Exam 2: Week 9, Wednesday (Blood) Flashcards
What are the three functions of Erythrocytes (RBCs)?
- •Transport hemoglobin - O2 carrier to tissue
- •Transport enormous quantities of CO2 in the form of bicarbonate ion (HCO3−) away from the tissues to the lungs
- •Hemoglobin in the cells is an excellent acid-base buffer
Three details about how Hemoglobin in RBC’s is an excellent acid-base buffer:
- True of most proteins
- Binds H+
- RBCs responsible for most of the acid-base buffering power of whole blood
What is the main purpose of RBCs?
Main role is to transport oxygen
How does the concentration of RBC in people at normal altitude compare with those in people who live at high altitude?
Persons living at high altitudes have greater numbers of red blood cells
*sometimes athletes train at high altitude to acomplish natural, “legal” blood doping in this way.
What is the normal hematocrit for women?
37-47%
KNOW THIS!
What is the normal hematocrit for men?
42-52%
KNOW THIS!
What is the normal Hemoglobin for men?
14-18 g/dL
KNOW THIS!
What is the normal hemoglobin for women?
12-16 g/dL
KNOW THIS!
What is the abbreviation for Hemoglobin?
Hgb
what is the abbreviation for Hematocrit?
Hct
What is the total normal WBC count for adults?
5,000 - 10,000 per cubic mm
KNOW THIS!
What is the normal platelet count for adults?
KNOW THIS!
150,000 - 400,000 per cubic mm
what is the abbreviation for platelets?
Plt
What is the acronym for remembering the types of WBC and their order of prevelance?
Name the types of WBCs in order from most prevalent to least prevelant (KNOW THIS! - not neccessarily the actual percentages):
Never (Neutrophils)
Let (Lymphocytes)
Monkeys (Monocytes)
Eat (Eosinophils)
Bananas (Basophils)
What is a Leukocyte?
White Blood cell
leuko = “white”
cyte = “cell”
What should we always keep in mind when using lab values to help us determine how much and what type of exercise is safe/appropriate for a pt?
What is “normal for them” as far as the lab value.
For instance
- If a patient has altered lab values due to a chronic condition, their body may have compensated and something that looks like we shouldn’t exercise them, may be fine in their case. Use your clinical decision making, taking into account past medical history and the pt’s current s/s and condition.
- If a pateint has altered lab values due to an acute problem, they are more likely to not have compensated and you should give a lot more wieght to the lab values when making decisions about whether exercise is safe or not.
What is generally considered the cut-off for Hbg levels for exercise?
KNOW THIS!
Always use the “pt’s normal” to ultimately make decisions, but use the following as a guide especially for an acute problem with Hbg:
- If Hbg is less than 10 g/dL, it is problematic. We should expect lower endurance levels. Monitoring of tolerance and potential alteration in the therapeutic plan may be indicated.
- When Hbg levels are greater than 10 g/dL, resistive exercise should be tolerated well from a hemodynamic standpoint. We should still monitor blood pressure and pulses (to check for OH, etc.), especially at the initial assessment.
Above 10 we are okay for resistive exercise
Why is it important to consider things like Hbg and hematocrit levels?
They are part of what contribute to oxygen delivery.
A compromise in any part of the oxygen delivery system may impair tissue function and ability to exercise safely.
What are the three major organs that are most susceptible to relative low oxyten supply (hypoxia) that we should think of when considering pt symptoms?
- Brain
- Heart
- Kidneys
What are some s/s of hypoxia in the brain? (4)
- Dizziness
- Lightheadedness
- presyncope and syncope
- symptoms of TIA or CVA
- for example confusion,
- visual changes
- etc
- Seizure
What are some s/s of hypoxia in the heart? (4)
- Anginal and MI symptoms
- Chest pain
- SOB
- etc.
- Sudden and slow onset of CHF
- Tachycardia
- Arrhythmias
What are some s/s of hypoxia in the Kidneys? (3)
- low urine output
- Increased creatine and blood urea nitrogen
- possible fluid retention (edema)
What should perk up your ears (and you should take seriously) regarding edema in a pt?
If they ask why their ankles are swollen.
Because that means this is not normal for them.
What traditionally defines orthostatic hypotension?
Traditionally, a decrease in systolic blood pressure more than 20 mm with a corresponding increase in HR defines a positive orthostatic decrease.
(I assume they mean when going from supine to sit, sit to stand, or supine to stand).
What is generally considered the cut-off for Hct levels for exercise?
KNOW THIS!
Of course always use the “pt’s normal” to ultimately make decisions, but use the following as a guide especially for an acute problem with Hct:
Traditional thought has been that:
- Light exercise is permitted with hematocrit levels greater than 25%
- Resistive exercise is permitted with hematocrit levels greater than 30%
*Exercise often can be and is appropriate at much lower Htc levels (considering comobidities, etc, is a large factor in determining what level of therapy is appropriate).
Htc = hematocrit
What is a drug that can be given to help improve hematocrit/Hbg in some anemias?
Erythropoietin
It stimulates bone marrow production of RBCs
What is leukocytosis?
When WBCs increase with infection, inflammation, or tissue damage.
What is leukopenia?
When WBC count is abnormally low.
What are some things that can cause Leukopenia? (5-9)
- some viral infections
- some blood-borne cancers (leukemias and lymphomas)
- with bone marrow suppression
- chemotherapy
- radiation
- HIV/AIDS
- post-bone marrow transplant
- Late alcoholism
- Late diabetes mellitus
What is generally considered the cut-off for leukocytosis for exercise?
KNOW THIS!
Leukocytosis, in the presence of infection is a relative issue for the PT. One must consider the pt’s overall medical condition with the infection in determining efficacy of the treatment.
- In the presence of sepsis or septicemia, more caution is in order.
- If there is hemodynamic compromise, therapy may be contraindicated until the infection is controlled.
What is generally considered the cut-off for Leukopenia for exercise?
KNOW THIS!
There more be more specific precautions for a leukopenic patient, especially with an absoulte neutrophic count that is extremely low (neutropenia)
Usually
- if WBC count of less than 5,000 per cubic mm and has a fever greater than 100* F, exercise is contraindicated.
- Again, this is pt specific. Use the entire clinical picture to make ultimate decision.
- If absolute neutrophil count is less than 1,000 per cubic mm, “reverse isolation” or “neutropenic precautions” may be indicated to protect pt from risk of infection.
- it is critical to follow the precautions.
What is generally considered the cut-off for low platelets (thrombocytopenia) for exercise?
KNOW THIS!
- Resistive exercise can continue until platelets are less than 50,000.
-
Discussion with the MD should occur before therapy when platelent counts are less than 20,000 because spontaneous bleeding is a serious danger.
- The PT must be cautious with handling patients who have low platelet counts to avoid brusing.
**Spontanious bleeding rarely occurs with a platelet count greater than 40,000, but prolonged bleeding from surgery or trauma may occur.
What is thrombocytoisis?
When might it be seen pathologically? (4)
Increased platelet count
Can be seen pathologically in:
- myeloproliferative diseases
- collagen disorders
- chronic pancreatitis,
- acute infections
What is thrombocytopenia?
When can it be pathologically seen? (5)
Decreased platelet count
Can be seen pathologically in:
- Some cancers (lymphomas and leukemias)
- postchemotherapy
- pancytopenious causes
- idiopathic thrombocytopenia purpura
- disseminated intravascular coagulopanty (a serious condition seen in critical care)
What are four important ions to know about?
- Sodium (Na+)
- Potassium (K+)
- Chloride (Cl-)
- Calcium (Ca++)
Na+ is the major ________________ cation.
Na+ is the major extracellular cation.
What are 4-5 functions of Na+ in the body?
- Regulates serum osmolality (concentration of all the particles)
-
fluid balance
- retention or loss of intersitial fluid
- Influences blood volume and pressure
- retention or loss of intersitial fluid
- acid base balance
- maintains transmembrane electrical potential for neuromuscular functioning
- for anything involved in contractibility, sodium and potassium must be in balance
What is the word for high Na+ levels?
what is the possible critical value?
hypernatremia
more than 160 mEq/L
what is the term for low sodum levels?
what is the possible critical value?
Hyponatremia
less than 120 mEq/L
What are at least 7 causes of hypernatremia?
KNOW THIS (I think)
Any time the body cannot/does-not compensate for an abnormal concentration of Na+ within the body
- Increased dietary or intravenous intake of soduim (excessive intake)
- conditions that cause decreased sodium loss
- An excess of adrenocortical hormones
- Cushing’s disease
- Conn’s syndrome (primary hyperaldosteronism)
- Excessive water loss
- excessive sweating
- diabetes insipidus
- extensive thermal burns
- antiduretic hormone insufficiency
- Osmotic diuresis (increased urination rate caused by kidneys)
*Bold were 7 listed in a chart
What are at least 14 causes of hyponatremia?
(May Need to know this!)
Any time the body cannot/does-not maintain a normal concentration of Na+ within the body
- Deficient sodium intake
- increase in loss of sodium (possibly with other ions)
- vomiting
- suctioning
- trauma
- severe diarrhea
- diuretic therapy (CHF pts susceptible, for example)
- Addison’s disease (abnormally high Aldosterone levels)
- increased retention of water
- excessive oral or intravenous water intake (overhydration)
- Chronic renal failure (CRF)
- syndrome of inappropriate antidiuretic hormone (SIADH)
- CHF that causes excessive fluid retension and dilutes Na+
- third spacing of fluids accompanied by sodium
- peripheral edema
- Effusion
- Ascites (abdominal effusion)
- Pleural effusion
- Diuretic administration
- Addison’s Disease
- Osmotic dilution
- Intraluminal bowel loss
*Bold were 14 in a chart
What are some symptoms of hypernatremia?
KNOW THIS
I don’t know
It wasn’t in the book
how often did Dr. T say will we see Na+ out of balance?
“just all the time”
because just about any medication that is used for blood pressure regulation or issues for diabetes . . . all of these will mess with the electrolytes
Normal body pH
7.35 - 7.45
when is your body more acidic than normal (pH is high or low)?
when pH is low
when is your body more basic than normal (pH is high or low)?
when pH is high
If Na+ is out of balance, what is there a good chance of also being out of balance?
K+
What are some symptoms a patient may have if Na+ is out of balance? (at least 7)
The brain is very susceptible to fluid changes. Mental status changes may manifest when sodium values are abnormal.
The PT should monitor for symptoms of low sodium levels:
- weakness
- confusion
- stupor
- hyptension
- seizures
- edema
- weight gain
K+ is the major ________________ cation.
K+ is the major intracellular cation.
What are some important functions of K+? (4)
K+ is responsible for
- maintiaing hydration/osmotic pressure
- maintaining sodium-potassium pump
- normal skeletal muscle contraction and relaxation (the one Dr. T emphasized!)
-
normal smoothe muscle activity of the
- intestines
- heart
- respiratory tract
Book text: “K+ is responsible for maintiaing hydration and osmotic pressure. It is critical for maintenance of the sodium-potassium pump needed for normal skeletal muscle contraction and relaxation and normal muscle activity of the heart, intestines, and respiratory tract.”
What is abnormally elevated levels of potassium called?
critical values?
Hyperkalemia
above 6.5 mEq/L (adults)
What is abnormally depressed levels of potassium called?
critical values?
hypokalemia
below 2.5 mEq/L (adults)
What are 10 causes of hyperkalemia?
- Excessive intake
- Acute/CRF (chronic renal failure) - so renal failure (acute or chronic)
- Hypoaldosteronism
- long term heparin can cause it
- or adrenal gland inssuficiency
- Aldosterone-inhibiting diuretics
- Crush injury to tissues
- Hemolysis
- Transfusion of hemolyzed blood (RBC’s are ruptured)
- Infection
- Acidosis
- Dehydration
What are 15 causes of hypokalemia?
- Deficient intake
- Burns
- GI Disorders
- Diuretics
- Hyperaldosteronism
- Cushing’s syndrome
- Renal tubular acidosis
- Licorice ingestion (what??)
- Insulin administration
- Glucose administration
- Ascites
- Renal artery stenosis
- Cystic fibrosis
- Trauma
- Surgery
What are 3-4 symptoms of hypokalemia?
KNOW THIS!
- cardiac dysrhythmias
- dizziness
- hypotension
- (myocardiogram is most susceptible to potassium abnormalities)
What are 4-5 symptoms of hyerkalemia?
KNOW THIS!
- EKG changes
- irritability
- nausea
- diarrhea
- (myocardiogram is most susceptible to potassium abnormalities)
What measurement is most susceptible to potassium abnormalities?
myocardiogram is most susceptible to potassium abnormalities
Exercise limitations for someone with hyperkalemia?
Recent and current cardiac status (and “pt’s norm”) should awlays be considered when mamking decisions regarding a pateint’s appropriateness for rehabilitation exercise. Cardiact status should also be monitored closely before, during, and after exercise.
- Caution should be taken with potassium levels more than 5.1 mmol/L.
- Discussion with other members of the health care team may be indicated for the individual patient.
- Individuals with CRF may have chronically elevated leves of potassium and tolerate levels of 5.5 mmol/L.
***Dr. T said that someone over 5.5 is probably not appropriate for PT because of the high risk for arrhythmias. If you remember any potassium numbers, I would remember this one!!
Exercise limitations for someone with hypokalemia?
Recent and current cardiac status (and “pt’s norm”) should awlays be considered when mamking decisions regarding a pateint’s appropriateness for rehabilitation exercise. Cardiact status should also be monitored closely before, during, and after exercise.
- Caution should be taken with potassium levels less than 3.2 mmol/L.
- Discussion with other members of the health care team may be indicated for the individual patient
Does Dr. T expect us to remember potassium levels?
No, even though I put them in the cards.
She said if potassium is somewhere above 5.5, they are not appropriate for treatment. I think she wants us to remember this one number!
What are 3 important functions of Ca++?
- Bone and teeth strength
- Regulation of neuromuscular activity
- involved in the transmission of neural impulses and muscle contractility
- Blood clotting (serves as cofactor in enzyme reactions)
What term is used for elevated levels of circulating calcium?
hypercalcemia
What are 9-11 things that can cause hypercalcemia?
- Hyperparathyroidism
- Hyperthyroidism
- adrenal insufficiency
-
Tumors (especially tumors of the bone)
- Nonparathyroid PTH- producting tumor
- Metastatic tumor to bone
- Paget’s disease of bone
- osteoporosis
- immobility
- multiple myeloma
- excess intake of calcium or vitamin D
Dr. T suggested that we think that there is something wrong with the bone or the kidney because calcium shouldn’t be leaking out of the body. She emphasized bold.
What are 9 things that can cause hypocalcemia?
- inadequate dietary intake of calcium
- vitamin D deficiency
- impaired absorption from GI tract
- severe infection or burns
- renal failure (can cause hyperphosphatemia)
- pancrieatic insufficiency
- hypoparathyroidism
- administration of enemas containing phosphate
- rickets
term for abmormally low levels of ciruclationg calcium
hypocalcemia
What are some symptoms of hypocalcemia?
KNOW THIS!
- tetany (prolonged contraction), abnormal muscle contraction
- clotting problems
- abnormal hematocrit maybe
Why didn’t we look at Cl-?
Not sure, but the book says there oare no specific activity guidelines related to abnormal chloride.
What point did Dr. T make at the end of class about PT in the Acute setting?
It is very important to base our decisions about whether or not to get a pt up and how much exercise to give them on EBP. We have these values that can guide us, so don’t “bury your errors” because the pt won’t even be there that long. Be able to explain why you choose to do the exercises you do based on things like lab values, etc.
If you want to keep your platelet, Hct, and Hgb levels normal than do not __________
…go to this castle in Transylvania, Delia’s homeland
