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Nursing Lab Values Cheat Sheet, Cheat Sheet of Nursing

Allen CollegeNursing

Useful cheat sheet on the nursing laboratory values

Typology: Cheat Sheet

2019/2020

Uploaded on 11/27/2020

arien
arien 🇺🇸

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Nursing Lab Values: Cheat Sheet
Red Blood Cells (RBC):
-Normal: male = 4.6-6.2 x 106 cells/mm3 female = 4.2-5.2 x 106 cells /mm3
-Actual count of red corpuscles
Hemoglobin:
-Normal: male = 14-18 g/dl female = 12-16 g/dl
-A direct measure of oxygen carrying capacity of the blood
* Decrease: suggests anemia
* Increase: suggests hemoconcentration, polycythemia
Hematocrit (aka packed cell volume):
- Normal: males = 39-49% female = 35-45%
-= the percentage of blood that is composed of erythrocytes
-Hct = RBC X MCV
* Low: in anemics or after acute heavy bleeding
*High: pt has thick and sludgy blood.
Mean Cell Volume (MCV):
-Normal: male = 80-96 female = 82-98
-= Hct / RBC
* Large cells = macrocytic: due to B-12 or folate deficiency
* Small cells = microcytic: due to iron deficiency
* Increased: caused by elevated reticulocytes
Mean Cell Hemoglobin (MCH):
-Normal: 27-33 pg/cell
-= % volume of hemoglobin per RBC
-= Hgb / RBC
* Increase: indicates folate deficiency
* Decrease: indicates iron deficiency
Mean Cell Hemoglobin Concentration):
-Normal: 31-35 g/dL
-= Hgb / Hct
* Decrease: indicates iron deficiency
Reticulocyte Count:
-Normal: 0.5-2.5% of RBC
-An indirect measure of RBC production
* Increase: during increased RBC production
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Nursing Lab Values: Cheat Sheet

Red Blood Cells (RBC) :

  • Normal: male = 4.6-6.2 x 10^6 cells/mm3 female = 4.2-5.2 x 10^6 cells /mm
  • Actual count of red corpuscles

Hemoglobin :

  • Normal: male = 14-18 g/dl female = 12-16 g/dl
  • A direct measure of oxygen carrying capacity of the blood
  • Decrease: suggests anemia
  • Increase: suggests hemoconcentration, polycythemia

Hematocrit (aka packed cell volume) :

  • Normal: males = 39-49% female = 35-45%
  • = the percentage of blood that is composed of erythrocytes
  • Hct = RBC X MCV
  • Low: in anemics or after acute heavy bleeding ***** High: pt has thick and sludgy blood.

Mean Cell Volume (MCV) :

  • Normal: male = 80-96 female = 82-
  • = Hct / RBC
  • Large cells = macrocytic: due to B-12 or folate deficiency
  • Small cells = microcytic: due to iron deficiency
  • Increased: caused by elevated reticulocytes

Mean Cell Hemoglobin (MCH) :

  • Normal: 27-33 pg/cell
  • = % volume of hemoglobin per RBC
  • = Hgb / RBC
  • Increase: indicates folate deficiency
  • Decrease: indicates iron deficiency

Mean Cell Hemoglobin Concentration) :

  • Normal: 31-35 g/dL
  • = Hgb / Hct
  • Decrease: indicates iron deficiency

Reticulocyte Count :

  • Normal: 0.5-2.5% of RBC
  • An indirect measure of RBC production
  • Increase: during increased RBC production

Red Blood Cell Distribution Width (RDW) :

  • Normal: 11-16%
  • Indicates variation in red cell volume
  • Increase: indicates iron deficiency anemia or mixed anemia
  • Note: increase in RDW occurs earlier than decrease in MCV therefore RDW is used for early detection of iron deficiency anemia

Platelet Count :

  • Normal: 140,000 0 440,000/uL
  • Due to high turnover, platelets are sensitive to toxicity
  • Low: worry patient will bleed
  • High: not clinically significant

White Blood Cell (WBC) :

  • Normal: 3.4 – 10 x 10^3 cells/mm
  • Actual count of leukocytes in a volume of blood
  • Can help confirm diagnosis. Can NOT diagnose based solely on WBC count!
  • Increase: occur during infections and physiologic stress
  • Decreases: marrow suppression and chemotherapy
  • Differential = Seg/Band/Lymph/Mono/Eos/Baso  Shift to the left: implies the % of segs and bands (neutrophils) has increased. Often due to inflammation or infection  Note: differential must add up to 100%
  • Neutrophils  Normal: 45-73%  Increase: mostly due to bacterial infection
  • Eosinophils  Normal: 0-4%  Increase: due to parasitic infection and hypersensitivity reaction (drug/allergic rxn)  Absolute count = %Eos X WBC
  • Basophils  Normal: 0-1%  Play a role in delayed and immediate hypersensitivity reactions  Increase: seen in chronic inflammation and leukemia.
  • Lymphocytes  Normal: 20-40%  Increase: occurs in mono, TB, syphilis and viral infections  Decrease: HIV, radiation and steroids
  • Monocytes  Normal: 2-8%  Increase: during recovery from bacterial infection, leukemia, TB-disseminated infxn

Sodium (Na) :

  • Normal: 96-106 mEq/L
  • Chloride passively follows sodium and water
  • Chloride increases or decreases in proportion to sodium (dehydration or fluid overload)
  • Reduced: by metabolic alkalosis
  • Increased: by metabolic or respiratory acidosis

Bicarbonate (HCO3) :

  • Normal: 24-30 mEq/L
  • The test represents bicarbonate (the base form of the carbonic acid-bicarbonate buffer system)
  • Decreased: acidosis
  • Increased: alkalosis

GLUCOSE :

  • Fasting level is the best indicator of glucose homeostasis o Normal: 70-110 mg/dl
  • Hyperglycemia:  s/sx: increase thirst, increase urination and increased hunger (3Ps). May progress to coma  causes: include diabetes
  • Hypoglycemia:  s/sx: sweating, hunger, anxiety, trembling, blurred vision, weakness, headache or altered mental status  causes: fasting, insulin administration

BUN : Blood Urea Nitrogen

  • Normal: 8-20 mg/dl
  • May be a reflection of GFR and important in renal function
  • May be used to assess or monitor hydrational status, renal function, protein tolerance and catabolism.
  • Panic = > 100 mg/dl
  • Increased: leads to…… o Pre-renal: decreased renal perfusion, dehydration, blood loss, shock, severe heart failure, increased protein breakdown, GI bleed, crush injury, burn, fever, steroids, TCN, excessive protein intake o Renal: acute renal failure, nephrotoxic drugs, glomerulonephritis, chronic renal failure, analgesic abuse o Post-renal: obstruction
  • Decreased:  Causes: malnutrition, profound liver disease, fluid overload (dilutional)
  • BUN by itself is not really clinically significant. Look at it in correlation with SCr

Serum Creatinine (SCr) :

  • Normal: 0.7-1.5 mg/dl for adults and 0.2-0.7 mg/dl for children
  • SCr is constant in patients with normal kidney function.
  • Increase:

 Indicates worsening renal function  Causes: aminoglycosides, amphotericin, cyclosporine, lithium, MTX, cimetidine, dehydration, renal dysfunction, urinary tract obstruction, excess catabolism, exercise, hyperprexia, hyperthyroidism.

BUN/SCr Relationship

  • Normal ration is 10:

  • 20:1  pre-renal causes of dysfunction

  • 10:1-20:1  intrinsic renal damage
  • 20:1 ration may be “normal” if both BUN and SCr are wnl.

Total Protein and Albumin :

  • Total protein: normal = 5.5-9.0 g/dl
  • Albumin: normal = 3.-5 g/dl o Responsible for plasma oncotic pressure and give info re liver status
  • Low:  Leads to fluid leakage (edema) in low areas (ex: ankles if standing) due to decrease in oncotic pressure  Cause: liver dysfunction  S/sx: peripheral edema, ascites, periorbital edema and pulmonary edema.  May effect Ca and medication levels (those bound to albumin)  Treatment: find underlying problem or give albumin

Serum Calcium (Ca) :

  • Normal = 8.5-10.8 mg/dl
  • Corrected calcium = [ (4-Alb) * 0.8mgdl] + apparent Ca
  • Hypocalcemia: less than 8.5 mg/dl  Causes: low serum proteins (most common), decreased intake, calcitonin, steroids, loop diuretics, high PO4, low Mg, hypoparathyroidism (common), renal failure, vitamin D deficiency (common), pancreatitis  S/sx: fatigue, depression, memory loss, hallucinations and possible seizures or tetany  Lead to: MI, cardiac arrhytmias and hypotension  Early signs: finger numbness, tingling, burning of extremities and paresthias.
  • Hypercalcemia: more than 10.8 mg/dl  Cause: malignancy or hyperparathyroidism (most common), excessive IV Ca salts, supplements, chronic immobilization, Pagets disease, sarcoidosis, hyperthyroidism, lithium, androgens, tamoxifen, estrogen, progesterone, excessive vit D or thyroid hormone.  Acute (>14.5) s/sx: nausea, vomiting, dyspepsia and anorexia  Severe s/sx: lethargy, psychosis, cerebellar ataxia and possibly coma or death  Increased risk of digoxin toxicity

Phosphate (PO4) :

  • Normal: 2.6-4.5 mg/dl
  • Hypophosphatemia: les than 2.6 mg/dl
  • Normal: 0.1-0.3 mg/d;
  • Increase: associated with increases in other liver enzymes and reflect liver disease

Urine :

  • Normal: should be clear yellow
  • Cloudy: results from urates (acid), phosphates (alkaline) or presence of RBC or WBC
  • Foam: from protein or bile acids in urine
  • Side note: some medications will change color of urine o Red-Orange: Pyridium, rifampin, senna, phenothiazines. o Blue-Green: Azo dyes, Elavil, methylene blue, Clorets abuse o Brown-Black: Cascara, chloroquine, senna, iron salts, Flagyl, sulfonoamides and nitrofurantoin

pH :

  • Normal: 4.5-
  • Acidic urine: deters bacterial colonization
  • Alkaline urine: seen with Proteus mirabilis or tubular defects.

Specific Gravity :

  • Normal: 1.010 – 1.
  • Varies depending on the particles in the urine
  • Good indicator of kidney’s ability to concentrate urine

Protein content [in urine] :

  • Normal: 0 - +1 or less than 150 mg/day
  • Protein in urine: indication of hemolysis, high BP, UTI, fever, renal tubular damage, exercise, CHF, diabetic nephropathy, preeclampsia of pregnancy, multiple myeloma, nephrosis, lupus nephritis and others.

Microscopic analysis of Urine :

  • Urine should be sterile (no normal flora)
  • Few, if any, cells should be found
  • Significant bacteriuria is defined by an initial positive dipstick for leukocyte esterase or nitrites. If more than 1 or 2 species seen, contaminated specimen is likely.