Clotting
What is the normal range (seconds) for prothrombin time (PT)?
Normal: 11-13 seconds
What test is done to get electrolyte levels?
BASIC METABOLIC PANEL (BMP)
Serum pre-albumin is used to detect current nutritional status. What is the range for severe protein malnutrition?
0-5 mg/dL
What are normal levels of troponin?
<0.03 ng/mL
MI Diagnosis
>0.10 ng/mL
>30 pg/mL (hs-trop)
What is the normal range for platelets?
140-400 k/uL
When looking at aPTT, what is the range for therapeutic effectiveness when taking an anticoagulant?
Effectiveness of anti-coag: 2-2.5 times normal range (60-109 seconds)
What is a normal magnesium level?
1.2-1.9 mEq/L
When reviewing your patient’s chart, you notice that they have elevated Creatinine. What may be some other causes for this outside of renal disease?
Muscular dystrophy
Rhabdomyolysis
Dehydration
What does BNP look at?
BNP is a neurohormone which is released from the atrial appendage upon myocardial stretch. It is our body’s natural diuretic.
Therefore, it looks at stretch or pressure on the myocardium.
How might someone with high and uptrending WBC counts (> 11.0 109/L) present?
Fever
Malaise
Lethargy
Dizziness
Bleeding
Bruising
What would be the lab value to look at if your patient is being anti-coagulated by Low molecular weight heparin (LMWH – lovenox)?
Anti-factor Xa assay
Therapeutic ranges: 0.5-1.2 IU/mL
Prophylactic ranges: 0.25-0.5 IU/mL
If your patient is hyponatremic ((<130 mEq/L), what might be your clinical considerations?
They may present with Headache Lethargy Decreased reflexes Nausea, Vomiting, Diarrhea, Seizure, Coma, Orthostatic hypotension, Pitting edema
As a clinician, ensure to monitor cognitive status and watch VS for risk of orthostatic hypotension
What lab values would you want to look at if you have a patient with renal failure to assess severity and impact on your treatment session?
BUN: Used to measure RENAL EXCRETORY CAPACITY, estimate protein catabolism and tissue necrosis
In renal failure, we would expect this to be HIGH as the kidneys cannot filter properly
Serum Creatinine: a waste product made by your muscles as part of regular, everyday activity. Normally, your kidneys filter Creatinine from your blood and send it out of the body in your urine.
Which measure is more sensitive and specific for myocardial damage - troponin or CK-2?
Troponin is more sensitive and specific to myocardial damage
What are the negative health consequences associated with critically low hemoglobin (<7 g/dL)?
Low critical values (< 5-7 g/dL) can lead to heart failure or death.
Your patient has a (+) D-dimer test. Does this mean you have a DVT or PE?
Not necessarily. D-dimer is highly SENSITIVE for DVT (Snout) = rule out
Your patient is a 70 yo male with recent diagnosis of multiple myeloma, with PMH significant for COPD, DM, and frequent falls. You note that his calcium on intake was 15 mh/dL. What in his history places him at risk for hypercalcemia?
Hypercalcemia of malignancy occurs in approximately 20% of all cancer patients during their clinical course. The most common cancer associated with hypercalcemia of malignancy is multiple myeloma which has the highest prevalence of hypercalcemia of malignancy.
Your patient is admitted for acetaminophen overdose. You notice that she has elevated serum bilirubin, ammonia, ALT, AST and ALT. Clinically, how will you possibly adjust your intervention based on her clinical presentation?
She will likely present with Altered cognition, Ascites, Peripheral edema, Musculoskeletal pain, Right Upper abdominal pain, Weakness and fatigue.
May need to alter communication and education.
You have a patient admitted with heart failure exacerbation who has a BNP of 1020 pg/mL. Based on this alone, what symptoms do you think they will display? What are your clinical considerations?
Stage 4 HF. Severe limitations to activity. Likely symptomatic even at rest.
You receive new orders for a patient admitted with a primary diagnosis of lower GI bleed who has a history of frequent falls and reports one week of black tarry stool. When reviewing lab values, you note that his hemoglobin is 8.2 g/dL. Should you evaluate this patient? What signs and symptoms might you expect? How might your functional evaluation differ from usual?
Symptoms-based approach when determining appropriateness for activity, monitor symptoms, collaborate interprofessional team.
Monitor vitals including SpO2 to predict tissue perfusion. May present with tachycardia and/or orthostatic hypotension.
You have an LVAD patient who was just admitted to the hospital with a supratherapeutic INR of 6. Should you mobilize? Why and why not? How will you defend your position to the team?
At this time, risk likely outweighs benefits, wait 24-48 hours for INR to normalize.
You have just gotten your patient who is admitted for heart failure exacerbation and hypervolemia undergoing diuresis to the chair. You note on ECG T wave inversion, but your patient denies chest pain. This may be due to a deficiency of what electrolyte?
Potassium → Inverted T waves can be a presenting sign of Hypokalemia (K+ < 3.0 mEq/L).
Your patient is a 83 yo female admitted with rhabdomyolysis after suffering a femur fracture due to a GLF found down after 8 hours. Serum Creatinine is HIGH (2.9 mg/dL), BUN is HIGH (61 mg/dL) and her urine is dark. Would you mobilize this patient? What are your considerations or concerns?
In this case, we can see that she is having rhabdo, and it is affecting her renal function with decreased filtration / clearance evidenced by high BUN and creatinine.
Clinically, keep exercise below threshold – low intensity exercise. Used BORG scale, keep <3/10
Your patient suffered a large area burn. On admit they had a troponin of 22. They have since downtrended to 14. What other clinical questions would you like to consider before determining their appropriateness to mobilize?
Any signs of cardiac ischemia? (ECG changes, CP)
Generally, as we see trends DECREASE, mobility becomes appropriate.
A patient was recently transferred from the floor to the ICU following complicated child-birth with multiple bleeding events. Therapy has been held for the last 4 days in the setting of low and downtrending hematocrit (40% at admit to 13% at the lowest) but latest values show an increase to 18%. She has declined blood product due to religious beliefs. Should you mobilize this patient? How will you justify your decision to the team?
This was more for the discussion than the points any way :)