Mark Klimek Lab Tricks

NA (SODIUM)

135-145 mEq/L ABNORMAL=LEVEL B HYPO-OVERLOAD HYPER-DEHYDRATION IF THERE IS A CHANGE IN LOC=LEVEL C (hypo/hyperatremia) FALL RISK 1. IMPLEMENT PRECAUTIONS 2. CALL DR

WBCS

5000-10000 LEVEL C: <5000 1. IMPLEMENT NEUTROPENIC PRECAUTIONS

Bilirubin

pigment released by the liver in bile Tested in newborns-normally high Therapeutic level: 10-20 Toxicity level: ≥20 Jaundice-bilirubin in the skin Present at birth pathological (something is wrong) Slowly develops over the next few days physiological Kernicterus-bilirubin in the brain--> crosses BBB @ level 20--> asepsis (w/o infection), meningitis and encephalitis--> potentially lethal Opisthotonos position baby assumes when bilirubin is in the brain. Hyperextended (heels literally touching their ears) d/t to irritation w/meninges and bilirubin. RN Intervention: Place the child on the side (laterally)

Creatine (Cr)

Best indicator of kidney function Normal: 0.6-1.2 Elevated= Level A Do nothing unless they have a dye test the next day

WBC KEY TERMINOLOGY

HIGH WBC COUNT-LEUKOCYTOSIS LOW WBC COUNT: LEUKOPENIA NEUTROPENIA AGRANULOCYTOSIS (IN SEVERAL PSYCH RXS!!!!!) IMMUNOSUPPRESSION BONE MARROW SUPPRESSION

KNOW THE 5 D'S WHICH ARE THE MOST DANGEROUS!!!!

K+ ≥ 6 PH 6 & <6 CO2 60S AND UP PO2 60S AND DOWN PLT COUNT <40K ALWAYS ASSESS FIRST. CALL RRT WHEN SYMPTOMATIC AND ASAP!!!! D's, 6's, & 40 You cannot afford to not know the D's b/c this is a safety test!!!!

CD4 COUNT (TCELLS)

LEVEL C <200= AIDS 1. IMPLEMENT NEUTROPENIC PRECAUTIONS

ABSOLUTE NEUTROPHIL COUNT (ANC)

LEVEL C <500 1. IMPLEMENT NEUTROPENIC PRECAUTIONS

RULES

LEVELS: D>C>B>A FOR LEVEL D: "DO SOMETHING NOW!!!!" DEADLY AND DANGEROUS!!!!! FOR LEVEL C: "DO SOMETHING" 1. HOLD (IF THERE IS SOMETHING TO HOLD) 2. ASSESS 3. PREPARE 4. CALL PHYSICIAN LEVEL B: "BE CONCERNED" 1. ASSESS 2. MONITOR LEVEL A: ABNORMAL DO NOTHING. YOU CAN LITERALLY WAIT UNTIL THE NEXT SHIFT AND THE PATIENT WILL BE FINE !!! KEY RULE: ASSESS BEFORE YOU DO UNLESS "DOING (THE RN INTERVENTION)" PLACES THE PATIENT AT RISK IF YOU'RE STUCK BETWEEN 2 "DO'S (RN INTERVENTIONS)" POSITION THE PT FIRST UNLESS IT IS ASKING FOR THE BEST ACTION. THIS RULE ONLY APPLIES TO WHAT YOU DO FIRST!!!!! EXAMPLE: IN A "FIRST" QUESTION YOU REPOSITION THE PATIENT. IN A "BEST" Q YOU ADMINISTER O2. **MEMORIZE THE C's and D's.**

BNP

NORMAL <100 ELEVATED= LEVEL B GOOD INDICATOR OF CHF 1. MONITOR 2. ASSESS FOR CHF ****NOTE THIS IS A CHRONIC DISEASE THUS IT WILL NEVER TAKE PRECEDENCE OVER OTHER LAB VALUES.

Potassium (K+)

NORMAL: 3.5-5.3 mEq/L LEVEL C: 5.4-5.9 (HYPERKALEMIA) HIGH BUT STILL IN THE 5S 1. HOLD THE K+ 2. ASSESS THE HEART (MAY INCLUDE EKG WHICH AID CAN DO) 3. PREPARE KAYEXALATE (K-EXIT-LATE) AND D5W WITH REGULAR INSULIN 4. CALL THE PHYSICIAN LEVEL C: (HYPOKALEMIA) 1. ASSESS THE HEART 2. PREPARE TO GIVE K+ 3. CALL THE PHYSICIAN LEVEL D: ≥ 6 CARDIAC DANGER ZONE DO STEPS SIMULTANEOUSLY NEED HELP ONCE LEVELS HIT A 6; IF CARDIAC ASYMPTOTIC CALL RAPID RESPONSE TEAM!!!!!

P02

NORMAL: 78-100 LEVEL C-LOW 70-77 RESPIRATORY INSUFFICIENCY 1. ASSESS RESPIRATORY STATUS 2. GIVE O2 LEVEL D-DANGEROUS <60s RESPIRATORY FAILURE 1. ASSESS RESPIRATORY STATUS 2. PREPARE TO INTUBATE AND VENTILATE 3. CALL DR 4. CALL RT

O2 SAT

NORMAL: 93-100 LEVEL C: <93 1. ASSESS RR 2. GIVE O2

HGB (HEMOGLOBIN)

Normal: 12-18 LEVEL B-8-11: 1. Monitor 2. Assess for bleeding LEVEL C <8: 1. ASSESS FOR BLEEDING 2. (MAY TRANSFUSE AT 8) 3. CALL DR

HCO3 (BICARBONATE)

Normal: 22-26 mEq/L ABNORMAL=LEVEL A JUST MONITOR

CO2

Normal: 35-45 mEq/L IN THE 50S (LEVEL C) 1. ASSESS RESPIRATORY STATUS 2. HAVE THE PATIENT DO PURSED-LIP BREATHING (LIKE BLOWING A CANDLE) IN THE 60S (LEVEL D)- RESPIRATORY FAILURE: YOU'RE REALLY CHECKING TO SEE IF THEY ARE DEAD AT THIS POINT 1. ASSESS RESPIRATORY STATUS; IF SYMPTOMATIC CALL RRT 2. DO PURSED-LIP BREATHING (MORE FOR COMFORT) 3. PREPARE TO VENTILATE AND INTUBATE 4. CALL DR!!!! 5. CALL RT (RESPIRATORY THERAPIST)

HCT (HEMATOCRIT)

Normal: 36-54 (THIS 3X HGB (12-18)) ABNORMAL=B 1. MONITOR 2. ASSESS FOR BLEEDING

RBCS

Normal: 4-6 million ABNORMAL=LEVEL B 1. MONITOR 2. CHECK FOR BLEEDING

PH

Normal: 7.35-7.45 K+ can increase which can stop the heart Low pH in the 6's=D (SEVERE ACIDOSIS) 1. IMMEDIATELY ASSESS THE VITAL SIGNS 2. CALL DOCTOR IF V/S IS BAD, ALSO CALL RRT

BUN (BLOOD UREA NITROGEN)

Normal: 8-30 ELEVATED-LEVEL B CHECK FOR DEHYDRATION (THAT IS REALLY ALL YOU CAN DO) This most likely will not take priority.

Aminophyline /theophylline (xanthine) IV bronchodilator

Relieves spasms in the airway. Muscle spasm relaxer Therapeutic level: 10-20 Toxicity: ≥20

Phenotyoin

Seizures Therapeutic level: 10-20 Toxicity: ≥20

Lithium

Therapeutic Level: 1-2 Toxic: ≥2 Bipolar, Mania RN Interventions: Fluids, monitor Na, Electrolytes (trying to decrease dehydration/hypernatremia) Expected S/S (3P's): Peeing, Pooping, Paresthesia (numbness & tingling) Adverse effects: tremors, metallic taste, severe diarrhea 1. Hold 2. Notify provider

INR (international normalized ratio)

Therapeutic level: 2-3 LEVEL C ≥ 4 THE PATIENT COULD BLEED TO DEATH!!!!! PROCESS: 1. HOLD WARFARIN 2. ASSESS FOR BLEEDING 3. PREPARE TO ADMINISTER VITAMIN K 4. CALL PHYSICIAN

DRUG TOXICITY

Think in "2's"

PLATELETS (THROMBOCYTOPENIC PROTOCOL)

WIDE RANGE 150K-400K LEVEL C: <90K 1. ASSESS FOR BLEEDING 2. BLEEDING PRECAUTIONS 3. CALL DR LEVEL D: <40K ****COULD SPONTANEOUSLY BLEED TO DEATH!!!! 1. ASSESS FOR BLEEDING 2. BLEEDING PRECAUTIONS 3. PREPARE FOR TRANSFUSION 4. CALL DR

digitalis (Lanoxin) digoxin

cardiac glycoside can build up to toxic levels s/s anexoria, nausea, vomiting, diarrhea, headache, fatigue therapeutic level: 1-2 Toxicity: ≥2 Antidote: Digibond