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Question 1

Respiratory Rate Rhythm and Pattern

Answer 1

Interpretation * Newborn: 33-45 * 1 year: 25-35 * 10 years: 15-20 * Adult: 12-20 Rhythm * normal: Inspiration:Expiration = 1:2 * COPD: I:E = 1:3 , 1:4

Question 2

ABGs: SpO2

Answer 2

Normal: 98-100%High: n/a Low: below 88-90% requires supplemental O2

Question 3

ABGs: PaO2

Answer 3

Normal: 80-100 mmHg High: in hyperoxygenationLow: in cardiac decompensation, COPD, some NMSPT: n/a

Question 4

ABGs: PaCO2

Answer 4

Normal: 35-45 mmHgHigh: in COPD, hypoventilation Low: hyperventilation, pregnancy, PE and anxiety

Question 5

ABGs: pH, whole blood - Normal Range

Answer 5

Normal: 7.35-7.45 (< acid, > alkaline)

Question 6

Hemostasis: Prothrombin Time (PT)

Answer 6

Normal: 11-15 secHigh: factor X deficiency, hemorrhagic dx, cirrhosis, hepatitis drugs (warfarin)

Question 7

Hemostasis: Partial Thromboplastin Time (PTT)

Answer 7

Normal: 25-40 sec High: Factor VII, IX, X deficiency

Question 8

Hemostasis: INR

Answer 8

Normal: .9-1.1 * Target INR 2.5-3.5 = DVT, PE, Mechanical valves, A-fib * Target INR 3.5 = pts with clotting disorders PT: look for active signs of bleeding when treating patients and use compensatory training to reduce fall risk

Question 9

Bleeding Time and C-reactive protein (CRP) <10mg/L

Answer 9

Bleeding Time 2-10 min C-reactive protein (CRP) <10mg/LHigh: platelet disorders, thrombocytopenia, high levels associated with increased risk atherosclerosis >100 mg/L associated with inflammation and infection

Question 10

CBC: White Blood Cells WBCs

Answer 10

Normal: 4300-10800 cells/mm3 - indicative of immune systemHigh: infection (all kinds), inflammation, hematologic malignancy, leukemia, lymphoma, drugs (corticosteroids)Low: aplastic anemia, B12 or folate deficiencyPT: consider metabolic demands in presence of fever and use of mask when WBCs <1000-2000 or ANC <500-1000

Question 11

Exercise Guidelines: WBC Count

Answer 11

4800-10,800 cells/mm3 = Normal exercise > 5,000 = light or regular exercise < 5,000 +Fever = no exercise

Question 12

CBC: Red Blood Cells RBCs

Answer 12

Normal: male: 4.6-6.2 women: 4.2-5.9 x106/uL High: polycythemia Low: anemia

Question 13

CBC: Erythrocyte Sedimentation Rate ESR

Answer 13

Normal: male <15 women< 20 mm/hr High: infection and inflammation: rheumatic or pelvic inflammatory dx, osteomyelitis - used to monitor treatment; e.g. RA, SLE, Hodgkins Dx

Question 14

CBC: Hematocrit %

Answer 14

Normal: male: 45-52% female: 37-48% High: erythrocytosis, dehydration, shockLow: severe anemia, acute hemorrhage PT: can cause decreased exercise tolerance and increased fatigue, tachycardia

Question 15

Exercise Guidelines: HCT %RBC whole blood

Answer 15

**Normal - Men = 45-52%, women = 37-48% **>25% light or regular exercise

Question 16

CBC: Hemoglobin Hgb

Answer 16

Normal: male: 13-18 g/dL women: 12-16 g/dL High: polycythemia, dehydration, shockLow: anemia, prolonged hemmorhage, RBC destruction (cancer, sickle cell) PT: can cause decreased exercise tolerance and increased fatigue, tachnycardia

Question 17

Exercise Guidelines: HgB

Answer 17

men = 13-18, women = 12-16 g/dL >10 regular exercise 8-10 = light exercise < 8 = no exercise

Question 18

CBC: Platelet Count High Platelets > 450,000 cells/mm3

Answer 18

Normal: 150,000-450,000 cells/mm3 High: chronic leukemia, hemoconcentration

Question 19

Exercise Guidelines: Platelet Count

Answer 19

150,000-450,000 = normal, unrestricted 50,000-150,000 = some limitations 30,000-50,000 = moderate exercise 20,000-30,000 = light exercise < 20,000 = ROM, ADLs, walking w/ physician approval

Question 20

Pre-Albumin

Answer 20

20-40 mg/dL 2-day half life (short term gauge of nutrition) <15 mg.dL = malnutrition

Question 21

Albumin

Answer 21

3.5-5.5 g/dL 18-20 day half life (long term gauge nutrition) <3.5 = malnurished

Question 22

Creatinine

Answer 22

Normal: 0.6-1.2 mg/dL -measures GFR as a measure of renal function, regulated by arterial blood pressure and renal blood flow

Question 23

BUN

Answer 23

Normal: 8-18 mg/dL is urea produced in the liver as a by-product of protein metabolism that is eliminated by the kidneys * elevated with HF/RF, indicates elevated uremia retention in the blood * decreased with starvation, dehydration, and liver disease * BUN-creatinine ratio is abnormal in liver disease

Question 24

Glucose Levels

Answer 24

70-115 mg/dL (Fasting)Short term management of diabetes

Question 25

Glycosylated Hemoglobin Levels (HbA1C)

Answer 25

4-6% long term management of diabetes

Question 26

Hypokalemia K- \< 3.8 mEq/L

Answer 26

causes: \* deficient potassium \* excessive loss from diarrhea, vommiting \* metabolic acidosis \* renal tubular disease \* alkalosis observe: \* ms weakness \* fatigue \* cardiac arrhythmias \* abdominal distention \* nausea/vommiting

Question 27

Hyperkalemia K- \> 5.0 mEq/L

Answer 27

causes \* inadequate secretion w/ acute RF \* kidney disease \* metabolic acidosis \* diabetic ketoacidosis \* sickle cell anemia \* SLE observe: \* symptomless until very high levels \* ms weakness \* arrhythmias \* ECG changes (tall T wave, prolonged PR & QRS)

Question 28

Hyponatremia Na+ \<136

Answer 28

\* low sodium causes \* water intoxication (extracellular water) \* excess ADH observe: \* confusion \* decreased mental alertness to convulsions \* signs of high ICP \* poor motor coordination \* sleepiness \* anorexia

Question 29

Hypernatremia Na+ \>143

Answer 29

\* high sodium causes \* water deficits (not salt excess) dehydration \* insufficient water intake observe \* circulatory congestion \* pulmonary edema w/ dyspnea \* HTN \* tachycardia \* agitation \* restlessness \* convulsions

Question 30

hypocalcemia

Answer 30

low calcium \* reduced albumin levels \* hyperphosphatemia \* hypoparathyroidism \* malabsorption of Ca or Vit D \* alkalosis \* acute pancreatitis \* vit D deficiency observe: \* muscle cramps \* tetany \* spasms \* parasthesias \* anxiety \* irritability \* twitching \* convulsions \* arrhythmias \* hypotension

Question 31

hypercalcemia

Answer 31

high calcium \* hyperparathyroidism \* tumors \* hyperthyroidism \* vit A intoxication observe \* fatigue \* depression \* mental confusion \* nausea/vommiting \* increased urination \* occasional cardiac arrhythmias

Question 32

hypomagnesemia

Answer 32

low magnesium \* hemodialysis \* blood transfusions \* chronic renal disease \* hepatic cirrhosis (alcoholism) \* chronic pancreatitis \* hypoparathyroidism \* malabsorption syndromes \* severe burns \* excessive loss of body fluids Observe \* hyperirritability \* confusion \* leg and foot cramps

Question 33

hypermagnesemia

Answer 33

high magnesium \* renal failure \* diabetic acidosis \* hypothyroidism \* Addison's Dx \* dehydration \* use of antacids Observe: \* hyporeflexia \* muscle weakness \* drowsiness \* lethargy \* confusion \* bradycardia \* hypotension

Question 34

Normal Urine SampleColorClaritySpecific GravitypHProteinSugar

Answer 34

\* Color - yellow-amber \* Clarity - clear \* Specific Gravity - 1.010-1.025 \* pH - 4.6-8.0 (6 avg) \* Protein - 0.8 mg/dL \* Sugar - none

Question 35

Cardiac Biomarkers -Enzymes in blood stream after MI.

Answer 35

-Creatinine Phosphokinase (CPK) -Troponin -Myoglobin -Carbonic Anhydrase III -Cardiac Myosin light chains

Question 36

CBC Platelet Count Low Platelets \<

Answer 36

Normal: 150,000-450,000 cells/mm3 Low: thrombocytopenia, acute leukemia, aplastic anemia, cancer chemo, PT: increased risk of bleeding with low levels so monitor for hematuria, petechiae and other signs \<20k = AROM, ADLs only 20-30k = light exercise only \* 30-50k = moderate exercise

Question 37

creatine phosphokinase (CK-MB)

Answer 37

Normal: 5-75 mU.mL \* appears ~4 hrs after infarction \* peaks 12-24 hrs \* declines over 48-72 hrs \*Normally elevated after cardiac surgery, defibrillation, car accident, and critical illness

Question 38

Troponin

Answer 38

troponin protein (I) 0-0.1 (onset 4-6 hours \* remains elevated for 5-7 days in plasma \*peaks 18-24 hours Troponin T: 0-0.2 ng/mL 9 onset 3-4 hours)

Question 39

Myoglobin

Answer 39

Normal \<100 ng/mL \*male=10-95 \*female=10-65

Question 40

Carbonic Anhydrase III

Answer 40

Normal Myo/CAIII \<3.2

Question 41

CBC - Low pH \<7.35

Answer 41

Normal: 7.35-7.45 \* respiratory acidosis: hypoventilation, COPD, respiratory depressants, myasthenia \* metabolic acidosis: bicarbonate deficit, increased acids (diabetes, alcohol, starvation); renal failure , increased acid intake and loss of alkaline fluids

Question 42

CBC - High pH

Answer 42

Normal: 7.35-7.45 (\< acid, \> alkaline) High: \* respiratory alkalosis: hyperventilation, sepsis, liver disease, fever \* metabolic alkalosis: vomiting, potassium depletion, diuretics, volume depletion