Patho - KeithRN



|Patho |Normal Range |Causes |Treatments |Nsg Considerations | |

|I. Blood Chemistries |*Most abundant cation in |Serum below 135mEq/L…critical 160|*Dehydration-fluid loss through N-V-D |*Replace fluids *D5%W |THINK VOLUME |

|Hypernatremia | | |(water loss in excess of salt loss) or |*Diuretics- Excrete excess volume |*Monitor electrolytes |

| | | |excessive sweating |and excrete |*Monitor vital signs |

| | | |*Diabetes-DKA | |*Mental Status |

| | | |*Fever | |*Weight/I&O |

| | | | | |*Monitor for seizures |

|Potassium: |*Most abundant intracellular |Serum below 3.5 mEq/L…critical |*Inadequate intake of K+ |*Oral or Parenteral Potassium |THINK ELECTRICITY |

|Hypokalemia |cation and is essential for |6 |*Metabolic acidosis |*Insulin- Moves K into the cell |THINK ELECTRICITY |

| | | |*Dehydration |*D50- Prevents hypoglycemia caused |*Monitor electrolytes |

| | | |*Excess Potassium intake |by the infusion of Insulin |*Monitor cardiac responses |

| | | |*Potassium Sparing Diuretics |*IV Calcium Gluconate = ER measure |*Monitor musculoskeletal cramps, |

| | | |*Tissue damage= *Burns (K goes out of |to counteract cardiac effects of |weakness, parathesias |

| | | |cell) |Potassium |*Peaked T wave/ wide QRS |

| | | |*Renal Failure |*Sodium Bicarbonate- Treats the |*Monitor Neurological responses, |

| | | | |acidosis caused when K moves into |mental status, headache |

| | | | |the cell and pushes hydrogen ion |*Irregular heart rate and rhythm |

| | | | |into the serum |for increased ectopy-PVC’s/VT |

|Magnesium: |*Second most abundant |Serum below 1.8 mEq/L…critical |*Chronic Alcoholism |*Treat underlying cause |THINK NEUROMUSCULAR TRANSMISSION |

|Hypomagnesemia |intracellular cation |6.1 |*Severe metabolic acidosis |*Renal patients treat with dialysis|THINK CARDIAC RESPONSE |

| | | |*Renal Failure |*Monitor cardiac effects of | |

| | | |*Tissue trauma |magnesium-increased PVC’s-VT |*Monitor electrolytes |

| | | | |*Give Calcium Gluconate |*Monitor vital signs |

| | | | | |*Bradycardia |

| | | | | |*Hypotension |

| | | | | |*Muscle weakness |

| |Patho |Normal Range |Causes |Treatments |Nsg Considerations |

|Calcium: |*Most abundant cation in body and |Serum below 8.5 mEq/L…critical 12 |*Dehydration |through IV fluids |*Monitor electrolytes |

| | | |*Cancer |*Loop diuretic to promote |*Monitor vital signs |

| | | |*Excess Antacid Intake |elimination of calcium |Hypertension |

| | | | | |*Monitor GI: N&V-anorexia |

| | | | | |*Dysrhythmias |

|Creatinine |*End product of creatine |0.5-1.3 mg/dl |Decreased in: |Correct underlying problem |THINK FLUID BALANCE |

| |metabolism which is performed in | |Decreased skeletal muscle |Fluid resuscitation to keep SBP>90 | |

| |skeletal muscle | |Inadequate protein intake |Dialysis |*Assess I&O closely |

| |*Small amount of creatine is | | | |*Fluid restriction |

| |converted to creatinine which is | |Increased in: | |*Assess for signs of fluid |

| |then secreted by kidneys |*Gold standard for kidney function|CHF | |retention/edema |

| |*Amount of creatinine generated |because creatinine is produced in |Dehydration | | |

| |proportional to mass of skeletal |consistent quantity and rate of |Acute & chronic renal failure | | |

| |muscle |clearance reflects glomerular |Shock | | |

| | |filtration | | | |

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| |Patho | | | | |

| | |Normal Range | |Treatments | |

| | | |Causes | |Nsg Considerations |

|Blood Urea Nitrogen |Urea represents end product of |10-20 mg/dl …critical >100 |Decreased in: |*Fluid resuscitation-HIGH |THINK FLUID BALANCE |

|(BUN) |protein metabolism performed in | |Poor protein intake/malnutrition |*Dialysis-HIGH | |

| |the liver | |Liver disease |*Improve nutritional intake/Failure|*Assess I&O closely |

| |Urea diffuses freely in | |Malabsorption syndromes |to thrive-LOW |*Fluid restriction |

| |intra/extracellular fluid and then| | | |*Assess for signs of fluid |

| |excreted by kidneys | |Increased in: | |retention/edema |

| |BUN reflects balance between | |Acute renal failure | |*Assess for agitation, confusion, |

| |production and excretion of urea | |CHF | |fatigue, *N&V-HIGH |

| |Ratio to creatinine is 15-24:1 (if| |Hypovolemia-dehydration | |*Assess liver profile labs for |

| |creatine 1.0 expected BUN should | |Pyelonephritis | |correlating liver damage |

| |be 15-24) | |Hyperalimentation/TPN | | |

| |Is indirect measurement of renal | | | | |

| |function but does not reflect | | | | |

| |glomerular filtration | | | | |

|II.Hematology |*Primary protein of erythrocytes |Adult- 13-17 g/dl…critical 18 |Detect blood loss, anemia and response |*Blood transfusions if symptomatic | |

|Hemoglobin-HGB |and globin (protein) | |to treatment | |*Identify early signs of blood |

| |*Carries O2 to cells and CO2 back |Range of Anemias: |Detect any possible blood disorder | |loss: tachycardia, then hypotension|

| |to lungs |Mild Hgb 10-12 g/dl-asymptomatic | | |*Transfuse as needed-assess closely|

| |*Parallels Hematocrit which is the|Moderate: Hgb 6-10 g/dl |Decreased in: | |in first 30” for transfusion |

| |% of RBC in proportion to total |weakness, fatigue, palpitations, |Anemia | |reactions |

| |plasma volume |SOB, decreased tol to |Cancer | |*Assess for signs of tissue hypoxia|

| |*GOLD Standard for evaluating |activity-orthostatic hypotension |Fluid retention/overload | |(see above) |

| |blood/RBC adequacy (anemia, blood |Severe: Hgb < 6 g/dl |Hemorrhage | | |

| |loss) |Hypoxia: confusion, SOB,skin | | | |

| | |pallor- MM/nailbeds, dizziness, |Increased in: | | |

| | |weakness, tachycardia |COPD | | |

| | | |CHF | | |

| | | |Dehydration | | |

| | | |Polycythemia | | |

| |Patho |Normal Range |Causes |Treatments |Nsg Considerations |

|White Blood Cell Count |*WBC represent primary defense |4,500-11,000 mm3…critical 15,000 |ETOH abuse |*Confirm bone marrow depression in | |

| |*This is a total count of all 5 | |Anemia |chemo/radiation therapy |*Low or elevated WBC can represent |

| |leukocytes: neutrophils, | |Bone marrow depression | |sepsis |

| |lymphocytes, eosinophils, | |Viral infections | |*Assess closely for hypotension |

| |basophils, and monocytes | | | |with known infection (septic shock)|

| |*Indicates overall degree of | |Increased in: | |*Assess closely for any change in |

| |body’s response to pathology, but | |Infection | |temperature trend-hypothermia or |

| |must be evaluated and correlated | |Anemia | |febrile can both represent sepsis |

| |through differential count | |Inflammatory disorders | |especially in elderly |

| |*Elevated WBC due to significant | |Steroid use (acute or chronic) | | |

| |increase in one | | | | |

| |differential-usually the | | | | |

| |neutrophil | | | | |

| |*Physiologic stress or steroids | | | | |

| |will increase WBC | | | | |

|Neutrophils |*Most predominant differential |50-70% of differential…critical or|Increased in: |*Identify infectious process |THINK INFECTION |

| |WBC-comprise 50-70% of all WBC’s |clinical concern >80% |Infection |*Confirm bone marrow depression in | |

| |*First line of defense against | |Acute hemorrhage |chemo/radiation therapy |*Low or elevated WBC can represent |

| |bacterial infection through | |Physical stress | |sepsis |

| |phagocytosis (think pacman) | |Tissue necrosis/injury | |*Assess closely for hypotension |

| |*BANDS- if present on | | | |with known infection (septic shock)|

| |differential-correlate with | |Decreased in: | |*Assess closely for any change in |

| |overwhelming sepsis.Immature | |Bone marrow depression (chemo/radiation| |temperature trend-hypothermia or |

| |neutrophils body is kicking into | |therapy) | |febrile can both represent sepsis |

| |circulation before they are ready | |Viral infection (due to increased | |especially in elderly |

| |because of the severity of | |lymphocytes) | | |

| |infection/sepsis | | | | |

| |Patho |Normal Range |Causes |Treatment |Nsg Considerations |

|III. Cardiac |*Contractile protein found in | ................
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