CBC Interpretation
CBC tells us 3 things: Oxygen delivery (RBC), infection (WBC), &
hemostasis/clotting (PLT)
Oxygen delivery: RBC, Hgb (carries O2), Hct
• Multiply by 3: (RBC 3 Hgb 9 Hct 28)
• RBC increased in: hemoconcentration, COPD
• RBC decreased in: hemodilution, chemo, dietary deficiency,
hemolytic anemia, leukemia
• MCV (mean corpuscular volume): average volute in the red blood
cell. >100 = macrocytic; cells need Vit B12 and folate to divide, if
they do not divide they become large, <80 = microcytic: if cells
lack iron and protein they lack volume
• MCH (mean corpuscular hemoglobin): average
protein/hemoglobin inside the cell
• MCHC (mean corpuscular hematocrit): average hematocrit inside
the cell
• RDW (red cell distribution width): size and shape of the cell,
used in conjunction with anemia
Infection: WBC “Never Let Monkey’s Eat Bananas”, Neutrophils,
Lymphocytes
• Neutrophils: Bacterial
• Lymphocytes: Viral
• Monocytes: Chronic inflammatory process (eosinophils &
basophils)
• Eosinophils: Parasites, Allergies, Asthma
• Basophils: Parasites, Allergies, Immune response
• Segs: mature Neutrophils
• Bands: immature Neutrophils
Clotting: Platelets
• PLT: platelets show body’s clotting ability, go hand in hand with
LFTS (liver function tests), clotting factors are made by the liver.
Clot is made of Finbrin Mesh & Platelet; Fibrinogen is converted
by Thrombin into Fibrin. Fibrinogen is synthesized in the liver,
platelet synthesis is regulated by thrombopoietin, a hormone
that is produced by the liver and kidneys (ex. ETOH)
LFTS (Liver Function Tests)
ALT: (Alanine Aminotransferase) an enzyme found in the liver and
increases with liver damage
• Used to monitor liver disease such as ETOH abuse, cirrhosis, and
liver tumors. Medications can also cause an increase in ALT
(Tylenol OD)
• Dependent on vitamin B6 and will be decreased in low B6 &
cirrhosis
• Pt will be jaundice, fatigue, N/V, dark urine, pale stools, itching,
ascites (the accumulation of fluid in the peritoneal cavity, causing
abdominal swelling), and mental changes (decreased LOC)
AST: (Aspartate Aminotransferase) another enzyme found primarily in
the liver, but is also found in the heart, muscle, pancreas, kidney & brain
AST & ALT are often measured together. Dependent on B6
• Increased for the same reasons as above, however this can also be
elevated d/t damage of other organs, which is why they are
evaluated together
• Levels may also be elevated in bile duct blockage (gallbladder
stones) and muscle injury such as heart attacks, injections, and
strenuous exercise.
Lipase: an enzyme secreted by the pancreas to break down triglycerides
(fat)
• Most commonly elevated in acute pancreatitis. Also elevated in
duct obstruction, malignancy, cholecystitis, SBO, DKA & liver
disease
• Excreted by the kidney and can be found in Pts /c renal failure
• Onset 24-48 hours after symptoms and continuous for 5-7 days,
making in more useful in acute pancreatitis rather than chronic
Amylase: another enzyme excreted by the pancreas to break down CHO
• Most commonly elevated on acute and chronic pancreatitis, but
also in ulcers, obstructions, gallbladder attacks and cancer
• Onset is 12 hours and normalizes in 48-72 hours, is cleared
through the kidneys
Albumin is blood plasma protein synthesized by the liver. It’s the main
protein in human blood, and transports hormones such as thyroid,
estrogen, and cortisol. It tells us if our Pt has liver or kidney disease or if
the body is not absorbing enough proteins (malnutrition)
• Increased in liver disease, ascites, burns, malabsorption syndrome
and malnutrition
Basic Metabolic Panel (BMP)
Evaluates glucose levels, electrolytes, acid/base balance, kidney function.
Glucose: Normal 70-110 direct measurement of glucose in blood,
Elevated in DM or corticosteroids Decreased in poor PO intake
Sodium (NA+) Normal 135-145: Hypernatremia: dehydration, too
much sodium in IVF. S/Sx: confusion, muscle weakness, seizures;
Hyponatremia: water intoxication, decreased dietary intake, S/Sx:
weakness, confusion
Potassium (K+) Normal 3.5-5: Hyperkalemia: renal failure,
rhabdomyolysis, acidosis (K shifts from cell into serum) S/Sx: cramping.
Hypokalemia: dehydration, vomiting, diarrhea, endocrine
Magnesium (Mg) Normal 1.5-2.5: need normal Mg to maintain normal
K, muscles depend on Mg to function, increases absorption of Ca,
replacing Mg may fix Ca. Hypermagnesia: kidney failure. S/Sx: decreased
HR. Hypomagnesia: ETOH abuse, diuretics, V/D. S/Sx: seizures, cramping
Calcium (Ca+) Normal 8.5-10.5: Hypercalcemia: cancer (Ca moves from
bone into serum). S/Sx: weakness, thirsty. Hypocalcemia: decreased Vit
D (these go hand in hand), renal failure. S/Sx: cramping. Calcium binds to
albumin; if albumin is low, so is Ca+. Common cause is malnutrition.
Chloride (Cl-) Normal 95-105: Follows Na+. Hyperchloremia:
dehydration, metabolic acidosis, respiratory alkalosis, too much NS. S/Sx:
lethargy, weakness. Hypochloremia: overhydrated, CHF, V/D, burns.
S/Sx: shallow breathing, decreased BP, tetany
Blood Urea Nitrogen (BUN) Normal: 8-20: measures RENAL Function
and LIVER function. Urea is formed in liver and is end product of
metabolism. Elevated in shock, sepsis, dehydration, CHF, MI (decreased
blood flow), GI Bleeding, any time your body doesn’t have enough blood.
Decreased in liver failure, malnutrition, overhydration
Creatinine Normal 0.6-1.3: used to diagnose RENAL function, excreted
by kidneys. Elevated in renal disease & rhabdomyolysis
Glomerular Filtration Rate (GFR) Normal >60: equation of how much
blood passes through the kidney each 1 minute. Changes with factors
such as age, race, and sex. Used to decide if Pt needs dialysis: <60 for 3
months = chronic kidney disease, <15=kidney failure
Urinalysis
Reference Range/Normal Values
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Color --- Yellow (light/pale to deep amber)
Clarity/Turbidity – Clear to cloudy
pH – 4.5-8
Specific Gravity – 1.005-1.025
Glucose – < 130 mg/d
Ketones – negative
Nitrites – negative
Leukocyte esterase – Negative
Bilirubin – Negative
Urobilirubin – Small amount (0.5-1 mg/dL)
Blood – < 3 RBCs
Protein – <150 mg/d
RBCs – < 2 RBCs/hpf
WBCs – <2-5 WBCs/hpf
Squamous epithelial cells – < 15-20 squamous epithelial
cells/hpf
Casts – 0-5 hyaline casts/lpf
Crystals – Occasionally
Bacteria – None
Yeast – None
Review patient chart.
Temperature ___________ (Oral, Temporal, Axillary, Tympanic, Rectal) (98.6)
Pulse – rate _____, strength (strong, weak), rhythm (regular, irregular) (60-100 bpm)
Perform hand hygiene.
Resp – rate _____, rhythm (regular, irregular), depth (shallow, deep, normal), effort
(labored, unlabored) (12-20 resp/min)
Identify patient, introduce yourself,
Blood pressure (LA, RA) _______________ (120/80) MAP ___________
explain procedure.
Possible Pressure Points
• Elbows
• Sacrum
Oxygen (rate & route) _________________________________
• Heels/Ankles
Pain? Provoked ___________ Quality ____________ Radiate/Where ________
• Scapula
Scale (0-10) ________ Time/when did it start ____________
Pulse oximeter ______________ (>90)
Provide privacy.
Neurological
Assess hair &
nails as you go
Symptoms __________________ LOC ___________ Orientation? ___________
Affect/behavior ____________ Speech ____________ Facial symmetry ________
Ability to move extremities _________________ Gait _________________
JVD
Pupils (equal, round, reactive to light PERRL) bilat _________ mm
Neurovascular/Neuromuscular Strength ______________
Numbness/Tingling? ______________ Plantar/& dorsiflexion _________________
Nail beds (color, cap refill x10 fingers) __________ x10 toes__________
Edema General/Local Location, amount, pitting/nonpitting _____________________
Pulses (quality, presence) radial _____________ pedal _____________
Pallor (pink, warm & dry (W/D), intact) _______________________
Integrity ______________________________________________________
Turgor (elastic, tenting)
Radial
Pulse
Mucous membranes ______________
Sub Q
Sub Q
Glasgow Coma Scale Eye opening ____ Best motor _____ Best verbal _____
Respiratory
Symptoms _________ Breathing probs _________ regularity _________
Chest symmetry ________ Oxygen type __________ Cough ? __________
Sub Q
Sputum (color, amount, consistency) ________________________
X
Breath Sounds/What heard, where __________________________________
Cardiovascular
Symptoms ____________________ Apical (count 60 secs)____________
JVD __________ Heart rhythm _________________
Sub Q
LOC:
Squeeze
Push
Pull
Check for
swelling
Pedal Pulse
Gastrointestinal Symptoms __________________ Eating difficulties
________________
Nutrition risk _____________________ Appetite ______________________
1. Abdomen (flat, rounded, scaphoid) (soft, firm, distended)
2. BS x 4 quadrants (hypoactive, hyperactive) 3. Abdomen tenderness/Pain _______
Belching/flatus __________ Last BM ? ________Stool color, description _____________
Genitourinary
Symptoms ____________________ Bladder distention _________________
Urinary elimination (voiding difficulties, catheter) _____________________
Any Pain/burning with urination? For Females, any discharge?
Voiding difficulties (burning, dribbling, nocturia, etc.) __________________
Purposeful Rounding /QH
Activity order ________________ Position _________
Antiembolism devices ___________ ROM __________
Assistive devices ______________________________
Activity assist _____________ Family Present _______
Bed Safety Information
Brakes, alarms, side rails, low position, call light
HOB degrees ______________ Turn assist _________
Urine description (amount, clarity, color, odor) _____________________ Report <30 ml/hr Peripheral IV
Site assess ____________________________
Incision/Wound
Dressing ________________ Patency ____________
Description ___________________________ Size ______________
Potty ______________ Pain ______________
Surrounding tissue ___________________ Drainage ________________
Care _________________ Dressing ____________________
Pressure ulcer description ________________________________________
Nutrition
Diet type __________________ feeding assist _____________
NOTES: