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Interpretation of Laboratory Tests

Interpretation of Laboratory Tests. An Overview for Nurses in LTC. Topics Covered. BMP/CMP CBC Coagulation Studies Urinalysis. BMP/Chem-7: Sodium Chloride Potassium CO2/Bicarbonate BUN Creatinine Glucose. CMP/Chem-12: Same as BMP plus: AST ALT Albumin Bilirubin

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Interpretation of Laboratory Tests

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  1. Interpretation of Laboratory Tests An Overview for Nurses in LTC

  2. Topics Covered • BMP/CMP • CBC • Coagulation Studies • Urinalysis

  3. BMP/Chem-7: Sodium Chloride Potassium CO2/Bicarbonate BUN Creatinine Glucose CMP/Chem-12: Same as BMP plus: AST ALT Albumin Bilirubin Alkaline Phosphatase BMP vs. CMP

  4. Sodium (Na) • Normally 125-145 mmol/l • Collect in red top tube • Increased: Diabetes inspidius, exessive sweating, Cushing’s syndrome • Decreased: Excess body water (CHF, renal failure, small cell lung cancer, brain disorders), hypothyroidism, vomiting, diarrhea, pancreatitis

  5. Chloride (Cl) • Normally 97-107 mEq/L • Collect in tiger top tube • Increased: Diarrhea, hyperalimentation • Decreased: Vomiting, renal disease, diabetic ketoacidosis

  6. Potassium (K) • Normally 3.5-5 mEq/L • Collect in red or tiger top tube • Hemolysis may falsely elevate level • Increased: Renal failure, Addison’s disease, dehydration, ACE inhibitors, Spironolactone • Decreased: Diuretics, NG suctioning, vomiting, diarrhea, metabolic alkalosis

  7. Carbon Dixoide (CO2) • Normally 23-29 mmol/L • Collect in tiger tube top; don’t expose to air • CO2 excreted into blood as bicarbonate • Increased: COPD, severe vomiting • Decreased: Starvation, diabetic ketoacidosis, diarrhea, dehydration

  8. Blood Urea Nitrogen • Normally 5-20 mg/dl • Collect in tiger top tube • Increased: Renal failure, CHF, aminoglycosides • Decreased: Starvation, liver failure • BUN:Creatinine >20 suggests dehydration • BUN:Creatinine >30 suggests GI bleed

  9. Creatinine • Normally <1.1 mg/dl • Collect in tiger or red top tube • Measures blood flow through kidneys • Increased: Renal failure, false positive seen in diabetic ketoacidosis • Decreased: Muscle wasting, liver disease

  10. Glucose • Normally 80-140 mg/dl • Collect in red or tiger top tube • Slight increase normal with aging • Increased: DM, Cushing’s syndrome, pancreatitis, thiazide diuretics • Decreased: Liver disease, malnutrition, sepsis, endocrine tumors

  11. Aspartate Aminotransferase: Normally 7-42 IU/L Increased: Liver disease, muscle trauma, burns Decreased: Vitamin B6 deficiency, dialysis AST>ALT in alcoholic hepatitis Alanine Aminotransferase: Normally 1-45 IU/L Increased: Liver disease, billary obstruction ALT>AST in viral hepatitis AST/ALT

  12. Albumin • Normally 3.5-5 g/dl • Collect in tiger top tube • Best lab test for measuring protein • Decreased: Malnutrition, nephrotic syndrome, alcoholic cirrhosis, inflammatory bowel disease, metastatic cancer, leukemia, Hodgkin’s disease

  13. Bilirubin • Normally 0.3-1 mg/dl • Collect in tiger top tube • Increased: Liver damage, hemolysis, billary obstruction

  14. Alkaline Phosphatase • Normally 25-160 IU/L • Collect in tiger top tube • Increased: Liver disease, billary obstruction, bone tumors, healing fracture, hyperparathyroidism, hyperthyroidism • Decreased: Malnutrition, excessive vitamin D intake, pernicious anemia, zinc deficiency

  15. Complete Blood Count • WBC, H&H, Platelets most important • Collect in purple top tube • Capillary sample will decrease hematocrit • Platelets normally 150,000-450,000 uL

  16. White Blood Count • Normally 4500-11,000 • Differential provides more clues to cause than overall count does • Increased: Infection, inflammation, leukemia • Decreased: Bone marrow failure, vitamin B12 deficiency

  17. Cause of Increased Differentials • Basophils: Leukemia, s/p spleenectomy • Eosnophils: Allergies, asthma, parasites • Lymphocytes: Viral infections, leukemia • Monocytes: Bacterial infections, protozoan infections, ulcerative colitis • Neutophils: Bacterial infection, noninfectious tissue damage, metabolic disorders

  18. H & H • Hematocrit: ~40-50% (lower in women, higher in men) • The percentage of blood that is RBCs • Decreased with anemia and blood loss • Hemoglobin: ~12-16 g/dl (lower in women, higher in men) • Does not acurately reflect acute bleeding because plasma and RBC lost at same rate

  19. Coagulation Studies • Collect in blue top tube • PT: 11.5-13.5 second • INR: 0.8-1.4 • Higher with mechanical heart valves or history of thromboembolitic disease or atrial fibrillation • INR is now the standard measure reported

  20. Causes of Positive Values on UA • Bilirubin: Jaundice, hepatitis, fecal contamination of sample • Blood: Stones, BPH, infection, Foley cath • Glucose: DM, pancreatitis, steroids • Ketones: Starvation, high fat diet, diabetic ketoacidosis, vomiting, diarrhea, asprin overdose

  21. Causes of Positive Values on UA • Leukoesterase: UTI • Leukoesterase plus nitrates: 75% of UTI • Neither LE or nitrates: 92% not UTI • Protein: Renal failure, CHF

  22. Questions? This presentation has been made possible by an educational grant from Parragon Healthcare Group

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