Nurses

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 wheezing High-pitched whistling expirations stridor Harsh, high-pitched inspirations rhonchi Coarse, gravelly sounds PULSE OXIMETRY Range Value

Treatment

Normal

95-100%

None or placebic

Mild hypoxia Moderate hypoxia Severe hypoxia

91-94%

Give oxygen

86-90%

Give 100% oxygen

<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

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

51-153 IU/L

Venous 7.32-7.42 38-52

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

40-49

80-100

CREATININE KINASE (CK) ISOENZYMES CK-BB 0% CK-MB (cardiac) 0-3.9% CK-MM 96-100% Creatinine Phosphakinase 8-150 IU/L (CPK) Creatinine (mg/dl) 0.5-1.4 ELECTROLYTES Calcium Calcium, ionized Chloride Magnesium Phosphate Potassium Sodium Ferritin (ng/ml) Folate (ng/ml) Glucose, fasting Glucose (2 hours postprandial) (mg/dl) Hemoglobin A10 Iron (mcg/dl) Lactic acid (mEq/L) LDH (lactic dehydrogenase)

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 60-110 (mg/dl) Up to 140 6-8 65-150 0.7-2.1 56-194 IU/L

LIPOPROTEINS AND TRIGLYCERIDES Cholesterol, total <200 mg/dl HDL cholesterol 30-70 mg/dl LDL cholesterol 65-180 mg/dl Triglycerides 45-155 mg/dl (<160) Osmolality 289-308 mOsm/kg

SGOT (AST) <35 IU/L (20-40) SGPT (ALT) <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 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 Metochlorpramide Narcan Nicardipine Nubain NaHCO3 Nitroprusside Nipride Nimotop NTG (transderm) Nitrobid Orudis Promethazine HCl

Elec. Mod. Elec. Mod. Digitalis Analgesic Anti-ulcer Anti-convul Narcotic anal Anti-emetic Narc. Antag Ca channel blocker, antiangina, vasodilator, antihypertension Narc. Analg. Elec. Mod., alk. Agent Anti-hpn

Use Bronchodilator cdc stim. & Cal channel blocker vasoconstrictor Atni-ang., vasodil Anticholinergic Vasodil, anti-angi Bronchodilator Anti-inflam Anti-pyretic Anti-histamine, anti-emetic, Anti-histamine sed Diuretic Perlinganit Anti-angina Electrolyte modifier Reglan Anti-emetic Ca antagonist Sensorcain HCl Adrenalien Anti-arrhythmic Solucortef Immune response & inflame Analgesic/ anti-pyretic Supp. Anti-infective Toradol Analgesic Anti-infective Zantac Anti-histamine receptor Anti-arrhythmic 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, inotropic 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 osmolarity? 275-295 mOs/kg Anti-angina If a patient's level of Creatine Ca channel blocker, antiCell necrosis in heart. anginal, anti-hypertension, kinase (isoenzyme MB) is high, what does this mean? anti-arrhythmic

If a patient's level of Creatine kinase (isoenzyme BB) is high, what does this mean? If a patient's level of Creatine kinase (isoenzyme MM) is high, what does this mean? If LDH-1 is high, what does it mean? (lactate dehydrogenase isoenzyme 1) If LDH-5 is high, what does it mean? (lactate dehydrogenase isoenzyme 5) If AST level is elevated, what does that mean? (Aspartate aminotransferase) If ALT level is elevated, what does that mean? (Alanine aminotransferase) What is significance of elevated amylase? Normal value of total bilirubin?

Cell necrosis in brain Cel necrosis in heart or skeletal muscle Cell necrosis of heart, erythrocytes, or skeletal muscle Cell necrosis of Liver or skeletal muscle Cell necrosis of heart, liver skeletal muscle Cell necrosis of Liver, skeletal muscle Pancreas, salivary gland cell necrosis .2 - 1.5 mg/dl

Normal value of direct bilirubin?

0 to .3 mg/dl

Normal calcium levels

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.