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Special Populations > Evaluation of the Acute & Medically Complex Patient > Flashcards

Evaluation of the Acute & Medically Complex Patient Flashcards

1
Q

Diagnostic Tests/ Reports (7)

A
  • Complete blood count (CBC)
  • Arterial blood gases (ABG)
  • Electrolytes
  • Endocrine function
  • Electrocardogram (ECG)
  • Operative reports
  • Review all systems: Mental status, Vital signs
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2
Q

CBC (Hemoglobin)

A
  • assess anemia, blood loss, bone marrow suppression (cancer tx)
  • Anemia higher in older adult population
    • has profound impact on their ability to engage in rigorous exercise
    • primary cause if GI bleeding
  • anemia is presence of CAD may result in angina. Can lead to heart failure
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3
Q

Hemoglobin reference values

A
  • Male: 14-17 g/dL
  • Female: 12-16 g/dL
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4
Q

Hemoglobin: High vs Low critical values

A
  • Low critical values:
    • <5-7 g/dL (can lead to heart failure or death)
  • High Critical values:
    • >20 g/dL (can lead to clogging of capillaries)
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5
Q

Hemoglobin: “Trending upwards”

A
  • Polycythemia
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6
Q

Causes of high hemoglobin

A
  • CHD
  • Severe dehydration
  • COPD
  • CHF
  • Severe burns
  • High altitude
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7
Q

Polycythemia presentation

A
  • high hemoglobin
    • orthostasis
    • presyncope
    • dizziness
    • arrhythmias
    • CHF onset/exacerbation
    • seizure
    • TIA
    • symptoms of MI
    • angina
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8
Q

CBC (White Blood Cells)

A
  • routine test to identify: presence of infection, inflammation, allergens
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9
Q

WBC: Reference Values

A

5.0-10 10(9)/L

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10
Q

WBC Trending upwards

A
  • Leukocytosis
    • >11.0 10(9)/L
      • consider timing of therapy session due to early morning low level and late afternoon high peak
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11
Q

WBC Trending downwards

A
  • Leukopenia
    • <4.0 10(9)/L
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12
Q

Leukocytosis presentation

A
  • fever
  • malaise
  • lethargy
  • dizziness
  • bleeding
  • bruising
  • weight loss
  • painful inflammed joints
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13
Q

Leukopenia presentation

A
  • anemia
  • weakness
  • fatigue
  • fever
  • headache
  • SOB
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14
Q

CBC (Platelets)

A
  • elevated levels can lead to venous thromboembolism
  • fall risk awareness with low platelets
  • be cautious of how handling patients. could bleed further
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15
Q

Platelets: references values

A

140-400 k/uL

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16
Q

Platelets: Trending upwards

A
  • thrombocytosis
    • >450 k/uL
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17
Q

Thrombocytosis presentation

A
  • high platelets
    • weakness
    • headache
    • dizziness
    • chest pain
    • tingling in hands/feet
18
Q

Platelets: Trending downwards

A
  • thrombocytopenia
    • <150 k/uL
19
Q

Thrombocytopenia presentation

A
  • petechiae
  • ecchymosis
  • fatigue
  • jaundice
  • splenomegaly
  • risk for bleeding
20
Q

Electrolytes

A
  • Sodium (Na) is primary determinant for extracellular fluid volume
  • Potassium (K) important for function of excitable cells such as nerves, muscles, and heart
  • Calcium (Ca) important for bone formation, cell division and growth, blood coagulation, muscle contraction, and release of neurotransmitters
21
Q

Sodium: Reference values

A

134-142 mEq/L

22
Q

Sodium trending upwards

A
  • hypernatremia
    • > 145 mEq/L
    • impaired cognitive status
    • seizure precautions for patients with PMH
23
Q

Sodium trending downward

A
  • hyponatremia
    • < 130 mEq/L
    • impaired cognitive status
    • monitor vitals secondary to risk for orthostatic hypotension
    • risk for falls
24
Q

Hypernatremia presentation

A
  • high sodium
    • irritability
    • agitation
    • seizure
    • come
    • hypotension
    • tachycardia
    • decreased urinary output
25
Q

Hyponatremia presentation

A
  • low sodium
    • headache
    • lethargic
    • decreased reflexes
    • N/V
    • diarrhea
    • seizure
    • coma
    • orthostatic hypotension
    • pitting edema
26
Q

Potassium: Reference value

A

3.7-5.1 mEq/L

27
Q

Potassium trending upwards

A
  • Hyperkalemia
    • > 5.5 mEq/L
    • patients at risk for cardiac issues
    • could present with muscle weakness
28
Q

Hyperkalemia presentation

A
  • muscle weakness/paralysis
  • paresthesia
  • bradycardia
  • heart block
  • ventricular fibrillation
  • cardiac arrest
29
Q

Potassium trending downward

A
  • Hypokalemia
    • <3.5 mEq/L
    • collaberate with interprofessional team
30
Q

Hypokalemia presentation

A
  • extremity weakness
  • decreased weakness
  • paresthesia
  • leg cramps
  • EKG changes
  • cardiac arrest
  • hypotension
  • constipation
31
Q

Glucose

A
  • measures blood glucose at time sample obtained
32
Q

Glucose reference values

A
  • 70-100 mg/dL
  • fasting (90-130)
33
Q

Glucose trending upward

A
  • hyperglycemic
    • >200 mg/dL
    • present with severe fatigue
    • decreased tolerate to activity
34
Q

Glucose trending downward

A
  • hypoglycemic
    • <70 mg/dL
    • lethargy
    • irritability
    • shaking
    • extremity weakness
    • LOC
35
Q

Arterial Blood Gases (ABG)

A
  • pulmonary and renal systems regulate acids
  • renal system primary regulator of body’s major base
  • partial pressure of oxygen declines with age, secondary to:
    • reduction in eleasticity of musculoskeletal system
    • decrease in muscle fibers
    • decrease in alveolar gas exchange surface area
    • decrease in respinsiveness of CNS

***kyphosis could decrease partial pressure of oxygen (tighten chest muscles and limit expansion)

36
Q

pH values

A
  • normal= 7.4
  • acidotic= <7.4
  • alkalotic= > 7.4

***PaCO2: if >40mm Hg= acidotic, if <40mmHg= alkalotic

***HCO3: if >24= alkalotic, if <24= acidotic

37
Q

Complex patient: Medical complexity

A
  • including discordant conditions, chronic pain, medication intolerance, unexplained symptoms and cognitive issues
38
Q

Complex patient: Socioeconomic factors

A
  • such as the unaffordability of medication, family, stressors, and low levels of health literacy
39
Q

Complex patient: Mental illness

A
  • such as depression resulting in poor medication adherence, addiction, and anxiety that confused the clinical picture
40
Q

Complex patient: Behaviors and traits

A
  • demanding, argumentative, and anxious

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