LAB VALUES Flashcards
(28 cards)
Creatinine Kinase (CK)
Normal Values 51-294 u/L
RISE 4-6 hours following MI
PEAK at 24 hours (earlier with thrombolytic therapy)
BASELINE 48-72 hours after MI
in all striated muscle catalyzing the phosphorylation of creatine to creatine phosphate-not specific
Creatinine Kinase-MB (CK-MB)
Normal Values <5.5 ng/ml [An isoenzyme of CK found predominantly in cardiac muscle]
RISE 3-4 hours following MI
PEAK 8 hours
BASELINE 24-36 hours after MI
Sensitive (small MI’s may be missed)
Relatively specific to cardiac muscle
Cardiac-specific Troponin T (cTnT)
Cardiac-specific Troponin I (cTnI)
Critical Values ≥ 0.45 ng/ml [Specific proteins responsible for regulating the calcium mediated contractile process of cardiac muscle]
RISE 3-4 hours following MI PEAK at 16 hours BASELINE cTnT 10-14 days after MI cTnI 7-10 days after MI
Highly sensitive;
Very specific
Myoglobin
RISE 1-3 hours following MI
PEAK at 6 hours
BASELINE 12-18 hours
High sensitivity (negative predictive value) Not specific (Protein common to all striated muscle, not cardiac specific)
B-Type Natriuretic Peptide (BNP)
Detect heart failure
BNP < 100 pg/mL -> Heart failure very unlikely
BNP 100-400 pg/mL -> Intermediate likelihood
BNP > 400 pg/mL -> Heart failure very likely
Hgb
Men 13 - 18 g/dL
Women 12 - 16 g/dL
*of <8 g/dL do not exercise risk of coronary ischemia
Hct
Men 38 - 52%
Women 35 - 47%
*A Hct of < 30% do not exercise risk of coronary ischemia
WBC
3.5 - 9.1 x 103 cells/µL
High : do not exercise if also have fever of ≥ 101º F. (increased risk of coronary ischemia)
Decreased =Viral infx, cancers, extreme age, AIDS
Increased =Bacterial infx, leukemia, allergic reactions, parasitic infections
Platelets
165 - 415 x 103 cells/µL
Low –> risk spontaneous bleeding and activity may be restricted
<30k NO Chest PT
< 5 - 10 x 103 cells/µL strict bedrest
Platelets >150,000 /µL
Unrestricted resistance
platelets 80,000-150,000 /µL
Moderate resistance
Platelets 50,000-80,000 /µL
Minimal resistance
Platelets <50,000 /µL
NO resistance
Platelets 10,000-20,000 /µL
Possible transfusion
Platelets <10,000 /µL
Bed rest, ADLs only, Transfusion is necessary
Prothrombin Time (PT)
normal seconds?
therapeutic values?
Normal Values: 11 - 13 seconds (clotting time)
Therapeutic Values: 1.5 - 2.5 x the reference range
- Low values do not contraindicate therapy
- High values put the patient at increased risk of spontaneous bleeding. The physician should be consulted regarding therapy
International Normalized Ratio (INR)
ratio of the Prothrombin Time to the reference range
Therapeutic values depend on treatment rationale with adjustments for individual medical history
DVT prophylaxis ~2-3.0
Mechanical heart valve ~2.5-3.5
Considerations for Exercise
***High values put the patient at increased risk of spontaneous bleeding. The physician should be consulted regarding therapy.
Activated Partial Thromboplastin Time (APTT, PTT)
what it is
normal values
therapeutic values
consideration for exercise
screen for bleeding disorders and measure effectiveness of heparin therapy
Normal Values: 24-35 seconds (clotting time)
Therapeutic Values: 1.5-2.5 x the reference range (normal value)
Considerations for exercise
APTT >100 seconds signifies spontaneous bleeding
Confer with MD prior to exercise
PTT >100 seconds
signifies spontaneous bleeding
Confer with MD prior to exercise
Na+
136-146 mmol/L
LOW–>intracellular fluid shift, specifically, brain cell swelling
HIGH–>extracellular fluid shift increasing the risk for intracranial hemorrhage
Both situations cause a decrease in mental status Therapy decisions are based on the patient’s ability to participate
Potassium (K+)
Normal Values 3.6-5.0 mmol/L
DO NOT EXERCISE:
K+ <3.2
or K+>5.1
Abnormal K+–>life threatening b/c risk cardiac dysrhythmias
Chloride (Cl-)
Normal Values 102-109 mmol/L
Decreased Values: Excessive Sweating, vomiting, diarrhea, heart failure
Increased Values: Dehydration, renal failure, diabetes
Considerations for Exercise=No significant effect
Carbon Dioxide (CO2)
Normal Values 22 - 30 mmol/L
Low values if uncompensated may cause a decrease in mental status limiting the patient’s ability to participate in therapy
Blood Urea Nitrogen (BUN)
Normal Values 7-20 mg/dL
High levels do not contraindicate exercise
Patients with renal failure may also be anemic which often decreases their exercise tolerance
