Evaluation of the Acute & Medically Complex Patient Flashcards
Diagnostic Tests/ Reports (7)
- Complete blood count (CBC)
- Arterial blood gases (ABG)
- Electrolytes
- Endocrine function
- Electrocardogram (ECG)
- Operative reports
- Review all systems: Mental status, Vital signs
CBC (Hemoglobin)
- 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
Hemoglobin reference values
- Male: 14-17 g/dL
- Female: 12-16 g/dL
Hemoglobin: High vs Low critical values
- 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)
Hemoglobin: “Trending upwards”
- Polycythemia
Causes of high hemoglobin
- CHD
- Severe dehydration
- COPD
- CHF
- Severe burns
- High altitude
Polycythemia presentation
- high hemoglobin
- orthostasis
- presyncope
- dizziness
- arrhythmias
- CHF onset/exacerbation
- seizure
- TIA
- symptoms of MI
- angina
CBC (White Blood Cells)
- routine test to identify: presence of infection, inflammation, allergens
WBC: Reference Values
5.0-10 10(9)/L
WBC Trending upwards
- Leukocytosis
- >11.0 10(9)/L
- consider timing of therapy session due to early morning low level and late afternoon high peak
- >11.0 10(9)/L
WBC Trending downwards
- Leukopenia
- <4.0 10(9)/L
Leukocytosis presentation
- fever
- malaise
- lethargy
- dizziness
- bleeding
- bruising
- weight loss
- painful inflammed joints
Leukopenia presentation
- anemia
- weakness
- fatigue
- fever
- headache
- SOB
CBC (Platelets)
- elevated levels can lead to venous thromboembolism
- fall risk awareness with low platelets
- be cautious of how handling patients. could bleed further
Platelets: references values
140-400 k/uL
Platelets: Trending upwards
- thrombocytosis
- >450 k/uL
Thrombocytosis presentation
- high platelets
- weakness
- headache
- dizziness
- chest pain
- tingling in hands/feet
Platelets: Trending downwards
- thrombocytopenia
- <150 k/uL
Thrombocytopenia presentation
- petechiae
- ecchymosis
- fatigue
- jaundice
- splenomegaly
- risk for bleeding
Electrolytes
- 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
Sodium: Reference values
134-142 mEq/L
Sodium trending upwards
- hypernatremia
- > 145 mEq/L
- impaired cognitive status
- seizure precautions for patients with PMH
Sodium trending downward
- hyponatremia
- < 130 mEq/L
- impaired cognitive status
- monitor vitals secondary to risk for orthostatic hypotension
- risk for falls
Hypernatremia presentation
- high sodium
- irritability
- agitation
- seizure
- come
- hypotension
- tachycardia
- decreased urinary output
Hyponatremia presentation
- low sodium
- headache
- lethargic
- decreased reflexes
- N/V
- diarrhea
- seizure
- coma
- orthostatic hypotension
- pitting edema
Potassium: Reference value
3.7-5.1 mEq/L
Potassium trending upwards
- Hyperkalemia
- > 5.5 mEq/L
- patients at risk for cardiac issues
- could present with muscle weakness
Hyperkalemia presentation
- muscle weakness/paralysis
- paresthesia
- bradycardia
- heart block
- ventricular fibrillation
- cardiac arrest
Potassium trending downward
- Hypokalemia
- <3.5 mEq/L
- collaberate with interprofessional team
Hypokalemia presentation
- extremity weakness
- decreased weakness
- paresthesia
- leg cramps
- EKG changes
- cardiac arrest
- hypotension
- constipation
Glucose
- measures blood glucose at time sample obtained
Glucose reference values
- 70-100 mg/dL
- fasting (90-130)
Glucose trending upward
- hyperglycemic
- >200 mg/dL
- present with severe fatigue
- decreased tolerate to activity
Glucose trending downward
- hypoglycemic
- <70 mg/dL
- lethargy
- irritability
- shaking
- extremity weakness
- LOC
Arterial Blood Gases (ABG)
- 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)
pH values
- normal= 7.4
- acidotic= <7.4
- alkalotic= > 7.4
***PaCO2: if >40mm Hg= acidotic, if <40mmHg= alkalotic
***HCO3: if >24= alkalotic, if <24= acidotic
Complex patient: Medical complexity
- including discordant conditions, chronic pain, medication intolerance, unexplained symptoms and cognitive issues
Complex patient: Socioeconomic factors
- such as the unaffordability of medication, family, stressors, and low levels of health literacy
Complex patient: Mental illness
- such as depression resulting in poor medication adherence, addiction, and anxiety that confused the clinical picture
Complex patient: Behaviors and traits
- demanding, argumentative, and anxious
