NCM 103
LABORATORY VALUES
FUNDAMENTALS OF NURSING Mrs. Cheryl Mina E. Uy APRIL 21, 2022
Normal Values
Bleeding time 1-9 min
Prothrombin time 10-13 sec
Hematocrit Male 42-52%
Female 36-48%
Hemoglobin male 13.5-16 g/dl
female 12-16 g/dl
Platelet 150,00- 400,000
RBC male 4.5-6.2 million/L
female 4.2-5.4 million/L
COAGULATION STUDIES
Prothrombin Time
Bleeding Time
Platelet
D-Dimer Test
Activated Partial Thromboplastin Time (aPTT)
BLEEDING TIME
Assesses overall hemostatic function (platelet response injury and
vasoconstrictive ability)
Useful in detecting disorders of platelet function
Nursing Considerations:
1. Validate that the client has not been receiving anticoagulants, aspirin,
or aspirin containing products for 3 days prior to the test
2. For clients with bleeding tendencies a pressure dressing may be
needed post testing
3. Inform the client that punctures are made to measure the time it takes
for bleeding to stop
PROTHROMBIN TIME (PT)
Prothrombin is a vitamin K dependent glycoprotein produced by
the liver that is necessary for ibrin clot formation
The PT measures the amount of time it takes in seconds for clot
formation and is used to monitor response to warfarin sodium
(Coumadin) therapy or to screen for dysfunction of the extrinsic
clotting system resulting from liver disease, Vitamin K de iciency or
disseminated intravascular coagulation
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NURSING CONSIDERATION
If a PT is prescribed, baseline specimen should be drawn before
anticoagulation therapy is started; note the time of collection on
the laboratory form
Provide direct pressure to the venipuncture site for 3 - 5 minutes
Diets high in green leafy vegetables can increase the absorption of
vitamin K, which shortens the PT
Orally administered anticoagulation therapy usually maintains the
PT at 1.5 to 2 times the laboratory control value
If the PT value is longer than 30 seconds in a client receiving
warfarin therapy, initiate bleeding precautions
PLATELET COUNT
Platelets function in hemostatic plug formation, clot retraction and
coagulation factor activation
Platelets are produced by the bone marrow to function in hemostasis
Nursing Considerations:
1. Monitor the venipuncture site for bleeding in clients with known
thrombocytopenia (low blood platelet count)
2. High altitude, chronic cold weather and exercise increase platelet
count
3. Bleeding precautions should be instituted in clients with low platelet
count
D-DIMER TEST
A blood test that measures clot formation and lysis that results from
the degradation of ibrin
Helps to diagnose the presence of thrombus in conditions such as
deep vein thrombosis (DVT), pulmonary embolism or stroke; it is
also used to diagnose disseminated intravascular coagulation (DIC)
and to monitor the effectiveness of the treatment
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ACTIVATED PARTIAL THROMBOPLASTIN TIME
(APTT) H
Evaluate how well the coagulation sequence (intrinsic clotting
system) is functioning by measuring the amount of time it takes in
seconds for recalci ied citrated plasma to clot after partial
thromboplastin in added to it
The test screens for de iciencies and inhibitors of all factors, except
factors VII and XIII
Usually, the aPTT is used to monitor the effectiveness of heparin
therapy and screen for coagulation disorders
Value: 20-36 seconds, depending on the type of activator used
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NURSING CONSIDERATIONS
Provide direct pressure to the venipuncture site for 3-5 minutes
The aPTT should be between 1.5 to 2.5 times normal when the client
is receiving heparin therapy
If the aPTT value is prolonged (longer than 90 seconds) in a client
receiving IV heparin therapy, initiate bleeding precautions
If the client is receiving intermittent heparin therapy, draw the
blood sample 1 hour before the next scheduled dose
ERYTHROCYTE STUDIES
RBC count (Erythrocytes)
Hemoglobin and Hematocrit
Serum iron
Erythrocyte Sedimentation Rate
HEMOGLOBIN AND HEMATOCRIT
Hemoglobin is the main component of erythrocytes and serves as
the vehicle for transporting oxygen and carbon dioxide
Hemoglobin determinations are important in identifying anemia
Hematocrit represents red blood cell (RBC) mass and is an
important measurement in the identi ication of anemia or
polycythemia
Nursing consideration: Fasting is not required
RBC COUNT (ERYTHROCYTES)
RBCs function in hemoglobin transport, which results in delivery of
oxygen to the body tissues
RBCs are formed by the red bone marrow, have a life span of 120 days
and are removed from the blood via the liver, spleen and bone marrow
The RBC count aids in diagnosing anemias and blood dyscrasias
The RBC count evaluates the ability of the body to produce RBCs in
suf icient numbers
Nursing consideration: Fasting is not required
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SERUM IRON
Iron is found predominantly in hemoglobin
Iron acts as a carrier of oxygen from the lungs to the tissues and
indirectly aids in the return of carbon dioxide to the lungs
Aids in diagnosing anemias and hemolytic disorders
Normal value: Male 65-175 mcg/dL. Female 50-170 mcg/dL
Nursing Consideration: Level of iron will be increased if the client
has ingested iron before the test
SOURCE OF IRON
Meat
Liver
Dark green vegetables
Breads and cereals
Dried fruits
Egg yolk
Legumes
ERYTHROCYTE SEDIMENTATION RATE
A nonspeci ic test used to detect illnesses associated with acute
and chronic infection, in lammation, advanced neoplasm and tissue
necrosis or infarction
Normal: 0-30 mm/hour depending on the age of client
Nursing consideration: Fasting is not necessary, but a fatty meal
may cause plasma alterations
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Normal Values
Amylase 80-180 IU/L
Bilirubin(serum)direct 0-0.4 mg/dl
indirect 0.2-0.8 mg/dl
total 0.3-1.0 mg/dl or lower than 1.5 mg/dL
PaCo2 35-45
pH 7.35-7.45
HCO3 22-26 mEq/L
Pa O2 80-100 mmHg
SaO2 94-100%
SERUM GASTROINTESTINAL STUDIES
Amylase
Bilirubin
AMYLASE
This enzyme, produced by the pancreas and salivary glands, aids in the
digestion of complex carbohydrates and is excreted by the kidneys
In acute pancreatitis, the amylase level may exceed ive times the
normal value; the level starts rising 6 hours after the onset of pain,
peaks at about 24 hours and returns to normal in 2-3 days after the
onset of pain
In chronic pancreatitis, the rise in serum amylase usually does not
normally exceed three time the normal value
Value: 25-151 units/L
NURSING CONSIDERATIONS:
On the laboratory form, list the medications that the client has
taken during the previous 24 hours before the test
Note that many medications may cause false positive or false
negative results
Results are invalidated if the specimen was obtained less than 72
hours after cholecystography with radiopaque dyes
BILIRUBIN
Is produced by the liver, spleen, and bone marrow and is also a by-
product of hemoglobin breakdown
Total bilirubin levels can be broken down into direct bilirubin, which
is excreted primarily via the intestinal tract and indirect bilirubin,
which circulates primarily in the blood stream
Total bilirubin levels increase with any type of jaundice; direct
(conjugated) and indirect (unconjugated) bilirubin levels help
differentiate the cause of the jaundice
! Normal values
Sodium 135- 145 mEq/L
Potassium 3.5- 5.0 mEq/L
Calcium 8.6- 10 mg/dL
Chloride 98-108 mEq/L
Magnesium 1.5-2.5 mg/dl
BUN 10-20 mg/dl
Creatinine 0.4- 1.2
CPK-MB male 50 –325 mu/ml
female 50-250 mu/ml
Fibrinogen 200-400 mg/dl
Uric Acid 2.5 –8 mg/dl
ESR male 15-20 mm/hr
female 20-30 mm/hr
Cholesterol 150- 200 mg/dl
Triglyceride 140-200 mg/dl
Lactic Dehydrogenase 100-225 mu/ml
Alkaline phospokinase 32-92 U/L
Albumin 3.2- 5.5 mg/dl
ELEMENTS
GLUCOSE STUDIES
Fasting Blood glucose
Glucose tolerance test
Glycosylated hemoglobin
Glycosylated Hemoglobin Test A1C or HbA1C
A simple blood test that measures average blood levels over the
past 3 months
No fasting required
(FBS) FASTING BLOOD SUGAR TEST
This measures blood sugar after an overnight fast (NPO)
Normal 99mg/dL or lower
Prediabetes 100mg/dL to 125mg/dL
Diabetes 126mg/dL or higher
TESTS FOR GESTATIONAL DIABETES
Diagnosed using blood tests tested between 24 and 28 weeks of pregnancy
May be tested earlier if client has risk factors
Blood sugar higher than normal in early pregnancy may indicate type 1 or type 2
diabetes rather than gestational diabetes
Tests:
A. Glucose Screening Test - measures blood sugar at the time the client is tested. Client
is asked to drink a liquid that contains glucose. An hour later, blood will be drawn to
check blood sugar.
Normal: 140 mg/dL or lower; if level is higher then client needs to take OGTT
B. Oral Glucose Tolerance Test (OGTT) - measures blood sugar before and after drinking
a liquid containing glucose. Fasting is required. Blood is drawn irst to determine the
fasting blood sugar level. Then client will be asked to drink the liquid with glucose
and have blood sugar checked 1 hour, 2 hours and possibly 3 hours afterward.
