Hi NURSING.com family.  Are you getting ready for the NCLEX??   This show is the perfect NCLEX review, and as ALWAYS, we have pulled out the MOST important info that you need to become an Amazing nurse!

Listen in each week while we review 77 critical topics you need to pass the NCLEX-RN Exam.  Each episode will cover these MUST-know nursing topics with a perfect overview.  

Our new show is NCLEX Flash Notes.  You can search that in apple podcasts or spotify and pull up the SHOW.   NCLEX Flash Notes

NCLEX Flash Notes is your go-to last-minute refresher for the NCLEX exam. Cut through the fluff and get straight to the essential information with this free resource.  

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

1. Lab Values
2. 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