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Physical Assessment > Laboratory Module > Flashcards

Laboratory Module Flashcards

1
Q

Hypernatremia

A

Cause: Impaired thirst mechanism
Uncontrollable water loss

Symptoms: Hyperreflexia, muscle twitching,
thirst, irritability, coma, death

Useful in determining the fluid balance and maintaining the appropriate transmembrane electrical potential in neuromuscular function

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2
Q

Hyponatremia

A

Severe dehydration
Water intake > output
DRUGS

Depressed reflexes, disorientation, muscle cramps, nausea

Also related to Neuromuscular function

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3
Q

K (potassium ions)

A

Responsible for the control of intracellular volume ; also related to protein synthesis, enzymatic reactions and carbohydrates metabolism

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4
Q

Hyperkalemia

A 
Increased intake (Drugs, hemolysis, muscle damage, burns)
 Decreased output (Renal Failure, drugs)
 Extracellular shift (metabolic acidosis)

Arrythmias, hypotension, weakness, bradycardia, cardiac arrest

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5
Q

Hypokalemia

A
  • *Decreased intake** (alcoholism, diets low in K, eating disorders)
  • *Increased output** (drugs, laxatives, vomiting and diarrhea, Cushing syndrome)
  • *Intracellular shift**: insulin administration ; alkalosis

Arrythmias, hypotension, weakness, muscle cramps

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6
Q

Hyperchloremia

A

Dehydration, acidemia

Limited to underlying disorder

Related to acid-base balance

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7
Q

Hypochloremia

A

Vomiting, alkalemia

Limited to underlying disorder

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8
Q

Hypermagnesemia

A

Over-repletion
Renal dysfunction

Bradycardia, sweating, hypocalcemia, drowsiness

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9
Q

Hypomagnesemia

A

Renal wasting
Alcohol abuse
Malnutrition
Diarrhea

Weakness, tremors, tetany,
Increased reflexes

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10
Q

Hypercalcemia

A

Malignancy
Hyperparathyroidism

Gastrointestinal complaints, neuromuscular symptoms

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11
Q

Hypocalcemia

A

DRUGS
Vitamin D deficiency
Hypoparathyroidism

Fatigue, memory loss, hallucinations, seizures, tetany

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12
Q

Hyperphosphatemia

A

Decreased excretion
Increased intake
Extracellular shift

Signs and symptoms of hypocalcemia and hyperparathyroidism

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13
Q

Hypophosphatemia

A

Increased excretion
Intracellular shift
Alcoholism
Malnutrition

Irritability
 CNS effects (drowsiness, difficulty thinking or cognition)
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14
Q

Hyperglycemia

A

Diabetes
Diet
DRUGS

Thirst (Polydipsia)
Urination (Polyuria)

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15
Q

Hypoglycemia

A

DRUGS

Sweating, trembling, palpitations, headache, confusion

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16
Q

SCr

A

is an endogenous marker of renal function

i. Inverse relationship with renal function
ii. Affected by: muscle mass, sex, age, race, drugs, assays, low-protein diets
iii. Reference range vs baseline

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17
Q

BUN

A

is used to assess or monitor hydration, renal function, and protein tolerance

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18
Q

BUN

High

Causes and Symptoms

A

High protein diet

Upper GI bleeds

DRUGS

Greater than 100mg/dL: high risk of uremic syndrome

Limited to underlying disorders

19
Q

BUN

LOW

Causes and Symptoms

A

Malnourishment

Liver damage

Fluid overload

Limited to underlying disorders

20
Q

BUN:Scr ratio

A

BUN:Scr ratio > 20:1 and elevated

Pre-renal causes: dehydration, blood loss, shock, severe heart failure

10:1 to 20:1 Intrinsic causes

Acute: drugs, severe hypertension, tubular necrosis Chronic: diabetes, pyelonephritis, renal tubular disease

21
Q

RBC count

A

Normal range is decrease in adult females (blood loss during menstruation, but men have higher androgen levels that stimulate erythropoiesis)

Decreased in anemia (recommendations depend on types of anemia: iron deficiency, B12 deficiency, folic acid deficiency, hemolytic anemia, anemia of chronic disease, blood loss anemia)

Life span of 120 days

22
Q

RBC Indices

A

tests that further describe RBCs

MCV – mean corpuscular volume – average volume; how large the blood cells are (macrocytic or microcytic anemia)

MCH – mean corpuscular hemoglobin- (amount of hemoglobin in the RBC- average)

MCHC – mean corpuscular hemoglobin concentration (amount of hemoglobin in the RBC as function of hematocrit- %volume)

23
Q

RDW

and

Reticulocyte

A

RDW - RBC distribution width – indicates variation in size of RBC

Reticulocyte (immature RBC) count – indirect assessment of new RBC- precede mature RBC by 1-2days before they mature):

II. elevation occurs in acute blood loss b/c bone marrow trying to replenish RBC lost in the periphery)

24
Q

ESR

Causes and Symptoms

Low and High

A

RBC usually settles slowly in plasma but will settle faster when there are changes in the electrostatic forces

ESR – erythrocyte sedimentation rate- rate RBC settles

  • High

Causes: Pregnancy, Rheumatoid arthritis, Infection

Symptoms: Limited to associated disorder

  • Low

Causes: Heart failure, High dose steroids, Liver disease

Symptoms: Limited to associated disorder

25
Q

Hgb

A

–major content of RBC; carries O2 from lungs to the rest of body where it is then burned to create energy

II. - direct indication of oxygen-transport capacity of the blood

III. low in anemia (fatigue)

26
Q

Hct

A
  • percentage of blood composed of erythrocytes;
  • Usually 3x the value of Hgb
  • Decreased in anemia
27
Q

WBC

A
  • leukocytes (lymphocytes and granulocytes (which come from hematopoiesis)

High:
Causes: High Infection

Symptoms: Fever, chills

Low

Causes: Immune suppression

Symptoms: Limited to underlying disorder

28
Q

Differential (CBC with Dif)

A

Left Shift – absolute increase in number of bands
Indicates an acute infection

29
Q

Absolute Neutrophil Count (ANC)

A

ANC = [(WBC)(%PMN + %Bands)]/100%
ANC < 1500 indicates neutropenia (indicates risk of infection)

Caused by drugs (chemo) and by some diseases (HIV)

30
Q

Diagnosing or predicting risk of thrombosis

A

d-dimer

  • Primarily used to diagnose disseminated intravascular coagulation (DIC)
  • Needs further study for other disorders
31
Q

Monitoring anticoagulants

A

Normal INR in a non-anticoagulated patient: 1.0
Target INR/range for MOST indications: 2.5 (2-3)
Target INR for mitral valve replacement (MVR): 3 (2.5-3.5)

32
Q

aPTT

A

Target aPTT: 1.5 to 2.5 times the control

33
Q

Synthetic liver function
Albumin

A
34
Q

Pre-albumin

A
  • Shorter half-life (2 days)
  • Smaller volume of distribution
  • More sensitive to protein nutrition
  • Less sensitive of liver disease and hydration
  • Best test for assessing nutritional status (i.e. patients receiving TPN)
35
Q

PT/INR

A

Total bilirubin = insoluble + soluble
= unconjugated + conjugated
= indirect + direct

36
Q

Hepatocellular liver injury

A

False-positives: uremia, hemolysis, vigorous exercise

Medications: Rx, OTC, herbal STATINS

Unexplained: will usually return to normal

37
Q

Inflammation of liver

A
  • Specific histologic pattern in hepatocyte
  • Multiple cause:
    o Viral: Hep A, B, C, D, E, G
    o Medication: majority are minor, transient, asymptomatic
    o Fatty liver
38
Q

Putting it all together (NEED TO KNOW)

A

AST/ALT >1000 International units/mL: acute viral hepatitis, severe drug/toxin reactions,

AST/ALT = 2 & GGT elevated: alcoholic hepatitis

Isolated increase in AST: cardiac or muscle damage

Elevated AST/ALT & elevated creatine kinase: muscle damage

39
Q

Pancreatic function

A

>3-5 x ULN

40
Q

Urinalysis

Macroscopic

A
41
Q

Urinalysis

Microscopic

Cells

A

Casts – gives information about where the damage occurred

42
Q

Urinalysis

Microscopic

Crystals

A
  • Composed of uric acid, calcium phosphate, calcium oxalate, cystine
  • Drug-induced: indinavir, sulfamethaxazole, ciprofloxacin
43
Q
A

Physical Assessment (5 decks)

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