Normal Indications Evaluate for: Elevated triglycerides Risk for atherosclerotic heart disease and stroke Description Triglycerides (TG) are required to provide energy during the metabolic process, excess triglycerides are stored in adipose tissue. What would cause increased levels? Myocardial Infarction (MI) Alcoholism Alcoholic cirrhosis High carbohydrate diet Anorexia nervosa Cirrhosis Hypertension (HTN) Nephrotic Syndrome Obesity Renal failure Pancreatitis Stress What...

Normal 135-145 mEq/L Indications Monitor: Extracellular osmolality Electrolyte imbalance Description Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body. Sodium plays a role in blood pressure regulation and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; water follows salt. What would cause...

Normal 3.5 - 5.0 mEq/L Indications Evaluate: Electrolyte imbalances Cardiac arrhythmias Monitor patients who are: Acidotic Receiving diuretic therapy Description Potassium (K+) is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen will enter the cell which will force potassium out of the cell. A 0.1 decrease in pH will...

Normal 25 - 35 seconds Indications Detection of coagulation disorders Evaluate response to Heparin (PT for Coumadin) Preoperative assessment Description Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin. What would cause increased levels? Disseminated Intravascular Coagulation (DIC) Clotting Factor...

Normal 95 - 100% Indications Determine respiratory status Part of Arterial Blood Gas (ABG) testing Description Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen. Oxygen is transported in the blood in two ways: oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin (SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved in plasma. SaO2 and pO2 have direct relationships, if one is decreased so is...

Normal 261 – 280 mOsm/kg Indications Monitor: Electrolyte balance Acid-Base balance Hydration Evaluate function of antidiuretic hormone.   Description Osmolality is a measure of the particles in solution. The size, shape, and charge of the particles do not impact the osmolality   What would cause increased levels? Dehydration Azotemia Hypercalcemia Hyperglycemic Hyperosmolar Nonketotic State (HHNS) Hypernatremia Diabetes Insipidus Hyperglycemia Mannitol therapy Uremia Severe...

Normal 1.6 – 2.6 mg/dL Indications Monitor: Renal failure Chronic alcoholism Cardiac arrhythmias Description Magnesium (Mg) is a cation necessary for protein synthesis, nucleic acid synthesis, muscle contraction, ATP (adenosine triphosphate) use, nerve impulse conduction, and blood clotting. Magnesium affects the absorption of sodium, calcium, phosphorus, potassium.   What would cause increased levels? Renal insufficiency Uncontrolled Diabetes Mellitus (DM) Addison Disease...

Normal Indications Useful in determining risk of cardiovascular disease. Description Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein, LDL, and very low-density lipoprotein (VLDL). LDL cholesterol is considered bad cholesterol because as it travels through the blood, it deposits cholesterol into the lining of blood vessels, causing...

Normal 0.3 -2.6 mmol/L Indications Determine cause of acidosis Evaluate tissue oxygenation Description Lactate (Lactic Acid) is a byproduct of anaerobic metabolism. Normally, the tissues use aerobic metabolism to breakdown glucose for energy and the byproduct is CO2 and H2O which we excrete through our kidneys and exhalation. However, if the tissues are starved of oxygen (hypoxic), they use anaerobic metabolism. This can be compounded if the liver is also hypoxic causing the liver...

Normal 0.8 - 1.2 Therapeutic Levels of Warfarin 2.0 – 3.5 Indications Evaluate therapeutic doses of Warfarin Identify patients at higher risk for bleeding Identify cause of: Bleeding Deficiencies Description International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method. What would cause increased levels? Disseminated Intravascular Coagulation (DIC) Liver disease Vitamin K deficiency Warfarin What would...

Normal >60 optimal mg/dL Indications Monitor risks of heart disease Description Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein (LDL) very low-density lipoprotein (VLDL). HDL cholesterol is considered the good cholesterol because it travels through the blood picking up extra cholesterol and taking it back to the liver. What would cause...

Normal 5.6-7.5 % of total Hgb Indications Assess control of blood sugars over a several month time frame Diagnose Diabetes Mellitus (DM) Description Glycosylated Hemoglobin (HbA1c) is the combination of glucose and hemoglobin. When glucose is elevated in the blood the amount of glycosylated hemoglobin increases proportionally. A red blood cells lifespan is about 4 months, so you can get an idea of blood sugar control over the last several months. What would cause increased...

Normal 2 - 20 ng/mL Indications Diagnose megaloblastic anemia Monitor effects of long-term Total Parenteral Nutrition (TPN) Identify Folate Deficiency Description Folic acid is an essential water soluble B vitamin. It is stored in the liver and is an important part of Red Blood Cell (RBC) and White Blood Cell (WBC) function, DNA replication, and cell division. What would cause increased levels? Excess folate intake What would cause decreased levels? Vitamin B12 deficiency...

Normal 20-300 ng/mL Indications Diagnosing: Iron-deficiency anemiaH emochromatosis Monitor: Iron levels Description Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin. Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron. What would cause increased...

Normal 96-108 mEq/L Indications Identify Acid-Base Imbalance Description Chloride (Cl-), an anion found in the blood, works together with sodium to help maintain oncotic pressure and water balance in the body. Chloride is inversely related to bicarbonate levels in the blood. Chloride is also part of hydrochloric acid (HCL) which is utilized in the stomach to breakdown food. When red blood cells (RBCs) take up CO2 they take up chloride as well. The negative ion bicarbonate then leaves...

Normal 8.4-10.2 mg/dL Indications Identify problems with: Parathyroid Neuromuscular functions Diseases that affect bone Effectiveness of treatments. Description Calcium (Ca+), a positive ion in the body, is necessary for neuromuscular processes, bone mineralization, and hormonal secretion. The parathyroid gland and vitamin D are responsible for calcium regulation in the body. In the blood, about half of calcium travels in ion form, the other half is bound to proteins like albumin....

Normal 12-37 U/L Indications Monitor progression of: Liver disease Response to treatments. Monitor liver toxic medications Description Aspartate Aminotransferase (AST) is an enzyme primarily found in liver and heart cells, and to a smaller extent, AST can also be found in the pancreas, kidneys, skeletal muscle, and brain. Levels of AST increase from cell death (necrosis) because the AST enzyme is released into the blood. What would cause increased levels? Liver disease Liver...

Normal 0-130 U/L Indications Diagnosing: Pancreatitis Pancreatic Duct Obstruction Macroamylasemia Trauma to Pancreas Description Amylase is made in the pancreas. It is an enzyme that breaks down carbohydrates to allow our body to absorb it. Monitoring amylase levels can help identify problems with the pancreas. What would cause increased levels? Pancreatitis Pancreatic Cancer Pancreatic Cyst DKA Peritonitis Abdominal Trauma Duodenal Obstruction Mumps Alcohol use What would cause...

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Normal 30-40 seconds Indications Identifying congenital deficiencies in clotting Monitoring heparin therapeutic levels (PT for warfarin) Monitoring effects of: Liver Disease Protein Deficiency Fat malabsorption on clotting Description Activated Partial Thromboplastin Time (aPTT) is a test that measures the amount of time it takes for a fibrin clot to form after reagents have been added to the specimen. It is useful in diagnosing clotting disorders. In conjunction with PT it can ...

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Overview Urinalysis Color & Clarity Protein RBC WBC Glucose Specific gravity Ketones pH Bilirubin/Urobilinogen Nursing Points General Normal value range Color & Clarity Normal – Yellow Other colors Drug interactions Propofol  – green Methylene blue – blue/green Trauma Red/Brown Liver failure Brown/tea colored Clear – Normal Cloudy Cell or contaminant related Turbid Severe presence of cells (WBC, RBC) pH ~6 Changes in body condition can change pH...

Overview White Blood Cells Normal Value Range Pathophysiology Special considerations Abnormal values (high) Abnormal values (low) Nursing Points General Normal value range WBC 4500-10000/mcL Differential Neutrophils 40-60% Bands 3-5% >8% indicates signal to WBC for more production Infection or inflammation is severe Eosinophils 1-4% Basophils 0.5-1% Lymphocytes 20-40% Monocytes 2-8% Pathophysiology WBC Formed in the bone marrow Responsible for...

Overview Troponin I Normal value range Pathophysiology Special considerations Elevations in lab values Nursing Points General Normal value range Typically, less than 0.035 ng/mL or less Can vary among institutions Has to be greater than the 99th percentile Pathophysiology Troponin is released during myocardial cell damage Decreased perfusion causes myocardial cell damage Causes of myocardial cell damage Myocardial infarction Demand ischemia Cardiogenic ACS Noncardiogenic ...