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28 Cards in this Set

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RBC
4.5 - 5.9
Erythropoietin : stimulates production of RBCs by the bone marrow.
Lifespan of 120 days
Hgb
12 - 17
iron and protien
measure disorder response to tx
Hct
36 - 51
whole blood
amount of space it occupies RBC
helpful in the degree of blood loss
Plt
150, 000 - 450, 000 cells/ml
Critical Levels <50,000 and >1,000,000

Produce by the bone marrow
Function : Control bleeding
 Thrombocytosis (risk for thrombosis)
 Thrombocytopenia (risk of spontaneous bleeding)
WBC
4.3 - 10.8 x 109/L
Infection-Fighting System
Monitor bone marrow response to cancer treatment
“Differentials”
Erythrocyte Sedimentation Rate (ESR)
RBCs settle in saline or plasma.
larger -- fall faster than normal and visa versa
Increase indicates inflammatory process or neoplastic condition
Decreased value blood deficiency
Activated Partial Thromboplastin Time (APTT)
Reference range: 24 - 35 seconds
Therapeutic Range: 1.5 - 2.5 X normal value
Critical Range: APTT > 70 seconds
seconds needed for a clot to form
PTT reflects serum heparin at the moment the sample is taken(Heparin activity varies from moment to moment)
Protamine Sulfate- antidote to heparin
Prothrombin Time (PT)
Reference Range: 10 - 14 seconds
Therapeutic Range: 1.5 - 2.5 X the normal
Critical Values: >20 seconds

time it takes blood to clot

oral anticoagulant therapy- Coumadin (range monitored through INR)

NSAIDs, Aspirin and other anti-platelet agents can affect PT level

Vitamin K- Reduces the anticoagulation effect
International Normalized Ratio (INR)
Range: 1.00 - 1.30
Critical value: > 4.0 - 5.0

Oral anticoagulant only
measure the clotting time
INR level needs to be monitored for clients on coumadin for: Deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI) & mitral valve disease
Serum Proteins
Albumin: 4 - 6 g/L.
Prealbumin: 15.0 - 35.0 mg/dL

Total serum protein manufacture in the liver
osmotic pressure (electrolytes transport)
Prealbumin *(Nutritional assessment)
Increase albumin usually indicates Dehydration
Decrease value causes fluid shifts that result in edema.
Creatinine Phosphokinase (CPK)
CPK-II (MB) Heart Muscle ( 0 - 6% )

Remains elevated
12-48* Returns to normal
Troponins
Cardiac troponin T: <0.2mcg/L
Cardiac troponin I: <0.03mcg/L
Value > 1.5 ng/ml- Dx. Myocardial Infarction

Protein - helps to regulate cardiac contractility
Troponin I (specific to cardiac muscle injury)
Enzymes  earlier, remains  longer than CPK
Uric Acid
Range: 2.8 – 8.5 mg/dl
Critical levels: >12mg/dl
End product of purine metabolism
renal failure
Chemotherapy or radiation causes elevation
Gout: disease associated with consistently high serum uric acid levels ( more common in men)
Tx: allopurinol prevents elevation
Calcium ( Ca+ )
8.5 - 10.5 mg/dl

Controlled & regulated by parathyroid & calcitonin hormones
Increase in PTH causes an increase in Calcium
Calcium & phosphorous have an inverse relationship
Hypocalcemia
< 8.5mg/dl
Cause
Hypoparathyroidism
Low albumin
Prolonged IV fluid therapy
Diuretics
Malnutrition

Signs/Symptoms
Diarrhea
Cardiac changes
Trousseau’s & Chvostek’s signs

Intervention
Oral calcium supplements ( Taken with Vitamin D)
Hypercalcemia
>10.5mg/dl
Cause
Hyperparathyroidism
Dehydration
Immobilization

Signs & Symptoms
Cardiac dysrhythmias
Constipation
Renal calculi
Hypercoagulation
Phosphorus ( HPO4- )
2.5 - 4.5 mg/dL
Inverse relationship between phosphorus & calcium
increased PTH = increase calcium will result in decrease phosphorus (increase excretion of phosphorus by the kidney)
Hyperphosphatemia
>4.5 mg/dl
Cause
Hypoparathyroidism
*Renal failure
Hypovolemia
Dehydration

Signs/Symptoms
Cardiac irregularities
Hyperreflexia
Oliguria

Interventions
Insulin binds phosphorus
Dialysis
Check pt’s EKG for changes (hypocalcemia)
Monitor BUN & Creatinine levels
Magnesium Mg+
1.5 - 2.5 mg/dL

Essential for neuromuscular function
Used to monitor patients with cardiac disorders
Change will affect other serum ions
Hypermagnesemia
Cause
*Renal failure
Excessive antacids use (MOM) magnesium

Signs/Symptoms
Lethargy/Drowsiness
Diminished or absent deep-tendon reflexes
Bradycardia
Hypotension
Dysrhythmias
Cardiac arrest in severe state
Thirst

Interventions
Loop diuretics
Calcium supplements
Hypomagnesemia
Cause

Hemodialysis
Malabsorption/ malnutrition

Signs/Symptoms

Hyperactive deep tendon reflexes
Seizures
Anorexia & arrhythmias

Interventions

Monitor for EKG changes and monitor K+ & Ca++ (Hypo states)
Blood Urea Nitrogen (BUN)
10 - 20 mg / dL
Elevated BUN ( kidney damage, increased protein intake, dehydration
Decreased BUN ( liver failure, decreased protein, )
Creatinine (Cr+)
0.5 - 1.5 mg / dL
Evaluate renal dysfunction
Increased ( renal damage, nephrotoxic drugs, etc.
Decreased (muscle atrophy)
Glucose
60 - 120 mg / dL
Critical Value: <60 or >400).
Diagnose diabetes mellitus (DM)
Hypoglycemia(<60)
Insulin shock (excess insulin)
Confusion
Hunger
Cool moist skin (clammy skin)
Vision disturbance
Coma
Indicate the need for orange juice, sugar, milk,candy or food (if client is awake) or I.V. bolus of 50% dextrose (if client is unconscious)
Hyperglycemia(>140)
Hyperglycemia(>140)
Insulin deficiency/resistance
Polyuria(Increase urination)
Polydipsia(increase thirst)
Polyphagia(increase appetite)
Weight loss
Lethargy
Indicate need to determine the client’s glucose level and give insulin
Insulin Sliding Scale
Regular Insulin control glucose
Rise: 10mins
Peaks: 30mins-45mins
Returns to balance: 90mins

BS < 60 give OJ and call MD
BS > 400 give 12 units and call MD
HgbA1c (Glycosylated Hemoglobin Assay)
4 - 6% (no diabetes)
2.5 - 6% (controlled diabetes)
>8 (uncontrolled diabetes)
Monitor diabetic pt.
Prolonged blood glucose elevation