NCLEX Have in your head

Sodium NA+ 136-145mmol/L

Increased levels- edema, tachycardia, diaphoresis, fever

Decreased levels- abdominal cramps, HA, fatigue, weakness, postural hypotension,

restless, drowsiness

Potassium K+ 3.5-5.3 mmol/L

Increased levels- ventricular arrythmias, asystole, can lead to cardiac arrest, nausea,
fatigue, muscle weakness, tingling sensation

Decreased levels- ventricular arrythmias, constipation, muscle cramps, heart

palpatiations, and SOB

PH of Lung versus gastric contents

Sa02 97-100%
Decreased levels- hypoxia (deficiency in oxygen), rapid breathing, poor judgment,
cyanosis, poor coordination, lethargy, dizziness, muscle fatigue, HA

Bilirubin 0.2-1.2mg/dl
Increased levels- Jaundice, dark urine, light grey stools, may itch, abdominal pain,
vomiting, hepatic damage, bilary obstruction, hemolysis, fasting, cholestasis

Decreased levels- No direct symptoms

Platelet count 150-400,000 mm 3

Increased levels- thrombocythmeia (blood clots), changes in speech and mentation, may
pass out, seizures, SOB, nausea, malignant disorders, polycthemia vera, rheumatoid
arthritis, iron deficiency anemia

Decreased levels- hemorrhage, prolonged bleeding times, easily bruised, leukemia,

immune thrombocytopenia, pernicious anemia, cancer chemotherapy, infection

Cholesterol recommendations-
The American Heart Association endorses the National Cholesterol Education Program (NCEP)
guidelines for detection of high cholesterol. The Third Report of the Expert panel on
Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult
Treatment Panel III or ATP III) was released in 2001. It recommends that everyone age
20 and older have a fasting "lipoprotein profile" every five years. This test is done after a
9–12-hour fast without food, liquids or pills. It gives information about total cholesterol,
low-density lipoprotein (LDL) or "bad" cholesterol, high-density lipoprotein (HDL) or
"good" cholesterol and triglycerides (blood fats)
Total Cholesterol Level Category
Less than 200 mg/dL Desirable level that puts you at lower risk
for coronary heart disease. A cholesterol
level of 200 mg/dL or higher raises your
risk.
200 to 239 mg/dL Borderline high
240 mg/dL and above High blood cholesterol. A person with this
level has more than twice the risk of
coronary heart disease as someone whose
cholesterol is below 200 mg/dL.

HDL Cholesterol Level Category

Less than 40 mg/dL Low HDL cholesterol. A major risk factor for
(for men) heart disease.
Less than 50 mg/dL
(for women)
60 mg/dL and above High HDL cholesterol. An HDL of 60 mg/dL
and above is considered protective against
heart disease.

If your total cholesterol is 200 mg/dL or more, or your HDL cholesterol is

less than 40 mg/dL (for men) and less than 50 mg/dL (for women), you need
to have a lipoprotein profile done to determine your LDL cholesterol and
triglyceride levels. If your cholesterol is high or you have other risk factors,
your healthcare provider will likely want to monitor your cholesterol more
closely. Follow your provider's advice about how often to have your cholesterol
tested. He or she will set appropriate management goals based on your LDL
cholesterol level and other risk factors.

LDL Cholesterol Level Category

Less than 100 mg/dL Optimal
100 to 129 mg/dL Near or above optimal
130 to 159 mg/dL Borderline high
160 to 189 mg/dL High
190 mg/dL and above Very high

Your LDL cholesterol goal depends on how many other risk factors you have.†

• If you don't have coronary heart disease or diabetes and have one or no
risk factors, your LDL goal is less than 160 mg/dL.
• If you don't have coronary heart disease or diabetes and have two or more
risk factors, your LDL goal is less than 130 mg/dL.
 • If you do have coronary heart disease or diabetes, your LDL goal is less
than 100 mg/dL.

Triglyceride is the most common type of fat in the body. Many people who have
heart disease or diabetes have high triglyceride levels. Normal triglyceride levels
vary by age and sex. A high triglyceride level combined with low HDL cholesterol
or high LDL cholesterol seems to speed up atherosclerosis (the buildup of fatty
deposits in artery walls). Atherosclerosis increases the risk for heart attack and
stroke.

Triglyceride Level Category

Less than 150 mg/dL Normal
150–199 mg/dL Borderline high
200–499 mg/dL High
500 mg/dL and above Very high

On the whole, Americans should reduce the amount of saturated fat, trans fat,
cholesterol and total fat in their diet. If you have high blood cholesterol, it's very
important to control high blood pressure, avoid tobacco smoke, eat a healthy diet, get
regular physical activity, maintain a healthy weight, and control or delay the onset of
diabetes. Taking these steps will help lower your risk of heart disease and stroke. If you
still need drugs to reduce your blood cholesterol, a healthy diet and active lifestyle will
help lower your cholesterol and improve your overall cardiovascular health.

WBC 4-11.0 mm 3
Increased levels- infection, trauma, inflammatory disorder, ketoacidosis, gout

Decreased WBC- neutropenia, overwhelming deficiency, infection leukemia,

immunodeficiency disease, radiation therapy

BUN 7-20 mg/dl

The BUN test is primarily used, along with the creatinine test, to evaluate kidney function
in a wide range of circumstances, to help diagnose kidney disease, and to monitor
patients with acute or chronic kidney dysfunction or failure. It also may be used to
evaluate a person’s general health status when ordered as part of a basic metabolic panel
(BMP) or comprehensive metabolic panel (CMP). BUN levels can increase with the
amount of protein in your diet. High-protein diets may cause abnormally high BUN
levels while very low-protein diets can cause an abnormally low BUN.

Increased levels- renal failure, shock, volume depletion, GI bleed, stress, drugs

Decreased levels- starvation, liver failure, pregnancy, over hydration

Creatinine 0.6-1.5 mg/dl
Increased levels- renal failure, can be drug induced, glomerunlonephritis, pyleonephritis,
acute tubular necrosis, renal shock, dehydration, CHF

Decreased levels- decreased debilitation, loss of muscle mass, pregnancy, muscular

dystrophy, myasthenia gravis

HGB for males 14-18 g/dl Hct 42%-52%

HGB for females 12-16 g/dl Hct 37%-47%

Increased levels- congenital heart disease, polycythemia, hemoconcentration of blood,

COPD, CHF, high altitudes, severe burns, dehydration, severe diarrhea

Decreased levels- anemia, fatigue, dyspnea, hemorrhage, hemolysis, kidney disease,

lymphoma, cancer, nutritional deficiency, normal pregnancy, malnutrition

Glucose- 7-120 mg/dl

Increased BG- fruity breath, urinary frequency, thirst, dry mouth, drowsiness, loss of
weight, increase in appetite, blurred vision, itchy skin

Low BG- hunger, shakiness, nervousness, sweating, dizzy, confusion, difficult speaking,
anxiety, weakness

Calcium 8.6-10.2mg/dl
Increased levels- renal stones, polyuria, thirst, decreased muscle tone, carciac arrhythmia,
assystole, primary hyperthyroidism, vitamin D excess, CRF

Decreased levels- osteoporosis, muscle spasms/cramps, cardiac arrhythmia,

hypoparathyroidism, isufficient vitamin D

Chloride 98-106 mEQ/L

Increased levels- dehydration, diarrhea, renal tubular, acidosis, cushings syndrome,
eclampsia, kidney dysfunction, anemia

Decreased levels- overhydration, CHF, vomiting, addisons disease, burns, hypokalemia,

vomiting

Magnesium Normal Serum values

1.6 - 2.6 mg/dl

Increased: renal failure, hypothyroidism, severe dehydration, lithium intoxication, antacids,

Addison's disease.

Decreased: hyperthyroidism, aldosteronism, diuretics, malabsorption, hyperalimentation,

nasogastric suctioning, chronic dialysis, renal tubular acidosis, drugs (aminoglycosides, cisplatin,
ampho B)
Intracranial pressure (ICP) is the pressure inside the skull and thus in the brain tissue and
cerebrospinal fluid (CSF). The body has various mechanisms by which it keeps the ICP stable,
with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and
absorption of CSF. CSF pressure has been shown to be influenced by abrupt changes in
intrathoracic pressure during coughing (intraabdominal pressure), valsalva (Queckenstedt's
maneuver), and communication with the vasculature (venous and arterial systems). ICP is
measured in millimeters of mercury (mmHg) and, at rest, is normally 7–15 mmHg for a supine
adult, and becomes negative (averaging −10 mmHg) in the vertical position.[1] Changes in ICP
are attributed to volume changes in one or more of the constituents contained in the cranium.

The CVP catheter is an important tool used to assess right ventricular function and systemic fluid
status.

• Normal CVP is 2-6 mm Hg.

• CVP is elevated by :
o overhydration which increases venous return
o heart failure or PA stenosis which limit venous outflow and lead to venous
congestion
o positive pressure breathing, straining,
• CVP decreases with:
o hypovolemic shock from hemorrhage, fluid shift, dehydration
o negative pressure breathing which occurs when the patient demonstrates
retractions or mechanical negative pressure which is sometimes used for high
spinal cord injuries.

The three pressures that can contribute to the CPP are:

• Mean arterial pressure (MAP)

• Intracranial pressure (ICP)

• Jugular venous pressure (JVP)

Normal specific gravity range in urine. Shows the concentrating and diluting ability of the
kidneys.

• 1.020 -1.030 g/ml

• DECREASED specific gravity: diabetes insipidus, excess fluid intake, diabetes mellitus
• INCREASED specific gravity: dehydration, adrenal insufficiency, nephrosis, CHF, liver
disease

• Constant specific gravity w/ chronic renal disorder

The theraputic level for digoxin is 0.8-2.0 ng/mL. Low serum potassium increases the risk of
digoxin toxicity and cardiac dysrhythmias. The classic arrhythmia is a paroxysmal atrial
tachycardia with block. Symptoms include hypersalivation, fatigue, nausea/vomiting, changes in
heart rate and rhythm, loss of appetite (anorexia), diarrhea, visual disturbances (yellow or green
halos around objects), confusion, dizziness, nightmares, agitation, and/or depression, as well as
a higher acute sense of sensual activities. The primary treatment of digoxin toxicity is digoxin
immune Fab. Digoxin should not be given if the apical heart rate is below 60 BPM (beats per
minute).

Serum lithium concentrations are usually in the 0.5-1.3 mmol/L range in well-controlled patients,
but may increase to 1.8-2.5 mmol/L in patients who accumulate the drug over time and to 3-10
mmol/L in victims of acute overdosage. Lithium toxicity may occur in persons taking excessive
amounts either accidentally or intentionally on an acute basis or in patients who accumulate high
levels during ongoing chronic therapy. The manifestations include nausea, emesis, diarrhea,
asthenia, ataxia, confusion, lethargy, polyuria, seizures and coma. Other toxic effects of lithium
also include coarse tremor, muscle twitching, convulsions and renal failure.[39] Persons who
survive a poisoning episode may develop persistent neurotoxicity.

INR of 2.0 to 3.0 for basic "blood-thinning" needs. For some patients who have a high risk of clot
formation, the INR needs to be higher - about 2.5 to 3.5. Your doctor will use the INR to adjust
your drug to get the PT into the range that is right for you. Interpretation of PT and PTT in
Patients with a Bleeding or Clotting Syndrome PT resultptt resultCommon condition present
Prolonged Normal Liver disease, decreased vitamin K, decreased or defective factor VII Normal
Prolonged Decreased or defective factor VIII, IX, or XI, von Willebrand disease, or lupus
anticoagulant present Prolonged Prolonged Decreased or defective factor I, II, V or X, severe
liver disease, disseminated intravascular coagulation (DIC) Normal Normal or slightly
prolonged
May indicate normal hemostasis; however PT and PTT can be normal in conditions such as mild
deficiencies in other factors and mild form of von Willebrand disease. Further testing may be
required to diagnose these conditions.

Normal APTT results are usually between 25-40 seconds; PTT results are between 60-70
seconds. APTT results for a patient on heparin should be 1.5-2.5 times normal values. An APTT
longer than 100 seconds indicates spontaneous bleeding. Diagnosis

Blood clotting (coagulation) depends on the action of substances in the blood called clotting
factors. Measuring the partial thromboplastin time helps to assess which specific clotting factors
may be missing or defective.

Monitoring

Certain surgical procedures and diseases cause blood clots to form within blood vessels.
Heparin is used to treat these clots. The PTT test can be used to monitor the effect of heparin on
a patient's coagulation system.

Precautions

Certain medications besides heparin can affect the results of the PPT test. These include
antihistamines, vitamin C (ascorbic acid), aspirin, and chlorpromazine (Thorazine).

Normal levels:

The ranges for a normal RBC count (expressed in million red cells per microliter {uL} of blood)
are:

• Women: 4.2 to 5.4 million/uL

 • Men: 4.7 to 6.1 million/uL
• Children: 4.6 to 4.8 million/uL

Levels of RBCs out of the normal range (higher or lower) can be an indication of certain
conditions. Polycythemia is the presence of an elevated RBC count; anemia is a decreased RBC
count.

ESR

ESR stands for erythrocyte sedimentation rate. It is a test that indirectly measures how much
inflammation is in the body. However, it rarely leads directly to a specific diagnosis.

Adults (Westergren method):

• Men under 50 years old: less than 15 mm/hr and Men over 50 years old: less than 20
mm/hr
• Women under 50 years old: less than 20 mm/hr and Women over 50 years old: less than
30 mm/hr

An increased ESR rate may be due to: anemia, endocarditis, keidney disease, osteomyelitis,
pregnacy, rheumatic fever/arthritis, syphilis, lupus, thyroid disease, TB, other inflammatory
conditions.

Lower-than-normal levels occur with: CHF, low plasma protein, sickle cell anemia

SGOT: Serum glutamic oxaloacetic transaminase, an enzyme that is normally present in liver and
heart cells. SGOT is released into blood when the liver or heart is damaged. The blood SGOT
levels are thus elevated with liver damage (for example, from viral hepatitis) or with an insult to
the heart (for example, from a heart attack). Some medications can also raise SGOT levels.
SGOT is also called aspartate aminotransferase (AST).

Phosphate in blood Adults: 2.7–4.5 or 0.87–1.45

High phosphate levels may be caused by:

• Kidney disease, underactive parathyroid glands (hypoparathyroidism), acromegaly,

rhabdomyolysis, healing fractures, untreated diabetic ketoacidosis, or certain bone
diseases.
• Too much vitamin D in the body.
• A decrease in magnesium levels.
• Pregnancy.

Low phosphate levels may be caused by:

• Hyperparathyroidism, certain bone diseases (such as osteomalacia), lack of vitamin

D, severe burns, or some kidney or liver diseases.
• Severe malnutrition or starvation.
• A condition such as sprue that prevents the intestines from absorbing nutrients properly.
• Alcohol dependence.

• High calcium levels.

ALT-It is commonly measured clinically as a part of a diagnostic liver function test, to determine
liver health. When used in diagnostics, it is almost always measured in international units/liter
(U/L). While sources vary on specific normal range values, most show between 5-60 U/L as being
normal. Serum glutamic pyruvic transaminase, an enzyme that is normally present in liver and
heart cells. SGPT is released into blood when the liver or heart are damaged. The blood SGPT
levels are thus elevated with liver damage (for example, from viral hepatitis) or with an insult to
the heart (for example, from a heart attack). Some medications can also raise SGPT levels.

LDH is most often measured to check for tissue damage. The enzyme LDH is in many body
tissues, especially the heart, liver, kidney, skeletal muscle, brain, blood cells, and lungs.

Other conditions under which the test may be done: Anemia of vitamin B-12 deficiency,
Megaloblastic anemia, Pernicious anemia

A typical range is 105 - 333 IU/L (international units per liter).

Higher-than-normal levels may indicate: ischemia, CVA, MI, anemia, hepatitis, low BP, muscle
injury, pancreatitis.

Albumin normal levels

3.5 - 5.0 mg/dl

Increased serum values?

Decreased: cystic fibrosis, chronic glomerulonephritis, alcoholic cirrhosis, Hodkin's disease,

malnutrition, nephrotic syndrome, multiple myeloma, inflammatory bowel disease, leukemia,
collagen-vascular diseases