Page 277 - Cardiac Nursing

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C HAPTER 11 / Laboratory Tests Using Blood 253
level obtained in the hospital may be substantially lower than is
Table 11-3 ■ LIPID PROFILE REFERENCE RANGES usual for the patient. 13 See Chapter 36 for comprehensive evalu-
ation of lipids.
Lipid Profile
Total blood cholesterol
Desirable 200 mg/dL ADDITIONAL LABORATORY
Borderline high 200–239 mg/dL TESTS ASSOCIATED WITH
High 240 mg/dL
HDL-C-cholesterol CARDIAC DISEASE
Low- A major risk factor for CHD 40 mg/dL
Better 40–59 mg/dL Nearly half of all patients with known CHD have no established
High- Considered protective against heart disease 60 mg/dL
coronary risk factors (i.e., hypertension, hypercholesterolemia,
LDL-C-cholesterol cigarette smoking, diabetes mellitus, marked obesity, and physical
Goal for very high risk patients 70 mg/dL
Optimal 100 mg/dL inactivity). Atherosclerosis is now considered an inflammatory
Near or above optimal 100–129 mg/dL disease, with cytokines and other bioactive molecules involved in
Borderline High 130–159 mg/dL most steps of the atherogenesis process (see Chapter 5).
High 160–189 mg/dL With the knowledge that atherosclerosis is an inflammatory
Very High 190 mg/dL
disease, researchers are studying different markers to determine if
LDL-C-cholesterol treatment goals there are other independent risk factors for the disease and if these
No CHD or DM with one or no risk factors 160 mg/dL
No CHD or DM with two or more risk factors 130 mg/dL markers can be used to identify high risk individuals for CHD
Very high-risk patients—CHD or DM patients 70 mg/dL that may not have traditional risk factors. Markers being studied
include but are not limited to adhesion molecules, C-reactive pro-
Triglyceride
Normal 150 mg/dL tein (CRP), cytokines, fibrinogen, homocysteine (Hcy), lipoprotein-
Borderline High 150–199 mg/dL associated phospholipase A 2 , serum amyloid A, tissue-type plas-
High 200–499 g/dL minogen activator, and white blood cell (WBC) count. Hcy is
Very High 500 mg/dL
being researched extensively and is utilized as a possible risk factor
for CHD. CRP is showing promise from a clinical chemistry per-
CHD, coronary heart disease; DM, diabetes mellitus. spective and research perspective as a risk factor for CHD. 44
From Executive Summary of The Third Report of The National Cholesterol Education
Program (NCEP). (2001). Expert Panel on Detection, Evaluation, and Treatment of
High Blood Cholesterol in Adults (Adult Treatment Panel III), by National Choles-
terol Education Program. JAMA, 285, 2486–2497 and Grundy, S. M., Cleeman, J. I., C-Reactive Protein
Merz, N. B., et al. (2004). Implications of recent clinical trials for the National Cho-
lesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110, CRP is an acute-phase reactant protein that is produced primarily by
227–239. the liver during the acute inflammatory process. CRP is a nonspecific
but sensitive indicator of inflammation, bacterial infection, or
DISPLAY 11-2 Computation Formulas
Computation of LDL Cholesterol
Friedewald Formula*
LDL cholesterol total cholesterol HDL cholesterol (triglycerides divided by 5)
Computation of Ionized Calcium
Serum calcium can be presumed to be normal if:
(4.5 albumin level) (0.8)
lab value for total calcium 8.8 to 11.0 mEq/L
1. Obtain total calcium level (normal 8.8 to 10.5 mEq/L). If it is less than normal (e.g., 8.8 mEq/L), follow the steps
below.
2. Obtain serum albumin level (normal 4.5 g/dL).
3. If serum albumin level is decreased, subtract the decreased level from normal value for albumin (e.g., albumin level is
measured at 3.0; 4.5 [normal] 3.0 [measured] 1.5).
4. For every 1.0 decrease in albumin, add 0.8 to calcium level (e.g., for above example, 1.5 0.8 1.2).
5. Add the calculated figure to the total calcium level (e.g., 7.8
1.2 9 mEq/L, calcium is within normal range).
6. One-half of this level (9/2) is 4.5, within the normal range for ionized calcium (normal ionized calcium 4.5 to 5.0).
Computation of Anion Gap
Anion gap [sodium (140)
potassium (4.0)] [bicarbonate (24)
chloride (110)] 10 to 12 mEq/L
Computation of Serum Osmolality
Two times the serum sodium
serum glucose (Glu) divided by 18
blood urea nitrogen (BUN) divided by 1.8 serum
osmolality ([2 sodium]
[glucose/18]
[BUN/1.8]) 280 to 300 mOsm/kg
(e.g., (2 122)
(198/2)
(18/1.8) 265 mOsm (water or intracellular fluid excess); (2 155)
(108/2)
(5.4/1.8) 318
mOsm [water or intracellular fluid deficit])
*Formula valid for estimating LDL cholesterol if the triglyceride level is 400 mg/dL.