Exam and Eval 1 Flashcards by Alex Stein

Review their medical history - includes what

Hx of present illness
PMH
Lab values and tests
Medications
Contraindications for exercise

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Hx of present illness includes

Diagnosis
Date of admit
Date of event or course of events
Current medical status
Hx of present illness
Surgical procedures
Medications

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PMH - prior cardiovascular or pulmonary disease - primary risk factors for pulmonary disease

Smoking, environmental exposure, family history of asthma, alpha 1 antitrypsin deficiency

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PMH - prior cardiovascular or pulmonary disease - primary risk factors for cardiovascular disease

Obestiy, HPTN, Smoking, Sedentary lifestyle, family hx, cholesterol over 200 alone and especially if combined with family hx

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Social history - what are we looking for to progress our treatment

their goals, their previous function, where they are going after, will they have help, are they a caregiver for anyone

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Purpose of lab tests

Complete risk factor profile
Presence of illness 
Diagnosis of event
Determine cardiac anatomy
Assess LV function
Evaluate success of intervention
Preoperative risk profile

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Red blood cells
Male
Female

Male 25-35 ml/kg

Female 20-30 ml/kg

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COPD, altitude, anemia - high or low RBCs

COPD, altitude = higher

Anemia = lower

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Hemoglobin
Males
Females

Males = 14-17 gm/dl
Female = 12-16 gm/dl

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COPD high or low hemoglobin

higher

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Hemoglobin - when do we not treat (for heart patients)

If not surgical patient, don’t treat under 8

If surgical, don’t treat under 7

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Hematrocrit
M
F

male = 41-51%
female = 36-44%

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Hematocrit - COPD

higher

Also with other lung disease

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WBC count norm

3,900 - 10, 700 cells/mm

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What would make WBC count higher

infection

internal injury

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Platelets - norm

150,000 to 400,000 (avg 300,000)

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Platelets - chemo

lower

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Arterial blood gas analysis - pH

7.35 - 7.45

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Arterial blood gas analysis - PaO2

80-100 mmHg

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Arterial blood gas analysis - PaCO2

35-45 mmHg

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Arterial blood gas analysis - HCO3

22-26 MEq/l

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Arterial blood gas analysis - SpO2

over 90%

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Respiratory acidosis -
pH
PaCO2
HCO3
Disease

Low pH
inc PaCO2
normal HCO3
Hypoventilating?, lung disease like COPD

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Respiratory alkalosis - 
pH
PaCO2
HCO3
Disease

high pH
low PaCO2
little high HCO3
Fever

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``` Metabolic acidosis - pH PaCO2 HCO3 Disease ```

low pH normal PaCO2 dec HCO3 dec CO and renal failure

``` Metabolic alkalosis pH PaCO2 HCO3 Disease ```

high pH norm/high PaCO2 greater than 27 HCO3 Respirator insufficiency

How will pt present if CO2 is high

confused | resp acidosis

Cultures

Strep Staph TB

acute stage of metabolic acidosis - we will not work with - T or F

TRUE

Cultures - strep can lead to pt becoming

resistant to medications that they are taking for these | Need to put on isolation equipment

Cultures - TB - you need to get what before entering the room

fit mask! | they need 9 FULL months of medication

Cultures - TB - usually located where

lower lobes - unless has reoccurred then will be in different place (upper lobe)

Coagulation studies - PT

11-12.5 sec | over 36 is critical

Coagulation studies - what is PT looking at

how long it takes the blood to clot

Coagulation studies - PTT

30-40 sec | critical is over 100

Coagulation studies - fibrinogen

150-400 mg/dl | Less than 100 is critical

Coagulation studies - fibrinogen - is what

the ability to clot

Coagulation studies - INR (international normalization ratio)

0. 9 - 1.1 | 2. 5 to 3.5 for prosthetic heart valves (they are already on anticoagulants)

Coagulation studies - INR - when are we not working with them

5 - you are absolutely not working with them We can work with people up into 3 range even if they dont have the prosthetic valve, 4 you need to be cautious and consider the whole picture

Electrolyte studies - Na

136-145 mEq/l

If high Na - how will they present

swelling, HR inc, might be confused

Electrolyte studies - K

3.5 - 5 Meq/l

If high K how will they present

inc in dysrhythmias, they wont tolerate long bouts of treatment (could be high or low K)

Electrolyte studies - BUN

10-20 mg/dl

BUN tells you

how well their kidneys are working or ig they are in kidney failure

Electrolyte studies - creatinine

0.6 - 1.2 mg/dl

Creatinine - what is it telling you

breakdown of proteins

Electrolyte studies - glucose

70-110 mg/dl

Glucose - what if it is too low - how will patient present

Confused, fatigued

Glucose - what if it is too high - how will patient present

fatigued and confused - maybe HA

Electrolyte studies - Albumin

more than 2.5 g

Albumin is telling you

it is a protein and is giving you info about the hydration status of the patient Dehydrated = low albumin

Electrolyte studies - prealbumin

18-32 mg/l

Prealbumin - what is it

not impacted by hydration | is another protein factor

electrolyte studies - HgA1C

4.8 - 6.0%

HgA1C - tells you what

blood glucose over 90 days Indicates how their blood sugar is doing Higher - indicates diabetes

Cardiac enzymes - Troponin 1

0.0 to 0.1 ng/ml

Cardiac enzymes - troponin 2

less than 0.18 ng/ml

Cardiac enzymes - Troponin 1 and 2 - what is important to note

They start to rise within 3-4 hrs of having MI but dont peak until 12-24 hours - Could take up to 2 wks for troponins to come back to normal levels

Cardiac enzymes - Total CPK

30-170 uL/L

Cardiac enzymes CPK - MB

less than 3%

CPK - MB - what to take note of

what they look at for MI | 4 hrs to onset, peaks at 12 hrs, comes back down to normal in shorter time

Cardiac enzymes - LDH

70-180 U/L | takes 12-48 hours to peak

Cardiac enzymes - myoglobin - males and females

males - 10-95 ng/ml | females - 10-65 ng/ml

Blood lipids - total cholesterol | Adults and children

less than 200 mg/dl adults | less than 125-200 children

Blood lipids - HDL males and females

m - more than 33 | f - more than 43

Blood lipids - LDL

less than 100 mg/dl

Blood lipids - Triglycerides

less than 140 mg/dl

Blood lipids - total/HDL ratio

less than 4:1 ratio | for CP patients - for non they will look at total to LDL ratio

Cardiac cath, coronary angiogram - are looking at what

arteries cath - taking picture angio - inserting dye

Ventriculography is looking at what

ventricles

Cardiac cath, coronary angiogram, ventriculography provides valuable incuding what

establish or confirm a dx severity of dx guidelines for optimal management of the patient including medical and surgical management

what is protocol after cath, angiography, ventrculography

best rest for 4-6 hrs after

Data obtained from cath, angiogram, ventric

``` CO shunt detection L and R heart pressure Ventricular EF Presence/severity of CAD Presence of L vent dysfun and aneurysm Presence of pericardial disease Presence of valvular disease ```

Indication for cath

cardiac arrest or primary v fib pulm edema intolerance or noncompliance to cardiac drugs job mandate sig dec in exercise duration with stress test vent tachycardia with exercise ST depression prolonged chest pain that is not responsive to nitro