Evaluation of the Acute & Medically Complex Patient Flashcards
(40 cards)
1
Q
Diagnostic Tests/ Reports (7)
A
- Complete blood count (CBC)
- Arterial blood gases (ABG)
- Electrolytes
- Endocrine function
- Electrocardogram (ECG)
- Operative reports
- Review all systems: Mental status, Vital signs
2
Q
CBC (Hemoglobin)
A
- assess anemia, blood loss, bone marrow suppression (cancer tx)
- Anemia higher in older adult population
- has profound impact on their ability to engage in rigorous exercise
- primary cause if GI bleeding
- anemia is presence of CAD may result in angina. Can lead to heart failure
3
Q
Hemoglobin reference values
A
- Male: 14-17 g/dL
- Female: 12-16 g/dL
4
Q
Hemoglobin: High vs Low critical values
A
- Low critical values:
- <5-7 g/dL (can lead to heart failure or death)
- High Critical values:
- >20 g/dL (can lead to clogging of capillaries)
5
Q
Hemoglobin: “Trending upwards”
A
- Polycythemia
6
Q
Causes of high hemoglobin
A
- CHD
- Severe dehydration
- COPD
- CHF
- Severe burns
- High altitude
7
Q
Polycythemia presentation
A
- high hemoglobin
- orthostasis
- presyncope
- dizziness
- arrhythmias
- CHF onset/exacerbation
- seizure
- TIA
- symptoms of MI
- angina
8
Q
CBC (White Blood Cells)
A
- routine test to identify: presence of infection, inflammation, allergens
9
Q
WBC: Reference Values
A
5.0-10 10(9)/L
10
Q
WBC Trending upwards
A
- Leukocytosis
- >11.0 10(9)/L
- consider timing of therapy session due to early morning low level and late afternoon high peak
- >11.0 10(9)/L
11
Q
WBC Trending downwards
A
- Leukopenia
- <4.0 10(9)/L
12
Q
Leukocytosis presentation
A
- fever
- malaise
- lethargy
- dizziness
- bleeding
- bruising
- weight loss
- painful inflammed joints
13
Q
Leukopenia presentation
A
- anemia
- weakness
- fatigue
- fever
- headache
- SOB
14
Q
CBC (Platelets)
A
- elevated levels can lead to venous thromboembolism
- fall risk awareness with low platelets
- be cautious of how handling patients. could bleed further
15
Q
Platelets: references values
A
140-400 k/uL
16
Q
Platelets: Trending upwards
A
- thrombocytosis
- >450 k/uL
17
Q
Thrombocytosis presentation
A
- high platelets
- weakness
- headache
- dizziness
- chest pain
- tingling in hands/feet
18
Q
Platelets: Trending downwards
A
- thrombocytopenia
- <150 k/uL
19
Q
Thrombocytopenia presentation
A
- petechiae
- ecchymosis
- fatigue
- jaundice
- splenomegaly
- risk for bleeding
20
Q
Electrolytes
A
- Sodium (Na) is primary determinant for extracellular fluid volume
- Potassium (K) important for function of excitable cells such as nerves, muscles, and heart
- Calcium (Ca) important for bone formation, cell division and growth, blood coagulation, muscle contraction, and release of neurotransmitters
21
Q
Sodium: Reference values
A
134-142 mEq/L
22
Q
Sodium trending upwards
A
- hypernatremia
- > 145 mEq/L
- impaired cognitive status
- seizure precautions for patients with PMH
23
Q
Sodium trending downward
A
- hyponatremia
- < 130 mEq/L
- impaired cognitive status
- monitor vitals secondary to risk for orthostatic hypotension
- risk for falls
24
Q
Hypernatremia presentation
A
- high sodium
- irritability
- agitation
- seizure
- come
- hypotension
- tachycardia
- decreased urinary output
25
Hyponatremia presentation
* low sodium
* headache
* lethargic
* decreased reflexes
* N/V
* diarrhea
* seizure
* coma
* orthostatic hypotension
* pitting edema
26
Potassium: Reference value
3.7-5.1 mEq/L
27
Potassium trending upwards
* Hyperkalemia
* \> 5.5 mEq/L
* patients at risk for cardiac issues
* could present with muscle weakness
28
Hyperkalemia presentation
* muscle weakness/paralysis
* paresthesia
* bradycardia
* heart block
* ventricular fibrillation
* cardiac arrest
29
Potassium trending downward
* Hypokalemia
* \<3.5 mEq/L
* collaberate with interprofessional team
30
Hypokalemia presentation
* extremity weakness
* decreased weakness
* paresthesia
* leg cramps
* EKG changes
* cardiac arrest
* hypotension
* constipation
31
Glucose
* measures blood glucose at time sample obtained
32
Glucose reference values
* 70-100 mg/dL
* fasting (90-130)
33
Glucose trending upward
* hyperglycemic
* \>200 mg/dL
* present with severe fatigue
* decreased tolerate to activity
34
Glucose trending downward
* hypoglycemic
* \<70 mg/dL
* lethargy
* irritability
* shaking
* extremity weakness
* LOC
35
Arterial Blood Gases (ABG)
* pulmonary and renal systems regulate acids
* renal system primary regulator of body's major base
* partial pressure of oxygen declines with age, secondary to:
* reduction in eleasticity of musculoskeletal system
* decrease in muscle fibers
* decrease in alveolar gas exchange surface area
* decrease in respinsiveness of CNS
\*\*\*kyphosis could decrease partial pressure of oxygen (tighten chest muscles and limit expansion)
36
pH values
* normal= 7.4
* acidotic= \<7.4
* alkalotic= \> 7.4
\*\*\*PaCO2: if \>40mm Hg= acidotic, if \<40mmHg= alkalotic
\*\*\*HCO3: if \>24= alkalotic, if \<24= acidotic
37
Complex patient: Medical complexity
* including discordant conditions, chronic pain, medication intolerance, unexplained symptoms and cognitive issues
38
Complex patient: Socioeconomic factors
* such as the unaffordability of medication, family, stressors, and low levels of health literacy
39
Complex patient: Mental illness
* such as depression resulting in poor medication adherence, addiction, and anxiety that confused the clinical picture
40
Complex patient: Behaviors and traits
* demanding, argumentative, and anxious
