NURSES’ POCKET NOTES
RBC’s (x106/ml)
45-55
NORMAL VALUES
RDW (RBC distribution width) MCV
<14.5
MCH
26-34
MCHC %
31-37
Platelet count
100000450000
LUNG SOUNDS Crackles or Crackling or rattling sounds rales whee wheezi zing ng Highigh-pi pitc tche hed d whis whistl tlin ing g expirations stridor Harsh, hi high-pitched inspirations rhonchi Coarse, gr gravelly so sounds PULSE OXIMETRY Range Value
Treatment
Normal
95-100%
None or or pl placebic
Mild hypoxia Moderate hypoxia Severe hypoxia
91-94%
Give ox oxygen
86-9 6-90%
Giv Give 100% 100% oxygen ygen
<85%
Give 100% oxygen with positive pressure
Albumin
3.2 g/dl
Alkaline Phosphatase (Adults: 25-60) Adults: >61yo
33-131 IU/L
Ammonia
20-70 mcg/dl
51-153 IU/L
Bilirubin, direct
0-0.3 mg/dl
Bilirubin, tota
0.1-1.2 mg/dl
BLOOD GASES Arterial pH 7.35-7.45 pCO2 35-45
80-100
CREATININE KINASE (CK) ISOENZYMES CK-BB 0% CK-MB (cardiac) 0-3.9% CK-MM Creatinine Phosphakinase (CPK) Creatinine (mg/dl) ELECTROLYTES Calcium Calcium, ionized
pO2
70-100
28-48
HCO3
19-25
19-25
O2 Sat %
90-95
40-70
BUN
7-20 mg/dl
COMPLETE BLOOD COUND (CBC) ADULTS Male Female Hemoglobin (g/dl) 13.5-16.5 12.015.0 Hematocrit (%) 41-50 36-44
96-100% 8-150 IU/L 0.5-1.4
8.5-10.2mg/dl 2.242.46mEq/L 95-107 mEq/L 1.6-2.4mEq/L 2.5-4.5 mg/dl 3.5-5.2 mEq/L 135-145 mEq/L 13-300 3.6-20
Chloride Magnesium Phosphate Potassium Sodium Ferritin (ng/ml) Folate (ng/ml) Glucose, fasting
Venous 7.32-7.42 38-52
40-49
Glucose (2 hours postprandial) (mg/dl) Hemoglobin A10 Iron (mcg/dl) Lactic acid (mEq/L) LDH LDH (la (lact ctic ic deh dehydr ydrogen ogenas ase e)
60-110 (mg/dl) Up to 140 6-8 65-150 0.7-2.1 56-1 6-19 94 4 IU/L IU/L
LIPOPROTEINS AND TRIGLYCERIDES Cholesterol, to total <200 mg mg/dl HDL cholesterol LDL cholesterol Triglycerides Osmolality
30-70 mg/dl 65-180 mg/dl 45-155 mg/dl (<160) 289-308 mOsm/kg
SGOT (AST) SGPT (ALT)
<35 IU/L (20-40) <35 IU/L
THYROID FUNCTION TESTS Free T3 2.3-4.2 pg/ml Serum T3 70-200 ng/dl Free T4 0.5-2.1 ng/dl Serum T4 4.0-12.0mcg/dl TSH 0.25-4.30 microunits/ml Total iron binding capacity 250-420 mcg/dl (TIBC) Transferrin >200 mg/dl Uric acid (male) 2.0-8.0 mg/dl Uric acid (female) 2.0-7.5 mg/dl WBC + DIFFERENTIAL WBC (cells/ml) Segmented neutrophils Band forms Basophils Eosinophils Lymphocytes monocytes
4500-10000 54-62% 3-5% (above 8% indicates left shif) 0-1 (0-0.75%) 0-3 (1-3%) 24-44 (25-33 %) 3-6 (3-7%)
NURSING CONSIDERATIONS FOR BT Confirm that the transfusion is prescribed Check if Px blood has been typed and crossmatched Verify the consent from has been signed Explain the procedure to the Px and instruct px for s/sx of transfusion reaction (itching, hives, chills, sweeling, fever, shortness of breath) Take px’s vital signs to establish baseline for comparing of vital signs during transfusion Standard precaution during BT as per hospital policy Use gauge 20 or larger needles for BT Maximum hours for BT is 4 hours Double check obtained PRBC from blood bank Double check labes with other RN or MD to make sure of ABO and Rh compatibility Check blood for unusual color, bubbles or cloudiness, it may indicate bacterial growth or hemolysis Make sure PRBC is initiated within 30 minutes after removal from blood bank refrigerator
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For first 15 minutes, run transfusion slowly not more than 5ml/min, observe for side effects, then increase flow rate unless px is risk for circulatory overload. Observe px frequently for 15 to 30 minutes Be alert for adverse reactions, circulatory overload, sepsis, febrile reactions, allergic reactions and hemolytic reactions. Change tubing after every 2 units transfused Obtain BS and compare with initial VS Document procedure Monitor px for response to and effectiveness of the procedure Drug Adrenaline atSO4 Aminophylline Aeknil Benadryl Burinex Ca gl gluconate Cardepine Carricor Calmegic Cefamandole Cefuroxime Cordarone Cyklokapron Demerol Dexamethasone Dextrose Diazepam Diclofenac Na (Voltaren) Dilantin Dobutrix Dopamine Dormicum Ephedrine Famotidine Furosemide Hyosine Hbr. Isoket Isoptin
Isotonic NaCl KCl Lanoxin Cystine Acetate Losec MgSO4 Morphine Meto Metoch chlo lorp rpra rami mide de Narcan Nicardipine
Nubain NaHCO3 Nitroprusside Nipride Nimotop NTG NTG (tra (tran nsder sderm) m) Nitrobid Orudis Prom Promet etha hazi zine ne HCl HCl
Elec. Mod. Elec. Mod. Digitalis Analgesic Anti-ulcer Anti-convul Narcotic anal A nti nti-e -eme m eti tic c Narc. Antag Ca channel blocker, antiangina, vasodilator, antihypertension Narc. Analg. Elec. Mod., alk. Agent Anti-hpn
If a patient's level of Creatine kinase (isoenzyme BB) is Cell necrosis in brain high, what does this mean? If a patient's level of Creatine Cel necrosis in heart or kinase (isoenzyme MM) is skeletal muscle high, what does this mean? If LDH-1 is high, what does it Cell necrosis of heart, mean? (lactate erythrocytes, or skeletal dehydrogenase isoenzyme muscle 1) If LDH-5 is high, what does it mean? (lactate Cell necrosis of Liver or dehydrogenase isoenzyme skeletal muscle 5) If AST level is elevated, what Cell necrosis of heart, liver does that mean? (Aspartate skeletal muscle aminotransferase) If ALT level is elevated, what Cell necrosis of Liver, skeletal does that mean? (Alanine muscle aminotransferase)
Use Bronchodilator cdc stim. & Cal channel blocker vasoconstrictor Atnitni-a ang., ng., vasodi sodill Anticholinergic Vasodil, anti-angi Bronchodilator Anti-inflam Anti-pyretic AntiAnti-hi hist stam amin ine, e, antianti-em emet etic ic,, What is significance of Anti-histamine sed elevated amylase? Diuretic Perlinganit Anti-angina Normal value of total Electrolyte mo modifier Reglan Anti-emetic bilirubin? Ca antagonist Sensorcain HCl Adrenalien Anti-arrhythmic Normal value of direct Solucortef Immune response & inflame bilirubin? Analgesic/ anti-pyretic Supp. Anti-infective Toradol Analgesic Anti-infective Zantac Anti-histamine receptor Anti-arrhythmic Normal calcium levels Zofran Anti-emetic Coagulant Zinacef Anti-infective Narcotic agent Anti-inflammatory What is the normal value of Caloric agent 60-110 mg/dl serum glucose? Sedative What is the normal arterial Non-steroidal anti7.35 to 7.45 blood pH value? inflammatory agent What is the normal PaC02? 35-45 mmHg Anti-convulsant; atniarrythmic Normal Pa02? 80-100mmHg Inotropic agent Normal HC03? 22-28 mEq Vasopressor, in inotropic ag agent Normal value of K? 3.5 to 5.5 mEq/l Sedative Bronchodilator Normal serum sodium level? 135-145 mEq/l Anti-ulcer Diuretic Normal BUN? 8-25 mg/dl Antispasmodic Normal blood osmolarit y? 275-295 mOs/kg Anti-angina If a patient's level of Creatine Ca channel blocker, antiCell necrosis in heart. anginal, anti-hypertension, anti-hypertension, kinase (isoenzyme MB) is high, what does this mean? anti-arrhythmic
Pancreas, salivary gland cell necrosis .2 - 1.5 mg/dl 0 to .3 mg/dl Serum (total) is 9.0 to 10.5, ionized is 4.5 to 5.6. 50% of calcium in blood is bound to protein, 40% is free or ionized.
