normal values & lab tests
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I & O Conversions
1 cup = 240 ml
1 tsp = 5 ml
1 tbs = 15 ml (3 tsp)
1 oz = 30 ml
1 gr = 60 ml
1 kg = 2.2 lbs
1 inch = 2.54 cm
Serum Electrolyte Normal Values
Magnesium 1.5 - 2.5
Phosphate 2.5 - 4.5
Potassium 3.5 - 5.0
Calcium 4.5-5.5 (ionized)
Calcium 8.5 10.5 (total)
Chloride 95 108
Sodium 135 - 154
Normal Blood Gases
pH 7.35 7.45
pCO2 35 45
HCO3 22 26
PO2 80 - 100
Osmolarity
270 320
320 = hypertonic (exits cells)
Normal Adult
Vital Signs
BP: 110-120/ 60-80 (140/90 = hypertension)
HR: 60 -100
RR: 12 20
Temp:
(axillary): 97.6
(oral): 98.6
(rectal): 99.6
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Normal Newborn
Vital Signs
BP: 65/41
HR: 120 160 (180 when crying)
RR: 30 - 60
Normal 1-4 Years
Vital Signs
BP: 90-100/ 60-65
HR: 80 140
RR: 20 - 40
Normal 5-12 Years
Vital Signs
BP: 100-110/ 55-60
HR: 70 115
RR: 15 - 25
Fluid Volume Excess
Symptoms: BP, HR (bounding pulse), Resp,
CVP, confusion, muscle weakness, distended neck
veins, peripheral edema, lung crackles, DECREASED
values, low specific gravity.
Causes: CHF, renal failure, burns, excessive Na+, live
cirrhosis.
Implementation: Diuretics, fluid restriction, ambulat
high flowlers, breath sounds
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Fluid Volume Deficit
Symptoms: BP (orthostatic hypotension), CVP,
rapid/weak pulse, Resp, HA, confusion, tachycard
dizziness, weakness, oliguria, poor turgor (cool &
moist), flat neck veins in dependent position,
INCREASED lab values, high specific gravity.
Causes: V/D, suctioning, diuretics, diabetes insipidus
diabetic ketoacidosis, third spacing, hemorrhage.
Implementation: Isotonic solution
*The higher the hematocrit and specific gravity, the
dryer they are high and dry.
SODIUM
*Main extracellular ion that regulates fluid balance.
Hypernatremia
*similar to fluid balance deficit
Symptoms: Hypotension, tachycardia, deep tendo
reflex, twitching, edema, oliguria, dillusions.
Causes: Fluid loss, increase Na+, renal failure,hypertonic fluids, diabetes insipidus, burns, fever,
Cushings syndrome (increased secretion of
aldosterone, which increases Na+ reabsorption).
Implementation:Hypotonic solution to shift Na+ int
cells, decrease sodium in diet.
Hyponatremia
Symptoms: BP, HR (thread pulse), deep tend
reflex, twitching, headache (ICP), confusion, musc
weakness.
Causes: V/D, tap enemas, excessive admin of dextroand water IVs, excessive water intake, NG suction,
diuretics, burns, renal disease, Addisons (decrease
secretion of aldosterone, which decreases Na+
reabsorption).
Implementation:Oral admin, water restriction. If
combined with fluid volume deficit, IV sodium chorid
is administered. If combined with fluid volume exces
osmotic diuretics given to excrete water rather than
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sodium.
*precipitates LITHIUM toxicity!!!
Diabetes Insipidus
(Decrease in ADH posterior pituitary)
Symptoms: Excessive UOP (inability to concentrate
urine, so it stays in blood), chronic severe dehydratio
excessive thirst, weakness, constipation, wt. loss.
Causes: head trauma, brain tumor, meningitis,
encephalitis (tumors that hypersecrete), high serum
sodium, low specific gravity and plasma osmolality
(water is not being reabsorbed into the plasma getting lost in urine).
Implementation: Administer Vasopressin (Pitressin)
causes venous constriction to preserve H2O loss.
Syndrome of Inappropriate Antidiuretic Hormone
Secretion (SIADH)
(Increase in ADH posterior pituitary)
Acts like hyponatremia: Onconologic Emergency (br
oncology patients suffer from this)
Symptoms: N/V, anorexia, tachycardia, HA, lethargy
change in LOC, in DTR, blood volume, UOP,
edema not seen (all water reabsorbed into plasmabloodstream)
Causes: tumors that hypersecrete (small cell carcino
of lung, brain tumors), head trauma, stroke,
meningitis, encephalitis, pneumonia, positive pressu
ventilation, plasma osmolality (concentration),
specific gravity (H2O not lost in urine, all being
reabsorbed), serum sodium (115-120).
Implementation: FIRST restrict H2O intake
(500ml/24hr), hypertonic saline (pull fluid out of celladminister demeclycline (Declomycin) side effect i
to induce diabetes insipidus
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POTASSIUM
Main intracellular ion. Involved in cardiac rhythm an
nerve transmission.
Hyperkalemia
Symptoms: BP, HR (weak, irregular), resp.
depression, twitches, weakness, parathesias, diarrhe
increased GI motility.
Causes: Renal failure, cellular destruction (burns,
trauma) diabetic ketoacidosis, hyperglycemia,
Addisons.
Implementation: Administer loop diuretics, Kayexala(diarrhea inducer), dialysis. In emergency: Calcium
gluconate, sodium bicarbonate, regular insulin &
dextrose (shifts K+ into cells).
ECG: Tall, peaked T waves; Flat P waves; widened QR
prolonged PR interval.
Hypokalemia
Symptoms: BP, HR (thready, irregular), shallow
respirations (failure), muscle weakness, confusion,
polyuria, GI mobility, dysrhythmias, DT hyporeflex
Causes: D/V, NG suction, diuretics or corticosteroids
diaphoresis, wounds, metabolic alkalosis, Cushings.
Implementation: Increase dietary intake, supplemen
IV (cant give >40mEq/L into periph IV or without
cardiac monitor)
ECG: ST depression, inverted/flat T wave, prominent
wave.
*Hypokalemia may precipitate Digitalis toxicity.
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Potassium Administration
Oral K+- (can cause nausea or vomiting, shouldnt be
taken on empty stomach).
IV K+ - infusion must be controlled. Liquid form K+ h
unpleasant taste.
Points about administering K+: Never given by IV pu
or IM or SQ route. Dilution of no more than 1 mEq/L
K+ to 10 ml of IV solution is recommended.
Recommended infusion rate = 5-10 mEq/Hr. ShouldNEVER exceed >20 mEq/Hr.
K+ infusion can cause phlebitis. Assess site frequent
CALCIUM
*Functions in bone formation, blood clotting, nerve
impulse transmission and contraction of myocardial
and skeletal muscle.
*Regulated by the parathyroid hormone (parathyroi
gland) & Vitamin D (also activated by the PTH).
*When serum phosphorus levels decrease, serum
calcium levels increase and vice versa. So
hypocalcemia acts like hyperphosphatemia.
Hypercalcemia
*Sedative effect on NS
Symptoms: Confusion, Muscle weakness, lack of
coordination, Depressed deep tendon reflexes,
Constipation, ECG Changes dysrhythmias, GI
Motility.
Causes: Hyperparathyroidism, Malignant neoplastic
disease, Immobility, Excessive intake of calciumcarbonate antacids.
Implementation: Foods low in calcium, high in
phosphorus. Fluids, Lasix, Calcitonin (to decrease Ca
level), Mobilize patient, Maintain acidic urine
ECG: Shortened ST segment, Widened T wave.
Hypocalcemia
*NS becomes excitable
Symptoms: BP, HR, Confusion, Tetany,
dysrhythmias, Seizures, Positive Trousseau andChvostek signs, Parathesia (tingling, numbness),
hyperactive DTR, anxiety, irritable, GI motility.
Causes: Hypoparathyroidism, Pancreatitis, Renal
Failure, Steroids & Loop diuretics, Post-thyroid surge
Malabsorption (Crohns), Immobility
Implementation: Foods high in calcium and low in
phosphorus. Calcium gluconate or calcium chloride
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(administer with OJ to maximize absorption). USE
CAUSIOUSLY with digitalis patients (b/c both are
cardiac depressants). Administer phosphate-binding
antacids = calcitrol, Vitamin D.
ECG: Prolonged ST and QT intervals.
MAGNESIUM
*Used as an index to determine metabolic activity a
renal function.
*Needed in blood clotting, regulates neuromuscular
activity, effects metabolism of calcium.
*Magnesium acts as a depressant. Think Deep Tend
Reflexes. It is a smooth muscle relaxant (diaphragmbladder)
Hypermagnesemia
Symptoms: Depresses the CNS, hypotension,
depresses cardiac impulse transmission, shallow
respirations, muscle weakness, absent DTR,
drowsiness, lethargy.
Causes: Renal failure, antacids or cathartics
(excellerates defication mag citrate, mag sulfate,
maalox).
Implementation: Administer calcium gluconate
ECG: Prolonged PR, widened QRS.
Hypomagnesemia
Symptoms: Tremors, tetany, (positive trousseaus an
chvostek) seizures, dysthythmias, confusion,
dysphagia, irritable, confusion.
Causes: V/D, alcoholism, GI suction, abuse of laxativ
Implementation: Dietary, IV mag sulfate
ECG: Tall T waves, depressed ST
*Low mag potentiates Digitalis toxicity.
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Addisons Disease
(Adrenal insufficiency = hyposecretion of adrenal
hormones (mineralcorticods: Aldosterone -regulates
the amounts of Na+ absorbed by the kidneys;
glucocorticoids, androgens)
SKINNY (hypoglycemic) = add hormones
Hyperkalemia, Hyponatremia
Symptoms: BP, wt. loss, weakness, orthostatic
hypotension, hyperpigmentation, alopecia.
Diagnosis: Na+ = dehydration, Blood volume =
shock, blood sugar = insulin shock, K+ = metaboacidosis & arrhythmias.
Implementation:High protein, carb, sodium and low
potassium diet. Hormone replacement.
Addisoninan Crisis
Symptoms: N/V, fever, abdominal pain, muscular
weakness, fatigue, severe hypoglycemia, hyperkalem
and dehydration. BP drops, leading to shock and
coma.
Interventions: Administer Hydrocortisone
Isotonic fluids, IV glucose, Kayexalate.
Cushings Disease
(Adrenal insufficiency (hypersecretion) =
Aldosterone (regulates the amounts of Na+
absorbed by the kidneys)
FAT (hyperglycemic)
Hypokalemia, Hypernatremia
Symptoms: BP, muscle wasting, cramps, edema,
purple skin striations, hirtuism, moon face, buffalo
hump, retain Na+ and fluid, immunosuppressed,
obesity (trunk), thin extremities with bruising, moodswings, female masculinization.
Diagnosis: Na+, blood volume (BP), blood
sugar = ketoacidosis, K+ = metabolic alkalosis.
Implementation: Hypophysectomy (removal of the
pituitary gland), adrenalectomy (removal of the
adrenal gland). High protein, potassium and Low
sodium diet. Low calaries, fluid restriction. Administ
aminoglutethimide and metyrapone to decrease
cortisol production.
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Red Blood Cells
Male: 4.5 6.2 million/mm3
Female: 4.0 5.5 million/ mm3
Child: 3.2 5.2 million/mm3
Platelets
Normal: 150,000 400,000
Low = thrombocytopenia (bleeding precautions)
WBC
Normal: 4,500 11,0000
Low = immune compromised
High = infection
Hemoglobin
Male: 14 18 g/dL
Female: 12 16 g/dL
Child: 11 12.5 g/dL
*Vehicle for transporting O2 and CO2. Determines
anemias.
Hematocrit
Male: 42 52%
Female: 35 47%
Child: 35 45%
*Represents RBC mass, identifies anemia or
polycythemia.
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Clotting Time
Normal: 8 15 minutes
Bleeding TimeNormal: 1.5 9.5 minutes
Prothrombin Time (PT)
Used to monitor response to Warfarin (Coumadin)
Control: 9.5 12 seconds
Warfarin should maintain the PT at 1.5 2 times the
control (14 24).
*If PT time > 30 seconds, initiate bleeding precautio
*Diets high in green leafy veggies can increase Vitam
K, which shortens the PT.
International Normalized Ratio (INR)
Used to monitor response to Warfarin (Coumadin)
Control: 1-3 for standard Warfarin therapy
2.54 for high-dose therapy (heart valves
Warfarin should maintain the PT at 1.5 2 times the
control (2 - 4).
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Partial Thromboplastin Time (PTT)
Used to monitor response to Heparin therapy
Lower Limit: 20 25 seconds
Upper Limit: 32- 40 seconds
Heparin should maintain the PTT 1.5 2.5 times the
control (30 90).
*If PTT> 90 seconds, initiate bleeding precautions.
Erythrocyte Sedimentation Rate
(ESR)
Male = < 15 mm /hr
Female < 50 yrs = < 25 mm/hr
Female > 50 yrs = < 30 mm/hr
*Tests acut/chronic infection, inflammation, neplasm
tissue necrosis, infarction.
Iron
Male: 65 175 mg/L
Female: 50 170 mg/L
*Iron found in Hg, acts as a carrier of O2 from lungs
tissue.
Total Cholesterol
< 160 mg/dL (No CAD, less than 2 risk factors)
< 130 mg/dL (No CAD, greater than 2 risk factors)
< 100 mg/dL (CAD present)
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Triglycerides
Normal: 100 200 mg/dL
Low Density Lipoproteins
(LDL)
Optimal 160
*you want to be LOW
High Density Lipoproteins
(HDL)
Males: 35 70 mg/dL
Females: 35 85 mg/dL
*you want your HDL to be HIGH
Glucose Tolerance Test
(GTT)
Fasting = 60-110 mg/dL
1 hr = 190
2 hr = 140
3 hr = 125
*140 200 = impaired
*>200 = diagnostic of diabetes
Glycosylated Hemoglobin (HbA1c)
*A reflection of how well BG levels have been
controlled for the past 3-4 months.
Poor control of diabetes = >8%
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Creatinine Kinase (CK)
Males: 50 235 U/L
Females: 50 250
Child: 0 - 70
*used to diagnose acute MI, can detect in 3 5 hour
Myoglobin
When > 90 = Diagnostic of an MI
Tropinin
Troponin I if > 1.5 = Diagnostic of an MI
Troponin T if > 0.2 = Diagnostic of an MI
Lactase Dehydrogenase
(LDH)
When LDH 1 > LDH 2 = diagnostic of an MI
Serum Creatinine
Adult: 0.7 1.4
Child: 0.4 1.2
Infant: 0.3 0.6
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Creatinine Clearance
24 hour collection
Normal: 1.67 2.5 ml/s
*tests how well creatinine is removed from your blo
by your kidneys.*Decreases with nephrotoxicity
Blood Urea Nitrogen
(BUN)
Normal = 8-20 mg/dL
*Tests renal function. Is affected by protein intake,
tissue breakdown and change in fluid volume.
*BUN/Creatinine ratio = 10:1 or 20:1
Specific GravityNormal: 1.010 1.030
*Increased levels indicate slowing of GFR.
Protein
Normal: 6-8 g/dL
*Regulates osmotic pressure and is major building
material for blood, skin, hair, nails and organs.
*Increased in Addisons, chronic infection, crohns
disease.
*Decreased in liver disease, burns, edema.
Albumin
Normal: 3.5 5.5 g/dL
*detects protein malnutrition
*presence in urine = abnormal renal fucntion
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Alkaline Phosphatase
Normal: 50 150 U/L
*level rises during periods of bone growth, liver
disease, and bile duct abstruction.
Serum Ammonia
Normal 10 40 mcg/dL
Elevated = liver dysfunction
Alanine Aminotransferase (ALT)
Normal: 4 6
Liver function test
Asparatate Aminotransferase (AST)Normal: 5 35
Liver function test
Amylase
Normal: 25 160 U/dL
*Diagnostic of pancreatitis and acute cholecystitis
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Gastric AspirateNormal is < 4.0
Hypothyroidism
(Myxedema puffy face)
TSH, T3,T4, basal metabolic rate.
FAT, COLD, DRY, SLOW
Symptoms: Decreased activity and HR, cold
intolerance, wt gain, constipation, alopecia, dry (
sweating), slowed physical and mental function,
sensitivity to narcotics (risk for resp depression).
Causes: inflammation of thyroid, thyroidectomy,pituitary deficiencies, iodine deficiency.
Implementation: Hormone replacement (Synthroid,
Levothyroid). Low calorie, high protein, high fiber di
*Myexedema coma causes: acute illness, surgery,
chemo, DC of meds
*Destruction of thyroid can be caused from
Hashimotos Disease where cells of immune system
attack T-cells and destroy tissue.
Hyperthyroidism
(Graves Disease)
TSH, T3,T4, basal metabolic rate.
SKINNY, HOT, HYPER
Symptoms: Heat intolerance, tachycardia, wt loss,
diarrhea, bulging eye, accelerated physical and ment
functions (hyperactive, diff. sleeping), fine/soft hair.
Implementation: antithyroid drugs (SSKI methimazo
proplthiouracil), surgery, irradiation.
*Thyroid Storm (post thyroidectomy): increased tem
and pulse, hypertension, abdominal pain, seizures.
Treatment = hypothermia blanket, O2, PTU (slows
down body).
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