Lab Values Podcast by NURSING.com (Nursing Podcast, normal lab values for nurses for NCLEX®) by NURSING.com (NRSNG)

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 would cause decreased levels? Chronic Obstructive Pulmonary Disease (COPD) Liver disease Hyperthyroidism Malnutrition Malabsorption

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 cause a 0.5 increase in K+. What would cause increased levels? Renal failure Hypoaldosteronism Addison's disease Injury to tissues Diabetes Mellitus (DM) Ketoacidosis Hyperventilation Acidosis Infection Dehydration Burns What would cause decreased levels? Hyperaldosteronism Excess insulin Alkalosis Diarrhea Vomiting Cystic Fibrosis Cushing Syndrome

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 the other. The relationship between oxygen saturation (SaO2) and partial pressure O2 (PaO2) is referred to as the oxyhemoglobin (HbO2) dissociation curve. SaO2 of about 90% is associated with PaO2 of about 60 mmHg. What would cause increased levels? Polycythemia Increased inspired O2 Hyperventilation What would cause decreased levels? Anemia's Hypoventilation Bronchospasm Mucus plugs Atelectasis Pneumothorax Pulmonary edema Adult respiratory distress syndrome

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 Dehydration Hypothyroidism Overuse of antacids Tissue trauma What would cause decreased levels? Alcoholism Diabetic acidosis Renal failure: Glomerulonephritis Hypercalcemia Malnutrition Malabsorption Hypoparathyroidism Diarrhea

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 to be unable to clear the lactic acid. What would cause increased levels? Shock Sepsis Tissue ischemia Carbon monoxide poisoning Lactic acidosis Diabetes Mellitus (DM) Heart failure Pulmonary edema Strenuous exercise What would cause decreased levels? N/A

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 increased levels? Familial HDL Lipoproteinemia Exercise Unsaturated fats: Mono- Poly- Hypothyroid What would cause decreased levels? Metabolic Syndrome Hepatocellular disease: Hepatitis Cirrhosis Hypoproteinemia: Nephrotic Syndrome Malnutrition Smoking High saturated and trans fat diets Excess body weight Hyperthyroid

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 Pernicious anemia Hemolytic anemia Celiac Disease or Crohn Disease Inflammatory Bowel Disease (IBS) Alcoholism Malnutrition

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 the red blood cell so that the electrical charge is maintained. Extra chloride is excreted into the urine by the kidneys. What would cause increased levels? Dehydration Acute Renal Failure Cushing Disease Metabolic Acidosis Respiratory Alkalosis. What would cause decreased levels? Congestive Heart Failure (CHF) Water intoxication Burns Metabolic Alkalosis Respiratory Acidosis Addison Disease Salt-losing Nephritis Excessive sweating Diarrhea Vomiting

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 cancer Shock Congestive Heart Failure (CHF) Pericarditis Biliary tract obstruction Dermatomyositis Pancreatitis Muscular Dystrophy CVA Hemolytic anemia Delirium Tremens (DT) What would cause decreased levels? N/A

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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 responding to foreign invaders Creating antibodies (immunity) Phagocytosis (eating bacteria or fungi) Multiple types with different purposes Neutrophils – inflammation and first response to invader Eosinophils – Inflammation Allergic response Parasites Basophils Inflammation Allergic response Lymphocytes Create antibodies Recognize antigens Destroy cells T Cells B Cells Natural Killer cells Monocytes Macrophages Engulf and destroy invaders Indicative of infection Special considerations Lavender top tube Will commonly be submitted for Complete Blood Count with differential Abnormal lab values Increased White Blood Cell count (leukocytosis) Infection Inflammation Trauma/Stress Pregnancy Asthma Allergic Reaction Decreased lab values (leukopenia) Systemic Lupus Erythematosus (SLE)/Rheumatoid arthritis Cancers Chemotherapy/Radiation Medications Neutropenic precautions Masks Gloves Wash hands Consider yourself infectious Prevent spread of infection to the patient Assessment Consider the overall WBC count plus abnormalities in differential Evaluate patient Signs or symptoms of: Trauma Inflammation Infection Therapeutic Management Antibiotic therapies where indicated by infection (followed by cultures to determine efficacy of antibiotics) Anti-inflammatories for inflammation Provide neutropenic precautions when necessary Nursing Concepts Lab Values Infection Control Patient Education Educate patient on the finishing any antibiotics completely. Do not stop prior, even if the patient says they are feeling better.

Objective: Determine the significance and clinical use of Thyroid Stimulating Hormone in clinical practice Lab Test Name: Thyroid Stimulating Hormone Description: Thyroid Stimulating Hormone (TSH) is released from the anterior pituitary in response to low levels of thyroid hormone. TSH stimulates the thyroid gland to release thyroid hormones Triiodothyronine (T3) Thyroxine (T4) T3 and T4 have an inverse relationship with TSH Indications: Aids to diagnose: Hyperthyroidism Hypothyroidism Anterior pituitary function Monitor: Thyroid replacement therapy Normal Therapeutic Values: Normal – 2-10 mU/L Collection: Plasma separator tube What would cause increased levels? TSH levels increase in the following conditions: Hypothyroidism Thyroidectomy Thyroid dysfunction Thyroiditis Thyroid Agenesis Large doses of iodine Pituitary TSH-secreting tumor What would cause decreased levels? Recall the inverse relationship between TSH and T3/T4 labs, and how the negative feedback loop works with these hormones. TSH levels decrease in the following conditions: Anterior pituitary hypofunction- If the pituitary isn't secreting TSH, the level will be low. Hyperthyroidism- If there is a large amount of thyroid hormone circulating, the feedback system relays the info upstream and less TSH is released.