1. Interpreting Laboratory Tests Mesa Community College NUR 152

2. Objectives Identify, interpret and discuss common lab values Discuss nursing responsibilities related to reporting of abnormal lab values Relate lab values to specific disease processes or conditions

3. Laboratory Test A diagnostic tool to assess body processes and disorders. Most common tests ordered (pg 845-SF/pg 1000-HF) Red and White blood cell counts (pg 508-Iggy) Electrolytes (pg 817-SF/pg 990-991-HF) Lipids (pg 641-Iggy) Clotting Factors (pg 608-Iggy) Enzymes (pg 641-Iggy) Urine Osmolality (pg 1001-HF) Urine (1356-Iggy)

4. Complete Blood Count (CBC) Information on the hematologic and organ systems. Red Blood Cells – carry oxygen White Blood Cells – fight infection Platelets – provide clotting

5. RBC (erythrocytes) Red Blood Cell Count The number of red blood cells per cubic millimeter of blood Adults: (males): 4.7–6.1 million (females): 4.2-5.4 million

6. Abnormal Findings……. Increased RBC’s? Dehydration COPD/Hypoxia Polycythemia Decreased RBC’s? Over-hydration Bleeding Anemia Nursing Dx? Nursing concerns?

7. Hemoglobin (pg 695-HF) Also known as “Hgb” Protein substance found in the RBC Composed of iron (gives blood red color) Carries oxygen Adults: (males): 14 - 18 g/dl (Females): 12 – 16g/dl

8. Hematocrit Hematocrit also known as “hct" or “crit” The percentage of RBC’s found in 100 ml of blood. Adults: (males): 42 - 52% (females): 37- 47%

9. Abnormal Findings……. Increased Hgb/Hct (H/H)? Dehydration COPD/Chronic Hypoxia Polycythemia Decreased Hgb/Hct? Overhydration Bleeding Anemia Nsg Dx & Nursing concerns? (similar to low RBC)

10. White Blood Cell Count WBC (Leukocytes) Fights infection and reacts against foreign bodies or tissues Two measurements of WBC’s are done 1. Total number of WBC’s Adults: 5,000 - 10,000 mm 3 2. Differential (%’s of each type of WBC)

11. WBC Differential (pg 508-Iggy) More specific information of infection Neutrophils: most numerous and respond quicker (acute infections). Lymphocytes: increase in chronic bacterial and acute viral infection. Monocytes: can ingest larger particles, stronger than neutrophils Eosinophils: increase during allergic and parasite attacks (do not respond to viral or bacterial infections) Basophils: increase during the healing process of allergic & parasitic reactions (do not respond to viral or bacterial infections).

12. Abnormal Findings…… Increased WBC’s? Leukocytosis Acute infectious process Inflammatory conditions Decreased WBC’s? Leukopenia Chronic or overwhelming infectious process Autoimmune disorder Immunosuppression therapy Nursing concerns? Nursing Dx?

13. Platelets (thrombocytes) (pg 793-Iggy) Essential for blood clotting Adults: 150,000 – 400,000 mm 3 Critical values 1,000,000 mm 3

14. Abnormal Findings…… Increased platelets? Thrombocytosis Decreased platelets? Thrombocytopenia Nursing concerns?

16. Metabolic Profile AKA Complete Metabolic Profile (CMP) Basic Metabolic Profile (BMP) / Chem-7 Chemistry Profile

17. Metabolic Profile Can include, but not limited to the following: Albumin Bilirubin BUN Calcium (Ca++) Carbon Dioxide (CO 2 ) Chloride (Cl-) Creatinine Glucose Potassium (K+) Sodium (Na+) Total Protein LDL HDL (good cholesterol) AST(SGOT) ALT (SGPT)

18. Electrolytes- Sodium (Na + ) Indicates balance between dietary sodium and renal excretion Adults: 135-145 mEq/L Increased Sodium? Hypernatremia Decreased Sodium? Hyponatremia Nursing Implications?

19. Electrolytes – Potassium (K + ) Found mostly in intracellular fluids Adults: 3.5 – 5 mEq/L Critical values: 6.5 mEq/L Increased Potassium? Hyperkalemia Decreased Potassium? Hypokalemia Nursing Implications?

20. Blood Urea Nitrogen - BUN Measures amount of nitrogen and urea in the blood Urea- end product of protein metabolism Urea normally excreted by the kidneys. Adults: 10 – 20 mg/dl Increased BUN? Decreased BUN? Nursing Implications?

21. Serum Creatinine Creatinine is the waste product of muscle breakdown. Excreted by the kidneys. Adults: Blood Creatinine Values Men 0.6 – 1.2 mg/dl Women 0.5 – 1.1 mg/dl Increased creatinine? Decreased creatinine? Nursing Implications?

22. Blood Glucose (pg 694-HF) To confirm a diagnosis of diabetes Adults: 70-110 mg/dl Fasting < 200 mg/dl Casual (anytime) Increased Glucose? Hyperglycemia Decreased Glucose? Hypoglycemia Nursing Implications?

23. You may see this: NaCl KCO2 BUN BG Creat

24. Urinalysis (pg 1355-1358 Iggy) Physical, chemical and microscopic analysis of the urine Assists in diagnosis of disorders Screens for glucose, ketones, blood, protein, and leukocytes Color and Clarity pH 4.6 - 8 (average 6) Specific Gravity 1.005 – 1.03

25. Coagulation These tests measure the effectiveness of anticoagulants PT / INR: Used to monitor clotting times for clients taking warfarin (Coumadin) PT Normal: 11-12.5 seconds- Under Therapy 1.5-2x amount INR Normal: 0.8 – 1.1 Increased PT? Decreased PT? Nursing Implications?

26. Coagulation (cont.) These tests measure the effectiveness of anticoagulants PTT: Used to monitor clotting times for clients taking Heparin Normal: 60-70 seconds- Under Therapy 1.5-2.5x amount Increased PTT? Decreased PTT? Nursing Implications?

27. Navigating Lab Values Glucose135 H65 – 99 mg/dl Urea Nitrogen (BUN)168 – 25 mg/dl Creatinine0.90.6 – 1.5mg/dl BUN/Creat Ratio1710.0-28.0 Sodium142135-145 mmol/l Potassium4.53.5-9.2 mmol/l Chloride10596-110 mmol/l Carbon Dioxide (CO2)2419-31 mmol/l Protein, Total7.06.0-8.2 g/dl Albumin4.33.3-4.9 g/dl Globulin2.72.1-3.9 g/dl Alb/Glob Ratio1.61-2 Calcium19.6 H8.4-10.5 mg/dl