by ArmyKitten

Well..probably not. But this IS bugging me.

I made some nice flash cards with all my lab values- including critical levels and all that jazz. I start reviewing, and realize that these are just not quite the same numbers I remember from critical care and med-surg. I start checking my resources against each other, and I keep finding discrepancies. Kaplan, Saunders, my Med Surg textbook, the notes from my critical care class, a lab reference book and one of those pocket flip guides all have slightly different numbers. Granted, they are generally not off by much, but this is driving me nuts. So who is right?

I know that there will be variations in the "normal" based on the equipment and the facility that I will be working at, and in general the lab normal ranges will be printed on the lab results sheet. But for the purposes of studying for NCLEX- who do I go with?

Lets take Chloride, for example. Saunders says 98-107 is normal. My textbook says 90-110. Or bicarb- I have in my ABG notes that it is 22-26, but my lab book says 22-28.

My point of this entirely too long rant is-- as long as I can recognize the general normal range of a lab value, will I be okay on NCLEX? Or do they have questions where the labs are only "slightly" off? I really want to just stick to one set of this junk and call it good....

<---this is me, loosing my mind

Re: This is going to drive me to drink!

It will be obvious on the NCLEX... Like say for Hypokalemia it will say 2.6 or something like that.. So you will KNOW it is wrong...

HTH

Re: This is going to drive me to drink!

The exam is not asking you for specific ranges but what to do with a patient that has a certain result, you will definitely recognize what you should do about it provided that you know your disease processes.

Re: This is going to drive me to drink!

Hey ArmyKitten,

A little off topic, but HOW do you memorize those values? Just wondering.

Re: This is going to drive me to drink!

Thanks- I think I am just over analyzing everything right now.

How do I memorize the values? I have a huge stack of index cards. Each lab gets their own card- I have cards for everything from Na to PTT to Bilirubin. On each card I write the abbreviation in the top left corner, then the full name in the top right corner. I skip down a couple lines and write the following: normal values, critical values, then a couple lines on the purpose/pathophys of the lab.

Example:
Na.
Normal= 135 to 145 mEq/L
Critical levels= <120 causes confusion, lethargy, stupor and coma
Fxn: maintains osmotic pressure, aids in transmission of nerve impulses, etc

It will take literally HOURS to write out all those cards, but once you have the set made the hard part is done. Then take 5 at a time, memorize them and add 5 more cards the next day. Day 3= 15 cards, day 4= 20, etc...Go through the ones you have memorized twice a day, with each day adding more cards. Eventually you learn them all

Re: This is going to drive me to drink!

AWESOME TIP FOR REMEMBERING LAB VALUES ARMY KITTEN!!!!!!!!!!!!!

Re: This is going to drive me to drink!

do you happen to have a list of values???? per chance?????? LOL

AmyD

Re: This is going to drive me to drink!

Originally Posted by Now or Never

AWESOME TIP FOR REMEMBERING LAB VALUES ARMY KITTEN!!!!!!!!!!!!!

Great tip....thanks! I've always made flash cards; however, never thought about memorizing the information on a scheduled basis like that. Again, thanks for the insight!

Re: This is going to drive me to drink!

I am going to copy and paste from a Word file...not sure how well this is going to turn out. The values on this are from the HESI review book and the Saunders book. It doesn't have everything, but this is a start. I don't have anything else in typed form- only note cards.


Lab Values
1) RBC 4.5-6.0 million/mm3
a. Transports hemoglobin & O2
2) Hemoglobin women: 12-16 g/dl men: 14-18 g/dl
a. Critical value < 5 or > 20
b. O2 transport
3) Hematocrit 40-50%
a. solid to liquid ratio, affected by hydration status
4) WBC 5-10 thousand
a. Increased bacterial infection
b. Decreased immusupression
c. Decreased viral infection
5) Platelets 200,000-400,000
a. Transfusion increased by 5,000
6) Potassium (K+) 3.5-5.0 meq
a. Intracellular transmission of impulses & acid-base balance
7) Sodium (N+) 135-145
a. Fxn osmolarity
b. <120 confusion, lethargy, stupor, coma
8) Chloride 90-110 meq
a. Acid-base balance & electrical neutrality
9) Bicarb 22-26
a. Acid-base balance
10) Prothrombin Time (PT)
a. Monitor coumadin
b. Antidote vitamin K
c. Teach about invasive procedures
11) Partial Thromboplastin Time (PTT) 1.5-2.5 times normal = therapeutic
a. Monitor heparin
b. Antidote protamine sulfate
c. Monitor for occult blood loss
d. Bleeding time = vascular & platelet fxn
12) Cholesterol <200 mg/dl (total)
a. HDL good: higher the better
b. LDL bad: decreased the better largest part of total cholesterol
13) Cardiac Enzymes LDH
a. 45-90
b. rises 12-24 hours
c. peaks 2-6 days
d. 300-800 probable MI
14) Cardiac Enzymes CPK
a. 60-400
b. rises 3-6 hours
c. peaks 24 hours
d. CK II (MB) 3% or 12 u/L probable MI
e.
15) BUN 8-25 mg/dl
a. Waste products of protein metabolism reflects kidney fxn, GI bleeding, hydration, tube feeding
16) Creatinine 0.6-1.3 mg/dl
a. Specifically reflects # of functional nephrons.
b. Caution with nephrotoxic medications
17) Bilirubin 0.1-1.0
a. Phototherapy for newborns
b. Jaundice after 2.5
18) ALT & AST
a. ALT < AST  cirrohsis & cancer
b. ALT > AST  acute hepatitis & hepatic obstruction
19) Fasting Blood Sugar 80-110: 60-110
a. 2 readings > 125 on fasting indicative of diabetes mellitus
20) Glycosylated Hemoglobin 4 – 8%
a. Good diabetic control 7%
b. Long term index of blood glucose (life of RBC)
21) Thyroid Stimulating Hormone (TSH) 0.2-5.4
a. Produced by pituitary gland
b. Negative feedback loop with thyroxine
22) Thyroxine 4-12
a. Produced by thyroid gland
b. Critical value < 2 & >20
23) ABG PH 7.35-7.45 Pco2 35-45 Hco3 22-26 Po2 96-100
a. Monitor acid-base balance & oxygenation
b. Kidneys & lungs involved
c. Put specimen on ice
d. Low acidic
e. High is alkalosis
24) Ammonia 35-65
a. Waste product from nitrogen breakdown during protein metabolism
b. Metabolized by liver and excreted by kidneys
c. Elevated levels result from hepatic dysfunction lead to encephalopathy
d. Indicator of hepatic coma
e. Fast except water, no smoking for 8-10 hours before test
f. Specimen on ice
25) Albumin 3.4-5
26) Calcium 8.6-10.0
a. Aids in blood clotting by converting prothrombin to thrombin
27) Magnesium 1.6-2.6
28) Phosphorus 2.7-4.5
29) CD4 T 500-1600
a. Immune system stays healthy with 500 or greater
b. Immune problems occur count is between 200-499
c. Severe immune problems with less than 200
30) Specific gravity 1.016-1.022

Therapeutic Blood Levels

1) Dilantin 10-20 mg/L
2) Digoxin 0.5-2.0 mcg/L 0.8-1.5
3) Theophylline 10-20
4) Lithium 0.6-1.2
5) Valproic Acid 50-100
6) Trough amount adequate to be effective. Draw prior to a dose
7) Peak amount below toxic level 30-60 mins after a dose
8) Amikacin Trough: 5 mcg/ml Peak: 35
9) Gentamicin Trough: 2 Peak: 10
10) Kanamycin Trough: 5 Peak: 35
11) Neomycin Trough: 2 Peak: 16
12) Streptomycin Trough: varies Peak: 25
13) Tobramycin Trough: 2 Peak: 20
14) Vancomycin Trough: 5-10 Peak: 25


Hypercalcium decreased symptoms
Hypocalcium increased symptoms

Antidotes

1) Acetaminophen acetylcysteine (mucomist)
2) Digoxin digibind
3) Opioid analgesics, heroin Nalmefene, Naloxone


Insulins

1) regular IV onset: 10-30 min peak: 15-30 min duration: 30-60 min
2) regular SC (clear) onset: 30-1 hour peak: 2-4 hours duration: 5-7 hours
3) NPH (cloudy) onset: 1-4 hours peak: 6-12 hours duration: 18-28 hours
4) Lente onset: 1-3 hours peak: 8-12 hours duration: 18-28 hours
5) Ultralente onset: 4-6 hours peak: 18-24 hours duration: 36 hours

hypoglycemia mental confusion, hallucinations, convulsions, pale, cool, clammy skin, admin oral glucose.

Hyperglycemia polyuria, polydipsia, polyphagia, hot, red and dry skin. Admin insulin.

Rule of 15
4 oz any juice 1 TBSP sugar in water
4oz regular soda not better in 15 min give 15 gm of carbs & pb & cracker
8oz milk, low fat

Re: This is going to drive me to drink!

ArmyKitten....... ......Did I forget to say thank you