IPC final exam - lab values, medical records Flashcards

Question

Albumin: a predominant serum-binding protein that transports various substances including medications. It is synthesized only in the liver(Normal range: 3.5 – 5 g/dL) Causes of hypOalbuminemia - cirrhosis in what organ - is the nutrition good - syndrome where

Answer 1

Causes of hypOalbuminemia - Liver cirrhosis(defective synthesis) - Malnutrition (decreased synthesis) - Nephrotic syndrome (increased loss)

Answer 2

One consequence of hypoalbuminemia is that drugs that are usually protein-bound become free in the plasma, allowing for higher drug levels, more rapid hepatic metabolism, or both

Answer 3

WBC Hgb Hct RBC Reticulocytes Red Blood Cells Indices (MCV, MCH, MCHC), Platelets

Answer 4

never let monkeys eat bananas - neutrophils - lymphocytes - monocytes - eosinophils - basophils Causes of increased WBCs/Leukocytosis - Infection - Leukemia "left shift" refers to infection or leukemia, increase in bands (immature neutrophils) - Trauma, stress Drugs from Top 200: corticosteroids: - prednisone, prednisolone, methylprednisolone Causes of decreased WBCs/Leukopenia Drugs: - Chemotherapy

Answer 5

A single erythrocyte can contain 300 million hemoglobin (Hgb) molecules, therefore, conditions that affect Hgb count will affect RBC count

Answer 6

Causes of increased Hgb: - COPD - Chronic smokers - Regular vigorous exercise - Living at high altitude - Polycythemia vera: a cancer that produces a lot of RBCs Causes of decreased Hgb: - Anemia - Blood loss - Pregnancy Drugs from Top 200: - Metformin - NSAIDs (may cause bleeding): ibuprofen, naproxen, meloxicam, diclofenac, celecoxib

Answer 7

Causes of increased Hct: Same as hemoglobin Dehydration Causes of decreased Hct: Same as hemoglobin Rule of thumb: Hct value = 3 X Hgb value

Answer 8

normal = 45% anemia = 30% polycythemia = 70%, produce lots of RBCs due to cancer dehydration = 70%, less plasma so measure Hgb instead of Hct

Answer 9

Causes of ↑ Platelets (thrombocytosis) - Malignancy - Splenectomy - Chronic inflammatory disorders - Polycythemia vera Causes of ↓ Platelets (thrombocytopenia) - Autoimmune disorders: - Idiopathic thrombocytopenia purpura (ITP) - Chemotherapy, radiation Drugs from Top 200: - Valproic acid

Answer 10

Causes of increased PT: - Liver disease - Vitamin K deficiency - Clotting factors deficiency Drugs: anticoagulants - Example Top 200: warfarin, rivaroxaban liver manufactures proteins and clotting factors

Answer 11

blood sample with citrate - binds calcium centrifuge discard blood cells get plasma-calcium, thromboplastin includes tissue factor and phospholipids fibrin clot

Answer 12

Used to monitor warfarin therapy The desired INR range depends on the indication of warfarin therapy - Target INR = 2-3 or 2.5-3.5 Normal INR (for patients not taking warfarin) = 1 warfarin: "alright, alright break it up, you guys!" a blood thinner

Answer 13

Infections or inflammatory disorders = erythrocytes settle more quickly = ↑ ESR Nonspecific diagnostic test Used to support a diagnosis or monitor progress of inflammation or infection

Answer 14

ALT AST ALP GGT Bilirubin Amylase Lipase

Answer 15

- ↑ > 3 x upper limit  SIGNIFICANT - Specific marker of liver disease Causes of high ALT: - Liver disease Drugs from Top 200: - HMG-CoA reductase inhibitors (statins): atorvastatin, lovastatin, pravastatin, simvastatin - Phenytoin - APAP toxicity liver produces more ALT than AST

Answer 16

Injury to these tissues  higher AST Less specific marker of liver disease than ALT AST : ALT > 2:1 (more than twice) means alcoholic liver disease Drugs: - APAP toxicity

Answer 17

CK, CK-MB, Troponin, CRP

Answer 18

Causes of elevated total CK: - Trauma - Surgery - Rhabdomyolysis Drugs from Top 200: - Statins - Fibrates: fenofibrate Causes of elevated CK-MB: - Acute myocardial infarction (AMI) - Begins to rise in 4 – 8 hours, cannot measure before 4 hours - Peaks in 12 – 24 hours - Returns to normal in 2 – 3 days

Answer 19

Troponins are proteins found in cardiac muscles, released during cardiac injury - Begin to rise in 4 hours - Sensitive markers of cardiac injury C-reactive protein (CRP) is produced in the liver - Diagnosis of inflammatory conditions like rheumatoid arthritis - Not specific; not unique to one disease - Can help monitor disease progress and flares

Answer 20

C. Glucose

Answer 21

A. Simvastatin lisinopril raises K+ levels HCTZ would cause hyponatremia & hypokalemia furosemide would cause hypokalemia & hypocalcemia

Answer 22

up, middle box start with the + then - then kidney then glucose at the far right

Answer 23

D. All of the above because all of the ions will be depleted

Answer 24

worry about their bleeding/bleed B. Hgb/Hct tells if you have bleeding AST/ALT tells about liver function ESR tells also check for inflammation or infection in your body. This is an immunological test

Answer 25

B. Serum creatinine with poor function, should be elevated if low, then could be elderly where they have low muscle mass

Answer 26

true "Left Shift” Increase in bands (immature neutrophils) due to: - Infection - Leukemia

Answer 27

According to Stedman’s Medical Dictionary: A chronologically written account that includes a patient’s initial complaint(s) and medical history, physical findings, results of diagnostic tests and procedures, any therapeutic medicines or procedures, and subsequent developments during the course of the illness.” Legal set of documents that are a record of a patient’s private medical information AKA “The Chart” - legal set of documents

Answer 28

Historically: medical records were actual paper in folders kept in physician’s office Most hospitals/institutions/physician offices now utilize: - Electronic medical records (EMR) or also called Electronic health records (EHR) - Personal health records (PHR)- maintained by patient

Answer 29

Central point for all medical data for a patient - Eliminate the majority of paper documentation - Communication across all healthcare institutions Even though this concept sounds like each patient would only need 1 EMR, often a patient has - 1 for in-patient - 1 for ambulatory setting since there are different requirements/sections of a medical record depending on the location of the care being provided (more to come on this)

Answer 30

Health care providers - Able to view and use the chart for the patients they are responsible for - ILLEGAL to access a patient’s chart if not currently under their care, protected by HIPAA Patient - Can view and in some cases, add/change their own chart (more to come on this) - cannot access chart

Answer 31

Must obtain a username and password for specific EMR May have limited access depending on your credentials With appropriate credentials, able to view the EMR from anywhere there is a computer (even off-site)

Answer 32

History and physical (H&P) - Emergency Department notes (possibly) Progress notes - how are they doing, every 24 hours Procedure reports - stitching wound, setting a broken leg, catheter, IV, etc, anything is done to the patient Laboratory and imaging data Consults - with other specialties Orders - nutrition, Allergies - meds, environmental Medication administration record (MAR)/home medication list - documents meds and when to take them Social work/case management notes

Answer 33

Demographics - family, surgical Allergies Problem list - what are all of their chronic conditions Social, family, and surgical histories Vitals/laboratory values Immunization records Notes/Documentation on previous visits, were you with me or the provider that I'm working with “Tasks” or referrals to other healthcare providers - Consult notes sent from other healthcare providers

Answer 34

Definition: An electronic application used by patients to maintain and manage their health information in a private, secure, and confidential environment Managed by patients Can include information from a variety of sources, including healthcare providers and patients themselves Can help patients securely and confidentially store and monitor health information, such as diet plans or data from home monitoring systems, as well as patient contact information, diagnosis lists, medication lists, allergy lists, immunization histories, and much more Separate from, and do not replace, the legal record of any health care provider Are distinct from portals that simply allow patients to view provider information or communicate with providers pmhx: past medical history OSA: obstructive sleep apnea C = critical

Answer 35

EMR: Accessed and utilized by health care providers only. Owned and maintained by doctors’ offices, hospitals, or health insurance plans. PHR: Record controlled by the patient and may use information from a wide array of sources (providers and patients) Important: a PHR is separate from the legal EMR

Answer 36

Standalone PHRs: - Patients provide information based on their memory or records - Stored on the patient’s computer or internet - Patients can determine if they want to share this with providers or others. Tethered/Connected PHR’s: - Linked to a specific healthcare organization's electronic health record (EHR) system or to a health plan's information system - Patients can access their own records through a secure portal and see, for example, the trend of their lab results over the last year, their immunization history, or due dates for screenings - Kept confidential through the HIPAA privacy act - “Patient Portal” Example of Personal Health Record: Health app for iPhones - Includes Medical ID: makes critical information available via lock screen for use by first responders in emergency

Answer 37

Patients can access doctor visit notes: - Summary of conversation - Symptoms patient described - Doctor’s findings from physical exam Patients have legal rights to medical records, but difficult and potentially costly to obtain

Answer 38

Goals: - Improve communication between patients and providers - Improve medication adherence

Answer 39

- storage - EMR is better - legibility - EMR is better - access - EMR is better - security - equal for EMR (could be cyber security, or someone could look over your shoulder) & paper (someone could break in, can be easy to print out and leave somewhere - cost - EMR (more expensive up front, long process, training people, working out bugs) and paper (is expensive)

Answer 40

easy to share info. between offices easier to track

Answer 41

- EHR faster to type in - 10-13 pieces of paper for each patent and physician sees 50-99 patients in a week so it wil cut down a lot - savings: 100B - 4.5M ambulatory visits related to adverse drug events occur annually in the U.S

Answer 42

Sample software- inpatient: epic or Cerner ambulatory: Allscripts or Athena health Data presented inpatient: episode based ambulatory: longitudinal Versatility inpatient: versatile due to all consultants writing into the same chart ambulatory: less versatile; very specific to that particular practice Ordering systems inpatient: Computerized Physician Order Entry (CPOE) Can only order medications from inpatient pharmacy ambulatory: Require access to order medications from various pharmacies Laboratory information Consultation vs. referral

Answer 43

A- EMR - do not have to be in a location or someone certain

Answer 44

B Lab data

Answer 45

D Consult notes

Answer 46

being able to have patient-provider communication med refills improve patient engagement coordinate info. from multiple providers ensure important info. is available for an emergency encourage family health management

Answer 47

Benefits: - more education about their health - better understanding of their own health status - will prevent forgetting directions or info/reduce med errors and increase adherence Risks: - malpractice if the physician did something wrong - may not know med abbreviations - may not fully understand what they read and could be hurt :( could cause confusion and miscommunication

IPC final exam - lab values, medical records Flashcards

(76 cards)