Normal Values and Interpretation Serum Electrolytes ELECTROLYTE HYPER – NORMAL VALUE HYPO – Sodium Potassium Calcium Chloride Magnesium Phosphorus ↓ 135 135 – 145 3.5 – 5.5 8.5 – 10.9 96 – 105 1.5 – 2.5 2.5 – 4.5 ↑ 145 ↓ 3.5 ↓ 8.5 ↓ 96 ↓ 1.5 ↓ 2.5 ↑ 5.5 ↑ 10.9 ↑ 105 ↑ 2.5 ↑ 4.5 Serum electrolytes • Sodium: 135—145 (Hyper/hyponatremia) • Potassium: 3.5—5.5 (Regular insulin that is given intravenously can reduce serum potassium levels) • Calcium: 8.5—10.9 • Chloride: 95—105 • Magnesium: 1.5—2.5 (A decrease can cause ventricular arrhythmias such as torsades de pointes) • Phosphorus (phosphate): 2.5—4.5 (An increase above 4.5 can cause pruritus (itchy skin) Vital signs - Heart rate: 80—100 bpm Respiratory rate: 12-20 rpm Blood pressure: 110-120/60 mmHg (Baseline: 120/80) Temperature: 37 °C (98.6 °F) Hematology values - RBCs: 4.5—5.0 million WBCs: 5,000—10,000 Platelets: 200,000—400,000 Hemoglobin (Hgb): 12—18 Hematocrit (Hct): 37—54 Chemistry Values - Specific Gravity: 1.010—1.030 LDH: 100-190 Protein: 6.2—8.1 Albumin: 3.4—5.0 (Measurement of protein in the bloodstream) Bilirubin: <1.0 Uric acid: 3.5—7.5 CPK: 21-232 Hypokalemia *Even a small decline in potassium levels can cause cardiac events - A supplemental potassium replacement is used to prevent cardiac arrhythmias Hyperkalemia -Patients with hyperkalemia (increased serum potassium) may exhibit bradycardia with widened QRS waveform on EKG and may develop ventricular fibrillation. -Can cause progressing muscle weakness, bradycardia, heart block, and can progress to asystole. Once symptoms begin to show, it is a medical emergency that requires immediate attention. -Hyperkalemia may cause numbness and tingling of the fingertips and numbness around the mouth. Nausea, vomiting, and abdominal cramps may also occur with hyperkalemia. Systemic shock -The condition of systemic shock from trauma often involves fluid volume depletion from blood loss. The decreased circulatory blood volume causes an increased heart rate (tachycardia) and decreased blood pressure (hypotension). The respiratory rate is usually increased to greater than 22 breaths per minute. Patients with shock usually have an altered mental status (AMS) due to decreased blood volume resulting in decreased oxygen to the brain. Blood glucose -Normal blood glucose is 70-110 -Blood glucose should be treated if less than 70. A patient should be given 4 ounces (1/2 cup) of juice or 8 ounces of nonfat or 1% milk. After the patient finishes the juice, the nurse should recheck the blood glucose after 15 minutes. If blood glucose remains below 70 mg/dL, the nurse should administer dextrose 50% per standing orders and report this to the provider. Once blood glucose returns to normal, the patient should be given a small snack if the meal time is more than an hour away. -Routine blood glucose checks use capillary blood and are done at least every morning. Total cholesterol -Should be maintained below 200 mg/dL. This will lower the risk of coronary artery disease. -HDLs should be above 60 mg/dL. -LDLs should be below 130 mg/dL. -Triglycerides 30-160 mg/dL Hypoparathyroidism -Causes: a decrease in calcium; an increase in serum phosphorus -Hypocalemia can cause muscle twitching, spasms, petechiae, and tingling. -Parathyroid hormone acts to increase serum calcium through the breakdown of bone. Removal of the parathyroid gland may cause hypocalcemia. Grave's disease -Causes hyperthyroidism through the stimulation of TSH receptors. This results in an elevated T4 level and a diminished TSH level (Due to the negative feedback loop). -A diminished T4 and elevated TSH occur in hypothyroidism when the thyroid gland is not producing enough thyroid hormone. Cirrhosis -Fluid buildup around the abdominal organs called ascites. In patients with low albumin, resulting low oncotic pressure allows fluid to leak into the intracellular space. -Ascites (abdominal fluid retention) is a common occurrence in cirrhosis and liver failure and can lead to physical discomfort. Patients with ascites should be maintained in an upright position with the head of the bed elevated to at least 45 degrees. This will reduce shortness of breath from the abdominal fluid restricting the diaphragm during respiration. As albumin levels rise, the ascites should resolve, and this is monitored by daily weights and measurement of abdominal girth. -Patients with cirrhosis and liver dysfunction often require supplemental protein because albumin (which makes up 60% of the total protein) is synthesized in the liver. Albumin levels will rise after approximately three weeks if the supplemental nutrition is effective. Jaundice Characterized by: 1. yellowing of the skin, mucous membranes, and sclera (eyes) 2. Itchy skin (pruritus) -It is caused by a buildup of bilirubin which is normally filtered by the liver. Hemolysis -The destruction of red blood cells. This causes the breakdown of hemoglobin, bilirubin becomes a byproduct. This causes an increase of bilirubin in the blood. Levels greater than 2.5 mg/dL usually cause jaundice. Hepatic Encephalopathy -Confusion, personality changes, and asterixis (shaking hands) may be present due to buildup of ammonia. -Ammonia is a byproduct of protein catabolism. It is normally converted into urea and excreted, but in liver disease, ammonia is not converted and serum levels rise. -A rise in ammonia levels is toxic to the brain and can cause encephalopathy. Liver disease -Causes an elevation in liver enzymes such as alanine transaminase (ALT), aspartate transaminase (AST) and bilirubin. -Liver disease will cause a reduction in plasma proteins and albumin production. -An elevation in bilirubin causes jaundice. Pancreatitis/Amylase The normal range for serum amylase is 25-120 U/L. Amylase is used to diagnose pancreatitis. If levels are extremely elevated it’s indicative of acute pancreatitis. If levels are only slightly elevated it’s indicative of chronic pancreatitis because of pancreatic atrophy, causing a decrease in amylase production and storage. Levels for Kidney Function BUN: 10-20 Creatinine: 0.5-1.2 (excreted by the kidneys) *BUN and Creatinine levels may be elevated if renal perfusion is inadequate, kidney disease, damage, or loss of function (Acute kidney failure) -Acute kidney injury (AKI) describes the abrupt loss of kidney function resulting in the retention of urea and other nitrogenous waste products and causing dysregulation of extracellular volume and electrolytes. -Informing the doctor quickly of any changes to renal functioning is very important to implement treatments to prevent long-term or permanent kidney damage. Normal Ranges Neutrophils should account for 55-70% of all white blood cells. *An elevation in neutrophils is indicative of an acute bacterial infection or complications after surgery. Lymphocytes 20-40% *If elevated it usually is indicative of a viral infection *Pertussis and tuberculosis will elevate leukocytes. Monocytes 2-8% *Fungal infections cause elevated monocytes and neutrophils. Eosinophils 1-4% *Elevated counts is indicative of a parasitic infection (parasitosis) *Can also play a role in allergic reactions and asthma. Basophils 0.5-1% BNP - Brain natriuretic peptide is a substance that opposes the action of aldosterone. When the ventricular wall is stretched during congestive heart failure, BNP is released. BNP causes vasorelaxation and inhibition of aldosterone, thereby lowering fluid volume and blood pressure. Diabetic ketoacidosis (Fruity Breathe) -Evidenced by the low pH (acidosis) and the low HCO3. -Bicarb is used to compensate for the buildup of beta-hydroxybutyric and acetoacetic acids/ketoacids caused bythe DKA. -The PCO2 will be high (if uncompensated) or low (if the lungs are compensating with classic Kussmual respirations to blow off CO2). Diabetes mellitus and DKA -Patients with type 1 diabetes mellitus may experience diabetic ketoacidosis (DKA) when there is insufficient insulin to transport glucose into cells for energy. -This condition can lead to fluid volume depletion (dehydration) due to polyuria (excess urination) as thek idneys attempt to filter glucose from the bloodstream. -Cells are unable to get glucose for energy production due to lack of insulin. This causes the body to breakdown fat and protein for energy. The by-products of this process are ketones which make the blood acidic. -Patients with type 2 diabetes mellitus still produce some insulin in the pancreas so DKA does not occur in these patients. Administering Insulin -When a diabetic patient with elevated blood glucose requires insulin, the nurse must always have the insulin dose verified by a second nurse. Insulin can cause severe harm if administered improperly. ***Never give insulin as an IM injection because this will interfere with the expected onset, peak, and duration times of the insulin. Insulin should be given subcutaneously unless otherwise ordered by the doctor. ***A patient with hyperglycemia (high blood glucose) should not be given extra sugar intake while the blood glucose is high or the insulin will be less effective in reducing overall blood glucose. Dehydration: **Increased hematocrit due to low fluid volume- (portion of total blood volume of red blood cells) Increased sodium- due to low fluid volume Increased hemoglobin- protein molecule in RBC’s that carry oxygen Increased chloride Chronic renal failure -Chronic renal failure can cause decreased hemoglobin formation due to insufficient erythropoietin production. -Carbohydrate intake is encouraged to help provide adequate energy for body functions. -Sodium bicarbonate helps prevent metabolic acidosis Acute renal failure -May cause elevation of serum electrolytes if the kidneys are unable to produce enough urine to filter out excess potassium and sodium Hyponatremia (decreased serum sodium level) -Occurs frequently in patients with acute renal failure because these patients often have decreased urine output (oliguria) causing dilute blood associated with fluid retention. Hyponatremia can be treated with fluid restriction. If this alone does not resolve the hyponatremia, a hypertonic 3% saline solution can be given intravenously for sodium replacement. Implementing neutropenic precautions -Neutropenia refers to count being < 1000/mm3 -A neutrophil count of less than 500/mm3 indicates a severe risk of infection. -Restricting fresh, uncooked fruits and vegetables from the diet and removing flowers and plants from the room is recommended due to the risk of microbial contamination. -Visitors with any potentially communicable disease should be screened for the presence of infection and must not be allowed near the patient. -The client should have a single room with positive air pressure (air pressure higher than the surrounding rooms) to prevent potentially contaminated air from coming in the client's room. Sepsis Lactate normal range: 0.5 to 2.2 Lactate (or lactic acid) elevation is indicative to sepsis or tissue ischemia due to low tissue perfusion and oxygenation. This causes the creation of energy through anaerobic metabolism, which forms lactic acid as a waste product. *Can cause metabolic acidosis Lumbar puncture -Lumbar puncture places the patient at high risk for complications, one of which is a subdural or epidural hematoma. Bleeding in the subdural or epidural space mechanically compresses the spinal cord, affecting sensation and movement. Compression of lumbar spinal roots may cause cauda equina syndrome and lower extremity paresis. Deficits progress over minutes to hours. -Prompt intervention is critical, so this finding should be reported to the physician immediately. Myocardial infarction (MI) (Heart Attack) -Troponin-I and CK-MB levels are elevated -Troponin-I level greater than 0.03 ng/mL is indicative of a myocardial damage. -Troponin-I is more specific for cardiac muscle injury than CK-MB and elevates 4-6 hours after infarction. ***CK-MB and troponin are cardiac muscle-specific enzymes. Troponin levels will remain elevated in the presence of cardiac muscle damage for up to 15 days after the injury. Troponin levels will be less than 0.01 ng/mL in patients without cardiac injury. CHF (Congestive heart failure) -People with a history of myocardial infarction are at an increased risk of developing congestive heart failure (CHF). This is due to damage to the heart muscle (myocardium) that occurs from ischemia (decreased oxygen) during a heart attack (MI). In this condition, the heart muscle is weakened and does not pump efficiently. -Excess fluid builds up in the heart chambers, which then backs up into the lungs, causing shortness of breath. -This process causes a backup of all circulatory blood and fluid resulting in excess fluid volume. This excess fluid volume causes an increase in weight. People with CHF need to manage this condition at home with daily weight measurements and report a weight gain of 2 or more pounds in 24 hours or 5 pounds or more in 1 week. -People with congestive heart failure (CHF) have difficulty with fluid volume excess causing edema (swelling) and shortness of breath. Water follows sodium, so these patients will be on a low sodium diet with less than 2 grams of sodium in 24 hours daily to prevent fluid retention and edema (excess fluid accumulation). Fluid intake will be restricted in these patients so that the diuretics used to expel excess fluid will be more effective. CHF patients also need to limit overall fluid intake to prevent over hydration which can contribute to fluid retention, edema, and shortness of breath. ***Antacids with bicarbonate should not be taken regularly because they can raise sodium levels, which is important for anyone on sodium restrictions. Right-sided heart failure -In a patient with right-sided heart failure, the edema is seen peripherally, in the extremities and organs (hepatomegaly). These right-sided heart failure patients often have lower extremity edema. This swelling can make the legs sore and tender. The nurse can assist the patient to keep the legs elevated to reduce swelling. If the patient is wearing compression socks, these should be changed daily but kept in place to help reduce swelling. Left-sided heart failure -In left-sided heart failure, the fluid backs up into the lungs, causing impaired gas exchange and breathing difficulties. In left-sided heart failure, the legs should not be elevated, to avoid fluid backing up into the lungs. DVT -D-Dimer is used to help diagnose a DVT. -D-dimer is a fibrin degradation product. These products increase during a thrombotic event. -An elevated D-dimer is indicative of a DVT, but an ultrasound is needed to confirm the presence of a DVT. Skeletal muscle damage -Elevated CK-MM levels (M) - muscle (B)- Brain Glycosylated hemoglobin (Hgb A1C) Normal value: 7% or below HgbA1c monitors long-term control of blood glucose levels. HgbA1c measures amount of glucose molecules that have reacted with a red blood cell over the lifespan of the cell (120 days). HgbA1c levels are done 2-4 times annually. Hypervolemia -excess fluid in the intravascular space. A bounding pulse, rapid heart rate and high blood pressure would be noted. ***If untreated, symptoms would progress to pink frothy sputum as the pressure increases in the lungs, resulting in pulmonary edema. Hypovolemia A weak, thread pulse, rapid heart rate, and low blood pressure would be seen Iron Supplements -Patients with reduced hemoglobin and hematocrit who are started on iron supplements should be given instructions to know how to properly take these supplements to increase absorption so that more red blood cells are produced. -Ferrous sulfate (iron) supplements should be taken with orange juice or vitamin C to increase absorption. -Iron supplements may cause constipation and dark brown or black stools. -Iron supplements should not be taken with milk or calcium as this prevents absorption in the GI tract. aPTT Reference range: 30-40 seconds Ratio: 1.5-2.5 Therapeutic level: 45-100 seconds (DVT prevention) PT Reference range: 11-12.5 seconds. For patients on warfarin, the therapeutic level is 1.5-to-2 times the normal level INR Reference range is 0.8-1.1. Patients requiring anticoagulation for atrial fibrillation have a target INR range of 2.0-3.0. Coumadin -Vitamin K is the antidote for Coumadin. -Green leafy vegetables are a good source of vitamin K and can reduce the effects of Coumadin when eaten. -Patients who require Coumadin to thin the blood may need the effect to be counteracted if the blood is too thin prior to surgical procedures. Head trauma -Secondary diabetes insipidus may occur as a result of trauma or a pathologic condition of the posterior pituitary that causes a decrease in the secretion of anti-diuretic hormone (ADH). -Decreased amounts of ADH will cause increased water loss through the urine with large amounts of very dilute urine and increased thirst related to the correlated dehydration that occurs. Syncope Temporary loss of consciousness cause by a fall in blood pressure -Patients with symptomatic hypotension related to dehydration and who have complaints of dizziness and lightheadedness should be placed supine with the feet elevated higher than the head. This position allows more blood to remain in the upper body allows more oxygen to reach the brain. -This position will help reduce symptoms of dizziness and lightheadedness and is the first intervention that should be used to relieve symptoms. Thyroidectomy A patient who has had a thyroidectomy has also had the parathyroid glands removed. The parathyroid glands are responsible for the calcium and phosphate levels in the blood. These patients will require regular monitoring of calcium and phosphate levels. *Hypocalcemia may cause tetany (painful contractions of muscles) and cardiac dysrhythmias. -Trousseau sign of latent tetany is sign seen in patients with hypocalcemia. This sign is believed to be more sensitive an indicator (94%) than the Chvostek sign (29%). To see the sign, you must inflate a blood pressure cuff for a couple minutes to occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and resulting neuromuscular irritability will induce the spasm of the hand and forearm. Coronary bypass graft surgery -Blood loss occurs with volume depletion during heart surgery. After surgery patients need to maintain a systolic blood pressure of greater than 90 for adequate perfusion of the myocardial tissue through the new bypass grafts and to prevent graft collapse. -Serum hemoglobin of less than 8.0 and hematocrit of less than 24.0 usually require transfusion of packed red blood cells. This is even more crucial in patients with coronary bypass grafts so the new graft sites will receive adequate oxygen supply. Transfusion -When a patient requires a transfusion of a blood product, the nurse must always verify that it is the correct product and the correct patient with a second nurse at the patient's bedside prior to administering it. The nurse should instruct the patient on possible side effects and what symptoms to report. Vital signs including temperature and blood pressure should be assessed prior to administration and 15 minutes after blood product is initiated. Arterial Blood Gasses pH: 7.35-7.45 (Determines the acidity or alkalinity of the blood) CO2: 35-45 (Respiratory) PaCO2: 80-100 (Respiratory) HCO3: 22-26 (Metabolic) O2 sat: 95-100% 90% is okay with COPD ROME Method: Respiratory Opposite; Metabolic Equal When pH is up, PaCO2 is down = Alkalosis When pH is down, PaCO2 is up = Acidosis When pH is up, HCO3 is up = Alkalosis When pH is down, HCO3 is down = Acidosis Metabolic Acidosis: (Metabolic equal pH & HCO3) -Caused by loss of bicarb or a buildup of acids- not caused by respiration. Ex: lactic acidosis, renal failure, ketones, or ammonium intoxication, emesis, diuretics, diarrhea -HCO3 decreases, pH decreases -Compensation- hyperventilation to eliminate CO2 * The rapid, deep breathing of Kaussmaul's respirations are a compensatory mechanism to try to eliminate acid in the form of carbon dioxide when the body is in metabolic acidosis Respiratory Acidosis: (Respiratory opposite pH & CO2) -Respiratory system is the cause Ex. Hyperventilation -Increase in PCO2, decrease in pH -Compensation- kidneys reabsorb Bicarb (HCO3) Respiratory Alkalosis: -Caused by excessive ventilation -Decrease in PCO2, increase in pH -Compensation - Kidneys excrete HCO3 *Hyperventilation is an increase in respiratory rate and/or volume which cause a decrease in PCO2. This in turn raises the pH to cause respiratory alkalosis. Metabolic Alkalosis -Acid (H+) lost from emesis, diuretics. Retention of HCO3 from medications, hyperaldosteronism -Increase in HCO3, Increase in pH -Compensation - Respiratory centers are not stimulated; this leads to hypoventilation and CO2 retention. Determine compensation Is the ABG Compensated, Partially Compensated, or Uncompensated. If pH is NORMAL, PaCO2 and HCO3 are both ABNORMAL = Compensated If pH is ABNORMAL, PaCO2 and HCO3 are both ABNORMAL = Partially Compensated If pH is ABNORMAL, PaCO2 or HCO3 is ABNORMAL = Uncompensated *Hyperaldosteronism increases renal loss of hydrogen ions and increases sodium-hydrogen exchange in the kidney. Sodium retention causes excess fluid volume and the hydrogen ion loss leads to metabolic alkalosis. *Gastric lavage and persistent vomiting cause removal of hydrochloric acid from the stomach, which may lead to metabolic alkalosis. Example: pH: 7.26, paCO2: 32, HCO3: 18 Metabolic Acidosis, Partially Compensated Example: pH: 7.44, PaCO2: 30, HCO3: 21 Respiratory Alkalosis, partially compensated Example: pH: 7.10, paCO2: 40, HCO3: 18 Respiratory Acidosis, Uncompensated PaO2- partial pressure of arterial oxygen -Depending on oxygen demands at tissue level a curve shifts rightwards (low saturation of PaO2) A curve shifts leftwards (higher saturation of PaO2) Right- needs more oxygen: Heat (hot weather) Exercise Acidotic (Low pH) Hypercarbia (high CO2 in blood) Releases oxygen Left- activity is minimal: Cold weather During rest Tissues are cold Alkalotic (high pH) Hypocarbia Carbon Monoxide poisoning Holds onto oxygen *Only 2-3 % of oxygen goes to plasma; the rest attaches to hemoglobin molecules in RBC’s - If PaO2 is higher- more attaches (it is more readily) -If PaO2 is lower- less attaches Common Signs and Symptoms Pulmonary Tuberculosis (PTB)—low-grade afternoon fever. Pneumonia—rust-colored sputum. Asthma—wheezing on expiration. Emphysema—barrel chest. Kawasaki Syndrome—strawberry tongue. Pernicious Anemia—red beefy tongue. Down syndrome—protruding tongue. Cholera—rice-watery stool and washer woman’s hands (wrinkled hands from dehydration). Malaria—stepladder like fever with chills. Typhoid—rose spots in the abdomen. Dengue—fever, rash, and headache. Positive Herman’s sign. Diphtheria—pseudo membrane formation. Measles—Koplik’s spots (clustered white lesions on buccal mucosa). Systemic Lupus Erythematosus—butterfly rash. Leprosy—leonine facies (thickened folded facial skin). Bulimia—chipmunk facies (parotid gland swelling). Appendicitis—rebound tenderness at McBurney’s point. Rovsing’s sign (palpation of LLQ elicits pain in RLQ). Psoas sign (pain from flexing the thigh to the hip). Meningitis—Kernig’s sign (stiffness of hamstrings causing inability to straighten the leg when the hip is flexed to 90 degrees), Brudzinski’s sign (forced flexion of the neck elicits a reflex flexion of the hips). Tetany—hypocalcemia, [+] Trousseau’s sign; Chvostek sign. Tetanus— Risus sardonicus or rictus grin. Pancreatitis—Cullen’s sign (ecchymosis of the umbilicus), Grey Turner’s sign (bruising of the flank). Pyloric Stenosis—olive like mass. Patent Ductus Arteriosus—washing machine-like murmur. Addison’s disease—bronze like skin pigmentation. Cushing’s syndrome—moon face appearance and buffalo hump. Grave’s Disease (Hyperthyroidism)—Exophthalmos (bulging of the eye out of the orbit). Intussusception—Sausage-shaped mass. Multiple Sclerosis—Charcot’s Triad: nystagmus, intention tremor, and dysarthria. Myasthenia Gravis—descending muscle weakness, ptosis (drooping of eyelids). Guillain-Barre Syndrome—ascending muscles weakness. Deep vein thrombosis (DVT)—Homan’s Sign. Angina—crushing, stabbing pain relieved by NTG. Myocardial Infarction (MI)—crushing, stabbing pain radiating to left shoulder, neck, and arms unrelieved by NTG. Parkinson’s disease—pill-rolling tremors. Cytomegalovirus (CMV) infection—Owl’s eye appearance of cells (huge nucleus in cells). Glaucoma—tunnel vision. Retinal Detachment—flashes of light, shadow with curtain across vision. Basilar Skull Fracture—Raccoon eyes (periorbital ecchymosis) and Battle’s sign (mastoid ecchymosis). Buerger’s Disease—intermittent claudication (pain at buttocks or legs from poor circulation resulting in impaired walking). Diabetic Ketoacidosis—acetone breathe. Pregnancy Induced Hypertension (PIH)—proteinuria, hypertension, edema. Diabetes Mellitus—polydipsia, polyphagia, polyuria. Gastroesophageal Reflux Disease (GERD)—heartburn. Hirschsprung’s Disease (Toxic Megacolon)—ribbon-like stool. Therapeutic Drug Levels Carbamazepine (Tegretol): 4—10 mcg/ml Digoxin (Lanoxin): 0.8—2.0 ng/ml Gentamycin (Garamycin): 5—10 mcg/ml (peak), <2.0 mcg/ml (valley) Lithium (Eskalith): 8—1.5 mEq/L Phenobarbital (Solfoton): 15—40 mcg/mL Phenytoin (Dilantin): 10—20 mcg/dL Theophylline (Aminophylline): 10—20 mcg/dL Tobramycin (Tobrex): 5—10 mcg/mL (peak), 0.5—2.0 mcg/mL (valley) Valproic Acid (Depakene): 50—100 mcg/ml Vancomycin (Vancocin): 20—40 mcg/ml (peak), 5 to 15 mcg/ml (trough) Anticoagulant therapy Sodium warfarin (Coumadin) PT: 10—12 seconds (control). The antidote is Vitamin K. INR (Coumadin): 0.9—1.2 Heparin PTT: 30—45 seconds (control). The antidote is protamine sulfate. APTT: 3—31.9 seconds Fibrinogen level: 203—377 mg/dL Conversions 1 teaspoon (t) = 5 ml 1 tablespoon (T) = 3 t = 15 ml 1 oz. = 30 ml 1 cup = 8 oz. 1 quart = 2 pints 1 pint = 2 cups 1 grain (gr) = 60 mg 1 gram (g) = 1,000 mg 1 kilogram (kg) = 2.2 lbs. 1 lb. = 16 oz. Convert C to F: C+40 multiply by 9/5 and subtract 40 Convert F to C: F+40 multiply by 5/9 and subtract 40 Maternity Normal Values Fetal Heart Rate: 120—160 bpm Variability: 6—10 bpm Amniotic fluid: 500—1200 ml Contractions: 2—5 minutes apart with duration of < 90 seconds and intensity of <100 APGAR Scoring Appearance, Pulses, Grimace, Activity, Reflex Irritability. Done at 1 and 5 minutes with a score of 0 for absent, 1 for decreased, and 2 for strongly positive. Scores 7 and above are generally normal, 4 to 6 fairly low and 3 and below are generally regarded as critically low. AVA: The umbilical cord has two arteries and one vein.
