Labs CBC WBC: 4-10k WBC: inc = infection, dec = sepsis, autoimmune Neutrophils: inc = Bacterial infection (Antibiotic, fluids, rest); dec = sepsis/cancer Lymphocytes: inc = Viral infection (Tylenol, fluids, rest); dec = autoimmune Eosinophils: inc = allergies, parasitic infection Basophils: inc = Chronic conditions (RA/UA), Allergies Monocytes: inc = Cancer, Leukemia; dec = repeated can be bone marrow RBC: 4-6mil RBC: inc = dehydration; dec = anemia HGB (Hemoglobin): 11-15 The # of RBC; inc = dehydration; dec = fluid retention HCT (Hematocrit): 36-48 The % of RBC; inc = dehydration; dec = fluid overload, bleeding, cancer Platelets: 150-450k Inc = anemia, inflammation; dec = sepsis, cirrhosis COAGS PT: 11-16 Seconds INR: Therapeutic Range: 2-3 PTT: 25-35 Seconds PT & INR: Important w/ Coumadin (Antidote: Vit K) INR: <2 = Thicker the blood (risk of clotting); >3 = Thinner the blood (risk of hemorrhage = HOLD COAG) PTT: Important w/ Heparin (Antidote: Protamine Sulfate) U/A PH: 5-8 Specific Gravity: 1.001-1.030 ↑ with dehydration Electrolytes Sodium (Na): 135-145 inc = elevated BP; dec = weak, N/V, muscle ache, AMS; seizures with both Magnesium (Mg): 1.6-2.4 (Remember 2) Controls Ventricle; inc = renal failure; ↓ = Torsade de Pointes (Fatal vent condition) Potassium (K): 3.5-5.0 (Antidote for high potassium = Kayexalate) Controls Electrical Activity of Heart; inc/dec = arrhythmias Calcium (Ca): 8.8-10 Controls Contractility of Heart or SA Node; inc = afib (Calcium Channel Blockers given); dec = arrhythmias Glucose: 70-99 (inc = 100-125 = PreDM, 126+ DM; dec = hypoglycemia) Note: steroids can cause false high HGB A1C: 4-6.5 ↑ # Indicated diabetes; 6 avg 120 BG/day over last 3 months Renal BUN (Blood Urea Nitrogen): 8-23 inc = dehydration, impaired kidney func, CHF; dec = malnutrition, liver disease GFR (Glomerular Filtration Rate): ↑90= Normal ↓60= Chronic Renal Disease ↓15= Acute Renal Failure Creatinine: 0.5-1.2 ↑2= No Contrast Dye given d/t kidney failure Cardiac Troponin: ↓0.01 Inc directly related to MI/cardiac injury; takes 4-6 hours to become elevated BNP: ↓500 Inc directly related to CHF, dialysis noncompliant Liver AST& ALT: 10-40 ↑ the # = the worse the liver function; AMS CRP: 0-5 ↑ The #= More inflammation Made in the liver and shows inflammation; >3 normal, inc = sepsis, predisposition for CAD Bilirubin: 0.3 - 1.9 inc = liver disease, blocked duct, causes jaundice AGB’s PH: 7.35-7.45 inc = alkalotic, dec = acidic Co2: 35-45 inc/dec= impaired gas exchange O2: 80-100 dec = impaired gas exchange HCO3 (Bicarb): 22-26 shows you metabolism vs renal issues Pancreas Amylase: 25-85 inc = pancreatitis r/t alcoholism primarily; cancer, stone blockage, ARDS Lipase: 13-60 inc = pancreatitis r/t alcoholism primarily; cancer, stone blockage, ARDS Albumin: 3.5-5 Overall Nutrition; inc = dehydration, dec = malnutrition Lactic Acid: 0.5-22 ↑4 = Sepsis=ICU Procalcitonin: 0-0.5, 0.5-2 localized infection, ↑2 = Sepsis or Severe Inflam (R/O: sepsis vs bact/viral infect) ESR (sed rate): 0-26 mm/hr shows infection, inflame, cancer, autoimmune dis Scales Braden: 15-20 ↓15= Risk for skin breakdown Morse: 0-24 ↑The #= more risk for fall Glasgow Coma Scale GCS: 3-15 (↓8 = intubate); Measures eye, motor and verbal responses Pressure Ulcer Staging 1: red, painful area that doesn’t blanche but no skin disruption yet 2: skin blisters, open sore, red and irritated around border 3: crater, may see fat layer/fascia 4: damage to muscle/bone/tendon/joints IV’s 14(orange) 16 18 20 22 24 Trauma Surgery Normal Normal Elderly Peds Rapid Blood Rapid Blood Routine Blood Routine Blood X X HTN Med Classes/Actions ACE Inhibitors (PRIL) = blocks angiotensin 1 from becoming angiotensin 2 which prev systemic and renal vasoconstriction and the release of aldosterone; first drug of choice d/t not elevating HR; “ace cough” and 1st dose syncope Calcium Channel Blockers (PINE) = relaxes arterial smooth muscle and dec HR; controls SA node/ “Pacemaker”; need: BP or Apical Pulse (hold: if HR under 60) Beta Blockers (OLOL) = dec cardiac workload, inc efficiency, vasodilation; need: apical pulse (hold: if HR under 60) Cardiac (Ejection Fraction AKA EF: 55+ normal, 40-55 dysfunction, 30-39 failure) PR=Atrial Depolarization QRS=Ventricle Depolarization SP=Ventricle Repolarization