Normal Lab Values & Contraindications

Question 1

Creatine Kinase

Answer 1

Cardiac serum marker
51 - 294u/L
non specific

Question 2

Creatine Kinase- MB

Answer 2

Cardiac serum marker
(myocardial band)
<5.5 ng/mL
relatively specific, but small amounts are normally in blood

Question 3

Cardiac-specific Troponin T and I

Answer 3

Cardiac serum marker
best measure of MI
greater than/equal to 0.45 gn/mL

Question 4

Myoglobin

Answer 4

Cardiac serum marker

nonspecific, but great for ruling out.

Question 5

BNP

Answer 5

Heart Failure Marker (secreted by ventricles with pressure changes that occur when failure develops or worsens)
B-Type Natriuretic Peptide
HF very unlikely
100-400 pg/mL –> intermediate likelihood
>400 pg/mL –> heart failure very likely

*can help with COPD pts. SOB from lungs or heart??

Question 6

Do you treat a pt with cardiac serum levels that rule in MI?

Answer 6

don’t exercise them until the levels start coming down. don’t have to be normal values, but they need to be trending down.

Question 7

What’s in a complete blood count?

Answer 7

Hgb, Hct, WBCs, Plts

Question 8

Hgb

Answer 8

Part of CBC
Men = 13-18 g/dL
women = 12 - 16 g/dL

Question 9

Hct

Answer 9

Part of CBC

<30% is a contraindication to exercise in patient with CAD due to risk of coronary ischemia.

Question 10

WBCs

Answer 10

Part of CBC
high value, fever exercise okay
high value, fever >/= 101–>exercise contraindicated in pt with CAD due to risk of coronary ischemia.
low –> reverse isolation

Question 11

Plts

Answer 11

Part of CBC
165-415 x10^3 cells/uL 
decreased value --> risk of bleed
increased value --> clotting risk 
 Chest PT contraindicated
<5K)

Question 12

PT

Answer 12

Blood Coagulation Test
Prothrombin Time
11- 13 seconds = normal
1.5 - 2.5 = therapeutic values
low values –> therapy NOT contraindicated
High value –> pt at increased risk of spontaneous bleeding. consult physician

Question 13

INR

Answer 13

Blood Coagulation Test
International Normalized Ratio
2-3.0= DVT prohylaxis
2.5-3.5= mechanical heart valve
high values = increased risk for spontaneous bleed --> consult physician about therapy.

Question 14

Chem 7

Answer 14

sodium, potassium, chloride, carbon dioxide, blood urea nitrogen, creatinine, blood glucose

Question 15

Sodium

Answer 15

136-146 mmol/L
low–> intracellular fluid shift (brain cell swelling)
high –> extracelluar fluid shift (intracranial hemorrhage)

Both –> decreased mental status

Question 16

Potassium

Answer 16

3.6-5.0mmol/L
5.1 is contraindication for exercise.
risk of cardiac dysrhythmias

Question 17

Carbon Dioxide

Answer 17

aka bicarbonate (venous)
22-30 mmol/L
low values (uncompensated) --> may cause a decrease in mental status limiting the pt's ability to participate in therapy.

Question 18

BUN

Answer 18

Renal Function Test
blood urea nitrogen
7-20mg/dL
high levels DO NOT contraindicate exercise, but may need to back off of intensity bc pts with renal failure may also be anemic

Question 19

Creatinine (Cr)

Answer 19

Renal Function Test
0.6-1.2mg/dL
high levels DO NOT contraindicate exercse, but may but may need to back off of intensity bc pts with renal failure may also be anemic

Question 20

Blood Glucose

Answer 20

fasting BG
75-100 mg/dL
300 = CONTRAINDICATION to exercise for all type I & type II diabetics who are symptomatic or with known ketones in urine.

Question 21

HgbA1c

Answer 21

Glycoslyated hemoglobin (control over 6 to 12 weeks)
/= 6.5%= consistent with Dx of DM

goal for diabetic is <7

Question 22

Magnesium

Answer 22

1.5-2.3mg/dL

hypo & hyper can be life threatening. back off of exercise especially if they have a history of arrythmia.