final

Question 1

Sodium concentration

Answer 1

natremia

Question 2

hyponatremia

Answer 2

lethargy, seizures, coma

Question 3

hypernatremia

Answer 3

irritability, confusion. Hypernatremia is often seen with neurosurgical procedures or after head injury (TBI). It is unlikely that you will see these patients for more than PROM or chest physical therapy if hypernatremia is a problem.

Question 4

Potassium concentration

Answer 4

kalemia

Question 5

hypokalemia

Answer 5

Skeletal muscle weakness (and if severe, myoglobinuria), and ECG abnormalities are common but severe arrhythmias are rare.

Question 6

hyperkalemia

Answer 6

Ventricular arrhythmias (tachycardia, fibrillation, standstill) and death usually precede neuromuscular signs and symptoms.

Question 7

hypocalcemia

Answer 7

hypocalcemia - results in increased alpha motor neuron permeability to sodium leading to a decreased threshold for firing (i.e., increased excitability leads to muscle spasm (hypocalcemic tetany)). If calcium levels continue to fall, there is decreased neurotransmitter release at the neuromuscular junction leading to diminished muscle fiber activation resulting in muscle weakness.

Question 8

hypercalcemia

Answer 8

Results in decreased alpha motor neuron permeability to sodium leading to a higher threshold for firing (i.e., muscle weakness, CNS and PNS depression).

Question 9

hyperglycemia

Answer 9

Usually due to poor control of diabetes mellitus but can result from hypercortisolism due to stress (traumatic diabetes). Increased stress from exercise or painful diagnostic/treatment procedures can also lead to hyperglycemia. Extreme hyperglycemia (>500mg/dl) can result in hyperosmolar coma usually preceded by lethargy, muscle weakness, and changes in mentation.

Question 10

hypoglycemia

Answer 10

Often called insulin shock, the patient suffers from lethargy and possibly coma. Due to the reliance of the CNS on glucose as an energy providing substrate, a decreased supply will result in reduced nervous system activity.

Question 11

hyper- or hypoglycemia

Answer 11

can occur very readily in diabetic patients. The timing of treatment in relation to the last meal is an important consideration; the optimal time is 30-60 minutes after a meal.

Question 12

Blood Urea Nitrogen (BUN)

Answer 12

An elevation could indicate a negative nitrogen balance due to overt or hidden stress. Increased protein breakdown could have a deleterious effect on skeletal muscle function.

Question 13

Cholesterol (lipid profile)

Answer 13

Elevations in total cholesterol, low density lipoprotein (LDL) and very low density lipoprotein (VLDL), and the total cholesterol / high density lipoprotein (HDL) ratio indicate an increased risk for cardiovascular disease. Coronary, kidney, brain, and peripheral arteries could be stenosed and possibly result in ischemia distal to the stenosis. Possible tissue infarction could result with increased tissue metabolic demands.

Question 14

White blood cell (WBC) count

Answer 14

An elevation would indicate either an acute or chronic infection (see differential).

Question 15

Red blood cell (RBC) count

Answer 15

Depressed levels mean that the heart is working harder to deliver oxygen to the periphery. If you add the demands of exercise, you are increasing the workload on the heart to possibly dangerous levels. This could result in an imbalance of the oxygen supply/demand in the heart. Increased reticulocytes (immature RBCs) are also indicative of anemia.

Question 16

Hemoglobin and hematocrit

Answer 16

Are they decreased? If so, the patient will have decreased endurance, suffer weakness and lethargy. Is hematocrit above normal (polycythemia)? If so, the viscosity of the blood becomes elevated making it difficult to perfuse many tissues. The result is ischemia and possible micro infarctions (brain and kidneys). Another difficulty with polycythemia is the resultant increased workload on the heart.

Question 17

Platelets

Answer 17

Are they decreased? If so, there could be a tendency for bleeding with increased activity (joint mobilization, friction massage, exercise, force testing, chest percussion, electrical stimulation). Inspection of the skin (integument) might indicate underlying bleeding abnormalities (petechia, purpura, ecchymoses).

Question 18

Differential

Answer 18

If neutrophils (granulocytes, polys - segs and bands) are elevated and monocytes and lymphocytes are not, then it is likely to be an acute infection. If lymphos and monos are elevated then it is likely to be a chronic infection. Another measure of inflammation is the sed rate (erythrocyte sedimentation rate-ESR) and the C-reactive protein (CRP). An increased level of either indicates an inflammatory process.

Question 19

COAGULATION STUDIES

Answer 19

If values are elevated (clotting time, prothrombin time, partial prothrombin times) then the likelihood of bleeding abnormalities exists. Proceed with caution if a patient is on anticoagulant therapy (Coumadin, heparin).

Question 20

Oxygen partial pressure (PO2)

Answer 20

decreased means fatigue, weakness, increased demands on the myocardium.

Question 21

Carbon dioxide partial pressure (PCO2) -

Answer 21

increased means irritability, uncooperativeness, confusion.