Lab Values Podcast by NURSING.com (Nursing Podcast, normal lab values for nurses for NCLEX®) by NURSING.com (NRSNG): Recent Episodes
Jon Haws RN: Critical Care Nurse & NCLEX Educator
By Jon Haws RN: Critical Care Nurse NCLEX Educator
Quick . . . is the aPTT within normal range? Are you sweating a bit? Nervous? Head over to NURSING.com/freebies for our free cheat sheet covering the 63 most important lab values for nurses. This podcast covers one essential lab value for episode including normal ranges, nursing considerations, and background information. Normal lab values are hard to keep straight. This show includes the most common including: Creatinine, WBC, BUN, aPTT, blood gasses, and more. Welcome to the Nursing family! For full disclaimer information visit nursing.com.
Normal 135-145 mEq/L
Indications
- Monitor:
- Extracellular osmolality
- Electrolyte imbalance
Description Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body. Sodium plays a role in blood pressure regulation and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; water follows salt.
What would cause increased levels?
- Cushing Syndrome
- Hyperaldosteronism
- Dehydration
- Burn injury
- Azotemia (elevated nitrogen)
- Lactic acidosis (LA)
- Fever/excessive sweating
- Excessive IV fluids containing sodium
- Diabetes Insipidus
- Osmotic diuresis
What would cause decreased levels?
- Congestive Heart Failure (CHF)
- Syndrome of Inappropriate
- Antidiuretic Hormone (SIADH)
- Cystic Fibrosis
- Diuretic use
- Metabolic acidosis
- Addison’s Disease
- Nephrotic Syndrome
- Vomiting
- Diarrhea
- Ascites
- Excessive Antidiuretic
- Hormone(ADH)
- Liver failure
Normal 3.5 - 5.0 mEq/L
Indications
- Evaluate:
- Electrolyte imbalances
- Cardiac arrhythmias
- Monitor patients who are:
- Acidotic
- Receiving diuretic therapy
Description
Potassium (K+) is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen will enter the cell which will force potassium out of the cell. A 0.1 decrease in pH will cause a 0.5 increase in K+.
What would cause increased levels?
- Renal failure
- Hypoaldosteronism
- Addison’s disease
- Injury to tissues
- Diabetes Mellitus (DM)
- Ketoacidosis
- Hyperventilation
- Acidosis
- Infection
- Dehydration
- Burns
What would cause decreased levels?
- Hyperaldosteronism
- Excess insulin
- Alkalosis
- Diarrhea
- Vomiting
- Cystic Fibrosis
- Cushing Syndrome
Normal 25 - 35 seconds
Indications
- Detection of coagulation disorders
- Evaluate response to Heparin (PT for Coumadin)
- Preoperative assessment
Description
Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin.
What would cause increased levels?
- Disseminated Intravascular Coagulation (DIC)
- Clotting Factor Deficiencies:
- Hypofibrinogenemia
- Von Willebrand Disease
- Hemophilia
- Liver disease:
- Cirrhosis
- Vitamin K deficiency
- Polycythemia
- Dialysis
What would cause decreased levels?
- N/A
Normal
95 - 100%
Indications
- Determine respiratory status
- Part of Arterial Blood Gas (ABG) testing
Description
Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen. Oxygen is transported in the blood in two ways: oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin (SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved in plasma. SaO2 and pO2 have direct relationships, if one is decreased so is the other. The relationship between oxygen saturation (SaO2) and partial pressure
O2 (PaO2) is referred to as the oxyhemoglobin (HbO2) dissociation curve. SaO2 of about 90% is associated with PaO2 of about 60 mmHg.
What would cause increased levels?
- Polycythemia
- Increased inspired O2
- Hyperventilation
What would cause decreased levels?
- Anemia’s
- Hypoventilation
- Bronchospasm
- Mucus plugs
- Atelectasis
- Pneumothorax
- Pulmonary edema
- Adult respiratory distress syndrome
Normal
261 – 280 mOsm/kg
Indications
- Monitor:
- Electrolyte balance
- Acid-Base balance
- Hydration
- Evaluate function of antidiuretic hormone.
Description
Osmolality is a measure of the particles in solution. The size, shape, and charge of the particles do not impact the osmolality
What would cause increased levels?
- Dehydration
- Azotemia
- Hypercalcemia
- Hyperglycemic Hyperosmolar Nonketotic State (HHNS)
- Hypernatremia
- Diabetes Insipidus
- Hyperglycemia
- Mannitol therapy
- Uremia
- Severe pyelonephritis
- Shock
- Ketosis
What would cause decreased levels?
- Hyponatremia
- Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
- Overhydration
Normal 1.6 – 2.6 mg/dL
Indications
- Monitor:
- Renal failure
- Chronic alcoholism
- Cardiac arrhythmias
Description Magnesium (Mg) is a cation necessary for protein synthesis, nucleic acid synthesis, muscle contraction, ATP (adenosine triphosphate) use, nerve impulse conduction, and blood clotting. Magnesium affects the absorption of sodium, calcium, phosphorus, potassium.
What would cause increased levels?
- Renal insufficiency
- Uncontrolled Diabetes Mellitus (DM)
- Addison Disease
- Dehydration
- Hypothyroidism
- Overuse of antacids
- Tissue trauma
What would cause decreased levels?
- Alcoholism
- Diabetic acidosis
- Renal failure:
- Glomerulonephritis
- Hypercalcemia
- Malnutrition
- Malabsorption
- Hypoparathyroidism
- Diarrhea
Normal
0.3 -2.6 mmol/L
Indications
- Determine cause of acidosis
- Evaluate tissue oxygenation
Description
Lactate (Lactic Acid) is a byproduct of anaerobic metabolism. Normally, the tissues use aerobic metabolism to breakdown glucose for energy and the byproduct is CO2 and H2O which we excrete through our kidneys and exhalation. However, if the tissues are starved of oxygen (hypoxic), they use anaerobic metabolism. This can be compounded if the liver is also hypoxic causing the liver to be unable to clear the lactic acid.
What would cause increased levels?
- Shock
- Sepsis
- Tissue ischemia
- Carbon monoxide poisoning
- Lactic acidosis
- Diabetes Mellitus (DM)
- Heart failure
- Pulmonary edema
- Strenuous exercise
What would cause decreased levels?
- N/A
Normal
0.8 - 1.2
Therapeutic Levels of Warfarin 2.0 – 3.5
Indications
- Evaluate therapeutic doses of Warfarin
- Identify patients at higher risk for bleeding
- Identify cause of:
- Bleeding
- Deficiencies
Description
International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method.
What would cause increased levels?
- Disseminated Intravascular Coagulation (DIC)
- Liver disease
- Vitamin K deficiency
- Warfarin
What would cause decreased levels?
- Too much vitamin K
- Estrogen containing medications such as birth control
Normal
60 optimal mg/dL
Indications
- Monitor risks of heart disease
Description
Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein (LDL) very low-density lipoprotein (VLDL). HDL cholesterol is considered the good cholesterol because it travels through the blood picking up extra cholesterol and taking it back to the liver.
What would cause increased levels?
- Familial HDL Lipoproteinemia
- Exercise
- Unsaturated fats:
- Mono-
- Poly-
- Hypothyroid
What would cause decreased levels?
- Metabolic Syndrome
- Hepatocellular disease:
- Hepatitis
- Cirrhosis
- Hypoproteinemia:
- Nephrotic Syndrome
- Malnutrition
- Smoking
- High saturated and trans fat diets
- Excess body weight
- Hyperthyroid
Normal
5.6-7.5 % of total Hgb
Indications
- Assess control of blood sugars over a several month time frame
- Diagnose Diabetes Mellitus (DM)
Description
Glycosylated Hemoglobin (HbA1c) is the combination of glucose and hemoglobin. When glucose is elevated in the blood the amount of glycosylated hemoglobin increases proportionally. A red blood cells lifespan is about 4 months, so you can get an idea of blood sugar control over the last several months.
What would cause increased levels?
- Poorly controlled Diabetes Mellitus(DM)
- Non-Diabetic Hyperglycemia:
- Stress
- Cushing Syndrome
- Pheochromocytoma
- Corticosteroid Therapy
What would cause decreased levels?
- Renal failure
- Blood loss
- Hemolytic anemia
- Sickle cell anemia
Normal
2 - 20 ng/mL
Indications
- Diagnose megaloblastic anemia
- Monitor effects of long-term Total Parenteral Nutrition (TPN)
- Identify Folate Deficiency
Description
Folic acid is an essential water soluble B vitamin. It is stored in the liver and is an important part of Red Blood Cell (RBC) and White Blood Cell (WBC) function, DNA replication, and cell division.
What would cause increased levels?
- Excess folate intake
What would cause decreased levels?
- Vitamin B12 deficiency
- Pernicious anemia
- Hemolytic anemia
- Celiac Disease or Crohn Disease
- Inflammatory Bowel Disease (IBS)
- Alcoholism
- Malnutrition
Normal
20-300 ng/mL
Indications
- Diagnosing:
- Iron-deficiency anemiaH
- emochromatosis
- Monitor:
- Iron levels
Description
Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin. Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron.
What would cause increased levels?
- Inflammation
- Alcoholic liver disease
- Multiple blood transfusions
- Hemochromatosis
What would cause decreased levels?
- Long term Gastrointestinal(GI) bleeding
- Iron-deficiency anemia
- Heavy menstrual bleeding
Normal
96-108 mEq/L
Indications
- Identify Acid-Base Imbalance
Description
Chloride (Cl-), an anion found in the blood, works together with sodium to help maintain oncotic pressure and water balance in the body. Chloride is inversely related to bicarbonate levels in the blood. Chloride is also part of hydrochloric acid (HCL) which is utilized in the stomach to breakdown food. When red blood cells (RBCs) take up CO2 they take up chloride as well. The negative ion bicarbonate then leaves the red blood cell so that the electrical charge is maintained. Extra chloride is excreted into the urine by the kidneys.
What would cause increased levels?
- Dehydration
- Acute Renal Failure
- Cushing Disease
- Metabolic Acidosis
- Respiratory Alkalosis.
What would cause decreased levels?
- Congestive Heart Failure (CHF)
- Water intoxication
- Burns
- Metabolic Alkalosis
- Respiratory Acidosis
- Addison Disease
- Salt-losing Nephritis
- Excessive sweating
- Diarrhea
- Vomiting
Normal
8.4-10.2 mg/dL
Indications
- Identify problems with:
- Parathyroid
- Neuromuscular functions
- Diseases that affect bone
- Effectiveness of treatments.
Description
Calcium (Ca+), a positive ion in the body, is necessary for neuromuscular processes, bone mineralization, and hormonal secretion. The parathyroid gland and vitamin D are responsible for calcium regulation in the body. In the blood, about half of calcium travels in ion form, the other half is bound to proteins like albumin. When albumin levels are low, calcium levels will appear lower. Calcium has an important relationship with phosphorus: they are inversely proportional.
What would cause increased levels?
- Cancers:
- Breast, lung, and multiple myeloma are the most common
- Hyperparathyroidism
- Acidosis
- Renal transplant
- Sarcoidosis
- Vitamin D toxicity
- Dehydration
What would cause decreased levels?
- Malnutrition
- Cirrhosis
- Chronic Renal Failure
- Hypoparathyroidism
- Alkalosis
- Hypomagnesemia
- Hypoalbuminemia
- Hyperphosphatemia
- Malabsorption
- Alcoholism
- Osteomalacia
- Vitamin D deficiency
Normal
12-37 U/L
Indications
- Monitor progression of:
- Liver disease
- Response to treatments.
- Monitor liver toxic medications
Description
Aspartate Aminotransferase (AST) is an enzyme primarily found in liver and heart cells, and to a smaller extent, AST can also be found in the pancreas, kidneys, skeletal muscle, and brain. Levels of AST increase from cell death (necrosis) because the AST enzyme is released into the blood.
What would cause increased levels?
- Liver disease
- Liver cancer
- Shock
- Congestive Heart Failure (CHF)
- Pericarditis
- Biliary tract obstruction
- Dermatomyositis
- Pancreatitis
- Muscular Dystrophy
- CVA
- Hemolytic anemia
- Delirium Tremens (DT)
What would cause decreased levels?
- N/A
Normal
0-130 U/L
Indications
- Diagnosing:
- Pancreatitis
- Pancreatic Duct Obstruction
- Macroamylasemia
- Trauma to Pancreas
Description
Amylase is made in the pancreas. It is an enzyme that breaks down carbohydrates to allow our body to absorb it. Monitoring amylase levels can help identify problems with the pancreas.
What would cause increased levels?
- Pancreatitis
- Pancreatic Cancer
- Pancreatic Cyst
- DKA
- Peritonitis
- Abdominal Trauma
- Duodenal Obstruction
- Mumps
- Alcohol use
What would cause decreased levels?
- Pancreatic Insufficiency
- Pancreatectomy
- Toxemia of Pregnancy
- Cystic Fibrosis
- Liver Disease
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Normal
30-40 seconds
Indications
- Identifying congenital deficiencies in clotting
- Monitoring heparin therapeutic levels (PT for warfarin)
- Monitoring effects of:
- Liver Disease
- Protein Deficiency
- Fat malabsorption on clotting
Description
Activated Partial Thromboplastin Time (aPTT) is a test that measures the amount
of time it takes for a fibrin clot to form after reagents have been added to the
specimen. It is useful in diagnosing clotting disorders. In conjunction with PT it can
be used to differentiate the specific factor that may be missing.
What would cause increased (Prolonged) levels?
- Vitamin K Deficiency
- Disseminated Intravascular Coagulation (DIC)
- Hemodialysis Patients
- Afibrinogenemia
- Polycythemia
- Liver disease
- Von Willebrand Disease.
What would cause decreased levels?
- N/A
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Overview 1. Urinalysis 1. Color & Clarity 2. Protein 3. RBC 4. WBC 5. Glucose 6. Specific gravity 7. Ketones 8. pH 9. Bilirubin/Urobilinogen
Nursing Points General 1. Normal value range 1. Color & Clarity 1. Normal – Yellow 1. Other colors 1. Drug interactions 1. Propofol – green 2. Methylene blue – blue/green 2. Trauma 1. Red/Brown 3. Liver failure 1. Brown/tea colored 2. Clear – Normal 1. Cloudy 1. Cell or contaminant related 2. Turbid 1. Severe presence of cells (WBC, RBC) 2. pH 1. ~6 1. Changes in body condition can change pH 2. Metabolic acidosis/alkalosis 3. Protein 1. 0-trace 2. Glomerular permeability/infection 4. RBC 1. 0-2 2. Bleeding 3. Trauma/injury below kidneys 5. WBC 1. Negative 2. Sepsis/Infection/UTI 6. Glucose 1. Negative 2. Diabetes 7. Ketones 1. Negative 2. Presence of ketones can indicate endocrine disease like Diabetes 8. Urine Specific Gravity 1. 1.010-1.030 2. Facilities vary 3. Ability to concentrate urine 4. Hydration 1. Overhydration 1. Decreased USG 2. Dehydration 1. Increased USG 5. Diabetes insipidus 1. Causes increased diuresis 6. SIADH (Syndrome of Inappropriate Antidiuretic Hormone) 1. Causes decreased diuresis 9. Bilirubin/Urobilinogen 1. Negative 1. Presence indicates potential liver problems
Nursing Concepts 1. Lab Values 2. Elimination
Overview 1. White Blood Cells 1. Normal Value Range 2. Pathophysiology 3. Special considerations 4. Abnormal values (high) 5. Abnormal values (low)
Nursing Points General 1. Normal value range 1. WBC 1. 4500-10000/mcL 2. Differential 1. Neutrophils 1. 40-60% 2. Bands 1. 3-5% 1. >8% indicates signal to WBC for more production 2. Infection or inflammation is severe 3. Eosinophils 1. 1-4% 4. Basophils 1. 0.5-1% 5. Lymphocytes 1. 20-40% 6. Monocytes 1. 2-8% 2. Pathophysiology 1. WBC 1. Formed in the bone marrow 2. Responsible for responding to foreign invaders 1. Creating antibodies (immunity) 2. Phagocytosis (eating bacteria or fungi) 3. Multiple types with different purposes 1. Neutrophils – 1. inflammation and first response to invader 2. Eosinophils – 1. Inflammation 2. Allergic response 3. Parasites 3. Basophils 1. Inflammation 2. Allergic response 4. Lymphocytes 1. Create antibodies 2. Recognize antigens 3. Destroy cells 1. T Cells 2. B Cells 3. Natural Killer cells 5. Monocytes 1. Macrophages 1. Engulf and destroy invaders 2. Indicative of infection 3. Special considerations 1. Lavender top tube 2. Will commonly be submitted for Complete Blood Count with differential 4. Abnormal lab values 1. Increased White Blood Cell count (leukocytosis) 1. Infection 2. Inflammation 3. Trauma/Stress 4. Pregnancy 5. Asthma 6. Allergic Reaction 2. Decreased lab values (leukopenia) 1. Systemic Lupus Erythematosus (SLE)/Rheumatoid arthritis 2. Cancers 3. Chemotherapy/Radiation 4. Medications 1. Neutropenic precautions 1. Masks 2. Gloves 3. Wash hands 4. Consider yourself infectious 1. Prevent spread of infection to the patient
Assessment 1. Consider the overall WBC count plus abnormalities in differential 1. Evaluate patient 1. Signs or symptoms of: 1. Trauma 2. Inflammation 3. Infection
Therapeutic Management 1. Antibiotic therapies where indicated by infection (followed by cultures to determine efficacy of antibiotics) 2. Anti-inflammatories for inflammation 3. Provide neutropenic precautions when necessary
Nursing Concepts 1. Lab Values 2. Infection Control
Patient Education 1. Educate patient on the finishing any antibiotics completely. Do not stop prior, even if the patient says they are feeling better.
Overview 1. Troponin I 1. Normal value range 2. Pathophysiology 3. Special considerations 4. Elevations in lab values
Nursing Points General 1. Normal value range 1. Typically, less than 0.035 ng/mL or less 2. Can vary among institutions 3. Has to be greater than the 99th percentile 2. Pathophysiology 1. Troponin is released during myocardial cell damage 2. Decreased perfusion causes myocardial cell damage 3. Causes of myocardial cell damage 1. Myocardial infarction 2. Demand ischemia 1. Cardiogenic 1. ACS 2. Noncardiogenic 1. Sepsis 2. Renal failure 3. Extreme exercise 3. Special considerations 1. Submitted in green top tube 2. Value peak 1. Detection 6-12 hours after acute injury 2. Peaks 24 hours after injury 3. Can stay elevated for a week 1. Knowing patient history is critical 4. Increased values 1. Any elevated value is typically considered critical 2. Acute elevations warrant immediate investigation 1. Typically PCI (percutaneous coronary intervention)/Angiography and EKG to rule out MI or ACS (acute coronary syndrome) 3. Other elevations 1. CABG 2. Extreme exercise 3. End Stage Renal Failure
Assessment 1. Assess for: 1. Acute chest pain 2. Symptoms of MI 1. Nausea 2. Vomiting 3. Angina in any form 4. Reflux (especially in women)
Therapeutic Management 1. EKG 2. Angiography or PCI 3. Management of non-cardiogenic etiology
Nursing Concepts 1. Lab Values 2. Perfusion
Patient Education 1. Educate patient on keeping history of elevated levels or cardiac disease for future reference 2. Educate patient on duration of elevated troponin levels, post injury
Objective: Determine the significance and clinical use of Thyroid Stimulating Hormone in clinical practice
Lab Test Name: Thyroid Stimulating Hormone
Description: Thyroid Stimulating Hormone (TSH) is released from the anterior pituitary in response to low levels of thyroid hormone.
TSH stimulates the thyroid gland to release thyroid hormones
- Triiodothyronine (T3)
- Thyroxine (T4)
- T3 and T4 have an inverse relationship with TSH
Indications: Aids to diagnose:
- Hyperthyroidism
- Hypothyroidism
- Anterior pituitary function
Monitor:
- Thyroid replacement therapy
Normal Therapeutic Values: Normal –
2-10 mU/L
Collection:
- Plasma separator tube
What would cause increased levels? TSH levels increase in the following conditions:
- Hypothyroidism
- Thyroidectomy
- Thyroid dysfunction
- Thyroiditis
- Thyroid Agenesis
- Large doses of iodine
- Pituitary TSH-secreting tumor
What would cause decreased levels? Recall the inverse relationship between TSH and T3/T4 labs, and how the negative feedback loop works with these hormones.
TSH levels decrease in the following conditions:
- Anterior pituitary hypofunction- If the pituitary isn’t secreting TSH, the level will be low.
- Hyperthyroidism- If there is a large amount of thyroid hormone circulating, the feedback system relays the info upstream and less TSH is released.
Overview 1. Red blood cells 1. Normal Value Range 2. Patho 3. Special considerations 4. Too High: Causes, Symptoms, Treatments 5. Too Low: Causes, Symptoms, Treatments
Nursing Points General 1. Normal range 1. Measured in millions 2. Normal values 1. Males 4.5-5.5 x106/mcL 2. Females 4-4.9×106/mcL 2. Pathophysiology 1. Red Blood Cell generation 1. Formed in bone marrow 2. Stimulated by kidneys by erythropoietin 2. Function 1. AKA Erythrocytes 1. Reticulocytes 1. Young RBC 2. Indicate regeneration 2. Carries oxygen 1. Via Hemoglobin 2. Allows for transfer of CO2 3. Bioconcave shape 1. Increases surface area 2. Allows for ability to “squeeze” into capillaries 4. 2.4 M made every 1 second 3. Special considerations 1. Submitted via LAVENDER top tube (EDTA) 2. Technique can destroy red blood cells 1. Allow vacuum in vacutainers to draw blood, never force blood into tubes 2. Consider angiocath/IV size when drawing blood 4. Elevated RBC results 1. Dehydration 1. Result of decreased plasma 2. Polycythemia 1. Bone marrow cancer, causes increase in RBC 3. COPD 4. Pulmonary fibrosis 5. Decreased RBC results 1. Anemia 1. Sickle-cell 2. ↓ EPO due to kidney disease 2. Hemorrhage 3. Bone marrow failure 4. Pregnancy
Assessment 1. Assess for signs of anemia 1. Tachycardia 2. Fatigue 3. Shortness of breath 4. Decreased SaO2 5. Pallor
Therapeutic Management 1. Blood transfusions as necessary 2. Treat primary cause of anemia
Nursing Concepts
- Lab Values
- Oxygenation
Objective: Determine the significance and clinical use of Prostate Specific Antigen in clinical practice
Lab Test Name: Prostate Specific Antigen – PSA
Description: Measurement of PSA in the bloodstream
Used to diagnose and assess prostate health, size and function.
Indications: Evaluate:
- Enlarged prostate when prostate cancer is suspected
- Stage cancer
- Effectiveness of treatments
Normal Therapeutic Values: Normal –
- Male: < 4 ng/mL
- Female: < 0.5 ng/mL
Collection:
- Serum Separator Tube
What would cause increased levels? Increased:
- Benign Prostatic Hypertrophy (BPH)
- Prostate cancer
- Prostatitis
- Urinary retention
What would cause decreased levels? Decreased:
- Long-term use of NSAIDs- explained in part by the anti-inflammatory effect of these medications
- Thiazides- reduces bioavailable testosterone, associated with resulting in functional hypogonadism
- Statins- cholesterol plays a role in synthesis of androgen, which affects the size of the prostate
- 5-alpha-reductase inhibitors- due to the effect on prostate size.
Overview 1. Platelets 1. Normal Value Range 2. Pathophysiology 3. Special considerations 4. Elevated platelet levels 5. Decreased platelet levels
Nursing Points General 1. Normal value ranges 1. 100,000 – 450,000/mcL 2. Also known as – Thrombocytes 2. Pathophysiology 1. Formed from Megakaryocyte 1. Formed from bone marrow 2. Produces 1000-3000 platelets 2. Injury occurs at site 1. Collagen releases activators 2. Thrombocytes activate “sticky fingers”, which allow them to bind together. 3. Travel to site (along with other clotting factors) 4. Adhere to site, increase stimulation for other PLT, until clot is formed with fibrin 3. Special considerations 1. Use a lavender top tube (EDTA) 2. Often sent in CBC 4. Abnormal lab values 1. Elevated platelets (thrombocytosis) 1. Cancers 2. Absence of a spleen 1. Breaks down platelets 3. Birth control 4. Polycythemia vera 1. Overproduction of cells 2. Treatment via bloodletting, medications or hydration 2. Decreased platelets (thrombocytopenia) 1. ITP (Idiopathic thrombocytopenic purpura) 1. Autoimmune disease 2. Medications 2. Hemorrhage 1. Treated with transfusion 3. Leukemia 1. Treated with chemotherapy/radiation 4. Medications 1. Some diuretics 2. Nonsteroidal anti-inflammatory drugs (NSAIDs) 3. Ranitidine 4. Some antibiotics
Assessment 1. Assess for signs of petechia (small purplish blemishes, indicating bleeding)
Therapeutic Management 1. Control and stop hemorrhage 1. Replace platelets via transfusion 2. Consider stopping or changing medications that cause thrombocytopenia
Nursing Concepts 1. Lab Values 2. Clotting
Patient Education 1. For patients who have bleeding disorders, instruct patients to be cautious of injury. 2. If patient has thrombocytopenia, instruct patient to seek emergency treatment in the event of bleeding that does not stop.
**DISCLAIMER – The video states that the normal value of platelets is 100,000 – 400,000 cells/mcL. The correct information is 100,000 – 450,000 cells/mcL.
Objective: Determine the significance and clinical use of Lipase in clinical practice
Lab Test Name: Lipase
Description: Lipase
Measurement of lipase in the blood
- Used to diagnose pancreatitis and pancreatic cancer
- An enzyme produced by the pancreas
- Aids in breakdown of fats
- Released into the bloodstream as a result of damage to the pancreas
Indications: Diagnose:
- Pancreatitis
- Severe upper abdominal pain
- Abdominal pain – radiates
- Fever
- N/V
- Tachycardia
- Pancreatic cancer
- Discoloration of urine and stool
- Weight loss
- Diabetes
Normal Therapeutic Values: Normal:
- 23-300 U/L
Collection:
- Plasma separator tube
- Serum separator tube
What would cause increased levels? * Pancreatitis * Pancreatic cyst * Pseudocyst * Pancreatic duct obstruction * Renal failure * Cholecystitis * Peptic ulcer disease
What would cause decreased levels? N/A
Objective: Determine the significance and clinical use of iron levels in clinical practice
Lab Test Name: Iron – Fe
Description: Measures the amount of Fe in the bloodstream.
Evaluates:
- Sufficient Fe level
- oxygen transport
- proper hemoglobin & RBC production
Iron (Fe) is an element that is an important component of hemoglobin in red blood cells.
Iron aids hemoglobin’s transport of oxygen from the lungs to all the cells of the body.
The storage form of iron is ferritin. Iron is transported in the blood by a protein called transferrin.
Indications: Identify:
- Blood loss
- Hemochromatosis
- Malabsorption of iron
- Iron overload
Type of anemia:
- Thalassemia
- Sideroblastic anemia
- Iron deficient anemia
Normal Therapeutic Values: Normal –
50-175 μg/dL
Collection:
- plasma separator tube
What would cause increased levels: What would cause Increased Levels of Iron?
- Hemochromatosis
- Lead toxicity
- Iron poisoning
- Acute liver disease
- Multiple blood transfusions
- Hemolytic anemia
- Sideroblastic anemia
What would cause decreased levels: What would cause Decreased Levels of Iron?
- Blood Loss:
- Gastrointestinal (GI) bleeding
- Heavy menstruation
- Chronic hematuria
- Hypothyroidism
- Iron-deficiency anemia
- Inadequate absorption of iron
Overview 1. Hemoglobin 1. Normal Value Range 2. Pathophysiology 3. Special considerations 4. Elevated hemoglobin 5. Decreased hemoglobin
Nursing Points General 1. Normal value range 1. Males – 13.5-16.5 g/dL 2. Females – 12.0 – 15.0 g/dL 2. Pathophysiology 1. Protein attached to red blood cell 2. Iron based protein 3. 4 groups 1. 2 alpha 2. 2 beta 4. Has a high affinity (attraction) for oxygen 1. Oxyhemoglobin 1. Has oxygen attached 2. Deoxyhemoglobin 1. Oxygen has been released 5. Oxyhemoglobin Dissociation Curve 1. Oxygen saturation 2. Shift to the right 1. Partial pressure is higher 2. HGB attraction to oxygen is lower 3. Oxygen becomes less “sticky” and wants to be released 4. Causes 1. ↓pH 2. ↑pCO2 3. ↑Temperature 3. Shift to the left 1. Partial pressure is lower 2. HGB attraction is higher 3. Oxygen wants to stay “stuck” to HGB 4. Causes 1. ↑pH 2. ↓pCO2 3. ↓Temperature 3. Special considerations 1. Submit in lavender top tube 2. Be cautious with phlebotomy technique 1. Reduce hemolysis with proper tubing and syringes 4. Elevated HGB values 1. Polycythemia vera 1. Treatments 1. Blood letting 2. Increased water intake 3. Some medications 2. Dehydration 3. Lung disease 1. Pulmonary fibrosis 2. COPD 4. Certain medical therapies 1. EPO supplementation 5. Decreased HGB values 1. Thalassemia 2. Blood loss 3. Sickle Cell anemia 4. Aplastic anemia 5. Cancers
Assessment 1. Assess for signs of anemia 1. Tachycardia 2. Fatigue 3. Shortness of breath 4. Decreased SaO2 5. Pallor
Therapeutic Management 1. Blood transfusions as necessary 2. Treat primary cause of anemia
Nursing Concepts 1. Lab Values 2. Oxygenation
Overview 1. Hematocrit 1. Normal Value Range 2. Pathophysiology 3. Special considerations 4. Elevations in lab results 5. Decreased HCT levels
Nursing Points General 1. Normal value range 1. HCT measured in percentage 2. Males – 41-50% 3. Females – 36-44% 2. Pathophysiology 1. Measurement of total pRBCs compared to rest of blood volume 2. Helps to indicate anemia 3. Often measured with HGB (hemoglobin) 3. Special considerations 1. Lavender top tube (EDTA) 2. Be cautious with technique 1. Do not force sample into tube 2. Can cause hemolysis 3. Alters results 4. Causes of HCT elevation 1. Dehydration 1. Change in % compared to total blood volume 2. Respiratory disease 1. COPD 2. Pulmonary fibrosis 1. Increased need for oxygen -> increased need for RBC production 3. Polycythemia vera 1. RBC overproduction due to bone marrow cancer 2. Treatment includes bloodletting and increasing water consumption (also some medications) 5. Causes of decreased HCT 1. Blood loss 1. Trauma 2. Hemorrhage 3. Treatment 1. Stop bleeding 2. Transfuse blood 2. Anemia 1. Kidney disease 1. Decrease in EPO production 2. Treatment 1. Supplement with EPO 2. Pregnancy 1. Relative to increase total blood volume 3. Leukemia 1. Decreased bone marrow production causes ↓ RBC 2. Treat leukemia via oncology pathways 1. Chemotherapy 2. Radiation 3. Bone marrow transplant
Assessment 1. Assess for signs of anemia 1. Tachycardia 2. Fatigue 3. Shortness of breath 4. Decreased SaO2 5. Pallor
Therapeutic Management 1. Blood transfusions as necessary 2. Treat primary cause of anemia 3. Use oncologic methods to treat leukemia 4. Bloodletting (phlebotomy) for polycythemia patients
Nursing Concepts 1. Lab Values 2. Oxygenation
Objective: Determine the significance and clinical use of Erythrocyte Sedimentation Rate in clinical practice
Lab Test Name: Erythrocyte Sedimentation Rate- ESR
Description: The Erythrocyte Sedimentation Rate (ESR) test measures sedimentation of Red Blood Cells (RBCs).
In normal conditions, RBCs settle or sediment very little.
Inflammation affects proteins in the blood causing RBCs to stick and settle together out of the liquid portion of the blood.
Indications: Identifies inflammation which assists in diagnosing:
- Cancer
- Infection
- Autoimmune diseases
Normal Therapeutic Values: Normal – 0-20 mm/hr
What would cause increased levels? Increased
Conditions:
- Anemia
- Chronic Renal Failure
- Systemic Lupus Erythematosus (SLE)
- Infection
- Tuberculosis
- Pregnancy
- Polymyalgia Rheumatica
- Multiple myeloma
Medications:
- Oral contraceptives
- Theophylline
- Vitamin A
What would cause decreased levels?
Decreased
Conditions:
- Sickle cell anemia
- Polycythemia Vera
- Leukocytosis
- Congestive Heart Failure (CHF)
Medications:
- Aspirin
- Cortisone
- Quinine
Objective: Determine the significance and clinical use of D-Dimer in clinical practice
Lab Test Name: D-Dimer- DDI
Description: Measurement of D-Dimer evaluates the amount of byproduct produced as part of fibrinolysis
D-dimer (DDI) is a product of fibrinolysis
D-dimer levels are elevated in the setting of clot breakdown, and will be significantly elevated in the setting of Disseminated Intravascular Coagulation (DIC).
Indications: Identify and monitor
Disseminated Intravascular Coagulation (DIC)
Rule out a blood clot:
- Pulmonary Embolism (PE)
- Deep Vein Thrombosis (DVT)
- Stroke
Normal Therapeutic Values: Normal – ≤ 250 ng/mL
Collection:
- Light blue lab tube
What would cause increased levels? Increased
- Surgery
- Trauma
- Infection
- Cancer
- Heart attack
- Pregnancy
- Deep Vein Thrombosis (DVT)
- Disseminated Intravascular Coagulation (DIC)
What would cause decreased levels? Indicates a lack of the substance that is released during the breakdown of a blood clot (i.e. lack of blood clots, or lack of fibrinolysis)
Objective: Determine the significance and clinical use of C-Reactive Protein in clinical practice
Lab Test Name: C-Reactive Protein – CRP
Description: C-reactive protein (CRP) is made in the liver in response to inflammation
Measures CRP in the blood
- Increases quickly
- Decreases quickly
Indications: Monitor or Identify:
- Inflammation in the body
- Appendicitis
- Pelvic Inflammatory Disease (PID)
- Crohn’s
- Ulcerative Colitis
- Rheumatoid Arthritis (RA)
- Lupus (SLE – Systemic Lupus Erythematosus)
Evaluate:
- Coronary Artery Disease (CAD)
- Cholesterol level – atherosclerosis
Normal Therapeutic Values: Normal – <1.0 mg/L
Collection:
- Serum separator tube
What would cause increased levels? Increased=Inflammation
- Bacterial Infection
- Crohn’s Disease
- Inflammatory Bowel Disease
- Lupus
- Rheumatoid Arthritis (RA)
- Pregnancy – estrogen
- Myocardial Infarction (MI)
What would cause decreased levels? Decreased=resolving inflammation
Medications that reduce inflammation:
- NSAIDs
- Statins
- Steroids
Overview 1. Creatinine 1. Normal Value Range 2. Pathophysiology 3. Special considerations 4. Elevations in creatinine 5. Decreases in creatinine
Nursing Points General 1. Normal values 1. 0.7 – 1.4 mg/dL 2. Pathophysiology 1. Muscle breakdown and use 1. Creatine -> creatinine 2. Released into bloodstream 1. Filtered through kidneys 2. Excreted in urine 3. Creatinine more specific to kidney function 3. Special considerations 1. Green top 2. Submitted with renal panels or chems 3. Creatinine clearance 1. Tests creatinine in urine 2. Compare to serum creatinine 3. 24 hour urine 1. Toss first urine sample, then start 2. On ice 4. Increased creatinine values 1. Renal disease 2. Rhabdomyolysis 1. Muscle breakdown 2. Trauma 3. Extreme workouts 3. Congestive heart failure 4. Dehydration 5. Shock 5. Decreased creatinine values 1. Loss of muscle mass 2. Muscular dystrophy 3. Decreased protein intake 4. Pregnancy 5. Liver disease
Assessment 1. Assess patient’s nutritional status 2. Assess urine output 3. Consider other causes for increase in creatinine 1. Muscle
Therapeutic Management 1. Treat cause of renal insufficiency 1. Dialysis vs medication
Nursing Concepts 1. Lab Values 2. Elimination
Objective: Determine the significance and clinical use of measuring Creatinine Clearance in clinical practice
Lab Test Name: Creatinine Clearance – CrCl
Description: Healthy kidneys remove creatinine from the blood. It then passes out of your body through urine. Creatinine is created in the body as a byproduct from normal wear and tear on muscles and protein in your diet.
Creatinine Clearance is a test that compares the level of creatinine in the blood against the level in the urine and evaluates Glomerular Filtration Rate. Hydration, blood volume status, blood pressure, and the state of the glomeruli impact GFR.
Remember that GFR is the amount of blood cleaned each minute by tiny filters in your kidneys called glomeruli.
An increase in CrCl indicates an increase in GFR.
Indications: The creatinine clearance test is done when your healthcare provider thinks that the eGFR result given with your blood creatinine level may not be accurate. This would be in patients who have diabetes, those with HF, those with kidney disease, and is sometimes evaluated in those with hypertension.
- Kidney Function
- GFR
- Diabetes
- Heart Failure
- Hypertension
Normal Therapeutic Values: Normal – Creatinine clearance rates go down as you age
- Male: 97 to 137 mL/min
- Female: 88 to 128 mL/min
For every decade after age 40, a normal test result is 6.5 mL/min less than the numbers above.
Collection:
- Plasma separator tube for serum
- Urine is collected for 24 H in a plastic container
- First void is flushed
- Date and time recorded, and urine collected and stored at room temperature
- Processed once collection is complete
What would cause increased levels? Increased Creatinine Clearance→ Increased GFR
- Pregnancy- higher blood volume
- Large protein intake
- Exercise
What would cause decreased levels? The kidneys are solely responsible for removing Creatinine from the blood. If kidney function is declining, the creatinine level increases in the blood, but less creatinine is excreted into the urine.
Decreased Creatinine Clearance→ Decreased GFR
- Abnormal kidney function
- Poor perfusion
- Dehydration
- Bladder obstruction
- Nephrotoxic medications
Overview 1. Cholesterol 1. Normal Value Range 2. Pathophysiology 3. Any special considerations when drawing the lab (i.e. on ice, etc.) 4. Too High: Causes, Symptoms, Treatments 5. Too Low: Causes, Symptoms, Treatments
Nursing Points General 1. Normal values 1. 60 mg/dL 2. Low Density Lipoprotein (LDL) 1. Contributes to plaque buildup 2. Goal
Overview 1. BNP 1. Normal Value Range 2. Pathophysiology 3. Special considerations 4. Lab value elevations
Nursing Points General 1. Normal value range 1. 100 pg/mL 2. Pathophysiology 1. Increased pressure overload due to increased SVR or volume 2. Ventricular stretching causes release of BNP into bloodstream 3. BNP released to aid in stress due to overload by: 1. Increases excretion of sodium in urine = natriuresis 1. Sodium follows water 2. Decreased intravascular volume 3. Decreased workload on the heart = improved cardiac function 3. Special considerations 1. Lavender tube (EDTA) 2. NT-proBNP may be requested instead 1. Submit in serum separator tube (tiger top) 4. Elevated lab values 1. >100 pg/mL – heart failure likely 2. The higher the value, the more likely the diagnosis of heart failure
Assessment 1. Assess patient for acute exacerbation of heart failure 1. Lung sounds 2. Oxygen status 1. Need for supplemental oxygen 2. Radiographic evaluation 3. May need diagnostics for evaluation 1. Echocardiogram can determine contractility function
Therapeutic Management 1. Treatment 1. Treat heart failure 1. Diurese 2. Improve contractility
Nursing Concepts 1. Lab Values 2. Perfusion
Overview 1. Blood Urea Nitrogen (BUN) 1. Normal Value Range 2. Pathophysiology 3. Special Considerations 4. Elevated Values 5. Decreased Values
Nursing Points General 1. Normal value range 1. 7-20 mg/dL 2. Pathophysiology 1. Protein broken into amino acids -> Ammonia 2. Ammonia converted to urea 3. Urea excreted via kidneys 3. Special considerations 1. Green top tube 2. Submitted in multiple panels 1. Chem 7/Chem 10 2. CMP 3. Renal panel 4. Elevated values 1. Renal failure 2. Congestive heart failure 3. Myocardial infarction 4. Dehydration 5. Urinary obstruction 6. Diabetes 5. Decreased values 1. Liver failure 2. Overhydration 3. Inadequate protein intake 1. Malnutrition 4. Pregnancy
Assessment 1. Assess patient’s nutritional status 2. Assess urine output 3. Find primary cause for renal impairment (pre-/intra-/post-renal)
Therapeutic Management 1. Treat cause of renal insufficiency 1. Dialysis vs medication
Nursing Concepts 1. Lab Values 2. Elimination
Overview 1. Total bilirubin 1. Normal Value Range 2. Pathophysiology 3. Special considerations 4. Elevations in Total bilirubin
Nursing Points General 1. Normal values 1. 0.1-1.2 mg/dL 2. Patho 1. Breakdown product of RBCs 1. Specifically heme (iron portion of hemoglobin) 2. Transported to liver 1. Bound with bile 2. Excreted via GI tract and kidneys 3. Conjugated 1. Water soluble 4. Unconjugated 1. Not able to excrete it 2. Carried to liver via albumin 3. Conjugated in liver 3. Special Considerations 1. Submit in green top tube 2. Usually submitted with liver function tests 4. Elevated Total Bilirubin 1. Newborn jaundice 1. Treated with phototherapy 2. Liver tumors 3. Liver disease 1. Cirrhosis 2. Hepatitis 3. Alcoholism 4. Cholecystitis 5. Biliary obstruction
Assessment 1. Assess patients for jaundice or icterus, or changes in color of stool (clay colored)
Therapeutic Management 1. Phototherapy for newborns, as they are unable to properly breakdown bilirubin 2. Treat primary cause of liver/gallbladder disease
Nursing Concepts 1. Lab Values 2. Gastrointestinal/Liver Metabolism
Overview 1. Ammonia 1. Normal Value Range 2. Pathophysiology 3. Special considerations 4. Too High: Causes, Symptoms, Treatments 5. Too Low: Causes, Symptoms, Treatments
Nursing Points General 1. Normal value range 1. 19-60 mcg/dL 2. Pathophysiology 1. Byproduct of protein metabolism 1. Proteins → ammonia 2. Ammonia → urea via the liver 3. Urea excreted to the kidneys 2. If ammonia is not converted to urea 1. Ammonia ↑ in bloodstream 2. Causes hepatic encephalopathy 1. Neurotoxic 2. ↓ Level of consciousness 3. Confusion 4. Altered mental status 3. Refer to Neuro lesson 03.06 Encephalopathies 3. Special considerations 1. Sent in either green or lavender tube 2. Typically sent on ice 3. Discuss with facility lab or unit 4. Elevations in ammonia 1. Liver failure 1. Treatment: 1. Lactulose 1. Ammonia binding agent 2. Given PO or PR 3. Ammonia excreted via stool 2. Hepatic encephalopathy 3. TPN 4. GI hemorrhage 5. Reye’s syndrome 5. Decreased ammonia levels 1. Antibiotics
Assessment 1. Assess patient’s cognition and level of consciousness 2. Assess patient’s ability to swallow and protect airway
Therapeutic Management 1. Lactulose via rectal tube or PO if patient can tolerate oral medications and follow directions
Nursing Concepts 1. Lab Values 2. Gastrointestinal/Liver Metabolism
Objective: Determine the significance and clinical use of alkaline phosphatase in clinical practice
Lab Test Name: Alkaline Phosphatase – ALP
Description: Measures amount of ALP in circulation
Located in several places in the body:
- Liver
- Intestines
- Biliary tract
- Bones
- Placenta
Different isoenzymes of ALP are used to determine:
- Liver, bone, intestine and other cancers
- Bone turnover in postmenopausal women
Indications: Evaluation of ALP:
- Hepatobiliary disease
- Malignancies
- Bone disease
- Bone damage in renal patients
Normal Therapeutic Values: Normal – 40-130 U/L
Collection:
- Plasma separator tube
What would cause increased levels? Increased levels assessed in:
- Liver disease
- Bone disease
- Pregnancy
- Amyloidosis
- Lung cancer
- Pancreatic cancer
- Congestive heart failure
- Ulcerative colitis
- Hodgkin’s disease
- Chronic renal failure
- Sarcoidosis
What would cause decreased levels? * Hypophosphatasia (spelling error on existing outline on NURSING.com) * Anemia * Kwashiorkor * Cretinism * Hypothyroidism * Zinc or magnesium deficiency * Scurvy
Overview 1. Albumin 1. Normal Value Range 2. Pathophysiology 3. Special Considerations 4. Too High: Causes, Symptoms, Treatments 5. Too Low: Causes, Symptoms, Treatments
Nursing Points General 1. Normal value range 1. 3.5 – 6.0 g/dL 2. Pathophysiology 1. Produced in the liver 2. Main protein of plasma 3. Responsible for maintaining oncotic pressure 1. Draws fluid into blood vessel 2. “Protein pulls” 3. Refer to Fluid & Electrolytes lesson 01.02 Fluid Pressures 4. Transport protein 5. Serves as amino acid 6. Nutrition 1. Poor indicator of nutrition 1. Due to long half-life 2. Pre-Albumin 1. Better indicator of nutrition 3. Special considerations 1. Green top typically 2. Usually sent with several other labs 1. Chemistries 2. Liver function tests 3. Nutritional labs 4. Elevated Albumin levels 1. Dehydration 2. Excess infusion of albumin 5. Decreased albumin levels 1. Liver disease 2. Fluid loss 1. Fistula 2. Hemorrhage 3. Kidney Disease 4. Burns 3. Congestive heart failure 4. Long term poor nutrition 1. Inadequate intake 5. Inflammation
Assessment 1. Assess patient’s pre-albumin for nutritional status or indications of acute illness
Nursing Concepts 1. Lab Values 2. Nutrition
Objective: Determine the significance and clinical use of Alanine Aminotransferase in clinical practice
Lab Test Name: Alanine Aminotransferase – ALT
Description: Measures amount of ALT, an enzyme produced by the liver, present in circulation
Found in:
Most abundantly in liver
Heart
Skeletal muscle
kidney
Increases in lab values indicate liver disease or liver damage
Indications: Evaluation of ALT:
- Progression of liver disease
- Monitoring response to treatment
Normal Therapeutic Values: Normal – 40-130 U/L
Collection:
- Plasma separator tube
What would cause increased levels? INCREASED:
- Cirrhosis
- Muscle damage
- Preeclampsia
- Biliary tract obstruction
- Burns
- Pancreatitis
- Long-term alcohol abuse
- Liver Cancer
- Muscular dystrophy
- MI
- Myositis
- Shock
- Infection-mononucleosis
What would cause decreased levels? DECREASED:
- Pyridoxal phosphate deficiency
- A rare genetic metabolic disorder
Overview 1. Glucose 1. Normal Value Range 2. Pathophysiology 3. Special considerations 4. Hyperglycemia 5. Hypoglycemia
Nursing Points General 1. Normal value 1. 70-115 mg/dL 2. Pathophysiology 1. Consumed via diet 1. Carbohydrates 2. Glycolysis 1. Creates net positive energy sources 3. Insulin 1. Produced in pancreas 2. Required to force glucose into cell 3. Deficiency in insulin causes high glucose in blood 4. Increase in insulin resistance causes high glucose in blood 3. Special considerations 1. Lab 1. Green or gray tube 2. Bedside 1. CBG (Capillary blood glucose) 2. Use glucometer 3. Use gauze and alcohol 4. Hyperglycemia (high levels of glucose) 1. Diabetes 1. Absent or inefficient insulin 2. Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) 3. Stress 1. Increases cortisol production 4. Pancreatitis 1. Disrupts insulin production 5. Renal failure 6. Cushing’s syndrome 7. Steroid use 1. Increases insulin resistance 5. Hypoglycemia (low levels of glucose) 1. Insulinoma 2. Hypothyroidism 3. Hypopituitarism 4. Addison’s Disease 5. Insulin overdose 6. Malnutrition
Nursing Concepts 1. Lab Values 2. Glucose Metabolism
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What is the Lab Name for White Blood Cell (WBC) Lab Values? White Blood Cell
What is the Lab Abbreviation for White Blood Cell? WBC
What is White Blood Cell in terms of Nursing Labs? White blood cells (WBCs) are created in the bone marrow. Their primary function is to defend the body against infection. There are various types of WBCs which have different shapes and functions. Decreased WBC count is called Leukopenia and increased WBC count is called Leukocytosis.
What is the Normal Range for White Blood Cell? 4,500 – 10,000 cells/mcL
What are the Indications for White Blood Cell? * Evaluate for infection
What would cause Increased Levels of White Blood Cell? * Infection/inflammation * Leukemic Neoplasia * Trauma/stress * Tissue necrosis * Pregnancy * Cushing Disease * Asthma * Allergic reaction
What would cause Decreased Levels of White Blood Cell? * Systemic Lupus Erythematosus (SLE) * Anemia * Rheumatoid Arthritis (RA) * Chemotherapy/radiation * Overwhelming infections (WBCs are all used up)
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Overview 1. Urinalysis 1. Color & Clarity 2. Protein 3. RBC 4. WBC 5. Glucose 6. Specific gravity 7. Ketones 8. pH 9. Bilirubin/Urobilinogen
Nursing Points General 1. Normal value range 1. Color & Clarity 1. Normal – Yellow 1. Other colors 1. Drug interactions 1. Propofol – green 2. Methylene blue – blue/green 2. Trauma 1. Red/Brown 3. Liver failure 1. Brown/tea colored 2. Clear – Normal 1. Cloudy 1. Cell or contaminant related 2. Turbid 1. Severe presence of cells (WBC, RBC) 2. pH 1. ~6 1. Changes in body condition can change pH 2. Metabolic acidosis/alkalosis 3. Protein 1. 0-trace 2. Glomerular permeability/infection 4. RBC 1. 0-2 2. Bleeding 3. Trauma/injury below kidneys 5. WBC 1. Negative 2. Sepsis/Infection/UTI 6. Glucose 1. Negative 2. Diabetes 7. Ketones 1. Negative 2. Presence of ketones can indicate endocrine disease like Diabetes 8. Urine Specific Gravity 1. 1.010-1.030 2. Facilities vary 3. Ability to concentrate urine 4. Hydration 1. Overhydration 1. Decreased USG 2. Dehydration 1. Increased USG 5. Diabetes insipidus 1. Causes increased diuresis 6. SIADH (Syndrome of Inappropriate Antidiuretic Hormone) 1. Causes decreased diuresis 9. Bilirubin/Urobilinogen 1. Negative 1. Presence indicates potential liver problems
Nursing Concepts 1. Lab Values 2. Elimination
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What is the Lab Name for Troponin I (cTNL) Lab Values? Troponin I
What is the Lab Abbreviation for Troponin I? cTNL
What is Troponin I in terms of Nursing Labs? Troponins are proteins that initiate contraction of muscle fibers. Troponin I (cTNL) is specific to heart muscle. Troponin levels stay elevated for a week after muscle damage before returning to normal.
What is the Normal Range for Troponin I? There is a wide range of normal values among varying institutions and texts with regard to Troponin I. It is essential to verify institutional norms. < 0.035 ng/mL
What are the Indications for Troponin I? * Evaluating damage to heart muscle * Diagnose a Myocardial Infarction (MI)
What would cause Increased Levels of Troponin I? * Heart damage * Myocardial Infarction (MI)
What would cause Decreased Levels of Troponin I? N/A
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What is the Lab Name for Triglycerides (TG) Lab Values? Triglycerides
What is the Lab Abbreviation for Triglycerides? TG
What is Triglycerides in terms of Nursing Labs? Triglycerides (TG) are required to provide energy during the metabolic process, excess triglycerides are stored in adipose tissue.
What is the Normal Range for Triglycerides?
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Objective: Determine the significance and clinical use of Thyroid Stimulating Hormone in clinical practice
Lab Test Name: Thyroid Stimulating Hormone
Description: Thyroid Stimulating Hormone (TSH) is released from the anterior pituitary in response to low levels of thyroid hormone.
TSH stimulates the thyroid gland to release thyroid hormones
- Triiodothyronine (T3)
- Thyroxine (T4)
- T3 and T4 have an inverse relationship with TSH
Indications: Aids to diagnose:
- Hyperthyroidism
- Hypothyroidism
- Anterior pituitary function
Monitor:
- Thyroid replacement therapy
Normal Therapeutic Values: Normal –
2-10 mU/L
Collection:
- Plasma separator tube
What would cause increased levels? TSH levels increase in the following conditions:
- Hypothyroidism
- Thyroidectomy
- Thyroid dysfunction
- Thyroiditis
- Thyroid Agenesis
- Large doses of iodine
- Pituitary TSH-secreting tumor
What would cause decreased levels? Recall the inverse relationship between TSH and T3/T4 labs, and how the negative feedback loop works with these hormones.
TSH levels decrease in the following conditions:
- Anterior pituitary hypofunction- If the pituitary isn’t secreting TSH, the level will be low.
- Hyperthyroidism- If there is a large amount of thyroid hormone circulating, the feedback system relays the info upstream and less TSH is released.
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What is the Lab Name for Sodium (Na+) Lab Values? Sodium
What is the Lab Abbreviation for Sodium? Na+
What is Sodium in terms of Nursing Labs? Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body, plays a role in blood pressure regulation, and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; Water follows salt.
What is the Normal Range for Sodium? 135-145 mEq/L
What are the Indications for Sodium? * Monitor: + Extracellular osmolality + Electrolyte balance
What would cause Increased Levels of Sodium? * Cushing Syndrome * Hyperaldosteronism * Dehydration * Burn injury * Azotemia (elevated nitrogen) * Lactic acidosis (LA) * Fever/excessive sweating * Excessive IV fluids containing sodium * Diabetes Insipidus * Osmotic diuresis
What would cause Decreased Levels of Sodium? * Congestive Heart Failure (CHF) * Syndrome of Inappropriate Antidiuretic Hormone (SIADH) * Cystic Fibrosis * Diuretic use * Metabolic acidosis * Addison Disease * Nephrotic Syndrome * Vomiting * Diarrhea * Ascites * Excessive Antidiuretic Hormone(ADH) * Liver failure
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What is the Lab Name for Red Blood Cell (RBC) Lab Values? Red Blood Cell
What is the Lab Abbreviation for Red Blood Cell? RBC
What is Red Blood Cell in terms of Nursing Labs? Red Blood Cells (RBCs) contain hemoglobin which is responsible for oxygen transport throughout the body. RBCs are primarily produced in the bone marrow, they have a life span of 120 days and are destroyed in the spleen and liver. RBC production is regulated by erythropoietin (EPO) which is produced and released from the kidneys.
What is the Normal Range for Red Blood Cell? Male: 4.5 – 5.5 x106/cells/mm3 Female: 4.0 – 4.9 x106/cells/mm3
What are the Indications for Red Blood Cell? * Identify: + Anemia + Blood loss
What would cause Increased Levels of Red Blood Cell? * Dehydration * Polycythemia Vera * Chronic Obstructive Pulmonary Disease (COPD) * High altitude * Congenital heart disease * CorPulmonale * Pulmonary fibrosis * Thalassemia trait
What would cause Decreased Levels of Red Blood Cell? * Chemotherapy * Anemia * Hemorrhage * Hemolysis * Hemoglobinopathy * Advanced cancer * Leukemia * Lymphoma * Pernicious anemia * Rheumatoid disease * Organ failure * Bone marrow failure * Hypervolemia * Pregnancy
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Objective: Determine the significance and clinical use of Prostate Specific Antigen in clinical practice
Lab Test Name: Prostate Specific Antigen – PSA
Description: Measurement of PSA in the bloodstream
Used to diagnose and assess prostate health, size and function.
Indications: Evaluate:
- Enlarged prostate when prostate cancer is suspected
- Stage cancer
- Effectiveness of treatments
Normal Therapeutic Values: Normal –
- Male: < 4 ng/mL
- Female: < 0.5 ng/mL
Collection:
- Serum Separator Tube
What would cause increased levels? Increased:
- Benign Prostatic Hypertrophy (BPH)
- Prostate cancer
- Prostatitis
- Urinary retention
What would cause decreased levels? Decreased:
- Long-term use of NSAIDs- explained in part by the anti-inflammatory effect of these medications
- Thiazides- reduces bioavailable testosterone, associated with resulting in functional hypogonadism
- Statins- cholesterol plays a role in synthesis of androgen, which affects the size of the prostate
- 5-alpha-reductase inhibitors- due to the effect on prostate size.
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What is the Lab Name for Potassium (K+) Lab Values? Potassium
What is the Lab Abbreviation for Potassium? K+
What is Potassium in terms of Nursing Labs? Potassium (K+) is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen with enter the cell as this happens it will force potassium out of the cell, a 0.1 decrease in pH will cause a 0.5 increase in K+.
What is the Normal Range for Potassium? 3.5 – 5.0 mEq/L
What are the Indications for Potassium? * Evaluate: + Electrolyte imbalances + Cardiac arrhythmias * Monitor patients who are: + Acidotic + Receiving diuretic therapyw
What would cause Increased Levels of Potassium? * Renal failure * Hypoaldosteronism * Addison disease * Injury to tissues * Diabetes Mellitus (DM) * Ketoacidosis * Hyperventilation * Acidosis * Infection * Dehydration * Burns
What would cause Decreased Levels of Potassium? * Hyperaldosteronism * Excess insulin * Alkalosis * Diarrhea * Vomiting * Cystic Fibrosis * Cushing Syndrome
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What is the Lab Name for Platelets (PLT) Lab Values? Platelets
What is the Lab Abbreviation for Platelets? (PLT)
What is Platelets in terms of Nursing Labs? Platelets (PLT) play a role in coagulation, hemostasis, and thrombus formation. Platelets are the smallest blood cell, damaged vessels send out signals that result in platelets traveling to the area and becoming “active”.
What is the Normal Range for Platelets? 100,000 – 450,000 cells/mcL
What are the Indications for Platelets? * Determine clotting vs bleeding disorders
What would cause Increased Levels of Platelets?
- Malignancy
- Polycythemia Vera
- Postsplenectomy syndrome
- Rheumatoid Arthritis (RA)
- Iron-deficiency anemia
- Hemolytic anemia
- Tuberculosis
- Birth control
What would cause Decreased Levels of Platelets? * Idiopathic Thrombocytopenia (ITP) * Inherited thrombocytopenia disorders: + Wiskott-Aldrich Syndrome + Bernard-Soulier Syndrome + Zieve Syndrome * Infection: + Hepatitis + Human Immunodeficiency Virus (HIV) + Measles + Sepsis * Hypersplenism * Hemorrhage * Leukemia * Lymphoma * Drug Therapy: + Aspirin + Ibuprofen + Sulfa antibiotics + Hydralazine + Thiazide diuretics * Systemic Lupus Erythematosus (SLE) * Hemolytic anemia’s
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What is the Lab Name for Partial Thromboplastin Time (PTT) Lab Values? Partial Thromboplastin Time
What is the Lab Abbreviation for Partial Thromboplastin Time? PTT
What is Partial Thromboplastin Time in terms of Nursing Labs? Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin.
What is the Normal Range for Partial Thromboplastin Time? 25 – 35 seconds
What are the Indications for Partial Thromboplastin Time? * Detection of coagulation disorders * Evaluate response to Heparin (PT for Coumadin) * Preoperative assessment
What would cause Increased Levels of Partial Thromboplastin Time? * Disseminated Intravascular Coagulation (DIC) * Clotting Factor Deficiencies: + Hypofibrinogenemia + Von Willebrand Disease + Hemophillia * Liver disease: + Cirrhosis * Vitamin K deficiency * Polycythemia * Dialysis
What would cause Decreased Levels of Partial Thromboplastin Time? N/A
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What is the Lab Name for Oxygen Saturation (SaO2) Lab Values? Oxygen Saturation
What is the Lab Abbreviation for Oxygen Saturation? SaO2
What is Oxygen Saturation in terms of Nursing Labs? Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen. Oxygen is transported in the blood in two ways: oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin (SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved in plasma. SaO2 and pO2 have direct relationships, if one is decreased so is the other. The relationship between oxygen saturation (SaO2) and partial pressure O2 (PaO2) is referred to as the oxyhemoglobin (HbO2) dissociation curve. SaO2 of about 90% is associated with PaO2 of about 60 mmHg. For more information on PaO2, SaO2 and oxyhemoglobin dissociation curve visit this link HERE.
What is the Normal Range for Oxygen Saturation? 95 – 100%
What are the Indications for Oxygen Saturation? * Determine respiratory status * Part of Arterial Blood Gas (ABG) testing
What would cause Increased Levels of Oxygen Saturation?
- Polycythemia
- Increased inspired O2
- Hyperventilation
What would cause Decreased Levels of Oxygen Saturation? * Anemia’s * Hypoventilation * Bronchospasm * Mucus plugs * Atelectasis * Pneumothorax * Pulmonary edema * Adult respiratory distress syndrome
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What is the Lab Name for Osmolality Lab Values? Osmolality
What is Osmolality in terms of Nursing Labs? Osmolality is a measure of the particles in solution. The size, shape, and charge of the particles do not impact the osmolality
What is the Normal Range for Osmolality? 261 – 280 mOsm/kg
What are the Indications for Osmolality? * Monitor: + Electrolyte balance + Acid-Base balance + Hydration * Evaluate function of antidiuretic hormone.
What would cause Increased Levels of Osmolality? * Dehydration * Azotemia * Hypercalcemia * Hyperosmolar Hyperglycemia Syndrome (HHS) * Hypernatremia * Diabetes Insipidus * Hyperglycemia * Mannitol therapy * Uremia * Severe pyelonephritis * Shock * Ketosis
What would cause Decreased Levels of Osmolality? * Hyponatremia * Syndrome of Inappropriate Antidiuretic Hormone (SIADH) * Overhydration
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What is the Lab Name for Creatinine (Cr) Lab Values? Magnesium
What is the Lab Abbreviation for Creatinine? Mg
What is Creatinine in terms of Nursing Labs? Magnesium (Mg) is a cation necessary for protein synthesis, nucleic acid synthesis, muscle contraction, ATP (adenosine triphosphate) use, nerve impulse conduction, and blood clotting. Magnesium affects the absorption of sodium, calcium, phosphorus, potassium.
What is the Normal Range for Magnesium? 1.6 - 2.6mg/dL
What are the Indications for Magnesium? * Monitor: + Renal failure + Chronic alcoholism + Cardiac arrhythmias
What would cause Increased Levels of Magnesium? * Renal insufficiency * Uncontrolled Diabetes Mellitus (DM) * Addison Disease * Dehydration * Hypothyroidism * Overuse of antacids * Tissue trauma
What would cause Decreased Levels of Magnesium? * Alcoholism * Diabetic acidosis * Renal failure: + Glomerulonephritis * Hypercalcemia * Malnutrition * Malabsorption * Hypoparathyroidism * Diarrhea
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What is the Lab Name for Low Density Lipoprotein Lab Values? Low Density Lipoprotein
What is the Lab Abbreviation for Low Density Lipoprotein? LDL
What is Low Density Lipoprotein in terms of Nursing Labs? Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein, LDL, very low-density lipoprotein (VLDL). LDL cholesterol is considered bad cholesterol because as it travels through the blood, it deposits cholesterol into the lining of blood vessels, causing atherosclerosis and an increase in cardiovascular disease.
What is the Normal Range for Low Density Lipoprotein?
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Objective: Determine the significance and clinical use of Lipase in clinical practice
Lab Test Name: Lipase
Description: Lipase
Measurement of lipase in the blood
- Used to diagnose pancreatitis and pancreatic cancer
- An enzyme produced by the pancreas
- Aids in breakdown of fats
- Released into the bloodstream as a result of damage to the pancreas
Indications: Diagnose:
- Pancreatitis
- Severe upper abdominal pain
- Abdominal pain – radiates
- Fever
- N/V
- Tachycardia
- Pancreatic cancer
- Discoloration of urine and stool
- Weight loss
- Diabetes
Normal Therapeutic Values: Normal:
- 23-300 U/L
Collection:
- Plasma separator tube
- Serum separator tube
What would cause increased levels? * Pancreatitis * Pancreatic cyst * Pseudocyst * Pancreatic duct obstruction * Renal failure * Cholecystitis * Peptic ulcer disease
What would cause decreased levels? N/A
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What is the Lab Name for Lactic Acid Lab Values? Lactic Acid
What is Lactic Acid in terms of Nursing Labs? Lactate (Lactic Acid) is a byproduct of anaerobic metabolism. Normally, the tissues use aerobic metabolism to breakdown glucose for energy and the byproduct is CO2 and H2O which we excrete through our kidneys and exhalation. However, if the tissues are starved of oxygen (hypoxic), they use anaerobic metabolism. This can be compounded if the liver is also hypoxic causing the liver to be unable to clear the lactic acid.
What is the Normal Range for Lactic Acid? 0.3 -2.6 mmol/L
What are the Indications for Lactic Acid? * Determine cause of acidosis * Evaluate tissue oxygenation
What would cause Increased Levels of Lactic Acid? * Shock * Sepsis * Tissue ischemia * Carbon monoxide poisoning * Lactic acidosis * Diabetes Mellitus (DM) * Heart failure * Pulmonary edema * Strenuous exercise
What would cause Decreased Levels of Lactic Acid?
N/A
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Objective: Determine the significance and clinical use of iron levels in clinical practice
Lab Test Name: Iron – Fe
Description: Measures the amount of Fe in the bloodstream.
Evaluates:
- Sufficient Fe level
- oxygen transport
- proper hemoglobin & RBC production
Iron (Fe) is an element that is an important component of hemoglobin in red blood cells.
Iron aids hemoglobin’s transport of oxygen from the lungs to all the cells of the body.
The storage form of iron is ferritin. Iron is transported in the blood by a protein called transferrin.
Indications: Identify:
- Blood loss
- Hemochromatosis
- Malabsorption of iron
- Iron overload
Type of anemia:
- Thalassemia
- Sideroblastic anemia
- Iron deficient anemia
Normal Therapeutic Values: Normal –
50-175 μg/dL
Collection:
- plasma separator tube
What would cause increased levels: What would cause Increased Levels of Iron?
- Hemochromatosis
- Lead toxicity
- Iron poisoning
- Acute liver disease
- Multiple blood transfusions
- Hemolytic anemia
- Sideroblastic anemia
What would cause decreased levels: What would cause Decreased Levels of Iron?
- Blood Loss:
- Gastrointestinal (GI) bleeding
- Heavy menstruation
- Chronic hematuria
- Hypothyroidism
- Iron-deficiency anemia
- Inadequate absorption of iron
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What is the Lab Name for International Normalized Ratio (INR) Lab Values? International Normalized Ratio
What is the Lab Abbreviation for International Normalized Ratio? INR
What is International Normalized Ratio in terms of Nursing Labs? International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method.
What is the Normal Range for International Normalized Ratio? 0.8 – 1.2 Therapeutic Levels on Warfarin 2.0 – 3.5
What are the Indications for International Normalized Ratio? * Evaluate therapeutic doses of Warfarin * Identify patients at higher risk for bleeding * Identify cause of: + Bleeding + Deficiencies
What would cause Increased Levels of International Normalized Ratio? * Disseminated Intravascular Coagulation (DIC) * Liver disease * Vitamin K deficiency * Warfarin
What would cause Decreased Levels of International Normalized Ratio? * Too much vitamin K * Estrogen containing medications such as birth control
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What is the Lab Name for High Density Lipoprotein (HDL) Lab Values? High Density Lipoprotein
What is the Lab Abbreviation for High Density Lipoprotein? HDL
What is High Density Lipoprotein in terms of Nursing Labs? Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein, LDL, very low-density lipoprotein (VLDL). HDL cholesterol is considered the good cholesterol because it travels through the blood picking up extra cholesterol and taking it back to the liver.
What is the Normal Range for High Density Lipoprotein? 60 optimal mg/dL
What are the Indications for High Density Lipoprotein? * Monitor risks of heart disease
What would cause Increased Levels of High Density Lipoprotein? * Familial HDL Lipoproteinemia * Exercise * Unsaturated fats: + Mono- + Poly- * Hypothyroid
What would cause Decreased Levels of High Density Lipoprotein? * Metabolic Syndrome * Hepatocellular disease: + Hepatitis + Cirrhosis * Hypoproteinemia: + Nephrotic Syndrome + Malnutrition * Smoking * High saturated and trans fat diets * Excess body weight * Hyperthyroid
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**What is the Lab Name for Hemoglobin (Hbg) Lab Values?** Hemoglobin
**What is the Lab Abbreviation for Hemoglobin?** Hbg
**What is Hemoglobin in terms of Nursing Labs?** Hemoglobin (Hbg), an iron containing compound, is the main protein in Red Blood Cells (RBCs). It enables oxygen and carbon dioxide (CO2) to bind to RBCs for transport throughout the body.
**What is the Normal Range for Hemoglobin?** Male: 13.5 – 16.5 g/dL | Female: 12.0 – 15.0 g/dL
**What are the Indications for Hemoglobin?** Identify:
* Bleeding disorders
- Anemia
- Blood loss
**What would cause Increased Levels of Hemoglobin?** * Erythrocytosis- Polycythemia Vera
- Shock
- Dehydration
- Severe burns
- Chronic Obstructive Pulmonary Disease (COPD)
- Congenital Heart Disease
**What would cause Decreased Levels of Hemoglobin?** * Anemia- Blood Loss
- Bone Marrow Disorders:
- Leukemia
- Lymphoma
- Multiple myeloma
- Aplastic anemia
- Severe burns
- Hyperthyroidism
- Renal disease
- Systemic Lupus Erythematosus (SLE)
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**What is the Lab Name for Hematocrit (Hct) Lab Values?** Hematocrit
**What is the Lab Abbreviation for Hematocrit?** Hct
**What is Hematocrit in terms of Nursing Labs?** Hematocrit (Hct) is the percentage of the blood that is made up of packed Red Blood Cells (RBCs). A hematocrit level of 40% indicates that there are 40 mL packed red blood cells in 100 mL of blood.
**What is the Normal Range for Hematocrit?** Male: 41 – 50% | Female: 36 – 44%
**What are the Indications for Hematocrit?** * Identify:
+ Anemia
+ Bleeding
+ Bleeding disorder
+ Fluid imbalances
**What would cause Increased Levels of Hematocrit?** * Erythrocytosis
- Polycythemia Vera
- Shock
- Dehydration
- Chronic Obstructive Pulmonary Disease (COPD)
- Congenital Heart Disease
**What would cause Decreased Levels of Hematocrit?** * Anemia- Blood loss
- Bone marrow disorders:
- Leukemia
- Lymphoma
- Hodgkin disease
- Multiple myeloma
- Aplastic anemia
- Hyperthyroidism
- Renal disease
- Rheumatoid arthritis (RA)
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**What is the Lab Name for Glycosylated Hemoglobin (HbA1c) Lab Values?** Glycosylated Hemoglobin
**What is the Lab Abbreviation for Glycosylated Hemoglobin?** HbA1c
**What is Glycosylated Hemoglobin in terms of Nursing Labs?** Glycosylated Hemoglobin (HbA1c) is the combination of glucose and hemoglobin. When glucose is elevated in the blood the amount of glycosylated hemoglobin increases proportionally. A red blood cells lifespan is about 4 months, so you can get an idea of blood sugar control over the last several months.
**What is the Normal Range for Glycosylated Hemoglobin?** 5.6-7.5 % of total Hgb
**What are the Indications for Glycosylated Hemoglobin?** * Assess control of blood sugars over a several month time frame
- Diagnose Diabetes Mellitus (DM)
**What would cause Increased Levels of Glycosylated Hemoglobin?** * Poorly controlled Diabetes Mellitus(DM)- Non-Diabetic Hyperglycemia:
- Stress
- Cushing Syndrome
- Pheochromocytoma
- Corticosteroid Therapy
**What would cause Decreased Levels of Glycosylated Hemoglobin?** * Renal failure- Blood loss
- Hemolytic anemia
- Sickle cell anemia
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**What is the Lab Name for Glucose Lab Values?** Glucose
**What is Glucose in terms of Nursing Labs?** Glucose is a sugar molecule that is a component of carbohydrates. Glucose provides energy in the body and is absorbed from the blood to the cells for nourishment via insulin. The pancreas secretes insulin to helps regulate levels of glucose in the blood. Glucose levels naturally rise after meals with the intake of carbohydrates.
**What is the Normal Range for Glucose?** 70-115 mg/dL
**What are the Indications for Glucose?** * Diagnose:
+ Hypoglycemia
+ Hyperglycemia
+ Diabetes Mellitus (DM)
- Monitor treatments for Diabetes Mellitus (DM)
**What would cause Increased Levels of Glucose?** * Diabetes Mellitus (DM)- Stress
- Pancreatitis
- Chronic Renal Failure
- Cushing Syndrome
- Corticosteroid therapy
**What would cause Decreased Levels of Glucose?** * Insulinoma- Hypothyroidism
- Hypopituitarism
- Addison Disease
- Insulin overdose
- Starvation
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**What is the Lab Name for Folic Acid Lab Values?** Folic Acid
**What is Folic Acid in terms of Nursing Labs?** Folic acid is an essential water soluble B vitamin. It is stored in the liver and is an important part of Red Blood Cell (RBC) and White Blood Cell (WBC) function, DNA replication, and cell division.
**What is the Normal Range for Folic Acid?** 2 – 20 ng/mL
**What are the Indications for Folic Acid?** * Diagnose megaloblastic anemia
- Monitor effects of long-term Total Parenteral Nutrition (TPN)
- Identify Folate Deficiency
**What would cause Increased Levels of Folic Acid?** * Excess folate intake **What would cause Decreased Levels of Folic Acid?** * Vitamin B12 deficiency- Pernicious anemia
- Hemolytic anemia
- Celiac Disease or Crohn Disease
- Inflammatory Bowel Disease (IBS)
- Alcoholism
- Malnutrition
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**What is the Lab Name for Ferritin Lab Values?** Ferritin
**What is Ferritin in terms of Nursing Labs?** Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin. Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron.
**What is the Normal Range for Ferritin?** 20-300 ng/mL
**What are the Indications for Ferritin?** * Diagnosing:
+ Iron-deficiency anemia
+ Hemochromatosis
- Monitor:
- Iron levels
**What would cause Increased Levels of Ferritin?** * Inflammation- Alcoholic liver disease
- Multiple blood transfusions
- Hemochromatosis
- Long term Gastrointestinal(GI) bleeding
- Iron-deficiency anemia
- Heavy menstrual bleeding
**What would cause Decreased Levels of Ferritin?** * Long term Gastrointestinal(GI) bleeding- Iron-deficiency anemia
- Heavy menstrual bleeding
- Iron levels
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Objective: Determine the significance and clinical use of Erythrocyte Sedimentation Rate in clinical practice
Lab Test Name: Erythrocyte Sedimentation Rate- ESR
Description: The Erythrocyte Sedimentation Rate (ESR) test measures sedimentation of Red Blood Cells (RBCs).
In normal conditions, RBCs settle or sediment very little.
Inflammation affects proteins in the blood causing RBCs to stick and settle together out of the liquid portion of the blood.
Indications: Identifies inflammation which assists in diagnosing:
- Cancer
- Infection
- Autoimmune diseases
Normal Therapeutic Values: Normal – 0-20 mm/hr
What would cause increased levels? Increased
Conditions:
- Anemia
- Chronic Renal Failure
- Systemic Lupus Erythematosus (SLE)
- Infection
- Tuberculosis
- Pregnancy
- Polymyalgia Rheumatica
- Multiple myeloma
Medications:
- Oral contraceptives
- Theophylline
- Vitamin A
What would cause decreased levels?
Decreased
Conditions:
- Sickle cell anemia
- Polycythemia Vera
- Leukocytosis
- Congestive Heart Failure (CHF)
Medications:
- Aspirin
- Cortisone
- Quinine
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Objective: Determine the significance and clinical use of D-Dimer in clinical practice
Lab Test Name: D-Dimer- DDI
Description: Measurement of D-Dimer evaluates the amount of byproduct produced as part of fibrinolysis
D-dimer (DDI) is a product of fibrinolysis
D-dimer levels are elevated in the setting of clot breakdown, and will be significantly elevated in the setting of Disseminated Intravascular Coagulation (DIC).
Indications: Identify and monitor
Disseminated Intravascular Coagulation (DIC)
Rule out a blood clot:
- Pulmonary Embolism (PE)
- Deep Vein Thrombosis (DVT)
- Stroke
Normal Therapeutic Values: Normal – ≤ 250 ng/mL
Collection:
- Light blue lab tube
What would cause increased levels? Increased
- Surgery
- Trauma
- Infection
- Cancer
- Heart attack
- Pregnancy
- Deep Vein Thrombosis (DVT)
- Disseminated Intravascular Coagulation (DIC)
What would cause decreased levels? Indicates a lack of the substance that is released during the breakdown of a blood clot (i.e. lack of blood clots, or lack of fibrinolysis)
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Objective: Determine the significance and clinical use of C-Reactive Protein in clinical practice
Lab Test Name: C-Reactive Protein – CRP
Description: C-reactive protein (CRP) is made in the liver in response to inflammation
Measures CRP in the blood
- Increases quickly
- Decreases quickly
Indications: Monitor or Identify:
- Inflammation in the body
- Appendicitis
- Pelvic Inflammatory Disease (PID)
- Crohn’s
- Ulcerative Colitis
- Rheumatoid Arthritis (RA)
- Lupus (SLE – Systemic Lupus Erythematosus)
Evaluate:
- Coronary Artery Disease (CAD)
- Cholesterol level – atherosclerosis
Normal Therapeutic Values: Normal – <1.0 mg/L
Collection:
- Serum separator tube
What would cause increased levels? Increased=Inflammation
- Bacterial Infection
- Crohn’s Disease
- Inflammatory Bowel Disease
- Lupus
- Rheumatoid Arthritis (RA)
- Pregnancy – estrogen
- Myocardial Infarction (MI)
What would cause decreased levels? Decreased=resolving inflammation
Medications that reduce inflammation:
- NSAIDs
- Statins
- Steroids
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Objective: Determine the significance and clinical use of measuring Creatinine Clearance in clinical practice
Lab Test Name: Creatinine Clearance – CrCl
Description: Healthy kidneys remove creatinine from the blood. It then passes out of your body through urine. Creatinine is created in the body as a byproduct from normal wear and tear on muscles and protein in your diet.
Creatinine Clearance is a test that compares the level of creatinine in the blood against the level in the urine and evaluates Glomerular Filtration Rate. Hydration, blood volume status, blood pressure, and the state of the glomeruli impact GFR.
Remember that GFR is the amount of blood cleaned each minute by tiny filters in your kidneys called glomeruli.
An increase in CrCl indicates an increase in GFR.
Indications: The creatinine clearance test is done when your healthcare provider thinks that the eGFR result given with your blood creatinine level may not be accurate. This would be in patients who have diabetes, those with HF, those with kidney disease, and is sometimes evaluated in those with hypertension.
- Kidney Function
- GFR
- Diabetes
- Heart Failure
- Hypertension
Normal Therapeutic Values: Normal – Creatinine clearance rates go down as you age
- Male: 97 to 137 mL/min
- Female: 88 to 128 mL/min
For every decade after age 40, a normal test result is 6.5 mL/min less than the numbers above.
Collection:
- Plasma separator tube for serum
- Urine is collected for 24 H in a plastic container
- First void is flushed
- Date and time recorded, and urine collected and stored at room temperature
- Processed once collection is complete
What would cause increased levels? Increased Creatinine Clearance→ Increased GFR
- Pregnancy- higher blood volume
- Large protein intake
- Exercise
What would cause decreased levels? The kidneys are solely responsible for removing Creatinine from the blood. If kidney function is declining, the creatinine level increases in the blood, but less creatinine is excreted into the urine.
Decreased Creatinine Clearance→ Decreased GFR
- Abnormal kidney function
- Poor perfusion
- Dehydration
- Bladder obstruction
- Nephrotoxic medications
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**What is the Lab Name for Creatinine (Cr) Lab Values?** Creatinine
**What is the Lab Abbreviation for Creatinine?** Cr
**What is Creatinine in terms of Nursing Labs?** Creatinine (Cr) is a byproduct of creatine metabolism, and it is excreted by the kidneys. Creatinine is created in proportion to muscle mass and usually stays stable.
**What is the Normal Range for Creatinine?** 0.7-1.4 mg/dL
**What are the Indications for Creatinine?** * Identify:
+ Muscular disorders
+ Renal disease
**What would cause Increased Levels of Creatinine?** * Gigantism
- Acromegaly
- Renal disease
- Rhabdomyolysis
- Congestive Heart Failure (CHF)
- Dehydration
- Shock
- Hyperparathyroidism
**What would cause Decreased Levels of Creatinine?** * Loss of muscle mass- Muscular Dystrophy
- Inadequate protein intake
- Pregnancy
- Liver disease
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**What is the Lab Name for Creatine Kinase (CK) Lab Values?** Creatine Kinase
**What is the Lab Abbreviation for Creatine Kinase?** CK
**What is Creatine Kinase in terms of Nursing Labs?** Creatine kinase (CK) enzyme is found in heart and skeletal muscle and to a lesser extent brain. When damage is done to these types of tissue CK is released into the blood. There are three isoenzymes, and depending on which one is elevated this lab value can help determine timing, location, extent of damage. The three isoenzymes are CK-MB (cardiac), CK-MM (skeletal), and CK-BB (brain).
**What is the Normal Range for Creatine Kinase?** 55 – 170 U/L
**What are the Indications for Creatine Kinase?** * Monitor:
+ Muscle damage
- Diagnose:
- Acute Myocardial Infarction(MI)
- Ischemia
- Muscular Dystrophy
- Evaluate success of treatment
**What would cause Increased Levels of Creatine Kinase?** * Muscle damage- Rhabdomyolysis
- Muscular Dystrophy
- Heart attack
- Exercise
- Kennedy’s Disease
- Stroke
**What would cause Decreased Levels of Creatine Kinase?** * Early pregnancy- Small stature
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**What is the Lab Name for Cholesterol (Chol) Lab Values?** Cholesterol
**What is the Lab Abbreviation for Cholesterol?** Chol
**What is Cholesterol in terms of Nursing Labs?** Cholesterol (Chol) is a lipid in the body. It is a part of cell membranes as well as a precursor for vitamin D, steroids, and bile acids. Cholesterol is primarily synthesized in the liver and intestines and is transported via lipoproteins. There are multiple types of lipoproteins, each have slightly different functions. The two most common types of lipoproteins are high-density lipoprotein (HDL) and low-density lipoprotein (LDL).
**What is the Normal Range for Cholesterol?** <200 mg/dL
**What are the Indications for Cholesterol?** * Determine risk of cardiovascular disease
- Evaluate response to treatment
**What would cause Increased Levels of Cholesterol?** * Malabsorption- Liver disease
- Diabetes Mellitus (DM)
- Obesity
- Cushing Syndrome
- Hypothyroidism
- Alcoholism
- Nephrotic Syndrome
- Chronic Obstructive Pulmonary Disease (COPD)
- Gout
- Werner’s Syndrome
- Ischemic Heart Disease
- Von Gierke Disease
- Acute Intermittent Porphyria
- Pregnancy
**What would cause Decreased Levels of Cholesterol?** * Burns- Tangier disease
- Pernicious anemia
- Thalassemia
- Hyperthyroidism
- Chronic Myelocytic Leukemia
- Malnutrition
- Polycythemia Vera
- Anorexia
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**What is the Lab Name for Chloride (Cl-) Lab Values?** Chloride
**What is the Lab Abbreviation for Chloride?** Cl-
**What is Chloride in terms of Nursing Labs?** Chloride (Cl–), an anion found in the blood, works together with sodium to help maintain oncotic pressure and water balance in the body. Chloride is inversely related to bicarbonate levels in the blood. Chloride is also part of hydrochloric acid (HCL) which is utilized in the stomach to breakdown food. When Red Blood Cells (RBCs) take up CO2 they take up chloride as well. The negative ion bicarbonate then leaves the red blood cell so that the electrical charge is maintained. Extra chloride is excreted into the urine by the kidneys.
**What is the Normal Range for Chloride?** 96-108 mEq/L
**What are the Indications for Chloride?** * Identify
+ Acid-Base Imbalance
**What would cause Increased Levels of Chloride?** * Dehydration
- Acute Renal Failure
- Cushing Disease
- Metabolic Acidosis
- Respiratory Alkalosis
**What would cause Decreased Levels of Chloride?** * Congestive Heart Failure (CHF)- Water intoxication
- Burns
- Metabolic Alkalosis
- Respiratory Acidosis
- Addison Disease
- Salt-losing Nephritis
- Excessive sweating
- Diarrhea
- Vomiting
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**What is the Lab Name for Calcium (Ca+) Lab Values?** Calcium
**What is the Lab Abbreviation for Calcium?** Ca+
**What is Calcium in terms of Nursing Labs?** Calcium (Ca+), a positive ion in the body, is necessary for neuromuscular processes, bone mineralization, and hormonal secretion. The parathyroid gland and vitamin D are responsible for calcium regulation in the body. In the blood, about half of calcium travels in ion form, the other half is bound to proteins like albumin. When albumin levels are low, calcium levels will appear lower. Calcium has an important relationship with phosphorus: they are inversely proportional.
**What is the Normal Range for Calcium?** 8.4-10.2 mg/dL
**What are the Indications for Calcium?** * Identify problems with:
+ Parathyroid
+ Neuromuscular functions
+ Diseases that affect bone
+ Effectiveness of treatments.
**What would cause Increased Levels of Calcium?** * Cancers:
+ Breast, lung, and multiple myeloma are the most common
- Hyperparathyroidism
- Acidosis
- Renal transplant
- Sarcoidosis
- Vitamin D toxicity
- Dehydration
**What would cause Decreased Levels of Calcium?** * Malnutrition- Cirrhosis
- Chronic Renal Failure
- Hypoparathyroidism
- Alkalosis
- Hypomagnesemia
- Hypoalbuminemia
- Hyperphosphatemia
- Malabsorption
- Alcoholism
- Osteomalacia
- Vitamin D deficiency
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**What is the Lab Name for Blood Urea Nitrogen (BUN) Lab Values?** Blood Urea Nitrogen
**What is the Lab Abbreviation for Blood Urea Nitrogen?** BUN
**What is Blood Urea Nitrogen in terms of Nursing Labs?** Blood urea nitrogen (BUN) measures the amount of urea in the blood. When protein is broken down ammonia is formed. Ammonia is converted to urea in the liver and is eventually excreted in the kidneys.
**What is the Normal Range for Blood Urea Nitrogen?** 7-20 mg/dL
**What are the Indications for Blood Urea Nitrogen?** * Identifying:
+ Liver Problems
+ Renal Problems
+ Hydration Status
+ Tumor Lysis
- Evaluate effects of drugs on:
- Liver
- Kidney
- Monitor effectiveness of hemodialysis
**What would cause Increased Levels of Blood Urea Nitrogen?** * Renal Failure- Congestive Heart Failure (CHF)
- Myocardial Infarction (MI)
- Kidney Disease
- Shock
- Dehydration
- Excessive Protein Intake
- Diabetes Mellitus (DM)
- Gastrointestinal (GI) bleed
- Urinary Tract Obstruction
**What would cause Decreased Levels of Blood Urea Nitrogen?** * Liver Failure- Over-hydration
- Inadequate Protein Intake
- Pregnancy
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Objective: Determine the significance and clinical use of measuring Direct or Conjugated Bilirubin in clinical practice
Lab Test Name: Direct or Conjugated Bilirubin
Description: Bilirubin is a substance made when your body breaks down old red blood cells. This is a normal process. Bilirubin is also part of bile, which your liver makes to help digest the food you eat.
A small amount of bilirubin in your blood is normal.
Some bilirubin is bound to albumin in the blood. This type of bilirubin is called unconjugated, or indirect, bilirubin.
In the liver, bilirubin is changed into a form that your body can get rid of. This is called conjugated bilirubin or direct bilirubin.
This bilirubin travels from the liver into the small intestine. A very small amount passes into your kidneys and is excreted in your urine. This bilirubin also gives urine its distinctive yellow color and contributes to the brown color of stool.
Indications: * Newborns – immature liver has trouble clearing bilirubin and manifests as jaundice * Investigate jaundice in adults * Blockage of bile ducts- (liver or gallbladder) * Detection of liver disease- particularly hepatitis * Monitor progression of hepatitis * Detect issues with RBC breakdown→hemolytic anemia * Suspected drug toxicity- many medications are metabolized and cleared in the liver
Normal Therapeutic Values: Normal – 0.0-0.2 mg/dL
Collection:
- Plasma separator tube
What would cause increased levels? Increased levels linked to:
- Poor liver function or hepatitis
- Certain medications
- Hemolytic anemia
- Pregnancy
- Sepsis- poor perfusion
- Exercise
- TPN
- ETOH
What would cause decreased levels? Studies are inconclusive regarding risk or association with disease process in the presence of a decreased bilirubin level.
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**What is the Lab Name for Aspartate Aminotransferase (AST) Lab Values?** Aspartate Aminotransferase
**What is the Lab Abbreviation for Aspartate Aminotransferase?** AST
**What is Aspartate Aminotransferase in terms of Nursing Labs?** Aspartate aminotransferase (AST) is an enzyme primarily found in liver and heart cells and to a smaller extent, AST can also be found in the pancreas, kidneys, skeletal muscle, and brain. Levels of AST increase from cell death (necrosis) because the AST enzyme is released into the blood.
**What is the Normal Range for Aspartate Aminotransferase?** 12-37 U/L
**What are the Indications for Aspartate Aminotransferase?** * Monitor progression of:
+ Liver disease
+ Response to treatments.
- Monitor liver toxic medications
**What would cause Increased Levels of Aspartate Aminotransferase?** * Liver disease- Liver cancer
- Shock
- Congestive Heart Failure (CHF)
- Pericarditis
- Biliary tract obstruction
- Dermatomyositis
- Pancreatitis
- Muscular Dystrophy
- CVA
- Hemolytic anemia
- Delirium Tremens (DT)
**What would cause Decreased Levels of Aspartate Aminotransferase?** N/A
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**What is the Lab Name for Amylase Lab Values?** Amylase
**What is Amylase in terms of Nursing Labs?** Amylase is made in the pancreas. It is an enzyme that breaks down carbohydrates to allow our body to absorb it. Monitoring amylase levels can identify problems with the pancreas.
**What is the Normal Range for Amylase?** 0-130 U/L
**What are the Indications for Amylase?** * Diagnosing:
+ Pancreatitis
+ Pancreatic Duct Obstruction
+ Macroamylasemia
- Trauma to Pancreas
**What would cause Increased Levels of Amylase?** * Pancreatitis- Pancreatic Cancer
- Pancreatic Cyst
- DKA
- Peritonitis
- Abdominal Trauma
- Duodenal Obstruction
- Mumps
- Alcohol use
**What would cause Decreased Levels of Amylase?** * Pancreatic Insufficiency- Pancreatectomy
- Toxemia of Pregnancy
- Cystic Fibrosis
- Liver Disease
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**What is the Lab Name for Ammonia (NH3) Lab Values?** Ammonia
**What is the Lab Abbreviation for Ammonia?** NH3
**What is Ammonia in terms of Nursing Labs?** Ammonia (NH3) is a byproduct created when protein is broken down. Ammonia is converted into urea in the liver, and urea is excreted by the kidneys. During liver disease, ammonia levels rise and can have a negative effect on the brain.
**What is the Normal Range for Ammonia?** 19-60 mcg/dL
**What are the Indications for Ammonia?** * Identifying liver disease
- Monitoring hepatic encephalopathy
- Evaluating effectiveness of treatment.
**What would cause Increased Levels of Ammonia?** * Liver Failure- Hepatic Coma (Hepatic Encephalopathy)
- Reye’s syndrome
- Total Parental Nutrition (TPN)
- Gastrointestinal Hemorrhage
**What would cause Decreased Levels of Ammonia?** * Some Antibiotics: + Neomycin- Hypertension
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Objective: Determine the significance and clinical use of alkaline phosphatase in clinical practice
Lab Test Name: Alkaline Phosphatase – ALP
Description: Measures amount of ALP in circulation
Located in several places in the body:
- Liver
- Intestines
- Biliary tract
- Bones
- Placenta
Different isoenzymes of ALP are used to determine:
- Liver, bone, intestine and other cancers
- Bone turnover in postmenopausal women
Indications: Evaluation of ALP:
- Hepatobiliary disease
- Malignancies
- Bone disease
- Bone damage in renal patients
Normal Therapeutic Values: Normal – 40-130 U/L
Collection:
- Plasma separator tube
What would cause increased levels? Increased levels assessed in:
- Liver disease
- Bone disease
- Pregnancy
- Amyloidosis
- Lung cancer
- Pancreatic cancer
- Congestive heart failure
- Ulcerative colitis
- Hodgkin’s disease
- Chronic renal failure
- Sarcoidosis
What would cause decreased levels? * Hypophosphatasia (spelling error on existing outline on NURSING.com) * Anemia * Kwashiorkor * Cretinism * Hypothyroidism * Zinc or magnesium deficiency * Scurvy
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**What is the Lab Name for Albumin Lab Values?** Albumin
**What is the Lab Abbreviation for Albumin?** alb
**What is Albumin in terms of Nursing Labs?** Albumin is a transport protein in the blood. It helps maintain the oncotic pressure of the blood. Albumin levels will drop if synthesis is slowed, protein intake is inadequate, or there are increased losses. Albumin has a long half life, however, so levels are not a good indicator of acute illness.
**What is the Normal Range for Albumin?** 3.5 – 6.0 g/dL
**What are the Indications for Albumin?** * Evaluation of chronic illness
- Liver disease
- Nutritional status
What would cause Increased Levels of Albumin?
* Dehydration
- Hyper infusion
- Albumin
**What would cause Decreased Levels of Albumin?** * Inadequate intake- Liver disease
- Inflammation
- Chronic disease
- Losses (fistula, hemorrhage, kidney disease, burns)
- Over hydration
- Increased catabolism
- Congestive heart failure
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Objective: Determine the significance and clinical use of Alanine Aminotransferase in clinical practice
Lab Test Name: Alanine Aminotransferase – ALT
Description: Measures amount of ALT, an enzyme produced by the liver, present in circulation
Found in:
Most abundantly in liver
Heart
Skeletal muscle
kidney
Increases in lab values indicate liver disease or liver damage
Indications: Evaluation of ALT:
- Progression of liver disease
- Monitoring response to treatment
Normal Therapeutic Values: Normal – 40-130 U/L
Collection:
- Plasma separator tube
What would cause increased levels? INCREASED:
- Cirrhosis
- Muscle damage
- Preeclampsia
- Biliary tract obstruction
- Burns
- Pancreatitis
- Long-term alcohol abuse
- Liver Cancer
- Muscular dystrophy
- MI
- Myositis
- Shock
- Infection-mononucleosis
What would cause decreased levels? DECREASED:
- Pyridoxal phosphate deficiency
- A rare genetic metabolic disorder
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**What is the Lab Name for Activated Partial Thromboplastin Time Lab Values?** Activated Partial Thromboplastin Time
**What is the Lab Abbreviation for Activated Partial Thromboplastin Time?** APTT
**What is Activated Partial Thromboplastin Time in terms of Nursing Labs?** APPT is a test that measures the amount of time it takes for a fibrin clot to form after reagents have been added to the specimen. It is useful in diagnosis clotting disorders. In conjunction with PT it can be used to differentiate the specific factor that may be missing.
**What is the Normal Range for Activated Partial Thromboplastin Time?** 25-39 seconds
**What are the Indications for Activated Partial Thromboplastin Time?** * Identifying
+ Congenital deficiencies in clotting
- Monitoring
- Effects of liver disease
- Protein deficiency
- Fat malabsorption on clotting
**What would cause Increased Levels of Activated Partial Thromboplastin Time?** * Vitamin K deficiency- DIC
- Patients on hemodialysis
- Afibrinogenemia
- Polycythemia
- Liver disease
- Von Willebrand disease
**What would cause Decreased Levels of Activated Partial Thromboplastin Time?** * N/A