Nursing Measurements Guide
A Guide to Deep Tendon Reflexes
There’s a recycling company inside the body that manufactures three important elements that keep the body going – albumin, bile, and coagulation factors – or what we call the ABCs. Keep this acronym in mind because it will be useful when remembering the different components that the liver produces that will be discussed due to their importance in determining diagnostic results.
The first on our ABC acronym is albumin. Albumin is mainly responsible for the following:
- Drawing fluid into the intravascular spaces
- Binding heavily with calcium
If clients have liver disease or any condition that involves the liver, expect that their albumin to be lower than the normal level which is 3.5 to 5.0. And since albumin is directly correlated with calcium levels, albumin will determine whether calcium will go up or down either. Normal calcium count is 9.0 to 10.5.
On the other hand, calcium has a teeter-totter effect with phosphorus; when calcium goes up, phosphorus goes down. Therefore, if albumin is low, you can expect phosphorus to be high.
The second letter in the ABC acronym is bile. Bile is primarily responsible for transporting bilirubin and excess cholesterol in the body. Insufficient bile or the absence of it will increase bilirubin, which will cause jaundice or the yellowing of the skin.
Jaundice in Newborns
What happens to newborns that have yellowish skin? Bilirubin is the breakdown of hemoglobin or the red blood cells. When newborns are birthed, there will be an exchange from the placenta to the umbilical cord, and the body of the baby will try its best to get rid of excess red blood cells from the mother. Thus, jaundice occurs. Because of this situation, they are placed under bilirubin lights to ensure that the body excretes bilirubin efficiently.
Jaundice in Diseased Livers
On the other hand, jaundice with adult clients who are suffering from liver disease is because of the poor transportation of bile. Once bile is compromised, there will be no mode of transportation for bilirubin and cholesterol; therefore, bilirubin and cholesterol will skyrocket.
Total cholesterol which is supposedly below 200 is going to increase dramatically, reaching up to 500. Low-density lipoproteins (LDLs) which are supposed to be less than 100 will become high, too. Even the high-density lipoproteins (HDLs) or the good cholesterols that are supposedly less than 40 will escalate.
Last on the ABC acronym is the coagulation panel, which is in charge of blood clotting. Without these coagulation factors, everything that makes the blood clot – fibrin and fibrinogen – will no longer be produced. What are the different determinants of the coagulation factors and their normal values?
- Partial thrombin (PT) or prothrombin time – 12 to 15
- Partial thromboplastin time (PTT) – 30 to 60
- International normalized ratio (INR) – 0.9 to 1.2
If there is a liver malfunction, all the standard values provided above will go up drastically. But it is important to note that these numbers may differ from one hospital policy to another; therefore, it is best to get acquainted with the normal values of your institution. The PTT panels usually vary, but the INR stays the same.
Keep in mind that if the factors that are mainly responsible for clotting are decreased, clotting or coagulation time will take a while or completely stop. Therefore, the coagulation panel will exhibit elevated values because it indicates that clotting time is taking some time or is not happening at all.
AST and ALT
So, aside from the ABCs, other liver labs are done, and these are the AST and ALT tests. The alanine aminotransferase (ALT) is very specific for the liver that is an indicator of functionality. On the other hand, the aspartate aminotransferase (AST) is broader because it does not only consider the liver but also takes into account the status of the body. We’ll be discussing these two elements further in our other lectures.
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