Class notes
NCLEX Fundmentals
Notes were compiled from Archer (NCLEX preparatory course). Covers lab values and ABG interpretation, Fluids and electrolytes, medications and pharmacology, and EKG interpretation.
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1. Lab Values & ABG InterpretationComplete Blood Count (CBC)
Hemoglobin (Hgb): transports O2
Hematocrit: % of RBCs in the body
● If these are HIGH then patient is dehydrated (losing fluid makes concentrated blood)
● If these are LOW then patient has anemia or is hemorrhaging
White blood cells: If LOW then immunocompromised, if HIGH then infection
Platelets: Clotting
Coagulation panel
PTT: For heparin, should be 1.5-2.5x normal if patient is on heparin
● Intrinsic cascade
● Heparin does NOT dissolve clots, just stops new ones from forming
PT: For warfarin
● Extrinsic cascade
INR: Tests how well warfarin is working
Metabolic panel
GFR: Is age-dependent, >90
● If LOW, makes toxins like Cr and BUN build up
Liver function tests
Goes UP when there’s a problem ● ALP
● AST
● ALT
All liver enzymes
Goes DOWN when there’s a problem ● Total protein
● Albumin
○ Helps H2O stay in the blood
○ If LOW, then edema can happen
Should be excreted by the liver, so ● Bilirubin
they should be very low ● Ammonia
Cardiac labs
Troponin: Protein found in the cardiac muscle, released under stress or injury (most specific)
BNP: A hormone released from the RA to tell the heart to pump harder to eject blood, so if HIGH,
then indicative of HF/fluid retention because more BNP is needed to pump
CPK: Enzyme; very general test
, ● If HIGH, tissue somewhere in body is damaged
CPK-MB: Should be 0%; specific to cardiac cells
Myoglobin: In cardiac muscle
● If HIGH, then injury to cardiac muscle
Lipid panel
Total cholesterol: made up of:
● HDL (should be HIGH)
● LDL (should be LOW)
● Triglycerides
Thyroid panel
Thyroid-stimulating hormone: uses a negative feedback loop; NOT made by the thyroid
● LOW in hyperthyroidism/Graves’ disease
● HIGH in hypothyroidism
Made by the thyroid:
● T4 (thyroxine)
● T3 (triiodothyronine)
● Both HIGH in hyperthyroidism
● Both LOW in hypothyroidism
Hemoglobin A1C (HgA1C)
● If HIGH, then higher % of RBCs attached to a glucose molecule → lower O2-carrying capacity
● Different range for diabetics (good under 7%)
Miscellaneous
D-dimer: Indicates a clot somewhere
CRP: Indicates inflammation
Erythrocyte sedimentation rate (ESR): Tests for inflammation
Urine studies
Specific gravity and osmolarity: Both test for how concentrated the urine is
● If HIGH, dehydration
● If LOW, diuted urine
Albumin: If HIGH then kidney disease
WBC in urine: If HIGH then inflammation or UTI
Protein: Should be negative
● If POSITIVE, indicates kidney disease/preeclampsia
Glucose: Should be negative
● If POSITIVE, indicates diabetes/kidney disease
Ketones: Should be negative
● If POSITIVE, indicates diabetes/kidney disease
, ABG Interpretation
● pH: 7.35-7.45
● Bicarbonate (HCO3): 22-28
○ Kidney/metabolic problem
● CO2: 35-45
○ Respiratory problem
Follow these 3 steps!
1. Acidotic or alkalotic?
● Uncompensated acidosis: < 7.35
○ Compensated acidosis: 7.35-7.39
● Uncompensated Alkalosis: > 7.45
○ Compensated alkalosis: 7.41-7.45
2. Metabolic or respiratory?
● LOW CO2: respiratory alkalosis
○ Hyperventilation
● HIGH CO2: respiratory acidosis
○ Hypoventilation, COPD, asthma, overdose
● LOW bicarb: metabolic acidosis
○ Renal disease, diarrhea
● HIGH bicarb: metabolic alkalosis
○ Too much sodium bicarb, antacids, vomiting
3. Compensated or uncompensated?
● Partially compensated: All three values are abnormal
● Uncompensated: Either CO2 or HCO3 is abnormal with abnormal pH
● Fully compensated: Normal pH
2. Fluids and Electrolytes
SODIUM
ALWAYS think of neuro status with sodium
Role ● Regulates water in the cells of the body, where it goes, water follows
● Needed for MSK
Note: Cushing’s = too much aldosterone = HYPERnatremia ; Addison’s = not enough
aldosterone = HYPOnatremia
HYPOnatremia Euvolemic hyponatremia: Water level increases but same level of Na so
concentration of Na is diluted (however water level isn’t enough where it messes up
their fluid balance)
● Treatment: Restrict H2O/give diuretics, give more Na
, Role ● Regulates water in the cells of the body, where it goes, water follows
● Needed for MSK
Note: Cushing’s = too much aldosterone = HYPERnatremia ; Addison’s = not enough
aldosterone = HYPOnatremia
Hypervolemic hyponatremia: WAYYY too much water, dilutes Na
● CHF, kidney failure, liver failure, water intoxication
● Treatment: Restrict H2O/give diuretics, give more Na
Hypovolemic hyponatremia: Both Na and water lost
● Vomiting, diarrhoea, NG suction, diuretics, burns, diaphoresis
● Treatment: Restore both Na and H2O with IV fluids
Causes: “DOBS Fail”
Diuretics: hydrochlorothiazide, spironolactone
Oral gastric tube suctioning
Burns
SIADH
Failure of the heart, liver, kidneys
Assessment: most concerning is neuro (i.e seizures)
● Any muscles are affected: Shallow respirations, hyperactive bowel sounds,
muscle spasms, decreased DTR, weakness, orthostatic hypotension, cerebral
edema, increased ICP, stupor
“LOW SODIUM”
LOC
Orthostatic hypotension
Weak muscles
Seizures
Osmolality in blood low
Diarrhoea
Increased ICP
Urine osmolality high
More bowel sounds
HYPERnatremia Euvolemic hypernatremia: Decreased water with near normal Na (not enough to
mess with fluid balance)
● Insensible water loss: hyperventilation, excessive sweating, fever
● Water is more concentrated because same amount of Na
● Treatment: PO intake of water
Hypovolemic hypernatremia: Decreased water, relative increase of Na in blood
● Dehydration, NPO
● Diarrhoea
● Vomiting
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