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Alkaline Phosphatase ALP

Alkaline Phosphatase

Type of Test: Blood

Body Systems and Functions:

Hematological system

Normal Findings:

Findings vary widely depending on the method of analysis.
Check your laboratory for the reference values. Children generally have lowerlevels than adults.

Test Results Time Frame:

Within 48 hr

Test Description:

Alkaline phosphatase is a group of enzymes found primarily in the liver, gallbladder, and intestinal and bone tissues. They function best at an alkaline pH of 9. The test is done primarily to assist in the diagnosis of hepatic and bone disease. High levels are also found in the placenta, so that ALP levels rise during pregnancy.

Consent Form:

Not required

List of Equipment:

Red-top tube or serum separator tube; needle and syringe or vacutainer; alcohol swab

Tst Procedure:

1. Label the specimen tube. Correctly identifi es the client and the test to be performed.
2. Obtain a 5-mL blood sample.
3. Do not agitate the tube. Agitation may cause RBC hemolysis.
4. Send tube to the laboratory.

Clinical Implications and Indications:

1. Highly elevated levels are found with obstructive jaundice, liver cancer, cirrhosis, biliary obstruction, l osteogenic sarcoma, metastatic bone disease, hyperparathyroidism, and Paget’s disease.
2. Moderately elevated levels are found with infectious mononucleosis, pancreatitis, pregnancy, osteomalacia, rickets, bone infections, and extrahepatic duct obstruction.

3. Mildly elevated levels are found with viral hepatitis, chronic hepatitis, growing children, large doses of vitamin D, and leukemia.
4. Decreased levels are found with hypophosphatasia, malnutrition, cretinism, scurvy, hypothyroidism, pernicious anemia, placental insuffi ciency, and CHF.

Nursing Care:

Before Test: Explain the test procedure and the purpose of the test. Assess the client’s knowledge of the test. Teach client to be NPO for 12 hr prior to the test.
Assess medication history and specifically check for IV albumin administrationwithin the past 10 days.
During Test: Adhere to standard precautions
After 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.

Potential Complications:

Bleeding and bruising at venipuncture site

Interfering Factors:

Postmenopausal women have higher levels of ALP; medications that cause false decreases are clofibrate, fluorides, and azathioprine; most of the drugs that cause an increase do so because they are toxic to the liver or causecholestasis.

Nursing Considerations:

Pregnancy: Normal pregnancy will increase levels due to ALP in the placenta.
Pediatric: Infants and children will need assistance in remaining still during the venipuncture and ageappropriate comfort measures following the test. Rapid growth in children causes increases in ALP.

Listing of Related Tests: AST; ALT; albumin; GTT; bone studies