a.

Other function tests 

A. AST/ALT, 
a) Definition

Aspartate aminotransferase (AST), formerly known as glutamic-oxaloacetic

transaminase (GOT), catalyzes the reversible transfer of an amino between the amino acid,
aspartate, and alpha-ketoglutamic acid. ALT exists in large amounts in both liver and
myocardial cells and in smaller but significant amounts in skeletal muscles, kidneys,
pancreas, and brain. Serum AST rises when cellular damage occurs to the tissues in which
the enzyme is found.

Alanine aminotransferase (ALT), formerly known as glutamic-pyruvic transaminase

(GPT), catalyzes the reversible transfer of an amino group between the amino acid, alanine,
and -ketoglutamic acid. Hepatocytes are virtually the only cells with high ALT
concentrations, although the heart, kidneys, and skeletal muscles contain moderate
amounts.

b) Purposes

An AST blood test measures the amount of AST in your blood and can help your health care
provider diagnose liver damage or disease.

Elevated serum ALT levels are considered a sensitive index of liver damage resulting from a
variety of disorders and numerous drugs, including alcohol. Elevations also may be seen in
nonhepatic disorders such as muscular dystrophy, extensive muscular trauma, myocardial
infarction, congestive heart failure (CHF), and renal failure, although the increase in ALT
produced by these disorders is not as great as that produced by conditions affecting the
liver.

c) Indication

Alanine Aminotransferase
 Known liver disease or liver damage caused by hepatotoxic drugs:
o Markedly elevated levels (sometimes as high as 20 times normal) are
considered confirmatory of liver disease
o A sudden drop in serum ALT levels in the presence of acute illness after
extreme elevation of blood levels is an ominous sign and indicates so many
cells have been damaged that no additional source of enzyme remains.
 Monitoring for response to treatment for liver disease, with tissue repair indicated
by gradually declining levels
Aspartate Aminotransferase
 Suspected disorders or injuries involving the liver, myocardium, kidneys, pancreas,
or brain, with elevated levels indicating cellular damage to tissues in which AST is
normally found.
 Monitoring of response to therapy with potentially hepatotoxic or nephrotoxic
drugs.
  Monitoring of response to treatment for various disorders in which AST may be
elevated, with tissue repair indicated by declining levels.
d) Contraindication
None

Interfering factors
Exercise increases levels; medications that increase results are antibiotics, allopurinol,
anabolic steroids, barbiturates, antihypertensives, salicylates, albumin, Imuran, and
flourides; pregnancy falsely decreases and increases levels

e) Equipment
1. Red-top tube or serum separator tube
2. Needle
3. Syringe or vacutainer
4. Alcohol swab

f) Patient Preparations
 Client should abstain from alcohol for at least 24 hours before the study.
 Because many drugs may alter ALT levels, a medication history should be obtained.
It is recommended that drugs that may alter test results be withheld for 12 hours
before the test, although this practice should be confirmed with the person ordering
the study.

g) Normal values
Alanine Amino Transferase

Aspartate Aminotransferase
 h) Procedure
1. Label the specimen tube. Correctly identifies the client and the test to be
performed.
2. Obtain a 5-ml blood sample.
3. Do not agitate the tube. Agitatation may cause RBC hemolysis.
4. Send tube to the laboratory

i) Implications of abnormal results

1. Elevated levels are found with acute myocardial infarction, severe angina,
hepatitis, liver necrosis, cancer of liver, alcoholism, musculoskeletal disease,
recent convulsions, heat stroke, severe burns, acute pancreatitis, strenuous
exercise, toxic shock syndrome, cerebral infarction, trauma, and
intramuscular injection.
2. Decreased levels are found with diabetic ketoacidosis, hemodialysis and
chronic liver disease.

j) Important Nursing Responsibilities

Nursing Care:
 Resume any drugs withheld before the test.
 Abnormal levels: Note and report increased levels. Assess symptoms of liver
dysfunction associated with increases such as jaundice, anorexia, and fatigue. Relate
increases to other liver function tests. Provide rest and interventions to conserve
energy. Tell client which drugs to avoid and encourage client to eat a healthy diet.

B. LDH, 
a) Definition

Lactic dehydrogenase (LDH) catalyzes the reversible conversion of lactic acid to pyruvic acid
within cells. Because many tissues contain LDH, elevated total LDH is considered a
nonspecific indication of cellular damage unless other clinical data make the tissue origin
obvious.

b) Purposes

Pronounced elevations in total LDH are seen in clients with megaloblastic anemia,
metastatic cancer (especially if the liver is involved), shock, hypoxia, hepatitis, and renal
infarction. Moderate elevations occur in those with myocardial and pulmonary infarctions,
hemolytic conditions, leukemias, infectious mononucleosis, delirium tremens, and muscular
dystrophy. Mild elevations are associated with most liver diseases, nephrotic syndrome,
hypothyroidism, and cholangitis.

c) Indication
  Confirmation of AMI or extension thereof, as indicated by elevation (usually) of total
LDH, elevation of LDH1 and LDH2, and reversal of the LDH1:LDH2 ratio within 48
hours of the infarction
 Differentiation of acute myocardial infarction from pulmonary infarction and liver
problems, which elevate LDH4 and LDH5
 Confirmation of red blood cell hemolysis or renal infarction, especially as indicated
by reversal of the LDH1:LDH2 ratio
 Confirmation of chronicity in liver, lung, and kidney disorders, as evidenced by LDH
levels that remain persistently high
 Evaluation of the effectiveness of cancer chemotherapy (LDH levels should fall with
successful treatment.)
 Evaluation of the degree of muscle wasting in muscular dystrophy (LDH levels rise
early in this disorder and approach normal as muscle mass is reduced by atrophy.)
 Signs and symptoms of other disorders associated with elevation of the several LDH
isoenzymes

d) Contraindication

None

Interfering factors
 Numberous drugs may produce elevated LDH levels (e.g., anabolic steroids,
anesthetics, aspirin, alcohol, fluorides, narcotics, clofibrate, mithramycin, and
procainamide).

e) Equipment

1. Red-top tube or serum separator tube

2. Needle
3. Syringe or vacutainer
4. Alcohol swab

f) Patient Preparations

It is recom recommended that drugs that may alter test results be withheld for 12 to 24
hours before the test, although this practice should be confirmed with the person ordering
the study.

g) Normal values
 h) Procedure

1. Label the specimen tube. Correctly identifies the client and the test to be
performed.
2. Obtain a 5-ml blood sample.
3. Do not agitate the tube. Agitatation may cause RBC hemolysis.
4. Send tube to the laboratory

i) Implications of abnormal results

 LDH1 and LDH2: supports CK-MB test results in diagnosing acute myocardial
infarctions; aids in differential diagnosis of myocardial infarction, pulmonary
infarcts, hepatic disease, and anemias.

j) Important Nursing Responsibilities

Before Test:
Explain the test procedure of the test. Assess the client’s knowledge of the test. Inform
client that repeat blood draws may be done.
During Test:
Adhere to standard Precaution
After Test:
Apply pressure to venepuncture site. Explain that some swelling, bruising, or discomfort
may occur at the site and warm, moist compresses can alleviate this. Monitor for signs of
infection.

C. ALP, 
a) Definition

Alkaline phosphatase is a group of enzymes found primarily in the liver, gallbladder and
intestinal and bone tissues. They function best at an alkaline pH of 9.

b) Purposes

The test is done primarily to assist in the diagnosis of hepatic and bone disease. High levels
are also found in the placenta, so that ALP levels rise during pregnancy.
c) Indication
 Signs and symptoms of disorders associated with elevated ALP levels (e.g., biliary
obstruction, hepatobiliary disease, bone disease including malignant processes)
 Differentiation of obstructive biliary disorders from hepatocellular disease, with
greater elevations of ALP seen in obstructive biliary disorders
 Known renal disease to determine effects on bone metabolism
 Signs of growth retardation in children

d) Contraindication

None
Interfering Factors:
 Numerous drugs, including IV albumin, may falsely elevate levels.

e) Equipment
1. Red-top tube or serum separator tube
2. Needle
3. Syringe or vacutainer
4. Alcohol swab

f) Patient Preparations
 Teach client to be NPO for 12 hours prior to the test.

g) Normal values

h) Procedure
1. Label the specimen tube. Correctly identifies
the client and the test to be performed.
2. Obtain a 5-ml blood sample.
3. Do not agitate the tube. Agitatation may cause
RBC hemolysis.
4. Send tube to the laboratory

i) Implications of abnormal results

1. Highly elevated levels are found with obstructive jaundice, liver cancer, cirrhosis, biliary
obstruction, osteogenic sarcoma, metastatic bone disease, hyperparathyroidism, and
Paget’s disease.
2. Moderately elevated levels are found with infectious mononucleosis, pancreatitis,
pregnancy, osteomalacia, rickets, bone infections, and extrahepatic duct obstruction.
 j) Important Nursing Responsibilities

Before Test:
Explain the test procedure and the purpose of the test. Assess the client’s knowledge of
the test. Teach client to be NPO for 12 hr prior to the test. Assess medication history and
specifically check for IV albumin administration within the past 10 days.
During Test:
Adhere to standard precautions
After Test:
Apply pressure to venipuncture site. Explain that some bruising, discomfort, and
swelling may appear at the site and that warm, moist compresses can alleviate this. Monitor
for signs of infection.

D. HBSAG, 
a) Definition

Hepatitis B surface antigen is the earliest indicator of hepatitis B and often procedes
symptoms. The test may be positive 2-24 weeks after exposure, with the average time being
4-8 weeks.

b) Purposes

The presence of hepatitis B surface antigen may indicate acute or chronic (carrier) hepatitis
B. This test is required for all blood donors, and if positive, the blood will be discarded ant
the donor notified of results.

c) Indication
1. Screens for the presence of hepatitis B.
2. Blood donor screening.
3. Evaluates and monitors the progress of hepatitis
management
d) Contraindication

None

e) Equipment
1. Red-top tube or serum separator tube
2. Needle
3. Syringe or vacutainer
4. Alcohol swab

f) Patient Preparations

None
g) Normal values

HBsAg: Negative

h) Procedure
1. Label the specimen tube. Correctly identifies the client and the test to be performed.
2. Obtain a 5-ml blood sample.
3. Do not agitate the tube. Agitatation may cause RBC hemolysis.
4. Send tube to the laboratory

i) Implications of abnormal results

 Hepatitis B carrier

j) Important Nursing Responsibilities

Before Test:
Explain the test procedure and the purpose of the test. Assess the client’s knowledge of
the test. Ascertain history of hepatitis or exposure history. Ascertain if client has had test
requiring radioactive materials in the past week.
During Test:
Adhere to standard precautions.
After Test:
Apply pressure to venipuncture site. Explain that some bruising, discomfort, and
swelling may appear at the site and that warm, moist compresses can alleviate this. Monitor
for signs of infection. If client has hepatitis, instruct client regarding the importance of a
balanced diet, adequate fluid intake, and adequate rest.