Medical Record Flashcards
What can a basic metabolic panel detect?
- Kidney failure
- Diabetes related problems
- Respiratory distress
- Electrolyte imbalances
What are the main symptoms of electrolyte imbalances?
- Alter excitability of neurons, cardiac muscle, skeletal m
1. Weakness
2. Spasticity
3. Altered sensations
4. Cardiac arrhythmias
What causes hyponatremia?
- Excessive ingestion or infusion of water
- Excessive ADH
- Diseases that cause water retention: CHF, Cirrhosis, nephrotic syndrome, SIADH
What are causes of hypernatremia?
- Excessive water loss from body – sweating, diabetes insipidous, vomiting, diarrhea
- decreased ADH
Why would you look at potassium levels?
- Renal function
- Adrenal function
- Water balance
- Acid-base imbalances
What causes mental status changes, dizziness, weakness, myalgia, muscle twitches, nausea, vomiting, clammy skin, potential respiratory failure?
Hypokalemia
- loop diuretics can lead to this
- Any abnormalities in potassium levels should lead to consultation before treatment
What causes Numbness, tingling, flaccid paralysis, nausea, vomiting, diarrhea, anorexia?
Hyperkalemia
- Any abnormalities in potassium levels should lead to consultation before treatment
Bicarbonate and chloride move in [same/ opposite] directions into RBC. [Hyper-/ Hypo-] chloremia associated with hyperventilation.
opposite; Hyper
- chloride is involved with acid/base balance
- levels change with sodium and water
Evaluate kidney function in patients with renal failure; Differential diagnosis if kidney disease is suspected; Monitor kidney function secondary to certain drug
BUN (together with nitrogen)
What happens to BUN levels when there is decreased renal function, particularly renal blood flow?
BUN increases
- Other factors that can increase BUN: Increased protein catabolism, Increased protein dietary intake, GI bleeding
What can decrease BUN?
severe liver disease
Breakdown product of heme – yellow color in jaundice
Bilirubin
What can increase bilirubin levels?
- liver disease
- Bile duct occlusion
- Hemolytic anemia – excessive destruction of RBCs
Located in liver, heart, kidney and skeletal muscles; Increased in Liver disease and Myopathy
AST
Sensitive indicator of damage to liver cells; Primary means of detecting hepatitis
ALT
Mostly in heart and skeletal muscles - Used in differential diagnosis of chest pain; Elevated in injury to cancer cells
LDH
What is GGT elevated by?
Elevated by injury to liver cells
Related to bile ducts (Increased when they are blocked) Levels increased by: - Gall bladder disease - Liver disease - Bile duct disease - Chronic renal failure – secondary to increased bone turnover - Paget’s disease of bone - Hyperparathyroidism - Rheumatoid arthritis - Hepatocystic carcinoma
ALP
Alkaline phosphatase
What can decrease RBC count?
- Anemia
- Blood loss** most common
- Dietary deficiency of iron and specific vitamins
- Chemotherapy
- Other disorders
What can increase RBC count?
- Polycythemia
- Dehydration
- Pulmonary fibrosis
- High altitude
- Chronic heart disease
What lab results can you find for RBCs? other than count
- hematocrit- volume of whole blood is RBCs
- Hb levels- per volume of blood or per erythrocyte
- RBC shape - sickle cell, spherocytosis
- Reticulocytes - immature RBC
What WBCs are looked at during lab tests?
- Neutrophils – major WBC - phagocytotic (Neutropenia= Risk factor for infection, Neutrophilia = Usually indicates infection)
- Basophils – immune responses, particularly allergies
- Eosinophils – worm infections, allergies, and certain diseases
- Macrophages - phagocytotic
- Lymphocytes - B cells (antibodies), T cells, NK cells, decr. in AIDs
What are the measurements for hemostasis?
- PT - prothrombin time
- aPPT - activated partial thromboplastin time (used for low-molecular weight heparin)
- INR - PT results that do not vary between labs
What does a higher INR indicate?
increase risk of bleeding during surgery or after trauma
- Higher number INR = clotting time increases
- People on anticoagulants should have INR between 2 and 3
What can increase creatine kinase brain (CK-BB)?
- CNS surgery
- cardiac arrest
- Reye syndrome
- Cerebral contusion
- CVA
- renal failure
What can increase creatine kinase myocardium (CK-MB)?
- MI
- cardiac contusion
- CHF without MI
- cardiac surgery
- myocarditis
What can increase creatine kinase skeletal muscle (CK-MM)?
- IM injections
- Skeletal muscle trauma
- extreme muscle exertion
- tonic clonic seizures
- excessive alcohol use
- alcohol withdrawal
- muscular dystrophy
- severe hypokalemia
Produced by liver in response to inflammation; Associated with atherosclerosis; Increased risk of MI and Stroke
- can be an indicator of stroke regardless of lipid levels
- associated with diabetes, poor diet and sedentary lifestyle
C-reactive protein (CRP)
Most common hormone disorder in adults; symptoms include:
- Cold sensitivity
- Brittle coarse skin and nails
- Constipation
- Slower cognitive processing
- Linked to muscle injury, depression and anxiety
Hypothyroidism
What is in a medical record?
- Medical History
- Laboratory Test Results
- Diagnostic test results
- Problem list
- Clinical notes
- Treatment notes
Performed during part of a routine physical examination or when a physician suspects an abnormality that may be detected by one or more parts of the BMP; Sample is procured through venipuncture, preferably after 10-12 hours of fasting
Basic Metabolic Panel
- 8 tests measuring electrolyte levels, blood sugar, and kidney function
- venous blood (not arterial)
Why are potassium levels important?
Important for regulation of excitable cells (nerves, muscles, heart)
- Levels are usually tightly controlled – small range of normal values
What effects can an imbalance of potassium levels result in?
Heart: arrhythmias, cardiac arrest
Muscle: Weakness
What is the purpose for testing calcium levels?
- Rule in/rule out renal or bone disease
2. Rule out changes in calcium levels as a potential cause for neuromuscular problems
What other tests may accompany a calcium level test?
- Vitamin D
- Phosphorus
- Parathyroid hormone
What effect does decreased renal function have on creatinine levels in the blood?
Increases creatinine levels
- creatine is a normal waste product of sk. m.
- clearance occurs in the kidneys
What kidney diseases can result in increased creatinine levels?
- Glomerulonephritis
- Pyelonephritis
- Acute tubular necrosis
- Obstruction by prostatitis or kidney stones
- Decreased renal blood flow
- Can also be elevated by skeletal muscle injury
What effect on creatinine results from aging?
Decreases creatinine
- with age, the amount of sk. m. decreases
- in older adults with decreases in renal fxn, creatinine levels may stay in the ‘normal’ range
By-product of aerobic metabolism; Involved in acid/base balance
Carbon dioxide
- Renal disease can impair the ability to regulate pH, most often leading to acidosis
In addition to the tests included in a BMP, what tests are also done with a comprehensive metabolic panel?
Tests for liver function:
- Bilirubin
- Total protein
- Albumin
- Serum enzymes – all can be elevated by injury to liver cells:
- Aspartate aminotransferase (AST, formerly SGOT)
- Alanine aminotransferase (ALT, formerly SGPT)
- Lactate dehydrogenase (LDH)
- γ-glutamyltransferase (GGT)
- Alkaline phosphatase (ALP)
What does liver failure increase the risk of?
multiorgan dysfunction syndrome
- bacteria and toxins can reach the heart and lungs if liver doesn’t filter them out
Index of the ability of the liver to synthesize proteins; Also may be decreased in kidney disease – loss of protein in urine; Decreased in malnutrition
Protein and albumin levels
testing for liver function
What are the effects of decreased albumin serum concentration of drugs?
- Edema – due to decreased oncotic pressure
- Can alter serum concentration of drugs which bind to albumin - If take a certain amt of a drug that binds to albumin, half of it may circulate in blood (and have and effect), while the other half may bind to albumin (therefore becoming inactive)
What are the CV lab tests?
- Enzymes: Creatine kinase, Myoglobin, Troponin
- Lipids
- C-reactive protein
What causes troponin I and T levels to rise?
MI
What causes myoglobin levels to rise?
Cardiac or sk. m. injury
What is included in a lab test for lipids? why would this test be ordered?
- Total cholesterol
- LDL – risk factor
- HDL – negative risk factor
- Triglycerides
- Assess risk of atherosclerotic disease
