Download Interpreting Laboratory Test

Interpreting Laboratory Tests
Mesa Community College
NUR 152
Objectives
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Identify, interpret and discuss common lab
values
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Discuss nursing responsibilities related to
reporting of abnormal lab values
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Relate lab values to specific disease
processes or conditions
Laboratory Test
A diagnostic tool to assess body processes
and disorders.
 Most common tests ordered (pg 845-SF/pg 1000-HF)
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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)
Complete Blood Count
(CBC)
Information on the hematologic and organ
systems.
 Red Blood Cells
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White Blood Cells
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carry oxygen
fight infection
Platelets
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provide clotting
RBC - Red Blood Cell Count
(erythrocytes)
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The number of red blood cells per cubic
millimeter of blood
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Adults:
 (males):
4.7–6.1 million
 (females): 4.2-5.4 million
Abnormal Findings…….
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Increased RBC’s?
Dehydration
 COPD/Hypoxia
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 Polycythemia
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Decreased RBC’s?
Over-hydration
 Bleeding
 Anemia
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Nursing Dx? Nursing concerns?
Hemoglobin (pg 695-HF)
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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
Hematocrit
Hematocrit also known as “hct" or “crit”
 The percentage of RBC’s found in 100 ml
of blood.
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Adults:
 (males):
42 - 52%
 (females): 37- 47%
Abnormal Findings…….
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Increased Hgb/Hct (H/H)?
Dehydration
 COPD/Chronic Hypoxia
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 Polycythemia
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Decreased Hgb/Hct?
Overhydration
 Bleeding
 Anemia
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Nsg Dx & Nursing concerns? (similar
to low RBC)
White Blood Cell Count
WBC (Leukocytes)
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Fights infection and reacts against foreign
bodies or tissues
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Two measurements of WBC’s are done
1. Total
number of WBC’s
Adults: 5,000 - 10,000 mm3
2. Differential
(%’s of each type of WBC)
WBC Differential (pg 508-Iggy)
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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).
Abnormal Findings……
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Increased WBC’s?
Leukocytosis
 Acute infectious process
 Inflammatory conditions
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Decreased WBC’s?
Leukopenia
 Chronic or overwhelming infectious process
 Autoimmune disorder
 Immunosuppression therapy
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Nursing concerns? Nursing Dx?
Platelets (thrombocytes)
(pg 793-Iggy)
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Essential for blood clotting
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Adults: 150,000 – 400,000 mm3
 Critical
values < 50,000 mm3 or > 1,000,000 mm3
Abnormal Findings……
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Increased platelets?
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Decreased platelets?
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Thrombocytosis
Thrombocytopenia
Nursing concerns?
Metabolic Profile
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AKA
Complete Metabolic Profile (CMP)
 Basic Metabolic Profile (BMP) / Chem-7
 Chemistry Profile
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Metabolic Profile
Can include, but not limited to the following:
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Albumin
Bilirubin
BUN
Calcium (Ca++)
Carbon Dioxide (CO2)
Chloride (Cl-)
Creatinine
Glucose
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Potassium (K+)
Sodium (Na+)
Total Protein
LDL
HDL (good cholesterol)
AST(SGOT)
ALT (SGPT)
Electrolytes- Sodium
+
(Na )
Indicates balance between dietary sodium
and renal excretion
Adults: 135-145 mEq/L
 Increased Sodium?
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 Hypernatremia
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Decreased Sodium?
 Hyponatremia
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Nursing Implications?
Electrolytes – Potassium (K+)
Found mostly in intracellular fluids
Adults: 3.5 – 5 mEq/L
 Critical values: < 2.5 or > 6.5 mEq/L
 Increased Potassium?
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 Hyperkalemia
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Decreased Potassium?
 Hypokalemia
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Nursing Implications?
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?
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Decreased BUN?
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Nursing Implications?
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?
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Decreased creatinine?
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Nursing Implications?
Blood Glucose (pg 694-HF)
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To confirm a diagnosis of diabetes (along
with A1c)
Adults: 70-110 mg/dl Fasting
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< 200 mg/dl Casual (anytime)
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Increased Glucose?
 Hyperglycemia
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Decreased Glucose?
 Hypoglycemia
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Nursing Implications?
You may see this:
BUN
Na
Cl
BG
K
CO2
Creat
Urinalysis (pg 1355-1358 Iggy)
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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
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 1.005
– 1.03
Coagulation
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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 warfarin therapy = 1.5-2x
normal value
INR Normal: 0.8 – 1.1
 Increased PT?
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Decreased PT?
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Nursing Implications?
Coagulation (cont.)
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These tests measure the effectiveness of
anticoagulants
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PTT: Used to monitor clotting times for clients taking
Heparin
Normal: 60-70 seconds- Under Therapy 1.5-2.5x amount
Increased PTT?
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Decreased PTT?
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Nursing Implications?
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Navigating Lab Values
Glucose
135 H
65 – 99 mg/dl
Urea Nitrogen (BUN)
16
8 – 25 mg/dl
Creatinine
0.9
0.6 – 1.5mg/dl
BUN/Creat Ratio
17
10.0-28.0
Sodium
142
135-145 mmol/l
Potassium
4.5
3.5-9.2 mmol/l
Chloride
105
96-110 mmol/l
Carbon Dioxide (CO2)
24
19-31 mmol/l
Protein, Total
7.0
6.0-8.2 g/dl
Albumin
4.3
3.3-4.9 g/dl
Globulin
2.7
2.1-3.9 g/dl
Alb/Glob Ratio
1.6
1-2
Calcium
19.6 H
8.4-10.5 mg/dl