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Lab Values, part 2: Lab Panels - CMP, Lipids, Thyroid Panel, ABG

Updated:
  • 00:00 Intro
  • 00:38 Comprehensive Metabolic Panel (CMP)
  • 1:43 Lipid Panel
  • 3:01 Thyroid Panel
  • 4:05 Arterial Blood Gas (ABG)
  • 8:33 Quiz
Cool Chicken Hint:

When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

This series follows along with our Lab Values Flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

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Lab Values & ABG Interpretation - Nursing Flashcards

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In your nursing practice you will encounter a variety of lab panels, including CMP, lipids, ABG, and thyroid panel values, which are covered in THIS video and article; and CBC, BMP, and liver function, which are covered in our previous video, Lab Panels - CBC, BMP, Liver Function. As a nurse, it's important to understand what each of the tests means, what the components of each panel are, and what information you can get from that panel. As Meris shares in the video, she sometimes gets feedback from nurses along the lines of, "it's not my job to know this panel, it's the provider's."

While it's definitely true that it is the provider's job to know which tests are in which panel, when to order them, and why—it's also true for nurses that knowing what the lab panels mean helps you advocate for your patient—nurses should be empowered to question orders when needed, and also to answer questions patients might have about these panels.

Complete Metabolic Panel (CMP)

A complete metabolic panel (CMP) includes a basic metabolic panel (BMP) and a liver function panel, both of which we covered in the previous video/article, Lab Values, part 1: Lab Panels - CBC, BMP, Liver Function.

Good news—if you've mastered BMP and the liver function tests, then you've got the CMP put together already. The CMP is simply the BMP plus additional tests of a patient's liver function. CMP gives a more global view of the metabolic processes in a patient, reporting on electrolytes and the kidneys, plus liver function. Meris notes in the video that the CMP is a helpful test, especially for somebody like her who is an ER nurse— it's something she sees frequently.

Lipid Panel

The lipid panel includes total cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Depending on the facility, very-low-density lipoprotein (VLDL) and other related values may also be reported.

A lipid panel provides detailed information about the blood lipids and serves as a helpful screening tool during a patient's annual physical. It can detect hyperlipidemia (elevated cholesterol), and give insight into the current lipid makeup of a patient's blood, particularly in cases where a patient's blood looks fatty.

A lipid panel is also important as part of ongoing management for patients on statins or other cholesterol-lowering drugs.

Total cholesterol level on a lipid panel

Cholesterol is a waxy, fat-like substance used to make hormones, vitamin D, and bile acid. Excess cholesterol in the blood can combine with other substances to form plaque and lead to atherosclerosis. Total cholesterol incorporates LDL, HDL, and triglyceride levels.

The expected range of total cholesterol is levels under 200 mg/dL

Cholesterol levels over 200 mg/dL indicates increased risk for atherosclerosis, heart disease, and myocardial infarction.

Triglyceride level on a lipid panel

In the body, extra calories are turned into triglycerides and stored in fat cells. When energy is needed, triglycerides are released from the fat cells.

The expected female range for triglycerides is 35 - 135 mg/dL. The expected male range for triglycerides is 40 - 160 mg/dL

Elevated levels of triglycerides indicates increased risk for atherosclerosis, heart disease, and myocardial infarction.

Cool Chicken Hint:

You should try to lower your triglycerides to prevent heart disease.

High-density lipoprotein (HDL) on a lipid panel

Lipoprotein that transports cholesterol from other parts of the body back to the liver (where it can be removed from the body).

The expected female range of HDL is levels over 55 mg/dL. The expected male range of HDL is levels over 45 mg/dL.

Decreased levels of HDL are associated with increased risk of heart disease. HDL is the "good" cholesterol because it works to remove harmful buildup that can lead to atherosclerosis.

Low-density lipoprotein (LDL) on a lipid panel

Low-density lipoprotein (LDL) serves as a transporter for cholesterol, and it can lead to a buildup of cholesterol in the arteries. LDL is the "bad" cholesterol because it works to add harmful buildup that can lead to atherosclerosis.

Cool Chicken Hint:

L for Lethal/Lousy (i.e., bad). H for Happy (i.e., good).

The expected range of LDL is levels under 130 mg/dL, while some patients have a lower recommended level—patients at high risk for cardiovascular disease should have LDL levels under 100 mg/dL.

LDL levels over 130 mg/dL indicate increased risk for atherosclerosis, heart disease, and myocardial infarction.

Thyroid Panel

A thyroid panel provides information about a patient's thyroid function and thyroid hormones. This panel includes the thyroid-stimulating hormone (TSH), which provides brain-level stimulation of the thyroid gland, as well as free or total thyroxine (T4) and triiodothyronine (T3). Depending on the facility, this panel may include additional values, but a thyroid panel is always exclusively focused on the thyroid.

Thyroid-stimulating hormone (TSH) on a thyroid panel

Thyroid-stimulating hormone (TSH) is a hormone produced by the pituitary gland that regulates the amount of hormones released by the thyroid gland.

The expected range of TSH is 0.5 - 5.0 mU/L. We've got a Cool Chicken hint to help you remember the expected range of TSH.

Cool Chicken Hint:

If you touch my TUSH (TSH) again, I will smack you with all 5 fingers.

Low levels of TSH (under 0.5 mU/L) can be caused by primary hyperthyroidism or secondary hypothyroidism. Primary hyperthyroidism would show decreased levels of TSH and increased levels of T3 and T4; while secondary hypothyroidism would show decreased levels of TSH and decreased levels of T3 and T4.

Elevated TSH levels (over 5 mU/L) can be caused by primary hypothyroidism or secondary hyperthyroidism. Primary hypothyroidism would show increased levels of TSH, decreased levels of T3 and T4; while secondary hyperthyroidism would show increased levels of TSH and increased levels of T3 and T4.

Free or total thyroxine (T4) on a thyroid panel

Free or total thyroxine (T4) is a hormone produced by the thyroid gland that regulates metabolism and growth.

The expected range of T4 is 4 - 12 mcg/dL.

Cool Chicken Hint:

T4 has a range of 4 - 12.

Low levels of T4 (under 4 mcg/dL) can indicate hypothyroidism. High levels of T4 (over 12 mcg/dL) can indicate hyperthyroidism.

Thyroid dysfunction can be primary (a problem with the thyroid gland itself), secondary (a problem with the pituitary gland), or tertiary (a problem with the hypothalamus).

Free or total triiodothyronine (T3) on a thyroid panel

Free or total triiodothyronine (T3) is a hormone produced by the thyroid gland that regulates metabolism and growth.

The expected range of T3 is 70 - 205 ng/dL

Cool Chicken Hint:

T3 reminds you of "times three." If you can remember 70, then 70 x 3 = 210, which is approximately the upper end of the range!

Low T3 levels (under 70 ng/dL) can indicate hypothyroidism. High T3 levels (over 205 ng/dL) can indicate hyperthyroidism.

Arterial Blood Gas (ABG)

An arterial blood gas (ABG) measures arterial blood to provide information on: pH, indicating how acidic or alkaline the blood is; partial pressure of oxygen (PaO2); partial pressure of carbon dioxide (PaCO2); oxygen saturation of hemoglobin (SaO2); bicarbonate (HCO3); and base deficit or excess.

Not every patient gets an ABG—it's primarily used for patients with an abnormal respiratory status, or where there are respiratory-related concerns. Ventilated patients, who may be sedated or paralyzed, will require more frequent ABG monitoring than non-ventilated patients. Why? If a patient is on mechanical ventilation, they aren't able to control their respiration and adjust accordingly. As Meris notes in the video, ABGs are prominent in intensive care units (ICUs) but are also used in emergency rooms (ERs). Depending on the facility and its patients and policies, ABGs may also be needed in other situations including progressive, step-down, or intermediate units.

While a venous blood gas (VBG) shares similar components with an ABG, it will result in different values because it measures venous blood rather than arterial blood. For a VBG, it's important to reference lab-specific reference ranges, rather than standard ABG values.

Interpreting an ABG

We have flashcards that can help you interpret an ABG—check out Lab Values & ABG Interpretation - Nursing Flashcards.

pH on an ABG

pH is a measure of hydrogen ion (H⁺) concentration in the arterial blood, or acid-base balance.

The expected range for pH on an ABG is 7.35 - 7.45.

A pH below 7.35 indicates the presence of acidosis, and a pH above 7.45 indicates the presence of alkalosis. Acidosis and alkalosis can both be either respiratory or metabolic, which can be interpreted by knowing the levels of PaCO₂ and HCO₃.

Partial pressure of oxygen (PaO₂) on an ABG

Partial pressure of oxygen (PaO₂) is a measure of oxygen pressure in the arterial blood.

The expected range for PaO₂ on an ABG is 80 - 100 mmHg.

A PaO₂ level below 80 mmHg indicates poor oxygenation in the arterial blood. Causes of low PaO₂ can include COPD, pneumonia, asthma, pneumothorax, and acute respiratory distress and failure.

A PaO₂ level above 100 mmHg indicates hyperoxemia related to prolonged exposure to high levels of oxygen (e.g., mechanical ventilation).

Partial pressure of carbon dioxide (PaCO₂) on an ABG

Partial pressure of carbon dioxide (PaCO₂) is a measure of carbon dioxide pressure in the arterial blood.

The expected range for PaCO₂ on an ABG is 35 - 45 mmHg

A PaCO₂ level under 35 mmHg indicates the presence of respiratory alkalosis due to hyperventilation OR compensation for metabolic acidosis.

A PaCO₂ level over 45 mmHg indicates the presence of respiratory acidosis due to hypoventilation OR compensation for metabolic alkalosis.

Oxygen saturation of hemoglobin (SaO₂) on an ABG

Oxygen saturation of hemoglobin (SaO₂) is the amount of oxygen bound to hemoglobin in the arterial blood.

The Expected Range for SaO₂ on an ABG is 95 - 100%.

An SaO₂ level under 95% indicates hypoxemia due to anemia, pneumonia, COPD, asthma, ARDS, pneumothorax, pulmonary embolism, or pulmonary edema.

Patients with COPD are expected to have SaO2 levels in the low 90s.

Bicarbonate (HCO₃) on an ABG

Bicarbonate (HCO₃) is an important chemical buffer regulated by the kidneys.

The expected range for HCO₃ on an ABG is 21 - 28 mEq/L.

An HCO₃ level under 21 mEq/L Indicates metabolic acidosis OR compensation for respiratory alkalosis.

An HCO₃ level over 28 mEq/L Indicates metabolic alkalosis OR compensation for respiratory acidosis.

Quiz Questions

The nurse is caring for a patient who takes atorvastatin and is present for his annual physical. What panel should the nurse anticipate being ordered to assess the efficacy of this treatment regimen?
A lipid panel

The nurse is caring for a patient who is receiving mechanical ventilation at APRV settings. Which lab panel is most appropriate to monitor their respiratory status?
An arterial blood gas (ABG)

A patient taking levothyroxine for hypothyroidism complains of tachycardia, weight loss, insomnia, and heat intolerance. Which lab panel would be most appropriate to examine the efficacy of their treatment regimen?
A thyroid panel

Full Transcript: Lab Values, part 2: Lab Panels - CMP, Lipids, Thyroid Panel, ABG

Hi, I'm Meris. And in this video, I'm going to be talking to you about four common laboratory panels, the complete metabolic panel, CMP, the lipid panel, thyroid panel, and arterial blood gas, ABG. I'm going to be following along using our Lab Values flashcards. These are available on our website, leveluprn.com, if you want to grab a set for yourself. Or if you are more of a fan of digital products, I would invite you to check out Flashables, which is the digital version of all of our flashcards available on demand and at your fingertips wherever you are. All right, let's go ahead and get started.

So first up, we are talking about the complete metabolic panel. And if you refer back to the previous video, you can see where I talked to you about the basic metabolic panel. Good news, if you've mastered BMP and the liver function tests that we talked about in the previous video, then you've basically got the CMP put together already. The comprehensive metabolic panel, CMP, is just the basic metabolic panel plus some additional tests that tell us about the status of our patient's liver function. So when I think about CMP, I think of this as giving me much more of a global view of the metabolic processes going on in my patient. This is letting me look both at the electrolytes and the kidneys and all of the things that we talked about in BMP; however, it's additionally adding in that information about the liver function. Very helpful test, especially for somebody like me who is an ER nurse. It is something that we see with frequency.

The next test I want to talk to you about is the lipid panel, and there's a few things in here that you should be familiar with. So there's the total cholesterol level, the triglycerides, the high-density lipoprotein, which is HDL, and the low-density lipoprotein, LDL. Depending on your facility, you may have a couple of other values in there such as VLDL, very-low-density lipoprotein. You may see some other stuff, but the point here is that we are examining in depth the different types of lipids that may be found in our blood. This is going to give us great information. This is a really good screening tool at your annual physical. They will be looking to see if you have any signs of hyperlipidemia, elevated cholesterol. This can also give us information about what's going on right here in this moment. Do we have somebody who has some kind of a situation where I think, "Man, their blood looks really fatty"? We can add a lipid profile on and see what the exact lipid composition of that blood is. So very important there in monitoring for patients who are taking statins, for instance, or any other cholesterol-lowering drug. That's going to be an important lab panel that you should be keeping your eye on.

So up next, we're looking at the thyroid panel. And as the name would suggest, this is going to be giving us some information about the different hormones that play a role in my thyroid function. So of course, right off the jump, you know one of the most important ones is going to be the TSH, the thyroid-stimulating hormone. That's going to tell me what's going on at the level of the brain to stimulate the thyroid. And then I'm going to look at two other values. I'm going to look at the free or total T4 and T3. Now, T4, you might know better as thyroxine. And T3, you might know better as - and bear with me, because we're going to get through this pronunciation together - triiodothyronine. There we go. Triiodothyronine. Try for three, right? That's how you can remember that that is T3. So again, your mileage may vary. Your facility might have some additional values in this panel. But the point here is that we're looking at the function of the thyroid and nothing else when we're looking at a thyroid panel.

And lastly, I'm going to talk to you about the arterial blood gas components, or ABG. And before we start, I do just want to let you know if you need help interpreting ABGs, we have so many resources to help you. We, of course, have information here in the cards for you. But additionally, we do have an entire video series on ABG interpretation plus an ABG interpretation course, which is available through our Level Up RN membership. So that's not what this is. This, I'm just going to talk to you about some of the components of the ABG.

So in the ABG, you know one of the most important things that we're going to look at is, what is the pH of that arterial blood? Is it acidic, is it alkaline, or is it in that perfect homeostatic range that we love so much? We're also going to look at the partial pressure of oxygen, PaO2; the partial pressure of carbon dioxide, PaCO2; the saturation of hemoglobin with oxygen, SaO2; we're going to look at bicarbonate HCO3; and we're also going to look at something called the base deficit or excess. So you'll hear that called the base deficit or BE for base excess sometimes. Just depends on your facility, what they call it. But these are the different components that are going to go into our arterial blood gas.

So who is getting an arterial blood gas? That's a great question. It's certainly not everybody. This is mostly going to be anybody that we have a respiratory concern for. If I think something is going on with their respiratory status and I need to know, how well are they compensating? How well are they doing? Then yes, this might be somebody that I'm getting an ABG on in the ER.

Now, my ventilated patients, meaning that they are on a mechanical ventilator, they are receiving positive pressure ventilation, well, what this means is that this person is not in control of their own respirations most of the time. And so if they're not in control, then they cannot make any sort of compensation. They cannot adjust how often they breathe, or how much volume is delivered to their lungs, or what the fraction of inspired oxygen is, or what the pressure used to deliver it is. Any of these things, they cannot regulate any of this, which you and I do, breath for breath, right? I regulate the rate at which I'm breathing. I regulate the volume with which I breathe based on what's going on in that situation. So you've taken away that ability in somebody who is receiving mechanical ventilation, especially if they are sedated and/or paralyzed.

So when we talk about that, yeah, this should be a person that gives you a red flag that says this patient needs more frequent ABGs than just a general respiratory patient. The body cannot do anything to change the respiratory status, so I need to keep a close watch on those values and see what's going on with their respirations to make sure that I don't need to make any adjustments. This is predominantly going to be done in the ICU, however, absolutely takes place in the ER. And depending on your facility and what kinds of patients you have and what your policies are, this could also be present in a progressive or a step-down or intermediate floor as well, depending on what you call it. So that is the component of an ABG and the purpose behind ordering it.

One thing I do want to mention is that we don't go into depth into a VBG, a venous blood gas. However, it's going to have many of the same components. What you need to know is that it's going to have slightly different values because we're testing venous blood and not arterial blood. So it is important to use the reference ranges provided by your laboratory, and don't use those hardwired ABG numbers that you're going to have stamped in your memory for the rest of your life, right? It's important to remember if you're using a VBG that we are looking at venous and not arterial blood.

All right. That is it for this video, but I am so glad you stayed until the end because I am going to test your knowledge of key facts provided in this video with some quiz questions.

The nurse is caring for a patient who takes atorvastatin and is present for his annual physical. What panel should the nurse anticipate being ordered to assess the efficacy of this treatment regimen?

A lipid panel.

The nurse is caring for a patient who is receiving mechanical ventilation at APRV settings. Which lab panel is most appropriate to monitor their respiratory status?

An arterial blood gas.

A patient taking levothyroxine for hypothyroidism complains of tachycardia, weight loss, insomnia, and heat intolerance. Which lab panel would be most appropriate to examine the efficacy of their treatment regimen?

A thyroid panel.

All right, that is it for this video. I hope you enjoyed it and that you learned something. If you did, would you leave us a comment and let me know something that you learned? We love that feedback. And also, if you have a great way of remembering something that I didn't mention in this video, I'd love it if you'd leave a comment so that we can see it, but also so that other learners can see it as well. All right, that's it for this one. Thanks so much, and happy studying.

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