پرستاري مراقبت ويژه

این وبلاگ جهت آموزش واطلاع رسانی به پرستاران عزیز و زحمت کش شاغل در هر جای کشور

-      بیوشیمی 

 

1-1-1: Sodium, including Free Water Deficits, and an Extremely Important Thing

1-1-2: Potassium

 1-1-3: Magnesium

1-1-4: Chloride

1-1-5: Bicarb

1-1-6: BUN

1-1-7: Creatinine

1-1-8: Glucose

i.   Acetone

ii. HbA1C

1-1-9: Calcium

              i.      Ionized Calcium

              ii.      Corrected Calcium

                 iii.      Calcium and Citrate Toxicity

1-1-10: Phosphorus

 1-2- Some other basic chems:

 1-2-1: Lactate

1-2-2: Osmolality

1-2-3: Amylase

1-2-4: Lipase

1-2-5: Ammonia

1-2-6: Albumin

 1-3: Renal Labs

 1-3-1: Creatinine Clearance

1-3-2: Uric Acid

1-3-3: Myoglobin

1-3-4: Urinalysis

1-3-5: 24-hour urine collections

1-3-6: urine electrolytes

 1-4: Drug Levels

1-4-1: Dilantin

1-4-2: Valproate

1-4-3: Tegretol

1-4-4:Lithium

1-4-5:Theophylline

1-4-6:Thiocyanate

1-4-7: Vancomycin

1-4-8: Gentamicin

1-4-9: Digoxin

1-4-10: Tacrolimus, cyclosporine

1-4-11: Peaks, Troughs, and Random Levels

 1-5: Tox Screen Panel Meds

1-5-1: Tylenol

1-5-2: Salicylates

1-5-3: Opiates

1-5-4: Cocaine

1-5-5: Benzodiazepines

1-5-6: Ethanol

1-5-7: Methanol

1-5-8: Ethylene glycol

1-5-9: Miscellaneous

1-5-10: A really cool thing.

1-5-11: A scary story…

  1-6: Cardiac Labs

               -     Electrolytes

 1-6-1: Potassium

1-6-2: Magnesium

       -     Cardiac Enzymes

  1-6-3: What are cardiac enzymes?

1-6-4: كدام انزيمهاي قلبي بايد در بيمار پيگيري شوند?

1-6-5: ايا بدون انفركتوس ميوكارد هم ممكن است انزيمها افزايش يابند?

1-6-6: ايا ممكن است بيماري انفاركتوس قلبي بدون افزايش انزيم ها داشته باشد?

1-6-7: چيستCPK ?

1-6-8: منبع اصلي اندازه گيريCPK  چيست ?

1-6-9: ايزو انزيم چيست?

1-6-10: چيست“MB fraction”?

1-6-11: چيست MM and BB?

1-6-12:  ايا CPK بيشتر نشانگر وسيع تر است ?

1-6-13:  1-6-14:  چيست troponin?

1-6-15:  منبع افزايش troponin چيست ?

1-6-18:  ايا ممكن است انزيمهاي قلبي در ايسكمي بدونMI افزايش يابد1

-6-19: چيستhBNP ?

1-6-20:  C-reactive protein چيست?

 1-7: Lipids

 1-7-1: Total Cholesterol

1-7-2: HDL

1-7-3: LDL

1-7-4: Triglycerides

 2- Respiratory Labs:

             2-1: ABGs:

2-1-1: pO2

2-1-2: pCO2

2-1-3: pH

2-1-4: bicarb

 

2-2: VBGs

 

2-2-1: ايا انچهVBG  ميگويد را باور كنيم ?

2-2-2:  sats ورید مرکزی چیست?

2-2-3: تفاوت بین central venous sat وmixed venous sat?

 2-2: Carboxyhemoglobin

2-3: Methemoglobin

2-4: چیست anion gap” labs?

2-4-1: Acidoses

2-4-2: Alkaloses

2-4-3: Calculating the Gap

2-5: Alpha-1 Antitrypsin

3- Liver Function Tests

             3-1: A story.

 -    3-1-1: Cherry blossoms

            3-2: Bilirubin: direct, indirect, total

            3-3, 4: ALT, AST

            3-5: Alkaline Phosphatase

            3-6,7: PT and PTT (Why are these here?)

            3-8: SPEP

            3-9: Hepatidites

3-9-1: Hepatitis A

3-9-2: Hepatitis B

3-9-3: Hepatitis C

4 – Hematology

            4-1: Hematocrit

            4-2: White count4-2-1: the differential

4-2-2: A true saying

4-3: Platelets

4-3-1: Heparin-Induced Thrombocyopenia

4-4: Coagulation Studies

4-4-1: PT

4-4-2: PTT

4-4-3: INR

4-5: D-dimer

4-6: DIC screen

4-7: Fibrin Split Products

4-8: Fibrinogen

4-9: ESR

4-10: Coombs test

5- ID

 

            5-1: Cultures

            5-2: Sensitivity Reports

            5-3: Some specific tests:

 

5-3-1: TB/ AFB’s

5-3-2: Influenza

5-3-3: H5N1 Avian Flu

5-3-4: HIV testing/ CD4 count

5-3-5: Viral Load

5-3-6: CMV

5-3-7: RSV

5-3-8: Herpes testing

5-3-9: Branch-chain DNA and PCR

5-3-10: Kary Mullis

5-3-11: Lyme Disease and Babesia

 

5-4: CSF

 

5-4-1: Which kind of infection?

5-4-2: Some normal values for CSF

 

5-5: Opportunistic Infections in the MICU

 

5-5-1: MRSA

5-5-2: VRE

5-5-4: C.difficile

 6- Endocrine

 6-1: Thyroid Studies

            6-2: “Cort-stim” tests

            6-3: Testosterone

            6-4: Beta HcG

7- Immunology

 7-1: A New Discovery - “Anti-RN” Antibodies

            7-2: ANA

            7-3: ANCA

            7-4: Rheumatoid Factor

            7-5: Scleroderma Antibody

            7-6: Immunoglobulins

     10- Odds and Ends:

                10-1: Tumor markers

 

                        10-3-1: PSA

                        10-3-2: CEA

 

            10-2: Haptoglobin

  12- Collecting lab specimens:

            12-1: Blood Draws

 12-1-1: peripheral sticks

12-1-2: specimens from arterial lines

12-1-2-1: ABGs

12-1-2-2:Other labs

12-1-3: specimens from central lines

1-      VBGs/ CV sats

2-      What is a “true” mixed venous specimen?

12-1-4: blood cultures

12-2: Urines

12-2-1: UA specimens

12-2-2: Urine cultures

12-2-3: 24-hour urine collections

 

 12-3: Sputum Specimens

12-4- Stool specimens

12-4-1: stool for O&P

12-4-2: stool for C.diff

12-4-3: stool for occult blood

 

 
HEMATOLOGY VALUES  
Red Blood Cell Values  
RBC (Male) 4.2 - 5.6 M/µL
RBC (Female) 3.8 - 5.1 M/µL
RBC (Child) 3.5 - 5.0 M/µL
White Blood Cell Values  
WBC (Male) 3.8 - 11.0 K / mm cubed
WBC (Female) 3.8 - 11.0 K / mm cubed
WBC (Child) 5.0 - 10.0 K / mm cubed
Hemoglobin Values  
Hgb (Male) 14 - 18 g/dL
Hgb (Female) 11 - 16 g/dL
Hgb (child) 10 - 14 g/dL
Hgb (Newborn) 15 - 25 g/dL
Hematocrit Values  
Hct (Male) 39 - 54%
Hct (Female) 34 - 47%
Hct (Child) 30 - 42%
MCV 78 - 98 fL
MCH 27 - 35 pg
MCHC 31 - 37%
Neutrophils 50 - 81%
Bands 1 - 5%
Lymphocytes 14 - 44%
Monocytes 2 - 6%
Eosinophils 1 - 5%
Basophils 0 - 1%
Hematology Values  
CD4+ (normal % value) 31 - 63%
CD4+ (absolute count) 416 - 1751/µL
Red Cell Distribution Width (RDW) Coefficient of variation: 11.5 - 14.5%, Standard deviation: 35 - 47 fL
Reticulocyte (adult) 0.5% - 1.5%
Reticulocyte (infant) 0.5% - 3.1%
Reticulocyte (newborn) 1.1% - 4.5%
Polymorphonuclear WBC's (PMN) 35 - 80%
CARDIAC MARKERS  
Troponin I 0 - 0.1 ng/ml (onset: 4-6 hrs, peak: 12-24 hrs, return to normal: 4-7 days)
Troponin T 0 - 0.2 ng/ml (onset: 3-4 hrs, peak: 10-24 hrs, return to normal: 10-14 days)
Myoglobin (Male) 10 - 95 ng/ml (onset: 1-3 hrs, peak: 6-10 hrs, return to normal: 12-24 hrs)
Myoglobin (Female) 10 - 65 ng/ml (onset: 1-3 hrs, peak: 6-10 hrs, return to normal: 12-24 hrs)
Troponin I 0 - 0.1 ng/ml (onset: 4-6 hrs, peak: 12-24 hrs, return to normal: 4-7 days)
Creatinine Kinase Index (CK-Index) 0 - 3
Creatinine Kinase-MB (CK-MB) 0 - 3 ng/ml
Total Creatinine Kinase 38 - 120 ng/ml
GENERAL CHEMISTRY  
Acetone 0.3 - 2.0 mg%
Alanine Aminotransferase (ALT) 7 - 56 U/L
Albumin 3.5 - 5.0 gm/dL
Albumin (newborn) 2.9 - 5.5 gm/dL
Albumin (child) 3.8 - 5.4 gm/dL
Alkaline Phosphatase 32 - 110 U/L
Anion gap 5 - 16 mEq/L
Ammonia 11 - 35 µmol/L
Amylase 50 - 150 U/dL
Anti-streptolysin O Titer (ASO) (adult) <125
Anti-streptolysin O Titer (ASO) (child) <250
AST, SGOT (Male) 7 - 21 U/L
AST, SGOT (Female) 6 - 18 U/L
Bilirubin, Direct 0.0 - 0.4 mg/dL
Bilirubin, Indirect total minus direct
Bilirubin, Total 0.2 - 1.4 mg/dL
BUN 6 - 23 mg/dL
Calcium (total) 8 - 11 mg/dL
Carbon dioxide 21 - 34 mEq/L
Carbon monoxide symptoms at greater than or equal to 10% saturation
Chloride 96 - 112 mEq/L
CK-MM 96 - 100%
CK-BB 0%
Cortisol (8 AM) 5 - 25 gm/dL
Cortisol (8 PM) 2 - 9 gm/dL
Creatine (Male) 0.2 - 0.6 mg/dL
Creatine (Female) 0.6 - 1.0 mg/dL
Creatinine 0.6 - 1.5 mg/dL
Creatinine (newborn) 0.3 - 0.7mg/dL
Creatinine (child) 0.3 - 1.0 mg/dL
Creatinine Kinase Isoenzyme, MB 0 - 121 U/L
Creatinine Phosphokinase (CPK) 24 - 195 U/L
Ethanol 0 mg%; Coma: greater than or equal to 400 - 500 mg%
Ferritin (male) 18 - 250 ng/mL
Ferritin (female) 12 - 160 ng/mL
Folate 3.6 - 20 ng/mL
Folic acid 2.0 - 21 ng/mL
Gamma GT 8 - 78 U/L
Gamma-glutamyl transferase (GGT) (male) 1 - 94 U/L
Gamma-glutamyl transferase (GGT) (female) 1 - 70 U/L
Glucose 70 - 110 mg/dL (diuresis greater than or equal to 180 mg/dL)
Growth Hormone (male) 0 - 4 ng/mL
Growth Hormone (female) 0 - 18 ng/mL
IGF-1 (male) 54 - 329 ng/mL
IGF-1 (female) 142 - 329 ng/mL
HDL (Male) 25 - 65 mg/dL
HDL (Female) 38 - 94 mg/dL
Insulin 0 - 180 pmol/L
Iron 52 - 169 µg/dL
Iron binding capacity 246 - 455 µg/dL
Lactic acid 0.4 - 2.3 mEq/L
Lactate 0.3 - 2.3 mEq/L
Lipase 10 - 140 U/L
Magnesium 1.5 - 2.5 mg/dL
Osmolarity 276 - 295 mOsm/kg
Parathyroid hormone 12 - 68 pg/mL
Phosphorus 2.2 - 4.8 mg/dL
Potasssium 3.5 - 5.5 mEq/L
Protein (total) 6.0 - 9.0 gm/dL
SGPT 8 - 32 U/L
Sodium 135 - 148 mEq/L
T3 0.8 - 1.1 µg/dL
Thyroglobulin Less than 55 ng/mL
Thyroxine (T4) total 5 - 13 µg/dL
Thyroxine-binding Globulin (TBG) 12 - 30 mg/L
Free Thyroxine (T4 Free) 0.8 - 1.5 ng/dL
Total protein 5 - 9 gm/dL
Total serum iron (male) 76 - 198 µg/dL
Total serum iron (female) 26 - 170 µg/dL
Transferrin 204 - 360 mg/dL
TSH Less than 9 µU/mL
Urea nitrogen (BUN) 7 - 25 mg/dL
Uric acid (Male) 3.5 - 7.7 mg/dL
Uric acid (Female) 2.5 - 6.6 mg/dL
LIPID PANEL (ADULT)  
Cholesterol (total) Less than 200 mg/dL desirable
Cholesterol (HDL) 30 - 75 mg/dL
Cholesterol (LDL) Less than 130 mg/dL desirable
Triglycerides (Male) Greater than 40 - 170 mg/dL
Triglycerides (Female) Greater than 35 - 135 mg/dL
URINE VALUES  
Color Straw
Specific Gravity 1.003 - 1.040
pH 4.6 - 8.0
Na 10 - 40 mEq/L
K Less than 8 mEq/L
Cl Less than 8 mEq/L
Protein 1 - 15 mg/dL
Osmolality 80 - 1300 mOsm/L
24 HOUR URINE VALUES  
Amylase 250 - 1100 IU / 24 hr
Calcium 100 - 250 mg / 24 hr
Chloride 110 - 250 mEq / 24 hr
Creatinine 1 - 2 g / 24 hr
Creatine Clearance (Male) 100 - 140 mL / min
Creatine Clearance (Male) 16 - 26 mg / kg / 24 hr
Creatine Clearance (Female) 80 - 130 mL / min
Creatine Clearance (Female) 10 - 20 mg / kg / 24 hr
Magnesium 6 - 9 mEq / 24 hr
Osmolality 450 - 900 mOsm / kg
Phosphorus 0.9 - 1.3 g / 24 hr
Potassium 35 - 85 mEq / 24 hr
Protein 0 - 150 mg / 24 hr
Sodium 30 - 280 mEq / 24 hr
Urea nitrogen 10 - 22 gm / 24 hr
Uric acid 240 - 755 mg / 24 hr
COAGULATION  
ACT 90 - 130 seconds
APTT 21 - 35 seconds
Platelets 140,000 - 450,000 / ml
Plasminogen 62 - 130%
PT 10 - 14 seconds
PTT 32 - 45 seconds
FSP Less than 10 µg/dL
Fibrinogen 160 - 450 mg/dL
Bleeding time 3 - 7 minutes
Thrombin time 11 - 15 seconds
CEREBRAL SPINAL FLUID  
Appearance clear
Glucose 40 - 85 mg/dL
Osmolality 290 - 298 mOsm/L
Pressure 70 - 180 mm/H2O
Protein 15 - 45 mg/dL
Total cell count 0 - 5 cells
WBC's 0 - 6 / µL
HEMODYNAMIC PARAMETERS  
Cardiac Index 2.5 - 4.2 L / min / m squared
Cardiac Output 4 - 8 LPM
Left Ventricular Stroke Work Index 40 - 70 g / m squared / beat
Mean Arterial Pressure 70 - 105 mm Hg
Pulmonary Vascular Resistance 155 - 255 dynes / sec / cm to the negative 5
Pulmonary Vaslular Resistance Index 255 - 285 dynes / sec / cm to the negative 5
Right Ventricular Stroke Work Index 7 - 12 g / m squared / beat
Stroke Volume 60 - 100 mL / beat
Stroke Volume Index 40 - 85 mL / m squared / beat
Systemic Vascular Resistance 900 - 1600 dynes / sec / cm to the negative 5
Systemic Vascular Resistance Index 1970 - 2390 dynes / sec / cm to the negative 5
Systolic Arterial Pressure 90 - 140 mm Hg
Diastolic Arterial Pressure 60 - 90 mm Hg
Central Venous Pressure 2 - 6 mm Hg; 2.5 - 12 cm H2O
Ejection Fraction 60 - 75%
Left Arterial Pressure 4 - 12 mm Hg
Pulmonary Artery Systolic 15 - 30 mm Hg
Pulmonary Artery Diastolic 5 - 15 mm Hg
Pulmonary Artery Pressure 10 - 20 mm Hg
Pulmonary Artery Wedge Pressure 4 - 12 mm Hg
Pulmonary Artery End Diastolic Pressure 8 - 10 mm Hg
Right Atrial Pressure 4 - 6 mm Hg
Right Ventricular End Diastolic Pressure 0 - 8 mm Hg
NEUROLOGICAL VALUES  
Cerebral Perfusion Pressure 70 - 90 mm Hg
Intracranial Pressure 5 - 15 mm Hg or 5 - 10 cm H2O
ARTERIAL VALUES  
pH 7.35 - 7.45
PaCO2 35 - 45 mm Hg
HCO3 22 - 26 mEq/L
O2 sat 96 - 100%
PaO2 85 - 100 mm Hg
BE -2 to +2 mmol/L
VENOUS VALUES  
pH 7.31 - 7.41
PaCO2 41 - 51 mm Hg
HCO3 22 - 29 mEq/L
O2 sat 60 - 85%
PaO2 30 - 40 mm Hg
BE

0 to +4 mmol/L

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