CP LEC 6: LABS Flashcards
increased WBS from ____
decreased from ______
infection
immunosuppressants or steroids
How would a pt with altered WBC present?
tired, intense exercise an modalities’ may be contraindicated if active infection
If pt is having chest pain or dyspnea, what labs might you look at to rule out anemia?
CBC - RBC, HG, HCT
T/F: pt may have normal looking SpO2 levels with decreased hemoglobin
True! so watch symptoms
Critical high values of Hematocrit are ____ and can put pt at risk for
Low values ____ put pt at risk for
High: > 60% of blood is RBC, risk for blood clotting
Low: < 15-20%, cardiac failure and death
Hemoglobin critical values, high and low
low: < 5-7 g/dL
high: > 20 g/dL, clotting risk
SpO2 below ____% or a decrease of ___% or more from baseline is concerning and you should check your pt and stop exercising
88%
4%
Symptoms of high WBC
Symptoms of low WBC
high - fever, malaise, lethargy, dizzy, bleeding, bruising, inflamed joints, wt loss, lymphadenopathy
low - anemia, weakness, fatigue, fever, SOB, headache
Thrombocytopenia is platelet count of ____ and would present as
Thrombocytosis is _____ and would present as
<150 k/uL, increased risk for bleeding, weakness, HA
> 450, impaired tolerance to activity, increased clotting risk
Platelet counts are often reduced in pts with what heart condition?
HFrEF
What medications may reduce platelet counts?
heparin, anticoagulants, antiplatelets, histamine-2 blockers, aspirin, plavix
If platelet counts are below ___, do not do resistive exercises, the patient is at high risk of bleeding
50 k / uL
Hypernatremia is reuslt of _______ and may present as
dehydration
confusion, hyperreflexia, seizures, coma
Hyponatremia is result of _________ and may present as
fluid overload
*confusion, *weakness, *hypotension, low energy, seizures, coma
Na+ reference range
134-142
If a pt has hyponatremia what medication should they take?
diuretics! too much fluid retention
Decreases in K+ may be due to what?
diuresis, vomiting, diarrhea
High levels of K may be due to what?
renal failure (not excreting)
dehydration
ACE inhibitors
Low K levels are associated with acidosis/alkalosis and ____glycemia.
alkalosis, hypoglycemia (low K+ allows insulin into blood)
High K levels are associated with acidosis/alkalosis and ____glycemia.
acidosis, hyperglycemia (high K+ blocks insulin)
Potassium should be kept at what levels? Especially for what patients?
4.0-5.0 in cardiac patients, acute MI, cardiomyopathy, arrythmias, diuretic therapy
What might you see on an ECG if your pt has hypokalemia?
PVC!
atrial tachycardia, ventricular tachycardia or fibrillation
risk for arrythmias!
What might hyperkalemia present as in the heart/ecg?
bradycardia, heart block, Vtach, Vfib, ventricular arrest, tetany
Metabolic _____ puts patients at risk for arrythmias
acidosis
How does CHF affect BUN levels?
increases BUN because decreased BF to kidneys, causing dysfn
Pts with increased BUN levels or serum creatinine levels will have
decreased tolerance to activity
Pts with hyperglycemia will present with
diabetic ketoacidosis, extreme fatigue
Pts with hypoglycemia will present as
lethargy, irritable, shaking, weak, may not tolerate therpay until glucose levels increased
Hyperglycemia is > ____
hypoglycemia is < _____
target range of ____ - ____ is recommended for pts
> 200
< 70
140-180 recommended
A1c levels
normal < 5.7%
pre-diabetes 5.7-6.4
diabetic > 6.5
educate patient on blood sugar control and importance of exercise
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)
What is a major risk for pts with decreased Mg?
arrythmias, look for QT prolongation and atrial/ventricular arrythmias
Thyroid abnormalities can cause…
arrythmias, fatigue, anemia
start my checking TSH
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
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
When can you mobilize a pt with elevated CK-MB levels?
when it trends downward, 2-3 days after acute MI
MB index
percentage of MB in comparison with total CK (CK also in skeletal muscle and brain)
how should you order CK-MB labs to confirm/diagnose an acute MI?
3 sets of cardiac isoenzymes should be ordered 8 hours apart
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
Myoglobin is used as an early marker of
muscle damage in MI
When would you see elevated BNP?
when ventricles volume expansion and pressure overload, ventricular systolic and diastolic dysfxn
Dilated cardiomyopathy / HFrEF
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)
Peaked T waves indicate
hyperkalemia
also PR elongation, wide QRS, ST depression
flattened T waves indicate
hypokalemia
how would toxic drug effects show up on an ECG?
QT prolongation
An inverted T wave may indicate
ischemia during acute MI
An ECHO can show
structural abnormalities, chamber sizes, valve fxn, left ventricle fxn/ejection fraction
doppler echo
shows BF in heart, can asses pulmonary HTN
What is stress testing?
evaluate how the heart responds to increased workload, evaluate myocardial ischemia
exercise treadmill, Myocardial Perfusion Imaging, stress echo
A myocardial perfusion imaging stress test can determine
areas of ischemia, scar tissue from heart attacks
looks at BF during rest vs exercise
What does radionuclide angiography or MUGA test for?
ejection fraction
Helical CT used to diagnose…
aortic dissection, PE
Plain CT used to diagnose…
masses, hematomas, aneurysms
Ultrafest CT used to detect
Coronary artery calcification as an indicator of atherosclerosis
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
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
A swan ganz catheter measures what?
- Pulmonary artery BP
- right atrial and ventricular pressure
- left atrial P indirectly
mPAP HTN is considered
> 25 at rest or > 30 with exercise
What is cardiac index? how do you measure it?
Cardiac index = CO / Body SA
swan ganz catheter
How is arrythmias monitoring conducted?
via telemetry
Holter monitor (24 hrs), event recorder (weeks), loop recorder (implanted in chest)
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
T/F: VTEs can occur spontaneously in healthy, ambulatory outpatients
T
can be asymptomatic at first
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
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
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
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)
What is a positive WELLS score?
greater than or equal to 2.
0 low prob
1-2 moderate
3+ high prob
What is the name of the UE DVT test?
constans criteria, 2-3 is high probaility
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
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.
if your patient test positive for a DVT, what medication is given?
anticoagulants!
ex: heparin
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
What might increase a patients partial thromboplastin time?
being on heparin
Before you get your pt up, if they are taking an anticoagulant/blood thinner, what should you ALWAYS CHECK??
INR!!
What is the purpose of and INR value? (international normalized ratio)
monitors the effectiveness of warfarin (common anticoagulant after surgery) for blood thinning
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)
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
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
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
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.
What is fondaparinux? When can you work with a pt taking this medication?
anticoag
2-3 hours medical team check
3 hours, mobilize
When should you screen for a VTE?
during initial patient interview and physical exam
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
What is a common preventive measure aside from mobility for patients at risk of a DVT?
mechanical compression
What scoring system can be used to assess someone’s risk to a DVT? (not someone with symptoms = use WELLS)
Padua Score
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
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
What test is used to diagnose a PE?
VQ scan not DOPPLER
radioactive dye in lungs to find the PE
If the PE is severely impairing circulation and meds (thrombolysis) aren’t working, what would be done?
embolectomy - surgery to remove clot
What is the most serious kind of PE?
saddle PE
saddles the bifurcation of the pulmonary trunk, blocking both as it splits
