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By Jon Haws RN: Critical Care Nurse NCLEX Educator Quick . . . is the aPTT within normal range? Are you sweating a bit? Nervous? Head over to NURSING.com/freebies for our free cheat sheet covering the 63 most important lab values for nurses. This podcast covers one essential lab value for episode including normal ranges, nursing considerations, and background information. Normal lab values are hard to keep straight. This show includes the most common including: Creatinine, WBC, BUN, aPTT, blood gasses, and more. Welcome to the Nursing family! For full disclaimer information visit nursing.com.
- 162 - Triglycerides (TG) Lab ValuesWed, 27 Sep 2023 - 03min
- 161 - Sodium (Na+) Lab Values
Normal 135-145 mEq/L
Indications
Monitor: Extracellular osmolality Electrolyte imbalanceDescription Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body. Sodium plays a role in blood pressure regulation and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; water follows salt.
What would cause increased levels?
Cushing Syndrome Hyperaldosteronism Dehydration Burn injury Azotemia (elevated nitrogen) Lactic acidosis (LA) Fever/excessive sweating Excessive IV fluids containing sodium Diabetes Insipidus Osmotic diuresisWhat would cause decreased levels?
Congestive Heart Failure (CHF) Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Cystic Fibrosis Diuretic use Metabolic acidosis Addison’s Disease Nephrotic Syndrome Vomiting Diarrhea Ascites Excessive Antidiuretic Hormone(ADH) Liver failureMon, 25 Sep 2023 - 04min - 160 - Potassium (K+) Lab Values
Normal 3.5 - 5.0 mEq/L
Indications
Evaluate: Electrolyte imbalances Cardiac arrhythmias Monitor patients who are: Acidotic Receiving diuretic therapyDescription
Potassium (K+) is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen will enter the cell which will force potassium out of the cell. A 0.1 decrease in pH will cause a 0.5 increase in K+.
What would cause increased levels?
Renal failure Hypoaldosteronism Addison’s disease Injury to tissues Diabetes Mellitus (DM) Ketoacidosis Hyperventilation Acidosis Infection Dehydration BurnsWhat would cause decreased levels?
Hyperaldosteronism Excess insulin Alkalosis Diarrhea Vomiting Cystic Fibrosis Cushing SyndromeWed, 20 Sep 2023 - 04min - 159 - Partial Thromboplastin Time (PTT) Lab Values
Normal 25 - 35 seconds
Indications
Detection of coagulation disorders Evaluate response to Heparin (PT for Coumadin) Preoperative assessmentDescription
Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin.
What would cause increased levels?
Disseminated Intravascular Coagulation (DIC) Clotting Factor Deficiencies: Hypofibrinogenemia Von Willebrand Disease Hemophilia Liver disease: Cirrhosis Vitamin K deficiency Polycythemia DialysisWhat would cause decreased levels?
N/AMon, 18 Sep 2023 - 03min - 158 - Oxygen Saturation (SaO2) Lab Values
Normal 95 - 100%
Indications
Determine respiratory status Part of Arterial Blood Gas (ABG) testingDescription Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen. Oxygen is transported in the blood in two ways: oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin (SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved in plasma. SaO2 and pO2 have direct relationships, if one is decreased so is the other. The relationship between oxygen saturation (SaO2) and partial pressure O2 (PaO2) is referred to as the oxyhemoglobin (HbO2) dissociation curve. SaO2 of about 90% is associated with PaO2 of about 60 mmHg.
What would cause increased levels?
Polycythemia Increased inspired O2 HyperventilationWhat would cause decreased levels?
Anemia’s Hypoventilation Bronchospasm Mucus plugs Atelectasis Pneumothorax Pulmonary edema Adult respiratory distress syndromeWed, 13 Sep 2023 - 03min - 157 - Osmolality Lab Values
Normal 261 – 280 mOsm/kg
Indications
Monitor: Electrolyte balance Acid-Base balance Hydration Evaluate function of antidiuretic hormone.Description Osmolality is a measure of the particles in solution. The size, shape, and charge of the particles do not impact the osmolality
What would cause increased levels?
Dehydration Azotemia Hypercalcemia Hyperglycemic Hyperosmolar Nonketotic State (HHNS) Hypernatremia Diabetes Insipidus Hyperglycemia Mannitol therapy Uremia Severe pyelonephritis Shock KetosisWhat would cause decreased levels?
Hyponatremia Syndrome of Inappropriate Antidiuretic Hormone (SIADH) OverhydrationMon, 11 Sep 2023 - 05min - 156 - Magnesium (Mg) Lab Values
Normal 1.6 – 2.6 mg/dL
Indications
Monitor: Renal failure Chronic alcoholism Cardiac arrhythmiasDescription Magnesium (Mg) is a cation necessary for protein synthesis, nucleic acid synthesis, muscle contraction, ATP (adenosine triphosphate) use, nerve impulse conduction, and blood clotting. Magnesium affects the absorption of sodium, calcium, phosphorus, potassium.
What would cause increased levels?
Renal insufficiency Uncontrolled Diabetes Mellitus (DM) Addison Disease Dehydration Hypothyroidism Overuse of antacids Tissue traumaWhat would cause decreased levels?
Alcoholism Diabetic acidosis Renal failure: Glomerulonephritis Hypercalcemia Malnutrition Malabsorption Hypoparathyroidism DiarrheaWed, 06 Sep 2023 - 03min - 155 - Low Density Lipoprotein (LDL) Lab ValuesMon, 04 Sep 2023 - 03min
- 154 - Lactic Acid Lab Values
Normal 0.3 -2.6 mmol/L
Indications
Determine cause of acidosis Evaluate tissue oxygenationDescription Lactate (Lactic Acid) is a byproduct of anaerobic metabolism. Normally, the tissues use aerobic metabolism to breakdown glucose for energy and the byproduct is CO2 and H2O which we excrete through our kidneys and exhalation. However, if the tissues are starved of oxygen (hypoxic), they use anaerobic metabolism. This can be compounded if the liver is also hypoxic causing the liver to be unable to clear the lactic acid.
What would cause increased levels?
Shock Sepsis Tissue ischemia Carbon monoxide poisoning Lactic acidosis Diabetes Mellitus (DM) Heart failure Pulmonary edema Strenuous exerciseWhat would cause decreased levels?
N/AWed, 30 Aug 2023 - 04min - 153 - International Normalized Ratio (INR) Lab Values
Normal 0.8 - 1.2 Therapeutic Levels of Warfarin 2.0 – 3.5
Indications
Evaluate therapeutic doses of Warfarin Identify patients at higher risk for bleeding Identify cause of: Bleeding DeficienciesDescription International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method.
What would cause increased levels?
Disseminated Intravascular Coagulation (DIC) Liver disease Vitamin K deficiency WarfarinWhat would cause decreased levels?
Too much vitamin K Estrogen containing medications such as birth controlMon, 28 Aug 2023 - 04min - 152 - High Density Lipoprotein (HDL) Lab Values
Normal >60 optimal mg/dL
Indications
Monitor risks of heart diseaseDescription Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein (LDL) very low-density lipoprotein (VLDL). HDL cholesterol is considered the good cholesterol because it travels through the blood picking up extra cholesterol and taking it back to the liver.
What would cause increased levels?
Familial HDL Lipoproteinemia Exercise Unsaturated fats: Mono- Poly- HypothyroidWhat would cause decreased levels?
Metabolic Syndrome Hepatocellular disease: Hepatitis Cirrhosis Hypoproteinemia: Nephrotic Syndrome Malnutrition Smoking High saturated and trans fat diets Excess body weight HyperthyroidWed, 23 Aug 2023 - 03min - 151 - Glycosylated Hemoglobin(HgbA1c) Lab Values
Normal 5.6-7.5 % of total Hgb
Indications
Assess control of blood sugars over a several month time frame Diagnose Diabetes Mellitus (DM)Description
Glycosylated Hemoglobin (HbA1c) is the combination of glucose and hemoglobin. When glucose is elevated in the blood the amount of glycosylated hemoglobin increases proportionally. A red blood cells lifespan is about 4 months, so you can get an idea of blood sugar control over the last several months.
What would cause increased levels?
Poorly controlled Diabetes Mellitus(DM) Non-Diabetic Hyperglycemia: Stress Cushing Syndrome Pheochromocytoma Corticosteroid TherapyWhat would cause decreased levels?
Renal failure Blood loss Hemolytic anemia Sickle cell anemiaMon, 21 Aug 2023 - 03min - 150 - Folic Acid Lab Values
Normal 2 - 20 ng/mL
Indications
Diagnose megaloblastic anemia Monitor effects of long-term Total Parenteral Nutrition (TPN) Identify Folate DeficiencyDescription Folic acid is an essential water soluble B vitamin. It is stored in the liver and is an important part of Red Blood Cell (RBC) and White Blood Cell (WBC) function, DNA replication, and cell division.
What would cause increased levels?
Excess folate intakeWhat would cause decreased levels?
Vitamin B12 deficiency Pernicious anemia Hemolytic anemia Celiac Disease or Crohn Disease Inflammatory Bowel Disease (IBS) Alcoholism MalnutritionWed, 16 Aug 2023 - 03min - 149 - Ferritin Lab Values
Normal 20-300 ng/mL
Indications
Diagnosing: Iron-deficiency anemiaH emochromatosis Monitor: Iron levelsDescription
Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin. Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron.
What would cause increased levels?
Inflammation Alcoholic liver disease Multiple blood transfusions HemochromatosisWhat would cause decreased levels?
Long term Gastrointestinal(GI) bleeding Iron-deficiency anemia Heavy menstrual bleedingMon, 14 Aug 2023 - 03min - 148 - Chloride (Cl- ) Lab Values
Normal 96-108 mEq/L
Indications
Identify Acid-Base ImbalanceDescription
Chloride (Cl-), an anion found in the blood, works together with sodium to help maintain oncotic pressure and water balance in the body. Chloride is inversely related to bicarbonate levels in the blood. Chloride is also part of hydrochloric acid (HCL) which is utilized in the stomach to breakdown food. When red blood cells (RBCs) take up CO2 they take up chloride as well. The negative ion bicarbonate then leaves the red blood cell so that the electrical charge is maintained. Extra chloride is excreted into the urine by the kidneys.
What would cause increased levels?
Dehydration Acute Renal Failure Cushing Disease Metabolic Acidosis Respiratory Alkalosis.What would cause decreased levels?
Congestive Heart Failure (CHF) Water intoxication Burns Metabolic Alkalosis Respiratory Acidosis Addison Disease Salt-losing Nephritis Excessive sweating Diarrhea VomitingWed, 09 Aug 2023 - 04min - 147 - Calcium (Ca2+) Lab Values
Normal 8.4-10.2 mg/dL
Indications
Identify problems with: Parathyroid Neuromuscular functions Diseases that affect bone Effectiveness of treatments.Description
Calcium (Ca+), a positive ion in the body, is necessary for neuromuscular processes, bone mineralization, and hormonal secretion. The parathyroid gland and vitamin D are responsible for calcium regulation in the body. In the blood, about half of calcium travels in ion form, the other half is bound to proteins like albumin. When albumin levels are low, calcium levels will appear lower. Calcium has an important relationship with phosphorus: they are inversely proportional.
What would cause increased levels?
Cancers: Breast, lung, and multiple myeloma are the most common Hyperparathyroidism Acidosis Renal transplant Sarcoidosis Vitamin D toxicity DehydrationWhat would cause decreased levels?
Malnutrition Cirrhosis Chronic Renal Failure Hypoparathyroidism Alkalosis Hypomagnesemia Hypoalbuminemia Hyperphosphatemia Malabsorption Alcoholism Osteomalacia Vitamin D deficiencyMon, 07 Aug 2023 - 06min - 146 - Aspartate Aminotransferase (AST) Lab Values
Normal 12-37 U/L
Indications
Monitor progression of: Liver disease Response to treatments. Monitor liver toxic medicationsDescription Aspartate Aminotransferase (AST) is an enzyme primarily found in liver and heart cells, and to a smaller extent, AST can also be found in the pancreas, kidneys, skeletal muscle, and brain. Levels of AST increase from cell death (necrosis) because the AST enzyme is released into the blood.
What would cause increased levels?
Liver disease Liver cancer Shock Congestive Heart Failure (CHF) Pericarditis Biliary tract obstruction Dermatomyositis Pancreatitis Muscular Dystrophy CVA Hemolytic anemia Delirium Tremens (DT)What would cause decreased levels?
N/AWed, 02 Aug 2023 - 03min - 145 - Amylase Lab Values
Normal 0-130 U/L
Indications
Diagnosing: Pancreatitis Pancreatic Duct Obstruction Macroamylasemia Trauma to PancreasDescription Amylase is made in the pancreas. It is an enzyme that breaks down carbohydrates to allow our body to absorb it. Monitoring amylase levels can help identify problems with the pancreas.
What would cause increased levels?
Pancreatitis Pancreatic Cancer Pancreatic Cyst DKA Peritonitis Abdominal Trauma Duodenal Obstruction Mumps Alcohol useWhat would cause decreased levels?
Pancreatic Insufficiency Pancreatectomy Toxemia of Pregnancy Cystic Fibrosis Liver DiseaseMon, 31 Jul 2023 - 03min - 144 - Survive NCLEX Prep - No More Drowning, Study Anywhere You Want (with NURSING.com)
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Fri, 28 Jul 2023 - 02min - 143 - Activated Partial Thromboplastin Time (aPTT) Lab Values
Normal 30-40 seconds
Indications
Identifying congenital deficiencies in clotting Monitoring heparin therapeutic levels (PT for warfarin) Monitoring effects of: Liver Disease Protein Deficiency Fat malabsorption on clottingDescription Activated Partial Thromboplastin Time (aPTT) is a test that measures the amount of time it takes for a fibrin clot to form after reagents have been added to the specimen. It is useful in diagnosing clotting disorders. In conjunction with PT it can be used to differentiate the specific factor that may be missing.
What would cause increased (Prolonged) levels?
Vitamin K Deficiency Disseminated Intravascular Coagulation (DIC) Hemodialysis Patients Afibrinogenemia Polycythemia Liver disease Von Willebrand Disease.What would cause decreased levels?
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Mon, 24 Jul 2023 - 03min - 141 - Urinalysis (UA) Lab Values
Overview
- Urinalysis
- Color & Clarity Protein RBC WBC Glucose Specific gravity Ketones pH Bilirubin/Urobilinogen
- Normal value range
- Color & Clarity
- Normal – Yellow
- Other colors
- Drug interactions
- Propofol – green Methylene blue – blue/green
- Red/Brown
- Brown/tea colored
- Cloudy
- Cell or contaminant related
- Severe presence of cells (WBC, RBC)
- ~6
- Changes in body condition can change pH Metabolic acidosis/alkalosis
- 0-trace Glomerular permeability/infection
- 0-2 Bleeding Trauma/injury below kidneys
- Negative Sepsis/Infection/UTI
- Negative Diabetes
- Negative Presence of ketones can indicate endocrine disease like Diabetes
- 1.010-1.030 Facilities vary Ability to concentrate urine Hydration
- Overhydration
- Decreased USG
- Increased USG
- Causes increased diuresis
- Causes decreased diuresis
- Negative
- Presence indicates potential liver problems
- Lab Values Elimination
Mon, 24 Jul 2023 - 04min - 140 - White Blood Cell (WBC) Lab Values
Overview
- White Blood Cells
- Normal Value Range Pathophysiology Special considerations Abnormal values (high) Abnormal values (low)
- Normal value range
- WBC
- 4500-10000/mcL
- Neutrophils
- 40-60%
- 3-5%
- >8% indicates signal to WBC for more production Infection or inflammation is severe
- 1-4%
- 0.5-1%
- 20-40%
- 2-8%
- WBC
- Formed in the bone marrow Responsible for responding to foreign invaders
- Creating antibodies (immunity) Phagocytosis (eating bacteria or fungi)
- Neutrophils –
- inflammation and first response to invader
- Inflammation Allergic response Parasites
- Inflammation Allergic response
- Create antibodies Recognize antigens Destroy cells
- T Cells B Cells Natural Killer cells
- Macrophages
- Engulf and destroy invaders
- Lavender top tube Will commonly be submitted for Complete Blood Count with differential
- Increased White Blood Cell count (leukocytosis)
- Infection Inflammation Trauma/Stress Pregnancy Asthma Allergic Reaction
- Systemic Lupus Erythematosus (SLE)/Rheumatoid arthritis Cancers Chemotherapy/Radiation Medications
- Neutropenic precautions
- Masks Gloves Wash hands Consider yourself infectious
- Prevent spread of infection to the patient
- Consider the overall WBC count plus abnormalities in differential
- Evaluate patient
- Signs or symptoms of:
- Trauma Inflammation Infection
- Antibiotic therapies where indicated by infection (followed by cultures to determine efficacy of antibiotics) Anti-inflammatories for inflammation Provide neutropenic precautions when necessary
- Lab Values Infection Control
- Educate patient on the finishing any antibiotics completely. Do not stop prior, even if the patient says they are feeling better.
Wed, 19 Jul 2023 - 03min - 139 - Troponin I (cTNL) Lab Values
Overview
- Troponin I
- Normal value range Pathophysiology Special considerations Elevations in lab values
- Normal value range
- Typically, less than 0.035 ng/mL or less Can vary among institutions Has to be greater than the 99th percentile
- Troponin is released during myocardial cell damage Decreased perfusion causes myocardial cell damage Causes of myocardial cell damage
- Myocardial infarction Demand ischemia
- Cardiogenic
- ACS
- Sepsis Renal failure Extreme exercise
- Submitted in green top tube Value peak
- Detection 6-12 hours after acute injury Peaks 24 hours after injury Can stay elevated for a week
- Knowing patient history is critical
- Any elevated value is typically considered critical Acute elevations warrant immediate investigation
- Typically PCI (percutaneous coronary intervention)/Angiography and EKG to rule out MI or ACS (acute coronary syndrome)
- CABG Extreme exercise End Stage Renal Failure
- Assess for:
- Acute chest pain Symptoms of MI
- Nausea Vomiting Angina in any form Reflux (especially in women)
- EKG Angiography or PCI Management of non-cardiogenic etiology
- Lab Values Perfusion
- Educate patient on keeping history of elevated levels or cardiac disease for future reference Educate patient on duration of elevated troponin levels, post injury
Mon, 17 Jul 2023 - 03min - 138 - Thyroid Stimulating Hormone (TSH) Lab Values
Objective:
Determine the significance and clinical use of Thyroid Stimulating Hormone in clinical practice
Thyroid Stimulating Hormone
Thyroid Stimulating Hormone (TSH) is released from the anterior pituitary in response to low levels of thyroid hormone.
TSH stimulates the thyroid gland to release thyroid hormones
Triiodothyronine (T3) Thyroxine (T4) T3 and T4 have an inverse relationship with TSHAids to diagnose:
Hyperthyroidism Hypothyroidism Anterior pituitary functionMonitor:
Thyroid replacement therapy Normal Therapeutic Values:Normal –
2-10 mU/L
Collection:
Plasma separator tubeTSH levels increase in the following conditions:
Hypothyroidism Thyroidectomy Thyroid dysfunction Thyroiditis Thyroid Agenesis Large doses of iodine Pituitary TSH-secreting tumorRecall the inverse relationship between TSH and T3/T4 labs, and how the negative feedback loop works with these hormones.
TSH levels decrease in the following conditions:
Anterior pituitary hypofunction- If the pituitary isn’t secreting TSH, the level will be low. Hyperthyroidism- If there is a large amount of thyroid hormone circulating, the feedback system relays the info upstream and less TSH is released.Wed, 12 Jul 2023 - 03min - 137 - Red Blood Cell (RBC) Lab Values
Overview
- Red blood cells
- Normal Value Range Patho Special considerations Too High: Causes, Symptoms, Treatments Too Low: Causes, Symptoms, Treatments
- Normal range
- Measured in millions Normal values
- Males 4.5-5.5 x106/mcL Females 4-4.9×106/mcL
- Red Blood Cell generation
- Formed in bone marrow Stimulated by kidneys by erythropoietin
- AKA Erythrocytes
- Reticulocytes
- Young RBC Indicate regeneration
- Via Hemoglobin Allows for transfer of CO2
- Increases surface area Allows for ability to “squeeze” into capillaries
- Submitted via LAVENDER top tube (EDTA) Technique can destroy red blood cells
- Allow vacuum in vacutainers to draw blood, never force blood into tubes Consider angiocath/IV size when drawing blood
- Dehydration
- Result of decreased plasma
- Bone marrow cancer, causes increase in RBC
- Anemia
- Sickle-cell ↓ EPO due to kidney disease
- Assess for signs of anemia
- Tachycardia Fatigue Shortness of breath Decreased SaO2 Pallor
- Blood transfusions as necessary Treat primary cause of anemia
Nursing Concepts
- Lab Values Oxygenation
Mon, 10 Jul 2023 - 03min - 136 - Prostate Specific Antigen (PSA) Lab Values
Objective:
Determine the significance and clinical use of Prostate Specific Antigen in clinical practice
Prostate Specific Antigen – PSA
Measurement of PSA in the bloodstream
Used to diagnose and assess prostate health, size and function.
Evaluate:
Enlarged prostate when prostate cancer is suspected Stage cancer Effectiveness of treatmentsNormal –
Male: < 4 ng/mL Female: < 0.5 ng/mLCollection:
Serum Separator Tube What would cause increased levels?Increased:
Benign Prostatic Hypertrophy (BPH) Prostate cancer Prostatitis Urinary retentionDecreased:
Long-term use of NSAIDs- explained in part by the anti-inflammatory effect of these medications Thiazides- reduces bioavailable testosterone, associated with resulting in functional hypogonadism Statins- cholesterol plays a role in synthesis of androgen, which affects the size of the prostate 5-alpha-reductase inhibitors- due to the effect on prostate size.Wed, 05 Jul 2023 - 02min - 135 - Platelets (PLT) Lab Values
Overview
- Platelets
- Normal Value Range Pathophysiology Special considerations Elevated platelet levels Decreased platelet levels
- Normal value ranges
- 100,000 – 450,000/mcL Also known as – Thrombocytes
- Formed from Megakaryocyte
- Formed from bone marrow Produces 1000-3000 platelets
- Collagen releases activators Thrombocytes activate “sticky fingers”, which allow them to bind together. Travel to site (along with other clotting factors) Adhere to site, increase stimulation for other PLT, until clot is formed with fibrin
- Use a lavender top tube (EDTA) Often sent in CBC
- Elevated platelets (thrombocytosis)
- Cancers Absence of a spleen
- Breaks down platelets
- Overproduction of cells Treatment via bloodletting, medications or hydration
- ITP (Idiopathic thrombocytopenic purpura)
- Autoimmune disease Medications
- Treated with transfusion
- Treated with chemotherapy/radiation
- Some diuretics Nonsteroidal anti-inflammatory drugs (NSAIDs) Ranitidine Some antibiotics
- Assess for signs of petechia (small purplish blemishes, indicating bleeding)
- Control and stop hemorrhage
- Replace platelets via transfusion
- Lab Values Clotting
- For patients who have bleeding disorders, instruct patients to be cautious of injury. If patient has thrombocytopenia, instruct patient to seek emergency treatment in the event of bleeding that does not stop.
**DISCLAIMER – The video states that the normal value of platelets is 100,000 – 400,000 cells/mcL. The correct information is 100,000 – 450,000 cells/mcL.
Mon, 03 Jul 2023 - 04min - 134 - Lipase Lab Values
Objective:
Determine the significance and clinical use of Lipase in clinical practice
Lipase
Lipase
Measurement of lipase in the blood
Used to diagnose pancreatitis and pancreatic cancer An enzyme produced by the pancreas Aids in breakdown of fats Released into the bloodstream as a result of damage to the pancreasDiagnose:
Pancreatitis Severe upper abdominal pain Abdominal pain – radiates Fever N/V Tachycardia Pancreatic cancer Discoloration of urine and stool Weight loss DiabetesNormal:
23-300 U/LCollection:
Plasma separator tube Serum separator tubeN/A
Wed, 28 Jun 2023 - 03min - 133 - Iron (Fe) Lab Values
Objective:
Determine the significance and clinical use of iron levels in clinical practice
Iron – Fe
Measures the amount of Fe in the bloodstream.
Evaluates:
Sufficient Fe level oxygen transport proper hemoglobin & RBC productionIron (Fe) is an element that is an important component of hemoglobin in red blood cells.
Iron aids hemoglobin’s transport of oxygen from the lungs to all the cells of the body.
The storage form of iron is ferritin. Iron is transported in the blood by a protein called transferrin.
Identify:
Blood loss Hemochromatosis Malabsorption of iron Iron overloadType of anemia:
Thalassemia Sideroblastic anemia Iron deficient anemiaNormal –
50-175 μg/dL
Collection:
plasma separator tubeWhat would cause Increased Levels of Iron?
Hemochromatosis Lead toxicity Iron poisoning Acute liver disease Multiple blood transfusions Hemolytic anemia Sideroblastic anemiaWhat would cause Decreased Levels of Iron?
Blood Loss: Gastrointestinal (GI) bleeding Heavy menstruation Chronic hematuria Hypothyroidism Iron-deficiency anemia Inadequate absorption of ironMon, 26 Jun 2023 - 03min - 132 - Hemoglobin (Hbg) Lab Values
Overview
- Hemoglobin
- Normal Value Range Pathophysiology Special considerations Elevated hemoglobin Decreased hemoglobin
- Normal value range
- Males – 13.5-16.5 g/dL Females – 12.0 – 15.0 g/dL
- Protein attached to red blood cell Iron based protein 4 groups
- 2 alpha 2 beta
- Oxyhemoglobin
- Has oxygen attached
- Oxygen has been released
- Oxygen saturation Shift to the right
- Partial pressure is higher HGB attraction to oxygen is lower Oxygen becomes less “sticky” and wants to be released Causes
- ↓pH ↑pCO2 ↑Temperature
- Partial pressure is lower HGB attraction is higher Oxygen wants to stay “stuck” to HGB Causes
- ↑pH ↓pCO2 ↓Temperature
- Submit in lavender top tube Be cautious with phlebotomy technique
- Reduce hemolysis with proper tubing and syringes
- Polycythemia vera
- Treatments
- Blood letting Increased water intake Some medications
- Pulmonary fibrosis COPD
- EPO supplementation
- Thalassemia Blood loss Sickle Cell anemia Aplastic anemia Cancers
- Assess for signs of anemia
- Tachycardia Fatigue Shortness of breath Decreased SaO2 Pallor
- Blood transfusions as necessary Treat primary cause of anemia
- Lab Values Oxygenation
Wed, 21 Jun 2023 - 04min - 131 - Hematocrit (Hct) Lab Values
Overview
- Hematocrit
- Normal Value Range Pathophysiology Special considerations Elevations in lab results Decreased HCT levels
- Normal value range
- HCT measured in percentage Males – 41-50% Females – 36-44%
- Measurement of total pRBCs compared to rest of blood volume Helps to indicate anemia Often measured with HGB (hemoglobin)
- Lavender top tube (EDTA) Be cautious with technique
- Do not force sample into tube Can cause hemolysis Alters results
- Dehydration
- Change in % compared to total blood volume
- COPD Pulmonary fibrosis
- Increased need for oxygen -> increased need for RBC production
- RBC overproduction due to bone marrow cancer Treatment includes bloodletting and increasing water consumption (also some medications)
- Blood loss
- Trauma Hemorrhage Treatment
- Stop bleeding Transfuse blood
- Kidney disease
- Decrease in EPO production Treatment
- Supplement with EPO
- Relative to increase total blood volume
- Decreased bone marrow production causes ↓ RBC Treat leukemia via oncology pathways
- Chemotherapy Radiation Bone marrow transplant
- Assess for signs of anemia
- Tachycardia Fatigue Shortness of breath Decreased SaO2 Pallor
- Blood transfusions as necessary Treat primary cause of anemia Use oncologic methods to treat leukemia Bloodletting (phlebotomy) for polycythemia patients
- Lab Values Oxygenation
Mon, 19 Jun 2023 - 05min - 130 - Erythrocyte Sedimentation Rate (ESR) Lab Values
Objective:
Determine the significance and clinical use of Erythrocyte Sedimentation Rate in clinical practice
Erythrocyte Sedimentation Rate- ESR
The Erythrocyte Sedimentation Rate (ESR) test measures sedimentation of Red Blood Cells (RBCs).
In normal conditions, RBCs settle or sediment very little.
Inflammation affects proteins in the blood causing RBCs to stick and settle together out of the liquid portion of the blood.
Identifies inflammation which assists in diagnosing:
Cancer Infection Autoimmune diseasesNormal – 0-20 mm/hr
Increased
Conditions:
Anemia Chronic Renal Failure Systemic Lupus Erythematosus (SLE) Infection Tuberculosis Pregnancy Polymyalgia Rheumatica Multiple myelomaMedications:
Oral contraceptives Theophylline Vitamin AWhat would cause decreased levels?
Decreased
Conditions:
Sickle cell anemia Polycythemia Vera Leukocytosis Congestive Heart Failure (CHF)Medications:
Aspirin Cortisone QuinineWed, 14 Jun 2023 - 02min - 129 - D-Dimer (DDI) Lab Values
Objective:
Determine the significance and clinical use of D-Dimer in clinical practice
D-Dimer- DDI
Measurement of D-Dimer evaluates the amount of byproduct produced as part of fibrinolysis
D-dimer (DDI) is a product of fibrinolysis
D-dimer levels are elevated in the setting of clot breakdown, and will be significantly elevated in the setting of Disseminated Intravascular Coagulation (DIC).
Identify and monitor
Disseminated Intravascular Coagulation (DIC)
Rule out a blood clot:
Pulmonary Embolism (PE) Deep Vein Thrombosis (DVT) StrokeNormal – ≤ 250 ng/mL
Collection:
Light blue lab tubeIncreased
Surgery Trauma Infection Cancer Heart attack Pregnancy Deep Vein Thrombosis (DVT) Disseminated Intravascular Coagulation (DIC) What would cause decreased levels?Indicates a lack of the substance that is released during the breakdown of a blood clot (i.e. lack of blood clots, or lack of fibrinolysis)
Mon, 12 Jun 2023 - 02min - 128 - C-Reactive Protein (CRP) Lab Values
Objective:
Determine the significance and clinical use of C-Reactive Protein in clinical practice
C-Reactive Protein – CRP
C-reactive protein (CRP) is made in the liver in response to inflammation
Measures CRP in the blood
Increases quickly Decreases quicklyMonitor or Identify:
Inflammation in the body Appendicitis Pelvic Inflammatory Disease (PID) Crohn’s Ulcerative Colitis Rheumatoid Arthritis (RA) Lupus (SLE – Systemic Lupus Erythematosus)Evaluate:
Coronary Artery Disease (CAD) Cholesterol level – atherosclerosisWed, 07 Jun 2023 - 02min - 127 - Creatinine (Cr) Lab Values
Overview
- Creatinine
- Normal Value Range Pathophysiology Special considerations Elevations in creatinine Decreases in creatinine
- Normal values
- 0.7 – 1.4 mg/dL
- Muscle breakdown and use
- Creatine -> creatinine
- Filtered through kidneys Excreted in urine
- Green top Submitted with renal panels or chems Creatinine clearance
- Tests creatinine in urine Compare to serum creatinine 24 hour urine
- Toss first urine sample, then start On ice
- Renal disease Rhabdomyolysis
- Muscle breakdown Trauma Extreme workouts
- Loss of muscle mass Muscular dystrophy Decreased protein intake Pregnancy Liver disease
- Assess patient’s nutritional status Assess urine output Consider other causes for increase in creatinine
- Muscle
- Treat cause of renal insufficiency
- Dialysis vs medication
- Lab Values Elimination
Mon, 05 Jun 2023 - 03min - 126 - Creatinine Clearance Lab Values
Objective:
Determine the significance and clinical use of measuring Creatinine Clearance in clinical practice
Creatinine Clearance – CrCl
Healthy kidneys remove creatinine from the blood. It then passes out of your body through urine. Creatinine is created in the body as a byproduct from normal wear and tear on muscles and protein in your diet.
Creatinine Clearance is a test that compares the level of creatinine in the blood against the level in the urine and evaluates Glomerular Filtration Rate. Hydration, blood volume status, blood pressure, and the state of the glomeruli impact GFR.
Remember that GFR is the amount of blood cleaned each minute by tiny filters in your kidneys called glomeruli.
An increase in CrCl indicates an increase in GFR.
The creatinine clearance test is done when your healthcare provider thinks that the eGFR result given with your blood creatinine level may not be accurate. This would be in patients who have diabetes, those with HF, those with kidney disease, and is sometimes evaluated in those with hypertension.
Kidney Function GFR Diabetes Heart Failure HypertensionNormal – Creatinine clearance rates go down as you age
Male: 97 to 137 mL/min Female: 88 to 128 mL/minFor every decade after age 40, a normal test result is 6.5 mL/min less than the numbers above.
Collection:
Plasma separator tube for serum Urine is collected for 24 H in a plastic container First void is flushed Date and time recorded, and urine collected and stored at room temperature Processed once collection is completeIncreased Creatinine Clearance→ Increased GFR
Pregnancy- higher blood volume Large protein intake ExerciseThe kidneys are solely responsible for removing Creatinine from the blood. If kidney function is declining, the creatinine level increases in the blood, but less creatinine is excreted into the urine.
Decreased Creatinine Clearance→ Decreased GFR
Abnormal kidney function Poor perfusion Dehydration Bladder obstruction Nephrotoxic medicationsWed, 31 May 2023 - 03min - 125 - Cholesterol (Chol) Lab Values
Overview
- Cholesterol
- Normal Value Range Pathophysiology Any special considerations when drawing the lab (i.e. on ice, etc.) Too High: Causes, Symptoms, Treatments Too Low: Causes, Symptoms, Treatments
Mon, 29 May 2023 - 04min - 124 - Brain Natriuretic Peptide (BNP) Lab Values
Overview
- BNP
- Normal Value Range Pathophysiology Special considerations Lab value elevations
- Normal value range
- 100 pg/mL
- Increased pressure overload due to increased SVR or volume Ventricular stretching causes release of BNP into bloodstream BNP released to aid in stress due to overload by:
- Increases excretion of sodium in urine = natriuresis
- Sodium follows water
- Lavender tube (EDTA) NT-proBNP may be requested instead
- Submit in serum separator tube (tiger top)
- >100 pg/mL – heart failure likely The higher the value, the more likely the diagnosis of heart failure
- Assess patient for acute exacerbation of heart failure
- Lung sounds Oxygen status
- Need for supplemental oxygen
- Echocardiogram can determine contractility function
- Treatment
- Treat heart failure
- Diurese Improve contractility
- Lab Values Perfusion
Wed, 24 May 2023 - 02min - 123 - Blood Urea Nitrogen (BUN) Lab Values
Overview
- Blood Urea Nitrogen (BUN)
- Normal Value Range Pathophysiology Special Considerations Elevated Values Decreased Values
- Normal value range
- 7-20 mg/dL
- Protein broken into amino acids -> Ammonia Ammonia converted to urea Urea excreted via kidneys
- Green top tube Submitted in multiple panels
- Chem 7/Chem 10 CMP Renal panel
- Renal failure Congestive heart failure Myocardial infarction Dehydration Urinary obstruction Diabetes
- Liver failure Overhydration Inadequate protein intake
- Malnutrition
- Assess patient’s nutritional status Assess urine output Find primary cause for renal impairment (pre-/intra-/post-renal)
- Treat cause of renal insufficiency
- Dialysis vs medication
- Lab Values Elimination
Mon, 22 May 2023 - 05min - 122 - Total Bilirubin (T. Billi) Lab Values
Overview
- Total bilirubin
- Normal Value Range Pathophysiology Special considerations Elevations in Total bilirubin
- Normal values
- 0.1-1.2 mg/dL
- Breakdown product of RBCs
- Specifically heme (iron portion of hemoglobin)
- Bound with bile Excreted via GI tract and kidneys
- Water soluble
- Not able to excrete it Carried to liver via albumin Conjugated in liver
- Submit in green top tube Usually submitted with liver function tests
- Newborn jaundice
- Treated with phototherapy Liver tumors Liver disease
- Cirrhosis Hepatitis Alcoholism
- Assess patients for jaundice or icterus, or changes in color of stool (clay colored)
- Phototherapy for newborns, as they are unable to properly breakdown bilirubin Treat primary cause of liver/gallbladder disease
- Lab Values Gastrointestinal/Liver Metabolism
Wed, 17 May 2023 - 03min - 121 - Ammonia (NH3) Lab Values
Overview
- Ammonia
- Normal Value Range Pathophysiology Special considerations Too High: Causes, Symptoms, Treatments Too Low: Causes, Symptoms, Treatments
- Normal value range
- 19-60 mcg/dL
- Byproduct of protein metabolism
- Proteins → ammonia Ammonia → urea via the liver Urea excreted to the kidneys
- Ammonia ↑ in bloodstream Causes hepatic encephalopathy
- Neurotoxic ↓ Level of consciousness Confusion Altered mental status
- Sent in either green or lavender tube Typically sent on ice Discuss with facility lab or unit
- Liver failure
- Treatment:
- Lactulose
- Ammonia binding agent Given PO or PR Ammonia excreted via stool
- Antibiotics
- Assess patient’s cognition and level of consciousness Assess patient’s ability to swallow and protect airway
- Lactulose via rectal tube or PO if patient can tolerate oral medications and follow directions
- Lab Values Gastrointestinal/Liver Metabolism
Mon, 15 May 2023 - 04min - 120 - Alkaline Phosphatase (ALK PHOS) Lab Values
Objective:
Determine the significance and clinical use of alkaline phosphatase in clinical practice
Alkaline Phosphatase – ALP
Measures amount of ALP in circulation
Located in several places in the body:
Liver Intestines Biliary tract Bones PlacentaDifferent isoenzymes of ALP are used to determine:
Liver, bone, intestine and other cancers Bone turnover in postmenopausal womenEvaluation of ALP:
Hepatobiliary disease Malignancies Bone disease Bone damage in renal patientsNormal – 40-130 U/L
Collection:
Plasma separator tubeIncreased levels assessed in:
Liver disease Bone disease Pregnancy Amyloidosis Lung cancer Pancreatic cancer Congestive heart failure Ulcerative colitis Hodgkin’s disease Chronic renal failure SarcoidosisWed, 10 May 2023 - 04min - 119 - Albumin Lab Values
Overview
- Albumin
- Normal Value Range Pathophysiology Special Considerations Too High: Causes, Symptoms, Treatments Too Low: Causes, Symptoms, Treatments
- Normal value range
- 3.5 – 6.0 g/dL
- Produced in the liver Main protein of plasma Responsible for maintaining oncotic pressure
- Draws fluid into blood vessel “Protein pulls” Refer to Fluid & Electrolytes lesson 01.02 Fluid Pressures
- Poor indicator of nutrition
- Due to long half-life
- Better indicator of nutrition
- Green top typically Usually sent with several other labs
- Chemistries Liver function tests Nutritional labs
- Dehydration Excess infusion of albumin
- Liver disease Fluid loss
- Fistula Hemorrhage Kidney Disease Burns
- Inadequate intake
- Assess patient’s pre-albumin for nutritional status or indications of acute illness
- Lab Values Nutrition
Mon, 08 May 2023 - 04min - 118 - Alanine Aminotransferase (ALT) Lab Values
Objective:
Determine the significance and clinical use of Alanine Aminotransferase in clinical practice
Alanine Aminotransferase – ALT
Measures amount of ALT, an enzyme produced by the liver, present in circulation
Found in:
Most abundantly in liver
Heart
Skeletal muscle
kidney
Increases in lab values indicate liver disease or liver damage
Evaluation of ALT:
Progression of liver disease Monitoring response to treatmentNormal – 40-130 U/L
Collection:
Plasma separator tubeINCREASED:
Cirrhosis Muscle damage Preeclampsia Biliary tract obstruction Burns Pancreatitis Long-term alcohol abuse Liver Cancer Muscular dystrophy MI Myositis Shock Infection-mononucleosisDECREASED:
Pyridoxal phosphate deficiency A rare genetic metabolic disorderWed, 03 May 2023 - 03min - 117 - Glucose Lab Values
Overview
- Glucose
- Normal Value Range Pathophysiology Special considerations Hyperglycemia Hypoglycemia
- Normal value
- 70-115 mg/dL
- Consumed via diet
- Carbohydrates
- Creates net positive energy sources
- Produced in pancreas Required to force glucose into cell Deficiency in insulin causes high glucose in blood Increase in insulin resistance causes high glucose in blood
- Lab
- Green or gray tube
- CBG (Capillary blood glucose) Use glucometer Use gauze and alcohol
- Diabetes
- Absent or inefficient insulin
- Increases cortisol production
- Disrupts insulin production
- Increases insulin resistance
- Insulinoma Hypothyroidism Hypopituitarism Addison’s Disease Insulin overdose Malnutrition
- Lab Values Glucose Metabolism
Mon, 01 May 2023 - 06min - 116 - WBC
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White Blood Cell
WBC
White blood cells (WBCs) are created in the bone marrow. Their primary function is to defend the body against infection. There are various types of WBCs which have different shapes and functions. Decreased WBC count is called Leukopenia and increased WBC count is called Leukocytosis.
4,500 – 10,000 cells/mcL
Sat, 22 Apr 2023 - 03min - 115 - Urinalysis
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- Urinalysis
- Color & Clarity Protein RBC WBC Glucose Specific gravity Ketones pH Bilirubin/Urobilinogen
- Normal value range
- Color & Clarity
- Normal – Yellow
- Other colors
- Drug interactions
- Propofol – green Methylene blue – blue/green
- Red/Brown
- Brown/tea colored
- Cloudy
- Cell or contaminant related
- Severe presence of cells (WBC, RBC)
- ~6
- Changes in body condition can change pH Metabolic acidosis/alkalosis
- 0-trace Glomerular permeability/infection
- 0-2 Bleeding Trauma/injury below kidneys
- Negative Sepsis/Infection/UTI
- Negative Diabetes
- Negative Presence of ketones can indicate endocrine disease like Diabetes
- 1.010-1.030 Facilities vary Ability to concentrate urine Hydration
- Overhydration
- Decreased USG
- Increased USG
- Causes increased diuresis
- Causes decreased diuresis
- Negative
- Presence indicates potential liver problems
- Lab Values Elimination
Sat, 15 Apr 2023 - 04min - 114 - Troponin I
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Troponin I
cTNL
Troponins are proteins that initiate contraction of muscle fibers. Troponin I (cTNL) is specific to heart muscle. Troponin levels stay elevated for a week after muscle damage before returning to normal.
There is a wide range of normal values among varying institutions and texts with regard to Troponin I. It is essential to verify institutional norms. < 0.035 ng/mL
N/A
Sat, 08 Apr 2023 - 03min - 113 - Triglycerides
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Triglycerides
TG
Triglycerides (TG) are required to provide energy during the metabolic process, excess triglycerides are stored in adipose tissue.
Sat, 01 Apr 2023 - 03min - 112 - Thyroid Stimulating Hormone
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Determine the significance and clinical use of Thyroid Stimulating Hormone in clinical practice
Thyroid Stimulating Hormone
Thyroid Stimulating Hormone (TSH) is released from the anterior pituitary in response to low levels of thyroid hormone.
TSH stimulates the thyroid gland to release thyroid hormones
Triiodothyronine (T3) Thyroxine (T4) T3 and T4 have an inverse relationship with TSHAids to diagnose:
Hyperthyroidism Hypothyroidism Anterior pituitary functionMonitor:
Thyroid replacement therapy Normal Therapeutic Values:Normal –
2-10 mU/L
Collection:
Plasma separator tubeTSH levels increase in the following conditions:
Hypothyroidism Thyroidectomy Thyroid dysfunction Thyroiditis Thyroid Agenesis Large doses of iodine Pituitary TSH-secreting tumorRecall the inverse relationship between TSH and T3/T4 labs, and how the negative feedback loop works with these hormones.
TSH levels decrease in the following conditions:
Anterior pituitary hypofunction- If the pituitary isn’t secreting TSH, the level will be low. Hyperthyroidism- If there is a large amount of thyroid hormone circulating, the feedback system relays the info upstream and less TSH is released.Sat, 25 Mar 2023 - 03min - 111 - Sodium
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Sodium
Na+
Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body, plays a role in blood pressure regulation, and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; Water follows salt.
135-145 mEq/L
Sat, 18 Mar 2023 - 04min - 110 - Red Blood Cells
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Red Blood Cell
RBC
Red Blood Cells (RBCs) contain hemoglobin which is responsible for oxygen transport throughout the body. RBCs are primarily produced in the bone marrow, they have a life span of 120 days and are destroyed in the spleen and liver. RBC production is regulated by erythropoietin (EPO) which is produced and released from the kidneys.
Male: 4.5 – 5.5 x106/cells/mm3 Female: 4.0 – 4.9 x106/cells/mm3
Sat, 11 Mar 2023 - 03min - 109 - Prostate Specific Antigen
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Determine the significance and clinical use of Prostate Specific Antigen in clinical practice
Prostate Specific Antigen – PSA
Measurement of PSA in the bloodstream
Used to diagnose and assess prostate health, size and function.
Evaluate:
Enlarged prostate when prostate cancer is suspected Stage cancer Effectiveness of treatmentsNormal –
Male: < 4 ng/mL Female: < 0.5 ng/mLCollection:
Serum Separator Tube What would cause increased levels?Increased:
Benign Prostatic Hypertrophy (BPH) Prostate cancer Prostatitis Urinary retention What would cause decreased levels?Decreased:
Long-term use of NSAIDs- explained in part by the anti-inflammatory effect of these medications Thiazides- reduces bioavailable testosterone, associated with resulting in functional hypogonadism Statins- cholesterol plays a role in synthesis of androgen, which affects the size of the prostate 5-alpha-reductase inhibitors- due to the effect on prostate size.Sat, 04 Mar 2023 - 02min - 108 - Potassium
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Potassium
K+
Potassium (K+) is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen with enter the cell as this happens it will force potassium out of the cell, a 0.1 decrease in pH will cause a 0.5 increase in K+.
3.5 – 5.0 mEq/L
Sat, 25 Feb 2023 - 04min - 107 - Platelets
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Platelets
(PLT)
Platelets (PLT) play a role in coagulation, hemostasis, and thrombus formation. Platelets are the smallest blood cell, damaged vessels send out signals that result in platelets traveling to the area and becoming “active”.
100,000 – 450,000 cells/mcL
What would cause Increased Levels of Platelets?
Malignancy Polycythemia Vera Postsplenectomy syndrome Rheumatoid Arthritis (RA) Iron-deficiency anemia Hemolytic anemia Tuberculosis Birth control What would cause Decreased Levels of Platelets? Idiopathic Thrombocytopenia (ITP) Inherited thrombocytopenia disorders: Wiskott-Aldrich Syndrome Bernard-Soulier Syndrome Zieve Syndrome Infection: Hepatitis Human Immunodeficiency Virus (HIV) Measles Sepsis Hypersplenism Hemorrhage Leukemia Lymphoma Drug Therapy: Aspirin Ibuprofen Sulfa antibiotics Hydralazine Thiazide diuretics Systemic Lupus Erythematosus (SLE) Hemolytic anemia’sSat, 18 Feb 2023 - 04min - 106 - Partial Thromboplastin Time
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Partial Thromboplastin Time
PTT
Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin.
25 – 35 seconds
N/A
Sat, 11 Feb 2023 - 03min - 105 - Oxygen Saturation
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Oxygen Saturation
SaO2
Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen. Oxygen is transported in the blood in two ways: oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin (SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved in plasma. SaO2 and pO2 have direct relationships, if one is decreased so is the other. The relationship between oxygen saturation (SaO2) and partial pressure O2 (PaO2) is referred to as the oxyhemoglobin (HbO2) dissociation curve. SaO2 of about 90% is associated with PaO2 of about 60 mmHg. For more information on PaO2, SaO2 and oxyhemoglobin dissociation curve visit this link HERE.
95 – 100%
What would cause Increased Levels of Oxygen Saturation?
Polycythemia Increased inspired O2 Hyperventilation What would cause Decreased Levels of Oxygen Saturation? Anemia’s Hypoventilation Bronchospasm Mucus plugs Atelectasis Pneumothorax Pulmonary edema Adult respiratory distress syndromeSat, 04 Feb 2023 - 03min - 104 - Osmolality
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Osmolality
Osmolality is a measure of the particles in solution. The size, shape, and charge of the particles do not impact the osmolality
261 – 280 mOsm/kg
Sat, 28 Jan 2023 - 05min - 103 - Magnesium
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What is the Lab Name for Creatinine (Cr) Lab Values?Magnesium
Mg
Magnesium (Mg) is a cation necessary for protein synthesis, nucleic acid synthesis, muscle contraction, ATP (adenosine triphosphate) use, nerve impulse conduction, and blood clotting. Magnesium affects the absorption of sodium, calcium, phosphorus, potassium.
1.6 - 2.6mg/dL
Sat, 21 Jan 2023 - 03min - 102 - Low Density Lipoprotein
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Low Density Lipoprotein
LDL
Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein, LDL, very low-density lipoprotein (VLDL). LDL cholesterol is considered bad cholesterol because as it travels through the blood, it deposits cholesterol into the lining of blood vessels, causing atherosclerosis and an increase in cardiovascular disease.
Sat, 14 Jan 2023 - 03min - 101 - Lipase
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Determine the significance and clinical use of Lipase in clinical practice
Lipase
Lipase
Measurement of lipase in the blood
Used to diagnose pancreatitis and pancreatic cancer An enzyme produced by the pancreas Aids in breakdown of fats Released into the bloodstream as a result of damage to the pancreasDiagnose:
Pancreatitis Severe upper abdominal pain Abdominal pain – radiates Fever N/V Tachycardia Pancreatic cancer Discoloration of urine and stool Weight loss DiabetesNormal:
23-300 U/LCollection:
Plasma separator tube Serum separator tubeN/A
Sat, 07 Jan 2023 - 03min - 100 - Lactic Acid
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Lactic Acid
Lactate (Lactic Acid) is a byproduct of anaerobic metabolism. Normally, the tissues use aerobic metabolism to breakdown glucose for energy and the byproduct is CO2 and H2O which we excrete through our kidneys and exhalation. However, if the tissues are starved of oxygen (hypoxic), they use anaerobic metabolism. This can be compounded if the liver is also hypoxic causing the liver to be unable to clear the lactic acid.
0.3 -2.6 mmol/L
What would cause Decreased Levels of Lactic Acid?
N/A
Sat, 31 Dec 2022 - 04min - 99 - Iron
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Determine the significance and clinical use of iron levels in clinical practice
Iron – Fe
Measures the amount of Fe in the bloodstream.
Evaluates:
Sufficient Fe level oxygen transport proper hemoglobin & RBC productionIron (Fe) is an element that is an important component of hemoglobin in red blood cells.
Iron aids hemoglobin’s transport of oxygen from the lungs to all the cells of the body.
The storage form of iron is ferritin. Iron is transported in the blood by a protein called transferrin.
Identify:
Blood loss Hemochromatosis Malabsorption of iron Iron overloadType of anemia:
Thalassemia Sideroblastic anemia Iron deficient anemiaNormal –
50-175 μg/dL
Collection:
plasma separator tubeWhat would cause Increased Levels of Iron?
Hemochromatosis Lead toxicity Iron poisoning Acute liver disease Multiple blood transfusions Hemolytic anemia Sideroblastic anemiaWhat would cause Decreased Levels of Iron?
Blood Loss: Gastrointestinal (GI) bleeding Heavy menstruation Chronic hematuria Hypothyroidism Iron-deficiency anemia Inadequate absorption of ironSat, 24 Dec 2022 - 03min - 98 - INR
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International Normalized Ratio
INR
International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method.
0.8 – 1.2 Therapeutic Levels on Warfarin 2.0 – 3.5
Sat, 17 Dec 2022 - 04min - 97 - High Density Lipoprotein
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High Density Lipoprotein
HDL
Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein, LDL, very low-density lipoprotein (VLDL). HDL cholesterol is considered the good cholesterol because it travels through the blood picking up extra cholesterol and taking it back to the liver.
60 optimal mg/dL
What are the Indications for High Density Lipoprotein? Monitor risks of heart diseaseSat, 10 Dec 2022 - 03min - 96 - Hemoglobin
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Hemoglobin
Hbg
Hemoglobin (Hbg), an iron containing compound, is the main protein in Red Blood Cells (RBCs). It enables oxygen and carbon dioxide (CO2) to bind to RBCs for transport throughout the body.
Male: 13.5 – 16.5 g/dL | Female: 12.0 – 15.0 g/dL
Identify:
Bleeding disorders Anemia Blood lossSat, 03 Dec 2022 - 04min - 95 - Hematocrit
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Hematocrit
Hct
Hematocrit (Hct) is the percentage of the blood that is made up of packed Red Blood Cells (RBCs). A hematocrit level of 40% indicates that there are 40 mL packed red blood cells in 100 mL of blood.
Male: 41 – 50% | Female: 36 – 44%
Sat, 26 Nov 2022 - 05min - 94 - Glycosylated Hemoglobin A1c
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Glycosylated Hemoglobin
HbA1c
Glycosylated Hemoglobin (HbA1c) is the combination of glucose and hemoglobin. When glucose is elevated in the blood the amount of glycosylated hemoglobin increases proportionally. A red blood cells lifespan is about 4 months, so you can get an idea of blood sugar control over the last several months.
5.6-7.5 % of total Hgb
What would cause Decreased Levels of Glycosylated Hemoglobin?
Renal failure Blood loss Hemolytic anemia Sickle cell anemiaSat, 19 Nov 2022 - 03min - 93 - Glucose
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Glucose
Glucose is a sugar molecule that is a component of carbohydrates. Glucose provides energy in the body and is absorbed from the blood to the cells for nourishment via insulin. The pancreas secretes insulin to helps regulate levels of glucose in the blood. Glucose levels naturally rise after meals with the intake of carbohydrates.
70-115 mg/dL
What are the Indications for Glucose? Diagnose: Hypoglycemia Hyperglycemia Diabetes Mellitus (DM) Monitor treatments for Diabetes Mellitus (DM)Sat, 12 Nov 2022 - 06min - 92 - Folic Acid
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Folic Acid
Folic acid is an essential water soluble B vitamin. It is stored in the liver and is an important part of Red Blood Cell (RBC) and White Blood Cell (WBC) function, DNA replication, and cell division.
2 – 20 ng/mL
What would cause Decreased Levels of Folic Acid?
Vitamin B12 deficiency Pernicious anemia Hemolytic anemia Celiac Disease or Crohn Disease Inflammatory Bowel Disease (IBS) Alcoholism MalnutritionSat, 05 Nov 2022 - 03min - 91 - Ferritin
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Ferritin
Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin. Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron.
20-300 ng/mL
Sat, 29 Oct 2022 - 03min - 90 - Erythrocyte Sedimentation Rate (ESR)
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Determine the significance and clinical use of Erythrocyte Sedimentation Rate in clinical practice
Erythrocyte Sedimentation Rate- ESR
The Erythrocyte Sedimentation Rate (ESR) test measures sedimentation of Red Blood Cells (RBCs).
In normal conditions, RBCs settle or sediment very little.
Inflammation affects proteins in the blood causing RBCs to stick and settle together out of the liquid portion of the blood.
Identifies inflammation which assists in diagnosing:
Cancer Infection Autoimmune diseasesNormal – 0-20 mm/hr
Increased
Conditions:
Anemia Chronic Renal Failure Systemic Lupus Erythematosus (SLE) Infection Tuberculosis Pregnancy Polymyalgia Rheumatica Multiple myelomaMedications:
Oral contraceptives Theophylline Vitamin AWhat would cause decreased levels?
Decreased
Conditions:
Sickle cell anemia Polycythemia Vera Leukocytosis Congestive Heart Failure (CHF)Medications:
Aspirin Cortisone QuinineSat, 22 Oct 2022 - 02min - 89 - D Dimer
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Determine the significance and clinical use of D-Dimer in clinical practice
D-Dimer- DDI
Measurement of D-Dimer evaluates the amount of byproduct produced as part of fibrinolysis
D-dimer (DDI) is a product of fibrinolysis
D-dimer levels are elevated in the setting of clot breakdown, and will be significantly elevated in the setting of Disseminated Intravascular Coagulation (DIC).
Identify and monitor
Disseminated Intravascular Coagulation (DIC)
Rule out a blood clot:
Pulmonary Embolism (PE) Deep Vein Thrombosis (DVT) StrokeNormal – ≤ 250 ng/mL
Collection:
Light blue lab tubeIncreased
Surgery Trauma Infection Cancer Heart attack Pregnancy Deep Vein Thrombosis (DVT) Disseminated Intravascular Coagulation (DIC) What would cause decreased levels?Indicates a lack of the substance that is released during the breakdown of a blood clot (i.e. lack of blood clots, or lack of fibrinolysis)
Sat, 15 Oct 2022 - 02min - 88 - CRP
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Determine the significance and clinical use of C-Reactive Protein in clinical practice
C-Reactive Protein – CRP
C-reactive protein (CRP) is made in the liver in response to inflammation
Measures CRP in the blood
Increases quickly Decreases quicklyMonitor or Identify:
Inflammation in the body Appendicitis Pelvic Inflammatory Disease (PID) Crohn’s Ulcerative Colitis Rheumatoid Arthritis (RA) Lupus (SLE – Systemic Lupus Erythematosus)Evaluate:
Coronary Artery Disease (CAD) Cholesterol level – atherosclerosisSat, 08 Oct 2022 - 02min - 87 - Creatinine Clearance
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Determine the significance and clinical use of measuring Creatinine Clearance in clinical practice
Creatinine Clearance – CrCl
Healthy kidneys remove creatinine from the blood. It then passes out of your body through urine. Creatinine is created in the body as a byproduct from normal wear and tear on muscles and protein in your diet.
Creatinine Clearance is a test that compares the level of creatinine in the blood against the level in the urine and evaluates Glomerular Filtration Rate. Hydration, blood volume status, blood pressure, and the state of the glomeruli impact GFR.
Remember that GFR is the amount of blood cleaned each minute by tiny filters in your kidneys called glomeruli.
An increase in CrCl indicates an increase in GFR.
The creatinine clearance test is done when your healthcare provider thinks that the eGFR result given with your blood creatinine level may not be accurate. This would be in patients who have diabetes, those with HF, those with kidney disease, and is sometimes evaluated in those with hypertension.
Kidney Function GFR Diabetes Heart Failure HypertensionNormal – Creatinine clearance rates go down as you age
Male: 97 to 137 mL/min Female: 88 to 128 mL/minFor every decade after age 40, a normal test result is 6.5 mL/min less than the numbers above.
Collection:
Plasma separator tube for serum Urine is collected for 24 H in a plastic container First void is flushed Date and time recorded, and urine collected and stored at room temperature Processed once collection is completeIncreased Creatinine Clearance→ Increased GFR
Pregnancy- higher blood volume Large protein intake ExerciseThe kidneys are solely responsible for removing Creatinine from the blood. If kidney function is declining, the creatinine level increases in the blood, but less creatinine is excreted into the urine.
Decreased Creatinine Clearance→ Decreased GFR
Abnormal kidney function Poor perfusion Dehydration Bladder obstruction Nephrotoxic medicationsSat, 01 Oct 2022 - 03min - 86 - Creatinine
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Creatinine
Cr
Creatinine (Cr) is a byproduct of creatine metabolism, and it is excreted by the kidneys. Creatinine is created in proportion to muscle mass and usually stays stable.
0.7-1.4 mg/dL
Sat, 24 Sep 2022 - 03min - 85 - CK
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What is the Lab Name for Creatine Kinase (CK) Lab Values?Creatine Kinase
CK
Creatine kinase (CK) enzyme is found in heart and skeletal muscle and to a lesser extent brain. When damage is done to these types of tissue CK is released into the blood. There are three isoenzymes, and depending on which one is elevated this lab value can help determine timing, location, extent of damage. The three isoenzymes are CK-MB (cardiac), CK-MM (skeletal), and CK-BB (brain).
55 – 170 U/L
Sat, 17 Sep 2022 - 04min - 84 - Cholesterol
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Cholesterol
Chol
Cholesterol (Chol) is a lipid in the body. It is a part of cell membranes as well as a precursor for vitamin D, steroids, and bile acids. Cholesterol is primarily synthesized in the liver and intestines and is transported via lipoproteins. There are multiple types of lipoproteins, each have slightly different functions. The two most common types of lipoproteins are high-density lipoprotein (HDL) and low-density lipoprotein (LDL).
Sat, 10 Sep 2022 - 04min - 83 - Chloride
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Chloride
Cl-
Chloride (Cl–), an anion found in the blood, works together with sodium to help maintain oncotic pressure and water balance in the body. Chloride is inversely related to bicarbonate levels in the blood. Chloride is also part of hydrochloric acid (HCL) which is utilized in the stomach to breakdown food. When Red Blood Cells (RBCs) take up CO2 they take up chloride as well. The negative ion bicarbonate then leaves the red blood cell so that the electrical charge is maintained. Extra chloride is excreted into the urine by the kidneys.
96-108 mEq/L
Sat, 03 Sep 2022 - 04min - 82 - Calcium
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Calcium
Ca+
Calcium (Ca+), a positive ion in the body, is necessary for neuromuscular processes, bone mineralization, and hormonal secretion. The parathyroid gland and vitamin D are responsible for calcium regulation in the body. In the blood, about half of calcium travels in ion form, the other half is bound to proteins like albumin. When albumin levels are low, calcium levels will appear lower. Calcium has an important relationship with phosphorus: they are inversely proportional.
8.4-10.2 mg/dL
Sat, 27 Aug 2022 - 06min - 81 - Blood Urea Nitrogen (BUN)
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Blood Urea Nitrogen
BUN
Blood urea nitrogen (BUN) measures the amount of urea in the blood. When protein is broken down ammonia is formed. Ammonia is converted to urea in the liver and is eventually excreted in the kidneys.
7-20 mg/dL
Sat, 20 Aug 2022 - 05min - 80 - Bilirubin
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Determine the significance and clinical use of measuring Direct or Conjugated Bilirubin in clinical practice
Direct or Conjugated Bilirubin
Bilirubin is a substance made when your body breaks down old red blood cells. This is a normal process. Bilirubin is also part of bile, which your liver makes to help digest the food you eat.
A small amount of bilirubin in your blood is normal.
Some bilirubin is bound to albumin in the blood. This type of bilirubin is called unconjugated, or indirect, bilirubin.
In the liver, bilirubin is changed into a form that your body can get rid of. This is called conjugated bilirubin or direct bilirubin.
This bilirubin travels from the liver into the small intestine. A very small amount passes into your kidneys and is excreted in your urine. This bilirubin also gives urine its distinctive yellow color and contributes to the brown color of stool.
Normal – 0.0-0.2 mg/dL
Collection:
Plasma separator tubeIncreased levels linked to:
Poor liver function or hepatitis Certain medications Hemolytic anemia Pregnancy Sepsis- poor perfusion Exercise TPN ETOHStudies are inconclusive regarding risk or association with disease process in the presence of a decreased bilirubin level.
Sat, 13 Aug 2022 - 04min - 79 - Aspartate Aminotransferase
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Aspartate Aminotransferase
What is the Lab Abbreviation for Aspartate Aminotransferase?AST
What is Aspartate Aminotransferase in terms of Nursing Labs?Aspartate aminotransferase (AST) is an enzyme primarily found in liver and heart cells and to a smaller extent, AST can also be found in the pancreas, kidneys, skeletal muscle, and brain. Levels of AST increase from cell death (necrosis) because the AST enzyme is released into the blood.
What is the Normal Range for Aspartate Aminotransferase?12-37 U/L
What are the Indications for Aspartate Aminotransferase?N/A
Sat, 06 Aug 2022 - 03min - 78 - Amylase
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Amylase
Amylase is made in the pancreas. It is an enzyme that breaks down carbohydrates to allow our body to absorb it. Monitoring amylase levels can identify problems with the pancreas.
0-130 U/L
What would cause Decreased Levels of Amylase?
Pancreatic Insufficiency Pancreatectomy Toxemia of Pregnancy Cystic Fibrosis Liver DiseaseSat, 30 Jul 2022 - 03min - 77 - Ammonia
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Ammonia
NH3
Ammonia (NH3) is a byproduct created when protein is broken down. Ammonia is converted into urea in the liver, and urea is excreted by the kidneys. During liver disease, ammonia levels rise and can have a negative effect on the brain.
19-60 mcg/dL
Sat, 23 Jul 2022 - 04min - 76 - Alkaline Phosphatase
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Objective:Determine the significance and clinical use of alkaline phosphatase in clinical practice
Alkaline Phosphatase – ALP
Measures amount of ALP in circulation
Located in several places in the body:
Liver Intestines Biliary tract Bones PlacentaDifferent isoenzymes of ALP are used to determine:
Liver, bone, intestine and other cancers Bone turnover in postmenopausal womenEvaluation of ALP:
Hepatobiliary disease Malignancies Bone disease Bone damage in renal patientsNormal – 40-130 U/L
Collection:
Plasma separator tubeIncreased levels assessed in:
Liver disease Bone disease Pregnancy Amyloidosis Lung cancer Pancreatic cancer Congestive heart failure Ulcerative colitis Hodgkin’s disease Chronic renal failure SarcoidosisSat, 16 Jul 2022 - 04min - 75 - Albumin
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Albumin
alb
Albumin is a transport protein in the blood. It helps maintain the oncotic pressure of the blood. Albumin levels will drop if synthesis is slowed, protein intake is inadequate, or there are increased losses. Albumin has a long half life, however, so levels are not a good indicator of acute illness.
3.5 – 6.0 g/dL
What would cause Increased Levels of Albumin?
Dehydration Hyper infusion AlbuminSat, 09 Jul 2022 - 04min - 74 - Alanine Aminotransferase
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Objective:Determine the significance and clinical use of Alanine Aminotransferase in clinical practice
Alanine Aminotransferase – ALT
Measures amount of ALT, an enzyme produced by the liver, present in circulation
Found in:
Most abundantly in liver
Heart
Skeletal muscle
kidney
Increases in lab values indicate liver disease or liver damage
Evaluation of ALT:
Progression of liver disease Monitoring response to treatmentNormal – 40-130 U/L
Collection:
Plasma separator tubeINCREASED:
Cirrhosis Muscle damage Preeclampsia Biliary tract obstruction Burns Pancreatitis Long-term alcohol abuse Liver Cancer Muscular dystrophy MI Myositis Shock Infection-mononucleosisDECREASED:
Pyridoxal phosphate deficiency A rare genetic metabolic disorderSat, 02 Jul 2022 - 03min - 73 - Activated Partial Thromboplastin Time
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Activated Partial Thromboplastin Time
APTT
APPT is a test that measures the amount of time it takes for a fibrin clot to form after reagents have been added to the specimen. It is useful in diagnosis clotting disorders. In conjunction with PT it can be used to differentiate the specific factor that may be missing.
25-39 seconds
Sat, 25 Jun 2022 - 03min
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