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Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Chapter TwentyChapter Twenty
Laboratory Values and the Older Adult
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Meaning of Laboratory ValuesMeaning of Laboratory Values
Many normal ranges are different for older adults Greater deviation from normal when under stress Return to normal is slower Relationship to clinical status
Lab values should be evaluated in relationship to individual’s entire clinical situation
Abnormal lab value may indicate a clinical
stressor or medication side effect rather than illness
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Meaning of Laboratory ValuesMeaning of Laboratory Values
Routine laboratory evaluations Complete blood cell count Serum glucose Serum creatinine level Serum electrolytes Thyroid function tests Urinalysis Stool guaiac test
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Common Screening TestsCommon Screening Tests
Tuberculin skin test Negative result <10 mm of induration Screening method for tuberculosis May need to be repeated 1 week later
Urinalysis Appearance—clear yellow/straw Specific gravity—1.005–1.020 pH—4.5–8.0 Negative for glucose, ketones, blood, bilirubin
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Common Screening TestsCommon Screening Tests
Urinalysis (cont.) Types of specimens
Mid-stream clean catch Fasting 24-hour
Send specimen to lab within 10 minutes or keep refrigerated
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Common Screening TestsCommon Screening Tests
Stool for occult blood Negative result—absence of test color Test three specimens and two different sections of
each stool Avoid red meat, vitamin C intake, iron supplements,
and aspirin 2 to 3 days before and during stool collection
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Hematological IndicatorsHematological Indicators
Complete blood count Values do not change with age Red blood cell count
Men—5.4 ± 0.9 × 1012/L Women—4.8 ± 0.6 × 1012/L Diagnose anemia, polycythemia, other bone
marrow abnormalities
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Hematological IndicatorsHematological Indicators
Complete blood count (cont.) Hemoglobin
Men—14–18 g/dL Women—12–16 g/dL Increase—polycythemia, dehydration Decrease—anemia, recent hemorrhage, fluid
retention, kidney disease
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Hematological IndicatorsHematological Indicators
Complete blood count (cont.) Hematocrit
Men—47.0 ≠ 5.0% Women—42.0 ≠ 5.0% Measures percentage by volume or packed RBC in
whole blood Increased—polycythemia Decreased—anemia, hemodilution, bone marrow
disease
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Hematological IndicatorsHematological Indicators
Complete blood count (cont.) RBC indices
MCV 90 ± 7 fl MCH 29 ± 2 pg MCHC 34 ± 2%
Aid in diagnosis and classification of anemias
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Hematological IndicatorsHematological Indicators
Complete blood count (cont.) White blood cell count
4.5–11.0 ×109/L Used to identify infectious or inflammatory
processes, monitor response to chemotherapy
and radiation therapy Increased—infection, leukemia, inflammation Decreased—bone marrow depression, viral
infection
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Hematological IndicatorsHematological Indicators
Complete blood count (cont.) White blood cell differential
Neutrophils 1.8–7.7 ×109/L or 30%–60% Eosinophils 0–0.45 ×109/L or 1%–4% Basophils 0–0.20 ×109/L or 0%–0.5% Lymphocytes 1.0–4.8 ×109/L or 25%–35% Monocytes 0–0.8×109/L or 1%–4.0%
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Hematological IndicatorsHematological Indicators
Complete blood count (cont.) White blood cell differential (cont.) Used to determine severity of infection, detect
allergic reactions, identify various leukemias
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Hematological IndicatorsHematological Indicators
Complete blood count (cont.) Platelet count
130,000–400,000/mL Required for clot formation and hemostasis Increased—iron-deficiency anemia, hemorrhage,
malignancies, splenectomy Decreased—bone marrow disease, folic acid or
vitamin B12 deficiency, drug side effects
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Hematological IndicatorsHematological Indicators
Complete blood count (cont.) Coagulation
Prothombin timeNormal: 9.5–11.8 s (control ±1 s)Therapeutic: 1.5–2.0 times normal control
Determined before anticoagulation therapy and monitored throughout therapy
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Hematological IndicatorsHematological Indicators
Complete blood count (cont.) Coagulation
Activated partial thromboplastin time (APTT)Normal: 25–36 sTherapeutic: 1.5–2.5 times normal control
Evaluated clotting factors of the intrinsic pathway
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Blood Chemistry IndicatorsBlood Chemistry Indicators
Blood glucose Fasting:
Normal: 75–115 mg/dL Diabetes mellitus: 140 mg/dL on at least two occasions
Two hours after eating: Normal: 140 mg/dL Impaired glucose tolerance: 140–200 mg/dL Diabetes mellitus: >200 mg/dl on at least two occasions
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Blood Chemistry IndicatorsBlood Chemistry Indicators
Blood glucose (cont.) Decreased—side effects of various medications,
strenuous exercise Increased—medication side effects, recent illness
or infection Electrolytes
Sodium 136–145 mEq/L
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Blood Chemistry IndicatorsBlood Chemistry Indicators
Electrolytes (cont.) Sodium (cont.)
HyponatremiaCaused by vomiting, diarrhea, renal disorders,
diuretics, congestive heart failure Hypernatremia
Caused by inadequate fluid intake, diarrhea, diuretics
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Blood Chemistry IndicatorsBlood Chemistry Indicators
Electrolytes (cont.) Potassium
3.5–5.0 mEq/L Hypokalemia
Caused by diuretics, malnutrition, vomiting, diarrhea
Hyperkalemia Caused by renal failure, injuries, acidosis,
diabetes mellitus, several medications
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Blood Chemistry IndicatorsBlood Chemistry Indicators
Electrolytes (cont.) Calcium 9–10.5 mg/dL
Hypocalcemia Caused by hypoparathyroid, laxative,
chemotherapy, corticosteroids Hypercalcemia
Caused by hyperparathyroid, thiazide antidiuretics, immobilization, excessive vitamin D, calcium-containing antacids
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Blood Chemistry IndicatorsBlood Chemistry Indicators
Electrolytes (cont.) Phosphate 3–4.5 mg/dL Chloride 98–106 mEq/L
End products of metabolism Blood urea nitrogen (BUN) 10–20 mg/dL
Increased caused by renal disease, urinary tract obstruction, drugs
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Blood Chemistry IndicatorsBlood Chemistry Indicators
End products of metabolism (cont.) Blood urea nitrogen (cont.)
Decrease caused by severe liver failure, malnutrition, overhydration
Creatinine <1.5 mg/dL Increase caused by renal disease, diabetic
acidosis, starvation, diuretics High levels indication of renal failure
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Blood Chemistry IndicatorsBlood Chemistry Indicators
End products of metabolism (cont.) Bilirubin
Total: 0.3–1.0 mg/dL Direct: 0.1–0.3 mg/dL Indirect: 0.2–0.7 mg/dL
Uric acid Men: 2.5–8.0 mg/dL
Women: 1.5–6.0 mg/dL Increase caused by loop diuretics, thiazides, starvation,
alcohol abuse, chemotherapy
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Blood Chemistry IndicatorsBlood Chemistry Indicators
Liver function tests ALT 0–35 U/L
Increase caused by liver disease, medications, cholecystitis, trauma, lead ingestion
AST or SGOT 0–35 U/L Increase caused by myocardial infarction, liver
disease, hemolytic anemia, pulmonary emboli
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Blood Chemistry IndicatorsBlood Chemistry Indicators
Liver function tests LDH 60–100 U/mL
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nutritional IndicatorsNutritional Indicators Protein indicators
Total serum protein 5.5–8.0 g/dL Increase caused by dehydration, infection, diabetic acidosis,
chronic alcoholism Decreased caused by malnutrition, hepatic disease, renal
disease, congestive heart failure Albumin 3.5–5.5 g/dL
Increased caused by multiple myeloma Decreased caused by malnutrition, liver and renal disease,
collagen diseases, rheumatoid arthritis
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nutritional IndicatorsNutritional Indicators
Globulins 2.0–3.0 g/dL Increase caused by tuberculosis, chronic syphilis,
subacute bacterial endocarditis, myocardial infarction, diabetes mellitus
Iron indicators Iron: Men 80–180 mg/dL Women 60–160 mg/dL
Essential in production and function of hemoglobin
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nutritional IndicatorsNutritional Indicators
Iron indicators (cont.) Ferritin 15–200 ng/mL
Increased in hepatic disease, iron overload, leukemia, chronic renal disease
Decreased in chronic iron deficiency Total iron-binding capacity
250–460 mg/dL
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nutritional IndicatorsNutritional Indicators
Lipoproteins Total plasma cholesterol
Desired <200 mg/dL Borderline 200–239 mg/dL High 240 mg/dL
High-density lipoprotein HDL Desired >35
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nutritional IndicatorsNutritional Indicators
Lipoproteins Low-density lipoprotein (LDL)
Desired 130 mg/dL Borderline 130–159 mg/dL High 160 mg/dL
Triglycerides 160 mg/dL
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nutritional IndicatorsNutritional Indicators
Lipoproteins Lipid abnormalities are often familial Secondary causes
Diets high in saturated fat or cholesterol Excessive alcohol intake Estrogen supplements Smoking Sedentary lifestyle
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Nutritional IndicatorsNutritional Indicators
Lipoproteins Cholesterol is decreased in malnutrition,
hyperthyroidism and chronic obstructive pulmonary disease
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Drug Monitoring and ToxicologyDrug Monitoring and Toxicology
Drug monitoring is important when toxic and therapeutic range is narrow
Commonly monitored drugs Digoxin
Therapeutic: 0.5–20 ng/mL Toxic: 2.5 ng/mL
Signs of toxicity Visual changes, headache, nausea and
vomiting, weakness and fatigue
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Drug Monitoring and ToxicologyDrug Monitoring and Toxicology
Commonly monitored drugs (cont.) Theophylline
Therapeutic: 10–20 µg/mL Toxic: 20 µg/mL
Signs of toxicity Anorexia, abdominal discomfort, dizziness,
shakiness, restlessness, palpitation, tachycardia, hypotension
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Drug Monitoring and ToxicologyDrug Monitoring and Toxicology
Commonly monitored drugs (cont.) Phenytoin
Therapeutic: 10–20 µg/mL Toxic: 30 µg/mL
Signs of toxicity Drowsiness, mental confusion, tremors,
photophobia, blurred vision