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Blood functions: transports nutrients, O2, hormones & enzymes to tissues, carries CO2 and waste products away

from tissues, helps regulate temp, fluid electrolytes & pH, protects body from bacteria and foreign substances, coagulates to prevent excess fluid loss

What is total blood volume? Volume of blood present in the circulatory system (arteries, veins, capillaries)

Total blood volume is approximately.... 4-5 L in females 5-6 L in males

Normal pH range is... 7.35-7.45 (arterial blood)

Whole blood refers to... the formed elements and plasma (Blood as a whole)

What kind of tissue is blood classified as... Connective tissue

(Blood consists of cells and cell fragments surrounded by a liquid intercellular matrix)

Cellular elements comprise ____% of the blood volume? 45%

Plasma comprises ___% of the blood volume 55%

Approximately 95% of the volume of the formed elements consists of..... red blood cells

Cell fragments are called.... platelets

Approximately 5% of the volume of the formed elements consists of.... WBC and platelets

The formed elements account for ____% to ___% of the total blood volume in females. (AKA Hematocrit) 38% to 48%

The formed elements account for ____% to ___% of the total blood volume in males. (AKA Hematocrit) 44% to 54%

The % of total blood volume composed of formed elements in the blood sample is the... Hematocrit

Red Blood Cells or RBC functions: transport O2 and CO2 throughout body

White Blood cells or WBC functions... body's defense against microorganisms and foreign material.

Platelets are essential for... preventing blood loss (hemostasis)

In a healthy person, only _______ blood cells are found in blood circulation. mature

In persons with disease states, immature and abnormal cells may be present.

What is plasma? Is a viscous (sticky) pale yellow colloidal fluid accounting for slightly more than half the total blood volume.

What is plasma made of? 92% water and 8% dissolved or proteins such as albumin, globulins and fibrinogen, salts, nutrients, gases, waster products, hormones and enzymes.

Plasma without the proteins that clot blood is called.... serum

How does water enter plasma? from digestive tract, interstitial fluids and as a by-product of metabolism.

How does water leave plasma? Kidneys, lungs, intestinal tract and skin

Where do the solutes come from in the plasma? liver, kidneys, intestines, endocrine glands and immune tissues such as the spleen.

What are other terms for circulatory system? vascular space or vascular system.

Blood or fluid within the vascular system is referred to as.... intravascular

Blood or fluid outside the vascular system is referred to as.... extravascular

What is the interstitial space? the space surrounding the cells outside the vascular system.

The exchange of nutrients, gases, hormones, waste products takes place between blood and tissues occurs where? at the capillary level (the walls are one cell thick)

(microvasculature)

The process by which nutrients and other substance cross the capillary wall is called.... diffusion

How does the lymphatic system differ from the circulatory system? It is not a closed loop system.

What does the lymphatic system do? 1.)picks up fluids and large complex substances that have left the circulatory system and entered the tissues 2.)returns them to the vascular system (helps maintain normal blood volume)

What do lymph nodes do? filter lymphatic vessels

What are two large lymph vessels? the thoracic duct on the left side of body the right lymphatic duct on the right side

What do the thoracic duct and right lymphatic duct do? empty into veins in the upper chest and return fluid to the vascular system.

What would happen to a person if fluid remains in the interstital space? would develop a balloon-like appearance. Their blood volume is depleted (fluid lost from their circulation)

Vascular system includes both: peripheral and cardiopulmonary systems

Peripheral system refers to...

circulatory system but not the cardiopulmonary system

What are the major veins in the body? superior vena cava (receives blood from head and upper part of body) inferior vena cava (blood from lower part of body) Both vessels enter the Right atrium of the heart. (RA)

Cardiopulmonary system refers to.... heart and lungs as they function together.

Blood going into right atrium from both vena cavae is.... deoxygenated

From the right atrium, blood is pumped to the right ventricle through which valve? tricuspid

From the right ventricle (RV), deoxygenated blood is pumped out through which valve? pulmonary

blood goes to pulmonary arteries to go to lungs

What happens in the aveolar capillary newtwork in the lungs? O2 and CO2 are exchanged.

(CO2 is the waste product of cellular metabolism)

Where does the oxygenated blood go from the lungs? through pulmonary veins to the left atrium (LA)of the heart.

Where does blood go from left atrium (LA)? pumped into the left ventricle (LV) through the mitral or biscuspid valve.

Where does blood go from left ventricle (LV))? ejected through aortic valve to the aorta.

What is Alkaline Phosphatase (ALP)? enzyme produced mainly in liver, bone, intestine, kidney & placenta.

What does Alkaline Phosphatase (ALP)test? differentiates between liver and bone disorders when other enzyme tests are done (ALP isoenzymes 1 & 2, GGTP and/or 5'N)

ALP isoenzyme, ALP1 is of what origin? liver

ALP isoenzyme, ALP2 is of what origin? bone

What could a decreased ALP level mean?

alkaline phosphatase

hypothyroidism, malnutrition, scurvy, hypophosphatasia, pernicious anemia, placental insufficiency

What drugs may decrease alkaline phosphatase (ALP)values? flouride, oxalate, propranolol (Inderal)

What could an increased ALP level mean?

alkaline phosphatase obstructive biliary disease (juandice), cancer of the liver, hepatocellular cirrhosis, hepatitis, leukemia, cancer of the bone, breast or prostate, Paget's disease (osteitisdeformans) healing fx, multiple myeloma, osteomalacia, GI ulcerative dx, late pregnancy, hyperthyroidism, hyperparathyroidsim, rheumatoid arthritis, CHF

What drugs may increase alkaline phosphatase (ALP)values? ABX, cochicine, methyldopa(Aldomet), allopurinol, phenothiazines, indomethacin (Indocin) procainamide, some oral contraceptives, tolbutamine, INH (isoniazid) and IV albumin

Procedure for ALP test? Collect 5-10ml of venous blood in red-top tube. No food or fluid restrictions are required. Withhold drugs that may elevate ALP for 8-24 hrsw/Dr's permission. List client's age & drugs that may affect results on lab slip.

Nursing implications for ALP test: Know factors that can elevate serum ALP levels (drugs, IV albumin), age of client, late pregnancy to 3 weeks postpartum, blood drawn 2-4 hrs after fatty meal. record info on lab slip. informpt that other enzyme tests may be ordered to verify dx, assess for s/s of liver dx or bone dx.

Normal ALP levels for adult

20-90 U/L at 30 C, 24-97 U/L at 37 C, 2-4 U/dL, 4-13 U/dL

elderly-slightly higher

What is amylase? enzyme that is derived from the pancreas, salivary gland and liver. increases in acute pancreatitis.

Normal ALP levels for child: 0-12 yr = 40-300 U/L

13-18 yr = 30-165 U/L

What cause increase amylase levels? acute pancreatitis (can be 2X normal at peak at 20-30 hrs and returns to normal in 2-4 days), abdominal surgery involving gallbladder and stomach

What are the two major types of amylase isoenzymes and what do they relate to? P-type, occur more frequently in acute pancreatitis. elevated S-type can be d/t ovarian and bronchogenic tumors.

Why is the urine amylase helpful to know? determines the significance of a normal or slightly elevated serum amylase, esp when pt has sxs of pancreatitis. Urine amylase can remain elevated up to 2 wks after acute pancreatitis.

What are normal serum levels of amylase? adult - 60-160 Somogyi U/dL pregnancy: slightly increased

child: usually not done elderly: could be slightly higher than adult

What are normal lvels of serum amylase isoenzymes? S (salivary) type 45-70% P (pancreatic) type 30-55%

What is normal urine amylase level? adult: 4-37 U/L2h

What can a decreased level of amylase indicate? IV D/W, advanced chronic pancreatitis, acute and subacute necrosis of the liver, chronic alcoholism, toxic hepatitis, severe burns, severe thyrotoxicosis

What drugs can decrease amylase values? glucose, citrates, flourides, oxalates

What can an elevated level of amylase indicate? acute pancreatitis, chronic pancreatitis (acute onset), partial gastrectomy, peptic ulcer perforation, obstruction of pancreatic duct, acute cholecystitis, CA of pancreas, DKA, DM, acute alcoholic intoxication, mumps, RF, BPH, burns, pregnancy

What drugs may increase amylase value? narcotics, ethyl alcohol (large amts) ACTH, guanethidine, thiazide diuretics, salicylates, tetracycline

What is the ANA test?

is a screening test for diagnosing systemic lupus erythematosis (SLE) and other collagen diseases. Scleroderma, RA, cirrhosis, leukemia, infectious mononucleosis and malignancy.

What is reference value for ANA test? Adult: negative

What is an elevated level of ANA? >1:20

What drugs may increase ANA value? abx, HTN meds, methyldopa (Aldomet) isoniazide (INH) diuretics, thiazides, phenytoin (Dilantin) oral contraceptives, antiarrhythmics

Why are arterial blood gases (ABGs) assessed? to assess disturbances of acid-base balance caused by a respiratory disorder or a metabolic disorder or both.

a pH of less than 7.35 indicates.... acidosis

a pH greater than 7.45 indicates.... alkalosis

a decreased pH (<7.35) and an elevated PaCO2 (>45) indicates... respiratory acidosis

An elevated pH (>7.45) and a decreased PaCO2 (<35) indicates....

respiratory alkalosis

To determine whether an acid-base imbalance has a metabolic cause, you should look at... bicarbonate (HCO3)

A decreased pH (<7.35) and a decreased HCO3 (<24) indicates... metabolic acidosis

An elevated pH (>pH 7.45) and an elevated HCO3 (>28> indicates.... metabolic alkalosis

Adult ABG reference values... pH 7.35-7.45 PaCO2 35-45 PaO2 75-100 HCO3 24-28 BE +2 to -2 (base excess)

Child ABG reference values... pH 7.36-7.44 PaCO2 35-45 PaO2 75-100 HCO3 24-28 BE +2 to -2 (base excess)

What can cause respiratory acidosis? (pH<7.35, PaCO2 >45) COPD, (emphysema, chronic bronchitis, severe asthma)ARDS, Guillian-Barre syndrome, anesthesis, pneumonia

What can cause metabolic acidosis? (pH<7.35, HCO3 <24) DKA, severe diarrhea, starvation/malnutrition, kidney failure, burns, shock, acure myocardial infarction

What drugs may cause a low pH? narcotics, barbiturates

What can cause respiratory alkalosis? (pH>7.45, PaCO2 <35) salicylate toxicity (early phase) anxiety, hysteria, tetany, strenuous exercise, (swimming, running) fever, hyperthyroidism, delirium tremens, PE

What can cause metabolic alkalosis? (pH>7.45, HCO3 >28) severe vomiting, gastric suction, peptic ulcer, potassium loss (hypokalemia) excess administration of sodium bicarbonate, cystic fibrosis, hepatic failure.

What drugs may cause an elevated pH? sodium bicarbonate, sodium oxalate, potassium oxalate

What is bilirubin?

is formed from the breakdown of hemoglobin by the reticuloendothelialsytem and is carried in the plasma to the liver where it is conjugated or unconjugated.

If the total bilirubin (serum bilirubin) is within normal range, then what? direct and indirect bilirubin levels do not need to be analyzed.

If total bilirubin elevated, look at direct bilirubin.

If one value of bilirubin is reported, what does it represent? the total bilirubin

Jaundice is frequently present when serum bilirubin (total) is greater than.... 3 mg/dL

Remember to check sclera of the eyes and inner aspects of the arm for jaundice.

Increased direct or conjugated bilirubin is usually the result of ... obstructive jaundice, either extrahepatic (from stones or tumor) or intrahepatic (damaged liver cells)

Indirect or onconjugated bilirubin is associated with... increased destruction of RBCs (hemolysis)

Adult Reference values for Bilirubin (Total, Direct, Indirect) serum: Total: 0.1-1.2 mg/dL Direct(conjugated): 0.0-0.3 mg/dL Indirect (unconjugated):0.1-1.0 mg/dL

Newborn Reference values for Bilirubin (Total) serum: Total: 1-12 mg/dL

Child Reference values for Bilirubin (Total) serum: Total: 0.2-0.8 mg/dL

What can cause a decreased direct bilirubin level? iron deficiency anemia

What drugs may decrease bilirubin value? barbituates, ASA (in large amts), PCN, caffeine

What can cause an increased direct bilirubin level? obstructive jaundice caused by stones or neoplasms, hepatits, cirrhosis of the liver, infectious mononucleosis, liver CA, Wilson's disease

What can cause an increased indirect bilirubin level? erythroblastosisfatalis, sickle cell anemia, transfusion reaction, hemolytic anemias, pernicious anemia, malaria, septicemia, CHF, decompensated cirrhosis

What drugs may increase bilirubin value: ABX, sulfonamides, diuretics, INH, valium, narcotics, barbiturates, Dalmane, Indocin, Aldomet, Pronestyl, steroids, oral contraceptives, orinase, vitamins A, C and K

How do you figure out the indirect bilirubin? subtract the direct bilirubin from the total bilirubin.

What should a nurse remember when drawing a bilirubin sample? Avoid hemolysis. Pt to be NPO except for water. List drugs pt is taking protect sample from sun and light. Blood should be sent asap to lab. Tell pt to NOT eat carrots or foods high in fat the night before test.

What should a nurse remember when drawing ABGs? Collect blood in heparinized needle and syringe place syringe with arterial blood in an ice bag and deliver to lab asap. indicate on lab slip if pt is receiving O2 and what rate. apply pressure for 2-5 min. blood not to be drawn from same arm as IV No food or fluid restriction.

What should a nurse remember when drawing an amylase test? restrict food for 1-2 hours before the blood sample is drawn. ifpt ate or received a narcotic 2 hrs before test, may be invalid.

What are 2 methods to test bleeding times? Ivy and Duke method

Why are bleeding time tests done?

to determine whether bleeding time is normal or prolonged. frequently done when pt has a hx of bleeding (easy bruising) familial bleeding or peroperative screening.

Describe Ivy method: cleanse below the antecubital space w/alcohol and allow to dry. inflate BP cuff to 40mm Hg and leave inflated during test.puncure skin 2.5 mm deep. start timing on stopwatch. blot blood q 30 sec until bleeding stops. the time required for bleeding to stop is recorded.

When should Ivy test method not be done?

more popular than Duke method whenpt is taking anticoagulants or ASA. Pt should stop these meds 3-7 days prior to test w/ Drspermission. ASA therapy will prolong bleeding time.

Describe Duke method: earlobe is used. no food or fluid restriction.

What can disorders can increase bleeding times (prolonged time)? thrombocytopenia (decreased platelet count <50,000), platelet function abnormality, vascular abnormalities, severe liver dx, disseminated intravascular coagulation (DIC) aplastic anemia, factor deficiencies (V, VII, XI) Christmas disease, hemophilia, leukemia

What drugs may increase bleeding time? salicylates, (ASA, others) warfarin (Coumadin) dextran, streptokinase (fibrinolytic agent)

What are adult reference values for Ivy method? 3-7 minutes

What are adult reference values for Duke method? 1-3 minutes

What is urea? Urea is an end product of protein metabolism.

If both BUN and Creatinine levels are elevated, nurse should suspect what? kidney disease

What should nurse do w/Dr's permission if pt's BUN is 26-35? Encourage fluids.

serum calcium (Ca) normal range for Adults adult: 4.5-5.5 mEq/L, 9-11 mg.dL

serum calcium (Ca) normal range: newborn, infant, child newborn: 3.7-7.0 mEq/L, 7.4-14.0 mg/dL Infant: 5.0-6.0 mEq/L, 10-12 mg/dL Child: 4.5-5.8 mEq/L, 9-11.5 mg/dL

what is total serum calcium? ionized and nonionized calcium level together.

How does pH affect calcium ionization? acidosis-moreCa ionized

alkalosis-most of Ca is bound to protein and cannot be ionized.

What does a calcium deficit cause? tetany symptoms, unless acidosis is present

What can a calcium excess cause? cardiac dysrhythmias

What can a 24-urine specimen for calciuria determine? parathyroid disorders

In hyperparathyroidism, hyperthyroidism and osteolytic disorders, the urinary calcium excretion is usually... increased.

it is decreased in hypoparathyroidism.

What can cause a decreased level of serum calcium? malabsorption of Ca from GI tract, lack of Ca&Vit D intake, hypoparathyroidism, CRF caused by PH retention, laxative abuse, extensive infections, burns, pancreatitis, alcoholism, diarrhea, pregnancy

What drugs can decrease Ca value? cortisone preparations, ABX (gentamicin, methicillin), Mg products (antacids), excess laxatives, heparin ,insulin, mithramycin, acetazolamide (Diamox)

What can cause elevated level of serum calcium?

hyperPTH, malignant neoplasm of bone, lung, breast, bladder or kidney, hypervitaminosisVit D, multiple myeloma, prolonged immobilization, multiple fx, renal calculi, exercise, milk-alkali syndrome

What drugs can increase Ca value? thiazide diuretics, alkaline antacids, calcium salts, estrogen preparation, vit D

What are sx of decreased level of Ca? tetany: muscular twitching and tremors, spasms of the larynx, parathesis, facial spasms and spasmodic contractions

What is Chvostek's sign? a spasm of the facial muscles following a tap on one side of the face over the facial nerve. + inhypocalcemia

What is Trousseau's sign? muscular spasm resulting from pressure applied to nerves and vessels of the upper arm such as inflating a BP cuff) + in hypocalcemia

Why should nurse look for sx of tetany when pt receives massive transfusions of citrated blood? citrates prevent calcium ionization. serum calcium level may not be affected.

What can occur if pt receives ca supplements and a digitalis preparation? digitalis toxicity (sx: N/V, anorexia, bradycardia)

What should nurse do when giving IV fluids with 10% Cagluconate? GIVE SLOWLY. Ca should be administered in D5/W and not in saline solution. Na promotes Ca loss.

Why should Ca not be added to solutions containing bicarbonate? rapid precipitation will occur.

What are sx of hypercalcemia? lethargy, HA, weakness, muscle flaccidity, heart block, anorexia, N/V

What should nurse teach ptwho is hypercalcemic? avoid high ca foods, be ambulatory when possible, and increase oral fluid intake.

What should nurse promote if pt is bedridden? active and passive exercises. this will prevent ca loss from bone.

What happens when pt is hypercalcemic and is taking a thiazide diuretic? thiazide diuretic inhibit ca excretion and promote hypercalcemia.

What is normal Chloride serum level for adult? 95-105 mEq/L

What is normal serum Chloride level for newborn, infant and child? newborn: 94-113 mEq/L infant: 95-110 mEq/L child: 98-105 mEq/L

Where is chloride found, extracellular or intracellular? It is found in the extracellular fluid.

What roles does chloride play? maintain body water balance, osmaolality of body fluids (with sodium), and acid-base balance.

What causes decreased levels of chloride? vomiting, gastric suction, diarrhea, low serum K+ or Na (or vomiting, gastric suction, diarrhea, low serum K+ or Na (or both), Low Na diet, continuous IV D5/W, adrenal gland insufficiency, heat exhaustion, acute infections, burns, excess diaphoresis, metabolic alkalosis, chronic resp acidosis, CHF

What drugs may decrease chloride value? thiazide and loop diuretics, bicarbonates

What causes increased levels of chloride? dehydration, high serum Na level, adrenal gland hyperfunction, multiple myeloma, head injury, eclampsia, cardiac decompensation, excessive IV saline (0.9% NaCl) kidney dysfunction

What drugs may increase chloride level? ammonium chloride, cortisone preparations, ion exchange resins, acetazolamide (Diamox), prolonged use of triamterene (Dyrenium)

What should nurse look for in hypochloremia? hyperexcitability of the nervous system and muscles, tetany, slow and shallow breathing, hypotension

What should nurse tell Dr can happen with continuous IV D5/W? a chloride deficit can occur.

What should nurse encourage the pt who is Cl deficient to do? drink fluids containing sodium and chloride (ex. broth, tomato juice) NO PLAIN WATER)

What other labs should nurse look at if pt'sCl is decreased? serum K+ and Na levels. Cl is frequently lost with Na and K+.

What are sx of overhydration when pt is receiving several L of normal saline for Na and Cl replacement? Na holds water. Sx of overhydration: constant, irritating cough, dyspnea, neck&hand vein engorgement, chest rales.

What are sx of hyperchloremia? Sx similar to acidosis; weakness, lethargy and deep, rapid vigorous breathing

What should nurse instruct pt to do if hyperchloremic? tellpt to avoid drinking or eating salting foods and to use a salt substitute. (avoidCa chloride and K+ chloride substitutes)

If pt is hyperchloremic, what IV fluid would be a concern? NS. Nurse should check for sx of overhydration.

If pt is hyperchloremic, what could be monitored to determine fluid retention? daily weight and intake and output

What is desirable serum Cholesterol level for adult? < 200 mg/dL

What serum cholesterol level for adult is a risk? 200-240 mg/dL moderate risk >240 mg/dL

What may happen to cholesterol levels during pregnancy? may go to high risk levels (>240 mg/dL) but returns to prepregnancy values 1 month after delivery.

What are infant serum level of cholesterol? 90-130 mg/dL

What are child (age 2-19 yr)serum level of cholesterol? normal and risky levels desirable level: 130-170 mg/dL moderate risk: 171-184 mg/dL high risk: > 184 mg/dL

Why should nurse look for sx of tetany when pt receives massive transfusions of citrated blood? citrates prevent calcium ionization. serum calcium level may not be affected.

What can occur if pt receives ca supplements and a digitalis preparation? digitalis toxicity (sx: N/V, anorexia, bradycardia)

What should nurse do when giving IV fluids with 10% Cagluconate? GIVE SLOWLY. Ca should be administered in D5/W and not in saline solution. Na promotes Ca loss.

Why should Ca not be added to solutions containing bicarbonate? rapid precipitation will occur.

What are sx of hypercalcemia? lethargy, HA, weakness, muscle flaccidity, heart block, anorexia, N/V

What should nurse teach ptwho is hypercalcemic? avoid high ca foods, be ambulatory when possible, and increase oral fluid intake.

What should nurse promote if pt is bedridden? active and passive exercises. this will prevent ca loss from bone.

What happens when pt is hypercalcemic and is taking a thiazide diuretic? thiazide diuretic inhibit ca excretion and promote hypercalcemia.

What is normal Chloride serum level for adult? 95-105 mEq/L

What is normal serum Chloride level for newborn, infant and child? newborn: 94-113 mEq/L infant: 95-110 mEq/L child: 98-105 mEq/L

Where is chloride found, extracellular or intracellular?

It is found in the extracellular fluid.

What roles does chloride play? maintain body water balance, osmaolality of body fluids (with sodium), and acid-base balance.

What causes decreased levels of chloride? vomiting, gastric suction, diarrhea, low serum K+ or Na (or both), Low Na diet, continuous IV D5/W, adrenal gland insufficiency, heat exhaustion, acute infections, burns, excess diaphoresis, metabolic alkalosis, chronic resp acidosis, CHF

What drugs may decrease chloride value? thiazide and loop diuretics, bicarbonates

What causes increased levels of chloride? dehydration, high serum Na level, adrenal gland hyperfunction, multiple myeloma, head injury, eclampsia, cardiac decompensation, excessive IV saline (0.9% NaCl) kidney dysfunction

What drugs may increase chloride level? ammonium chloride, cortisone preparations, ion exchange resins, acetazolamide (Diamox) prolonged use of triamterene (Dyrenium)

What s&s should nurse look for in hypochloremia? hyperexcitabillity of the nervous system and muscles, tetany slow and shallow breathing, hypotensions

Why should nurse inform Dr when pt is receiving IV D5/W continuously? a chloride deficit could occur.

what should nurse encourage to do with hypochloremia? drink fluids containing sodium and chloride (broth, tomato juice) NO PLAIN WATER!

Why should nurse check serum potassium and sodium levels in pt that is hypochloremic? chloride is frequently lost with sodium and potassiu.

What should nurse look for when pt is receiving several L of NS for sodium and chloride replacement? Sx of overhydration. Sodium holds water. Sx include: constant irritating cough, dyspnea, neck and hand vein engorgement, chest rales.

What are s&s of hyperchloremia? similar to acidosis, (weakness, lethargy and deep, rapid, vigorous breathing)

What should nurse instruct pt do when hyperchloremic? avoid drinking or eating salty foods and to use a salt substitute (avoid calcium chloride and potassium chloride substitutes)

Why should nurse notify dr when pt receiving NS IV fluids and has an elevated serum chloride? NS increases chloride level more. check for overhydration.

What should nurse do when pthyperchloremic? Monitor daily weights and intake and output to determine whether fluid retention is present.

What is desirable level for cholesterol in adults? <200 mg/dL

What are risky levels for cholesterol in adults? moderate risk: 200-240 mg/dL high risk: >240 mg/dL

What can happen to cholesterol levels in pregnancy? can be a high risk levels but returns to prepregnancy values 1 month after delivery.

What are desirable cholesterol levels in infant? 90-130 mg/dL

What are cholesterol levels in child (2-19yr)? desirable: 130-170 mg/dL moderate risk: 171-184 mg/dL High risk: >184 mg/dL

What is cholesterol and where is it produced? blood lipid synthesized in liver. used by body to form bile salts for fat digestion and for formation of hormones by the adrenal glands, ovaries and testes.

What hormones decrease the concentration of cholesterol? thyroid and estrogen

What causes decreased level of serum cholesterol? hyperthyroidism, starvation, malabsorption

What drugs may decrease cholesterol level?

thyroxine, estrogens, ASA, ABX (tetracycline, neomycin) nicotinic acid, heparin, colchicine

what causes increased level of serum cholesterol? hypercholesterolemia, atherosclerosis, hypothyroidism, AMI, uncontrolled DM, biliary cirrhosis, pancreatectomy, pregnancy (3rd sem) heavy stress periods, nephrotic syndrome, high cholesterol diet. What drugs may increase cholesterol level? oral contraceptives, vit A & D, phenothiazines, epinephrine, sulfonamides, phenytoin (Dilantin)

What should nurse instruct pt with hyperchlesterolemia? decrease the intake of foods rich in cholesterol (i.e. bacon, eggs, fatty meats, seafood, chocolate and coconut) encourage weight loss.

What is the Coombs' indirect (serum) antibody screen test? detects free circulating antibodies in the serum. checks for antibodies in recipients's and donor's serum prior to transfusions to avoid a reaction. does not identify specific antibodies. is part of cross-match blood test.

When is the Coombs' indirect antibody screen test positive? (+1 TO +4) When incompatible cross-matched blood, specific antibody (previous transfusion) anti-Rh antibodies, acquired hemolytic anemia.

What drugs may increase Coombs' indirect? ABX (cephalosporins (Keflin) PCN, tetracycline, streptomycin, amnopyrine (Pyradone) Dilantin, Thorazine, sulfonamides, antiarrhythmics, quinidine, pronestyl) L-dopa, Aldomet, INH, rifampin

What result do we want with the Coombs' indirect antibody screen test? Negative in both adult and children

What is the Coombs' direct antiglobulin test? detects antibodies other than the ABO group which will attach to RBCs. The RBCs are tested and if sensitized will agglutinate.

When is the Coombs' direct antiblobulin test positive? (+1 to +4) when antibodies are present on RBCs. erythroblastosisfetalis, hemolytic anemia, transfusion hemolytic reactions, leukemias, SLE

What drugs may increase the Coombs' direct test? ABX (cephalosporins (Keflin) PCN, tetracycline, streptomycin, amnopyrine (Pyradone) Dilantin, Thorazine, sulfonamides, antiarrhythmics, quinidine, pronestyl) L-dopa, Aldomet, INH, rifampin

What are sx of blood transfusion reactions? chills, fever (slight temp elevation) rash

What is CRP? (C-Reactive Protein) CRP appears in blood 6-10 Hrs after an acute inflammatory process or tissue destruction (necrosis), or both, peaks within 48-72 Hrs. is a non-specific test.

What are reference values for CRP serum in adults and children? (C-Reactive Protein) Not usually present in both. >1:2 titer = positive

When is CRP (C-Reactive Protein) elevated? during bacterial infections but not viral infections. RA, rheumatic fever, acute myocaridal infarction (AMI) pyelonephritis, SLE, inflammatory bowel disease, CA with metastasis, late pregnancy, Burkitt's lymphoma

What drugs may increase CRP value? (C-Reactive Protein) oral contraceptives

If CRP positive, (C-Reactive Protein), what should nurse look for in pt? s&s of an acute inflammatory process (pain, swelling in joints, heat, redness, increased body temp)

What is creatinine? a by-product of muscle catabolism, is derived from the breakdown of muscle creatine and creatine phosphate. amt of creatinine produced is proportional to muscle mass. kidneys excrete creatinine. When 50% or > nephrons destroyed, serum Cr level increases. evaluates glomerular function.

What are normal reference values for adult serum and urine creatinine? serum: 0.5-1.5 mg/dL Females may have slightly lower values d/t less muscle mass.

urine: 1-2 g/24 hr

What are normal reference values for newborn, infant, 2-6 yo, older child and elderly? newborn: 0.8-1.4 mg/dL infant: 0.7-1.7 mg/dL 2-6yo: 0.3-0.6 mg/dL older child: 0.4-1.2 mg/dL elderly: may have decreased values d/t decreased muscle mass and decreased creati