Unit 1: Hematological, Fluid + Electrolyte Imbalance Flashcards
What are the components of blood?
-Plasma: Albumin (oncotic pressure)
Fibrinogen (Blood clotting)
-Cells: Erythrocytes (oxygen transport)
Thrombocytes/Platelets (Blood clotting)
Leukocytes (inflammation and immunity)
What are the indications and action of albumin?
Indications: Volume expansion, liver failure, hypoproteinemia
Action: increase vascular volume by increasing colloidal oncotic pressure
What are the indications and action of Fresh frozen plasma?
Indications: Bleeding caused by clotting factor deficiencies, emergency reversal of warfarin, and plasma protein deficiency
Action: to improve coagulation hemostasis
What are the indications and action of Packed red blood cells
Indications: Acute Blood loss and anemia
Action: To improve or restore oxygen carrying capacity hemoglobin
What are the indications and action of Platelets ?
Indications: Bleeding caused by thrombocytopenia
Action: Treat of prevent bleeding due t decreased or dysfunctional platelets
What are ketones?
A bi-product of carb and protein metabolism
What are casts?
When protein binds and takes the shape of cells. Normal when clear, irregular with WBC and RBC
What happens to the hematocrit value with anemia?
Hematocrit decreases
What are the 5 W’s of post-op fever
Wind: (Day 1-2, Lack of moving bases) Lungs, pneumonia, pulmonary embolus, not atelactisis (collapsed lung).
Water: (Day 3-5) Urinary Tract infection
Walking: (Day 4-6) DVT- pulmonary embolus
Wound: (Day 5-7) Surgical Site infection
Wonder drugs, what did we do?: (Day 7+) Drugs, infection related to invasive lines
What are ‘bands’?
Immature neutrophils
What is un-conjugated bilirubin?
Indirect bilirubin. Increased with Jaundice
Pre-hepatic: before the liver, not water soluble.
Hepatic: within the liver
What is conjugated bilirubin?
Direct bilirubin. Increased with jaundice
Post-hepatic: after the liver
What are liver function tests?
Liver enzymes are normally contained within the liver cell.s When liver cells are injured these enzymes spill into blood.
Examples, ALT, AST, ALP, GGT
What tests are indicative of liver cell damage?
ALT: Highly specific to liver, ALT rises dramatically in acute liver damage
AST: Not as specific as ALT as enzymes also present in liver, cardiac and skeletal muscle
What test are indicative of biliary flow obstruction?
ALP and GGT: increase in either or both is highly suggestive of obstructive disease.
4 causes of edema, which are not fluid excess
- Increased hydrostatic pressure: Push pressure out. eg. Venous obstruction, heart failure, renal failure
- Decreased Plasma oncotic pressure: (colloid pressure). Albumin production: liver disease, protein malnutrition. Albumin loss: kidney disease, burns, wounds. ALBUMIN SUCKS fluid into the vascular space
- Increased capillary membrane permeability: Leaky vessels, dilated vessels, trauma, allergic response
- Lymphatic obstruction: masectomy
What are Pancreas/Endocrine function tests?
Fasting Glucose (4-6), Random Glucose (3.6-10), Hgb A1C (
Heart function tests
Troponin, CK-MB, CRP, BNP (brain natuiretic peptide, + evidence of heart failure)., coags (baseline), CBC
How can LDL be impacted?
‘statins’ medications
How can HDL be impacted?
Exercise
What is the normal range for APTT?
Heparin monitoring
26-36 seconds
What is the normal range for INR?
Warfarin monitoring
0.8-1.2
What are colloids?
Large molecules, usually protein, DO NOT pass through semi-permeable membrane
Remain intravascular
They draw fluid in
What are crystalloids?
Small molecules, that pass through semi-permeable membrane.
Electrolyte (Na, K+), and none electrolyte (dextrose)
Isotonic, hypotonic, hypertonic
What are the three general causes of anemia?
Losing it (blood loss): acute trauma, chronic ibuprofen use Trouble making it (Decreased RBC production): decreased erythropoieten (kidney disease), decreased nutrients (iron, B12, folic acid) Destroying it (Increased RBC destruction): Intrinsic hemolysis, RBC abnormal or extrinsic, hemolysis, RBC normal. Autoimmune disease
RBC descriptive features, What is MCV?
size
RBC descriptive features, What is MCH?
weight
RBC descriptive features, What is MCHC?
Hgb concentration
RBC descriptive features, What is RDW?
Uniformity of the cell
What are the three causes of Neutropenia?
- Latrogenic (most common) decreased bone marrow function in the treatment of cancer or autoimmune disease, eg. chemotherapy or immunosupression
- Disease : overwhelming bacterial infection
- Disorder: cancer
What is febrile neutropenia ?
MEDICAL EMERNGENCY
Neutrophils 38
What are the 3 T’s of Heparin Induced Thrombocytopenia?
Throbocytopenia: platelet count falls by 50% or more
Timing :occurs between 4-14 days of heparin therapy
Thrombosis: presence of a venous or arterial thrombotic event
What is Von Willebrand’s disease?
Mild hemophillia
Most common congenital coagulation disorder
clotting factors are missing or deficient
continuum of severity
Normal Random Glucose
3.6-10.0
Normal Potassium
3.5-5.1
Normal Sodium
135-146
Normal Creatinine
45-110
Normal Urea (BUN)
3.7-7.0
Normal hematocrit
0.33-0.48
Normal Hemoglobin
110-160
Normal Platelets
150-400
Normal WBC
4-11
Normal APTT
26-36
Normal INR
0.8-1.2
