Blood sample Arterial Blood Gases (ABG)

Normal PaO2 = 80100 mm Hg PaCO2 = 3545 mm Hg pH = 7.35-7.45 HCO3 = 2226 mEq/l SaO2 = 95-99%

Clinical Significance Panic Values for ABGs PaO2: < 40 PaCO2: < 20 or > 70 pH: < 7.2 or > 7.6 HCO3: < 10 or > 40 SaO2: < 60% Degrees of Hypoxia: mild: PaO2 of 60-80 mm mod: PaO2 of 40-60 mm severe: PaO2 < 40 mm Low values = Anemia: monitor for fatigue, dyspnea, tachycardia, tachypnea
RBC / Whole Blood = ___ %

Hematocrit (Hct)

Female: 3646% Male: 42-52%

Hemoglobin (Hgb)

Female: 1215 g/dl Male: 14-17 g/dl Female: 4 5.5 million/mm3 Male: 4.5 6.2 million/mm3

Low values = Anemia: monitor for fatigue, dyspnea, tachycardia, tachypnea Chemotherapy: < 10 -- hold aerobic exercise

RBC Count

Low values = Anemia: monitor for fatigue, dyspnea, tachycardia, tachypnea High values: In COPD, may indicate Polycythemia, a compensation for pulmonary dysfunction that makes blood thicker, and increases risk of CVA, etc. > 10,000 indicates systemic infection (more than just local colonization) Chemotherapy : < 5,000: use reverse isolation, see patient in room, careful hygiene, hold aerobic exercise

Total WBC Count

5,000 10,000 /mm3

Platelets, 200,000 Thrombocytes 500,000 /mm3

Chemotherapy:

30,000 50,000: avoid resisted exercise, risk of internal hemorrhage, ambulation OK < 30,000: bedside, gentle AROM

< 20,000: consult with physician or nurse before activity

"Sed Rate", Erythrocyte Sedimentation Rate (ESR)

Female: 125 mm/hr Male: 017 mm/hr

Bad if elevated. Used to diagnose, or follow the course of inflammatory diseases, e.g. rheumatic conditions
Alternative calculation of normal value: Female: (age + 10) / 2 Male: age / 2

Creatinine

Female: 0.6 1.2 mg/dl Male: 0.5 1.1 mg/dl

Elderly values are lower because of reduced muscle mass

Renal function measure: high values are bad. May indicate nephropathy, end stage renal d. Can occur in brittle diabetics also.

Potassium (K) 3.5 - 5.0 mEq/l

Low (hypokalemia) secondary to: vomiting, diarrhea, sweating, or use of loop diuretics e.g. Lasix, furosemide. Also increases the risk of digitalis toxicity. Result of low K: ventricular arrhythmias High (hyperkalemia) secondary to: overuse of K supplements, renal or endocrine problem. Result of high K: ventricular arrhythmias, asystole

Calcium (Ca)

8.2 -10.2 mg/dl

Low (hypocalcemia): secondary to: abuse of laxatives, renal failure, low dietary calcium or Vit. D intake, excessive magnesium intake. Result of low Ca: osteoporosis, muscle spasms / tetany, calcium deposits in tissue; cardiac arrhythmia, asystole High (hypercalcemia): secondary to: immobilization, metastatic bone CA; overuse of antacids containing calcium Result of high Ca: thirst; polyuria; renal stones; decreased muscle tone and DTRs; tachycardia; cardiac arrhythmia, asystole

Sodium (Na)

136 -145 mEq/l

Low (hyponatremia) secondary to: fluid loss from

diarrhea, vomiting, diaphoresis, diuretic use. Result of low Na: postural hypotension, abdominal cramps, headache, fatigue, weakness High (hypernatremia) secondary to: dehydration, high salt intake, poor renal function Result of high Na: edema, tachycardia

Diabetes
Fasting Blood Glucose (FBG) Glucose Level 70 to 99 mg/dL 100 to 125 mg/dL >126 mg/dL Normal fasting glucose Impaired fasting glucose (pre-diabetes) Contributes to the diagnosis of Metabolic Syndrome Diabetes Indication

Oral Glucose Tolerance Test (OGTT) (Sample drawn 2 hours after a 75-gram glucose drink) Glucose Level < 140 mg/dL 140 to 200 mg/dL > 200 mg/dL Indication Normal glucose tolerance Impaired glucose tolerance (pre-diabetes) Contributes to the diagnosis of Metabolic Syndrome Diabetes

Conversion tool for Blood Glucose to HBA1c Chart with comparative values for HBA1c & Blood Glucose

Glycosylated HemoglobinHBA1c, or A1c

4 - 6% is normal

Lab work done at the doctor's office, that gives an average of the last 3 month's blood glucose. The goal for diabetic patients it to keep the value < 7%

Pulmonary Function Test (PFT) results: COPD & RLD

FVC
(Normal/Predicted is 80120%)

FEV1
(Normal/Predicted is 80120%)

FEV1 / FVC
(Normal/Predicted ratio is 80%)

Decreased. COPD
Mild: 65-80% of predicted Mod: 50-65% of predicted Severe: < 50% of predicted

Decreased.
Mild: 65-80% of predicted Mod: 50-65% of predicted Severe: < 50% of predicted

Decreased.
Mild: 65-80% Mod: 50-65% Severe: < 50%

Decreased. RLD
Mild: 65-80% of predicted Mod: 50-65% of predicted Severe: < 50% of predicted

Decreased.
Mild: 65-80% of predicted Mod: 50-65% of predicted Severe: < 50% of predicted

Normal, or increased.
80-100%

BP - lifespan values Vital signs - pediatric values

Adult Values Normal SBP < 120 DBP < 80 80-89 90-99 > 100

PreHypertension 120-139 HTN - Stage 1 HTN - Stage 2 140-159 > 160

- According to the Seventh Report of the Joint National Committee on Detection, Education, and Treatment of High Blood Pressure (JNCVI). 2003

Ejection Fraction (EF), defines degrees of heart failure:

> 55% 40-55% 30-40% < 30%

normal mild LV dysfunction moderate LV dysfunction severe LV dysfunction

Ottawa Cardiovascular Centre. (2004). Congestive Heart Failure Survival Kit. Continuing Medical Implementation Inc. Retrieved 7-2-2011. http://www.cvtoolbox.com/downloads/CHF_SurvivalKit.pdf

CHF is quantified by an echocardiogram (US) reading of elevated EDV (End Diastolic Volume and decreased SV (Stroke Volume)

Rheumatic diseases and tests with which they may be strongly associated:
Bartlett, S. (2006). Clinical Care in the Rheumatic Diseases. (3rd ed.). Association of Rheumatology Health Professionals. American College of Rheumatology. Atlanta : ARHP

Rheumatoid factor (RF) Antinuclear Antibodies: ANA (Fluorescent ANA = FANA) HLA B27: Human Leukocyte Antigens ESR Erythrocyte Sedimentation Rate & CRP (Creactive protein)

RA -70%, Sjogrens -90% (p.44-5) SLE - 99% (p.45)

AS - 90%, Reiters - 80% (p.178) RA and Polymyalgia Rheumatica Most useful as serial measurements to track the course of the disease, especially when in active inflammation (p.48)

Uric Acid Crystals (synovial aspiration) WBC levels

Gout or pseudogout (p.44) Most indicative of Gout (synovial aspiration) Normal in RA, but can be elevated during inflammatory phase (p.47-48). Leukopenia and other hematologic disorders can occur in SLE (p.188)

BMI calculator BMI table

Underweight Normal weight Overweight Obesity Morbid Obesity < 18.5 18.5 - 24.9 25 - 29.9 > 30 > 40

VO2 Max / 3.5 = METs

Ankle Brachial Index (ABI): Clinical application: decisions about use of compression, and use of sharp debridement. Prognostic for wound healing. Ankle SBP / Brachial SBP Must have a doppler US to hear SBP at the dorsalis pedis artery. Cuff goes around calf). For normal persons, leg SBP is higher than brachial SBP.
0.9 1.2 0.7 0.9 0.5 0.7 < 0.5 Normal Mild arterial disease (intermittent claudication pain) Moderate arterial disease (claudication pain at rest) Severe arterial disease (risk of gangrene)

Falsely high values that are > 1.2 may indicate arteriosclerosis (diabetes), because the vessels are calcified and non-compressible by the BP cuff. Referral for other testing would be appropriate.