Lab Values Podcast by NURSING.com (Nursing Podcast, normal lab values for nurses for NCLEX®) by NURSING.com (NRSNG)

Ammonia (NH3) Lab Values


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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
...more
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Lab Values Podcast by NURSING.com (Nursing Podcast, normal lab values for nurses for NCLEX®) by NURSING.com (NRSNG)By Jon Haws RN: Critical Care Nurse & NCLEX Educator

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