Mr. NicholsPHHS

Introduce vital signs and their use in clinical practice

Introduce basic laboratory tests and their use in clinical practice

Discuss normal values and test interpretation

TemperaturePulse rateRespiration rate (RR)Blood pressure (BP)

Measure of body’s core temp (temp of internal organs) in ° F (or °C, 1C=1.8F)Locations: oral, rectum, earRectal = 0.5 – 0.7° F higher than oral

tempAxilla = 0.3 – 0.4° F lower than oral

tempNormal: 97.8 – 99° F (36.5 – 37.2° C)Critical: > 98.6° F orally or 99.8° F

rectally (pyrexia [fever]); < 95° F (hypothermia)

Heart rate (HR) or number of heart beats/min

Normal: 60 – 100/min↑ (tachycardia): ↑ Na+ intake,

↓ Na+ loss, Excessive free body H2O loss

↓ (bradycardia): ↓ Na+ intake, ↑ Na+ loss, ↑ free body H2O

Number of breaths/minAt restAlso note breathing effort or

difficultyNormal: 15 – 20/minCritical: < 12 or > 25↑ (hyperventilation): ↑ Na+ intake,

↓ Na+ loss, Excessive free body H2O loss

↓ (hypoventilation): ↓ Na+ intake, ↑ Na+ loss, ↑ free body H2O

Measures the force of blood against the arterial vessel walls Measured while seated, after resting for 5

mins, arm resting @ heart level (if possible) Reported as a fraction (systolic/diastolic) &

consists of 2 separate measurements: Systolic – pressure within artery during

cardiac contraction Diastolic – pressure within artery during

cardiac relaxation and fillingNormal: < 120 mm Hg systolic and <

80 mm Hg diastolicCritical: > 220 mm Hg systolic or >

125 mm Hg diastolic↑ (hypertension [htn]): ↑ Na+

intake, ↓ Na+ loss, Excessive free body H2O loss

↓ (hypotention): ↓ Na+ intake, ↑ Na+ loss, ↑ free body H2O

Provides information on cellular components of blood

Includes RBC count, Hemoglobin (Hgb), Hematocrit (Hct), RBC indices, White blood cell (WBC) count and differential, Platelet count

Measurement of total WBC count Consists of total # of WBCs/mm3 of

peripheral venous blood Part of “routine” testing Useful for evaluation of infection,

neoplasm, allergy & immunosuppression

Normal: 4,000 – 10,000/mm3

Critical: < 2,500 or > 30,000/mm3

↑ (leukocytosis): infection, malignancy, trauma, stress, hemorrhage, tissue necrosis, inflammation, dehydration, thyroid storm

↓ (leukopenia): drug toxicity, bone marrow failure, overwhelming infections, dietary deficiency, congenital marrow aplasia, bone marrow infiltration, autoimmune disease, hypersplenism

Measures # of circulating RBCs/mm3 of peripheral venous blood Direct measure of RBC count Part of “routine” testing and

anemia evaluation Normal: 3.5 – 5.5 x 106/μL ↑: erythrocytosis, congenital

heart disease, severe COPD, polycythemia vera, severe dehydration, hemoglobinopathies

↓: anemia, hemoglobinopathy, hemorrhage, bone marrow failure, renal disease, leukemia, prosthetic valves, normal pregnancy, multiple myeloma, Hodgkin disease, lymphoma, dietary deficiency

Measures total amount of Hgb in blood Indirect measure of RBC count Part of “routine” testing and anemia

evaluationNormal: 12 – 15 g/dL Critical: < 5 or > 20 g/dL↑: erythrocytosis, congenital

heart disease, severe COPD, polycythemia vera, severe dehydration

↓: anemia, hemoglobinopathy, hemorrhage, bone marrow failure, renal disease, leukemia, prosthetic valves, normal pregnancy, multiple myeloma, Hodgkin disease, lymphoma, dietary deficiency

Measure of RBC percent of total blood vol Indirect measure of RBC # & volume Part of “routine” testing and anemia

evaluationNormal: 36 – 48% Critical: < 15% or > 60%↑: erythrocytosis, congenital heart

disease, severe COPD, polycythemia vera, severe dehydration

↓: anemia, hemoglobinopathy, hemorrhage, bone marrow failure, renal disease, leukemia, prosthetic valves, normal pregnancy, multiple myeloma, Hodgkin disease, lymphoma, dietary deficiency

Measure of average volume/size of single RBC MCV = Hct (%) x 10/RBC (million/mm3) Useful in anemia classification

Normal: 80 – 100 mm3

↑ (macrocytic): pernicious anemia (vit B12 deficiency), folic acid deficiency, antimetabolic therapy, alcoholism, chronic liver disease, hypothyroidism

Normocytic: bone marrow failure/replacement, acute blood loss, chronic diseases, hemolytic anemias

↓ (microcytic): Fe deficiency anemia, thalassemia, anemia of chronic illness

Measure of average amount of hgb within a single RBCMCH = Hgb (g/dL) x 10/RBC

(million/mm3)Provides little additional info to

other indicesNormal: 24 – 32 pg↑: macrocytic anemias↓: microcytic anemia,

hypochromic anemia

Measure of average [hgb] within a single RBCMCHC = Hgb (g/dL) x 100/Hct (%)37 g/dL = maximum Hgb able to fit

into an RBC (cannot be hyperchromic)

Normal (normochromic): 32 – 36 g/dL

↑: spherocytosis, intravascular hemolysis, cold agglutinins

↓ (hypochromic): Fe deficiency anemia, thalassemia

Measure of variation of RBC size (indicator of degree of anisocytosis)Useful in anemia

classificationNormal: variation of

11.5 – 16.9%↑: Fe deficiency

anemia, vit B12 or folate deficiency anemia, hemoglobinopathies, hemolytic anemias, posthemorrhagic anemias

Measurement of platelets (thrombocytes) Consists of actual # of platelets/mm3 of

peripheral venous blood Part of “routine” testing Useful for evaluation of petechiae,

spontaneous bleeding, increasingly heavy menses or thrombocytopenia

Useful for monitoring discourse/therapy of thrombocytopenia/bone marrow failure

Normal: 150,000 – 400,000/mm3

Critical: < 50,000 or > 1,000,000/mm3

↑ (thrombocytosis): malignant disorders, polycythemia vera, postsplenectomy syndrome, rheumatoid arthritis, Fe deficiency anemia

↓ (thrombocytopenia): Hypersplenism, hemorrhage, immune thrombocytopenia, leukemia & other myelofibrosis disorders, TTP, DIC, SLE, chemotherapy, pernicious anemia

Leukocytosis – abnormally large number of leukocytes; generally indicated by WBC count of ≥ 10,000 cells/mm3

Lymphocytosis – form of actual or relative leukocytosis due to increase in numbers of lymphocytes

Left shift – increase in the number of immature neutrophils (bands/stabs) found in the blood

Measurement of percentage of each WBC type in specimenUseful for infection, neoplasm,

allergy & immunosuppression evaluations

Normal: Neutrophils (50 – 70%), Lymphocytes (20 – 40%), Monocytes (2 – 8%), Eosinophils (0 – 5%), Basophils (0 – 2%)

↑: refer to individual cell types on chart

↓: refer to individual cell types on chart

Measures electrolytes, chemicals, metabolic end products & substrates

Consists of Glucose, Blood Urea Nitrogen (BUN), Creatinine, Na+, K+, Cl-, Bicarbonate (HCO3

-), Ca2+

Direct measure of blood glucose Commonly used to evaluate diabetic pts Part of “routine” testing

Normal: 70 - 100 mg/dLCritical: < 50 and > 400 mg/dL ( ) or < ♂

40 and > 400 mg/dL ( )♀↑ (hyperglycemia): DM, acute stress

response, Cushing syndrome, pheochromocytoma, chronic renal failure, acute pancreatitis, acromegaly, corticosteroid therapy

↓ (hypoglycemia): insulinoma, hypothyroidism, hypopituitarism, Addison disease, extensive liver disease, insulin overdose, starvation

Measures urea nitrogen in blood End product of protein metabolism (produced in

liver) Indirect measure of renal function & glomerular

function (excretion) Measure of liver metabolic function Part of routine labs Usually interpreted along with Cr (less accurate

than Cr for renal disease)Normal: 6 -21 mg/dLCritical: > 100 mg/dL↑: prerenal causes, renal causes,

postrenal azotemia↓: liver failure, overhydration because of

SIADH, neg nitrogen balance, pregnancy, nephrotic syndrome

Measures serum sodium level Major cation in EC space Balance between dietary

intake and renal excretionNormal: 136 – 146

mEq/LCritical: < 120 or > 160

mEq/L↑ (hypernatremia): ↑

Na+ intake, ↓ Na+ loss, Excessive free body H2O loss

↓ (hyponatremia): ↓ Na+ intake, ↑ Na+ loss, ↑ free body H2O

Measures serum potassium level Major cation within cell

Normal: 3.4 – 5.2 mEq/LCritical: < 2.5 or > 6.5

mEq/L↑ (hyperkalemia):

excessive intake, acidosis, acute/chronic renal failure, Addison disease, hypoaldosteronism, infection, dehydration

↓ (hypokalemia): deficient intake, burns, hyperaldosteronism, Cushing syndrome, RTA, licorice ingestion, alkalosis, renal artery stenosis

Measures CO2 content of blood Major role in acid-base

balance Regulated by kidneys Used to evaluate pt pH status

& electrolytes Normal: 22 – 32 mEq/L Critical: < 6 mEq/L ↑: severe vomiting, high-

volume gastric suction, aldosteronism, mercurial diuretic use, COPD, metabolic alkalosis

↓: chronic diarrhea, chronic loop diuretic use, renal failure, DKA, starvation, metabolic acidosis, shock

Measures serum calcium level Direct measurement Used to evaluate parathyroid

function & Ca metabolism Used to monitor renal failure,

renal transplantation, hyperparathyroidism, various malignancies, & Ca level when giving large-volume blood transfusions

Normal: Total = 8.3 – 10.3 mg/dL, Ionized = 4.5 – 5.6 mg/dL

Critical: Total < 6 or > 13 mg/dL, Ionized < 2.2 or > 7 mg/dL

↑ (hypercalcemia): hyperparathyroidism, bone mets, Paget disease of bone, prolonged immobilization, milk-alkali syndrome, vit D intoxication, hyperthyroidism

↓ (hypocalcemia): hypoparathyroidism, renal failure, rickets, vit D deficiency, osteomalacia, pancreatitis, alkalosis, malabsorption, fat embolism

Measures total protein in blood Combination of prealbumin, albumin &

globulins

Normal: 6.4 – 8.3 g/dL

Provides information about kidneys & other metabolic processes

Used for diagnosis, screening & monitoring

Frequently used to test for urinary tract infections (UTIs)

Appearance: clearColor: amber yellowOdor: aromaticpH: 4.6 – 8Protein: 0 – 8 mg/dLNitrites: noneKetones: none

Crystals: noneGlucose: negativeWhite Blood Cells: 0 –

4/low-power fieldWBC casts: noneRed Blood Cells

(RBCs): ≤ 2RBC casts: none

Examples: β-hydroxybutyric acid, acetoacetic acid, acetone

Associated with poorly controlled diabetes

Used to evaluate ketoacidosis associated w/ alcoholism, fasting, starvation, high-protein diets, isopropanol ingestion

Screen for UTI (dipstick method)

Test based on chemical rxn by bacterial reductase (reduces nitrate to nitrite)

50% accurate

Collected via lumbar puncture (LP)

Useful for the diagnosis metastatic brain/spinal cord neoplasm, cerebral hemorrhage, meningitis, encephalitis, degenerative brain disease, autoimmune diseases w/ CNS involvement, neurosyphilis, demyelinating diseases

Opening pressure: <20 cm H2O

Color: clear & colorlessBlood: noneRBCs: 0WBCs: 0 – 5 cells/μLNeutrophils: 0 – 6%Lymphocytes: 40 – 80%Monocytes: 15 – 45%

Protein: 15 – 45 mg/dLGlucose: 50 – 75 mg/dL

or 60 – 70% of blood glucose level

Causes of ↑ lymphs/plasma cells: viral, tubercular, fungal or syphilitic meningitis; multiple sclerosis (MS), Guillain-Barré syndrome