HCO3/Bicarbonate
21-28 Decreased Values: Respiratory Alkalosis/Metabolic Acidosis Volume Overload
Increased Values: Respiratory Acidosis/Metabolic Alkalosis/Diuretics
Critical values: <15 or >40
ROME: Respiratory Opposite Metabolic Equal
PaCO2
33-45 Decreased Values: Respiratory Alkalosis from fever, hyperventilation, incorrect ventilator settings. Liver disease. Sepsis. Increased Values: Respiratory acidosis from COPD. Respiratory depressants. Critical values <20 or >60.
PaO2
75-105 Decreased Values: Anemia, alcohol, atelectasis, COPD, Pneumonia, PE, Benzo, barbs, opiates. Increased Values: High doses of oxygen. Polycythemia. Critical values: <45.
pH
7.34-7.45 Decreased Values: Diarrhea, uremia, metabolic acidosis, DKA, ischemia, diarrhea, respiratory acidosis. Increased Values: Respiratory alkalosis hyperventilation, incorrect ventilator settings, liver disease, sepsis, metabolic alkalosis, diuretics
BUN
7-20. Final product of protein metabolism. BUN is an indicator of problems with kidney function. Decreased Values: Hemodilution, infancy, liver failure, low protein intake, malabsorption, nephrotic syndrome, starvation. Increased Values: Acute glomerulone
Chloride
95-107. Critical value <80 or >115. Decreased Values: Acute infections, Addison's disease, Adrenal insufficiency, Cushing's syndrome, SIADH, renal failure with sodium loss, vomiting, drugs: bicarbonates, corticosteroids, diuretics. Increased Values: Diarr
Creatinine
Female: 0.6-1.2 Male: 0.8-1.4. Decreased Values: Decreased muscle mass, myasthenia gravis, muscular dystrophy. Increased Values: Acute tubular necrosis, CHF, dehydration, diabetic nephropathy, eclampsia, glomerulonephritis, hypothyroidism, muscular dystro
Glucose, Fasting
65-110. Critical valuesL <50 or >400. Decreased Values: Adrenal insufficiency, alcohol, exogenous insulin, adrenocortical insufficiency, hypopituitarism, insulinoma, malignancy, drugs: ethanol, insulin, oral hypoglycemic agents, propranolol. Increased Val
Potassium
3.5-5. Decreased Values: Alkalosis, ascites, burns, chronic pyelonephritis, Cushing's syndrome, diarrhea, low potassium intake, vomiting, drugs: diuretics, salicylate, and insulin. Increased Values: Acidosis, Addison's disease, dehydration, infection, IV
Hypokalemia
Alkalosis, shallow respirations, irritability, confusion, drowsiness, weakness, fatigue, arrhythmias, tachycardia, irregular rhythm, bradycardia, lethargy, thready pulse, decreased intestinal motility, nausea, vomiting, and ileus.
Hyperkalemia
Muscle twitches, cramps, paresthesia, irritability, anxiety, decreased blood pressure, EKG changes, dysthymias-irregular rhythms, abdominal cramping, diarrhea.
Sodium
135-147. Decreased Values: AIDS, adrenal insufficiency, CHF, cirrhosis, exercise, heavy sweating, nephrotic syndrome, NG suctioning, SIADH, vomiting, water intoxication, drugs: ACE inhibitors, D5W, diuretics, hypotonic saline, thiazides. Increased Values:
Hematocrit
Female 37-48. Male 42-52. Child 31-43. Decreased Values: Iron deficiency anemia, microcytic anemia, thalassemia, bone marrow suppression, chronic infection, normocytic anemia, acute blood loss, hemorrhage, anemia of chronic disease, fluid volume excess, h
Hemoglobin
Female 12-16. Male 13-18. Decreased Value: Anemia, acute blood loss, anemia of chronic disease, fluid volume excess, hemolytic anemia, vitamin b and folate deficiency. Increased Value: Burns, COPD, dehydration, vomiting.
Platelets
100,000-400,000. Decreased Values: Alcohol, aplastic anemia, bone marrow infiltration/replacement/suppression, chemotherapy, DIC, Evan's syndrome, HIV, Drugs: Cephalosporins, clopidogrel, quinidine. Increased Values: Acute blood loss, cancer, CML, essenti
Red Blood Cells
Female 4.7-6.1. Male 4.2-5.4. Decreased Values: Addison's disease, alcohol abuse, anemia of chronic disease, bone marrow suppression, chronic infection, chronic renal failure, hemolysis, hemorrhage, anemias across the board, drugs: Acetaminophen, allopuri
ALP Alkaline Phosphatase
44-147. Used to detect liver diseases or bone disorders. Decreased Values: Blood transfusions, hypophoshatemia, hypothyroidism. Increased Values: Bile duct obstruction, bone metastasis, hyperparathyroidism, liver cancer, Paget's disease, sarcoma, Ricket's
ALT Alanine Transaminase
10-35. ALT is found mainly in liver tissue but can be found in kidneys, heart, and skeletal. Decreased values: Vitamin B deficiency. Increased values may indicate: Acute viral hepatitis, alcoholic hepatitis, biliary obstruction, liver abscess, liver cance
AST
<35. Indicator of heart and liver disease. Decreased values: Vitamin B deficiency. Increased values may indicate: Acute viral hepatitis, alcoholic hepatitis, biliary obstruction, liver abscess, liver cancer, liver failure, mononucleosis, drugs: Acetaminop
Albumin
3.5-5.5. Assists in the transport of bilirubin, calcium, progesterone, and certain medications. This test can help determine if a patient has liver disease or kidney disease, or if the GI tract doesn't absorb nutrients properly. Decreased Values: Burns, c
Autograft Positioning (Intugmentary assessment)
Autograft: After surgery, the site is immobilized for approximately 3 to 7 days to provide the time needed for the graft to adhere and attach to the wound bed.
Burns of face and head
Elevate the head of the bed to prevent or reduce facial, head, and tracheal edema.
Circumferential burns of the extremities
Elevate the extremities
Mastectomy
a. Position the client with the head of the bed elevated at least 30 degrees (semi-Fowler's position), with the affected arm elevated on a pillow to promote lymphatic fluid return after the removal of axillary lymph nodes.
b. Turn the client only to the b
Perineal and vaginal procedures
Place the client in the lithotomy position.
Hypophysectomy
Elevate the head of the bed to prevent increased intracranial pressure.
Thyroidectomy
a. Place the client in the semi-Fowler's or Fowler's position to reduce swelling and edema in the neck area.
b. Sandbags or pillows may be used to support the client's head or neck.
c. Avoid neck extension to decrease tension on the suture line.
Hemorrhoidectomy
Assist the client to a lateral (side-lying) position to prevent pain and bleeding.
GERD
Reverse Trendelenburg's position may be prescribed to promote gastric emptying and prevent esophageal reflux.
Liver Biopsy
a. During the procedure
(1) Position the client supine with the right side of the upper abdomen exposed.
(2) The client's right arm is raised and extended over the left shoulder behind the head.
(3) The liver is located on the right side, and this positio
Paracentesis
The client is positioned in a semi-Fowler's position in bed, or sitting upright on the side of the bed or in a chair with the feet supported. The client is assisted to a position of comfort following the procedure.
Nasogastric tube
a. Insertion
(1) Position the client in a high Fowler's position with the head tilted forward.
(2) This position will help close the trachea and open the esophagus.
(3) If the client receiving a continuous tube feeding needs to be placed in a supine posit
Irrigations and tube feedings
(1) Keep the head of the bed elevated 30 degrees (semi-Fowler's position) to prevent aspiration.
(2) Maintain head elevation for 1 hour after an intermittent feeding.
(3) The head of the bed should remain elevated for continuous feedings.
Rectal irrigations or enemas
Place the client in left Sims' position to allow the solution to flow by gravity in the natural direction of the colon.
COPD
For the client with advanced disease, place the client in a sitting position, leaning forward, with the arms over several pillows or on an overbed table. This position will help the client to breathe easier.
Laryngectomy (radial neck dissection)
Place the client in a semi-Fowler's or Fowler's position to maintain a patent airway and minimize edema.
Bronchoscopy postprocedure
Place the client in a semi-Fowler's position to prevent choking or aspiration resulting from an impaired ability to swallow.
Postural drainage
The lung segment to be drained should be in the uppermost position. Trendelenburg's position may be used.
Thoracentesis
a. During the procedure: To facilitate the removal of fluid from the pleural space, position the client sitting on the edge of the bed and leaning over the bedside table with the feet supported on a stool or lying in bed on the unaffected side with the he
Abdominal aneurysm resection
a. After surgery, limit the elevation of the head of the bed to 45 degrees (Fowler's position) to avoid flexion of the graft.
b. The client may be turned from side to side.
Cardiac Catherization
a. If the femoral artery was used, the client is maintained on bed rest for approximately 3 to 4 hours. The client may turn from side to side.
b. The client's affected extremity is kept straight and the head elevated no more than 30 degrees until hemostas
Peripheral arterial disease
a. Obtain the HCP's prescription for positioning.
b. Because swelling can prevent arterial blood flow, clients may be advised to elevate their feet when at rest. They should not raise their legs above the level of the heart, because extreme elevation slow
Heart failure and pulmonary edema
Position the client upright (high Fowler's position), preferably with the bed in a chair-sitting position, to decrease venous return and lung congestion. Most often, clients with respiratory and cardiac disorders should be positioned with the head of the
Thoracotomy
Check the HCP's prescriptions regarding positioning. With a
thoracotomy, lung wedge resection, lobectomy of the lung, or pneumonectomy Always check the HCP's prescription regarding positioning for the client who had a thoracotomy, lung wedge resection, lo
Arterial vascular grafting of an extremity
a. To promote graft patency after the procedure, bed rest is usually maintained for approximately 24 hours, and the client's affected extremity is kept straight.
b. Limit movement and avoid flexion of the client's hip and knee.
Amputation of the lower extremity
a. During the first 24 hours after amputation, elevate the foot of the bed to reduce edema. The stump is supported with pillows but not elevated because of the risk of flexion contractures.
b. Consult with the health care provider (HCP) and, if prescribed
Deep vein thrombosis
a. If the extremity is red, edematous, and painful and traditional heparin therapy is initiated, bed rest with leg elevation may be prescribed for the client.
b. Clients receiving low-molecular-weight heparin can usually be out of bed after 24 hours, if t
Varicose veins
Leg elevation above the level of the heart is usually prescribed. The client is also advised to minimize prolonged sitting or standing during daily activities.
Venous insufficiency and leg ulcers
Leg elevation is usually prescribed.
Cataract Surgery
Postoperatively, elevate the head of the bed (semi-Fowler's to Fowler's position), and position the client on the back or the nonoperative side to prevent the development of edema at the operative site.
Retinal Detachment
a. If the detachment is large, bed rest and bilateral eye patching may be prescribed to minimize eye movement and prevent the extension of the detachment.
b. Restrictions in activity and positioning after the repair of the detachment depend on the HCP's p
Autonomic dysreflexia
Elevate the head of the bed to a high Fowler's position to help with adequate ventilation and prevent hypertensive stroke.
Cerebral Aneurysm
Bed rest is maintained with the head of the bed elevated 30 to 45 degrees (semi-Fowler's to Fowler's position) to prevent pressure on the aneurysm site.
Cerebral angiography
a. Maintain bed rest for the length of time, as prescribed.
b. The extremity into which the contrast medium is injected is kept straight and immobilized for approximately 8 hours.
Stroke
a. In clients with hemorrhagic strokes, the head of the bed is usually elevated 30 degrees to reduce intracranial pressure and facilitate venous drainage.
b. For clients with ischemic strokes, the head of the bed is usually kept flat.
c. Maintain the clie
Craniotomy
a. The client should not be positioned on the site that was operated on, especially if the bone flap has been removed, because the brain has no bony covering over the affected site.
b. Elevate the head of the bed 30 to 45 degrees (semi-Fowler's to Fowler'
Laminectomy
a. Logroll the client.
b. When the client is out of bed, the client's back is kept straight (the client is placed in a straight-backed chair) with the feet resting comfortably on the floor.
Increased intracranial pressure
a. Elevate the head of the bed 30 to 45 degrees (semi-Fowler's to Fowler's position), and maintain the head in a midline, neutral position to facilitate venous drainage from the head.
b. Avoid extreme hip and neck flexion.
Do not place a client with a hea
Lumbar puncture
a. During the procedure: Assist the client to the lateral (side-lying) position, with the back bowed at the edge of the examining table, the knees flexed up to the abdomen, and the head bent so that the chin is resting on the chest.
b. After the procedure
Spinal Cord Injury
a. Immobilize the client on a spinal backboard with the head in a neutral position to prevent an incomplete injury from becoming complete.
b. Prevent head flexion, rotation, or extension. The head is immobilized with a firm, padded cervical collar.
c. Log
Total Hip Replacement
a. Positioning depends on the surgical techniques used, the method of implantation, and the prosthesis. Also follow the surgeon's prescriptions and agency procedures.
b. Avoid extreme internal and external rotation.
c. Avoid adduction; in most cases side-
Bed Boards
These plywood boards are placed under the entire surface area of the mattress. They are useful for increasing back support and body alignment.
Foot Boards
Foot boots are made of rigid plastic or heavy foam, and they keep the foot flexed at the proper angle. They should be removed two or three times a day to assess skin integrity and joint mobility.
Hand Rolls
Hand rolls maintain the fingers in a slightly flexed and functional position, and they keep the thumb slightly adducted in opposition to the fingers.
Hand Wrist Splints
These splints are individually molded for the client to maintain the proper alignment of the thumb in slight adduction and the wrist in slight dorsiflexion
Pillows
Pillows provide support, elevate body parts, splint incisional areas, and reduce postoperative pain during activity, coughing, or deep breathing. They should be the appropriate size for the body part to be positioned.
Sandbags
Sandbags are soft devices filled with a substance that can be shaped to body contours to provide support. They immobilize extremities and maintain specific body alignment.
Side Rails
These bars, positioned along the sides of the length of the bed, ensure client safety and are useful for increasing mobility. They also provide assistance in rolling from side to side or sitting up in bed. Agency policies regarding the use of side rails s
Trapeze Bar
This bar descends from a securely fastened overhead bar attached to the bed frame. It allows the client to use the upper extremities to raise the trunk off of the bed, to assist with transfer from the bed to a wheelchair, and to perform upper-arm strength
Trochanter Rolls
These rolls prevent the external rotation of the legs when the client is in the supine position. To form a roll, use a cotton bath blanket or a sheet folded lengthwise to a width that extends from the greater trochanter of the femur to the lower border of
Wedge Pillows
This triangular-shaped pillow is made of heavy foam, and it is used to maintain the legs in abduction after total hip replacement surgery.
Bilirubin
0.3-1. Bilirubin which is one of the components of bile, is formed in the liver, spleen, and bone marrow. It is also formed as a result of hemoglobin breakdown, as in the destruction of red blood cells. Decreased Values: N/A. Increased Value: Alcoholism,
Calcium
8.5-10.2. Decreased Values May Indicate: Acute pancreatitis, alcoholism, bisphonates, chronic renal failure, magnesium deficiency, tumor lysis, vitamin D deficiency. Drugs: biphosphanates. Increased Values: Acromegaly acute pancreatitis, Addison's disease
Hypocalcemia
Chvostek's sign: A clinical test for hypocalcemia test. A light tap over the facial nerve in front of the ear, will cause contractions of the facial muscles. Trousseau' sign: The client's thumb and index finger will draw together (caropopedal spasm) when
Hypercalcemia
Calcium >11. It can be the outcome of hyperparathyroidism and bone metastasis with calcium reabsorption from the breast, the lung, or multiple myeloma. Fatigue, weakness, lethargy, anorexia, nausea, constipation, and kidney stones from increased calcium s
Phosphorous
2.4-4.1. Decreased Values: Alcoholism, antacid abuse, carbohydrate loading, chronic alcoholism, diarrhea, hypercalcemia, hyperparathyroidism, hypomagnesia, hypothyroidism, vitamin d deficiency, vomiting. Drugs: OCPs and Phosphate binders. Increased Values
GFR
>60. Decreased values may indicate: Dehydration, hemorrhage, shock, renal failure, drugs: nephrotoxic drugs and aminoglycosides. Increased values may indicate: Acromegaly, early diabetes, exercise, high cardiac output, hypothyroidism, and infections.
Troponin I
<0.04. May stay elevated for several days following an MI.
CK-MB
0.3. CK-MB may be elevated for up to 4 days after an MI.
BNP
<100
Total cholesterol
<200
Ejection fraction
>50
HDL
40-100
LDL
<100
Triglycerides
54-150
TSH
0.4-0.6.
T3
Decreased Value: Hypothyroidism. Increased Values: Hyperthyroidism.
T4
Decreased Value: Hypothyroidism. Increased value: Hyperthyroidism.
Immunoglobulin (Ig)
Is found in high concentrations in the mucous membranes, particularly those lining the respiratory passages and gastrointestinal tract, as well as in saliva and tears.
What are immunoglobulins?
An immunoglobulin test measures the level of certain immunoglobulins, or antibodies, in the blood. Antibodies are proteins made by the immune system to fight antigens, such as bacteria, viruses, and toxins.
The body makes different immunoglobulins to comb
Immunoglobulin G (IgG)
The most abundant type of antibody, is found in all body fluids and protects against bacterial and viral infections.
Immunoglobulin M (IgM)
Immunoglobulin M (IgM), which is found mainly in the blood and lymph fluid, is the first antibody to be made by the body to fight a new infection.
IgE
Immunoglobulin E (IgE), which is associated mainly with allergic reactions (when the immune system overreacts to environmental antigens such as pollen or pet dander). It is found in the lungs, skin, and mucous membranes.
Urine pH
4.8-7.5. Decreased values: DKA, diarrhea, fever, high protein diet, metabolic acidosis, respiratory acidosis, sleep, starvation, UTI. Increased values: Gastric suction, renal tubular acidosis, alkalosis, vegetarian or low carb diet, vomiting: acetazolamid
Therapeutic Digoxin level
0.8-2.0.
Carbamazepine
4-12
Lithium
0.5-1.5
Cef-
Cephalosporins. Examples: Cefadroxil, cefaclor, cefixime, ceftibuten.
Ceph-
Cephalosporins. Examples: Cephalexin, cephapirin, cephradine.
Cort-
Corticosteroids. Example: Cortisone.
Rifa-
Antituberculines: Rifamate, rifampin, rifapentine, rifater.
Sulf-
Sulfonamides (antibiotic). Examples: Sulfadiazine, sulfamethazole, sulfisoxazole.
-Actone
Potassium sparing diuretics. Examples: Aldactone and spirolactone.
-Ane
General anesthetic. Examples: Cyclohexane, ethane, flourane.
-Ase
Thrombolytics (clot busters). Examples: Eminase, retavase, streptokinase.
-Azole
Antifungals. Examples: Butoconazole, econazole, fluconazole.
-Azosin
Alpha blockers (adrenergic antagonists). Examples: Doxazosin, prazosin, terazosin.
-Barbital
Barbiturates. Examples: Amobarbital, pentobarbital, secobarbital.
-Caine
Local anesthetics. Bupivacaine, cocaine, lidocaine, xylocaine.
-calci
Calcium and vitamin d supplements. Examples: Calciferol, calcitrol, ergocalciferol.
-Cillins
Penicillins. Examples penicillin and ampicillin.
- ciclovir
Antivirals. Examples: Famciclovir, ganciclovir.
-curium
Neuromuscular blockers. Examples: Atracurium.
-curonium
Neurovascular blockers. Vecuronium, pipercuronium, rocuronium.
-cycline
Tetracyclines. Demeclocycline, doxycycline, minocycline.
-cyclovir
Antivirals. Acyclovir, valacyclovir.
-dazole
Nitroimiadazole antimicrobial. Metronidazole.
-dipine
Calcium channel ion blockers. Amlodipine, felodipine, isradipine, nifedipine.
-dronate
Biphosphonates. Alendronate, etidronate, pamidronate, risedronate.
-ergot
Ergotamines (anti-migraine). Ergotamine, dihydroxyergotamine.
-floxacin
Fluoroquinolones. Ciprofloxacin, gatifloxacin, levofloxacin.
-ine
Stimulants. Amphetamine, caffeine, terbutaline, theophylline.
-lam
Benzodiazepines. Alprazolam, midazolam.
-lol
Beta blockers (adrenergic antagonists). Atenolol, propranolol, sodalol.
-lone
Corticosteroids. Methylprednisolone, prednisolone, triamcinolone.
-micin
Aminoglycosides.Gentamicin.
-mycin
Aminoglycosides/Macrolides. Erythromycin, tobramycin, vancomycin.
-navir
HIV/AIDS antivirals. Amprenavir, indinavir, nelfinavir, ritonavir.
-pam
Benzodiazepines. Diazepam, lorazepam.
-parin
Anticoagulant. Enoxiparin.
-prazole
Proton pump inhibitors. Lansoprazole, omeprazole, pantoprazole.
-pril
ACE inhibitors. Benazepril, captopril, moexipril, quinapril.
-profen
Fenoprofen, ibuprofen, ketoprofen.
-quine
Antiparasitics. Chloroquine, hydroxychloroquine, mefloquine.
-sartan
Angiotensin-II receptor antagonists. Candesartan, losartan, telmisartan, valsartan.
-semide
Loop diuretic. Furosemide.
-setron
5-HT3 receptor antagonists (antiemetics) dolanestron, graniestron, ondansetron.
-sone
Corticosteroids. Cortisone, dexamethasone, prednisone.
-statin
HMG-CoA Reductase Inhibitor. Rosuvastatin.
-stigmine
Cholinergics. Neostigmine, physostigmine, pyridostigmine.
-stine
Antineoplastics (anti-tumor). Carmustine, lomustine, vinblastine, vincristine.
-terol
Bronchodilators. Albuterol, bitolterol, levalbuterol, pirbuteral.
Which hormone regulates fluid volume?
Aldosterone. Aldosterone is a steroid, it is found in the kidneys and affects the kidneys.
When does aldosterone kick in?
When volume issues occur like vomiting, hemorrhaging, etc. It increase to increase sodium and water and this increases volume.
What diseases involve too much aldosterone?
Coons/hyperaldosterone, Cushing's.
What diseases involve too little aldosterone?
Addison's disease
What does ANP do?
Excretes sodium and water and has the opposite effect of aldosterone.
Work does the Anti-diuretic hormone work?
It retains water and makes you pee.
Diseases with too much ADH
SIADH.
What is the blood like when someone has SIADH?
There will be diluted blood but concentrated urine. Urine output decreases and concentration numbers decrease.
Diseases when there is too little ADH
Diabetes insipidus
What will the urine and blood be like with too little ADH?
Urine diluted but blood is concentrated.
What is the relationship between SIADH and ADH to water?
Too much ADH = Too much water. Not enough ADH=lose water.
Urine, specific gravity, sodium, and hematocrit values increase with
Dehydration
Urine, specific gravity, sodium, and hematocrit values decrease with
Dilution