1. Other Blood Tests Blood Urea Nitrogen (BUN) – Evaluates protein intake, the liver's ability to metabolize, and the functioning ability of the kidney – May be abnormally elevated by hormones or a high protein diet, or gastrointestinal bleeding, dehydration, shock, myocardial infarction, and congestive heart failure – Critical values are over 100 mg/dL.

2. Other Blood Tests Blood Urea Nitrogen (BUN) – Lower levels during starvation or a low- protein diet, liver disease, overhydration, and during pregnancy – Test provides information to use for evaluation; creatinine levels are better indicators of kidney disease

3. Other Blood Tests Creatinine – Waste product of muscle energy metabolism that is excreted by the kidney – Test is a good renal indicator

4. Other Blood Tests Creatinine – Not used as an early indicator of dysfunction – Elevated creatinine may be seen with dehydration, muscular dystrophy, preeclampsia, and eclampsia

5. Other Blood Tests Calcium (Ca) – Important for neuromuscular activity and blood coagulation – Hypocalcemia: low calcium levels Levels less than 7 mg/dL are considered critical and may be life threatening; report to the physician immediately.

6. Other Blood Tests Calcium (Ca) – Hypercalcemia High blood calcium levels Critically elevated levels noted above 12 mg/dL If prolonged, can lead to calcifications, such as kidney stones

7. Other Blood Tests Sodium (Na) – Primarily controls the distribution of water throughout the body – Assists in muscle contraction and nerve impulse transmission

8. Other Blood Tests Sodium (Na) – Critical values noted at less than 130 or more than 160 mEq/L – High sodium levels (hypernatremia) Loss of body water, decreased water intake, or excessive sodium ingestion

9. Other Blood Tests Sodium (Na) – Low sodium levels (hyponatremia) Excessive loss of sodium or an excessive intake of water

10. Other Blood Tests Potassium (K) – Helps to maintain activity of the heart and skeletal muscles by influencing the conduction of electrical impulses – Abnormal levels often asymptomatic until very severe changes are present – Less than 2.5 or more than 6.5 mEq/L is considered critical and may easily become lethal

11. Other Blood Tests Potassium (K) – Hyperkalemia (high potassium levels) A result of excessive absorption or impaired removal – Hypokalemia (low potassium levels) Can occur with poor absorption or excessive removal

12. Other Blood Tests Bicarbonate/Carbon dioxide (CO 2 ) – CO 2 is a gas that is made during metabolism and removed by the kidneys and lungs. – CO 2 produces bicarbonate when combined with water in the blood. – Acidosis Low blood pH

13. Other Blood Tests Bicarbonate/Carbon dioxide (CO 2 ) – Alkalosis High blood pH – Respiratory acidosis Results from inadequate ventilation of the lungs – Respiratory alkalosis Results from low CO 2 levels with an increased pH

14. Other Blood Tests Chloride (Cl) – Works with other electrolytes to help maintain fluid and acid-base balance and osmotic pressure within the body – Produced by the stomach as hydrochloric acid, to help with digestion

15. Other Blood Tests Chloride (Cl) – Hyperchloremia An elevated level of chloride in the blood – Hypochloremia A lower than usual level of chloride in the blood

16. Other Blood Tests Albumin – A liver protein that helps in fluid balance maintenance and assists with movement of small molecules through the blood

17. Other Blood Tests Albumin – Hypoalbuminemia Low levels may suggest: – A patient has kidney or liver disease – A digestive disorder that does not allow the body to absorb enough protein – Other tests should be done to confirm this.

18. Other Blood Tests Total Protein – Test is a measure of the overall state of nutrition in the body, as well as liver or collagen disease – Total protein is rarely increased, unless as a result of certain medications, dehydration, or excessive exercise. – This test can be used to monitor response to therapy.

19. Other Blood Tests Bilirubin – A substance produced in the liver, spleen, and bone – A wide variety of disease processes cause increases

20. Other Blood Tests Bilirubin – Elevated levels are found with: Gallbladder stones or biliary obstruction Alcoholism Anemia Liver disorders Pulmonary embolism

21. Other Blood Tests Alkaline phosphatase (ALP) – A group of enzymes found in the liver, gallbladder, intestine, and bones – Test is useful for assistance in evaluating bone and liver functions – Elevated levels seen in aldosteronism, dehydration, and cirrhosis

22. Other Blood Tests Alkaline phosphatase (ALP) – Decreased levels noted with certain medications, licorice consumption, and Cushing's syndrome – Diuretics and estrogen may also affect values

23. Other Blood Tests Aspartate amino transferase (AST or SGOT) – An enzyme found mostly in heart muscle and the liver – Abnormalities may represent liver disease or recent heart attack

24. Other Blood Tests Aspartate amino transferase (AST or SGOT) – Not used to diagnose myocardial infarction – Elevated levels seen with liver or musculoskeletal disease, pancreatitis, heat stroke, or trauma

25. Other Blood Tests Aspartate amino transferase (AST or SGOT) – Decreased levels seen with chronic liver disease, hemodialysis, and diabetic ketoacidosis – Excessive exercise, certain drugs, and pregnancy can alter the results.

26. Other Blood Tests Alanine amino transferase (ALT) or Serum Glutamic Pyruvic Transaminase (SGPT or GPT) – ALT or SGPT is an enzyme found primarily in the liver. – Abnormalities may represent hepatobiliary disease.

27. Other Blood Tests Alanine amino transferase (ALT) or Serum Glutamic Pyruvic Transaminase (SGPT or GPT) – Elevated levels seen with anything that may cause liver damage or dysfunction – Small elevations may be noted with cardiac and renal tissue destruction.

28. Other Blood Tests Diabetic Tests – Diabetics monitor their blood sugar with a portable machine called a glucometer. – Physician will often order a HbgA1C to test the long-term control of diabetes – Physician may also order a glucose tolerance test (commonly used to detect pregnancy-induced diabetes)

29. Performing a HbgA1C Test Using a Bayer DCA Vantage Analyzer 1.Verify physician orders and check for allergies. Perform hand hygiene and apply gloves. 2.Inspect and assemble equipment and supplies. If a seal is loose or the containers are damaged, discard and replace.

30. Performing a HbgA1C Test Using a Bayer DCA Vantage Analyzer 3.Cleanse skin with alcohol and allow to air dry. Perform capillary puncture and wipe the first drop of blood. (May alternately use venipuncture blood from a tube with EDTA, heparin, citrate, or fluoride/oxylate after inverting the sample several times to properly mix it.) Dispose of sharps properly.

31. Performing a HbgA1C Test Using a Bayer DCA Vantage Analyzer 4.Touch the tip of the capillary tube into blood until filled. Wipe sides of the tube with gauze to remove excess. Inspect the sample for bubbles; if present, discard and begin again. Once a sample is properly collected, analysis must be performed within five minutes.

32. Performing a HbgA1C Test Using a Bayer DCA Vantage Analyzer 5.With the flat side toward the cartridge, gently insert the capillary tube into the cartridge until it snaps into place. Use caution not to contaminate or touch the optical window on the bottom corner of the cartridge. Do not remove the foil.

33. Performing a HbgA1C Test Using a Bayer DCA Vantage Analyzer 6.Hold the reagent cartridge so that the barcode faces to the right. Using the track on the left side of the analyzer, scan the cartridge by inserting it into the track above the blue dot and sliding it down quickly. If no beep is heard, try again.

34. Performing a HbgA1C Test Using a Bayer DCA Vantage Analyzer 7.Open the compartment door on the front of the machine. Hold the cartridge with the barcode facing right and insert until a gentle snap is heard or felt. It will fit only when held in the right direction.

35. Performing a HbgA1C Test Using a Bayer DCA Vantage Analyzer 8.Using a smooth, continuous motion, pull the foil tab completely out of the cartridge and close the door. Within five seconds, a beep should sound. 9.Read the results, when ready. 10.Open the cartridge door. Push/hold the button on the right side of the cartridge while pushing the cartridge tab to the right and gently pull the cartridge out. Discard in a sharps container.

36. Performing a HbgA1C Test Using a Bayer DCA Vantage Analyzer 11.Remove gloves and perform hand hygiene 12.Record the value as a percentage on the patient's medical record.

37. Other Blood Tests Phenylketonuria – A congenital disease caused by a defect in the metabolism of the amino acid phenylalanine – Unmetabolized protein, if undetected and untreated, will result in mental retardation.

38. Other Blood Tests Phenylketonuria – Test always performed on newborns – Typically performed in the hospital but may be performed in the office if not done in the hospital – Refer to Procedure 48-6 in the student text.

39. Other Blood Tests Mono Testing – Used to help determine whether a patient has infectious mononucleosis – Frequently ordered along with a CBC – Strep test may also be ordered with this test

40. Other Blood Tests Mono Testing – Primarily ordered when an adolescent patient has symptoms such as fever, headache, swollen glands, and fatigue – Test may be repeated when it is initially negative, but suspicion of mono remains high

41. Performing a Mono Test 1.Perform hand hygiene. 2.Apply gloves. 3.Assemble equipment and supplies. 4.Cleanse patient's finger with alcohol and allow to dry. Perform a capillary puncture. 5.Fill a capillary tube end to end, dispensing all the blood into the test tube.

42. Performing a Mono Test 6.Slowly add 1 drop of diluent to the bottom of the test tube. 7.Mix. 8.Remove the test stick(s) from the container. Recap the container immediately. 9.Place the absorbent end of the test stick into the treated sample. Leave the test stick in the test tube.

43. Performing a Mono Test 10.Read result at five minutes. Positive results may be read as soon as the red control line appears. 11.Discard used test tubes, lancet, and test sticks in the biohazard waste container.

44. Performing a Mono Test 12.Remove gloves and dispose of them correctly. Perform hand hygiene. 13.Document findings in the patient record. 14.Clean the work area and equipment according to OSHA guidelines.