Lab Test Erythrocytes (RBC)

Normal Value Range 3.8-5.8x10 /L

12

Description & Possible Reasons for abnormal value -function of erythrocytes is to carry oxygen and carbon dioxide wastes from external and internal respiration, respectively. -can indicate problems with RBC production or lifespan, used in conjunction with Hbg and Hct -high due to dehydration, high altitudes, polycythemia, severe diarrhea -low due to anemia, leukemia, overhydration -haemoglobin is the oxygen carrying component of erythrocytes -used in conjunction with RBC and Hct; can indicate problems with RBC production or lifespan -higher with COPD, high altitudes, polycythemia -lower with anemia <100 g/L, begin concern that oxygenation/recovery, would cause more stress on the heart. -measure percentage of RBC as part of overall composition of blood -can indicate problems with RBC production or lifespan, used in conjunction with RBC and Hgb -used to monitor anaemia, dehydration -higher due to dehydration, high altitudes, polycythemia -lower due to anaemia, overhydration -measures amount of WBCs in a given volume of blood - to monitor treatment, infection, inflammation, or disease that affects RBC production/survival -higher due to inflammation or infection, leukemia -lower in autoimmune diseases, chemotherapy, overwhelming infection - to monitor conditions that affect platelets production, or component of clotting -high: acute infections, polycythemia, cirrhosis (risk for clots) -low: leukemia, chemotherapy, hemorrhage, infection, lupus, DIC (risk for hemorrhage) -prolonged/increased with deficiency of clotting factors, liver disease (risk for bleeding) -Low value associated with risk of blood clots (thrombi) -aPTT/PTT is affected with unfractionated heparin use (reversed with protamine sulphate) -LMWH is normal or mildly prolongs (not usually monitored) -normal or mildly prolonged with warfarin (not usually monitored) -prolonged/increased with deficiency of clotting factors and vitamin K, liver disease (risk for bleeding) -Low value associated with risk of blood clots (thrombi) -affected with warfarin therapy (prolonged/increased clotting time) -target range of therapy 2-3 with warfarin -high: dehydration -low: burns, chronic liver disease, mal-absorption, malnutrition, pregnancy -found in the largest concentration in the extracellular fluid compartment -proper muscle function, nerve conduction, fluid balance (Na+, K+ pump) -high in dehydration, increased dietary/IV sodium intake, corticosteroid therapy -low with excessive perspiration, diuretic therapy, decreased sodium intake, water intoxication -found in the largest concentration in the intracellular fluid compartment -often ordered in diagnosis and evaluation of kidney disease, high blood pressure, iv therapy -high in acute/chronic renal failure, dehydration, diabetic ketosis, excess intake, massive tissue destruction -low: deficient intake, diarrhea, diuretic therapy, insulin administration, starvation Outside range can cause heart arrythmias; -found in the largest concentration in the extracellular fluid compartment -usually mirrors Na+ concentration, though can be imbalanced with an acid/base imbalance -can be used to monitor hypertension, heart failure, liver and kidney disease -high with corticosteroid therapy, dehydration, excess saline infusion, uremia -low with overhydration, SIADH, CHF, vomiting, diarrhea -used primarily to diagnose diabetes -high in diabetes -low with hyperinsulinism 12 hr fast; 75g oral glucose; >11.1 mmol/L indicates diabetes, 2hr post test

Hemoglobin (Hgb)

120-160 g/L F 140-180 g/L M

Hematocrit (Hct)

0.36-0.46 F 0.37-0.49 M

Leukocytes (WBC)

4-11 x10 /L

Thrombocytes (platelets) PTT (partial thromboplastin time) aPTT (activated) International normalized ratio (INR) PT (prothrombin time) Albumin Sodium (Na+)

150-400 x10 /L

25-35sec

0.8-1.2 PT 11-13sec

35-50g/L 135-145 mmol/L

Potassium (K+)

3.5-5 mmol/L

Chloride (Cl-)

95-105 mmol/L

Plasma Glucose (Fasting Glucose Tolerance Test, 2HR) Random Capillary Blood Glucose

>11.1 mmol/L indicates diabetes

HbA1C

4-7mmol/L (FPG/ac) 5-10mmol/L 2hr pc) CDA guidelines (<7% HBA1C) <0.07 <6.5% consider in some T2 7.1%-8.5% if: limited life; severe hypog; comorbidities; difficult

-measures percentage of glycosylated haemoglobin (haemoglobin with a glucose molecule attached) -correlated with the average 3 month blood glucose concentration -used for long term glucose control monitoring to prevent long term complication of diabetes -high in poorly controlled diabetes -low with chronic blood loss, renal failure, pregnancy, sickle cell anaemia

Urea (blood urea nitrogen) BUN

despite insulin/oral (CDA p.48) 3.5-7 mmol/L

Creatinine (blood)

50-100 mol/L

C-reactive protein Creatine Phosphokinase

<10mg/L >4-6% indicative of MI

Troponin cardiac (cTnI)

<0.5 mcg/L negative >2.3 mcg/L indicative of MI

-used primarily to evaluate kidney and liver function -produced when liver breaks down protein, then usually excreted via kidneys -high with burns, dehydration, protein catabolism due to fever, stress, renal disease, shock, UTI -low with fluid overload, malnutrition, severe liver damage -used to monitor kidney function, usually in conjunction with BUN and creatinine urine -creatinine is a product of muscle metabolism -high in severe renal disease -lower with diseases that decrease muscle mass (muscular atrophy) High in response to acute and chronic inflammation (ex. bacterial, viral, fungal infections, malignancy, tissue injury) High in myocardial infarction (heart attack), rhabdomyolysis (severe muscle breakdown), muscular dystrophy, and acute renal failure. Post MI: (CPK-MB) Rises within 4-6hrs, peak within 18-24hours, fall back to normal within 2-3 days. Occasionally missed by small infarcts. More sensitive than troponin in first 6 hours. Cardiac muscle damage, (myocardial infarction, myocarditis or pericarditis), chronic renal failure, multi-organ failure. Post MI: peak 18-24hrs, persists for 10 days. More sensitive than CPK. Bedside testing available.

Urinalysis (R&M) C&S (urine, stool, wound, etc.) Lewis, S. M., Barry, M., Goldsworthy, S., & Goodridge, D. (2009). Medical-surgical nursing in Canada: assessment and management of clinical problems. Toronto: Mosby Elsevier Canada. (p. 1971) Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2013). Daviss drug guide for nurses. Philadelphia: F.A. Davis. Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2013). Daviss drug guide for nurses. Philadelphia: F.A. Davis. Canadian Diabetes Association. (2013). Canadian Diabetes Association 2013 Clinical Practice Guidelines. http://www.diabetes.ca/forprofessionals/resources/2013-cpg/