Egan's 17
normal anion gap
8 to 14 mEq/L
What term is used to describe a red blood cell (RBC) count that is above normal values?
Polycythemia Polycythemia helps prevent the negative side effects of reduced PO2 in the blood by increasing the oxygen-carrying capacity of the blood.
What term is used to describe a white blood cell (WBC) count that is above normal values?
Leukocytosis
Blood products given thru transfusions
RBCS platelets plasma whole blood
What is the name used for mature neutrophils?
Segs known as segs because of the segmented shape of their nucleus.
Which of the following tests is used to evaluate renal function? a. Creatinine b. Protein level c. Serum enzymes d. Sweat chloride
a. Creatinine The most common tests performed to evaluate kidney function are blood urea nitrogen and creatinine.
Leukopenia
Abnormally low white blood cell count
What term is used to describe a result significantly outside the reference range that may represent a pathophysiologic condition?
Critical test value A critical test value is a result significantly outside the reference range and represents a pathophysiologic condition. A critical value may be potentially life threatening unless corrective action is taken promptly.
What term is used to describe a platelet count below normal?
Thrombocytopenia A significant reduction in the platelet count (known as thrombocytopenia) occurs with bone marrow diseases or with disseminated intravascular coagulation.
Your patient has an elevated aspartate aminotransferase (AST). What two organs are most likely diseased?
Heart and liver The highest concentrations of AST are found in patients with liver disease, such as hepatitis, and during the second day after a myocardial infarction.
What term is used to describe a chloride concentration that is below normal in the blood serum?
Hypochloremia
Which of the following Gram stain results suggests the most legitimate sputum sample in a patient with pneumonia? a. Many epithelial cells and many pus cells b. Few pus cells and many epithelial cells c. Few pus cells and few epithelial cells d. Few epithelial cells and many pus cells
d. Few epithelial cells and many pus cells In such cases, the Gram stain will demonstrate few (<25 per low-power field) or no pus cells and numerous epithelial cells.
What type of white blood cell increases in response to allergic reactions?
eosinophils
Factors to consider in patient-centered transfusion
hemoglobin level AND percent change in hemoglobin
normal serum lactate level
0.7 to 2.1 mEq/L
causes of leukopenia
1. Chemotherapy 2. Bone marrow disease 3. Radiation therapy Diseases of the bone marrow (e.g., leukemia, lymphoma) and chemotherapy and radiation therapy for cancer are common causes of leukopenia.
A patient is brought into the ER with chest pain. The physician is having difficulty confirming the patient's diagnosis through an ECG. Blood results show an elevated level of CPK-2. What can the physician suspect after reviewing the blood work?
Myocardial infarction The most common CPK enzyme test is CPK-2 (CPK-MB) which is released from the heart following myocardial infarction. Peak levels occur sometime between 12 and 24 hr following injury. Serial CPK-2 measurements are monitored in patients with suspected myocardial infarction, as well as patients with cardiac contusion from chest trauma, open-heart surgery, or myocarditis.
An ICU patient in septic shock shows the following electrolyte panel results: a serum Na+ of 150 mmol/L, a total CO2 of 18 mmol/L, lactate of 4 mmol/L, and a serum Cl- level of 110 mmol/L. The patient is hypotensive and the RT is unable to obtain an ABG for analysis. What conclusion(s) can be drawn regarding this patient's acid-base status?
- Metabolic acidosis is present. - Anion gap is increased. - Lactic acidosis is present. The anion gap is calculated by subtracting the sum of CO2 and Cl- from the Na+ (150 - [110 + 18]). In this case the anion gap is elevated (22 mmol/L) and is consistent with a metabolic acidosis. Normal anion gap is 8-14 mmol/L. The increased lactate values reveal the presence of lactic acidosis due to anaerobic metabolism as a cause of the metabolic acidosis in this patient. Normal lactate range is 0.7 to 2.1 mmol/L.
Sodium serum level
135-145 mEq/L
What term is used to describe a red blood cell (RBC) count that is below normal values?
Anemia An abnormally low RBC count is referred to as anemia and suggests that either RBC production by the bone marrow is inadequate or excessive loss of blood has occurred.
What is the name used for immature neutrophils?
Bands Immature neutrophils are known as bands due to the banded shape of the nucleus.
The total carbon dioxide (CO2) value is linked to what electrolyte in the blood serum?
Bicarbonate The total CO2 represents the level of HCO3 in venous blood.
What term is used to describe a potassium concentration that is below normal in the blood serum?
Hypokalemia normal is 3.5-5.0 mEq/L
An 80-year-old patient arrives in the emergency room complaining of difficulty breathing with signs of pulmonary edema. The clinician orders a B-type Natriuretic Peptide (BNP) test to be performed on the patient. The test result shows 800 pg/ml. What is the patient's possible condition?
Severe heart failure B-type Natriuretic Peptide (BNP) is a substance secreted by the heart in response to increased stretch in the cardiac muscle. The BNP test is used primarily to evaluate patients for heart failure, particularly those who present to the emergency department with dyspnea and pulmonary edema. In general, values greater than 300 pg/ml are indicative of mild heart failure whereas values in excess of 600 and 900 pg/ml are found in patients with moderate and severe heart failures, respectively.
In which of the following clinical settings would hypokalemia be a significant problem? a. During weaning from mechanical ventilation b. In a patient with pleural effusion c. In a patient with kyphoscoliosis d. During a bronchial challenge test
a. During weaning from mechanical ventilation The potassium level is of particular interest in the patient being weaned from mechanical ventilation, because both hyperkalemia and hypokalemia may render the diaphragm weak and less effective.
What test is useful for evaluating the blood-clotting ability of your patient?
Platelet count The complete blood cell count also reports the number of circulating platelets (thrombocytes), which are the smallest formed elements in the blood and are important for coagulation.
normal serum sodium level
135-145 mEq/L
What is the upper limit of normal for the fasting blood glucose level?
140 mg/dl
Normal platelet count
150,000-400,000/mm3
Length of stay (LOS) in patients with transfusion
2-2.5x more
Which of the following values represents a normal serum potassium level?
3.5 to 5.0 mEq/L
Potassium serum level
3.5-5.0 mEq/L
How long can you store blood?
42 days, w/o freezing you can freeze blood and store for 10 years.
blood transfusion and mortality meta-analysis
69% increase in mortality 88% increase in infections
glucose levels
70-110 mg/dL upper limit for fasting blood glucose: 140mg/dl
normal chloride levels
98 to 106 mEq/L
BNP normal range
<100 pg/mL The BNP test is used primarily to evaluate patients for heart failure, particularly those who present to the emergency department with dyspnea and pulmonary edema. In general, values greater than 300 pg/ml are indicative of mild heart failure whereas values in excess of 600 and 900 pg/ml are found in patients with moderate and severe heart failures, respectively.
An RT receives a doctor's order to perform an ABG on a 71-year-old woman. Upon reviewing the patient's chart, the RT notices that the patient has a platelet count of 110 ́ 10^3 mcl. What should the RT do?
After ABG is performed, compress the puncture site for a longer time. Recommend that an ABG should be performed on the patient only when it is absolutely necessary. In patients requiring arterial blood gas (ABG) testing, or who need nasotracheal suctioning, RTs must evaluate the clotting characteristics of the blood. For ABG testing, patients with an abnormally low platelet count, or an elevated PT and INR, will need to have the puncture site compressed for a longer time after the arterial sample is obtained to prevent bleeding and hematoma development. Patients with an extremely low platelet count should have an arterial puncture performed (or undergo nasotracheal suctioning) only when it is essential because of the extraordinary high risk of bleeding. Normal platelet count is 150 to 400 ́ 10^3 mcl.
Which of the following are formed elements in the blood? 1. Leukocytes 2. Erythrocytes 3. Thrombocytes 4. Electrolytes
Erythrocytes Thrombocytes Electrolytes The complete blood count (CBC) is routinely performed from a venous blood sample and examines the formed elements in the blood. It provides a detailed description of the number of circulating white blood cells (WBCs), called leukocytes, red blood cells (RBCs), called erythrocytes, and platelets, called thrombocytes.
A patient receiving heparin has a prothrombin time (PT) of 19 sec and an International Standardized Ratio (INR) of approximately 5.0, what does this indicate?
High likelihood of excessive bleeding. Prothrombin time (PT) is defined as the time in seconds required by plasma to form a fibrin clot following exposure to tissue factors. Clinically, abnormal increases in PT and PTT are found in patients with vitamin K deficiencies, and patients on anticoagulation therapy such as warfarin or heparin. PT is accompanied by an additional measurement known as the International Standardized Ratio (INR). The INR expresses PT relative to an established sample value. A normal INR value is 0.9 to 1.3. INR values of approximately 5.0 indicate a high likelihood for bleeding. Values of 0.5 are associated with a tendency toward increased clotting.
The mean cell hemoglobin concentration of your patient is reduced. What type of anemia is this?
Hypochromic Patients with an inadequate hemoglobin concentration will have red blood cells that are smaller than normal (microcytic) and lack normal color (hypochromic).
What term is used to describe a sodium concentration that is below normal in the blood serum?
Hyponatremia may occur with diuretic therapy, diarrhea, or certain kidney problems. normal: 135-145 mEq/L
What type of white blood cell increases in response to viral infections?
Lymphocytes
What is indicated by an elevation of the anion gap?
Metabolic acidosis and further evaluation of the patient's acid-base status is necessary.
What should be done in response to a sputum sample that has many epithelial cells in it?
Obtain new sputum sample. Many epithelial cells indicate that the sample is merely saliva and should be discarded because it will not reflect the type of infection occurring in the lung.