LABS NORMAL RANGE

Na+ 135 - 145 Sodium Swells the body

K+ 3.5 - 5.0 Potassium Pumps Heart
Cl- 97 - 107
Ca 9.0 - 10.5 Calcium Contracts Muscles
Mg+ 1.3 - 2.1 Mag. Mellows Muscles
Albumin 3.5 - 5.0 Liver
Creatinine Over 1.3 Bad Kidney
BUN 10 - 20 Kidney
Glucose 70 - 110 Hypogly = Brain Die
WBC 5,000 - 10,000 High = Infection
RBC (M) 4.7 - 6.1 (F) 4.2 - 5.4 Low = Anemia
Hgb (M) 14 - 18 (F) 12 - 16 Below 7 = Blood Trans
Hct (M) 42 - 52 (F) 37 - 47
PLTS 150k - 400k AsaParin, CloPidogrel
PT 11 - 12.5
aPTT 30 - 40
INR 0.9 - 1.2
Therapeutic Range while on Anticoags
aPTT 46 - 70
INR 2-3

* 3 x MAX range
Top 5 Toxic Drug Levels

1. Lithium 1.5 +
NCLEX TIP
2. Digoxin 2.0 +
HIGHEST risk for toxicity
3. Theophylline 20 +
Decreased renal function
4. Phenytoin 20 +
Creatinine Over 1.3 = Bad Kidney
(brand: Dilantin)
• Renal Failure
5. Kidney Killers: • Older Age
Creatinine Over 1.3 = dead kidney
� CT contrast Creatinine > 1.3
� Antibiotics: Vancomycin
& Gentamicin

CREATININE
Digoxin 2.0 +
Lithium: 1.5 + Top Signs of toxicity
Theophylline 20+
Top Signs leading to toxicity • Nausea & Vomiting Top Signs of toxicity
1. Extreme thirst • Vision changes • Seizures
2. Excessive urination “difficulty reading” T - Theophylline
3. Vomiting / diarrhea D - Digoxin T - Tonic Clonic seizures
D - Difficulty reading

D D T T
Digoxin Difficulty reading Theophylline Tonic Clonic seizures

A WB I

DIGOXIN
Theophylline
20+

Phenytoin 2.0 + Kidney Killers

Top Signs of toxicity (creatinine over 1.3 = bad kidney)
1. Ataxia - unsteady gait • CT Contrast
2. Hand tremors
Vancomycin
Gentamicin

• Mycin Antibiotics
3. Slurred speech

Notes
Fluid Volume
Deficit & Excess

Cardiovascular
• Thready, increased pulse rate, decreased blood pressure and orthostatic hypotension,
flat neck and hand in veins in dependant positions, diminished peripheral pulses,
“HypOvolemia” decreased central venous pressure, dysrhythmias
(LOw fluid volume) Respiratory
• Increased rate and depth of respirations, dyspnea
Neuromuscular
• Decreased central nervous system activity, from lethargy to coma, fever, depending
on the amount of fluid loss, skeletal muscle weakness
Renal
• Decreased urine output
Integumentary
• Dry skin, poor turgor, tenting, dry mouth
Gastrointestinal
• Decreased motility and diminished bowel sounds, constipation, thirst, decreased
body weight
Serum Blood Lab Findings
• Increased serum osmolality, increased hematocrit,
• Increased blood urea nitrogen (BUN), Increased serum sodium level,
• Increased urinary specific gravity
Memory Trick:
• If Osmolality is HIGH = Body is DRY
• If Specific gravity is HIGH = Body is DRY

Cardiovascular
• Bounding, increased pulse rate, elevated blood pressure, distended neck and hand
veins, elevated central venous pressure, dysrhythmias
Respiratory
“Hypervolemia” • Increased respiratory rate (shallow respirations), dyspnea, moist crackles on
(High fluid volume) auscultation
Neuromuscular
• Altered level of consciousness, headache, visual disturbances, skeletal muscle
weakness, paresthesias
Renal & Urinary
• Increased urine output if kidneys cannot compensate; decreased urine output if
kidney damage is the cause
Integumentary
• Pitting edema in independent areas, pale cool skin
Gastrointestinal
• Increased motility in gastrointestinal tract, diarrhea, increased body weight, liver
enlargement, ascites
Serum Blood Lab Findings
• Decreased serum osmolality, decreased hematocrit, decreased BUN level,
• Decreased serum sodium level,
• Decreased urine specific gravity
Memory Trick:
• If Osmolality is Low = Body is Liquidy
• If Specific gravity is Low = Body is Liquidy
F&L Quick Notes:
IV Solutions

Isotonic solutions
• Definition: when solutions on both sides of a selectively permeable membrane have
established equilibrium or are equal in concentration, they are isotonic

• Human blood is isotonic thus very little osmosis occurs since isotonic solutions have
the same osmolality as body fluids & thus increase extracellular fluid volume.

Memory Trick:
• Iso-tonic Solutions
• I-so-Perfect (no fluid shift, “I’m so perfect” perfect balance)

• List of fluids:
• 0.9% sodium chloride (normal saline)
• 5 % dextrose in water (DWS)
• 5 % dextrose in 0.225% saline (DSW/ 1⁄4 NS)
• Lactated Ringer’s (LR)

Hypotonic solutions
• Definition: when a solution contains a lower concentration of solute than another more
concentrated solution, then it is a hypotonic solution.

• These solutions have lower osmolality than body fluids.

• They cause the movement of water into cells by osmosis, swelling the cells like a BIG fat
hippo, and therefore, should be administered slowly to prevent cellular edema

Memory Trick:
• HypO - tonic
• HippO - tonic = fluid swells the cell like a big hippo

• List of fluids:
• 0.45% sodium chloride (1⁄ 2 NS)
• 0.225% sodium chloride (1⁄4 NS)
• 0.33% sodium chloride (1.3NS)

Hypertonic solutions
• Definition: when a solution contains a higher concentration of solutes than another
less concentrated solution, then it is a hypertonic solution.

• These solutions have higher osmolality than body fluids.

• They cause the movement of water outside the cells by osmosis, making the cells skinny
like a hyper person.

Memory Trick:
• Hyper - tonic
• Hyper person = very skinny cells like a hyper person is skinny

• List of fluids:
• 3% sodium chloride (3% NS)
• 5% sodium chloride (5% NS)
• 10% dextrose in water (D10W)
• 5% dextrose in 0.9% sodium chloride (D5W/NS)
• 5% dextrose in 0.45% sodium chloride (D5W/ 1⁄ 2 NS)
• 5% dextrose in Lactated Ringer’s (D5LR)
Fluid & Electrolytes
Cheat Sheet

Electrolyte Function HYPER “HIGH” Hypo “low”

HYPERkalemia (over 5.0) Hypokalemia (below 3.5)
Heart - TIGHT & CONTRACTED
1ST elevation and Peaked T waves HEART - LOW & SLOW
1 Flat T waves, ST depression, & prominent U wave
2 Severe = Vfib or Cardiac Standstill! MUSCULAR - LOW & SLOW
P - Potassium 3 Hypotension, Bradycardia
Potassium
1 Decreased DTR
P - Priority! Since it.. GI TRACT - TIGHT & CONTRACTED 2 Muscle cramping
1 Diarrhea 3 Flaccid paralysis (paralyzed limbs)
3.5 - 5.0 P - Pumps the heart
& muscles
2 Hyperactive bowel sounds
NEUROMUSCULAR GI - LOW & SLOW
Decreased motility, hypoactive to absent bowel
- TIGHT & CONTRACTED
Paralysis in Extremities sounds, Constipation
Increased DTR Abdominal distention
Profound Muscle Weakness, Paralytic ileus, paralyzed intestines!
(General Feeling of heaviness) *PRIORITY* for SB0 (small bowel obstruction)

HYPERnatremia (over 145) Hyponatermia (below 135)

S - Sodium HYPERNATREMIA = BIG & BLOATED HYPONATREMIA - DEPRESSED & DEFLATED
S - Swells the body 1. SKIN
Sodium to maintain:
FLUSH ‘’Red & Rosy’’
EDEMA ‘’waterbed skin’’
NEURO = Seizures & Coma
HEART = Tachycardia, & weak thready pulses

135 - 145 • Blood Pressure LOW GRADE FEVER RESPIRATORY ARREST

2. POLYDIPSIA EXCESS THIRST
• Blood Volume 3. LATE SERIOUS SIGN
• pH balance SWOLLEN dry tongue NCLEX TIP
GI = nausea & vomiting NCLEX TIP
INCREASED muscle tone NCLEX TIP

Sodium’s sidekick HYPERchloremia (over 107) Hypochloremia (below 97) t

Chloride Maintains:
NEARLY SAME AS HIGH SODIUM NEARLY SAME AS LOW SODIUM
• Blood Pressure
97 - 107 • Blood Volume
NAUSEA & VOMITING
SWOLLEN DRY TONGUE
EXCESSIVE DIARRHEA,
VOMITING, SWEATING
• pH balance CONFUSION FEVER TEST TIP: ONLY DIFFERENCE

HYPERmagnesemia (over 2.1) Hypomagnesemia (below 1.3)

1. CARDIAC - CALM & QUIET 1. CARDIAC - BUCK WILD!

Heart block EKG: ST depression, T wave inversion
Prolonged PR intervals Torsades de pointes
Magnesium M - Magnesium
M - Mellows the
VITALS = bradycardia, hypotension
2. DEEP TENDON REFLEXES -
SEVERE = V fib
VITALS = Tachycardia

1.3 - 2.1 M - Muscles (relaxes) CALM & QUIET

Hyporeflexia - Decreased DTR
2. DEEP TENDON REFLEXES - BUCK WILD
Hyporeflexia - increased DTR
3. EYES - BUCK WILD
3. LUNGS - CALM & QUIET Abnormal eye movements (nystagmus)
Depressed shallow respirations 4. GI - BUCK WILD
3. GI - CALM & QUIET Diarhea
Hypoactive bowel sounds

HYPERcalcemia (over 10.5) Hypocalcemia (below 9.0)

SWOLLEN & SLOW - MOANS, GROANS T - Trousseau’s

Keeps the 3 Bs Strong
Calcium B - Bone
& STONES
1. CONSTIPATION
T - Twerking arm with BP cuff on
C - Chvostek’s
9.0 - 10.5 B - Blood
B - Beats (heart)
2. BONE PAIN
3. STONES Renal Calculi (kidney stones)
C - Cheek smile when touched
Diarrhea
4. DEEP TENDON REFLEXES
Decreased DTR
Circumoral tingling
Severe muscle weakness Weak bones

HYPERphosphatemia (over 4.5) Hypophosphatemia (below 3.0)

‘’LOW CALCIUM’’ BAJA CA+ Swollen & SLOW - MOAN,

1. TROUSSEAU’S SIGNS GROANS & STONES
Helps with bone & teeth 2. CHVOSTEK’S SIGNS
Phosphate formation.
Helps regulate calcium
3. DIARRHEA
4. WEAK Bs
1. CONSTIPATION
2. DECREASED DTR & SEVERE
3.0 - 4.5 Ca HIGH = Phosphate LOW Strong bones? -
WEAK! (fractures)
MUSCLE WEAKNESS
3. DECREASED HR, RR
Ca LOW = Phosphate HIGH 4. INCREASED BP
Strong blood clotting? -
WEAK! (risk for bleeding)
Strong heart beats? -
WEAK! (cardiac dysrhymias)

*Disclaimer: Values above are based on NCLEX standards, many books & hospitals will differ in their values.
Labs
BMP Panel & Electrolytes

BMP Basic Metabolic Panel

Sodium (Na+) Swells the body

Potassium (K+) Potassium pumps the heart muscles

Chloride (Cl-) Helps to maintain acid base balance

CO2 Helps to maintain acid base pH balance (too much can
Na Cl BUN
(Carbon Dioxide)
HCO3
put the body in Acidosis) Memory trick: Carbon DiACID
Pushes the body into an alkalotic state
Glucose
(Bicarbonate) Memory trick: Bicarb Base
2 labs for 2 kidneys. High BUN over 20, usually means
K CO2/ HCO3 Cr
BUN & Creatinine dehydration. Creatinine over 1.3 = Bad Kidney (kidney injury)
70 - 110 Normal
Glucose Hyperglycemia (over 120) usually clients with uncontrolled diabetes,
Hypoglycemia (60 or less) brain will DIE! Very deadly

Electrolytes Labs Treatment

K+ 3.5 - 5.0 mEq/L Hyperkalemia Hypokalemia

P P P PHARMACOLOGY FOR HIGH K+ Potassium IV (Normal 3.5-5.0)
NCLEX TIP 1. IV Calcium Gluconate = Dysrhythmias 1. First Action = Heart monitor
Potassium Priority Pumps the heart 2. IV 50% Dextrose + Regular INsulin 2. Never push = DEATH
LAB: High or Low
3. Kayexalate (polystyrene sulfonate) 3. Only 10-20 mEq MAX per HOUR
Potassium (K+)
4. Dialysis IV!!! (IV Pump)
3.5-5.0 (normal)
Potassium 4. Slow infusion (if arm burns)
RITY
K+ PRIO

Common NCLEX Question

HIGH Potassium (5.0+) LOW Potassium (Below 3.5)
HIGH Pump LOW Pump Patient with chronic kidney disease missed 3 dialysis End stage renal disease… potassium 7.2, BUN 35,
sessions… potassium level of 8.1 … creatinine of 3.8, and urine output of 300 ml in 24
Peaked T waves, ST elevation Flat T wave, ST depress, U wave wide QRS complexes, heart rate of 58 & lethargy. hours. Which order is the PRIORITY?
Which order should the nurse implement first?

1. IV Regular insulin R & 50% Dextrose

1. IV 50% Dextrose & regular insulin
2. IV loop diuretic
2. Sodium polystyrene sulfonate
O2 3. Dialysis
3. Hemodialysis
4. Put in for vacation time?
4. IV calcium gluconate

Normal ST elevation ST Depression

Na 135 - 145 mEq/L Ca 9.0 - 10.5 mEq/L Mg+ 1.3 - 2.1 mEq/L

S S C C M M
Sodium Swells the body with FLUID Calcium Contracts the muscles Magnesium Mellows the muscles

Sodium Calcium Magnesium

Na+ Ca Mg+

Ca 9.0 - 10.5 mEq/L Mg+ 1.3 - 2.1 mEq/L

Low calcium
Diarrhea
Low magnesium
Na 135 - 145 mEq/L 2 dance moves:
T&C
• Torsades De Pointes
& V Fib! NCLEX TIP
• T - Trousseau's • Hyperreflexia
Twerking arm when BP cuff on
Low Sodium - Low & Slow • C - Chvostek’s • Increased DTR
Cheek smile when stroking face
• “Mental Status change” = PRIORITY
• Seizures & Coma HIGH magnesium
HIGH Calcium • Decreased DTR
• Respiratory Arrest Stones, moans & groans
Kidney Stones • Hyporeflexia
Constipation
HIGH sodium = Big & Bloated
Torsades de pointes
• Edema (swollen body) T C
• Increased muscle tone Trousseau's Chvostek’s
Twerking arm when BP cuff on Cheek smile when stroking face
• Flushed “red & rosy” skin

Ventricular Fibrillation
Labs II
CBC - Complete Blood Count

Immunity - the defense system of the body to fight infection.

White Blood Cells
Normal: 5,000 - 10,000
(WBC)

Hgb The whole blood in the blood vessels.

CBC Test

Hemoglobin & Hematocrit

WBC PLT (H & H)
Hemoglobin: oxygen carriers on the red blood cells.
HCT Hematocrit: the ratio of RBC & total blood volume.

Blood clotting proteins that help to stop bleeding by

Platelets
forming scabs, but also creates blood clots which can KILL!
(PLT)
MemoryTRICK:
MEMORY Trick: Platelets Plug the bleeding

Hemoglobin Normal 12 - 18
Normal: 12 - 18
Risky: 8 - 11
• REPORT to HCP & Surgeon
02 Risky 8 - 11
(if before surgery)
• Bleeding & Anemia
Below 7
Malnutrition, Cancers

Below 7 = Heaven or blood transfusion

• Top S/S: NCLEX TIP
1. Pale skin: pallor, dusky skin tones
2. Cool clammy skin
3. Fatigue, Weakness

Hematocrit - hemato creek

Hematocrit H/H: Ratio
Normal: 36 - 54% 1/3 ratio 12/36 ratio 18/54 ratio
Elevated Hct = Dehydration
Decreased Hct =
• Fluid Volume Overload
1:3 12:36 18:54
• Bleeding, Anemia, Malnutrition

Saunder’s
Client with gastrointestinal (GI)
bleeding… laboratory results
hematocrit level of 30%. Which
action should the nurse take?
RBC - Red blood cell count 10 Hemoglobin
Report the abnormally
4 - 6 million
! !
low level

Low = Anemia, Renal Failure

• Iron (Fe+) 1
Abnormally low level
• Erythropoietin
High = Dehydration
! 10
• High Labs = Dry body
30%
Labs III
WBC’s & Coagulation Panel

WBC - White Blood Cells

1. WBC Total Count

Normal: 5,000-10,000 Common Exam Question
Higher = Leukocytosis
• Which blood laboratory test results should the nurse report to the HCP?
• Steroids (prednisone) Select all that apply
Low = “Leukopenia”
1. Hemoglobin 6 g/dL
• Chemotherapy
• 2. Potassium 6.5 mEq/L 5,000 - 10,000
• Immunosuppressant Drugs
3. Sodium 150 mEq/L
• Lupus - Autoimmune Diseases
PRIORITY 4. White blood cells,
- Low Grade Fever = Priority 2,000 mm3
- Private Room
- No fresh fruits / flowers 100.4
5. Platelets 45,000 mm3
- Avoid crowds & sick people
- NO

2. CD4 Count
Norm: Over 200

Coagulation Panel
Never be more than
PLATELETS PTT INR these max ranges!
150k - 400k 30 - 40 0.9 - 1.2
!
HeParin WarfarIN
P P P
!
AsPirin CloPidogrel EnoxaParin
46 - 70 2-3
PTT
!
INR
CLOPIDOGREL WARFARIN
ASPIRIN

<150k <50k

! NCLEX Question
! Client is on Warfarin with an INR of 4.5 …
Client on Heparin PTT of 100
! 1. Stop or Hold drug
2. Assess - bleeding

NCLEX 3.
STOP Assess Prep Report
4. Report to HCP
SAFETY FIRST! 1

ANTIDOTE
Focus on things that WILL KILL FIRST!

Notes
Labs V
Highest Priority - Safety

Who to see first

Infection PRIORITY

ABCS Priority: Less than 5,000 WBC

Airway, Breathing = Oxygenation “Leukopenia”
Low PaO2 norm: 80 -100
Kidney Labs
High CO2 OVER 45 < 5000
Creatinine OVER 1.3 = Bad kidney! Leukopenia
Mental changes: Restless, agitation
Skin: Pale, dusky, cool & clammy Pain
Circulation Lose life or limb Creatinine > 1.3
Bleeding - High PTT / INR T
▪ Chest Pain = #1 priority
INR & PT
Shock - Severe low BP ▪ Compartment Syndrome
Chest pain (any kind) Cast / broken limb pain
BUN/Creatinine

HTN crisis (over 180 sys) = Unrelieved with pain meds

PTT & INR

ABGs (not pulse oximeter)

PaO₂
PaO2: 80 - 100 normal 60 or less Abnormal blood gases (ABGs) 60 80 100

= HypOXemic Respiratory
failure LOW O2
PaCO2: 35 - 45 50 or MORE
ABG HCO3 pCO2 pH 0₂
= HyperCapnic Respiratory Respiratory Acidosis Normal
failure HIGH CO2
Respiratory Alkalosis Normal
1. HyperCap = Give BiPAP
2. Intubate & ventilate

INR > 1.3 aPTT > 100 PRIORITY

Bleeding
TT
INR & P
INR - Over 4
Infection

aPTT - Over 100 Priority: Less than 5,000 WBC

“Leukopenia” < 5000
1. STOP / Hold drug Leukopenia
Low Grade FEVER = KILL!
2. Assess - bleeding Memory tricks
3. Prep antidote ● Immunocompromised Low Grade FEVER <100.4 F
WarKin HePTT
Warfarin - Vitamin K ● Chemotherapy
K
● Taking Immunosuppressants
Heparin - Protamine Sulfate
4. Report to HCP

Common NCLEX Question

An emergency room nurse is presented with
four clients at the same time. Which of the
following clients should the nurse see FIRST?

1. A client with a low-grade fever, headache, and fatigue

for the past 72 hours.
2. A client with swelling and bruising to the left foot
following a running accident.
3. A client with abdominal and chest pain following a
large, spicy meal.
4. A child with a 10 cm laceration to the chin
Labs IV
Cardiac Labs & Acid Base ABG

Cardiac Labs

T T MI (myocardial infarction) B B
T - Troponin Over 0.5
TROPONIN > 0.5 TRAUMA TO HEART T - Trauma to heart muscles BNP <100 BIG STRETCHED
MUSCLES (CELL DEATH) OUT VENTRICLES

100
CHF (Congestive Heart Failure)

BNP - TEST
B - BNP - Under 100
10

B - Big stretched out ventricles

0.1

0.01

0 1 2 3

Acid Base ABG

A B
pH
pH 7.35 7.45
Acid “acidosis” Base “alkalosis”

B A Acidotic NORMAL pH Alkalotic

Carbon Di-ACID PaCO₂ 7.35 pH 7.35 pH 7.45 pH 7.45 pH
35 45

A B
Alkalosis (Base) HCO₃
22 26

Respiratory Acidosis = Low & Slow Kaplan Question

breathing
Respiratory ALKalosis = FAST
Alcohol intoxication Most Tested Cause for respiratory
Overdose (Low & slow RR)
breathing
alkalosis? A - Anxiety Attack
Opioids / Benzos (diazepam)
C - COPD Hyperventilation (Hyperventilation)
C - CO2 retained A - Alkalosis
Sleep apnea
Treatment: Breathing into a
Head trauma PaCO2 35 - 45
paper bag - slow down breathing
Treatment: Hyperventilation, pursed
lip breathing to blow off the CO2
alk alk alk & retain CO2
alk-alooosis
“Panting like a dog will put you into
CO2
Alk alk alkalosis”

Severe Acidosis = Hypercapnic Hypoxia earliest sign

respiratory failure Mental Status changes:
Metabolic ALKalosis
Example: 1. Restlessness
Client with a Ph of 6 & CO2 of 65 Vomiting
2. Confusion
Treatment:
NGT suction
3. Agitation
1. HyperCap = Give BiPAP
2. Intubate & ventilate Metabolic Acidosis:
PaO2 80 -100%
Diarrhea
PaO₂
HIGH CO2 80 100

HyperCapnic #1
Renal Failure
4
5
6 7 8 9
10

CO₂ 0₂
0₂

0₂
11
3

12
2

13 14
0 1

0₂