Lab Values Basic Metabolic Panel - Sodium: 135-145 - Potassium: 3.5-5.0 - Chloride: 98-106 - BUN: 6-20 - Glucose: 70-99 - Creatinine: Male (0.6-1.2), Female (0.5-1.1) Complete Blood Count - RBC’s: Male (4.7-6.1), Female (4.2-5.4) - Hemoglobin: 10-18 - Hematocrit: 30-48 - WBC’s: 4,000-11,000 Lipid Studies - Total Cholesterol: Less than 200 - HDL Cholesterol: Male (greater than 45), Female (greater than 55) - LDL Cholesterol: Less than 130 - Triglycerides: Male (40-160), Female (35-135) Liver Function Studies - Albumin: 3.3-5 - Bilirubin: 0.3-1.0 - ALT: 4-36 - AST: 0-35 - Alkaline Phosphatase: 30-120 Cardiac Marker Studies - Creatinine Kinase: Elevated indicates damage in skeletal, cardiac or brain tissue: Male (55-170), Female (30-135) - CK-MB: Greater than 3 is abnormal. - Myoglobin (released with damage): Greater than 90 is abnormal - Troponin I (found in cardiac muscle): Greater than 0.04 is abnormal - Troponin T (cardiac muscle): Greater than 0.1 is abnormal Urine Studies - Specific Gravity: 1.005-1.030 - Glucose: Should be negative, positive indicates DM or infection. - Ketones: Should be negative - Protein: 0-8 - Bilirubin: Should be negative, positive with hepatic issues. ABG’s - pH: (acidotic) 7.35-7.45 (basic, alkalosis) - PaCO2: (basic) 35-45 (acidotic) Respiratory Marker - HCO3 (bicarbonate): (acidotic) 22-26 (basic) Metabolic Marker - PaO2: 80-100: Lower marks hypoxemia Electrolytes and Acid Base Respiratory Acidosis - Caused by: Hypoventilation (buildup of CO2) - COPD, overdose, low ventilation - Increased PaCO2, decreased pH - Manifestations: - Neuro: Lethargy, confusion, dizziness, headache. - CV: hypotension, warm/flushed skin. - Seizures and hypoventilation with hypoxia. Respiratory Alkalosis - Caused by: Hyperventilation (anxiety, fear, exercise) or mechanical - Decreased PaCO2, Increased pH - Manifestations: - Neuro: Dizziness, confusion, headache - CV: Tachycardia, arrhythmias - GI: N/V/D, epigastric pain - Neuromuscular: tetany, numbness, tingling, hyperreflexia Metabolic Acidosis - Caused by: DKA, diarrhea, starvation, renal failure, shock. - Decreased pH, decreased HCO3. - Manifestations: - Neuro: lethargy, confusion, dizziness, headache, muscle weakness. - CV: hypotension, cold/clammy skin. - GI: N/V/D, abdominal pain. Metabolic Alkalosis - Caused by: Prolonged gastric suctioning, vomiting, diuretics. - Increased HCO3, Increased pH - Manifestations: - Neuro: Irritability, lethargy, confusion, headache. - CV: Tachycardia, arrhythmias. - GI: Nausea, vomiting, anorexia - Neuromuscular: tetany, tremors, tingling, cramping, seizures. Fluids - - - Isotonics - 5% Dextrose in water - 0.9 Saline - 5% Dextrose in 0.25 Saline - Ringer’s solution - Lactated Ringer’s (not to use with renal or hepatic issues) Hypertonics - 10% Dextrose - 3.0% Saline - 5% Dextrose in 0.45 Saline - 5% Dextrose in 0.9 Saline Hypotonics: - 0.45% Saline - 5% Dextrose in water Random - - Intraocular Pressure (IOP): 10-21 mmHg Intracranial Pressure (ICP): 5-15 mmHg Urine Output: Greater than 30 ml/h Cerebral Perfusion Pressure: 60-100 mmHg - Less than 50 equals ischemia and neuronal death - Less than 30 equals ischemia and is incompatible with life. - MAP-ICP=CPP Mean Arterial Pressure: Greater than 65 - Systolic + Diastolic X2 / 3 Drainage Types - Serous drainage: clear to yellow, expected from wounds. Serosanguineous drainage: pink Sanguineous: red Cranial Nerves - I Olfactory: Sensory from olfactory (smell) II Optic: Sensory from retina (vision) III Oculomotor: Motor for eye movement IV Trochlear: Motor for eye movement V Trigeminal: VI Abducens: Motor for eye movement (3,4,6 tested together) VII Facial: Motor for facial expression and cheek muscle. VIII Vestibulocochlear: Sensory in the ears. IX Glossopharyngeal: Sensory and motor for tongue. X Vagus: Sensory from viscera and thorax, motor for larynx XI Accessory: Motor for sternocleidomastoid and trapezius. XII Hypoglossal: Motor to muscles of tongue. Cardiovascular Values - - - Systole: Contraction of heart muscles (pumping) Diastole: Relaxation of the heart muscles (filling) Pulse Pressures: SBP-DBP - Normal is around 30-40 (if your BP is good, you PP is good). Systolic Blood Pressure: Peak pressure in arteries with contraction. Diastolic Blood Pressure: Residual pressure in arteriole system with Ventricular relaxation (filling) Cardiac Output: Amount of blood pumped by the ventricles in 1 min. - Stroke Volume X Heart rate = CO - 4-8 for the average resting adult. Cardiac Index: Cardiac output divided by body surface area. - 2.8-4.2 considered normal. Stroke Volume: Volume squeezed out with each contraction. Preload: Volume of blood stretching the ventricles at the end of diastole. - May decrease with tachycardia or hypovolemia. - May increase with hypertension, aortic valve disease, hypervolemia. Afterload: Peripheral resistance that the left ventricle must pump against. Electrolytes - Hypernatremia: Greater than 145 - Causes: Excessive intake, inadequate water intake, excessive water loss, DI, cushings, uncontrolled diabetes. - Manifestations - Restlessness, lethargy, thirst, dry swollen tongue, tachycardia, decreased CVP, muscle cramps - Treatment: fluid replacement, diuretics - Hyponatremia: Less than 135 - Causes: - Excessive sodium loss: diarrhea, vomiting, suctioning. - Renal losses: diuretics, adrenal insufficiency. - Skin: burns, wound damage. - Inadequate intake, excessive water intake. - Diseases: SIADH, HF, Cirrhosis. - Manifestations: - Irritability, confusion, muscle spasms, N/V/D, weight gain, hypertension, increased CVP. - Treatment: Replace sodium. - Hyperkalemia: Greater than 5.0 - Causes: excessive intake, renal disease, medications sparing potassium. - Manifestations: fatigue, irritability, muscle weakness, loss of muscle tone, decreased reflexes, diarrhea, confusion, tetany. - EKG changes: arrhythmias high risk (V Fib) - Tall T waves, wide QRS, prolonged PR, ST depression. - Interventions: - Stop oral intake, - Increase excretion (polystyrene sulfonate) - Force K+ to ICF: Insulin w/ Dextrose - Hypokalemia: - Causes: Potassium loss (V/D, diuretics, diaphoresis), lack of intake. - Manifestations: fatigue, muscle weakness, decreased reflexes, shallow respirations, irregular pulse, nausea. - ECG changes: risk for ventricular arrhythmias, first and second degree heart block. - Flattened T wave, ST depression, prolonged QRS. - Interventions: Supplements or increasing in diet. - Hypercalcemia:
