Overview

1. Total bilirubin
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Elevations in Total bilirubin

Nursing Points General

1. Normal values
   1. 0.1-1.2 mg/dL
2. Patho
   1. Breakdown product of RBCs
      1. Specifically heme (iron portion of hemoglobin)
   2. Transported to liver
      1. Bound with bile
      2. Excreted via GI tract and kidneys
   3. Conjugated
      1. Water soluble
   4. Unconjugated
      1. Not able to excrete it
      2. Carried to liver via albumin
      3. Conjugated in liver
3. Special Considerations
   1. Submit in green top tube
   2. Usually submitted with liver function tests
4. Elevated Total Bilirubin
   1. Newborn jaundice
      1. Treated with phototherapy
      2. Liver tumors
      3. Liver disease
         1. Cirrhosis
         2. Hepatitis
         3. Alcoholism
      4. Cholecystitis
      5. Biliary obstruction

Assessment

1. Assess patients for jaundice or icterus, or changes in color of stool (clay colored)

Therapeutic Management

1. Phototherapy for newborns, as they are unable to properly breakdown bilirubin
2. Treat primary cause of liver/gallbladder disease

Nursing Concepts

1. Lab Values
2. Gastrointestinal/Liver Metabolism

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

Objective:

Determine the significance and clinical use of  alkaline phosphatase in clinical practice

 

Lab Test Name:

Alkaline Phosphatase – ALP

 

Description:

Measures amount of ALP in circulation

Located in several places in the body:

• Liver
• Intestines
• Biliary tract
• Bones
• Placenta

Different isoenzymes of ALP are used to determine:

• Liver, bone, intestine and other cancers
• Bone turnover in postmenopausal women

 

Indications:

Evaluation of ALP:

• Hepatobiliary disease
• Malignancies
• Bone disease
• Bone damage in renal patients

 

Normal Therapeutic Values:

Normal – 40-130 U/L

Collection:

•  Plasma separator tube

 

What would cause increased levels?

Increased levels assessed in:

• Liver disease
• Bone disease
• Pregnancy
• Amyloidosis
• Lung cancer
• Pancreatic cancer
• Congestive heart failure
• Ulcerative colitis
• Hodgkin’s disease
• Chronic renal failure
• Sarcoidosis

 

What would cause decreased levels?

• Hypophosphatasia (spelling error on existing outline on NURSING.com)
• Anemia
• Kwashiorkor
• Cretinism
• Hypothyroidism
• Zinc or magnesium deficiency
• Scurvy

Overview

1. Albumin
   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. 3.5 – 6.0 g/dL
2. Pathophysiology
   1. Produced in the liver
   2. Main protein of plasma
   3. Responsible for maintaining oncotic pressure
      1. Draws fluid into blood vessel
      2. “Protein pulls”
      3. Refer to Fluid & Electrolytes lesson  01.02 Fluid Pressures
   4. Transport protein
   5. Serves as amino acid
   6. Nutrition
      1. Poor indicator of nutrition
         1. Due to long half-life
      2. Pre-Albumin
         1. Better indicator of nutrition
3. Special considerations
   1. Green top typically
   2. Usually sent with several other labs
      1. Chemistries
      2. Liver function tests
      3. Nutritional labs
4. Elevated Albumin levels
   1. Dehydration
   2. Excess infusion of albumin
5. Decreased albumin levels
   1. Liver disease
   2. Fluid loss
      1. Fistula
      2. Hemorrhage
      3. Kidney Disease
      4. Burns
   3. Congestive heart failure
   4. Long term poor nutrition
      1. Inadequate intake
   5. Inflammation

Assessment

1. Assess patient’s pre-albumin for nutritional status or indications of acute illness

Nursing Concepts

1. Lab Values
2. Nutrition

Objective:

Determine the significance and clinical use of Alanine Aminotransferase in clinical practice

 

Lab Test Name:

Alanine Aminotransferase – ALT

 

Description:

Measures amount of ALT, an enzyme produced by the liver, present in circulation

Found in:

Most abundantly in liver

Heart

Skeletal muscle

kidney

Increases in lab values indicate liver disease or liver damage

 

Indications:

Evaluation of ALT:

• Progression of liver disease
• Monitoring response to treatment

 

Normal Therapeutic Values:

Normal – 40-130 U/L

Collection:

•  Plasma separator tube

 

What would cause increased levels?

INCREASED: 

• Cirrhosis
• Muscle damage
• Preeclampsia
• Biliary tract obstruction
• Burns
• Pancreatitis
• Long-term alcohol abuse
• Liver Cancer
• Muscular dystrophy
• MI
• Myositis
• Shock
• Infection-mononucleosis

 

What would cause decreased levels?

DECREASED:

• Pyridoxal phosphate deficiency
  • A rare genetic metabolic disorder

Overview

1. Glucose
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Hyperglycemia
   5. Hypoglycemia

Nursing Points General

1. Normal value
   1. 70-115 mg/dL
2. Pathophysiology
   1. Consumed via diet
      1. Carbohydrates
   2. Glycolysis
      1. Creates net positive energy sources
   3. Insulin
      1. Produced in pancreas
      2. Required to force glucose into cell
      3. Deficiency in insulin causes high glucose in blood
      4. Increase in insulin resistance causes high glucose in blood
3. Special considerations
   1. Lab
      1. Green or gray tube
   2. Bedside
      1. CBG (Capillary blood glucose)
      2. Use glucometer
      3. Use gauze and alcohol
4. Hyperglycemia (high levels of glucose)
   1. Diabetes
      1. Absent or inefficient insulin
   2. Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
   3. Stress
      1. Increases cortisol production
   4. Pancreatitis
      1. Disrupts insulin production
   5. Renal failure
   6. Cushing’s syndrome
   7. Steroid use
      1. Increases insulin resistance
5. Hypoglycemia (low levels of glucose)
   1. Insulinoma
   2. Hypothyroidism
   3. Hypopituitarism
   4. Addison’s Disease
   5. Insulin overdose
   6. Malnutrition

Nursing Concepts

1. Lab Values
2. Glucose Metabolism

Get a free nursing lab values cheat sheet at NURSING.com/63labs

 

What is the Lab Name for White Blood Cell (WBC) Lab Values?

White Blood Cell

 

What is the Lab Abbreviation for White Blood Cell?

WBC

 

What is White Blood Cell in terms of Nursing Labs?

White blood cells (WBCs) are created in the bone marrow. Their primary function is to defend the body against infection. There are various types of WBCs which have different shapes and functions. Decreased WBC count is called Leukopenia and increased WBC count is called Leukocytosis.

 

What is the Normal Range for White Blood Cell?

4,500 – 10,000 cells/mcL

 

What are the Indications for White Blood Cell?

• Evaluate for infection

  What would cause Increased Levels of White Blood Cell?

• Infection/inflammation
• Leukemic Neoplasia
• Trauma/stress
• Tissue necrosis
• Pregnancy
• Cushing Disease
• Asthma
• Allergic reaction

  What would cause Decreased Levels of White Blood Cell?

• Systemic Lupus Erythematosus (SLE)
• Anemia
• Rheumatoid Arthritis (RA)
• Chemotherapy/radiation
• Overwhelming infections (WBCs are all used up)

Get a free nursing lab values cheat sheet at NURSING.com/63labs

 

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

Get a free nursing lab values cheat sheet at NURSING.com/63labs

 

What is the Lab Name for Troponin I (cTNL) Lab Values?

Troponin I

 

What is the Lab Abbreviation for Troponin I?

cTNL

 

What is Troponin I in terms of Nursing Labs?

Troponins are proteins that initiate contraction of muscle fibers. Troponin I (cTNL) is specific to heart muscle. Troponin levels stay elevated for a week after muscle damage before returning to normal.

 

What is the Normal Range for Troponin I?

There is a wide range of normal values among varying institutions and texts with regard to Troponin I. It is essential to verify institutional norms. < 0.035 ng/mL

 

What are the Indications for Troponin I?

• Evaluating damage to heart muscle
• Diagnose a Myocardial Infarction (MI)

  What would cause Increased Levels of Troponin I?

• Heart damage
• Myocardial Infarction (MI)

  What would cause Decreased Levels of Troponin I?

N/A

Get a free nursing lab values cheat sheet at NURSING.com/63labs

 

What is the Lab Name for Triglycerides (TG) Lab Values?

Triglycerides

 

What is the Lab Abbreviation for Triglycerides?

TG

 

What is Triglycerides in terms of Nursing Labs?

Triglycerides (TG) are required to provide energy during the metabolic process, excess triglycerides are stored in adipose tissue.

 

What is the Normal Range for Triglycerides?