Patient Assessment Values Flashcards
Vital Signs 4 + 2
Temp
Blood Pressure
Heart Rate
Respiratory Rate
+
Oxygen Saturation
Pain
hypothermia temp
< 96.9F or 36C
Hyperthermia temp
> 100.4F or 38C
Temp conversion
(C* 1.8)+ 32
(F-32)/ 1.8
Systolic BP
Peak pressure in arteries
N: 120, R 100 - 140
Diastolic BP
Lowest Arterial Pressure
N: 80, R 70-90
Hypotensive BP
S <100 or D <70
or both
Normotensive BP
S 100-139 and D 70-89
Hypertensive BP
S > 140 or D > 90
or both
Reference Range HR
60 to 100 bpm
Bradycardia HR
< 60 bpm
Tachycardia HR
> 100 bpm
Reference Range Respiratory Rate (RR)
14 to 18 breath/min
Referemce Range O2 Sat
92 - 100% on Room air
Actual Body Weight
Wt Lbs / 2.2 = KG
Ideal Body Weight
Men: 50 + 2.3 (# of in over 5f)
Women: 45.5 + 2.3(# of in over 5f)
Metabolic Profile Chart Thingy
Na, Cl, Bun
—————– Glucose
K, HCO3, Cr
Sodium
R: 135 - 146 MEQ/L
Found predominantly in Extracellular fluid
Abnormalities usually result of change in water homeostasis
Fluid imbalances can be caused by volume overload (HF/LF) or volume depletion (V/ Blood loss)
Hypernatremia
> 146 MEQ/L
Sodium gain most common cause’Occurs secondary to intake of high-Na containing products (0.9 NaCL, antibiotics like oxacillin)
Typically asymptomatic, but muscle spasm may occur
Hyponatremia
< 135 MEQ/L
typically caused by loss of sodium, gain of water or both
Hyponatremia Symptoms
Fatigue
confusion
muscle weakness/spasm
and coma in serious case
Hyponatremia Sodium causes
Excess sweating, nausea/vomiting, medication (diuretics), or shifting from extra to intracellular spaces.
Hyponatremia Water Gain
Increased intake
SIAD which incur water retention
Potassium
R 3.4-5.2 MEQ/L
Hypokalemia
<3.4 MEQ/L
Typically caused by fluid loss
Bleeding, diarrhea, diuresis, vomiting
Poop can have 40-60 mEq/L of K
Hyperkalemia range
Typical cause and induced by
> 5.2 MEQ/L
Typically caused by renal dysfunction (Decrease clrance)
May be drug induced (ACEi,ARB,Ksparing Diuretics)
Hypo-, Hyperkalemia Symptoms and Signs
Muscle Weakness
Dysrhythmias can be induced
Chloride
R 98-110 MEQ/L
Hypochloremia
Cause and symptoms
< 98 MEQ/L
Cause: Diuretic use, vomiting
May cause muscle excitability and tremors
Hyperchloremia
Range, cause, symptoms
> 110 MEQ/L
Cause: Diuretic use, vomiting
May cause weakness and Lethargy
Bicarbonate
R 24-32 MEQ/L
Marker of Acid/base balance
Hypobicarbonatemia
<24 MEQ/L
may indicate acidotic process (Metabolic, diabetic ketoacidosis) or OD of ethylene, methanol, salicylates
hyperbicarbonatemia
> 32 MEQ/L
levels may indicate long term COPD or alkaloid process
Blood Urea Nitrogen (BUN)
R 7-23 MG/DL
waste product from production of ammonia by liver
healthy kidney can filter and remove this via urine
Low BUN levels may indicate
Liver Disease/Damage
Malnutrition
High BUN levels may indicate
Renal Disease/damage
dehydration
high protein intake
Serum Creatinine (SCR)
0.5 - 1.1 MG/DL
waste product produced mostly by muscle metabolism
Low Scr can indicate
Lack of nutrition
muscle disease
high Scr can indicate
Renal Disease/damage
excess muscle mass
Glucose (Glu)
R 70-100 Mg/DL
regulated by insulin and glucagon
Glucose level <60 mg/dl can…
induce somnolence and coma
Glucose level >125 mg/dl can…
indicate impairment and may lead to diagnosis of diabetes
Serum Calcium (CA)
R 8.4 - 10.4 Mg/DL
Regulated by Vitamin D and parathyroid hormone
99% stored Skeleton and teeth
40% bound to serum albumin
Hypocalcemia Causes
< 8.4 mg/DL
Poor calcium intake and/or Vitamin D deficiency
Hypoparathyroidism
Hypocalcemia Symptoms/side effects
Paraesthesia
Tetany
QTc Prolongation/ Arrhythmias
Hypercalcemia Causes
> 10.4 mg/DL
Malignancy due to bone metastases
Hyperparathyroidism
Renal insufficiency
Hypercalcemia Symptoms/ side effects
“Bones, stones, groans and psychic moans”
Lytic lesions Urinary calculi Malaise N/V Mental Status Changes (Confusion, depression)
Components of Serum Calcium
Albumin Bound Calcium (40%)
ionized (free) Calcium ( 45%)
Salt-bound calcium (15%)
Serum vs Ionized Calcium
Changes in serum calcium can be due to any one of the 3 features (Albumin, Ionized, salt bound)
Not as sensitive as changes in serum calcium can be seen with no alteration to ionized calcium
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Ionized calcium
only fluctuates with changes in parathyroid hormone and vitamin D levels
C Range: 4.4-6 mg/dL
A Range: 4.4 - 5.3 mg/dL
Corrected serum Ca calc
Observed serum Ca + 0.8(4-serum albumin)
Phoshate
R 2.4 - 4.4 MG/DL
Hypophosphatemia
< 2.4 mg/DL
Moderate: 1-2.5 mg/DL
Severe < 1mg/DL
Hypophosphatemia Causes
Inadequate dietary intake
Hyperparathyroidism (Inc excretion0
DKA = Diabetic ketoacidosis
Hypophosphatemia Symptoms/Side effects
Muscle Weakness/dysfunction
Mental Status changes
Hyperphosphatemia
> 4.4 mg/DL
Hyperphosphatemia Causes
Common renal failure
Calcium Phosphate Product
Ca X PO4
If product is >55 in CKD, precipitation occurs and lytic lessons form
Magnesium
R 1.6 - 2.6 mg/dl
Hypomagnesemia
< 1.6 mg/dL
Hypomagnesemia causes
V, diarrhea, diuretics
often coincides with hypokalemia, replace Mg along with K
Hypomagnesemia Symptoms/Side effects
N,V, and EKG changes
Hypermagnesemia
> 2.6 mg/DL
Hypermagnesemia Causes
Excessive magnesium intake or renal failure
Hypermagnesemia Symptoms/Side effects
Sedation, N/V, decreased reflexes and EKG changes
AST/ALT
R 0-35 IU/L
Increase may indicate injury (hepatitis or cirrhosis)
Meds that can cause increase AST/ALT are..
Statins
TZDs
EtOH
Alkaline Phosphatase
R 30-120 U/L
increases may indicate an obstruction (Liver/biliary) or bone disease/breakdown (Paget’s disease)
Lactate Dehydrogenase
R 50-150 U/L
increases may indicate some type of liver dysfunction
almost always increases post MI within 10/12hr
If total bilirubin increase > 2mg/dl then…
jaundice can develop
Bilirubin
total: 0.1-1 mg/dl
Direct: 0-0.2mg/dl
Hyperbilirubinemia
Prehepatic (hemolysis)
Hepatic (defective removal of bilirubin from blood or conjugation)
Posthepatic or cholestatic (obstruction)
Albumin
R 3.5-5 G/DL
marker of true hepatic function
3 Major functions of Albumin
controlling oncotic pressure in plasma
Transporting amino acids synthesized in liver to other tissues
Transporting poorly soluble ligands
Amylase & Lipase
0-130 IU/L
0-160 IU/L
enzymes secreted b pancreas for breakdown
increase after onset of acute pancreatitis in most patients
INR
R 0.8-1.2
Measure clotting tendency of blood
prolonged in those receiving warfarin, or liver damage
Complete blood count includes
Hgb
Hct
WBCs
RBCs
HgB range
Males: 14-18 g/DL
Females: 12-16 g/dL
Platelets range
140-400 x 10^3 m/l
Hct
39-49% males
33-43% females
WBC
3.2-9.8 10^3 cells
Anemia occurs when….
Hgb,HcT, and/or RBC decrease
Neutrophils
60% of WBC
increase: infection, tissue destruction, inflam disease, stress, steroids
decrease: cancer, post chemo, side effects of drugs
Absolute neutrophil count
WBC * % Neutrophils
Bands
5% of WBC
increase in response to acute infection
left shift = bands >5%
Lymphs
30% of WBC
moncytes
7% of WBC
increase in subacute bacterial endocarditis, malaria, TB, recovery phase form infection, initial recovery from chemo
Eosinophils
make up 3% of WBC
Basophils
Make up <1% of WBC
maybe increased in chronic inflam and leukemia
Cockcroft and Gault Equation
use IBW unless patients ABW is less, then use ABW
((140-age)X(IBW))/(72XSCr)
X 0.85 if women
Hematology Chart thing
\ HgB /
WBC———– Platelets
/ Hct \