Hey everyone, it's nurse Mike here from simple nursing.com. Today we're going to be talking all about lab values. But before we get started, for my simple nursing members, we're going to make sure this information actually sticks. So be sure to follow along with the study guides we show you right up here. From the first section, you'll want to have these two study guides from your membership ready to go. Starting with BMP, our basic metabolic panel. This is collected typically as a general survey of a patient when they come into the hospital for any reason. Sort of like a sampler platter at a restaurant. We get a lot of different tests and are able to see a wide variety of stuff. So for electrolytes, we have sodium Na, which remember sodium swells the body. We have K for potassium. So just think potassium pumps the heart muscles. and chloride, which no one really cares about to be honest, helps to maintain acid base balance, which we'll break down all the main electrolytes in a moment. CO2 is carbon dioxide, which helps to maintain acid and base pH balance. I call it carbon dia acid since too much can put the body into an acidotic state. This area can also have HCO3, our bicarb, which also maintains pH balance, pushing the body into an alkalotic state. So just think base for bicarb. And we have the two kidney labs, Ben and creatinine. So just think two labs for two kidney functions. Now the biggest one here is creatinine. Usually if creatinine is high, then the kidneys have died. And if BUN only is elevated, then usually we have burned buns or basically dehydration. Now glucose is our sugar reading. If it's really high, we have hypoglycemia. Typically for clients with uncontrolled diabetes or if it's low in hypoglycemia, this one is very deadly since the brain might die. Clients can slip into a diabetic coma here, typically from missing a meal or having too much insulin in clients with diabetes. So just think hypogly. The brain might die. And there you have it, the good old BMP. We actually sing about this in our metabolic panel song on YouTube. It's a parody to the music video for Gangdom Style. So I'll play that segment right now. [Music] Hey nursing students, confusing help subscribing to this channel. Many nursing subjects are pretty tough to handle. Let's simplify this freedom battles. Heo concentration an indication dehydration too much [Music] solutes. Heodo dilution is an indication over hydration increased fluid in blood and vascular spaces. You need to know your BMP. Don't care if you don't. Hey, starts with sodium potassium for calcium. A b2 glucose and creatin. Metabolic battle. Bollix battle. Do you know the metabolic battle? Metabolic paddle. Do Do you know the metabolic [Music] battle? Nursing students. Do Do you know the metabolic [Music] battle? Nursing students. Do Do you know the metabolic battle? N A, C, A, and K. They aid in muscle contraction. BU and creatin and they test the renal function. CO2 measures your body's acid production. Glucose sugar consumption. He concentration an indication dehydration too much solutes. Heod dilution an indication overhydration increased fluids in blood and vascular spaces. Nursing students you need to know your BMP. Don't care if you don't. A starts with sodium, potassium for calcium. A B U N A CO2, glucose and [Laughter] creatin metabolic battle panel. Do do you know the metabolics battle? Bollics battle. Do do you know the metabolic battle? Nursing students. Do do you know the metabolic battle? Nursing students. Do do you know the metabolic battle? Know the norm. Trending. What's out of norm? Get attached to a lab panels on your arm. Know the norm trending. What's out of norm? Go to simple nursing.com for more. Know what I'm saying? Nursing. Do Do you know the metabolic panel? Nursing. Do Do you [Music] know metabolic [Music] panel? Wowza. Okay. Hopefully you'll like that song. You can get it for $1 on iTunes or Google Play for Android. We also have eight other songs in the full album. Just search Simple Nursing in your music store. Now, as promised, here are the top electrolyte labs that you need to know for the Enclelex here. So, sodium 135 to 145. Remember the double S's of sodium. Sodium swells the body with fluid. So with low sodium we end up with low and slow signs and symptoms. Mental status change is a priority as well as seizures and coma and respiratory arrest from low and slow respirations. And in high sodium we get big and bloated since it swells the body with fluid. So we see edema or swollen body, increased muscle tone and flushed red and rosy skin signs. Now for potassium this is 3.5 to 5.0. Now this is the number one electrolyte to know for the enclelex and nursing exams. So just think of the three Ps of potassium. So potassium is priority since it pumps the muscles. So let's cover all the key points from our med surge video here. So just think high potassium. We have high pumps. So we get peak T- waves and ST elevations for potassium over 5.0. And the exact opposite for low potassium below 3.5. Just think low pumps. So we get flat T- waves and ST depression. And even this weird little Uwave. What the heck's a Uwave? Shut up. You. Now we have potassium wasting and potassium sparing diuretics. Potassium wasting ends in ey like ferosomide or hydrochloroioide. Both rhyme with dried. But again be careful not isosodbide that's a nitrate guys the enlex will try and trick you. So remember the O's in isos so make it a vaso dilator similar to nitro. Now loop diuretics like ferosomide and torsomide are the first drugs we use in acute or that worsening heart failure. So enlex key words like worsening crackles, new edema in the legs and even rapid weight gain. Guys, we give eyes to make the body dried. These guys work by blocking the reabsorption of sodium in the kidneys. So with less sodium retained, we have less swelling retained and our patient is saved. Now we only give potassium wasters if potassium is normal between 3.5 and 5.0. Anything less than 3.5 is a big no no, guys. We don't give the drug. So we encourage our patients to eat melons, bananas, green leafy veggies, and even liver. And a big no no here, we avoid licorice root, which lowers potassium like those found in black licorice candy. That's a common select all that apply question. So just remember the double L's here. Licorice lowers potassium. Now potassium sparing diuretics. S for spironolactone. Just think S for spares the potassium. Just like prills and sartin, this spares potassium too. But instead of blocking the angotensin, this guy blocks eldoststerone directly to let fluid out of the body and into the body and it ends in tone. So think it blocks eldoststerone. Since fonolactone spares the potassium, we teach patients to avoid those potassium rich foods guys. So we don't eat those green leafy veggies, those melons, avocados, and we avoid that salt substitute. and again and again any potassium abnormality the first nursing action is to place them on a cardiac monitor always asked on the enclelex and exams as a priority intervention. Lastly, since potassium pumps the muscles enclelex key words like muscle spasm and even muscle cramps, this indicates a potassium problem. Even words like weakness or paristhesas. So with potassium wasters that lower potassium, think low pumps in the heart, we get flat T- waves and ST depression and also this little weird Uwave. Now a little side note, if you have to replace potassium via IV or guys, don't kill your patient. We never push potassium IV. This means instant death. So the four rules of potassium revolve around protecting the heart with potassium. Number one, our first action is heart monitor placement. And secondly, guys, we never push potassium. This means sudden death. The heart will cramp up and not pump anymore. Third, we only do 10 to 20 mls max per hour. Not 30 minutes, not even 45 minutes, guys. Per hour. A full 60 minutes or more. Usually around 4 hours. And lastly, we always put potassium on an IV pump. Never a solo drip, guys. It's too risky. And as always, slow the infusion pump if the arm starts burning, which is pretty common. Okay, now that you know how to fix the low potassium, well, how do you treat the high potassium over 5.0 with those high pumps in the heart leading to deadly cardiac dysriythmias? Now, this gets a little tricky here. The Enklex loves to ask about clients with renal failure or chronic kidney failure who have built up a lot of potassium waiting for dialysis since their kidneys are broken and can't urinate out that potassium from the body and into the potty. So let's play a segment from our renal failure videos. So key terms to know peak T- waves happens when potassium is 6 to 7 microequivalents per liter. ST elevation happens when potassium is between seven to eight and wide curis complexes is a late sign over eight. Basically the heart is cramping up from too much potassium. Too much high pumps makes a very tight heart that is just basically cramping all up. You have to think that the heart's a muscle, right? So do you really think the heart can pump normal if this muscle is cramping? Well, no. So this leads to brada cardia that low heart rate since the heart is too tight and can't beat correctly and which ultimately results in weakness fatigue and lethargy from less cardiac output meaning less oxygen out of the heart into the body and then finally leading to deadly ventricular dysriythmias like VTAC and VIB that ventricular tacicardia and ventricular fibrillation. If not treated immediately, this will cause death by cardiac arrest. Basically, that stopped heart. So that's why potassium is priority on the enclelex and nursing exams since it pumps those heart muscles. Now Kaplan had a scenario asking a client with kidney disease is very weak, lethargic and bradaartic asking for a suspected finding for this patient. So the key term here is kidney disease that is weak, lethargic and brada cardartic that low heart rate. So you have to automatically prioritize and think about potassium here. So potassium 8.5 is the lab value to be suspected. Now in terms of treatments, the long-term solution is to wash the blood with dialysis, but this can take some time to set up. So the immediate priority solution and treatment is to lower the potassium and protect the heart from deadly dysriythmias. We do this with drugs in a very specific order. So write this down for priority treatment. Number one is IV calcium gluconate. For the key term, write this down. Disriythmias. Just think gluconates helps to glue down those crazy heart muscles preventing deadly disriythmias like wide cure complexes which will eventually progress into deadly vtac and vib. We must glue down those heart muscles with calcium gluconate. Now if the key term of dysriythmias is not involved in the question then we progress number two which is IV 50% dextrose and regular insulin. This helps to lower the potassium. So just think insulin puts sugar and potassium into the cell out of the blood and into the cell which lowers blood serum and potassium. Most effective way to lower blood potassium very quickly. But insulin also lowers blood glucose too. Basically that blood sugar. So that's why we also give dextrose to help prevent that low blood sugar that hypoglycemia. Now don't let the enklex trick you here. What if the key term disriythmias is not in the question? Well then we progress to option two which is just to give the iv dextrose and insulin first to lower that high potassium. And lastly three and four we can also give kaxalate that polyyrene sulfanate as well as dialysis but again these typically take longer to lower potassium. So that's why we put them last here on the list because they take a longer time. Now pulling from our simple nursing enlex question bank written by the people that actually wrote the enclelex. Here are the top missed test questions. So question number one, a patient with chronic kidney disease missed three dialysis sessions. Oh, with key terms here, potassium level of 8.1, wide QRS complexes, a heart rate of 58, and lethargy. Which order or prescription should the nurse implement first? So the key term here is high potassium with wide QRS complexes. That key term indicates dysriythmias. So just think you have to give calcium gluconate first to glue down those crazy heart muscles and prevent the progression into those deadly heart dysriythmias. So option number four IV calcium gluconate because the key term was about disriythmias and high potassium. Now question number two endstage renal disease with a potassium of 7.2 2, a bun of 35, creatinine of 38, and urinary output of 300 mls in 24 hours. Which order is priority? So this question says high potassium, right? But nothing about ECG dysriythmias or basically heart dysriythmias. So we need to lower that potassium first with insulin, which puts sugar and potassium into the cell. So option number one, IV regular insulin and 50% dextrose. Yes, we give this first, not loop diuretics and not dialysis. This is used later and definitely not option number four, the vacation time, even though it's pretty tempting. For a deep dive into everything you need to ace the ENLEX, be sure to check out our ENLEX review lecture series and live CRAM sessions with insights from current professors, former ENLEX writers, and myself. Next up is calcium 9.0 to 10.5. Think of the double C's. Calcium contracts the muscles with smooth contractions here when it's in balance. So for low calcium, we have diarrhea. not so smooth contractions of the GI track. And we have two dance moves T and C. We have trusos is a twerking arm with the BP cuff on. And for C, we have shiovastics or just vostics. Think C, the cheek smile when stroking the face. And for high calcium, just think high contractions. We have stones, moans, and groans. So all that calcium leads to kidney stones. And high contractions inside the GI will lead to constipation. Next is magnesium 1.3 to 2.1. Just think of the double M's. Magnesium mellows out the muscles. So low magnesium we get low mellow. Basically hyperexitability, the opposite of mellow. So we have torsadus deoes and vib two deadly cardiac dysriythmias that will kill your patient. So write those down. Remember on the enclelex the most deadly complication is the most tested complication. Next is hyperrelexia as well as increased DTRs those deep tendon reflexes. And for high magnesium we have high mellow. Everything is just mellowed out. So decreased DTRs and hypo reflexia here. Now for the CBC, the complete blood count. You've probably seen this chart in the hospital during your clinical rotations. So on the left side we have WBC's, the white blood cells. These are the immunity of the body. In the middle we have the H&H, hemoglobin and hematocrit, the whole blood inside the blood vessels. And on the right we have platelets, our little blood clotting proteins that help to form scabs when we get cut. But it also creates blood clots too which can kill. So starting with H&H, hemoglobin and hematocrit. Hemoglobin by far is the one to know for your enclelex and nursing exams. It's the part of the blood that carries around oxygen. So the normal range is between 12 to 18. Now this is the general range for men and women. I know they vary a little bit different and books and hospitals will differ greatly. So on the enclelex they won't have you specify between ages directly. They're mainly going to focus on how low numbers will kill your patient. So, be sure to write these down. It's very risky when it goes between 8 to 11. So, we must report this to the HCP and surgeon if it's before surgery. Typically, it's due to bleeding or anemia or even malnutrition and cancers. Now, a critical one, write this one down. Below seven sends your patient to heaven or they're going to get a blood transfusion. It's either one of those two options. So, the top signs and symptoms to know for the Enclelex is pale skin, also called palor or dusky skin tones, as well as cool clammy skin and fatigue and weakness. So, once again, write that key number down. Below seven sends your patient to heaven. And the top number one sign and symptom is the skin tones and the cool clammy skin there. So, Saunders mentions the client with a hemoglobin of 10.8 8 is most likely caused by which condition? Iron deficiency anemia. The key term there is anemia. Basically meaning low blood counts. And another question, the nurse determines that the hemoglobin level is normal if which value is noted on the laboratory report. And the answer is 14. Now, as far as the other H in H&H, our hematocrit, which I call hematic creek, like a creek or a river that flows, since it's the ratio of red blood cells and total blood volume, like the liquid part of the blood. Now, normally it's between 36 and 54. So, elevated hematocrit is from dehydration. And the memory trick we use is when labs are high then the body is dry. Now this is due to hemocentration. So we use the memory trick. Hemo concentration is an indication of dehydration. Now for decreased hematocrit this is from fluid volume overload. The labs are very very low. Just think the body is very liquidy. So when the body is liquidy we get low labs which I call low liquidity labs. Now hemodilution is an indication of overhydration or it could be from bleeding anemia and even malnutrition. So Saunders mentions a client diagnosed with fluid volume overload. The nurse would expect to note which finding on the hematocrit level decreased. Yes. Remember low liquidity labs here. And a second question here. A client with a gastrointestinal bleed laboratory results of a hematocrit level of 30%. Which action should the nurse take? Report the abnormally low level? Yes, we must report these critical labs here. Now the H&H ratio is easy to calculate. It's a 1:3 ratio. So if you only have a hemoglobin level, you can estimate the hematocrit too. So let's just say the hemoglobin is 12 just times it by 3 and it's 36. Or if the hemoglobin is 18, then the hematocrit would be 54. Or let's just say from that Saunders question, you were given 30% for the hematocrit level. So divide that by three and you have a 10 hemoglobin level. Very very bad. You must report that to the HCP. Now in terms of red blood cells or RBC's it should be between 4 to 6 million. So below this in our low RBCs this is typically from anemia and renal failure. So we give our clients iron in vitamins or foods like spinach or green leafy veggies. These serve as materials to build the blood. We can also give ariththropoetin which is a hormone released by the kidneys to produce those RBCs. So when the kidneys fail the urethropoetin fails too. Now if it's high this can be from dehydration. Remember high labs means the body is dry. Next we have the white blood cells the police of the body protecting the body from infection. So WBC total count normally is between 5,000 to 10,000. Higher than 10,000 is what's known as luccoytosis. This is present with infection or sepsis the bloodborne infection and even steroids can cause this too. So steroids end in zone like predinazone. So both of these can cause the WBC's to be higher than 10,000. Now when the white blood cells are lower than 5,000 this is known as lucopenia and typically results from chemotherapy and radiation where bone marrow suppression takes place as well as imunosuppressants and even lup the autoimmune disease where the body attacks the bone marrow since the bone marrow makes blood cells both white blood cells and red blood cells and all these conditions lower the bone marrow. So a big thing to watch out for is neutropenic precautions. A huge priority for any low WBC count. So watch for a low-grade fever. That is priority. Since the body is suppressed and the immunity is low here, a low-grade fever typically means a bad infection. The patient should have a private room, no fresh fruits or flowers, avoid sick people as well as crowds, and no drinking water from a pitcher or water that has been sitting out for more than an hour. Now, the second thing to know here is the CD4 count. Normally over 200. Anything below 200 indicates AIDS, the active form of HIV, but we cover more of that in the HIV lectures. So, a common exam question, which blood laboratory test result should the nurse report to the HCP? Select all that apply. A hemoglobin of six. Yes, less than seven sends the patient to heaven. Must report here. How about a potassium of 6.5? Yes, that's way over 5.0. Remember, potassium pumps, so we'll get high pumps in the heart leading to ECG dysriythmias. How about a sodium of 150? Yes, the normal range is between 135 to 145. Sodium will swell the body here leading to edema. And white blood cells of 2,000. Yes, remember 5,000 to 10,000 is normal. So having less than 5,000 means that we have no defenses. Huge risk for infection here. And lastly, a platelet level of 45,000. Yes, anything less than 150 gets very risky. Now, that was a little bit tricky because we haven't covered platelets yet, but we'll do that right now. In terms of coagulation panel, the three labs to know are platelets, PTT, and INR. The key points to know is that the lower the platelets go, the more bleed risk. And the higher the PTT and INR go, the higher the bleed risk. So these are the most tested out of five different exam question banks. PET was mentioned but not directly tested. So don't focus on that directly. So the platelets the key numbers are 150 to 400 or 150,000 to 400,000. So we notify the HCP for anything less than 150. Now anything less than 50,000 gets very risky. So we just say anything less than 50 gets very risky. The drugs that decrease platelets just look for the P's here. Aspirin clipil brand name plavix enoxiparin our lower molecular weight hepin as well as heeperin. So be sure to write these down and look for the P's to know that they decrease the platelets. Now for PTT, our partial thromben time, normally between 30 to 40 seconds, but exams really don't ask for normal ranges. The ENKLEX will typically ask for max ranges since this will kill your patient. So clients on Hepin, the PTT should be between 46 to 70 seconds for therapeutic range. Again, think higher is horrible. And think of the P and heperin as PTT. You must know your therapeutic range. So again, write it down. PTT for heperin should be between 46 to 70. Now INR normally between 0.9 to 1.2. But again don't focus on that. Focus on the client on Warren with an INR therapeutic range of 2 to three. The key number there is 2 to three. So just think war for in is for INR. Again think higher is horrible. Now for both PTT and INR we should never be more than these max ranges or key term here on the enlex it should never be three times their range or three times their normal range. So write that part down. I saw it a few times on various question banks. Now, if you get an ENLEX question about a client on Warren with an INR of 4.5, now that's way higher than the 2 to three or a client on Hepin with a PTT of 100, way over 70 there. What do you do? Well, number one, you stop or hold the drug. Number two is assess for bleeding. Number three is you prep the antidote. And number four is you report to the HCP immediately. Always these four on the ENCLEX. Stop, assess, prep, and report since the ENLEX mainly tests you on safety first and not about tiny various little details. So always focus on the things that will kill the patient first. Therefore, I highly recommend that you focus the majority of your attention on the coagulation panel and how drugs affect it since the majority of ENLEX questions come from here. So, write down these key points from our pharmarmacology master course. First up, let's cover antiplatlets like clitigil and aspirin aka salicellate. Now guys, let the name help you here. Antiplatlets are just that. They're anti-platelet. They lower platelet aggregation. So we have a less chance of them sticking together and clogging the arteries. So just think AC for aspirin and culpitigral brand name plavix like AC for anti-logging of the arteries preventing platelets from forming clots. Now the indication is mainly for clot prophylaxis basically meaning clot prevention. So guys, in heart and brain clot like an MI or CBA prevention, narrowed arteries like ACS in the heart or a TIA in the brain or even P A in the extremities or even prevention after a stent or bypass preventing the recclusion of that artery there. Now the Hessie key term we use postPCI that perccutaneous coronary intervention fancy words for cath lab to clear the clot. Again guys, AC is aspirin and clitigil. AC for anti- clot. Now the mechanism of action guys, it's very simple. They prevent the platelets from aggregating together or clumping up. Sort of like spreading them out like a bunch of plates. Now the key points before giving we always assess. So the key numbers here is hemoglobin levels. So, anything less than 7, just think you might be sending your patient to heaven. Huge bleed risk there. And also platelets, normally between 150 to 400. So, just think anything less than 150 is very iffy. Always notify the HCP, but less than 50 is very risky. These meds should not be decreasing platelet levels, guys. This is known as thrombocytoenia. basically meaning a huge risk for bleeding. So common questions on exams, they'll give you a scenario of a plate count about 75,000 or less than 40 guys. What's the priority nursing action? Always the priority is to hold the drug and question the prescription and then notify the HCP. Now guys, don't let the enclelex trick you. Aspirin and capigral think platelets, not INR, not PTT. That's for anti-coagulants in our next section. So key numbers here 2 to three INR for warerin antidote again was vitamin K. So the memory trick warin. So warerin vitamin K and in for INR. Just think and you wonder if it's working since it takes 5 days to reach full effect. Next is 46 to 70 apt for heperin with the antidote proamine sulfate. So the memory trick was hepit like the frog. H for heperin, P for proteamine sulfate and PTT for hepit. And since heperin acts fast, just think the frog jumps really fast. A common Hessie question here was Hepin drip PTT 85 or a PTT of 100. Guys, anything over 70. The priority action here is to number one stop the Hepin drip and notify the HCP. Number two, prepare the antidote protein sulfate. And number three, reassess the labs in about an hour. Looking for more tips and strategies for questions like the ones we just covered? Well, our simple nursing membership includes exit prep lectures and thousands of questions across all nursing school and enclelex topics. Now, a common ATI question. A patient on Hepin with bleeding at the IV site. What's the priority action guys? Key term here to know blood oozing at the surgical incision or IV site. Again, same priority actions here. Number one, stop the hepin. Notify the HCP. prepare protein sulfate the antidote and reassess labs. Now on the other side warrin we measure INR and the therapeutic range is 2 to three and 2.5 to 3.5 for heart valve replacements guys therapeutic INR was mentioned multiple times across a lot of quiz banks. Now a side note here PT that prothroen time we measure that too but the values were not tested directly on any question banks. Now guys, the antidote here is vitamin K, which you can think kills the warin. So the key term is vitamin K, not to be given if warphin's within therapeutic range and not to be given until at least 5 days of war therapy when switching from IVin. Now guys, vitamin K is found in some very specific foods. Key term here is liver and green leafy veggies like broccoli and spinach. Now the key point for patient teaching is that it should be eaten consistently guys and moderation. So just keep the K consistent. Key words is not increased, not decreased and not avoided totally. Just a nice consistent moderation. Now don't be tricked. Bananas and oranges are okay. That's for potassium that is a K+, not vitamin K. Now a common ATI question is a client on Warframe which statement requires intervention while the statement that includes I will increase my intake of dark green leafy vegetables guys that's a big no no vitamin K. Now a side note that's a nice to know. Antibiotics actually increases the risk for bleeding by increasing INR. This is because antibiotics kill the intestinal bacteria that produce vitamin K and we end up with a vitamin K deficiency which increases our risk of bleeding. Now, some common exit exam questions here. Giving an INR of four or five. Guys, we're assessing for bleeding and we're getting that vitamin K antidote ready. Or on the other side of things, the INR of a 2.0 with a patient with eskeemic CVA. Guys, we give warin to get up to 2.5. Now, for patient teaching, warrin is taken lifelong to prevent clots like with patients with atrial fibrillation or artificial heart valve replacements. Typically more prevalent in key term here guys, write this one down, mechanical valve replacements. So, another key term, we always do frequent blood tests definitely needed to check therapeutic range. Now, Hepin's different in that it's typically only given for a few days or a few weeks. So, Hepin IV is usually given after an MI heart attack or a PE in the lung to prevent the clot from growing. And hepin subq ends in paren like heperin. So, just think anoxiperin or anoxiprin brand name lovox or delta. Guys, these are lower molecular weight Hepin. Basically, a lighter version. Sort of like a Diet Coke. They're just less heavy and a less chance of major bleeding, which is a great thing. Now, it's given for a key term prevention of a DBT after surgery. Now, a common ATI question is anoxiprin. Which statement needs further teaching? Well, the statement that says, I will inject the med into my thigh. guys know in the abelagus near the belly button and I will need frequent blood tests guys know that's warrin now we always notify the hcp and clarify the order of anoxiprin if the h&h is even slightly low since guys we don't know exactly how much blood has been lost so open fractures and h&h low then anoxiprin is a nogo now a common hessie question was a client on anoxip what do you report to the HCP? And the answer was H&H that has been decreased and a blood pressure that is dropping. In that scenario, it dropped by 20 points. So guys, decreasing H&H with decreasing blood pressure usually means blood loss. Now, as far as labs for anoxiprin are lowweight hepins, we monitor for those low platelets, guys. We're not monitoring for coagulation studies. So not BTT and not INR. This was the most commonly chosen distractor. Over 30% of students got this wrong. So guys, think of the double P's for pins. So P for pin and inoxiparin or inoxiprin is P for platelet focused. So just like aspirin the key numbers here platelet should be between 150 and 400. And guys, we hold the med for any platelets less than 50. So less than 50 gets really risky. We hold really any blood thinner. Now another risk is a deadly condition from any type of hepin. Now this is called hit or hepin induced thrombocytoenia. This happens if platelets are decreased by half within key number here 24 hours after starting hepin of any type. This usually indicates hit guys. Very deadly. So think of the triple H's here. H for hit is when H half the platelets are gone within 24 hours after starting H for hepin. Now for patient teaching the big contraindication here and to be honest for any blood thinner is key term active bleed like a peptic ulcer or peptic ulcer disease. And we always avoid any patients with liver problems since the liver makes coagulation factors. So we use the acronym chant. C for cerosis, H for hepatitis, A for alcohol. Key term on the Hessie was a client just drank six beers. N for NSAIDs. And the ATI loves to name neproxen and ibuprofen. And T for Tylenol overdose leading to liver damage. Now we monitor signs of bleeding and we notify the HCP ASAP. Keywords used on ATI was black to stools usually indicating a GI bleed, hematura or blood tinged urine, epistaxis or nose bleed and even petiki on the chest mentioned by Hessie and easy bruising. Now supplements to avoid completely. No egos guys like that old waffle commercial. Lego my egos. E for vitamin E, G for ginsing, ginko baboa and well garlic and O for omega-3s and the S is for St. John's warts. Lastly, we avoid trauma. So, the big key terms used on the hessi, no small rugs or dim halls, always well-lit hallways. No brushing hard, we use a soft bristled toothbrush. No flossing, no alcohol-based mouthwashes, no razors, only electric shavers, no constipation, only fiber and fluids, guys. And no contact sports. And we always wear a medical alert bracelet. Now, three common test questions. Number one, when do you hold hepin and contact the HCP? Select all that apply. So guys, Hepin, just think he we're looking for PTT between 46 and 70. Anything north of 70, we got to call the doctor. So patient has recent diagnosis of peptic ulcers. So we're going to be holding that medication. Number two is patient has a PTT of 105. Guys, that's way north of 70. What about option three? Patient has an INR of 4.5. Nope, that is warerin, not heperin. How about four? Patient has black tar stools. Yes, that could be indication of a GI bleed. And patient has a PTT of 25. Well, that's under 46. So, just keep on giving the hepin for sure. And lastly, patient is taking GKO or vitamin E. Guys, definitely hold the medication. Huge risk for bleeds. Now question number two, when do you question the order of aspirin or clitigel? Well guys, the P for platelets, we want it to be over 150. So aspirin and clipil for platelets. So option one, now the patient has 65,000 platelets, guys, that's way less than 150. So it's very iffy. Number two, patient with 1.5 INR. Number three, the patient with 46 PTT. Again, that's Hepin with Hepit the frog. So, no, not a platelet thing. Number four, currently taking Warfin. Yes, guys, we want to hold this medication because we don't mix aspirin or caplitigil with an anti-coagulant. And number five, regular consumption of six glasses of wine per night. Guys, we're not doing alcohol for sure. And lastly, another common question. A patient on deigatran for a fib. Which action should the nurse initiate? So guys, number one, place an IV line. No, we're not trying to place an IV line here. That would indicate a big bleed. Number two, report stools that are black and tar. For sure, that's a GI bleed. Number three, teach the patient to avoid clipidigral. Most definitely. Number four, administer aspirin instead. No, big no. No, we do not mix. And number five, teach the patient to stop taking this med before surgery for sure. Definitely want to do that. Now for the cardiac labs for an MI or myocardial inffection, fancy words for a heart attack. Just know the double T's here. Trapponin over 0.5 means trauma to the heart muscles. Basically cell death. Now, I know there's a lot of other nice to know cardiac enzymes, but real talk here, those are typically not tested on the Enclelex or exit exams. So, I wouldn't recommend using your precious time memorizing all the other cardiac enzymes because the one to know is traropponin coming up 99% of the time on many question banks. Out of 10,000 questions, traropponin was the only cardiac enzyme. Now for CHF or congestive heart failure, just think of the double B's. BMP under 100. Think big stretched out ventricles if that BMP is high. Now, it's not a high priority. So again, I wouldn't focus on this since it indicates chronic long-term condition. But if you want to impress your clinical instructor, then watch this next 3minut segment. Now, what the heck are nutritic peptides? Well, the medical definition are hormones secreted by cells that lie in the heart chambers when there is damage presented. They're simply a good way to determine if the chambers in your heart are being stretched out too much for a buildup of blood pressure in the heart. Now, we have two types of nutritic peptides. The first type is A&P, atrial nutritic peptides in the atriums, the upstairs of the heart. Next is the BNP, the brain nutritic peptides in the ventricles, the downstairs of the heart. It's kind of like a speedometer hormone to show us how bad the damage in the heart actually is. So more hormone that is present, the more damage in those ventricles. Now, let's dive a little deeper into our brain nutritic peptides, which is vital lab for our heart failure patients. Now, I want you guys to think very, very simply here. If the heart has to work harder than usual over a long period of time from all that high blood pressure being pushed on it, maybe from a super high sodium diet, maybe from a seditary couch potato lifestyle or even high cholesterol foods or even renal failure holding all that fluid inside the body. Ultimately, BNP is the biggest indicator for heart failure. The heart releases more BNP to the measure and degree of the wear and tear or the deterioration of the ventricles. mainly the big mama ventricle on the left. Now, atrial nutritic peptides are very different than BNP. They're not necessarily a marker that measures the wear and tear on the heart. A&P are kind of like a special forces that tries to assassinate eldostyone in the kidneys because eldoststery is the bouncer or security guard in the kidneys that hold sodium and fluid in the body. So A&P is secreted as kind of a defense system in response to increasing blood pressure and increasing blood volume which stretches out and damages the heart tissue. The atrial nutritic peptides act like the special forces because they go down into the nefron into the functioning unit of the kidney and they create an opposite effect of eldoststerone. So now in the kidney the reabsorption of sodium is blocked and at the same time the filtration rate of the kidney is increased. So what happens is we have a release of fluid from the body and into the body. All fancy words for A&P done killed eldoststerone. So all that water flows out of the body and into the body. Now it's technically kind of bad when A&P levels do increase because this indicates a war is going on. And this happens with acute heart failure or SAT superventricular tacoc cardia even hyperthyroidism and even in small cell lung cancers. But interestingly enough levels actually decrease with chronic heart failure. And critically think this for a second. It's because A&P gets worn out over a long period of time. It gives up in the battle. Basically the body can't do everything to combat this high blood pressure. So that's what our patients get put on drugs like ACE inhibitors, ARBs or potassium sparing diuretics. In order to finish the job your body was unable to do so in closing, please understand that even before we give your patients any type of medication, your body already has tried numerous backup plans to try and fix the problem. This will be called a self-regulation process. Now for the acid base ABGs. Oh no. The key numbers that you need to know is a pH of 7.35 to 7.45, a PA2 of 35 to 45, and a HCO3 of 22 to 26. So write these out at least 5 to 10 times the week of your exam. And I recommend using the marching band suit method to interpret ABGs found in our full ABG video and really not the Rome or tic-tac-toe method. And I explain why in the full ABG video. Now for pH 7.35 to 7.45. Anything less than 7.35 is acidic blood. This one is the most important here. Now over 7.45 45 is alkyotic or base blood which has a higher pH which generally is not as important as acid doses as acid can lead to respiratory failure. Next is pa CO2 35 to 45. You see we just dropped the sevens there. So for carbon dioxide just think carbon dio acid. Under 35 we get alkyossis or that base state typically from hyperventilation or basically blowing off all that carbon dia acid or carbon dioxide which leaves the body into an alkyotic state. So the memory trick we use for respiratory alkyossis that fast breathing just pant like a dog alkyossis or you can think of the double A's here. Anxiety attack for hyperventilation will lead to alkyossis. So Kaplan mentions the cause for respiratory alkalossis is hyperventilation. So we simply treat the patient by breathing into a paper bag to slow down the breathing and retain that CO2 that carbon dio acid that is lost. Now, if this CO2 is over 45, then this is acidosis, typically from low and slow breathing, the body's retaining too much carbon dioxide or too much carbon dio acid. This is far more deadly since it can lead to respiratory failure. So, the memory trick for the causes here is respiratory acidosis. Just think anything that can cause low and slow breathing like a snoring person. Just think acidosis which retains more CO2 more carbon dia acid. So really anything that can cause lower or slow breathing. So alcohol intoxication and even overdose with low and slow respirations and opioids and benzo like dasipam or even alprazilam typically those are the most tested there. So I'd write those down and think of C and COPD as C for CO2 is retained because in COPD are chronic obstructive pulmonary disease. Just think chronic destructive lungs. The lungs are really destroyed here. And lastly we have sleep apnea and head trauma which can lead to low and slow breathing. So the key treatment to get rid of all this CO2 is hyperventilation. We use purse lip breathing to blow off all that CO2. So just think we have to pant like a dog and that'll put you into how alkalossis. Now for severe acidosis this is called hypercapnic respiratory failure. Just think high CO2 for hypercapnic respiratory failure. An example is a client with a pH of six and a CO2 of 65. way off there. So the key treatment for hyper cap is to give a byp. And if that doesn't work, then we have to innovate and ventilate. Lastly, we have HCO3 22 to 26. This is our by carb, which we remember as a byarb is our base. This helps to balance out the acid. So the memory trick for the causes for metabolic alkalossis, just think of vomiting likeosis or NG tube suctioning. We're basically sucking out all that stomach acid out of the body and now the body's only left in a base or alkalotic state. And for metabolic acidosis, we have diarrhea. Like you're pooing out of your acidosis. The body gets rid of all the base in diarrhea. And so the body's left in an acidotic state or even in renal failure. So just think when the kidneys fail, acid prevails. This happens because hydrogen ions inside the urine means high acid. So in renal failure, you can't urinate. Retaining all that high acid, hydrogen in the body and not in the body. And lastly, the PAO2 should be 80 to 100%. Hypoxia's earliest sign is mental status changes. And the top three on the ENLEX to know is number one restlessness, number two is confusion, and number three is agitation. So write these down. They're always key terms for hypoxia. Now, in terms of the highest priority, just think safety. We call it loss of life and loss of limb. So for ABCs, airway breathing equals oxygen. So, low PAO2 or high CO2. Again, we're looking for mental status changes with restlessness and agitation. And even for skin signs like pale, dusky, and even cool and clammy. Those are typically the most tested out of 10,000 questions. Now, for C in the ABCs for circulation, the top four to know, number one is bleeding. Look for the high PTT and high INR. Remember, you have to know your ranges. Number two is shock. Think severely low blood pressure. Low blood pressure will kill the patient and so will bleeding. Number three is chest pain of any kind, even heartburn or anything really. Chest pain is a priority. And number four, hypertension crisis over 180 systolic is critical. Now the enclelex usually won't pit these kind of patients against each other. They'll put them in a random bunch. Now in terms of infection, the priority here is less than 5,000 WBC's known as lucopenia, high high risk for infection. And for kidney labs, the real big one to know is creatinine over 1.3 is bad kidney. We get loss of organ here and bad kidneys will actually lead to toxicity all over the body. And for pain, our last one here, this is manageable. It's not technically going to kill someone unless it's chest pain of course. So ask yourself, will the patient lose life or limb? So chest pain is number one priority. And number two is the loss of limb when we're talking about pain. So compartment syndrome if the question states that the client just had a cast placed or if the limb is broken and key terms here unreieved with pain meds like morphine or hydromorphone. The key term is unreieved pain. The client may lose their limb due to compartment syndrome. So pause the screen and write these key terms down and you'll know how to prioritize your patients for the enlex and your nursing exams. Okay. Now for a deeper dive and more specifically for airway and breathing, let's talk about oxygenation. So for AGs, not the pulse oximter, a PA2 is 80 to 100. That's normal. 60 or less is hypoxmic respiratory failure. Very very low O2. Patients can go into respiratory failure and die. And again, a Pa CO2 of 35 to 45 is normal. 50 or more can lead to hyperc C or hypercapnic respiratory failure. Just think high CO2 for hypercapnic. So once again hypercappy we give a by papappy or we innovate and ventilate. Now more specifically for circulation the bleeding here in terms of prioritization an INR over four and a PTT over 100. What do you do? Well, number one is you stop and hold the drug. Number two, assess bleeding. Number three, prepare the antidote. For warerin, it's vitamin K. And for heperin, it's protein sulfate. So the memory trick, just think warin is for vitamin K. And think of hepit like a frog. Heperin is PTT. And very lastly, number four is we report it to the HCP. Now, after the ABCs, we have to think infection. So, the priority is less than 5,000 WBC's is lucopenia. Just think a low-grade fever will kill. The client has like no defenses here. So, watch out for imunompromised clients, clients on chemotherapy, and those taking imunosuppressants. Again, pulling from our massive pool of over 4,000 enlex questions, here's a common exam question. An emergency room nurse is presented with four clients at the same time. Oh my goodness. Which of the following clients should the nurse see first? Okay. Now, before looking at the options, always ask yourself who dies first. So, start with the ABCs. Loss of life first and then loss of limb. So option one, a client with a low-grade fever, a headache, and fatigue for the past 72 hours. Maybe the question doesn't really say amunosuppressed or chemotherapy. So it's probably a common cold or flu. Option two, a client with swelling and bruising to the left foot following a running accident. Well, not really. It seems like a sprain and it states running accident. Now, it doesn't state pale skin or tingling or unreieved pain typical of compartment syndrome. Now, option three, a client with abdominal and chest pain following a large spicy meal. Yes, we always choose chest pain. Think, am I heart attack here now? Yes, it could be gastric reflux. It could be heartburn after the spicy meal. It could be a burrito. I don't know. But we must assess any type of chest pain first. And the last option, a child with a 10 cm laceration on the chin. No, the client's not dying here, and it's only a chin cut. So, you have to ask yourself, who dies first? And it's the third option. The client would die first from a heart attack. Now for cholesterol labs, let's cover the need to know numbers and some patho behind high cholesterol and some pharmarmacology to treat it in this next segment. The numbers you need to know for the enlex. All land animals increase bad cholesterol like total cholesterol, triglycerides and LDLs, the loser lipids. High cholesterol means high clogging and these numbers love to show up on the enlex and exam. So guys, write these down. All these numbers should be low except HDLs, the happy lipids, the only ones that should be high over 40. So HDLs help get rid of the bad cholesterol. And also eating fiber found in fruits and veggies can help clean out that cholesterol. Now, what causes this narrowing? Well, fatty deposits called plaque develops on the walls of the coronary arteries, narrowing the vessels, which makes it harder for oxygen to get to the heart muscle. So what causes this? Well, just like hypertension, we use the acronym soda. S for stress. This can cause momentary narrowing. So, anxiety, cold temperatures, even physical exercise like sex. And stimulants like caffeine, even inetamines like meth and aderall also narrows the arteries momentarily. But what really causes the most damage here are irritants found in smoking, which scars the arteries. and long-term obesity. Key term here, guys, a BMI over 25. But also, diabetes and hypertension can cause stretching and tearing to the coronary arteries, which severely damages them. Coupled with a bad diet high in cholesterol from animal fats like meats and dairies, can cause fatty buildup getting stuck in the cracks. And over time, this growth makes the blood vessels stiff and hard, something we call plaque. This plaque causes hardening and narrowing in the arteries which is typically called atheroscerosis. So just think arteriocarosis, hardening of the vessels from the scarring and plaque. Lastly, heart disease is more common in African-American males and increased age over 50 and more common in men than women. Maybe women just handle stress better than men. I don't know. Eventually, too much plaque can turn into blockages. And if one of these plaques ruptured, usually from stress, a blood clot can form in minutes. And this blood clot can completely block all the oxygen to the heart muscle. Without oxygen, heart cells die within minutes, releasing proteins called tropponin. And guys, this is the number one indicator of an MI, but we're going to cover that in the diagnostic section. Now narrowing is classified into three sections under the big umbrella of eskeemic heart disease meaning a disease of lower oxygen to the heart and it comes in three sizes small medium and large kind of like a pizza. So for small it's called coronary artery disease then stable angina the stress induced angina or basically chest pain. Now medium is ACS the acute coronary syndrome which encompasses unstable angina and MI. Now unstable angina is our unsafe angina which is unreieved with rest and totally unpredictable far worse because it means we're closer to the larger condition of an MI and then to death. So typically more pain experienced means more tissue death is occurring. Okay. Lastly, we can give two very particular drugs that prevent future MI. Let's play that segment right here. So think AC for anti-logging of the arteries. A is for antiplatlets like aspirin and clipopidigil. Brand name Plavix. This guy prevents platelets from clumping together and forming clot. And C for cholesterol lowering drugs. Guys, these end in statin like lova statin. So remember, stay clean because it cleans out the arteries keeping them free from cholesterol. Now since statins prevent the production of cholesterol in the liver, it is very liver toxic. So guys, don't give this to patients with liver problems like hepatitis or cerosis. Oh, and also avoid grapefruit juice since it blocks statin drugs. Now, for diabetic labs, we have glucose and hemoglobin A1C. It's very important in diagnosing diabetes. So, let's play that segment now for our diabetes lecture. Now, as far as diagnosing diabetes, the top three must know labs for the ENLEX that you will get tested on. Guys, write these down. Number one, normal glucose must be 70 to 115. Number two, fasting glucose less than 100. And third, hemoglobin A1C must be less than 6.5. Those are big ENLEX key numbers there. Write those down. Now, as you know, the A1C test is our long 2 to 3 month sugar audit, and it's best used to see if patients are being compliant with controlling their blood sugars the long term. So, remember, below six is controlled and fixed. and over 6.5 we got to revise. So review diet and exercise compliance for our type two problem. Basically the U problem and with type one insulin compliance always on the ENLEX. Now the most deadly is low sugar under 70 called hypoglycemia since it causes brain death. So we say hypogly the brain will die. Now, all the other numbers on this chart just help diagnose the severity of diabetes, but are not highly tested on the ENLEX. And speaking of something that's not highly tested, a little side note here, the GTT or glucose tolerance test is when we give an 8 oz drink of syrupy glucose to see if insulin is doing its job by putting the sugar into the cell. If it's not, then the sugar will go high. But guys, that's not usually tested on the ENLEX directly. Now, signs and symptoms and causes of high sugar or hypoglycemia. Just think the blood is turned to mud. So, the body tries to get rid of all this thick syrup with the three Ps. First P for polyurea, a lot of urine. Basically, the body tries to urinate it out. Now, polyypipssia is a lot of drinking fluid. The body tries to dilute all that sugar. Now, third is polyphasia, which is excess hunger as cells starve. since insulin is not doing its job to get sugar inside the cells. Now, a little side note, this is not polyphasia, which is a psych disorder. Now, the causes of acute high sugar can be caused from the four S's. The number one key term on the ENLEX is sepsis or infection, guys. That's a number one cause. But also, stress from surgery or hospital stay and even skipping insulin doses. And a big one here is steroids. Those zone ending drugs like predinazone. That is a big cause. But high sugar can also be caused from hormone therapy like estrogen. Now we treat that high sugar with insulin to put that sugar into the cells. So for your test, I know that's going to come up. Yes, we increase the insulin during stress like sepsis, surgery, and especially with steroids. And guys, no, the patient's not on insulin forever. Once the S's stop, then the insulin stops. And guys, big key word here, if the sugar is still high after the insulin, that's a critical situation. Always call the doctor or HCP. Now, on the other side, for hypoglycemia, that low sugar below 70, guys, just think low brain function, which leads to rapid brain death. So remember, hypogly, the brain will die. We're going to be watching for critical signs, the cool, pale, sweaty, or clammy. We need to give that patient some sugary candy. Now, typical Enclelex keywords include highwash. So, headache, irritability, weakness or anxiety, and even shakiness and hunger. It's kind of like a Snickers commercial. You're just not you when you're hungry. Now, since hypo is so deadly that hypoglide, the brain will die, our very first treatment is giving sugar. So on the enclelex if the patient is awake then we a ask them to eat specifically juice soda crackers and low-fat milk not high milk or peanut butter. Big key word right there. The fat actually slows down the sugar absorption. And if they're asleep big key word here is not alert or unarousable or only arousable to painful stimuli. Then we s stab them with dextrose IV. And always reassess sugars every 15 minutes after giving insulin. Now causes of hypoglycemia. They usually come from exercise, alcohol, and even insulin peak times. Big ENLEX tip right there. So watch out for diabetic athletes who exercise. If your patients exercise, then give extra glucose. Keywords, bicyclists, swimmers, and even runners. Now alcohol is also a big no no technically with any disease but it actually lowers sugar doesn't increase it and insulin peak times is when patients are most at risk for that low sugar. So remember if there's a peak time then we give a plate of food since hypogly the brain will die. Now three common test questions for that low or high sugar. Here we go. Test question number one. A client with type 1 diabetes is only responsive to painful stimuli with a blood sugar of 42. What's the first action taken by the nurse? Guys, this is the worst case scenario here. Anything less than 70 is bad. So hypoglide, the brain will die. Now patient is not alert, only responsive to painful stimuli. So if they're not awake, we can't ask them to eat. Technically, the patient's sleep. So, we stab them with Dextrose IV and then we reassess blood sugar in 15 minutes. Oh, and if you chose option four, shaking my head at you. Question number two, which medication could cause hypoglycemia? Now, guys, before you even look at the options, you should already be saying steroids increase the sugar ending in zone like predinazone. So, guys, zone ending steroids. Steroids increase the sugar. Now the tricky question number three. The non-diabetic client is admitted for a kidney infection that has now turned septic. The blood sugars have increased from 150 to 225. What is the best answer to give a family member who's asking why insulin is used? So option number one, the client now has type 2 diabetes. No, that's a wrong answer. Option two, insulin is given to control hypoglycemia. Totally wrong. It's for hyperglycemia. Option three, high sugar is common during infection and stress to the body and insulin will help lower the sugar until the infection resolves. Guys, yes, option three is the best option. Super high sugars, we want to land like a plane, slow and steady. We don't want to crash into that hypoglycemia, that low sugar with low brain function. Now, if you chose option number four, you're nasty. Now for renal lab values and urine analysis. Again, use the memory trick hook. H U C since the kidneys sort of look like a pirate hook. Now H is for hydrogen ions. U is for ura for blood ura nitrogen. And C is for creatinine. So starting with H are hydrogen ions. These are very acidic. So during renal failure, we have failed washing machines, right? So acid builds up in the blood and clients end up in metabolic acidosis. So a pH below 7.35 which damages the muscles, bones and the kidneys. Now a common test question asks about a list of clients most at risk for metabolic acidosis. So just think here metabolic means the kidneys and body not the lungs here. So anyone with more acid in the body and not in the body. So option number one renal failure. Well think are the kidneys broken here? Yes. Well that means we retain more waste and retain hydrogen ions that acid. Now option number two pyonfritis is that kidney infection. So are the kidneys impaired? Yes. So we retain more hydrogen ions and end up in acidosis. Now option number three, a patient waiting for hemodiialysis. So we have a patient waiting to get their blood washed with hemodialysis, right? That kidney machine that helps to filter the blood. So the key term here is they're waiting. So the blood is filled with acidic waste. So yes, they're at risk for metabolic acidosis. Now option four is a little bit tricky here. Hyperventilation related to an anxiety attack. H well this is a tricky one. It's not necessarily the kidneys. We have a risk for respiratory because of the rapid breathing specifically respiratory alkyossis that hyperventilation because we're blowing off that CO2. So just think acid carbon dioxide we call carbon dia acid. So the memory trick we use just think of a dog breathing like Hulkosis hyperventilation. Now lastly option five a child with diarrhea for 2 days. Well, yes, they're at risk for metabolic acidosis, but we'll cover more of this in the acid base lectures, but real quick, diarrhea does cause metabolic acidosis for a different reason. It's because they poo out all their alkaline, that base inside the GI tract. So, just think base comes out the butt. So, clients end up with an acidic body and end up in acidosis. Or just think if it comes out of your acidosis like diarrhea, well then you'll be left with metabolic acidosis. Now U is for ura that buun blood ura nitrogen. The key number to know for exams is 10 to 20 maximum. Now this is a byproduct of protein waste after the body consumes the nutrients it needs from protein, which I call it the protein bar wrapper since it's basically the trash that the body needs to toss out. Now before it becomes ura it starts as ammonia which it gets sucked into the liver to be broken down into ura. Then it gets pushed into the blood before it's excreted by the kidneys from the body into the body. Hence the name blood ura nitrogen that buun. So buun can be high for various reasons but most commonly due to dehydration. So just think if the buns are high then the body is dry typically or we say if you got burned buns then you stay out in the sun too long and you got dehydration. So if your buns are burned then your bun is typically high because the body is dry. Now C is for creatinine our most critical kidney lab value to assess kidney function. This one is the one to know by far for nursing exams and the ENCLEX. Once again, the key number to know here is over 1.3 means bad kit knee. That is the key number to know. We'll be saying it multiple times throughout this renal course. So, creatine is a waste product produced by the muscles coming from normal everyday wear and tear. So, the higher the creatment since it shows if the washer machines the kidneys are getting clogged up with muscle waste and impairing its function to wash the blood. So the memory trick is the three C's for creatinine. Just think critical kidney lab value that shows third C clogging of the kidneys with muscle waste indicating kidney failure or kidney injury. Now for a quick study tip always focus on the max ranges for pharmarmacology and lab values since the enclelex and nursing exams mainly focus on how drugs or values will harm the patient. So safety is priority here. They want to test and see if you're going to be a safe nurse. So always focus on the max ranges here. So the key numbers for the ENLEX and nursing exams for renal function just in case you missed it. BUN is 20 max. Creatinine over 1.3. Just think bad kidney. And urine output 30 mls or less. Just think the kidneys are in distress. Now a common ENLEX question. A client with infected toe due to diabetes is scheduled for a cardiac caization with contrast. Which lab value should the nurse report to the provider? So option one, blood ura nitrogen level of 19. That is borderline. So no, technically it's less than 20, so we're okay. Option two, a blood glucose of 155. This one's close. It's a little elevated, but it's typical for diabetic clients. Now option three is the one to know. Creatinine level of 1.9. Yes, that's way over. Remember creatinine is the critical kidney lab. So creatinine over 1.3 means bad kidney. And contrast kills the kidneys which we cover in our cardiac lectures. Now option four is incorrect. A white blood cell count of 14,500. No. Elevated WBC's are typical because the key term here is infection. since the client has an infected toe. So, we expect those WBC's to be high. And last but not least, we have our UA, the urine analysis. So, for color, light typically means hydrated and dark urine typically means dehydrated. Now, there are certain cases when this doesn't match up. So, for example, like when we dump too much urine in DI that diabetes incipitus. So we end up diasing a lot of fluid and end up with light urine but a dry body or on the other side of things in SIADH we s stop urinating. So we end up with dark urine and a really fluid-filled body. But we cover that in full detail in the endocrine lectures. Now for specific gravity students get this confused all the time. So pay attention here. The key numbers here are 1.003 003 and 1.03. So let the name help you here. Specific gravity, just think gravity here. The weight of the urine. So the memory trick we use is for light urine with a specific gravity that is low. Just think a low and liquidy body, very dilute urine. So we have a dilute body with low liquidy lab values. And on the other side for heavier urine, the gravity is high. So just say the body is dry. Now, be sure to memorize these numbers because the last thing you want to do is get those zeros and threes confused. Now, if you see RBC's or blood inside the urine, this is known as hematura. Typically due to kidney stones, bladder cancer or even trauma like after prostate surgery or a procedure. And WBC's those luccoytes is general infection like a UTI or a kidney infection. So, clients will complain of burning during urination. Now nitrites that's a key term there. This is typical for kidney infection like a pyonfritis. So just think of the ends here for a kidney infection or pyon nephritis. We check for nitrites. Now if either are suspected we can always do a culture and sensitivity test. So culture identifies the bacteria and sensitivity. Which antibiotic is the bacteria most sensitive to to best kill it? So, we take a sterile urine sample and the key number here is over 10,000 organisms per ml indicates a UTI. Anything less for a culture is normal. And the last two here, protein and glucose. So, if protein's high, that typically means nefrotic syndrome, which I call nerfic syndrome, like a bunch of nerf balls inside the urine. And if glucose is high, that typically means diabetes. That really sweet, sugary urine there. Now, a common ENLEX question gives you an exhibit with all these screwed up UA values. So, be sure to focus on the ones that are out of range. So, a specific gravity that's high, and little side note, don't get confused with the zeros and threes. That's a high specific gravity there. Glucose that is high and luccoytes that are medium. So, right off the bat, you're thinking if it's high, then the body's dry, right? And for glucose, you're thinking diabetes and luccoytes, I'm already thinking infection. So the question asks, a client with a history of diabetes, okay, which does the nurse suspect? The correct answer is dehydration. Some question bank said low fluid intake and possible UTI, that urinary tract infection. So perfect. The SG was high, so the body was dry, right? Dehydration. And we had luccoytes. So obviously an infection UTI. Now for a Kaplan question, it asks a procedure for collecting a sterile urine specimen from a Foley bag. And it was an order response question. So the correct sequence is number one, clamp the drainage tube below the port. Number two, wait 15 to 30 minutes. Number three, scrub the port using an antiseptic swab. And lastly, number four, attach a sterile needleless device to aspirate a specimen via the port. But I wouldn't focus on this one too much. It was the only question out of about 10,000 questions we surveyed here. So, I would focus on the critical values. Now, last but not least is our liver labs, the key labs for liver disease patients. For this section, grab these study guides to keep up with the important points we'll be covering. Now in terms of hippatic encphylopathy as mentioned before this is that cloudy toxic brain from the high levels of ammonia in that protein. So the key signs to write down is twitching extremities in the arms and legs known as mental status changes seen as confusion or bizarre behavior as well as sleepiness. Now select all that obliques love to ask about assessments for hiphatic encphylopathy. So write this down. The key assessments include assessing hand movements with arms extended. Write that one down. Arms must be extended. Assess mental status with those from the previous shift. And assess recent blood draws for ammonia levels. Again, write those down. I can almost guarantee you it will come up on your exam. Now the top miss enclelex question from this section. Which assessment would indicate if a client with cerosis has progressed to apatic encphylopathy? Select all that apply. Ask the client their date of birth, name, date, and location. Yes, these four questions are to monitor mental status to see if the client is oriented. Tell the client to extend their arms. Yes, the key term there is to extend the arms to assess the muscle twitching. And lastly, compare the ammonia blood levels with that of previous shifts. Yes, ammonia levels should not be going up. If they are, it will cause more hpatic encphylopathy. Now, don't let the anklelex trick you here. For apatic encphylopathy, we are not assessing the skin for thinning blood vessels like spider veins. And we're not assessing the eyes or skin for jaundice, that yellow skin. These will typically be present with any client in liver failure, not specific to apatic encphylopathy. So just make sure to know your key assessments for apatic encphylopathy. Now Saunders mentions a client with cerosis shows signs of apatic encphylopathy. The nurse should plan dietary consultation to limit which ingredient and the key answer was protein. Yes, protein has the ammonia waste. Remember ammonia is the protein wrapper the waste around the protein which causes the hpatic encphylopathy. So limiting protein will limit the ammonia. Now in terms of liver failure labs big enlex tip write these down they love to come up on select all the apply questions. So ammonia will be high causing the hippatic encphylopathy our cloudy brain and the ABCs of the liver will be all jacked up here. So A for albumin that's going to be low under 3.5 as well as calcium will be low since calcium binds to albumin and we'll also see low platelets. Now B for Billy Rubin that'll be high since our bile bus is out of commission not scooping up little Billy our Billy Rubin causing the body to become jaundice yellow and C is the coagulation panel or the clotting factors basically our clotting times will be high so we'll have high PT PTT and INR so a higher risk for bleeding bruising is very common with these clients and lastly will have elevated ALT and A which are common really for any liver disease client from cerosis to hepatitis and even others. So you really don't need to memorize the ALT or A numbers. Most exams will give you the ranges. Now a top mission for which blood lab values are expected to be elevated in a client with worsening cerosis. Select all that apply. So just slow it down here before you look at the options. So just think ammonia, billy rubin and proth thromben time. The PT will all be elevated. The only two that are really going to be low is elbumin and calcium here because albumin is that protein that the liver produces. And since binds with calcium, both will be low together. Now don't let the enclelex trick you here. They always try and get you to choose albumin and calcium saying that they're elevated. But no, they will always be low. Now, another sign and symptom is paritis, that itchy skin. You see, as toxins and bile salts build up under the skin, this causes major itching. Just think about it here. The recycling detox filter, the liver is broken. So, the body is naturally filling up with waste products. So the four key points that love to show up on exams and select all the applied questions, it always revolves around protecting the skin and avoiding the scratching. So write this down. Four key points. Number one, apply a cool moist cloth to the affected area to soothe the skin. Not a hot shower or a hot bath. Always keep it cool. Number two is applying moisturizing cream over unbroken skin to protect the skin. The key term is unbroken skin. So moisturizing cream is good. Now number three is wear long sleeve clothes and cotton gloves to avoid the scratching here. And number four is trim the fingernails short to prevent skin breakdown if the client accidentally scratches themselves. So, I'd recommend pausing your screen and writing these four things down. Now, for a top missed enclelex question here, a client with worsening liver failure presents to the med search floor. Which assessment finding should the nurse expect? Select all that apply. So, just slow it down and look at the key terms. Worsening liver failure and it's looking for an assessment finding here. So option one, an enlarged abdomen from asiades. Yes, as is that abdomen filled with fluid and bruising marks all over the skin. Yes, from the lack of clotting factors leading to easy bleeding resulting in bruising and fatigue and possible confusion for sure from possible elevated ammonia levels leading to hippatic encphylopathy. How about scalera that appears yellow? Yes, from jaundice. Remember that building up of Billy Rubin inside the blood makes the entire skin look yellow like a school bus. So just think of your patient like a little lemon here. It's big and it's yellow and it might have some bruising. And very lastly here is reports of itchy skin. Yes, from all those toxins building up inside the blood. Now for diagnostics, a liver biopsy can be taken to analyze tissues. So key point here is after the procedure we have clients lay on the right side to prevent bleeding. So we always put pressure on anything that is bleeding. In that same way we want to put pressure on the liver to prevent bleeding. Now for interventions there's many here. So write this first one down. For as we do a paracentesis. So again remember a for asiades is a for abdominal fluid from all that portal hypertension where fluid now overflows into the peritineal cavity. So in a paracentesis the hcp simply pokes the abdomen with a needle to drain the fluid. Now there's a lot of nursing actions prior to the procedure. So write these down. They love to come up on enclelex questions. Have the client number one empty the bladder to avoid poking or perforating the bladder. Number two is vital signs. The key number here is to monitor for blood pressure. Since clients who are getting fluid drained can go into shock, meaning severely low blood pressure. Number three is we measure the abdominal circumference and take the client's weight. That one is a big one here. It's always tested and we have to measure how much fluid was taken out of the abdomen. Now lastly number four is head of the bed up in high fowler's position to keep that fluid in one place and to help the drainage here. So Hessie mentions a nurse is assisting with a paracentesis for a patient with aesides caused by cerosis. Which action should the nurse take first? Have the patient empty their bladder? Yes, we always empty the bladder first. So, make sure to write down the four key points before a paracentesis. Then we can also give IV to treat the hypoalbummia. Remember, elbumin attracts water, transports drugs and binds to calcium. So it attracts water like a magnet to bring fluid back into the vascular spaces to help decrease aciades which causes an increase in blood pressure and bounding pulses as fluid gets drawn out of the abdomen and into the blood vessels. So once inside the blood vessels we give eyending diuretics like feroseamide to drain that fluid from the body and into the body. Now here's the key point for exams. How do you know if albumin has been effective? H well write this down. We assess the vital signs. They must remain in key term normal limits. That's how you know if elbummen has been effective. A big key point for the enlex there. So write it down. A lot of students get this wrong all the time. Now don't let the enclelex trick you here. Albumin effectiveness does not depend on the reduction of abdominal circumference with the sites and it does not resolve muscle tremors or twitching in the arms and legs. That's mostly for hippatic and sephylopathy. So remember elbumin is effective if vital signs are within normal limits. Now in terms of nursing care the first thing is diet. We always recommend low protein which results with low ammonia and prevents hypatic encphylopathy. Next is low sodium and low fluid to get low swelling with that as obviously no alcohol. We already have a scarred liver and we don't need more of that. And for malnutrition we provide oral care before meals to wake up those taste buds. So the Hessie mentions the nurse is caring for a patient with severe liver cerosis and imbalanced nutrition. Which nursing intervention would prevent malnutrition in this patient? Provide oral care before meals. Yes, we want to wake up those taste buds. Next is the bleed risk from the low coagulation factors. So soft toothbrush, electric razor, and monitor blood inside the stool. Next is esophageal veraces. As mentioned before, we always avoid valva maneuvers or basically bearing down like during bell movements. Remember any pressure can pop this esophagus and no new NG tubes, those nasogastric tubes. No pressure inside the esophagus. Remember this esophagus is like an overfilled water balloon just waiting to explode with all that blood. Now lastly pharmacology. Neomiacin is used to decrease ammonia producing bacteria and lactolose we call lactose. We lose the ammonia via loose spells but we also lose potassium too resulting in hypoc calmia potassium less than 3.5. So we must expect low potassium and explosive diarrhea. Again, these are completely normal and to be expected. So, don't stop giving the drug for loose stools and low potassium. We just monitor the potassium since we lose potassium through the loose stools from the body and into the body. So, Kaplan mentions lactolose. We monitor for hypoc calmia that low potassium. Now for all the other key points on lactolose, let's watch this segment from the pharmarmacology master course. Now lactalos we call lactose since it loosens the bowels to lower the ammonia levels. So we use the acronym lac for lactolose, L for a laxative, A for ammonia levels that should be decreasing and C for the cognition that returns. So key word here is improved mental status. Now it's given to decrease ammonia levels in cerosis patients. It treats hippatic encphylopathy. Fancy words for a cloudy brain that decreased mental status from those high levels of ammonia. So guys, lactolose helps the body poo out all that ammonia. Basically massive explosive diarrhea. So just think lactose. We lose that ammonia. Now some common distractors on the enclelex ammonia levels decrease via the bowel guys not the urine since it's not a diuretic. So no renal excretion of ammonia and no it does not decrease portal hypertension and no guys abdominal distension will not improve with lactolose. Again it helps us lose the ammonia in lactose via those loose bowels. Now, how does a nurse evaluate the effectiveness? Guys, write down these key points here. Number one, two to three soft stools per day. Number two, ammonia levels are decreasing. But here is the key term. Write this down. Cognition must be improving. So, we must have improved mental status. Guys, the biggest test tip I can give you here is don't let the enclelex trick you. Diarrhea and loose stools are not indicators that ammonia levels are decreasing. The only indicator here is improved mental status. That's how you know the drug is working. Thanks for watching. Did you know you can unlock beautifully handcrafted study guides packed with key points and memory tricks from all our videos? Plus, you'll get access to over 1,200 exclusive videos not on YouTube, all neatly organized by nursing school topic to make that complex nursing knowledge actually stick. You'll also gain thousands of practice questions written by current professors and actual ENLEX writers. So, for access to all this and more, click right up here or visit simplening.com. And don't forget to subscribe to our YouTube channel. Happy studying and we'll see you in the next videos.