“NORMAL LABORATORY VALUES WITH
NURSING CONSIDERATION”
SERUM ELECTROLYTES
Electrolyte (Range) Nursing Considerations
Calcium (Ca2+) 8.5-10.5 mg/dL Hypocalcemia
• Signs and symptoms
o Seizures, neuromuscular
irritability or tetany (may include
paresthesia, bronchospasm,
laryngospasm, carpopedal spasm
[Trousseau’s sign], Chvostek’s
sign [facial muscle contractions
elicited by tapping facial nerve on
ipsilateral side], tingling
sensations of the fingers, mouth,
and feet, increased deep tendon
reflexes [DTRs]), bleeding
abnormalities.
o ECG changes may include
prolonged QT interval and
arrythmias.
• Implement seizure precautions and close
monitoring of respiratory status.
Hypercalcemia
• Signs and symptoms
o Lethargy, confusion, nausea,
vomiting, anorexia, constipation,
muscle weakness, depressed DTRs
• Monitor cardiac rate and rhythm.
• Increase mobilization, provide adequate
hydration either with IV fluids or
encouragement of oral intake.
• Watch for digitalis toxicity.
Chloride (Cl- ) 97-107 mEq/L Hypochloremia
• Signs and symptoms
o Muscle spasms, alkalosis, and
depressed respirations
• May be precipitated or exacerbated by GI
losses (vomiting, diarrhea).
Hyperchloremia
• Monitor for acidosis.
Magnesium (Mg2+) 1.8-3 mg/dL Hypomagnesemia
• Signs and symptoms
o Cardiac/ventricular arrhythmias,
laryngeal stridor/spasm,
neuromuscular disturbances
• Risk factors: chronic diarrhea, PPI use,
alcoholism, diuretic use
• Implement seizure precautions.
• Monitor cardiac rate and rhythm.
• Monitor for digitalis toxicity.
Hypermagnesemia
• Signs and symptoms
o Early: nausea, vomiting, flushing
o Cardiac: hypotension, bradycardia,
complete heart block, cardiac arrest
o Neurologic: lethargy/somnolence,
decreased DTRs, muscle paralysis,
coma, respiratory muscle weakness
(shallow respirations, apnea)
• Avoid Mg-containing medications in
patients with compromised renal function.
• Monitor cardiac rate and rhythm.
• Monitor neurologic status, including
DTRs.
Phosphate (PO4 - ) 2.5-4.5 mg/dL Hypophosphatemia
• Signs and symptoms (rare unless PO4 - <
1mg/dL)
o Muscle weakness, rhabdomyolysis
• Treatment indicated when PO4 - <
2mg/dL.
• Oral replacement preferred.
• IV indicated if PO4 - < 1mg/dL;
administer slowly.
• Administer IV phosphate products and
parenteral nutrition (PN) cautiously.
• Monitor for hypocalcemia, renal failure,
arrhythmias, and diarrhea (with oral
replacement).
• Monitor for signs and symptoms of
infection.
Hyperphosphatemia
• Signs and symptoms
o Typically asymptomatic
o May have tetany if hypocalcemia also
present
• Soft tissue calcification can be a long-
term complication of chronically elevated
serum phosphate levels.
• More common in those with advanced
renal insufficiency.
Potassium (K+ ) 3.5-5 mEq/L Hypokalemia
• Signs and symptoms
o Muscle cramps/weakness,
rhabdomyolysis, respiratory muscle
weakness, decreased bowel motility,
cardiac arrythmias, hypotension,
mentalstatus changes, speech changes.
• Characteristic ECG findings include ST
segment depression, flattened T wave
and U wave.
• Monitor cardiac rate and rhythm.
• Common causes include GI losses
(diarrhea/vomiting) and diuretic therapy.
o Educate patient on using laxatives and
diuretics only as prescribed.
• Monitor potassium levels in patients on
digoxin; hypokalemia will potentiate its
effects.
Hyperkalemia
• Signs and symptoms
o Irritability/anxiety, paresthesias,
ascending muscle weakness, cardiac
arrhythmias, cardiac conduction
abnormalities, lethargy, GI symptoms
(nausea and intestinal colic)
• Characteristic ECG findings include tall,
peaked T waves with shortened QT
interval, prolonged PR interval, wide QRS
complex and in severe cases, ventricular
standstill.
• Monitor cardiac rate and rhythm. • Avoid
potassium-sparing diuretics, potassium
supplements, or salt substitutes in patients
with renal insufficiency.
• Use ACE inhibitors cautiously, as they
cause K+ retention.
Sodium (Na+ ) 135-145 mEq/L Hyponatremia
• Signs and symptoms
o Neurologic: lethargy, weakness,
irritability, confusion, tremors,
myoclonus, seizure
o Other: hypotension, GI symptoms
(anorexia, nausea, vomiting,
abdominal cramping)
• Correction should be slow (4 to 6 mEq/L
in first 24 hours) to avoid osmotic
demyelination syndrome; monitor serum
Na+ levels and neurologic status
frequently.
• Avoid large water supplements to patients
receiving isotonic tube feedings.
• Implement seizure precautions in severe
cases.
• Monitor fluid losses and gains.
Hypernatremia
• Signs and symptoms
o Excessive thirst, dehydration,
dry mucous membranes,
oliguria, mental status changes
including lethargy,
disorientation, restlessness,
elevated body temperature
• Monitor fluid losses and gains; urine and
plasma osmolality may assist in
establishing etiology.
• Give sufficient free water with tube
feedings or salt-free IV fluids to keep
serum Na+ and BUN within normal
limits.
ACID-BASE STATUS
Arterial Blood Gas (ABG) Component
(Range)
Nursing Considerations
pH 7.35-7.45 • Identification of the specific acid–base
disturbance is important in identifying the
underlying cause of the disorder and
determining appropriate treatment.
• A pH less than 7.35 indicates acidosis and
a pH greater than 7.45 indicates alkalosis.
PaCO2 35-45 mmHg • The PaCO2 is influenced almost entirely
by respiratory activity.
• When the PaCO2 is low, carbonic acid
leaves the body in excessive amounts;
when the PaCO2 is high, there are
excessive amounts of carbonic acid in the
body.
HCO3 - 22-26 mEq/L • The bicarbonate level of the ABG reflects
the bicarbonate level of the body.
• The kidneys are involved in either
reabsorbing bicarbonate or excreting
bicarbonate, depending upon what is
needed to maintain acid-base balance.
RENAL FUNCTION
Laboratory Value (Range) Nursing Considerations
Blood urea nitrogen (BUN) 10-20 mg/dL • Increased BUN may be seen in patients
with impaired renal function.
• Increased BUN may be caused by
hypotension/shock, heart failure, and salt
and water depletion), diabetic
ketoacidosis, and burns.
Creatinine 0.7-1.4 mg/dL • Increased creatinine levels may be seen in
patients with impaired renal function due
to decreased blood flow to the kidney
(heart failure, shock, liver disease,
dehydration), urinary tract obstruction,
intrinsic kidney disease (i.e.,
glomerulonephritis), or certain
medications
• Acute kidney injury (AKI) is diagnosed
when baseline creatinine increases
abruptly by ≥ 0.3 mg/dL, even if creatine
remains in the normal range.
COAGULATION STUDIES
Laboratory Value (Range) Nursing Considerations
Prothrombin time (PT) 9.5-12 seconds • The PT measures the activity of the
extrinsic pathway of the clotting cascade
and can be used to monitor the level of
anticoagulation.
Partial thromboplastin time (activated) • The PTT is a measure of the activity of
(PTT) 20-39 seconds the intrinsic pathway of the clotting
cascade.
• The PTT is used to monitor the effects of
unfractionated heparin.
International normalized ratio (INR) • The INR is used to monitor the
1.0; 2-3.5 for patients taking warfarin sodium effectiveness of warfarin therapy.
(varies based on diagnosis)
• As INR increases, time for blood to clot
increases
PROTEIN
Laboratory Value (Range) Nursing Considerations
Total protein 6-8 g/100 mL • Proteins influence the colloid osmotic
pressure.
• Includes albumin and globulin.
Albumin 3.5-5 g/100 mL • Makes up 60% of total protein.
• Keeps fluid from leaking out of blood
vessels.
• Changes in serum albumin affect total
serum calcium. • Decreased albumin can
be due to malnutrition or liver disease and
can lead to edema, ascites, and pulmonary
edema.
SERUM OSMOLALITY
Laboratory Value (Range) Nursing Considerations
Osmolality • Increased osmolality may be caused by
280-300 mOsm/L water severe dehydration, free water loss,
diabetes insipidus, high hypernatremia,
hyperglycemia, stroke or head injury,
renal tubular necrosis, or ingestion of
methanol or ethylene glycol (antifreeze).
• Decreased osmolality may be caused by
volume excess, SIADH, renal failure,
diuretic use, adrenal insufficiency,
hyponatremia, overhydration, or
paraneoplastic syndrome associated with
lung cancer.
URINE TESTS
Laboratory Value (Range) Nursing Considerations
pH (urine) 4.6-8.2 • Decreased urine pH may be caused by
metabolic acidosis, diabetic ketoacidosis, or
diarrhea.
• Increased urine pH may be caused by
respiratory alkalosis, potassium depletion, or
chronic renal failure.
Specific gravity (urine) 1.010-1.025 • The urine specific gravity range depends on
the patient’s state of hydration and varies
with urine volume and the load of solutes to
be excreted.
• Increased urine specific gravity may be seen
with dehydration, vomiting, diarrhea,
infection, and heart failure.
• Decreased urine specific gravity can occur
with renal damage
