH ✹ Increased sodium intake ➥ Excess oral sodium ingestion ➥ Excess administration of IV fluids w/ sodium ➥ Hypertonic IV fluids ✹ LOSS OF FLUIDS! ➥ Fever ➥ Watery diarrhea ➥ Diabetes insipidus ➥ Excessive diaphoresis ➥ Infection HYPONATREMIA HYPOVOLEMIC HYPONATREMIA: BIG & BLOATED 135 - 145 mEq/L ✹ Adrenal insufficient (adrenal crisis) ✹ Inadequate sodium intake ➥ Fasting, NPO, Low-salt diet ✹ Kidney disease ✹ Heart failure hemoconcentration = Increased sodium! ✹ Decreased sodium excretion ➥ Kidney problems ADMINISTER IV sodium chloride infusions (Only if due to hypovolemia) DIURETICS (If due to hypervolemia) Hyponatremia → high fluids & low salt = hemodilution Daily Weights MANAGEMENT ✹ If due to fluid loss: ➥ Administer IV infusions ✹ If the cause is inadequate renal excretion of sodium: ➥ Give diuretics that promote sodium loss ✹ Restrict sodium & fluid intake as prescribed © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Where sodium goes, water FLOWS Safety (orthostatic hypotension AKA risk for falls) Airway protection (NPO) Don’t give food to a lethargic, confused client (INCREASED RISK FOR ASPIRATION) Hypervolemic hyponatremia (high fluid & low salt) Limit water intake Teach to avoid a diet high in salt (Canned food, packaged/processed meats, etc.) 24