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

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Triglycerides

TG

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

• Evaluate for:
  • Elevated triglycerides
  • Risk for atherosclerotic heart disease and stroke

• Myocardial Infarction (MI)
• Alcoholism
• Alcoholic cirrhosis
• High carbohydrate diet
• Anorexia nervosa
• Cirrhosis
• Hypertension (HTN)
• Nephrotic Syndrome
• Obesity
• Renal failure
• Pancreatitis
• Stress

• Chronic Obstructive Pulmonary Disease (COPD)
• Liver disease
• Hyperthyroidism
• Malnutrition
• Malabsorption

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Determine the significance and clinical use of Thyroid Stimulating Hormone in clinical practice

Thyroid Stimulating Hormone

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

Aids to diagnose:

• Hyperthyroidism
• Hypothyroidism
• Anterior pituitary function

Monitor:

• Thyroid replacement therapy

Normal –

2-10 mU/L

Collection:

• Plasma separator tube

TSH levels increase in the following conditions:

• Hypothyroidism
• Thyroidectomy
• Thyroid dysfunction
• Thyroiditis
• Thyroid Agenesis
• Large doses of iodine
• Pituitary TSH-secreting tumor

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.

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Sodium

Na+

Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body, plays a role in blood pressure regulation, and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; Water follows salt.

135-145 mEq/L

• Monitor:
  • Extracellular osmolality
  • Electrolyte balance

• Cushing Syndrome
• Hyperaldosteronism
• Dehydration
• Burn injury
• Azotemia (elevated nitrogen)
• Lactic acidosis (LA)
• Fever/excessive sweating
• Excessive IV fluids containing sodium
• Diabetes Insipidus
• Osmotic diuresis

• Congestive Heart Failure (CHF)
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
• Cystic Fibrosis
• Diuretic use
• Metabolic acidosis
• Addison Disease
• Nephrotic Syndrome
• Vomiting
• Diarrhea
• Ascites
• Excessive Antidiuretic Hormone(ADH)
• Liver failure

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Red Blood Cell

RBC

Red Blood Cells (RBCs) contain hemoglobin which is responsible for oxygen transport throughout the body. RBCs are primarily produced in the bone marrow, they have a life span of 120 days and are destroyed in the spleen and liver. RBC production is regulated by erythropoietin (EPO) which is produced and released from the kidneys.

Male: 4.5 – 5.5 x106/cells/mm3 Female: 4.0 – 4.9 x106/cells/mm3

• Identify:
  • Anemia
  • Blood loss

• Dehydration
• Polycythemia Vera
• Chronic Obstructive Pulmonary Disease (COPD)
• High altitude
• Congenital heart disease
• CorPulmonale
• Pulmonary fibrosis
• Thalassemia trait

• Chemotherapy
• Anemia
• Hemorrhage
• Hemolysis
• Hemoglobinopathy
• Advanced cancer
• Leukemia
• Lymphoma
• Pernicious anemia
• Rheumatoid disease
• Organ failure
• Bone marrow failure
• Hypervolemia
• Pregnancy

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Determine the significance and clinical use of Prostate Specific Antigen in clinical practice

Prostate Specific Antigen – PSA

Measurement of PSA in the bloodstream

Used to diagnose and assess prostate health, size and function.

Evaluate:

• Enlarged prostate when prostate cancer is suspected
• Stage cancer
• Effectiveness of treatments

Normal –

• Male:
• Female:

Collection:

• Serum Separator Tube

Increased:

• Benign Prostatic Hypertrophy (BPH)
• Prostate cancer
• Prostatitis
• Urinary retention

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.

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Potassium

K+

Potassium (K+) is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen with enter the cell as this happens it will force potassium out of the cell, a 0.1 decrease in pH will cause a 0.5 increase in K+.

3.5 – 5.0 mEq/L

• Evaluate:
  • Electrolyte imbalances
  • Cardiac arrhythmias
• Monitor patients who are:
  • Acidotic
  • Receiving diuretic therapyw

• Renal failure
• Hypoaldosteronism
• Addison disease
• Injury to tissues
• Diabetes Mellitus (DM)
• Ketoacidosis
• Hyperventilation
• Acidosis
• Infection
• Dehydration
• Burns

• Hyperaldosteronism
• Excess insulin
• Alkalosis
• Diarrhea
• Vomiting
• Cystic Fibrosis
• Cushing Syndrome

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Platelets

(PLT)

Platelets (PLT) play a role in coagulation, hemostasis, and thrombus formation. Platelets are the smallest blood cell, damaged vessels send out signals that result in platelets traveling to the area and becoming "active".

100,000 – 450,000 cells/mcL

• Determine clotting vs bleeding disorders

What would cause Increased Levels of Platelets?

• Malignancy
• Polycythemia Vera
• Postsplenectomy syndrome
• Rheumatoid Arthritis (RA)
• Iron-deficiency anemia
• Hemolytic anemia
• Tuberculosis
• Birth control

• Idiopathic Thrombocytopenia (ITP)
• Inherited thrombocytopenia disorders:
  • Wiskott-Aldrich Syndrome
  • Bernard-Soulier Syndrome
  • Zieve Syndrome
• Infection:
  • Hepatitis
  • Human Immunodeficiency Virus (HIV)
  • Measles
  • Sepsis
• Hypersplenism
• Hemorrhage
• Leukemia
• Lymphoma
• Drug Therapy:
  • Aspirin
  • Ibuprofen
  • Sulfa antibiotics
  • Hydralazine
  • Thiazide diuretics
• Systemic Lupus Erythematosus (SLE)
• Hemolytic anemia's

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Partial Thromboplastin Time

PTT

Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin.

25 – 35 seconds

• Detection of coagulation disorders
• Evaluate response to Heparin (PT for Coumadin)
• Preoperative assessment

• Disseminated Intravascular Coagulation (DIC)
• Clotting Factor Deficiencies:
  • Hypofibrinogenemia
  • Von Willebrand Disease
  • Hemophillia
• Liver disease:
  • Cirrhosis
• Vitamin K deficiency
• Polycythemia
• Dialysis

N/A

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Oxygen Saturation

SaO2

Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen. Oxygen is transported in the blood in two ways: oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin (SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved in plasma. SaO2 and pO2 have direct relationships, if one is decreased so is the other. The relationship between oxygen saturation (SaO2) and partial pressure O2 (PaO2) is referred to as the oxyhemoglobin (HbO2) dissociation curve. SaO2 of about 90% is associated with PaO2 of about 60 mmHg. For more information on PaO2, SaO2 and oxyhemoglobin dissociation curve visit this link HERE.

95 – 100%

• Determine respiratory status
• Part of Arterial Blood Gas (ABG) testing

What would cause Increased Levels of Oxygen Saturation?

• Polycythemia
• Increased inspired O2
• Hyperventilation

• Anemia's
• Hypoventilation
• Bronchospasm
• Mucus plugs
• Atelectasis
• Pneumothorax
• Pulmonary edema
• Adult respiratory distress syndrome

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Osmolality

Osmolality is a measure of the particles in solution. The size, shape, and charge of the particles do not impact the osmolality

261 – 280 mOsm/kg

• Monitor:
  • Electrolyte balance
  • Acid-Base balance
  • Hydration
• Evaluate function of antidiuretic hormone.

• Dehydration
• Azotemia
• Hypercalcemia
• Hyperosmolar Hyperglycemia Syndrome (HHS)
• Hypernatremia
• Diabetes Insipidus
• Hyperglycemia
• Mannitol therapy
• Uremia
• Severe pyelonephritis
• Shock
• Ketosis

• Hyponatremia
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
• Overhydration