Laboratory and Diagnostic Tests

Components of hematologic testing

RBCs are necessary for maintaining oxygen and carbon dioxide transport.

Low Production = Anemia

Anemia may be attributed to

(1) impaired erythrocyte production,

(2) blood loss,

(3) increased erythrocyte destruction,

(4) dietary deficiency,

(5) genetic disorders,

(6) a combination of these causes.

Over Production = Polycythemia / Sickle cell

Hemoglobin

- Contains Iron
- transport of oxygen
- less O2 increase in fatigue

Hematocrit

- is the percentage of total blood volume that represents erythrocytes.

- Hematocrit and hemoglobin values decline slightly after the age of 90

White Blood Cells

- defense against foreign substances.

- LOW WBC = due to drugs and severe infection
- ( unchanged with aging ) Leukocytes consist of (check notebook)
1. Neutrophils - prevent infections by attacking and killing disease-causing microbes.
2. Lymphocytes - help your immune system remember every antigen it comes in contact with.
After an encounter, some lymphocytes turn into memory cells. Types: B ( recognize the antigen
(foreign body) and produce antibodies against it.) and T ( identify viruses and microorganisms
by the antigens present on their surface. )
3. Monocytes - ability to destroy invaders like viruses, bacteria, and fungi. Monocytes form in the
bone marrow and are released into the blood. They can also help support the removal of
infected cells and aid in healing and repair of the body. Destroy large bacterial organisms and
virally infected
4. Eosinophils - work with other WBCs and immune proteins to help destroy and remove
infectious material from the body
 5. Basophils - defense against infection but are also involved in processes
like inflammation and allergies.

Folic Acid

- help the body convert food (carbohydrates) into fuel (glucose), which is used to produce energy.
These B vitamins, often referred to as B-complex vitamins, also help the body use fats and protein.
B-complex vitamins are needed for a healthy liver, and healthy skin, hair, and eyes.
- necessary for the normal functioning of RBCs and WBCs
- decrease in folic acid may indicate macrocytic anemia, megaloblastic anemia, and liver and renal
disease.
**nurse to assess nutritional intake, including alcohol consumption habits.**

Vitamin B12

- important for normal erythrocyte maturation

- Strict vegetarian or vegan diets may also lead to vitamin B12 deficiency
- present in nearly a quarter of older adults.

Iron

- Iron is found in the hemoglobin of the RBCs.

- When ironcontaining foods are ingested, iron is absorbed by the small intestine and transported to
the plasma
- necessary for controlling protein synthesis in the mitochondria and for generating energy in the
cells
** The gerontologic nurse should assess older adults for poor dietary intake of iron-containing
foods and occult or chronic blood loss**

Uric acid

- a product of purine catabolism and is excreted by the kidneys. Age-related changes in uric acid
levels are significantly different between the genders. Because estrogen is thought to promote the
excretion of uric acid, elevated levels are rarely seen in women before the onset of menopause.
- Elevated uric acid levels are seen in patients with gout

Foods that are high in purine content include12345:

 Wild game, such as deer (venison)
 Some fish and seafood, such as: trout, tuna, haddock, sardines, anchovies, mussels, and herring
 High fat foods, such as bacon, dairy products, and red meat, including veal
 Organ meats, such as liver and sweetbreads
 Sugary foods and beverages
 Some alcohol, including beer and liquor
 Soybeans
 Vegetables such as cauliflower, asparagus, and mushrooms.
 Thiazide diuretics, caffeine, low-dose aspirin, and antiparkinsonian drugs are also a common cause of
increased uric acid levels in older adults
Excess uric acid accumulates in the body’s fluids, especially blood and synovial fluid

forming crystals in high concentrations.

These crystals deposit in the connective tissue of the body, causing painful, inflamed joints

GOUT

Prothrombin Time
- Clotting time

- Check the effectiveness of Vit K.

- Warfarin is mostly given to adults to avoid thrombus

**Gerontologic nurses should help patients understand the importance of keeping their
appointments for PT checks and consulting their health providers before taking any over-the-
counter (OTC) medications or supplements.**
** Vitamin K is used in emergency situations to counteract the increased coagulation times that
sometimes occur when patients receive warfarin. The nurse should be aware that foods high in
vitamin K may affect clotting times and counteract the prescribed therapy. Foods such as turnip
greens, broccoli, cabbage, spinach, and liver, which are high in vitamin K, should be eaten in
moderate amounts while receiving anticoagulant therapy**

Partial Thromboplastin Time

- a good indicator of the adequacy of anticoagulation therapy

d-dimer Test
- ordered when a person has symptoms of thrombus, embolus, or disseminated intravascular
coagulation.
Erythrocyte Sedimentation Rate
- An erythrocyte sedimentation rate (ESR) blood test can be done to check for inflammation or
infection in your body.
- useful in monitoring the course of inflammatory activity in autoimmune diseases, infections, and
cancers

C-reactive protein (CRP)

- is useful in assessing patients with tissue injury
Platelets
- are small, irregular bodies, also known as thrombocytes, which are essential for clotting. They are
formed in bone marrow and stored in the spleen.
- When an injury occurs to a blood vessel, platelets are released and become “sticky,” forming a plug
at the site and triggering the clotting cascade
- Decreases in platelet counts (to less than 100,000 per cubic millimeter [mm3]) require investigation.
In a condition known as myelodysplastic syndrome (MDS), pancytopenia is noted in more than half
the patients diagnosed

Components of blood chemistry testing

Electrolytes
- negatively charged particles known as ions. Positively charged ions are known as cations; negatively
charged ions are called anions
- Compounds formed from acids and bases are known as salts.
- Dehydration is the most common form of electrolyte disorder that occurs in older adults, and it is
usually attributed to excess loss of water or altered fluid intake.
Sodium
- important for the maintenance of blood pressure, transmission of nerve impulses, and regulation of
body fluid levels in and out of the cells
- Aging changes in the kidney, such as decreased glomerular filtration rate (GFR) and a decrease in
the number of functioning nephrons, can mean that an older adult has difficulty in maintaining
homeostasis in the presence of sodium depletion or overload
**It is essential that gerontologic nurses understand the goal of treatment for patients with fluid and
sodium disorders. In patients with fluid deficiencies, the nurse can help identify reasons for a given
condition, for example, restrictions in mobility, visual disturbances, urinary incontinence, and
swallowing disorders. Hypernatremia (a high sodium level) may be caused by infusion of highsodium
solute fluids, excessive water loss, prolonged diarrhea and vomiting, and decreased oral intake.**
- neurologic signs are those of lethargy and weakness, progressing to altered consciousness and
coma
- Inversely proportional with potassium

Potassium (K+)
- maintains cell osmolarity, muscle function, and the transmission of nerve impulses, and it regulates
acid–base balance.
- Cardiac muscle is particularly sensitive to serum concentrations of potassium.
- Inversely proportional with sodium
- Hypokalemia = prominent U wave
- Hyperkalemia = tall peak T wave
Chloride (Cl –)
- mostly present in the fluid outside the cell; it is the major anion in the extracellular fluid
Calcium
- level measures only the amount of calcium in blood, which is about 1% of the body’s total calcium.
Approximately 99% of the body’s calcium is found in bones and teeth
- loss of calcium from bone maintains the normal level of calcium in blood, but the resulting bone
loss secondary to calcium leaching may lead to osteoporosis
- important in blood clotting, conduction of nerve impulses, enzyme activity, and especially muscle
contraction and relaxation
- Inversely proportional with phosphorus
Phosphorus (phosphate)
- mineral found mostly in bone in combination with calcium.
- generally well absorbed from the small intestine in the presence of vitamin D.
- Long-term use of antacids, which bind to phosphorus, may interfere with absorption.
Magnesium
- plays a significant role in the enzymatic processes needed for energy production.
- important sites of function are muscles and nerves.
- Approximately one-half of the body’s magnesium is contained in bones
Glucose
- used for energy by the cells.

Diagnosing Diabetes

1. Fasting plasma glucose. Blood is drawn after fasting for 8 hours. A fasting plasma ≥ 126 mg/dL is
indicative of diabetes.
2. Oral glucose tolerance test. A person fasts for at least 8 hours; then, 2 hours after the person
drinks a liquid containing 75 grams of glucose dissolved in water, blood sugar is tested. This test is
typically used to diagnose gestational diabetes; a 2-hour plasma glucose ≥ 200 mg/dL is indicative of
diabetes.
3. Glycohemoglobin (hemoglobin A1c ; HbA1c ). This is a blood test that checks the amount of
glucose bound to hemoglobin. Test is used to diagnose diabetes and monitor therapy. It provides an
average of blood glucose levels over the previous 2 to 3 months. An A1c ≥ 6.5% is indicative of
diabetes.
4. Random blood sugar. This test measures blood glucose without fasting. A random glucose
measurement ≥ 200 mg/dL, combined with symptoms of hyperglycemia, is indicative of diabetes.
Amylase
- important enzyme in the catabolism of carbohydrates in the intestine
- Elevated levels may occur secondary to damage to or disease of the pancreas, or obstruction of the
pancreatic duct.
Total Protein Protein
- makes up a significant portion of vascular osmotic pressure.
- major component in muscle, enzymes, hormones, transport vehicles, and hemoglobin.
- Total protein testing measures the amount of albumin and globulin in the plasma.
- This test is performed to identify nutritional problems
Albumin and Prealbumin
- used to monitor nutritional status, and liver and kidney disease
- insufficient to sustain sufficient colloidal osmotic pressure to counterbalance hydrostatic pressure,
edema develops.
Blood Urea Nitrogen
- indicative of both liver and kidney function
Creatinine
- rise in a patient’s BUN and creatinine levels is indicative of kidney disease.
- The physiologic decline in the GFR in older adults is not generally accompanied by a rise in the
creatinine level secondary to a decrease in muscle mass with aging.
Creatinine clearance
- measure of the GFR
- 24-hour urine test is required along with a serum level within the same 24-hour period.

Creatinine clearance ( milliliters per minute ( ML/min))

= 140-Age ( in years) x weight ( in Kgs ) / 72 x serum creatinine (%mg/dl)
(For women, multiply the result by 0.85.)
Triglycerides
- principal lipids found in circulating blood bound to a protein
- produced in the liver from glycerol and fatty acids found in blood
Cholesterol
- steroid compound that helps stabilize the membranes of the body’s cells.
- the major lipid associated with cardiovascular disease.
- The liver metabolizes cholesterol and binds it to LDLs and HDLs for transport in the bloodstream
Low-density lipoprotein cholesterol. High levels of low-density lipoprotein (LDL) can eventually build up
within the walls of your blood vessels and narrow the passageways. Sometimes a clot can form and get
stuck in the narrowed space, causing a heart attack or stroke. This is why LDL cholesterol is often
referred to as "bad" cholesterol.

LDL = Total Choles – HDL Choles – ( triglyceride level / 5 )

High-density lipoprotein cholesterol. HDL cholesterol is often referred to as "good" cholesterol. HDL
picks up excess cholesterol in your blood and takes it back to your liver where it's broken down and
removed from your body.

Brain Natriuretic Peptide

- The brain natriuretic peptide (BNP) is a neurohormone secreted from the cardiac ventricles in
response to ventricular stretching and pressure overloading.
- This test helps diagnose and treat patients with HF.
Alkaline phosphatase (ALP)
- an enzyme found in many tissues, although it has its highest concentrations in the liver and bone.
Aspartate transaminase (AST)
- measures the enzyme of the same name, which is found in muscles and in the liver and kidneys.
- It is primarily used to diagnose liver disease.
Creatine kinase (CK)
 - is present in cardiac and skeletal muscles, and in the brain and lungs.
- CK-BB is primarily found in the lungs and brain
- CK-MB is associated with cardiac muscle cells.
- CK-MM is normally found in circulating blood, and the level rises with damage to skeletal muscle.
- CK levels rise and peak at specific intervals during myocardial infarction, and these levels may be
used to determine the amount of myocardial damage; however, this test has largely been replaced
by troponin.
Troponin
- test measures the levels of certain proteins in the blood that are released when cardiac muscle has
been damaged.
 Troponins (troponin I or troponin T) are the preferred tests for a suspected heart attack because they
are more specific for detecting heart injury compared with other tests Troponin I (cTnI) is the most
cardiac-specific biomarker, and an increase in cTnI is only seen in myocardial injury.
 Troponin T (cTnT) is cardiac specific, but the cTnT assays also detect proteins released from skeletal
muscle.
Thyroid Function Tests
- screening for hypothyroidism or hyperthyroidism and for monitoring the effectiveness of thyroid
suppression or hormone replacement therapy.
- T4 and T3 are generally elevated in hyperthyroidism and decreased in hypothyroidism.
- Thyroid-stimulating hormone (TSH), a hormone secreted by the pituitary gland, is also usually
tested when thyroid function is investigated; TSH is elevated in hypothyroidism and decreased in
hyperthyroidism

Urinalysis
- testing for the presence of protein, glucose, bacteria, blood, ketones (FAT), and leukocytes in the
urine.
Arterial blood gas (ABG)
- measurements the acidity and alkanity of your arterial blood circulation
Ph = (acidic) 7.35 – 7.45 (alkalosis)
PaCO2 = 35 – 45 ( acidic )
HCO3 = 22 – 26 ( Base )
PaO2 = 80 – 100

1. Identify acidosis or alkalosis (ph)

Less than 7.35 acidosis
More than 7.45 alkalosis
2. Identify if it is respiratory or metabolic ( CO2 / HCO3 )
(acid) PaCO2 regulated by the LUNGS = respiratory
(base) HCO3 regulated by the kidneys = metabolic

Examples
PH = 7.25 (acid) PaCO2 = 50 (acid ) HCO3 = 24 (N)
 Respiratory acidosis
Ph = 7.56 (alka) PaCO2= 28 (acid) HCO3 = 22 (N)
Respiratory alkalosis
Ph = 7.25 (acid) PaCO2= 37 (N) HCO3 = 21 (acid)
Metabolic Acidosis
Ph = 7.56 (alka) PaCO2= 40 (N) HCO3 = 35 (base)
Metabolic Alkalosis

3. Identify if it is compensated and uncompensated

COMPENSATION
RESPIRATORY
ACIDOSIS ALKALOSIS

HCO3 > 26 <22

(METABOLIC)

METABOLIC

ACIDOSIS ALKALOSIS

CO2
(RESPIRATORY) <35 >45