GLYCOSAT ED HAEMOGL

DEFINITION
Glycosylated Hemoglobin- (HbA1c) is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a nonenzymatic glycation pathway by hemoglobin's exposure to plasma glucose. INDICATION Glycated hemoglobin testing is recommended for both: Checking blood sugar control in people who might be pre-diabetic Monitoring blood sugar control in patients with more elevated levels, termed diabetes mellitus. Glycated hemoglobin/protein testing is widely accepted as medically necessary for the management and control of diabetes. It is also valuable to assess hyperglycemia, a history of hyperglycemia or dangerous hypoglycemia. Glycated protein testing may be used in place of glycated hemoglobin in the

CONTRAINDICATION Glycated hemoglobin measurement is not appropriate where there has been a recent change in diet or treatment within 6 weeks. Likewise the test assumes a normal red blood cell aging process and mix of hemoglobin subtypes (predominantly HbA in normal adults). Hence people with recent blood loss or hemolytic anemia, or hemoglobinopathy such as sickle cell disease are not suitable for this test. The alternative fructosamine test may be used in these circumstances and it similarly reflects an average of blood glucose levels over the preceding 2 to 3 weeks. EQUIPMENT USED Needle Syringe Tourniquet (elastic band) Alcohol Swab

PROCEDURE Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood. Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding. NURSING RESPONSIBILITIES PRE TEST Positively identify the patient using at least two unique identifiers before providing care, treatment, or services. Inform the patient that the test is used to assist in the diagnosis of

DURING Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement. A blood sample is taken from a vein, usually from the inside of your elbow or the back of your hand. Collecting blood from a vein carries minimal risk. Some people may develop a bruise, or a small collection of blood under the skin at the site of the needle stick, called a hematoma. The chance of a hematoma developing is greater for people taking aspirin or other blood-thinning medications. POST-TEST A report of the results will be sent to the requesting health care provider or patient, who will discuss the results with the patient. Instruct the patient to resume usual diet, as directed by the Health care provider or the patient. Discomfort or bruising may occur at the puncture site, or the person may feel dizzy or faint. Warm packs relieve discomfort The elastic band is removed. Once the blood has been collected, the needle is removed and the area is covered with cotton or a

POSSIBLE COMPLICATIONS Excessive bleeding Fainting (rare) or feeling lightheaded Bruising (small amount of blood collecting under the skin) Hematoma (larger amount of blood accumulating under the skin) Infection Multiple punctures to locate vein NORMAL VALUES An Glycosylated hemoglobin of 6% or less is normal. The following are the results when the HbA1c is being used to diagnose diabetes: Normal: Less than 5.7% Pre-diabetes: 5.7% to 6.4% Diabetes: 6.5% or higher

SIGNIFICANT RESULT/ INTERPRETATION

Laboratory results may differ depending on the analytical technique, the age of the subject, and biological variation among individuals. Two individuals with the same average blood sugar can have A1C values that differ by as much as 3 percentage points. Results can be unreliable in many circumstances, such as after blood loss, for example, after surgery, blood transfusions, anemia, or high erythrocyte turnover; in the presence of chronic renal or liver disease; after administration of high-dose vitamin C; or erythropoetin treatment. In general, the reference range (that found in healthy persons), is about 2040 mmol/mol (4%5.9%). Higher levels of HbA1c are found in people with persistently elevated blood sugar, as in diabetes mellitus. While diabetic patient treatment goals vary, many include a target range of HbA1c values. A diabetic person with good glucose control has a HbA1c level that is close to or within the reference range. The International Diabetes Federation and American College of Endocrinology recommend HbA1c values below 48 mmol/mol (6.5%), while American Diabetes Association recommends that the HbA1c be below 53 mmol/mol (7.0%) for most patients. Recent results from large trials suggest that a target below

VALIDITY OF THE TEST According to World Health Organization (WHO) recommends that HbA1c can be used as a diagnostic test for diabetes, provided that stringent quality assurance tests are in place and assays are standardized to criteria aligned to the international reference values. An HbA1c of 6.5% is recommended as the cut-off point for diagnosing diabetes. A value less than 6.5% does not exclude diabetes diagnosed using glucose tests. One advantage of using HbA1c for diagnosis is that the test does not require a fasting blood sample.

ORAL GLUCOSE TOLERANCE TEST (OGTT)

A medical test in which glucose is given and blood samples taken afterward to determine how quickly it is cleared from the blood.[1] The test is usually used to test for diabetes, insulin resistance, and sometimes reactive hypoglycemia and acromegaly, or rarer disorders of carbohydrate metabolism.
INDICATIONS: An adults, the presence of diabetic symptoms with unequivocal hyperglycemia, or fasting plasma glucose levels greater than 140 mg/dl on more than one occasion, is diagnostic of diabetes mellitus, and an oral glucose tolerance test is not required for diagnosis. In children, the presence of classic symptoms of diabetes together with a random plasma glucose > 200 mg/dl is diagnostic, and an oral glucose tolerance test is not required for diagnosis in this case. The oral glucose tolerance test is indicated on patients where there is a clinical impression of possible diabetes: where classic overt signs of diabetes with unequivocally elevated glucose are not present, and in adults, fasting plasma glucose levels that are not greater than 140 mg/dl on more than one occasion.

CONTRAINDICATIONS:
should not be done if the patient is ill. Is known to have DM or has symptoms suggestive or diabetes mellitus (e.g. fasting plasma glucose 7.0 mmol/L or random plasma glucose 11.1mmol/L Post surgery, trauma, or infection or extreme psychological stress as these may give misleading results. Periodic hypokalaemic paralysis EQUIPMENT Blood glucose analyzer Blood collection apparatus glucose Scales

PROCEDURE For a 2-hour postprandial test, a meal is eaten exactly 2 hours before the blood sample is taken. A home blood sugar test is the most common way to check 2-hour postprandial blood sugar levels. The health professional taking a blood sample will:[1] Wrap a tourniquet around the upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein. Clean the needle site with 70% isopropyl alcohol. Put the needle into the vein at a 10-30 degree. Place the vacutaner tube into the vacutaner holder of the needle to fill it with blood. Remove the torniquet from the arm when the tube is almost filled. Apply a gauze pad or cotton ball over the needle site as the needle is removed. Apply pressure to the site and then a bandage. Results are often ready in 1 to 2 hours. Glucose levels in a blood sample taken from the vein (called a blood plasma value) may differ a little from glucose levels checked with a finger stick.

NURSING RESPONSIBILITIES
Pre-test: Explain to the patient that the oral glucose tolerance test evaluates glucose metabolism. Notify the laboratory and physician of drugs the patient is taking that may affect test results; it may be necessary to restrict them. Instruct the patient to maintain a high-carbohydrate diet for three days and then to fast for 10-16 hours before the test. Tell the patient not to smoke, drink coffee or alcohol, or exercise strenuously for 8 hours before or during the test. Tell the patient that this test requires five blood samples and usually five urine samples. The procedure usually takes 3 hours but can last as long as 6 hours Alert the patient to the symptoms of hypoglycaemia (weakness, restlessness, nervousness, hunger, and sweating) and tell him to report such symptoms immediately.

INTRA-TEST: Between 7 am to 9 am, perform a venipuncture to obtain a fasting blood sample in a 7-ml clot activator tube. A saline lock may be inserted and used to collect the multiple blood samples per facility protocol Collect a urine sample at the same time if your facility includes this as a part of the test. After collecting these samples, give the test load of oral glucose and record the time of ingestion. Encourage the patient to drink the entire glucose solution within 5 minutes. Encourage the patient to drink water throughout the test to promote adequate urine excretion. Draw blood samples 30 minutes, 1 hour, 2 hours, and three hours after giving the loading dose, using 7-ml clot-activator tubes. Collect urine samples at the same intervals. Send blood and urine samples to the laboratory immediately or refrigerate them. Specify when the patient last ate and the blood and urine sample collection times. Record the time the patient received his last pretest dose of insulin or oral antidiabetic drug. Tell the patient to lie down if he feels faint.

POST-TEST: Apply direct pressure to the venipuncture site until bleeding stops. After the last blood sample is taken, and if no other blood tests are needed, your heparin lock may be removed. Instruct the patient to eat and resume his usual activities. POSSIBLE COMPLICATIONS: Hematoma at a venipuncture site Excessive bleeding Fainting or feeling light-headed Infection (a slight risk any time the skin is broken) NORMAL VALUES: Plasma glucose levels peak at 160 to 180 mg/dl (SI, 8.8 to 9.9 mmol/L) within 30 minutes to 1 hour after the patient receives an oral glucose test dose; they return to fasting levels or lower within 2 to 3 hours. Urine glucose test negative throughout.

SIGNIFICANT RESULTS/ INTERPRETATIONS: Decreased glucose tolerance, in which levels peak sharply before falling slowly to fasting levels, may confirm diabetes mellitus or may result from Cushings disease, hemochromatosis, pheochromocytoma or central nervous system lesions. Increased glucose tolerance in which levels may peak at less than normal levels, may indicate insulinoma, malabsorption syndrome, adrenocortical insuffiency (addisons disease), hypothyroidism or hypopituitarism.

DRUG STUDY: Insulin Classification: Antidiabetic Hormone Action: a hormone secreted by beta cells of the pancreas that, by receptor-mediated effects, promotes the storage of the bodys fuels, facilitating the transport of metabolites and ions (potassium) through cell membranes and stimulating the synthesis of glycogen from glucose, of fats from lipids, and proteins from amino acids. Dosage: Adults and pediatric patients 0.5-1 unit/kg/day. The number and size of daily doses, times of administration, and type of insulin preparation are determined after close medical scrunity of the patients blood and urine glucose, diet, exercise and intercurrent infections and other stresses

Usually given subcutaneously. Regular insulin and insulin glulisine may be given IV in diabetic coma or ketoacidosis. Insulin injection concentrated may be given subcutaneously or IM but do not administer IV. Adults with type 2 diabetis mellitus requiring basal insulin control: 10 units/day subcutaneously, given at the same time each day. Range: 2-100 units/day or 0.1-0.2 units/kg subcutaneously in the evening or 10 units once or twice a day Side effects: Rash, anaphylaxis or angioedema Allergy- local reactions at injection site (redness, swelling, itching) Hypoglycaemia, ketoacidosis Decline in pulmonary function

THYROID PANEL

TFT panel typically includes thyroid hormones such as thyroidstimulating hormone (TSH, thyrotropin) and thyroxine (T4), and triiodothyronine (T3) depending on local laboratory policy. INDICATIONS: Total T3 is elevated in most cases of hyperthyroidism. It is more sensitive than T4. T3 can be normal and T4 low, indicating hypothyroidism. T3 is often low during acute illness or malnutrition. Free T4 measures are not bound and so are not affected by proteins as are T4. Increased free T4 levels are indicative of Graves disease. Decreased free T4 levels are indicative of hypothyroidism. If T3 uptake deviates in the same direction as T4 and T3 levels, then there is a true thyroid problem. If T3 uptake deviates from T4 and T3 in the same direction, then there is a problem with binding capacity. Increased levels of TSH indicate primary hypothyroidism. Decreased levels of TSH may reflect hyperthyroidism, secondary or tertiary hypothyroidism, or a problem with the pituitary gland or the hypothalamus.

EQUIPMENT: Red top tube or serum separator tube; needle and syringe or vacutainer; alcohol swab. PROCEDURE: 1. Label The specimen tube. Correctly identifies the client and the test to be performed. 2. Obtain a 10-ml blood sample. 3. Do not agitate the tube. Agitation may cause RBC hemolysis. 4. Send tube to the laboratory. Pre-test: Explain the procedure and the purpose of the test. Assess the clients knowledge of the test. Instruct client not to take thyroid medication for 6 weeks prior to the test. During test: Adhere to standard precautions.

Post-test: Apply pressure to venipuncture site. Explain that some bruising, discomfort, and swelling may appear at the site and that warm , moist compresses can alleviate this. Monitor for signs of infection Resume prescribed thyroid medications. Interpret test result; counsel and monitor appropriately for abnormal thyroid function and disease. Follow-up testing may be required. Remember that thyroid antibody testing can also be done for diagnosis of autoimmune thyroid disease. POSSIBLE COMPLICATIONS: Bleeding or bruising at venipuncture site. NURSING CONSIDERATION PEDIATRICS: Infants and children will need assistance in remaining still during the venipuncture and age appropriate comfort measures following the test.

LIVER ENZYMES

The liver, one of the most important organs, has many metabolic and regulatory roles in the body including the processing of all things ingested, eliminating wastes and filtering the blood. In order to perform these tasks, proteins called enzymes are needed to help speed up reactions. Liver enzymes participate in metabolism, storage, filtration and excretion. If the liver becomes injured or diseased, however, liver cells may leak enzymes into the bloodstream, resulting in elevated liver enzyme tests.

Liver enzymes most commonly measured are alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT). ALT and AST are made in the liver where they participate in the metabolizing of amino acids and the production of proteins. ALT is found in the liver only, whereas AST is found in the liver and other organs. ALP is found in the bones, intestines, placenta, kidneys and the liver. ALP is responsible for the production of energy and the metabolism of phosphorus. GGT is exclusively found in the liver and helps with the delivery of oxygen to body tissues

Purpose: Liver function tests done individually do not give the physician very much information, but used in combination with a careful history, physical examination , and imaging studies, they contribute to making an accurate diagnosis of the specific liver disorder. Different tests will show abnormalities in response to liver inflammation; liver injury due to drugs, alcohol, toxins, or viruses; liver malfunction due to blockage of the flow of bile; and liver cancers. Indications: To screen for liver infections, such as hepatitis To monitor the progression of a disease like viral or alcoholic hepatitis and determine how well a treatment is working To measure the severity of a disease, particularly cirrhosis an irreversible scarring of the liver To monitor possible side effects of certain medications Liver function tests check the levels of certain enzymes and proteins in your blood. Higher or lower than normal levels can

Precautions

Blood for LFTs is collected by venipuncture. The nurse or phlebotomist performing the procedure must be careful to observe universal precautions for the prevention of transmission of bloodborne pathogens. Blood for ammonia testing should be iced immediately after collection, stored anaerobically until measured, and assayed within 30 minutes to prevent an increase in ammonia caused by deamination of amino acids in the blood. Hemolysis will falsely increase tests for LD, AST, and ALT.

PRE-TEST:
Although the hepatic function panel can be done without any preparation, it's more accurate when performed after fasting. Patient may be asked to stop eating and drinking for 10 to 12 hours before this blood test. Instruct patient to avoid: Drugs that may increase ALT levels include acetaminophen , ampicillin, codeine, dicumarol, indomethacin, methotrexate, oral contraceptives, tetracyclines , and verapamil. Previous intramuscular injections may cause elevated levels Drugs that may cause increased GGT levels include alcohol, phenytoin, and phenobarbital. Drugs that may cause decreased levels include oral contraceptives. Strenuous activity may raise levels of LDH. Alcohol, anesthetics, aspirin , narcotics, procainamide, and fluoride may also raise levels. Ascorbic acid (vitamin C) can lower levels of LDH On the day of the test, ask patient to wear a short-sleeve shirt can make things easier for the technician who will be drawing the blood.

DURING TEST A health professional will usually draw the blood from a vein. For an infant, the blood may be obtained by puncturing the heel with a small needle (lancet). If the blood is being drawn from a vein, the skin surface is cleaned with antiseptic, and an elastic band (tourniquet) is placed around the upper arm to apply pressure and cause the veins to swell with blood. A needle is inserted into a vein (usually in the arm inside of the elbow or on the back of the hand) and blood is withdrawn and collected in a vial or syringe. After the procedure, the elastic band is removed. Once the blood has been collected, the needle is removed and the area is covered with cotton or a bandage to stop the bleeding. Collecting blood for this test will only take a few minutes.

POST-TEST
Patients will have blood drawn into a vacuum tube and may experience some pain and burning at the site of injection. A gauze bandage may be placed over the site to prevent further bleeding. If the person is suffering from severe liver disease, they may lack clotting factors. The nurse or caregiver should be careful to monitor bleeding in these patients after obtaining blood. Expected results: Aspartate Aminotransferase (AST or SGOT) Aspartate Aminotransferase (AST) catalyses conversion of nitrogenous portion of amino acid. It is essential to energy production in Krebs cycle. AST is released into serum in proportion to cellular damage and most elevated in acute phase of cellular necrosis. Found in decreasing levels in: (Relatively low organ specificity) Liver, cardiac, skeletal muscle, kidney, brain, pancreas, red blood cells

Normal values: 5 to 40 IU/L Abnormal values: An increase in AST levels may be due to: Acute kidney failure Cirrhosis (scarring of the liver) Heart attack Hemochromatosis Hemolytic anemia Hepatitis Lack of blood flow to the liver (liver ischemia) Liver tumor Medicines that are toxic to the liver Mononucleosis ("mono") Muscle disease or trauma Pancreatitis (swollen and inflamed pancreas) AST levels may also increase after: Burns (deep) Heart procedures Seizure Surgery

A decrease in AST levels may be due to: Liver (Chronic hepatitis) Skeletal muscle Duchenne muscular dystrophy Dermatomyositis Influenza B calf myositis in children Blood (Haemolyticanaemia, haemolysis) Liver (Fatty liver, Metastatic hepatic tumour) Other: Pulmonary embolus, Alcoholic delirium tremens, Acute pancreatitis, IM injection, Strenuous physical exercise Drugs Opiates, Erythromycin, Sulphonamides, anti-tubercular Large doses of paracetamol, aspirin, vitamin A Alanine Aminotransferase (ALT or SGPT) Alanine Aminotransferase catalyses reversible amine group transfer in Krebs cycle. Unlike AST, it is mainly in liver cells and is a relatively specific indicator of Hepatocellular damage. It is released early in liver damage and remain elevated for weeks Normal values: 10-35 IU/L

INTERPRETATION: An increase in ALT levels may be due to: Hepatocellular injury Usually associated with much lower rise in AST Infection - Infectious mononucleosis Liver Chronic hepatitis and intrahepatic cholestasis Cardiac -Severe hepatic congestion in cardiac failure Other - Acute passage of gallstone A decrease in ALT levels may be due to: Classically associated with alcoholic liver disease Liver: acute Hepatocellular injury Alcoholic hepatitis Active cirrhosis

GGT (gamma glutamyltranspeptidase)Is an enzyme produced by the liver. It is used by doctors to diagnose obstructions in the biliary system, pancreatitis and liver disease. GGT may also be elevated in liver and pancreatic cancer as well as alcoholism. It is also used as a marker for tumor progression and to evaluate response to treatment. Normal values: GGT (in men) = 11 - 50 IU/L GGT (in women) = 7 - 32 IU/L INTERPRETATION: An increase in GGT levels may be due to: Alcohol abuse Flow from the liver is blocked (cholestasis) Heart failure Hepatitis Liver ischemia (lack of blood flow) Liver necrosis Liver tumor Scarring of the liver (cirrhosis) Use of drugs that are toxic to the liver A decrease in GGT levels may be due to: Low level only indicates that it is unlikely that a patient has liver disease. Oral contraceptives can also decrease GGT levels

POSSIBLE COMPLICATIONS: Viral infection, such as viruses A, B, C, D, HIV coinfection Hepatotoxic medicationsacetaminophen, statins Substance abusealcohol, cocaine, Exposure to environmental toxins End stage liver disease
MEDICAL MANAGEMENT: Liver transplant Nursing Care Priorities for the Patient with ESLD Monitor lab values, especially watching for BG's, fluid and electrolyte imbalances (possibly due to fluid retention and treatment with diuretics, malnutrition, and vomiting or diarrhea), platelet count, and lactic acid. LR is not used with these patients d/t the liver's inability to clear lactate adequately. Monitor for s/sx of bleeding, including checking stools for occult blood. Administer blood products as ordered. Monitor respiratory status and watch for decompensation d/t ascitic pressure on the diaphragm or pulmonary edema. Elevate HOB to pressure on lungs in patient with ascites, and perform PD&C as well as encourage ambulation prn. Monitor I& O and watch for signs of volume overload and administer diuretics as ordered. A low sodium diet may also be ordered.

Monitor for encephalopathy. Administer lactulose and/or neomycin as ordered to treat high serum ammonia levels. *At least 3 bowel movements daily is a desired effect of lactulose to rid the body of excess ammonia. A low protein diet may be ordered. Intracranial pressure monitoring may be indicated with risk for cerebral edema. Protect the encephalopathic patient's airway by taking measures to avoid aspiration. OT & PT may be necessary and encourage ROM exercises to maintain existing strength, which may improve the patient's rehabilitation process posttransplantation. Monitor for signs of renal failure. The patient may be on dialysis and possibly CVVHD d/t BP, in addition to hepatorenal syndrome. Monitor for skin breakdown and apply lotion prn since puritis is common Impaired Liver Function related to Viral infection, such as viruses A, B, C, D, HIV coinfection, Hepatotoxic medicationsacetaminophen, statins, Substance abusealcohol, cocaine, Exposure to environmental toxins

Determine presence of condition(s), as listed above. Note whether problem is acuteviral hepatitis or acetaminophen overdoseor chroniclongstanding alcoholic hepatitis. Rationale: Influences choice of interventions. medicationssulfonamides, phenothiazines, isoniazidfor hepatotoxic drugs or OTC drug use such as acetaminophen.

 Ascertain if client works in high-risk occupation; for example, performs tasks that involve contact with blood, bloodcontaminated body fluids, other body fluids, or sharps or needles. Rationale: Helps in identifying source of infectionoccupational high risk for exposure to HBV and HCV.

Assess for exposure to contaminated food or untreated drinking water or for evidence of poor sanitation practices by foodservice workers, if source is known. Rationale: Helps in identifying source of infectionrisk for exposure to enteric viruses, such as HAV and HEV.
Review results of laboratory tests, such as hepatitis viral titers, liver function, and other diagnostic studies. Rationale: Identifies cause of hepatitis, influences choice of interventions, and monitors response to therapies. Assist with treatment of underlying condition. Rationale: Supports organ function and minimizes liver damage and risk of organ failure. For chronic HBV and HCV infections, in particular, the goals of therapy are to reduce liver inflammation and fibrosis and to

Administer medications, as indicated, for example: Antivirals, such as, amantidine (Symmetrel), famciclovir (Famvir), and entecavir (Baraclude) Rationale: The particular or combination of medication used depends on the type of infection. Inhibit viral reproduction. Lamivudine (Epivir), adefovirdipivoxil (Hepsera), tenofovin (Viread), and telbivudine (Tyzeka) Rationale: Help reduce viral load and treat chronic active HBV. Alternative choice for individuals unable or unwilling to use interferon; or, in the presence of impaired immune function such as coinfection with HIV (Mukherjee, 2005). Note: Long-term therapy required because the virus begins to replicate when drug is terminated. BMRs, such as interferon alpha-2a (Roferon A) and interferon alpha-2b (Intron A) Rationale: Reduce viral load and treat symptoms of HCV; may lead to temporary improvement in liver function. Also used in HDV. Note: Interferons have been found to induce remission in 25% to 50% of clients with chronic HBV and in 40% of those with chronic

 Steroid therapy, such as prednisone (Deltasone), alone or in combination with azathioprine (Imuran) Rationale: Steroids may be contraindicated because they can increase risk of relapse or development of chronic hepatitis in clients with viral hepatitis; however, anti-inflammatory effect may be useful in chronic active hepatitis, especially idiopathic, to reduce nausea and vomiting and to enable client to retain food and fluids. A brief course may also be useful in cholestatic HAV to shorten the illness (Buggs& Kim, 2006).Steroids may decrease serum aminotransferase and bilirubin levels, but they do not affect liver necrosis or regeneration. Combination therapy has fewer steroid-related side effects.

ALBUMINGLOBULIN(A/G) RATIO

Definition: Albumin globulin ratio or A/G ratio is a blood test, where the albumin value is divided by the globulin value. It is used to evaluate different liver diseases, kidney diseases as well as check the nutritional status of a patient. If a person experiences unexplained weight loss, fatigue or shows symptoms of liver diseases or kidney disorder, he or she is asked to take total protein or albumin globulin ratio test. The person needs to give a blood sample that is drawn from the vein in the arm by a phlebotomist. This blood sample is used to evaluate the ratio. Indications: Assess nutritional status of hospitalized patients, especially geriatric patients Evaluate chronic illness Evaluate liver disease

N U R S I N G RESPONSIBILITIES PRETEST: Positively identify the patient using at least two unique identifiers before providing care, treatment, or services. Inform the patient that the test is used as a general indicator of nutritional status, hydration, and chronic disease. Obtain a history of the patients complaints, including a list of known allergens, especially allergies or sensitivities to latex. Obtain a history of the patients gastrointestinal, genitourinary, and hepatobiliary systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures. Obtain a list of the patients current medications including herbs, nutritional supplements, and nutraceuticals. Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture. Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before,

INTRATEST:
If the patient has a history of allergic reaction to latex, avoid the use of equipment containing latex. Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement. Observe standard precautions, and follow the general guidelines in Appendix A. Positively identify the patient, and label the appropriate tubes with the corresponding patient demographics, date, and time of collection. Perform a venipuncture. Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage. Promptly transport the specimen to the laboratory for processing and analysis.

POST-TEST: A written report of the results will be sent to the requesting health care provider (HCP), who will discuss the results with the patient. Nutritional considerations: Dietary recommendations may be indicated and will vary depending on the severity of the condition. Ammonia levels may be used to determine whether protein should be added to or reduced from the diet. Reinforce information given by the patients HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family. Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patients symptoms and other tests performed.

NORMAL VALUES: Age Conventional Units (ConventionalUnits _ 10) Newborn11 mo 2.95.5 g/Dl g/L 140 yr 3.75.1 g/dL 4160 yr 3.44.8 g/dL g/L 6190 yr 3.24.6 g/dL g/L Greater than 90 yr 2.94.5 g/dL g/L SIGNIFICANT RESULTS AND IMPLICATIONS High Albumin Globulin Ratio A high A/G ratio is used to indicate under production of immunoglobulins. This condition is seen due to presence of some genetic disorders, hypothyroidism, high protein/high carbohydrate diet, Glucocorticoid excess, low levels of globulin SI Units 2955 3751 g/L 3448 3246 2945

LIPID PROFILE

DEFINITION This test is done to evaluate the risk for myocardial or coronary artery occlusion and coronary heart disease, and to determine total cholesterol, the bad cholesterol(LDL-C), the good cholesterol(HDL-C) and triglyceride levels.

INDICATION/CONTRAINDICATIONS Cholesterol screens for coronary heart disease risk factors Assess other diseases, such as liver, biliary, thyroid, renal, and diabetes mellitus. Monitor the effectiveness of diet, medication, lifestyle changes, and stress management on test outcomes and lowered risk.
EQUIPMENT Red -topped, gold-topped, or serum separator tube Needle or syringe, or vacutainer Alcohol swab PROCEDURE Blood (5-10 mL) is obtained by venipuncture, using a red-top Vacutainer tube.

A NURSING RESPONSIBILITIES PRETEST Explain the purpose and procedure of the test and the importance of fasting(no foods or fluids for 12-16 hours before drawing blood) before the test to avoid false outcomes. Withhold medications according to physician directives; for example, hold oral contraceptives, estrogen and salicylates before lipoprotein testing. Note if the patient has had any drastic weight change last few weeks before HDL testing. POSTTEST Monitor the venipuncture site for bleeding or infection, and allow the patient to resume the pretest diet and medications. Evaluate outcomes, and counsel the patient appropriately (eg, for high cholesterol levels instruct on the importance of decreased animal fat, replacement of saturated fats with polyunsaturated fats, a consistent, and stress reduction).

POSSIBLE COMPLICATIONS

NORMAL VALUES Cholesterol (C) Fasting Normal values vary with age, diet, and geographic location. The desirable values are given in the following ranges: Adult: 140-199 mg/dL or 3.63-5.15 mmol/L Children and adolescents(12-18 years): Desirable level: <170 mg/dL or 4.39 mmol/L Borderline high: 170-199 mg/dL or 4.40-5.16 mmol/L High: >200 mg/dL or >5.18 mmol/L Triglycerides Fasting Values are related to age,sex, and diet: Normal: <200 mg/dL or <2.26 mmol/L Borderline: 150-199 mg/dL(3.9-5.15 mmol/L) High: 200 mg/dL (5.18 mmol/L) or greater High- Density Lipoproteins (HDLs) Fasting Adult: 60 mg/dL ( 1.55 mmol/L) Low- Density Lipoproteins(LDLs) Optimal adult: <100 mg/dL(2.6 mmol/L) Very Low-Density Lipoproteins (VLDLs) Normal: 25% to 50% of total triglyceride levels

SIGNIFICANT RESULTS/INTERPRETATIONS Cholesterol(C) Adult: borderline high: 200 to 239 mg/dL or 5.18 to 6.19 mmol/L; high: >240 mg/dL or >6.22 mmol/L Elevated cholesterol levels(hypercholesterolemia) occur in cardiovascular disease and atherosclerosis, type II familial hypercholesterolemia, hyperlipoproteinemia, hepatocellular disease, biliary cirrhosis, hypothyroidism, von Gierkes disease, pancreatic and prostate neoplasms, Werners syndrome, poorly controlled diabetes mellitus, chronic nephritis, glomerulosclerosis, obesity, and dietary affluence. Decresead cholesterol levels(hypocholesterolemia) can occur in malabsorption, starvation, severe liver disease, hyperthyroidism, chronic obstructive lung disease, mesoblastic, siderolastic, chronic anemias, Tangier disease, severe burns, acute illness, chronic obstructive lung disease and mental retardation. Triglycerides High: 200-499 mg/dL (2.26-5.64 mmol/L):associated with peripheral vascular disease Very high: >500 mg/dL (5.65 mmol/L): associated with very high risk of pancreatitis >1000 mg/dL(>11.3 mmol/L): associated with type I or type V

Increased levels of triglycerides occur in types I, IIb, III, IV and V hyperlipoproteinemias; liver disease; alcoholism; nephritic syndrome; renal disease; hypothyroidism, poorly controlled diabetes mellitus; pancreatitis; gout; glycogen storage disease; myocardial infarction; hypothyroidism, Downs syndrome Decreased levels occurs with malnurtrition, malabsorption syndrome, hyperparathyroidism, hyperthyroidism, congenital alpha beta lipoproteinemia, brain infarction, and chronic obstructive lung diasease. HDL(Good Cholesterol) HDL increased levels (>60 mg/dL) help to lower the risk for heart disease and also are associated with chronic liver disease or chronic alcoholism, long term aerobic exercise, vigorous exercise Decreased levels (<40 mg/dL) indicate an increased risk for coronary heart disease, familial hypo-alpha-lipoproteinemia and hypertriglyceridemia, hepatocellular disease, uncontrolled diabetes mellitus, obesity, chronic renal failure, uremia LDL Adults:

Increased LDL levels occur with familial type 2 hyperlipidemia, familial hypercholesterolemia, and secondary causes such as diet high in cholesterol, saturated fat, nephritic syndrome, chronic renal failure, pregnancy, porphyria, diabetes mellitus, multiple myeoloma steroids, progestins, and androgens. Increased VLDL levels occur with familial hyperlipidemia and secondary causes such as alcoholism, obesity, diabetes mellitus, chronic renal disease, pancreatitis, pregnancy, estrogen, birth control pills and progestins. Decreased LDL and VLDL levels occur with malnutrition and malabsorption.

Two-hour postprandial plasma glucose

Postprandial Plasma Glucose Test is a blood test often used in conjunction with the Fasting Plasma Glucose Test, again looking at the effectiveness of the bodys carbohydrate metabolism and the ability to produce insulin. -A 2-hour post-prandial blood sugar (glucose) test measures the blood sugar exactly 2 hours after eating a meal. Blood sugar tests may be used to check for diabetes and to see how treatment for diabetes is working. Indication: To aid in the diagnosis of DM To monitor drug or diet therapy in the pt with DM Equipment used: Needle Vacutaner tube Vacutaner holder Gauze/cotton ball 70%isopropyl alcohol

Procedure:
For a 2-hour postprandial test, a meal is eaten exactly 2 hours before the blood sample is taken. A home blood sugar test is the most common way to check 2-hour postprandial blood sugar levels. The health professional taking a blood sample will: Wrap a tourniquet around the upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein. Clean the needle site with 70% isopropyl alcohol. Put the needle into the vein at a 10-30 degree. Place the vacutaner tube into the vacutaner holder of the needle to fill it with blood. Remove the torniquet from the arm when the tube is almost filled. Apply a gauze pad or cotton ball over the needle site as the needle is removed. Apply pressure to the site and then a bandage. Results are often ready in 1 to 2 hours. Glucose levels in a blood sample taken from the vein (called a blood plasma value) may

Nursing Responsibilities Pre-test: Explain to the patient that the 2-hour postprandial plasma glucose test evaluates glucose metabolism and detects diabetes. Tell the patient that the test requires a blood sample. Explain who will perform the venipuncture and when. Notify the laboratory and physicians of drugs the patient is taking that may affect test results; it may be necessary to restrict them. Tell the patient to eat a well balanced meal or one containing 100g of carbohydrates before the test and then fast for two hours. Instruct him to avoid smoking and exercising strenuously after the meal. Explain to the patient that he might experience slight discomfort from the tourniquet and the needle puncture. Intra-test: Perform a venipuncture and collect the sample in a 5-ml clotactivator tube. Send the sample to the laboratory immediately or refrigerate it. Specify on the laboratory request when the patient last ate, the time of the sample collection, and when the last pretest dose of insulin or

Post-test: Apply direct pressure to the venipuncture site until bleeding stops. Instruct the patient that he may resume his usual diet, medications, and activity stopped before the test. Possible complications: Hematoma at the venipuncture site. Normal values: In patients who dont have diabetes, postprandial glucose values are 145 mg/dl (SI,8 mmol/L) by the glucose oxidase or hexokinase method. Levels are slightly higher in patients older than age 50. Significant results/ Interpretations: two-hour postprandial blood glucose values of 200 mg/dL (SI, 11.1 mmol/L) or above indicate diabetes mellitus. High glucose levels (hyperglycemia) occur with pancreatitis, Cushings syndrome, acromegaly, pheochromocytoma, hyperlipoproteinemia, chronic hepatic disease, nephritic syndrome, brain tumor, sepsis, gastrectomy with dumping syndrome, eclampsia, anoxia and seizure disorders. Low glucose levels occur in hyperinsulinism, insulinoma, Von Gierkess disease, functional and reactive hypoglycaemia, myxedema, adrenal insufficiency, congenital adrenal hyperplasia, hypopituitarism, malabsorption syndrome, and hepatic insufficiency.

THE END.