Clinical Lab Values & Nursing Responsibilities: 2013-Keith Rischer/www.KeithRN.

com

Patho Ranges Causes Treatments Nsg. Considerations

*Most abundant cation Serum below *Excess sodium loss *Sodium containing IV THINK VOLUME
I. Blood in EXTRAcellular fluid 135mEq/L through N-V-D, skin and fluids *Monitor electrolytes
Chemistries *Maintains osmotic
pressure of Critical RED FLAG:
kidneys
*Excess diuretic dosage
*Lactated Ringers
*NS 0.9% or 3%
*Monitor vital signs
*Monitor neurological
extracellular fluid <120 *Liver Failure responses
Sodium: *Regulates renal *CHF *Mental Status
retention & excretion of *Increased hypotonic IV *Headaches
Hyponatremia water fluids *Monitor fluids/I&O for
*Responsible for overload
Normal: 135-145 mEq/L stimulation of *Weights daily
neuromuscular *Cardiac overload-CHF
reactions & maintains *Monitor
SBP musculoskeletal-cramps/
weakness/tremor

Sodium: Serum above 145 *Dehydration-fluid loss *Replace fluids *D5% THINK VOLUME
mEq/L through N-V-D (water loss *Diuretics- Excrete *Monitor electrolytes
Hypernatremia in excess of salt loss) or excess volume and *Monitor vital signs
Critical RED FLAG: excessive sweating excrete *Mental Status
Normal: 135-145 mEq/L >160 *Diabetes-DKA (sodium is then *Weight/I&O
*Fever concentrated with fluid *Monitor for seizures
volume deficit)

Potassium: *Most abundant Serum below 3.5 *Inadequate intake of K+ *Oral or Parenteral THINK ELECTRICITY
INTRAcellular cation mEq/L *ETOH abuse Potassium *Monitor electrolytes
Hypokalemia and is essential for *CHF/HTN *Diet high in potassium *Monitor vital signs-low
transmission of Critical RED FLAG: *GI Loss-V&D *Balanced electrolyte BP
Normal: 3.5-5.2 mEq/L electrical impulses in <2.5 *Renal Loss solutions *Monitor cardiac
cardiac and skeletal *Diuretics-Loop: *Pedialyte responses
muscle Furosemide (Lasix) *Sports drinks *Irregular heart rate and
*Helps maintain acid- Bumetadine (Bumex) rhythm for increased
base balance and has ectopy-PVCs/VTach
inverse relationship to
metabolic
pHdecrease in pH of
0.1 (acidosis) increases
K+ by 0.6 mEq/L
*80-90% K+ filtered
through the kidney
Clinical Lab Values & Nursing Responsibilities: 2013-Keith Rischer/www.KeithRN.com

Potassium: Ranges Causes Treatments Nsg Considerations

Hyperkalemia Serum above 5.0 mEq/ *Metabolic acidosis *Insulin- Moves K+ into THINK ELECTRICITY
*Dehydration the cell *Monitor electrolytes
Normal: 3.5-5.0 mEq/L Critical RED FLAG: >6 *Excess potassium intake *D50- Prevents *Monitor cardiac
*Potassium sparing hypoglycemia caused responses
diuretics by the infusion of Insulin *Monitor musculoskeletal
*Tissue damage-Burns (K+ *IV Calcium Gluconate cramps, weakness,
goes out of cell) also given at the same parathesias
*Renal Failure time to counteract *Peaked T wave/wide
cardiac effects of QRS
potassium *Monitor neurological
*Sodium Bicarbonate- responses, mental
treats the acidosis status, headache
caused when K+ moves *Irregular heart rate and
into the cell and pushes rhythm for increased
hydrogen ions into the ectopy-PVCs/Vtach
serum
Magnesium: *Second most Serum below 1.6 mg/dL *Chronic Alcoholism *Treat underlying cause THINK
abundant intracellular Critical RED FLAG: *GI Loss-V&D *GI Loss NEUROMUSCULAR
Hypomagnesemia cation <1.2 *Impaired absorption *Give Magnesium TRANSMISSION
*Required for *Renal Disease replacement THINK CARDIAC
Normal: 1.6-2.6 mg/dL transmission of nerve *Pancreatitis RESPONSE
impulses and muscle *Monitor electrolytes
relaxation *Monitor vital signs
*Controls absorption of *Tachycardia
sodium, potassium, *Hypertension
calcium, and *Tremors, tetany,
phosphorus paresthesias
*Magnesium.Potassium *Muscle weakness
and Calcium all go low
or high together!
Magnesium: Serum above 2.6 *Dehydration *Treat underlying cause THINK
mg/dL *Severe metabolic acidosis *Renal patients treat NEUROMUSCULAR
Hypermagnesemia *Renal Failure with dialysis TRANSMISSION
Critical RED FLAG: *Tissue trauma *Monitor cardiac effects THINK CARDIAC
>6.1 of magnesium- RESPONSE
Normal: 1.6-2.6 mg/dL increased PVCs-VT *Monitor electrolytes
*Give Calcium *Monitor vital signs
Gluconate *Bradycardia
*Hypotension
*Muscle weakness
Clinical Lab Values & Nursing Responsibilities: 2013-Keith Rischer/www.KeithRN.com

Patho Ranges Causes Treatments Nsg Considerations

Calcium: *Most abundant cation Serum below 8.2 mg/dL *ETOH abuse Oral Calcium THINK MUSCLE
in body and necessary *Pancreatitis carbonate/gluconate RESPONSE
Hypocalcemia for almost all vital Critical RED FLAG: *Chronic renal failure Calcium chloride (more *Monitor electrolytes
processes <7 Inadequate intake irritating to the vein) *Monitor vital signs
Normal: 8.2-10.6 mg/dL *Half of total body *Decreased Vitamin D Watch for extravasate *Cardiac Output
calcium circulates as (Sunshine) into subcutaneous decreased
free ions that *Lack of weight bearing tissue *Hypotension
participate in *Loop Diuretics *Dysrhythmias
coagulation, *Hypomagnesemia *Monitor neuromuscular
neuromuscular 1q` responses: seizures,
conduction, intracellular tetany, paresthesias,
regulation, control of muscle spasms
skeletal and cardiac
muscle contractility
*98-99% calcium
reserves stored in teeth
and skeleton

Calcium: Serum above 10.6 *Prolonged immobilization *Eliminate Calcium THINK MUSCLE
mg/dL *Dehydration through kidneys through RESPONSE
Hypercalcemia *Cancer IV fluids *Monitor electrolytes
Critical RED FLAG: *Excess Antacid Intake *Loop diuretic to *Monitor vital signs
Normal: 8.2-10.6 mg/dL >12 promote elimination of Hypertension
calcium *Monitor GI: N&V-
anorexia
*Dysrhythmias

Creatinine *End product of Serum above 1.2 mg/dl Decreased in: Correct underlying THINK FLUID
creatine metabolism Decreased skeletal muscle problem BALANCE
which is performed in *Gold standard for Inadequate protein intake Fluid resuscitation to *Assess I&O closely
Normal: 0.5-1.2 mg/dl skeletal muscle kidney function keep SBP>90 *Fluid restriction
*Small amount of because creatinine is Increased in: Dialysis *Assess for signs of fluid
creatine is converted to produced in consistent CHF retention/edema
creatinine which is then quantity and rate of Dehydration
secreted by kidneys clearance reflects Acute & chronic renal
*Amount of creatinine glomerular filtration failure
generated proportional Shock
to mass of skeletal
muscle
Clinical Lab Values & Nursing Responsibilities: 2013-Keith Rischer/www.KeithRN.com

Nsg Considerations
Patho Ranges Causes Treatments
Blood Urea Urea represents end Critical RED FLAG: Decreased in: *Fluid resuscitation- THINK FLUID
product of protein >100 Poor protein HIGH BALANCE
Nitrogen metabolism performed intake/malnutrition *Dialysis-HIGH *Assess I&O closely
(BUN) in the liver Liver disease *Improve nutritional *Fluid restriction
Urea diffuses freely in Malabsorption syndromes intake/Failure to thrive- *Assess for signs of fluid
intra/extracellular fluid LOW retention/edema
Normal: 10-20 mg/dl and then excreted by Increased in: *Assess for agitation,
kidneys Acute renal failure confusion, fatigue,
BUN reflects balance CHF *N&V-HIGH
between production Hypovolemia-dehydration *Assess liver profile labs
and excretion of urea Pyelonephritis for correlating liver
Ratio to creatinine is Hyperalimentation/TPN damage
15-24:1 (if creatine 1.0
expected BUN should
be 15-24)
Is indirect
measurement of renal
function but does not
reflect glomerular
filtration

*Primary protein of Critical RED FLAG: <6 Clinical Uses: *Correct underlying THINK BLOOD
II.Hematology erythrocytes that is or >18 Detect blood loss, anemia problem LOSS/ANEMIA
composed of heme and response to treatment *Blood transfusions if *Identify early signs of
(iron) and globin Range of Anemias: Detect any possible blood symptomatic blood loss: tachycardia,
Hemoglobin-HGB (protein) Mild Hgb 10-12 g/dl- disorder then hypotension
*Carries O2 to cells and asymptomatic *Transfuse as needed-
Normal: Adult- 13-17 g/dl CO2 back to lungs Moderate: Hgb 6-10 Decreased in: assess closely in first 30
*Parallels Hematocrit g/dl Anemia for transfusion reactions
which is the % of RBC weakness, fatigue, Cancer *Assess for signs of
in proportion to total palpitations, SOB, Fluid retention/overload tissue hypoxia (see
plasma volume decreased tol to Hemorrhage above)
*GOLD Standard for activity-orthostatic
evaluating blood/RBC hypotension Increased in:
adequacy (anemia, Severe: Hgb < 6 g/dl COPD
blood loss) Hypoxia: confusion, CHF
SOB,skin pallor- and Dehydration
MM and nailbeds, Polycythemia
dizziness, weakness,
tachycardia
Clinical Lab Values & Nursing Responsibilities: 2013-Keith Rischer/www.KeithRN.com

Patho Ranges Causes Treatments Nsg Considerations

White Blood Cell *WBC represent Critical RED FLAG: Decreased in: *Identify infectious THINK INFECTION
primary defense <2500 or >15,000 ETOH abuse process *Low or elevated WBC
Count against invading Anemia *Confirm bone marrow can represent sepsis
(WBC) infections Bone marrow depression depression in *Assess closely for
*This is a total count of Viral infections chemo/radiation therapy hypotension with known
all 5 leukocytes: infection (septic shock)
Normal: 4,500-11,000 neutrophils, Increased in: *Assess closely for any
mm3 lymphocytes, Infection change in temperature
eosinophils, basophils, Anemia trend-hypothermia or
and monocytes Inflammatory disorders febrile can both
*Indicates overall Steroid use (acute or represent sepsis
degree of bodies chronic) especially in elderly
response to pathology,
but must be evaluated
and correlated through
differential count
*Elevated WBC due to
significant increase in
one differential-usually
the neutrophil
*Physiologic stress or
steroids will increase
WBC

Neutrophils *Most predominant Critical RED FLAG: Increased in: *Identify infectious THINK INFECTION
differential WBC- >80% Infection process *Low or elevated WBC
comprise 50-70% of all Acute hemorrhage *Confirm bone marrow can represent sepsis
Normal: 50-70% of WBCs Physical stress depression in *Assess closely for
differential *First line of defense Tissue necrosis/injury chemo/radiation therapy hypotension with known
against bacterial infection (septic shock)
infection through Decreased in: *Assess closely for any
phagocytosis (think Bone marrow depression change in temperature
pacman) (chemo/radiation therapy) trend-hypothermia or
*BANDS- if present on Viral infection (due to febrile can both
differential-correlate increased lymphocytes) represent sepsis
with overwhelming especially in elderly
sepsis.Immature
neutrophils body is
kicking into circulation
before they are ready
because of the severity
of infection/sepsis
Clinical Lab Values & Nursing Responsibilities: 2013-Keith Rischer/www.KeithRN.com

Patho Ranges Causes Treatment Nsg Considerations

*Contractile protein Critical RED FLAG: Increased in: *Standards of cardiac THINK CARDIAC-MI
III. Cardiac found in cardiac muscle ANY ELEVATION Acute MI care include continuous *Assess closely for
that will be released Unstable angina telemetry, b-blockers to recurrent or new onset of
into systemic circulation If elevated this Minor myocardial damage decrease cardiac chest pain
Troponin with cardiac ischemia establishes diagnosis of after CABG or PTCA/stent workload, heparin or *Assess cardiac rhythm
or acute MI acute MI placement nitroglycerin gtts. for any changes such as
Normal: <0.05 ng/ml *Levels will rise 2-6 *If positive MI, the *Definitive treatment of PVCs, VTach or atrial
This may vary depending hours after injury-peak degree of elevation MI includes PTCA/stent fibrillation
on each hospital lab 16-24 hours and then provides general or CABG *Assess HR and SBP
remain elevated for barometer of degree of carefully to promote
several days heart muscle damage decreased cardiac
*If acute onset CP to workload (maintain heart
r/o MI they will be done rate <80 and SBP <140
every 6 hours x3 to *Assess tolerance to
determine pattern of activity closely
abnormal elevation

Brain Natriuretic *Hormone that is stored 100-500 ng/L abnormal *CHF exacerbation *Aggressive diuresis for THINK CARDIAC-HF
in the ventricle of the but not critical for *Ventricular hypertrophy fluid overload *Assess respiratory
Peptide heart ventricular strain (mild) (cardiomyopathy) *May be on NTG gtt or status for tachypnea and
(BNP) *When left ventricle is *Severe hypertension po Nitrates to decrease breath sounds closely for
distended and Critical RED FLAG: preload which basilar or scattered
stretched due to CHF >500 decreases workload of crackles
Normal: <100 ng/L exacerbation BNP is critical for positive heart *Assess HR and SBP
released into circulation correlation of HF carefully to promote
Inhibits the release of exacerbation decreased cardiac
renin by kidneys which workload (heart rate <80
promotes water and and SBP <140
sodium loss as well as *Assess tolerance to
increases glomerular activity closely
filtration rate (Bodys *Assess I&O closely
own ACE inhibitor!) *Assess K+ closely with
loop diuretics

References
1. Van Leeuwen, A. & Poelhuis-Leth, D.J. (2009). Daviss comprehensive handbook of laboratory and diagnostic tests with nursing
implications. Third ed. Philadelphia, PA: F.A. Davis Company.