1
Q
- In acute care or subacute care, the mostcommon blood tests that we see include _____________ (_____), anddifferential and basic metabolic profile or routine chemistry.
- The normal values at each institution are typically determined based on ___% of healthy people in a certain group. For many tests, the normal ranges will vary depending on age, gender, race, or other factors.
A
- complete blood count (CBC)
- 95%
2
Q
The lab values alone may or may not determine whether you’re going to intervene with a patient, or whether you’re going to hold. In addition to looking at the lab values and determining whether they are within normal ranges or guidelines, clinical decision making also needs to be based on what?
A
- a thorough chart review
- the trends of labs or vital signs
- clinical discussion with the team
- the ability to monitor for clinical signs and hemodynamic stability during intervention
3
Q
Other things to consider when looking at the patient’s big picture include:
- Potential ______ interactions.
- _______ the patient has consumed (which may have an effect on their most recently reported lab values).
- Significant _________ in the values over time.
- ___________ panels might change with intervenous infusions, medications, and diet.
- Chronic medical conditions (such as anemia) might be ___________ during exercise, while a patient with a precipitous drop in hemoglobin and hematocrit might require urgent medical attention.
A
- drug
- Meals
- trends
- Electrolyte
- asymptomatic
4
Q
Complete Blood Count (CBC):
- One of the most ______ ordered blood tests.
- Calculation of the cellular formation of _______.
- Major portion of the CBC is the measure of the concentration of _________, __________, and __________ in the blood.
A
- common
- blood
- WBC, RBC, and platelets
5
Q
WBC (Leukocytes):
- Can be divided into __________ and __________.
- List them off and their function.
A
Granulocytes
- Neutrophils: comprises largest %
- Eosinophils: play role in allergies
- Basophils: allergies, release of histamine and heparin
Agranulocytes
- Monocytes: differentiate into macrophages
- Lymphocytes: T and B lymphocytes; big role in immunity
6
Q
- What is the primary function of WBC?
- What is the normal range?
- What is leukocytosis?
- What is leukopenia?
- What is neutropenia?
A
- WBC primary function is to fight infection
- 5000-10000/mm3
- > 11000/mm3
- <4000/mm3
- <1500/mm3
7
Q
- Elevated levels of WBC usually indicates _________.
- What are some ways a patient may present with elevated WBC?
A
- infection
- fever, malaise, lethargy
8
Q
- Decreased levels of WBC may indicate ______________ state.
- What is the patient at high risk for?
A
- immunocompromised
- additional infection
9
Q
What are the (3) parts of RBC values?
A
- Hemoglobin: protein contained in RBCs that delivers oxygen to tissues
- Hematocrit: measures volume of RBCs compared to total blood volume
- Platelets: blood cells that form clots
10
Q
____________ and _________ values vary by gender while _____________ are the same for male/female.
A
- hemoglobin and hematocrit
- platelets
11
Q
- What are the normal hemoglobin levels?
- What are elevated levels?
- What are decreased levels?
A
Hemoglobin Normal:
- Male: 14-17 g/dL
- Female: 12-16 g/dL
- Elevated: High critical >20 g/dL
- Decreased: Low critical <7 g/dL
12
Q
- What are the normal hematocrit levels?
- What are elevated levels?
- What are decreased levels?
A
Hematocrit Normal:
- Male: 42-52%
- Female: 37-47%
- Elevated: High critical >60%
- Decreased: Low critical <15-20%
13
Q
- What are the normal platelet levels?
- What are elevated levels?
- What are decreased levels?
A
- Normal: 150-400 k/uL
- Elevated: >450 k/uL
- Decreased: <150 k/uL
14
Q
- What can elevated levels of hemoglobin and hematocrit mean?
- -What can decreased levels of hemoglobin and hematocrit mean?
A
- Elevated can result in clogging/clotting.
- Decreased can result in heart/cardiac failure and death.
15
Q
- What can elevated levels of platelets result in?
- What can decreased levels of platelets result in?
A
- Elevated can result in thrombocytosis (clot risk).
- Decreased can result in thrombocytopenia (bleeding risk).
16
Q
WBC Implicatons:
- If patients are under 1500 ANC we should initiate __________ precautions.
- If patients are under 1000 ANC, the patient needs a ______ and needs MD approval to ____________.
- If patients are under 500 ANC __________ is recommended.
A
- neutropenic
- mask, ambulate in hall
- isolation
17
Q
Hematocrit and Hemoglobin Implications:
- If patients are under __ g/dL (males) or __ g/dL (females) in regards to hemoglobin levels, we should treat to patient tolerance and communicate with the medical team.
- If patients are under __% in regards to hematocrit levels they may present with what?
A
- 9 g/dL (males), 7 g/dL (females)
- 20%, SOB, tachycardia, fatigue, muscle cramping
18
Q
Platelet Implications:
- If patients are between ___k-___k we want to limit resistive exercises, encourage ambulation, ADL’s, aerobic exercise equipment.
- If patients are between ___k-___k we want no MMT and no resistive exercises, only AROM.
- If patients are between ___k-___k we want only light exercise, no bicycle, no treadmill, no ADLs, with ambulation as tolerated.
- If the patients are below ___k then we want guarded therapy intervention.
A
- 50-150k
- 35k-50k
- 20-35k
- 20k
19
Q
With WBC count consider timing of therapy sessions due to ________ low levels and ______ peaks.
A
- early morning low levels
- late time high peaks
20
Q
What are the 2 pathways for blood coagulation?
A
- Extrinsic
- Intrinisic
21
Q
What are some ways we can measure to make sure a patient is in a therapeutic range if they are on anticoagulant medication? (4)
A
- Prothrombin time (PT): measures speed of clotting by means of the extrinsic pathway
- International normalized ratio (INR): used to correct for differences in lab reagents to test PT
- Partial thromboplastin time (PTT): measures speed of clotting by means of two consecutive series of biochemical reactions (intrinsic pathway and common pathway of coagulation)
- Activated partial thromboplastin time (aPTT): activator added that speeds up clotting time and results in more narrow reference range
22
Q
Often patients are given heparin as a bridge to long term anti-coagulation therapy (ie, Warfarin) during that time aPTT is the lab value to monitor. Once a patient transitions to Warfarin, ____ is then used to assess clotting risk.
A
INR
23
Q
- What is normal INR value?
- What is a normal INR value if a patient has Afib/DVT/PE?
- What is a normal INR value if a patient has a valve replacemement?
A
- 0.9-1.1
- 2-3
- 2.5-3.5
24
Q
With PT/PTT/aPTT values, high values put patient at risk for _________ while low values put patients at risk for __________.
A
- high=bleeding
- low=clotting
25
Patient Scenarios: Can you Mobilize Them?
- 60 year old male on Coumadin following surgical procedure. History of DVT. INR value is 2.
- 55 year old female with IVC due to high risk for PE. She is on no anticoagulant.
- 72 year old male was given Lovenox (LMWH) 6 hours ago.
- 49 year old female received Fonduparixum 1 hour ago.
- Yes
- Yes
- Yes
- No
26
What things are electrolyte balance required for?
- Nerve conduction
- Muscle contraction/relaxation
- Cardiac rhythm/conduction
- Bone health
- Blood coagulation
- Maintenance of proper fluid balance
27
- Balance of electrolytes is mostly controlled by ________ plus neurologic, endocrine, GI, and MS.
- Are electrolyte disorders frequent and challenging in acute care?
- kidneys
| - yes
28
Sodium Rehab Considerations:
- Reductions?
- Elevations?
Reductions
-cramps, weakness, confusion
Elevations
-fluid retention, swelling, HTN
29
Potassium Rehab Considerations:
- Reductions?
- Elevations?
Reductions
-flattened t-waves, arrhythmias, muscle weakness
Elevations
-peaked t-waves, shortened q-t wave interval
30
Calcium Rehab Considerations:
- Reductions?
- Elevations?
Reductions (mod-severe)
-parathesias, muscle spasms, and seizure and QT interval prolongations
Elevations (severe only)
-bradycardia, AV block, short QT interval, coma
31
Magnesium Rehab Considerations:
- Reductions?
- Elevations?
Reductions
-prolonged PR or QT intervals, t-wave flattening or inversion, SVT, ventricular arrhythmias
Elevations
-weakness, respiratory failure, coma, paralysis, respiratory failure
32
Chloride Rehab Considerations:
- Reductions?
- Elevations?
Reductions
-often occur during metabolic alkalosis
Elevations
-metabolic acidosis
33
What 3 lab values do we look at in regards to cardiac function?
- Creatinine Kinase
- Troponin
- BNP
34
Cardiac:
- What main measure do we look at with cardiac?
- Creatinine Kinase is often _________ after MI, skeletal muscle injury, and strenuous exercise.
- Creatinine Kinase
| - elevated
35
Creatinine Kinase Precautions and Considerations:
- Elevated __-__ hours after MI, peaks __-__ hours after MI, clears about __-__ hours.
- Activity should be ________/_____ when CK trend is rising.
- Activity can continue once CK trends down to normal range.
- 4-6 hours, 12-24 hours, 48-72 hours
| - limited/held
36
Cardiac:
- What is a second lab value we look at other than Creatinine Kinase?
- What is it?
- Troponin
| - Protein involve in muscle contraction; used as a diagnostic marker for heart disorders and MI (elevates after MI)
37
Troponin Precautions and Considerations:
- Troponin enzyme begins rising at __ hours after MI, peaks at ___-___ , returns to normal within __ week(s).
- Troponin >___ mcg/L indicates myocardial damage (hold activity until 24 hours after troponin peak and it begins trending down).
- 8 hours, 12-16 hours, 1 week
| - 0.2 mcg/L
38
- What is BNP?
- What is it indicative of?
- What values suggest that heart failure is present?
- Brain-type Natriuretic Peptide
- Congestive Heart Failure
- 100-300 pg/mL
39
Acid-Base Disorders:
- Acid-base balance: equilibrium of ___ in extracellular fluid.
- Range of pH necessary for life?
- pH
| - 6.8-7.8
40
- _________ and _______ systems responsible for maintaining acid-base balance.
- Hyperventilation lowers arterial CO2 -> ___________ pH.
- Kidney disease decreases renal bicarbonate -> _________ pH.
- respiratory and renal
- elevated
- decreased
41
What are the normal ranges for:
- pH
- PaO2
- PaCO2
- HCO3
- pH = 7.35-7.45
- PaO2 = >80mmHg
- PaCO2 = 35-45mmHg
- HCO3 = 22-26 mmol/L
42
- pH <7.35 = ____________
| - pH >7.45 = ____________
- acidosis
| - alkalosis
43
Acid-base imbalances can be either ______, _________, or mixed.
- metabolic
| - respiratory
44
Respiratory Alkalosis:
- Elevated pH associated with _________ PaCO2
- Arterial CO2 < ___ mmHg; pH ≥ _____
- ________ventilation
- Associated with nervousness, anxiety, pain, pregnancy, PE
- reduced
- 35, 7.45
- hyperventilation
45
Respiratory Acidosis:
- Reduced pH associated with _________ PaCO2
- Arterial CO2 > ___ mmHg; pH ≤ _____
- _______ventilation
- Associated with COPD, pneumonia, sleep apnea, head trauma
- elevated
- 45, 7.35
- hypoventilation
46
Metabolic Alkalosis:
- Elevated pH associated with loss of normal _________ acids
- Arterial HCO3- > ___ mEq/L; pH ≥ ____
- Associated with severe vomiting, excess use of antacids, diuretics, hypokalemia
- metabolic
| - 26, 7.45
47
Metabolic Acidosis:
- Reduced pH associated with deficit of __________(HCO3-)
- Arterial HCO3- < ___ mEq/L; pH ≤ ____
- Associated with chronic diarrhea, shock/sepsis, trauma, diabetic ketoacidosis, renal failure/uremia, hypoxia
- bicarbonate
| - 22, 7.35
48
Kidney function is generally based on the _______ levels.
Blood Urea Nitrogen (BUN)
49
Blood Urea Nitrogen:
- _____ forms in the liver from the breakdown of proteins and amino acids. The kidney is responsible for excreting it.
- _________ BUN levels indicate renal disease, high protein diet, decreasing volume, or CHF. ________ levels are uncommon but can result from malnutrition.
- Urea
| - elevated, decreased
50
- What are (4) values we can use to measure liver function?
| - _________ in values are indicative of liver dysfunction.
- alkaline phosphotase (ALP)
- aspartate aminotransferase (AST)
- alanine aminotransferase (ALT)
- Bilirubin
-increases
51
What, if elevated, can cause jaundice?
Bilirubin
52
Diabetes Mellitus:
- Glucose normal range?
- If a patients glucose is below ___mg/dL, the patient needs carbs before activities.
- If a patients glucose is above ____mg/dL, we should hold activity until patient receives insulin.
- Hemoglobin (Hgb) A1C normal value?
- A1C is an indicator of blood glucose level for past ___ months.
- Pre diabetic = ___-___%.
- DM = >___%
- 70-100 mg/dL
- 70
- 240
- <5.7%
- 3 months
- 5.7-6.4%
- >6.5%
53
Other Labs:
- _______ is converted to urea and normally excreted quickly in urine; very toxic to body and affects acid-base balance.
- What is the normal range?
- Elevated levels are due to ________ disease and hepatic dysfunction.
- Ammonia
- 10-40 micromol/L
- renal
54
Other Labs:
-_______ ________ is use to assess nutritional status and has a half-life of 21 days.
-What is the normal range?
-
- Serum albumin
- 3.5-5.0 g/dL
- 3.0, 2.8
55
Other Labs:
- _______ ________ is more accurate indicator of recent nutritional status due to shorter 2 day half-life.
- What is the normal range?
- -
- Serum pre-albumin
- 16-30 g/dL
- <10
S4- Acute Care
flashcards
Decks in class (15)
# Cards
-
Week 1- Introduction and Outcome Measures92
-
Week 1- Emergency Department PT and Acute Care Billing26
-
Week 2- ICUAW and Early Mobility55
-
Week 2- Lab Values55
-
Week 3- Cardiac Conditions75
-
Week 3- Pulmonary Conditions50
-
Week 3- Mechanical Ventilation45
-
Week 4- Orthopedic Conditions81
-
Competency7
-
Midterm Study (Incomplete)119
-
Wound Care Module 141
-
Week 5- Lymphedema63
-
Week 6- Oncology and Organ Transplant112
-
Week 6- Patient Positioning/Orthotics/Adaptive Equipment, Integumentary Basics/Burns56
-
Week 7- GI54
