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Mr. NicholsPHHS
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Introduce vital signs and their use in clinical practice
Introduce basic laboratory tests and their use in clinical practice
Discuss normal values and test interpretation
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TemperaturePulse rateRespiration rate (RR)Blood pressure (BP)
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Measure of body’s core temp (temp of internal organs) in ° F (or °C, 1C=1.8F)Locations: oral, rectum, earRectal = 0.5 – 0.7° F higher than oral
tempAxilla = 0.3 – 0.4° F lower than oral
tempNormal: 97.8 – 99° F (36.5 – 37.2° C)Critical: > 98.6° F orally or 99.8° F
rectally (pyrexia [fever]); < 95° F (hypothermia)
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Heart rate (HR) or number of heart beats/min
Normal: 60 – 100/min↑ (tachycardia): ↑ Na+ intake,
↓ Na+ loss, Excessive free body H2O loss
↓ (bradycardia): ↓ Na+ intake, ↑ Na+ loss, ↑ free body H2O
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Number of breaths/minAt restAlso note breathing effort or
difficultyNormal: 15 – 20/minCritical: < 12 or > 25↑ (hyperventilation): ↑ Na+ intake,
↓ Na+ loss, Excessive free body H2O loss
↓ (hypoventilation): ↓ Na+ intake, ↑ Na+ loss, ↑ free body H2O
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Measures the force of blood against the arterial vessel walls Measured while seated, after resting for 5
mins, arm resting @ heart level (if possible) Reported as a fraction (systolic/diastolic) &
consists of 2 separate measurements: Systolic – pressure within artery during
cardiac contraction Diastolic – pressure within artery during
cardiac relaxation and fillingNormal: < 120 mm Hg systolic and <
80 mm Hg diastolicCritical: > 220 mm Hg systolic or >
125 mm Hg diastolic↑ (hypertension [htn]): ↑ Na+
intake, ↓ Na+ loss, Excessive free body H2O loss
↓ (hypotention): ↓ Na+ intake, ↑ Na+ loss, ↑ free body H2O
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Provides information on cellular components of blood
Includes RBC count, Hemoglobin (Hgb), Hematocrit (Hct), RBC indices, White blood cell (WBC) count and differential, Platelet count
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Measurement of total WBC count Consists of total # of WBCs/mm3 of
peripheral venous blood Part of “routine” testing Useful for evaluation of infection,
neoplasm, allergy & immunosuppression
Normal: 4,000 – 10,000/mm3
Critical: < 2,500 or > 30,000/mm3
↑ (leukocytosis): infection, malignancy, trauma, stress, hemorrhage, tissue necrosis, inflammation, dehydration, thyroid storm
↓ (leukopenia): drug toxicity, bone marrow failure, overwhelming infections, dietary deficiency, congenital marrow aplasia, bone marrow infiltration, autoimmune disease, hypersplenism
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Measures # of circulating RBCs/mm3 of peripheral venous blood Direct measure of RBC count Part of “routine” testing and
anemia evaluation Normal: 3.5 – 5.5 x 106/μL ↑: erythrocytosis, congenital
heart disease, severe COPD, polycythemia vera, severe dehydration, hemoglobinopathies
↓: anemia, hemoglobinopathy, hemorrhage, bone marrow failure, renal disease, leukemia, prosthetic valves, normal pregnancy, multiple myeloma, Hodgkin disease, lymphoma, dietary deficiency
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Measures total amount of Hgb in blood Indirect measure of RBC count Part of “routine” testing and anemia
evaluationNormal: 12 – 15 g/dL Critical: < 5 or > 20 g/dL↑: erythrocytosis, congenital
heart disease, severe COPD, polycythemia vera, severe dehydration
↓: anemia, hemoglobinopathy, hemorrhage, bone marrow failure, renal disease, leukemia, prosthetic valves, normal pregnancy, multiple myeloma, Hodgkin disease, lymphoma, dietary deficiency
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Measure of RBC percent of total blood vol Indirect measure of RBC # & volume Part of “routine” testing and anemia
evaluationNormal: 36 – 48% Critical: < 15% or > 60%↑: erythrocytosis, congenital heart
disease, severe COPD, polycythemia vera, severe dehydration
↓: anemia, hemoglobinopathy, hemorrhage, bone marrow failure, renal disease, leukemia, prosthetic valves, normal pregnancy, multiple myeloma, Hodgkin disease, lymphoma, dietary deficiency
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Measure of average volume/size of single RBC MCV = Hct (%) x 10/RBC (million/mm3) Useful in anemia classification
Normal: 80 – 100 mm3
↑ (macrocytic): pernicious anemia (vit B12 deficiency), folic acid deficiency, antimetabolic therapy, alcoholism, chronic liver disease, hypothyroidism
Normocytic: bone marrow failure/replacement, acute blood loss, chronic diseases, hemolytic anemias
↓ (microcytic): Fe deficiency anemia, thalassemia, anemia of chronic illness
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Measure of average amount of hgb within a single RBCMCH = Hgb (g/dL) x 10/RBC
(million/mm3)Provides little additional info to
other indicesNormal: 24 – 32 pg↑: macrocytic anemias↓: microcytic anemia,
hypochromic anemia
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Measure of average [hgb] within a single RBCMCHC = Hgb (g/dL) x 100/Hct (%)37 g/dL = maximum Hgb able to fit
into an RBC (cannot be hyperchromic)
Normal (normochromic): 32 – 36 g/dL
↑: spherocytosis, intravascular hemolysis, cold agglutinins
↓ (hypochromic): Fe deficiency anemia, thalassemia
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Measure of variation of RBC size (indicator of degree of anisocytosis)Useful in anemia
classificationNormal: variation of
11.5 – 16.9%↑: Fe deficiency
anemia, vit B12 or folate deficiency anemia, hemoglobinopathies, hemolytic anemias, posthemorrhagic anemias
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Measurement of platelets (thrombocytes) Consists of actual # of platelets/mm3 of
peripheral venous blood Part of “routine” testing Useful for evaluation of petechiae,
spontaneous bleeding, increasingly heavy menses or thrombocytopenia
Useful for monitoring discourse/therapy of thrombocytopenia/bone marrow failure
Normal: 150,000 – 400,000/mm3
Critical: < 50,000 or > 1,000,000/mm3
↑ (thrombocytosis): malignant disorders, polycythemia vera, postsplenectomy syndrome, rheumatoid arthritis, Fe deficiency anemia
↓ (thrombocytopenia): Hypersplenism, hemorrhage, immune thrombocytopenia, leukemia & other myelofibrosis disorders, TTP, DIC, SLE, chemotherapy, pernicious anemia
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Leukocytosis – abnormally large number of leukocytes; generally indicated by WBC count of ≥ 10,000 cells/mm3
Lymphocytosis – form of actual or relative leukocytosis due to increase in numbers of lymphocytes
Left shift – increase in the number of immature neutrophils (bands/stabs) found in the blood
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Measurement of percentage of each WBC type in specimenUseful for infection, neoplasm,
allergy & immunosuppression evaluations
Normal: Neutrophils (50 – 70%), Lymphocytes (20 – 40%), Monocytes (2 – 8%), Eosinophils (0 – 5%), Basophils (0 – 2%)
↑: refer to individual cell types on chart
↓: refer to individual cell types on chart
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Measures electrolytes, chemicals, metabolic end products & substrates
Consists of Glucose, Blood Urea Nitrogen (BUN), Creatinine, Na+, K+, Cl-, Bicarbonate (HCO3
-), Ca2+
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Direct measure of blood glucose Commonly used to evaluate diabetic pts Part of “routine” testing
Normal: 70 - 100 mg/dLCritical: < 50 and > 400 mg/dL ( ) or < ♂
40 and > 400 mg/dL ( )♀↑ (hyperglycemia): DM, acute stress
response, Cushing syndrome, pheochromocytoma, chronic renal failure, acute pancreatitis, acromegaly, corticosteroid therapy
↓ (hypoglycemia): insulinoma, hypothyroidism, hypopituitarism, Addison disease, extensive liver disease, insulin overdose, starvation
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Measures urea nitrogen in blood End product of protein metabolism (produced in
liver) Indirect measure of renal function & glomerular
function (excretion) Measure of liver metabolic function Part of routine labs Usually interpreted along with Cr (less accurate
than Cr for renal disease)Normal: 6 -21 mg/dLCritical: > 100 mg/dL↑: prerenal causes, renal causes,
postrenal azotemia↓: liver failure, overhydration because of
SIADH, neg nitrogen balance, pregnancy, nephrotic syndrome
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Measures serum sodium level Major cation in EC space Balance between dietary
intake and renal excretionNormal: 136 – 146
mEq/LCritical: < 120 or > 160
mEq/L↑ (hypernatremia): ↑
Na+ intake, ↓ Na+ loss, Excessive free body H2O loss
↓ (hyponatremia): ↓ Na+ intake, ↑ Na+ loss, ↑ free body H2O
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Measures serum potassium level Major cation within cell
Normal: 3.4 – 5.2 mEq/LCritical: < 2.5 or > 6.5
mEq/L↑ (hyperkalemia):
excessive intake, acidosis, acute/chronic renal failure, Addison disease, hypoaldosteronism, infection, dehydration
↓ (hypokalemia): deficient intake, burns, hyperaldosteronism, Cushing syndrome, RTA, licorice ingestion, alkalosis, renal artery stenosis
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Measures CO2 content of blood Major role in acid-base
balance Regulated by kidneys Used to evaluate pt pH status
& electrolytes Normal: 22 – 32 mEq/L Critical: < 6 mEq/L ↑: severe vomiting, high-
volume gastric suction, aldosteronism, mercurial diuretic use, COPD, metabolic alkalosis
↓: chronic diarrhea, chronic loop diuretic use, renal failure, DKA, starvation, metabolic acidosis, shock
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Measures serum calcium level Direct measurement Used to evaluate parathyroid
function & Ca metabolism Used to monitor renal failure,
renal transplantation, hyperparathyroidism, various malignancies, & Ca level when giving large-volume blood transfusions
Normal: Total = 8.3 – 10.3 mg/dL, Ionized = 4.5 – 5.6 mg/dL
Critical: Total < 6 or > 13 mg/dL, Ionized < 2.2 or > 7 mg/dL
↑ (hypercalcemia): hyperparathyroidism, bone mets, Paget disease of bone, prolonged immobilization, milk-alkali syndrome, vit D intoxication, hyperthyroidism
↓ (hypocalcemia): hypoparathyroidism, renal failure, rickets, vit D deficiency, osteomalacia, pancreatitis, alkalosis, malabsorption, fat embolism
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Measures total protein in blood Combination of prealbumin, albumin &
globulins
Normal: 6.4 – 8.3 g/dL
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Provides information about kidneys & other metabolic processes
Used for diagnosis, screening & monitoring
Frequently used to test for urinary tract infections (UTIs)
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Appearance: clearColor: amber yellowOdor: aromaticpH: 4.6 – 8Protein: 0 – 8 mg/dLNitrites: noneKetones: none
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Crystals: noneGlucose: negativeWhite Blood Cells: 0 –
4/low-power fieldWBC casts: noneRed Blood Cells
(RBCs): ≤ 2RBC casts: none
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Examples: β-hydroxybutyric acid, acetoacetic acid, acetone
Associated with poorly controlled diabetes
Used to evaluate ketoacidosis associated w/ alcoholism, fasting, starvation, high-protein diets, isopropanol ingestion
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Screen for UTI (dipstick method)
Test based on chemical rxn by bacterial reductase (reduces nitrate to nitrite)
50% accurate
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Collected via lumbar puncture (LP)
Useful for the diagnosis metastatic brain/spinal cord neoplasm, cerebral hemorrhage, meningitis, encephalitis, degenerative brain disease, autoimmune diseases w/ CNS involvement, neurosyphilis, demyelinating diseases
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Opening pressure: <20 cm H2O
Color: clear & colorlessBlood: noneRBCs: 0WBCs: 0 – 5 cells/μLNeutrophils: 0 – 6%Lymphocytes: 40 – 80%Monocytes: 15 – 45%
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Protein: 15 – 45 mg/dLGlucose: 50 – 75 mg/dL
or 60 – 70% of blood glucose level
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Causes of ↑ lymphs/plasma cells: viral, tubercular, fungal or syphilitic meningitis; multiple sclerosis (MS), Guillain-Barré syndrome