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Christina > CP LEC 6: LABS > Flashcards

CP LEC 6: LABS Flashcards

1
Q

increased WBS from ____
decreased from ______

A

infection

immunosuppressants or steroids

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2
Q

How would a pt with altered WBC present?

A

tired, intense exercise an modalities’ may be contraindicated if active infection

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3
Q

If pt is having chest pain or dyspnea, what labs might you look at to rule out anemia?

A

CBC - RBC, HG, HCT

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4
Q

T/F: pt may have normal looking SpO2 levels with decreased hemoglobin

A

True! so watch symptoms

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5
Q

Critical high values of Hematocrit are ____ and can put pt at risk for

Low values ____ put pt at risk for

A

High: > 60% of blood is RBC, risk for blood clotting

Low: < 15-20%, cardiac failure and death

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6
Q

Hemoglobin critical values, high and low

A

low: < 5-7 g/dL
high: > 20 g/dL, clotting risk

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7
Q

SpO2 below ____% or a decrease of ___% or more from baseline is concerning and you should check your pt and stop exercising

A

88%
4%

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8
Q

Symptoms of high WBC
Symptoms of low WBC

A

high - fever, malaise, lethargy, dizzy, bleeding, bruising, inflamed joints, wt loss, lymphadenopathy

low - anemia, weakness, fatigue, fever, SOB, headache

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9
Q

Thrombocytopenia is platelet count of ____ and would present as

Thrombocytosis is _____ and would present as

A

<150 k/uL, increased risk for bleeding, weakness, HA

> 450, impaired tolerance to activity, increased clotting risk

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10
Q

Platelet counts are often reduced in pts with what heart condition?

A

HFrEF

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11
Q

What medications may reduce platelet counts?

A

heparin, anticoagulants, antiplatelets, histamine-2 blockers, aspirin, plavix

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12
Q

If platelet counts are below ___, do not do resistive exercises, the patient is at high risk of bleeding

A

50 k / uL

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13
Q

Hypernatremia is reuslt of _______ and may present as

A

dehydration
confusion, hyperreflexia, seizures, coma

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14
Q

Hyponatremia is result of _________ and may present as

A

fluid overload

*confusion, *weakness, *hypotension, low energy, seizures, coma

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15
Q

Na+ reference range

A

134-142

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16
Q

If a pt has hyponatremia what medication should they take?

A

diuretics! too much fluid retention

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17
Q

Decreases in K+ may be due to what?

A

diuresis, vomiting, diarrhea

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18
Q

High levels of K may be due to what?

A

renal failure (not excreting)
dehydration
ACE inhibitors

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19
Q

Low K levels are associated with acidosis/alkalosis and ____glycemia.

A

alkalosis, hypoglycemia (low K+ allows insulin into blood)

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20
Q

High K levels are associated with acidosis/alkalosis and ____glycemia.

A

acidosis, hyperglycemia (high K+ blocks insulin)

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21
Q

Potassium should be kept at what levels? Especially for what patients?

A

4.0-5.0 in cardiac patients, acute MI, cardiomyopathy, arrythmias, diuretic therapy

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22
Q

What might you see on an ECG if your pt has hypokalemia?

A

PVC!
atrial tachycardia, ventricular tachycardia or fibrillation

risk for arrythmias!

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23
Q

What might hyperkalemia present as in the heart/ecg?

A

bradycardia, heart block, Vtach, Vfib, ventricular arrest, tetany

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24
Q

Metabolic _____ puts patients at risk for arrythmias

A

acidosis

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25
How does CHF affect BUN levels?
increases BUN because decreased BF to kidneys, causing dysfn
26
Pts with increased BUN levels or serum creatinine levels will have
decreased tolerance to activity
27
Pts with hyperglycemia will present with
diabetic ketoacidosis, extreme fatigue
28
Pts with hypoglycemia will present as
lethargy, irritable, shaking, weak, may not tolerate therpay until glucose levels increased
29
Hyperglycemia is > ____ hypoglycemia is < _____ target range of ____ - ____ is recommended for pts
> 200 < 70 140-180 recommended
30
A1c levels
normal < 5.7% pre-diabetes 5.7-6.4 diabetic > 6.5 educate patient on blood sugar control and importance of exercise
31
ALT, ALP and AST are labs for what organ? When might they be elevated?
liver fxn elevated in pts with CHF due to hepatic congestion (leaking out bc backup) or low perfusion states (liver shock due to ischemia)
32
What is a major risk for pts with decreased Mg?
arrythmias, look for QT prolongation and atrial/ventricular arrythmias
33
Thyroid abnormalities can cause...
arrythmias, fatigue, anemia start my checking TSH
34
When would you see elevated CK-MB?
enzyme in myocardium released with injury to cells increases with acute MI, myocarditis, post-CABG, cardioversion, chronic renal failure
35
CK-MB presence is diagnostic of an MI. It will commonly be elevated within __ - ___ hours of cardiac injury and returns to normal within __-___ days.
3-6 hours or 6-12hrs 2-3 days
36
When can you mobilize a pt with elevated CK-MB levels?
when it trends downward, 2-3 days after acute MI
37
MB index
percentage of MB in comparison with total CK (CK also in skeletal muscle and brain)
38
how should you order CK-MB labs to confirm/diagnose an acute MI?
3 sets of cardiac isoenzymes should be ordered 8 hours apart
39
Besides CK-MB, what other enzyme may be elevated after acute MI? When would it trend downwards?
Troponin I, levels return to normal in 7-10 days
40
Myoglobin is used as an early marker of
muscle damage in MI
41
When would you see elevated BNP?
when ventricles volume expansion and pressure overload, ventricular systolic and diastolic dysfxn Dilated cardiomyopathy / HFrEF
42
Symptoms you might see if a pt has elevated BNP
indicates CHF SOB and poor exercise tolerance because pulmonary fluid impacts gas exchange (vessels will also constrict in periphery and compensatory increased RBC increases the strain on the heart)
43
Peaked T waves indicate
hyperkalemia also PR elongation, wide QRS, ST depression
44
flattened T waves indicate
hypokalemia
45
how would toxic drug effects show up on an ECG?
QT prolongation
46
An inverted T wave may indicate
ischemia during acute MI
47
An ECHO can show
structural abnormalities, chamber sizes, valve fxn, left ventricle fxn/ejection fraction
48
doppler echo
shows BF in heart, can asses pulmonary HTN
49
What is stress testing?
evaluate how the heart responds to increased workload, evaluate myocardial ischemia exercise treadmill, Myocardial Perfusion Imaging, stress echo
50
A myocardial perfusion imaging stress test can determine
areas of ischemia, scar tissue from heart attacks looks at BF during rest vs exercise
51
What does radionuclide angiography or MUGA test for?
ejection fraction
52
Helical CT used to diagnose...
aortic dissection, PE
53
Plain CT used to diagnose...
masses, hematomas, aneurysms
54
Ultrafest CT used to detect
Coronary artery calcification as an indicator of atherosclerosis
55
Cardiac MRI allows for confirmation of heart disease following other tests, more precise measurements of...
ejection fraction chamber size BF tumors infections diseases ischemia congenital heart disease dont memorize
56
What does cardiac catheterization measure, what's an example if this method?
measures pressures in chambers/aorta, LV wall motion and ejection, coronary anatomy and valve fxn ex: coronary angiogram
57
A swan ganz catheter measures what?
- Pulmonary artery BP - right atrial and ventricular pressure - left atrial P indirectly
58
mPAP HTN is considered
>25 at rest or > 30 with exercise
59
What is cardiac index? how do you measure it?
Cardiac index = CO / Body SA swan ganz catheter
60
How is arrythmias monitoring conducted?
via telemetry Holter monitor (24 hrs), event recorder (weeks), loop recorder (implanted in chest)
61
Where is a DVT more dangerous, the proximal or distal segment of the leg?
proximal, higher tendency to dislodge and become PE popliteal, femoral or iliac venous system
62
T/F: VTEs can occur spontaneously in healthy, ambulatory outpatients
T can be asymptomatic at first
63
What are the strong risk factors for a DVT?
- fracture (pelvis, femur, tibia) - hip or knee replacement - major general surgery - major trauma - SCI (5) FHSMM moderate: CHF or respiratory failure
64
what are the classic symptoms of a DVT? can these be used to diagnose a DVT?
pain, tenderness, swelling, discoloration (can progress to fever, warmth, etc) NO - not by themselves
65
What is meant that PDVT tests need to have high sensitivity?
means that a negative test would indicate that the clinician can confidently rule out the disorder
66
What is the WELLS rules?
assesses the probability of a DVT when patient has symptoms or there is suspicion of one (not a screening tool!!) tells you whether to continue with further tests (d-dimer, ultrasound)
67
What is a positive WELLS score?
greater than or equal to 2. 0 low prob 1-2 moderate 3+ high prob
68
What is the name of the UE DVT test?
constans criteria, 2-3 is high probaility
69
If your pt scores a low probability of DVT, what would you do vs if your patient had a moderate to high probability?
low prob - do d-dimer test, if positive, perform ultrasounds --> + give anticoagulant moderate to high prob - start with emergency ultrasound, if its negative follow up with d-dimer --> + give anticoagulant
70
a d-dimer test is highly ____ but not _____. What test could you use to fix this gap?
d-dimer is highly SENSITIVE but not SPECIFIC, doesnt tell you WHERE the clot is. a doppler test will, it tests specific veins.
71
if your patient test positive for a DVT, what medication is given?
anticoagulants! ex: heparin
72
What is prothrombin time? What time is marked as a risk?
measures the time it takes to convert prothrombin to thrombin (time it takes a persons blood to clot) > 25 seconds = high risk for bleeding
73
What might increase a patients partial thromboplastin time?
being on heparin
74
Before you get your pt up, if they are taking an anticoagulant/blood thinner, what should you ALWAYS CHECK??
INR!!
75
What is the purpose of and INR value? (international normalized ratio)
monitors the effectiveness of warfarin (common anticoagulant after surgery) for blood thinning
76
Normal range of INR is _____ lower INR values have pts at increased risk of ____ whereas high INR values put pts at increased risk of
normal: 0.8-1.2 low = increased risk of clots high = increased risk of bleeding (think very effective is high values so thinner blood)
77
What questions should you ask if your patient has a known DVT or is taking an anticoagulant?
what type of anticoagulant, when was it taken/initiated dictates when you can work with the pt
78
What are DOACs? When can you work with a pt taking this medication?
direct acting oral anti-coagulant wait 2-3 hours before mobilizing pt <2 hrs= dont mobolize 2-3 check with med team -aban -eliquis rivaroxaban, apixaban, dabigatran
79
What are LMWH anticoagulants? When can you work with a pt taking this medication?
3-5 hours check with medical team, 5 hours you can mobilize -parin enoxaparin (lovenox), dalteparin, nadroparin, nadroparin, tinzaparin
80
What are UFH anticoags? When can you work with a pt taking this medication?
unfractionated heparin need to wait 24hrs then check with medical team! and chest aPTT b/w 1.5-2.5 control value. this looks at lab time and longer wait period.
81
What is fondaparinux? When can you work with a pt taking this medication?
anticoag 2-3 hours medical team check 3 hours, mobilize
82
When should you screen for a VTE?
during initial patient interview and physical exam
83
What is post thrombotic syndrome?
after clot is resolved, pt still experiences symptoms like pain, swelling, varicose veins, etc does not mean there is another DVT, usually because of vein or valves damage
84
What is a common preventive measure aside from mobility for patients at risk of a DVT?
mechanical compression
85
What scoring system can be used to assess someone's risk to a DVT? (not someone with symptoms = use WELLS)
Padua Score
86
When would you use an inferior vena cava filter IVC?
a filter than catches blood clots before they enter the lung used when pt has high risk of DVT or PE, but has contraindications to anticoagulation meds such as a history of major bleeding
87
If a patient has a PE, what symptoms are likely present?
-clinical S&S of DVT -no alternative diagnoses -HR >100 -immobolization > or 3; surgery previous 4 weeks -previous DVT or PE -hemoptysis -malignancy w/ active txt in past 6 months or under pallitative care
88
What test is used to diagnose a PE?
VQ scan not DOPPLER radioactive dye in lungs to find the PE
89
If the PE is severely impairing circulation and meds (thrombolysis) aren't working, what would be done?
embolectomy - surgery to remove clot
90
What is the most serious kind of PE?
saddle PE saddles the bifurcation of the pulmonary trunk, blocking both as it splits

Christina (74 decks)

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