Interpreting Lab Values
10-20 mg/dL
normal BUN
0.5-1.2 mg/dL
normal creatinine
37-52%
normal hematocrit
12-18 g/dL
normal hemoglobin
150,000-400,000/mm3
normal platelet count
5,000-10,000/mm3
normal white blood cell count (WBC)
normal phosphate levels
3.0-4.5 mg/dL
MCV
mean corpuscular volume
Patient on Warfarin has a PT of 18 seconds, control is 10 seconds. Is this considered normal?
yes -10 x 1.5 = 15 seconds -10 x 2 = 20 seconds
increased BUN and creatinine
Renal failure
normal urine specific gravity
1.010-1.025
A HPC prescribes two units of blood for a client. Which nursing interventions are necessary before the blood transfusion is adm? Select all that apply
A. Obtain clients vital signs B. Monitor hgb and hct levels C. Allow the blood to reach room temp D. Determine typing and crossmatching of blood E. Use a Y- type infusion set to initiate 0.9% normal saline Answer: A,D,E
Serum Osmolality (normal range)
275-295 mOsm/kg
The laboratory report establishes that the pt has a warfarin overdose. Which anecdote would the nurse anticipate adm?
A. Physostigmine B. Vitamin K C. Iron dextran D. Protamine sulfate Answer: B.
Serum Potassium levels
3.5-5.0 mEq/L
Normal glucose levels
70-110 mg/dL
Normal calcium levels
9-10.5 mg/dL
Red Blood Cell indices
Helps with classification of anemias and their causes
Has a short half life, therapeutic effect within 2-4hrs
Heparin
Renal disease, nephrotoxic drugs, hypovolemia/ dehydration, excessive protein ingestion
Increased BUN levels
30-40 seconds pt receiving heparin- 1.5-2.5x control value Average therapeutic value: 50-100 seconds
Normal activated partial thromboplastin time (APTT)
4.2-6.1 million/mm3
RBC count for adults
Decrease risk of clot formation is the goal of?
Warfarin
Long half life, takes while to reach therapeutic effect and return to normal range when stopped
Warfarin
renal disorders, rhabdomyolysis
increased creatinine levels
MCH
mean corpuscular hemoglobin
muscular dystrophy
decreased creatinine levels
Monocytes
-phagocytic -4-8% -fighting bacteria
WBC count and differential
-neutrophils, eosinophils, basophils, lymphocytes, monocytes -measures % of each leukocyte -increase of one means a decrease of another
CBC (complete blood count)
-hemoglobin -WBC -RBC -hematocrit
Interfering factors of aPTT
-hemophilia -liver disease
International Normalized Ratio (INR)
-Normal 1, Warfarin 2-4 reported with PT -no units
Red Cell Count (RBC)
-count number of circulating rbc -produce bone marrow -altered by same conditions that rise and lower Hb and Hct
Causes shortened PT times
-diet high in leafy greens -Vitamin K -birth control
Platelet count
-essential for blood clotting -thrombocytosis: malignant disorders, inflammation -thrombocytopenia: hemorrhage, leukemia, chemo
extrinsic pathway
-factors released by damaged tissues begin cascade -PT -INR
white blood cell count
-main line of defense -arise from bone marrow -increased value indicates: infection, inflammation, tissue injury/ death, malignancies -decreased value indicates: bone marrow depression, chemo, overwhelming infection, autoimmune disease
blood urea nitrogen (BUN)
-measurement of urea levels in blood -directly related to metabolic function of liver and excretory function of kidneys
Neutrophils
-phagocytosis -50-70% -acute bacterial infection -trauma
Hematocrit (Hct)
-reflects RBC compared to total blood volume -spun down in centrifuge -increased levels indicate: dehydration, burns -decrease levels indicated: anemia, hemorrhage -Hct usually 3x the Hb value
Hemoglobin (Hb)
-reflects number of RBC in peripheral blood -Hgb transports oxygen and carbon dioxide -increased levels indicate: dehydration, burns -decreased levels indicate: anemia, hemorrhage
"Racoon eyes" or periorbital ecchymoses are associated with ____
-spontaneous hemorrhage -platelet count falls below 20,000/mm3
When a staff nurse is instructed by the charge nurse to adm a scheduled dose of warfarin to a pt whose INR is 6, which action should the staff nurse take first?
A. Refuse to adm unsafe dose of warfarin B. Remind charge nurse of INR result C. Ask hospital pharmacist to talk to charge nurse D. Ask HCP whether to adm the medication Answer: B
liver failure, over hydration, malnutrition
Decreased BUN levels
intrinsic pathway
-cascade of clotting factors leading to the formation of a clot within an injured vessel -APTT
Creatinine
-catabolic product of creatinine phosphate -directly proportional to renal excretory function
Eosinophils
-0-4% -allergic reaction
Activated partial thromboplastin time (aPTT)
- Intrinsic path - Used to monitor and reach therapeutic levels when a patient is on heparin
Prothrombin Time (PT)
-11 - 12 sec (warfarin) -extrinsic system -when I, II, V, VII, X are deficient: bleeding prolonged
Basophils
-<2% -allergic reaction
Lymphocytes
-T and B cells -20-40% -chronic bacterial infection -acute viral infection
Causes prolonged PT times
-alcohol -sulfamides -allopurinol -antibiotics
Antifactor Xa
-what levels have been used to replace aPTT at some facilities -affected by amount of heparin in body -low molecular weight TR: 0.5-1 (lovenox) -unfractured TR: 0.3-0.7 (heparin)
Normal magnesium levels
1.8-2.6 mEq/L
Normal AST levels
10-30 units/L
Normal ALT levels
10-40 units/L
Normal sodium levels
135-145 mEq/L
Which medication is often contraindicated when taking warfarin?
A. Atenolol B. Ferrous sulfate C. Chlorpromazine D. Acetylsalicylic acid Answer: D
When a pt is admitted with thrombocytopenia , which nursing actions would be included in the plan of care? Select all that apply
A. Avoid IM injections B. Institute neutropenic precautions C. Monitor WBC count D. Adm prescribed anticoagulants E. Examine the skin for ecchymotic areas Answer: A,E
A CBC, urinalysis, and x-ray examination of the chest are prescribed for pt before surgery. The pt asks why these test are done. What is the best response for the nurse?
A. "Don't worry; these test are routine." B. "They are done to identify other health risks." C. "They determine wether surgery will be safe." D. "I don't know; your healthcare provider prescribed them" Answer: B
Which is the first sign that would assist the nurse in suspecting MH in a pt?
A. Abnormal rapid heart rate B. Abnormal rapid breathing C. Increased body temperature D. Increased expired carbon dioxide Answer: D
The outpatient surgery nurse reviews the CBC count results for a patient who is scheduled for surgery. The results are WBD count 10.2, Hgb 15 g/dL, Hct 45%, platelets 150,000. Which action should the nurse take?
A. Continue to prepare pt for procedure B. notify surgeon/ anesthesiologist immediately C. Ask the pt about symptoms of recent infection D. Discuss possible blood transfusion with pt Answer: A
The RN delegates the care of a client in the immediate postoperative period to a PCA. Which task are within the scope of a PCA? Select all that apply
A. Feeding B. Ambulating the pt for the first time C. Monitoring the vitals D. Assisting client with bathing E. Teaching leg exercises to pt Answer: A, D
A pt who takes diuretic and beta blocker to control bp is scheduled for a breast reconstruction surgery. Which pt information is most important to communicate to the HCP before surgery?
A. Hct 40% B. Serum potassium 3.2 mEq/ L C. Bp 144/82 D. PR 54-58 bpm Answer: B
When a client with a venous thrombosis is receiving warfarin, which test result would the nurse use to determine whether the daily dose of warfarin is therapeutic?
A. INR B. aPTT C. bleeding time D. sedimentation rate Answer: A
Which condition may be present in a pt with a neutrophil count of 12,000/mm3?
A. Influenza B. Pneumonia C. Immunosuppression D. Autoimmune disorder Answer: B
A pt develops thrombophlebitis in the right calf. Bedrest is prescribes and IV infusion of heparin is initiated. Which drug action will the nurse include when describing the purpose of this medication to the pt?
A. It prevents the extension of the clot B. It reduces the size of the thrombus C. It dissolves the blood clot in the vein D. It facilitates the absorption of RBC Answer: A
A pt admitted to the hospital with a diagnosis of DVT and IV heparin sodium is prescribed. If pt experiences excessive bleeding, the nurse will prepare to adm which medication?
A. Vitamin K B. Oprelvekin C. Warfarin sodium D. Protamine sulfate Answer: D
Using heparin allows levels anticoagulation to reach therapeutic range with warfarin by measuring the INR/PT or allowing the INR/PT of therapeutic range to drop back to normal in order to have a procedure.
Heparin Bridging
MCHC
mean corpuscular hemoglobin concentration
Why use heparin bridging?
prevention of recurrent blood clots, stroke, and heart valve issues
RDW
red cell distribution width
Normal albumin levels
3.4 - 5 g/L
A client is hospitalized with dehydration and dysphagia. Which tasks are appropriate to delegate to LPN? Select all that apply
A. Adm medications B. Performing initial swallow screen C. Assisting UAP with ambulation D. Completing adm skin assessment E. Record vital signs in electronic health record Answer: A,C,E
Warfarin is prescribed for a pt who has been receiving IV heparin for a partial occlusion of the left common carotid artery. The client expresses concern about why both medications are needed at the same time. Which rationale would the nurse include to address the pt concern?
A. This allows for smaller doses of both medications B. Giving both medications allows clot dissolution while preventing new clot formation C. Heparin provides anticoagulant effects until warfarin reaches therapeutic level D. Adm of heparin with warfarin provides immediate and maximum protection from clot formation Answer: C
A nurse reviews the laboratory data for an older adult. The nurse would be most concerned about which finding?
A. WBC count of 2800 B. Hct of 35% C. Platelet count of 400,000 D. Hgb 11.8 g/dL Answer: A
Which client would most benefit from adm of prophylactic antibiotics? Select all that apply
A. chickenpox infection B. fever of unknown origin C. preoperative hip replacement D. Congenital bicuspid aortic valve E. Current chemotherapy treatment Answer: C,D,E
The INR results for a pt on warfarin have been variable. Which factor can help the nurse identify the cause of INR fluctuations?
A. intake of foods high in potassium B. serum glucose levels C. Platelet count D. Adherence to prescribed medication regimen Answer: D
The nurse is caring for a pt on bedrest. Which nursing intervention would prevent a pulmonary embolus?
A. limit clients fluid intake B. Teach the pt how to exercise the legs C. Encourage use of incentive spirometer D. Maintain the knee gatch position at an angle Answer: B
A pt with continuous IV heparin drip is prescribed IV vancomycin every 12 hrs. Which action will the nurse take when it is time to adm the vancomycin?
A. stop the heparin, flush the line with normal saline, and adm vancomycin B. Adm vancomycin into heparin line using an IV piggyback set C. Start a second IV line for the vancomycin and continue heparin as prescribed D. Hold the vancomycin and tell HCP that the medication is incompatible with heparin Answer: C
Increased BUN with normal creatinine
Dehydration
