EP 201: Lab Values to Know as a Nurse

EP 201: Lab Values to Know as a Nurse

Lab Values to Know as a Nurse

What are the lab values to know as a nurse? Lab values and what they show could mean so many things. They are used to determine the patient’s overall well-being and health and on nurses to base their care plan. Different factors affect the patient’s lab values result, but the most common factors affecting it are the patient’s age, race, gender, medical history, and presence of any underlying conditions. Knowing and understanding lab values is essential in your nursing career.

There are different lab values to know as a nurse. In this episode, we will talk about all the different labs we look at in the hospital. We will go over their normal values, what they signify, and what can happen if they are out of their normal range.

This will be a good refresher episode for everyone who deals with labs and a great one for any nursing students because these are the labs you’ll need to know to pass some of your classes and the NCLEX.

Electrolytes

Potassium K+

  • Potassium is one of the most important minerals in the body. It helps regulate fluid balance, muscle contractions, and nerve signals. 
  • Normal level: 3.5-5 mEq/L
    • Hyperkalemia signs: heart arrhythmias, numbness, and tingling, breathing problems
    • Hypokalemia signs: muscle weakness, fatigue, heart arrhythmias
  • Clinical problem
    • Increased level: Acute renal failure, Crushed/burn injury, acidosis 
    • Decreased level: vomiting/diarrhea, dehydration, malnutrition, gastric suction, Diuretics 

Sodium Na+ 

  • Sodium plays a key role in your body. It helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates your body’s fluid balance.
  • Normal level: 135-145 mEq/L
    • Hypernatremia signs: lethargy, myoclonic jerks, confusion, nystagmus, tachycardia
    • Hyponatremia  signs: nausea and vomiting, lethargy, seizure, neurological deficits
  • Clinical problem
    • Increased level: Dehydration, severe vomiting, diarrhea, Heart failure, hepatic failure, Cushing’s disease 
    • Decreased level: vomiting, diarrhea, gastric solution, D5W, SIADH,

Calcium Ca+ 

  • It is a mineral that is necessary for life. In addition to building bones and keeping them healthy, calcium enables our blood to clot, our muscles to contract, and our heart to beat. About 99% of the calcium in our bodies is in our bones and teeth.
  • Normal level: 8.5 to 10.2 mg/dL
    • Hypercalcemia signs: bone pain, muscle weakness, excessive thirst, lethargy, nausea
    • Hypocalcemia signs: numbness and tingling in digits, muscle cramps, wheezing, fatigue
  • Clinical problem
    • Increased level: Hyperparathyroidism, malignant neoplasm of bone, lung, breast, kidney, multiple myeloma, and prolonged immobilization. 
    • Decreased level: Diarrhea, malabsorption of calcium, Hypoparathyroidism

Chloride CI- 

  • Chloride is one of the essential electrolytes in the blood. It helps keep the amount of fluid inside and outside of your cells in balance. It also helps maintain proper blood volume, blood pressure, and pH of your body fluids.
  • Normal level: 95-105 mEq/L
    • Hyperchloremia signs: diarrhea, vomiting, fatigue, dry mucous membrane
    • Hypochloremia signs: diarrhea, vomiting, weakness, dehydration
  • Clinical problem
    • Increased level: Dehydration, hypernatremia, head injury, metabolic acidosis.  
    • Decreased level: Vomiting, gastric suction, diarrhea, hypokalemia. 

Magnesium Mg+

  • It helps to maintain normal nerve and muscle function, supports a healthy immune system, keeps the heartbeat steady, and helps bones remain strong. It also helps adjust blood glucose levels. It aids in the production of energy and protein.
  • Normal level: 1.5-2 mEq/L
    • Hypermagnesemia: diminished deep tendon reflexes, flushing, headache, nausea, drowsiness.
    • Hypomagnesemia: muscle weakness, twitches, or tremors; irritability, insomnia, drowsiness
  • Clinical problem
    • Increased level: Severe dehydration, renal failure, leukemia
    • Decreased level: Protein malnutrition, malabsorption, cirrhosis of the liver, alcoholism, hypokalemia

Phosphorus 

  • It is a mineral that makes up 1% of a person’s total body weight. It is the second most abundant mineral in the body. It is present in every cell of the body. Most of the phosphorus in the body is found in the bones and teeth.
  • Normal level: 2.5-4.5 mg/dl
    • Hyperphosphatemia signs: osteoporosis, cardiovascular disease
    • Hypophosphatemia signs: changes in mental state, bone pain/fragility, fatigue, weight loss, weakness
  • Clinical problem
    • Increased level: Renal failure, hypocalcemia, hypoparathyroidism 
    • Decreased level: starvation, hypercalcemia, hypomagnesemia, chronic alcoholism

Ammonia

  • Ammonia is a waste product made by your body during protein digestion.
  • Normal level: 15-50 μmol/L
    • Hyperammonemia signs: Lethargy (ETOH Pt), rapid or heavy breathing, Altered mental status 
  • Clinical problems
    • Increased level: Hepatic failure, High protein diet with liver failure, acidosis. 

Uric acid 

  • It is a chemical created when the body breaks down substances called purines.
  • Purines are usually produced in the body and are also found in some foods and drinks.
  • Normal level 0.18-0.48 mmol/L
    • High signs: Joint pain, joint stiffness, redness, and swelling. 
  • Clinical problems
    • Increased level: Gout, alcoholism, severe eclampsia, renal failure

Creatinine

  • Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine. It is removed from the body by the kidneys.
  • Normal level 0.8-1.3 mg/dL
    • High signs: Nausea, muscle cramps, vomiting, fatigue, HTN
  • Clinical problem
    • Increased level: Hypothyroidism, CKD, intense exercise, dehydration 
    • Decreased level: Renal impairment, hyperthyroidism, ALS

BUN 

  • BUN is the end product of protein metabolism and is excreted by the kidneys
  • Normal level 8-21 mg/dL
    • High signs: Frequent urination, itching, muscle cramps, fatigue. 
  • Clinical problem
    • Increased level: Dehydration, GI bleeding, prerenal failure, Acute MI, sepsis, shock
    • Decreased level:  Severe liver damage, overhydration, malnutrition

Specific Gravity

  • A urine-specific gravity test compares the density of urine to the density of water. This quick test can help determine how well your kidneys dilute your urine.
  • Normal level 1.010-1.030 
    • High signs: Dehydration, Diabetes, Proteinuria, SIADH
    • Low signs: Polydipsia, Diabetes Insipidus, Diuretics, early stages of CKD

LDH 

  • Lactic dehydrogenase (LDH) is an intracellular enzyme in nearly all metabolizing cells, with the highest concentration in the heart, skeletal muscle, liver, kidney, brain, and RBCs.
  • Normal level 50-150 U/L
    • Increased level: Acute MI, P.E, Sepsis, shock, CVA, sickle cell.

Hematology

RBC 

  • The reticulocyte count is an indicator of bone marrow activity
  • Normal level 4.5-5.0 million
    • Increased level: sickle cell, hemolytic anemia, leukemias 
    • Decreased level: Anemia, radiation therapy, post hemorrhage, cirrhosis of the liver (alcohol suppresses reticulocytes)

WBC 

  • White blood count, part of a complete blood count, is composed of 5 types of WBCs 
  • Normal level 5,000-10,000
    • Increased level: Acute infection, Inflammatory diseases (RA, gout), Tissue damage (acute MI, burns)
    • Decreased level: leukemias, immunosuppressive agents

Plt 

    • Platelets (thrombocytes) are essential elements in the blood that promote coagulation.
  • Normal level 200,000-400,000
    • Increased level: Polycythemia vera, trauma, acute blood loss, Metastatic carcinoma
    • Decreased level: Multiple myeloma, Anemias, Leukemias, liver disease, lupus, DIC, Cirrhosis 

Hgb 

  • Hemoglobin responsible for the transportation of oxygen
  • Normal level 
    • male 13-17 g/dL
    • female 12-15 g/dL
  • Increased level: Dehydration, polycythemia, COPD, HF, severe burns
  • Decreased level: Anemias, Hemorrhage, cirrhosis of the liver, Leukemias, Hodgkin’s disease, kidney disease

Hematocrit 

  • The hematocrit is a ratio of the volume of red blood cells to the volume of all these components, called whole blood. The value is expressed as a percentage or fraction.
  • Normal level Male 40%-52% Female 36%-47%
    • Increased level: Dehydration/hypovolemia, severe diarrhea, diabetic acidosis, burns.
    • Decreased level: Acute blood loss, anemias, RA, lupus, CKD, cirrhosis

PTT 

  • Partial thromboplastin time (PTT) is a blood test that looks at how long it takes for blood to clot. It can help tell if you have a bleeding problem or if your blood doesn’t clot properly.
  • Normal level 25-35 sec.  If on Heparin 1.5-2.5x normal
    • Increased level: Hemophilia, cirrhosis, vitamin k deficiency, Von Willebrand disease, DIC. 

PT 

  • Prothrombin Time. It is synthesized by the liver and is an inactive precursor in the clotting process.  
  • Normal level 11- 14 sec
    • Increased level: Liver disease, Clotting factor issues (Factor 2 deficiency), Heart failure, leukemias
    • Decreased level: Thrombophlebitis, MI, P.E 

INR 

  • The international normalized ratio (INR) is a laboratory measurement of how long it takes blood to form a clot. It is made to monitor patients receiving warfarin. 
  • Normal level 0.9-1.2 If on Coumadin 1.5 – 3

Reticulocytes

  • Reticulocytes are immature red blood cells (RBCs).
  • Normal range  0.5-1.5%

Neutrophils 

  • Are the most numerous circulating WBCs, respond mainly to inflammation & tissue injury.
  • Normal range 2-8 x 10^9/L

Bands 

  • Basophils increase during the healing process
  • Basophils are white blood cells that defend your body from allergens. Basophils release histamine
  • Normal Range < 1 x 10^9/L

Lymphocytes 

  • Increased during chronic and viral infections
  • Normal range 1-4 x 10^9/L

Monocytes 

  • The second line of defense. More extensive and more substantial than neutrophils can ingest large particles and debris.
  • Normal range 0.2-0.8 x 10^9/L

Eosinophils 

  • Increase during allergic and parasitic conditions 
  • Normal level < 0.5 x 10^9/L

HBA1C 

  • The hemoglobin A1c test tells you your average blood sugar level over the past 2 to 3 months. It’s also called HbA1c, glycated hemoglobin test, and glycohemoglobin.
  • Normal level <6.5%

Glucose 

  • Simple sugar is used as an energy source and is stored as glycogen in the liver and skeletal muscles.
  • Normal level 70-110 mg/dL
    • Increased level: DM, Diabetic acidosis, adrenal gland hyperfunction (Cushing’s) 
    • Decreased level: Hypoglycemia, malnutrition

Gastrointestinal

Bilirubin

  • Bilirubin is formed from the breakdown of hemoglobin by the reticuloendothelial system and is carried in the plasma to the liver. Bilirubin (unconjugated or indirect) is bound to serum albumin and transferred to the liver, which is conjugated to glucuronate by glucoronyl transferase. Conjugated (direct) bilirubin is excreted into the bile.
  • Normal level 
    • Direct Bilirubin 0-6 µmol/L 
    • Total Bilirubin 2-20 µmol/L
  • Increased level: Obstructive jaundice caused by stones, hepatitis, cirrhosis, liver cancer
  • Decreased level: Iron-deficiency anemia. 

Albumin 

  • Albumin is a protein made by your liver. Albumin helps keep fluid in your bloodstream so it doesn’t leak into other tissues. It also carries various substances throughout your body, including hormones, vitamins, and enzymes.
  • Normal level 35-50 g/L
    • Increased level: Dehydration, severe vomiting, severe diarrhea 
    • Decreased level: Cirrhosis of the liver, acute liver failure, severe burns, severe malnutrition, preeclampsia, renal disorders, prolonged immobilization. 

ALT/AST

  • ALT/AST is an enzyme found primarily in the liver cells and is effective in diagnosing hepatocellular destruction.
  • Normal level 5-30 U/L
  • Increased level: Acute (viral) hepatitis and liver necrosis (Drug or chemical toxicity).

Amylase 

  • Amylase is an enzyme derived from the pancreas, the salivary glands, and the liver. Its function is to change starch to sugar. 
  • Normal level: 30-125 U/L
  • Increased level: Acute pancreatitis, obstruction of the pancreatic duct, acute cholecystitis, diabetic acidosis, diabetes mellitus, renal failure. 

Lipase 

  • Lipase, an enzyme secreted by the pancreas, aids in digesting fats. Appears in the bloodstream following damage to the pancreas. 
  • Normal level: 10-150 U/L
  • Increased level: Acute and chronic pancreatitis, cancer of the pancreas, and obstructions. 

Hormones

Hydroxyprogesterone 

  • IHydroxyprogesterone is a hormone made by the adrenal glands, two glands on top of the kidneys. A 17-OHP test is used for Hydroxyprogesterone levels to help diagnose a rare genetic disorder called congenital adrenal hyperplasia.
  • Normal level: 0.2-1 mg/L

Adrenocorticotropic ACTH 

  • Adrenocorticotropic hormone (ACTH) is made in the pituitary gland. It is needed for your adrenal glands to work properly and help your body react to stress. ACTH stimulates the release of another hormone called cortisol from the adrenal gland’s cortex (outer part).
  • Normal level: 4.5-20 pmol/
  • Increased level: Addison’s disease, Stress, pituitary neoplasm, pregnancy. 
  • Congenital adrenal hyperplasia (CAH) refers to a group of genetic disorders that affect the adrenal glands, a pair of walnut-sized organs above the kidneys. The adrenal glands produce essential hormones, including Cortisol, which regulates the body’s response to illness or stress.

TSH 

  • Thyroid-stimulating hormone is a pituitary hormone that stimulates the thyroid gland to produce thyroxine (T3), and triiodothyronine (T4)  which stimulates the metabolism of almost every tissue in the body.
  • Normal level: 0.5-5 mIU/L
  • Increased level: Hypothyroidism, acute thyroiditis, viral hepatitis, myasthenia gravis, preeclampsia
  • Decreased level: Hyperthyroidism

Thyroxine

  • Serum T4 levels are commonly used to measure thyroid hormone concentration and the function of the thyroid gland. 
  • So, if your T3 and T4 levels are too low, the pituitary gland will release more TSH. If they’re too high, the gland will release less TSH — but this give-and-take system only works if everything functions properly.
  • Normal level:
    • Free T3 0.2-0.5 ng/dL
    • Free T4 10-20 pmol/L
    • Total T4 4.9-11.7 mg/dL
    • Total T3 0.7-1.5 ng/dL
  • Increased level: Hyperthyroidism, acute thyroiditis, myasthenia gravis, preeclampsia
  • Decreased level: Hypothyroidism, Protein malnutrition.

Follicle-stimulating hormone 

  • FSH, a gonadotropic hormone produced and controlled by the pituitary gland, stimulates the growth and maturation of the ovarian follicle to produce estrogen in females and promote spermatogenesis in males. 
  • Normal level:
    • (FSH) 1-10 IU/L (M/F) 
    • 5-25 IU/L (ovulation) 
    • 30-110 IU/L (postmenopause)
  • Increased level: Gonadal failure such as menopause, Pituitary tumor, Turner’s syndrome, Klinefelter’s syndrome 
  • Decreased level: Neoplasms of the ovaries, testes, adrenal: polycystic ovarian disease, hypopituitarism; anorexia nervosa. 

Growth Hormone 

  • Human growth hormone (hGH), a hormone from the anterior pituitary gland, regulates the growth of bone and tissue. 
  • Normal level: (fasting) 0-5 ng/m
  • Increased level: Gigantism (children), Acromegaly (adults), major surgery. 
  • Decreased level: dwarfism in children, hypopituitarism

Progesterone 

  • It is secreted by the corpus luteum, a temporary endocrine gland that the female body produces after ovulation during the second half of the menstrual cycle.
  • Normal level 70-280 ng/dL
  • Increased level: Ovulation, pregnancy, ovarian cysts, tumors of the ovary or adrenal gland. 
  • Decreased level: Gonadal dysfunction, luteum deficiency, threatened abortion, placental failure.

Prolactin 

  • It is a hormone produced by your pituitary gland, which sits at the bottom of the brain. Prolactin causes breasts to grow and develop and causes milk to be made after a baby is born. 
  • Normal level: < 14 ng/mL
  • Increased level: Pregnancy, breastfeeding, pituitary tumor, amenorrhea, hypothalamic disorder, endometriosis, chronic renal failure, Addison’s disease.
  • Decreased level: Postpartum pituitary infarction

Testosterone (male):  

  • Testosterone is the primary male sex hormone and an anabolic steroid. In male humans, testosterone plays a crucial role in developing male reproductive tissues such as the testes and prostate and promoting secondary sexual characteristics such as increased muscle and bone mass and body hair growth.
  • Normal level: 10-25 nmol/L
  • Increased level: Adrenal hyperplasia or tumor, polycystic ovaries in females
  • Decreased level: Testicular hypofunction, Klinefelter’s syndrome (primary hypogonadism), Alcoholism, hypopituitarism

Lipids

LDL 

  • LDL stands for low-density lipoproteins. It is sometimes called the “bad” cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
  • Normal level: 85-125 mg/dL
  • Saturated fat and cholesterol in your food make your blood cholesterol level rise.

HDL 

  • HDL stands for high-density lipoproteins. It is sometimes called the “good” cholesterol because it carries cholesterol from other parts of your body to your liver. Your liver then removes the cholesterol from your body.
  • Normal level: 40-80 mg/dL

Triglycerides 

  • Triglycerides are a type of fat (lipid) found in your blood. When you eat, your body converts any calories it doesn’t need to use right away into triglycerides. The triglycerides are stored in your fat cells.
  • Normal level: 50-150 mg/dL
  • Increased level: Hyperlipoproteinemia, acute MI, Hypertension, cerebral thrombosis, hypothyroidism
  • Decreased level; Hyperthyroidism, hyperparathyroidism, and protein malnutrition.

Total chol 

  • A measure of the total amount of cholesterol in your blood. It includes low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol.
  • Normal level: 3-5.5 mmol/L

Cardiac Markers

Creatine kinase

  • Creatine kinase is an enzyme found in the heart, brain, skeletal muscle, and other tissues. Increased amounts of CK are released into the blood when there is muscle damage. 
  • Normal level:  25-200 U/L
  • Increased level: exercise and inflammation of muscles, called myositis, and myopathies such as muscular dystrophy. Rhabdomyolysis.

Troponin 

  • Troponins are a group of proteins found in skeletal and heart (cardiac) muscle fibers that regulate muscular contraction—used for cardiac disease diagnosis of acute MI.
  • Normal level: 0-0.4 ng/mL
  • Increased level: MI, myocardial damage

C-reactive protein 

  • It is produced in the liver in response to tissue injury and inflammation. 
  • Normal level < 5 mg/L
  • Increased level: Chronic infections, cardiovascular and peripheral disease, acute MI, Stroke, inflammatory bowel disease, RA, Lupus, bacterial meningitis.

D-dimer 

  • D-dimer is a fibrin degradation product, a small protein fragment in the blood after a blood clot is degraded by fibrinolysis.
  • Normal level: < 500 ng/mL
  • Increased level: DIC, P.E, Thrombosis, COVID 

BNP

  • Brain Natriuretic peptide is a neurohormone secretion primarily in the cardiac ventricles and will increase in response to volume expansion and pressure overload.
  • Normal level:  < 100 pg/ml
  • Increased level: Heart failure, Left ventricular hypertrophy, myocarditis, AMI, Renal failure, prolonged systemic hypertension.

Tumor Markers 

Alpha-fetoprotein 

  • Serum alpha-fetoprotein (AFP), a screening test, is usually done between 16 and 20 weeks gestation to determine the probability of twins or to detect low birth weight or severe birth defects, such as neural-tube defects. 
  • Normal level: 0-44 ng/mL
  • Increased level: Cirrhosis of the liver, hepatitis, Spina bifida, Fetal death, fetal distress, Turner’s syndrome
  • Decreased level: Down’s syndrome, absence of pregnancy

HCG 

  • Human chorionic gonadotropin is a hormone produced by cells that surround a growing embryo, which eventually forms the placenta after implantation. The presence of hCG is detected in some pregnancy tests. Appears in the blood and urine 14-26 days after conception.
  • Normal level: <5 IU/I
  • Increased level: Pregnancy, Chorionepithelioma of pregnancy is a malignant tumor originating in connection with pregnancy. 
  • Decreased level: Nonpregnant, dead fetus, postpartum (3-4 days)

CA 19-9

  • Cancer Tumor Markers (CA 19-9) is a cancer antigen in diagnosing pancreatic, hepatobiliary, gastric, and colorectal cancer. 
  • Normal level: <40 U/mL
  • Decreased levels = Effective response to treatment, benign disease
    • There are also different tumor markers. You won’t need to know all of these, but we thought we should include them. 
    • CA 15-3: Metastatic breast cancer, ovarian, lung, pancreas, cirrhosis, colon cancer.
    • CA-27.29: Recurrence of breast cancer
    • CA 50: Gastrointestinal tumor, biliary tract tumors
    • CA 125: Ovarian breast cancer, uterine tumors, pancreas, breast, colon, lung, cirrhosis, pancreatitis.  

CEA 

  • Carcinoembryonic antigen (CEA) has been found in the gi epithelium of embryos and has been extracted from tumors in the adult gastrointestinal tract. 
  • Normal level: <4 ug/L
  • Increased level: GI tract (esophagus, stomach, small and large intestine, rectum cancer), leukemia, Ulcerative colitis. 

PAP 

  • Prostatic acid phosphatase (PAP) originates in the prostate and usually is present in small amounts in the blood. 
  • Normal level: 0-3 U/dL
  • Increased level: prostate cancer, testicular cancer, leukemia, and non-Hodgkin’s lymphoma.

 

PSA 

  • Prostate-specific antigen (PSA) is always present in low concentrations in the blood of adult males.
  • Normal level: <4 ug/L
  • Increased level: Prostate cancer

Vitamins 

Folate 

  • Folate is one of the B vitamins needed to make red and white blood cells in the bone marrow, convert carbohydrates into energy, and produce DNA and RNA.
  • Normal level: 7-36 nmol/L
  • Increased level: Pernicious anemia (is a deficiency in red blood cells caused by lack of vitamin B12)
  • Decreased level: Folic acid anemia, vitamin b6 deficiency anemia, malnutrition, malabsorption syndrome (small intestine), pregnancy, liver disease.

Vitamin A 

  • It is a Fat-soluble vitamin absorbed from the intestine in the presence of lipase and bile. Vitamin A moves to the liver and is then stored in the body as retinol.
  • Vitamin A is vital for normal vision, the immune system, reproduction, and growth and development.
  • Normal level: 30-65 µg/dL
  • Increased level: Hypervitaminosis, Chronic kidney disease
  • Decreased level: Night blindness, liver, intestinal, or pancreatic disease, chronic infections, cystic fibrosis, protein malnutrition, malabsorption, celiac disease

Vitamin B6

  • Vitamin B6, also known as pyridoxine, is a water-soluble vitamin your body needs for several functions. It’s significant to protein, fat, and carbohydrate metabolism and the creation of red blood cells and neurotransmitters.
  • Normal level: 5-30 ng/mL
  • Decreased level: Malnutrition, chronic alcoholism, gestational diabetes, pregnancy, lactation, small bowel inflammatory disease, renal failure.

Vitamin B12 

  • Vitamin B12 is a nutrient that helps keep the body’s nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 also helps prevent a type of anemia.
  • Normal level: 130-700 ng/L
  • Decreased level: Pernicious anemia, malabsorption syndrome, liver diseases, hypothyroidism (myxedema), pancreatic insufficiency, Crohn’s disease.
  • Increased level: Acute hepatitis, leukemia.

Vitamin C 

  • Ascorbic acid is a water-soluble vitamin important for forming collagen and certain amino acids for wound healing and withstanding stress, injury, and infection. 
  • Normal level: 0.4-1.5 mg/dL
  • Decreased levels: Scurvy, malabsorption, pregnancy, cancer, and severe burns. 

Vitamin D

  • Vitamin D is a fat-soluble vitamin occurring from exposure to the ultraviolet rays of sunlight and is absorbed in the presence of bile and stored in the liver. Vitamin D helps regulate the amount of calcium and phosphate in the body. These nutrients are needed to keep bones, teeth, and muscles healthy. 
  • Normal level:  5-75 ng/mL
  • Decreased level: Malabsorption, cirrhosis of the liver, rickets, osteomalacia, hypoparathyroidism, celiac disease, inflammatory bowel disease

Miscellaneous

Rheumatoid Factor

  • RF factor is a screening test used to detect antibodies (Igm, IgG, or Ig)
  • Normal level:  <25 IU/ml
  • Increased level: Rheumatoid arthritis, lupus, tuberculosis, leukemia

ESR 

  • An erythrocyte sedimentation rate (ESR) is a type of blood test that measures how quickly erythrocytes (red blood cells) settle in unclotted blood in millimeters per hour. 
  • It can show if you have inflammation in your body.
  • Normal level: >2 mm/h
  • Increased level: RA, rheumatic fever, AMI, Hodgkin’s disease, multiple myeloma, bacterial endocarditis, gout, hepatitis
  • Decreased level: Polycythemia vera, heart failure, sickle-cell anemias, factor V deficiency

ACE 

  • The ACE test measures the level of angiotensin-converting enzyme (ACE) in the blood.
  • Normal level: 20-50 µmol/L
  • Increased level: Sarcoidosis, Diabetes Mellitus, hypothyroidism, Respiratory distress syndrome
  • Decreased level: Therapy for sarcoidosis, diabetes mellitus, hypothyroidism

Lead

  • Found in lead-based paint, unglazed pottery, batteries, leaded gasoline
  • Normal level: < 25 IU/ml 
  • Higher levels can damage the kidneys and nervous system.

Refresh your memory and relearn the lab values by watching the full episode here 👇👇👇

TIMESTAMPS:

00:00 Introduction
01:21 About the episode
02:35 Electrolytes Potassium K+
Sodium Na+
Calcium Ca+
Chloride CI-
Magnesium Mg+
Phosphorus
Ammonia Uric acid
Creatinine
BUN
Specific Gravity
Lactic Dehydrogenase (LDH)
17:02 Hematology
RBC
WBC
Platelets (thrombocytes)
Hemoglobin (Hgb)
Hematocrit
Partial thromboplastin time (PTT)
Prothrombin Time (PT)
International Normalised Ratio (INR)
Reticulocytes
Neutrophils Bands
Lymphocytes
Monocytes
Eosinophils
HBA1C
Glucose
27:25 Gastrointestinal
Bilirubin
Albumin
ALT/AST
Amylase Lipase
30:40 Hormones
Hydroxyprogesterone
Adrenocorticotropic ACTH
Thyroid-Stimulating Hormone (TSH)
Thyroxine Follicle-Stimulating Hormone (FSH)
Human Growth Hormone (hGH)
Progesterone
Prolactin
Testosterone
36:57 Lipids Low-Density Lipoproteins (LDL)
High-Density Lipoproteins (HDL)
Triglycerides Total Cholesterol
39:11 Cardiac Markers
Creatine kinase
Troponin
C-Reactive Protein
D-Dimer
Brain Natriuretic Peptide (BNP)
41:56 Tumor Markers
Alpha-Fetoprotein (AFP)
CA 19-9 Carcinoembryonic Antigen (CEA)
Prostatic Acid Phosphatase (PAP)
Prostate-Specific Antigen (PSA)
44:15 Vitamins
Folate
Vitamin A
Vitamin B6
Vitamin B12
Vitamin C
Vitamin D
48:12 Miscellaneous
Rheumatoid Factor (RF)
Erythrocyte Sedimentation Rate (ESR)
Angiotensin-Converting Enzyme (ACE)
Lead

The Best and the Worse Things About Travel Nursing

The Best and the Worse Things About Travel Nursing

The Best and the Worse Things About Travel Nursing

Just like any job, there are pros and cons of travel nursing. Don’t get me wrong, travel nursing is an excellent job, but knowing the pros and cons will help you understand it better. Do you plan to become a travel nurse? Great! Here are the pros and cons of travel nursing that you should know.

Worse Things About Travel Nursing

Before we get to the good part, we will first talk about the cons of travel nursing. It will give you an insight into why travel nursing isn’t ideal for all nurses. 

No paid time off

Understand that not all travel nurse companies pay their nurses during their day off. It means you will not be paid if you want to go out of town to visit your friends or family during your day off. What if you’re sick and have to miss work, and you’ll use your days off to get rest? Sometimes, your living stipend can be deducted for the days you missed. It is something to think about. 

Taxes could be your nightmare

As a travel nurse, you are constantly on the move. That said, you will be claiming your income in different places of work too. Filing multiple income tax returns can be daunting. It also needs to be clarified as different states may have other requirements for travel nurses. You could make mistakes along the way. And because of this, you might need to hire a professional to do your returns to avoid errors. So besides paying taxes, you will also pay someone to do it for you. That’s double expenses on your part. 

You’re always in new and unfamiliar places

If you need help adjusting to a new environment, being a travel nurse is not for you. As a travel nurse, you will be assigned to unfamiliar places, and you have to learn the ropes once you get there. It means you will find ways to learn the policies and procedures of the facility you’re assigned to. You will also familiarize yourself with the area you’re temporarily living in. And if you find this uncomfortable, you will not survive this job. 

Pay rates may vary

Besides the possibility of not getting paid on your day off, you will also have to deal with varying pay rates. Understand that not all travel nursing companies pay their nurses the same rates. Some of them may offer lower pay, but you have benefits, while others may pay higher but no other benefits. Some states also offer higher wages for travel nurses, while others only pay a little. If you prefer earning fixed wages, there may be better jobs than travel nursing. 

The “new guy” role

Since this job includes traveling to different places for work, there’s a stigma of being the “newbie” on the job. There’s nothing wrong with being the new guy on the job, but it can get tiring to know different people or remember names. it also feels lonely when you’re alone in a new setting, and making friends can be challenging. Even if you’re a good person who wants to interact with people, it may sometimes be different for others. So you have to take time to adjust to the loneliness. 

Work assignments can sometimes suck

As the new guy on the team, you will sometimes get assigned to work that no other nurses would like to do. Sure, you may not care too much because it’s part of the job, but sometimes, you don’t want to be someone who cleans up poo and urine all the time, right? It may not always be the case, but you can’t avoid it. You’ll eventually get assigned to a job that no one wants. 

The work schedule is only sometimes favorable

Your job is to fill in as additional nursing staff to healthcare facilities that need help. It also means that you need to pick your work schedule. There will be times when you’re assigned hours you don’t like or on days you don’t want. It will affect your schedule and plans in many ways. Most of the time, you will be working the night shifts too. If this doesn’t bother you initially, it will be difficult to adjust to in the long run. 

Floating assignments

Your assignment as a travel nurse brings you to many places, but at the same time, it also gives you assignments you won’t like. One of these is being assigned as a float nurse. Although you’re supposed to be placed in a specific area, you will also be assigned as a float nurse due to staff shortage. 

A float nurse is when you’re sent to another unit to help as a staff besides the unit you were assigned in first. And their healthcare facilities have policies in which travel nurses are the first to float around units. That said, you will have to learn everything about the unit you float to and be the new nurse in a new place all over again. So, if you don’t want to do this kind of assignment, you may have to think twice about becoming a travel nurse. 

Licensing issues

Each state has a different licensing requirement for travel nurses. Some require a compact license, while others are okay with your current one. But as you progress into your travel nurse career, you will need a couple of licenses in different states, and it can be challenging to obtain them. And if you choose to avoid getting multiple licenses, this can limit your contract choices. So, not only is it costly, but it’s also time-consuming to complete. 

A contract can be canceled at any time

There will be times when your contract gets canceled before it even starts. It could be because the hospital you’re assigned to feels like they no longer need to fill in the travel nurse position. When this happens, you end up with no job. It’s even uncomfortable when you’re already in the location waiting for your shift to start, then all of a sudden, your contract gets canceled. What will you do then? This is one disadvantage of travel nursing that you need to be prepared for. You must have a backup plan in case this happens. 

Homesickness is an issue

When you’re a new travel nurse, being homesick is normal. But if you still get homesick even after years of being a travel nurse, the issue is in you. Accepting a contract in a location that is near your family and friends may ease this longing. However, your travel nurse assignments may only sometimes be near your home. If this is going to be an issue for you, you need to rethink your decision to become a travel nurse. 

Best Things About Travel Nursing

Travel nursing has many disadvantages, yes, but it is also a rewarding job. If you love nursing and traveling, this is your ideal job. So, what are the advantages of being a travel nurse? Here’s what you need to know. 

There’s job security

Travel nurses will always have a job. There’s a need for nurses all over the country. Remember that we’re still dealing with the Covid-19 crisis, and nurses must care for thousands of complex patients affected by the pandemic. Hospitals always need nurses, and there will be vacancies to fill in. The number of nurse retirees and nurses that left the profession because of the pandemic is countless. So, the need for staff nurses is always there. Travel nurses will never be out of jobs in the future, that’s for sure. 

Pay is Great

One of the best advantages of being a travel nurse is earning a six-figure salary. Sounds good. In some cases, some hospitals can even increase the travel nurse’s pay if they need staff. It’s an excellent chance to grab. You can expect to get paid higher than the permanent employees at any hospital you’re hired in, something which you should consider. 

The chance to travel 

If you’re a nurse with a wanderlust, travel nursing is an excellent option to do. By the job title itself, you always have the chance to travel all over the country. Not only o you get to travel, but you can also live in different places where you’re assigned. This is your dream job if you love working and exploring various places. 

No workplace politics

Drama at work is inevitable. It is a real problem when you stay in one job and work with the same people for years. Be a travel nurse to avoid getting tangled in workplace politics. All you have to do is show up for work, get paid, and leave. You don’t have to attend meetings, participate in clubs, or deal with the politics of your unit. Sounds like a dream to me. 

Meeting and making new friends.

You will always be the new nurse as a travel nurse, but you can still make friends. Traveling as a nurse is more fun when you meet new people and make friends. The experience becomes more memorable. Not only do you get to meet people, but you also make connections. And these connections can help your career in the future. Now that’s a win-win situation! 

It teaches you new life skills

When you become a travel nurse, you will find yourself in situations that are not normal. You also leave the comforts of your home and everything that you know. As a travel nurse, you set out into the unknown. You will have to use every survival and critical thinking skill you know to adapt to the changes and new environment. It also enhances your communication skills and builds your resilience. 

There’s flexibility

You may not get paid on your day off, but you have control over your working hours. It is one of the advantages of this job. Unlike permanent positions, travel nurses can apply for vacation and get certain days off in their schedules. You can plan as many activities as possible because you can choose which days you want to work and days to slack off. If this is your kind of thing, we recommend becoming a travel nurse today. 

Reimbursements

Your travel expenses, uniforms, and nursing license expenses will be reimbursed by the company that hired you. So, besides your take-home salary, you also have additional payments through reimbursements. It’s like starting your career for free.

Your Takeaway

Being a travel nurse is a mixture of leisure and work. It may be challenging at first, but as your work pushes on, you will realize it’s not all bad. Travel nursing has many benefits if you like to be on the go and enjoy working as a nurse. It’s a practical job if you wish to remain untied to long-term positions. So, why not try it for a couple of months and see how it goes? You’ll never know what’s in store for you!

6 Things That Will Happen When We Don’t Have Enough Nurses

6 Things That Will Happen When We Don’t Have Enough Nurses

6 Things That Will Happen When We Don’t Have Enough Nurses

The nursing shortage has been an ongoing issue for many years, but this is all propaganda. We now know that there is no real shortage of nurses. But then again, what will happen if we are short on nurses? What happens when there are not enough nurses in the healthcare field? Here are six things that will happen.

When Nurses Disappear

Nurses are the jack of all trades in the healthcare industry. They do almost everything. From completing their front desk duties to transferring patients, and laboratory work, nurses, are there, working all the time. But when nurses are gone, will the world still be the same? Six things could happen when nurses are no longer here to do their job.

There will be more burnouts

When there are not enough nurses, more nurses are compelled to work more and stay on longer shifts. There’s no more downtime, and spending time with their family and friends is little to none. Tasks will pile up, and the remaining nurses will feel overwhelmed. This will drain them more to the point that they are no longer happy to do their job. In time, they will also quit, leaving fewer nurses to do the same routine and heading to the same route as their former colleagues. If no more nurses are left, this cycle will continue until no one is left to care for the sick and dying.

Low-quality patient care

Burnout causes nurses to lose patience quickly. When you’re always tired, dealing with difficult patients is challenging. And worse, burnout nurses won’t bother getting to know their patients or their cases any longer. This could affect the kind of care they give to their patients. And as a result, this could lead to poor quality care and many problems for patients and nurses.

More medical errors

No other healthcare professional stays with the patient longer than nurses. We are the ones who take care of the patient when the doctors are not around, and we make sure that all of them are taken care of. But what happens when a nurse is burned out? Tending to one patient can take around 15-20 minutes tops.

If you have ten patients waiting in line for their medication, you must take time and assess each medication so the right one goes to the correct patient. And when you’re a burned-out nurse, you could miss a small yet important detail about your patient’s medication. It can cost your patient’s life and your job on the line.

Low patient satisfaction

A burned-out nurse cannot provide quality patient care, leading to low patient satisfaction. The lack of available nurses can also affect this; many patients will feel like they are not given the care they came to the hospital for.

High mortality rate

Nurses are the ones who care for the sick and dying. When there are not enough nurses on the floor, emergency patients will be forced to wait longer. Emergency services will be delayed, and medical assistance will also be slow. We know that time is of the essence, especially when it comes to critical patients. When nurses are burned out, the lives of our patients are at stake.

Animosity among nurses

A short-staffed hospital means more work for the remaining nurses. This puts them under a lot of pressure and stress. And when stress takes over, peer relationships can get strained easily. Misunderstandings, like a simple bathroom break, coming in a few minutes late for work, or late endorsements, become a big deal to each other.

Your Takeaway

There is no nursing shortage if healthcare facilities take care of their nurses. Providing them with the help they need when they’re feeling down, like counseling or some needed time off, will make a difference. Nurses are not robots; we must take care of them. If we want nurses to be around longer and happier, we must find a way to help them too.

EP 199: The Renal System and RAAS

EP 199: The Renal System and RAAS

The Renal System

The renal system produces, stores, and eliminates urine. Kidneys make urine by filtering wastes and extra water from the blood. Urine travels from the kidneys through two thin tubes called ureters and fills the bladder. When the bladder is full of urine, a person urinates through the urethra to eliminate the waste.

Functions of the Kidneys

The kidneys are located on either side of the spine at the lowest level of the rib cage, consisting of the functional unit called a nephron. 

There are about one million nephrons in each kidney; these nephrons consist of tiny blood vessels called glomerulus attached to a tubule. 

When blood enters the glomerulus, it is filtered, and the remaining fluid passes to the tubule. In the tubule, minerals, elements, chemicals, and water are absorbed or filtered according to the body’s needs to create the final product, urine.

Our kidneys maintain a delicate balance of water and electrolytes in the body and remove excessive waste:

  • Remove wastes, urea, and ammonia, from the blood.
  • Maintain fluid status balance in the body by holding or retaining water and releasing and removing water from the bloodstream
  • It maintains the electrolyte balance of the blood.
  • Maintain acid-base/pH balance of the blood
  • Assist with endocrine functions such as the production of erythropoietin and calcitriol.
    • It is needed to produce red blood cells and calcium reabsorption, respectively.
  • Produce the enzyme renin
    • Help regulate blood pressure.
  • Convert vitamin D into its active form

Fun Fact: 

  • Every 24 hours, your kidney filters 200 quarts of fluid. About two quarts are removed from the body, and 198 quarts are returned to the bloodstream. 
  • The right kidney sits lower than the left kidney. 
    • It helps accommodate the large size of the liver, right above the right kidney.
  • We call it REabsorption rather the just absorption because the substances filtered from the glomerulus were already absorbed through the GI tract and taken into the bloodstream. Then the substances travel through the body via the heart and are sent to the kidneys through the renal artery to be filtered out. Therefore, our body reabsorbs these nutrients based on their needs, and the leftovers are excreted in the urine.

Anatomy of the Kidney

As a nurse and a nursing student, you’ll need to know these most critical parts of the kidney to understand how the renal system works.

Renal Capsule 

  • The outer layer of the kidney protects the kidney from outside organ infections. 

Renal cortex: 

  • A layer outside contains the renal corpuscles, which house the glomerulus and Bowman’s capsule, whose primary functions are to FILTER the urine and renal tubules. 

Renal medulla: 

  • The inside layer is located within the renal pyramids. It is hypertonic and very salty. Along with the nephron, these conditions help maintain water and salt balance in our body, specifically the Loop of Henle.

Renal artery:  

  • The renal artery takes oxygenated blood from the heart and moves it to the kidney to be filtered. It branches off around the renal columns into the renal cortex, into arterioles, and finally to the peritubular capillaries.

Renal vein:

  • The renal veins take filtered blood to heart for re-oxygenation and are pumped throughout the body. It comes from the efferent arterioles.

Renal pyramids: 

  • Lie Within the renal medulla contains the loop of Henle and parts of the collecting tubule.

Renal papilla, minor and significant calyx:

  • Pointed projections of the renal pyramid play a role in draining urine along with the renal pelvis, ureters, bladder, and urethra.

Nephrons: 

  • The functional part of the kidneys. 
  • Filters the blood via the renal corpuscle
  • Reabsorbs minerals/water and secretes waste via the renal tubule
  • Produces urine which drains down into the ureters, is stored in the bladder, and voided out via the urethra.
  • Each nephron is composed of 
    • Renal corpuscle (glomerulus within Bowman’s capsule)
    • Proximal tubule
    • An intermediate tubule (loop of Henle)
    • A distal convoluted tubule, a connecting tubule, and cortical, outer medullary, and inner medullary collecting ducts.

Glomerulus:

  • Lies within the nephron
  • Circular capillaries that have incredibly high pressure helps perform ULTRAFILTRATION.

Bowman’s capsule

  • Forms a cup-like sack around the glomerulus
  • It helps the glomerulus filter blood 

The Nephron and blood supply

Blood enters the afferent arteriole and sends blood to the first part of the nephron, called the glomerulus.

In the glomerulus, blood will be filtered, and filtrate will be created, a liquid consisting of the collection of fluid and particles from the blood. The filtrate will “drip” down into a capsule surrounding the glomerulus called Bowman’s capsule.

  • Bowman’s capsule collects the filtrate.
    • Water, NA, CL, CA, K, Mg, Phos, Bicarb, amino acids, glucose, creatinine, and urea.

Then the filtered blood exits via the efferent arterioles to the peritubular capillaries surrounding the nephrons. 

Peritubular capillaries carry the reabsorbed nutrients from the filtrate back into the body’s system to the renal vein. They secrete urea, ions, and drugs in the blood into the tubules.

The created filtrate then flows through the proximal convoluted tubule (PCT); here, the tubule reabsorbs most of the parts of the filtrate that we need to function that just came from the Bowman’s capsule.

Then the filtrate enters the Loop of Henle; we are now in the renal medulla. The loop of Henle has a descending limb and ascending limb. Its goal is to concentrate the urine via the renal medulla. The renal medulla’s interstitial fluid is hypertonic, helping reabsorb water from the filtrate to maintain the body’s water and salt balance.

  • Descending limb is only permeable to water.
  • Ascending limb is only permeable to ions.

The filtrate then enters the distal convoluted tubule, where more substances are reabsorbed and secreted. 

Then it travels to the collecting tubule, where parts of the filtrate are reabsorbed. Finally, the filtrate leaves the collecting tubule as urine which flow through the renal papilla, minor/major calyx, renal pelvis, ureters, bladder, and urethra.

Kidney and Blood Pressure Management 

The renin-angiotensin-aldosterone system (RAAS) is the system of hormones, proteins, enzymes, and reactions that regulate your blood pressure and blood volume long-term.

It regulates your blood pressure by increasing sodium (salt) reabsorption, water reabsorption (retention), and vascular tone (the degree to which your blood vessels constrict or narrow). The RAAS consists of three major substances including:

  • Renin (an enzyme).
  • Angiotensin II (a hormone).
  • Aldosterone (a hormone).

RAAS System

  • Increases blood pressure when it drops too low by activating Angiotensin II
    • Angiotensin II increases vasoconstriction, causing an increase in blood pressure. Conserves sodium and water to increase volume. Aldosterone and ADH are released. 
  • RAAS steps
  1. Blood pressure drops too low. 
  2. The sympathetic nervous system sends nerve impulses to Juxtaglomerular Cells in the kidneys to release RENIN.
  3. RENIN present in the blood will activate ANGIOTENSINOGEN in the liver.
  4. ANGIOTENSINOGEN then turns into ANGIOTENSIN I causing a release of ACE
  5. ACE is Angiotensin-Converting Enzyme. ACE converts Angiotensin I into ANGIOTENSIN II
  6. ANGIOTENSIN II activation will cause
  7. Vasoconstriction
    • Increases systemic vascular resistance (SVR) and blood pressure.
  1. Increase Blood Volume
      • Kidneys will keep water and sodium.
      • The adrenal cortex gland will be triggered by angiotensin II to release aldosterone. Aldosterone will also cause the kidneys to keep sodium and water and excrete potassium.
    • Angiotensin II triggers the pituitary gland to release ADH. It causes the kidneys to keep water.

2. Increased blood pressure

To learn more about the renal system, click here for the full episode 👇👇👇

TIMESTAMPS:

00:00 Introduction
02:10 The functional parts of the kidney
03:18 What does a kidney do
04:40 Kidney fun facts
05:40 Anatomy of the kidney
10:00 The nephron and blood supply
15:48 Kidney and blood pressure management
17:39 How the Renin-Angiotensin-Aldosterone System (RAAS) works
21:50 Further views on the episode
24:02 Wrapping up the show

 

 

Standing Up for Your Health

Standing Up for Your Health

Standing Up for Your Health

Being an advocate for your own health is essential, especially as you age. If you feel you’re not receiving the right type of treatment, you may need to address previously overlooked health concerns or simply take a more active role in physical and financial matters involving your health. Advocating for your health and taking full responsibility for your own care can be both empowering and rewarding. So here are some tips from The Cup of Nurses to help you get started!

Maintain Healthier Habits

One crucial way you can advocate for your health is by actively maintaining it. Exercising and eating healthy on a consistent basis will help you to feel better and avoid illnesses and injuries more consistently. Having more physical strength also enables you to continue living independently. Working out often enough can be challenging if you have a busy work schedule but small movements throughout the day. Yoga can be a fun and challenging way to keep fit, as well!

Be Prepared

If you’re unsure what you might be dealing with, pull up some symptoms and express your concerns. To make things a little easier, you can always organize medical records and other important documents on a PDF. This free tool will enable you to edit a PDF online, which you can then save to your iPhone for easy access once you reach the doctor’s office.

Prepare for Insurance Needs

If you’re unsure about a diagnosis, get a second opinion! Whether or not you have Medicare, you need to know how your insurance policy in Virginia works, what it covers, and how often you can use it.

Stand Up for Your Care Needs

If you’re unsure about a diagnosis and want a second opinion, you shouldn’t feel bad about getting one. You’re the last defense against poor medical care and should be adamant about getting opinions you trust and being sure about them. If you don’t feel like the medical professional in Alexandria, you’re currently seeing is providing adequate care, don’t hesitate to explore other options.

Look After Yourself

Taking an active role in maintaining your health is essential. Not only does improving your health have a tremendous impact on your body, but it can also benefit your mind as well. When your body is healthy, you’ll feel less depressed. What’s more, your stress levels may decrease, too.

Be Brave

Dealing with health concerns or chronic conditions is never easy, so you’ll want to get familiar with your insurance plan and financial arrangements, hold your doctor accountable and ask questions. Don’t be afraid to involve a loved one if you need help or emotional support.

The Cup of Nurses is your source for current health news and hot nursing topics. If you have any questions, please contact us at marketing@cupofnurses.com.

Post solely for the use of cupofnurses.com By Roxanne Brent
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